Month: March 2020

Virtual visits to our chatbots are 10-15 times more than pre-pandemic levels

Coronavirus conversations

Coronavirus conversations

Sara Vaezy, Chief Digital Strategy Officer Providence Health

"Virtual visits to our chatbots are 10-15 times more than pre-pandemic levels"

paddy Hosted by Paddy Padmanabhan

In this episode, Sara Vaezy, Chief Digital Strategy Officer of Providence Health, the first health system to confirm a Covid-19 infection in the U.S., discusses how the organization has come together in a coordinated way in response to the crisis. Providence was one of the first health systems to enable patients with a set of FAQs and assessment tools by reconfiguring their chatbot Grace, which was developed over two years ago. In addition, the digital innovation group has helped Providence Health significantly scale up virtual visit capacity by redeploying and training clinicians in their same-day care operations to provide telehealth consults.

Providence Health has also successfully launched creative efforts to crowdsource PPE such as the 100 million mask challenge to ensure adequate availability of PPEs to protect the caregivers at the frontlines. Take a listen.

Sara Vaezy, Chief Digital Strategy Officer, Providence Health in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Virtual visits to our chatbots are 10-15 times more than pre-pandemic levels



PPWe are continuing with our series of conversations related to how technology is helping respond to the Coronavirus crisis. This week we have with us Sara Vaezy, Chief Digital Strategy Officer of Providence Health. So, Sara;Seattle has been ground zero for the Coronavirus epidemic in America. What’s life been like for the last few weeks? 

SVWe have been at the unfortunate leading edge of the pandemic for quite a while now. Providence Regional Medical Center in Everett, which is just outside of Seattle, had received the first coronavirus patient in the United States. We have been dealing with this for about a month now. We are coming together across every department, every function of the organization, under the leadership of Dr. Amy Compton Phillips, who is our Chief Clinical Officer. And in multiple times per day, emergency operations, command, huddles on various issues to tackle this. So, it’s been a busy month of doing whatever we can to help our patients, our caregivers, our broader communities, which include other community partners as well as other health systems. It’s been an extraordinarily busy time where a lot of the best has come out in folks in terms of the service that we provide. 

PPI have been following some of the extraordinary steps that you’ve taken at Providence Health to respond to this crisis and some extraordinary humanitarian stories, as well as.The stories related to how a large health system can come together to respond in a very coordinated way. What has been the single biggest challenge in your view in responding to the pandemic, how has Providence Health addressed it so far? 

SV:I think one thing that holds for everything is that things are changing. They’re so fluid and we’re learning a lot along the way. It’s a quickly evolving situation and it’s different for every city, county, and state. Each has diverse needs and manifestations of the situation. So, just dealing with that has been an interesting challenge. There’s also just basic stuff like we’re all bracing ourselves for the volumes that we’re afraid will result from this pandemic. There is quite a bit of sort of consternation out there about this. It’s sort of two sides of the same coin. Our biggest concern is supporting our frontline caregivers while they deliver high-quality care to patients in a very difficult situation. If I were to summarize it into one sentence, that would be it. 

PPWith a constantly evolving situation and all indications seem to be that we haven’t crested yet as far as the pandemic itself is concerned, as far as the United States is concerned. Everybody’s talking about the shortage of testing kits, PPE for frontline healthcare workers. And as you pointed out, that is a top priority for a health system to keep your healthcare workers, especially on the frontlines, safe so that they can deliver care and take care of themselves as wellYou’ve taken some very creative approaches to address some of the shortages in the near term. Can you talk about a couple of those just to help our listeners understand how you respond on the fly to these kinds of situations

SVAbsolutely. Thecredit goes to again our clinical teams who have been amazing. Our Chief Quality Officer, Jen Bayersdorfer, had an amazing idea for the hundred million mask challenge. Iresponse to the shortage of PPE, she pulled together this effort and engaged the public around making PPE and masks to protect our caregivers. They found a template and high-quality supplies. Then our digital team supported them by putting it on a website and asking for volunteers in getting engagement. We were so overwhelmed with the enthusiasm and outpouring of support from volunteers. We didn’t even need as many volunteers as we got. Part of that was due to some local companies coming out and working with us and saying, we’ll make masks for you, we were a furniture company before this, but we think it’s important and we’ll make surgical masks for you by using this template and these materials. So that was incredible and was very creative in terms of making the most out of available resources. Volunteers providing their time and organizations just stepping up and supporting us. That was by far one of the more uplifting experiences that we’ve had throughout this whole thing. 

PPIt’s an amazing story and I’m sure we’re going to see many more like that emerge in the coming weeks. There’s a lot of creative repurposing of our existing assets and resources across the country to deal with this. Hotels have been converted into hospitalsUnited Center, one of our biggest arenas, has been converted into a logistics hub for dealing with all the supplies and the logistics required to support this. You started a go funding program to help impacted residents. Tell us a little bit about that. 

SVThis was a volunteer-run effort between many of us and the digital innovation team as well as population health, where we really wanted to focus on homeless, shelters and services, and homeless individuals who received services from those organizations.With a situation like this, those places had significant challenges with getting disinfectants, enough funding for buying food, and other supplies for the folks. Thanks to the broader community and all those who participated.From around 80 donors, we received over $22,000 that we distributed to 56 shelters across three states. And those shelters provide services to almost 500000 people. And we were able to do that in just a matter of three days from start to finish. It was in the interest of supporting our most vulnerable populations. And it was the brainchild of Dr. Rhonda Medow’s, who is our Chief Population Health Officer at Providence. 

PP: I want to switch tracks a little bit and talk about the technology side of it. How your virtual care models have kicked in, in response to this crisis, especially telehealth, and anything else that you may have either built or repurposed from what you already have in responding to this crisis? What kind of adoption rates in terms of numbers you see and how is it the technology itself held up? 

SVI’ll focus primarily on what the digital innovation group has done. Before that, I want to mention that our IS colleagues have done a tremendous amount of work on a whole host of other technology-related things like standing up drive-through clinics, making iPads available to patients in the hospitals who are isolated, working closely with our physician enterprise to get thousands of providers who were providing care for established patients like chronic disease management care and things like that, getting them onboarded and ramped up on virtual visits. Our digital innovation group are absolutely at the forefront of everything happening from a technology standpoint and their efforts are running in parallel to everything else thatthe organization is doing.Froma patient-facing standpoint, we have stood up an assessment and FAQ chatbot, we call her Grace, and she does quick assessment by asking simple questions and triages patients to the appropriate next level of care, whether that just stay at home and rest or conducting a virtual visit with the provider. The second thing is really scaling up our virtual capacity for those same day use cases with folks who have concerns about Covid, whether they’ve been exposed, or they may have other risk factors. And that virtual visit capability has just seen tremendous ramping up over the course of the last few weeks. The third area is patient home monitoring. And for sub-acute patients who are either PUI patients under investigation or have tested positive but are not exhibiting the symptoms that would require them to be an inpatient in the hospital. We have sent them home and are monitoring their conditions remotely. And then we’ve done a lot of work around just a hub for consumer education and things like live locations for testing. So those are the primary activities that we’ve engaged in from a digital team standpointGrace is our chatbot, we call her Grace because we are a Catholic healthcare system. But Grace is a chatbot that we had made investments in for a couple of yearsWe could leverage those investmentsfortunately for Covid-19 specific use cases which means for patients essentially, we stood up a pathway that was with specific questions and workflow tied to Covid-19. So, things like have you traveled to a specific place that may have made you at higher risk for contracting the virus? And a whole host of other questions. We created the country’s first virtual assessment tool for quickly and safely assessing patients for Covid19. In the first few weeks, we helped over 70000 patients and had over a million messages exchanged between patients and the bot. It’s been a tremendous way to touch a lot of folks. In particular, keepthe worried one well, give them some peace of mind, and keep them in their homes, which we all know is very important, and then get folks who may need more sophisticated care. Care by talking with a provider live, get them triaged into virtual visits. 

