S2E4 Locally Driven Healthcare and Integration (ft. Dr. Dave Rich, West Virginia University Health System)

Jordan Cooper 0:23
So Dave, you've mentioned, is there a different number of providers?

Jordan Cooper 0:29
How many?

Rich, David 0:29
Yeah, I think I E.

Rich, David 0:32
About 3000 providers is our number.

Rich, David 0:35
So I I think the bed number is off.

Rich, David 0:36
I'm sorry.

Jordan Cooper 0:37
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.

Jordan Cooper 0:49
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?

Jordan Cooper 1:02
How will you handle ingestion of other external data?

Jordan Cooper 1:04
What's integration looking like now and in the future?

Jordan Cooper 1:07
Post epic?

Rich, David 1:08
Great.

Rich, David 1:08
Well, that's a big question.

Rich, David 1:10
Is, as you said, we're up to 202324 hospitals.

Rich, David 1:16
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.

Rich, David 1:35
So we've been on this path where the relationship start?

Rich, David 1:40
Uh, the the acquisition journey begins.

Rich, David 1:42
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.

Jordan Cooper 1:51
What are some of your challenges with interoperability?

Rich, David 1:55
Yeah, there's as we approach each of the hospitals, they they have some legacy systems that we have to decide.

Rich, David 2:03
You know, we can.

Rich, David 2:04
Can we keep her?

Rich, David 2:05
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.

Rich, David 2:17
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.

Jordan Cooper 2:29
And what are some of your top challenges when you think about archiving data?

Jordan Cooper 2:33
Is that both clinical data and non clinical data and are your top concerns kind of legal compliance?

Jordan Cooper 2:39
If there were a need to pull up that data due to a patient request or a pending lawsuit, what is the driving force?

Jordan Cooper 2:48
That's kind of shaping your decision about how to archive your data.

Rich, David 2:54
Well, all the ones you mentioned are important.

Rich, David 2:56
Clinically, we find that most of our clinicians rely more on the current data over time.

Rich, David 3:04
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.

Rich, David 3:14
But over time, the cure, the record for the patient evolved.

Rich, David 3:18
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.

Rich, David 3:33
But most of the clinicians are looking forward in terms of the clinical data.

Jordan Cooper 3:38
Are there any other use cases for archive data?

Jordan Cooper 3:41
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.

Jordan Cooper 3:50
And again, is the data all clinical or is it also AR is it claims?

Jordan Cooper 3:55
Is it other sorts of data too?

Rich, David 3:57
Ohh, it is both and we you know.

Rich, David 4:00
Sorry, archive different data in different places for population.

Rich, David 4:05
Help perspective.

Rich, David 4:07
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.

Rich, David 4:18
So.

Rich, David 4:19
So that's often what the clinicians are asking for in terms of the data that they would like to see.

Jordan Cooper 4:25
And is there research that's being done at WVU that relies on that?

Jordan Cooper 4:29
Sort of historical data?

Jordan Cooper 4:31
Or is it more just to support the frontline clinicians?

Rich, David 4:35
Mostly to support the frontline clinicians.

Jordan Cooper 4:43
Umm.

Rich, David 4:38
Uh, I can't speak to a specific research project that's looking back at historical data, but I'm sure there are some.

Jordan Cooper 4:46
Got it.

Jordan Cooper 4:47
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.

Jordan Cooper 5:08
You may be a significant employer in certain markets.

Jordan Cooper 5:11
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?

Rich, David 5:20
Yes, is in a time when you see or you read about hospitals closing in different parts of the country.

Rich, David 5:28
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.

Rich, David 5:55
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.

Rich, David 6:05
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.

Jordan Cooper 6:22
Could you elaborate on some of the programs that have grown out of those partnerships?

Rich, David 6:29
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.

Rich, David 6:42
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.

Rich, David 6:59
Yes.

Jordan Cooper 6:55
So kind of opening up new service lines to those rural communities are there.

Jordan Cooper 7:00
What are the financial incentives or WVU to engage in preserving those kind of those, those local hospitals, right there are critical access hospitals.

Jordan Cooper 7:10
You're going out there.

Jordan Cooper 7:11
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?

Rich, David 7:26
I I I don't wouldn't see them as a hit on the hospital.

Rich, David 7:29
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.

Rich, David 7:41
And so in addition to providing the necessary care for the patients that care is is coming through our specialty network.

Rich, David 7:48
So that's an advantage.

Jordan Cooper 7:58
Mm-hmm.

Rich, David 7:50
But but I I really think the mission of our organization is to provide care across the state to focus it.

Rich, David 7:59
So I I it's more mission oriented.

Jordan Cooper 8:01
Got it.

Jordan Cooper 8:02
But OK, so mission oriented first, but also there's a added benefit of driving referrals to WVU specialty practices.

Rich, David 8:09
Yes.

Jordan Cooper 8:10
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.

Jordan Cooper 8:24
Have there been challenges with enabling providers to hook up to your EHR?

Jordan Cooper 8:30
I guess epic and in the future, are there technological challenges with ingesting imaging from external labs from external providers?

Jordan Cooper 8:43
What sort of technological challenges you have with ingesting data and ensuring that providers are operating in the same space?

Jordan Cooper 8:51
When you're servicing these populations?

Rich, David 8:54
Yeah.

Rich, David 8:54
The general infrastructure challenges are making sure the bandwidth is there for Internet and and high speed connectivity.

Rich, David 9:04
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.

Rich, David 9:14
So getting past those barriers again, we use the same infrastructure.

Rich, David 9:20
So the exchange of data, once we have those areas live the exchange of data is instantaneous.

