Month: October 2020

Digital health is about applying digital capabilities across the care continuum to maximize efficacy and experience

Episode #64

Podcast with Pamela Arora, SVP and CIO, Children’s Health

"Digital health is about applying digital capabilities across the care continuum to maximize efficacy and experience"

paddy Hosted by Paddy Padmanabhan

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In this episode, Pamela Arora, SVP and CIO of Children’s Health discusses how their holistic approach towards digital health is transforming the experience of their team members, providers, patients, and the whole continuum of care. At Children’s Health, digital health is about effectively applying digital capabilities across the continuum of care to maximize efficiency, effectiveness, and experience.

According to Pamela, by increasing the touchpoints and simplifying data across the care continuum healthcare organizations can deliver the three E’s: efficiency, effectiveness, and experience. However, one of the challenges in achieving this digital engagement in healthcare involves the data itself. If an organization is taking a patient-centric approach, continuity of data is critical. To ensure data flows easily across the continuum of care, it is important to promote interoperability initiatives across the healthcare organizations.

Technology is the key element in any digital program of an organization. Assessing the right technology at the right time is crucial to enhance patient as well as provider experience. Other aspects while evaluating technology is to consider its ease of adaptability and reliability among providers so that they can deliver a seamless patient experience. Pamela suggests health systems to keep advancing with new technologies and start with pilot first approach and then scale up the process.

Our Partner:

Pamela Arora, SVP and CIO, Children’s Health in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Digital health is about applying digital capabilities across the care continuum to maximize efficacy and experience”

PP: Hello everyone and welcome back to my podcast. It is my great privilege and honor today to introduce my special guest, Pamela Arora, Chief Information Officer of Children’s Hospital in Dallas. Thank you so much for setting aside the time and welcome to the show.

PA: My pleasure. Thank you very much, Paddy.

PP: You’re most welcome. So, let’s get started. Tell us a little bit about Children’s Health and the patient populations you serve.

PA: We have several hospitals and ambulatory clinics as well as extensive telehealth into schools and other community hospitals here in the Dallas Fort Worth area. It’s our honor to serve the patients and families in this community.

PP: This podcast is mostly about digital transformation and the technology enabling aspects of it. Could you give us an overview of the digital programs that you’re currently operating in your institution?

PA: Absolutely, Paddy. Our enterprise IT systems are designed to support enterprise organizational initiatives and strategies. I will give you an example, we have an enterprise initiative ‘becoming the difference together,’ it is really transforming the experience of our team members, our providers, our patients and those that enable and provide their care. And in this initiative, we apply digital capabilities across the continuum of care so that we can maximize the efficiency and effectiveness of the experience we deliver to our patient families. So, instead of just having these one of technology solutions, we really tried to look at technology holistically. And in light of this, ‘becoming the difference together’ enterprise initiative, our telehealth programs help to support that. Our patient monitoring programs allow patients to be in their home setting in some instances so that they don’t have to be in our hospital walls. Our voice recognition programs, for example, are initially piloted with providers and then really expanded to other care givers so that they can be more optimized in how they deliver that care experience. And then more specifically, our patient experience programs where we leverage mobility to make it more convenient for our patient families. We have a digital front door that can basically round you from your front door to the clinic’s door and the third floor of a particular building. So, as we’re looking at how we want to support digital, we really wrap it around these enterprise initiatives in the patient experience which is a really key one. But the patient experience touches on so many different technologies from telehealth to customer relationship management systems, CRM information that’s gathered and shared and used along the continuum of care, our electronic medical record, of course and that really is key to inform care delivery. But also, being able to work it so that it’s very patient family centric, even down to our biomedical devices. And how that information flows from a biomedical device into our EMR so it can trigger certain kinds of logic or allow us to make better decisions when we apply algorithms to that kind of data. But it gives you an idea of how holistic the programs are at Children’s when it comes to digital health.

PP: Yeah, I like that actually, your holistic approach which takes into account your core infrastructure and your systems but also look at emerging technologies in the context of digital health and digital transformation. How do you define digital health?

PA: I find every organization has different nuances to how they define it. But at Children’s Health, like the example I gave with enterprise initiatives, with ‘becoming the difference campaign.’ The way we look at digital health and how it’s defined, it’s through effectively applying our digital capabilities across the continuum of care and support structures thereby maximizing efficiency, effectiveness, and experience. When you think of pediatrics in that whole digital health experience, there are examples of where you can use the digital experience to enhance the capabilities that you’ve delivered at patient families.

PP: So you serve a very unique population group, you are a children’s hospital. What kind of unique capabilities did you have to develop a digital program to serve your populations?

PA: Very good question. And when you think about just care in general, we all have our own healthcare experience with ourselves, with our parents, with our children, with neighborhood folks that you see who are getting care delivered and having unique needs. But when you take a look at pediatrics, you’re really working with the family unit, not just patients. Children can always be sent on their own behalf and depending on their age in some cases they can. And as you are looking to kind of enhance an experience, you have to consider this broader support structure for those children. So, the beauty of the EHR is it’s highly configurable and very necessary, because, for example, we’re located in Texas and we need to configure to our state laws and regulations. If you work with a foster care CPS patient, in these cases, the data is not shared in our patient portal. It’ll be shared among clinicians, but it won’t be shared in a portal. It’s because we don’t want to place the patient or foster care families at risk. Once a patient is out of the foster care system, then we’re able to facilitate information sharing for the patient through our portal. At the same time, clinical data regarding these patients is available via interoperability, and it’s the capability that every EHR needs because basically you want clinicians to always have informed care. But that foster care example is kind of helpful for people to get around the nuances of what you have to do with the system to work it effectively. So, I will give you a second example. Adolescents are treated differently in every state. In Texas, certain conditions, such as drug, alcohol abuse, or STD status are shareable with parents and guardians. In other states, these conditions cannot be shared. This is a kind of unique area of pediatrics. But when you think about it, pediatrics is really addressed through Medicaid programs that are state governed and the state laws apply to patient’s health records. The adult world is different because patients are governed by the federal regulated Medicare program. So, these are some examples of where we have different nuances that need to be addressed according to a state regulation. But also, in some cases, preferences by a family unit versus just the individual patient and highly configurable systems allow us to simplify clinical and business workflows economically instead of high maintenance systems that require custom-built. We try to be a package implementation shop where we try to take things off the shelf and configure them. We don’t want to get into custom code if we can avoid it. But there are a handful situations where we actually need to do custom code because the market doesn’t supply what we need. But when it comes to patient families, there’s just a lot of areas that you have to make sure you handle appropriately and make the data available when it needs to be. But in certain instances, it doesn’t necessarily follow the rule for all patient families.

PP: Those are fascinating examples. I have no idea how intricated, how nuanced the laws are and how it varies from state to state when it comes to pediatrics. You mentioned technology choices and actually it is a great segue to my next topic of discussion. How do you go about assessing your technology choices, specifically in the context of digital programs? Where do you start? Do you start reading EHR or do you look for best in class tools? How do you go about it? Can you walk us through your typical thought process when it comes to this?

PA: When it comes to making technology choices, I offer a common quote, “just because you’re a hammer, not everything is a nail.” It’s important to understand the organization’s goals and recognize where technology can be a game changer and can better support your strategic direction. But while technology is a key element in digital programs, there are instances where process or culture change may make the most impact. In any event, the role of enterprise IT is to make sense of the architecture so we can economically build, buy, or rent the systems needed to support our vision. So, as we’re assessing technology, we kind of look at it and say, you know what makes sense at this particular time? Some solutions are better to build, some to buy and some are preferred to rent. For example, we originally built our data center out and it hosts our ERP system on site and that was a simple solution at that time. But several years back, our vendor eventually developed a solution that they can provide better, faster, and cheaper in the cloud. So, we shifted our model, and the key is the price point, because in some cases you have some investments in certain assets in your organization. But when we’re doing the technology refresh, we’re checking what is the right answer now. And in addition to that, we’re constantly monitoring to see if we need to make a change because we can do it more economically or in a more simplified way. IT tends to have to figure out how to simplify technology so it’s more adaptable. Similarly to the examples I gave about the enterprise and how you assess the technology, when you think about data flow across the continuum of care that’s inside the walls and outside our walls of our institutions. We are the ultimate Plummer, and we want the systems to be reliable, like a utility where you can just count on it. Our mind set is to create simplicity in your system so that it becomes a reliable tool that your organization can count on. And when a workflow or architecture is complex, IT should try and simplify its application to improve adoption. If a particular model is difficult to understand or use, providers won’t use it, your back-office staff won’t use it. Another plus for simplifying the utility of the system is cost savings, scalability, efficiency. All of those come into play when you try to work towards that simple, adaptable solution. For example, a solution we’re evaluating is a patient identification patch. They can place the armband and we use it to scan for medications. We use it to identify the patient and all of that’s taken care of. We’re currently piloting a technology that can replace that with a very thin patch that can go on the patient family. And not only it can identify the patient family member, but the patient be scanned through clothing, that can help monitor vital signs such as the pulse. Today, we have a little piece of equipment that clips to the patient, it’s not necessarily very comfortable, especially for tiny patients. So, anything we can do that can help the patient family experience from a comfort level, as well as improve the experience for providers and staff. Imagine in the middle of the night having to scan your child and they have to get to that armband, and they wake up the child because that’s the only way they can get to it. We’re talking about something that can identify the patient that much more readily scan through clothing so that child stays sleeping. And on top of that, be able to give you the vital signs. These types of technologies really get into hitting on all the aspects that really can help care because people think about the patient experience. But if we can’t provide an excellent clinical provider experience, then they’re not delivering the best care. So, we are pretty excited about that.

PP: Those are great examples. In fact, you talk about the experience in context of providers. You mentioned a couple of times that the technology has to be easy to use to gain adoption, at least among the providers. With digital, it’s a whole different expectation. As consumers we’re all used to seamless experiences from the retailing industry, the e-commerce industry, the personal banking industry and so on. Healthcare by all accounts has catching up to do in that context. What are some of the big challenges that you see when it comes to engagement and adoption with your user community, namely your patient and all your patient families when you roll out some of these tools?

