"To succeed with digital health is to become really good at technology integration"

Podcast with Marc Probst, Former CIO of Intermountain Healthcare and CIO of ELLKAY in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “To succeed with digital health is to become really good at technology integration”

PP: Hello again, and welcome back to my podcast. This is Paddy, and it is my great privilege and honor to introduce my special guest today, Marc Probst, former CIO of Intermountain Healthcare and currently, CIO of ELLKAY. Marc, thank you so much for setting aside the time, and welcome to the show.

MP: Paddy, thank you very much. Appreciate the opportunity.

PP: You’re most welcome, Marc. So, let’s get started with this. You were CIO of Intermountain for a very long time and you’ve experienced your own share of technology changes. What do you think are the top two or three technology trends that are now going to determine the future of healthcare?

MP: Well, one of those may sound kind of self-serving, but I think interoperability is going to be a key requirement as we move forward for any of these things to succeed, because the second thing I would add would be digital health. And we will go into that, you will know what I mean by that in a second. But none of that really meets the needs of the populations that we serve, if our systems can’t talk together and share data in a responsible way. So, I think interoperability will continue to be really important. I’ve got a lot of history with that and why I think interoperability, I think digital health. I was just talking to a group at ELLKAY about that. They asked what I thought about digital health. And my answer was, there’s kind of two phases to digital health, from my perspective. One is just facilitating what we do today, using digital mechanisms like telehealth or even some of the handheld, iPhone-based kind of services and apps and that kind of digital health. And, of course, telehealth, our ability to communicate with physicians and other care providers through the digital means. So, it facilitates what we’re doing today. And I believe what we’re moving to is a digital health that is full interaction with the technology versus with human beings, where the technology will provide a lot of knowledge and capability and expertise to us as the consumers of healthcare. So those would be the two that come top of mind to me Paddy.

PP: We will unpack some of that in the course of this conversation. And, of course, you mentioned interoperability and you mentioned digital health. Those are kind of related to one another, one kind of drives the other, I guess. Also, I think alluded to the data and insights and we will come to that. Intermountain has done a lot of work in these areas. I do want to explore some of your thoughts on that. But before that, you’ve recently retired from Intermountain and have taken a role at a health IT firm. And I realize it’s early days yet, but I’d love to hear your first impressions on the view from the other side of where you’ve been all these years.

MP: Well, because of the organization I’m working with, my view is one of great excitement and opportunity. I love ELLKAY, I love the people there. I was a customer of theirs. And so, it’s something I’m very excited about and I think has a lot of potential. I spent 23 years actually in professional services serving the healthcare industry. So, I was a partner with ELLKAY and a partner with Ernst and Young. So, I wasn’t completely naive to what we affectionately called the dark side, when I was a CIO of our industry. I don’t mean that from dark is in mean, but, you know, we always are constantly looking for improvements.

But I am really excited about the potential of the organization I’m working with and just the kind of people that are there and leveraging. I felt I was valuable for twenty-three years. I kind of proved it to myself just how little value I was actually providing when I was a CIO. And now I think I have a richer skill set that hopefully, I can be of more value to the industry.

PP: Well, I wish you all the best in your new role. I want to talk a little bit about your experience at Intermountain since you were with Intermountain until very recently. Let’s talk about what you mentioned at the outset of this conversation, which was, digital health and interoperability. Let’s talk about digital health. Intermountain, to my knowledge, is one of the early adopters of telehealth. And you’ve had great success, especially with rural populations. And it’s well published. And there has been widely published articles about some of your work in that space. What do you see today as the general level of preparedness for this coming era of digital health and virtual care among your peer health systems? Can you also in that way, comment on the gap between what the top tier health systems may be doing and what the next tier is doing?