PPI’ve talked to other health systems as well. And self-triaging bot serves two purposes. One is, it prevents an overwhelming of thehealthcare system when people start calling in such large numbers. And secondlyit triages into the right and the appropriate care. And I imagine that you have to put the clinical community through a new set of training or orientation to responding to what’s coming in through the triaging tool, and then appropriately responding to them. Have you had to invest quicklyhave a lot of training, are our providers comfortable with this mode of operation? Overnight you went from seeing patients to not seeing them anymore. What has been the challenge?

SV:When folks get triaged into virtual visits, they get triaged into what we call express care virtually. Express care is a clinical service that we have, and which is part of our ambulatory care network. We have over 50 providers who are just servicing express care. These folks are very specifically focused on express care. And in this case, they’ve been trained on those same-day use cases, particularly, virtualWe have been working with them really closely. Through our product team, they provide training like how to pull up the dashboards on your computer and just making that experience frictionless, not just for the patient who is accessing the virtual visit, but also for the provider who is delivering that care. So, they have stood up an entire customer success essentially team to be able to get our providers onboarded and trained for those same day’s virtual visits through Express Care Virtual. 

PPI want to share an anecdote with you, my daughter who lives in the city. She came down with a cold and a mild fever. The first thing that we told her to do was to schedule a virtual appointment. It took her a day to actually get to speak with a doctor even through a telehealth visit. So I imagine that even with a virtual model in place, even with the triaging in place, and the tools in place, there is still a feeling of maybe getting overwhelmed just because of the sheer volume of cases, all your routine cases which would have come in anyway. But then you layer on Covid-19 cases on top of that. How has the system responded in terms of Express care? Is it still same daycare, even though you switch to virtual or have the goalposts shifted a little bit? 

SV: There are significant challenges that the ambulatory care and the express care team rose to those challenges to findlarge number of providers to staff those visits. On the technology side of things, the volume that is coming through the platforms is 1015 times greater than what we had seen prior to the pandemic. We saw more volume in three weeks than we had in the entire previous year. And that has been a very interesting challenge in terms of the model. So previously it was on-demand telehealth and now what we’re seeing is almost like on-demand virtual visit. And lately, now what we’re seeing is like virtual urgent care or like a queuing model. And patients do wait in a waiting room in order to be able to access those visits. Now that it’s not a one day wait time, but they do sit in a waiting room in order to be able to access it. So, it’s almost a new model of care as compared to what we had previously. 

PPI’m hoping that, it’ll flatten out once we climb out of this crisis. And then hopefully when we go back to some level of normalcy, if you will, whatever, however, we may define normalcy going forward. 

SV:An interesting point, though there is a lot to be said for the adoption of technology potentially being accelerated through this process, given patients’ behavior is potentially different because they’ve now experienced a new form of care, a new modality of care that they otherwise wouldn’t have. And it’s unlikely that it will go back to completely the way it was and revert to the pre-pandemic days. This is alsobeen facilitated by a lot of regulatory and payment changes. And it’s also unlikely that it will willfully revert again just because we’re all getting used to engaging in a different way. And so the hope is actually that things like telehealth will be more ubiquitous in the future.We have this opportunity to meet patients and customers where they are with some of the enablers in place, too, like payment and like the regulatory environment has changed. 

PPOne of my previous guests said that with every crisis, a new opportunity arises. Maybe telehealth and virtual care models are what is going to be going forward. Switching to one more topic here, the dramatic jump in work from home employees. Solike every other business, every other enterprise across the land, you have seen remote workforce, double or triple. I know this is probably more or less function kind of responding to sit them all up remotely. What have been the challenges? Have there been more technological or cultural? 

SV:From a technological standpoint, Providence has a strategic alliance with Microsoft that is led by ourIS teamOur utilization of Microsoft Teams has just been through the roof. It has saved us in so many different ways. We’ve used it as a collaboration platform across the entire organization and it’s been tremendous. I’m sure that all of these collaboration platforms have been strained to the full extent that they possibly could be. But it has really served us well to have been up on Teams and be able to utilize all of its functionality from its video conferencing, but also to like collaboration spaces and SharePoint integration and things like that. So that’s been reallyhelpful for us. We also use things that are cultural in nature, like virtual social hours and happy hours and with the teams just to reconnect. And we’ve put some best practices in place, like actually having video when we are talking with each other and meetings so that we can ensure that folks are engaged and that we get to see each other’s faces. It’s not a requirement, but it is definitely something that we try to encourage. So, we maintain that closeness while we’re social distancing. 

PPI know the Providence Innovation Group has a significant portfolio of investments in digital health startups that have developed a range of innovative solutions. How this crisis has impacted them one way or another. And what are some of the things you’re seeing and how are they responding to it? Can you talk about a couple of your portfolio companies as illustrative examples?

SVAbsolutely. I think across the board they’ve all risen to the challenge with various creative solutions for how they can help and that’s been really heartening.I’ll talk about a couple of our portfolio companies, Xealth, which is a digital prescription platform and an integration mechanism into the EMR and Twistle, which is a digital pathway company that we’ve partnered with both of them, both in an investment capacity from a portfolio company standpoint. Providence was the home for Xealth when it was incubated. And we’ve worked with them for over two years prior to making an investment. They are working together to provide that core platform for the home monitoring that we just talked about. So,Twistle is the pathway that patients use to input their data. And that alerts our providers when a patient needs additional care and Xealth has been the mechanism by which Twistle has integrated into Epic for us. So, they’ve been tremendous partners and Xealth has also done some other separate innovative things. For instance, Kroger grocery delivery and making that available for patients directly. They are all doing really interesting and kind of creative things and have done them very quickly. I thinkthis crisis has focused on all of us. And just the sense of urgency has made things go 10 times faster than they ever did in the past. For all of us. 

PPThat is the sense I’m getting from digital health leaders, from other health systems as well as some of these programs and put them on a sense of urgency that may not have existed prior. And the part of the technology to dramatically change the way you deliver care and also do it in an efficient, cost-effective way is becoming more and more evident. As you’re aware, my second book was about to come out about digital transformation that I was co-authoring with Ed Marks, the former CEO of Cleveland Clinic. We have put it on hold for now. We are going to write a new chapter on how the digital health landscape is transformed as a consequence of this crisis. And I hope to come back to you and maybe request introductions to some of these portfolio companies of yours to really understand how they changed their product roadmap or turn on a dime, if you will, to respond to this crisis. Thank you for sharing those examples. Anything else you’d like to share with us Sara before we close the podcast.

SVThank you for having me and thank you for continuing to spread the word. We just want all of us to rally together, to marshal our resources, and manage the situation as much as possible. So, folks should feel free to reach out and learn more about how they can leverage what we’ve already done. 

PPThank you, that is indeed part of the purpose of these series of what I’m calling the Coronavirus conversations. I want to be able to spread the word of how health systems across the land are responding to the crisis. And our hope is that someone, somewhere is picking up something useful from these conversations

We hope you enjoyed this podcast. Subscribe to our podcast series at www.thebigunlock.com and write to us at info@thebigunlock.com

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

About our guest

saraveazy-profile

Sara leads the development of the digital strategy and roadmap, digital partnerships with health systems and technology companies, new business commercialization and business development, technology evaluation and pilots, and digital thought leadership at PSJH.

