"Data if done right, has the power to galvanize communities, inform leaders, and empower people."

Steve Miff, PhD, President and CEO of Parkland Center for Clinical Innovation in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Data if done right, has the power to galvanize communities, inform leaders, and empower people.”

PP: Hello again, everyone and welcome back to my podcast. This is Paddy and it is my great privilege and honor to welcome back, Steve Miff, President and CEO of the Parkland Center for Clinical Innovation or PCCI, as it is called. Steve, thank you so much for setting aside the time and welcome back to the show. For the benefit of our listeners can you tell us who PCCI is?

SM: I have a huge passion for innovation and to use next-generation analytics and technology to help serve the most vulnerable and those underserved residents across our communities. PCCI has been the perfect place to make this a reality since it is a mission-driven organization with some interesting expertise in what I consider to be very practical application of both advanced data science and social determinants of health. At PCCI our focus is to try to innovate. We are called pioneers in new ways to health. We started the department of health and hospital system and spun out as an independent nonprofit organization in 2012 to not only serve the needs of Parkland but to also pursue additional transformative initiatives that could have a broader impact. At PCCI, we believe data if done right, has the power to galvanize communities, inform leaders, and empower people. We also believe that clinical data only paints a partial picture of an individual and his or her specific needs. Our business model focuses on cutting edge uses of data science, social determinants of health, and clinical expertise across both clinical and community settings.

PP: We covered some of your work in our previous podcast. Since then, you have written a book along with one of your colleagues. The name of the book is – Building Connected Communities of Care. Would you care to tell us what is a connected community of care?

SM: A connected community of care, I consider to be a local ecosystem that is comprised of health systems, payers, community-based organizations, philanthropic organizations, and municipality officials. They are all connected by digital technology and centered around the need of an individual to address his or her social determinants of health. I consider the aim of a connected community of care is to improve the health, the safety, as well as the well-being of the community’s most vulnerable residents and do this in a coordinated, cost-effective, and ultimately sustainable manner.

PP: I was fortunate to obtain a copy of your book and I read through it. It is very interesting and is a great playbook for several healthcare executives in different roles. In your book you explain in detail how to build this community of care. This ecosystem that you refer to of different participants in an individual’s care, especially those who are underserved and are vulnerable populations. This is obviously particularly relevant in the current context of the pandemic. You’re based in Dallas, Texas, and it has seen a surge. But how have the core themes in your book helped in responding to the pandemic? I know the book came out a little bit before the pandemic but felt like a lot of those themes were still probably very applicable in the context of the pandemic. Can you share a little bit of that?

SM: I think we’ve been fortunate that we’ve been on this journey in Dallas for the last six plus years. We realized that having a connected community of care during a pandemic is more important than ever. I think there are three key themes that we’ve been leveraging here locally, as we’ve been trying to connect individuals to better manage the pandemic.

One is targeting. The first thing that we’ve done is to be able to bring social determinants of health data that we’ve had through the connected communities of care with the clinical data and other demographic information and mobility information, and build a corporate vulnerability index. That has been instrumental to give us a very direct and tangible way, to understand where individuals across the community are. They are most vulnerable for not only contracting the disease but also displaying symptoms that require more advanced interventions. So, being able to use that to work with community-based organizations, local government leaders, and several large health systems across the Dallas metroplex to quickly assemble not only the data, but use that to identify and hotspot neighborhood specific locations where the virus is having a disproportionate impact on the residents. To be able to really inform where testing should be done, both physical locations as well as mobile testing and do it in a way that not only meets those needs, but is also very accessible by those that might lack transportation or have difficulty getting to the more traditional points of access. I think that is the first component, the targeting piece.

Number two, is the communication and the value of the connected communities of care communication network to link the healthcare providers and CBOs that cannot be underestimated as it represents a highly effective and efficient mechanism to disseminate information, particularly information that requires both clinical information and a specific element about at-risk population. And we’ve seen first-hand that communication delivered to community residents through familiar entities, whether it’s a food pantry at a homeless shelter or a place of worship, are much more effective than community wide public information campaigns, broadcast, radio or television. They all play a role, but similar to targeting and understanding where resources are needed, targeted messaging aims at specific community residents. In this case, they have been tested positive for COVID-19 or are living in close proximity to other individuals previously diagnosed, much more effective when their communication is done via those known entities in the community. Having already an established relationship via connected community has proven to be very beneficial.

