Transcript:
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Jordan Cooper
We are here today with Doctor Dave Rich to see Mio West Virginia University health system.
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Jordan Cooper
Dave, thanks so much for joining us today.
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Rich, David
Thanks for having me, Jordan.
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Jordan Cooper
So for those who don’t know, West Virginia University health system is a 23* (correction) hospital health system spread across four States and based in Morgantown, WV with 3000 beds and 30 thousand employees and 4200 providers and APPs.
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Jordan Cooper
So Dave, you’ve mentioned, is there a different number of providers?
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Jordan Cooper
How many?
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Rich, David
Yeah, I think I E.
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Rich, David
About 3000 providers is our number.
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Rich, David
So I I think the bed number is off.
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Rich, David
I’m sorry.
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Jordan Cooper
OK, well, in any case, there are a large system across four states in West Virginia now, Dave, you’ve mentioned that you’ve been working to bring all hospitals on EPIC by 2024.
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Jordan Cooper
Could you speak to how you’ve been going about integrating specialty tertiary and quaternary care to date and how that will look post epic implementation for example with any new acquisitions that aren’t already on Epic, how will you handle that?
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Jordan Cooper
How will you handle ingestion of other external data?
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Jordan Cooper
What’s integration looking like now and in the future?
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Jordan Cooper
Post epic?
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Rich, David
Great.
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Rich, David
Well, that’s a big question.
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Rich, David
Is, as you said, we’re up to 202324 hospitals.
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Rich, David
We’ve been growing over the last couple of years and part of that growth is not just a a partnership between the hospitals, but we found our secret sauce is to get the electronic record and supporting infrastructure in place as soon as we can as we bring on those additional hospitals.
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Rich, David
So we’ve been on this path where the relationship start?
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Rich, David
Uh, the the acquisition journey begins.
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Rich, David
And then we are close behind with respect to the IT team to make sure we can get our EMR in place, which is Epic.
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Jordan Cooper
What are some of your challenges with interoperability?
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Rich, David
Yeah, there’s as we approach each of the hospitals, they they have some legacy systems that we have to decide.
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Rich, David
You know, we can.
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Rich, David
Can we keep her?
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Rich, David
Can we change over to our systems really that I would say the biggest challenge we face is that legacy data and we do have a plan for archival of that data from whichever the hospital.
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Rich, David
It may be that takes more time, so we we’ll get our electronic medical record in place, but then we have to work towards archiving that data and making it available through a standard means.
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Jordan Cooper
And what are some of your top challenges when you think about archiving data?
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Jordan Cooper
Is that both clinical data and non clinical data and are your top concerns kind of legal compliance?
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Jordan Cooper
If there were a need to pull up that data due to a patient request or a pending lawsuit, what is the driving force?
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Jordan Cooper
That’s kind of shaping your decision about how to archive your data.
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Rich, David
Well, all the ones you mentioned are important.
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Rich, David
Clinically, we find that most of our clinicians rely more on the current data over time.
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Rich, David
So yes, during that transitional period, it’s it’s nice to be able to access the old system and look at the data from the previous visit or the last hospitalization.
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Rich, David
But over time, the cure, the record for the patient evolved.
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Rich, David
So the clinicians don’t look back to the historical data quite as much, but certainly for release of information purposes, that’s important for any we go cases or implications, we certainly need to have that.
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Rich, David
But most of the clinicians are looking forward in terms of the clinical data.
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Jordan Cooper
Are there any other use cases for archive data?
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Jordan Cooper
For example, population health, quality reporting, measurement, risk based payments, or any sort of other use cases that are driving your need to access this data.
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Jordan Cooper
And again, is the data all clinical or is it also AR is it claims?
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Jordan Cooper
Is it other sorts of data too?
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Rich, David
Ohh, it is both and we you know.
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Rich, David
Sorry, archive different data in different places for population.
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Rich, David
Help perspective.
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Rich, David
Yes, we wanna know for certain health maintenance items, IE colon cancer screening, breast cancer screening, we definitely rely on that historical data to make sure that we’re keeping track with patients.
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Rich, David
So.
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Rich, David
So that’s often what the clinicians are asking for in terms of the data that they would like to see.
