NTT Data

Ricardo Jorge Constantino, head of Clinical Innovation Europe at NTT DATA, describes innovation in clinical trials and measures to drive rapid adoption of insights from these trials into clinical practice.

Achieving the “payvider” business model, in health systems may establish their own health plan or partner closely with an existing payer, requires simplifying existing processes and bridging many information silos.

Healthcare systems with well-functioning electronic health record (EHR) systems often find that smaller hospitals and clinics in their service area are in no such shape, hard-pressed to afford and operate a top-shelf EHR that would immensely improve care and enable them to mesh digitally with larger referral systems. But there’s a way around this disconnect for both the IT haves and have-nots, to their mutual benefit. Organizations with EHR technical and operational acumen are extending their capabilities out to community or rural facilities through a program called provisioning. For example, UnityPoint Health, from its base in Des Moines, has connected its Epic EHR system to 18 hospitals and 62 clinics, while Providence St. Joseph Health, based in Renton, Washington, has provisioned 13 hospitals and 37 physician practices to date. For organizations seeking to expand their reach, provisioning is giving critical access and other resource-limited care facilities a reason to affiliate, said Brian Moreau, director of UnityPoint’s Community Connect unit, which packages the health system’s Epic EHR and related services for resale to others. Moreau called it “a big part of our growth strategy” and cited “a direct connection” between its success and “the growth of our community network of rural hospitals.” Several rural hospitals became affiliates specifically because they wanted to participate in the Epic Community Connect program, he said. Enhanced expertise, technology A dedicated team was set up to reorient everything from implementation to workflow around the needs of critical access hospitals. This has brought not only the particulars of EHR operation but also the evidence-based practices, quality improvement initiatives and analytics of a large system to rural providers via applications and tools that would be unaffordable for the small facilities that Epic does not target. “Sharing of best practices and elevating quality is the vision,” Moreau said, a vision that includes opportunities to network with other hospitals and to benefit from the more than 600 IT staff in UnityPoint’s employ, all working to improve access to data on patients shared by multiple providers and strengthening population health efforts.  Providence, also an Epic EHR user, bills the costs of licenses, third-party applications, the work of analysts and other services as a “pass-through” to affiliates, at no markup, to further the program’s affordability for largely rural, outlying facilities, said Sherry Maughan, vice president of the Community Connect program. The Providence St. Joseph program, which is accredited by Epic, has grown over the past several years and includes a breadth of services such as account management, operational support for contracting, invoicing and purchase order management. Physicians at affiliated rural practices and hospitals see the same record and user interface as clinicians working within the Providence St. Joseph Health organization, which includes Swedish Medical Center and Providence St. Joseph Health locations in western Washington and Kadlec Regional Medical Center in southeastern Washington and neighboring states. It makes for a seamless experience whether a patient is at a rural clinic or seeing a specialist in a Providence facility, said Rob Watilo, chief strategy officer for Providence St. Joseph Health, Southeast Washington service area. Seamless, efficient access When bringing provisioned doctors and hospitals into the existing Epic EHR system, from a patient clinical information standpoint, “it’s like that patient in the outlying community was seeing one of our primary care physicians or specialists ― it’s that seamless as far as access to information,” said Watilo. If a patient has to leave the community for additional care, it’s a much cleaner referral ― all medication lists, history and clinical information from the smaller hospital’s EHR are a touch away instead of scattered in faxes and scanned documents, he said. The family doctor can see specifics of what was done and any changes in medical picture after the patient returns home. Small hospitals gain information access and efficiencies in clinical care they could not have managed on their own, said Katie Heldt, chief nursing executive of Greene County Medical Center, a UnityPoint affiliate in Jefferson, Iowa. “We are very fortunate as a rural facility to have Epic as our electronic medical record; it helps us to be able to share patient information in a protected way, a consistent way that everybody understands.” At a Des Moines facility or an urgent care center, a doctor can seek a Greene County patient’s record and “it’s all right there,” Heldt said. “It saves time, it saves money, it’s efficient and reduces variability.” Best practices and standardization through Community Connect have improved outcomes in quality, which has bolstered clinician acceptance. Physicians still have the ability “to use their knowledge and think on their feet, but it does provide some guidelines for patient care, and it’s truly appreciated.”

