Stepping in as the new CIO is never easy, particularly if you’re filling the shoes of a longtime leader who ushered the organization into the digital era. So when Jim Venturella took the helm at WVU Medicine, he knew he had a fine line to walk. He wanted to be patient enough not to push for any changes without first understanding the processes, while still pushing his team to do their best. In this interview, Venturella talks about what it was like to take over for Rich King, why he welcomed the opportunity to lead a system-wide transformation, and the role that having an integrated EHR can have in uniting an organization. He also discusses his roadmap for the Epic changes at WVU Medicine, what he believes are the biggest challenges for today’s CIOs, and why he still “operates as a consultant.”
- Data warehouse — “There are a lot of capabilities we haven’t fully utilized.”
- Self-service with advanced analytics
- Prioritization — “Everyone’s always balancing.”
- “Huge opportunity” for telemedicine
- Epic Care Everywhere vs state HIE — “It’s materially different on what’s being exchanged.”
- Being “the lead person” at WVU
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We’re in the early stage of defining our full strategy of what we want to do around analytics and getting people to start to utilize some of the new tools that are available to them. There’s a lot of capabilities that we have that we haven’t fully utilized, so the plan is to work with the different operational units to help enable them with what we already have.
Like everyone else, we do lots of reporting and we have lots of dashboards and we present information, but we really haven’t done a whole lot at this point from a more advanced analytics standpoint.
There is a huge opportunity for telemedicine. There are some other barriers around some of the other infrastructure and population that we need to overcome, but I think those are coming down rather quickly. The consumer movement is changing some of those things.
As we move more into the ACO model, and with all our payers take on more of the risk, I think everyone in our organization understands that we may have to spend money on things that we’re not necessarily getting directly reimbursed for, but are going to have another financial benefit from a bigger picture standpoint.
From a cultural standpoint it appeared to be a great fit, and fortunately it’s been probably even better than I thought. It’s been a really wonderful experience.
Gamble: You mentioned analytics. What are some things you’re doing now in that area?
Venturella: We just brought up Epic’s data warehouse a month ago. That’s an area where we’re in the early stage of defining our full strategy of what we want to do around analytics and getting people to start to utilize some of the new tools that are available to them. There’s a lot of capabilities that we have that we haven’t fully utilized, so the plan is to work with the different operational units to help enable them with what we already have. And in parallel, we’re doing some evaluation of some other third parties to say do we have some gaps that we need to plug in, or in the short term do we have enough capability already with what we already own?
Gamble: So this is still pretty new in the game as far as having that particular data warehouse, but I imagine once more of these things are figured out, it will be a matter of the users being able to play around with it more and see what they can do?
Venturella: Exactly, yes. Self-service is a big part of that strategy in figuring out the right model to enable them to do more and not have to do everything through our group, as well as more of the advanced analytics. Like everyone else, we do lots of reporting and we have lots of dashboards and we present information, but we really haven’t done a whole lot at this point from a more advanced analytics standpoint where a lot of other industries are going, and where a lot of people in health care are at least talking about going.
Gamble: Right, a lot of it is setting the stage for that.
Venturella: Yes, exactly.
Gamble: So as far as bringing up the Epic data warehouse, that was just part of the whole strategy that started back in the summer as far as getting everyone on the same system?
Venturella: Yes, that was somewhat being run in parallel to the overall strategy. One of the things we’re looking at in the interim is how much integration we want to do the warehouse to the legacy system, versus waiting to bring them on in the next two years when Epic gets rolled out to them. At our quality retreat, we had some of those discussions yesterday on the cost-benefit of combining some that data early versus waiting. Those are some decisions we still need to make.
Gamble: So definitely it seems like the world doesn’t stop and you can’t be in a holding pattern, but there are some things where you may be making a different decision two years from now, so I imagine there are some challenges there.
Venturella: Absolutely. Everyone’s always balancing. I think all my peers are probably in that same boat, maybe different situations, but it’s always a balance.
Gamble: You mentioned practice plans before. Are the physician practices that are owned by the system on Epic at this point or how is that laid out right now?
Venturella: The majority of physicians are on Epic. We do have about 60 doctors that are affiliated with one of the hospitals that aren’t on Epic yet that we still need to move over to Epic, but all of the rest are at this point. We’re working on the rollout for them; they’ll most likely come live at some point next year, ahead of when the hospital converts over to Epic.
Gamble: With that rollout, is there a certain steering group set up or something along those lines just as far as handling all the unique concerns that physician practices have with switching over?
Venturella: The overall steering committee we have formed across the health system will oversee that as well. And we do have different workgroups from a departmental standpoint or specialty standpoint, so they look at more of the detail and the content in that as we’re looking at the high-level plans, it’s a smaller group across the system that’s looking at that.
