Daniel Barchi, CIO, Yale New Haven HS & Yale School of Medicine
During the six years he spent as an officer in the US Navy, Daniel Barchi endured quite a few “white-knuckle moments” that tested his skills in crisis management and leadership. But without that experience, he might not feel so comfortable guiding Yale New Haven Health System and Yale School of Medicine through a large-scale infrastructure project designed to unify IT operations across the system, facilitate better data management, and reduce costs. In this interview, Barchi talks about rolling out Epic, the importance of clinician buy-in and solid leadership, and how he is leveraging his dual CIO roles to bridge the gap between two organizations. He also discusses the value of IT rounding, the challenges of working in academics, and why he wouldn’t trade his job for anything.
Chapter 2
- Deploying CRMS to help manage large amounts of data
- Linking clinical trial data with Epic
- Using consultants — “We needed to get this right the first time”
- Head start on data reporting – “Coming out of the box with capability”
- Getting 3 hospitals onto one platform
- Atul Gawanda’s “Checklist manifesto”
- In Step with a Clinician
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Bold Statements
Clinical trials are complex, not only in that we have patients we need to make sure that we give explicit care to and use novel ways of caring for them, but we also need to make sure that we’re documenting the care well and that we’re billing for it appropriately.
We’re able to take that information out and use an SAP business object tool and tie it together with other Health System and School of Medicine financial and operational data. So our ability to report out of a clinical research data repository will grow over time, but we’re coming out of the box with capability.
When we talk about technology, it’s not about single sign-on or better workstations on wheels or integrating iPads into the way we do business. Those are the things that the IT team is going to do, but what’s a lot more important is, what kind of data are we getting, how are we capturing it, and how can we get it back in the hands of our physicians and physician leaders?
I find that our trained workforce who can take pride in the ability to do things on our own is, in the long run, a lot more efficient. And it keeps people engaged in a way that having somebody else to do our work for us just doesn’t.
The IT teams that we have coming back are changed teams. They say, ‘Wow, I’ve worked for this organization for 12 years and I’d never been on a nursing unit’ or ‘I never really saw how the doctors use that tool that I built.’ It really connects us to what we do and I really think it is one of the intangibles that’s part of working in healthcare that you can’t just get through perks.
Gamble: So the next component of the IT infrastructure project is the clinical research management system and it looks like the goal of this is to help manage the large amount of data involved in the operation of clinical research. Can you talk a little bit about the phase that this in and the overall goals of this component?
Barchi: Absolutely. With both the School of Medicine and the Yale New Haven Health System selected a tool called CTMS OnCore from a company named Forte based in the Midwest. With this tool, what we’re doing is we’re managing our clinical trials in a way that we haven’t before. Clinical trials are complex, not only in that we have patients we need to make sure that we give explicit care to and use novel ways of caring for them, but we also need to make sure that we’re documenting the care well and that we’re billing for it appropriately so that we’re not inadvertently billing payers for what is, in many cases, clinical trials work. So it’s many different things that need to get coordinated. We felt like the Forte OnCore tool did that well and also allowed us to tie it in with Epic. So we’ve built OnCore; we’ve actually rolled it out for Oncology at the Smilow Cancer Center within the Yale New Haven Health System and have about 100 clinical trials built and operating in OnCore already.
In February of 2013 when we turn up Epic at the Yale New Haven health System, where the Smilow Cancer Center is, we’ll roll out OnCore across all of the Yale New Haven Health System and the School of Medicine. So OnCore is built, it’s running today, and we’re doing the last 10 months or so of development to make sure it ties in exclusively with the EMR that we’re building and rolling out as well.
Gamble: I can imagine that there’s a lot of complexity when you’re dealing with clinical trials. Now when you were selecting the system and thinking about implementation, you decided to use consultants?
Barchi: Yes, we needed to get OnCore rolled out relatively quickly because we wanted to get it functioning in our oncology practices. So we brought a consulting team in to help us for the first six months of the project and they’ll continue to help us while we are building into other practices including internal medicine which is our next step, and they’re working at the same time with our Epic team.
Gamble: Looking back at the clinical research management project, are you glad that you did decide to use outside help, especially because of the complexity of clinical trials and what you’re dealing with there?
Barchi: Absolutely, we needed to get this right the first time. Clinical trials are such an important area, both from the patient perspective and on the billing side. We wanted to make sure that we got it right. We selected a team from the outside that had done this before to make sure we were able do it correctly at the same time we were turning up the EMR.
Gamble: And then as far as the data repository, is this something that’s still in the planning stages?
Barchi: Actually, one of the nice things about Epic is it comes with a database that it stores, separately from the production database, all of the information that’s in it. So we already have over 2 million patients’ worth of data that we fed into Epic before we’d gone live; so that’s available in a searchable database. We’re able to take that information out and use an SAP business object tool and tie it together with other health system and School of Medicine financial and operational data. So our ability to report out of a clinical research data repository will grow over time, but we’re coming out of the box with capability.
