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Today on This Week Health.

(Intro)   And there's a lot of partners who are ready and willing to help but it's about connecting the right patient to the right service. And that's what we're attempting to do first by gathering data and understanding our patients, and then by being able to make these referrals. 

Thanks for joining us on this keynote episode, a this week health conference show. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week Health, A set of channels dedicated to keeping health IT staff current and engaged. For five years, we've been making podcasts that amplify great thinking to propel healthcare forward. Special thanks to our keynote show. CDW, Rubrik, Sectra and Trellix for choosing to invest in our mission to develop the next generation of health leaders. Now onto our show.

  (main ) all right, here we are for another keynote episode, and I'm looking forward to this conversation. I'm going to be talking with Ellen Wiegand, CIO for VCU Health. Ellen, welcome to the show. Thank

you,

Bill. Happy to be here. I should say fairly new CIO to VCU Health. So how long have you been there?

That's right. I just had my nine month anniversary on Monday.

Wow. Nine months. So we're going to be talking about the first nine months there, transitioning in. This is sort of a quiz because every CIO when they go to a new system has to learn the pitch for their health system that they're at.

So I'm going to ask you to tell us about VCU Health.

All right, great. Well, here at VCU Health, we're a 3 billion comprehensive academic health system. We have a major academic medical center in Richmond and two community hospitals in central Virginia. We are one of two NCI designated cancer centers in Virginia, and we have the only full service children's hospital in the region.

We just recently opened our new Children's Hospital of Richmond Children's Inpatient Tower, which was very exciting. We're, we also serve as a safety net hospital for Virginia. So we serve the underserved across the Commonwealth. So we have a mission in education, research and innovation as well as, being that safety net and serving the underserved.

We just recently were recognized. U. S. News and World Report as the number one hospital in Richmond and number two hospital in Virginia. And our children's hospital was nationally recognized in eight clinical specialties, so that was really exciting. We're all really proud of the accomplishments of the team there.

Wow. Well, you definitely have it down. You sound like you've been there for 10 years and you're very proud. of the institution. It does have a great tradition in history of VCU Health and serving Richmond. I've talked to some people over the years who've worked there. Give us a little background on you.

Where did you come from? What was your path to the CIO role at VCU? Sure,

that's a great question. I actually moved here from Seattle back last October, so I made a big cross country move. I previously served as CIO at Virginia Mason Health System in Seattle, which then became Virginia Mason Franciscan Health when we affiliated with Common Spirit in 2021.

So, my road to CIO, I started my career with healthcare. Software vendor, worked for a vendor for a number of years, did a bunch of consulting with different consulting practices, and then really found my home at the healthcare provider organization. I love helping the community in which I live, which makes it, working for a provider organization such a great fit.

So many opportunities to improve healthcare with technology and getting to see that come to life in your own community is really special.

Yeah, it is. It is fantastic. I remember when I moved cross country to work at St. Joe's in Orange County, and I'd go out and tell people I'm the CIO at St.

Joe's, and they invariably, I'd get one of two reactions. Either I'd get The person who would pull me aside and say, Oh my gosh, you wouldn't believe how great these people were. My wife was sick and, they helped us with the bills. And I get those great stories.

And then I, of course, I'd also get the other stories, which is like, I had to wait for three months to get an appointment. And I'd be like, we're working on that. there's nothing like

real time feedback to help us plan our work.

Exactly. So tell us a little bit about so the podcast is about the intersection of technology and healthcare.

So tell us a little bit about the the, what are the priorities right now at VCU Health?

Yeah, well, it's a really interesting time here at VCU Health. Everybody's going through kind of the similar effects coming out of COVID. But VCU Health decided to do some really transformational things during COVID.

So it took that time to implement all new enterprise systems. So we implemented ServiceNow, Workday, and EPIC, all in 2021. So we stacked those go lives. It culminated with EPIC in December of 2021, which also coincided with the opening of our new ambulatory outpatient pavilion and our first ever ASC.

That all happened really within a week. At that month of December 2021. So being 18 months or so out from those implementations from a technology perspective, we're really focused on making those new systems work for us. We're setting ourselves up with a really strong foundation. And it's all new to everybody.

