As one of the regional CIOs at Vanguard Health, Kristin Darby is tasked with guiding the IT strategy for seven hospitals located in the Chicago and Boston areas. It’s a role that requires a lot of juggling, and constant communication — which Darby facilitates through “huddle meetings” with the staff. In this interview, she talks about the work her team is doing to enable data flow between facilities, increase patient engagement, and lay the groundwork for ACOs. Darby, who was named one of Boston Business Journal’s Top 40 Under 40 in 2010, also discusses the key advantages in being part of a large system, the changes she is seeing in physician acceptance of EHRs, and why community involvement is so important to her.
- HIE landscape in Illinois
- Upgrading Meditech to connect with Mass HIWay
- Plans to expand the New England market
- Attesting to MU in 2 states
- The power of shared knowledge — “You’re not doing it for the first time in most cases.”
- Real-time surveys on iPads
- OpenTable’s model
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We’re stepping back strategically to say, in the long term, which HIE do we think will be viable? And secondly, which one makes the most sense based on the referral network for our facilities.
That’s one of the conversations we’ve been having there — what do the HIEs look like? Is there a large presence? How mature is it? Connecticut does not have strong HIE presence or utilization, so one of the things we’ll have to evaluate is whether we continue direct connections as our only strategy, or take a parallel path.
We’re very performance-focused, and so we can always look across the organization and say: ‘We’re struggling with this particular metric. Who else is doing it better than us,’ and go find out what they’re doing. That shared knowledge becomes extremely powerful.
That type of immediate access to information is becoming an expectation at all facets of our life in looking at how demographics are changing with our patient population and who’s making the appointments.
One in five healthcare appointments are now being made online. That trend is only going to continue, and so we recognize it’s important for us to enable functionality.
Gamble: Looking at HIEs, this is interesting to me because you’re dealing with two different states, and HIEs are so different in every single state. I can imagine that has been a bit challenging. What kind of activity do you have right now?
Darby: In Illinois, we’re not active in an HIE. I am looking into a few there, but within that market there doesn’t seem to be one standard HIE that everyone’s moving toward. There are a lot of different options, and so I think we’re stepping back strategically to say, in the long term, which HIE do we think will be viable? And secondly, which one makes the most sense based on the referral network for our facilities, because certainly every HIE tends to have different participants. But I haven’t found any that have a large utilization rate where it’s been clear as to what that choice should be.
Within the state of Massachusetts, we’re certainly leaning toward leveraging the state HIWay that has launched here. We were a Golden Spike participant last October and we have connectivity to the HIway now, so what we’re doing is building out quite a few of the use cases to enhance the connectivity. Meditech just released a new version that has connectivity to the state HIWay — we’re going live with that in September — which will enhance our ability for exchange.
We also recently received a grant for our MetroWest Accountable Health Organization to build out some of those use cases. We think that has a lot of viability here in the state. Everyone seems to have bought into that if they were using separate regional HIEs connecting into the state, which is really important because we want to make sure that the data necessary for the continuity of care for our patients is available, whether they are being seen within our ACO or outside, because ultimately, we’re all responsible for that care. That connectivity and sharing of information is extremely important to us, so we’ll continue to work on building out the different use cases and enhancing our connectivity there within the state of Massachusetts.
Gamble: It’s interesting how you have those two pretty drastic differences between the states. I’m sure that from your perspective it would be easier if they were similar, but I guess the flipside of that is down the road, you might be able to use some of the best practices in Illinois that you’ve picked up with the Massachusetts HIE.
Darby: Absolutely. We’re looking at expanding in Connecticut also and so that’s one of the conversations we’ve been having there — what do the HIEs look like? Is there a large presence? Is there not? How mature is it? Connecticut also does not have strong HIE presence or utilization, so one of the things we’ll have to evaluate is whether we continue direct connections as our only strategy, or take a parallel path where you certainly want to continue to focus on that direct connectivity because you’re often able to more intelligently share information in a way that is consumed by your recipient’s EMR in the way that you fully intend. The state HIEs certainly facilitate that exchange, but oftentimes I’ve found that the level of intelligence of consumption of that information isn’t as developed. I’m hoping we’ll get there with the state HIway here in Massachusetts, but in the interim we’re continuing to take a parallel path to that development.
Gamble: What about Meaningful Use? Where are you with the two markets?
Darby: In Massachusetts, we attested in late 2011 for stage 1 so we’re actively preparing for stage 2. We’re doing extremely well with stage 1, exceeding the threshold very close to 100 percent in most of the measures. So we’re in very good shape there. These next few months we’ll be implementing quite a few new pieces of technology to ready us for Meaningful Use Stage 2.
In the Illinois market, in two of the facilities we’re approaching stage 1, year two, and we also have two other facilities that are in their first stage 1, 90-day attestation window. That market we’re also starting to prepare for stage 2, so over the next few months we’re also enhancing our technology platform to ensure our readiness for stage 2.
Gamble: As far as the approach to Meaningful Use, was the intention to start with one of the markets and see how that goes and look at some of the challenges and work through those before going to the second market, or was it not necessarily a one-after-another type thing?
