Jeffrey Ferranti, MD, CIO & VP for Medical Informatics, Duke Medicine
For most organizations, having a CIO with a background as a clinician and a passion for research would be viewed as a plus; at Duke Medicine, however, it’s practically a necessity. Not only did Jeffrey Ferranti meet those criteria, but as the CMIO, he knew the organization well and was prepared to guide it through a major implementation. In this interview, Ferranti talks about how his team created its own set of best practices and applied them during the Epic rollout; how he has benefited from his experience as a clinician; why it was a “really natural transition” from the CMIO to the CIO role; and what it’s like working for an organization where innovation is part of the DNA.
Chapter 2
- Physician leadership — “We have very engaged chief medical officers.”
- From 130 systems to 1
- Data exchange with Care Everywhere
- “Seamless communication of health information is where the future is.”
- Patient portal access through mobile devices
- The “natural transition” from CMIO to CIO
- Art Glasgow as his mentor
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Bold Statements
Our CMOs have been integral to the success of this project. During the go-live they were on the wards walking around, engaging with users, helping to make decisions, and that was remarkable.
It’s also helped us to collapse down some of our processes that were disparate across the health system, like thinking critically about what do our order sets need to look like between Duke Hospital Raleigh and Duke Regional, and what does our formulary need to look like between our different hospitals to try to have a more singular environment.
As we think through our strategic plans for the coming year, patient engagement becomes one of the central themes of what we’re working on.
I think that moving forward, we’re all going to be accountable for better managing populations of patients and for looking at health more holistically.
Gamble: Was there a specific group of physician leaders that was heavily involved the whole time, whether it was super users or just leaders who took that lead and who you met with on a regular basis — did you have anything like that?
Ferranti: We have very engaged chief medical officers at Duke who have been helping us through this project since the very beginning — Dr. (Thomas) Owens, our system CMO, Dr. (David) Zaas, our practice CMO, as well as all of our hospital CMOs have just been integral to the success of this project. During the go-live they were on the wards walking around, engaging with users, helping to make decisions, and that was remarkable. Our associate CMIO, Dr. (Eugenia) McPeek Hinz, came to us from the Cleveland Clinic and had a lot of experience with Epic and really helped to lead our physician champion group. We had about 20 or 22 physician champions to really lead them on what are the best practices and how you should configure the system and how we can improve things. So I really would say that a lot of the efforts, particularly during RCI (rapid cycle improvement), but also in building up the system, were physician-led. And those physicians that were leading it were both IT physicians, as well as the operational leaders from across Duke Medicine.
Gamble: Right. Now going back a little bit, what was in place before? Were there different systems in place at the various hospitals before Epic?
Ferranti: We had a really heterogeneous, best-of-breed environment prior to going live with Epic, and part of the business case for moving to Epic was really to collapse down some of our IT and have a single seamless electronic health record across Duke. We were using McKesson in Duke Hospital for our CPOE project, and we were using McKesson in the ambulatory arena as well. Over at Duke Regional Hospital, we had Siemens, and at Raleigh, we had Meditech. We were using IDX for the revenue cycle. So when we went live with Epic, we were replacing a whole bunch of disparate systems with one. In the end, we will retire over 130 systems and replace it all with Epic. We’ve installed almost every module that Epic has, and we have one environment now that we’re managing across the enterprise.
It’s also helped us to collapse down some of our processes that were disparate across the health system, like thinking critically about what do our order sets need to look like between Duke Hospital Raleigh and Duke Regional, and what does our formulary need to look like between our different hospitals to try to have a more singular environment where we have similar order sets, similar formularies, and similar workflows across all of Duke Medicine. We’re using this project as an opportunity to do that.
Gamble: And I’m sure another part of it is having access to Care Everywhere and being able to exchange information with other Epic hospitals.
Ferranti: North Carolina is a state where a large portion of the state is on Epic, and so really on day 1 after our go-live, we started exchanging records over Care Everywhere, and that’s been a remarkable thing. I remember the first time I used it in the newborn ICU. We were getting a baby in from a referring hospital, and to be able to click on the link and pull down the serologies of the mom and some of the birth history directly was just an amazing thing.
We’re really focused this year and next year on building out our HIE strategy beyond just Epic Care Everywhere to look at the direct interchange of records using our HISP as well as participating in Healtheway, which is the national HIE exchange, because I really think that this seamless communication of health information is where the future is at, and we want to be front and center in making that all work.