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Jordan Cooper
And is there research that’s being done at WVU that relies on that?
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Jordan Cooper
Sort of historical data?
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Jordan Cooper
Or is it more just to support the frontline clinicians?
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Rich, David
Mostly to support the frontline clinicians.
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Jordan Cooper
Umm.
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Rich, David
Uh, I can’t speak to a specific research project that’s looking back at historical data, but I’m sure there are some.
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Jordan Cooper
Got it.
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Jordan Cooper
Now, another priority, shifting topics a bit that you said and and at WVU is working to keep healthcare local while preserving local jobs, especially due to kind of some of your catchment area being rural in nature.
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Jordan Cooper
You may be a significant employer in certain markets.
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Jordan Cooper
Can you talk more about what you’ve been doing to keep health care local, the benefits of doing so and preserving local jobs, how you’ve been able to accomplish that?
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Rich, David
Yes, is in a time when you see or you read about hospitals closing in different parts of the country.
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Rich, David
Uh, we’ve been able to partner with some of the smaller hospitals, particularly in West Virginia and rural areas, critical access facilities who may not have survived independently, were able to partner with them and give them the infrastructure with respect to the medical record and the the other related infrastructure for billing, so that they can stay open, serve the community and in many cases grow programs there.
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Rich, David
So we once we build that relationship with our hospital, we identify the programs they have made, the programs, they don’t have that the Community needs.
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Rich, David
So we’ve often seen a growth in in jobs for those specific facilities and the communities and the folks in the community like it, they can get their healthcare locally and those who have jobs in healthcare often can stay in that community and and work and contribute locally.
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Jordan Cooper
Could you elaborate on some of the programs that have grown out of those partnerships?
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Rich, David
The in terms of clinical programs in in many of our hospitals, in addition to placing primary care general Pediatrics practices in those communities, we built up more of our our Heart Vascular Institute care.
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Rich, David
So cardiology care in in those regions and again you can think of other regions that that didn’t have surgery programs and were were finding surgeons who can work in those communities and serve those communities.
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Rich, David
Yes.
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Jordan Cooper
So kind of opening up new service lines to those rural communities are there.
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Jordan Cooper
What are the financial incentives or WVU to engage in preserving those kind of those, those local hospitals, right there are critical access hospitals.
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Jordan Cooper
You’re going out there.
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Jordan Cooper
You’re giving them access to your EHR, to your billing infrastructure other than kind of doing the right thing, is there a financial incentive or are these programs a complete hit on the hospital and they’re just provided as a community benefit?
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Rich, David
I I I don’t wouldn’t see them as a hit on the hospital.
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Rich, David
I I think the general incentive is that with connected care, we’re able to feed some of the specialty care to other parts of the state when when needed.
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Rich, David
And so in addition to providing the necessary care for the patients that care is is coming through our specialty network.
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Rich, David
So that’s an advantage.
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Jordan Cooper
Mm-hmm.
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Rich, David
But but I I really think the mission of our organization is to provide care across the state to focus it.
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Rich, David
So I I it’s more mission oriented.
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Jordan Cooper
Got it.
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Jordan Cooper
But OK, so mission oriented first, but also there’s a added benefit of driving referrals to WVU specialty practices.
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Rich, David
Yes.
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Jordan Cooper
And then finally on this topic, I’m interested since this is healthy data podcast, I’m interested to ask you about some of the technological challenges associated with these partnerships with these critical access hospitals.
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Jordan Cooper
Have there been challenges with enabling providers to hook up to your EHR?
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Jordan Cooper
I guess epic and in the future, are there technological challenges with ingesting imaging from external labs from external providers?
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Jordan Cooper
What sort of technological challenges you have with ingesting data and ensuring that providers are operating in the same space?
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Jordan Cooper
When you’re servicing these populations?
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Rich, David
Yeah.
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Rich, David
The general infrastructure challenges are making sure the bandwidth is there for Internet and and high speed connectivity.
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Rich, David
So sometimes we’ve had to overcome that with some of the facilities and and make sure the infrastructure is there for the outline clinics who, many of which didn’t have electronic medical records in place.
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Rich, David
So getting past those barriers again, we use the same infrastructure.
