Virtua is a multi-hospital healthcare system headquartered in Marlton, N.J. A non-profit organization, it employs 7,900 clinical and administrative personnel and has 1,800 physicians as medical staff members. Virtua is an early adopter of clinical and digital technologies, led on the IT side by CIO Al Campanella. Recently HCI Editor-in-Chief Anthony Guerra caught up with Campanella to see if HITECH was changing his strategic plans.
GUERRA: I’d like to talk a little about HIEs, specifically working with other local health systems, like with your buddy Dan Morreale over at AtlantiCare. How do you balance the desire to interoperate and collaborate with the fact you’re often competitors?
CAMPANELLA: Well, I think it’s really important for the respective organizations to put the patient first, above the politics. None of us would want one of our patients, or for that matter a family member, to be disenfranchised by two health systems that are not willing to share information on a very episodic basis. The beauty of the HIE standards is that episodic sharing can be done. The HITSP standards that came out in July are very specific about the whole query response dynamic between HIEs. So if I can’t find Jane Smith in my HIE – if I have a partnership with AtlantiCare – then it will go out and ping AtlantiCare’s HIE, look for Jane Smith, then if she has a record there it will come back and notify me. I, in turn, can view or download that particular piece of information.
And if HIEs are done right, someone is only doing that querying because they have a specific need-to-know basis. So if your HIE has the right participation agreements, and it has the right level of auditing and monitoring to make sure usage is appropriate, then it’s really above board and people are only querying for patient information that they need. So I don’t really see an issue there.
Dan and I’ve talked several times, as a matter of fact, our teams are now actively engaged in dialogue on getting our HIEs to talk. Virtua did sign up with Wellogic, it was a coincidence, but that’s what Dan uses, and it’s written actually into my Wellogic contract that we will interface over to his, and the same is true for Fox Chase over in Philly. They use MedDecisions’ HIE and we have this formal discussion going on with them about data exchange there.
I don’t see competition as an issue, but what can be an issue, of course, is having a health system-sponsored HIE. How many hospitals participate directly when you’re sharing MPIs. Because when you have multiple hospitals on an HIE, one of the first things you do is create a common mega master patient index. In that sense, people could legally mine that data, but that’s a barrier for competitor hospitals. The way I see it moving is each hospital system — at least in New Jersey — is there’s going to be one HIE per major health system and those will, in turn, talk to each other.
GUERRA: Tell me about some of the projects you’re working on.
CAMPANELLA: Well, two days ago, we go live on the Siemens’ Soarian acute care EMR, and we are rolling that out over 18 months. It’s been a year of preparation, and now the rollout will be 18 months going forward, and we will rollout nearly every Siemens’ Soarian module. So it will be results viewing, bedside medication administration, nursing documentation, CPOE, and physician documentation. And last but not least – this is a really cool part – we will be integrating our bedside biomed devices with Soarian. So the data from bedside devices will also be transmitted to Soarian and available in the electronic record. And I think we will be probably the most integrated hospital in the country when it’s all done. I recently had a status meeting with Siemens on this exact topic, and they have no other customers that are doing this at the scale. So that’s a big project.
GUERRA: What were you on before Soarian?
CAMPANELLA: We were on INVISION Clinicals, but we did not have nursing documentation or, obviously, CPOE or physician documentation turned on. It was only just the results viewing and clerk order entry. So Soarian’s real big. We’re actually live with Microsoft’s Amalga system. However, we haven’t released it to the user base yet. We’re actually having an external firm audit the system because it’s so self-developed, and you customize basically all the interfaces into it. We’re having Ernst & Young actually audit it before we release it to the general user base, but we’re excited about that.
We’re also turning on the McKesson Horizon Patient Folder, and that system will be the repository of all transcription and any residual paper in our hospitals. So any residual paper that, for some reason, still exists despite Soarian will be scanned. We’ll have a complete 100 percent paperless environment. We also, about a month ago, turned on Sentillion’s (recently acquired by Microsoft) single sign-on. So you sign on once and that allows you to automatically get to three or four of their applications. That’s the acute side.
GUERRA: What systems will you be using Amalga to pull data from?
CAMPANELLA: The way it works is you feed data into it. We have 22 data sources feeding into Amalga real time. So unlike a data warehouse where you typically put data in the evening or once a week or every couple of days, as the data is generated in its source system it then gets fed real time into Amalga.
Once it’s there, you can slice and dice it and present it in dashboard format to the user. The number of views that you can build are infinite, and because you can tie the views to a person’s Microsoft active directory identification, you can very readily manage what particular views a person sees. So you can have views just cleared for a single doctor like “doctor X’s patients today at Virtua” and it would have, for example, a list of his patients that are in-house, a list of patients that are in the emergency department at the moment, a list that got discharged yesterday and are at nursing homes, or they got discharged last week and they’re still getting home care.
And so it allows these customized aggregations of data, and then you can present them in dashboard format. Things like: who’s in house right now with potential flu, based on their lab tests, all sorts of filtering that one can do and then put out the data in dashboard format. So that’s really the main reason, and then the secondary reason is using it as a more traditional analytical tool where you’re doing data analysis, data mining retrospectively.
GUERRA: Are the doctors intuitively able to jump on that and start building queries or do you need specialists to assist them?
CAMPANELLA: There are some shortcuts to customizing certain views. Others, you have to have someone create. With so much data in the system, you need an analyst to interpret what your needs are and make sure that the right data was pulled and presented and formatted. But others are easy, like when you set certain views, you can hide columns, you can apply different filters. So you have certain views that are very straightforward like, “all my patients in the hospital today,” but if you want to easily filter out patients who were just admitted this morning or patients who are on particular floor, or patients who are at this hospital versus that hospital, all that can be done more or less on the fly.
