Population Health Management

Is Salesforce Ripe for Partnership with Health Cloud as a Patient Relationship Operating System?

Its human nature to draw analogies from past disruptors and apply to parallels in other industries. After all, we take experiences and lessons from the past to derive inspiration for future innovation. It’s in this regard that pundits have pointed to ATMs as a model to solve for healthcare’s interoperability woes, or present MINT.com and Kayak as a model for the healthcare’s move to retail and consumerization. It’s also in this regard that Salesforce is used as an example for patient engagement for healthcare. However, unlike the other industry-specific disruptors, Salesforce’s model fits healthcare as well. But just because it fits on-paper, that doesn’t mean that Salesforce is ripe to disrupt healthcare. There is certainly a lot of inertia to overcome in healthcare information technology, as Chilmark Research was quick to point out after Salesforce Health Cloud was announced

After several years of circling the healthcare market, Salesforce finally announced its intent to formally enter the market this week with the announcement of Salesforce Health Cloud. Unlike other enterprise vendors who have jumped into this market, with Blue Ribbon advisory panels (Google Health), or series of acquisitions (IBM Watson Health, Intuit) or a mixture of both (Microsoft), this announcement by Salesforce had little in the way of any of these attributes to bolster its announcement.

Salesforce is taking a much more tentative and low risk approach to entering the healthcare market and will look to its expansive ecosystem of partners who will leverage Salesforce’s existing tools to create healthcare specific solutions and services.

-Salesforce Enters the Fray: Will They Succeed Where Others Have Failed? CHILMARK BIGHT, September 2015, Brian Murphy and John Moore

Salesforce touts Health Cloud as a vehicle to acquire and manage patient data from multiple sources, from electronic health records, to patient generated data through wearable fitness trackers. Salesforce has also positioned the application as a communications platform for patient engagement and care coordination, as well as a dashboard for outcomes management and population health. Sound like every other vendor touting themselves as a PHM solution? Chilmark takes a deeper look into strengths and weaknesses:

Salesforce won’t compete with established transactional systems, but rather be a front end, as it’s not interested in being an electronic medical record provider like EPIC. As Salesforce CMO Dr. Joshua Newman told MedCity News, he sees competition from three places: electronic medical records vendors, startups and analytics firms.

EMR vendors may be entrenched, Newman said, but “they’re never going to be Internet-focused and multi-tenant.” A multi-tenant approach typical of a cloud service like Salesforce helps manage patients seen by physicians with privileges at multiple hospitals, according to Newman.

HISTalk also offered an optimistic assessment of Salesforce, declaring Health Cloud “the most interesting product I saw at HIMSS.” Mr. H from HIStalk noted the following advantages Salesforce Health Cloud offers:

  • Existing EHRs and other healthcare software products are way behind the times in meeting new requirements for health systems to treat patients and doctors as customers and to build relationships with them, including patient engagement.
  • It lets health systems that are willing to change their relationships with patients and doctors to do so effectively, with strong analytics and communications.
  • It’s cloud-based and is purchased on a relatively inexpensive per-user, per-month price with no capital outlay.
  • It’s built on the standard Salesforce CRM that has been battle-tested for years, with just those customizations needed to make it work for healthcare.
  • It integrates with the EHR and other patient and provider data sources.
  • The Salesforce open ecosystem allows using third-party apps when needed.
  • It Includes tools that allow users to build their own rules and apps.
  • Salesforce is a juggernaut that can force EHR vendors to open up their systems to obtain the data it needs.
  • Salesforce isn’t Oracle or Microsoft – they didn’t create a healthcare-specific product from scratch or acquire a questionable one, so they have no incentive to rebalance their product portfolio and walk away from healthcare and leave users hanging as big healthcare toe-dippers tend to do.

Given the optimistic outlook, what does this mean for healthcare startups and entrepreneurs Salesforce represents a good horse to attach your cart to. We’ve witnessed a plethora of companies go at patient engagement with their own custom solution. This approach lacks scale, established technology, and is crowded with competition. Not to mention, the path to monetization and profit is muddy at best. Further, Salesforce has built a rich ecosystem of extensibility via its app marketplace. Some could argue that this is exactly what healthcare needs.

The content presented in the Health Cloud Integration eBook suggests that Salesforce is still in the somewhat nascent stages, with limited adoption outside of pilots. Despite this, HCOs who have implemented the platform, such as Cancer Treatment Centers of American (CTCA) have demonstrated tangible benefits. CTCA now uses Salesforce to improve service in three different areas: physician referral intake; a 24/7 contact center; and, patient communities. The result is a 60% productivity boost for their technical team. One of the benefits to patients is their community platform, built on Salesforce Community Cloud, that empowers patients and families to support one another, join groups, participate in local events, find educational resources, and chat in real time. In turn, CTCA benefits from an enhanced referral process that improves customer loyalty and provides another way to communicate with patients.

