Month: November 2020

Data interaction with digital tools must be as easy and seamless as possible

Episode #67

Podcast with Daniel Nigrin, SVP and CIO,
Boston Children’s Hospital

"Data interaction with digital tools must be as easy and seamless as possible"

paddy Hosted by Paddy Padmanabhan

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In this episode, Daniel Nigrin discusses how digital at Boston Children’s Hospital is about transforming healthcare by improving the care experience for consumers, patients, families, and clinicians and their interaction with the health system.

Digital transformations are disruptive for healthcare organizations. It leads to new ways of doing things and enables healthcare providers to care for patients in ways they have not done before. Being a children’s hospital, Boston Children’s Hospital has to deal with the unique scenario of dealing with two sets of patient populations: the child and the parent or the caregiver. This requires a multidisciplinary approach to assessing any new technology.

Daniel talks about digital program governance at Boston Children’s and has some practical advice for startups looking to partner on innovative approaches to digital health. Daniel also discusses emerging technologies, such as voice, that will play an essential role in healthcare, both in inpatient and home settings. Take a listen.

Our Partner:

Daniel Nigrin, SVP and CIO, Boston Children’s Hospital in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Data interaction with digital tools must be as easy and seamless as possible”

PP: [00:00:43] Hello everyone and welcome back to my podcast. This is Paddy and it is my great privilege and honor to introduce my special guest today, Daniel Nigrin, CIO of Boston Children’s Hospital. Dan, thank you so much for setting aside the time and welcome to the show.

DN: [00:01:00] Thanks so much for having me, Paddy. It’s a privilege being on here with you.

PP: [00:01:05] Thank you so much. I appreciate that. Dan, would you like to tell us a little bit about Boston Children’s and the patient populations that you serve?

DN: [00:01:14] Sure. Boston Children’s is a storied organization. We celebrated our one hundred twenty-five years anniversary a few years ago. We’re an old organization based in Boston and we are the primary teaching facility for Harvard Medical School. And as the name implies, we care for predominantly children throughout our programs. I say predominantly because we do actually have a few adult programs that tends to be for patients who’ve grown up with what used to be just childhood disorders, congenital heart problems, things such as that. And it’s telling that now-a-days care has become so good that those patients are now in their adult years. So, along with serving Boston and surrounding areas, we’re also a destination for families around the world who have specially challenging problems. Although we obviously have primary care pediatrics, we also serve patients with really difficult and challenging problems, where families are willing to travel from all over the world to come and seek care at our organization. It’s a great place and I’ve been there for a long time. This is my twenty fifth year at the organization as the CIO, which when I look back sort of boggles my mind a bit as to how that long a period of time has passed. I should probably point out that I’m actually nearing the end of my tenure at Boston Children’s. I’m heading to a new role up at MaineHealth in Portland. Maine is really a fantastic organization that serves as one of the largest systems in the northern region of the country. I am excited about that change after such a long time at Boston Children’s.

PP: [00:03:13] Congratulations on the change and congratulations on completing twenty-five years. That is quite a testament to the organization and your contributions there. So, all the very best in your new role as well.

DN: [00:03:26] Thank you so much Paddy, I really appreciate that.

PP: [00:03:29] Excellent. In this podcast, we talk about digital health, digital transformation and what I’d love to explore with you is what does digital heath mean in the context of a children’s hospital at Boston Children’s? Can you share with us the highlights of some of your two or three digital programs that are making a significant difference to your patient populations?

