One Patient. One Record. That’s the philosophy at Contra Costa Health Services, where David Runt is Chief Information Officer. Their uniquely structured health department has everything health-related under a singular patient record, all fueled by Epic. They’re most healthcare organization’s dream. Runt considers himself fortunate to be a part of it. In this interview, he discusses CCHS’s transition from build to buy, including the sunset of a large amount of legacy systems; their data warehouse good fortune; why their data retention standard is “forever”; and how CHIME stands out from other industry events.
CHIME Fall CIO Forum provides valuable education programming, tailored specifically to meet the needs of CIOs and other healthcare IT executives. Justin Campbell, of Galen Healthcare Solutions, had the opportunity to attend this year’s forum and interview CIOs from all over the country. Here is the next interview in the series:
Our philosophy is one patient, one record.
Use those talented internal development resources to build niche product for customers that you can’t buy.
However, that served as the foundation to feed data into Epic. All of our data is going into the warehouse. It’s fantastic, the amount of data we have at our fingertips now. It’s revolutionizing our capabilities.
Our philosophy is to retain the data forever. Given our model, we don’t lose patients, so to speak, to our competitors.
Don’t be everything for everybody. Pick your niche. Get successful there and make a name for yourself there.
Campbell: Please tell me a bit of about yourself and your organization.
Runt: I’ve been with Contra Costa Health Services for eight years. I was in Arizona for ten years prior to that. Contra Costa Health Services is a county health department. We are probably the only one in California that’s structured the way we are, in that everything “health” related falls under one patient record. This means that, public health, mental health, EMS, hazmat, health plan, hospital clinics, everything falls under one health officer. We provide health in five jails across the county as well. In our organization, public health reporting falls under one umbrella, with health services & traditional hospital clinic structure falling under the other umbrella. As a result, we have a lot of flexibility in managing health across the enterprise.
Our philosophy is one patient, one record. Whether that patient is seen in our hospital, our clinic, in our psych emergency room, in the jail, in public health – we know everything about them. We’re fortunate that we have that data in one location and we don’t have to coerce the data out of a perceived competitor such as the health plan or public health, like the other county health IT departments have to do.
Campbell: What platform do you leverage for the EHR?
Runt: We’re leveraging Epic across the enterprise. We’ve got it in the five detention facilities, as well as in our health plan. We’ve deployed it in behavioral health, in our own behavioral health clinics, and made it available to our network providers as well. We’re not selling services, but rather we’re giving the providers portal access for their patients. In this next year or so, we are rolling it out more into the public health space.
Campbell: That’s exactly where your peers want to be. In talking to a lot of other folks, they have one system on the outpatient side, and a different system on the inpatient side. As a result, harmonization of nomenclatures and dictionaries between the two systems, as well as reconciliation of the data poses to be an ongoing challenge.
Runt: Not to mention your health plans on another system! I could not imagine trying to get payer information on your own patients with that model. My counterparts are just pulling their hair out and feel fortunate to be where we are.
Campbell: It allows you to focus for sure. Speaking of that focus, tell me a little bit about your application portfolio, outside of EHR. How big is the portfolio? Are there legacy systems that are sort of sitting in the corner?
Runt: Everybody has the legacy systems. When I got there, we were a cat and dog shop. We were a development shop and I had 50 developers on staff. They were actually writing—which got killed before I got there—a patient appointment system. Really that’s a commodity, you buy that, so a lot of these things were sunset when I got there. We turned the organization into a buy instead of a build. We had a LOT of cats and dogs, best of breed systems. We were the poster child for the best of breed shop. As a result, bringing in Epic proved to be tremendous, as we sunset somewhere around 75-100 systems. Some of these were just little Access databases sitting on someone’s PC, but we were able to sunset a lot of that and reduce a lot of the ongoing licensing, maintenance and support costs.
We’ve gotten out of the “build your own stuff” mentality except for specialty areas such as environmental health, where you have an underground storage tank inspection system for instance. You can’t buy applications like that, so we build those. We use those talented internal development resources to build niche products for our customers that we can’t buy.
I am very fortunate that we’ve had a data warehouse for well over 15, maybe 20, years. It wasn’t very populated, in fact it was primarily financial data, because of these cat and dog systems. However, that served as the foundation to feed data into Epic. All of our data is going into the warehouse. It’s fantastic, the amount of data we have at our fingertips now. It’s revolutionizing our capabilities.
