Care redesign. It’s a concept that can mean different things to different organizations. At Rady Children’s, it goes far beyond cutting costs and improving workflows; it’s about leveraging genomics to enable early diagnoses. It’s about partnering with outside organizations to connect children to the right care providers. It’s about using tools like telemedicine to improve care in the most vulnerable patients. For Albert Oriol and his team, care redesign is at the core of everything they do.
Recently, healthsystemCIO.com spoke with Oriol about the projects his team is working on, the challenges they face from reimbursement standpoint, how they’ve made patient engagement a top priority, and why he believes “we’re just scratching the surface” with telemedicine. He also talks about how Rady has been able to align IT’s strategy with the organization’s overall goals, the advice he received from his mentor before taking on the CIO role, and the key to building a strong team.
- About Rady Children’s
- Epic in the hospital & pediatric subspecialties
- Enabling data exchange — “It’s a never-ending process”
- Creating a “quasi-ACO” with California Children’s Services
- Partnering with operations
- Challenges with pediatric reimbursement — “We’ve had to get creative.”
- Groundbreaking work with the Genomics Institute
We’re responsible for coordinating the care of those patients and making sure that we aren’t just continuing the cost — which is a lot of what drives these types of programs on the payer side — but really improving the quality of care and making sure folks are engaged in their care.
We’ve certainly made a significant investment in analytics, and yet at the same time, we’ve been conservative in that rather than going out and buying a lot of off-the-shelf systems early on, we did a lot of this work ourselves with our existing systems.
Part of our secret has been to partner with the folks that have the content expertise and make sure that we are not just doing things because everybody else is doing them, but that we’re doing the things that make sense for us and the way we do things.
This is part and parcel of the care redesign concept of incorporating precision medicine, big data, sensors, and the Internet of Things into the practice. It’s all part of the digital transformation that is really beginning to shape, in a noticeable way, how we care for kids.
Our teams have been working very closely to build some artificial intelligence that allows us to automate the process from order to diagnosis. We’re trying to break the 24-hour barrier for that.
Gamble: Hi Albert, thanks so much for taking some time to speak with us today. Can you start by providing some information about Rady Children’s Hospital?
Oriol: Sure. Rady Children’s is both the provider of choice and the safety net provider for pediatric care in San Diego County in California, as well as Imperial County, which is to our east, and Southern Riverside, which is to our northeast. We collaborate quite a bit with CHOC in Orange County, and we partner with UC San Diego School of Medicine as a teaching hospital.
In addition to our main hospital, we have six NICUs that are on our license, but are physically based in adult hospitals throughout the region, as well as a couple of pediatric units that operate the same way. We have about 44 pediatric subspecialty clinics and we partner with community primary care pediatricians as well.
Gamble: What type of EHR system is in place?
Oriol: We are on Epic, both the hospital and the pediatric subspecialists. In addition, about a third of the community pediatricians are on our instance of Epic.
Gamble: For the physicians that are not on that instance of Epic — or are on a different EHR — what type of system is in place for exchanging data?
Oriol: In San Diego, we have about four different groups of pediatricians. First, we have the ones that are on our instance of Epic. Second, we have pediatricians that belong to other IDMs such as Kaiser, Sharp or Scripps, and use their respective systems. Third, we have the community clinics, which are federally qualified health centers. They’re on a variety of EHRs as well, and through all of those, we connect either through Carequality, through Epic’s Care Everywhere, through the regional HIE, San Diego Health Connect, of which we are founding members. We use this HIE to connect, for instance, to the community clinics or Sharp physicians who are on Allscripts, or the Sharp Hospitals, which are on Cerner.
The fourth is a group of smaller providers that are on a variety of different systems. It’s their choice to connect to the HIE — some of them are pursuing that route or have pursued that route, others haven’t. Either way, we provide Epic Care Link, which allows remote access into our systems. And we still, like it or not, deal with faxes and those types of things for providers who don’t have the capability on their end. We also offer the possibility to extend our EHR — some have signed up for that and others haven’t.
Gamble: So in some ways, it’s a never-ending process to find ways to get the information flowing.
Oriol: Yes, you said it well. It’s a never-ending process, but I think we’re in a good place in that San Diego is a fairly consolidated healthcare space, and so I would say the bulk of care does happen across organizations and providers that are fairly well connected as far as data transfer is concerned.
Gamble: I just read about a project with California Children’s Services, which is a managed care program to try to bring in some of the data. How does that work?
Oriol: We’re working with the state on a number of fronts. One of the things that we’re working on is a project where we will take on risk for populations that are high-complexity, high-utilization, and high-cost for the continuum of care. It’s like of quasi ACO, if you will. We get data from the state, and we’re responsible for coordinating the care of those patients and making sure that we aren’t just continuing the cost — which is a lot of what drives these types of programs on the payer side — but really improving the quality of care and making sure folks are engaged in their care. These tend to be folks with chronic diseases, and so we want to make sure they learn how to manage those diseases effectively so that they can grow into well-adjusted and healthy adults, and as productive as they can be when we turn them over to the adult health systems.
Gamble: And is this initiative something you’ve recently become involved in?