PA: Very good question. I also have worked in multiple industries prior to being a CIO in healthcare. At one point I was the CIO of Ross Perot’s company, Perot Systems, and had a chance to work in about every industry. And I’ve been able to really witness different types of consumer engagement. And as a patient in the health system I experienced varying levels of engagement as well because we all have our own healthcare experience. One of the challenges of digital engagement in healthcare involves data. And this is something that I respectfully share when I talk to peers in manufacturing and different industries. If an organization such as mine is taking a patient-centric approach, continuity of data is critical because it informs patient care. However, patient data is fragmented because it’s created in different provider organizations and not within our four walls. That is why it’s important to promote interoperability initiatives to make data flow easier across the continuum of care. And back to that example of foster care, the patient could receive care in varying locations with different families over the course of their youth. And in this type of situation, the impact of interoperability is evident. I mean, it can get down to just whether it’s safe care or not if you’re not aware of certain challenges and different kinds of prior clinical care delivery, that could impact it when a physician is delivering care to that patient and if the data can be integrated, it makes it much easier for the provider to be more effective and deliver informed care. Also, it’s just catering to preferences. Maybe that patient family prefers to be communicated with text or prefers Thursday appointments versus Monday appointments. If the data isn’t integrated, providers may not have full visibility into the care of the patient, including those support systems, support processes like scheduling. So, it’s important when you consider the constant frequency of how these are used. I am going to give you another example. Think of testing or think of even immunizations. Without visibility into the patient’s care, you could subject a patient to multiple tests that may have already been completed. Bottom line is, if you don’t have visibility to that data and various touchpoints within the health system then it all needs to come together so that a patient can have a favorable experience because you have to know the patient and you have to know their needs.

PP: Fascinating examples. How do you measure success with your digital health programs? Imagine you’re making the investments today. You talked about a number of them. How do you go about measuring the impact and measuring success?

PA: With our existing enterprise programs, we continue to extend their reach and in turn impacts our organization and the communities such as our EHR, EMR (electronic medical record) and our ERP solutions, enterprise resource planning and CRM solutions. In some areas we see more opportunity for growth. We have a lot more that we can do with our patient-centric focus by building up the data in our customer relation management system. It’s getting a lot of attention right now, but as far as its success some of its reach, one thing for the system to be able to have that reach; another is for the system to be adapted and be able to see the growth in the populations that are using it. So, take telehealth, for example, we have an existing infrastructure that is being used to support our telehealth programs and they have been in place for over a decade. We are continuously looking to enhance our tools to ensure we can deliver on our mission. Some of that is beyond telehealth. Basically, going in and having remote monitoring so kiddos can go home even sooner. But the telehealth program we’re in is over 100 schools today, and that has been fabulous for being able to deliver optimal care. Increasing those touchpoints across the continuum of care is key and simplifying that data across the continuum of care so that we can deliver on the three E’s, efficiency, effectiveness, and experience is really a key. Our measure of effectiveness for our programs are based on the impact that we’re making with that transformation of care. Some of it is adoption where we’re improving no show rates because telehealth visit is allowing people to be in a more comfortable setting, so, they end up showing up. It is just expensive when you have no shows and a tap of just inefficiency of it. It’s also a sign that we’re not delivering care where it’s optimized for that patient family. So, we have our KPIs as our key performance indicators. Using the data in another way, such as data analytics and AI is another opportunity to be able to make sure that we’re delivering care, and you’ve heard this quite often from many right resources at right time and right place. It’s critical. But with the KPI, we can see that we’re moving the needle.

PP: You talked about telehealth and we’ve seen a significant shift toward virtual models in general. What are your thoughts on where you see the market headed as it relates to the telehealth and virtual care in general?

PA: Yeah. That’s in the area where I would say that the ‘toothpaste is out of the tube and it’s difficult to put it back.’ From our standpoint, we believe in telehealth and we believe it’s here to stay. And from our standpoint, that’s great news because it’s one of the many tools we’ve invested in to ensure we can deliver care to our patients when and where they need it conveniently. We want to deliver care where kiddos live, learn, and play. We spent the last decade developing programs. We have a very robust Tele NICU program and a school-based telehealth program, we are in over a 100 schools. Post-COVID-19, our organization will continue to expand these tele health solutions. But what’s been wonderful is to see the broader community adoption during COVID. We’re really excited and encouraged. Not only it is an added benefit to help telehealth programs, the convenience to those patient families, but it’s better for your whole health systems because we’re reducing those no-show rates. An anecdotal observation: It’s interesting how just changing a location can reduce anxiety and help patients feel more at ease. The comfort of convenience and staying at home for your doctor where it’s improving the adoption. The other thing is it’s giving a different insight to the clinical care delivery, the provider, the doctor, the nurse, because they’re actually seeing kiddos in their home setting. And that can tell you a lot of information as well. As far as providing care to our patients, it’s this whole virtual experience that it’s been able to scale and I think the key is making sure that people put whatever infrastructure they’re putting in because some of the organizations are kind of late to the playing field here with reference to virtual health. And what has occurred is because the payers have relaxed some of the requirements around telehealth. Some of these things are propped up where everything you need to capture to properly bill and all of the components that need to go into a robust telehealth solution. Some of that’s been bypassed. In our organization, it’s we’ve really put the pluming. And as I mentioned before, we’ve put robust solutions in place that allow you to capture all the data that you need. But when it comes to some of the organizations that haven’t necessarily put all that in place, they’ve kind of worked within the boundaries of relaxed standards. It’s here to stay and the consumers, the patient families will not go back because they know we can do this. The organizations that have put it in, in more of a, let’s say, minimal way, need to look and really work on getting those infrastructures in place so that when we’re post COVID-19, we are in a position to be able to continue the widespread adoption, which really is what patient families need.

PP: Yeah. So, Pamela we’re almost at the end of our time here. I’d like to close with one last question. Based on your experience and you know, you’ve got years of fantastic experience with technology in the context of healthcare. Specifically, in the last couple of quarters, based on what you’ve seen and digital health programs in general, if you’ve got one best practice that you’d like to share with your peers in the industry. What would it be?

PA: That’s a wonderful question. And there’s so many different practices that can really enhance a program. But what I offer is we need to keep advancing new technologies and pilot first. And there you can evaluate and determine if you need to adopt more broadly. I’ll give the example of something that we’ve been working with for some time. So, we deployed natural language processing system years ago where physicians could use voice to text for dictation. Now, initially, we use the software with the surgeons and then we expanded it and we ran it locally on their PCs. But first, we were kind of working hard to change the behavior of the physicians. And then we expanded it to an enterprise solution where any physician could use it. And it was in the cloud. As we’ve been getting great success over the years with that, we’ve been working with other clinicians like the nurses and some of the rad techs and such where they can actually use this natural language processing. But if we would have jumped straight to having enterprise solutions for every caregiver, we wouldn’t have been successful, and it would have been more expensive. We really could not have afforded at the time because the adoption wasn’t where we needed it to be. And some of these solutions needed to be refined so that they could be optimized. When you really take a look at that pilot first and then scale philosophy, you can really change the landscape. When you’re doing that wherever possible walk in the clinician’s shoes, walk in the patient families so you can understand that experience and the struggles they’re having so that you can fix it during the smaller pilot phase with people who are usually giving you a little more latitude, if you will, and then scale it up. Also, there’s all these tech companies that want you to try their new technologies and they have brilliant ideas around how to refine the experience. But I would also suggest them to participate in conferences so people can be aware without kind of badgering them with all this polyphony of cold calls and work with the innovation labs that are out there. We actually participate in the International Society of Pediatric Innovation, the ISPI and we have an innovation lab within Children’s Health. And these types of programs are really helping tech firms develop effective ways of approaching organizations to try their new product and really do it when you’re ready to try it and pilot it. Another example is we participate in other health systems innovation labs. We visited, for example, Cedars Sinai’s innovation lab, where we discovered a product, Aiva, that helps with using voice recognition where we’re applying it and one of our hospitals are deploying it across the entire hospital. And then as we pilot more, we hope and plan to put it in our other hospitals as well as home use for our patients. Imagine them learning how to use Alexa to understand their condition and their new normal when they go home. And being able to ask Alexa at home rather than having a big stack of papers to go through to figure out how to do something like the wound care, etc. But in any case, I think if you pilot first and scale then you can figure out what’s the appropriate size of your pilot. It works not only for your organization, but also for these feeder tech firms that really can feed into innovation and getting it to the bedside faster, getting it to the clinicians in the home setting faster. So, we need to speed this up.

PP: Yeah, well, that is great advice. I’m sure the technology firms listening to this podcast would take that to heart. Pamela, it’s been such a pleasure speaking with you. Thank you so much for setting aside the time. And I wish you and your team all the very best.

PA: Very good. Thank you, Paddy. It’s been an honor. I appreciate it and I love your podcast.

PP: Thank you so much.

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

Pamela Arora serves as SVP and CIO at Children’s Health in Dallas, where she directs all Information Services efforts including systems and technology, Health Information Management, and Health Technology Management.

She has led the organization to achieve HIMSS Stage 7 Electronic Medical Record Adoption Model designation, InformationWeek500, InformationWeek Elite 100 and Most Wired designations, the HIMSS Enterprise Davies Award for the organization’s innovative use of the electronic health record, HITRUST Common Security Framework (CSF) and SECURETexas Certifications. Through her leadership, Children’s Health won the AHIMA Grace Award for excellence in Health Information Management, the CHIME/AHA Transformational Leadership Award for the organization’s work to promote cybersecurity across the continuum of care, and Infor’s Innovation in the Time of COVID-19.

Ms. Arora has been named to Becker’s 130 Women Hospital and Health System Leaders to know, received the HIMSS/CHIME John E. Gall CIO of the Year Award (2017), the CIO of the Year ORBIE Award (2018 nonprofit category), and Tech Titans Corporate CIO of the Year (2019). She is a lifetime member of the College of Healthcare Information Management Executives (LCHIME), a member of the Health Information and Management Systems Society (HIMSS), and the Children’s Hospital Association (CHA). Pamela currently serves on the AAMI Board, HITRUST Board, Dallas CIO Advisory Council, Tech Titans Board, Philips Global Medical Advisory and HIMSS North America Board.

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.

It’s time for health systems to change focus from optimization to transformation

Episode #63

Podcast with Stephanie Lahr, MD
CIO and CMIO, Monument Health

"It’s time for health systems to change focus from optimization to transformation"

paddy Hosted by Paddy Padmanabhan

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In this episode, Dr. Stephanie Lahr, CIO and CMIO of Monument Health, discusses how as a community-based health system, they transformed their healthcare delivery in a short time during the pandemic. With the knowledge of technology and informatics, Dr. Lahr’s clinical background is helping the health system choose the right tools at the right time to solve the right problems.

Monument Health is part of the Mayo Clinic Care Network. They are based in South Dakota, where the rural population accounts for fifty percent of the total population. Before the pandemic hit, the health system was already using several antiquated tools such as telephones, paper fliers, questionnaires, etc., to cater to the population spread apart by miles. However, as the pandemic hit, Monument Health rapidly evolved its technology environment in just two weeks. They started using tools like COVID-19 nurse triage, RPM, online testing, and more to manage their patients.

Dr. Lahr states that healthcare systems can improve their quality and efficiency by having a strong foundation in data and analytics. Data is the language of transparency; access to it can help patients know more about their health information. In terms of digital patient engagement, using a combination of automated tools to maintain a personalized care experience is the key to improve care delivery.