And so teaching the organization how to use those systems, really making them efficient and effective is what it's all about this year. As we in parallel, like everybody has to plan for the future, what are we going to do next, knowing that we're not going to get where we need to go just on those enterprise platforms alone, but how can we then layer on some technologies to really make Some transformational improvements.

So

there's a couple of directions I'd love to go here. One is you're laying the foundation for something. What was the vision that led to the platforms you put in? All very good, I mean, Workday, ServiceNow, Epic. These are top tier systems that you put in. But there had to be a, we believe, we're putting these technologies in because we believe they will enable us to do what?

What was the

driver? Absolutely. Yeah, that's a really great question. So thinking about implementing EPIC as our enterprise health record the key drivers were our patients, provide a really great patient experience, be able to empower our patients to own their own health care and have access to all their information and really be able to.

interact with us effectively. Our providers, you know, making sure our providers and our care teams have all the information they need to care for the patients in front of them, and to understand who their patients are, and make the best decisions for care for those patients. We engage with a number of community providers, and so being able to share information across the community.

to serve the entire community is really what drove us to implementing EPIC. The information exchange capabilities obviously are huge. We have 4, 000, give or take, providers set up on EPIC Care Link, submitting, sending referrals into VCU Health, sharing patient information, and that really just bolsters the entire community.

So that was a huge driver.

Was that the common EHR in your market?

It is, yeah. Across Virginia EPIC is the EHR. So

there is sort of a pull because of that. It's, if you want to, if you want the referrals, if you want to exchange the information and integrate your system, there is sort of a pool that goes on there.

Oh, absolutely. it's so much easier to share EPIC to EPIC and not to downplay that. Information sharing capabilities across all vendors, but to be on the same platform just makes it so much easier. Providers already know how to use it. Patients are already engaged with, MyChart, Patient Portal.

They understand how to use those tools. It's just, makes things a lot easier. I'm

curious, your other two platforms, those are more internally ServiceNow can be externally focused and internally focused, but primarily it starts internally focused and then Workday. is primarily internally focused as well.

Was there a focus on the staff and administrative experiences or were there other drivers as well? Yeah,

absolutely. And I think we have to take care of ourselves and really be efficient in running our own operation before we can take care of our patients. And the ServiceNow and the Workday implementations were really acknowledgement of that.

Workday replaced a large number of Systems that were not integrated, so it's real hard to run a business if you don't have that complete picture. And so Workday provided that. ServiceNow, certainly for the IT team, is a great platform for running our IT business. We've now extended that out to our teams in HR and in finance to help them, automate some workflow.

So, I call that kind of getting our own house in order, we have to get our own house in order to take care of our patients and customers.

having done an EHR implementation myself. I know it gets worse before it gets better. everyone's like, Hey, we're getting this new car.

And then they get into it and they're like, Hey, it doesn't have a key. They're like where are all the knobs? I remember my daughter took my Tesla for her driver's test, and then she didn't pass her driver's test. cursed me for having her take that car. She goes, for example, where's the emergency break?

I'm like, there is no emergency break. It just automatically goes into the emergency break. She goes, well, that would have been good to know. It's like, it's just different. Like the controls are all in different places. Talk about that process that you're going through right now of a couple of months, almost a year into the EPIC.

Yeah, we're about a year and a half.

How do you bring the entire clinical staff up to speed on using it? How do you ensure that everybody's optimized in their use of it, and how do you make sure you're getting the most out of the tool that you've put in

there?

Yeah, that's a great question. As we've been talking about it, I totally agree with you. I think we're at the hardest point in any EHR implementation right now, because you're super excited for the new tools you think is going to solve all your problems and that go live adrenaline. Kicks in and now it has worn off and we're realizing all the things that we want it to do that we don't know how to do or wish it did that it doesn't do.

We're sort of in that trough. And so what we have done is create a specific program around EHR usability. So we have teams made up of folks from IT and informatics and "operations who are going through it. Specialty by specialty to do some training. 'cause as you can imagine, rolling out all those things at once during the time of Covid and doing virtual training, that left a little bit to be desired.

People can't see me when you're talking, but I'm laughing in the background because I went through all of this and they'd say, well, the tool doesn't do this. It's like, it does do that. Let me, you know, and it's interesting 'cause the arch Collaborative came back and said, That training obviously is an important piece, but the customization that you can do that most people don't do out of the box is so important.

