Craig Richardville, SVP & CIO, Carolinas HealthCare System, Chapter 2

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

Chapter 2

• MyCarolinas Tracker
• Virtual visit apps & e-visits
• “We’re using technology to improve the contact we have with patients.”
• Knowledge-sharing with oncologists
• Board’s vision: “A national leader in the transformation of healthcare”
• From volume-based to value-based care — “It’s a whole different strategy.”

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By being able to consume that information and bring it in, we’re able to run decision support against it. So if somebody is not putting in their weight or their glucometer reading, we’re able to contact that person to understand what is happening with that situation and get it corrected before he or she goes down a path for an extended period of time.

If you start seeing a certain trend for areas outside of that, then the care team is able to engage much sooner than before some other crisis would happen.

The whole aspect of improving and increasing our access to patients or our patients’ access to us is done through the virtual care service. We’re also able to extend certain specialties and subspecialties to other providers in the region, so we’re able to converse and have referrals and consults back and forth electronically via a physical presence.

Shifting from the volume-based world and value-based world is a whole different strategy and a whole different level of effort. And so, by utilizing a lot of the tools that we’re utilizing today, that allows us to be able to reduce our total cost of care, increase the quality of the outcomes, and provide a highly satisfied patient experience.

Gamble:  You talked about taking information from wearables and that’s something that I find really interesting because we know the patients are entering information into Fitbit and all these things, but it’s about taking that next step and actually having that accessible to clinicians. How have you been able to do that?

Richardville:  A couple of different ways. One in particular is we do have home monitoring devices, clinical devices that have been around for years, and we do consume data from many of those devices. But what we did — and this goes back to the mobility piece — was we actually developed an app and we made it available to the consumer market late last year so that anybody could go out and grab that app. We developed with a couple of partners an app that was ubiquitous to the system.

It wasn’t like an Apple HealthKit where you had to have an Apple device in order to be able to use it. This was Apple and Android, and so we felt for us that was a big differentiator because when you look out into the patient market or even in the consumer market, both platforms are extremely popular. And when you look at some of the demographics and the usage of people who are utilizing healthcare, some population would indicate that since they’re primarily Android-based that that information would have to come through an Android device versus exclusively an Apple device. We made ours very generic and then we put that out there and tested it back out with the market.

And then earlier this year, we announced the MyCarolinas Tracker. It was called the Carolinas Tracker — what we developed was MyCarolinas Tracker, which really was the same application, but allowed you in a very safe, secure and private manner to allow that information to be interpreted or seen by your healthcare provider. And by I mean the healthcare team, so based upon the relationship you have with your provider, you are able to create that information that connects to over 70, nearly 80 apps and consumer grade devices — things that you buy on Amazon and apps you would download from the stores — and it brings all that information together under one platform. And then that information can be shared based upon your relationship with your provider, so your provider then can take a look at the information.

In some of our pilot groups, we’re looking to prescribe this app, which then allows us to be able to capture information that he or she should be doing to be compliant with the instructions that were given by the provider. And by being able to consume that information and bring it in, we’re able to run decision support against it. So if somebody is not putting in their weight, for example, or not putting in their glucometer reading, we’re then able to contact that person to understand what is happening with that situation and get it corrected before he or she goes down a path for an extended period of time, and we find ourselves in more of a crisis situation trying to react.

It’s similar to how you would monitor or share information from your car or other devices — some home appliances can phone home. These are very similar to that concept. Most of the information would likely not be actionable or not be purposeful because you’re falling within the guardrails that were established. So as long as your weight doesn’t fluctuate, your blood pressure stays within here, and your exercise routine stays within here, those things don’t have to get acted upon and you get a green light for it. But if you start seeing a certain trend for areas outside of that, then the care team is able to engage much sooner than before some other crisis would happen.

Gamble:  Okay. And then also you have other things like teleconsulting and other things being used with your rural patients, so kind of covering the whole gamut.

Richardville:  Yeah. That’s getting into what we would call a different business line, our virtual care services. With virtual care services, we’re basically utilizing the technology to improve the access or the contact that we’re having with our patients or persons by utilizing your electronic mechanism.

If I pull out my phone, I have a virtual visit app, so I can do a virtual visit that way. We are also piloting e-visits, which allows you to be able to answer evidence-based questions to help with the diagnosis. Similar to what a provider would ask you in person, you’re able to, in a non-acute way, service that up, and then within a service level agreement, we can get back with you with what we feel your diagnosis is. If that requires a more in-depth review, then we can either generate a virtual visit so we can see, talk and converse more, or we can do a referral to an urgent care center or emergency department, or schedule an appointment for you with the primary care physician or primary care provider.

So the whole aspect of improving and increasing our access to our patients or our patients having access to us, that’s done through the virtual care service. We’re also able to extend certain specialties and subspecialties to other areas or other providers in the region, so we’re able to converse and have referrals back and forth and have consults back and forth electronically via a physical presence.

We do the same thing in other services. We even have this now for translator services, which allows patients via iPad to have a translator, so if somebody is a non-English-speaking person, as opposed to having a translator present — and dealing with the cost and the time that it takes to have somebody there — we’re able to do that via a service. It’s an iPad based on an IV pole, and it allows you to have the interpreter there virtually, so you save a lot of time.

We also do a very similar type of approach in other aspects. In our Levine Cancer Institute, we actually spread our oncologists’ knowledge out to other areas of the states where the patient can, in many cases, stay very local to their care. We’ll have the oncologist speak back and forth with the local oncologists, and also in some cases, with the patient as well. It avoids the travel time, the stress of having to travel, and the cost, as well as allowing other loved ones to be with you. Being back at home in a very safe local comfortable environment is also part of the healing process.

Gamble:  Right. It seems like your organization is adopting what patient-centered care is really supposed to be about and taking these different steps and measures to make that a reality, which is something where people have been saying the industry needs to go.

Richardville:  Yeah, it’s part of our vision, given who we are and the outcomes we’re able to produce. When you look at the triple aim and how well we progressed against that, our board changed the vision several years ago to be a national leader in the transformation of healthcare. And so with that, we’ve taken the stance that we are going to take this, spread it, and also not only use it within the services that we have for quality and value that we provide ourselves, but also to help transform the industry and have others across the country continue to see, observe, and hopefully take heed to what we’re doing and be able to continue this progression of healthcare and be advancing as this transformation continues for us.

The whole aspect of shifting from the volume-based world and value-based world is a whole different strategy and a whole different level of effort. And so, by utilizing a lot of the tools that we’re utilizing today, that will allow us to be able to reduce our total cost of care, be able to increase the quality of the outcomes, and provide an extremely satisfied, highly satisfied patient experience. Those are the three legs of a stool to the triple aim and so we feel very strong in being not only in the position that we are, but also in our ability to execute against that vision and be able to impact the families and lives what we’re privileged to serve.

Chapter 3