"Digital is not about magically transforming experiences with technology "

Welcome to the big unlock where we discuss data analytics and emerging technologies in healthcare here’s some of the most innovative thinkers and health care information technology talk about the digital transformation of healthcare and how they are driving change in their organizations

Hello everyone and welcome back to my podcast. It is my honor and privilege to have as my guest today David Chou, Chief Information and Digital Officer for Children’s Mercy in Kansas City. David welcome to the show.

Thanks for having me Paddy and I am looking forward to this discussion as always.

Thank you so much David, before we get started on the discussion do you want to maybe take a minute or two for the benefit of our listeners to tell us a little bit about Children’s mercy.

Sure, so Children’s Mercy is a pediatric specialty hospital located in the state of Missouri and Kansas. We have two hospitals and 45 plus locations spanning across the two states were one of these unique standalone children’s hospitals where we do have some affiliations with the local adult systems in the neighborhood, but I would say we are the only one in the rally 100-mile radius that provides the high acuity care for a kids in the region.

Thank you for that introduction so let’s jump into the discussion digital is you know and has been the buzzword for a couple of years now. What does digital mean to you how do you define it in your world?

Yeah that’s a really good question because I every time I hear or attend a lot of events that’s focused on digital it feels like people have different definitions or they really don’t know what the definition is and then associate just technology with it. So, the way I like to define digital is the use of technology in creating or enhancing new business models because that’s where it comes down to. You have to figure out how to maximize your investments and the technology portfolio. But I would love to hear you know what are the different definitions that you have heard and how what is it that you commonly use in terms of your definition digital as well Paddy.

Yeah you know I talked to a lot of people as well and you’re you’re absolutely right the term digital means a lot of different things to different people and depending on whether you’re talking to a health system or whether you’re talking to a technology provider and obviously technology providers tend to have a definition that is typically more aligned towards whatever products are offerings they are putting out in the marketplace and their definitions also tend to be more technology focused to your point earlier. Would it help systems there is a quite a range of definitions as well and you know the one that resonates the most with me is the one that you just said which is digital is not about technology it’s really about the business and it’s really about you know creating some of the things that I hear or it’s about creating new experiences it’s about reimagining existing experiences with the use of digital tools and technologies. And you hear other terms that are typically thrown into that context I hear the term innovation for instance that is thrown and when people talk about the definition of digital. So there is a short answer to your question, I don’t hear a single consistent definition of digital but there are some common themes that that I hear you know the most common one especially when I talk to health systems is that it’s not about technology is more about business but technology is an important enabler. Does that resonate with you?

Yeah definitely that point where I think we are on the same page.

Right, so you know healthcare and digital transformation if I look at healthcare and if I look at what’s happening in other sectors of the economy healthcare is definitely not a leader it’s a follower so I’m curious to hear what you think about the current state of digital transformation and what you see as you know where health care is? Specifically health systems which is kind of the world that you live in and which is where I live in most of the time.

So I hate when I hear that people saying health care is truly laggard. I do believe we are we are behind retail but if you think back just even the last ten years where we have evolved from just being electronic right we went from an industry that was dominated by paper and now we’re at a point to where almost everything is electronic. Now that’s a big leap in the last eight to ten years so to say healthcare is laggard I would say if you look back at the entire ecosystem we’ve made some good progress. But comparing to some of the other sectors where the experience is it’s completely different in the retail model that is where the catch it needs to happen so most health care coordination are still struggling they’re struggling because people think you could just build technology and it’ll magically appear where you have this experience. But I would say you really have to look back and really transform you know your process so that it could become that digital experience and without going through that exercise it is very tough I don’t believe a lot of folks in healthcare are thinking that they there’s a lot of talk about consumer zooms things of that nature but no one has shifted their entire business model to consumerism. So I would to that extent people are working in pockets there’s some silos of this transformation but the overall state of it to where some where there’s uplifting them and retrained their entire operating model to be aligned with the future it’s I don’t see that happening yet.

