Facing Hospital Integration-Driven IT Challenges in New Haven

The Yale-New Haven Health System, based in New Haven, Connecticut, encompasses three hospital organizations on four campuses, for a total of 2,300 inpatient beds, as well as 1,400 employed physicians in two separate large physician organizations. Since October 2010, when he arrived at the organization, Daniel Barchi, who is CIO of both the Yale-New Haven Health System and of the Yale School of Medicine, has been involved in intensive information system integration work, and has been helping to lead his organization in IT governance designed to prepare for the future. Barchi spoke recently with HCI Editor-in-Chief Mark Hagland regarding everything going on at Yale-New Haven. Below are excerpts from that interview.

Tell me about the IT integration efforts you’ve been leading at Yale-New Haven since late 2010.

When I showed up in New Haven, I found that I was CIO of a health system that didn’t really operate like a health system—it had three separate EMRs, three IT teams, etc., plus a medical school; so functionally, it was operating like four separate organizations. Plus, I joined just weeks after the Epic contract had been signed. We started implementing Epic in October 2010; our first physician practice went live in October 2011; our first hospital live in April 2012; our second hospital in February 2013; and the third one in June 2013. And then we acquired a hospital along the way, and that hospital went live in September 2013. So it was a $300 million, three-year implementation project, and we ended up on schedule and $10 million under-budget.

And at the same time, I was integrating us into a single IT team, and integrating us into one network; we had to go from many different ancillary applications, to fewer ancillary applications, so it was like playing three-dimensional chess, but it worked out.

Daniel Barchi

What lessons have you and your colleagues been learning from all of the technology, people, and process integration you’ve been engaged in?

Above all, to set aggressive timelines, and to let the aggressive schedule be your friend. Setting a goal, even a challenging one, let us accelerate the process much faster, both in terms of the Epic implementation and the IT team integration, than we otherwise would have.

You’ve gone live with your physician practices also, correct?

Yes. We have two different physician groups; the health system has a 400-physician group, and the Yale School of Medicine has a 1,000-physician group, all employed.

The primary care doctors are in the health system group, and the specialists are in the school of medicine group?

Yes, that’s correct. And there are 5,000 affiliated community physicians with privileges at our hospital; and 125 are using Epic in their practices.

Have you developed a heath information exchange yet?

Not yet.

What other areas have you been involved in? I know you’ve been involved in bundled-payment contracting.

Yes, we’re participating in the federal bundled payments program, in 13 different clinical areas. Of the roughly 70 or so potential areas in which to do bundles, we chose three areas—cardiovascular care, diabetes care, and CABG [coronary artery bypass graft surgery].

When did you join the program?

Just a few months ago.

Are you involved in any other major payment or delivery model initiatives yet?

None so far; we’re an integrated health system, closely aligned with the school of medicine, so we’re already operating in an integrated way. The challenge for us is that we’re standardizing to clinical best practices across the health system and the school of medicine, and we’re leveraging the tools within the EHR [electronic health record], including clinical decision support, especially in terms of the identification of patients for appropriate time of discharge per readiness and risk of readmission; as well as also the use of integrated order sets, so we have almost wholly standardized the order sets for inpatient care across all of our hospitals. We went from several thousand independent order sets, to fewer than 1,000 integrated order sets.

What has the process been like for that initiative?

We have a great physician leadership team, led by our associate CMIO, Allen Hsiao, M.D. In 2010-2012, he and our other physician leaders led the specialists in focused groups, to review and standardize order sets.

Did they custom-develop all the order sets?

It was a well-defined but manual process.

So that was a two-year process?

Yes, because we did it continuously, even as our hospitals were going live. We got all of our basic order sets live before our 200-bed community hospital went live in April 2012; but as we went live in February 2013 with our 1,000-bed academic medical center, there were more order sets, specialized ones, that needed to go live; and there were services offered at the academic medical center, that weren’t offered in the community hospitals.

What learnings have come out of that process?

There were two. One was communication—being very broadly open about what was happening. And the other was participation, giving everybody a chance to participate in the process. By following both of those, we made sure that all the physicians who wanted to be involved in the process, understood it, and understood how they could be involved.

That requires a lot of resources, correct?

Yes, I lead a 500-person IT team for a $4 billion enterprise, and the focus is almost entirely around people and process.

So it’s like moving an army forward?

Absolutely.

In terms of order set integration, will the development process continue?

Yes, absolutely. We’re doing a biannual review, one every two years, of the order sets, since they need to remain up-to-date and clinically relevant. So we need to update and review them.

Do you have any other initiatives on the horizon in the next few years?

Certainly we do; healthcare today is about delivering integrated care. And being responsible for IT is great, because I’m at the table for all of our key discussions about how we deliver that care, because technology doesn’t cure people, but it helps physicians cure and care. And because technology is an enabler, my team and I are involved in all our discussions about growth, and about improved care.

In the context of what you’ve been working on, do you have any advice for your fellow CIOs?

Sure; in every situation in which IT is involved, there are some guiding principles. First, always put the patient first, because that will make clear what the answer is to any question; and have a close partnership with operational and clinical leaders.