“Testing Is the Way to Go”: How a Statewide Initiative Is Breaking New Ground in Disease Management

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.

Part 1

Part 2

• Creating a model with Epic – “We’re way ahead of the curve.”
• Working with Jackson Labs
• UConn’s interface engine – “It works with all types of systems.”
• State testing requirements
• Provisioning outside employees – “You have to make sure there’s a solid approach.”
• Vendor cooperation – “We’re not trying to make money out of this. We’re trying to do good.”
• Scalability challenges

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Bold Statements

The private labs are not going to do 20 interfaces to 20 different organizations. They’re not just going to do it. But if you can present them with a way for a single interface to bring in all these various organizations, then they’ll listen.

If a Covid test comes back and you’re positive but don’t have a provider on record, you’re the only one who knows that you’re Covid positive. There’s no one involved from a care coordination standpoint. That’s why you need an order from a provider.

You have to provision people who don’t work for your organization to have access to your system. You have to make sure there’s a solid approach to how you’re getting that provisioning done to get them signed up and set limits on what they can do.

Epic is a corporation. They need to make money to survive, but they understand that we’re all in this together, and this is their way of giving back and being part of the solution. I love that.

Podesta:  Epic views this as a model that could potentially be used in other states; they’re doing something similar in Wisconsin. Based on all their clients across the United States, I asked them where are we compared to everybody else with this initiative, and they said we’re way ahead of curve, and other people are going to want to know about this.

Someone like Sutter Health in Northern California can do the same thing. You can take any large Epic site — or small Epic site, for that matter — and as long as you have an interface to the private labs, they’re the only ones that can scale. Unless of course it’s Yale-New Haven or Cleveland Clinic, but even then, you can’t scale as high as these private labs, and so you need some way to connect to them. The private labs are not going to do 20 interfaces to 20 different organizations. They’re not just going to do it. But if you can present them with a way for a single interface to bring in all these various organizations, then they’ll listen. If you’re Sutter Health or you Cleveland Clinic, then everyone has to plug into you to get to the lab. That’s model that Epic is pretty excited about.

 

Gamble:  What was involved in creating in a single interface?

Podesta:  When I talk about the interface we had in place, the information from Epic went to Jackson’s interface through our engine. It goes from Epic, to the interface engine, to Jackson Labs, back to the interface engine, and to Epic.

In this case, Hartford HealthCare has its own EHR, and so we bypassed Epic and plugged them into our interface engine using the same record layout we had from our Epic. It was pretty easy. It’s basically unplugging a plug from one outlet and plugging into another, but it’s the same electrical source. And so we don’t care if it’s Meditech or any other system, because we can unplug our Epic and plug Meditech into that interface engine, because the interface engine doesn’t care. It works with all different types of systems.

 

Gamble:  You mentioned this possibly being a model for other states. Was there anything that was particularly challenging that you could share with others?

Podesta:  One thing you need to realize is that the requirements are different depending on the state. Connecticut requires a provider order; you just can’t schedule a test, drive up to a tent, and say, ‘I’m here. I want to get tested.’ The first thing they’re going to say is, ‘Where is your order?’

If you’re in a state that has these types of requirements, it’s very difficult sometimes. For example, there are about 13,000 first responders. A lot of them have their own doctors, and a lot probably don’t have a primary care physician.  So how do you get them all tested without a provider order?

The reason being, if a Covid test comes back and you’re positive but don’t have a provider on record, you’re the only one who knows that you’re Covid positive. There’s no one involved from a care coordination standpoint. That’s why you need an order from a provider — so that if you get a Covid positive result, you can have a conversation about what to do next. Every state could be a little bit different, but that was a challenge we had.

Another thing to be aware of is that with Epic, pricing is based on product volumes. The lab system, Beaker, is based on a certain volume of tests flowing through the system. If you use Beaker and the interface engine, and you’re flowing through Epic using the MyChart function (and not bypassing it), that’s going to add volume. It’s going to add patients to your database and add to the volume of lab tests.