Campbell: Data liquidity cures all. Now when you went through that consolidation process, did you archive the data into that data warehouse?
Runt: Most of the data was already there. Those cat and dog systems, the ones that were sitting on somebody’s desk, we probably didn’t need that data anyway. It was Excel spreadsheets, or Access databases – those really didn’t have an impact on the business overall. Some of those systems that we sunset, we just took the data, imported it into SQL and populate it into the warehouse.
Campbell: That’s a critical point. The archival strategy whitepaper we discussed examines the tradeoffs, when you extract data from a legacy system and you store it because inherently you’re changing the shape of that data. You’re changing the shape of it to store that data; you’re changing the shape of it to present that data. There’s also metadata and audit trails considerations. All that said, looking back on what was your archival strategy and how did you handle it?
Runt: We did not have an EHR. We had MEDITECH primarily for billing and ADT functions, and consequently, we didn’t have much clinical data in there. A year after I got there, CCHS finished a painful implementation of ED, and that’s the only clinical data we had. That was already in the data warehouse – we took it from MEDITECH and populated the warehouse. Other than that, it was billing information from our third party billing systems. We really didn’t change the shape of the data that much.
Campbell: Shifting gears a little bit, I’d like to get your perspective on data retention requirements. I’ve been talking to some of your peers about the fact that most states require persistence of the data for 7-10 years. A lot of EHR vendors don’t allow the ability to purge and there may be some instances when you do you want to purge that data. For instance, when that patient is no longer yours, you’re no longer seeing that patient, yet you still have their data so there’s still some liability associated with that if there’s an eDiscovery request.
Runt: Our philosophy is to retain the data forever. Given our model, we don’t lose patients, so to speak, to our competitors. Being the county, we serve a unique, well-defined, patient population. Yes, some people will flow in and out of the system, depending on their economic or social background, but for the most part we retain our patients. So we want that birth to death record to be available, wherever that patient may present. The patient could move around the county, but they’re still going to be seen in one of our clinics.
Campbell: And does Epic natively allow for ease of eDiscovery if you have an inquiry for a record? Or do you go to the data warehouse?
Runt: We go to the data warehouse for that.
Campbell: Shifting gears again, let’s talk a little bit about CHIME. Certainly the networking aspect alone is unparalleled. Tell me a little bit about how long you’ve been coming to CHIME and what you are looking to get out of it, specifically, this year as it relates to your initiatives.
Runt: I’ve been in healthcare IT for 36 years and have been a CHIME member for about 15 years or so, maybe longer. It’s much better than other industry events in that you have the one-on-one interaction with your peers. CHIME gives you the opportunity to reconnect with peers whom you have a relationship, and also connect with the important vendors. Other events have 20,000 vendors there and half of them won’t be around the next year; half of them aren’t relevant to the types of things I’m focused on.
It seems that only the “cream of the vendors” are associated with CHIME. It gives you the opportunity to interact with them, have meetings and meals with them, social interaction with them, which for me has been a benefit. Unlike CHIME, I don’t go to other events for the sessions, I go there to talk to vendors. The sessions at CHIME are different from a lot of industry events and conferences in that they are educational and not sales driven.
Campbell: It’s just more focused here.
Runt: Exactly. It is more focused, and I wish there were more organizations like CHIME for non-healthcare because there are a lot of good ideas out there in the marketplace around data, around PMO activities, and other things that are not purely healthcare-related.
Campbell: Lastly, focusing on HealthIT & mHealth’s audience, which are startups and entrepreneurs, do you have pieces of advice for them? How does a niche, small, little-known startup- vendor capture your attention? A lot of these startups are jumping into the fray with patient engagement solutions and if you really look at it, are they really solving a problem for their end customers? This is a very broad question, but if you have any piece of advice for startups and entrepreneurs entering into the healthcare space what would it be?
Runt: Don’t be everything for everybody. Pick your niche. Get successful there and make a name for yourself. We’re doing business with some small vendors who were probably startups five years ago. They’re small, they’ve got their niche product or their niche service, and they don’t want to be everything to everybody. Stay true to your initial idea and your initial concept. Answer the questions of ‘Why did you go into business? What need does your services or solution address?’
This interview has been edited and condensed.