Our Partner:

Stephanie Lahr, MD, CIO and CMIO, Monument Health in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “It’s time for health systems to change focus from optimization to transformation”

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, Stephanie Lahr, CIO and CMIO for Monument Health in South Dakota. Stephanie, thank you so much for setting aside the time and welcome to the show.

SL: Thanks, Paddy. I’m super excited to be here.

PP: You’re most welcome. So, can you tell us for the benefits of our listeners a little bit about Monument Health and the populations you serve. I understand you’re also affiliated to the Mayo Clinic in some way, can you talk about that too.

SL: Sure. So, Monument Health is a not for profit healthcare system based in Rapid City, South Dakota. We serve most of western South Dakota, parts of eastern Wyoming and some part of east of northern Nebraska as well. We have five hospitals, three of which are critical access over 40 clinic locations. We participate in caring for most medical specialties other than transplant and complex pediatric care. We have long term care facilities and home health pharmacy services as well. So, we have a pretty broad spectrum of comprehensive care, serving rural environments which is several hundred miles between us and it’s like really any other substantial healthcare center. So, with respect to our relationship with the Mayo Clinic, we are part of the Mayo Clinic Care Network, which is a designation we are really proud of and has been in place for just about a year. As a member of the Mayo Clinic Care Network, we have special access to Mayo clinics’ knowledge and resources. Our physicians and clinicians have an opportunity to collaborate with their clinicians in an effort to get in a rural setting, allow our patients to get more of the care than they need and be able to stay close to home, while we take advantage of that additional resource set at no additional cost to our patients.

PP: You mentioned rural a couple of times and I’ll come back to that because maybe it’s defining a unique attribute of your health system or the populations that you serve.

But I wanted to ask you briefly about your title and your role. You have an unusual role, you are both CIO and CMIO for the health system. Could you maybe briefly describe the scope of your responsibilities and where digital initiatives fit within the organization context?

SL: Sure. So, I am an internal medicine physician by background. I came to what was Regional Health, now Monument Health, about four and a half years ago, and I was recruited to come here as the CMIO to lead the clinical aspects of an EHR replacement across the entire health system. The CIO that I reported to at that time began to make plans for his retirement. Shortly after our go live, the CEO really saw the value in having a clinical leader with knowledge of technology as the best fit to lead the information and technology division moving forward. Given that there’s such a tight integration and rapid evolution of technology as an enabler and transformer of healthcare. So, it was sort of decided that a combination role of CIO, where I have the responsibilities for the strategy and the management of the tools that we use across the health system to enable care delivery and business efficiency, etc., with my clinical knowledge, my background in informatics, to then be able to leverage those skills together to make sure we were really choosing the right tools at the right time to solve the right problems. And fortunately, given that broad scope, I have a super great team who helps me keep all those responsibilities in motion. More specifically, all of the caregivers and technology that surrounds everything from our telephone systems to our data centers to our EHR and third-party systems, to our patch system, to our financial and revenue cycle systems report through me. The one thing that doesn’t report through me directly is our enterprise intelligence group. They report through our Chief Performance Officer, which was another decision that was made at the time that I took on both of these roles. A very close friend and colleague and partner of mine who was also within the IT division at the time, became our Chief Performance Officer. And so, our enterprise intelligence and analytics lies under her direct authority, but our teams work super collaboratively together. And that’s been something worked quite well for the last couple of years.

PP: That’s a very helpful context. And you mentioned that the technology environment is evolving rapidly. COVID has accelerated technology enabled transformation from years to months. I hear all the time that what was expected to take five years through transformation has effectively taken place in five months. Can you talk about how COVID-19 has impacted the pace of transformation at Monument Health and about the initiatives that you’ve launched specifically in response to the pandemic?

SL: Yeah, this is such a great question, because it really allows us to highlight some of the powerful and positive things that have come from such a challenging and difficult situation and a situation that is still so rapidly evolving. So, what was interesting for us is, coincidentally, around the time when this all came to the forefront in March. We had just brought a big team together and brought in a consultant. And some of this flavored by the landscape of both the financial licensing, all of the different kinds of complexities that go on in creating the environment in which we are able to do things that we do. We put together a telehealth strategy, and what we were really looking was at a two-year plan. And within about a week of that big meeting of bringing everyone together, we suddenly had a two-week plan. And within about five days, we had every specialty across the entire health system live with telehealth visits. Now, there’s certainly room for optimization of the tools and the workflows that we’re using within telehealth. But it was a really exciting time for us to see just what we could do when everybody was rowing in the same direction and had a common goal. So, that’s one really exciting example that I’m proud to share.

PP: That story is so familiar to me when I talk to health systems executives across the board. The order of magnitude of the change, the number of telehealth visits to the increase they made with the pandemic, that is across the board. It’s been a dramatic change, but for the most part, everyone seems to have pulled through. I think optimizing the technology environment is an ongoing process. So, I guess over time, all will settle down. What about the remote workforce? Can you talk about that? How did you enable them?

SL: Yeah, absolutely. So, my IT team had already been transitioning towards a work from home model part time. This was really advantageous to the whole organization. We didn’t realize how lucky we were to have already been making those moves because we had established a really strong foundation for the technology that was needed and the bumps in the road might be living in a rural geography. One of the things I often talk about to some of our physicians is that as we talk about wanting to do telehealth visits from home and things like that, I remind people I sometimes have physicians and other caregivers who live between two slabs of granite here in the Black Hills. And that can create some obstacles when it comes to create connectivity and those kinds of things. But we already had experience working through some of those challenges. We had a robust virtualized desktop environment. So, from a security, workflow, and even from a policy perspective, we had done a lot of the work with HIPAA and compliance and those teams to have a foundation. So, that was actually almost too easy for us that we didn’t even really take a lot of effort. It was more just in a matter of figuring out that who else beyond the IT team needs to work from home? What additional hardware might they need in order to do so? And we’ve been really successfully enabling several hundred of our both clinical, but not directly patient facing caregivers, as well as many of our corporate service caregivers to be able to work successfully from home for the last seven months. And I really don’t know that I see those teams ever coming back to our physical spaces in the way that they used to be before. So, that certainly has been a really positive thing. I think a lot of our caregivers have appreciated that opportunity, both from the standpoint of how it impacts their personal ability to make decisions in their own personal safety and how much they want to be interacting around other people, depending on what their personal situations are. It is also something that has allowed us to have our caregivers adapt to so many of the other cultural things that have happened in the landscape in the fabric of our society. Everything from schools and our other support systems, whether that’s daycare or other childcare options, all have become more complex and having opportunities to be able to keep people productive and working successfully at home, I think is a huge win and something I think that is here to stay.

PP: It’s such a great example. And when people talk about telehealth and virtual care models, they’re mostly talking about how you deliver care to your patients in a direct and interactive kind of way. But this is a great example of how you’re actually enabling your remote workers, caregivers, clinicians, using technology to work just as effectively as they would if they were on campus. And that’s a great example of digital transformation. It’s just that one doesn’t normally get to care about what happens in the back end of technology enabled care delivery. They’re mostly focused on the front end. So, thank you for sharing that. I’d like to talk a little bit about your CMIO role. Can you share what are some of your top priorities, as CMIO today, especially in a post-COVID-era?

SL: Yeah. So, I will tell you that during the time period of the early days, as we were trying to understand kind of clinically how all this was going to come together. And for us, because we’ve had a bit of a delay in the pandemic impacts on our numbers and are really seeing probably higher numbers now than we really have ever before. It’s a very interesting experience to be a physician who is not on the front lines. And so, it has been really important to me to offer to my colleagues, both the physicians as well as the other clinical team members, tools that can help them help patients and also keep them as safe as possible. So, telehealth is one of those options. I think it’s traditional. Some of the more common things that we think about telemedicine as far as a patient being at home and a physician being either at home or in their office and being able to maintain that relationship and the connectedness, which is wonderful. But in our hospitals, there are really challenging situations that we’re asking our clinical caregivers to walk into every day. And if there are elements with technology that I can use to help them monitor a larger group of patients with a smaller number of caregivers or providers that would allow them to have safe interactions with those patients, where instead of having to go into a patient’s room two or three or five times a day, they may be able to go in just once or twice. That has been, really very important to me to make sure that I was supporting my colleagues in that way. Bigger picture than that kind of outside response to the pandemic is that I think, we are seeing more than ever that clinical care is hard work. It’s emotionally, physically, and intellectually hard work. And the people that are providing that care need all the tools they can get to make them good at their job. Whether we’re talking about nurses or therapists or physicians, they’ve all gone through years of training and specialization and licensing to be the best that they can be. And we have so many great and burgeoning tools available to really help augment what they are capable of doing, because the data sets that are available are not getting any smaller. The human mind is not getting any bigger and the day is not getting any longer. And so how do we really help people be efficient, avoid burnout. The whole other aspect, I think that’s really exciting right now is both my combination of clinical background as well as the technology side and informatics is that of patient engagement. And how do we engage with our patients to take on more responsibility in their own healthcare is to encourage them and educate them and move them toward a more positive future. And then just in general, all healthcare systems have an opportunity to improve quality and efficiency. One of the underpinnings of that is a strong data and analytics framework. I talked a little bit about our partnership with enterprise intelligence and creating a lot of transparency around that data. We really need to be transparent there, both within the healthcare system about what we’re doing and where opportunities are for improvement. We need to be transparent with our patients about how we’re doing and how the information is related to their care. I feel like data is the language of transparency. That’s the thing that’s going to get us to the transparency where we can all be kind of on the same playing field is when we have widely available and accessible data.

PP: You mentioned patient engagement, and that is something we talk about a lot on the show, especially on the digital front doors. But before that, I just wanted to go back to the theme of your rural populations from a CMIO standpoint. I imagine that you’ve been managing your chronic populations and other high-risk populations remotely for a while, because that is just the nature of your landscape. How is the pandemic changed any of that, especially from technology enablement standpoint?

