As someone with nearly three decades of health IT experience, Mary Anne Leach knows that accomplishing anything worthwhile means being willing to learn from the past, and not being afraid to lead the way. Children’s Hospital Colorado was one of the first pediatric hospitals to fully implement an EHR and was a participant in Colorado’s first RHIO. Now, the organization is drawing from that experience to help build an improved HIE, and leveraging its relationship with Epic to extend its pediatric network. In this interview, Leach talks about the complex Meaningful Use picture in Colorado, how Children’s is partnering with vendors to develop a clinician-friendly mobile device strategy, why it’s critical to participate in advocacy initiatives, and how her background has given her a “well-rounded view.”
- About Children’s
- Connecting with independent physicians
- Pushing clinical decision support across the continuum
- Building a sustainable, affordable HIE model
- “It’s all about the value proposition”
- Partnering with Epic
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It’s really an independent relationship. We’re kind of an application service provider, if you will. So they have to want it and they have to sign a contract with us. We’re not trying to force this on anyone. We really make it as an offering to the community.
For the next generation on CORHIO, we’re contracting with Medicity to provide our HIE technology, and we’ve been using what we’ve learned about community identity management and asking Medicity to enhance their product to reflect those MPI learnings from the first generation.
It’s not discreet data sharing yet, but it pushes a complete clinical care document between those partners and really has streamlined care communications. And eventually, as we start to really share clinical data and manage populations, we think that all of this will ultimately reduce the cost of care.
If they have to go out and log into another application and put in another set of credentials, then they’re probably not going to use it, whereas if it’s seamlessly linked from their EMR, they’ll use it. And we’re hoping to build that kind of integration.
Epic has been a great partner. They’re on the forefront of advancing technology as well as healthcare. They’ve been at the table in Washington as these rules were being developed.
Gamble: Good morning, Mary Ann. Thanks so much for joining me on this call.
Leach: Good morning.
Gamble: Why don’t you start by giving us an overview of the organization? I see that the Children’s Hospital Colorado has 318 beds. Why don’t you tell us about the clinics, other facilities, and things along that line?
Leach: That’s correct. Children’s Hospital Colorado is a large, multispecialty children’s hospital. We’re also an academic medical center in affiliation with the University of Colorado. We’re about a $1 billion integrated child health system in 17 locations across Colorado, and we continue to serve a large population from out-of-state and internationally. We do about 20,000 in-patients a year and we just reached 500,000 ambulatory visits in our many clinics and network of care locations.
Gamble: Is system fairly spread out geographically?
Leach: Yes, we’re primarily along the Front Range here; so Denver, Aurora, Littleton, Parker — communities around Denver. But we’re also now in Grand Junction, which is pretty far west of Denver. And our ambulatory EHR program, PedsConnect, extends us to other communities like Frisco and Evergreen and we’re now talking with folks in Billings, Montana. So our network is quite extensive and our referral network is pretty much the Rocky Mountain region.
Gamble: As far as the physician mix in the clinics, are most of the physicians employed by the health system, or do you have independents that refer in?
Leach: None of the physicians are employed here. They are all part of the faculty at the university. So we have about 1,700 medical staff members that all hold appointments at the School of Medicine at the University of Colorado. So they’re all, I guess, independent, but partnered with us through an affiliation agreement. And then we have a broad base of independent community pediatricians that refer to the Children’s Hospital.
Gamble: As far as PedsConnect, how is that set up? Do these physicians have to be using Epic? And how did that come about?
Leach: So under the Stark Safe Harbor, we actually helped sponsor and implement Epic. We actually extend our Epic system into these independent practices that want to join our family, and it’s a full sweep of the ambulatory EHR. And we think many of our providers will actually qualify for the Meaningful Use incentives as well.
Gamble: About how many years in is PedsConnect?
Leach: PedsConnect is about four years in, and prior to that was about 18 to 24 months in planning phases — planning and financial modeling. And we have deployed to about 12 practices in a total of about 65 independent providers in the region here; physicians, nurse practitioners, or physician assistants are considered in that provider mix. We’ll probably get to about 100 to 125 providers when we reach kind of our peak mix. We’re still implementing at this point.
Gamble: Were most of these docs like on board with this? Was there any resistance as far as implementing Epic, or has it been pretty much smooth sailing?
Leach: It’s been pretty smooth sailing. It’s really an independent relationship. We’re kind of an application service provider, if you will. So they have to want it and they have to sign a contract with us. We’re not trying to force this on anyone. We really make it as an offering to the community. And so far, they have been really excitedly embracing this opportunity. Part of the advantage, for all of us, is that it really builds a community electronic health record. It’s really one record that clinical data is shared across the community. So our ED, our clinics, our hospital, and now our independent physician practices are all really sharing the same electronic clinical data, and it really helps improve the quality of care. It helps improve care coordination and communications.
