Welcome to the big unlock podcast where we discuss digital transformation and emerging technologies in healthcare. Here are some of the most innovative thinkers and leaders in healthcare and technology talk about how they are driving change in their organizations.

Paddy: Hello again and welcome back to my podcast. This is Paddy and it is my great privilege and honor to introduce my special guest today Sylvia Romm, Chief Innovation officer of the Atlantic Health System. Sylvia thank you so much for coming on our show and welcome.

Sylvia: Thank you so much Paddy. I’m really happy to be here.

Paddy: Thank you. So, let’s get started. Can you maybe just tell us a little bit about the Atlantic Health System and your current role for the benefit of our listeners.

Sylvia: Absolutely. So Atlantic Health System is the health system that’s in northern New Jersey. We are a mid-market sized health system with six hospitals and four ACOs, about 4000 physicians, and between the hospitals we have just around a thousand beds. So that gives you a sense of the size of our health system. We have really a visionary and strong leadership which is actually one of the main reasons that I came here. Our CEO is actually one of the leaders at the American Hospital Association and he’s been really great about bringing Atlantic Health System together really as a health system and thinking about ideas in a broader and more visionary way.

Paddy: I know that you came into your role recently and prior to that you were involved for several years in pioneering telehealth adoption. Do you want to talk a little bit about that and maybe give us your assessment of telehealth adoption today?

Sylvia: Yeah absolutely. I’ll sort of start a little bit back and give a little bit of my background just so your listeners understand how I think about telehealth and what angle I’m coming from. So, I’m a pediatrician by training and I was practicing as a hospitalist when I had my second child and wanted to have a little bit more flexibility in my schedule. I actually came into the telemedicine world as a physician looking to use telemedicine as a way to see patients and as a way to see patients from home. So that was a little over five years ago which doesn’t seem very long, but it is kind of an eternity in the adoption of telemedicine. And I started with a company that was just starting up doing urgent care video visits at the time. Pretty soon after that I started practicing with them and I thought as a pediatrician and as a new mom for the second time that new parents are the ideal target for telemedicine. And you have lots of questions and it’s kind of hard to leave the house. And so, I started a telemedicine company for new parents with breastfeeding support that eventually started offering nutrition support as well. After getting that going, I became a subcontractor of a much larger telemedicine company called American Well providing those clinical services to them. And then eventually came on to American Well full time. And through American well, started off in kind of a medical director role. So initially looking at clinical guidelines and quality but pretty soon thereafter really going into more of an executive role working with health systems to think about how to adopt digital technology. So, my view changed really from a user as a physician of telemedicine technology to truly finding out how digital healthcare delivery can fit into the larger ecosystem. So, when I think about that and I look at telehealth adoption there’s a really wide variety of adoption depending on which population you’re looking at both from the patient side and from the provider side. So, from the patient side you see most of the visits particularly in video visits. And this did take another step back. I’m going to be talking about telemedicine not meaning only live synchronous audio video connection. I actually like the term digital healthcare delivery more because I think that allows people to think about different technologies in the same way. But I know that most people when they talk about telemedicine, they’re talking about video visit and so I’ll try to be clear when I’m talking with one of the about one or the other, but I sometimes will use it interchangeably. But the vast number of video visits or even phone visits that are happening between patients and physicians are really urgent care style visits that are set up by health plans. The adoption by health systems of using telemedicine again the volume still tends to be third party clinical providers. That are providing video or telephone visit but you’re starting to slowly see health systems using telemedicine technology so their own physicians can see own patients. But that’s taking a lot longer to ramp up.

Paddy: That’s still in early stages. So that’s an interesting background. So now you are Chief Innovation officer at Atlantic Health System. How do you define innovation and what is your innovation model at Atlantic Health System?

Sylvia: Yeah that’s really a great question because innovation can be defined in so many different ways. So, when you look at innovation roles and innovation divisions and this is a new role at Atlantic Health System. And so, I am defining a lot of what it means to be Chief Innovation Officer at Atlantic health as we speak. When you think about innovation departments or innovation shops there are a couple of just very large buckets that you can put the shops into. One is taking internal innovation within the health system and developing it maybe standardizing it across the health system especially if you have a very large health system. You can have pockets of innovation and it doesn’t even make it to the other sections of the health system and potentially even taking some of those ideas and commercializing them and spinning them out. Another way to think about innovation is bringing in external partners. This is often done through something like a venture arm where you are seeing the innovation that is happening in the entire ecosystem and trying to bring that innovation into your health system. One to get the innovation that is happening explicitly with that company and with that partnership. But also to bring in some of those ideas and the mentality maybe for example design thinking which has been supported perhaps a little bit more in some of these external companies and just bring that type of thinking within the health system so that it helps you innovate as well. And this position is doing a little bit of both. Our health system has a group called Atlantic Health Care Advancement that has been working as an innovation pipeline to bring innovative ideas from people across the health system and it really is why swath of people that have been submitting ideas to the pipeline anywhere from specific devices that then we support to prototype and look to use internally and externally. But also, in thinking about care model delivery in certain processes. I mean it’s been really great to see people get really engaged in that and really think about how to bring innovation into their day to day. We’ve also started building out thinking about investments. The American Hospital Association for example has an investment fund that we’ve become an LP of and we are working with them to become an active LP and have really a reciprocal relationship where not only are they bringing in pipeline companies for us to look at but we’re also helping them understand which companies would be good for the fund to invest in by looking at the ones that really have clinical applicability within our health system. So, it’s definitely a give and take with learning on both sides. So, it’s exciting that I’m really getting to build up and develop both of these areas.