Prior to PSJH, she worked for The Chartis Group, a healthcare management consulting firm, where she focused on enterprise strategic planning, payer-provider partnerships, and the development of population health companies.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

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We’ve seen a 500% increase in telehealth visits

Coronavirus conversations

Coronavirus conversations

John M. Kravitz, Chief Information Officer Geisinger Health System

"We’ve seen a 500% increase in telehealth visits"

paddy Hosted by Paddy Padmanabhan

In this episode, John Kravitz, CIO of Geisinger Health, one of the largest health systems in the country, speaks about how the organization’s leaders have been “blown away” by how technology has stepped up to help address the covid-19 crisis. Geisinger’s IT organization has kept up with a 500% increase in telehealth visits and a doubling of remote workers to 13,000 employees and minimized disruptions to operations. John believes this crisis has created a new awareness of the opportunities with digital transformation. It’s a remarkable story. Take a listen.

John M. Kravitz, Chief Information Officer of Geisinger Health Systemin conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – We’ve seen a 500% increase in telehealth visits”

 
 

PPWe are starting a new series – coronavirus conversations – where we will feature healthcare leaders, especially those who are leading IT in large health systems and healthcare organizations on how they’re responding to the crisis. Today is March 20th and it’s my honor and privilege to introduce my first guest for these series, John Kravitz, CIO of Geisinger Health Plan and Health System. 

John can you tell us what is the situation at Geisinger? How many Covid-19 cases have come in and how are they being screened and tested? 

JKAt Geisinger Health System the number keeps changing by the hour. We’ve had several Covid-19 confirmed cases, some have come into our acute care system and others are being treated in ambulatory settings. The numbers have continued to increase in the state of Pennsylvania. My last count was 158 patients had tested positive for Covid-19. Most are in ambulatory, some very sick are in the acute setting, and some have expired. Unfortunately, happening all over the country. We, like others, have set up screening tents and treatment tents. Trying to keep those patients outside of our ED settings to avoid infection to other people. We’ve used a lot of technologies to support that, like iPads or FaceTime so that people can do work at their existing workstations. For example, registration people can get into communication with patients. Not everybody has to be in the tent and exposed to things. This minimizes for us the PPE because they are becoming in short supply, especially masks, even level 1 and level 3 masks, not include in the N-95 masks. We have 11 campuses and 13 hospitals in our system. We’ve set up these screening and treatment tents in every one of them with all the technology. They have got workstations on wheels, printers for lab labels, patient wristbands, everything you can imagine. It’s like a MASH unit and is well established. 

PPDo you develop your own test too?

JKYes, we were one of the two in the state of Pennsylvania to do our own testing. We got validation from the state and were cleared to begin our testing process. The challenge is the test kits. There aren’t enough test kits for all the requests coming through. We’ve been using a triage process. We use a bot that helps us considerably on our website and direct patients to that. Communication goes out through our patient portal as well to let people know what the process is. They can access that bot there. But it goes to a nurse triage hotline where they go through several questions with the patients and then set up appointments to be screened. 

PP: ChatBots have been introduced to respond to the crisis. Anything else for launching a new tool or reconfiguring any existing tool or technology in order to respond to the crisis? 

JKWe have a particular tool at the bot that is called SyllableWe have some in concept testing but haven’t had more fully deployed yet. Our main concern in responding to this crisis is getting people to have access to work from home so that we can do social distancing, so the disease doesn’t spread across our employee platform. Anyone who is a non-clinician can work from home in our environment. Clinicians can as well, when they don’t have to have direct patient care. Part of our process has been establishing remote connectivity for home workers. We use VMware’s VDI when people are in contact centers and need to make phone calls. We provide the Meraki type device; it’s an IP address mobile device that allows them to work at home effectively. We do not allow printers at home because of PHI or credit card processing machines at home because of PCI. But we take measures and provide access so that our employees can be separated. For example, in a contact center or a call center where we make appointment calls for our patients, if we have 300 people in a contact center we will move 100 those people to the home setting provided they have proper internet connectivity and speed and everything else to support that. We’ve created our own speed test and can run that for any of our potential people moving at home which has worked effectively. This allows us to spread people out more than 6-foot distance easily between contact center agents because we’ve taken people out of that mix. So those are some of the things that we’ve done. At this point time, we have 13000 remote workers at home on our systems and working well.  

PPSowhen your work is going from a campus-based workforce to a remote workforce, what have been some of the challenges you faced both from clinician standpoint as well as from a technology standpoint? 

JKWe have a lot of radiologists that do work from home with high-speed connectivity at their homes with high-resolution monitors. We call them broadband monitors,standard in the industry. We have a number of those people and we are doubling the size of the folks working from home. This adds new challenges to make sure they have adequate bandwidth, adequate facilities, and proper security at the devices at home. With our employees working from home, we still are cautious of PHI and making sure that the data is protected. And folks using Zen desktop or VDI, the work goes on back in your data center or in the cloud, where you’re connecting to, adding a layer of protection. That information isn’t sitting on someone’s home equipment. It’s easy to install that connectivity and in most cases, in a matter of minutes, people are functioning as long as they have adequate bandwidth. 

PPAre you seeing any increased threats from cyber-attacks in this current situation and are you being extra vigilant about any of that? 

JKWe do have surveillance systems that are in place. I have not received any through our Chief Information Security Officer about any new attack vectors that I’m aware of.Although I’ve been reading that there are increased attacks that are occurring. When there is a potential for vulnerability, the bad guys always want to look at new ways to attack and leverage their cause, unfortunately.We have not seen an uptick on that. We do have endpoint security, which is very strong to minimize or mitigate the spread of malware. I think it is the network surveillance that goes on all the time through MSSP. That’s a cloud-basedsolution and it’s worked well for us. Fortunately, we have not seen those increased attacksor are just not allowed to occur. So thankfully, that is the case for us so far. 

PPSwitching to the frontend technologies, the ones that you use for engaging with your patients. Telehealth is now front and center as you want to try and avoid in-person contact in the current situation unless it’s absolutely necessary. Have you seen an uptick in telehealth visits and how your platforms coping with that? 

JKWe’ve seen a tremendous increase, probably a 500% increase in telehealth visits. And our platforms and our physicians are all being trained as we speak now. It’s been happening all week, but they’ve been trained in proper technique. We have a thousand new providers that are going to be doing telehealth visits. Whether in the office or in their home settings, they will be able to do telehealth consultation visits. We pulled roughly a thousand iPads which can be used to do the telehealth visits. This is a crisis situation where good opportunities will come. I am hopeful of the relaxation of payments by commercial insurance as Medicare, Medicaid. In our state, Medicaid has paid for telehealth visits for a number of years in Pennsylvania as an in-person visit. But I would hope that the changing tipping pointfor people to really utilize telemedicineis seen in crisis, how it works. We can see it works effectively in daytoday settings. It’s a new opportunityOut of every crisis, a new opportunity arises. I believe telemedicine is a new opportunity for us and I am excited about it. We have patients in our ICU that may be nearing end of life because of this disease, we will utilize telemedicine. We will utilize links into our eICU so that they can talk to their loved ones. I hope there will not be any end of life and people do recover from this. 

PPHow is the technology itself holding up against this surge in usage? 

JKActually, very well, we’re using VDI in our cases where people may be using Zen desktop. It is really sending a minimal amount of data back and forth. When I looked at our internet pipes just yesterday to see the trendswe have not spiked up. We do have three major internet providers coming into our organization and we have the ability to burst and grow considerably higher if necessary. But honestly, I am surprised with 13,000 people at home, radiologists moving at home, and contact center agents, we have not spiked considerably. We may have gone up about 25 percent on our usage, but we still have a lot of capability. I expected more to be honest with you but seeing very pleasant results here and our systems have been doing very well.

PP:What about the IT organization itself John? These are new timeshas there been any impact to your daytoday operations in the data center? What kind of adjustments you had to maketo respond to the crisis and to support that with your capability? 

