The health network of the University of Vermont (UVM), based in Burlington, Vermont, was created in October 2011, when it was called Fletcher Allen Health (now the University of Vermont Health) in Burlington, Vermont and Central Vermont Medical Center in Berlin, Vermont, has signed an affiliate agreement. Six hospitals: the Medical Center of the University of Vermont, the Alice Hyde Medical Center, the Central Vermont Medical Center, the Hospital of the Doctors of Champlain Valley, the Elizabethtown Community Hospital and the Medical Center Porter and the Health and Hospice of the UVM Health Network (formerly the Visiting Nurse Association of Chittenden and Grand Isle Counties) form the network. As the organization's website notes, "Working together to better serve our communities makes us stronger, focused on collaboration rather than competition." As a team, University Health of Vermont improves the lives of our patients by offering extraordinary care to costs, as close as possible to patients' homes, "he adds. "The University of Vermont Health Network takes care of communities on both sides of Lake Champlain, from the Adirondacks to the Green Mountains and beyond."
Gathering different hospital facilities and health services has made formal data governance processes necessary. And in this context, Leah Fullem, vice president of business information management and analysis at UVM Health Network, contacted Stephanie Crabb, co-founder and director of the Immersive consulting firm in Tampa, Florida. Recently, Fullem and Crabb talked with Health informatics Editor-in-Chief Mark Hagland regarding the journey around data governance at the UVM Health Network. The following are extracts from that interview.
Can you share the origins of your initiative with me to create a formal data governance structure at the UVM Health Network?
Leah Fullem: a couple of things have made this time the right time to carry on this work. UVM Health Network – we met several years ago, anchored by UVM Medical Center, and affiliated with public and critical access hospitals in Vermont and northern New York. And we had some on-site network facilities. And a few years ago, we decided to implement a common cost accounting and financial services solution; and now we are in the early stages of a system-wide implementation of Epic. The medical center has been on Epic for several years on patients and ambulantes; and revenue cycle components will be included in November 2019. So we are looking to implement common tool sets across the network, with common workflow standards and documentation.
Leah Fullem
We are trying to improve the way we acquire information, so we can work better like a network. That's why it's a good time to start corporate data governance. But we still have several areas where data is consumed, produced and analyzed, with many different ways of doing it. So we contracted with Immersive about a year ago, and then scanned, examining our data resources, tools, data governance and the standards we had in place, and provided us with a series of recommendations and a table of march.
What were the biggest gaps you found?
Our history is not rare; we found that we had more areas where we were duplicating our efforts; the analysts of the financial and quality area, or more different areas, wrote different questions with different parameters, in the same thematic areas, for reports. And they were using different metrics to calculate from. So we had data silos, which meant that teams of data analysts directed by different supervisors were not able to collaborate with each other. So there were many gaps in knowledge; we had tremendous talent for analysts, but we were not able to exploit the talent we have. We have SQL servers, many other forms of storage, data; and the launch of Epic will include a company-level data platform that we will implement in the course of next year and which will enable us to be sure of being on common platforms with common platforms.
Stephanie Crabb: An unusual thing about UVM is that UVM has had incredible executive support and sponsorship around data for a long time. Dr. John Brumstead, the current CEO, was the CMO of the network and the quality manager; so he is an individual who has always been very confident and visionary about the use of data and information. And he himself had taken the first step to implement data governance when it was the CMO. So it's very important: we talk a lot about executive sponsorship in data governance and the fact that it's really there, it's real. And a success factor in UVM was the fact that Dr. Brumstead was a brave supporter and leader. And he pointed out from the first meeting that bankruptcy was not an option. So he really set the tone, and he was open to creative ideas, and he was focused on putting ideas into action. This is how Leah's position was created.
Stephanie Crabb
What were the biggest lessons learned so far in all of this?
Fullem: I am still at the beginning of my involvement in all this; I've been in this position for six weeks until now, but a lot of work has already been done. We have established a network-level data management council with a broad representation of corporate functions and institutions; has created a data governance policy at the network level; we have started a project on suppliers' dictionaries / best data management processes; and we focused on data governance, administration and the advancement of a new structure. When Dr. Brumstead started talking about establishing data governance, there was no place of authority to participate in data governance or collaborative efforts; now, this is here.
And in the first six weeks of my work, I went around talking to as many people as possible in Vermont and northern New York. And we're talking about how people access data and what tools analysts could be. So I had expected some rejection, but overwhelmingly people in this network were enthusiastic and supportive, which was surprising. The commonality is someone who says, "I had something that I thought was easy, but it was not, and nobody could come back to me in a timely manner, and I had to wait six months, and by then, it was not relevant to me." we are moving heavily in managing the health and care of the population, so there is a great deal of interest.
The biggest lesson we are learning is that this is a cultural change more than anything else. Yes, the data is involved. Report to the person responsible for the health and quality of the main population. This is a cultural change. We will improve access to data, improve the quality and accessibility of data and information, to enable us to make better decisions on behalf of our patients and people. We have people who still trust only the data given to them by their analysts, or data they have extracted on their own. Yet there are numbers in conflict everywhere. So building trust, opening people to change in the way people receive or experience data, through new ways of looking at information, involves an enormous effort to change. So, above all, I need agents for change.
Crabb: The lessons learned from our point of view through work – to increase the piece of change – were different. One thing that UVM has done very well is that they have not just made an evaluation and have carried out 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 hard job, it's an ambitious program. But in the first year of their preparation, they were very careful, set the right goals, took the best from what they learned and are trying to apply it in a very tactical way. Secondly, they focused on people and the organizational structure. One of our tips to them was, not through a bunch of tools in this; if you do not have the people, the processes and the organizational structure that makes sense, it will not help. The creation of Leah's position as an organizational position of the network was a huge demonstration of good faith and commitment. Not only did they say they wanted Leah, they agreed a leadership group of eight or nine positions in its currently fulfilling office, positions in managing the data that are needed.
So, the lesson is, not only give the maximum, but put the skin in the game and follow. And this advice on the data governance of 25 people who started meeting in February this year was incredibly important. And it was incredibly well built, with critical business functions. That team recovered from day one and got an incredible amount of work done in five short meetings. And the status that they have created for themselves, together with the creation of a good operating environment to carry out the mission, are two very important things and indications on the seriousness with which they have taken it.
What would be your advice for CIOs and CMIOs who will face similar situations and challenges related to data and IT governance?
Fullem: this is a common council, but we must be sure to meet the needs of our doctors, our financial departments, our operational leaders, because data is the key to making good decisions. All this needs to be done in order to make the technology available to our users in ways that are easy to use and accessible, with the right principles of information security, to move forward as a company.
Crabb: Our data earth information leaders are important partners for our CIOs and CMIOs. This initiative, born of the IT, was led by Dr. Doug Gentile, our CIO. But the goals have far exceeded the limits in which IT is attracted to that organization today. And it was not a tug of war of any kind; it was a natural extension of the work that was incubated in IT. It was a healthy and symbiotic relationship that was first incubated in IT and allowed to fly, understanding that data as a resource deserves its center of excellence, just as IT is a center of excellence.
