If you think your organization has a hard time gaining access to data, trying working with the military. For organizations like Fort Drum, it has long been a struggle to provide clinicians with updated health records of military members because of the firewalls that exist. But finally, there’s a light at the end of the tunnel, says Corey Zeigler, whose organization is participating in a pilot that could finally break down those walls. In this interview, he discusses the unique operating model that he believes will position Fort Drum well for the future; the governance challenges that come when hospitals aren’t owned; and how his team is leveraging an HIE to pull together data from multiple EHRs. Zeigler also talks about the organization’s population health journey, his military background, and what it’s like to get outside the four walls of the hospital.
- FDRHPO’s goal: to “leverage the health system in an around Ft. Drum to take care of soldiers and their families.”
- 150 practices & community-based organizations
- “We’re a centralized, trusted partner.”
- Governed by 3 boards
- HIT initiatives — “We primarily operate through grants.”
- Supporting “heterogeneous environments” in hospitals & clinics
- NY’s HIE landscape
LISTEN NOW USING THE PLAYER BELOW OR CLICK HERE TO SUBSCRIBE TO OUR iTUNES PODCAST FEED
The planning organization just brings all those folks together. We’re a centralized, trusted partner. We have no agenda or affiliation with any of the organizations, so we’re able to operate in a unique position to bring folks to the table
The way we kind of look at it is, the med management group is the ‘what,’ so they focus on what we need to do, and then the HIT governance group is the ‘how’ — how are we going to implement this, how are we going to support it.
Through technology, we’ve divided into specialties, subspecialties and even niche specialties, and created all these silos. Hopefully we’re turning the corner with technology where we’re using it to bring it back to a system that can be more patient-centric again and have those providers know everything they need to know
We can do patient queries from other RHIOs. It doesn’t support direct workflow, meaning that if you have a lab in a hospital that’s not in your RHIO, that won’t find its way back to the provider. But a provider can go in and do a query on you.
Gamble: Hi Corey, thank you so much for taking sometime to speak with healthsystemCIO.com.
Zeigler: It’s my pleasure.
Gamble: To get things started, can you talk a little bit about your organization, Fort Drum Regional Health Planning Organization?
Zeigler: I guess being affiliated with the military you have to have a good acronym list to compete with theirs, but we’re a health planning organization that was put in place specifically when Fort Drum went from what was a National Guard and reserve training base to full active duty, meaning that they had soldiers here year round. So it went from a maybe couple of hundred folks there fulltime to now 40,000 soldiers and family members.
Generally speaking, they would build a hospital there, but there was a conscious decision to leverage the health system in and around Fort Drum to take care of the soldiers and family members. What our organization does is make that into a health system for both the betterment of the community at large, and of course for the soldiers and family members that are stationed here.
Gamble: And what’s included in that — it’s a collaborative of hospitals?
Zeigler: Depending on the initiatives that we’re undertaking, we go anywhere from seven down to four hospitals because we’ve got multiple programs that overlay each other. We’ve got an ACO that’s right here in the area that includes six of our hospitals. We have what I would describe as a Medicaid ACO, the Delivery System Reform Incentive Payment program (DSRIP), which is part of the Medicaid waiver that’s here in New York — that’s overlaid on top of it, and that is six hospitals. And our planning organization region here includes an additional hospital to the south of us that we oversee in some other projects and grants. In addition to that, we have about a 150 practices and community-based organizations that, again, participate in varied initiatives.
Primarily, the biggest one right now as I mentioned is that Medicaid redesign, DSRIP. The planning organization just brings all those folks together. We’re a centralized, trusted partner. We have no agenda or affiliation with any of the organizations, so we’re able to operate in a unique position to bring folks to the table, and we’ve been doing so since we were formed in 2005.
Our committee structures are specifically built around the community needs. We have behavioral health and Emergency Medical Services; the quality committee; technology, which is primarily the area that I serve under; and the Population Health Improvement Program. So those committees do change sometimes, but they’re set up around the needs of the community, and we go through a strategic planning cycle every year.
Gamble: How is the governance set up — do those committees that report up to a group, or how does it work?
Zeigler: We have actually three boards right now because we have the ACO and the DSRIP are mirror boards, so they’re the same folks, and they’re made up of the participants of those two initiatives. And then we have the FDRHPO board, which has many of the same members but it’s a little bit different, including an ex-officio member of the military. We have the MEDDAC (medical activity commander) as an ex-officio on the FDRHPO board. So the subcommittees will report up to those boards.
