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At UVM Health Network, Advancing an Integrated Health System’s Initiatives through Data Governance Strategies

December 5, 2018
by Mark Hagland, Editor-in-Chief
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At the Burlington, Vermont-based UVM Health Network, Leah Fullem is helping to lead data governance processes intended to speed the advancement of key IT strategies

The Burlington, Vermont-based University of Vermont (UVM) Health Network was created in October 2011, when what was then known as Fletcher Allen Health (now the University of Vermont Medical Center) in Burlington, Vermont, and Central Vermont Medical Center in Berlin, Vermont, signed an affiliation agreement. Six hospitals—the University of Vermont Medical Center, Alice Hyde Medical Center, Central Vermont Medical Center, Champlain Valley Physicians Hospital, Elizabethtown Community Hospital, and Porter Medical Center—and the UVM Health Network Home Health & Hospice (formerly the Visiting Nurse Association of Chittenden and Grand Isle Counties) make up the network. As the organization’s website notes, “Working together to better serve our communities makes us stronger, focused on collaboration instead of competition. As a team, The University of Vermont Health Network improves the lives of our patients by delivering outstanding care cost-effectively, as close to patients’ homes as possible,” it adds. “The University of Vermont Health Network cares for communities on both sides of Lake Champlain, from the Adirondacks to the Green Mountains and beyond.”

Bringing together those diverse hospital facilities and healthcare services has necessitated formal data governance processes. And, in that context, Leah Fullem, vice president of enterprise information management & analytics at the UVM Health Network, reached out for consulting support to Stephanie Crabb, co-founder and principal in the Tampa, Florida-based Immersive consulting firm. Recently, Fullem and Crabb spoke with Healthcare Informatics Editor-in-Chief Mark Hagland regarding the journey around data governance at UVM Health Network. Below are excerpts from that interview.

Can you share with me the origins of your initiative to create a formal data governance structure at UVM Health Network?

Leah Fullem: A couple of things made this time the right time to pursue this work. The UVM Health Network—we came together several years ago, anchored by UVM Medical Center, and affiliated with community and critical access hospitals in Vermont and in northern New York. And we had some network structures in place. And a few years ago, we decided to implement a common cost accounting and financial services solution; and now we’re in the initial phases of a rollout of Epic system-wide. The medical center has been on Epic for several years now on inpatient and ambulatory; and revenue cycle components will be included in November 2019. So we’re looking at implementing common tool sets across the network, with common workflow and documentation standards.


Leah Fullem

We’re trying to improve the way in which we capture information, so that we can better work together as a network. That’s why it’s a good time to initiate enterprise-wide data governance. But we still have multiple different areas in which data are consumed, produced, and analyzed, with a lot of different ways of doing that. So we contracted with Immersive about a year ago, and then did a scan, looking at our data resources, tools, data governance and standards we had in place, and gave us a nice set of recommendations and a roadmap.

What were the biggest gaps you found?

Our story is not uncommon; we found that we had multiple areas where we were duplicating effort; analysts in the finance area and quality area, or multiple different areas, were writing different queries with different parameters, across the same subject areas, for reports. And they were using different metrics to calculate from. So we had data silos, which meant that data analyst teams being directed by different supervisors, weren’t able to partner with each other. So there were a lot of knowledge gaps; we had a huge amount of analyst talent, but we weren’t able to leverage the talent we have. We have SQL servers, many other forms of storage, of data; and the Epic rollout will include an enterprise-wide data platform that we’ll implement over the course of the next year, and that will allow us to make sure we’re on common platforms with common platforms.

Stephanie Crabb: One unusual thing about UVM is that UVM has had incredible executive support and sponsorship around data for a long time. Dr. John Brumsted, the current CEO, was the network CMO and chief quality officer; so he’s an individual who’s always been very bullish and visionary around the use of data and information.  And he himself had taken the first pass at implementing data governance when he was the CMO. So it’s really important—we talk a lot about executive sponsorship in data governance, and about whether it’s really there, whether it’s real. And one success factor at UVM was the fact that Dr. Brumsted was a stalwart supporter and leader. And he put forth from the very first meeting that failure was not an option. So he really set the tone, and was open to creative ideas, and was focused on putting ideas into action. That’s how Leah’s position was created.


Stephanie Crabb

What have been the biggest lessons learned so far in all of this?

