Chris Van Pelt, CIO, Indiana University Health, Chapter 2

As if CIO Chris Van Pelt didn’t have his hands full with the hospitals and physician practices already in his health system, IUH keeps building and acquiring new ones for him to automate and integrate. To bind them all together, Van Pelt and his team are using Cerner, rolling it out one facility and practice at a time, after a thorough readiness review has been conducted by a team formed specifically for that purpose. But getting to a basic level of automation isn’t enough, as Meaningful Use Stages 1 & 2 call the organization to further action, including the use of PHRs as a basis for patient engagement. To learn more about Van Pelt’s wins and challenges, healthsystemCIO.com recently caught up with the Indiana-based executive.

Chapter 1

Chapter 2

• Managing Meaningful Use
• HIE work — IHIE’s accomplishments

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BOLD STATEMENTS

I laugh a little bit when I see two hospitals inter-operating data or five hospitals have exchanged transactional data, and that’s being touted at the same time that we’ve got basically a statewide EMR to access anything that’s out there, which is good stuff.

We were pretty aggressive with constructing that over a decade ago and again, under the auspices of research, but now in the last 7 years heavily pushed it into direct patient care. It’s a huge leveragable asset my physicians couldn’t live without.

… we absolutely have to have the lab results that were done in our competitor hospitals, almost real-time, to know what’s going on, especially if we’re trying to manage a chronic condition across time with a patient population that we’re at risk for.

Gamble:  In your position as CIO at a really large organization, do you have a committee, task force or a group of people who focus on Meaningful Use?  How do you break that down?

Van Pelt:  Not a task force, per se. We have many constituents from around all of our statewide entities participate, and I wouldn’t call it a governance committee; it’s more of a collaborative. I’ve had an executive director assigned to it — Kathy Mathina — who’s an RN, and was one of our CNOs at one point, has led and spearheaded that for the last two years — she’s done a really phenomenal job.

So as we have interpreted the rules, gone off all of the clarifications that the government has provided and sought some of our own clarifications, when we determine how we want to report a specific thing, we make sure that we consistently communicate that to all of our 19 hospitals, and all of our physician practices, so they know what our interpretation of the given standard was, because there’s still a lot that’s subject to interpretation as you all know. So we have that group that collaborates on it.

Then with respect to IS governance that ARRA comes up under, we have a governing body we call the clinical process team (or CPT) that’s made of all the CNOs, CMOs, many of the COOs throughout all of our facilities, and the ambulatory governance models, that come together every other week and review the entire portfolio of everything we’re doing, if it’s opening a hospital, working on med reconciliations, CPOE, ARRA, all of those matters get discussed there on an every other week basis.

Gamble:  Are you part of those meetings or do you try to be part of them?

Van Pelt:  Absolutely, yes. We formed that committee originally when I got here 8 years ago.

Gamble:  Now as far as HIEs, what does that landscape look like in Indiana?

Van Pelt:  Indiana has the world’s largest data repository through Regenstrief, who is part of a research arm under Indiana University School of Medicine. The data repository itself is called INPC (Indiana Network for Patient Care), and we have all 90+ hospitals in the state contributing data to that single repository, both for research purposes but also for patient care.

IHIE (Indiana Health Information Exchange) is the customer service front to that database called INPC. So yes, we’re members of IHIE. We’re one of the founding members of that INPC database. I sit on the steering committee for both those groups, and we’re heavy advocates for it. We’ve got data on patients going back over a decade. We have real-time access to a longitudinal record, irrespective of what hospital or clinic you’ve been seen in, as long as the data’s being contributed to the INPC database. When Jane Doe presents, they just need 5 pieces of demographic data off of Jane and then they can jump from Cerner to Jane Doe’s record, after they’ve established that clinical relationship at the registration point. We can then open Jan Doe’s record on INPC and get all of her historical information, wherever it was resulted. If there’s an EKG, cath report, radiology film, anything sitting out on INPC, the ED physicians or hospitalists can all see that data at their fingertips immediately in context, which is really cool stuff.

We don’t do a good job of marketing that around the country. I laugh a little bit when I see two hospitals inter-operating data or five hospitals have exchanged transactional data, and that’s being touted at the same time that we’ve got basically a statewide EMR to access anything that’s out there, which is good stuff.

We’ve also extended that to the EMTs within an 8-county radius of Indianapolis, so Marion County and the 7 surrounding counties in a circle. We’ve got wireless access for the EMTs to those same records. So there again, if Jane on June 20, 2012 presents in an ambulance rig, as long as they can get demographic data off of her, they can launch that same INPC record and get historical or trended information on her that goes back as far as she’s got data in there, which could be critical in determining an allergy or looking at an EKG as they get her in the rig, monitoring an EKG there. So it’s good stuff.

Gamble:  That’s really impressive. What you’re doing sounds like what a lot of the states are talking about doing. We talk to CIOs from around the country and I really haven’t heard anything like that.

Van Pelt:  I encourage you to go to IHIE’s website. You can go read more about that INPC database and what we’re doing. Like I said, they don’t push too much of it out there but, I agree with you, it’s a shame because we have a model that works. We were pretty aggressive with constructing that over a decade ago and again, under the auspices of research, but now in the last 7 years heavily pushed it into direct patient care. It’s a huge leveragable asset my physicians couldn’t live without.

Gamble:  The one issue that we always hear about is funding. How have you been able to work past that challenge?

Van Pelt:  In the early phases, which you call the first 10 to 12 years, it was heavily subsidized by the 5 major health systems that came together to fund it. But a push in the last year or two is to make it self-sustaining and not require that subsidization. So we’ve been trying to get back into the cost model to make it run based on either hospital size, patient volume, data contributed, all those types of metrics. So IHIE is intent on making it independently viable and running.

So for a for-profit LabCorp that wants to use INPC and IHIE as the brokering engine to get lab results communicated to the 90,000+ physicians that are in the state of Indiana, that takes a lot of workload off of them to fax, call, do those types of things, and they can automatically transfer that to a single database. So it’s in their best interest to do it. So they’re going to pay a service fee to subscribe to INPC and push their data through there.

Obviously, we as hospitals and physicians, as consumers, would prefer that the data just goes to the one place, versus going around and risking that it not being in a contiguous record. Everybody seems to be coordinating and coming together on that. As I said, the economics will start to bear themselves out a little bit more. I think as most states foray into this a little bit, they’re going to have to do some subsidization at the early phases.

Gamble:  That does seem to be the hurdle that we hear about. I’m surprised I haven’t heard more about this. I bet there would be a lot of interest.

Van Pelt:  Yes, I agree with you. It’s been kind of a – I wouldn’t call it a stealth project, but it certainly has evolved well-beyond anybody’s appreciation for what we’ve actually got in operation right now. In fact, we still find a few hospitals around the state that aren’t using it to its fullest and I’d love to turn them loose for 5 minutes with my ED physicians or my hospitalists so they could see that contiguous record and how it’s invaluable from a care delivery perspective. As we’re all going to be challenged with accountable care and medical homes, obviously we can’t control where patients go, especially the Medicaid population; there’s a high bounce rate between different EDs, so we absolutely have to have the lab results that were done in our competitor hospitals, almost real-time, to know what’s going on, especially if we’re trying to manage a chronic condition across time with a patient population that we’re at risk for.

Chapter 3