How UCHealth bridged tech architecture and clinical expertise within its virtual health program

As co-leaders of UCHealth's virtual care strategy, Steve Hess and Richard Zane, MD, bring a mix of operational and clinical expertise to the health system's IT efforts through their respective roles as chief information officer and chief innovation officer.

Mr. Hess and Dr. Zane work collaboratively to move forward the innovation and IT strategies at the Aurora, Colo.-based health system. In the past four years, the pair launched a virtual health program, which is now live in more than 70 of UCHealth's specialty and primary care clinics.

The program's strategy is twofold: Its virtual health capability is embedded into the system's standard Epic EHR workflow — so that virtual visits are conducted the same as in-person appointments — and UCHealth's virtual health center supports continuous surveillance and monitoring of patients in its hospitals.  

"We want to move away from the traditional vision of everything is bricks and mortar and care is delivered in person," Dr. Zane said. "We want to show that we can participate in the spectrum of care however we describe it. It can be synchronous and asynchronous, and it can be in person or it can be through other communicative devices."

Located about 15 minutes away from UCHealth's main campus, the virtual health center is staffed with technicians, nurses and physicians who monitor patients at risk of fall, cardiac events and other conditions. The virtual program also extends to consumers, offering the opportunity to partake in an urgent care visit directly from their home.

Here, Mr. Hess and Dr. Zane discuss their co-ownership of UCHealth's virtual health strategy as well as the thought process behind their decision to internally build the program rather than partnering with an outside company.

Editor's note: Responses have been lightly edited for clarity and length.

Question: As leaders of IT and innovation strategies, how do you work together to drive UC Health's tech initiatives like the virtual health program?

Steve Hess: We firmly believe in dyadic relationships where we try to pair up an operational leader with a medical leader. Dr. Zane and I simply co-own our virtual health strategy, with Dr. Zane in the lead role. It's important that we have both that medical leadership because the physician relationship and medical management really is at the heart of all of this. At the end of the day, the relationships are still between physicians and patients. Having that medical leader panel guiding us is important, but we also want to support that physician leader with operations and administrative oversight. So, really our roles are dyadic. We're both ultimately responsible for the virtual health strategy and innovation strategy at UCHealth. Dr. Zane and I bring obviously different perspectives, different competencies and different methods but what's important to us is that our strategies, our approach and our styles are congruent. And that's how this has been successful. 

Dr. Richard Zane: That dyadic structure is true from the top all the way down to the day to day. Both Mr. Hess and I report to the CEO of the health system. We both sit at the highest levels of the health system, and then the day-to day-running of the virtual health center is Chris Davis, MD, and Amy Hassell, who are dyadically linked as a physician and nurse operator together. That structure goes down across our entire system at every level. It's very important that we have these dyads and triads that run our operations in our system, and that it goes from the top all the way down to the front line.

Q: What inspired you to build the virtual care program internally?

SH: A lot of people have gone down this path of where they have an EHR but then essentially build a third-party application or service that is available to their patients. This somewhat disconnects them from their bricks and mortar practice. We made a strategic decision to create that seamless and intuitive experience for both our patients as well as our physicians and nurses. We did this by building out the virtual health capability on top of our EHR and embedded everything — audio and video capabilities, our mobile app and so on — within the platform. The idea then is that when a patient updates their medication list, whether they're coming in for a visit in the outpatient clinic or they're doing a virtual visit, it's the same medication list. The physician who's placing an order does it the same way whether it's a face-to face-visit in clinic or a virtual visit.

We're not creating these bifurcated differentiated workflows depending upon where you're seen. That seamlessness and intuitiveness, whether it's a physical encounter or a virtual counter, is really important to us. From an IT architecture perspective, we're using industry standard tools, but we're using the same tools: our Epic EHR, standard audio and video tools embedded within the EHR, standard mobile apps and so on all integrated to create that seamless experience no matter where you are. 

RZ: From the healthcare delivery and medical management perspective, we very firmly believe that there should be no differentiation between what is synchronous and asynchronous and what is in person and what is virtual. This means that if Dr. Smith, for example, is the patient's primary care physician and they need a primary care visit, Dr. Smith is going to be their primary care physician whether they drive to her office or they do a virtual, synchronous visit. That's true from primary care all the way to cardiology, cardiac surgery, intensive care, everything. There shouldn't be this bifurcation both in technology and in people. The quality, attention to detail and the relationship that you expect from your healthcare provider is the same regardless of the modality that you have care delivered to you.

Q: As tech continues to help healthcare evolve and bust out from traditional brick and mortar delivery, what do you think the virtual care space will look like in the next few years?

SH: There are ways of taking everything we're doing outside the walls of the hospital. I think what's going to end up happening is a couple of things. One, the number of devices that patients have, either wearables they carry around or the amount of data that we can aggregate, is only going to exponentially grow. Think about all the different things around your home — the Fitbits, the movement trackers and the continuous glucose monitors. All those devices essentially are data acquisition devices. The amount of data that we can get, whether you're in the hospital or outside the walls of the hospital, will only increase. That data then will be able to feed essentially artificial intelligence machines that can crunch that data really effectively and start to find patterns in the data, which then can be served up to the appropriate clinicians and provide actionable intelligence for them to predict deterioration and try to intervene as soon as possible to keep those patients out of the more expensive hospitals. 

RZ: From the perspective of evolution of healthcare delivery, we are going to move from our current place of descriptive and reactive, meaning for the most part that healthcare is reactive to something — something hurts, something is wrong and we react to it and we try and describe what is wrong. We're going to transition from reactive to eventually prescriptive, which really means being able to surveil. We're working very hard to build the competency around surveillance across multiple silos of care. We want to be able to do surveillance, predict and then be prescriptive around when someone may become ill or has risks for becoming ill so we can intervene prior to them becoming ill. For example, patients with chronic diseases like diabetes or heart failure, being able to surveil and see that they are getting worse before they actually have any symptoms or they feel as though they are getting worse, this will help caregivers intervene and prevent that acute exacerbation of chronic disease.

Q: Whether used for predictive insights or medical research, data is becoming more and more centric to healthcare. How do you ensure patient trust and navigate security concerns when it comes to collecting their health data?

SH: Security and privacy are foundational elements for us and other health systems as well. We take the fact that we are custodians of the patient's data while we're taking care of them extremely seriously. Everything we do from an IT perspective is to protect that patient's privacy. The security controls, eliminating phishing attempts and all those different initiatives — that's what we do every day and we do that with our standard EHR data. As we continue to add more and different data, it feeds the same data architectures that we're already protecting.

With this new world of opportunity to deliver predictive and prescriptive intelligence, part of what we must do is really around a change management initiative, as in we're really trying to educate the patients, and frankly their loved ones, of this additional capability. If we can have additional physicians and nurses watching over the patient and then actually coach them to intervene to prevent more serious acute events, there's a relationship between that provider and patient that we need to continue to enhance and develop. There is a change management education and communication element to ensure patients understand how their data is being used to better take care of them.

RZ: One of the things that we work on in addition to this cultural transformation is thinking very specifically about the interface between machine and human and where the human must adjudicate. One end of the spectrum is that a machine is much better at interpreting a pap smear, and that's pretty discreet. At the other end of the spectrum, how you sort of interpret the facial expression of a patient when you first meet them is a long way away from a technology perspective. Although there's facial recognition happening in security, it's a long way away in medicine. How do we build that cultural transformation to adapt to the interface between technology and human adjudication? We spend a lot of time on that because I think that's going to be as hard and just as important as it is to develop a new technology and algorithms.

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