Making “Care Anywhere” a Reality: The Challenges of Architecting the Virtual Hospital

INTRODUCTION

Health systems are actively seeking more cost-effective ways to deliver high-quality results to their patients. Decentralizing the care process helps to improve access to care, patient experiences, and staff recruitment and retention. But in a data environment that remains highly siloed and poorly standardized, CIOs are finding it difficult to bring together all of the clinical and operational data required to support seamless care journeys for patients and staff.

During this discussion, panelists noted that many organizations are still working on the very first step: Understanding what data is available and useful to make decisions about clinical and operational actions. Once this task is in hand, organizations can then move on to developing a platform based approach to health IT infrastructure and begin to get strategic about evolving into a virtual-first delivery system.

Participating CHIME members:

• Rhonda Bartlett, Corporate Director, Information Technology at New York Presbyterian
• Lynette Clinton, VP of Applications at BayCare Health Systems
• Paul Williams, Assoc. VP of Information Services Infrastructure Technology, Penn Medicine
• Dustin Hufford, Sr VP and CIO, Cooper University Health Care
• Kaitlin Baston, MD, Medical Director, Government Relations at Cooper University Health Care
• Glynis Cowart, VP, CIO, Monteflore St. Luke’s Cornwall
• Cathy Dwyer, VP, CIO, Burke Rehabilitation Hospital

INITIATING THE SHIFT TO VIRTUAL CARE

COVID-19 hasn’t been the only driver of virtual care, but it did provide a crash course in what a primarily digital healthcare system could look like. Most patients have embraced the idea of using telehealth and other remote services for at least a portion of their needs, and human resources leaders are eager to start offering remote work options to prospective staff members in an effort to recruit top talent in an extraordinarily competitive labor market.

“Virtual care is coming to the forefront in conversations about the future of health care,” said Lynette Clinton, Vice President of Applications at BayCare Health Systems. We have to think creatively to respond and make sure high-quality care continues.”

Rhonda Bartlett, Corporate Director, Information Technology at New York Presbyterian Hospital, agreed that virtual care is becoming a top priority for health systems that hope to get ahead in a rapidly changing environment.

“There’s so much we can do virtually now that we couldn’t do before. The idea of the hospital at home is emerging very quickly, and patients want to take advantage of remote monitoring and remote care in every way they can,” she said. “But from a CIO perspective, there are lots of big changes to make before we can get there. We have to get a move on standardizing our data and standardizing our platforms, so we have the information we need at our fingertips without getting lost in data that we don’t really need. It’s a huge challenge.”

Success will bring many advantages, from potentially higher patient satisfaction and retention to the overall benefits of having more seamless access to actionable data for virtual and in-person care needs, added Kaitlin Baston, MD, Medical Director, Government Relations at Cooper University Health Care.

“To me, it’s a really exciting development for population health,” she said. “Virtual care is going to break our reliance on fee-for-service, procedure-based medicine. It’s going to allow true population health management and much more preventive care.”

Operational costs are a huge hurdle in the move to the virtual care anywhere approach, noted Cathy Dwyer, VP and Chief Information Officer at Burke Rehabilitation Hospital, but the upsides can be massive. “Going virtual could help minimize staffing shortages,” she said. “People don’t want to be in a building these days.”

A major factor in the cost issue is the reimbursement model, Baston added. “The problem is that payment systems haven’t yet caught up to what we want to achieve,” she explained. “There are so many things we could do virtually, but we can’t get reimbursement for those activities yet. We’re going to need to work with payers to revamp our financial models as well as our data models so virtual care can really thrive.”

CREATING COHESIVE DATA PLATFORMS TO ENABLE VIRTUAL CARE

Reimbursement is one major obstacle to accelerating virtual care, but the current state of the data landscape is equally problematic.

Many health systems are still struggling to define the data elements necessary to make informed clinical and operational decisions, let alone use that information in an intentional way to foster improved outcomes and lower costs.