And now we’re able to push clinical decision support, so with automated rules and best practice alerts, we can collaborate on those more effectively and really push those across the continuum. It’s really been a fantastic program for us. And then other independent clinics that may have their own EMRs already, we hope to connect with all of them through CORHIO, that’s our Colorado Health Information Exchange. Once all those physicians come on board, we’ll be connected through the CORHIO Exchange. And that’s probably many years out still.
Gamble: In terms of health information exchanges, Children’s is involved with two different HIEs at this time, right?
Leach: That’s correct. We have one with the state of Colorado, CORHIO, and we were actually one of the pioneers here in the state collaborating on the original RHIO which was called COHIE and now CORHIO, and that was University of Colorado Hospital, Denver Health, Kaiser Permanente and Children’s. And that was really an ARC grant. It was a demonstration project and we learned a lot from that and we’re actually using a lot of the patient identity, science, and algorithms that we learned in helping develop our next generation. So for the next generation on CORHIO, we’re contracting with Medicity to provide our HIE technology, and we’ve been using what we’ve learned about community identity management and asking Medicity to enhance their product to reflect those MPI learnings from the first generation. So, that’s one HIE.
The second HIE that we’re currently participating in is really for Epic-to-Epic clients, called Care Everywhere. And in the Denver area, there really are enough users of Epic that it makes sense for us to do this. Our business partners were users of Epic, so Kaiser Permanente, Exempla Healthcare, and now University of Colorado Hospital is on Epic and Children’s is on Epic, so the four of us actually use Care Everywhere and that’s really a great HIE. It’s embedded in Epic. It’s embedded in the clinician’s workflow. It’s not discreet data sharing yet, but it pushes a complete clinical care document between those partners and really has streamlined care communications. And eventually, as we start to really share clinical data and manage populations, we think that all of this will ultimately reduce the cost of care.
Gamble: Yeah, definitely. We know that HIEs have significant implications in terms of improving patient care and reducing costs, but what we’re finding is that a lot of them have kind of stalled. And I was reading an article that pointed out that Colorado, Maryland, and Rhode Island as three of the states that really seem to be finding success with HIEs. What do you think has made the difference in Colorado?
Leach: Well, I think it’s a challenge for everyone to ensure long-term sustainability, and I think in Colorado, we’ll be challenged with that as well. Some of us were around in the 80s when we did CHINS (Community Health Information Networks), and those came and went for all the reasons why all of us are challenged today — issues around governance and funding and creating a business model and a sustainability model that really carries us into the future. I think CORHIO has worked very hard with the CIOs in Colorado and other technology leaders in healthcare here to make sure that we built a model that we can all afford.
I think in Colorado, we still have to get many of the payers at the table because ultimately, at least in this initial phase, the payers are going to be huge beneficiaries of this by lack of repeated tests and duplicative studies and things like that. So we have some distance to go to get the payers financially contributing.
But we think we’ll be able to offer them some de-identified data and analytics that will be of value to them. So it’s all about the value proposition, and I think that Colorado has worked very hard at building that value proposition for the community and has engaged a lot of stakeholders here. And we’re still in the developmental stages. We’re getting this next generation of Medicity up and running, and we’ve got a couple of hospitals and clinics already contributing data, but we have quite a ways to go to realize the end state.
Gamble: Right, it’s something that you have to keep working toward. I thought it was interesting what you said about the Colorado RHIO applying some of the lessons learned and I think that’s a key thing too with HIEs — there isn’t one formula to stick to, you kind of have to make changes along the way.
Leach: Right. Another key lesson learned I think in our demonstration project was the importance of having this embedded in their clinical workflow; embedded in the EMR they’re into. So if they have to go out and log into another application and put in another set of credentials, then they’re probably not going to use it, whereas if it’s seamlessly linked from their EMR, they’ll use it. And we’re hoping to build that kind of integration and make sure it really gets used.
Gamble: As far as your clinical application environment, you use Epic for your EMR. Are you an Epic shop?
Leach: We have several enterprise partners that we work with. Epic is certainly our major partner in terms of patient management, patient billing, scheduling, and all of the clinical applications. Epic has been a great partner. They’re on the forefront of advancing technology as well as healthcare. They’ve been at the table in Washington as these rules were being developed. So they’ve been a really great partner for us. We have several other what I consider enterprise class vendors or multi applications suites in one integrated vendor. Our financial vendor is People Soft, so HR, finance, and supply chain is all under Oracle People Soft, and then our enterprise content management is under EMC Documentum. That’s where we have scanned documents.
Gamble: Do you know how long Children’s has been working with Epic? I’m sure it’s been a good couple of years at this point.
Leach: I want to say we started our Epic journey in about 1996 or 1997, and started on the ambulatory side. And Children’s Colorado was one of the first, if not the first, free-standing pediatric hospital to have fully implemented an EMR. So we have a quite long history with Epic.
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