Rick Skinner, Chief Information and Technology Officer, UVA Health System, Chapter 3

When Rick Skinner took on the role of CIO at UVA Health System last year, he came with a specific goal: to accelerate the academic medical center’s use of analytics. But for Skinner, who had spent four years at Cancer Care Ontario, it was also an opportunity to “return to the front line” in supporting IT. In this interview, he talks about what it was like to go from a single-payer, government-sponsored system in Canada to an academic organization in Virginia, his team’s goals in starting an ACO, and his experience with an integrated record system in the Army 20 years ago. Skinner also discusses UVA Health’s support model with Epic, his patient portal strategy, and his thoughts on population health management.

Chapter 1

Chapter 2

Chapter 3

• Title of chief information and technology officer
• Canada’s single-payer, government-sponsored system
• Standardized performance measures
• Oahu’s integrated record system — “A vision of how it could be.”
• Managed care in the 90s
• Population health lessons from GB & Singapore
• Returning to the front lines

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Bold Statements

We can’t make all these things work together so let’s just pick a platform and we’ll all be on that platform and that way we can achieve the standardization that we’re interested in.

It was all one record, all one set of documentation, all electronic. That gave me the perspective and the vision for this is how it ought to work in the future. Now, it’s been a long time coming in the rest of healthcare, but we’re getting there.

We’re starting to learn that there are other practices in other parts of the world that might be useful here.

I wanted to return to a place where my discipline, information and technology, could really make a difference in the frontline provision of health care.

Gamble:  Another thing I wanted to talk about was your role of chief information and technology officer and what exactly that title entails, whether that’s actually a dual role or if that just sums up your role.

Skinner:  I don’t know who created the title, but it actually is not a bad title because it emphasizes both the information and the technology management aspects of my role. The reason why that’s germane; my accountabilities include IT, project management office, systems engineering, clinical engineering, so all the medical technology in the institution, and health information management or medical records. So in essence, I’m accountable for all the information and all the technology, regardless of which flavor of each you’re talking about.

Gamble:  Okay. Now, you had mentioned before that you were in Canada, and that was at Cancer Center Ontario, correct?

Skinner:  Yes, Cancer Care Ontario. As you probably know in Canada the health system is organized on a provincial basis. It’s a single payer province-sponsored or government-sponsored health system. In Ontario, the responsibility or accountability for managing chronic disease — in particular, cancer, chronic kidney disease and others — rests with this agency of the provincial government. You can think of it as a specialty insurance company or a specialty ACO in that this agency was responsible for paying for chronic disease services — paying hospitals and other physicians and so forth.

But more importantly, and different from a traditional insurance function in the United States, it was responsible for setting all the performance standards for the provision of those services. So whether it was the percentage of time a surgeon should leave clear margins after a prostatectomy to radiation intensity for radiation oncology, there’s a whole host of performance measures that this agency established and monitored over a province of 13 million with 160 hospitals and 20,000 physicians.

Gamble:  I imagine it was an interesting transition then going back to the US health system. What are thoughts on some of the differences in things like data ownership in your experience?

Skinner:  Actually, the difference is striking, not just in the payment model but in the technology approach. My take on the evolving US healthcare organization model is, in essence, we can’t make all these things work together so let’s just pick a platform and we’ll all be on that platform and that way we can achieve the standardization that we’re interested in. The Canadian model, or at least in Ontario, was you can be on whatever platform you want — hospital, doctor, etc., but because we’re paying you, you are accountable for reporting in a particular format a certain set of performance measures.

And so, we were able to centrally, for that province, run a cancer screening program that knew every resident in the province; knew whether they had had an FOBT test or a colonoscopy and whether that was positive or negative; knew who their doctor was and whether their doctor had followed up on that test and so on and so forth — not because we had a standard set of laboratory or pathology systems, but rather we had engineered a standard way to collect information from all of them.

Gamble:  That’s really interesting. I can imagine some of the benefits that we could have if we had a similar system here, but I guess there are a lot of factors that come into play.