There are clear gaps to fill. As the saying goes, “if the doctor doesn’t use it, it doesn’t matter.” Insights must reach the point of care and not be disruptive to existing workflows, but rather enhance it. It’s in this vein that partners are needed build the detailed workflows to support patient and care team communications. Salesforce represents a great candidate to partner instead of going at the crowded patient relationship management and patient engagement space alone.

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, 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.

CHIME Fall Forum Interview Series: Robert Napoli, SVP, CIO, Planned Parenthood of the Great Northwest and the Hawaiian Islands

Have you ever started a new job with a lengthy to-do list? Robert Napoli, Senior Vice President and CIO at Planned Parenthood Great Northwest and the Hawaiian Islands, can relate. When he first joined the organization three and a half years ago he began a rip and replace of their entire system, and in the end, the only thing that remained was the telecommunication system.  Once he was finished redesigning and replacing, he moved on to strategic initiatives including BI and analytics strategy, mobile health, patient engagement, and more. With experience on both the acute care and ambulatory side, Napoli offers up a unique perspective on the harmonization of clinical data. In this interview, he discusses his organization’s journey through data archival; why integrated solutions are the way to go; and the question on everyone’s mind: what’s happening with the potential defunding of Planned Parenthood? Napoli is a well-seasoned healthcare technologist who’s always aiming to innovate, and we discussed what he’s done and where he’s going.

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

In my experience, I have found that integrated solutions are typically easier to deploy and maintain, provide more predictable and lower TCO, and offer better support for overall organizational workflows.

So long as the data exists, we have a repository that is easily reference-able and accessible.

We ripped out the entire network, redesigned it, upgraded the equipment, installed wireless for the first time, replaced email and moved services to the Cloud.

Given the political landscape and the potential for defunding, we’re looking at ways coalesce those services, perform consolidation, and expand the expertise that some of the individual affiliates have to a broader, more national effort.

There’s hardly a CHIME event that I don’t come back with something that I can either implement or use in my organization.

We were recognized by CIO Magazine IDG for successfully launching the federation’s first mobile health app. This service virtually extends our medical expertise and allows patients either through a smartphone or computer, to have a real-time visit through a secure video consultation system.

Campbell: Thank you for taking the time to chat with me. Can you provide a little bit of background about yourself and about your organization?

Napoli: Sure. I’m the Senior Vice President and Chief Information Officer of Planned Parenthood of the Great Northwest and the Hawaiian Islands. We’re the affiliate that is based in Seattle and operate health centers in Alaska, the Hawaiian Islands, Idaho and Western Washington. We have ambulatory clinics in each of those states, providing both primary and reproductive care for men and women. I’ve been in this position for a little over three and a half years now. Prior to that, I was the IT Director at a mid-size hospital in Connecticut and before that, held CIO accountability at a similarly sized hospital just north of New York City. In that role, I reported to the CFO and oversaw the strategic and tactical direction of the department as well as the operational management of our technology and information systems.  I was in that position for nearly nine years. So, I have both acute care as well as ambulatory experience.

Campbell: Certainly valuable to be able to understand both of those perspectives, especially given the challenges surrounding the harmonization and coalescence of that data from the ambulatory side to the acute side. Thank you for that background. In terms of applications within the portfolio, can you provide an overview of that? Specifically, the applications that fall under your umbrella in your organization? Could you also elaborate on your enterprise portfolio approach – best of breed, integrated, etc. –  and whether you have plans to consolidate in the future?

Napoli: In my experience, I have found that integrated solutions are typically easier to deploy and maintain, provide more predictable and lower TCO, and offer better support for overall organizational workflows. Certainly, this isn’t the case with all information systems and there have been occasions, throughout the years, when we’ve gone with best of breed solutions – cybersecurity tools being one such example. Also, a slightly different question, although related, is what to do when native functionality in systems isn’t as robust or feature-rich as third-party options. Population health and analytics are good examples of this. In these cases, we have no problem implementing third-party solutions to provide additional functionality and capabilities. But as a rule, I tend to push for integrated technologies when possible.

