Craig Richardville is SVP/CIO of Carolinas HealthCare System of Charlotte, NC.
Tell me about yourself and the health system.
Carolinas HealthCare System is the largest healthcare system in the Southeast. We are about 3,000 providers, about 40 hospitals, many post-acute care services. We have about 12 million encounters a year.
I’ve been at the healthcare system for 17 years. Prior to that, I was with Promedica Health System for 12 years. Then I was in general industry for a couple of years.
What have you learned in creating a cohesive IT environment that span all those entities and practice settings that you mentioned, plus the complexity of acquisitions?
That one size does not fit all. We’ve been able to build a core competency around interoperability and the ability to connect disparate information systems — whether they’re business, administrative, or clinical –and bring those together in a single unified environment, but with the source systems being very varied. That’s been what we feel is a secret to our success.
What are the tools and the techniques that have made you successful at that?
First and foremost, it’s making sure you have the right people on board. People who understand how to work with others, how to come across as being very much a change agent, but understanding of the change management process as we go through and try to bring things up to a higher level.
There’s a variety of different tools that are available to us, but if you look at your classic people, process, and technologies, typically it’s the process that causes you most of the issues. You can get the technology, you can hire great people. Putting it all together along with our customer base is really where the challenge comes in.
What we try to do is minimize variances across our system, which is pretty standard other than we do that regardless of what source system that you’re using. We’re big on ensuring that we get a return on the investments that people have made, that companies have made. When they become part of the system, we don’t rip and replace and put them on the same platform, but we do present what we would call a single unified enterprise with everybody having common goals. We’re working together with the tools and the techniques that we have in place.
Leaving those systems in place is an unusual strategy. How do you make it appear that they are tied together?
The patient is the core of our strategy. As you follow the patient across our system, people have access to the relevant administrative, clinical, and business information for that patient. Then we also present that information to the caregiver in that unified fashion. We have wrappers, wraparounds that go around the different systems so that as you move through our healthcare system, you are easily accessible and your information is available.
You use Cerner, but you’re far from being an all-Cerner shop. When you’re tying those pieces together to create that single patient-centric view, is it with tools or technology that you’ve developed, or do you have help from the integration standpoint?
A combination of all of them. We have 14 hospitals. If you’re looking at only the core clinical systems, we have a handful of hospitals that run Epic. We have 14 hospitals that run Cerner. I’ve got 10 hospitals that run McKesson Paragon. Another six, seven hospitals that run McKesson Horizon. A few other one-offs in between.
We are very typical of a lot of the large communities in our health system in that we have varied platforms. Our opportunity that we can do within our health system and the communities we serve is to tie these different systems together, including the ambulatory systems that are either associated with or that they’ve installed separately. That is pretty much many of your large communities. They have a variety of different systems, especially when you get into the ambulatory environment and the home health environment and the post-acute care services, skilled nursing facilities or otherwise.
There’s a lot of different systems that need to be pulled together. We’ve partnered with several companies, but health information exchange is a big part of our strategy. The patient engagement, which is a larger based portal more at the information exchange level versus at the provider level. That’s part of our strategy, and certainly data analytics and data management above and beyond what the different feeder systems are is a key component of how we’re looking at managing and predicting the future.
How are your systems changing as you move toward managing population health rather than just encounters?
We definitely have moved toward the understanding of what the future lies for us in moving from the volume base to the value base and have positioned ourselves to be very successful in our communities.
Another big piece for us is also telemedicine or telehealth. We just classify all that as virtual care. Whether you’re talking about provider-to-provider or provider-to-patient or even patient-to-patient, allow them to communicate with each other if they have similar illnesses or diseases. Establishing those platforms within North and South Carolina has really been successful for us.
We’re looking forward to the changes in the law in the future that will allow us to even penetrate outside of our existing borders into other parts of the country as we become a true leader in the transformation of healthcare delivery.
Can you describe the telehealth offerings?
There are tools that we utilize that allow patients to have what some might term to be a virtual visit. That virtual visit would be very similar to a face-to-face visit by using videoconferencing and communicating back and forth between the provider and the patient.
We also have the ability to have protocols be delivered to the patient or prospective patient as well, where he or she can go online and answer a set of questions. Within a certain period of time, we would then get back with that patient as to what we believe the diagnosis would be, and/or any follow-up that would occur as a result of it. That’s a little bit more of an asynchronous method to communicate.
