Dr. Hal Baker is in a unique situation as a CIO who is also still a practicing physician at WellSpan. As his organization finalizes their Epic transition plans, he recognizes the importance of having an integrated patient record across the system and creating new workflows to accommodate the 5 hospitals and over 100 practice locations that are all coming together. In this interview, he talks about his organization’s community-focused, health data retention practice, his plans for legacy application support, and the value of attention units in the healthcare industry.

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:

Key Insights

We quickly experienced the value of an integrated patient record across offices, which highlighted the previous disconnect between maintaining two separate records in an inpatient and outpatient setting.

We’re bringing over seven years of laboratory and clinical information for our patients. We recognize that’s more than typical, but we think there’s value in having that depth in the record for our community.

I’ve been through enough of these to know that everything looks good in a demo and you need to get through the first couple of weeks before you figure out what have been the great wins and what have been the great challenges you didn’t appreciate until you got there.

The reality is that the most significant innovations arise out of smaller startups who then become large. However, a majority of small startups aren’t successful, and most legacy systems persevere.

The currency of the business of healthcare is dollars, but healthcare is applied in a currency of minutes and each minute a doctor or nurse spends doing one thing is a minute they’re not spent doing another.

Campbell: What has your focus these days?

Baker: To provide some background, we’ve had a couple of mergers or acquisitions into WellSpan, that we are trying to consolidate. We have McKesson, MEDITECH, Cerner, Allscripts systems that we’re migrating to Epic.

Campbell: That’s a good launching point. I presume that decision was made to simplify the portfolio and to move forward with an enterprise standard for an EHR. Can you elaborate on your decision to consolidate applications, and maybe also elaborate on how your organization manages applications within the portfolio today? Do you have further consolidation plans in the future?

Baker: From an electronic health record perspective, we went live in ambulatory and inpatient in a best of breed approach for legacy WellSpan. At the time, it was hard to appreciate the value of an integrated medical record, when you had disintegrated paper records at each office. We very quickly started to see the value of an integrated patient record across offices, which highlighted the disconnect that occurs between the two separate records in an inpatient and outpatient setting. As we had other communities join WellSpan we recognized the need to consolidate around a corporate-wide solution. It didn’t make sense to further propagate our non-integrated solution—a different billing system vendor, and a different EHR vendor on the inpatient and outpatient side. That’s how we came to our ‘Project One”, of coming together with one record for all of WellSpan.

Campbell: Related to the topic of consolidating data, what are your thoughts on health data retention? I talked to some of your peers at CHIME and they had concerns over ‘hey I have to store this data for the patient but I may not care about a lab result for a patient that’s 8 years old, but I also have no way of purging that data.’ Is that something that you have an opinion on or you could perhaps go in a different direction with that topic in regard to the eDiscovery inquiries you get and how your organization manages that?

Baker: We are converting seven years of clinical data in our migration – we’re bringing over seven years of laboratory and clinical information for our patients. We recognize that that’s more than normal but we think there’s value in having that depth in the record for our community. We have an archival strategy put in place to retire our legacy applications.  With the absence of a rigorous purging strategy, the entire database record needs to be maintained for the longest patient whom you have a record retention requirement for. In our state that, would be last baby born on the old record plus 21 years plus 7 – so 28 years. Our statute of limitations is age of majority plus 7.

Campbell: That makes sense. In talking with another one of your peers, who’s migrating over to Epic as well, he discussed the considerations and challenges with migrating data from a legacy application over to Epic.

Baker: Right. There are three buckets to my mind: there’s the data you need to import into the database; there’s perhaps a subset of that, which is data that you don’t want to import in bulk, but you want the ability to import selectively as needed later on; then there’s the data that you need to have access to for when you need it. For example, I need to go back and look at the past reports from 15 years ago, but I don’t necessarily need to move every pathology report from 15 years ago into the record— rather I need to have access to it from your archive system. Then there’s the metadata that you either may need for population health or business purposes in the future that you haven’t recognized you need. This could be due to requirements from a legal medical auditing perspective or for quality or for billing purpose under statute of limitations for regulations.

Campbell: I imagine the legacy systems are going to have to have some sort of application support, how are you approaching that? Are you going to dedicate all your existing staff to the new application and seek outside back-fill to support the back-end, or are you taking the approach of have some people support the legacy application while others in their departments learn Epic?

Baker: We staffed up for Epic with a combination of experienced IS staff, experienced operational staff, and a few outside people. We got everybody trained and certified. For the staff who continue to support the legacy application who did not move into the Epic team, we generally supplemented vacancies there with contracted staff from some of our contract partners. A critical element was implementing a very tight change control for the legacy systems and limiting any nonessential changes.

Campbell: Very good. What’s been the sentiment around Epic? Being a provider and talking to the other providers, I’m sure you have a keen awareness. Is there a lot of excitement of moving to the application, given the seamless nature with which you’re likely to be able to access data across care settings in the new environment? Are there any apprehensions they may have?