JKAs every other health systemwe have tried to minimize disruption in operations. Our service deskbeen doing very well. When we have information, we can communicate. Communication is the key for us and getting proper communication out to people. For example, when we started this telemedicine expansion, we’ve set up on our ACDour automated call distribution. We have a menu item that says if you are calling about telehealth problem there is a special small group of technology people supportthat will address those callsOur data center has been working very smooth. I think part of the challenge is because we’re looking at new and creative ways to tackle this problemWe have six enterprise implementation systems going simultaneously, including CRM and billing systems and everything else. We’ve not really stopped them, but we have reprioritized our work for this period and we’re going on two weeks now and I don’t see it stopping anytime soon. We have people working, unfortunately, in some cases 1617 hours nowadays. And we are not the only ones. At some point we’ve got to give our staff rest time and we want to do that. Butthe patient and our providers are top of mind for us. I am the CIO for the health plan and the health system and have been pulling resources from my health plan in augmenting for our health system, which is beneficial. 

PPHow do you think healthcare is going to get reshaped as a consequence of this crisis? Do you think that telehealth is going to become more and more mainstream?

JKWe’re all looking in digital. How do we do digital technology? How do we provide the best service for our customers? I think this is the opportunity and telehealth is one area. But, reach outs, capabilities make the process smoother to enable and get good care, whether it’s in the setting or in an ambulatory setting or an acute setting. Using technology to leverage that is going to be importantLeaders from all over our organizationare blown away by the level of support they’ve received from information technology and information services throughout this entire process. They never expect that we could respond like this and they are so thankful. I am sure every organization is hearing the same thing because we’re all hardworking, good people. As Winston Churchill said – never miss the opportunity.Do not miss the opportunity for innovation. That’s what we’re doing now, and I think it’s going to only continue. It’s an upward trajectory for us. Unfortunately, lives are at stake, but we’re doing what they can with technology to support that. 

PPJohn, I really appreciate you taking the time and I want to extend my deepest gratitude to healthcare workers all across the country for all that they’re doing in responding to this crisis. I think we’re going to be forever indebted to all of them. 

JKPaddy, if I could put in one plug for my fellow CIOs. I happen to be the chairman of CHIME. And I know there is a lot of work going on behind the scenes for policy and in communication to CHIME members. I think that the team works extremely hard to support our CHIME members. A lot of these initiatives, telehealth, national patient identifier, things that we’re going to need for the future. CHIME is really working hard to help support us to push that forward. I just wanted to give acknowledgment to them because the team, while it’s very small, is very agile and they’ve done fantastic work. I’m really honored to be the chairman of the board for that group. And I think this will help us as well for my fellow colleagues and members of IT. 

We hope you enjoyed this podcast. Subscribe to our podcast series at www.thebigunlock.com and write to us at info@thebigunlock.com

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

About our guest

John brings more than 25 years of healthcare experience to Geisinger Health System. As the Senior Vice President and Chief Information Officer, John is responsible for IT Strategy, Digital Strategy, Cloud Migration Strategy, Governance and Operations and business growth through merger and acquisition or joint venture activities. John has the technical responsibility for the organization’s advanced analytics platforms, including two Big Data platforms to support innovation of the Integrated Delivery Network as well as the Population Health Platform. Responsible for the regional health information exchange, KeyHIE, which currently connects organizations throughout Pennsylvania & New Jersey.

He is responsible for all technology support for the enterprise. This is comprised of the Geisinger Health Clinical Enterprise, Geisinger Health Plan IT support of business operations as well as Geisinger Commonwealth School of Medicine.

John is Board Chairman of the College of Health Information Management Executives (CHIME). He is a member of Health Information Management System Society (HIMSS), has been a past CPHIMSS Board member (Central Pennsylvania HIMSS Chapter Board), and KINBER Board, which provides fiber optic connectivity throughout the Commonwealth of Pennsylvania.

John currently serves as the CHIME Board Chair and is very active in the CHIME Policy Steering Committee which advocates on behalf of its member organizations. His areas of focus in the past have been the Opioid Crisis, testifying to the House Energy and Commerce Committee on behalf of Geisinger’s work in reducing the impact of Opioid prescriptions by more than 66%. Other initiatives include interoperability, use of telemedicine services and 5G Broadband in rural communities.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

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Digital front door is just the start for digital transformation

Episode #38

Podcast with Diana Nole, Chief Executive Officer, Wolters Kluwer Health

"Digital front door is just the start for digital transformation"

paddy Hosted by Paddy Padmanabhan

In this episode, Diana Nole discusses Wolters Kluwer’s healthcare business and how they are building expert solutions for insights and evidence that are more deeply embedded into clinical workflows. She also discusses how digital transformation is much more than digital front doors.

Wolters Kluwer Health has invested significantly in digitizing their products and offerings over the past few years. They now use advanced technologies such as AI and NLP to enhance their heavily curated content to provide quick and easy-to-find answers for evidence-based clinical decisions. They are also enhancing the delivery of their content with emerging technologies such as voice-recognition. Additionally, they are also improving the user interface by delivering smaller nuggets of curated information customized for individual patients and caregivers. Diana and her team are using voice-enablement to enable clinicians to learn in a setting that’s more interactive and stay updated on the latest practices and clinical knowledge.

Diana believes in evidence-based data to enhance user experience with the latest available technology. Their focus now is on getting patients to engage more, especially those that need stay on very good pathways for their own health.

Wolters Kluwer Health, Chief Executive Officer, Diana Nole in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Digital front door is just the start for digital transformation”


PP: Can you tell us a little bit about your healthcare business for the benefit of our audiences?

DN: We like to think of ourselves as a very helpful business. Our focus is around making sure every patient has the opportunity to benefit from the best evidence and data. We really focus on what prevents that and what causes variation. We start with education. We have a suite of education tools that continually evolves. As you think about how students get educated today, it’s very different than in the past. But then when they go into practice, as soon as they walk out of the door, they need to keep learning and be updated on what’s the latest practice techniques. As they continue their research and education, we stay with them throughout that. Again, really focusing on what causes breakdowns in clinical care, really caused by variation. So that’s a little bit about who we are and our suite of solutions really tailors towards that.

PP: Would you care to share your thoughts on the final ruling on the interoperability question made recently by the HHS?

DN: I think all of us are trying to digest it as I understand it. I think it’s over like twelve hundred pages. So, we will learn a lot. But I think at the core of this, we really are a supporter of needing to have good strong interoperability without sacrificing any issues relative to privacy or security. So we believe for the long term, if you really want to have the benefits of a digital system and digital ecosystem and be able to support things like AI and its ability to really alter and augment the intelligence that our clinicians need, you have to be able to do this. And we still struggle with that in many cases. And so, the aspect of standards and procedures and interoperability is very important. So, I look forward to, as does my team, really understanding how this may help advance that. I think it’s early days, but certainly we are positive that a ruling has come out and helps to put guidelines for all of us that are kind of working within the system of how to operate best.

PP: Did anything leap out at you when you saw the initial press release, anything at all?

PP: Yeah, I think that the interesting thing is, there’s always been this aspect of who owns the data and whether they have to pay for the data; so they clearly are saying patients should be able to get access to their data without any issues and without having to pay any fees. I think for us working within the ecosystem, it helps to understand how this will actually work as we interface and integrate it into, like the EHR systems. For us the most important thing on our clinical practice side is really how can we do this and how can we do this as quickly and efficiently as possible. So, I think there have been some things written in the document that kind of talks about from a contractual arrangement, things you can and can’t do that would sort of define you being information blocking or not. So, we think that will maybe actually help us in our arrangements with our EHRs. We were very critical and important to us.

PP: What is the current state of maturity of digital transformation as it’s defined broadly in the healthcare ecosystem, in your perspective?

