We are here today with Doctor Dave Rich to see Mio West Virginia University health system.

Dave, thanks so much for joining us today.

Thanks for having me, Jordan.

So for those who don't know, West Virginia University health system is a 24 hospital health system spread across four States and based in Morgantown, WV with 3000 beds and 10,010 thousand providers.

So Dave, you've mentioned, is there a different number of providers?

Yeah, I think I E.

How many?

About 3000 providers is our number.

So I I think the bed number is off.

I'm sorry.

OK, well, in any case, there are a large system across four states in West Virginia now, Dave, you've mentioned that you've been working to bring all hospitals on EPIC by 2024.

Could you speak to how you've been going about integrating specialty tertiary and quaternary care to date and how that will look post epic implementation for example with any new acquisitions that aren't already on Epic, how will you handle that?

How will you handle ingestion of other external data?

What's integration looking like now and in the future?

Post epic?

Great.

Well, that's a big question.

Is, as you said, we're up to 202324 hospitals.

We've been growing over the last couple of years and part of that growth is not just a a partnership between the hospitals, but we found our secret sauce is to get the electronic record and supporting infrastructure in place as soon as we can as we bring on those additional hospitals.

So we've been on this path where the relationship start?

Uh, the the acquisition journey begins.

And then we are close behind with respect to the IT team to make sure we can get our EMR in place, which is Epic.

What are some of your challenges with interoperability?

Yeah, there's as we approach each of the hospitals, they they have some legacy systems that we have to decide.

You know, we can.

Can we keep her?

Can we change over to our systems really that I would say the biggest challenge we face is that legacy data and we do have a plan for archival of that data from whichever the hospital.

It may be that takes more time, so we we'll get our electronic medical record in place, but then we have to work towards archiving that data and making it available through a standard means.

And what are some of your top challenges when you think about archiving data?

Is that both clinical data and non clinical data and are your top concerns kind of legal compliance?

If there were a need to pull up that data due to a patient request or a pending lawsuit, what is the driving force?

That's kind of shaping your decision about how to archive your data.

Well, all the ones you mentioned are important.

Clinically, we find that most of our clinicians rely more on the current data over time.

So yes, during that transitional period, it's it's nice to be able to access the old system and look at the data from the previous visit or the last hospitalization.

But over time, the cure, the record for the patient evolved.

So the clinicians don't look back to the historical data quite as much, but certainly for release of information purposes, that's important for any we go cases or implications, we certainly need to have that.

But most of the clinicians are looking forward in terms of the clinical data.

Are there any other use cases for archive data?

For example, population health, quality reporting, measurement, risk based payments, or any sort of other use cases that are driving your need to access this data.

And again, is the data all clinical or is it also AR is it claims?

Is it other sorts of data too?

Ohh, it is both and we you know.

Sorry, archive different data in different places for population.

Help perspective.

Yes, we wanna know for certain health maintenance items, IE colon cancer screening, breast cancer screening, we definitely rely on that historical data to make sure that we're keeping track with patients.

So.

So that's often what the clinicians are asking for in terms of the data that they would like to see.

And is there research that's being done at WVU that relies on that?

Sort of historical data?

Or is it more just to support the frontline clinicians?

Mostly to support the frontline clinicians.

Uh, I can't speak to a specific research project that's looking back at historical data, but I'm sure there are some.

Umm.

Got it.

Now, another priority, shifting topics a bit that you said and and at WVU is working to keep healthcare local while preserving local jobs, especially due to kind of some of your catchment area being rural in nature.

You may be a significant employer in certain markets.

Can you talk more about what you've been doing to keep health care local, the benefits of doing so and preserving local jobs, how you've been able to accomplish that?

Yes, is in a time when you see or you read about hospitals closing in different parts of the country.

Uh, we've been able to partner with some of the smaller hospitals, particularly in West Virginia and rural areas, critical access facilities who may not have survived independently, were able to partner with them and give them the infrastructure with respect to the medical record and the the other related infrastructure for billing, so that they can stay open, serve the community and in many cases grow programs there.

So we once we build that relationship with our hospital, we identify the programs they have made, the programs, they don't have that the Community needs.