The application portfolio that my group manages is pretty standard and includes all of our clinical and business systems including the EHR and practice management systems. Shortly after arriving, I initiated a business intelligence and analytics strategy, so we support and manage these systems as well. There are a couple of outliers. For example, there’s a Cloud-based learning management system that we provide some support for, but that is managed primarily by our education and training departments. Outside of that, nearly every other piece of technology or software used by the organization is supported by my group. We’re comprised of the technical folks that support our infrastructure, computers, and telecommunication systems as well as the clinical and business analysts and data management teams. As the organization’s Chief Security Officer, I am also responsible for ensuring our organization’s HIPAA and cybersecurity posture, which our technical team supports with assistance from external consultants.

Campbell: Very good. Let’s touch a bit on data archival strategy. Do you leverage a data archival solution today? I know you mentioned the data warehouse, and I’ve talked with some folks where they’ve used the data warehouse for archival purposes.

Napoli: We do, although we haven’t been able to reach a consensus on a specific archival period. Fortunately, we have the capacity to archive all of our data without limitation, so landing on this hasn’t been a priority.

When I arrived at the organization in July of 2013, we didn’t have a report writer or database administrator, let alone a cohesive data management or analytics strategy. I made the decision very early on that once I had addressed our operational issues by stabilizing systems and redirecting staff, that we would need to focus on being a modern, data-driven organization. One of the first strategic initiatives that I proposed to my executive team and board was a comprehensive business intelligence strategy – it was an easy sell. In hindsight, this project was a heavy lift, and our biggest challenge was transforming an organization that wasn’t accustomed to working with a lot of data to one that now had a ton of data available. To realize full value from our investment and effort, we needed to get our business leaders to a point where they understood the data and owned the business results of using the system. Architecting the system was relatively easy compared to the cultural shifts that needed to take place. My goal from the outset was to provide a self-service data platform – I didn’t want our end users dependent on Information Services to understand our business and to get access to the data that is most meaningful to them. Although this work was extremely difficult at first, it has been a huge success.

Our biggest consideration when architecting the system was whether to build a data warehouse (which is better for archiving) or go with an OLTP approach, which is more suited for real-time business operations and better met my objective of empowering our business leaders. We decided on a hybrid approach that includes a data warehouse precisely for its archival capabilities. Our warehouse includes historical and current data feeds from both internal and external data sources for all our business units. So long as the data exists, we have a repository that is easily referenceable and accessible.

Campbell: One of the things I talked about with several of your peers was requests to access legacy data. The archival whitepaper we published addressed some of the concerns and challenges when there are eDiscovery requests for data. Specifically, when you archive that data, the shape of the data is inherently changed. Another consideration is what the chart that the clinician was presented with at the exact time of inquiry. That could differ from the PDF of the chart that is produced from most archival applications. There’s certainly a lot of metadata considerations. If you could elaborate on how your organization approaches that today and any insights you may have, that would be helpful.

Napoli: Fortunately, we haven’t had many eDiscovery requests in the time that I’ve been at the organization. We implemented our first EHR in 2010, so there isn’t a lot of data that I would describe as “legacy.” Other information systems were minimal prior to this. Our EHR vendor provides an archiving module which helps make our underlying storage environment more efficient, but our most requested data is in our repository where our users can access what they need although It’s not uncommon for us to receive requests for ad-hoc reports or custom dashboards. The requests for eDiscovery information typically occurs between the business unit making the request and our data management team, and I don’t necessarily have a lot of visibility into the actual discussions themselves. My team does a great job ascertaining that the data we’re pulling is correct and appropriate for the need.

Campbell: Shifting gears a bit, tell me a little about what keeps you busy these days. Any major organizational initiatives? Perhaps you could touch on some items you went to CHIME looking to find out more about.

Napoli: Right now, things at my affiliate are extremely stable. As I mentioned earlier, when I first got to the organization there were a ton of operational challenges that we needed to address. We spent the first couple of years ripping out and replacing every piece of core technology in the organization, except for the telecommunications system, which was replaced the year before I got there. We replaced every endpoint, server, and storage device including the infrastructure that housed our EHR and PM systems. We ripped out the entire network, redesigned it, upgraded the equipment, installed wireless for the first time, replaced email and moved services to the Cloud. In the middle of all this, we acquired the Hawaii affiliate and had to merge their systems with ours and bring them up on our EHR, so operationally we had a ton going on. We’ve spent the past couple of years focusing on the more strategic stuff – getting the data warehouse and business intelligence environments up and running, releasing a mobile app, implementing population health and patient engagement platforms, expanding our telehealth services, among other things. We’re at a point now where, not only operationally, but tactically and strategically, we’re in a great spot.

