Last year, Children’s Hospitals and Clinics of Minnesota became the first pediatric hospital in the US to achieve interoperability between infusion pumps and EHRs. Although the initiative required a great deal of effort, leadership saw it as an opportunity to leverage IT to improve patient safety. Projects like this are precisely the reason Jeff Young made the leap from the pharmacy benefit management world to health IT five years ago, and he hasn’t looked back. In this interview, we talk about Childrens’ efforts to create a clinically integrated system, the special considerations of IT when it comes to pediatric patients, and Young’s unique career path.
- About Children’s Hospitals & Clinics
- Vision “to be every family’s partner in raising the health of their children”
- From PBM world to CIO
- Cerner in acute, eClinicalWorks in physician practices
- Steering docs down the path of an integrated system
- Physician leaders & work groups — “The community was very active.”
- “There are always going to be tweaks.”
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I had a great experience, but I’d been traveling quite a bit, had small kids and was ready for a bit of a change. I received a call from Children’s and the rest is history.
We looked at both children’s and non-children’s providers to determine the most appropriate EMR system to implement throughout the general practice community in the metro area.
About 80 percent of the community-based practices were on an EMR system at the time, and so we had to spend some time to really talk through the benefits of migrating toward one system. But once we spent that time, for the most part the groups were willing to move down that path.
From a technology perspective we’re mostly integrated, and there are a number of things happening as well related to coming together and agreeing on quality measures and really driving quality of care across the community as well.
Gamble: Hi Jeff, thank you so much for taking the time to speak with us today.
Young: Hi Kate, how are you?
Gamble: Good, thank you. To get us started, why don’t you give our readers and listeners some information about Children’s Hospitals and Clinics?
Young: Absolutely. We’re a Minnesota-based organization. We have our initial roots in St. Paul, opening in 1924 and growing to what is now our St. Paul Hospital, which is now across the highway from the original house where we started. Our Minneapolis hospital opened in the early 70s and was founded by a number of physicians who believed that we needed a pediatric presence in Minneapolis as well. The two hospitals merged in the early 90s to form what we now call Children’s Hospitals and Clinics of Minnesota, and we’ve grown from there. We’re close to 400 beds; I think right now we’re just over 380. We’re one of the largest pediatric health systems in the US. We serve kids throughout the upper Midwest with our two freestanding hospitals, which are in Minneapolis and St. Paul. I believe we have around 12 specialty care clinics, six rehabilitation sites, and I believe 10 general pediatric practice clinics across the community. We have locations throughout the twin cities metro area in Minneapolis, St. Paul, Minnetonka, where we have an outpatient surgery center, Woodbury, Roseville, Maple Grove. We also have community clinics throughout the metro area as well as a couple beyond that.
To give you a feel for our activity, I believe last year we saw about 125,000 total patients in our hospitals and hospital-based clinics. We did have about 345,000 outpatient clinic visits if we include our community-based clinics, almost 23,000 surgical procedures, about 9,200 home care visits, 78,000 rehabilitation visits, and around 90,000 emergency room department visits. Our organization compromises almost 4,600 employees. Our vision is to be every family’s essential partner in raising the health of their children; that vision stems past hospital and clinic visits to become advocates for children’s health and bring healthcare more into their daily lives versus, in many instances, becoming a diversion from it. So we’re very focused on moving down that path. So at a high level that’s Children’s Hospital and Clinics of Minnesota.
Gamble: Great. So obviously you’re a pretty busy organization. Do you see a decent amount of referral patients?
Young: We do. We work fairly closely with both our community general pediatric practices as well as many of the adult institutions both in the metro area and across the state. Often from a specialty perspective, we provide some capability that they in many instances don’t have within their organization. So based on the relationships that we have and our pediatric competency, both from a specialty and acute care perspective, we do see quite a few referrals.
Gamble: And you’ve been CIO there for three or four years?
Young: It’s been just about five now. I’ve been at Children’s since 2009. I’ve been in healthcare, not necessarily hospitals, for the past 20 years. My previous role was on the PBM (pharmacy benefit management) side of healthcare. Back in late 1991, I started in a dual role of programming network support. Through my time at that organization, I had the opportunity to play roles in just about every part of IT, and then moved into management — everything from application development to data warehousing and reporting to helping mature the architecture group to infrastructure. I actually spent a bit of time on the business side as well and worked through a number of acquisitions and mergers. It was a great organization. I had a great experience, but I’d been traveling quite a bit, had small kids and was ready for a bit of a change. I received a call from Children’s and the rest is history.
The past five years have been great. I’ve learned the hospital side of healthcare. The organization has continued to mature and grow. We have a great team, both from an IT perspective and really across the organization. Overall, we’re in a pretty good place and I’m excited for the future.
Gamble: In your current role, the HIM department also falls under your purview?
Young: That is correct.
Gamble: What type of clinical application environment is in place in the hospitals? What EHR system?
Young: From a hospital perspective or an acute perspective, we’ve been in the integrated EMR space since about 1998 and are Cerner Millennium in all of our major clinical areas. Prior to that we had a number of smaller, non-integrated systems in a number of areas and made that decision to move down the integrated system path. We have also implemented GE’s PACS system and we have Sunquest for labs, but really outside of that from a clinical perspective, we’re mostly Cerner.
