"We connect the dots with our solutions for better healthcare outcomes"

Karen Kobelski, VP and General Manager of Clinical Surveillance, Wolters Kluwer Health in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “We connect the dots with our solutions for better healthcare outcomes”

PP: Hello everyone, we are continuing our series of Coronavirus conversations. It’s my privilege and honor to introduce my special guest today, Karen Krobelski, General Manager of Clinical Surveillance and Compliance for Wolters Kluwer Health. Karen, welcome to the show. Can you telling us about the Wolters Kluwer’s offering for healthcare and how you help clinicians and educators at a high level?

KK: Wolters Kluwer’s mission is to bring the latest evidence-based medicine into the workflow of clinicians, students, and the learning community. So from the beginning of their journey in medicine, whether they’re studying nursing or studying to be a doctor, we’re providing the textbooks and the clinical education and we take them all the way through their journey and continue to provide the latest evidence-based medicine; and then provide electronic workflow solutions to actually make their lives easier, their jobs easier, more efficient, to bring that evidence-based medicine to the benefit of both the clinicians and the patients in the healthcare system. That’s really the mission of Wolters Kluwer Health and that’s the mission behind our solutions.

PP: You recently released some new offerings to help clinicians respond and cope with the COVID-19 pandemic. What those offerings are and how you’re helping clinicians in the current context?

KK: There are a few different areas that we’ve been able to jump right in and help with the existing solutions that we already have in hospitals. I’ll give you a specific example. One of our solutions is an infection prevention solution that does infection surveillance for hospitals. We recognize that, right now, the best thing that we could do with the COVID-19 situation is to create a dashboard for hospitals where we could put in one place, a snapshot of the status of every patient in the hospital that has been tested or not tested for COVID-19, whether they are in the ICU or not. Some of the demographic information like, how long they had been there and their prognosis, some of the other complications, etc. So, you have a one-stop-shop for the COVID-19 status in your hospital or your health system. We can aggregate it up to the health system level. So that has really simplified the data collection process. You can imagine how complicated it would be to try to aggregate all that information on a real-time basis. We do that for them. Another thing that we do is we help them automate the process of submitting that information to the National Health System Network. As you know, the CDC is trying to collect that information on a daily basis so they can track the progress of this pandemic. We’re able to aggregate all that data for them and provide that to them so they can serve that up very easily to the CDC. So, in that way, we’re helping to streamline that workflow, make it easier, and provide that information at their fingertips to make sure that they know they can do that without having to go through the complicated process of trying to build those reports, aggregate that data and distribute it on an ongoing basis. Another thing that we’ve done, we also have surveillance in the pharmacy. So, you can imagine patients have been prescribed things like Hydroxychloroquine, [they’ve been prescribed Azithromycin another some of these emerging medications that they’re trying to treat patients with. Those can have some adverse effects. So we’ve written alerts into our pharmacy surveillance system to help bring to the attention of pharmacies someone who might have been prescribed Azithromycin, [but might also have been prescribed something that’s contraindicated]for Azithromycin or someone who might have a condition such as heart arrhythmia or something that would be contraindicated with Hydroxychloroquine. So, we’re really trying to bring to the surface someone’s attention that patients who would need an intervention might be overlooked in the hubbub and the constant presses of the workflow that’s going on right now. So, that’s another solution that we’ve introduced very rapidly and pushed out to our hospital customers who use our solutions.

PP: So, your solution reads the clinical notes in an electronic health record system and surfaces insights that could be indicative of an infection or some other indicator. Is that a fair assessment?

KK: That’s a fair assessment. We are basically bringing in real-time, as the patient’s status changes, vital signs, lab results, medication orders, and we’ve written a series of algorithms. When certain conditions are met to alert a physician or clinician to a patient that needs intervention, you can imagine it’s very hard to sometimes tie all those things together. So we do that for you proactively and push that to the attention of the clinician so they might get a text on their handheld device or they might go to a dashboard and say, hey, show me all the patients that have triggered this alert so that I can do something about that.

PP: So, in terms of the benefits to the clinician, obviously there is a benefit to having all of this information aggregated and presented in a consolidated way, so it saves them a lot of effort. Does it also have an impact in terms of earlier detection of a condition that could potentially become complicated or even fatal? Is there a timesaving involved here that could mean a difference between life and death? Is there an aspect

