There are many reasons why vendor executives might consider a move to the provider side; for Joel Vengco, who worked with product development at GE Healthcare IT, it was an opportunity to truly innovate. And sure enough, two years accepting the CIO role at Baytate Health, Vengco founded TechSpring, which provides “a platform for innovators to test out solutions” in a real-life environment. In this interview, Vengco talks about his goals with TechSpring and how it has helped shape the organization’s strategic direction, the work his team is doing to drive value-based care, and the goal of moving to an integrated platform. He also discusses the CIO’s role in managing expectations, why analytics is “the next big boom,” and the biggest challenge for today’s leaders.
- About Baystate
- Next Generation ACO — “It takes an army and a village to pull this off.”
- Moving 2 acquired hospitals to Cerner
- HIE for integration — “It’s a nice solution in the interim, but we’d like to have a centralized system.”
- Centralized analytics
- Normalizing data — “There’s still work to be done.”
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Everything is consolidating, and reimbursements continue to shrink, and so of course there’s a push for innovating on how you might deliver differently, more efficiently, more effectively a higher value.
When it’s a clean slate, you still have to provide some level of pre-population for patient demographics, but certainly the challenge is more focused on user adoption and training and understanding the new workflows.
We’ve created a central repository because it helps us ensure that we are achieving data that’s of high integrity and data that’s normalized and standardized in that we can ensure a single source of truth.
It’s not as easy as just pulling data out and then seeing some very cool graphs and visualizations. It takes a lot more effort to actually get to that end-game, and I think it’s prudent and worthwhile to actually make sure you’ve got a good information architecture and strategy so that you can reap those benefits of good information and insight.
Gamble: Can you give us an overview of Baystate Health? I know you’re a pretty decent-sized system. You have five hospitals?
Vengco: We have five hospitals now after our two acquisitions. We’re about $2.5 billion organization. We have 90 medical groups. We also have a health plan that we own called Health New England which has roughly 150,000 to 170,000 lives, and we’re also a Next Generation ACO. Originally there were 21, now there are 18 Next Gen ACOs.
Gamble: So you’ve been able to stand the test of time so far with that.
Vengco: Yes, so to speak. We feel hopeful that we have the ability and the partnerships across the region to really push forward with this new value-based arrangement and risk-sharing arrangement and hopefully, it’ll benefit the partners as well as the patients.
Gamble: It’s really interesting, and I can tell why it’s a topic that with such interest throughout the industry right now.
Vengco: Everything is consolidating, and reimbursements continue to shrink, and so of course there’s a push for innovating on how you might deliver differently, more efficiently, more effectively a higher value. So we hope that this will show that this is a certainly a possible initiative, and that what one would think to be able to do in light of value-based care is certainly possible. But it takes a whole army and a whole village to be able to pull this off.
Gamble: How long has the ACO been in place?
Vengco: The ACO has been in place for at the very least five years, if not, longer.
Gamble: And it was a pioneer, right?
Vengco: That’s right, and then we went into MSSP, and that proved to be, maybe not savings where we could actually share revenues with the CMS, but certainly it provided some insight to being able to decrease cost, be more efficient, and provide higher value. So we decided that going into the Next Gen ACO would put us to the next level of this risk-sharing and value-based care delivery model.
Gamble: In terms of the EHR, what do you have in place in the hospitals?
Vengco: Our main EHR is Cerner and that’s we have deployed both inpatient and outpatient for Baystate Health. We have acquired, as I mentioned, two community hospitals, both of which were on Meditech and Allscripts in the ambulatory setting. Actually one of the hospitals didn’t have an ambulatory EHR in place, so we’re deploying Cerner across those environments now as we speak.
Gamble: And what does the timeline look like?
Vengco: We’re slated to complete our deployment for Baystate Wing Hospital in March of 2017. Shortly thereafter, we’re going to be starting with the second acquisition. Hopefully within 12-16 months after March 2017 we’ll be completed with that implementation, both inpatient and outpatient.