Lately, I’ve been focusing more of my time on assisting Planned Parenthood Federation of America with some newer and broader initiatives, such as cybersecurity and a shared services model. Let me quickly explain our relationship to the federation as this can be confusing. The national office provides our branding and accreditation, but they do not operate any health centers directly, which is the responsibility of one of 56 affiliates. Each affiliate is an independent organization with its own executive team, board of directors, budgets, information systems, and internal decision-making process. Given the political landscape and the potential for defunding, we’re looking at ways to coalesce those services, perform consolidation, and expand the expertise that some of the individual affiliates have to a broader, more national effort. It’s exciting because one of my earliest observations was that affiliates could benefit from centralizing systems and services, but there were internal politics and personal interests that prevented these conversations from moving forward. Although I do not welcome the thought that we could lose a significant part of our revenue, the situation is forcing us to be more agile and lean, and this is a good thing.

Campbell: I imagine sustainability and solvency is top of mind for you, providing value added services to create revenue generation in creative ways, and as you mentioned, finding economies of scale, and getting more operationally efficient because you need to. Tell me a bit about data sharing that may occur from a regional level to a national level.

Napoli: That’s one of the areas we’re evaluating. We decided to build our own data warehouse because there weren’t any viable options available through the national office or another affiliate. During the requirements gathering phase of this work, we heard anecdotally from many of our business leaders who expressed a desire to benchmark our measures against other affiliates or even those of other organizations. We’ve recently partnered with OCHIN, Inc. located in Portland, for our EHR template customizations and they offer an extremely robust real-time healthcare-specific data aggregation tool called Acuere that would provide this benchmarking. We’re impressed with Acura’s capabilities and are moving forward with a subscription. However, its ultimate usefulness and value are dependent on our end user adoption and whether other affiliates see the value in a data aggregation tool and participate in the program.

Campbell: Do you leverage any health information exchange technology? Or have you evaluated that? I know with some groups, it makes it easier if there are other affiliates that need to connect, to move to that hub and spoke model. An alternative is asynchronous requests where you web services are leveraged to broadcast out to other affiliates, ‘hey do you have any data that I care about,’ and that request is fulfilled.

Napoli: We don’t. We do share data with OneHealthPort, which is the Washington State HIE, so the interfaces and configuration necessary to exchange that data are in place. However, this is a state requirement if you see Medicaid patients and there isn’t much of a business case for participating without this mandate. There is, however, a huge business need to share patient data across the federation since most patients don’t realize that our affiliates (even those that are near one another) are independent, stand-alone organizations with separate EHRs, unique patient identifiers and completely closed data systems. Our patients are often surprised that their medical record is not universally accessible in all our health centers since we present a unified brand.

The aforementioned OCHIN has a potential solution to this that, although not an overnight fix, provides what I believe is the best opportunity for coalescing our disparate EHRs into a truly portable patient record. I’ll be working closely with them over the next few months as we explore this further.

Campbell: I wanted to get your thoughts on CHIME. I talked to Chuck Christian, VP at  Indiana HIE –  one of the founding members of CHIME – and he just raved about how refreshing it is to be amongst your peers. There is a lot of noise at the HIMSS conference whereas the CHIME forum is much more focused. At CHIME, you’re talking about the things that are meaningful to you and given the multitude of issues and responsibilities that come with being a healthcare CIO, it’s seemingly invaluable. I’ll give you another perspective you may have read in one of our earlier interviews, that was extremely cogent advice, from Dr. R Hal Baker at Wellspan. He mentioned the currency of a healthcare leader is measured in attention units. You want ambitiously desire to accomplish a great deal of initiatives, but your primary job as a CIO is to ensure extraordinary care to the patient population you serve. There’s so many ways where you can get distracted or lose your focus. Without me rambling on too much I’d like to hear your perspective on what CHIME means to you and the value you get out of it?

Napoli: I would agree that there’s a lot of noise out there, especially at the HIMSS Conference, just because of the size and scope of it. In many respects, I find it overwhelming even though I’m a proud member of HIMSS, hold CPHIMS certification, and serve on the HIMSS Innovation Committee. CHIME is an association that I value, and the annual conference is one that I look forward to for a couple of reasons. For starters, there are so many people over the years that I’ve connected with and met through CHIME. Chuck Christian, for example, was one of my faculty at the CHIME CIO Bootcamp that I attended several years back. Having the opportunity to reconnect with people who you invariably meet over the years is vital. Additionally, the content of the program is extremely relevant, and it’s engaging and useful. There’s hardly a CHIME event that I don’t come back with something that I can either implement or use in my organization. I sit on the CHCIO Exam Review Panel and recently agreed to serve as a CHIME Ambassador – these are testaments to the value I place on my membership.

