The Burlington, Vermont-based University of Vermont (UVM) Health Network was created in October 2011, when what was then known as Fletcher Allen Health (now the University of Vermont Medical Center) in Burlington, Vermont, and Central Vermont Medical Center in Berlin, Vermont, signed an affiliation agreement. Six hospitals—the University of Vermont Medical Center, Alice Hyde Medical Center, Central Vermont Medical Center, Champlain Valley Physicians Hospital, Elizabethtown Community Hospital, and Porter Medical Center—and the UVM Health Network Home Health & Hospice (formerly the Visiting Nurse Association of Chittenden and Grand Isle Counties) make up the network. As the organization’s website notes, “Working together to better serve our communities makes us stronger, focused on collaboration instead of competition. As a team, The University of Vermont Health Network improves the lives of our patients by delivering outstanding care cost-effectively, as close to patients’ homes as possible,” it adds. “The University of Vermont Health Network cares for communities on both sides of Lake Champlain, from the Adirondacks to the Green Mountains and beyond.”
Bringing together those diverse hospital facilities and healthcare services has necessitated formal data governance processes. And, in that context, Leah Fullem, vice president of enterprise information management & analytics at the UVM Health Network, reached out for consulting support to Stephanie Crabb, co-founder and principal in the Tampa, Florida-based Immersive consulting firm. Recently, Fullem and Crabb spoke with Healthcare Informatics Editor-in-Chief Mark Hagland regarding the journey around data governance at UVM Health Network. Below are excerpts from that interview.
Can you share with me the origins of your initiative to create a formal data governance structure at UVM Health Network?
Leah Fullem: A couple of things made this time the right time to pursue this work. The UVM Health Network—we came together several years ago, anchored by UVM Medical Center, and affiliated with community and critical access hospitals in Vermont and in northern New York. And we had some network structures in place. And a few years ago, we decided to implement a common cost accounting and financial services solution; and now we’re in the initial phases of a rollout of Epic system-wide. The medical center has been on Epic for several years now on inpatient and ambulatory; and revenue cycle components will be included in November 2019. So we’re looking at implementing common tool sets across the network, with common workflow and documentation standards.
We’re trying to improve the way in which we capture information, so that we can better work together as a network. That’s why it’s a good time to initiate enterprise-wide data governance. But we still have multiple different areas in which data are consumed, produced, and analyzed, with a lot of different ways of doing that. So we contracted with Immersive about a year ago, and then did a scan, looking at our data resources, tools, data governance and standards we had in place, and gave us a nice set of recommendations and a roadmap.
What were the biggest gaps you found?
Our story is not uncommon; we found that we had multiple areas where we were duplicating effort; analysts in the finance area and quality area, or multiple different areas, were writing different queries with different parameters, across the same subject areas, for reports. And they were using different metrics to calculate from. So we had data silos, which meant that data analyst teams being directed by different supervisors, weren’t able to partner with each other. So there were a lot of knowledge gaps; we had a huge amount of analyst talent, but we weren’t able to leverage the talent we have. We have SQL servers, many other forms of storage, of data; and the Epic rollout will include an enterprise-wide data platform that we’ll implement over the course of the next year, and that will allow us to make sure we’re on common platforms with common platforms.
Stephanie Crabb: One unusual thing about UVM is that UVM has had incredible executive support and sponsorship around data for a long time. Dr. John Brumsted, the current CEO, was the network CMO and chief quality officer; so he’s an individual who’s always been very bullish and visionary around the use of data and information. And he himself had taken the first pass at implementing data governance when he was the CMO. So it’s really important—we talk a lot about executive sponsorship in data governance, and about whether it’s really there, whether it’s real. And one success factor at UVM was the fact that Dr. Brumsted was a stalwart supporter and leader. And he put forth from the very first meeting that failure was not an option. So he really set the tone, and was open to creative ideas, and was focused on putting ideas into action. That’s how Leah’s position was created.
What have been the biggest lessons learned so far in all of this?
Fullem: I’m still early on in my involvement in all this; I’ve been in this position six weeks so far, but much work has already been done. We’ve set up a network-wide data governance council with broad representation across business functions and institutions; created a network-wide data governance policy; we’ve begun a project on provider dictionaries/better data management processes; and we’ve been focusing on data governance, stewardship, and moving forward with a new structure. When Dr. Brumsted first started talking about instituting data governance, there was no locus of authority for participating in data governance or collaboration efforts; now, that’s here.
And in the first six weeks of my job, I’ve been going around speaking with as many people as possible in Vermont and northern New York. And we’re talking about the way people access data, and what tools analysts might be using. So I had expected some pushback, but overwhelmingly, people across this network have been enthusiastic and supportive of this, which was surprising. The commonality is someone saying, “I had something that I thought was easy, but it wasn’t, and no one could get back to me in a timely way, and I had to wait six months, and by then, it wasn’t relevant to me.” And we’re moving heavily into population health and care management, so there’s a great deal of interest.
The biggest lesson we’re learning in process is that this is a cultural change more than anything. Yes, data is involved. I report up to the chief population health and quality officer. This is a cultural change. We will improve access to data, improve the quality and accessibility of data and information, to allow us to make better decisions on behalf of our patients and people. We have people who still only trust the data given to them by their analysts, or data they’ve extracted themselves. And yet there are conflicting numbers all over the place. So creating trust, to open people up to changing the way people receive or experience data, through new ways of looking at the information, involves a huge change effort. So above all, I need change agents.
Crabb: Lessons learned from our point of view through the work—to augment the change piece—have been several. One thing that UVM has done very well is that they didn’t just do an assessment and roll forward with a roadmap; they were really honest about their strategic, tactical, and cultural readiness. And I applaud Leah up and down, because she has a really tough job, it’s an ambitious agenda. But in the first year of their preparation, they’ve been really attentive, have set the right objectives, have taken the best of what they’ve learned and are trying to apply that very tactically. Second, they’ve focused on the people and organizational structure piece. One of our recommendations to them was, don’t throw a bunch of tools at this; if you don’t have the people and processes and organizational structure that make sense, it won’t help. Creating Leah’s position as a network organizational position, that was a huge demonstration of good faith and commitment. Not only did they say they wanted Leah, they agreed to a leadership team of eight or nine positions in her office that she’s currently fulfilling, positions in data management that are needed.
So, the lesson is, not just giving lip service to it, but putting skin in the game and following through. And this 25-person-plus data governance council that started meeting in February of this year, was incredibly important. It was incredibly well constructed, with critical business functions. That team has rallied from day one, and has gotten an incredible amount of work done in five short meetings. And the charter they created for themselves, and coupled with creating a good operating environment to carry out the mission, are two very important things, and indications of the seriousness with which they’ve taken this.
What would your advice be to CIOs and CMIOs who will be facing similar data and IT governance situations and challenges?
Fullem: This is common advice, but we need to make sure that we’re meeting the needs of our clinicians, our finance departments, our operational leaders, since data is the key to making good decisions. All of this has to be done in a way that we make technology available to our users in ways that are easy to use and access, with the right information security principles, to move forward as a business.
Crabb: That our data and information leaders are important partners to our CIOs and CMIOs. This initiative originated out of IT, was led by Dr. Doug Gentile, our CMIO. But the goals far exceeded the boundaries where IT is drawn in that organization today. And it wasn’t a tug of war of any kind; it was a natural extension of work that was incubated in IT. It’s been a healthy, symbiotic relationship that was first incubated in IT, and allowed to fly, understanding that data as an asset deserves its own center of excellence, just as IT is a center of excellence.