Despite its immense institutional know-how and its pure heft—11 hospitals, 5,000 medical staffers, $4 billion in net revenues—the Hospital Corporation of America’s multi-state, Denver-based Continental Division still found itself sending CDs and printouts via, among other low-tech image-sharing options, the chests of patients in ambulances and helicopters.

That was as recent as 2013. CIO Andy Draper knew that the time had come for things to change. He set out to combine his team’s down-with-CDs initiative with a move to leverage the image-sharing power of the cloud. The endgame would not be simply modernization but, rather, in keeping with the parent company’s mission and vision, helping to dramatically increase the division’s referral base.

Measurable success followed sooner than Draper expected. In January 2015, HCA Continental became a Nuance PowerShare Network user. Three months later, the division had connected 30 referring hospitals, clinics, and other provider sites, and at the six-month mark, the count topped the 100-site mark. HCA Continental is growing its PowerShare network referral base at an average monthly rate of 28%, including some sites that had never previously referred to HCA.

Draper took questions from Clinical Innovation + Technology about what it took to gain buy-in so quickly—and how the HCA Continental will build on its momentum moving into 2016 and beyond. 

Q: The drive to get away from CDs set you on the path to looking for a new solution. Can you talk a bit more about how you arrived at PowerShare?

Draper: I’ve known some of the Nuance leadership team, including [Nuance Healthcare president] Trace Devanny, since we worked together at Cerner years earlier. I think very highly of him, so I had very high expectations. Plus, folks on the provider side—radiologists, technologists, PACS users—are aware of PowerShare and its predecessor technology. Our people were excited that Nuance owned it now.

The imaging community is tight-knit. These people know things. They knew this was an ancestor product of a proven technology. And they saw that the technology is secure and very easy to use. We sent it through the HCA information security team, which is very rigorous.

Q: What was your priority in settling on a solution?

Draper: What’s most important is getting information from a referral source, whether it’s a physician in a small clinic or a hospital, to the clinician as quickly as possible. PowerShare is as easy to use as Facebook. Creating an account takes less than a minute. Then you upload the image and, immediately, there is a site on the web to which that image can be pushed so that others who need it can access it. And practices subscribe to it, so it’s a pull technology.

Q: Can you give a real-world example?

Draper: I went on a couple of sales calls with our team because I love that part of our work. There was a referring OB/GYN practice in Kansas. They saw how easy PowerShare is to use when the [pregnant] patient comes in for an ultrasound. She is excited to see her sonogram. But the doctor sees something that looks a little funny. The doctor can leave the exam room, immediately upload that ultrasound to a maternal-fetal imaging specialist in Wichita and say, “I’ve got the patient here and I see something funny.” The specialist can log in, look at the image and say, “Yes, have her come here in the morning.”

Then that OB/GYN physician goes back into the exam room and says, “I found something that, just to stay on the safe side, should be looked at by a specialist. I’ve already reserved an appointment for you with your doctor in Wichita and he will be able to see you tomorrow at 9 a.m.” That is amazing.

Q: Let’s talk about implementation. How would you compare getting up and running system-wide with PowerShare to implementation of, says, a new PACS?

Draper: Well, the ultrasound scenario I just described would not have been possible without a solution like PowerShare. It would have required a B2B configuration with a dedicated VPN. Those configurations are nifty, but they require a lot of maintenance. Some high-dollar network people have to make sure that they are up and running. They are often not up and running when you need them or during off hours, and they’re really not very reliable.

With the CD-ROM, what we found is you need a kind of modality-neutral, reader-neutral image viewer. And there are not very many of them. PowerShare is probably the most elegant.

So to get back to your question, in the implementation, Nuance was very aggressive with our team—which we asked them to be. We asked them to be very prescriptive. We’re all big boys and big girls. We aren’t going to get our feelings hurt. Tell us exactly what we need to do and when we need to do it. They did that. And it worked out very well.

Basically we were live within three weeks with the technical setup and things like that. We were then pushing it out to our physician sales team in four or five weeks. I remember many members of our physician relationship team coming up to me and saying, “Wow, I’ve never had a solution go this well and this fast.” Good relationship, good implementation.

Q: What were your expectations going in with PowerShare, and what has been your experience in actual use?

Draper: Qualitatively, as a leader, I had high expectations. We got this agreement signed literally in December of 2014. We have a calendar year for our fiscal year. The CFO believed in us [as a selector of solutions]. So we wanted to make it work very well right out of the gate. I said to Nuance, “Look, we want to be your best regional deployment site. We want to be your ‘A’ student. Help us get there.”

Immediately, within the first weeks of January 2015, we set up a weekly process conference call. We had all of the radiology folks on the phone—our imaging analysts, the IT imaging analyst. We had lists, we did demos. We wanted to be the best from Nuance’s perspective because they do this a lot.

Quantitatively, we pushed it out in the first half of the year, this year, and we have a great number of sites that can upload on the network. My last official count had it at about 110. I am very happy with that. What we are focused on now is detailed reporting.

Q: What unique things about the solution and the relationships have proven most critical to the success of the rollout and implementation?

Draper: Nuance had a system approach on pricing. We said, “Look, we want to expand this across Kansas and Colorado, and we don’t want to nickel and dime. We don’t want you guys coming back to us and telling us that we’ve reached our 50th network site and the fee is now going to be 110% of what it was yesterday when we were at 49 sites.”

We wanted a system-wide agreement that wouldn’t penalize us for growth, because we knew we were going to go out there and really push this thing. That was key. And the price point was very reasonable.

Q: Where do you hope to take image sharing as you move into 2016 and beyond?

Draper: In 2016, I will be very focused on looking at, for example, if we have 110 sites using the network, should we have over 1,000 uploads? I don’t know what the time frame should be.

We are going into the optimization phase. That’s an overused term, but what we’re going to do is have metrics by uploads, site by site, showing who is and isn’t using PowerShare. We will know how many uploads the OB/GYN group I talked about is pushing up to the network. We will know how many Vail Valley Medical Center is pushing up. And so on.

One of the great strengths of HCA is that, once you give somebody a number, there is a lot of activity. So we will attack this from the standpoint of metrics. We will go out and reengage those sites that have low usage, and we’ll learn from the sites that have high usage. Those are in my 2016 goals, and we are starting to get that data from Nuance PowerShare right now.