MP: Yeah, a lot of use of technology has to do with the sophistication of the health systems itself. And I don’t mean the sophistication of the technologies, but the actual care providers in the health systems itself. And Intermountain is remarkably sophisticated and courageous in taking technology and trying new things and what to do with it. So, we started really early on with telehealth. In fact, I remember our first foray into it was a good 15 years ago and the technology was incredibly young. But we decided to put it in an urgent care center and see how many people we could get the call in. And I think you could count on two hands how successful we were with that? The industry wasn’t ready, our people weren’t ready. But the thinking was there. And so, we kept a very close eye on the capability. And as it became more sophisticated, we started down the road of telehealth. We also had the advantage, like you just said, Paddy, of having a lot of rural healthcare facilities where we couldn’t afford to have all the specialists out there. So, if we wanted to provide care in those rural settings and not force the patients to come into one of the urban centers, we needed to get involved in telehealth and we did. So, we really started on the kind of B2B telehealth services and then ventured into the more retail kind of urgent care services. I think Intermountain is ahead not because, again, of our technical prowess, but because we developed a lot of playbooks and capabilities and people and getting them used to it. I don’t think the gap is massive between an Intermountain Healthcare and a much smaller facility that’s just getting started. Being a pioneer doesn’t mean you’re always going to stay ahead. It means you took some arrows and maybe you’re ahead for a while. But you also created a path that lots of other people could follow. I believe the gap isn’t that small and that it will get filled very, very quickly.

PP: Now, of course, COVID-19 has accelerated the shift towards digital and especially virtual care/ telehealth models. In this context, what do you think are or should be the top priority areas for health system CIOs, in that, not just dealing with the current situation, but also positioning the organization for what might be coming as their future state?

MP: Yeah. So, there’s always two sides to a coin. COVID had a silver lining in that. It got us really quickly involved in leveraging these digital capabilities, whether that was increasing our communications through texts or through other tools with our constituents or bringing in telehealth or just televideo to do meetings and the kind of things we’re doing right now. So, it means there was that bright side that a lot of technology got brought in very quickly and a lot of people got more sophisticated using it. But there’s the other side of that coin, the difficult side of that coin is the way we did it because we are forced to do it so quickly. In some instances, hours, but certainly in days, doctors moved home, administrators moved home, teams moved home. We would deploy just about any kind of technology to facilitate doing that. So now we find ourselves in an environment where a lot of disintegrated tools are out there that need to either be brought together or brought to a more singular platform to really make it efficient and effective for both, us as an organization providing the service, and for the patients or members or families that we serve. I think one of the big challenges right now that CIOs will be going through, I know they are doing it. So it’s you know, this is a novel that is to get this kind of quagmire, this cobbled-together solutions to something that is much more seamless, much more easy to maintain, secure, share data across. So, I think that is going to be one of the challenges that we have as we move more rapidly to this digital age. I feel kind of strongly about I don’t know how broadly this is shared, but you wrote the book so you can tell me is we’re creating non-native applications to facilitate communication or data sharing with the people that we serve. And what I mean by that is, if I want to text a doctor, I end up going into an application, signing into it outside of my phone, and then I can text within this very secure environment. And I believe more and more the challenge we’re going to have as technologists is not having these separate applications, but using tools that are native to the heart, the solutions that we have in our hands. So texting will be just like texting anyone else or looking up data like, I can ask Siri about my medical record versus having to log in into a separate application to do it. That creates challenges, but that’s when it’s really going to make this digital interaction much better for those that we serve.

PP: Yeah. You’ve covered several themes that we actually discussed in detail in the book, and you covered the fragmentation of the technology landscape and the need to integrate them in order to create a seamless experience for the patient. You talked about non-native application and that’s an interesting one, because when you say non-native, I’m hearing non-native to let’s say the electronic health record system and lot of health systems are kind of growing beyond their EHRs and are looking to best in class tools for certain kinds of functionalities. And I get the sense that they are doing that because the EHR system cannot be everything to everyone, which they also acknowledge. And so, it’s kind of forcing a certain best in class approach, which requires the EHR platform or the system of record whatever it is to be wrapped by best in class tools and solutions. And of course, the fragmentation and the use of best in class on top of the system of record creates interoperability issue, which is unfinished business. We have come a long way in the last few years. But it’s still unfinished business and we’ve still got a way to go. So, what will be the big takeaway from this is it that health system CIOs should avoid fragmentation of technology as much as possible or get better at integrating it, so they get a bit more seamless experience. What is your recommendation?

MP: No, I think they’re going to have to get better at integrating it. I mean, it would be naive to think that even the EHR vendors want to do, like you said, all the things that need to be done. And so, we can either depend on them to integrate solutions which will limit our options, or we can get really good at integrating and really good at creating the right kind of environments that allow us to plug and play solutions that we know. I mean, they’re going to change annually, maybe more often just because that’s how quickly the landscape is changing for us. So, I think the only way we succeed is become really good at integration.