KK: Yes, we actually have one solution that we have with customers right now that’s focused on early detection of sepsis. A little different from COVID, but COVID and sepsis does go hand in hand. But for sepsis detection, every hour counts. You usually have about eleven hours between the onset of sepsis and death. So, if you can detect that a patient is decompensating earlier and bring that to the attention of the clinician so they could start treatment faster, you’re going to have a better outcome. They may not end up in the ICU and may have a shorter length of stay, it is an overall better outcome for that patient if we can detect it earlier. And so, we can detect when the signs and symptoms start to indicate that someone has sepsis, we can bring that alert to the forefront. We’re working right now on trying to do the same thing for patients who are in the hospital with COVID, who might start to show signs that they’re going into respiratory distress. So, we’ve been testing out some alerts. We’re not quite ready to release them, but alerts that are detecting those patients who are starting to decompensate in terms of their respiratory rates and things like that, that we can push an alert to somebody who may not realize that 15 minutes ago they were fine. But suddenly their oxygen levels are dropping, the respiration is faster, and they need intervention earlier. So, what we’re really trying to do is to bring to the attention of the clinician, a patient who they may have overlooked just because they’re dealing with so many patients and so much going on and haven’t really connected the dots. We connect the dots with our solution.

PP: CEO of Wolters Kluwer Health Diana Nole was recently on my podcast. We spoke just before the national shelter at home guidance went into effect. I think this was in early March and we kind of knew what was coming. She mentioned that Wolters Kluwer already instituted some travel restrictions in anticipation of what was coming. How has the demand environment changed for your company? How you’re adapting to the change in the environment, either in terms of changing up your product portfolio? You talked about some of the new offerings and how are your traditional offerings are doing?

KK: I think, as you said, WK, to some degree, saw it coming and we really started preparing to be able to work from home immediately. In fact, the entire worldwide organization has been working from home for about four weeks now. This is the end of our fourth week working remotely. And it’s good that we’ve made that digital transformation as an organization because it was pretty seamless to be able to be in the office one day and then be working from home and just keep going. You can imagine that this is not the time for someone to try to roll out a new workflow solution or change necessarily to assess the software. So, our focus has really shifted from new sales to helping our existing customers with new features, new solutions, new reporting, new alerting, new code sets to help them manage the current pandemic and navigate through this as fast as possible. To help them kind of get to a new normal it’s important to focus on our existing customers, bring them the resources that we have. And not only our customers, but we also have actually kind of mobilized across the entire health division to put a lot of resources out there into the public. On our web site we’ve taken some of the things that are usually available only under a subscription and we’ve made them publicly accessible, such as our UpToDate content for how to treat COVID, the information related to drugs that are used to treat COVID through our lexicon product. We put that all out there for the public to consume. And we’re continuing to try to innovate every day, to try to find other things that we can put out there to sort of help the world deal with this current crisis. Our focus has shifted from selling new units to new customers to really helping our existing customers benefit from what they have and point them to the right direction and also pushing out new things, new reporting, new learning, and new code sets that they can use to help navigate themselves through this difficult time.

PP: You mentioned that you had gone through your own digital transformation and you were able to seamlessly transition into a remote mode of operation, if you will. I listened to a podcast, with your Global CEO, Nancy McKinstry on one of the other podcasts. I think it was HBR Ideacast, what she talked about is transformation that you’ve gone through as an enterprise. And it seemed like a pretty dramatic change for the organization. But it also sounds to me now like it’s placed you in a very good position to seamlessly transition from what you were a month ago to what you are today, which is virtual cooperation. So it’s really interesting that some organizations either saw it come in or they just grew up in a certain way of working virtually and the other ones that are probably seamlessly transitioning into this, whereas others are, probably struggling a little bit. But I guess the question that I would lead into from that is what do you see as all the trends and future as it relates to virtually delivering care? How does the virtual model translate into the healthcare environment? What do you see as the long-term trends taking hold today as we go through this crisis?

KK: Yeah, I’ve had more telehealth visits with my doctor through in the last couple of weeks that I’ve had ever. And I just think telehealth is here to stay. I know that a lot of the requirements that were in place for telehealth visits have been waived. But, potentially, I think those could be waived in the future. But I also think that we’re going to see all these new modalities in terms of delivering health insights to patients. When you take that and you couple that with this new interoperability rule that’s passed, where the patient record can really be seamlessly exchanged from one vendor to another, and so that you can kind of take your record with you as you go. You’re going to start to see that patients can be treated in a lot of different ways and they will have their full health record with them. I can only give you an example of what’s happened over the course of this past couple of weeks that I think is going to be the future. My mother’s Apple Watch indicated that she was in Fib and I took her to the hospital and she got a pacemaker put in during this whole thing right in the middle of the COVID crisis. But in the future, if Apple has access to or if the provider can actually get the history from that Apple watch of all the incidents of my mother’s heart rate, etc, and marry that with the rest of the patient record, you’re going to have a much better and more efficient and better treatment,. You’re not going to need to traditionally go into these hospitals to see somebody or into a doctor’s office to see somebody, the treatment will really be virtual, just like we’re working virtually today.