Campbell: That’s great. Certainly, when you get so much out of an organization it’s great to hear that you pay it forward and give back to it as well. Any closing thoughts that you may have? The readership for healthIT & mHealth is primarily health entrepreneurs or digital health startups and in past interviews I’ve tried to inquire to the interviewees about advice they may have for folks in that space or what’s on the mind of your organization.  You mentioned patient engagement, and it’s a crowded space with a lot of apps offered in that area, but who’s moving the needle in a meaningful way? Any parting insights you’d like to leave our audience with?

Napoli: Mobile health is a personal interest of mine. After all these years, I still consider myself a technologist at heart. I helped develop one of the first medical transcription and dictation systems in the early 90’s and still like architecting systems and solutions as time allows. In 2015, we were recognized by CIO Magazine IDG for successfully launching the federation’s first mobile health app. This service virtually extends our medical expertise and allows patients either through a smartphone or computer, to have a real-time visit through a secure video consultation system. I also recently designed a mobile health app that I’m hoping to deploy nationally to all affiliates. It’s an app that patients can use to find our health centers, book appointments, connect and communicate with us. I’ve provided our national office with the design documentation, so that’s something to look for in the future.

It’s an extremely exciting time to be in Health IT. The more progressive organizations understood long ago the value that technologies such as big data, mobility, social media and the Cloud brought to the business. Increasing numbers of CIOs are now viewed as business drivers as opposed to the business enablers or operators of old. In my opinion, the real innovation is happening around technologies such as artificial intelligence, augmented reality, autonomous systems among others, which have the potential to greatly improve patient outcomes. The work around cancer genomics is especially encouraging. We’re not quite there yet, but I believe that we are on the cusp of some significant breakthroughs.

Campbell: I appreciate your perspective. It sounds like a lot of innovation is occurring and that’s something our readers will certainly be interested in.

CHIME Fall Forum Interview Series: Jeff Weil, CIO, District Medical Group

jeff-weil-cio

Jeff Weil, CIO, CHCIOe, CPHIMS, District Medical Group

There is no shortage of projects going on at District Medical Group, where Jeff Weil is CIO. From an integration engine implementation to clinical, business and infrastructure upgrades, and implementation of workflow optimization technologies, Weil and his team certainly have their plate full for 2017. However, for someone who has worn almost every hat in the industry, you would expect nothing less.  Weil talks about population health initiatives and how Technology Leadership approaches have changes over the past year; the inexpensive side of data storage; interoperating between different practices with different systems; and how in some cases it is working with records that are literally still in boxes.

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

Eventually the ROI is going to turn in our favor if we’ve got staff in house to design and develop interfaces and if we purchased an integration engine as opposed to outsourcing this work to our Vendor Partner.

We really didn’t have a robust infrastructure from which to have an appropriate foundation to expand our business. That was my primary mission when I came in, and I’m finally starting to feel that we’ve accomplished most of that mission.

The thing that really stuck out to me at CHIME this past year was the difference in attitude toward population health technology. Last year, most CIO’s felt they needed all the technology. This year, since people have started to get into these initiatives already, and have started to actually practice some of the data gathering and some of the reporting around population health initiatives and value based care contracts, they took a much more conservative approach.

I think we’re moving into a very interesting time. We still haven’t quite figured out how to optimize our electronic health record systems. We still have physicians struggling with utilization of these systems, yet now we’re being asked to add on new technologies whether it’s connected health or population health initiatives.

Campbell: First and foremost, if you could tell me little bit about yourself and the organization, what EMR application that you use and some initiatives that you’re working on.

Weil: I’ve been in this business a little over 20 years. I sort of fell into it and have worked on large scale engagements in engagement management, mostly with multi-facility or academic health systems. I’ve worked on the provider side in both the acute and ambulatory space, as well as on the vendor side for a little bit, and I’ve done my share of consulting. A couple years ago, I had an opportunity to come here [District Medical Group], from a health system in Fort Worth, Texas and decided it was the right time for this move.

We are primarily a large physician practice, and we also have a couple of our own clinics. About 70% of our revenue is based on the fact that we supply all the physicians and mid-level providers–CRNAs, physician assistants, etc.—to Maricopa Integrated Health System here in the Phoenix area. We also head all eleven departments over there as well as oversee residency programs for the University of Arizona College of Medicine. We just recently made an announcement that we’re going to be working with Dignity Health and Creighton University to train some of their residents as well.