Well I think you make a really really good point about the fact that health care which was predominantly paper-based about a decade or so ago is now completely transforming it’s been digitized and it’s been one of the biggest transformations that any industry is gone through. So that I think is a fair point and I guess the you know once you’ve gotten the whole digitization process mainly the implementation of the electronic health record systems once you put that behind you. I guess the next question is what do we do next how do we use all of the data and all the infrastructure that we have invested in and how do we transform the experience for patients or caregivers as the case may be. Would you say that that’s a more fair representation of where things are?

Yeah I would definitely say that’s a pretty good description of it because the healthcare future somewhere really has to shape and shift and there are relevant. So I think people are working at that but as you know with change there’s no there’s not it’s not that someone could just follow. So organization really have to utilize their experiences, utilize their gut intuition and utilize what they feel the market is moving towards them really make a gutsy call and the ones that can do that the one that is really going to reshape the industry and stay relevant become market leaders.

Right, what are some of the examples that you see out there that represent this shift. Well, you know let’s talk a little bit about I know you’ve done some fairly advanced working your own organization you want to you know do you want to share a little bit of what kind of success you’ve seen, what are some of the areas you focused on?

A lot of it you know I thought there’s two things I focus on for all of the technology projects. The focus is on experiences and speed so we must do things with speed. So utilizing cloud technologies in one way to be more agile and really get things up in terms of speed and then experience think about experience not just externally with the patient but also creating the best experience for your internal stakeholders. So given those two themes every project revolves around that. Just to give you an example you know, that optimization that they have, the greatest health best experience from IT perspective so now we put in self-service tools where people can create tickets for the helpdesk on the mobile devices, mobile first platform they have the ability to just send a chat in and then we also incorporate some social tools. We have an internal social tool called Yammer for Microsoft which is similar to Facebook for work where we create discussions and throw ideas that gain responses to listening and bill it has also become a forum to where people submit questions as far as their troubleshooting. Now the next challenge is I want to incorporate an immigrate that’s our help desk software as well as another pipeline. So, over all those create a good positive experience I don’t have to do anything drastic I don’t have to go buy something that’s not available in the market and just be that market leader. So now that was that’s just one internal sort of transformation that we have done in the first phase from an experience perspective. Another one is a very simple one when you think about it for people who are going to urgent care clinics with their kids obviously they’re going to that type of setting it is nothing of an emergency but one thing that is painful it is when you get to a clinic you have to wait so just installing something as simple as can I say ‘my spot in life’ through online check-in you know that creates a better experience where the parents and family members can know exactly approximately when they are going to see be seen by a doctor by saving their spot and then they could by personally take care of a few errands before they go to the doctor’s. So these are simple things that health systems can really put together to create a positive experience and eventually evolve and transform how sort of the transformation occurs with the community and their patience. So they are just two simple ones that we didn’t have to do anything drastic but overall improve the experience then it’s really transform how we operate and we’ve also learned a lot because when you start putting in these new features you have to operationalize a little bit differently than what you have been doing historically so we’re still adapting and learning about how to be more efficient having that operation to some of these new enhanced features that we have implemented.

I think those are you know really great examples, and this was all the work that I do, one theme emerges is that people are cautious about not getting caught up too much in let’s say the sexiness of a technology or something new that is out there that you know looks and feels really good. But what is the impact that is making on your patient experience or your caregivers experience. Increasingly seen caregiver experience being an important aspect of their any kind of a digital program and in general in the transformation of the organization but your two examples are they really underscore the fact that ultimately it’s about making an impact to one of your important stakeholders in this case it’s making a difference to your patient if the patient doesn’t lose her spot in line by using an app that ensures that you know if she’s running an errand what she has to step out and you know take care of her baby or whatever that’s a really value added kind of a feature that’s a fantastic example. So a logical question on that David would be how do you how do you measure returns on something like, healthcare is of course like with many other sectors very cautious about discretionary dollars right so how do you look at something like this and how do you demonstrate the terms of benefits for something like this.

