Virtua, a four-hospital system serving southern New Jersey, is so deeply committed to information technology that when it opened a new data center, the board of trustees held a meeting there, sitting among the rows of servers. That same board has a standing IT committee that meets every two months, along with the usual committees for audit, finance and quality.
The data center is only the tip of a $169 million-and-counting capital investment in IT that's transformed the organization into a leader in using data for clinical care.
When Virtua decided about 10 years ago to build a replacement for one of its facilities, President and CEO Richard Miller made a pitch to his board that seemed somewhat radical at the time. The new hospital should use the most advanced information technology it could afford from the day it opened, and minimize paper in favor of easily analyzed electronic record-keeping. Though bold, that plan in itself was not unique. But Miller thought the organization should use the long planning and building period to switch the other three hospitals over to the new IT first.
“The move itself was enough of a challenge for the staff that it would have been impossible” to move to a new clinical computing platform simultaneously, says Dr. James Dwyer, the system's executive vice president and chief medical officer. By the time 368-bed Virtua Voorhees (N.J.) finally opened in 2011, with all private rooms, much more space, and state-of-the-art technology in every cranny, all of the system's hospitals and outpatient facilities were using a common clinical data repository and linked by a fiber-optic network.
A new acute-care electronic health record, chosen largely by the clinicians who use it, connects with dozens of departmental systems in a “best of breed” IT environment, and an ambulatory EHR is being rolled out now at outpatient sites and physician offices.
Virtua also has a host of other capabilities linked to its advanced IT infrastructure, including centralized appointment scheduling, online dashboards for its managers to track quality and financial performance, dozens of telehealth monitoring devices to track the health of patients in their homes, asset-management systems that use radio-frequency identification, a health information exchange that connects Virtua with reference laboratories and radiology practices, a personal health record using Microsoft HealthVault, several patient education websites and a mobile app to help patients find Virtua facilities, physicians and other resources.
“Rich has been absolutely supportive and visionary from day one,” says Al Campanella, chief information officer, who accepted the post at Virtua in 2008 after spending three months there as a strategic planning consultant.
“I talk to other CIOs whose CEOs are clueless. They don't appreciate the role of IT, and they think of it as an afterthought rather than something that's part and parcel of the strategic vision.”
For that strategic vision, and the courage to stick to it, Miller, 59, was named one of the three winners of this year's CEO IT Achievement Awards
, presented by Modern Healthcare and co-sponsored by the Healthcare Information and Management Systems Society.
Miller doesn't consider himself a computer guy. He has a finance background and is all about results. But when it comes to clinical IT, he takes a broad view of what constitutes return on investment.
“It's not like figuring out a balance sheet,” he says. “The question is, are you improving care? Are your safety results better? When you talk to your people, do they feel that they're giving patients a better experience? If the answer is yes, you've got your ROI.”
Miller authorized the creation of a CIO position after Virtua was formed through a merger in 1998, and he supported a 35% increase in the IT staff over several years. He also created an IT subcommittee of the medical staff.
Virtua's largest IT projects, including the acute-care and ambulatory EHRs, are considered “enterprise projects,” and as such, their success generates performance bonuses for the senior management team. Other enterprise IT projects include the health information exchange and, most recently, the effort to qualify Virtua to receive federal incentive payments for meaningful use of IT.
Miller is a nationally recognized leader in applying Lean and Six Sigma management principles to healthcare, using them to increase efficiency and reduce waste. He used those principles in guiding Virtua's clinical transformation, not only improving the quality of care but also generating more than $28 million in sustained savings. In 2008, he was recognized by Worldwide Convention and Business Forums as the Lean Six Sigma CEO of the Year.
Miller says it's vital to analyze how an organization functions before trying to computerize it.
“Sometimes when you put IT in, your underlying processes are still bad,” he says. “When that happens, you'll never get the functionality out of the system that you should be able to.” Part of the Virtua implementation plan was to create an elaborate analysis of how more than 100 information systems interacted, and to find ways to make that information flow as efficiently as possible.
Miller believes strongly in listening to the prime users. During the shopping process for the new EHR systems, he bypassed the CIOs at sites already using the software in favor of quizzing clinicians.
“I want to know if the nurses and doctors are happy, and if the systems are easy to use,” he says. Physician acceptance is crucial, because Virtua makes computer training a condition of being credentialed at its facilities, and it's also actively acquiring physician practices. Computerized physician order entry has been instituted at all of Virtua's facilities over the past year, and Miller says it has gone very smoothly.
“Our medical staff is completely onboard,” he says. “I haven't heard any negative reactions.”
Dwyer has been with Virtua since the beginning and held several roles at one of its component organizations prior to the merger. He also uses the word “visionary” when describing Miller's approach to IT, especially his demand for the data necessary to measure quality of care.
“In the old days, it was bad enough to try to interpret what was written in the paper record,” Dwyer says. “Now the information is very reliable and we can be sure what we're looking at is real.” Dwyer has seen clear improvement in a number of clinical areas, including the accuracy of medication and test orders, and says Virtua now has the tools to undertake any quality-improvement initiative.
Despite his relative lack of interest in technology as such, Miller is devoted to solid data. He has served on the board of the National Committee for Quality Health Care (now the National Quality Forum) and the leadership advisory council for the Joint Commission's Center for Transforming Healthcare.
Information technology was a top priority ever since Virtua’s new hospital in Voorhees, N.J., was on the drawing board. The 368-bed facility opened last year.
Miller remembers the dubious quality of the information pulled from manual chart review, and he relishes the ability to gather systematic data in real time and discuss it with the physicians while the cases are still fresh in their minds.
“The inordinate amount of time we spent previously on gathering information is now spent on analyzing it,” he says.
Miller points with pride to Virtua's improvements in treating congestive heart failure and reducing surgical-site infections, and he says those improvements and many more will be key to the organization's economic survival.
“This goes way beyond bragging rights,” he says. “Some of our payers are already looking at putting these (quality-improvement measures) in our contracts. They will be the linchpin of future reimbursement.” Elizabeth Gardner, a former Modern Healthcare reporter, is a freelance writer based in Riverside, Ill. Reach her at firstname.lastname@example.org.