DN: It’s a big question. And obviously you’ll get lots of opinions. But from my perspective, I think we’re beyond sort of the foundation building. I mean, things really are in digital format. We did talk just briefly now about the interoperability issue. We still are plagued by the fact that we can’t probably get data in and out of the system for all the various use cases that could potentially use it. So, I think we’re beyond the foundation building. I do think you’re seeing some nice basic enhancements to experiences on the patient side. You know, there’s pretty basic things, but you can see what your lab results are. You sort of have a place where all of your data is. If you’re in a certain system, you have the ability to do electronic check-ins. We see telemedicine kind of coming up and we’re starting to see some ability to see sort of AI and its application where we have large data sets of labeled things.

I came from the world of radiology. I think there’s a lot of thought that now that we have all of this labeled data, we could apply AI and AI could augment a radiologist role and understanding where there are issues. So, we’re still I would say sort of early on. I think that is really where I think the hope is. If you go back to our focus around variations in care, you still have a lot of handoffs that aren’t managed well within the digital ecosystem. Once the doctor sees the patient and they kind of decide on a treatment path, is it all carried out even out to the patient? I mean, a customer told me, you know, a simple thing is now we can tell whether a patient has actually picked up their medication or not. It’s a simple thing, but obviously goes into a lot of parameters around, OK. They didn’t pick it up. Should we reach out? Can we have a discussion with them? Can we understand what happened? Is it a cost issue? Is it an access issue? What is it?

I think we’re also in that stage where we’re starting to better appreciate what the true connection of digital health could mean for us. And I think that’s still you know, that’s the vision that we’re all kind of working toward. So still in the basics. But, you know, moving through and got a lot of good foundations laid.

PP: In another podcast, the CEO of Wolters Kluwer, Nancy McKinstry, talked about the massive digital transformation that you folks have gone through as a company. Can you share a little bit about what that feels like for your business and share some learnings from that?

DN: Yeah. So, in health, we’ve gone through a similar transformation in our content-oriented business. It’s very heavily curated, just like the rest of our businesses within Wolters Kluwer. And so, the first step was taking everything from what used to be in a printed format and getting in a digital, and 90 percent of all of our solutions now are in digital. We still do have books. People do like hard books and hard journals.

But now, just like we talked about the transformation, the EHR kind of gets everything into digital. We have gotten everything into digital. But now what we’re really focused on is something we referred to as expert solutions and expert solutions or more deeply embedded into the workflow, take into context the use cases of how they’re used. I’ll use as an example UpToDate. We have now gone to something referred to as UpToDate Pathways, and that is more than augmented or guided decision-making tool for specific things that have evidence that’s very strong but wide areas of variation. So, we are really starting to see the move from just taking something that was in print and moving into digital and now moving it into expert solutions. And that’s really where our focus is, where I think we’ll unlock a lot more value and being able to serve exactly the content that our customers need. Having them have to rely on the questions to ask to serve up the content is not the long-term goal. We want to be able to take the patient information from the EHR and provide what we think is most relevant and help them kind of walk through, especially for complex situations. The best way that they could consider a treatment for their patients. So, we also are in a transformation. It’s very exciting, though, because I think that’s really where you see significant impact on patient outcomes if you can do that.

PP: I imagine you use a lot of natural language processing because you’re a content-heavy business in order to curate the content and to get to answers faster than you would through conventional or traditional news. Are you also changing the way you deliver this content?

DN: So, in terms of digitizing it and delivering it in different ways, we’ve been thinking about what’s the interface. We are working on voice because we think voice will be one element of how you might want to get the content and then serving it up. I think what you’ll find is instead of lengthy textual things, you’ll see something either in a curated order or much smaller. We also have, just recently, even in our more patient oriented space, videos that interact with the patient to help them get prepared or help educate them on things that they’re experiencing. We definitely have found in that world we need to have smaller nuggets and to be able to kind of customize it more for the patient and allow them a little bit more flexibility. So, I think you’re right in the fact that the way we serve up the content will be very different, and different types of content, whether it’s video, whether you do it by voice; those things will continue. It’s all about the user experience now and how can you best use the most available technology? So, you hit on a great point there.

PP: Based on what we are seeing, the focus of digital transformation is on digital front doors and the consumer interface.  Do you think that is too narrow and limiting a definition? What are your thoughts on what else health systems should be looking at as we transform the entire system really?

DN: I think the digital front door is just the start. If you use that analogy, there’s so much more in the house that you want to be able to use. I think that we obviously had to have that window and you have to have that be some kind of an enhanced experience. So, people want to open that door. But if you think about it, the type of information I mentioned before, you can now get your lab results. But the lab results, most of us as consumers of that information, we don’t really quite understand what it would be. So if you think about moving more into how are you going to actually manage your health and how do you really get the patients to engage, especially those that really do need to engage and stay on very good pathways for their own health. That’s why we saw so much value and made the investment in the acquisition we did a few years ago. Emmi was really beyond just patient engagement, but it was shared decision making as well as really helping patients as they move into their home healthcare in a transitional environment. So that’s more of how do you stay connected with them? Get things like, register your sugar levels, how is your pain level doing and then how do you really get to understand how that patient wants to interact? And do you see the ability to see when a patient is going into rising risk such that you will outbound and outreach to them to help keep them in their home healthcare environment, which is probably the best situation for them? So, I see it much more oriented towards true engagement with the patient on a much more sophisticated level. But it’s easy to interface with not just the portal, if you will.

PP: You’re kind of at the intersection of education and healthcare. Education itself is going through a dramatic transformation in its own way. What are you seeing there that’s comparable to the kind of transformation the health systems are going through? And how are you enabling that transformation?

DN: Yeah. And it’s really interesting because I called on an academic and I think the professor said people don’t really come to the lectures anymore. And so, it’s sort of indicative of what a student wants, and a student wants to kind of mimic what they’re going to be asked to do outside in the real world. So, we definitely see virtual simulation for things like nursing labs. The interface with the EHRs so they practice within sort of a version of that. But more importantly, what we’ve also done is we’ve integrated technology around adaptive testing where the student can self-test themselves. You can’t game the system. It’s based on AI so it constantly kind of thinks about how you answer something and then serves up additional things. But it really understands if you are getting to the core of clinical judgment. Can you actually understand in these various scenarios how you would react? And we believe and there’s evidence that shows that they’re much more ready. They have higher scores on their high-risk test exams and they really then get out into the world and are ready to go and practice right off the bat.

So, I think that that’s one aspect at the initial education and then the subsequent things, we do a lot of education. We obviously have the ability to do continuing medical education within UpToDate. And then we also have the aspects of our product called Audio Digest, where you can actually continue to learn along the way in a setting that’s more indicative again. Listen in the car, listen while you’re working out, how do you just continue to kind of have those? So, the way people stay updated on the latest practices and how they get their clinical knowledge and judgment at the beginning has definitely changed. It’s much more exciting, I think, as well. Students react much better about getting in and really kind of looking at real life situations.

PP: There is also a component of the infrastructure that is required to support digital front doors and patient engagement and so on. What is your sense of where health systems are, especially as it relates to your solutions? Are the infrastructural components that you expect health systems to have in place and are they ready for what you are providing to them?

DN: Yeah, that’s a really big broad question because I would probably say we all think that there’s still things to invest in. The EHR kind of is the big road, right? The big pipes around the hospital system. But what you’re tending to see, which is typical of where we’re at in the stages, is you see digital solutions popping up. And it’s unclear to us sometimes that as a vendor exactly who will own that. Some of our systems have put in place, like a Digital Health Officer, but we still find that projects and initiatives seem to be owned and influenced in a particular area. And so, will the Chief Nursing Officer still be overly responsible for things that deal with patient experience, patient education, patient interface. I don’t know that we see the need for additional infrastructure to be built. I do think people are still very worried about the aspects of security and privacy and all of those. So, I think that will continue to be an evolving state of affairs.