Darby: I think each market really has their own timeline based on the maturity of where they were from a technology perspective, and also the availability of the facility to be able to operationally absorb the changes. Those schedules were made very independently, but with an overall focus across the organization of sharing information. For example, we do a lot of lessons learned, not only within our markets, but we share them across the market. Our informatics team in Massachusetts is meeting with the informatics team in Illinois who’s meeting with Arizona and Texas. We’re always trying to share that information back and forth so we’re not duplicating efforts or repeating mistakes, and making sure that whoever within the organization has attempted a particular initiative or project first, that the knowledge and learnings are shared, whether that’s under the Meaningful Use umbrella or any other initiative that we approach.
Gamble: That’s something I could see as a benefit of being a part of a larger system, or a system with a presence in different markets — being able to reach out to those who have done it and talk about what works and what doesn’t work. It’s a nice thing that you don’t have to go outside the organization; that first, you can see what your colleagues within Vanguard have done.
Darby: One of the real strengths of being part of such a large hospital system is that in most cases, you’re not doing it for the first time. In addition to that, we’re very performance-focused, and so we can always look across the organization and say: ‘We’re struggling with this particular metric. Who else is doing it better than us,’ and go find out what they’re doing. That shared knowledge becomes extremely powerful, because you’re always working towards optimal performance at all facilities.
I think the culture here is phenomenal from an information sharing perspective. It’s a very engaged environment. Everyone’s really looking to make sure that our facilities are the best hospital facilities, whether it’s within the acute setting or any of our supporting services, that they’re the best place for our patients to go. And so that information sharing across the organization really supports that effort and builds relationships that you wouldn’t necessarily have access to in a smaller, non-connected, community-based facility.
Gamble: When you talk about things like patient engagement, that’s something that we hear mentioned a lot as being a challenge for CIOs. Is that something where you’ve been able to share some best practices within Vanguard? This is something that a lot of CIOs in a lot of organizations are struggling with in terms of Meaningful Use 2 Guidelines.
Darby: We’re certainly putting together strategies of how to approach that as part of our stage 2 readiness. We track patient experience very closely as part of our HCAHPS bundle, and we’ve started to look at the overall experience of our patients, which ties in to their engagement while in the facility. We’ve been working with our Chief Nursing Executive to understand what those scores are and how IT can possibly benefit that process and leverage that technology. We have done some things such as implementing real-time surveys on iPads that the nursing community can use with patients to get immediate feedback. So if adjustments need to be made while a patient’s in a facility, whether it’s education or any of the other elements of the HCAHPS bundle, that they’re able to react proactively while the patient is still with us, and make sure that any adjustments necessary to ensure maximum engagement of that patient are being done in real time.
We’ve looked at many different facets of functionality to include in the patient portal that we’re going to be deploying or upgrading as part of stage 2. That, hopefully, is a way that patients can leverage the knowledge and information that’s shared with them while they’re in the acute facility to their transition externally, and continue to have access to that. So whether you think about it as educational content or other types of information that’s being shared with them, we want to make sure that they still have access to those resources post-discharge.
Gamble: Online scheduling is another initiative you said you’re working on. I’m not sure how closely it relates to the patient engagement requirements, but it is something I could see a going a significant way toward improving the patient experience and improving the rates of showing up at appointments.
Darby: Absolutely. It wasn’t Meaningful Use that drove us to that, but when you step back and look at how internet connectivity has increased over the last few years and how the utilization of mobile devices have changed, it’s amazing. Before we go out to eat in our family, the first thing we do is jump on OpenTable and see who has a location near the house where we don’t have to wait. That type of immediate access to information is becoming an expectation at all facets of our life in looking at how demographics are changing with our patient population and who’s making the appointments. When I say that, I mean that you might have a large elderly population within your facility, but is it those patients themselves that are making the appointment, or is it perhaps the son or daughter who’s managing a lot of their care that’s making the appointment.
We’ve done a lot of analysis of the statistics. One of the recent Google Healthcare Statistics found that one in five healthcare appointments are now being made online. That trend is only going to continue, and so we recognize it’s important for us to enable functionality that our providers and the hospitals can take advantage of to make sure the ease of use for our patients is there to access the healthcare services they need.
We’ve partnered with HealthPost and focused on providing preregistration services for our ED. And so if you know you’re en route and two people are driving, the person in the passenger seat could fill out the preregistration information and let the ED know the emergency — ‘I have a broken leg’ or ‘I have some other symptom’ — and provide that description so the ED is waiting for them and have the registration already processed when they walk through the door. It expedites their ability to access the triage area. Our employed physician offices are up on this, and we’re expanding it to the affiliated physician offices that want to participate.
We can do two-way integration with the online scheduling, so if you’re a PCP and your panel has spots open and you want to make those available to patients to book online, they can certainly do that. It’s no different than booking an airline seat where that real-time availability is there. And it certainly supports transitions of care. When a patient is being discharged, if they need a follow-up appointment within 72 hours, it gives us the ability to book that appointment before the patient leaves the facility. That’s pretty powerful when you think of a patient getting discharge instructions that say, ‘You need to call your doctor tomorrow and make an appointment and go there within two days.’ There’s a lot of information in discharge instructions and patients sometimes are overwhelmed. Instead, this type of functionality allows us to say, ‘You have an appointment. You need to go see your physician at this address, tomorrow at 3 p.m.’ That’s a much more proactive directive that we’re hoping will continue to increase the compliance of patients making those appointments; making it easier for them and enabling them to get the care that they need.