Fullem: I’m still early on in my involvement in all this; I’ve been in this position six weeks so far, but much work has already been done. We’ve set up a network-wide data governance council with broad representation across business functions and institutions; created a network-wide data governance policy; we’ve begun a project on provider dictionaries/better data management processes; and we’ve been focusing on data governance, stewardship, and moving forward with a new structure. When Dr. Brumsted first started talking about instituting data governance, there was no locus of authority for participating in data governance or collaboration efforts; now, that’s here.

And in the first six weeks of my job, I’ve been going around speaking with as many people as possible in Vermont and northern New York. And we’re talking about the way people access data, and what tools analysts might be using. So I had expected some pushback, but overwhelmingly, people across this network have been enthusiastic and supportive of this, which was surprising. The commonality is someone saying, “I had something that I thought was easy, but it wasn’t, and no one could get back to me in a timely way, and I had to wait six months, and by then, it wasn’t relevant to me.” And we’re moving heavily into population health and care management, so there’s a great deal of interest.

The biggest lesson we’re learning in process is that this is a cultural change more than anything. Yes, data is involved. I report up to the chief population health and quality officer. This is a cultural change. We will improve access to data, improve the quality and accessibility of data and information, to allow us to make better decisions on behalf of our patients and people. We have people who still only trust the data given to them by their analysts, or data they’ve extracted themselves. And yet there are conflicting numbers all over the place. So creating trust, to open people up to changing the way people receive or experience data, through new ways of looking at the information, involves a huge change effort. So above all, I need change agents.

Crabb: Lessons learned from our point of view through the work—to augment the change piece—have been several. One thing that UVM has done very well is that they didn’t just do an assessment and roll forward with a roadmap; they were really honest about their strategic, tactical, and cultural readiness. And I applaud Leah up and down, because she has a really tough job, it’s an ambitious agenda. But in the first year of their preparation, they’ve been really attentive, have set the right objectives, have taken the best of what they’ve learned and are trying to apply that very tactically. Second, they’ve focused on the people and organizational structure piece. One of our recommendations to them was, don’t throw a bunch of tools at this; if you don’t have the people and processes and organizational structure that make sense, it won’t help. Creating Leah’s position as a network organizational position, that was a huge demonstration of good faith and commitment. Not only did they say they wanted Leah, they agreed to a leadership team of eight or nine positions in her office that she’s currently fulfilling, positions in data management that are needed.

So, the lesson is, not just giving lip service to it, but putting skin in the game and following through. And this 25-person-plus data governance council that started meeting in February of this year, was incredibly important. It was incredibly well constructed, with critical business functions. That team has rallied from day one, and has gotten an incredible amount of work done in five short meetings. And the charter they created for themselves, and coupled with creating a good operating environment to carry out the mission, are two very important things, and indications of the seriousness with which they’ve taken this.

What would your advice be to CIOs and CMIOs who will be facing similar data and IT governance situations and challenges?

Fullem: This is common advice, but we need to make sure that we’re meeting the needs of our clinicians, our finance departments, our operational leaders, since data is the key to making good decisions. All of this has to be done in a way that we make technology available to our users in ways that are easy to use and access, with the right information security principles, to move forward as a business.

Crabb: That our data and information leaders are important partners to our CIOs and CMIOs. This initiative originated out of IT, was led by Dr. Doug Gentile, our CMIO. But the goals far exceeded the boundaries where IT is drawn in that organization today. And it wasn’t a tug of war of any kind; it was a natural extension of work that was incubated in IT. It’s been a healthy, symbiotic relationship that was first incubated in IT, and allowed to fly, understanding that data as an asset deserves its own center of excellence, just as IT is a center of excellence.

 


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Take the Lead to Deploy Emerging Technologies for Improved Outcomes

December 14, 2018
by Brad Wilson, Industry Voice, former CEO of Blue Cross and Blue Shield of North Carolina
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It is a thrilling time to work in healthcare. As the former CEO of Blue Cross and Blue Shield of North Carolina (Blue Cross N.C.), I have had the opportunity to be at the forefront of using new technologies to improve outcomes for our members. Now as a member of the CitiusTech advisory board, I continue that focus on emerging technologies, such as artificial intelligence (AI), and the potential to accelerate the shift to value-based care and improve the healthcare system in material ways.