Rich, David 9:26
And when I go to our go lives across the system and talk with the providers, that's their kind of ah, ha moment.

Rich, David 9:32
The day they go live, is it?

Rich, David 9:34
Wow, I can see everything that happened up in Morgantown.

Rich, David 9:38
We're a different part of the state instantaneously.

Rich, David 9:40
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.

Rich, David 9:59
We work through that as well.

Jordan Cooper 10:01
A number of follow up questions there.

Jordan Cooper 10:03
I are these rural access hospitals.

Jordan Cooper 10:07
Are they accessing the Internet through broadband or satellite connections?

Rich, David 10:12
Broadband.

Jordan Cooper 10:12
Yeah, broadband.

Jordan Cooper 10:14
OK.

Jordan Cooper 10:15
And and so you said that the exchange of data is instantaneous.

Jordan Cooper 10:20
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.

Jordan Cooper 10:31
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?

Rich, David 10:46
We've not seen that.

Rich, David 10:47
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.

Jordan Cooper 10:56
Got it.

Jordan Cooper 10:56
And so telemedicine isn't impaired at all due to connectivity issues.

Rich, David 11:01
It has not been.

Jordan Cooper 11:02
Cool.

Jordan Cooper 11:02
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.

Jordan Cooper 11:16
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?

Rich, David 11:30
Yeah.

Rich, David 11:31
We just hit this last month.

Rich, David 11:32
We hit over 800,000 patients who are active in our my chart instance, so that's great milestone.

Rich, David 11:39
I'd love to see us reach the million mark, maybe next year or the following year.

Rich, David 11:43
And as a clinician, he should engagement understanding of their record involvement in their record is very helpful.

Rich, David 11:51
We find that that helps improve outcomes.

Rich, David 11:53
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.

Rich, David 12:05
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.

Rich, David 12:14
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.

Rich, David 12:26
We, as I know at a topic you know.

Rich, David 12:31
High on everyone's list is patient messaging to their providers.

Rich, David 12:34
Uh.

Rich, David 12:35
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.

Rich, David 12:43
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?

Jordan Cooper 12:52
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.

Jordan Cooper 13:07
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.

Jordan Cooper 13:20
Have you been seeing that challenge?

Jordan Cooper 13:23
And if so, have you been trying to address it at all?

Rich, David 13:26
Yeah, we've definitely seen an increase in patient messages that coincided with the pandemic.

Rich, David 13:32
I think it also also was sort of driven by the 21st Century Cures Act and increased transparency of the record.

Rich, David 13:41
So we get more patient questions about information they see, which is a good thing.

Rich, David 13:46
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.

Rich, David 13:59
So they don't have as much time to look at those messages during the day.

Rich, David 14:03
And of course, after the day's over, they go home.

Rich, David 14:06
We want them to be with their families.

Rich, David 14:07
Rest recuperating all that.

Rich, David 14:09
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.

Rich, David 14:25
In our case, to to look for those messages.

Rich, David 14:27
So we're working on that.

Jordan Cooper 14:29
Any AI solution to address that challenge?

Rich, David 14:33
We we are our vendor.

Rich, David 14:35
Epic has an AI solution that will read, read the patient messages and and draft responses.

Rich, David 14:41
So we've not yet done that, but are on a pathway to do that.

Rich, David 14:44
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.

Rich, David 14:59
But if it can save the clinician time and and provide a an appropriate response to the patient, we think that's great.

Jordan Cooper 15:07
Umm, there's another topic.

Jordan Cooper 15:09
I think that's very particular to to certain areas of the country.

Jordan Cooper 15:14
I know you've you've written about the opioid abuse and prevention of opioid abuse using technology.

Jordan Cooper 15:21
Is that been an issue that continues to be present for West, West Virginia Medicine?

Rich, David 15:28
Yes, opioid crisis is still a crisis across the country.

Rich, David 15:32
Uh, West Virginia and the region are certainly the epicenter of it.

Rich, David 15:37
For many, yeah, we are definitely using technology in that space.

Rich, David 15:42
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.

Rich, David 15:59
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.

Rich, David 16:08
We can see that information, so that's at the point of prescription.

Rich, David 16:11
We have that information.

Rich, David 16:13
We also do things looking for those at risk for overdose and suggesting Co prescription of Narcan, which is a reversal agent.

Rich, David 16:23
So we've been doing things in that space as well.

Jordan Cooper 16:27
I.

Rich, David 16:27
We're also, you know, moving away from opioids.

Rich, David 16:31
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.

Jordan Cooper 16:51
So we are approaching the end of this podcast episode.

Jordan Cooper 16:54
We certainly have covered a lot of ground.

Jordan Cooper 16:56
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.

Jordan Cooper 17:03
What's maybe the number one priority?

Jordan Cooper 17:06
What's the number one challenge that you would wish to go away?

Jordan Cooper 17:09
What's the biggest kind of obstacle or headache that's keeping you up at night?

Jordan Cooper 17:13
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.

Rich, David 17:22
Uh, well, we'll call it technical and clinical.

Rich, David 17:26
The documentation burden for providers and staff nurses too, has grown tremendously over the years.

Rich, David 17:35
It it's part of that regulatory based.

Rich, David 17:39
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.

Rich, David 18:04
Other other tools you know, flow sheet macros and other things for nursing are also important.

Rich, David 18:11
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.

Jordan Cooper 18:21
Well, Dave, I do appreciate your time.

Jordan Cooper 18:23
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.

Jordan Cooper 18:31
Dave, thank you so much for joining us today.

Rich, David 18:33
Thank you.

Rich, David 18:34
My pleasure.