SL: Yeah, it’s very interesting. As you mentioned, because of the nature of being as rural as we are, we have to manage patients who are not right next to us. They may be hundreds of miles from us but I’ll be perfectly honest, until recently we were doing that with pretty antiquated tools, mostly telephone calls, paper fliers, questionnaires. And there are a few reasons for that, we still are in our area in a relatively heavy fee-for-service model. And as we move into value-based care, there’s more resources available to sort of prioritize how we do this chronic disease management strategy. And so, we’ve been slowly working our way there. But I think for a long time, even though we were doing it and we knew we weren’t using the right tools to do it, we had some degree of analysis paralysis around just executing on what are the tools that would help because there’s so many out there. Which one to use it, what are the benefits and which group wants to use it and how are we going to manage it and how are we going to standardize. And then a year and a half goes by and you haven’t made any changes. And so, one of the really fantastic things to come out of the pandemic is we now know what we can do in a super short period of time. And there is no wasting a year and a half with analysis paralysis. So, another example of things that we did is our CEO came to me just shortly after things got started in the spring and said: ‘hey Stephanie, we really need something for the community. They have lot of questions. We’re working on the web site and that’s going to be one element of it. But they might need more support than that. We need to funnel them to the right location. Do they need to tele visit? Do they need an in-person visit? Should they go to the emergency room? If they need testing, how are we going to set them up for what can we do?’ So, I brought back some options. A lot of which were actually kind of a quick outsourcing opportunity. And she said: ‘well, I don’t think we can afford that. What else can we do?’ So, five days later, we went live with a nurse triage that is clinically managed by myself and my Ambulatory Medical Information Officer who works for me. And I pulled all of my nurses out of clinical informatics and they all started answering phones. And we created a COVID-19 nurse triage line. And we created an opportunity for patients to call and interact with us and ask questions and in some cases just get counseling and reassurance that everything was OK. And then we took it a step further and we rolled out some functionality within our electronic medical records system to be able to do remote monitoring of these patients. And so, through the use of some thermometers and devices to be able to check their pulse ox, their oxygen levels, and then some tools that we use through our patient portal, we were able to manage a really large number of people who are sick with COVID-19. But not sick enough to be in the hospital but are still scared and still have questions. We monitor them every day, we get this information back into the system, we feed it up to other areas when necessary, and recontact those patients when necessary. And so now we’re looking at something that was created essentially out of IT as a temporary process to get us through in “kind of this crisis situation”, which we now realize is no longer a crisis situation. It’s more just a part of the fabric of our lives. And how do we morph that into something that we can maintain and sustain and expand. So some really great things that we’re working on there, one of which is we’re going to be rolling out a new tool where instead of needing to call and interact with us to, for example, schedule testing, you’ll be able to go to a secure interactive portal on our web site. Whether or not you have a patient portal account or my chat account and look at the schedules across the geography of our health system, find the one that’s most convenient for you and schedule your own test. And you don’t have to interact with anyone and then you drive up to that location and you’re able to get your test. We have methods then to be able to get you your results. And again, if you’re positive, we can offer you a home monitoring program. So, we’re working on both the combination of the workflows as well as the tools that allow us to do that. But this is really the first time we’ve taken a system approach in doing it. It’s been very educational for the whole organization to see how centralizing this can be of benefit to everyone. And now we’re really starting to look, as we get to handle this, what are those other areas like diabetes management, heart failure and some of those other chronic disease situations that you mentioned where we know we’ve got patients that live on a farm seventy-five miles out of town and they’re not going to come in. So how do we interact with them where they’re at?

PP: Very interesting examples, especially the one where you talk about repurposing your nurses towards a nurse triaging function for the near term at least. Now, that’s a segue into some of the automation and digital engagement opportunities that when I talk to other health systems executives, I see them investing in. So, you talked about patient engagement and if we look at digital patient engagement besides telehealth, what are some of the other opportunities we’re looking at from especially an access standpoint. The example of the tool that you gave for scheduling COVID-19 test is fantastic. What other opportunities are you looking at? Could you give us a sense of what you’re thinking about right now?

SL: Yeah. So, some of the things that we are looking at are tools that will allow our patients and their families to get updates on things that are happening, particularly when you look at the inpatient environment for hospitalized patients or patients that are going through surgery. Right now, we limit the number of visitors even when we’re not limiting the visitors and if your family lives one hundred miles from here, they are likely not going to be all coming to Rapid City, for example, when you have your surgery or if you’re hospitalized. So, we are looking at some tools that help keep both the family and the patient, depending on the scenario up to date on what’s happening and creating sort of automated tools. Whereas different elements happen, and different progress is made that it automatically let people know that we’ve had sort of a successful transition to a next stage. But also allows for personalization so that if there are things that need to be more specifically shared or discussed with a patient’s family, we can have a portal in a way to be able to share that information. So, I think a really major opportunity is a combination of using some automation, but also bringing in the personalization. And I think that’s going to be the key in healthcare. As we look to automation is how do we maintain a personal experience using automated tools so that our teams can do more and can take care of more people, but it still feels personalized. I think there are a lot of great tools out there and if we look at the airline industry, there are some cool things that they do. When they call, volumes are high, when they need to make adjustments to things in the way they communicate with us has all become very automated. It’s not super personal, but we don’t have an expectation that the airlines interact with us in a very personalized way. We also have to take it a step further. In healthcare, we can leverage the same tools that they are using, but we have to push them to go a little bit farther so that when they reach a certain point or certain scenario develops, we can add personalization into it as well. So, we don’t lose that connectedness with our patient population.

PP: OK, we are coming up to the end of our time. Stephanie I’d love to close out with one more question. You’ve had to live through some dramatic changes in the wake of COVID and some fascinating examples you’ve shared with us. If you had one best practice that has emerged from this experience that you would like to share with your peers in other health systems. What would it be?

SL: Yeah, I think this is really poignant at this time for me, where I’m at and what I’m talking with my teams about a lot right now is it’s time to change our focus from optimization to transformation. As a leader in healthcare IT It’s not only appropriate, but essential for us to take the lead, I think we over time have been reluctant. Even as a physician, I at times set myself aside and say: ‘well, operations really have to own and has to lead this. You have to have a strong, partnership.’ But the reality is operations is trying to operate the business today. They don’t necessarily have the time and the skills and the connections to understand what else is out there, to change the work that we’re doing today from one kind of work to another and really transform it. And so, the optimization of work will always be there. But we’ve got to start thinking transformation and we have to as IT leaders, be willing to lead that charge tightly connected to our clinical and operational counterparts. But we really have to take the lead.

PP: That is so well said and we’re going to have to leave it there. It’s been such a fascinating conversation. Stephanie, thank you so much once again for setting aside the time and all the very best to you and your team. I look forward to staying in touch.

SL: Absolutely. Thanks so much.

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

Stephanie-Lahr,-MD-profile

Dr. Stephanie Lahr serves as the CIO and CMIO for Monument Health, formerly Regional Health, the largest healthcare provider in Western South Dakota. Dr. Lahr joined Monument Health in April 2016, shortly after their decision to transform the organization through a process of EHR Unification and a selection of Epic as their transformative partner. Dr Lahr led the clinical aspects of that project as well as the data conversion strategy. In January of 2018 Dr. Lahr added the role of CIO and is now responsible for the strategy and management of the Information Technology Division. Since the Epic implementation the focus for the division is now on optimizing the EHR to improve end user and provider satisfaction, assessing new technologies that fit in the healthcare space and evolving the IT infrastructure to meet with the growing pressures on performance and security. Prior to her role at Monument Health, Dr. Lahr was the Medical Director of IT at Kootenai Health in Coeur d’Alene, Idaho, a role she developed during her 8 years there as a hospitalist.

Dr. Lahr has nearly a decade of experience assisting hospitals and their medical staffs with the changes associated with EHR implementation and transition across the country in a consultant role, prior to her time at Monument Health that focus was primarily in MEDITECH hospitals.

Stephanie attended medical school at the University of Texas Medical Branch in Galveston, Texas. She completed Obstetrics and Gynecology residency at Washington University in St Louis, but her heart drew her to complete her training in Internal Medicine. She completed Internal Medicine residency at UTMB in Galveston. She is Board Certified in Internal Medicine and in 2015 became Board Certified by the American Board of Preventive Medicine in Clinical Informatics. She has also completed the CHIME CIO Bootcamp and is now a certified CHCIO.

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.

Digital health will change the mindset that care delivery can happen only in clinics

Episode #62

Podcast with Nick Patel, MD
Chief Digital Officer, Prisma Health

"Digital health will change the mindset that care delivery can happen only in clinics"

paddy Hosted by Paddy Padmanabhan

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In this episode, Dr. Nick Patel, Chief Digital Officer of Prisma Health discusses his role and how the pandemic has transformed the healthcare industry with emerging technologies like online scheduling, virtual visits, chatbots, remote patient monitoring, and AI.

Since March 2020, Prisma health has completed 360,000 virtual visits. Nick says that implementing digital health will eliminate the mindset that care can be provided only in an office setting. He believes that introducing automation in healthcare processes and digital front doors is important to improve care delivery. In the post-COVID-19 world, around 20 to 30 percent of all ambulatory visits will convert to virtual visits. However, social determinants of health also need to be considered such as lack of broadband access and technology challenges in older and high-risk patients.

Patients today expect a retail experience from healthcare throughout their journey. Nick advises health systems to prioritize on solving the problems and focus on patient needs rather than starting with technology. Healthcare technologies must be an interconnected ecosystem that is efficient, intuitive, and can take advantage of automation driven by data.

Our Partner:

Nick Patel, MD, Chief Digital Officer, Prisma Health in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “With digital health we are getting out of the mindset that care can be rendered only in the office”

PP: Hello and welcome to my podcast. This is Paddy, and it is my great privilege and honor to introduce my special guest today, Nick Patel, Chief Digital Officer of Prisma Health. Nick, thank you so much for setting aside the time and welcome to the show.

NP: Thank you, Paddy. Great to be here.

PP: Prisma Health, I believe, came about as a merger of a couple of different health systems. Would you like to take a couple of minutes for the benefit of our listeners to tell us a little bit about who Prisma Health is?

NP: Yes, sure. Prisma Health is the largest, most comprehensive non-profit hospital in South Carolina. It was formed about three to four years ago when Palmetto Health, which was located in the central portion of South Carolina and Greenville Health System in the upstate, merged to form Prisma Health. We span over 50 percent of the state. We have 18 hospitals and about thirty thousand team members, and were actually the largest private employer in the state of South Carolina, with 330 ambulatory practices and about 45 percent of South Carolina live within fifteen minutes of us. We also have two comprehensive stroke centers and two affiliated medical schools as part and I actually did my residency training here with them.

PP: You’ve been with Prisma Health in its previous form for a long time, so, you’ve really seen this organization grow. Fantastic. So, Nick, you’re currently the Chief Digital Officer. What does that mean? What are your responsibilities? Who does the role report to today?

NP: It’s an interesting journey to get to become Chief Digital Officer. I was previously an internal medicine physician and I’ve been practicing for 17 years. And through my 17 years, I’ve seen us transform from paper to EHR and the disruption that caused into what we’re moving into now digital health and digital transformation. As my career grew, I was asked to be on different committees when we were rolling out the electronic health system and I eventually became CMIO for the medical group. And as we were going through this transition to becoming Prisma Health, the CEO asked me: ‘So, Nick, what would you like to do next? What should you be doing in Prisma Health from a digital innovation standpoint? I had attended HIMSS, the big healthcare conference that happens every year, and Hal Wolf, who was the CEO of HIMSS, had a presentation and keynote that he was giving. And I got a chance to have dinner with him the night before he had invited a small group and he leaned over to me and said: ‘Nick, what do you do and what do you see yourself doing in the next couple of years? And I described that no one was really focusing on patient experience and access and digital transformation. CMIOs really just focus on informatics and day-to-day activities of EHR and optimization. CIOs focus on infrastructure, hardware, networking, and making sure we follow security guidelines and things of that nature. But there was no one in between that looked beyond the EHR and hardware infrastructure. And that’s how Wolf talked about this role called the Chief Digital Officer. How that person will be instrumental in truly transforming delivery, that is patient focus, improving access, taking digital health, remote patient monitoring, artificial intelligence and other things to the next level. And so, I pitched that and wrote my job description and gave it to the CEO and they really liked it. And after some wordsmithing, I came to an agreement of my role as Chief Digital Officer and Vice Chairman for innovation. Currently, I answer directly to the system CMIO. But if you look across the country, the role has different reporting structures. For example, a CDO can in a lot of places answer directly to the CEO where they shape the true strategy for a health system. Similarly, sometimes they answer to the CIO, the chief or the chief administrative officer. So, it just really varies.