From an ambulatory perspective we’re a little bit different. Our hospital-based practices or specialties are running Cerner’s Ambulatory EMR product — it still runs on Millennium, but it’s got a little bit of a different look and feel. However, as we look at our general pediatric practices, we had made the decision a number of years ago to work with our community-based providers that really aren’t owned by Children’s Hospital and Clinics of Minnesota. And so we looked at both children’s and non-children’s providers to determine the most appropriate EMR system to implement throughout the general practice community in the metro area, which is Minneapolis/St. Paul and the surrounding areas. Through that process we had chosen and implemented eClinicalWorks’ EMR and exchange capabilities, which they call eEHX or hub. This was a decision really to drive better continuity of care long term across our community. So again, we’re mostly Cerner, but for general practice, we’re eClinicalWorks.
Gamble: You said both owned and non-owned practices are using eClinicalWorks?
Young: That is correct. One of the things over the past three and a half years that we’ve been able to accomplish with our community providers is really driving and creating a closer relationship and creating what we would call a clinically integrated network to allow us down the road really to focus on insuring that we can provide better continuity of care for a patient, regardless as to where they are across any of these clinics. One of the discussions that we had had a number of years ago is the fact that we may have a child that will come into one clinic and that child may get referred to another clinic or to a specialty, and given that we’re either not on the EMR system at the time or on a different system, the patient typically gets a phone number, they have to make a phone call, schedule an appointment, come to that appointment, and restate their history. And many times the same lab tests are taken and there are a number of things that very duplicative. And the same thing can happen if a patient ends up getting referred into the hospital.
So the goal of moving down this path was to create that continuity of care so at some point the physician in the general practice can actually say to our patient, ‘I need to refer you to a specialty and it looks as though they have an appointment time at 10:00 on Tuesday, would you like to take it?’ And by the way, they have access to all of your history.’So it’s about really driving that better care.
Gamble: Have the physicians been pretty willing to go onto one system? Have the physicians in the community been open to this, or have you had issues as far as getting them onto the same system?
Young: About three and a half years ago, I would say about 80 percent of the community-based practices were on an EMR system at the time, and so we had to spend some time to really talk through the benefits of migrating toward one system. But once we spent that time, for the most part the groups were willing to move down that path.
One of the things that we also had done at the time was offer through Stark laws to help through some of these implementations. Many of these groups don’t necessarily have both the IT knowledge and the overall capability to implement the system in a streamlined fashion. So we did offer to help as well, and I think that helped also. And so now we’re most of the way there. We do have a number of clinics that aren’t eClinicalWorks that weren’t on prior to this decision, and we’re moving down the path of integrating them as well.
Gamble: Are there physician leaders or leaders on the hospital side who have been pretty involved in this and pretty active as far as getting that engagement?
Young: There were, both from a physician perspective as well as an operational perspective, a number of individuals that were involved in moving down this path. One of the things that we were part of is that we worked with what we now call the Children’s Hospital Network to create a number user groups related to a number of different things like the EMR decision, and as we move toward integration, ensuring that we have the right agreements in place across the community to ensure that we can transition data as we need to in a bunch of additional areas. Through those work groups, there were representatives from the majority of clinics, and I think it made the ability to make progress much more effective. And so yes, we had a number of Children’s individuals, but the community was very active as well.
Gamble: That only makes sense that on the hospital side you can have all the enthusiasm and willingness, but you need to have it on their side as well.
Young: Absolutely. Overall, in context of how it could have been, it was a fairly smooth process.
Gamble: But one that definitely does take a lot of time.
Young: Yes, and again, this was something that we started, I’ll say three and a half years ago, but really the initial discussions started shortly after I came on board. And so a little over four years later, from a technology perspective we’re mostly integrated, and there are a number of things happening as well related to coming together and agreeing on quality measures and really driving quality of care across the community as well. So we’re off to a good start.
Gamble: Now as far as Cerner Millennium, is that something where at this point you’re just focused on optimization as far as in the acute setting?
Young: Yeah, in the acute setting I would say we’re mostly implemented. There are always going to be a number of tweaks. The one area where I would say that we’ve made more progress maybe on the ambulatory side than the inpatient side is clinician documentation. That’s something that over the next year and a half we’ll finalize on the acute care side and implement. But for the most part right now, it’s streamlining process, ensuring that our clinician experience is easy and streamlined, and ensuring that we’re focusing on quality and safety as well.
Gamble: Do you have any type of system in place for rounds or things like that or how do you best communicate with the users?
Young: So for rounding, depending upon the unit, we have some different processes, but in many of our units we have a group of individuals that round to see patients that is inclusive sometimes of a scribe, of an attending physician, and a number of other individuals that need to work with those patients, first of all to ensure that there’s consistency of communication to the patient, but also from a care perspective that the care plan is consistent and that everybody understands it for the day. In most areas, that is how we round. We utilize Cerner. We don’t have a separate necessarily system that we utilize for rounding, but the processes work fairly well.