DN: [00:03:52] Absolutely. Well, the first challenge is having conversation with so many individuals about what digital means to them. That’s the biggest challenge, I think it’s just sort of defining it, because it really does mean so many things to different people and organizations. We’ve always viewed digital as really the transformation of healthcare, as we know today, in terms of making, not just consumers, patients and their families, but also providers and clinicians within the hospital, as comfortable and interacting with the healthcare system as it is for any of the other aspects of their lives for which there’s a digital role today. So, when you think about ordering products online, whether it be Amazon or anywhere else, when you think about ordering groceries, when you think about booking your next hair appointment, when you think about making reservations for a restaurant, all of those things are just so facile now-a-days. And are literally in the palm of your hand through your smartphone. We view digital as the transformation of healthcare to be able to achieve that level of ease of use and familiarity to people, whether that’s patients or staff. We’ve been on this journey for some time and also COVID has accelerated many of these. But even pre-COVID, we were offering many things through our portals, like many other organizations are, and we viewed that as the beginning of the consumer centric digital transformation. And those go back many years, obviously, in fact, we were one of the first organizations in the country as a pediatric organization to offer a personal health record accessible over the Web to our families that continued on. And over many years, we’ve offered things like online second opinions for families. As I mentioned, we tend to be a destination for difficult situation to solve problems for our patients. And so we’ve offered those services as well in conjunction with the patient’s primary care providers or local care providers to help augment them and give them our assessment of what’s going on with their child’s care. Most recently, and again, similar to, I’m sure, many organizations, we really had a massive increase in our telehealth adoption. We went from anywhere from 20 or 30 visits a day to over two thousand a day. I think we differ a bit from our peers. We’ve continued with that very high rate of adoption of telehealth even once things subsided a bit over the late summer and early fall with COVID. Clearly it’s ramping up again now but still we’re seeing about forty five percent or so of our ambulatory encounters and outpatient encounters being done virtually now. I’m not entirely sure why we still got that volume. But with COVID we’re pleased that we’ve got that infrastructure in place and our providers and patients both seem to have adapted well to it. Beyond that we do a lot of additional things as well. We tend to be a pretty forward leaning organization. We’re very bullish on innovation and taking innovative steps in the digital and IT realms. We’re doing things together with many smaller startups. Tonic is a vendor that we’ve recently started working with to enhance our ability to get information from our patients digitally in advance of their visits, whether virtual visits or in-person visits. So, essentially substituting for that clipboard, not just for administrative or rudimentary data, but really specialty specific data for things that providers need to know in terms of interval changes or things that have occurred since the patient’s last visit. One last example I’ll use is around voice technologies. We’re feeling that voice is going to play an important role in healthcare, whether in a inpatient setting or even in the patient’s home.

We were one of the first organizations in the country to build a HIPAA compliant Alexa skill, on Amazon’s platform. We implemented a tool that allows families with patients who underwent cardiac surgery to be able to do follow up together with us via voice, via the HIPAA compliant Alexa skill that we built. And so that was something we piloted late last year and we continue to work with that now. So, it’s just a small sampling. We’ve got many other examples, but we really do take digital seriously and think it’s where things are headed for healthcare.

PP: [00:08:59] That’s very interesting and great background. I have talked to a couple of your peers who are Chief Information Officers and Chief Technology Officers and other children’s hospitals across the country. And I’m struck by the similarities, but also by the differences in the needs of their individual patient populations. And the one thing that I didn’t know about earlier and which struck me is something very unique to children’s hospitals, it’s not just the child that is your audience. Your audience also includes their parents. So, you’re serving two different groups of individuals, one is actually receiving the care, but the other one is equally important stakeholder in care. How does that influence your choices when it comes to adopting digital technologies?

DN: [00:09:52] I absolutely think that plays an important role, Paddy. And it’s one of the unique aspects of pediatrics, obviously not unique to Boston Children’s Hospital or any pediatric organization. We always like to say that there are two patients, there’s the child, but then there’s the child’s parents or caregivers and that’s your other patient. So, it’s absolutely something that adds an interesting twist to many of our digital outreaches. For things like telehealth, in some instances, you’re dealing with a parent who is not in the same location as the child or potentially one parent is with the child. But the other parent is right at work and they want to be looped in. So, by default, we need to think about a telehealth platform that’s able to loop in more individual on the patient’s side, and so that adds an interesting twist. There’s also lots of other considerations around the privacy aspect for just basic things like let’s say we collect cell phone numbers of the patient or the family to communicate with them. If it’s a teen patient then they may be arranging for care that is sensitive and they don’t want their parents to know about, which in some states in particular is their legal right too. We’ve got to think very heavily about, whose cell phone number is this that’s in our system. And we need to be very careful around whom we communicate with and whom we don’t. So, just sort of basic things like that really do add a lot of twist to this that make things much more challenging, but fun and interesting, too, as well.