So the way I think about this first we reimagine return we just measure the improvement of access and possibly the patient satisfaction scores have increased and just the community has been providing positive feedback so there’s some spot all right. But the way I view digital transformation is similar to lean right you know how everyone is getting strives to be that lean organization and then they go through this whole Lean Six Sigma exercise where they’re on this journey for 10 or 15 years and they may still be on a journey. I view this digital transformation in that same format to where you’re looking at ways to be more efficient, you’re looking at ways to reinvent your process and now you’re incorporating technology. So when you think about lean some of these soft ROI’s, how do you measure it? Well that I would measure the same way that you would have these soft ROI’s were lean if your organization wants to get down to some sort of monetary value in terms of return on investment. That’s how I have approached it but at the end day you’re not going to get at sort of a big number in your bottom line you may as a result of these various initiatives but as you’re aware there’s also other things tied into that leads to a healthier bottom line so it’s something I don’t have the direct formula but I would say if you’re a lean organization try to tie that in and utilize the same calculation that you currently have.

Right so we’ve talked about patient experiences one of the big focus areas of digital transformation what about the caregivers what are some of the high-value caregiver use cases or caregiver focus areas that you’ve come across or have try to implement in your own organization?

Well when you just think about something as simple as nurse call or secure paging right you think about the fact that a clinician may have it what a wide variety of tools it’s kind of like a handyman where they have the entire toolkit belt so what I just tried to do is create one platform that can achieve all those features so we’re working on a tool a platform that’s going to allow the clinical staff specifically nurses to have a centralized app just for their nurse call, another one for a secure messaging, another one to be utilize for their clinical documentation and lookup. So now it’s really moving towards the mobile first environment and creating a stable platform that’s going to be encompassing all that. So that’s one that just comes by mind when we talk about ways to improve the clinical workflow and clinical experiences I don’t want to have a clinician utilize multiple system I don’t want to carry multiple devices I just want them to have the same personal experience that I have in my world which is I use my mobile for everything so allowing them to be efficient on their mobile from a clinical workflow perspective whether it’s like that patients or communicating with their peers creating that one ecosystem. So that’s just one example of that we have done but there’s plenty of there’s always new things that were enhancing and optimizing from a clinical workflow perspective utilizing latest tools, utilizing tools that can predict outcomes I mean those are when I think about digital it really encompasses four core technology and the four core technologies are cloud, data, mobile and social. So when you start incorporating those four technologies that’s what really transforms into a digital product as an output. So these use case I’m sure every organization has something in the play right now and it really matter whether are you defining it as a digital transformation or are you just calling it organizational transformation.

Right well that’s an important distinction too, you know let me go back to technology for a second. The health systems are kind of unique and I say that because the systems of record across the United States at least they’re dominated by a handful of electronic health record platforms and you know you have your standard just like everybody else has a standard and it’s a handful of these platforms kind of dominate the environment and lots of money I mean lots of money has been spent on implementing these and so one thing that I hear from health systems and I talk to is that you know utilizing the existing investments and getting them to function optimally and making use of all the existing features and functionalities available is a priority area especially as it relates to no financial investments. So in that context when you talk about improving patient experience or improving caregiver experience and so on so well this is a lot of potentially better tools for individual functions or individual use cases even though a functionality or feature may be available within your existing electronic health record system. How do you do the trade-offs when you find something out there in a tool that is vastly superior than what your EHR system provides for the same functionality you know. What’s the tipping point and there’s a broader implication for my question because this billions being spent on these digital health startups how do you want to find a spot in an environment that’s dominated by electronic health record system like a Cerner or an Epic.