Paddy: So that’s really interesting. And it seems like you’ve already covered quite a few aspects of innovation models that some of the larger health systems we’ve been at this for much longer under the purview. And in some sense your innovation function seems fairly mature even though you’re the first innovation officer. Come back to a couple of those themes so literally especially on the commercialization models for internal innovation and also harnessing of external innovation. One of the questions that I get asked and I also like to ask is how do you really prioritize your innovation ideas and innovation pipeline in a way that aligns with organizational priorities even though individual initiatives may or may not be the best business cases. So how do you really do the tradeoffs and how do you ensure that the right initiatives are getting funded and nurtured and supported?

Sylvia: Yeah that’s an excellent question because when I think of innovation in general if you don’t know where you’re going with the innovation it’s like you have a vector. You need a direction because if you just have the size of a vector you can really go in any direction and you might not be moving towards where you want to be. And this is an incredibly simplistic thing that I’m about to say but I really think it’s important. One of my friends told me years ago that one of the schools that she went to had them ask themselves every day who am I. Who do I want to become and who I may become with my actions? And obviously that’s an incredibly simplistic rubric. Thinking about the words but it’s so useful when you think about these very large ideas like innovation. You have to understand what your priorities are. And every time you’re investing in something you have to take that step back even if it’s just for a moment even if it’s just beginning. But make sure you’re headed in the right direction with that decision because there are so many shiny things out there and there are many shiny things that get wonderful things done. But if they aren’t helping you become who you want to be. If they aren’t helping Atlantic become the health system that it wants to be then it’s not an innovation that we want to invest time in. You think it’s really important as well because in my role in American Well while I work with a lot of different health systems and it’s very common for organizations to be pretty reactive as opposed to proactive. So that when they’re looking for something there’s this general feeling that they need something new that they need some innovation and then kind of wait and see who approaches them with new ideas or new care models or new ways of doing things and then evaluate each of those ideas on an individual basis. And one of the things that I think is really important is to again take a step back and put the time and energy into understanding what your problems are and what you need solved. And then once you have a much clearer understanding about that then proactively go out and find the people that are trying to solve those problems and work with them to solve the problems that you want as opposed to waiting and seeing kind of who falls in your fishing net and examining each one of those individually.

Paddy: You know the observation that you just made our own research confirms that. We see a lot of health systems that are funding and launching a lot of new innovative solutions. They are kind of standalone ad hoc initiatives. They don’t really fall in line with the broad enterprise strategy and to your point being more proactive about what the enterprise should be looking at as opposed to looking at the interesting ideas that are coming into the pipeline and then funding and implementing the ones that look promising. And those are important distinction that you make there. Switching topics a little bit, you mentioned digital a little earlier on when you talked about telehealth and digital transformation is in early stages for healthcare. At the same time, there’s a lot of innovation, there’s a lot of effort that is going into helping healthcare enterprises get ready for the future. And we all agree that healthcare is a little bit behind other sectors such as retail, or banking, or hospitality for instance. So, when we talk to, in our research on in our work with health systems we hear about digital transformation being all about reimagining patient and caregiver experiences. Do you agree with that definition? First of all, and then can you may be share an example or two of innovation initiatives that really align with the digital transformation of the enterprise at Atlantic Health System?

