When Don Reichert came to MetroHealth six years ago, he had three goals: achieve Stage 6, then Stage 7 recognition, and win a HIMSS Davies Award. Not bad for a safety-net hospital that neighbors two very prestigious systems, Cleveland Clinic and University Hospitals. But with the support of the executive team and buy-in from the staff, the dream became a reality. In this interview, Reichert talks about MetroHealth’s multi-year journey from best-of-breed to a core vendor strategy; how he’s been able to lead major change at two different organizations; and how taking analytics to the next level is similar to implementing an EHR. He also shares his thoughts on vendor management — something CIOs aren’t doing as effectively as they can, and the balance leaders walk of taking risks without alienating senior executives.
- EHRs in jail — “It’s developing a true community record.”
- Gearing up for pop health
- Big data with Explorys — “We’re upping our game considerably.”
- Getting “the right vision and support” to win a Davies Award
- Value of “truly thinking outside the box.”
- HIMSS Stage 7 as a checklist
- “We’re always trying to be one step ahead.”
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We recognize that this is where everything is going. From a contractual standpoint, organizations are also looking to potentially take on more risk, and you have to have good numbers. You have to have a good strategy. You have to have good systems. Otherwise you’re going to lose your shirt.
With the age of mobility, there are a lot of things you can do and have in your little black bag that can help keep patients healthy and try to find better ways of customer service and delivery of care.
This is not something that you’re going to put together in a year and be done. The tools are going to evolve, the analysis is going to evolve, and you’re going to be looking at different types of skills sets. We’re going to start seeing the evolution of the data scientist that has been common in other industries.
Clinically and business wise, where did we want to go? How did we want to leverage the EMR? That was really the message that the CMIO and myself wanted to deliver to the organization, and we did.
Too many times, people look at this and say, ‘this is going to cost me hundred million dollars to do this.’ Well, you have to have the right people in place. You have to have the commitment from the top-down. You have to be open to change — if you’re not, then you’re never going to succeed.
Reichert: One of the things we’ve also done — and we’re one of a few in the country — is we’ve have taken Epic and put it in the jail system here. Not in prison, but the jail system. They’re two distinct things. What we found out in talking to the county was, if they had a prisoner, they would get their care here at Metro. It would take two police officers, with a car, and they would be here an average of three to four hours. That’s a lot of money being spent in what would be considered unproductive time from an employee standpoint.
We’ve introduced Epic into the environment. When you think about a jail, even though it’s short term, there’s three different phases: there’s an ambulatory phase, there’s a potential ED phase, and then there’s a potential inpatient phase. Epic doesn’t sell a jail package. But what we did is we worked with Epic in developing a package that takes the best of all three of those modules to work in that area. We’ve set up video visits. For example, from a psychiatry standpoint, we can have video visits with the inmates. We do lab tests, and I think we’re looking in doing radiology tests there as well. Once again, it’s treating the patient.
Now, the good thing is that if a patient comes here at Metro after they’re freed from the jail system, they can come here and get their treatment. We have all their medical record information. If there’s an unfortunate process where they end up back in jail, they have their record again. It’s truly taking things to another level and developing a true community record that can be shared. We’re having other discussions with the county on other areas too that I can’t elaborate on. But we’re always asking, what other opportunities are there that we can utilize an electronic medical record as information is exchanged from different departments within the city and the county?
Gamble: What you’re talking about certainly sounds like what population health really means. But are you set up with anything like a formalized ACO or anything like that at this point?
Reichert: We do have an ACO that is set up. Certainly we are getting into the population health game. Epic has a product called Healthy Planet. We have most of the functionality already up and running. That’s just through the process of implementing Epic; there are a few pieces that we still need to install. I know we are looking at actually hiring a VP of population health in the near future also. Because we recognize that this is where everything is going. From a contractual standpoint, organizations are also looking to potentially take on more risk, and you have to have good numbers. You have to have a good strategy. You have to have good systems. Otherwise you’re going to lose your shirt as an organization.
And to put the financials aside, it’s really now the next step in the evolution of the electronic medical record. So you’re tying all these different areas together, not only inside but outside the organization. You’re able to exchange information electronically. You’re able to make better decisions and diagnoses and use comparative analytics that ultimately benefits the patient at the end of the day, and keeps them healthy and out of the hospital.
Gamble: Right. The goal of all of this digitization is to be able to really improve outcomes and that means getting outside the four walls of the hospital, but as you obviously know, that’s not as easy as that sounds.
Reichert: We have different people who have different religious backgrounds that may or may not accept certain levels of healthcare. You have different levels of people’s ability to afford care, and different people’s ability to physically come to a doctor’s appointment.
One of the trends that is talked about in the country — certainly we’ve talked about here — is what about the old-fashioned things that were done in the 1700s and 1800s when the doctor came to you? The concept of having medical treatment in the house. With the age of mobility, there are a lot of things you can do and have in your little black bag that can help keep patients healthy and try to find better ways of customer service and delivery of care. You see that happening with Drug Mart, Walgreens, and CVS, where they have all these minute clinics. Once again, another way to help deliver care in a society that in some cases, they don’t have patience and they want a quick fix. We go to a Drug Mart, we get what we need and we get out. That option is there. We do have an arrangement with Drug Mart where it’s like a minute clinic concept to provide healthcare.