If you look at our specialty services that we offer, probably one of our classic examples is Levine Cancer Institute. We utilize that to connect specialists within oncology that are based here in Charlotte with the other oncologists in our system that may be geographically located in Charleston, for example, and be able to pull the patient into those conversations as well and have a three-way conversation with the oncologist specialist here in Charlotte as well as the patient.
The nice part of an example like that is historically — and you still see that today with a lot of the other cancer centers — is they want that patient to come into that main center, that home center. That usually would require travel and time to get that patient there. The program that we developed allows the patient, for the most part, to stay at their home where their needs can be better met. Outside of medical needs, the social needs and other aspects of their care can be met much easier and also reduce the anxiety of the travel.
You used the term “feeder system" in referring to the EMR. Is that the next level of IT maturity, where the EMR/EHR is not the center of the universe that we’ve grown to think that it might be?
Yes. There’s a lot of good clinical support built into the EMR. There’s a lot of aspects, and certainly it’s a core system. But it’s not really the data that becomes competitive. It’s how we use the data. That’s what we believe would be our competitive advantage.
Everybody is going to have the data, but it’s what you do with it is what’s going to make a difference to how you treat your patients and be looked at within the communities that you serve. For us, it’s really doing things above and beyond and outside of that.
If you look at many providers, how they’re established today, most of the core information they have is the information that is attainable and available from when they were seen at those locations, but not outside. That’s why, at least right now for us, the next level for us is this whole information exchange, the community-based type services so that we can get information from the disparate other providers that are providing care have that access to that, so when the patients do present themselves, it’s the holistic view of the patient, not just the holistic view that happens within that single provider.
Our critical mass allows us to have statistically significant outcomes of what we’re doing with the data. Whether we’re looking at readmissions or length of stay or other aspects that you’re trying to resolve for your healthcare system, having that mass allows you to be able to start understanding and writing the evidence versus purchasing a lot of the evidence that is out there. I think you’ll see us aggressively moving toward having top-decile performance and being able to do things that others may be currently learning from.
It’s a challenge for the whole industry and everybody has their own method. I don’t think our plan is all that different than others. It’s just the approach that we’re taking and the aggressiveness of pursuing it really is a delta for us.
What are your top IT challenges over the next several years?
I wish I had a crystal ball to allow me to clearly know what all those challenges are. For me and my peers across the country, it seems like every day there’s a new challenge or two that seems to be presenting itself.
If you look at things that are material, the biggest piece for us is to be able to help our clinical caregivers with the predictive analysis of what’s going to be happening to their patient population and migrate away from individual episodic care into managing populations, which is a very different way of looking at it. For us to be able to help them to understand the transition from being volume-oriented to being value-oriented.
I look at the analogy of what’s happening with the banks. Many of us are very proud that we’re able to handle most of our finances from home with even better service than what we had 10 years ago when we used to go into banks. Many people say, when was the last time you’ve gone to a bank or gone to a branch? They’re proud to say that.
In our industry, we have to clearly move ourselves away and have a lot of tools to make access available remotely and virtually and allow our patients to help manage themselves. You’d like to at some point to say, when was the last time I need to go see my doctor, because I’m getting all my services and then something above and beyond without the physical travel and the physical aspect of seeing the provider.
That’s the whole transition, a different way of looking at it. People have been educated and trained and been very successful in the world. The new world is a whole different way of looking at that relationship.
Any final thoughts?
The only thing I would like to say is, it’s a pleasure meeting you. I read HIStalk literally when I get out of bed, and one of the first emails I get I’ll click on that link and at least browse through it, then when I get in the office, read a little bit deeper. It really is a very nice service. I’m somewhat surprised when I talk to some of my peers and even members of my team that a lot of their information is sourced off of what you’re able to uncover. Some of it’s true, some of it’s reality, some is an anonymous person that threw this tip out there. It’s really a great source. You’ve really built something that … it was almost like a solution looking for a problem, and everybody now is focusing on it. It’s kind of how KLAS was a few years ago. Everybody always quoted “Best in KLAS”, “Best in KLAS.” Now it’s like, “Well, you know, this was in HIStalk.” It’s like the gospel. [laughs]