When you go from a large, integrated health system in the northeast to a Florida-based organization focused on hospice, palliative care, and home health, there are going to be some glaring differences. But for Sheryl Sypek, who took on the CIO role at Chapters Health System three years ago, the biggest contrast she saw was in the EHR market, which is “far less mature” than in the acute care hospital world.
As one can imagine, it made for a much different vendor selection process. But it also resulted in both an education, and a bonding experience, for her team. Recently, we spoke with Sypek about how she learned to navigate the brave new world of palliative and hospice care, why she made the move, and how she and her team plan to continue to forge a new path in this growing sector. Sypek also talks about how her time in consulting made her “a better CIO,” why Chapters is uniquely positioned to thrive in a value-based care world, and why giving back is so important.
- About Chapters: large system providing a range of services in the non-acute, non-physician practice setting
- “It’s like running a community hospital that’s divided into eight pieces.”
- In-house pharmacy services
- Three service lines, three “very siloed” EHRs
- “It’s challenging to be able to interface outside of our organization.”
- The immature non-acute EHR market
- Reimagining the vendor selection process – “We really did our due diligence.”
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It’s that whole care navigation piece — that’s what we do. We’ve called it post-acute for a long time; but now it’s about navigating a patient’s care when they want to stay in their home.
We often get referrals from hospitals where the patient is days or even hours from passing. We would prefer to provide that benefit much further upstream for a patient.
In the integrated world where you have Epic, Meditech, and Cerner, these areas are often afterthoughts. It’s not that they didn’t offer these applications, but it certainly wasn’t where they were putting their research and development dollars.
As a vendor, you have the opportunity to go in and do the dog and pony show, and they end up picking the one with the shiniest objects, because that’s the best they can do. They’re small, and they don’t have dedicated resources.
Gamble: Hi Sheryl, thank you so much for taking some time to speak with us. Let’s start with some information about Chapters Health System — the type of care you provide, where you’re located, things like that.
Sypek: Sure. We’re located in the Tampa Bay area in sunny Florida. We provide care in eight counties currently, and we have a range of services across our continuum in the non-acute, non-physician practice setting. We do home health, both private duty and Medicare-certified care. We provide palliative care through consults in hospitals and nursing homes, and we have clinic-based palliative care in the community.
The largest portion of our care is hospice, although that’s starting to shift. But right now, we do hospice in seven counties with three affiliates. Across those counties, we have seven freestanding care centers, and one that’s hospital-based. That adds up to about 156 beds across seven counties. It’s a bit like running a community hospital that’s chopped up into eight pieces.
We also have our own pharmacy. Currently, we provide all of our own pharmacy services — or at least the majority of our pharmacy services — to our hospice service line. To put that in perspective, we fill about 170,000 prescriptions annually in our pharmacy.
Gamble: I imagine it makes a difference having a pharmacy that’s owned by the system.
Sypek: It does. It gives us some control over cost and quality in terms of how we manage the pharmacy services that are provided to our hospice patients.
Gamble: Right. And you said the largest portion of care provided is in hospice, but that was shifting. What did you mean?
Sypek: Hospice has always been the driver in our organization, but we’re really trying hard through growth — both organic and by acquisitions — to be able to provide better solutions for our patients further upstream in the care continuum.
And they’re all very complementary. Many of our hospice patients can benefit from private duty care services. And of course, many home health patients start out managing some post-acute episodes, then perhaps move into our palliative care group. They may stay there for some period of time while we help them to manage a chronic illness, or they may move quickly into hospice. It’s that whole care navigation piece — that’s what we do. We’ve called it post-acute for a long time; but now it’s about navigating a patient’s care when they want to stay in their home.
Gamble: I think that’s important to point out, because the term ‘post-acute care’ doesn’t give the full picture.