PP: You mentioned interoperability on the final rule of from the ONC and the CMS. What kind of changes are you making to your products and what kind of changes you’re seeing health systems, your clients making as they prepare for the upcoming deadline? Are those deadlines even going to be enforced? Assuming that they are, despite the current situation, what is Wolters Kluwer doing and what do you see your clients doing in preparation for that?

KK: Yeah, I do think they’re considering whether or not to stick with the initial six-month deadline that they have. Most people knew that it was coming and hopefully had been sort of preparing for it. I’m not exactly sure that’s the case though. What I would say is that one of the products that we sell is what we call data normalization solutions and reference data management solutions. And this allows hospitals, payers, and healthcare vendors to take all that unstructured data and convert it to the standards that are mandated by the interoperability rule. And so, while we’ve seen hospitals and health systems really be consumed with the COVID crisis, we’ve actually seen a spike in demand from our payer and our vendor customers because they realize they do have to react to this interoperability rule. And so, we’ve been seeing a lot of payers come to us trying to organize how can they embrace these data normalizations solutions and the reference data management solutions so that they can comply with the interoperability rule. And similarly, for vendors, they’re going to need to be able to create a patient record that complies with those standards from a lot of unstructured medical data that they have on the records. So, they have to quickly mobilize to do this. I think what you’re going to see is that providers themselves are going to rely on the vendors to do that for them. So, whether it’s their electronic health record or vendors like us who will do that and help take their unstructured medical data and turn it into a structured format that’s required by interoperability. It’s going to be done through your vendor as opposed to necessarily by the providers themselves, so the demand is really actually still coming to us because of the interoperability rule from payers and from healthcare vendors. And then those providers themselves will actually look to the vendors to be the way that they solve the problem or meet the requirement.

PP: Do you think providers should be doing anything more than relying on their vendors to ensure compliance with interoperability rules. Are there systems that may be homegrown or something else that they need to be preparing for? Is there any burden on them?

KK: I think that the burden came really through meaningful use. Because of meaningful use, they all deployed electronic health records that became the repository of that information. And so, what they really are going to rely on those health record companies to be the place where this transformation happens to the standards. Now, a lot of health record companies have maybe not been as fast to act on this, but I think they realize that this is a mandate that they have to comply with now. There are very few, I think at this point in time, providers across the country, health systems who don’t already have an electronic health record. So that was the first stage of this. And now it’s just taking the electronic health record and making sure that they can now seamlessly exchange the information electronically between vendors and between providers, etc. I think it’s less about the provider having to do something themselves and more about relying on their vendors to be the source of that solution for them.

PP: Just like every other large global organization or every other company, every other business, employees are now working from home. And it’s created a set of circumstances for them in terms of how they manage their life and their work and so on in what is virtually confinement and also, they have to keep themselves safe. They also need to make sure that they don’t feel sick and don’t fall prey to the pandemic. How has Wolters Kluwer been helping your employees cope with both aspects, having to work from home and having to deal with this whole new paradigm, but also keep themselves safe?

KK: Yeah, as I said before, WK acted very quickly to halt travel and to make sure that people could seamlessly transition from being in the office to working from home. So, everybody’s been working from home really for the last four weeks or last month. We’ve been able to make sure that people can comply with social distancing. The company has really gone out of its way to communicate and to provide resources and guidance to people working from home, we have been able to provide free online exercise program, a whole library of resources so people can work out at home. So, you get that physical exercise out of the way since they can’t go to gyms anymore. They’ve provided increased medical coverage to cover the testing and covering the treatment if anybody does have to be treated for COVID or tested for COVID. They’ve made telehealth resources available, so people do not have to go to the doctors. They can actually be treated through telehealth. And we’ve also really stepped up our communication. So from Nancy McKinstry, our CEO, sending regular video messages to everybody worldwide, even down, from Diana’s level at the division level and myself, our business unit level really trying to on a regular basis, just be out there and be in touch with every employee. In fact, I do something every day to my teams across the country where I just send them a note just to check in, send them something just to say, we are here for you. I’m here for you. Let me know what you need. At Wolters Kluwer we have thousands of employees worldwide and there are a few people who still do have to go into the office. One of the things we do is we see lawsuits in service of process. So those have to be served physically. So, for those employees, we’ve actually increased their compensation during this time so that they don’t have to take public transportation. They can go in privately to the office and then they can get childcare provided for them. So, you know, those are exceptions. Most of the workforce is able to work virtually. But for those who are, they are able to, get some extra compensation to help them during this time. So really, I think the WK has gone out of its way to make a variety of resources and provide a variety of support to its employees to help us navigate our way through this unusual time.

PP: That’s wonderful to hear. Karen, thank you so much for joining us. And it’s been a pleasure speaking with you. Stay safe and all the best to you, your team, and the whole Wolters Kluwer family.

KK: Thank you very much. You, too.

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