Gamble: Right. As everything moves closer to that direction, I’m sure that having one system across the board makes a huge difference.
Ferranti: It really does.
Gamble: You mentioned the 300-plus clinics, are there also independent practices that are hooked into your system?
Ferranti: We have a physician practice called the PDC (Private Diagnostic Clinic) and we also have community practices, which are called CPDC or community PDC clinics. These are clinics that are affiliated with Duke that are live on Epic. We haven’t yet deployed Epic to a non-affiliated facility. Epic has the capability of doing that through what they call Community Connect, and we’re looking at what that would take to actually deploy Epic to a non-affiliated practice. That’s certainly something that we’re very interested in doing, but we haven’t actually done that yet.
Gamble: Right. You’ve certainly had your hands full on the hospital side too in the last couple of months. As far as patient portals, is that something where you’re seeing some decent traction already, or is it just getting off the ground?
Ferranti: We had a portal for many years before we went live with Epic. I actually think partnership with our patients is one of the most important things that we need to do.So we transferred our patient accounts from our Legacy portal over into Epic and started with nearly half a million patients on our MyChart portal. And so as we think through our strategic plans for the coming year, patient engagement becomes one of the central themes of what we’re working on.
I saw a great statistic last year that nearly 10 times as many patients use your EHR as providers. I think that’s true, and so we need to make sure that we’re building out functionality in our electronic health record that would really benefit our patients. So we’re looking at things like e-visits or patient scheduling of appointments directly online, and patients being to fill out forms and information about themselves or their condition before they show up in clinics. I think those sorts of things really encourage partnership and care, and that’s really what we’re all about — how do we partner with our patients to take better care of the population we serve. The patient portal is up and running. We have many, many patients on it, and this is really an area that we would want to expand the functionality of in the coming years.
Gamble: Right. I think that something like having patients be able to schedule their own appointments online can go a long way.
Ferranti: Access to the system is so important, and being able to do it on your time to fit your schedule through an online portal is important. The other thing that we’ve deployed is the ability to access your portal account through iPhones, iPads, Android devices, etc. So it’s beyond just having to be at your computer; you can be on the road or be out and about and use your mobile device to access your health information. All of that is to allow the patient to participate more actively in care.
Gamble: That kind of segues a little bit into what I wanted to talk about with your background. You are a physician, and as a result of that, I would imagine you’ve had experience with patient engagement from having that interaction with patients. I want to talk about how your past experiences — especially as a CIMO and as a clinician — have shaped the CIO role for you so far.
Ferranti: I think that having a clinical background gives an appreciation of what it means to take care of a patient, how important a doctor-patient relationship is, and how fundamental information technology can be in the overall care of individual patients and populations of patients. I really try to bring sort of that framework and that background to what we’re doing, because I think that moving forward, we’re all going to be accountable for better managing populations of patients and for looking at health more holistically. Being able to one day work in the newborn ICU and use the system and understand how it works and the next day work with teams of people who are building out the system and installing new functionalities, I think brings a certain perspective to what I do that I find very helpful, because I actually get to use the technology that we build in taking care of patients.
This is something that I’ve always wanted to do. I love taking care of patients in the unit one by one, but I actually think the ability to impact lives is much greater through the IT work that I do, because you’re deploying systems that really have an impact on whole populations of patients, and that’s really exciting as it ties the two together.
Gamble: Now when you were brought into the CIO role, I imagine it was laid out pretty clear that you were going to help lead through the Epic implementation. Was there any hesitancy on your part to take on this gigantic task?
Ferranti: I’ve always wanted to be a CIO. I love large integrated projects like this. The truth is I had been doing it for prior years in the CMIO role; I had been working on the Epic project and was actively engaged in nearly all aspects of the project. I think that as I moved into the CIO role, a lot of the forums that I participated in and the groups and the tables that I sat at changed, but the core work that I was doing — the things I was really passionate about — stayed the same.
It was a really natural transition, especially because our last CIO, Art Glasgow, was a tremendous leader and a great mentor to me. Over the years that I was CMIO, he really took the time to give me some insight into what it was like to be a CIO. That made the transition a little bit easier, and I really appreciate all the effort that he put into that.
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