AI is starting to make a distinct impact in helping providers deliver more effective care, lower costs and create a more consumer-friendly healthcare system. Blue Cross NC recently piloted the use machine learning, a type of AI, to identify spikes in prescriptions for a costly medication. The company reached out to doctors who had been prescribing the medicine in significant numbers. Alerting just one particular physician practice to a generic equivalent brought estimated annual savings of $750,000 for Blue Cross NC customers. The potential of AI is not measured only in dollars, but cost savings are an important consideration.

Machine learning works by applying sophisticated algorithms to rich datasets from electronic medical records (EMRs), patient-reported data, claims and a host of other sources. To be successful, this requires both access to data and significant investment to support the depth and breadth of data analytics capacity and capability.

Yet, historically, one of the biggest barriers to value-based models has been providers’ and payers’ possessiveness of their own data. There is a good business reason for that possessiveness: competitive advantage. The different parts of the healthcare system do not want competitors to use shared data to steal business. But the guarding of data drives healthcare costs higher and, more importantly, makes delivering better, more personalized healthcare more difficult. In the past, power came from hoarding information; today, there is power in serving as an information hub.  Healthcare providers and payers are starting to understand this and there is more willingness to work together in sharing what has traditionally been closely held information.

As consumers’ voices gain in numbers and decibels, it’s clear that analytics technologies that can lead to better care at lower cost are desperately needed, particularly for payers. But the entire healthcare industry needs to move more rapidly. Health plans need to enrich, deepen and widen their analytics capabilities as quickly as possible. If they don’t, we will continue to see disruptors like Google, Apple, and Amazon enter the healthcare market—companies that have a demonstrated ability to be nimble and maximize the impact of their data.

For both providers and payers, forward-thinking organizations recognize that building their own data analytics solutions is not always the answer. Often there is not enough time, resources or enough of the right talent to deliver the capacity and capability required. Fortunately, robust turnkey solutions coupled with deployment expertise are available to efficiently and cost-effectively integrate data and analytics within an organization’s clinical, financial and administrative processes.

As health plan executives map out their strategic plans, look to these emerging technologies as accelerators for leveraging data to manage risk, optimize performance, engage consumers, enhance population care, and improve clinical outcomes to reduce readmissions and further drive evidence-based medicine. The opportunity is here to transform healthcare delivery in significant ways. Success will go to those organizations that understand the potential of these new technologies and take the lead to deploy them effectively—today. 

Brad Wilson is former CEO at Blue Cross and Blue Shield of North Carolina and is a member of the new CitiusTech Advisory Board. Mr. Wilson joined Blue Cross NC in 1995 as General Counsel and held a variety of senior-level positions before being named CEO in 2010. Under his leadership, Blue Cross NC grew to a $9 billion company serving over 3.8 million customers. Mr. Wilson has also served as Director of the BCBS Association, AHIP and numerous other national and state healthcare organizations.

 


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Investors Have Strong Interest in HIT Sector, Despite Valuation Concerns

December 13, 2018
by Heather Landi, Associate Editor
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Healthcare IT remains a hot investment sector despite concerns about these companies being overvalued, according to KPMG-Leavitt Partners 2019 Investment Outlook, a survey of health care investment professionals.

Looking ahead to 2019, more than a third of respondents (34 percent) said they were most interested in investing in health care IT, followed by care management (31 percent), home health (23 percent), retail-centric medical groups (22 percent) and primary care practices (21 percent).

New York City-based KPMG and Leavitt Partners, based in Salt Lake City, surveyed 175 respondents online from corporations, health systems, investment banks, venture capital and private equity firms between September 17, 2018 and October 21, 2018. Of those surveyed 32 percent were C-suite executives; 29 percent were principal, partner or managing director; 32 percent were vice president or director; 6 percent were analysts/associates and 2 percent held other titles.

“We are not surprised by the great deal of interest in health care IT and care delivery outside the hospital,” Governor Mike Leavitt, founder of Salt Lake City-based Leavitt Partners and former Utah Governor and U.S. Health & Human Services Secretary said in a statement. “As health care continues to march toward value, the emphasis on moving care to lower cost sites and enhanced coordination will continue, and those who can increase quality and lower cost will win.”

According to an October report from Rock Health, 2018 is already the most-funded year ever for digital health startups. Digital health funding in this past third quarter soared to $3.3 billion across 93 deals, pushing 2018 funding to $6.8 billion, already exceeding last year’s annual funding total, which was $5.7 billion, by more than a billion dollars.

