For Yale New Haven Health, one of the key components in being able to successfully launch a hospital-at-home initiative was maintaining “the simple connectivity and continuity of the medical record,” said Lisa Stump, SVP and Chief Information and Digital Transformation Officer, in a recent podcast interview. The others, which are just as critical, are appointing the right people to help lead the project and identifying an outside partner that can provide the missing pieces.
During the discussion, Stump also talked about the challenges Yale New Haven Health is facing with retaining IT talent; how her team was able to draw on relationships and trust during the most difficult days of Covid-19; and why it’s so important for leaders to be able to tie the everyday work teams are doing to the mission of healthcare.
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- When it comes to IT applications, the philosophy is to utilize Epic first, said Stump. “Sometimes we need a little bit more sophistication than some of those specialty modules provide; but for the most part, we try to keep a true enterprise platform.”
- “We had many of the right pieces and parts, we just didn’t have all of the right pieces and parts,” said Stump, explaining why her team sought an outside partner to create the hospital at home.
- A critical step in rolling out new technology is to run “a full clinical dress rehearsal,” which YNHH did with its mission control piece. “We kicked the tires made sure all the technology worked as we would have expected it to.”
- Another key benefit in partnering with an outside organization? The relationships they’ve developed with third-party providers. “We didn’t have to do our own market assessments and negotiate contracts. I don’t think we would be live yet if we had to create it all.”
Q&A with Lisa Stump, Yale New Haven Health, Part 1
Gamble: Hi Lisa, thank you, as always for your time. I want to talk about what your team is working on, and how your strategies have evolved in the past two years. First, can you give a high-level overview of Yale-New Haven Health?
Stump: Yale New Haven Health System is a 5-hospital network across seven inpatient campuses that span Rhode Island and Connecticut. We are also supporting our northeast medical group physician practice, which has over 300 locations in New York, Rhode Island, and Connecticut. And we have a close partnership with the Yale School of Medicine and the Yale Medicine Specialty Physician Practices. We employ about 28,000 employees across our health system. We’re about a $4.5 billion enterprise.
Gamble: And you have Epic in the hospitals or is it pretty much Epic across the board at this point?
Stump: We are Epic across the enterprise inpatient/outpatient, revenue cycle, access and then some of the specialty areas like dental. Our philosophy generally is, it’s all in Epic unless it can’t be. So sometimes we need a little bit more sophistication than some of those specialty modules provide through Epic; but for the most part, we try to keep a true enterprise platform.
Gamble: Right. So I wanted to talk about the home hospital program that was recently launched. The ‘why’ is pretty clear with something like this, but the ‘how’ is probably much more tricky. Can you about how it came about and what it has taken for your team to get it up and running?
Stump: The ‘why’ is pretty clear. For us, it was a combination of really needing to address prolonged length of stay and constrained capacity in our inpatient hospitals as well as offering what we fundamentally believe is care in the right place. Most people don’t want to be in the hospital, and if we can avoid it, we will. The nurturing environment of the home has some key advantages.
So we created a team, which consisted of our post-acute care leadership team, our physician and nurse dyad partners. We also have a physician executive director around our telehealth programs who reports in through me in our information technology and digital transformation space. We connected him early with that effort, anticipating that the simple connectivity and continuity of the medical record needed to be maintained, and recognizing that remote patient monitoring of patients in the home was going to be an important piece of the overall program.
We initially determined that partnering with an external company — Medically Home — would accelerate our ability to get the program launched. We had many of the right pieces and parts, we just didn’t have all of the right pieces and parts. We didn’t yet have that business knowledge around how to construct the operations that would make it efficient right out of the gate. And so, partnering with Medically Home made a lot of sense.
“Basic connection points”
From that IT digital perspective, we were there from the inception to help the teams think through what I call basic connection points. The medical record, to me, is a key construct of that. And so, we didn’t want a patient to leave the four walls of the hospital, continue their care in the home and have a separate medical record there. We thought that continuity was really important.