We have two of our own clinics right now. One is a behavioral health clinic in the East Valley. We have a very large multi-specialty pediatric practice for special needs children through a contract with the state and United Healthcare. We also have a partnership with a behavioral health organization here in the valley, where we’re providing physical health to complement their behavioral health. We’re looking to do more in partnerships and with population health cooperatives in the coming years

Campbell: In terms of the technology that is being leveraged from an EHR and EMR perspective, does that vary from physician to physician or is there an enterprise standard? Tell me a little bit about how you’ve acquired physicians in the past and perhaps the need to migrate data into the system.

Weil: Usually we start from scratch in determining the technology requirements for each one of our partnerships. There will be requirements for clinical documentation as well as practice management. For instance, we do the bulk of the professional billing for the physicians that are at Maricopa. As such, when there’s an encounter that happens over there, Maricopa does the facility billing and we do the professional billing for that physician’s charge. We have an interface with them and their Epic system. All of the clinical work they perform is in MIHS’ Epic system.  In terms of own internal systems, for our clinics, we have GE Centricity EMR as well as GE Centricity Business for our practice management system.

Campbell: Are there challenges around interoperating, maybe between different care settings – acute care versus outpatient care – and are there any technologies that you’re leveraging to facilitate that?

Weil: There are because we’re working on these partnerships activities. For instance, with the behavioral health provider partner here in town, we have to bring in the billing information from a different EMR and practice management system into ours, so we always have to get creative in working on integration strategies. Moving into this next fiscal year, we’re investing in our own integration engine, as well as bringing on staff to support that initiative. If you think about it—and I’ll just throw out the normal budgeting number—but every single time we do an interface it may cost $15,000 and take 90 days to develop. Eventually the ROI is going to turn in our favor if we’ve got staff in house to design and develop interfaces on our own integration engine platform. We’re getting ready shortly after the first of the year to start our implementation on that.

Campbell: Interoperability is a topic that’s near and dear to me. We actually hosted an interoperability panel last year with some folks representing HIEs, some representing government, and some representing practices. It was eye opening to say the least. I imagine you’ve got the short list of vendors out there. Are you going through the selection process now?

Weil: We already went through a bit of a selection process. What it came down to was the fact that our analysts need to wear multiple hats and even though I may bring in an interface engineer, they may also be doing a bit of database administration for our healthcare systems. That’s why we decided to go with Corepoint, because it offers an object-oriented programming interface, as well as a modular build approach.

Campbell: Absolutely. We’ve heard great things about Corepoint; rated top of KLAS and they offer some great thought leadership. They have a great community and resource center, so it’s no surprise that they would be at the top of the list. I imagine, coming from a diverse background where you’ve actually worked on the consulting side of it before, you get it and you understand from the vendor perspective the things to look for and the things you want to do your due diligence on.

Weil: We’re a fairly small shop. I’ve got seventeen people in all of IT, and that’s both on the applications and technology side, supporting almost 1100 employees. We’ve got quite a bit going on so I do need people to wear multiple hats and if I can make it a little bit easier for the person working on the interfaces to do their job to build and maintain, then so be it.

Campbell: Tell me how integration works today for the medical group. Is it point-to-point as opposed to hub-and-spoke, and will you be replacing that current model?

Weil: Everything is point-to-point. The plan is to deploy the new interface engine and move to a hub-and-spoke model. Any new initiatives would be implemented first on the new platform with the goal being that by end of June, we will have migrated all of the legacy interfaces over to that platform.

Campbell: And the good news is, at this time, there’s really a lot of interface libraries to leverage out there. It’s not like in the early days of EMR adoption when it was a challenge, based on the APIs that were available. Today, given the communities that are out there, it should make for a more efficient deployment of integration across the enterprise.

Shifting gears, a bit, tell me a little bit about archival, is that a topic that’s relevant to your organization? Do you ever face legacy application retirement? Tell me about the strategy within the organization in terms of managing the application portfolio, if that’s something that falls underneath your purview.

Weil: When they brought me in two and a half years ago, my primary mission was to build a robust infrastructure from which we would have an appropriate foundation to expand.  That was my goal when I came in, and we finally got to the point where the infrastructure is in a good place. We haven’t had to retire any systems yet, but what we did do was implement more of a cloud-based archive strategy. We have an appliance on-site and everything gets backed up to it on a schedule. If we need to restore, we can do quick restore. The appliance actually archives to the cloud and replicates so it gives us multiple layers of redundancy that we really need.