“It’s not always easy for health systems to figure out where to even start,” acknowledged Paul Williams, Associate Vice President of Information Services Infrastructure Technology, Penn Medicine, University of Pennsylvania Health System. “Your data has to inform your progress steps as you move toward more of a single platform, silo-free environment. Common platforms are essential for solving problems, because otherwise you can’t even get visibility into what’s feasible based on the data you have.”

The roundtable participants all supported the platform approach, noting that data fragmentation an obstacle they all share, no matter what their objectives.

For Dustin Hufford, Senior Vice President and Chief Information Officer at Cooper University Health Care, a hybrid on premise and cloud-based approach to platform building has helped to scale up infrastructure while remaining flexible for both virtual and in-person care services.

“The pandemic really showed us the constraints of relying wholly on hardware and data centers,” he said. “When we were launching our vaccine center, we had tens of thousands of people rushing to log into our standard patient portal run from our data center, which obviously wasn’t designed for that type of load.”

“When we think about the concept of untethering, we’re also thinking about how to scale up from our baseline and reaching deeper into the community than we’ve reached before,” he continued. “Cloud is really the only way to scale like that with the least number of issues. But we do need to keep everything organized, which is always a huge challenge in healthcare. We can all implement all the versions of cool buzzword technology, but without governance and leadership to guide the process, it won’t do any good.”

Pushing through silos to create a unified platform can help to abolish workarounds and unify processes across previously disparate departments — and can even help to save money on applications that are no longer needed.

“When we started to really rationalize all of our applications and get rid of our shadow IT, we found a lot of skeletons in a lot of closets,” laughed Bartlett. “A lot of people have had credit cards and they’ve bought a lot of stuff . We’re still opening up some of those closets and finding out exactly what we’ve been working with. It’s a tough process, but it’s necessary. Strong governance and standardization are the way forward, especially as we’re looking to expand clinical systems into patient homes and deal with all the data generated from those activities.”

BUILDING BETTER CONNECTIONS TO SUPPORT HIGH-IMPACT SERVICES

Without a coordinated approach to managing virtual care data, health systems risk gaps in connectivity between patients, devices, providers, and operational staff, cautioned Glynis Cowart, VP and Chief Information Officer at Montefiore St. Luke’s Cornwall.

“If you are going to care for patients holistically wherever they are in the community, you need to know when they were last treated in the Emergency Department, or if they followed up with their primary care provider or a specialist for a specific concern. If you don’t know if their issues have been addressed, all the devices in their homes or on their person will be ineffective at keeping them healthier and out of more costly care facilities,” she said.

“People are starting to understand that these connections happen in the data, and that the data is vital to building a meaningful, actionable story around each patient. It has to be more than clinical data, though. We must bring together clinical, financial, and operational data to make a difference in a patient’s health journey.”

Added Bartlett, “You can’t run a report on data that’s living in five different systems. Somebody has to bring it all together and uncover all the ‘dark data’ living somewhere in our infrastructure that isn’t currently useful to us. That’s the magic we’re all trying to accomplish. That’s what’s going to improve our processes, our efficiencies, and our ability to make virtual care a reality. It’s going to require a lot of hard work and a major reevaluation of what governance means and what standards mean. It’s tough, but we have to get it done.”

BRINGING IT ALL TOGETHER FOR CONNECTED CARE

“Care anywhere” is a shared goal for health systems and patients, both of whom want more efficient and convenient methods of engaging with one another. But untethering staff and patients from the traditional campus-based approach to healthcare will be challenging, especially as many organizations are still working on building more seamless, scalable data platforms, and as reimbursement restrictions continue to limit the possibilities of remote and virtual care.

To succeed in a challenging environment, health systems must identify their goals, unlock the data assets that support their objectives, create scalable, open platforms using agile infrastructure building blocks, and develop strong connections across disparate workflows to enable coordinated, proactive care.

Creating this data-driven foundation will enable the next generation of virtual care services, keeping health systems competitive and offering more robust, accessible, and intuitive care to patients and their communities.

 

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