Gamble: You’ve talked about a lot of the things on your plate. Is there anything else that you’re looking at or you have on the back burner just as far as your big priorities?
Venturella: I mentioned telehealth. We do a number of different activities in that space and we as an organization are trying figure out how much and how far we want to go with that. So there is some more activity right now, at least at the strategy level, and I know there will be a number of things that come out of that from our team that are going to be needed, in addition to what we already do today.
Gamble: Is there a pretty high number of patients who are remotely located?
Venturella: There’s a lot. The state of West Virginia only has about 1.8 million people in the state, but they are spread all over. There are a half-dozen larger population areas but then most everyone else is spread in the smaller areas, and you have a lot of geography barriers that makes things difficult to get from one place to another within the state.
So there is a huge opportunity for telemedicine. There are some other barriers around some of the other infrastructure and population that we need to overcome, but I think those are coming down rather quickly. The consumer movement is changing some of those things that even five years ago seemed to be bigger barriers but really aren’t as much today.
Gamble: Right. You always have to deal with reimbursement and the value questions, but being in an area where you are, I feel like it’s a little bit of a different conversation than somebody who’s not even in a city but in a more populated area?
Venturella: It definitely is, and as we look at that question, there’s obviously the direct reimbursement that you have to figure out because it’s not quite where everybody wants it from a payer standpoint. But as we move more into the ACO model, and with all our payers take on more of the risk, I think everyone in our organization understands that we may have to spend money on things that we’re not necessarily getting directly reimbursed for, but are going to have another financial benefit from a bigger picture standpoint. And I think telemedicine fits into that category of understanding where we want to spend the money and invest the dollars. It may not get that direct benefit when we spend it, but we’ll get the longer-term benefit — the patient will get the benefit, and we’ll get the benefit overall as well.
Gamble: With all the hospitals and practices, I know it’s a pretty good chunk of the state that WVU Medicine covers, but as far as other health systems, what kind of data exchanges are you doing?
Venturella: The state itself has an HIE set up that we’ve been a member of for several years now. I don’t know the exact number of hospitals within the state that are connected, but a fair number of them are connected. So we are exchanging data with those hospitals, and we’ve also got a significant exchange of data with other Epic clients through the Care Everywhere platform.
Gamble: It was interesting, some of the findings that came out in the KLAS report talked about EHR’s private HIEs really being the better value proposition. I don’t think it was that surprising for a lot of people to see that?
Venturella: No, it wasn’t. If you look at our numbers, I think this year through the state HIE, we’ll probably send and receive about 8,000 documents back and forth, and our direct Epic to Epic exchange is way over 300,000. It’s materially different on what’s being exchanged back and forth between Epic to Epic and Epic to everything else through the West Virginia HIE.
Gamble: That’s a pretty big difference.
Venturella: Yeah. When we first got the reports, I was kind of shocked and had to ask my team if the data was right for some of them, but it is. Now, some of those we got when we were in close proximity to another health system that has Epic where some automatic queries were set up, and so the numbers are a lot higher. And they’re not all individual doctors making a one-off query, but it’s for patients of ours, so you know there’s a direct need to potentially have the data.
Gamble: And the latest version of Epic is something you’re looking into for 2017?
Venturella: Yes. We just upgraded this spring and the code that was just released in the June/July timeframe is what will be the basis for the enterprise rollout.
Gamble: Okay. You mentioned before about what you were walking into when you came to the organization, and that’s interesting to me. You said it was a big draw for you as far as making that leap?
Venturella: It was definitely part of it. It was an opportunity for me to be the lead person to help the organization through this transformation as they were coming together, and there were a lot of interesting projects out there. From a cultural standpoint it appeared to be a great fit, and fortunately it’s been probably even better than I thought. It’s been a really wonderful experience. And then there were some key leadership changes that were being made, and so there are actually some people that I used to work with in my past that are here, and that helped influenced my decision as well to come down there.
Gamble: From UPMC?
Gamble: Okay. Yeah, that’s always a nice thing to be able to work with people you really enjoyed working with.
Venturella: Yeah, it’s been really nice.
Gamble: Did you have reservations about taking on this transformation? Even though it’s exciting, I’m sure that maybe there was a little bit of hesitation, or just a lot of thinking about how to approach it?
Venturella: Well, actually I didn’t have a whole lot of reservations from that standpoint. I did think that they were further along on the integration path than they actually were, and that may have been just my read through the process of interviewing. But once I got there, I realized there was more work to do — not just in the IT area, but in all areas from an integration standpoint. But it’s been moving really quickly, as I said earlier. Just the last eight months, seeing where the organization was then in large to where they are now is materially different. It’s been exciting to be a part of that.