Campbell: Absolutely. We actually recently supported a client with our business continuity product called VitalCenter. They had a downtime situation and VitalCenter allowed them to continue to document through the downtime. It’s like an insurance policy – you have to have it.

What are your thoughts on data retention requirements? What is your policy in regards for retaining data whether that’s in paper form or electronic form? Have you had eDiscovery inquires in the past where you’ve had to furnish and produce a patient chart based upon an inquiry?

Weil: You can imagine that with a large number of providers, record inquiries occur quite often, so we’ve had to do quite a bit or eDiscovery. We do a combination of things, depending on the situation. For instance, at the large special needs children’s clinic, all of the legacy medical records have been scanned in to the system. We basically have a database of scanned documents that we have to use if there’s older information we’re trying to pull.

For the most part, as part of eDiscovery process, we either take some sort of an export out and send it to file or we have to print a whole bunch of stuff. We end up looking through all of our databases. We also provide medical directorship to some nursing homes/long term care facilities and other facilities here in the area. They don’t – as I’m sure you well know – necessarily have EMR systems and as such many records are in boxes in basements or over at Iron Mountain. We have to go to wherever they store their records and pull that information out.As you might imagine, it’s not an easy task.

Campbell: No, certainly not. I can imagine just the amount of effort that’s needed and that detracts you from other organizational objectives. It’s not as easy as one thinks when it becomes electronic because then you have to pull from different systems, you an audit trail to maintain. A lot of the time the metadata is the most important component because it tells you what happened, when and why. You have to protect the integrity of that patient record and be able to show why the care was provided in a certain way for that patient.

Closing out that topic, one of the challenges Galen finds when working with clients is that, when we’ve migrated them from, let’s say Allscripts to Epic, we archived a lot of the data. What they don’t get sometimes is they think it’s simply a matter of using one of the industry agnostic vendors, but healthcare’s’ a lot different. Fundamentally, when you archive that data you may be forced to change the shape of. You’re moving it out of the system and the shape of that data could change. In addition, when you present that data for viewing, you could also be changing the shape of it. There’s just so many considerations and as you can tell, it’s been a focal point for us.

One of the things I’ve talked about with your peers is the purging of data. What is your policy on retention? Do you hold data forever? I imagine that takes up boxes, and that takes up storage space.  Tell me a little bit about the organizational policies and maybe future strategy in regards to that.

Weil: My understanding is that it’s seven years and then for pediatrics it’s until they’re 21. We haven’t gotten to the point yet where we feel like we have to get rid of anything just because storage is fairly cheap at this point. For now, we’ll keep on storing and storing until it seems like it’s worthwhile to move things off to something, which I don’t know what that would be yet. It’s an interesting topic because it used to be much more relevant than it is now. The cost of storage has gone down so much. Years ago you used to have information life cycle management and based on the type of data you used to do this that and the other thing, but that isn’t necessarily as relevant anymore.

Campbell: Now the issue is that it’s the volume of the data. As so many people can appreciate, with the deluge of data, how do I get at the data I want and how do I derive insights from that. That’s the promise and premise of population health.

Let’s talk about initiatives for next year. I imagine the deployment of the interface engine technology and development and delivery of those interfaces is going to consume a lot of your time next year. Do you have a plan as to when you anticipate completing that project? Are there other population health initiatives that you have on the agenda for next year?

Weil: There are a couple of population health initiatives under discussion. We just started a value based contract with one of our payer partners. We’ve got the Corepoint implementation. We’re talking about two factor identification for our remote access portal. We’re going to implement an across the board email archiving strategy. We just updated to Exchange 2013 and that has its own robust archiving strategy, and we want to be able to handle the archive activities for our users. We’ve got a decent sized EMR upgrade coming, that will be done hopefully sometime in the first quarter. We will likely replace some of our ancillary clinical systems with a cloud based solution.  We have a SharePoint upgrade scheduled.

Campbell: So no shortage of projects in the next year!

Weil: No and if you know me this is pretty typical, I don’t necessarily like to remain stagnant too much. This years’ workload is actually less than it has been in the past couple of years so my team feels like we’re going a little bit easy. This years’ projects are smaller in scope and size and will allow for focus on optimization activities.

Campbell: Let’s circle back to CHIME. Tell me why you chose to attend the event? Were there key themes that stood out to you this year? Was there a focus group that struck you? A presentation that was compelling?