PP: [00:11:41] You are in one of the big metro markets in the country – Boston. When you look at your patient populations, you look at the technology choices in front of you especially, and you mentioned this interesting tool, which is like a digital clipboard kind of a tool. When you start looking at tools and technologies like that, especially at the front end and digital front door, if you want to call it that, how do you go about assessing these tools? What do you look for that will be different from if you were looking at the same tool from the context of a more conventional health system?

DN: [00:12:18] Because of the type of patients we’ve got and some of the unique aspects of the care that we provide, I think it’s extremely important for us and for similar types of organizations to have a multidisciplinary approach to assessing the options out there, whether it’s digital front door or any of these digital tools. To think that IT is going to be able to do this type of thing on its own is just not going to work. And it’s not just the doctors either. I’d add that we really do try and be as multidisciplinary as we can. So, we include lots of nurses in our evaluations, social workers, translators or rather interpreters. We include all of them in our assessment of new technologies that we’re evaluating for possible implementation, because each has a perspective and a need when it comes to these tools. Obviously, it depends on the particular use case that we’re talking about. But I think getting everyone’s opinion is absolutely critical in making sure that we choose wisely when we do. The other thing that we at Boston Children’s have always done is – ‘try before we buy.’ We test and pilot a lot of things. We have an innovation and digital health accelerator program. And within that group, we really do try and partner with many organizations and try to do a little proof of concept trial runs, pilot initiatives to see whether or not the technology is going to be able to scale and serve our needs. I think between those things, getting lots of eyes and assessments of the technology, as well as doing a bit of a trial before scaling it, are two important aspects that we can be sure that the choices are going to work for us.

PP: [00:14:17] I was going to ask you about how you harness the innovative technologies out there and sounds like this is a way for you to try before you buy and manage the risks or the technology risks as well as the financial risks involved in committing to some of these innovative programs and innovative technology solutions.

DN: [00:14:37] Along those lines we fully expect to have many of them fail at that pilot stage. That’s almost intentional I’d say. If we’re not failing at some of them we’re probably not extending our reach as broadly as we should.

PP: [00:14:51] I’ve heard some of my guests tell me that if you’re going to fail, fail fast and move on. So, you’re not lingering on something that’s not going to work, but you’re moving on to the next thing which is more likely to work than reducing your risks and minimizing the financial impact of these decisions as well. In that context, what is the role of enterprise, specifically, EHR systems. We’ve seen EHR systems evolve from what they were a few years ago to more of digitally enabling platforms. A lot of front end digital front door kind of functionalities are now available with your platforms like Epic and Cerner. When you look at those, firstly, what do you see as the central role of the EHR for enterprise like yours? And how do you view them in the context of digital health innovations?

DN: [00:15:46] We absolutely see EHRs as of the core repository for our patient care. There’s really no other way around it. And I should say that we look to those vendors because we’re still in a bit of a unique position at Boston Children’s, where we have both Cerner as well as Epic primarily for our rev cycle and kind of backend processes and Cerner for our clinician-facing functions. So, we do look to those platforms, first and foremost, to see what offerings they have because the last thing we want to do is start to layer additional vendors and additional technologies when our core vendors can accommodate our need. But assuming that thing that we’re after is not provided by them, we like to see EHR serve as the ultimate repository for interactions that might occur with that third-party digital tool. And we also like to see the data interaction with the digital tool be as easy and seamless as possible. So, by that I mean, let’s hope that the Cerner or Epic platform has exposed the data that’s required via APIs via FHIR. Let’s hope that the third-party vendor is utilizing those APIs and can accommodate them and in essence sort of lay on top of the hour in a way that makes it seamless for the provider. So, as much as possible to integrate into the workflows that are part and parcel of the EHR platform. So again, thinking about SMART on FHIR kinds of applications.

PP: [00:17:29] And you touched upon something that obviously is central to making this entire ecosystem of applications work seamlessly, which is the notion of integration, interoperability, if you will. And we’ve come a long way in the last few years. It used to be that there was a lot of frustration, maybe a few years ago about the lack of interoperability. But we’ve come quite a way since then. I still hear though that it is a challenge. And so, from that standpoint, and you mentioned early on that, you’ve seen the telehealth visits go up significantly since the pandemic.