Yeah I think you’re I think you hit that now I’m ahead in terms of that observation because when we when most organizations have made that investments in the EMR that is the preferred platform when you spend hundreds of now billions of dollars on this platform you’ve already committed to it and that means you’ve committed to knowing that it may not be the best certain areas in terms of specific functionality but as an entire ecosystems you want to have that closely integrated to have that interoperability. So now when you have these one-offs it is tough to break in so for example I have a portfolio of six hundred plus different applications my goal is to reduce that I’m trying to reduce this reduced as much as I can by establishing some major partnerships where I go to the preferred model so whether that’s EMR preferred, whether that is a ERP preferred model I made a strategic investment and I told the board that here’s our direction to try to shrink the portfolio number one. Number two is we will create the integration because we’re reducing the number of different integration points and therefore reducing the complexity. So now you throw in these one-off digital health start ups well they’re great at the point solution but some can even be integrated well and then you hear the discussion back and forth overall well now your enterprise EMR system is closed therefore we can’t integrate it as its their fault not our fault we have an open API platform that can integrate anyone. Well when it comes that discussion on the buyer side they probably do not have the time to go back and forth to get those integrations we just want something to work out of the box and check it off and they move towards the next set of problems. When you think about the CIOs and the trend and where they’re moving towards we don’t really want to manage technology especially the core infrastructure and especially having to worry about integration we just want this to work seamlessly so that now we could focus on more strategic elements, we could focus on how do we take the investment that we have made turn that to a positive ROI and hopefully resulting in a net positive revenue. But when we when we have to get in the middle of working the interoperability making sure it’s integrated as it becomes cumbersome and that I would say most of the buyers the CIOs probably do not want to play in that space anymore. But there is still some that likes the blocking tackling both the progressive ones the ones that really are going to be leading the future enterprises are more business driven versus technology driven.

Right and there’s all kinds of trade-offs and cost involved and what you just said right so you know I mean it’s not just the standalone you know tool or platform there is also the integration infrastructure so you’re talking not just about investing in a new start up solution but you’re also talking what we’re putting in and it may be an API platform in place as an example and all of those problems are eliminated when you’ve got the entire thing kind of wrapped up in one complete fully internally integrated system. The only big trade-off there is that number one you may not have what you’re looking for today and if even if you do have it may not be the best tool that is out there. So is that a big trade-off that you’re making when it comes to digital transformation in both in terms of quality of experience and in terms of the ability to turn on something today when you know you may be compelled to wait for another six or 12 months for the next release is that is that a big trade-off do you see that as a big trade-off?

I don’t see that as a that bigger trade-off I hear that comment a lot I see the biggest challenge and barriers to really transforming is more on the sort of the cultural and leadership side, that has nothing to deal with these tool sets that’s available because let me just say that you have these one-off platform that’s great that works well and you have the enterprise platform that’s not up to par well if you don’t if you don’t transform the entire culture to embrace that enterprise platform doesn’t matter. Whether you get the shiniest object and whether the right tool set you may never have the culture to embrace them to begin with so you know one of the biggest challenge for successes most organizations do not have the right culture to change because the transformation is all about changed now anything different except changing behaviors and now we’re changing behaviors with the adoption of technology to do that.

That’s what well said so what would do what are the three or four words or terms you would use to describe an organization that is culturally you know well positioned for the kind of transformation that that you’re referring to?

We must be driven top-down I mean that’s number one, now for this be successful it’s got to be the initiative all the way from the board members that’s the CEO all the way transforming downtown orientation this initiative cannot just be made by a CFO, COO, CIO without the support from the entire organization going up all the way to the board. Because without that it will fail what was interesting I was just at a recent innovation summit and well what’s interesting in that this innovation summit was the Chief Innovation Officer is a role that I used to see pop up a lot more and it’s always debatable as far as who leads innovation how come the CIO does now lead innovation why would you have to go out to create a set of role and a lot of these Chief Innovation Officers are a clinician. So now you have a clinician that is out there in the market just listening to the latest and greatest, but they may they may be missing the role of how do you operationalize this tool within an organization or how do you even fit it into the technology ecosystem you know I see that sort of feel like they’re just doing a new role out there for someone to try to see they could stick this landing. Overall I would say the for this to be successful it has to be top-down versus going out and silos, creating a separate function for transformation, creating a separate role or even a separate department. If it’s not being led by the leader then doesn’t matter what kind of roads are created.

Right that’s a great point and I hear that a lot its got to be top down yeah I hear that a lot it’s also interesting you made the distinction between the role of Chief Innovation Officer. I imagine that they have to work very closely with the Chief Information Officer, Chief Digital Officer, so cross-functional anyway at the end of the day it’s not one single domain right.