And the third one, is truly connecting services. One of the first things that we’ve always considered to be really important as part of a connected community that technology piece is to have that up to date referral directory of who’s offering services, where and what type of services, who’s eligible to receive those services. As the pandemic started, we realized that those referral directories need to be updated on a daily basis for them to have the right information, because not only the supply of food or other services was becoming challenging, but also the volunteers that the community based organizations were previously heavily relying on. So, the hours and the availability of resources changed. Having an establish connected community and ecosystem to be able to update those referral directories real time became a very important component of managing this on an ongoing basis.

PP: It sounds to me like for all these years, you have basically been preparing for the pandemic in many ways and you were ready when the pandemic hit. You had the information on your communities, where to reach them, who they are. You had the partnerships with the community-based organizations who could reach out to them. And you have the technology infrastructure that could quickly identify at-risk individuals and populations. Now, were you able to enhance the value of this platform or this service, this community that you’ve built by additional partnerships like maybe public health agencies for maybe launching contact tracing as an example? Were you able to turn on those kinds of things as a consequence of the pandemic? Did you have to make any changes to the platform?

SM: Fortunately, we built a platform that is robust enough to be able to manage these very specific, not only personal information but health information. I think it’s a very critical component because we’re able to quickly create data sharing partnerships with the local health department, and that something was an important piece before, but became a critical component during the pandemic. The ability to integrate and merge PHI data with other factors is something that was very important. I think about the technology aspect itself, there are several things that are important.

One, is the ability to integrate and bring healthcare data with other social determinants of health data that requires a level of security that needs to be HIPAA compliant, multifactor security, etc. It requires how you deploy it rapidly and for it to be cloud based, accessible anywhere, we get an internet. That is something really important and also minimize the onboarding process. And that’s something that our partners at PIECES Technologies who are managing this on an ongoing basis. Also deployed a web-based opportunity for community-based organizations to be able to do the right licensing, download this quickly and become part of the connected ecosystem. Those are just a couple of the key elements that have proven to be very important as the epidemic has played out.

PP: In your book, you basically lay out the different phases of setting up a connected community of care as a six-step process. And it includes several things: a legal framework, governance, and so on. Obviously, one of the tracks is the technology track, which is something that PCCI is heavily investing in. I read the chapter, basically the technology track, there are two components to it, data component and the underlying infrastructure component to it. So, in the data and the analytics, you spend a long-time kind of building up the platform. Did you develop any new algorithms or capabilities specifically in response to the pandemic?

SM: A couple of points, one, our patent application for our SDOH case management technology has been approved. And I believe this is the first patent for this type of a system in the space. It’s kind of nice that they came together right when we released the book. I think that is another important development in this journey, as you mentioned, that we started a while back. The key things that have been relevant during COVID-19 are not only the front-end technology itself but its integration with electronic medical systems such as Epic. The technology now is on the app orchard. So that level of integration is important on how you connect to the providers?

I think that the second one, I mentioned briefly was the ability to and download this for quick onboarding, particularly on the community side.

And the third factor that was mentioned is the ability to have this multi-level of consent because ultimately consent needs to reside in the hands of the individuals that we are trying to help. But giving those individuals multiple ways to opt in anywhere from just sharing basic demographic information all the way to be able to share sensitive information, whether it’s around the safety and domestic abuse or around two very specific comorbid conditions. That is something critically important. We have seen a measurable impact in our ability to actually use this technology during this time.

PP: Congratulations on the patent and this is a great news. All the very best with that. Let’s talk a little bit about the community partners themselves. You’ve gone out and built this fantastic platform, you’ve got the governance, players, data, consent rights and all of the good stuff that you’ve put in place. What kind of enablement do your partners need to participate effectively in this connected care ecosystem? Can you give us a couple of examples of some of the typical challenges that you’ve had to overcome? I hear, for instance, about the digital divide where you might have the technology, but your communities may not be technologically ready to accept it, either because of bandwidth issues or lack of access to devices. Tell us a little bit about a couple of the challenges that you have had to overcome to build the community of care.

SM: You are so right in that, so it’s sort of as we structured the book. Technology was one of six chapters. And while it’s a critical enabler by itself, it cannot solve for everything. So, of all the other components probably one of the most important one is the governance upfront to be able to establish some of those specific areas of how data is being shared. Also, to establish how consent of some of the other things that we’ve talked about. Then some of the other factors, one being the community workflow is so important. So, we can help those community-based organizations figure out how do they weave this in within the processes that already have. And they’re working on a meeting to comply with. To be able to demonstrate the effectiveness and the value that they bring to those that fund their operations.