Absolutely. The usability approach is first training, how do you use the things that we have? How do we get your user settings and we're calling it localization for you as a provider and your specialty in general set up so that you can be most efficient. We have stood up a user settings lab and a team staff that providers can go drop in and have a consult and get themselves really well set up.

And then the last piece is some kind of what we call low hanging fruit enhancements. Where can we make some small improvements that will really offer big benefit to our providers and care team. So our goal is to go through all of our specialties. This year, we're starting with some of the ones that we have already some dedicated provider informatics support.

We have a great team of provider informaticists who are epic physician builders and helping to really drive this work through the organization. And another thing we've done is stand up a real specific team, a provider support team, that is, Dedicated to onboarding our providers. So, the best place to catch a provider is right when they start, let's get them trained the right way the first time.

And so this team will be offering really that great onboarding experience. He kind of handhold providers through the process of getting all their accounts set up, their user settings done, their Epic training done, and set them up to be successful right from The beginning. So we have just launched that team as well.

It's been so well received, both from the providers who are trying to learn the system, but also actually from our IT team, as they can bring back feedback from the teams. Like, hey, if we did this little thing in Epic, it would make life so much better for all our providers. And then we can start to make some of those small changes that we know will be so impactful.

So I suppose you'll be heading out to UGM. Are you taking a team with you to UGM?

Yeah, we have a small team going to UGM. As you might imagine, we're all under the financial constraints with the travel and whatnot, but I think it's so important that we get out there and build relationships with Epic, build relationships with other Epic clients, and really share, share information.

We're all trying to work through the same things, right? \

Regardless of whatever EHR people have decided to implement it's good to have a community of, People who are using your system that you can share stories with. And I've already talked to some people who are doing presentations out there.

And if you're an epic shop, great presentations to to take back. You mentioned early on the importance of getting the information into the hands of the consumer and the consumer experience. And you now have some interesting platforms in place. to create new experience for don't know if you call them consumers at your health system.

Some don't. Some just refer to patients. Yeah, we're great with patients. Patients. I'm curious, what kind of experience are you looking to enhance or create for your patients? Yeah,

that's a great question. We really want to help our patients navigate their own health care journey. We've had a huge adoption of our MyChart portal since Epic Go Live.

Our previous portal was not terribly well adopted, but we have great adoption now. Over 60% of our patients are actively using the portal. And I think that's because we focused on really providing them tools they can use to do something that's of value to them. Sometimes we roll out these portals and we think patients are going to flock to it because they can view their results and whatnot, but that's a one time thing.

And once you've done that you're done. And so we're giving them tools to advance their healthcare. One of the things that's been super successful, and I know they're not always talked about, but it's just the basics of bill pay. We have almost half our patients get their statements and pay their bills on the portal, which is just easy, right?

It reduces the burden of work on the. Patient to do that administrative work and it, helps us as well, reduce administrative burden, but that then drives them to do other things in the portal, like appointment scheduling. We rolled out the FastPass tools to let patients. Know when appointments get canceled and they might be able to come in earlier.

And patients are getting in on average 70 days earlier, which is huge. If you think about not having to wait two months for an appointment it's huge for them, but it's huge for us because the schedules stay full. And that future appointments available for another patient. So we really want to get tools that they can use to do something that is of value.

Scheduling is interesting. I just had conversations with a bunch of academic medical centers and and scheduling is one of the most challenging not from a technology standpoint, but from an operation standpoint. You almost have to sit down with each individual specialty and talk through and align.

the policies and those kinds of things. Have you been able to expand it to the specialty areas or are you mainly looking at primary care at this point?

We're

going through that same process. It's really a specialty by specialty thing. For example, if you're looking at our ortho specialty, they have great online appointment scheduling.

They have adjusted their operational flows to be able to schedule. Online, get same day appointments and all of that. And that's harder for some other specialties and some of it's our own internal operations. Some of it is. More of the way healthcare works and the way the requirements, right?

Like some appointments you need, referrals, or prior authorizations. And all of that is really hard to manage in a self scheduling portal environment. So I agree. It's really, it's tricky and it is a specialty by specialty thing. And, the more we can adjust our operations to open these tools up to patients, the better off we'll, everyone will

be.