Skinner:  Yeah. I wouldn’t dare wade into which system is better. It all depends upon where you sit.

Gamble:  Absolutely. So I noticed from your LinkedIn page that you’ve had varied experience in healthcare, spending some time in consulting, and as CIO at Providence Health, which is a very large organization, and also had time in the Army. It’s interesting to me to learn about how people came to the CIO position, and how some of these experiences helped to shape that role for you. I just wanted to talk a little bit about those past experiences and how you benefit from them in your role today.

Skinner:  I’m not sure I could point to all the influences and how they’ve come together but a couple of thoughts. During the latter stages of my career in the Army, when I was finished with running around in the jungle and that kind of stuff, it’s how I got into health care IT through the Department of Defense’s electronic medical record system, which used to be called CHCS. Implementing that and then subsequently being the CIO for a region that used that particular system in its hospitals gave me the vision for how it could be.

Even 20 years ago on the island of Oahu, you could go to your primary doctor on a Marine Corps base on the east side of the island, go to an Army hospital in the center of the island in the afternoon, and go to an Air Force facility in the southern part of the island to pick up your prescriptions later that afternoon, and it was all one record, all one set of documentation, all electronic. That gave me the perspective and the vision for this is how it ought to work in the future. Now, it’s been a long time coming in the rest of healthcare, but we’re getting there.

And a couple of other thoughts is with Providence, I experienced first the wave of managed care on the West Coast in the nineties, which is very similar to what we’re starting to experience with ACOs — hopefully ACOs will go a bit better. And secondly, the coming together of a health system, which is going on all over the country as health systems consolidate, and as they consolidate, trying to figure out who does what, how do governance work and those kinds of issues.  I went through that with Providence.

Then at First Consulting Group, I had an interesting job running the outsourcing business for First Consulting, which was my introduction to the use of offshore resources. We had people in Vietnam and India, and being able to use those resources of very smart and passionate people to help our clients in the US was a learning experience.

I’ve talked a bit about my time in Canada, which was also formative in that in a lot of ways, the single payer or jurisdictional health systems that exist in almost the rest of the world outside of the United States, we’re starting to move down that path now — whether we’ll ever get all the way down there, who knows. But a lot of the population-health type of thinking that we’re now experiencing in the US grew out of things that the National Health Service in Great Britain does, along with Singapore and Australia. We’re starting to learn that there are other practices in other parts of the world that might be useful here.

Gamble:  That’s really interesting. You have all these different experiences and you gain things along the way. Now, you had mentioned that one of the reasons that you came to UVA was for work in analytics and you’ve been there about a year or so?

Skinner:  About a year and a half.

Gamble:  A year and a half. Was it a good transition as far as moving to Virginia?

Skinner:  The winters are certainly a lot better than in Toronto, I have to say that, even though I’m a big skier. For one, the community here is lovely. It’s a great place to live. Secondly, my goal in coming to the University of Virginia Health System was to return to the frontline of information and technology support in health care. Just this morning, I’ve been up in the OR for a while, in a clinic for a while, and in a senior executive meeting. I wanted to return to a place where my discipline, information and technology, could really make a difference in the frontline provision of health care. I don’t know if I’ve made a difference or not, but certainly there’s the opportunity here to do that.

Gamble:  Alright, well, I know we’ve touched on a lot of the things you’re working on. I don’t know if there was anything else you wanted to add, but I definitely would like to check back with you down the road and talk about the analytics and everything that you have going on.

Skinner:  Sure, that would be great. Hopefully, I’ll have some updates for you.

Gamble:  Thank you so much for taking the time to speak with me. I really appreciate it. It sounds like you have a lot of interesting things going on down there.

Skinner:  It’s a great place to work, and there’s certainly no end of good opportunities.

Gamble:  All right. Thank you so much, and I hope to speak with you again.

Skinner:  Okay, sounds good. Thank you.