In today’s healthcare landscape, it’s rare that organizations are presented with a no-brainer (or, as close to that concept as is realistically possible). UConn Health, however, has come awfully close with an initiative to dramatically expand Covid-19 testing throughout the state. Along with several other Connecticut-based providers, UConn Health is working with Jackson Laboratory to facilitate the process. But rather than simply participate, the organization is acting as a hub for the 20,000 or so tests that come through each day, capitalizing on its exclusive interface with Jackson Labs.
Of course, it wasn’t going to be easy; there were legal and compliance issues that needed to be addressed, as well as the added volume placed on the EHR, said Chuck Podesta in a recent interview. Fortunately, those proved surmountable, thanks largely to UConn’s partnership with Epic, and the overwhelming desire of all parties involved to help make an impact.
- Connecticut’s plan to “test everybody”
- Interface engine with Jackson Laboratories
- UConn Health’s Epic as a “hub”
- “If you’re doing testing and collecting, it has to go through us.”
- 20K tests per day, starting with first responders
- Avoiding multiple MyChart accounts – “It didn’t make sense.”
- Working w/ other EHR vendors (DocuTAP, Meditech)
- “It’s very powerful and it’s very simple.”
- Incremental expansion plans – “It will open up to others over the summer.”
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For everybody else who uses them, it’s a manual process. They send the requisition, and they get the tests back. We probably use them more than anyone in the state — that’s why we automated.
We started talking to Epic and they were intrigued by it. They thought it was a cool model that could potentially be used in other parts of the country.
The last thing we want to do is set up a MyChart account for someone who already has one, because then they’d have accounts with UConn and Hartford. I know there are ways within Epic that you can look both of those, but it didn’t make sense.
If a test is being sent to Jackson Labs for someone in the state of Connecticut, it’s coming through UConn Health in some way, shape, or form.
Gamble: Have you been working remotely, in Connecticut?
Podesta: For the most part, yes. I’ll go to my office maybe one day of week and walk around. We still have some people onsite — including desktop engineers — and I like to say hello to them. And we’re masked up; you get your temperature taken on the way in. We’re doing thermal imaging now. It’s like Fort Knox just to walk in the door; just to get in the office.
Gamble: I know you have a lot going on, but I’d really like to talk about what you guys are doing with Covid-19 testing.
Podesta: It’s very cool. The genesis of it was that we use Quest and LabCorp for regular testing, like many organizations, but we also have a private company called Jackson Laboratories, which is based in Maine. They have employees in Maine, California, and Connecticut. We have a close relationship with them; they’re actually on our campus. And so we have an orders and results interface to them, just as you would to Quest or LabCorp.
Our orders come through Epic and the results go back into Epic for testing; what we didn’t realize at the time was that we were the only ones that had that interface with Jackson Labs. For everybody else who uses them, it’s a manual process. They send the requisition, and they get the tests back. We probably use them more than anyone in the state — that’s why we automated versus going with a manual process.
And so, when the state announced its reopening plan, it was to start testing everybody: first responders, people in nursing homes, front-line healthcare workers, and even department of correction employees. That becomes a daunting task. So an RFP was put out to all the labs in the state.
When Jackson Labs responded, they asked us if we could respond with them; what they were proposing, and what we were proposing, was to use our Epic instance as a front end to any of the testing, because we had that interface to Jackson Labs. There are other health systems in the state (Hartford Healthcare and Yale, for example), but they didn’t have that interface to Jackson. We started talking to Epic and they were intrigued by it. They thought it was a cool model that could potentially be used in other parts of the country.
And so Epic jumped in and put together a project team with us. They didn’t charge us anything, which was great, and the state accepted Jackson’s proposal. Of course, we’re not the only ones doing statewide testing, but we’ll be doing a lot of it. The goal is to get to 40,000 or 50,000 tests per day by July, and Jackson’s portion of that is going to be 20,000 per day. It’s a big chunk of the statewide testing, and our UConn Epic will be front and center.
Gamble: Can you talk a little more about the relationship with Epic?