So you have to work with Epic. In our case, they waived all fees for one year, which was really nice. By then, hopefully we’ll have a vaccine and we’ll be through this. But you have to be cognizant of those types of costs as well.

The other piece is provisioning, because you have to have security involved. In our case, we had the National Guard accessing our system because they were doing the collecting. If there’s anybody more secure than the National Guard, I don’t know who it is.

But still, you have to provision people who don’t work for your organization to have access to your Epic system. You have to make sure there’s a solid approach to how you’re getting that provisioning done to get them signed up and set limits on what they can do as part of the testing and terminating when they’re done. You have to track that as well, because they’re not actually your employee.

 

Gamble:  I can imagine that was challenging.

Podesta:  It was. In working with our security, compliance, and legal teams, there were a lot of discussions around that and what our liability is based on having that access. But we were able to lock it down pretty well.

 

Gamble:  Obviously there are benefits for Epic too in waving fees or extending licenses, but it’s also the smart thing to do, especially right now.

Podesta:  Right. When you think about it, Epic is a corporation. They need to make money to survive, but they understand that we’re all in this together, and this is their way of giving back and being part of the solution. I love that. At some point, I’ll reach out to Judy and thank her, because the team she put on this was just amazing. We have calls with them a few times a week now, but at one point it was every day. We had daily calls that their team coordinated of us, which was amazing.

The cooperation with my senior leadership has been amazing as well; we’re a state agency and we’re not-for-profit — we’re not trying to make money out of this. We’re trying to do good. Our senior leadership team recognized this and gave their full support, and Jackson Labs did the same. When we had calls, we had people from Epic, Jackson Labs, and UConn Health, all working on this together. Everybody was focused on doing the right thing; when somebody needed to get something done, whether it was my team or Jackson Labs or Epic, by the next meeting it was done. Everybody is pulling in the same direction, which was wonderful to see. We’re seeing that across the country in healthcare, but it’s really wonderful to see everybody pulling in that direction, toward a common goal.

 

Gamble:  It’s very cool. I hope this can be a model for other states so we can get rid of this thing.

Podesta:  Testing is the way to go. And you can add to it as things develop. They’re working on a saliva test, and hopefully the antibody test will become more accurate. When that happens, you can plug that in as well; and instead of doing the saliva or the nasal test, you can add a blood test at the same drive-up location, and send that through the same process. This thing has scalability to other tests and could potentially be a delivery model in some days.

That’s why I think it’s super important for states to get this in place as part of a reopening plan. If your volumes go up, you can see who is COVID positive; you can run contact tracing and have them removed from the area. That’s the only way we’re going to be able to stay open, especially when we get into flu season.

 

Gamble:  I think that’s such a big part of it; being able to avoid having to start from square one if the second surge comes. And of course, scalability.

Podesta:  Right. We want to scale it big now so that we’re not scrambling later and are forced to cap it at 1,000 tests per day. Get it big right now so we can get that first bolus of people through — knowing they’re probably going to have to come through again at another point in the future.

 

Gamble:  Right. From my own standpoint, I really hope New Jersey climbs onboard with this.

Podesta:  I know. In Boston, CVS is cleaning up. They’re opening areas all over the place for testing. We have Mass General, Beth Israel, Harvard — all these areas have to have some testing capacity, but there’s no program. There’s no centralized program in the state, which is really needed. It’s the same thing in New Jersey; you have some big players. If one of them stepped up and worked with a private lab, you could knock this thing out. The state can get federal funding; some of it is still out there to pay for the equipment and things like that, but it won’t be there forever. It’s going to dry up.

 

Gamble:  I really hope we see more efforts to create centralized testing programs.

Podesta:  I do too, because it will allow people to go back to restaurants. If testing is widespread and the people in those restaurants are getting tested, you’re going to feel more comfortable. You’ll still wear the face mask and distance, but you’ll feel a little bit more comfortable.

Knowing that people who are Covid positive aren’t walking around; that contact tracing is being used to make sure they’re not walking around asymptomatic and spreading it everywhere — that’s the only way we’re going to get through this.