And I’ve talked with health systems where they’ve had to put in telehealth platforms at short notice because they really didn’t have a telehealth program. And now they’re seeing that they are well integrated with the backend EHR systems and they’re having to go back and revisit their choices. What has been your experience with regards to the interoperability challenges and the technology choices that you’ve made? What’s your advice for your peers out there who are facing these issues?

DN: [00:18:33] Yeah, this is challenging because in theory the API push that’s occurred should have solved many of these problems. We should have data liquidity everywhere. It’s now mandated in 21st century cures and so on. But as we all know, the reality is that we’re only just starting and we’ve only got certain data elements that are exposed by the vendors. And we have many instances in which we really tried to just say, no, we’re only going to use FHIR. We’re only going to take advantage of these interoperable features that have been added. And yet we inevitably will end up recognizing that we need some data element or some aspect of the core system that’s not yet available. And so, we need to revert to things like HL7 and so on. So, I think it’s still a work in progress. I’m encouraged by the forward steps that we’ve continued to see the vendors make, as well as the third-party vendors and startup companies that are building upon those. So, I’m encouraged and I think that will eventually get there. But for now, I think we’re still in this sort of middle ground place where we’ve still got to rely a little bit on our tried and true old interfaces and previous approaches that we took. The one other thing that we’ve taken quite a bit of an advantage of, after a lot of investment over many years, is to establish an enterprise wide data warehouse that we still put the vast majority of all of our data into. Not just our clinical EHR data, but lots of other additional data, social determinants of health kinds of administrative data. And in many instances, we find that we run things, whether analytic kinds of tools or other sort of AI based kind of efforts. All are run of from that enterprise data warehouse, for which we’ve developed a data dictionary for. So, I still think there’s a purpose for that kind of thing within our organizations. And that’s also helped us quite a bit as we thought about some of these emerging tools and as we’ve tried some of them as well.

PP: [00:20:56] So are you looking to use that enterprise data warehouse now as the single source of truth, if you will, for applications that want to integrate into your system through an API interface?

DN: [00:21:10] We absolutely use the single source of truth. We tend to try and avoid using it for operational or for real time kinds of purposes. But absolutely for analytics kind of efforts, for machine learning efforts where we want to train new algorithms and so on. We are absolutely looking to our warehouse for those kinds of feeds.

PP: [00:21:32] Very interesting. So, I want to go back to the question of startups and harnessing the innovation ecosystem , if you had to give them advice, if they want to come in and be a part of your journey at Boston Children’s, would you tell them first and foremost to have a SMART on FHIR kind of an application that integrates seamlessly with the EHR system? If so, what else would you tell them if they want to start working with you? What is your advice to them?

DN: [00:22:00] I absolutely do think that gets them a good foot in the door. Being one of the places in the country that helped to establish SMART on FHIR and really push for it, that definitely endears themselves in our eyes if they come in with that out of the gate. But I’d say beyond that is they need to have a grounded background in terms of what the clinical problem is that they’re trying to solve. One thing that we detest, and that’s a strong word, but it is when we’re approached by vendors who have an interesting technology or technological approach to something. But they’ve given no thought or have no background in the real challenges that our clinical care teams face as they take care of our patients. And so, having either someone on their teams themselves or if not perhaps having spoken with organizations to get that real-world feedback, is this something that’s really going to help our clinical providers. And is it going to work in a clinical setting? Those are elements that they had to have thought about ahead of time and that their products have to address. Well, because if there’s one thing that irks me is technology for technology’s sake. I don’t like just putting in a shiny new object because it’s an interesting new technology. It’s got to be clear what clinical problem it’s solving. They need to have tailored their product with that in mind. Now all of that said, I will absolutely say that I subscribe to the classic Steve Jobs idea, which is – consumer doesn’t know what they need or what they want. And in some cases, I will say that there’s opportunity for that in healthcare. We need to have our eyes opened to new ways of doing things and to new approaches that we haven’t really ever considered before, simply because we’ve never done it that way. I do think, having said everything that I just said about knowing the clinical environment and accommodating, that there is a place in some instances where a new disruptive approach would and could work. And so, we’re open to that at the same time.

