PROGRESS 2014: Valley Health works to create coordinated system of care

New medical records system meets government standards, improves patient experience

By Katie Demeria

Major changes are underway for Valley Health in the upcoming year, many of which are expected to have a direct, positive impact on patients.

With national health care undergoing widespread adjustments through legislation, the health system has been working to both meet new government standards and continue to provide their patients with quality care.

“This is going to be a dramatic year in health care, for multiple reasons, especially in the Commonwealth and other states,” Valley Health CEO Mark Merrill said.

Merrill cited the implementation of the Affordable Care Act as one of those dramatic changes, along with the discussion of Medicaid expansion in Virginia.

“These are major economic forces in terms of looking at population health,” he said. “We’re seeing movement toward larger deductibles, and over time we think there will be movement toward different health plans as well.”

“It’s transformational,” he added.

The health system has seen an overall dampening of demand, Merrill said, in both the senior population and commercial population, a term which refers to the younger generations.

Those changes will likely result in nationally shifting systems of health, many of which will become more apparent over coming years.

“Five percent of the population accounts for 49 percent of health care costs,” Merrill said. “Twenty percent of the population accounts for about 80 percent of healthcare costs.”

The issue now is attempting to meet those radically adjusting numbers and keeping up with the demand, Merrill said.

“How can we create systems to identify 5 percent of the population that accounts for almost 50 percent, and better manage these patients to avoid unnecessary tests, avoid readmission, and provide early intervention to avoid serious conditions later?” he said.

Some of these national health care changes are already making a major impact on Valley Health. The balance, Merrill said, comes from meeting those demands so the system continues to benefit patients.

He referred to a traditional discussion in health about the three-legged stool of payer, employer and provider: insurance companies, health systems, and physicians.

“I’m a firm proponent that it has to be a four-legged chair that includes the patients,” he said.

The most dramatic way in which Valley Health is moving in this direction, Merrill said, is through the implementation of EPIC.

EPIC is a medical records system that will transform the way in which Valley Health departments interact with other departments within Valley Health, other health systems altogether, and their patients.

Dr. Jim Wiedower of Winchester Medical Center was a major player in Valley Health’s search for a new medical records system that would meet government standards.

Medical health records became a major part of many systems several years ago, when encouraged through legislation, Wiedower said.

“The government got involved by providing financial benefits if you purchased electronic medical records, and financial penalties if you did not,” he said. “So when that happened, many hospitals started buying that software.”

One problem hospitals have run into, however, has to do with the transfer of information between programs belonging to different departments. Emergency department files are not available to physicians within the pediatric department, for example.

Instead, information is passed along through hard copies, Wiedower said. Not only does this system inconvenience physicians, but the issues are evident to patients as well.

“My wife’s aunt went to the hospital, and was admitted into the emergency room,” Wiedower said. “She gave them her information, but later, when she was sent to other caregivers, she was asked for the same information again.”

The patient is usually asked to give details of their situations multiple times within one hospital visit, Wiedower said. Things can get lost that way — they can forget certain conditions, or mix details up.

“A lot of people do not remember the names of their medications, for example,” he said.

EPIC is designed to prevent these issues.

“Essentially, [EPIC’s] whole plan is that you get an electronic health record based on a single database so each patient’s record is that patient’s record,” Wiedower said.

With EPIC, Wiedower will know if his patients went to see another caregiver and any medication changes that caregiver prescribed.

Several government standards were contained in the transition to medical health records. They are characterized as “stages of meaningful use,” and while Widower said it was easy for Valley Health to meet the first stage, the second would be difficult, and the third more so.

“We qualified for stage one, and we got some money from that, but if we stay on our current program it may be difficult to reach stage two, because they’ve not done a great job of getting us ready for it,” Wiedower said.

After researching several other programs, Wiedower and his team settled on EPIC because it would allow Valley Health to meet future meaningful use stages. It will also meet another national standard, the international classification of diseases.

“Right now we use ICD 9,” Wiedower said. “Most of the rest of the world has been using ICD 10, but doctors in America have been good at convincing the government not to make the switch.”