Drilling down into respondents’ predictions for investment activity in 2019, in the health care and life sciences market, 96 percent of respondents see either a lot or a moderate amount of investment in health IT and data next year, while a similar percentage (90 percent) see significant or moderate investment in outpatient services. Forty-four percent forecast a lot of investment in post-acute care services, 39 percent predict significant investment in provider services and about a quarter of respondents believe there will be a lot of investment in managed public programs, payer service providers and pharmaceutical and biotech manufacturers. Eighteen percent believe there will be significant investment in medical device and diagnostics and medical equipment.

The survey results indicate there is concern that health IT is overvalued, yet investors believe there is some room to climb.

The majority of investment professionals see health care IT investments as an overvalued sector (64 percent), yet 40 percent expect the valuations to increase in 2019 while 51 percent see them staying the same. About two-thirds of respondents (62 percent) think the health IT sector will grow faster than the market in 2019, and three quarters of investment professionals see increasing competition in the health IT market. Investors also estimate that the average purchase price multiple, in terms of EBITDA, will be 12.5 for the health IT sector in 2019. Survey respondents expect ongoing demand for tools to help with consumerism will impact investment and deal making in the sector, according to the survey.

About four in ten respondents believe the healthcare market is experiencing a “moderate bubble,” while 9 percent believe the bubble will likely burst.

Care management solutions for risk-bearing providers, a highly competitive sector which helps coordinate care of the chronically ill or seriously injured, are expected to be the second highest sector for investment behind health care IT, similarly driven by trends of consumerism and increased focus on early care interventions.

Looking at potential drivers of M&A activity in the health care and life sciences sector in the coming year, 64 percent of respondents cited cost consolidation and economies of scale, while 45 percent cited accretive acquisition strategies. Forty percent of respondents see changing payment models as a driver of M&A activity, and 38 percent cited pressure from competition. Other drivers cited by respondents include expansion/divestiture of service areas (25 percent), geographic expansion/contraction (24 percent), revenue synergies (22 percent), need to deploy cash on balance sheet (17 percent), and regulations and legislation (13 percent).

“Deals are largely being driven by the need for savings, economies of scale, and improving cash flow or accretive earnings per share,” Carole Streicher, Deal Advisory leader for healthcare & life sciences at New York City-based KPMG, said in a statement. “Secondarily, there is a bit of a defensive posture motivating investments as health care organizations contend with competition and reimbursement models connected to quality and efficiency, as well as the entrance of tech firms investing in the sector.”

 

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Report: Massachusetts General Hospital Targeting Various Blockchain Use Cases

December 7, 2018
by Rajiv Leventhal, Managing Editor
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Massachusetts General Hospital (MGH) researchers are partnering with MediBloc, a Korean healthcare blockchain company, with the aim to improve patient data sharing and storing, according to an article in CoinDesk.

Per the article, the Laboratory of Medical Imaging and Computation by MGH and Harvard Medical School will be escalating research in a variety of broad areas “from medical image analysis to health information exchange by leveraging our cutting-edge technologies such as blockchain, artificial intelligence and machine learning,” according to Synho Do who is the laboratory’s director.

Do specifically told CoinDesk, “In collaboration with MediBloc, we aim to explore potentials of blockchain technology to provide secure solutions for health information exchange, integrate healthcare AI applications into the day-to-day clinical workflow, and support [a] data sharing and labeling platform for machine learning model development.”

Interestingly, MGH won’t be using any real patient data for its research, but rather simulated data, according to officials, since the various institutions that have the real patient data keep it in a way “that can’t be shared securely and often is in various incompatible formats.”

MediBloc’s CEO noted that the company is not only developing a distributed ledger for storing and sharing medical data, but also working on a tool that would convert data now held by hospitals from existing formats to a universal one, per the article.

For this initiative, MediBloc has already gotten partners across Asia, including eight healthcare organizations and 14 technology companies, officials said.

Earlier this year, a testing environment version of the blockchain was launched, and the network is expected to go live before the end of the year before becoming fully functional in the second quarter of 2019. Furthermore, there are also apps in the works that are planning to go live next year, with one of them, currently in a beta testing phase, “designed for patients to sell the information about their symptoms and the prescriptions they get to MediBloc. After that MediBloc will analyze that data and sell the analysis to pharmaceutical and insurance companies,” according to the story.

In the end, the main goal of the blockchain project will be to let patients independently decide what to do with their information.

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