I'm impressed you have Ortho. Done. That's no small feat. We have

great leadership in Ortho working real hard on this.

I would imagine. let's talk about data a little bit. So, you now have legacy data, and you have new data, you have a new set of tools that you get with these things.

How are you thinking about data? How is your thoughts about data changing with the advent of some AI tools and generative AI and those kind of things? do you feel like there's a data strategy that I don't know, that has been handed to you or are you bringing a new approach to data as as it evolves in healthcare these days?

Yeah, I think, VCU Health, even before the EPIC implementation, had a very forward thinking data strategy. They had implemented a really robust data warehouse, some great self service, analytic tools for internal customers, things that I think others are, , still thinking about how to do.

I think the switch to Epic, there's work there to be done, right, to get the data that's now flowing from Epic available in those tools. We've decided and have, are in the process of implementing Snowflake for data warehouse and tools that sits out in Azure. And that really, The purpose of that is to make sure we have that foundation set to be able to take advantage of some of those new technologies, AI and machine learning and do some great predictive analytics and clinical decision support and research.

Research is a big focus here. So being able to De identify and segregate out data for research purposes is a huge priority for us. We have a really robust program in our School of Medicine and across the university and, partnering with them to develop ways that we can, safely and meeting all our regulatory requirements, share data for research purposes.

Yeah, you mentioned VCU Health is a safety net your region, I assume, and, as I think through that, and I think through social determinants of health and the importance of data and partnerships, because a lot of that data we don't have in partnerships, how are you thinking through, the data sharing strategy and specifically to that underserved population where a lot of times as much about healthcare as it is about all the other things that go on.

Yeah, that's a great question. Yeah, we have a organizational initiative, one of our strategic themes around advancing health equity and A lot of the work we're doing this year is really capturing those social determinants of health and creating good partnerships across the community. Because you're so right, these the concerns are so much more broad than just the health care component that we can handle here at the hospital.

Just as an example, one key partner is Feed More, which is the local food bank. They're a great partner of ours. They send food baskets to patients, and we can create referrals to them to be able to address some of those needs. So, it really is about creating that community network of services.

And there's a lot of partners who are ready and willing to help but it's about connecting the right patient to the right service. And that's what we're attempting to do first by gathering data and understanding our patients, and then by being able to make these referrals. So,

who's the quarterback of that?

Is the quarterback the health system, do you feel like? Do you feel like it's incumbent on you to drive some of those partnerships? Are there other people that sort of take that quarterback role and pull you into it?

Yeah, that's a great question. We have a chief of Health Impact, one of the senior vice presidents here at the health system, who really owns this for the health system and does a wonderful job of working with all these organizations across the community.

We're all kind of work as a consortium to care for the community. I think for us, it's about understanding who our patients are and what their needs are and coordinating the resources. But it's really a community effort.

  📍 📍 All right, we'll get back to the show in just a minute. If you've been with us for any period of time this year, we've partnered with Alex's Lemonade Stand to raise money for Cures for Childhood Cancer, and we are so excited. We set a goal to raise $50,000 and we're already up over 27,000, our 26,700 for the year.

So we're close to 27,000. I'm rounding up. We went to the Vibe Conference and with your. And the help of just an amazing community, generous community. And our partners as well. We were able to raise $16,500. So thank you all for your generosity. We're gonna do it again. As you know, we did Captains Cures for Childhood Cancer, at the Vibe Conference and anyone who got their picture taken with Captain who was facing the camera we gave $1 to Alex's Lemonade.

We're heading to hymns and bringing Captain again, and we're gonna do the same thing. As you know, captain is my producer service dog. He'll be roaming the floor. If you see Captain, stop us. We would love to have your picture taken and we would love to have you participate in this campaign.

We really appreciate our partners who helped to make this possible. For this one, so far we have rubrics, so we still have a couple of spots If you want to participate, if you want your company to participate, let 'em. That they can participate in this and we will give you the details. You can shoot us a note at partner at this week, health.com.

It's real simple. If you're on the floor, you see Captain, get your picture taken. Anyone facing the camera, go ahead and post it to social media Twitter or LinkedIn. Tag this week. Health, that's how we do the county. And again, 16,505. I think we can do it. At the HYMNS conference and really make a dent in our goal to get to $50,000 for childhood cancer.