PP: And what are the risks with that? If I can just stay on that point for another minute or so, you’ve got these best in class solutions or ostensibly the best in class solutions, but they are in many cases, small companies. They’re VC funded. They don’t make profits. They are very often new and not necessarily road-tested technologies. There are risks involved. And I’m sure you’ve taken your share of the risks as a CIO. What is your advice for not just the CIO, but also for tech firms that are trying to build a business in this kind of an environment?

MP: That’s probably a long conversation, but to boil it down, we’re going to make mistakes. I mean, we’re going to have like you said, we’re going to have to take some risks and place some bets. You know, you can do your homework so that they’re less risky, but there’s still risk out there. And I really think, again, these solutions are going to change rapidly. So, I need to be able to as a CIO, as a technologist or a technology team, I need to architect my overarching solutions in a way where I can plug and play these pieces in and out. And, that maybe I put certain requirements in place that the interfaces have to be FHIR based or some other kind of standards put in place that I’m going to do it, but that I don’t build these really difficult to build and unravel integration services, but that I have things that are much simpler to do so that I can change. I can take a chance with a certain AI-based solution. And if that company goes under or which would be the worst case, that if there’s something better that comes up that’s going to provide more value, that I can go ahead and make that change. And I really think that’s a skill set that we haven’t been tremendously strong on. We used to buy integration engines. And that was going to solve a lot of the problems and it didn’t. But we’re going to have to be good at this whole process of how to integrate things and be willing to change. I mean, we’re not going to sit on solutions like we do EHRs, a twenty-five-year-old solution, a solution would be a year or two.

PP: Yeah. It’s interesting you mentioned that, my firm is actually living through this with one of our clients where there is exactly this decision point just come to them with the firm that they’ve committed themselves to and it’s been going well for two or three years. And all of a sudden that firm is in difficulty. You know, there are financial difficulty. There is turnover among key staff. And then all of a sudden deadline have been missed and product is not coming out as quickly. So, I’m sure you’ve seen this movie before. And so, your advice is timely and makes a lot of practical sense. But that’s a nice Segue to my next question is kind of related to this. One of the reasons why you do choose to go out and acquire this best in class tools and platforms is in order to create a competitive differentiator for yourself with your population, the patient populations, give them better experiences, improve the quality of care in the process, improve productivity and all of that. Now, in the emerging landscape for health systems, the competitive landscape. How important do you think this is in order to compete against the CVS and Aetnas of the world on one hand, or maybe some tech firm that comes from left field and has got an entirely new way of doing things? Is this now becoming table stakes for health systems that you have to go out and work with best in class leading-edge technology solutions?

MP: Yeah. So, I’m a real believer that you have to be able to select good partners and work with those partners, whether those be technology partners or business partners in other ways. A strength that a CIO really needs to have is the ability to build those partnerships and maintain them and have them thrive. There’s no way, it’s just so complex. Everything that’s going on and it requires very fresh talent. And having been a CIO, it’s not easy to constantly refresh the talent on your team. You kind of have a team and you work with them and they’re excellent and they do great things. But to think that I can continually keep the most up-to-date skill set within my team is, again, kind of naive. So, you have to have the right kind of partnerships to help you solve those problems. And if you do that, then I think you can solve a multitude of problems. And you are going to have good partners, just like we were talking about, you are going to take risks on one that aren’t going to be that good a partner. That’s the skill that a CIO has to happen. That’s what we need to be able to do as CIOs.

PP: Just curious about one follow up thought on that. Do you think as a consequence, CIOs are going to become more technical in their personal abilities? Or do you think it’s going to be more to do with managing partnerships and having them all play well together?

MP: So, I think you’re going to see a bit of bifurcation. Those skills all need to exist, whether building those partnerships and technical skills. I do see a track for a very technical CIO. And the reason that’s going to happen is because the business itself is becoming so much more tech savvy. So where 20 years ago we had to convince people that a mouse was an OK thing and that this was a keyboard, this was a CRT. Because we were the only ones. We were the only nerds out there that were paying much attention to it. Today people are very sophisticated around technology. And what many organizations are going to need is someone that can get deeper into the technical aspects of it. And they’re going to have CIOs to do that. I don’t think you can get away from the skill set of being a good people person, a big builder of those relationships. So, it’s going to vary. It’s going to vary by the situation and what else exists in the leadership team of an organization that both skill sets are going to be very important.