Gamble: As far as the whole IT infrastructure overhaul, what are you looking for in terms of how it will benefit the organization as a whole in terms of things like being able to secure grants or reduce costs, things along that line.
Barchi: About two years ago, within the Yale New Haven Health System we had three different hospitals with three different IT organizations, each with its own call center, its own field service team, its own standards, and even its own procurement. And that of course it not an efficient way to operate, especially when we’re going to roll out a unified EMR. We couldn’t really roll out one EMR on multiple networks trying to use one database but using different teams to roll it out.
So even before we kicked off the Epic project, I unified the IT team for the Yale New Haven Health System. We’re now one 250-person organization which is focused on raising our standards and using the ITIL standard to make sure we’re operating in a unified way and in a replicable way. We’ve built an integrated call center, a service desk, and a network operations center which are co-located in one site, and in that way, we feel like we’ve created a sustainable model for IT support going forward that will get more efficient and less costly over time.
Gamble: In terms of other projects and plans that are in your plate, what are you really at looking right now and in the near future?
Barchi: We’d like to use IT, not as just a technology area, but really as a differentiator for the way we do business. We think that getting information out of the system that we’re implementing is more important than putting information in. So much of doing an EMR is how physicians use it, but we really believe that information is going to be the differentiator in healthcare going forward. Both the Yale School of Medicine and the Yale New Haven Health System want to become integrated networks; we want to care for patients in an integrated way and we think data is the way we’re going to be able to do that. We’d like to use evidence-based medicine in a way that not all of our areas are using today and standardize our care policies.
If you’ve read Atul Gawande’s book, The Checklist Manifesto, a lot of modern medicine is going to be driven by best practice standards, and technology can help us in many ways to make sure that we’re following those standards, that we know what they are, and that we have the data we can use to follow it. So when I meet with executives from the Health System or the School of Medicine, when we talk about technology, it’s not about single sign-on or better workstations on wheels or integrating iPads into the way we do business. Those are the things that of course the IT team is going to do, but what’s a lot more important is, what kind of data are we getting, how are we capturing it, and how can we get it back in the hands of our physicians and physician leaders? So for us it’s really about information management.
Gamble: Right, that makes sense. Everybody is collecting data but what you really want to be able to do with it is make it as practical as possible and put it right up front for the clinicians.
Barchi: Exactly.
Gamble: So with everything that CIOs and IT organizations have going on right now, we’re hearing a lot of concern about staff burnout. Some organizations I know are taking steps here and there to try to make sure that they can hold on to their good people. Is there anything that your organization is doing in this area, either in terms of little extras or even things like offering education or leadership programs for the staff?
Barchi: That’s a great question. One of the things we have done, both as a cost-cutting measure and a way to integrate our teams, is to try and use our own people and full-timers instead of consultants in every way possible. So instead of bringing in a consultant or contracted team to help do a major upgrade or implement a new tool where we felt like it wasn’t in our skill set, I said to my VPs, ‘Find our own people. Send them to training and let’s do it on our own.’ I find that our trained workforce who can take pride in the ability to do things on our own is, in the long run, a lot more efficient. And it keeps people engaged in a way that having somebody else to do our work for us just doesn’t. So we’ve doubled our education budget. This is the year that I said we really need to focus on getting our folks trained; we’re sending a number of people to offsite training for our larger systems so we can maintain them internally.
In addition to the training side, not so much perks as connecting us to our work. It’s easy to forget when you’re in a data center or you’re in a call center or you’re working in a cube that really is about patients. Healthcare is the most dynamic and diverse environment I’ve ever worked in, and connecting to the patients who really benefit from our work is important. So we instituted a system we call ‘In Step with a Clinician’ where we actually take our IT teams and send them to our various hospitals to follow a nurse or a therapist or a physician around for half a day. They meet at the hospital in the morning, they get briefed on what’s happening, they get told where they’re going, they meet the nurse or the clinician that they’re going to be following around, and then literally they round with that person for anywhere from six to eight hours. So they see the kind of work that happens; they actually see our tools in use.
And the IT teams that we have coming back are changed teams. They say, ‘Wow, I’ve worked for this organization for 12 years and I’d never been on a nursing unit’ or ‘I never really saw how the doctors use that tool that I built.’ It really connects us to what we do and I really think it is one of the intangibles that’s part of working in healthcare that you can’t just get through perks.
Gamble: I think that’s really interesting, especially since they spend an entire day with them, so it really helps IT to see how workflows are impacted or even something like downtime — just to get that real perspective of how it impacts patient care.
Barchi: I’m glad you said that because downtime has an entirely different perspective if you’re setting in a cube in the IT building than if you’re a nurse on the floor with patients that you need to care for. Fifteen minutes when you’re a conference call trying to troubleshoot a severity one can seem like it doesn’t take that long. But when you’re a nurse who is depending on that tool to calculate data for your patient or tell you when is the next time to give a drug, that 15 minutes can seem like a lifetime, and the difference of being there or not can make all the difference.
Gamble: I can imagine.
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