It's gonna be exciting. We appreciate our partners who stepped up during the Vibe Conference, and obviously we appreciate rubric being our first partner to step up for the hymns event. So look forward to seeing you at hymns now, back to the show. 📍  

Well, I'm gonna drag you into the conversation because we have been raising money for Alex's Lemonade Stand all year long.

One of the ways we're raising money is every time somebody says Generative AI on the podcast, we actually give a dollar to Alex's lemonade stand. And we're already up over 50, 000 by the way. Not that it's been said 50, 000 times, we haven't had other fundraisers this year, but I'm sort of leading the question, which is what technology are you keeping an eye on right now that you think is going to have a significant impact on healthcare, maybe over the next three years? Yeah.

Well, it's hard not to keep an eye on generative AI. It's in your face all the time, everywhere.

But I think good reasons for that, right? It's good. The technology is there. It has huge promise. I think that. Actual implementation and application in healthcare right now, what we're actually using is probably a lot more limited than what the impression might be given all the communications, but we're certainly looking to start and start in a kind of a safe manner.

I think it'll really be a journey and starting with more of the administrative work, we're thinking about things like how do we embed tools into Workday to help with administrative burden, or how do we you Set up an enterprise kind of environment to use some of the chat GPT like tools to help our operational administrative teams do their work, and then kind of progressively get into those clinical use cases.

So, a huge promise. We are definitely addressing it. We've pulled as many others have, a group of thought leaders across the organization together to think about and start putting together our guiding principles for responsible AI. What will we and won't we do? Do we need a policy? Don't we need a policy?

Varying opinions on that. Varying opinions on committees. Do we need an AI governance committee or is this part of an existing committee that we already have? So there's a lot of thought going into that right now. Well,

That was going to be my next question about governance. So governance, I find to be fairly uniform and then.

Very specific. I know it sounds like I'm talking out of both sides of my mouth, but, everybody has sort of a technology project governance group and a clinical informatics governance around the EHR and that kind of stuff. So there's some commonality, but I'm finding in this area, especially AI.

being one of those that there are new groups being stood up and they're cross disciplined kind of groups, but it's they're evolving differently. Some are actually writing policies right now. They're essentially saying, look we know that if we, even if we don't say it.

We know that some people are using the tool right now and we've heard use cases where physicians are using it for denials and like rewriting the letter and that kind of stuff. So we know it's being used, so we have to tell people, hey here's the guidelines. have you thought about guidelines?

I know you've talked about policy and it's not really in place yet. Are there guidelines for that you're thinking about and how do you think this might evolve? Yeah,

there are guidelines we're thinking about. I think, our plan is to start with the education. The fact of the matter is a lot of our existing policies kind of cover this situation, but we need to connect the dots for people.

We need to make sure they understand not to share our confidential information or PHI with a chat GPT like tool, right, and release that out into the wild. So it's a lot about education. At first, I think the guidelines for us are more about, people are being approached by vendors in a number of different situations in addition to what they might just experiment with themselves about AI powered tools and how we make decisions around what to use and what not to use, what's ready for a primetime healthcare use and what is not.

And those are decisions also that our tech governance services. Committee and our data governance committee are also already addressing. So I think it's about finding a approach that is, provides the appropriate level of oversight and decision making, but doesn't add unnecessary, bureaucracy and administrative overhead to the work because we're already so heavily laden with committees in healthcare, right?

We can stand up a lot of committees and we're all in all these meetings all the time. A lot of times we feel like, we're the same people, Meeting about different topics under a different committee name all the time. And so how can we simplify, yet still address the need?

One of the hardest things in healthcare, at least when I came into healthcare, and I would assume you've experienced this, is every request is a good request.

Like there's so many good things we want to do. from your perspective, from the CIO, from my perspective, it was looking at it going. I would love to do all of these, but we can't do all of them. And so somehow, the organization has to prioritize those things. And that's what we look to governance to do, so that we're not always the ones sitting there going, I just can't do it.

That's

right. I mean, the list of good ideas... I should say we have a list of great ideas. We have the good ideas, we have the great ideas, we have the groundbreaking ideas. It's a huge list and we can't do it all. We certainly can't do it all at once. And so that's what our tech governance committee, and you mentioned we have a tech governance committee.