The deadline to meet the second stage of meaningful use and ICD 10 is May of this year. Usually, it takes two years to implement EPIC, but Valley Health was only able to start the process nine months before the deadline.

“It’s like rebuilding an engine,” Wiedower said. “Not getting new sparkplugs, but taking out each piece of your engine and rebuilding it, while keeping the car running.”

Over 6,000 Valley Health employees will have to be trained to use EPIC, Wiedower said. It is a completely new system and will replace what he characterizes as the niche programs with which many departments are familiar.

“Not everyone is happy about having to switch to an entirely new system,” he said. “But this is really the best option we have, and it will allow us to do a lot more in the future.”

Patients visiting a Valley Health hospital in April or May will probably see the impact of the switch. Training staff will be moving around hospitals to assist others with any questions they may have about EPIC.

The 45 individuals hired to train those 6,000 Valley Health employees will be trained themselves to use EPIC throughout February. Christina Payne, a nurse with Winchester Medical Center, has been helping with that training coordination.

“It has been pretty intense and a very fast-paced process,” Payne said. “But it is definitely worth it, we’ll have access to a single record and a huge history. It’s going to be a wealth of knowledge throughout the system.”

A major aspect of EPIC that will be particularly useful to patients is MyChart. It will allow them to login online from home or on a portable device and look at their health records.

Patients will actually be able to exchange messages with their providers if they have any questions about their health, Payne said.

“It will also allow patients to update their own records,” Wiedower said. “If they get a flu shot, for example, they can plug it into MyChart.”

It will create an all-around engaging health community, Wiedower added.

Because Valley Health will use EPIC, medical records will be accessible to other health systems that use the program, which includes Inova Health and the University of Virginia.

“And a lot of our patients are sent to those hospitals, so it will allow those systems to just pick up their records and fully understand that patient’s background,” Wiedower said. “It’s going to be incredibly useful for everyone.”

The hope, he continued, is that patients will have a stronger relationship with their health care, adding their input and engaging with their physicians.

Increasing engagement is a theme other Valley Health departments are striving to achieve, especially emergency departments.

Dr. William John Zehner, emergency physician with Shenandoah Memorial Hospital, referred to the emergency department as the front door of the hospital.

“When will the average person come here, other than to visit family or friends?” Zehner said. “It’s when they have an emergency and find themselves here.”

Zehner said the emergency department is expected to work closely with EMS teams and, when in a system like Valley Health, other hospitals.

Communication is key, such as when EMS teams are transporting a patient having a heart attack.

“They need to read the ECGs and understand which hospital to send the patient to,” Zehner said. “And that decision can have a huge impact on that patient’s outcome. So having good technology is great, but only when the system works correctly.”

Zehner said one of the areas he hopes to improve in the upcoming year is communication with patients. Especially at Shenandoah Memorial, he said, many patients do not always understand what is happening while they are waiting for care.

“They will see someone laughing at the nurse’s station, and think they’re wasting time while they are sitting there waiting,” he said. “It’s very important that we start reaching out to patients, explaining to them what’s gong on.”

It is in this way, Zehner said, that hospitals such as Shenandoah Memorial can improve what patients think of hospitals. Engagement with patients is very important, he said, and can make a big difference to the average individual.

Dr. Jack Potter, with Winchester Medical Center, pointed out the difficulties of coordinating a system of health in a small community without a level one trauma center.

“It’s about planning protocols and systems,” he said. “We have preliminary plans in case of emergency situations — we know where everyone is going and what to do in order to keep people safe.”

These protocols range from emergency situations hospitals see regularly — such as heart attacks — to major natural disasters. Valley Health meets with emergency officials from the University of Virginia in order to create those protocols.

“In rural areas like this, it’s necessary to have a plan of action,” Potter said. “And we have that here. A lot of smaller hospitals are closing, but we are keeping ours open because we know that people in those areas need that care.”

The communication Potter referred to will doubtlessly become easier when EPIC is implemented by the spring of this year. Valley Health sends patients in serious condition to the University of Virginia, a level one trauma center which also uses EPIC.

“This is huge for us, and I think it’s going to change everything we do,” Payne said.

Contact staff writer Katie Demeria at 540-465-5137 ext. 155, or kdemeria@nvdaily.com