Sylvia: Yeah. No that’s a really great question as well. So again, I’m going to be pulling a little bit more on my previous role to answer this than my current one since I’m just a few months in at Atlantic. But understanding that digital transformation is not simply automating or digitizing, all of the current workflows is really important. Because if all you think about for telemedicine for example is that you are replacing the in-person visit one-to-one with a video visit for example then you’re not going to fully understand all of the benefits that comes from having a digital transformation. In the way that I think about it that often resonates with health system leadership is around value-based care. And so, if you think of value-based care as simply a different way to pay for the same interactions that everybody was already having in the fee-for-service world then you’re never going to create good value-based care. Because a lot of the way that we practice medicine that we deliver care has been shaped by that. The fee-for-service interaction is actually not best for the patient or for the caregiver. And the same it is true for geography and the activation energy of coming in for a physical visit. A lot of what we do is based upon the idea that is difficult both for the caregiver and for the patient. And so, when you remove that it doesn’t make sense to just keep everything else the same. And then one of the examples they use for this and again coming from a pediatric background when you look at school-based medicine for example or school-based telemedicine programs. When schools are initially thinking about this it’s often because they don’t have enough money to pay for Nurses and so they have a shortage. And so, they initially think oh we can bring nurses in to replace the nurse that we have and that obviously has some benefit. But then you start to think oh well instead of a nurse maybe we can have a physician at this point because of the economies of scale and the efficiency that comes to telemedicine we can actually afford to have a physician that could maybe order and prescribe medication so that it just gives the office more flexibility. And then once you start thinking about that you could start to think about things like well maybe the kid with ADHD that needs to go and see their psychiatrist every month. Well one maybe this kid shouldn’t be missing a day of school because they’re already having problems. And you can have a psychiatrist come into the school. And then if you’re not missing school maybe really the kids should be seen for 10 minutes or five minutes once or twice a week instead of for a longer period of time once a month. And that you’re actually getting better clinical care when you do it that way. And again, that’s just one example of many. But you know I think of that as the evolution of understanding how digital technology can actually provide better care in circumstances. But it really needs to be thought of differently than just replacing what you’re doing one-on-one.

Paddy: If you mention value-based care and I want to touch on that a little bit. Now we all know that the shift from fee-for-service to value-based care is not happening as quickly as many of us would like to see. At the same time the investment in digital technologies which essentially assumes a capitated model of payment has to be justified in some ways. Part of it is justified through a strategic need so telehealth for instance you know you have to have a telehealth program because that is the way of the future whether or not you’re making money today you still have to invest in it. I see the sense I get is that a lot of health systems are making some of these investments to digitally transform them so as to reimagine their patients experience or their caregiver experience in anticipation of the day when you are going to be in the capitated model and value based care environment. Given that what is your sense, since you have come from the outside and you are relatively new to looking at it from the inside of the health system. What is your sense of where health systems are in the journey towards digitally transforming themselves?

Sylvia: Yeah. That’s very interesting because I think what you said is right there. It is so crucial to understand about every set it talks about………. [unclear]. It’s like trying to head towards value-based care but that being in direct competition with the fee-for-service model. And the health systems that have seen really moved forward as in digital transformation and you actually think that even more than I have in your role, you can say your thoughts as well. But are the ones that recognize that healthcare has to have this digital transformation and that it’s been a slow start. But before we know what it’s going to be here. And so, we might not be able to justify it and in fact it’ll probably eat into the fee-for-service revenue for the time being. But we have to do it. Otherwise there will be disruptors that will do it for us. And so, when I think of it in the retail world, I think of gosh how hard must have been to be on the leadership of some of these large retail store chains where having e-commerce as part of their model didn’t exist. And you know for a while there was this divide that you see in healthcare right now of all the old stores, all the old bricks and mortar stores and then you had the e-commerce disruptors and there wasn’t great integration between them. And so there wasn’t a good model, someone called this the other day as clicks and mortar which I think is great which some of these stores have adopted where for example you ordered the items that you want online and then you have a special spot in the store where they get picked up. It’s kind of a combination of e-commerce and the traditional retail. But a few years ago, that model didn’t exist right. Someone had to create that model. And so, your leadership of this big store you see these e-commerce shops opening up and they’re gaining market. But remember they still have a ton of market. You just see them coming and you have to make the decision. Do we change our entire model to try to compete with them or do we stay where we are and hope that something comes up between now and then that saves that? And you see large store chains you could see making both decisions and at the time I think that it was not an unreasonable business decision to say you know what. This is our model, we’re good at it, we’re going to keep it, we’re going to sit and wait and see what happens. But in the end, we know what happened. Lots of these stores closed and the only ones that are surviving are the ones that either have a completely different demographic or are incorporating e-commerce into how they work. And it’s a hard decision but I think the same thing is coming in healthcare. There are many health systems where I get the feeling that the leadership is like we just hold out a few more years until I retire. You know we’re not going to have to deal with this.

Paddy: So you know I hear this of being described as the two-canoe model. You have a leg in two canoes and you’re hoping that you’re going to be able to sail downstream without losing balance. Right. And what you’re describing as a clicks and mortar. You know I think that’s what they’re referring to as a two-canoe model. That’s fascinating. So, you know is the chief innovation officer. You necessarily have to deal with a lot of the risks that come with innovation. You are harnessing internal and external innovation. And by definition many of these ideas will never come to fruition. Some will consume resources and fail, and a small number will make it work. We all know that the digital health startup ecosystem is being fueled by billions and billions in venture capital money, but they have a high mortality rate for reasons not connected to the health system themselves but for their own business reasons or whatever it is. So, as the Chief Information Officer the risk becomes a very big part of your life. How do you look at this and what do you think health systems need to be doing in terms of either changing their mindset to embracing these kinds of risks? And at the same time also facilitating a pathway to success for the more promising ideas. I know it’s a two-part question. But hopefully that was clear.