In terms of the infrastructure, I think most of that is in place. I do also think that you’ll see these naturally have different types of solutions. But ultimately our customers are recognizing that the way a patient is cared for is kind of shifting from various pieces of the solution, like a doctor, a nurse, and a pharmacist to actually seeing the whole ecosystem of the care team. And that’s where we’re trying to work on our own solutions, of how to make sure that we start wherever possible, can populate our solutions with each other’s data. So, as an example, if you’re in UpToDate as a doctor, we do populate drug information and access that we will put Emmi videos in there so you can see what the patient might be prescribed as far as patient engagement. We’re just trying to make the user interface is consistent. So, we are trying to make our own sort of clinical decision support suite look like a suite, act like a suite, have information accessible to it so it can support the movement to the care team approach.

PP: You may have a Chief Digital Officer who is making decisions on certain types of solutions, but then there are other solutions for which functional leaders like the CNIO, for instance, are making the decision. Are you seeing this all converging in some way to some kind of an org model which is becoming a defacto standard like a digital transformation office, for example? Are you seeing that happening? Or do you anticipate that it will continue to be the way it is, which is that decision making will remain fragmented based on the type of solution that people are buying?

DN: We definitely are seeing decisions become more solution, holistic enterprise wide. I think the org models specifically are continuing to evolve. So even when organizations have put in place a Digital Health Officer, they themselves are still getting the lay of the land in terms of how to bring in the right influential clinical people to get to a decision. But we definitely have seen more and more decisions being made sort of enterprise wide, and consolidation sort of more structure around how the decisions are made, which ultimately I think is going to be a very good outcome while not sacrificing any particulars that may need to happen at a particular site. So, I think they’re being very thoughtful about it.

PP: We’re in the middle of the Coronavirus. How is your business coping with the impact and how are you helping your customers cope with the impact?

DN: Yeah. I really do truly hope that we’re more in the middle than it’s still at the beginning. Obviously, we have our own employees that we want to make sure that we have good care around them. And so, we always continue to make sure they’re in a safe environment and have flexibility for them in terms of working from home. In terms of our customers, we’ve made readily available whatever information we have on the situation. We’ve just posted it out there. We’ve posted access for patients. If you as a consumer want to understand what’s real and what’s the facts. We’ve made that available so that we try to put that out there to kind of depict fact versus, you know, maybe not facts.

In terms of our customers obviously, our customers are bearing the biggest burden of all of this right now. And so, we’ve been very flexible. I’ll give you some examples. From a sales call perspective, a support call perspective, if we had planned onsite visits, we’ve automatically called them and said, would you prefer us to just do it virtually. About 50 percent are doing virtual kind of conversations with us right now. And then we have a lot of relationships with societies and many of the societies have had to cancel their conferences. And so, we’re working with them on how we can get there. Very valuable information was going to be presented at those conferences, how can we still get it out? So, we’re kind of working with them on flexibility of trying to still sort of in a virtual environment, get to the objectives that they had for those things. So those are some of the things that we are doing in this current state.

We hope you enjoyed this podcast. Subscribe to our podcast series at www.thebigunlock.com and write to us at info@thebigunluck.com

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

About our guest

Diana Nole is the CEO of Wolters Kluwer Health, a leading global provider of trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers, students, and the next generation of healthcare providers with advanced clinical decision support, learning and research, and clinical intelligence.

Wolters Kluwer Health solutions support more than 2.5 million clinicians in 187 countries and educate over 1 million medical and nursing students under Diana’s direction. Research and development investments leverage the latest technologies including artificial intelligence to deliver innovative solutions that improve the quality and cost of healthcare, specifically focused on: user experience, decision support, disease detection, advanced workflows, and analytics. Her approach as CEO for Wolters Kluwer is to focus on the customer, drive a sense of urgency, and execute on plans.

Prior to joining Wolters Kluwer Health, Diana served as President of Carestream’s Medical Digital division, a global leader in medical imaging systems. Under Diana’s leadership, the breakthrough wireless x-ray detector, DRX-1, and mobile x-ray solution, DRX-Revolution were introduced and gained market leadership positions. During her tenure, Carestream’s healthcare IT solutions also received “Best in KLAS” designations and the company was chosen as vendor of choice by large, prestigious global healthcare providers across the globe. A nice recognition and acknowledgement by customers that these solutions had a true and meaningful impact. She has held a number of executive positions and is a passionate leader behind many healthcare technology innovations. Her view of the rapid evolution of technology is not one of a challenge but, rather, a chance to unlock new opportunities.

Diana holds an MBA from the William E. Simon Business School and a B.A. degree with Magna Cum Laude honors in Computer Science and Mathematics from the State University of New York. In addition, Diana is currently a Board Trustee of St. John Fisher College, recently appointed their first female Vice Chair, a Board Director of ESL Federal Credit Union, and a Board Director and Chair of the Audit committee of the life sciences company, Clinical Ink.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

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Digital isn’t just about new care models but enhancing traditional care models through digital means

Episode #37

Podcast with Angela Yochem, EVP, Chief Digital and Technology Officer, Novant Health

"Digital isn’t just about new care models but enhancing traditional care models through digital means"

paddy Hosted by Paddy Padmanabhan

In this episode, Angela Yochem discusses how Novant Health, a $5.5 billion nonprofit integrated healthcare provider network based in North Carolina, focuses on improving care quality for consumers through advanced technologies. She also discusses her current role and responsibilities at the organization and how digital health is much more than digital front doors.

At Novant Health, digital care is not just about new models of care delivery using digital tools. It is also about enhancing traditional models of care delivery through digital means. Angela, along with her team, provide advanced digital capabilities to improve the quality of care for patients and community members and ensures increased access to care through digital means.

Angela believes that healthcare organizations must adopt contemporary methods and technologies to improve patient engagement and care delivery. However, this opportunity is closing rapidly due to the emergence of unconventional entrants in the healthcare ecosystem. In the podcast, she discusses how she and her team have developed approaches to identify and rapidly onboard innovative digital health solutions for high-impact areas such as stroke care. She advices health systems leaders to bring in people from outside of healthcare for diverse perspectives to solve the most complex problems.

Novant Health, Chief Digital and Technology Officer, Angela Yochem in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Digital care is about care delivery and enhancing traditional care models through digital means”


PP: Can you tell us a little bit about Novant Health and your role and perhaps also touch upon your unique org structure?

AY: Certainly. Novant Health is a $5.5 billion nonprofit integrated healthcare provider network. We have 15 major hospitals. We have between 650-700 clinics and physicians centers and about 30000 team members. As you can imagine, we’re focused on meeting our consumers’ needs by shaping new services and experiences that resonate with our consumers and the communities that we serve. Technology advances drive a lot of those expectations that our consumers have and certainly change the way we think about engaging with our patients. And, of course, our team members and the border communities. My position was added in late 2017. It was meant to provide a way to increase access to care through digital means and also to define how we can improve the quality of care by leveraging advanced technologies. And, of course, our unprecedented access to data that we enjoy in the healthcare space.

My teams, of course, helped the organization explore many ways that the digital capabilities that we provide can improve the health and the lives of our community members. I’m fortunate that I work for someone I would describe as a digital CEO, Carl Armato. This notion of a digital CEO I think is something that’s so important to so many industries today. Digital CEOs understand that advanced technology functions are essential to providing differentiated services and products regardless of industry and that the executive team for any company must have expertise in the tech field represented at the decision-making table so that they can identify those opportunities when they emerge. In my organization, we moved all of the roles, all of those related roles report to me. And that, of course, helps us reduce fragmentation and avoid conflicting investments or duplicative investments and technology and analytics space across the board. So my senior staff includes a Chief Information Officer, the Chief Technology Officer, our Chief Medical Informatics Officer, our CISO for cybersecurity, our Chief Data Officer and the Chief Digital Health and Engagement Officer, as well as an executive responsible for learning and research across the Digital Partner Services Group, which I believe is a strong, cohesive team of highly talented people from a variety of industries in a variety of backgrounds and credentials area. It’s been incredibly rewarding.