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Rich, David
So the exchange of data, once we have those areas live the exchange of data is instantaneous.
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Rich, David
And when I go to our go lives across the system and talk with the providers, that’s their kind of ah, ha moment.
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Rich, David
The day they go live, is it?
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Rich, David
Wow, I can see everything that happened up in Morgantown.
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Rich, David
We’re a different part of the state instantaneously.
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Rich, David
Now that I have access, so you know you do have the occasional folks who you know, if we think about COVID and remote care and folks not being on site, you have the occasional provider who doesn’t have the level of service or connectivity at their home site.
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Rich, David
We work through that as well.
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Jordan Cooper
A number of follow up questions there.
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Jordan Cooper
I are these rural access hospitals.
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Jordan Cooper
Are they accessing the Internet through broadband or satellite connections?
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Rich, David
Broadband.
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Jordan Cooper
Yeah, broadband.
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Jordan Cooper
OK.
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Jordan Cooper
And and so you said that the exchange of data is instantaneous.
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Jordan Cooper
I’m wondering if there’s any kind of if there’s lag with your maybe H high availability or disaster recovery sites or mirroring.
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Jordan Cooper
Since data centers may be located far away geographically from West Virginia and the broadband kind of download upload speed may not be as high as in other areas of the country, are there any lag issues due to geography?
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Rich, David
We’ve not seen that.
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Rich, David
And again, our our technical folks do that assessment well ahead of our transition to make sure that they have the pipeline, so to speak, for that capacity.
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Jordan Cooper
Got it.
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Jordan Cooper
And so telemedicine isn’t impaired at all due to connectivity issues.
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Rich, David
It has not been.
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Jordan Cooper
Cool.
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Jordan Cooper
Alright, moving on to engagement, I know that the topic of patient engagement in the rural setting of care through the my WVU chart is an issue that you’ve published on previously.
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Jordan Cooper
Do you have any thoughts about kind of what your goals are, where you’re looking to go in terms of patient engagement through the WVU chart app, where you’ve been what you were able to accomplish and hurdles that you overcame?
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Rich, David
Yeah.
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Rich, David
We just hit this last month.
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Rich, David
We hit over 800,000 patients who are active in our my chart instance, so that’s great milestone.
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Rich, David
I’d love to see us reach the million mark, maybe next year or the following year.
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Rich, David
And as a clinician, he should engagement understanding of their record involvement in their record is very helpful.
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Rich, David
We find that that helps improve outcomes.
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Rich, David
More engaged patients are the more likely they are to either follow instructions, seek care when necessary, and just generally be engaged in their care.
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Rich, David
There’s some convenience aspects of that that we’ve been working on self scheduling so that patients can schedule when it’s convenient for them based on availability.
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Rich, David
We’ve done some things in the self check in space where patients can do most of the check in without having to spend a lot of time in our front desk.
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Rich, David
We, as I know at a topic you know.
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Rich, David
High on everyone’s list is patient messaging to their providers.
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Rich, David
Uh.
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Rich, David
While we know that that can be overwhelming at times, I think that’s a great way of for patients to be able to connect and ask relevant questions of their providers.
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Rich, David
And then their providers and care teams can determine, OK, do you need to be seen for that or is that something we can address without having to have a office visit too?
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Jordan Cooper
So on that last topic, you know a goal is often more patient engagement in their own kind of care plan with patient centered care and and and and that’s obviously an admirable goal.
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Jordan Cooper
But as you just mentioned, significant engagement with patients may lead to an increase of patient messaging and sometimes that could inundate providers and adversely impact responsiveness to potentially urgent messages.
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Jordan Cooper
Have you been seeing that challenge?
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Jordan Cooper
And if so, have you been trying to address it at all?
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Rich, David
Yeah, we’ve definitely seen an increase in patient messages that coincided with the pandemic.
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Rich, David
I think it also also was sort of driven by the 21st Century Cures Act and increased transparency of the record.
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Rich, David
So we get more patient questions about information they see, which is a good thing.
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Rich, David
So we’ve definitely seen more and the the thing that we all wrestle with is those messages come in at all hours of the day and during the working part of the day, our clinicians are seeing patients in the office.