So we've often seen a growth in in jobs for those specific facilities and the communities and the folks in the community like it, they can get their healthcare locally and those who have jobs in healthcare often can stay in that community and and work and contribute locally.

Could you elaborate on some of the programs that have grown out of those partnerships?

The in terms of clinical programs in in many of our hospitals, in addition to placing primary care general Pediatrics practices in those communities, we built up more of our our Heart Vascular Institute care.

So cardiology care in in those regions and again you can think of other regions that that didn't have surgery programs and were were finding surgeons who can work in those communities and serve those communities.

So kind of opening up new service lines to those rural communities are there.

Yes.

What are the financial incentives or WVU to engage in preserving those kind of those, those local hospitals, right there are critical access hospitals.

You're going out there.

You're giving them access to your EHR, to your billing infrastructure other than kind of doing the right thing, is there a financial incentive or are these programs a complete hit on the hospital and they're just provided as a community benefit?

I I I don't wouldn't see them as a hit on the hospital.

I I think the general incentive is that with connected care, we're able to feed some of the specialty care to other parts of the state when when needed.

And so in addition to providing the necessary care for the patients that care is is coming through our specialty network.

So that's an advantage.

But but I I really think the mission of our organization is to provide care across the state to focus it.

Mm-hmm.

So I I it's more mission oriented.

Got it.

But OK, so mission oriented first, but also there's a added benefit of driving referrals to WVU specialty practices.

Yes.

And then finally on this topic, I'm interested since this is healthy data podcast, I'm interested to ask you about some of the technological challenges associated with these partnerships with these critical access hospitals.

Have there been challenges with enabling providers to hook up to your EHR?

I guess epic and in the future, are there technological challenges with ingesting imaging from external labs from external providers?

What sort of technological challenges you have with ingesting data and ensuring that providers are operating in the same space?

When you're servicing these populations?

Yeah.

The general infrastructure challenges are making sure the bandwidth is there for Internet and and high speed connectivity.

So sometimes we've had to overcome that with some of the facilities and and make sure the infrastructure is there for the outline clinics who, many of which didn't have electronic medical records in place.

So getting past those barriers again, we use the same infrastructure.

So the exchange of data, once we have those areas live the exchange of data is instantaneous.

And when I go to our go lives across the system and talk with the providers, that's their kind of ah, ha moment.

The day they go live, is it?

Wow, I can see everything that happened up in Morgantown.

We're a different part of the state instantaneously.

Now that I have access, so you know you do have the occasional folks who you know, if we think about COVID and remote care and folks not being on site, you have the occasional provider who doesn't have the level of service or connectivity at their home site.

We work through that as well.

A number of follow up questions there.

I are these rural access hospitals.

Are they accessing the Internet through broadband or satellite connections?

Broadband.

Yeah, broadband.

OK.

And and so you said that the exchange of data is instantaneous.

I'm wondering if there's any kind of if there's lag with your maybe H high availability or disaster recovery sites or mirroring.

Since data centers may be located far away geographically from West Virginia and the broadband kind of download upload speed may not be as high as in other areas of the country, are there any lag issues due to geography?

We've not seen that.

And again, our our technical folks do that assessment well ahead of our transition to make sure that they have the pipeline, so to speak, for that capacity.

Got it.

And so telemedicine isn't impaired at all due to connectivity issues.

It has not been.

Cool.

Alright, moving on to engagement, I know that the topic of patient engagement in the rural setting of care through the my WVU chart is an issue that you've published on previously.

Do you have any thoughts about kind of what your goals are, where you're looking to go in terms of patient engagement through the WVU chart app, where you've been what you were able to accomplish and hurdles that you overcame?

Yeah.

We just hit this last month.

We hit over 800,000 patients who are active in our my chart instance, so that's great milestone.

I'd love to see us reach the million mark, maybe next year or the following year.

And as a clinician, he should engagement understanding of their record involvement in their record is very helpful.

We find that that helps improve outcomes.

More engaged patients are the more likely they are to either follow instructions, seek care when necessary, and just generally be engaged in their care.

There's some convenience aspects of that that we've been working on self scheduling so that patients can schedule when it's convenient for them based on availability.

We've done some things in the self check in space where patients can do most of the check in without having to spend a lot of time in our front desk.