PP: There’s a fairly impressive set up there and we’ll talk about some of the initiatives that you mentioned. Novant Health is based in North Carolina. Is that right?

AY: It is. We’re headquartered in North Carolina. We operate primarily in three states and we have a footprint across five. And I guess what you’d call a super-regional.

PP: Angela, you came from outside the healthcare industry. What struck you the most when you came into healthcare and into this role? What is your assessment of the current state of maturity of digital transformation and digital health in the sector?

AY: Those are two very interesting questions. What struck me when I came here and in fact, one of the reasons I joined Novant Health is that the significance and the importance of the work being done in Novant Health, I mean, literally life and death work, right? Drives a tremendous appetite for adoption of the latest and greatest capabilities that would allow us to provide higher quality care, greater access to care, get better outcomes for our patients and communities. So, it’s that appetite and that ambition for improvement across the board and a passion that I think our team members bring, our clinicians bring at Novant Health that struck me that is so different than what I’ve seen in other industries. I had an opportunity to work with very, very smart, driven, amazing people across the other industries. But the life or death aspect of what it is that we do here just elevated that intensity and I’m the type of person that appreciates that intensity. So that’s one difference that I saw that I really appreciate it.

The other thing I’ll say in response to the second half of your question is that healthcare organizations have an opportunity to adopt more contemporary methods and technologies and architectures and philosophies related to engagement and the delivery of solutions sets to consumers and team members. And I’ll add that the window of opportunity for adopting more contemporary capabilities is closing rapidly. And I would say that based on the number of unconventional entrants that we’re seeing in the healthcare ecosystem.

PP: Defining digital health in terms of just digital front doors, is that too limiting? Should we be thinking about modernizing technology to your comment about bringing in contemporary technology and therefore expanding the scope of digital transformation? How are you defining digital transformation in your role?

AY: This is a fantastic point that you raise. Thinking about digital front doors and only that as being the scope of digital engagement is of course very, very narrow. At Novant Health, we define digital care in both the ways in which we use digital channels to offer care, which is what you’ve just described, but also in the ways in which we enhance our traditional models of care delivery through digital means. You see a lot of investment across the investor community in point solutions that are allowing us to provide as we adopt them. Unprecedented access to care using devices such as our on-demand TytoCare visits or, the ICU capability, tele-behavioral health, kiosks, and remote locations, community centers, and schools. All of these sorts of things are highly visible and they’re absolutely a real thing and a real focus area for us as well as for everybody else.

But to your point, we also focus very relentlessly on capabilities that increase the quality of care. I’ll give you a couple of examples. Earlier in 2019, we launched across all of our hospitals a stroke care solution. I’m sure that your listeners know what happens when a patient exhibiting stroke symptoms shows up in emergency department. But just for those who don’t, I will describe it very briefly. A stroke patient shows up, an emergency department whisks them back, puts them in a CT scanner. They get into a CT scanner, CT scanner runs. And then once the scan is complete, the images examined by the radiologist on call, who in turn might pass it along and see something that may need some care, some attention, will then pass along to the physician on call who then engages the neurosurgeon on call and somebody at some point ready for the operating room. And if there’s some sort of operable occlusion, the patient is treated in that operating room. My understanding is that the national average is somewhere in the mid-50s of minutes. So, between the time when the patient shows up to the time when the operation is being conducted, and if you think about a stroke patient losing a couple of million brain cells a minute, give or take, that’s a lot of minutes. It’s a lot of brain cells lost. So, we have partnered with a third party called Viz.aI who receives the CT scan data while the scan is still being conducted. So as soon as the patient goes into the CT scanner, in any of our hospitals, we stream the data into the Viz.aI environment and they apply AI-based algorithms to the streaming data as it comes through and they can identify an operable occlusion if it exists well before the scan is complete. And so, their solution actually sends the scan to the neurosurgeon on call and makes a notification to the OR so that we have treated patients in as few as 14 minutes from the time they show up to go and see department exhibiting stroke symptoms. Big deal. Our average amount of time with this AI solution in place is about somewhere between 22 and 25 minutes. Well below the national average.

Now coming back to an important point, between the time when we learned of the existence of this type of solution and the time we had it in all of our hospitals, its four months. So, it’s not just about adopting solutions that are truly life changing, life saving for our patients. Increasing the quality of care in this example in the stroke protocol. It’s also about preparing the environment so that you can adopt rapidly these sorts of solutions without the traditional sort of year-long analysis phase that might go on otherwise.

PP: Can you share any early learning, any data points that could benefit our listeners and all those who are implementing these kinds of tools for improving patient engagement?

AY: Absolutely. One of the things that was so interesting when we launched this digital health and engagement division, which is led by a practicing family physician and a strong team of people from a variety of backgrounds, is that the appetite in our patient community is so strong for helping us as we develop these solutions. Our strategy for everything we do at Novant Health starts with the patient. We want to know how we can eliminate their pain points, what do they need, how can we change to meet those needs, and so on. So, when we announced the creation of this division, we ended up having 7500 patients sign up to be members of this group we call ‘community voice’. So, this is a group of patients, community members, and caregivers who’ve agreed to be our focus group and sometimes a pilot group for new digital capability.

So, the learning that I would pass along to others is the appetite exists. And you can have a very, very large sample set of participants as you run experiments with new ways of engaging your patients digitally. I think you have to figure out how you’re going to manage that community, which we’ve done and obviously which can be done. It’s been a wonderful success. And the most recent example I’ll give you is our exclusive partnership with a company called TytoCare.

So, it’s just soft launched in North Carolina and it’s for On-Demand remote medical exam. We’ve had On-Demand video visits forever. TytoCare is a device that’s about the size of the palm of your hand and it has a variety of peripherals that plug into it. And these devices, when used by patients or caregivers, allow them to connect with a Novant Health provider who can virtually examine the heartbeat, the lungs, look at the breathing, look at the skin, look in the ears, look down the throat, look in the eyes, look at the nose, check the abdomen and so on, from wherever they are. And all of these examinations are not only being guided by remote provider but in the case where a patient might want to do the self-exam without a provider live, then the device itself will guide the patient through the process, analyzing the signals coming in from the advanced sensors and the device in real-time and using those signals to tell the patient how to adjust the device.

For example, if your patient is trying to capture a picture of his or her own eardrum, then the device will guide the patient until the image of the eardrums is collected and then it’s automatically, immediately saved in the electronic health record for that patient. So, a really interesting advancement in providing access to care. For anybody who’s ever had a child who suffers from multiple ear infections, if you can imagine, 10:30 at night your child exhibiting ear infection symptoms, wouldn’t it be great not to have to worry about taking off work the next day and trying to get the child an appointment and instead allowing an exam to happen right then, having the ear infection diagnosed right then and having the prescription called in right then and the child gets to start taking the treatment immediately before even going to bed that night. So, this is the sort of thing that the team is working on and doing some fairly groundbreaking work in our region.

PP: You’ve had great success in having your patients engage with the digital tools that you’re putting out and have thousands of patients sign up and be a part of it, willing to participate. Now you’ve got a self-triaging kind of a tool through the TytoCare device. So, it seems like that is a recurring theme that you’re getting patients engaged in their own care instead of having to push it out to them. And you’re getting a fair amount of success in the virtualizing care through advanced technologies. Am I getting it right? Would you agree with that assessment?