Gamble: That’s the direction things are definitely going in.
Gamble: In looking at things like business intelligence and analytics, there’s a lot of focus on this, but what that really comes down to also is being able to leverage the data to have better care outcomes. It sounds like that’s something that your organization has been pretty active in.
Reichert: We have been. On a couple of different fronts, there was a product called Explorys that was actually developed here in Cleveland, and we have nightly dumps of clinical information. It’s interesting, as a physician, 30 years ago if you wanted to do a study on pediatric diabetes and how many patients in the Cleveland area have received care for that, it would take you forever. It was a manual task. Today a physician can go into Explorys, set up a report, and in less than a half hour, you can touch a million visits and have the information at your fingertips. It’s amazing.
As far as a data warehouse, we’ve done a lot of analysis. There are a lot of products, a lot of different tools and extraction tools that are out there. We look to stay to our core. So we’re working with Epic and their product called Cogito, and using that as our basis for clinical analysis of information.
We are looking at bringing in other things. For example, Press Ganey Scores are critical to a healthcare organization. We now have that information electronically in the same garbage can, if you will, of data, so we’re able to do cross-mapping and cross-reporting in many different ways with the clinical information and what people are saying about their care. We have other aspirations of bringing in payroll information and bringing in the true hospital financial information into the mix as well, so that we ultimately are breaking down the silos of data and we’re able to have one repository of data and able to do analytics across multiple forms of data.
And once again, I attribute it very much like to the EMR journey. This is not something that you’re going to put together in a year and be done. The tools are going to evolve, the analysis is going to evolve, and you’re going to be looking at different types of skills sets. We’re going to start seeing the evolution of the data scientist that has been common in other industries, but not necessarily in healthcare.
Your world is evolving from what is known as the critical report writer, now to a true data scientist who is not only understanding the data schemas and where everything resides and making sure you pick the right data points to get to your answer; but bringing some normalcy to the data and how is it set up, and bringing some additional analytics to the table that the traditional report writer doesn’t bring. So you’re definitely upping your game considerably.
Gamble: It’s going to be interesting to see that as you start to see some of the people get in to the field.
Gamble: You mentioned briefly before the Davies Award. Can you just talk a little bit about what that entailed and why the organization was recognized?
Reichert: Sure. When I came to this organization about six years ago, I sat down with the CMIO and I said, ‘this organization has the potential to do a lot of great things.’ They had a lot of the pieces and parts in place. We just needed to have the right vision and the support of the organization to drive the business. So I said, ‘in five years I want to have this hospital at Stage 6, Stage 7, and receive the Davies Award.’ That was our mission five and a half years ago, and we achieved all three of those. Part of it was putting together a strategic plan on what needed to be accomplished, and sharing that plan with the organization and not necessarily just being about the awards, but clinically and business wise, where did we want to go? How did we want to leverage the EMR? That was really the message that the CMIO and myself wanted to deliver to the organization, and we did. I will tell you that with Stage 6, we weren’t that far off. Stage 7 was a little bit more difficult. There was a lot of work that a lot of people in IT and informatics had to do to put together the information and tell our story.
The Davies Award then is the next level up, it’s kind of like the pinnacle award that one can receive. It’s one thing to implement these systems and see results and improve care and your access to information. The Davies Award takes it to the next level — it’s taking all this information and process improvement and systems, and it’s really showing how you can truly make a difference in someone’s life or a group of people’s lives, for example, an asthmatic group or people with diabetes.
We ended up putting together 12 different case studies that showed improvements in care, dollar savings to the organization, dollar savings to patients, and truly thinking outside the box to make a difference in the lives of the patients that we serve. We don’t have a billion dollars in the bank. We’re a safety-net hospital, and we work very hard to get the most out of the dollar that we have. We had to put together our plan and we had to pick our poison as to what was the priority, keep ourselves focused, and from a quality standpoint, show that we’re truly making a difference in the lives of the people of Cuyahoga County. And we did that. The Davies group came in here and they spent a day with us. They had reviewed a lot of our casework prior to. They had additional questions through the process, and at the end of the day, they tell you right there if you earned it or not. It was very rewarding.
And we’re trying to do similar things in working with industry leaders, not just in healthcare, but with all vendors, on other ways that things can be measured. For example, I’ve been talking with HIMSS and many others about data analytics, data warehouse, and whether HIMSS can develop a staged approach similar to what they did with EMRs for data warehousing.
We’re looking at cyber security, which is a hot topic everywhere you look. And I’m not looking for awards, but from an industry standpoint, it’s like building a house — you need a strong foundation. What are the things that I need, and then to get me to the top of my game, what’s my path? I felt that the HIMSS Analytics group did a really good job of kind of laying out this for the EMR. It was a really good guide for any organization to follow. You can progressively see the process. I think too many times, people look at this and say, ‘oh my gosh, this is going to cost me hundred million dollars to do this.’ Well, you have to have the right people in place. You have to have the commitment from the top-down. You have to be open to change — if you’re not, then you’re never going to succeed. And that can translate into other things that you do in this space.
We’re always trying to be one step ahead of the process, always trying to find metrics or things like HIMSS analytics that we can repurpose that can help us not only with the sale of the idea and getting the organization to commit to what we’re selling, but then use it as a path, as a checklist, for us who are doing the work to make sure that we’re focused and we get to where we want to end up.