GUERRA: Talk about your strategy for the outpatient environment.
CAMPANELLA: We went live in August on a Soarian Enterprise scheduling product, which allowed us to combine all of our radiology and physical therapy scheduling onto one system, and we’re slowly but surely adding other ambulatory departments on to that system.
In the month of October, we signed two contracts – one with NextGen for the physician EMR and one with Wellogic, as I mentioned, for the HIE. We sent 1,100 letters out to our voluntary physicians offering the use of NextGen. So we got tremendous response, and we had three public information sessions. We have over 100 physicians who are in active due diligence right now, studying whether they want to fully sign on or not.
GUERRA: What are the specifics of the package you’re offering them?
CAMPANELLA: Basically, for the one-time fees for NextGen, we’re subsidizing 50 percent. So the doctors will be handing us $8,000 and, in turn, they get use of the license and the one time setup and training services. They, of course, have to pay for their own local hardware in their offices. So the real cost is $16,000, but they’re paying $8,000 and that’s per doctor. We’re also subsidizing the monthly maintenance fee at 80 percent. So we’re paying $240 out of the $300 monthly maintenance fee, and that includes telephone support and version upgrades of the software, the normal kinds of things you do to maintain software.
Our second offering is an EMR-light, and that is a Wellogic product. So we’re also subsidizing that at approximately 50 percent for the one-time fee, and the cost to the doctor is $2,500. Their monthly fee is $60.
Then, of course, there is the HIE itself, which is really a data exchange platform. They get that at no cost. I mean there’s no license cost for them to view HIE data. They’re basically viewing a portal of data that would otherwise be faxed to them or mailed to them. Now, if they want the data actually pushed to them into their EMR, then they will have to pay for the interface to receive the data. We, of course, will send the outbound messages – that’s just a normal part of the HIE software.
So it’s a very, very attractive program. We’ve just heard indirectly that ours is one of the best people have heard of.
GUERRA: And you are allowing them to keep any HITECH reimbursements they get?
CAMPANELLA: Oh yes. They’re paying us upfront. By law you cannot loan them monies for the EMR. So they have to pay upfront then, as the incentive payments come in, they would keep those monies.
GUERRA: Have you heard about the deal at North Shore Long Island Jewish? They went with Allscripts.
CAMPANELLA: Allscripts, yes.
GUERRA: It seems most ambulatory licenses are actually being bought by the hospitals and distributed under Stark to the practices. Do you see that as well?
CAMPANELLA: Yes. Again, why? Because the health systems can buy in bulk and provide implementation services, either on their own or in conjunction with the vendor. They can act as an advocate for these physicians who really do not have – many of them – a good knowledge base of how to buy an EMR and what to look for.
And I think it’s kind of a perfect storm at the moment. You have the president of United States continually talking about EMRs. You have the insurance industry talking about pay per performance and moving towards more of a case reimbursement, you have hospital systems that want to work more closely with their physicians for better patient care. You have the incentive payments. Finally, you have the Stark Law exemptions which expire in December 2013. So if they’re going to take advantage of that law, now is the time to do it. Once that all goes away, there’s one less reason to do it.
GUERRA: Under the Stark relaxations, there was a rational dissemination of EHRs into the ambulatory world, as it moved through the hospital. Under HITECH, you could have a Wild West environment where you have hundreds of practices in your area on dozens of systems. Does that analysis make sense?
CAMPANELLA: Yes, it does. Going through the hospital thins out the number of potential EMRs in the community, absolutely. You get more of a critical mass around a particular system. I think some systems are offering two or three EMRs which is very expensive. That kind of defeats the purpose of getting some economy to scale around support.
GUERRA: Are you doing anything around the PHR?
CAMPANELLA: Through our relationship with Microsoft, we’re going to offer Microsoft Healthvault. We are in discussions right now with Microsoft and one of its custom development partners regarding the actual user interface. Healthvault, per se, is a database (not a PHR) where the data resides. We’ve explored different commercial PHRs that would sit on top of Healthvault, and we’re in contract negotiation now with a particular company. That will be offered to our patients as well, and we will push data from Virtua’s Amalga system, where we have actually aggregated our data, to the personal health record. So things like Apgar scores, patient discharge instructions, pre-surgical instructions, allergy lists, medication lists, things that are understandable to patients – we will make those available in the PHR.
And then, secondly, in our home health agency, we are going to be taking data from home medical devices. They will also, through Microsoft’s API, come into Healthvault. So we’re excited at that. We have a good working relationship with Microsoft.
Also, two weeks ago, we signed a contract with GE, and we’ll be installing their bed management system.
GUERRA: Tell me a little bit about that.
CAMPANELLA: Commonly they call them RFID systems. We’re going to tag patients, as well as movable objects in the hospital, wheelchairs, biomed devices, and we’ll be able to electronically track them and, in real time, manage anything that moves. So it’ll help us better manage the patient flow to make sure our bed usage is maximized, patient waiting times throughout their hospital’s stay are minimized, flow of patients from the emergency department through the acute care side is as efficient as possible. And then for asset management, of course, we have 10,000 movable items in the hospitals, wheelchairs, beds, biomed devices, it will help us manage those better. We’ll be doing that next year as well.
GUERRA: It sounds like you are busy man, my friend.
CAMPANELLA: I really am, Anthony, but I love it. I have an awesome team. The entire organization and executive team are extremely supportive of what IT can do. It all supports our culture and mission.
GUERRA: I’m going to ask you one more question that I’ve been dying to ask someone.
GUERRA: It’s a CIO lifestyle issue. Especially with everything going on today, how do you keep a reasonable work/life balance?
CAMPANELLA: I rewrite my entire to-do list every day. I judiciously delegate, hopefully without over-delegating (laughing).