Baker: I think any move of this magnitude is both exciting and challenging. Our providers are looking at this thoughtfully and are actively involved in it, but we’ll know more when we get into training and go-live. I’ve been through enough of these to know that everything looks good in a demo and you need to get through the first couple of weeks before you figure out what have been the great wins and what have been the challenges that you didn’t appreciate until you got there.

Campbell: Let’s discuss data governance as it relates to the migration. There are different departments and specialties that will have different nomenclatures and dictionaries that they need to manage. How is WellSpan Health going about managing those dictionaries and deciding on potential adjustments to workflows to accommodate the new system?

Baker: We’re designing new workflows in the Epic process because we’re bringing together 5 hospitals and over 100 practice locations, many that were on different electronic records.  We’ve had a conjoined effort to find new workflows that everyone will be moving towards, and it has been around data governance principles, having single points of truth, and standardizing nomenclature. The expectation is that all traditional behaviors are going to need to be worked into the new workflows and those traditions will need to change to accommodate the workflows.

Campbell: Very good. Let’s shift gears to CHIME a little bit. Tell me about your impressions this year. Was there a particular session you attended that resonated with you? I know that CHIME is valuable from a networking perspective but what were the themes you witnessed this year, and in talking with your peers, what were the common topics?

Baker: The most interesting parts of CHIME are hearing people figure out how to creatively leverage the data. I went to a talk with a doctor from Mercy Health, who shared their approach to leverage data topography to understand correlations occurring in their system that are clinically meaningful, but would otherwise not be recognized. For instance, they discovered that a diabetes nerve medicine use seemed to correlate with an earlier discharge for a knee replacement. That was a hypothesis that arose from the data that’s being validated rather than one that was thought of and queried. I think it’s going to get very interesting when we look at how can we leverage these databases to generate information, opportunities for improvement, and for when the data becomes the source of hypothesis versus it all being contemplated.

Campbell: For the startup audience that follows the Health IT & mHealth, what catches your eye when it comes to smaller organizations or vendors? CIOs tend to be risk adverse and they’re attracted to something that solves a problem for them and a vendor organization that’s sustainable. Tell me why you might consider a smaller startup and/or what are the areas that you see as an opportunity for them to address the market incrementally?

Baker: I think it’s honestly a calculated gamble on whether to strategically bet on a small innovator or a major vendor. The reality is that the most significant innovations arise out of smaller startups who then become large. However, a majority of small startups aren’t successful, and most legacy vendor systems persevere, but get caught in some degree of inertia that makes innovation harder.

Campbell: While at CHIME, Blain Newton, Executive Vice President, HIMSS Analytics, shared with me that one of the more profound discussions he had with you was on the topic of currency for healthcare information technology leaders. Can you share that story with us?

Baker: The currency of the business of healthcare is dollars but healthcare is applied in a currency of minutes and each minute a doctor or nurse spends doing one thing is a minute they’re not spent doing another. We’re worrying about the percentage of the time available in day that is spent at the keyboard versus the bedside; the amount of time holding a mouse compared to the amount of time holding a hand. We want to be judicious with how we spend the currency of minutes of our staff so that it balances the needs of the business – the information systems, and the communications that the records provide – with the needs that the human beings who need our care and attention receive.

As a leader, the currency of my work as a manger and executive is attention. I have to decide where to spend my attention units and be judicious with that because there’s the same opportunity cost.  That’s why I have great sympathy for startups because it’s very hard for me to give up attention units to them that I could devote to my organization – to listen to a cold call pitch on a product solution. It’s also very difficult to try to dissect through the presentation to understand what the true opportunities of the product might bring – how it compares to its competitors, and what are the risks and unintended consequences that it might have. There’s a real challenge there because most of us don’t have enough time to spend with all the people who need our attention inside our organizations. So those who are outside, who are not currently our partners, and asking for 15 minutes are challenged because we all have to be very judicious in how we give up that time. One thing I will add is that it’s my opinion that the most persuasive approaches for a vendor is to have a credible client who has an enviable success that they’re willing to talk about with their colleague.

Campbell: Sound, candid, and sage advice & insight. Thanks again Dr. Baker.

This interview has been edited and condensed.

About Dr. R. Hal Baker
R. Hal Baker, M.D. FACP, serves as senior vice president for clinical improvement and chief information officer for WellSpan Health, a regional integrated health system that serves four counties in central Pennsylvania and northern Maryland. In this capacity, Dr. Baker leads quality and safety initiatives as well as the use of information technology as a means to create a reliable patient experience across the health system’s hospitals, physician practices and ambulatory facilities.

Dr. Baker joined WellSpan York Hospital in June 1995 as associate program director of the WellSpan York Hospital Internal Medicine Residency Program. He has also served as the lead physician at Apple Hill Internal Medicine, which is part of the WellSpan Medical Group. Dr. Baker came to York after completing a general internal medicine fellowship at Johns Hopkins Hospital and a residency at the Hospital of the University of Pennsylvania. He holds a bachelor’s degree in biology and a medical degree from Cornell University.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.