PP: Yeah, that is a fascinating story of how you saw the future through a chance conversation that you have with somebody. And that’s so interesting. As you are the first Chief Digital Officer for this system, could you give us a brief overview of the digital programs that you’ve rolled out in your role at Prisma Health the last couple of years and maybe give us an example of a program that has made a significant impact for your organization.

NP: Before COVID, we had already started looking at where we wanted to be when it comes to patient access, how we wanted to hold up Prisma Health around virtual visits and things of that nature. And the first project that I did as Chief Digital Officer in conjunction with the system CMIO was around online scheduling. So, when you bring two healthcare systems together, there is a lot of things that need to happen. Every system did their protocols and workflows differently.

We also needed to get to know each other as providers, who we were, what specialties we have and where do we have them. So, if you were to look at our web sites on both sides prior to us becoming together, it was disjointed. We have doctors in rural locations, we have doctors listed that were not even here anymore, things of that nature. So, what the first thing we want to do is produce a source of truth as our provider directory so that a patient can go online and find the right doctor for them. And so, if they put in diabetes and say, look at all the doctors in primary care internal medicine and family practice that specialize in diabetes, you might want to then put your zip code in, you’ll find the person closest to you.

And that helped for many reasons. Number one, it helped us as a system because we needed people to know who we were and our assets and what services we provided. It also helped us internally to setup a database of all our providers, where you had pictures, videos, testimonials, we had our ratings, our credentialling and all of that in one singular place. I guess my evil plan was to say that we now have a profile on every single provider. So, it’s like a user profile no matter what digital asset or virtual asset we then built, that same picture, same profile moves with that person. So, that was foundational for me. I think it obviously helped us come to some realization if we’re going to focus on patients and patient experience and we need to come to standardize rules around scheduling templates and all those things. So, that was part of that project and we’re live and it’s doing well. We’re now a year and a half into it, but still we got a lot of work to do to shape that. So, outside of online scheduling and video, some of the other assets that has really helped during COVID is automation and chatbots.

We had partnered with a company around different types of programs, hypertension programs, diabetes, post-operative care, and that automates the process and says: ‘hey, you are hypertension patient, I noticed your last three blood pressure readings are high. Have you been taking your medicine, yes or no? Have you been fine? Are you having an appropriate healthy diet? Yes or no. Are you doing X number of steps?’ So, it’s like engaging the patient at home as a little digital kind of nudge in between those office visits of how you are doing. What we’re doing with that is taking it to another level and adding remote patient monitoring. So, we partnered with the company to have connected devices that are fully connected to a person that literally puts on and I start getting data coming into our EHR and we’re setting a threshold. So, Paddy, if you’re my patient, you have hypertension, I’m going to put you on a blood pressure cuff. Just check your blood pressure once or twice a day to start. And if I on the background have setup a threshold, so if I want to know, when Paddy’s blood pressure goes over X over three consecutive times, then a chatbot is going to ping you saying: ‘hey Paddy, your blood pressure is going up.’ Now it’s going to really engage you and ask you some questions and if you answered those questions three times in a negative light, then a care coordinator or a Pharm D or nurse will call you and say: Paddy, what’s going on? And you reply: ‘well, I didn’t get that medicine, some were too expensive, when I got to the pharmacy, I figured I’d talk to Dr. Patel when I see him in three months. And the coordinator replies: ‘no, let’s change it now. So, we don’t want three months of higher blood pressure for you.’ So, this is the thing about digital health that we’re trying to do is to get out of that mindset of the only time your care is rendered is in the office. Care should be rendered at any time at home, especially in between office visits, because that’s where you live. You don’t live in my office. I can’t control what happens outside the office. And being a practicing internist for 17 years, I could tell you that how many times a patient sits on ‘I didn’t want to bother you, I figured we’d talk in three months or six months or next visit.’ You mean to tell me your blood pressure has been this high for that long and your sugars have been this high for that long.

Instead, me proactively knowing as your caregiver that how you’re doing and pinging you and keeping you engaged, go for walks and motivating you and gamifying that if you keep doing this to another 5000 steps and you going to get 10 percent off on your next visit here. You’re going to get 20 percent coupon devoted to your local grocery store, all these sort of things start to tie together. And that’s what I’m trying to achieve here.

PP: That sounds very, very comprehensive. And everything that you talked about, Nick, are things that I see other health systems also investing in. And, the point that you made about scheduling and access, that is by far seems the number one focus, especially when in the wake of COVID and in-person visits practically came to a halt. And now it’s probably going back a little bit and you’re getting people back within your clinic, facilities, and so on. Specifically in response to COVID, did you launch anything that was going to help your patients and your patient populations?

NP: Yeah, in the second week of March we had already, like many healthcare systems it was a very tough decision, stopped elective surgeries. As you know, surgeries specifically are huge revenue generator for any healthcare system. So that was a big decision. But then we started thinking about, well, if we are doing that, having patients come into their ambulatory visits also have a very high risk. We already noticed that our cancelation rates are going up through the roof. People are scared to come in. They saw what was happening. They were trying to follow the rules, distancing and wearing a mask and handwashing and as you remember, Paddy, in the beginning, it was chaotic. New information was coming out on a regular basis and was very fluid in the beginning. So, I reached out to the president of the medical group and said: ‘we need to virtualize all ambulatory visits right away.’ So, I came up with a workflow, worked with the team of how that would work. Essentially take the scheduled patients, flip into video visit or an audio visit. And at that time, there was still no clarity on reimbursement for those. But we knew that it was important because the last thing you need is to have patients who have chronic disease exacerbate and then go to the ER or be admitted. Its a last place you want people to go. And so, we found that it was important to be able to provide continuous care to our patients and virtualize that. And if you look at last year, we must have done about 20000 thousand virtual visits. Since March, we’ve done three hundred sixty thousand virtual visits at Prisma Health. And the thing about COVID is its pretty standard, that is fever, cough, shortness of breath, primary symptoms, secondary symptoms, loss of taste, smell, etc.

We wanted to make sure that when we screen patients, they wanted to know should they get tested, they didn’t have to call a provider and get the same questions that a CDC guideline or WHO already had out. So, we worked with our chatbot vendor and they had produced a COVID chat around COVID screening. And since March, we’ve had one hundred and ten thousand people used the COVID screening chat and it puts you in three boxes. Green says, you’re fine, you’re worried, here’s the education on how to stay well. Yellow says that you have some primary symptoms of COVID, but you may just have a common cold. You may have something else going on. Let’s do a virtual visit. And then red says you have all three primary symptoms plus travel, which is not an issue now, but it was at the beginning. You need to get tested. And here’s our community testing sites where you can go and get tested.

So, it had been very successful and then we expanded that because we also had to screen our own employees. So, instead of having screeners at every door, we rolled out a digital badge. So, one can do an abbreviated screen on phone. It gives you a green pass with a checkbox similar to what you would use to check in with something like an Apple Pay. And it would have your name, date and have the timestamp and it decays. So, after 12 hours, the pass goes away and in your next shift, you have to come and do it again. And obviously that gives us data on which of our employees are going to the red box, who needs to be tested, isolated and business health reaching out to them. We also had the demand from the community as COVID later on, in the summer, people were trying to return to work. A lot of employers wanted their employees to come back with a doctor’s excuse saying they’re OK to come back to work. Well, again, same process, but now we took that shot and you enter your name, your email address and if as long as you have pass, you get a digital email white labelled to you which says you are now clear to go. Plus, it has links and education is part of that e-mail. So, there are lot of things like that that we did. The virtual visits, both asynchronous and video that we did as Medicare and payers finally came up and gave us a final rule and reimbursement, they registered it back to March 1st. So, we have three hundred sixty thousand virtual visits and we got paid for that historically we wouldn’t.

PP: In the order of magnitude of the change, the 10x increase in visits seems to be a very common story across the nation. Whoever I talked to has seen that kind of volume changes. In your case, it seems like you already had a virtual visit, telehealth program in place and you have to scale it. But I’ve talked to others where they had practically no virtual consult and they had to overnight switch to a virtual care model. When you have this degree of change and I often hear this expression that what we plan to do in five years now, we’ve had to do it in five months and things like that. What kind of a stress does it impose on the system from a technology, process, people, and change management training standpoint? Can you talk about the experience you went through in just getting this up and running and getting it right?

NP: Yeah, I was pleasantly surprised. Historically, there are a lot of steps to take from change management, governance, making sure Infosec and ITS, informatics, clinical leadership, all are aligned. And it takes time and usually as you go from one to the other and other, here it was linear and we did it all together. So, we had a meeting around changing ambulatory visits to virtual, that workflow from a technology standpoint, from a provider standpoint, from leadership standpoint, or a revenue cycle standpoint, everybody was on the call. Everybody did their part. And that’s how we were able to move this so quickly. So, yes, there was a lot of stress, but there was also a lot of teamwork, which was very great to see and has made us understand how you can really streamline the process in the future by working together in a linear fashion versus a hierarchal manner. And we had challenges like anybody else because not every single computer within Prisma Health was telehealth ready. Not every monitor had a camera built in or speakers or mikes. So as everybody saw there is a massive shortage of web cams and speakers and mikes as everybody’s trying to buy them. And we had some of that. When I had a one-on-one with the CIOs, I was like: ‘hey, maybe from now on, let’s not skimp on ten dollars and twenty dollars when we can get an integrated camera that has mike, speaker and all in one computer or desktop that we have. Instead, just let’s make sure that any clinic asset or computer is telehealth ready with these basic things.