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Rich, David
So they don’t have as much time to look at those messages during the day.
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Rich, David
And of course, after the day’s over, they go home.
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Rich, David
We want them to be with their families.
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Rich, David
Rest recuperating all that.
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Rich, David
So we are trying to look at ways to triage those messages across all hours and then queue up those things that the physicians providers need to address so that they’re not constantly trying to go back to their in basket.
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Rich, David
In our case, to to look for those messages.
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Rich, David
So we’re working on that.
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Jordan Cooper
Any AI solution to address that challenge?
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Rich, David
We we are our vendor.
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Rich, David
Epic has an AI solution that will read, read the patient messages and and draft responses.
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Rich, David
So we’ve not yet done that, but are on a pathway to do that.
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Rich, David
And we’ve looked to the experience of others, most notably, you see San Diego and Stanford, who’ve had some of the earliest experience in that space, drafting responses to patient messages still don’t want to send those responses until a clinicians reviewed them.
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Rich, David
But if it can save the clinician time and and provide a an appropriate response to the patient, we think that’s great.
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Jordan Cooper
Umm, there’s another topic.
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Jordan Cooper
I think that’s very particular to to certain areas of the country.
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Jordan Cooper
I know you’ve you’ve written about the opioid abuse and prevention of opioid abuse using technology.
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Jordan Cooper
Is that been an issue that continues to be present for West, West Virginia Medicine?
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Rich, David
Yes, opioid crisis is still a crisis across the country.
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Rich, David
Uh, West Virginia and the region are certainly the epicenter of it.
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Rich, David
For many, yeah, we are definitely using technology in that space.
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Rich, David
You know, a lot of the just connecting to state based resources to see what has been prescribed for a patient previously that used to be a very manual process where users had to go to a different database login, get information, go back to there medical record.
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Rich, David
We have that integrated so that with one click our providers can check not only across our own state database, but other state databases that are collaborating.
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Rich, David
We can see that information, so that’s at the point of prescription.
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Rich, David
We have that information.
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Rich, David
We also do things looking for those at risk for overdose and suggesting Co prescription of Narcan, which is a reversal agent.
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Rich, David
So we’ve been doing things in that space as well.
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Jordan Cooper
I.
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Rich, David
We’re also, you know, moving away from opioids.
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Rich, David
We’ve we’ve done some work in the space of care plans, order sets and clinical guidance to suggest alternatives to opioids for those things that most commonly have for for those situations, back pain and other things that folks would have commonly prescribed opioids for in the past.
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Jordan Cooper
So we are approaching the end of this podcast episode.
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Jordan Cooper
We certainly have covered a lot of ground.
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Jordan Cooper
I’d like it to open it up to you, kind of with an open ended question if if you could wave a magic wand.
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Jordan Cooper
What’s maybe the number one priority?
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Jordan Cooper
What’s the number one challenge that you would wish to go away?
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Jordan Cooper
What’s the biggest kind of obstacle or headache that’s keeping you up at night?
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Jordan Cooper
At least technically from technical perspective that you would love to see resolve, where’s kind of the gap between where you are and where you would like to be.
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Rich, David
Uh, well, we’ll call it technical and clinical.
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Rich, David
The documentation burden for providers and staff nurses too, has grown tremendously over the years.
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Rich, David
It it’s part of that regulatory based.
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Rich, David
There’s some other factors which we could go on for a long time talking about, but if I could make that easier such that clinicians could do their care throughout the day, speak to the things that need to be captured in documentation and move on, we’d we’d have a much more energized workforce, I think so ambient listening is is one of those things that shows great promise.
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Rich, David
Other other tools you know, flow sheet macros and other things for nursing are also important.
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Rich, David
But if I could reduce that documentation burden, that would make, I think that would have a great impact on on burnout in the healthcare.
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Jordan Cooper
Well, Dave, I do appreciate your time.
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Jordan Cooper
We’ve come to the end of this podcast episode for a listeners this has been Doctor Dave Rich, the CMIO West Virginia University health system.
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Jordan Cooper
Dave, thank you so much for joining us today.
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Rich, David
Thank you.
0:18:34.340 –> 0:18:34.690
Rich, David
My pleasure.