Gamble: When you have different health IT initiatives, is this done through grants or is there a budget for it?
Zeigler: We primarily operate through grants. We do have some reserves that we’re able to hold over, but we do very much work through either grants or incentive programs. So, like most of the country, as we move to more of a value-based system, a lot of the incentives that reinvest back into the system also fund part of our operations here.
Gamble: Okay, so the hospitals aren’t necessarily members but it’s more that the technology committee makes some of the decisions for the hospitals based on their IT systems?
Zeigler: With hospitals, for instance, the HIT Governance Committee serves all three boards. The members of the boards have all seven CIOs on them — at least on the FDRHPO board and then six of the seven on both the ACO and Clinically Integrated Network board. The governance committee has the CIOs of the hospitals on it, as well as some of the key IT leaders and physicians — we actually have physicians on our committee. And so yes, they control the budget for the initiatives and the grants that have an HIT component to them, and they work in conjunction with the med management group, which is all physicians. The way we kind of look at it is, the med management group is the ‘what,’ so they focus on what we need to do, and then the HIT governance group is the ‘how’ — how are we going to implement this, how are we going to support it. And then that goes back to the individual organizations that do the individual work or participate in work groups.
Gamble: Are you in contact pretty often with the CIOs of those hospitals?
Zeigler: Yeah, almost daily.
Gamble: Are the hospitals on different EHR systems?
Zeigler: Yeah. We have all three flavors of Meditech. We have Meditech MAGIC, Meditech Client/Server, Meditech 6.X. We have CPSI. So we have those four HIS systems in the hospitals. And then in the ambulatory side, we have eClinicalWorks, Greenway Energy, Greenway PrimeSuite, Medent, Amazing Charts, and Practice Fusion. In the behavioral health world, we have Netsmart, Accumedic and TenEleven. So we’ve got quite a heterogeneous environment that we leverage the HIE for point-of-care interoperability, and we’re in the process right now of implementing our second PHM (population health management) platform to do interoperability around analytics and population health management.
Gamble: Can you talk a little bit about the HIE and how that works to make all this information flow?
Zeigler: Our HIE is HealtheConnections and they’re based in Syracuse. They run on the Mirth platform and they do receive state funding, so there’s no cost to the individual providers to participate. They have your traditional HL72.x or ADT interfaces and they also support the CCD and C-CDA interfaces. They operate a HISP for secure messaging between the EHRs. They do results delivery directly to the EHRs consuming that data from the hospitals and diagnostic centers, and they also do some EHR to EHR referral management. And we’re working through the process right now of delivering alerts to care managers and primary care physicians whose patient had a visit to the ED or an admission or discharge into the hospital.
I always use the analogy that back in the day, we had the generalist, the country doc that knew everything about you. You didn’t have anything clinically that went on with you that that person didn’t know, and through technology, we’ve divided into specialties, subspecialties and even niche specialties, and created all these silos. Hopefully we’re turning the corner with technology where we’re using it to bring it back to a system that can be more patient-centric again and have those providers know everything they need to know to take better care of you and reduce some of those silos.
Gamble: Right. There definitely are silos. Now has this particular HIE been in place for awhile?
Zeigler: Yes. New York had a few grants as they stood up their technology strategy. They called it Health Efficiency and Affordability Law for New Yorkers or HEAL, and then they have different phases. The HIEs primarily were stood up on HEAL phase 5, and that was back in 2006 I believe that really that got go on.
So HealtheConnections, I believe, was in place in 2008. They got stood up in that program, so they’ve been around for a quite a bit. New York had 13 HIEs at one point and I believe that now they’re down to either 7 or 8. They’ve collapsed quite a few of them.
And above the HIEs, there’s the SHIN-NY which is the State Health Information Network for New Yorkers which does the RHIO to RHIO activity, so we can do patient queries from other RHIOs. It doesn’t support direct workflow, meaning that if you have a lab in a hospital that’s not in your RHIO, that won’t find its way back to the provider. But a provider can go in and do a query on you by your name, date of birth, and a couple of other demographics, and then they will find you and any care you received in the other RHIOs and bring it back to you. So it’s not a push, but it’s rather a pull.