Virtua Health is a four-facility, community hospital-based, integrated health system based in the southern New Jersey town of Marlton, just outside Philadelphia. The largest healthcare provider in South Jersey, Virtua encompasses 1,000 inpatient beds and three community outpatient centers. At Virtua, Thomas F. Gordon, senior vice president and CIO, has been leading transformational change around the leveraging of technologies to facilitate population health management across the organization’s entire service area.
Among other initiatives, Virtua became a Medicare Shared Savings Program (MSSP) accountable care organization (ACO) in December 2012, with 13,000 lives so far, covered under that federal contract. It has also established its own patient-centered medical home (PCMH) program, covering 100,000 lives so far. One core facilitative technology in all this is health information exchange (HIE).
Within the context of the HIE initiative, already, clinicians can view hospital data, laboratory data from Quest, LabCorp, and Virtua labs; radiology data from South Jersey Radiology Associates, Larchmont Imaging, and Virtua Radiology; and soon, data from rehabilitation facilities, nursing and long-term care facilities, home health, and urgent care sources.
Not surprisingly, all the current initiatives, including the HIE initiative, are keeping Tom Gordon and his team of 185 IT professionals very busy; indeed, by his reckoning, they currently have 299 IT projects active at the moment. Gordon spoke with HCI Editor-in-Chief Mark Hagland about all this work recently, and about his perspectives on it all. Below are excerpts from that interview.
Tell me about your journey around HIE and population health management so far?
We have a strategy around technology vendors, but it’s just a Virtua strategy altogether. We do partnerships with vendors. They really are partnerships, and we tell the vendors upfront, we’re not just looking for a software solution, we’re looking for a partner, and we want you to be as invested in this as us. So it can be a pretty intensive process, as it was with HIE. And we saw some of the bigger problems happening around governance in some of the state and regional entities. So we found Wellogic [now Alere Accountable Solutions, a division of the Waltham, Mass.-based Alere) at the time, now Alere and we actually host the HIE in my data center. It’s privately funded, so we don’t have ownership problems. And we avoid most governance problems.
Thomas F. Gordon
And early on, we spent a lot of time around policies and procedures. And you can Google “Virtua HIE policies and procedures,” you’ll see that. We had put a lot of time, effort, and money into it, and it really was a situation where we wanted people to follow standards, and not just go through the motions. So yeah, it was an absolutely conscious decision to try to get others to use that same process.
And we had this partnership with Wellogic; and they had never allowed a customer to host an HIE So we hosted the solution. We partnered with another company through them, EnableCare, which does sensitive data-scrubbing. So anything that comes in, only authorized users have the ability to get to the data. And we knew other HIEs had had to deal with such security issues.
And right away, we connected our HIE to some local radiology centers, as well as Quest and LabCore, some laboratory vendors in the area. So we currently have 20 participants sending data into the HIE.
When did you go live?
About two years ago. And we’re collecting something like a million records a month. It’s become such an unbelievable data repository. So, two big things right off the bat that came into play. Last year, we started our accountable care organization planning. And we actually put out 25-30 RFPs for vendors offering accountable care-related solutions. So we ended up picking our HIE vendor for a portion of it, and another portion involved a company called TriBridge, and they had a solution around ACO using a CRM [customer relationship management] package, Microsoft Dynamics from Microsoft. It does all the normal CRM functions, but in a hospital environment, so, tasking—who are you calling that day, what appointments do you have for that day? On our HIE side, we already had this huge amount of data, where basically we have our patients’ entire record.
Siemens Soarian [from the Malvern, Pa.-based Siemens Healthcare] is our acute-care record, and our physician practices use NextGen [the Horsham, Pa.-based NextGen Healthcare]. And we don’t have anything in the middle except for this HIE, which has all the data for the continuum, so it made perfect sense At the same time, Alere went out and purchased a company called DiagnosisOne, for the clinical decision support. And now that’s called Alere Analytics, which a great decision support engineer, which covers not only the data we have internally at Virtua, but also the external data. It’s been a huge success using that data. We’re able to send near-real-time data to the care coordinators to make decisions.