The other thing was as we became Prisma, we still had digital disjointed network infrastructure. So, you’d have different SS Ids as you went from one system to the other, from university practice to non-university practice. And then with varied access, we had to quickly make sure that we had people with laptops and iPads that were fully connected in our secure network so, they can render care. And we needed to make sure, as all these providers from Monday to Friday and even weekend had high quality broadband access for delivering care. So, some of that was also you had to start to think about. You had to think about documentation. You had CMS and other set documentation that they had to delineate between an office visit and a virtual visit and in an audio visit and a video visit and at the station statement that went with that. So again working with informatics and educators, the revenue cycle and coding, billing and compliance being part of that and say: ‘Nick, this is what needs to be in every note and this is how it needs to sequence out.’ In the beginning this was a massive statement but then it became very narrow because we overshot and every health systems wanted to do everything they could, to make sure they got reimbursed for these visits. So, they put more than they needed. And then the questions from billing and coding of how do you do a level four or five visit when you don’t have components of a physical exam? And how do you maximize things that you can’t do? How do you make sure you document the time when you still have a time requirement? So, it’s a lot of work. Since March, my team and many others have been working 12 to 14 hour doing this and operationalizing this. At the same time, we continue to grow and say, we need to expand our RPM program, we need to expand, enhance video visits, and we need to expand chatbots. So, you can’t become stagnant because you just don’t know what’s going to happen with COVID. I think we’re in this for the long haul for at least another year. And so, we have to prepare as a health system to continue to innovate, to take care of our patients and be ready for whatever the next wave is going to happen.

PP: In that context you’ve seen a dramatic shift towards the virtual care everybody has. There was an extreme shift in the immediate wake of the pandemic and all the recent anecdotes and the data seems to indicate that there’s some degree of pullback and the traffic is flowing back into the facilities, maybe for pent up demand, maybe for procedures that cannot be put off anymore. Well, for something that you can’t continue to do on a virtual basis. So, for whatever reason, I don’t know if we have reached an equilibrium point in terms of the share of virtual care in the overall context of care. Could you talk a little bit about that? Where do you see some kind of an equilibrium in your own system? And if not, how long do you think we’re going to wait to see that? Because you’re making a lot of investments and these investments are not going to pay off immediately. Some of them are there for the longer term. How are you approaching this for the longer term?

NP: Yeah, it’s interesting. We actually try to get a pulse of our providers on how things are going on a regular basis. We know that our number of virtual visits have declined, and people are coming to our practices again and they want to get out of their house and see their provider. We’re also finding that a lot of social determinants have come to light that we did not typically think about, like technology literacy, broadband access, hardware access. A lot of the older or elderly patients who are higher at-risk have flip phones. They can’t do a virtual visit. They don’t have a desktop. They’re technology challenged. So, you still have to have a hybrid approach. You can’t just force everyone to use this. So, we had never closed our offices. We still have people come in. There are things like procedures that you have to do, minor procedures or lacerations or abrasions or an abscess or things of that nature. You still got to be able to do some hands-on care for patients.

So, asking the providers of where do you see this going post COVID or the new world post COVID, we find if reimbursement in the federal regulations and policies remain the way they are about 20 to 30 percent of all ambulatory visits will flip to virtual. And that does a couple things. One, it allows you to see patients who have appointments because they have transportation issues who live in rural areas. Helps you with outreach, but it also lets you see people more often. So, instead of seeing someone every six months with chronic disease or three months now you’re able to check in on them digitally and see how you’re doing, either through RPM that seamlessly coming or checking in through video.

And so, I think that’s kind of where we’re going to be. But do I think we still see patients. I’m still a practicing doctor and I can tell you on Monday, Wednesday, I saw most of my patients who wanted to come in and see me. And obviously, all the protocols are there and everybody was wearing masks. I think that’s where we’re going to land. What you learn about this is, as a doctor you have an average panel of fifteen hundred two thousand patients if you want to try to keep up the volume. But with true movement to population health, one doctor should be able to take care of 10000 patients using APPs, care coordinators, pharmacies, social workers in the community. And be able to take care of diabetes on a larger scale or in a community scale versus checking in one patient, checking out another patient because we don’t have enough doctors to go around. I mean, if you look at the Agency for Healthcare Research and Quality and CDC, in 2015 we did about a billion encounters. Nine hundred and ninety million encounters. Sixty one percent of those had chronic conditions and fifty one percent of the billion went to primary care. And there’s not enough primary care to go around.

And so, you have to start thinking about how you develop the next generation of care delivery. And this has been in discussions since the eighteen hundreds. My friend showed me an article that came in 1879 in Lancet, which was in a a peer reviewed physician journal, it talked about using telephone to reduce unnecessary office visits. And I think in 1925 it came out in Science Invention magazine of how to use it. So, I think that clinically we have some good momentum around that and it will stay for long post-COVID.

PP: Yeah, it’s interesting you mentioned the model where you do more with one doc, surrounded by a team of professionals from different disciplines. That is a in fact the model that many smaller countries around the world are actually practicing. The density of doctors to the population is nowhere near as close to where we are here in the United States. So, this is a problem. They’ve lived for a really long time and they’ve already gone down the path that you just described.

And I feel like the technology is the next stage of evolution in the model where you are able to achieve more through technology enablement and deliver more care, take care more people with the same group and the same number of individuals. So, that’s a whole interesting another conversation, I guess. So, Nick, in this show, as we discuss digital front doors and you have describe many of the initiatives that go into a digital front door program on a point of view of access in particular, and then you map out the patient journey. You identify the high impact touch points and you use digital solutions for implementing those care models. What would you say today are the high impact digital engagement touch points for a typical patient journey and more so in the context of your patient population? Could you share your thoughts from that?

NP: Yeah. I think that patients want a retail experience. They don’t want to have to fill out paperwork everywhere they go. And we’re good about doing that in healthcare. I think part of it is how do you use automation? I think for me, as much as we can automate processes in healthcare the better. As my friend on a previous call around artificial intelligence and medicine said, how do we take the robot out of the human? We do a lot of things in healthcare that are just robotic, that don’t require our clinical background and training to do those activities. And so, from a digital front door standpoint, how you virtualize the whole intake process and how does that data become singular? And that’s where it comes down to data is extremely important, discrete, non-siloed data that is continuous throughout all systems, no matter which when you’re in. And so when you look at one patient, you see a true 360 view. Doesn’t it matter if they’re calling through a contact center, through a CRM process or through an office or virtual or through a campaign in the community, data is singular. So, I think you have to concentrate on is thinking about how do you modernize your data systems? You know, we moved away from hard assets into the cloud. We partnered with Snowflake around cloud computing and storage, which has really helped efficiency. And there’s a lot of different things that we’re trying to do, standardize workflows and protocols, as you mentioned earlier, so that everyone is singing off the same sheet of music.

And that helps the patient. It brings the cost down and the experience is improved. I would say that having automation as part of your process and your digital front door as well as care is very important, through either chatbots or other means through your CRM. We are working very close with our CRM partner on some of these items.

PP: Yeah, interesting. We do see that in fact, we’re doing a lot of work in this space where we are using the CRM platform, helping the health systems use the CRM platform to drive a multi modern multi-channel communication protocol, which is driven largely through automation. And that’s exactly what you’re talking about. We are coming up to the end of our time Nick. I just wanted to take the last minute or two that we have to ask you a couple of questions. If you had one best practice that you would like to share with your peers in the industry, what would that be?

NP: I think the biggest advice I would give to anyone who’s going down this journey is don’t start with the technology, start with the need. What is the problem you are trying to solve? And then see how technology can help you get there. The technologies that you have must be an interconnected ecosystem that is efficient, intuitive, and then take advantage of automation driven by data, that is very important. I think what healthcare systems make a lot of mistakes is that they start with technology and try to solve a problem that’s not where you want to go and you want to keep it patient-centered, provider-driven is extremely important. So, that’s my key takeaway from our journey so far in this world.

PP: Fantastic. That is such a fantastic note to close this conversation Nick. Thank you so much for that and setting aside the time and talking to us and sharing all of the insights from your experience. I wish you all the very best.

NP: Thank you, Paddy.

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

nickpatelmd-profilepic

Dr. Patel serves as the Chief Digital Officer at Prima Health and Vice Chair for Innovation & Clinical Affairs at USC Department of Medicine in South Carolina. Prisma Health is the largest, most comprehensive, locally owned, non-profit hospital system in South Carolina. He also continues to practice as an internal medicine physician for the past sixteen years. Dr. Patel has given multiple presentations around the country ranging in topics from Healthcare IT transformation, governance, workflow enhancements, health equity, telehealth, AI, and population health. Spearheaded the largest, first-of-its-kind Microsoft Surface pilot in the nation to improve physician workflow, published in the International Journal of Medical Informatics. Played an instrumental role in the acquisition of over $24 million of venture capital funding for healthcare start-up companies.

Previously as the medical group’s CMIO, he co-led efforts in the optimization and integration of Epic and Cerner at Prisma Health. Recognized as a leader in defining and articulating a unique vision on the utilization and development of technology in healthcare. Because of his industry contributions, he currently serves on multiple healthcare advisory boards including HP Inc., University of South Carolina College of Engineering and Computer Science, Kyruus, Conversa, MDLive, Perfect Serve, and Fraunhofer USA. Subject matter expert for multiple Fortune 500 tech companies, such as Hewlett-Packard, and Microsoft. He also has served as principal investigator on multiple IRB approved IT studies in conjunction with USC. Holds a clinical faculty position at the USC School of Medicine department of internal medicine and USC School of Engineering and Computing. He is also one of two physicians in the world who have been awarded Microsoft’s Most Valuable Professional Award. Also recently named Top 20 Chief Digital Officers to know in 2020 by Becker’s Hospital Review.

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.

Due to COVID, health systems realized how far behind they were with virtual care technologies

Episode #61

Podcast with Drew Schiller, Founder and CEO, Validic

"Due to COVID, health systems realized how far behind they were with virtual care technologies"

paddy Hosted by Paddy Padmanabhan

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In this episode, Drew Schiller, Founder and CEO of Validic discusses how COVID-19 has impacted and accelerated the demand environment for remote patient monitoring and other virtual care technologies.

Validic is one of the pioneers in the remote patient monitoring space. Drew states that COVID-19 has accelerated the adoption of remote patient monitoring technologies. Due to the pandemic, health systems have realized that virtual care technologies can reduce the cost and burden of care, especially for at-risk populations.

According to Drew, big tech firms entering healthcare is both a challenge and an opportunity from a digital health startup’s perspective. He believes that the VC funding environment is strong but cautions that much of the funding is targeted at late-stage firms that have demonstrated significant traction. He advises the startups to think more creatively and develop unique approaches to the market that focuses on areas not adequately addressed by big tech firms. Take a listen.

Our Partner:

Drew Schiller, Founder and CEO, Validic in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Due to COVID, health systems realized how far behind they were with virtual care technologies”

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, Drew Schiller, Founder and CEO of the Validic. Drew; thank you so much for setting aside the time. And welcome to the show.

DS: Absolutely. Thanks for inviting me. Happy to be here.

PP: Awesome. So, Drew for the benefit of our listeners, who may not know Validic, would you like to tell us about the company and the prime needs that your company’s platform addresses?