Sypek: Right. And actually, it implies that there was an acute episode at some point in time. I can tell you from personal experience that it isn’t always the case. My father is one of our hospice programs. Since he was diagnosed with cancer more than a year ago, he has never had a hospital episode. He’s had outpatient surgery. He’s been in outpatient cancer treatment centers. He’s been to a palliative care clinic, but he has never once had an acute episode, and that’s what we’re trying to accomplish. Most people would much prefer to stay in their homes.
Gamble: Absolutely. And I’m sorry to hear about your father; I’m sure it’s been difficult.
Sypek: It is, but he’s an amazing person. It wouldn’t shock me if he graduated from hospice at some point.
Gamble: That’s great. Now, in terms of your patients, do most of them come through referrals? How does that work?
Sypek: We do get referrals from physicians — we wish we got more. It continues to be a hard conversation for most physicians to have, because that’s not how they’re trained. They’re trained to cure. But we do get referrals from there.
We also get referrals from hospitals. Unfortunately, those tend to happen late in the game. Hospice tends to have a frame drawn around it as a six-month benefit. It doesn’t mean we can’t provide services longer, but we often get referrals from hospitals where the patient is days or even hours from passing. We would prefer to provide that benefit much further upstream for a patient — when you get referrals from home health or palliative care, that’s definitely what is happening.
Gamble: In terms of the clinical application environment, what do you have in place as far as the EHR solution?
Sypek: I’ve been with Chapters for about three years. Right now, we have three very siloed electronic medical records for each service line that we provide. That, as you can imagine, is challenging in it of itself. Given the solutions that we have, it’s quite challenging also be able to interface outside of our organization. We have yet another system for our pharmacy because it functions as both an outpatient pharmacy filling prescriptions for our hospice patients, and an inpatient pharmacy. And of course, there are all the bolt-ons that go with those EMRs.
After spending the majority of my career with integrated health systems in New England, this was my first foray into the home health, palliative care, hospice world. The solutions are quite different for these areas, and much less mature than what I was used to.
Gamble: Sure. And I’m sure the fact that it is an immature market is an added challenge.
Sypek: It is. In the integrated world where you have Epic, Meditech, and Cerner, these areas are often afterthoughts. It’s not that they didn’t offer these applications, but it certainly wasn’t where they were putting their research and development dollars. It certainly wasn’t being driven by anything like Meaningful Use or anything like that.
We are starting to see some stronger players in this space, with the recognition that care is going to be driven into the home. There’s just no way that our health system as it stands now will have the capacity to handle the volume of patients that are going to have to be cared for. And in fact, the generations coming up are going to want to be in their home.
Gamble: Right. So where do you stand in terms of selecting an EHR?
Sypek: So, a good portion of the year was spent in a fairly traditional vendor selection process — quite different from what Chapters had ever gone through in the past as it relates to EMRs. It was also, as we learned throughout the process, quite different from what the vendors had experienced, because hospice or home health agencies usually are relatively small organizations. As a vendor, you have the opportunity to go in and do the dog and pony show, and they end up picking the one with the shiniest objects, because that’s the best they can do. They’re small, and they don’t have dedicated resources.
We were fortunate. Because of our size, we were able to apply resources to the project and engage everyone from our executive team through the staff level to participate. We really did our due diligence and came together as a team on this, and it was fun for me after so many years of doing this to see some enthusiasm build, and to see engagement from people who hadn’t participated in a process quite like this before. So it was really quite enjoyable; and ultimately we found a solution that I think is really going to make a difference for us going forward.
Gamble: What solution did you end up choosing?
Sypek: It’s funny because with healthcare software vendors, the one you think you’re selecting changes by the end of the selection process. The vendor we had selected, or were working toward contracting with, was a company called Consolo. Right at the end of the year, Consolo was acquired by WellSky.
Like some other vendors in the space, WellSky is putting together solutions that will work across the continuum of care in this home care space. For us, the decision to acquire Consolo solidified our decision to select them, because we felt that they were the leading vendor in the space.
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