Medically Home has a proprietary software platform. And so, we worked hard early to make sure we understood what needed to be transacted in that platform — what should continuously be documented and transacted in the electronic medical record — and then make sure we had the right interoperability to keep it all in sync. They also have an implementation consultant partner who helped bring their experience from other sites that had implemented it. I will say, I think we pushed hardest to ensure that the documentation we thought was important in the electronic medical record actually happened there, rather than model where some things get documented in a third-party system. And I’m still convinced that was the right approach. We managed to make it work and get that done. And then we layered in the digital monitoring pieces as appropriate, whether it’s blood pressure monitoring, other vital signs, etc.
Next, we stood up what we call mission control, which is the centralized command center. We have our clinical staff sitting in that space so that they have the right technologies to view all the information that’s coming in from patients in the home. We leveraged our existing text and mobile communication platform. We didn’t want the clinicians in the hospital to have to think, ‘Lisa is the patient who went home yesterday, and so, I have to reach that care team differently.’ We felt it was really important that we maintain common infrastructure to make care easy. And so, we put all of that in place as well.
“We kicked the tires”
And then we conducted what has become the norm for us as we’ve implemented the EMR Epic in many places, which is to do a full clinical dress rehearsal with the folks that would be in mission control and folks that would be out in the fields. That allowed the state department of public health to come in and observe us, which is part of their certification process, and so that worked incredibly well. Then, we kicked the tires made sure all the technology worked as we would have expected it to.
Gamble: Very interesting. Can you talk more about the concept of the full clinical dress rehearsal? Is that part of the process when implementing hospital-at-home programs?
Stump: If my memory serves me correctly, their version was a little bit pared down from what I consider to be our full-blown clinical dress rehearsal. They sort of envisioned a day in the life, but it was a little bit segmented where they tested one thing in one time block. So we said, ‘let’s just immerse people and do that fully. Let’s pretend there’s a patient.’ And so, we had some of our IT staff act as the patient. They sat in a room down the hall pretending they were at home. If they needed to call in, we did the work to make sure the right alert popped up on the screen in mission control. It really helps people because sometimes we find things we don’t anticipate when you just look at things. Life doesn’t happen in those clean little segments. We found it really helpful to create scenarios that folks could fully vet.
Gamble: How are you staffing mission control? And has it changed as you’ve gone through the process?
Stump: I think it will evolve over time in terms of how we envision it and how it’s stood up. Right now, it’s a hybrid model where we hired some new folks to work in mission control. Through the relationship with Medically Home, they’re providing some people so that there’s a shared learning environment. Eventually, we hope to wean ourselves off of the reliance on Medically Home and make it a fully in-sourced operation. The other thing Medically Home brought to the table are relationships with third-party providers in the region, which meant we didn’t have to do our own market assessments and negotiate contracts. I don’t think we would be live yet if we had to create it all. That was a really good speed-to-value approach. It was really helpful.
Gamble: Were there any challenges that came up that you really hadn’t anticipated through the process?
Stump: Not really. The consultants helped structure what I call feedback and input sessions. We spent the better part of a week in half-day sessions where they posed various questions, and we talked about the way we operate today. Ideally that would work for the home hospital, but if it presented a problem, we worked through it. Thankfully there haven’t been any issues. I think our biggest worry, honestly, was in the lead up and in hiring folks — the recruitment space is just really tough right now. But we were able to get through that as well.
So far, for the patients that we’ve treated, it’s borne out. People really appreciate being in the comfort of their own home. We’ve not had anyone need to come back and be readmitted. It’s progressing as we had hoped.
Gamble: And I’d imagine that from an infrastructure standpoint, so many of the pieces were already in place based on the work that had been done. I’m sure that was really key.
Stump: It was. We’ve operated teleICU for probably 10 years now. And so, the concept of a central bunker mission control and managing patients remotely was very familiar to us. I think even for a lot of the technological components, it was a big help in how we knew we needed to operate. I’ve got a really talented team that would call an audible and question how something was being done, because we know our Epic environment really well. We can anticipate what we’re going to need to build. So that was very effective as well.