DS: Absolutely. Thanks. So, Validic is the leader in connecting personal health data from in-home monitoring devices, wearables, health apps on the phone, really anything that you would capture from a device in your daily life. Standardizing and normalizing that information and making it usable for the health care system. Which means we connect with hundreds of disparate sources, everything from blood pressure monitors, glucose weights, continuous glucose, pulse ox, temperature, etc. and all other wearables you’d expect, as well as health apps on the phone. We bring all of those data into a common ontology and we can provide access for that information in a variety of different ways. The two primary use cases we service are health incentives, where we work with a lot of, for example, commercial health plans and organizations that service large, self-insured employers on wellness initiatives and general health initiatives with this type of platform. The other one is disease management. With disease management, we actually power RPM programs for health systems and health plans that are looking to manage patients who are living with chronic disease.

PP: Right. Your company is a pioneer in the remote patient monitoring space, the RPM space that you just referred to. Could you give us a little bit of a breakdown of what the RPM market looks like today? What is the demand? And how has COVID-19 impacted the marketplace in general? Can you give us a high level of an overview of the market?

DS: Absolutely. Before COVID, there was a high degree of interest in remote monitoring. Primarily around health systems and health plans trying to better understand what’s happening in people’s lives and looking to see if there could be new models of care to support things like Medicare Advantage programs as well as other at-risk models of care for folks living with chronic disease. However, this technology is been around for five, ten years, in some instances it is more. There were remote monitoring companies 20 years ago, but it didn’t really reach mass appeal yet, and COVID has changed all of that. So, what happened was when COVID hit and folks who are living with diabetes and hypertension and folks who are being treated for or being discharged of heart failure, things like that. They typically would have followed appointments or regular quarterly appointments to go in and see their cardiologist or endocrinologist etc. But with COVID, those regular checkups actually got pushed, either pushed out or pushed to virtual. And so now you have a whole population of individuals who were under-managed relative to how they had been seen previously. And even when they shifted to video visits, the physicians were actually missing one of the most critical elements to managing these chronic diseases, which is the data and doctors. Doctors need data to practice medicine, especially when they’re managing patients with chronic disease. So, what we’ve seen since COVID, over the last five to six months, the industry has accelerated by probably five to six years. I mean, it’s just a lot of interest in new programs, starting up new clients coming online very rapidly. In fact, to meet the demand, Validic actually launched a new rapid deployment RPM product just last month because we were trying to help our clients and our partners get up to speed and run even faster with these programs, rather than going through a traditional heavy implementation route and trying to fit into IT implementation schedules and things like that. So, it’s really exciting to see where the market is today. And I think it’s really going to be here to stay.

PP: That’s a great break down. I will come back to the demand environment again. But I just want to clarify a couple of things. You mentioned some things accelerated by five years. I hear that a lot about the impact of COVID on digital health programs in general and virtualization of care that you referred to. So, that’s obviously good news for companies like yours. At the same time, what are some of the challenges that now, kind of an acceleration imposes on health systems and folks who are running this digital program? What do they need to do in order to be able to respond to this sudden acceleration in their priorities?

DS: Yeah, absolutely. One of the challenges, I saw before COVID and has continued, is that change management in these organizations is really still a challenge. And while I have seen that RPM in virtual care in general is getting a heavy level of focus and investment, there’s very frequently sort of decision by committee. And that really slows down the selection and innovation process. That’s one of the biggest challenges we still see among health systems, so we can have the business sign off on something, but then there’s a multitude of committees that also need to sign off and getting through that whole process is a pretty hefty list.

The other challenge that we’ve seen is that sometimes these programs are not getting in place fast enough for the individual departments or physician groups. And so, we’re actually seeing pilot programs start in sort of skunkworks situations and it causes vendor conflict and legal conflict internally because there wasn’t a comprehensive strategy for the particular health system. And so, one of the things where we’ve seen a lot of success is when there is a strategy and we are working on a comprehensive enterprise wide solution, we want to definitely solicit everybody’s thoughts as part of this. And we expect that we’ll have something in place that we’ll be able to service everyone’s needs. So, it’s not just endocrinology or cardiology or pulmonology doing this, it’s just that the IT department gets very frustrated because there are too many projects to handle.

PP: And I can tell you from our experience that most health systems are now kind of moving away from this department of siloed, functional decision making and technology decisions. They want these technology decisions to have enterprise level impact. The good news is if you are doing business with a health system, more likely you’ve been considered for an enterprise level program. The bad news, of course, is that it takes longer because enterprise level progress and this is what you refer to. So, my next question for you is, when it comes to these digital programs, which is what I put the RPM solutions in as well. Who is driving these programs today? Is there a specific individual or a function that is driving it or do you see your clients setting up new organizations within their health systems to drive digital? What are you seeing as the org model to accelerate the adoption of these new technologies and accelerate the implementation of these new programs?

DS: Yeah, absolutely. So, we’re seeing a couple of roles emerging that were not around even a few years ago, at least not as much. So, one is a Chief Digital Officer or a Chief Digital Health Officer, something in that vein. And that’s a role that, generally speaking, is somebody who is really dedicated to thinking about digital transformation in the organization, how to bring all of these stakeholders together internally, as well as different vendor solutions together to build a comprehensive digital solution. We’re also seeing the rise of virtual care executives. So, whether this is a VP of virtual care or telehealth. And so, whereas it used to be that this role was, generally speaking, over care management and maybe video visits. That role is actually expanding quite a lot now to encompass a lot of other digital capabilities.

I’ll just say that one of the things we are really excited because of this shift toward a more enterprise focus is that the way the Validic came to market was a little different than how traditional RPM vendor does. So, traditionally with RPM vendors, they want to do remote monitoring for a disease state or maybe a set of disease states, and then they build a solution around that. And so, that solution has patient education around this type of thing. It has maybe some sort of patient engagement app around this very specific solution, it has a subset of devices that are very specific to those disease states that can deploy.

And that solution typically lives outside of the clinical workflow. And so, it’s something separate for folks in the enterprise to log into. And it may or may not support the needs in the workflows of folks across the enterprise. And Validic actually came to RPM almost in a reverse engineered way. When we launched Validic, it was primarily the personal health data platform. And so, what we did first was integrate with hundreds of disparate sources and in-home modern devices, etc. And then once we had that platform, we began to see use cases developing. One of the primary use cases was RPM in health systems and health plans. And so, what we’ve done is we went to them and said, hey, what are the things that you need for RPM? What we frequently heard was, we need it in the clinical workflow. We don’t need patient education because we already have patient education. We don’t need care plan design; we already have care plan design. What we need from your system to interface with all the other things that we’ve invested in to make this a seamless interaction. And it doesn’t feel like something separate, it’s like one more thing for our physicians and in other clinical key members. And so, we feel very fortunate that we are now in this position where things are moving to the enterprise. It’s what we were expecting would happen. And now we’re in a place where we actually have a solution that can scale across the enterprise and support any disease state with any type of device, with any type of data from multiple departments.

PP: So you mentioned that there’s the emergence of all these new roles, Chief Digital Officer and VP of Telehealth and so on. So, has your client profile therefore changed significantly? In a broader sense, has the ownership for digital programs in general shifted away from, let’s say, the CIO to an entirely new role? Is that a broad trend you’re seeing or is that still not a big enough percentage of the overall population of health systems out there?

DS: Yeah, I would say it is a broad trend we’re seeing with a little bit of an asterisk. So. the asterisk is that all of these programs ultimately roll up to the CIO, but there’s quite frequently a new executive, whether that’s VP, SVP, C-level, that reports to the CIO, who takes this on. Four or five years ago, if you are talking to the CIO, you are talking to the right person. And now there are so many other things that CIO’s have to manage, that is much more of a data and comprehensive platform strategy management role as opposed to do on digital initiatives. Now for talking to a CIO, the first question I ask is, who should I be talking to on your team? Who’s running this? That’s usually the very first question I ask because their purview has expanded and that’s really been a big evolution. I’m sure you’ve seen it in your work. It’s been a big evolution over the last five years or so.

PP: Yeah, I know, since you mentioned. We pay a lot of attention to this question because it’s important for my own business. We also want to understand how the market is changing, how the roads are changing. We do see the emergence of a Chief Digital Officer that you mention. There’s a lot of variation in the org models. In many cases, the CDO’s are peers to the CIO. Maybe they both report up to the CIO. In other cases, the CDO role is combined with some other role, which could be a clinical role, a patient experience role, could be an innovation role or a marketing role. So, there are different org models, some of which the CDO role is standalone. In others, it is combined with some other operational or clinical role. The most common model that we see is that the digital function sits with the CIO. But of course, that doesn’t mean that the CIO is driving every single program. To your point, there are different individuals that have discrete responsibilities for, let’s say, telehealth, on the one hand, RPM on the other population health management and so on, so forth. So, it is still evolving, but that is a good discussion. I want to switch tracks a little bit. I just came out with my second book, as you know, and you’re the only person who is in both my books. You’re in my first book and you are in this book. And of course, the walls change a little bit in the interim. But I wanted you to bring your attention to a comment that you made to me when I interviewed you for this book, which was just before the pandemic. And one of the things that you told me was very insightful, and it is in the book, too. So, what you said was startups are building the solutions to deliver clinical outcomes. But they’re not necessarily focusing on financial outcomes. So, there’s a lot of subtext to it. One, I believe you would have framed in some way to the reimbursement environment. You’re referring to the need for demonstrating a financial ROI for the ultimate customers of these solutions. So, can you comment on how the pandemic has changed that equation for digital health startups? Has the reimbursement environment become better? Have systems lowered their thresholds or otherwise because they see this as a strategic priority? What do you see?

DS: Yeah, absolutely. First, let me say I am flattered that I’m the only person in both your books. Thank you for that. I’m honored. What I’m seeing when I’m talking with other founders and other companies is a couple of things that have happened since COVID. The first is that if you have a solution that has something to do with virtual care, this could be some broad virtual care, this could be video visits, could be consumer engagement through an AI chat bot, this could be RPM anything like that. What I have personally witnessed, as well as anecdotally heard from my peers in the industry is that things are taking off like wildfire. The big difference is that, nothing has changed except from a reimbursement perspective, health systems realize how far behind they are in implementing these technologies. And they’ve been kicking these ideas around for the last two, three, four and five years. And now they needed to implement them in two, three, four or five months. And so, that really jumpstarted things. The other thing that, had it been shifted, this is more of a theory that I’ve been developing, but it’s not new that many health systems have some small portion, whether it’s 20, 25 percent or 30 percent of their patient population in some sort of at-risk contract. That’s pretty standard. But in order to service those at-risk contracts in a pre-COVID world, there are so many administrative things that you could cut out. And there’s just so much overhead that you can get rid of to make servicing those clients more cost effective. Here we saw a lot of the attention being placed. But once COVID hit, all of the virtual tools that could have been available to them, could have really reduced the cost of care and the burden of care for their team members weren’t in place. And so now those systems are saying we have to get this in place now. At the very minimum for our at-risk population, because if there’s another lockdown, if there’s another pandemic or whatever, virtual tools are the way that we’re going to come ahead on our at-risk population, which is absolutely critical if the fee-for-service goes away. So, it’s being used as more of a catalyst than what I had seen in the past and that’s where a lot of the conversations head on.