There are actually a couple of different things that are really important. One is the building of the capacity. Just because we are able to provide a community-based organization with technology, doesn’t mean necessarily that they can use it to its full effectiveness. So, I think building their own capacity, not only how to use the technology, to weave that in within their workflows, but constantly provide ongoing training is important. This is because often times they have quite a bit of turnover as they rely on volunteers. Those pieces become very important in this journey.

Number two, I think is important is to really help them. Again, this kind of goes into the capacity building to define and measure and use that. The backend reporting pieces of the technology so they can measure their outcomes. And in this case, most of them is the social outcome measures that become really important, things such as time to help somebody to obtain stable housing, to return to shelters, reduce rates, meet requirements, maintain housing assignments in transitional care units, etc., or documentation of a food insecure clients visit to a food pantry partner and adequate food provided to obtain that food. So those things are concurrently important on how useful technology can be to do some of their social outcome measures and how they can actually report on the impact they’re having.

And then one of the other things is, it’s not just funding the technology itself, but that backend digital data environment. You need to be able to enable them to provide you with the information in whichever way they can. Oftentimes we talk about, APIs, FHIR APIs and all the new things to integrate. In this case to be able to just ingest a spreadsheet here, you have to have that flexibility to be able to meet them where they are.

PP: You don’t have to make technology more complicated than it has to be. And yeah, we all like talking about FHIR APIs and so on, but spreadsheet can do a lot of good on its own, nothing wrong with using a spreadsheet. So, Steve you wrote this book and it was published just before the pandemic hit if you had the opportunity to release this book today, what would have changed in the book?

SM: I don’t think much would have changed. The message to me remains the same, that this is a complex, multi-year journey. And if you wait for a pandemic to start, you are probably late. So, you need to start now with a focus on how I manage beyond the pandemic. As we look at our own journey, there is the need to really start with a readiness assessment, to build a plan before you even jump both feet in and to build a connected community of care. You cannot stand up a fully functional and deploy the connected community overnight. Given all the other urgent priorities during a pandemic or natural disaster, you need to start doing this now for the next need. Each market is different and there are likely elements that can be leveraged. There are many things that I would say define a market maturity, things such as access to the social economic data, the willingness, and ability of organizations to collaborate, what and how the local incentives are structured. What is the maturity of the committee-based organizations and how aggregated or distributed they are throughout the community? So first, you need to sort of answer a few critical questions around, are you ready? Meaning that the entity that’s taking this on for the community, how ready is that community? And who do we need to work with first? What should be the measurement framework and what’s the sustainability plan? Because it’s not just getting it started, but then how do you sustain it over time? So not only sort of thinking about that front end component, but the other thing that it forced us to sort of just take a step back and think about is building and deploying it, what are the top three things that you need to consider? I mentioned that this being multi factorial, multi-dimensional, its people, its processes, its technology. And one of the new entities into this equation with COVID-19 been the public health department, needs to be an integral part of it.

Number two is engagement, which is complex. You have new diverse organizations that evolve. Many are small and many are volunteer based. The current challenge is how do you do this virtually and you do need to rely on the broad technology more than you have in the past. And how do you actually manage through staff shortages? As I mentioned, a lot of the community-based organizations’ motto is to rely on volunteers. How do you manage and enable them to manage through that? And finally, the technology and data are essential, it is an enabler. And you need to be able to integrate and manage PHI, not just social determinants of health. So that is why that upfront governance for the data decisions, data use, data sharing workflows is so critically important.

PP: I have to tell you, the book has so much for so many different types of executives within the healthcare ecosystem, regardless of which part of the spectrum you’re on, a private sector public sector, on the technology side, or on the administrative side, or even on the clinical side. There is something in the book for everyone. With your permission, I’m going to borrow some of those ideas in your book for my own work, because there’s just so much there that you’ve put into it. I strongly recommend anyone listening to this podcast to pick up a copy. You mentioned something about whether the pandemic has changed your views on what might have gone into the book. As you know, I’m coming out with my second book, co-authored with Ed Marx, on healthcare digital transformation. We did see a big change as far as the pace of acceleration of digital transformation, especially the adoption rate of telehealth and virtual care models and the shift towards those models accelerated in the immediate wake of the pandemic. Our book was going to come out in Q2, and we had the opportunity to put in some of our observations on what we saw happening in the immediate wake of the pandemic. Steve, thank you so much for coming on this podcast one more time. And for those listening, Steve’s book – Building Connected Communities of Care, is absolutely a real hands on playbook for anyone in this space trying to drive change by using technology. Thank you again, Steve. Look forward to speaking with you soon.

SM: Paddy, thank you so much for having me and thank you to all your audience for the opportunity.

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