Managed services organizations supply implementation and operational expertise to advance the capabilities of IT, both to relieve internal staffers of more mundane uptime duties and to supply the ready sophistication needed for specific applications and analyses. These companies have myriad combinations of technical and operational skill, and vendor selection can preordain the impact of managed services. IT in healthcare gets more complex and skill-dependent all the time. Care facilities both have to expertly implement new systems or upgrades and know how they can optimally serve clinical objectives. Outside assistance must be specific to healthcare, from clinical familiarity to cybersecurity idiosyncrasies, said Dawn Mitchell, an independent health IT consultant. “Be cautious with managed services providers that have been doing this in every other industry, recently moved into healthcare, and don’t have the internal expertise required to be successful,” she said. The services provider has to recognize healthcare demands such as responding very quickly when system problems put lives on the line, said Lee Kim, director of privacy and security at HIMSS. In managed services, critical shortcomings have a lower priority and are addressed belatedly or not at all, she said, adding, “You don’t want a dabbler in healthcare; you want someone with an established healthcare base.” Trusted partnership When Comanche County Medical Center needed to upgrade to the current priority pack of its EHR to meet meaningful-use requirements, it sought a managed services provider to do the implementation, add server capacity and manage operations, according to Ismelda Garza, CIO of the rural Texas critical-access hospital. The decision came down to expertise and a trusted partnership between the managed services provider and its EHR-specific hosting solution. The resulting close partnership with Comanche cannot be underestimated, according to Garza. “I generally see that other managed services are neither interested in becoming a true partner with my hospital nor ensuring we are successful,” she said. “Relationships are key.” The managed services firm should probe the customer to determine the best specific solution for the immediate term and then continually improve on it, Mitchell emphasized. “You really need to look for a partner, not a vendor,” she said. “It’s definitely not one-size-fits-all, and some vendors don’t have the flexibility required.” Expertise breadth and depth Expertise must be broad to effectively support hybrid IT environments and deep enough to meet the expectations of clinical and operational users, Mitchell said. Also, lack of depth in a level one service desk can delay problem resolution, increase the load for level two support, and frustrate physicians and other users who expect immediate resolution. Managed services staff should also be available to provide subject matter expertise and knowledge transfer to internal staff. “It’s a win-win when super-users can solve issues in the field, and they never have to call the help desk,” Mitchell said. End users get immediate resolutions and the number of service calls go down. Comanche’s managed service provider’s expertise is specialized ― teams for hardware, network, data backup and more ― which supplements the four-person IT staff at Comanche who “wear many hats,” Garza said. “Having our EHR system hosted allows my team to focus its priorities on other projects concerning patient care areas and other IT projects.” Solving problems at their roots All contracts should have service level agreements with metrics requiring quick problem resolution and nearly continuous uptime, as well as milestones for evaluating performance, but it’s just as important to categorize issues, address the root causes of recurring problems and fix them. “When your provider can identify that 20 percent of your calls during any given month come from a group of physicians who clearly need additional training, then you work together to make that change happen.” Mitchell said. “You reduce the number of calls, and your users are happy, more self-sufficient.” The services provider should have good reporting processes and tools to keep internal staff and users informed as to the status and estimated turnaround time-of-service requests. Long wait times and the lack of communication around them “are major dissatisfiers with service desks,” she said. Comanche’s services provider will “notify me of issues before I know of issues,” Garza said, and it keeps her continually informed through biweekly account rep calls, daily backup status updates and monthly reports on server availability. “It takes responsibility for issues or problems; it also works with [our EHR vendor] directly to resolve issues. All these things help contribute to my confidence in its ability.” Whether resolving a routine user access issue or planning to incorporate new breakthroughs in workflow automation, a managed services provider should always inspire such confidence, grounded in obvious know-how and the ability to put itself in the healthcare customer’s place.

Managed services allow organizations to offload routine IT tasks and to ensure they are getting the maximum value from their investment in their own IT team.