Oriol: We’ve been having conversations with the state for years, frankly, and we’ve been managing these populations for quite a bit. In fact, there was a proposal that was submitted about two or three years ago, but we’ve had a lot of back and forth in getting this established. I believe that because of the uniqueness of our region, we’re in a good place to do this well. We care for more than 90 percent of the children in San Diego, and so we’re well positioned to manage these populations of folks who need a lot of attention and could benefit from better coordination.
Gamble: Okay. Now, in order to participate in something like this, you have to have a strong infrastructure in place in terms of data management and analytics. I imagine that’s been a big priority for your organization during the last few years in terms of building those capabilities.
Oriol: Yes. We’ve certainly made a significant investment in analytics, and yet at the same time, we’ve been conservative in that rather than going out and buying a lot of off-the-shelf systems early on, we did a lot of this work ourselves with our existing systems. We’ve started to deploy Epic’s Healthy Planet — some pieces of it are up, while others are coming live in March. It’s a work in progress, but it’s been very well-received. It certainly provides quite a bit of visibility.
One of the things we do well is from an IT standpoint is we partner very well with our operations folks. We have a very strong group of folks, on our care redesign team, in leadership and operations, and in managed care and finance. Part of our secret has been to partner with the folks that have the content expertise and make sure that we are not just doing things because everybody else is doing them, but that we’re doing the things that make sense for us and the way we do things.
Gamble: Why do you believe it’s important to take a conservative approach and do a lot with the tools you already have — is that part of the organization’s philosophy?
Oriol: It just makes sense for us. Because reimbursement in California is so tough for pediatrics, we’ve had to figure out ways to get things done that we wouldn’t have been able to do going the traditional route. We’ve had to get creative and figure out how to use existing tools. We don’t have a big development shop like other institutions do. We’re relatively a small group of folks, and we have a small team that does development, but we partner strongly with operations. We leverage that partnership very much. And so yes, I think that has been the organization’s philosophy. We try to utilize off-the-shelf software when available, but it’s got to make financial sense for us.
Another area where we also partner extensively with our external community is in the genomics space. That’s very exciting for us, but it’s also an area where we have a small team of developers, because a lot of what we’re doing hasn’t been invented yet, if you will. So that’s one area where we’re trailblazing. But in general, our preference is to utilize commercial tools if they are available and affordable to us. If not, we’ll figure out a way to come up with the tools ourselves so that we can afford them.
Gamble: I’m glad you brought genomics — it’s such an exciting area. Can you talk about some of the work being done at the Institute for Genomic Medicine?
Oriol: Absolutely. It’s incredibly exciting. Just like the work we’re doing on the population health side, this is part and parcel of the care redesign concept of incorporating precision medicine, big data, sensors, and the Internet of Things into the practice. It’s all part of the digital transformation that is really beginning to shape, in a noticeable way, how we care for kids.
The Genomic Institute is something that sparked several years ago. We had been working on the concept for quite a long time, and then a couple of years ago, the Rady family donated $120 million to start the institute, and we were able to recruit Stephen Kingsmore, MD, who is now president and CEO. And it has picked up at a tremendous speed.
From its inception until the now, the Institution has gone through some evolving and maturing in terms of its focus. We had originally designed it as something that paralleled what already existed in the adult world, but instead with a focus on pediatric diseases. When Dr. Kingsmore joined us, we narrowed it to focus on genomics for intensive care; now that it’s up and running and has picked up speed, we’ve begun to expand into more traditional areas of cancer, heart conditions, etc.
But what we’re doing in the intensive care area is mind-blowing. It’s understood that somewhere between 20 and 30 percent of kids that end up in a NICU or PICU have a genetic basis to their disease. Being able to come up with a clear diagnosis quickly can be the difference between life and death for these kids. And so we’re focused on rapid whole genome sequencing. Compared with traditional sequencing, which tends to take anywhere between four and six weeks to could come back with a diagnosis, we’re turning over a diagnosis in two to three days on average.
Dr. Kingsmore has a Guinness World Record for doing it in 26 hours. We’re shooting to do it in less than that. In fact, our teams have been working very closely to build some artificial intelligence that allows us to automate the process from order to diagnosis. We’re trying to break the 24-hour barrier for that.
It’s incredibly exciting to be able to diagnose a kid early on and put them back on track to recovery quickly. It’s incredibly meaningful for that kid and their family, because as you can imagine, the longer these things go on, the longer impact they have at an early stage in the development of their vital organs, and something that is damaging to them can have sequelae for life. But if it’s taken care of quickly, it can have no further downstream effect, and they are able to live completely normal and healthy lives. Even in the instances where the diagnosis suggests the non-viability of the patient in the long term, it allows the families to start dealing with that earlier on.
What’s really incredible is that we’re not just doing this for kids in San Diego. We’ve got partnership agreements with other hospitals in the region and across the nation, and more have expressed interest. And that’s been very exciting, building a platform that enables that collaboration across the US, and soon, across the globe.
Gamble: I would think that makes the work even more meaningful — the possibility of being able to improve diagnoses for children everywhere and improve care on a global basis.
Oriol: Absolutely. That’s what we’re trying to do — put our little grain of sand to change the world for the better. I think this capability that we have developed allows us to do that a little bit right now, and as it continues to mature and develop, we’ll be able to do it in a bigger, more impactful way down the road.