Sylvia: Yeah. You know it’s funny. Having worked in the digital health world now for a few years. So, starting off as a physician working clinically in a health system and then moving to the digital health world for a few years, and now coming back to the health system faith. It’s been very interesting to see how different parties view the relationship between health systems and companies. And I actually posted something in LinkedIn, probably a week ago that has done such a tremendous response saying that I am retiring the word pilot and vendor. And replacing pilot with phase one which is you have you start something with a company that has a defined outcome that you are looking for and if you make that outcome there’s a trigger that moves on to phase two automatically which is some sort of scaling, and if you don’t meet that outcome then you stop. But it’s this death by pilot phenomenon that I think you hear a lot about in the digital health world that I’m really trying to tackle with that question and just the ideas behind it. And the other one is the word vendor which I think is supposed to be neutral. But I actually find it has implications around it that there is almost a master-servant relationship with that the company they’re working with is there just to serve the needs. You’re the vendor and having worked in a lot in one of these companies and you worked with a lot of other companies. They’re just really smart people obviously on both sides but also in the companies that are working on these problems that have a lot of knowledge of the area that they are working in. And I found this again being on the tech company side. I got to see these technologies being implemented in dozens of health systems. And so, I often had a very good view of the nuts and bolts of how this works. But I found it amazing how often I would offer to health system and leadership to help them think about implementation strategy. I mean how many of the leadership teams wouldn’t take me up on that offer. And now that I’m on the health system side a little bit more. I do think it’s this concept of -there’s a vendor that puts that barrier there because it makes it seem like this isn’t a back and forth relationship where we’re learning from one another. And I think that those types of relationships are really important. One to solve big problems because almost always you’re trying to sell something complicated in healthcare, very rarely that you’re trying to solve simple problems. And so, getting smart people with different experiences in the room working together is really important to get answers for this but it’s also you know as you said there’s a high mortality rate on the startup side. And so, as a health system part of the way that we can be a good partner. It’s not just you know offering a space for four people to implement but really giving that product and design feedback and helping them understand the complexity and value drivers of being in their health system and bring that tons of information that comes from having worked in such a complex environment to the company so that they get better. And in doing that in fact if you can implement and to health systems that puts you way ahead of the curve for most companies and the ability to scale and thrive.

Paddy: As someone who runs an advisory firm, I can’t tell you how much I appreciate just the thought that you want to replace the word vendor to something that suggests much more of a collaborative mindset. And I applaud you for that, and I wish the spirit behind that thought is something that spreads more because I think at the end of the day digital transformation is not going to be accomplished by any health system in a vacuum. This is going to be a sort of collaborative partnerships which are mutually reinforcing and where there are win-win outcomes and for that to happen words matter and once again I applaud you for this. So, you know we’re coming up to the end of our time here and I just wanted to ask you one question. Ultimately as Chief Innovation Officer. You are going to be tasked with certain goals and demonstrating certain results. How do you define and measure success or how do you propose to define and measure success or innovation function at the Atlantic Health System? How do you look at it?

Sylvia: And yet another really good question. So again, I am still just a few months into this position and really these first few months I’m more towards understanding these important meta questions that we were talking about earlier in our conversation. What are our strategic goals? Where are we headed? What do we have right now? And that’s the other thing being in a health system the size of Atlantic. As you said there is already a significant amount of innovation that exists and is developed. And so how do I bring that together. Where are we seeing the innovation? Who are the people that are taking the lead and still doing a lot of the groundwork assessment of what we have and generally where we want to go? And then once I’m able to do that then I’ll be able to look more closely at what success metrics are. In general, we talk about operations improvement and creating an innovative culture and environment, retaining our most innovative clinicians and staff into all of those are going to be a portion of what we look at. But we’re still I’m still creating the larger goals and then we’ll have to break that down into the success metrics as well.

Paddy: Right and I hope to have you back as a guest, maybe a year or so from now when you can maybe talk about some of the successes and how we were able to go about that process. But we look forward to that. So, you know I think you provided some really interesting perspectives by virtue of your having come from a technology provider organization and given your background as a pediatrician. So, it’s going to be really interesting times ahead of you and I wish you all the best in your new role.

Sylvia: Thank you very much. Yeah, look forward to talking to you in the coming years myself as well and comparing notes what was said here.

Paddy: Absolutely. Well once again thank you Sylvia for joining us and I appreciate your thoughts and appreciate your taking the time to talk to us. All the very best and I look forward to being in touch.

Sylvia: Thank you very much.

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