Gamble: So in the meantime, I imagine it presents some challenges having the hospitals on different systems.
Vengco: It does. Certainly we’ve got physicians that see patients in the community between those entities that have Cerner and have a record other than Cerner, but we are using our Health Information Exchange to enable some level of integration and a centralized view of patients who are shared among these non-integrated entities. So we do have a solution that enables a clinician who’s seeing a patient out at Baystate Noble that patient has records centrally located in the Health Information Exchange, to be able to see that from their Meditech record. They can launch it with a single click or a single sign-on, and it’s as seamless as it can be without being fully integrated across Cerner and Meditech. It’s a nice solution in the interim, but certainly, we would like to have a centralized system for a variety of reasons, including analytics and decision support obviously.
Gamble: Right. And you mentioned that one of the hospitals did not have an ambulatory record in place. So is it easier in that case? Maybe easy isn’t the word, but does it make it a little less challenging to go from paper to Cerner, as opposed to a different EHR system?
Vengco: Certainly, the technical deployment is a little less challenging, because when you’re migrating an EHR that they’ve had for even two or three years, you have to consider migrating data into the new centralize record. There’s a lot of work to be done in that regard if you decide to migrate historical digital information into a new centralize record.
When it’s sort of a clean slate, you still have to provide some level of pre-population for patient demographics, etc., but certainly the challenge is more focused on user adoption and training and understanding the new workflows. And if those clinicians who have been on paper are more reluctant to get on to computer or the digital environment, that certainly is a challenge. So I wouldn’t say it’s easier, it’s certainly different but certainly that the technical challenges are more focused on user adoption and user training when there is no incumbent EHR in an environment..
Gamble: Are you doing some analytics at this point or is it something you’re looking into for the near future?
Vengco: Yeah, we do analytics today, and we have done analytics in the past — quality analytics, safety, reporting, and also some level of predictive analytics, namely focused on things like readmission, prediction, or utilization analytics. But those, as with many traditional health systems, especially in the past, have been siloed; different groups will take on those analytics and they’ll use different sources or sources that they’ve created out of systems that are in the environment. So what we’ve been focusing on over the last two and a half years is really developing what we call the center for analytics, and that’s really focused on taking the data sources across the organization to map and normalize them so that we can begin to see a source of truth, but also have confidence that the data that’s in the center for analytics has high integrity and is curated consistently and constantly. We’ve created a central repository because it helps us ensure that we are achieving data that’s of high integrity and data that’s normalized and standardized in that we can ensure a single source of truth that gets us to an answer that we feel confident in when we’re trying to either report or develop analytics, so that we can ensure that we have good insight and knowledge of what’s going on in our environment.
Gamble: Right. It feels like this is another thing that’s an ever-evolving strategy as far of how you look at analytics and what data is needed the most for clinicians.
Vengco: It’s certainly a strategy that many health systems have to get into if they haven’t already. We’ve already digitized our health record, and many of the other parts of the business are digitized. And so now the challenge, is how do you take that data and derive knowledge and insight from that data, so that you can actually take action appropriately?
I think the misconception by many health system leaders is that this is easy, because now we’ve digitized the record, or digitized our scheduling system or our financial systems. But there’s still work to be done to normalize that data so that it can become true information. And that takes investment, and it takes resources. At some level it takes expert resources, but it also takes money and time. It’s not as easy as just pulling data out and then seeing some very cool graphs and visualizations. It takes a lot more effort to actually get to that end-game, and I think it’s prudent and worthwhile to actually make sure you’ve got a good information architecture and strategy so that you can reap those benefits of good information and insight continuously.
Because if you just do it as an ad hoc project or as a one-time analytic, you can’t re-use that, and you’re not even certain if you can re-use it. And that’s really, I think, where it becomes an expensive proposition, and you’re certainly not creating a path towards sustainable analytics, which is really what you want to get to.
Chapter 2 Coming Soon…