AY: I do agree with that assessment, but it’s a journey that goes on constantly. So, this is not a space in which we can rest on laurels. This is not a space that remains stagnant by any stretch. We have to continue to adjust to emerging patient expectations, the needs of our communities as they evolve. And those are the sorts of things that I think keep us on our toes. And that’s why we built these constructs that allow us to continually look for these opportunities and run experiments with some of the technologies so that we understand what the impacts would be and how to prioritize the work.

PP: Can you talk a little bit about what your goals are for the Institute of Innovation and AI and how you are harnessing data to drive these improved experiences? Talk a little bit about the institute itself and the goals, if you could.

AY: Sure. So, we launched the institute this past year. I co-founded it with Dr. Eric Eskioglu, who is our Chief Medical Officer. He happens to be a practicing neurosurgeon and before he was in medicine, before going to medical school, he was actually an aerospace engineer. So, he’s a rocket scientist. So really great partner to have as we think about things related to innovation and artificial intelligence and other advanced technologies that really need never be explained to him. He’s always there as a tremendous partner with me, as a digital leader. So, when we launched the institute, the goal was to identify these technologies that may not even be commercially available? How do we use them to accelerate solutions that allow us to provide the highest quality, highly personalized care.

The constructs allow us to work with our very engaged physician community, as well as other team members from across the system and partner very easily with a variety of third-party types. We partner with members of the startup community. We partner with universities and other research organizations, other healthcare organizations. A variety of unconventional partnerships tend to be crafted as part of the work that we do inside of the institute. And ultimately, this allows us to run rapid experiments with new solutions that understand impact based on real data that we can collect, not just, suppositions, better engage the broader community inside of Novant Health to get involved in making these game-changing advances for our patients and in our practices and also to best manage investment so that we’re not a naturally fragmented in the sorts of experiments that we run across the board. It’s been a great success in the sense that we’re able to do the work rapidly and with a feeling of having the right experts in the room at the right time.

PP: Can you give us the State of the Union on data interoperability and how are you really harnessing all the emerging datasets that we’ve talked about? We tend to talk a lot about EHR data, but there’s so many other emerging data sets. How are you actually harnessing the data for all the insights that you can potentially generate or some of your programs? Can you talk about that?

AY: Let’s break this down a little bit. So when we think about the broader state that we manage, what are our assets? What do we bring to the solutions that we define for the toughest problems that we’re facing in healthcare? Data is one of those assets. We have patient clinical data. We have consumer data. We have behavioral and trend data. We have our business’ master data. We have a variety of data from many, many sources. We have to have a place where the data can reside and we can apply functional capability to it.

Functional capability is expressed through a variety of solution sets. Some are homegrown, others are provided by various third parties. As we’ve discussed already, we have digital assets that provide care and other access related capabilities to our patients and our communities. We have capabilities that support the running of our business and other foundational elements. Many of these capabilities can and should be provided by a traditional healthcare vendor like an EHR vendor. It is about about data. It’s best for us to focus on creating an architecture that can allow for interoperability between solution sets and various third parties in a highly secure fashion. That’s how we get the most out of the unprecedented access to data that we have. This is what’s going to allow for rapid adoption of potentially differentiating services for our patients. This is what leads to that extreme personalization in all engagements with patients improving the quality of their care through faster diagnosis, breadth of treatment options and of course all the other advanced tech that we can apply to it.

With such extraordinary availability of data and the things that we know we can do within the existing constraints, and within our existing agreements that we have that patients for the usage of the data. We are watching with great interest this debate and the deliberations that are ongoing. And while I don’t have direct visibility into how those considerations are playing out, my hope is that the eventual ruling will benefit our patients. And meanwhile, the things that I can control are the architectural choices that I just mentioned. As long as I stand ready to be as interoperable as possible and as secure as possible across the board, then whatever the decision is, we will be best positioned to serve the patients and communities.

PP: Digital programs, in general, are in early stages of maturity and there’s a long way to go to your point earlier that it is a journey that is by no stretch it’s all done kind of thing. So how do you actually keep track? How do you measure progress? How do you keep score of whether a program is working or not?

Well, so we look at outcomes fairly consistently across the board. So, we measure the quality of our care through a variety of mechanisms. We measure the access to care, the ability that patients have to access care at Novant Health. We in the digital channel space have all of the usual measures that other industries have been using for engagement, for digital engagement, and we certainly track that because we are a business and we’re a rather large business. We track how we can continue to provide advanced capabilities to our patients and community still within an acceptable cost structure.

So, all of those sorts of things are measured as you’d expect them to be. I think that is the most important thing that is specific to digital capability to be able to measure and track progress. The nature of how we’ve defined progress outside of these broad buckets that I just mentioned would be different from case to case. But measurement is one of the most important things we can do post-launch. You’re not done when you’re launching a product or a solution. You are never done. The incorporation of the measures and the results that you’re getting should always feed into the next decision cycle and in our case that has a relatively short window of time.

So we continue to iterate on all of the services and products that we deliver to our communities as well as to our team members inside of Novant Health. As we think about how we are acting as stewards of the resource that our companies have that are so important to us ultimately to the health of our communities.

PP: Any final thoughts that you’d like to share with our listeners as it relates to how they could be looking at their digital programs or anything from your own experience as a best practice?

AY: One of the things that has been such an accelerator for us here is the creation of the chief data officer role and corresponding organization, which include the Cognitive Computing Group, which includes Enterprise Information Management Organization. These sort of constructs and the corresponding investment that allowed us to accelerate some of those foundational capabilities t are absolutely required in advance of being able to do any of the more exciting things we’ve talked about that are more functional in nature.

So, getting those foundations right is important. That doesn’t mean you have to take a couple of years to do it. It has been done in other industries. My advice to other healthcare systems is unless you are in need of additional health care expertise, don’t be afraid to pull people in from outside of healthcare because it’s a gift to allow them to participate in such a wonderful industry. And it will be a benefit to the industry to have diverse perspectives involved in solving some of our most complex problems.

We hope you enjoyed this podcast. Subscribe to our podcast series at www.thebigunlock.com and write to us at info@thebigunlock.com.

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

About our guest

Angela Yochem is EVP, Chief Digital and Technology Officer for Novant Health, a super-regional healthcare system with one of the largest medical groups in the US. She and her teams deliver the world-class consumer capabilities, differentiating technologies, and advanced clinical solutions that allow the high-growth system to provide remarkable patient care.

Angela has served as EVP/CIO at Rent-A-Center, Global CIO at BDP International, Global CTO at AstraZeneca, and divisional CIO at Dell. She’s held tech exec roles at Bank of America and SunTrust and held senior technology roles at UPS and IBM. In these roles, she built B2B digital product lines, grew digital retail channels (B2C), created technical services lines of business, and transformed global technology capabilities.

Angela has been a Director for the Federal Home Loan Bank of Pittsburgh, BDP Transport, BDP Global Services Asia and Europe, and Rocana, with experience on Audit, Enterprise Risk, Operational Risk, and Governance/Policy committees. She remains an EIR for Vonzos Partners, a Mentor for SKTA Innopartners, and an Advisor for Dioko Ventures. Angela serves on the board of Freedom School Partners, a non-profit committed to promoting literacy in the Charlotte area, and on the executive team of the Go Red for Women organization, part of the American Heart Association. She is a Trustee of the Charlotte Regional Business Initiative and is an advisory board member for the American Hospital Association Innovation Council and the University of Tennessee Electrical Engineering and Computer Science department.

Angela has a Bachelor of Music from DePauw University and a Master of Science in Computer Science from the University of Tennessee, holds three US Patents and is an author with Addison-Wesley and Prentice-Hall.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

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