Weil: From my standpoint, it’s where can you go and collaborate with close to a thousand people that have the same interests and challenges that you do. That’s why I enjoy being a part of CHIME and always get a lot out of it. I feel energized when I come back to the office from a CHIME forum. When you’re around the industry for as long as I’ve been, there’s a lot of benefit to being able to visit with and network with old friends and colleagues to be able to share ideas.

Security was up there. I have to say I think in the past two years I’ve come to learn more about security than I would have ever known.  I’m also the organization’s chief security officer, and we’ve implemented intrusion detection and protection systems. We have pretty sophisticated endpoint protection for both malware and viruses, and we have endpoint encryption. The only thing that we’re missing, that I really want to put in place, is SIEM technology. We are logging, but to actually get anything of value out of the logs is a monumental task right now.

The thing that really stuck out to me at CHIME this past year was the difference in attitude towards population health technology. I went to one focus group that was done by Cerner that I had attended last year. We run through an exercise where we are given $10 million dollars are provided the programs objectives, types of contracts, and the costs for all the different kinds of resources that may be needed including human capital, systems, and technology. We teamed with three other CIOs to determine what we thought the best plan is. Last year, everybody said I need a data warehouse, I need this, I need that, and blew all their money on the technology. This year, there was a stark difference in how the group approached the exercise. It seems that since people have started to get into these initiatives already, and have started to actually practice some of the data gathering and some of the reporting around population health initiatives and value based care contracts, they took a much more conservative approach. They were bringing on health coaches; bringing on a data scientist to look through the CMS data to do manual risk stratification; bringing on care managers and care coordinators. Then in year two or three, they begin to implement their pop health solution, when you see what you’re getting in from an incentive stand point. It’s sort of guarding that ROI in a much more conservative approach. I actually thought that was extremely interesting to see the difference in approach in just a year.

Campbell: Fascinating. It still remains a very fragmented pop health and analytics market. John Moore, of Chilmark Research, pointed out that people are still dipping their toes in the water, and like you said, what they want to do is understand the incentive and reimbursement side of it, and make sure that the dollars and cents are making sense, before they make a substantial investment in technology. As such, we’re seeing a lot of point solutions, such as spreadsheets, taking the place of adopting an enterprise population health management solution that is marketed as solving all problems, but certainly comes with a huge price tag.

Weil: As with any of these technologies when they first start out, there probably isn’t any one of them that has everything that you need. You notice people sort of piecing together little best of breed plugins as opposed to going with a single enterprise solution. That’s been typical of this industry over the time that I’ve been in it. When things start out people tend to go with a best of breed approach, and have to integrate the systems. The vendors eventually catch up and offer either all-in-one solutions or they end up buying and putting together suites of solutions.

Campbell: Right that makes a lot of sense. It seems the path to realizing true ROI is by approaching a slice, and solving for a particular problem, as opposed to trying to boil the ocean.

I certainly appreciate your time here in speaking with me and for the tremendously salient and cogent insights that you’ve provided. Are there any closing thoughts before we conclude?

Weil: It’s very interesting to speak about these things. I think we’re moving into a very interesting time. We still haven’t quite figured out how to optimize our electronic health record systems. We still have physicians struggling with utilization of these systems, yet now we’re being asked to add on new technologies whether it’s connected health or population health initiatives.

This interview has been edited and condensed.

About Jeff Weil
Jeff is an experienced Healthcare IT Executive with over 20 years of experience leveraging the use of technology to meet the needs of Healthcare Organizations in the Acute Care, Academic, Public and Ambulatory domains. He brings with him a wealth of experience in leading teams in the implementation and support of multiple vendor EMRs, Vendor Neutral Archives, Medical Imaging Systems, Ancillary Clinical Systems, Perioperative Systems, Supply Chain Management Systems, Solution Design and Disparate System Integration.

Prior to joining DMG, Jeff held the Role of Project Director at John Peter Smith Health Networks in Fort Worth Texas where he was responsible for the delivery of Information Technology and Reporting needs required to support the startup and sustainability of the organization’s 26 DSRIP (Delivery System Reform Incentive Plan) projects.

Jeff holds a Bachelor of Science in Business Administration from Ramapo College of New Jersey and is a Certified Professional in Health Information Management Systems and is Certified Healthcare CIO eligible. He has been an active member of the Healthcare Information Management Systems Society for over 20 years where he currently serves on the board of the Arizona state chapter as Director of Health Information Exchange, Interoperability, Privacy and Security. Jeff is also a member of the College of Healthcare Information Management Executives, also known as CHIME. Jeff serves on the Arizona Health-e Connection Board of Directors, which is a statewide non-profit organization driving the adoption and optimization of health information technology and health information exchange.

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.