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.”
- The complex MU picture in Colorado
- Managing reporting requirements with independent docs
- Modifying workflows for physician documentation
- Letting the market drive decisions
- Plans to move into a BYOD environment
- Undergoing an organizational name-change
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We’re pretty far along our electronic health record journey, so for us, it’s not a matter of implementation or upgrade, it’s some degree of adoption. We’ll need to get some folks using certain features they may not be using today.
We’re looking forward to the final rule coming out. I think we’ll decide at that time how aggressive we want to be with our Stage 2 efforts. We certainly don’t want to invest more in the effort than it will benefit us in terms of value proposition, either in incentives or in functionality that we may or may not find useful in the pediatric environment.
A lot of the work is in reporting. Some days we call it ‘meaningful reporting’ instead of Meaningful Use because of the analytics required, but Epic has been a great partner in terms of delivering a reporting environment and a data model and reports that are really going to reflect our current usage.
Physicians and nurses are mobile; it’s a mobile workforce. So the progression of the tablets and the applications has been welcomed in our community, and I think we have yet to see what we can really do with it.
Over time, I think we’re going to be moving toward more of a self-provisioned environment as these devices get more and more mature and more prolific and we’re able to secure them as a health system. I think our responsibility is the security of PHI and a secure connection between the devices.
Gamble: So one of the big topics, as you know, is Meaningful Use. How is your organization positioned for Meaningful Use? Have you attested yet to Stage 1 and what are your future plans?
Leach: Well, we have not yet attested though we would have liked to have. Our state is not quite ready. We’re under the Medicaid program—most children’s hospitals will come under the state Medicaid program. So our state is a little behind in setting up their attestation and registration processes and website, but I think they’re going to be ready to go in a few months. And we’re actually looking forward to our AIU (Adopt, Implement, or Upgrade) payment, probably in June or July of this year.
We really have three Meaningful Use programs going on here at Children’s Colorado. One is the Eligible Hospital Program – so under that Medicaid state eligible hospital program, we’ll be attesting. And then under our PedsConnect program, we’ll help our independent eligible professionals attest, and we think a number of them will qualify based upon their Medicaid volume. And then I just met this morning again with one of our chief operating officers in the faculty practice plan, UPI (University Physicians, Inc). Under the EP programs, we’ll have probably over 300 pediatricians in that faculty group that will qualify under the eligible professionals program. So there’s lots of activity going on here on our campus. We’re pretty far along our electronic health record journey, so for us, it’s not a matter of implementation or upgrade, it’s some degree of adoption. We’ll need to get some folks using certain features they may not be using today.
A large part of the work to date has been setting up the reporting environment — running the reports and doing all the data validation to make sure the reports are correct. And on the physicians’ side, we’re talking about 4,000 reports that are going to be required to measure independent physician compliance with each of the criteria. So it’s quite a large undertaking. At this point it’s a lot of monitoring and building and reporting, and then I imagine we may have some upstream work to do in Epic; for instance, we’re looking at the documentation of smoking cessation counseling that has to be documented by physicians in the record. And so we’re modifying some workflows as well as some templates of documentation. So those are some of the things we’re working on. We’ve been pushing compliance of problem lists. I think over the last few years, we’ve gone from 37 percent compliance with that criteria, to about 95 to 98 percent compliance across all specialties. So that’s been a huge achievement.
So there is a lot of activity going on in Meaningful Use, but we’re very optimistic we’ll qualify for AIU in stage 1 this year, probably, as soon as the state is ready to take our attestation. As far as Stage 2, we’re looking forward to the final rule coming out. I think we’ll decide at that time how aggressive we want to be with our Stage 2 efforts. We certainly don’t want to invest more in the effort than it will benefit us in terms of value proposition, either in incentives or in functionality that we may or may not find useful in the pediatric environment. So Stage 2 is kind of a TBD at this point for us.
Gamble: Right. And it sounds like it’s just a little bit more complex when you’re dealing with an organization like yours and then also the concerns with the state requirements. This is another thing that’s not so cut and dry; you can’t just take the same example and apply it everywhere.
Leach: Exactly. It’s complicated, and a lot of the work is in reporting. Some days we call it ‘meaningful reporting’ instead of Meaningful Use because of the analytics required, but Epic has been a great partner in terms of delivering a reporting environment and a data model and reports that are really going to reflect our current usage. So we’re happy to be an Epic partner at this point in time.
Gamble: All right. So I want to talk about some of the other recent projects your organization has been involved in and some of the changes you’re undergoing. I saw that last year you launched ChildrensMD, a mobile app that features a symptom checker.
Leach: ChildrensMD is really for patients and families to determine the right course of action. Dr. Bart Schmidt developed a set of protocols that tell a parent, ‘come to the ED’ or ‘you can wait and go see your independent physician’ or ‘you better come into the clinic.’ It gives them an algorithm based on symptoms. And then I think there are also probably directions to the closest ED or urgent care center. And so that was really our first foray into mobile applications. This year, we’re more aggressive in developing our mobile strategy to really start to flush out some opportunities and requirements.