We have an EHR steering committee and that's their charge is to, , put their system hats on and make good decisions for the system and do work that aligns and supports our strategic goals. As opposed to any one department's maybe very specific niche need, that's kind of our guiding principles, how can we make the best use of the investments across the system, grow this system ness here at VCU Health, both for our providers and care teams and our patients.

We want to look and feel like one system, and if we kind of go about having each department select their own tools and doing their own thing, then that begins to break down both, patient experience, our provider experience, our employee experience. So, it's hard, right? Everything is good.

Every provider has their own thing that would really help them in their workflow and really help their patients, and it's hard to say often we try and say, not now, or let's try it a different way. And, you know, all those conversations that happen to those governance committees.

and we live with it every day.

It's interesting. I was just. Just had a bunch of AMC CIOs together. And one of the CIOs shared their slide on imaging, just imaging. And the number of different imaging systems they had throughout their academic medical center. And I didn't even know we had that many areas that required imaging.

But his question was, what's the opportunity to consolidate this into enterprise imaging? Because I'm telling you, I think he had like 40 some odd different imaging systems. across the entire enterprise. And we live with that legacy of every system goes through it, where at some point they just sort of let the reins off.

And all of a sudden you end up with 45 to 50 different imaging systems. And then you have to come back in and go when they say, Hey, we want to share. Hey, we want to apply these new tools to it. And you're like, we have to write 45 different interfaces. I mean, that's three years worth of work, but if we had this, it would be.

Six months worth of work and we can apply it across all of our imaging platforms. I assume you have similar legacy challenges that you're dealing with. Oh, we

absolutely do. And I think if you're a part of any innovative organization, VCU Health is a very innovative organization. We try and we push boundaries in certain areas and, , that, that leads to some of that well called chaos, right?

People are doing their own thing and wanting some very specific niche products. But I think you're absolutely right. We come back to, we just spent all of this Resource and time and effort and energy on establishing a really strong enterprise foundation

Marker

so that we can run faster on some of those use cases.

And we can deploy things really widely in a quick way, as opposed to going back and retrofitting all the stuff that we either, custom developed in the past, or have one off vendor for a specific change. It feels good and it's good in the short term, but those solutions, they often don't age well.

Custom development. Wow. There's yeah, those are fun as well. Here's a closing question for you. By the way, thank you for the conversation. It's been fantastic. And I look forward to more in the future, hearing how you guys evolve the patient experience, the clinician experience, I think will be interesting.

But you have an interesting perspective. In that you have you've come from the vendor partner side into the provider side. Talk to me about what makes a good partner for you. What makes a good vendor partner? What are you looking for? Or what kind of vendor partner were you to health systems that brought value and enhanced.

Yeah,

that's a great question. I always look for vendors who are really thinking for the long term and focused on a long term strategic relationship to being too transactional. I think it's easy to come in and sell something quickly. It's hard to stay and make it work and help your customer really.

realize the value of that investment. And so I think vendors who can come in and just take the time to listen, understand what our organizational goals are, what are the barriers to getting there, kind of what is the full context, and then create Your pitch and your plan. How can you add value to this organization, meeting us where we're at and working with us for the longterm to get there?

and , I think that's really key.

And actually when you find those people, they might go from one company to the other

and you bring them in immediately because they just. There's somebody who the word partner is the right word for it, right? They're a thought partner. The conversations are generative and those kinds of things.

It's the people who say to me things like, it's my end of quarter. I'm like, I don't care. I mean, if it's your end of quarter, explain to me how that helps me. Do I get a better negotiating position? But at the end of the day, I have, I mean, in IT, you probably have a hundred vendors.

And it's like, if I reacted to everybody's end of quarter, I would look schizophrenic.

Yes. But my whole December signing, but I think you're so right. I mean, there's vendors vendor partners I've been working with the last 20 years and they've maybe switched companies three or four times, but we continue to work together.

And there's companies that we've started working together in kind of one lane, one project, and it's morphed over time. You know, it's been a decade working on different things within the same organization, just because there's that good relationship, that good understanding, and that trust there.

Ellen, I want to thank you again for your time, and I look forward to hearing how how things progress, especially with these new platforms, seeing where you take them.

Yeah, I really appreciate it. Love to come

back anytime.

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