Podesta: Sure. It’s a public-private partnership, which is great because UConn Health is a public institution owned by the state. When Epic was implemented here, it was a $100-million project, and it was paid for by the state basically. From a public relations standpoint, it’s a very good thing because the investment they put into Epic is now being returned to the state as part of testing its citizens.
Gamble: Right. And you said the goal is 40,000 tests per day by July?
Podesta: Yes, 40,000 to 50,000 a day, with Jackson’s portion being 20,000 a day. Other parts of the state will be doing testing as well. Yale-New Haven is doing testing, as well as another private lab, and UConn Health is even setting up to do about 1,000 per day. We’re all chipping in, but Jackson is the big player in this.
Gamble: How is it set up? Are tests done incrementally?
Podesta: We started with first responders; there are 13,000 of them across the state. We’re actually working with the National Guard on that because they did all the surge staffing with the hospitals. The state tapped them to work with us to get it off the ground and set up testing stations for first responders.
But using the National Guard isn’t sustainable over time. And so there was a transition period in which various hospitals tested first responders in their geographic area. It doesn’t matter where you’re located; if you’re using Jackson Labs and you’re part of the 20,000 tests per day, you have to go through UConn Health. Even if they’re doing collecting and testing in other parts of Connecticut, if it’s being done through Jackson Labs, it has to go through UConn Health.
And there are two ways that can happen. If you’re a fire station, for example, and you don’t have an EHR, the collection is done by a local hospital. They’ll then get a requisition from us. If the patient isn’t in UConn Health’s Epic system, they’ll register them, do the swab and the test itself, scan the label, and pack it up and ship it. In the meantime, that information goes from our system to Jackson Labs. The result comes back through our system and it automatically activates a MyChart Account for that individual so that they can see their result. It’s pretty cool. Epic helped us build all of that. The test results also go to the provider because you have to have an order to do a test, whether you’re symptomatic or asymptomatic. That’s the way that piece is handled.
If, for example, Hartford Health wants to use Jackson Labs, the information comes into Hartford’s EHR, and then it hits our interface engine. We’re the only ones that have the interface, and so, in this particular case we bypass Epic, because they’re already done the collection. They don’t need our Epic; it’s already in their Epic instance. We just connect them to our interface engine, which moves the information. It’s simple. And then the result goes back to Hartford’s Epic system and the patient and provider using their MyChart.
That’s one of the nice things about it, because the last thing we want to do is set up a MyChart account for someone who already has one, because then they’d have accounts with UConn and Hartford. I know there are ways within Epic that you can look both of those, but it didn’t make sense. Plus, then you get into squabbles about who owns the patient and whether UConn Health is trying to steal the patient. We avoided all of that by using the interface engine, because we’re not doing anything with that information. Hartford Healthcare had theirs turned on a few weeks ago, and all the testing comes through there. The first responders were in that group as well. We’ve done all the testing on Epic’s frontend, and it’s worked really well.
The nice thing about our model is that anyone the state brings in to do the collection and provider order, we can plug them in. For example, PhysicianOne Urgent Care, which has centers in New York, Connecticut and Massachusetts, is finalizing a contract for the state to enable drive-up testing services. They have their own EHR, and so we would just connect them to our interface engine so the test results can come over to Jackson Labs.
The best way to describe is to say that UConn Health is the hub for those 20,000 tests through Jackson Labs. If a test is being sent to Jackson Labs for someone in the state of Connecticut, it’s coming through UConn Health in some way, shape, or form.
Gamble: And you’re not just working with Epic users, correct?
Podesta: That’s right. It can be any EHR; even if you have Epic, we aren’t necessarily running it through our Epic system — you’re going through our interface engine. PhysicianOne uses DocuTAP. Griffin Hospital has Meditech. It really doesn’t matter because we have an alternate way with the interface engine. It’s very powerful and very simple. Once it’s set up to do 20,000 tests per day, it serves a good portion of Connecticut, because we’re talking about first responders, nursing homes — both residents and employees, and the department of corrections. At some point we’re going to hit up FQHCs, because that’s a very vulnerable population, all Medicaid patients.
That’s the goal. And you’re right, it’s incremental, and it’s the highest priority groups first. Once we get through those, it will open up to others over the summer.