I think our first order of business on the mobile front is really to partner with our vendors who are building mobile apps. Most hospitals aren’t really development shops, and that goes for mobile as well as other apps — we contract and purchase from major software vendors. So to the extent we can, we want to leverage those partnerships. For instance, from Epic, we’re already using Haiku, which is Epic on the iPhone. We have about 50 physicians using that today, and that use will expand this coming year. We’ll also be implementing Epic on the iPad. It’s called Canto, and that really gives providers access to the record and functions on the iPad. And then we have other vendors that we work with like Tableau that we imagine having mobile analytics running on the iPad and other Tablet platforms.
Our mobile strategy is still fairly young in its development, but being in healthcare for many years, we’ve always said that providers are mobile. Physicians and nurses are mobile; it’s a mobile workforce. So the progression of the tablets and the applications has been welcomed in our community, and I think we have yet to see what we can really do with it. So we’re very excited about that.
Gamble: That’s a really an interesting area and one in which we really starting to see more action. Now as far as deciding what types of devices to run applications on, is there a level of communication with the clinicians or a specific group of clinicians as to whether they prefer using the iPhone or iPad? How does that work in your organization?
Leach: Right now, we’re kind of letting the market drive and we’re monitoring the statistics, and it seems like many more physicians are gravitating to the iPhone as opposed to the Android or other platforms. So we will probably continue to deploy and develop on the iPhone/iPad/Apple iOS platform probably more rapidly than perhaps the Android. Although I do know that Epic is now building for the Android market as well.
We really watch the market as opposed to trying to enforce a device standard. I don’t think that would be possible. These are personal computers and they’re personal devices, and it’s a very personal decision. And at this point, we do not have any applications that require one or the other. So we’re kind of watching how this evolves, but I imagine we’ll be deploying on both Apple and Droid over time.
Gamble: And these are devices that clinicians own personally, right?
Leach: Yes, correct.
Gamble: That is interesting. And in terms of strategy, I think that like you said, letting the market drive it is the smart thing to do right now.
Leach: I suppose it would be different if we had developed our mobile apps on iPhone and we want everybody to get an iPhone, but then what happens if that market tanks and everything moves over to the Android market? It’s a pretty fast-moving and fluid market at the moment, and I think we’re wise to kind of let that drive. And eventually, we’ll move into kind of bring-your-own-device environment where people will choose what their personal device is, whether it’s a phone, a tablet, a laptop, or desktop. And other than desktops, perhaps bring in their own devices over time.
Certainly people are already bringing in their own phones, their own iPads, their own tablets, and their own Macs, and we deploy a Dell PC-based platform throughout the house. But over time, I think we’re going to be moving toward more of a self-provisioned environment as these devices get more and more mature and more prolific and we’re able to secure them as a health system. I think our responsibility is the security of PHI and a secure connection between the devices so that if people are accessing corporate resources or PHI, we make sure that we’ve secured and encrypted that. But I think we would be unable to rope in the entire mobile market ourselves. So our strategy has been to kind of follow it and not overspend.
Gamble: And that’s smart, especially since there are always upgrades coming out. I think there’s another iPad version coming out soon.
Leach: Right, I think there’s been three so far. So yes, it could be a very expensive proposition for us to be chasing technology.
Gamble: Okay. So in terms of your organization, it looks like two more satellite locations were added fairly recently and that you also changed your name — that was last summer, right, that the name was officially changed to Children’s Hospital Colorado?
Leach: So for a long time, we were the Children’s Hospital and were located in Denver. We moved out to Anschutz Medical Campus a few years ago, so we’re in Denver really as a satellite at St. Joseph Hospital, but really located centrally. Our main campus is no longer is no longer in Denver, and not that many people know where Aurora is, so we have moved our identity to really reflect more of our constituents. And so, it’s Children’s Hospital Colorado. The name change project is pretty big for us; of course from an IT perspective, we had to change all our URLs and email addresses, so that’s a pretty big forklift. And then we have all of the signage and other collateral that we have to change and that’s kind of ongoing, so that’s been a big project for us.
In terms of development, we have a new east tower being built. That should open up in the fall/winter of this year. That will ultimately add about 120 beds. So in three to five years once it’s fully opened, we should be about 495 beds and we’ll be one of the largest children’s hospitals in the world. In addition to that, we have a campus developing in Colorado Springs, and a satellite that we’re developing in the southwest region to add to our current 16 locations. So there’s a lot of growth and development going on as we expand to serve the needs of the children of Colorado.
Gamble: That’s exciting for you, guys. I would imagine that it’s also kind of reflecting the growth of your organization in that you’re representing not just the city but, you know, more like a large region in the state.