Oh definitely it’s not here’s where people who have those Chief Innovation Officer, Chief Digital Officer titles come in with a disadvantage unless they have a CEO support where they report to the CEO and the CIO doesn’t the work wise behind this effort is probably in the office of the CIO if you think about the technologies even the budget authority right the part with the largest budget is probably the CIO. So even you treat these one-offs when it comes down to a game of functional work done you still have to rely on the technology team and the CIOs team to figure it out so if that’s the case then why create this option. But the other side of that is there’s probably a lot better CIO just purely focus on keeping the lights on and the backup structure and they’re ok with it therefore the CEO and the senior leaders are not getting what they need so therefore they go out create these other road just to be able to get a different strategic view of the landscape but yeah it’s a tough challenge and I hear these classic struggles back and forth all the time between the various roles.

Yeah, so one of the important topics that comes up all the time in the context of digital transformation this technical debt you know healthcare again may be argued that healthcare is under invested traditionally in technology and of course you know they have made these huge investments in the electronic health record systems but is that a big factor in your view is that something that can derail or delay or adversely impact digital transformation?

Its not, in my opinion and I hear that from all time even here for my team so my direct report used to use that as I’m excused as far as why they can’t move faster which I tell them that’s not the right way to approach it you know think about it’s not how I think about. So my analogy would be to think about a developed country and a country that’s sort of in a start-up mode right it’s easy for the startup countries and one can start to really leapfrog to the developing countries just because they all have to deal with the legacy infrastructure and so forth so think about your organization where if you want to say you have legacy technical bet fine, start over or leapfrog legacy and jump to something new and jump to the latest but you’re always trying to build on top of this legacy then yeah you will be having you and you’ll be using this excuse for ever and ever because you will never leapfrog so it’s up to you to figure out how to leapfrog. I mean where my team tell you oh we have this legacy bad I just tell them no you don’t start leap frogging and make a decision versus following the traditional play works. So that’s why my response to that legacy there.

Well I think that that is that is that is such an interesting response and I tell you I grew up in India and we had a terrible landline infrastructure for our telecommunications systems and then you know the mobile phone showed up and boy the entire country leapfrogged over landline I don’t think anybody has landlines anymore and it’s been such an equalizer and has lifted so many people out of subsistence levels and able to run businesses and manage their finances and you know transact business in the most interior parts of the country and talk about an example of leapfrogging right and so I think that’s fantastic. Your example is fantastic so David we’re coming up to the end of our time here so any last one or two thoughts you want to share with you know either health systems there are you know kind of an early stages of digital transformation or for technology providers who are trying to kind of you know have a go at the opportunity here you know one thought for each of them maybe.

Yeah one thought for the Health System is you know we talked about what it takes to be successful where it takes the top-down leadership and in order to be to have the dual transformation you got to have this digital in your DNA so for the CEOs or the board members out there if you’re if you’re wanting you’re good to go through this whole entire transformation well make sure you’re a digital make sure you have your CIO and your technologies lead the table so that they can help you drive it because if you don’t have them at your table as your trusted advisor that it’s just pure talk you’re just playing the buzzword card of we’re going to go through the digital transformation but really not focus on us so you got you must be thinking, you must be digital first in order to go through those otherwise don’t go through it don’t bother. What is your second question?

What’s your thought for the technology providers?

Technology providers is you know your most of them have great solutions and I mean now-a-days just so hard to differentiate between the different manufacturers producing the same technology the differentiator is for the manufacturers to be able to deliver an actual end-to-end solution and help the buyer which is could be the CIO or another c-suite member help the buyer sell the use case. So go to that extreme to make sure you give end-to-end solution and put together the marketing marketing pitch that they could sell internally and that’s how you can be successful in this transformation it’s not just about delivering a project or delivering the latest technology.

All right fantastic oh this has been such a fascinating conversation David and I really appreciate your time and look forward to staying in touch with you and following your progress with all of your digital programs and the part of staying in touch thank you once again.

Thank you.

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