Another big piece of that is home monitoring. So Alere also has devices. So in the deal e negotiated, we negotiated home monitoring devices, so we’re in the process of rolling out 500 home monitoring devices, connected to the HIE.
And we have 1,000 interfaces at Virtua. And so for us, this is great; it’s a single interface So we’re able to deploy things across the HIE platform very rapidly So we don’t have to send our physicians out to the HIE to find data; we’re using the HIE to push data to them. So that was the big use case for HIE for us.
The other thing is that we have a strategic relationship with Children’s Hospital of Philadelphia [CHOP]. And we put their clinicians into our buildings, as part of a joint-venture partnership. And we put some pediatric service lines in all of our hospitals, called CHOP at Virtua. That began at the beginning of this year, and we just all the hospitals live as of October.
You’ve got many elements to all this work.
That’s right. And you know what was great about that from both a technology and partnership perspective, is that in the traditional bricks-and-mortar environment, you’d build facilities and then have to ramp up to find physicians. But in this case, we started with a partnership. And we started with a plan, and envisioned the need for 30 FTEs to do scheduling and so on. Because you’d have a situation where you might need to divert families to a different facility within our system. And CHOP uses Epic, and Virtua uses Soarian, and physicians simply stay in their native system, but have access to all the data from both organizations. And our Vorhees Hospital, our last one, went live in October.
And we were actually able to save some money, because we had anticipated that people would need to send e-mails and phone calls back and forth, but we did it seamlessly and didn’t need to create 30 new positions, so that was a huge win. And since the beginning of the year when we went live with this, we’ve had 8,000 radiology studies through this. And we no longer need to have families go into Philadelphia for imaging And some people find it an easier drive to stay in New Jersey; so it’s had huge benefits for us.
And the cool thing is, and I am not aware of any other organization that has pursued HIE in exactly this way. And we didn’t make a huge splash about that, but I still don’t think there’s another healthcare organization or HIE in the country that is sending registration, scheduling, and results data between two patient care organizations without manual intervention, involving two disparate systems—in this case, Epic and Siemens. And of course, Epic and Siemens weren’t thrilled that we didn’t pay them extra fees, but we didn’t need them to do anything more here. And we had Virtua and CHOP operations people at the New Jersey/Pennsylvania HIMSS Connect-A-Thon, as a use case. And when proposals came in front of me, I was like, let’s show what Virtua and CHOP are doing, that’s a real, live use case that clinicians are asking for, and we did that use case for HIMSS, that we’ve been asked to do it, to present it at the national HIMSS Conference in Orlando in February.
So what are the differences in perspective between an academic system CIO and a community hospital-based system CIO, when it comes to population health management and HIE?
Well, we were doing population health even before the Affordable Care Act, because we knew things were headed in that way. And we have recurring patients with COPD and diabetes, etc., who go into very expensive areas of the hospital, and we knew we had to fix that. The big difference is, you go to the University of Pennsylvania when you have something really serious wrong with you, but you don’t often come back so often. We see much more of those readmissions as a community-based system. And we recently did a deal with CVS where we have five minute clinics in CVSs in the area, and are connecting them up with the HIE also. And so I don’t have to worry what EHR CVS is using, because they can just connect up fast.
What have been the couple of biggest lessons learned in all this so far?
That’s a great question. I would say the biggest thing for us was getting the right people involved from the beginning. We went with a faster-built governance structure, which was the key to this—we had all the right stakeholders involved from the very beginning. And I walk down the hallway, and clinicians are asking, can we use the HIE for that? So getting the right people involved from the beginning was definitely one of the key decisions we made. And we’re a Medicare Shared Savings Program ACO, and are also doing a patient-centered medical home/medical neighborhood program, using the same program.
And clearly, HIE is going to be essential to success as an ACO?
Oh, absolutely. And the software we developed just went live today. And I did my report for the senior management, and was able to take what I drew on the whiteboard and drew it in PowerPoint. And what we drew in IT was actually what we delivered. We have four community-based care managers/care coordinators, using this tool, and also have an access center with 30-35 people in it, doing centralized scheduling for all our community-based physicians, involved in this program. And both are highly successful programs so far. We’ve had over 300,000 contacts through our access centers just this year.