PP: Clearly, the lockdown and the inability of patients to come into the clinic and the reduced foot traffic, has certainly accelerated the investments of virtual care platforms. And I do believe that the financial models to look at these investments have therefore necessarily changed. You cannot go through your traditional financial model where you do a pilot and you demonstrate the results on a limited scale and then you scale it up and then you do it in a gradual and incremental way. But COVID-19 is the ultimate black swan, right? That is what made this big shift in thinking around technology implementations, technology strategy, and, of course, the investments and the whole notion of what is overkilling today and what is necessary for survival and relevance in the future. So, we are seeing the same thing that you’re seeing, and this is what our research is telling us as well.

DS: To answer the second part of your question. We’re also seeing is organizations that have an efficiency ROI. Initially prior to COVID, it was really tough sell anything with efficiency ROI. And now, like only in the last maybe couple of months since August. All of a sudden, the efficiency ROI is actually something from what I understand health systems are paying a lot more attention to. And it’s because they’ve had to reduce so many team members, they are facing big furloughs, they’re facing staffing shortages. They were self-imposed because of the fiscal realities of COVID. All of a sudden, whereas before it was like some efficiency would be nice, efficiency ROI is actually really critical. That’s the other big thing that we’re seeing for organizations, that it’s not just the clinical ROI, they have efficiency ROI and that’s really helping them.

PP: [00:21:19] That’s very insightful. Thank you for that. I’m going to shift gears one more time. So, let’s talk about the startup environment. And I want to talk about the broader technology solution provider environment as well. So firstly, we’re in the midst of an IPO boom. It looks like to me every other week there’s some tech IPO and several digital health IPO’s have already occurred. And some big M&A referring to the Livongo-Teladoc one. But I have to believe that it’s more like they are coming down the pie. What do you make of this trend and what do you foresee in the next 12 months or so? As you know, digital platforms start taking advantage of the COVID opportunity and grow to some degree of skill. Do you see more IPOs, more M&A? Do you think there’s some risk that there’ll be a shakeout as well? What are you seeing? What is your assessment?

DS: Yeah, I think that we will definitely see more tech IPO and M&A in healthcare. And the reason is, like I said, the industry accelerated forward so fast and the same realization that we at Validic had when the pandemic hit and lockdown hit and we saw, oh, my gosh, what does this mean? And then we realized, oh, we’re a health care technology company. We can do something to help the markets and realize that.

The public investors have very clearly recognized that digital health is a way forward for healthcare, which is extremely exciting. As well as on the M&A front, what we’re seeing is that, the Teladoc-Livongo merger kind of woke a lot of folks up to this. But we’re seeing that the chips are being laid on the table today in terms of which organizations are going to own and dominate the virtual care space over the next two to three to five years. And so, I think it’s going to take six to 12 months really to kind of fully shake out with all of the IPO’s and the M&A. But I do think that we will see a very different, maybe slightly consolidated landscape of really strong players over the next of the next decade.

PP: So obviously that brings the question of what are the big tech firms going to do about this? The dominant position of the electronic health record vendor is well known. And they’re obviously trying to kind of transform themselves into big players in the emerging digital health landscape. But then the big tech firms like Microsoft, Amazon, Apple, they’re launching new products that are getting deeper and deeper into the health care delivery space. And Microsoft, for instance, their Teams platform is now the new video consult platform. You can launch it through the Epic EHR, its first-of-a-kind deal. Apple is getting into the fitness space and Amazon launched their wearable Halo. And they launched the virtual care service for their employees and so on. Where do you see them headed? Do you see them getting deeper and deeper into healthcare services? And in that context, what happens to the smaller digital health companies that are also playing in this fix?

DS: Yeah, it’s really a great question. I do see the big tech firms getting deeper into the healthcare space and within healthcare services. I think that each one is going to play to their respective strengths. I think, Amazon for example, came out with a consumer wearable device. They are a very, very consumer focused company and they have a lot of unique assets in that area. And I think they’re going to really head into health consumer, which could mean a lot of different things. That could still mean partnerships with healthcare organizations. I think it’ll be very consumer focused, and they take very similar to how Apple has really doubled down on the consumer focus with their solutions. Microsoft, for example, especially Satya Nadella has really invested heavily in enterprise platforms. That’s been the nature of the big acquisitions like LinkedIn and GitHub and what we’re seeing with the announcement of the Azure health cloud is that Microsoft is really going to double down on the enterprise side of health care in some pretty interesting ways.

I definitely think that there will be more. From a startup perspective, I think it’s a challenge and an opportunity. The challenge is that when you have these big players entering the market, and especially when you know the larger market dynamics where a lot of chips are being laid on the table today that are going to kind of lead the market forward over the next several years. That takes a lot of opportunity away from startups in terms of being able to really have a seat at the table. So that’s a big challenge.

However, the opportunity is that, for these big firms when they go to scale something, it takes them a lot of time and a lot of resources because they’re doing it at such scale and volume. And as you know, nothing moves fast in healthcare from a legal and implementation perspective. And so, there is a massive opportunity to look five years out or 10 years out for these startups today to say what is going to be needed that these companies are not going to be thinking about. And clinically we found ourselves in a very fortunate position seven years ago when we did market launch. There wasn’t anything like what we were doing and then all of a sudden there was. But we were able to kind of continue to rise to the top and continue to be the best in class for what we do. And I think there’s still that opportunity today. It’s just, entrepreneurs will have to think a little bit more creatively about where they could uniquely approach the market. And maybe it might be a blind spot for one of these big tech firms.

PP: Right. So obviously, that brings the question of how that last long. We’re talking about five or seven-year opportunity of these cycles. I agree with you. I think that there’s a huge opportunity opening up at very, very early stages. But that is here and now. And that is how you get from here to the next phase that requires scaling and remaining invested in the market, that requires dealing with long sales cycles and ultimately, it all boils down to your financial ability to ride this out and see it through the end so everybody can benefit from it. Which means that the VC environment has to be supportive for this outlook in the market. What are you seeing in the VC funding environment, especially in the post-COVID scenario? I’ve seen startups getting funded more or less, we are seeing funding drying up. What are some of the dynamics that you see?

DS: Yeah. So, there is just as much if not more capital today than it was a couple of years ago and that’s been a continual trend in this space. The challenge is, and unfortunately COVID does not change this, the companies that continued to get funded are the companies that are leaders at more growth stage, venture companies where they already achieved some level of scale. And that the bet is a little bit short. We’ve seen some really, really big funding announcements recently from some of the growth-oriented startups in the space. And it’s exciting and great for the industry. But the challenge is that there’s really a gap for early-stage companies between a pre-seed round and a Series B, because it’s really hard to get enough traction to get a full seed round or let alone get a full series A at a strong valuation. It’s just very difficult, especially if you’re targeting health systems or health plans. And so typically, when I’m talking with entrepreneurs of early stage companies, my counsel to them is to actually see where they can solve the problem they’re trying to solve but for a different stakeholder than a health system or a different stakeholder than a payer. It could mean that they could solve that problem for a health IT vendor to sell that to a health system, solve a problem for a nursing home or for senior living facility or could be for a direct to consumer, But try to find a path to scale that doesn’t initially require you to scale through health systems. It’s so hard to get initial traction there. I mean, our story of Validic was very similar to that. We looked into it as opposed to having a particular strategy. But we actually scaled initially through primarily, through wellness IT, and health IT vendors. They were selling consumer health solutions or sort of fully baked solutions for health systems. But we were an enabling function for them to have more capabilities in the space. And then we were able to leverage their scale to actually grow our business. And so it was a very fortunate circumstance that we found ourselves in. And I don’t think we’d be here today if we if we weren’t able to find that.

PP: Well, final question on that. So, obviously, you talk about the funding environment and it’s unfortunate that the funding is getting concentrated in late-stage companies, that it really creates a drought of the early-stage level, the consequences of which are going to be visible in a few years down the road. But the flip side of that equation is obviously the level of risk that clients so willing to take on unproven early-stage companies, albeit to innovative companies. Health systems has always been risk averse. Have they become more risk averse during COVID 19 and have that therefore complicated the landscape even further for early-stage companies and complicated their chances of securing funding? Is that what is happening?

DS: I don’t think it’s necessarily specifically because of COVID-19, but I, definitely think that over the last 18 to 24 months, they’ve become much less risk averse. And internally, I kind of label this theranos effect, which was like so many people believe in this really innovative technology and it turns out that it just wasn’t possible. So, the level of the burden of proof is so much higher. And it’s not just because of theranos, but that didn’t help. The burden of proof today is so much higher and even if you’re able to show some level of proof and some level of traction and adoption, you still have to convince the health system or the health plan etc. to take a little bit of a flier. That really comes down to personal relationships and the fact of the matter is that the way these organizations are structured now, you can have an innovation officer, a digital officer or something who believes in what you do and wants to shepherd that through. But there’s really huge firewall of procurement now that analyzes things very, very deeply. And they have extremely deep tech and security reviews. And that’s all great.

It’s necessary because we definitely don’t want to have our health records stolen and we don’t have security breaches. But it makes it much more difficult for an early stage company to get through that whole process than a company that’s later stage like ours, where we have dedicated practice and security folks and dedicated legal people. And the one who can actually navigate that whole thing and that’s the real challenge to get a champion. But it’s become harder for that champion to actually bring shepherd the company through.

PP: Well, to be continued, I guess we’re going to have to leave it there. We went way over time, and that is just an indication of how fascinating this conversation has been. I really want to appreciate your insights. Thank you for taking the time to talk to me today and be on the podcast. This is going to be one. I can tell you right now there’s going to be one of the more downloaded podcast just because of the quality of the conversations that we’ve had. And once again, all the very best to you and your dream. Congratulations on your recent successes and everything.

DS: We’ll be in touch. Thanks, Paddy. Really appreciate 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

Drew_s_headshot-Founder-and-CEO-Validic-profilepic

Drew Schiller co-founded and serves as the Chief Executive Officer and Board Director at Validic, the industry’s leading health data platform and remote patient monitoring technology. A patented technologist, Drew believes that technology will humanize the healthcare experience for patients and care providers. He regularly speaks and writes on a variety of topics, including the future of virtual care and the ROI and personal stories from remote monitoring programs.

Drew’s vision, and the mission of his company Validic, is to improve the quality of human life by building technology that makes personal data actionable. Beyond Validic and in pursuit of that mission, Drew serves on the boards of several advocacy and policy groups, including the Consumer Technology Association, the eHealth Initiative, and the Council for Entrepreneurial Development (CED) in North Carolina.

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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