PP: So I’m going to talk about digital health and digital transformation, Marc, switching topics here. So, one thing that I pay a lot of attention to as part of my work and part of my firm’s work as to how are health systems organizing themselves to drive digital transformation. What does the org model look like? Who owns the digital transformation function? And I see that there is no straightforward answer to this. By default, it seems like, it is the CIO in a lot of organizations. But with a lot of the leading health systems, you have these dedicated roles for Chief Digital Officers, many of whom have come from outside the industry as well. So, what is your sense today of where ownership for digital health and digital transformation lies today? And what, if anything, should change for accelerating transformation?

MP: It’s owned by the CEO; it is what it’s owned by. And again, pretty naive to think that’s not where we’re going right. That we can just continue to operate the way we’ve operated for the last 40 years. So, the CEO owns digital transformation and how we’re going to deliver services going forward. We all play different roles. So, at Intermountain Healthcare, we had a CIO and we had a Chief Digital Officer. And Chief Digital Officer was much more of a marketing type person. And that’s actually the background that he came to Intermountain with. But it served us really well because we were focused on digital and how are we going to change the way we did things and how are we going to change our perception within the community that we are more of a digital service? The technology work around that. That was mine, that was my team. That’s what we did. But CEO owned the problem and the CEO drove it. And that’s why Intermountain has been and will be very successful in this space. There are going to be places where it’s the CIO that’s going to be a much slower transition for that organization. They may even ultimately fail, not because the CIO is bad, but because it’s coming from the wrong place. Technology, it’s a tool. It can facilitate that shift. But the actual shift is people making that shift. And that takes the leadership of an organization and operations and ultimately CEO.

PP: Yeah, one thing I like to say is digital transformation is technology-enabled, or IT-enabled, it’s not necessarily IT led. The difference may sound insignificant to some, but what I see in the market is that CIOs don’t necessarily have to do it all. In some cases, I have seen a great collaboration, just like you described at Intermountain, which really makes the difference. And of course, you’re right about the fact that it has to come from the very top, the CEO and indeed the board, for that matter. We are coming up to the close of our time here, Mark, I just wanted to touch on one of the things in the immediate context of COVID. We have seen the results come out. The financial performance of health systems for the first six months has not been great. And in an environment of declining operating income, how do you see it impacting the pace of digital transformation, but also the level of technology investments? And what is your advice for tech firms in this context now that your part of a tech firm as well who are likely seeing reduced IT budgets and longer sales cycles as a consequence?

MP: Yeah, so the broad thing that comes to my mind is a race to the bottom makes everyone a loser. So, there’s no possible way that healthcare is going to cost cut itself to being successful or thriving. And so, it’s where investment gets made. And like just about every other industry, it’s come through investment in technology and using that technology to create efficiencies and better solutions for those we serve. So, I believe there’s a lot of wise people in leadership positions in healthcare, that those investments are going to continue to get made. That doesn’t mean we won’t see cost-cutting because there will be and there has to be. But there also has to be this investment in technical solutions, particularly digital solutions, digital health solutions that will allow the industry to thrive and will allow a much more ubiquitous set of solutions. You know, again, right now, it’s regional. I mean, healthcare is so regional and it’s so different. I mean, the level of care and the outcomes can vary by zip code. That’s because of the way we’re currently formed. But moving forward, technology is going to level the playing field not just across our country, but around the world. And that’s when we know we’re going to be successful. So, if I were, which I am involved in a technology company in healthcare, I’m very bullish on the future. However, to thrive, we have to show that value. And we can’t just be talking about it. We have to show the value that we can provide. And I think there’s a very white field out there just ready to be harvested.

PP: Oh, that is so well said Marc. That’s a perfect note on which we can end this podcast. Thank you so much for coming on the show. And I really appreciate your comments and your insights. I wish you all the very best to you.

MP: Thank you very much, Paddy. Appreciate the time. And congratulations on your book and look forward to staying in touch.

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