We, as I know at a topic you know.

High on everyone's list is patient messaging to their providers.

Uh.

While we know that that can be overwhelming at times, I think that's a great way of for patients to be able to connect and ask relevant questions of their providers.

And then their providers and care teams can determine, OK, do you need to be seen for that or is that something we can address without having to have a office visit too?

So on that last topic, you know a goal is often more patient engagement in their own kind of care plan with patient centered care and and and and that's obviously an admirable goal.

But as you just mentioned, significant engagement with patients may lead to an increase of patient messaging and sometimes that could inundate providers and adversely impact responsiveness to potentially urgent messages.

Have you been seeing that challenge?

And if so, have you been trying to address it at all?

Yeah, we've definitely seen an increase in patient messages that coincided with the pandemic.

I think it also also was sort of driven by the 21st Century Cures Act and increased transparency of the record.

So we get more patient questions about information they see, which is a good thing.

So we've definitely seen more and the the thing that we all wrestle with is those messages come in at all hours of the day and during the working part of the day, our clinicians are seeing patients in the office.

So they don't have as much time to look at those messages during the day.

And of course, after the day's over, they go home.

We want them to be with their families.

Rest recuperating all that.

So we are trying to look at ways to triage those messages across all hours and then queue up those things that the physicians providers need to address so that they're not constantly trying to go back to their in basket.

In our case, to to look for those messages.

So we're working on that.

Any AI solution to address that challenge?

We we are our vendor.

Epic has an AI solution that will read, read the patient messages and and draft responses.

So we've not yet done that, but are on a pathway to do that.

And we've looked to the experience of others, most notably, you see San Diego and Stanford, who've had some of the earliest experience in that space, drafting responses to patient messages still don't want to send those responses until a clinicians reviewed them.

But if it can save the clinician time and and provide a an appropriate response to the patient, we think that's great.

Umm, there's another topic.

I think that's very particular to to certain areas of the country.

I know you've you've written about the opioid abuse and prevention of opioid abuse using technology.

Is that been an issue that continues to be present for West, West Virginia Medicine?

Yes, opioid crisis is still a crisis across the country.

Uh, West Virginia and the region are certainly the epicenter of it.

For many, yeah, we are definitely using technology in that space.

You know, a lot of the just connecting to state based resources to see what has been prescribed for a patient previously that used to be a very manual process where users had to go to a different database login, get information, go back to there medical record.

We have that integrated so that with one click our providers can check not only across our own state database, but other state databases that are collaborating.

We can see that information, so that's at the point of prescription.

We have that information.

We also do things looking for those at risk for overdose and suggesting Co prescription of Narcan, which is a reversal agent.

So we've been doing things in that space as well.

We're also, you know, moving away from opioids.

I.

We've we've done some work in the space of care plans, order sets and clinical guidance to suggest alternatives to opioids for those things that most commonly have for for those situations, back pain and other things that folks would have commonly prescribed opioids for in the past.

So we are approaching the end of this podcast episode.

We certainly have covered a lot of ground.

I'd like it to open it up to you, kind of with an open ended question if if you could wave a magic wand.

What's maybe the number one priority?

What's the number one challenge that you would wish to go away?

What's the biggest kind of obstacle or headache that's keeping you up at night?

At least technically from technical perspective that you would love to see resolve, where's kind of the gap between where you are and where you would like to be.

Uh, well, we'll call it technical and clinical.

The documentation burden for providers and staff nurses too, has grown tremendously over the years.

It it's part of that regulatory based.

There's some other factors which we could go on for a long time talking about, but if I could make that easier such that clinicians could do their care throughout the day, speak to the things that need to be captured in documentation and move on, we'd we'd have a much more energized workforce, I think so ambient listening is is one of those things that shows great promise.

Other other tools you know, flow sheet macros and other things for nursing are also important.

But if I could reduce that documentation burden, that would make, I think that would have a great impact on on burnout in the healthcare.

Well, Dave, I do appreciate your time.

We've come to the end of this podcast episode for a listeners this has been Doctor Dave Rich, the CMIO West Virginia University health system.

Dave, thank you so much for joining us today.

Thank you.

My pleasure.