Craig Richardville, SVP & CIO, Carolinas HealthCare System, Chapter 1

What’s the key to retaining top talent in an industry where it is at a premium? Challenge them, says Craig Richardville, who believes the brightest stars should have the loftiest goals. And there’s perhaps none loftier than his organization’s mission to usher the industry into the era of transformative, patient-centered care. In this interview, Richardville talks about why interoperability is “always a work in progress,” why he has no plans to move to a single-vendor platform, and how his team is applying the same principles used in the financial and retail worlds to revolutionize patient engagement. He also discusses what the CIO of the Year award meant to his team, his vision of healthcare in the future, and the question leaders should ask before embarking on any initiative.

Chapter 1

• About CHS
• Multiple-vendor platform with Epic, Cerner & McKesson
• “The future is interoperability and being able to share data.”
• EDW, HIE & patient engagement
• Using patient-generated data to create a “unified, holistic view”
• Learning from Mint.com — “We’re going to you.”

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Bold Statements

Unless there is a strong financial or clinical reason to unify, the future of healthcare really is collaboration by developing clinically integrative networks and being able to truly let the patient determine a lot of their course of action.

The information that we’re building in our warehouse is truly not necessarily for our patient, because that would be only for those that are seeking care; instead, it is more person-centered.

What we’re looking at as part of our vision is that as a patient, I’ll be able to see all my health information together even though it may have been consumed or created at multiple healthcare institutions.

Just as with all of your financial transactions, many of which can be made with your phone today versus physically entering them — we’re doing the same thing with healthcare in putting all this information on a mobile platform so that we are actually coming to you.

Richardville:  We’re a multiple hospital healthcare system based out of Charlotte, North Carolina. We have about 40 hospitals that are part of the CHS family and several thousand employee providers as part of it, a little over 1,100 physical locations, and we do about nearly 12 million encounters a year.

Gamble:  Are you primarily in North Carolina?

Richardville:  We’re in North Carolina, South Carolina, and slowly starting to move into the contingent states around the Carolinas.

Gamble:  And you’ve been with the organization since 1997?

Richardville:  Yes, I’ve been here for 19 years. A long time.

Gamble:  How long have you been in the CIO role?

Richardville:  For nine years.

Gamble:  Okay. And the organization just got a new CEO?

Richardville:  Yes, we hired a new CEO. His name is Gene Woods, and he plans on coming in toward the end of the second quarter, in terms of moving forward.

Gamble:  And have you had a chance to speak with him?

Richardville:  We’ve had some very light conversations. He seems to be an extremely bright, intelligent, competitive person, focused on building relationships, and very collaborative. I think it’s going to be a very nice transition as we look to what the future of healthcare is.

Gamble:  So in terms of the EHR environment, starting on the hospital side, are you on one provider at this point? How is that structured?

Richardville:  Within our total enterprise, we have Cerner in some of our system, I have Epic in other parts of our system, I have McKesson, and I have one facility that actually has CPSI. Primarily we have Cerner, Epic and McKesson.

Gamble:  So the big question is, do you intend to be on one at some point, or is that not necessarily going to best serve the organization?

Richardville:  Well, as it sits today, interoperability is one of the core aspects of the future of healthcare, and with that comes our opportunity as a healthcare system to be able to continue to advance interoperability within our system, and spread that more easily within our communities. So unless there is a strong financial or clinical reason to unify, the future of healthcare really is collaboration by developing clinically integrative networks and being able to truly let the patient determine a lot of their course of action. And with that, he or she will likely move into different aspects of care. And so for us to be on a single system is really misleading, unless there is, again, some financial or clinical reason why to do so. Because the reality is, people are going to get their services from multiple different providers, not necessarily always one that is your provider. So there’s no burning platform to be single because the future is interoperability and allowing us to be able to share information among different providers.

Gamble:  Right. And how are you able to do that with so many hospitals and locations?

Richardville:  It’s always a work in progress, but we have a couple of strategies to improve that. One is our enterprise data warehouse. It’s a robust repository of information for both clinical and nonclinical information, so we bring in information from healthcare systems that are part of CHS and healthcare providers that are not part of CHS. We also look at different socioeconomic data and we consume that to be part of our system, including financial information from Experian, for example. We bring all of that into our portfolio.

We also recently have added patient-generated data, which I think is extremely important, and truly a differentiator today. Information that is generated by the patient — whether he or she is at home or at work or in certain travels, if he or she is generating that information, we bring that in as well. So the information that we’re building in our warehouse is truly not necessarily for our patient, because that would be only for those that are seeking care; instead, it is more person-centered. It brings in information — clinical, nonclinical, and information generated from the patient — that gives us a better view of who that patient is or that person is, and allows us to be able to have effective interaction with that person based upon his or her history or preferences, and other aspects of the life, not just healthcare.

We also have a health information exchange. We’ve connected it to other health information exchanges as well as hundreds of different providers and independent providers in the communities that we serve, where we are able to share information back and forth. This is not necessarily discrete data elements as it exists today, but it is more of the sharing of the CCDAs — the continuity of care documents that have been put together by the CMS. We utilize those to be able to share information back and forth.

In one aspect, it truly is automating manual services or fax services. It used to be that people would fax health records back and forth in between providers in a very untimely and less controlled manner. This allows us to be able to quickly and easily have access to somebody’s medical record outside of our healthcare system. So that’s another component.

Thirdly is our patient engagement piece, so the patient engagement piece that we have actually consumes data from multiple different information systems, and presents it in a very clean, unified way to our patients. We pull information out of McKesson, we pull information out of GE, we pull information out of Cerner, and we pull information out of the GetWellNetwork and out of Epic, and we’re able to present that information to the patients in a very unified, holistic way.

Gamble:  So it’s definitely a work in progress, as you said. And always evolving, I’m guessing?

Richardville:  Yes, a work in progress and always evolving. And I think it’s going to be very similar to what we’ve experienced in other aspects of our life, whether it’s retail or financial services. And you can make an analogy with financial services and all the things that they have been able to do to take your investments from different investment institutions and financial institutions, and bring that information together. If you look at Mint.com or some other tool somewhere that many banks offer, you’re able to see your investments altogether, even though they’re invested in different institutions. What we’re looking at as part of our vision is that as a patient, I’ll be able to see all my health information together even though it may have been consumed or created at multiple healthcare institutions.

It’s a very similar concept. And also, as we continue to progress and the expectations of not only new persons coming in to our environment but many others, is the whole mobility piece, and that ties into virtual care as well. And so, just as with all of your financial transactions, many of which can be made with your phone today versus physically entering them — we’re doing the same thing with healthcare in putting all this information on a mobile platform so that we are actually coming to you and you don’t have to come to us. As opposed to us being a destination center, similar to what you have seen with banks and branches in the past or even ATM machines, where you’d have to go to those places, in this case, we’re going to you. You don’t necessarily need to come to our physical plant all the time; we will bring the intellectual capital we have, and bring that to you via the phone or some other mobile or electronic device.

Chapter 2