PP: [00:24:16] That’s great advice then. And I’ve heard many of your peers say the same thing, that technology for technology’s sake is really not going to cut it. And startups who listen to my podcast take note of these comments, by the way. I think this message is coming through very consistently to startups from the CEOs and others who are looking at evaluating these solutions. So, let me switch back to the digital transformation program at Boston Children’s. Can you share a little bit with us about how you govern your digital programs in terms of the org structure? Do you have a separate budget for it? How do you prioritize the initiatives?

DN: [00:25:00] Great question, Paddy. So, first and foremost, I should say our digital initiative has been marked as an enterprise wide strategic goal and has been there for the last several years now. So, this is not just an IT goal. This is not a CIO sort of dream. This is a top-level enterprise level strategic goal. And I think that’s incredibly important because many of these digital transformations are disruptive for organizations. It will lead to new ways of doing things, pushing our providers to care for patients in ways that they’ve not before. And so, without that top-level leadership being on board and willing to push in some instances, you won’t be nearly as successful as if you do have that support so that’s first and foremost. With respect to the financing, to underscore the importance of this and the fact that it’s been marked as a strategic goal. The organization has set aside strategic level funds to support our digital sets of initiatives to the tune of tens of millions of dollars. I won’t say the exact amount, but tens of millions of dollars over a multi-year period so that we don’t sell ourselves short, because I appreciate that many organizations have tried to do this. But have said we’ll just do it using your existing budgets. I don’t think that’s going to work. I think to do this properly, you really do need to make an investment with dedicated resources and a big push from an organizational perspective. So, that’s the money and that’s the top-level goals. With respect to the ‘who,’ this is clearly one of my top-level goals and strategies from the IT and the CIO perspective. But we’ve got an interesting organizational structure at Boston Children’s where we also have a Chief Innovation Officer. I affectionately refer to him as the other CIO and we really are locked arm in arm on this set of initiatives. In addition, we’ve got a Chief Digital Transformation Officer and she’s been a critical part of this digital set of efforts as well. And so, we all partnered together and we each have got our respective teams. We try and ensure that we’re going fast. And this is primarily the part that our Chief Innovation Officer is overseeing. He oversees the digital health accelerator that I mentioned before. So, this is where we’re really piloting and evaluating lots of potential new opportunities. But we work together and say to our Chief Innovation Officer, who is John Brownstein, what are the kinds of things that you think we should be testing? And he tells me his list and then he turns to Jean Mixer, the Chief Digital Transformation Officer, and myself to say what will work well within our organizational IT infrastructures. Because the last thing we want to do is try a new digital approach, new potential tool, only to find that it’s going to be a horrific fit for the rest of our IT infrastructures and would be something that we couldn’t ever support moving forward. So, we like to work together and talk a lot together, even in those initial piloting phases. This is to make sure that what’s being evaluated initially by the digital health accelerator is something that could eventually scale if those initial pilot units or pilot efforts are successful. Because then we’re going to have a handoff from the digital health accelerator over to the production IT department that I oversee. And it will become that group’s job to continue to nurture and support that tool and expand it to the rest of the organization. So, there’s a lot of collaboration and partnership between teams, and I think that’s incredibly important. You cannot sort of spin off a digital effort under a chief digital or whatever title you want to call it and have them go off independently and hope that’s going to yield a result that will eventually work well for your organization. You’ve got to collaborate and collaborate early.

PP: [00:29:26] Fascinating. One quick question on that. Is it fair to say that whatever technology decisions you’re making today, especially in the context of digital health, they are out of the game, they are meant to be eventually enterprise level decisions and not departmental or one of kind of decisions? Do you keep that as an end in mind, even as you start your early stage evaluations with some of these solutions?

DN: [00:29:53] We definitely do Paddy. That’s not to say that there are not some ideas and proposals for things that are centered around one particular group. But we like to evaluate them and think about them with an eye towards as to who else or what other programs might this be applicable and useful to. Because we don’t want to have 20 different small-scale initiatives or small-scale technologies that are going to serve the needs of many individual groups. I’d rather deploy five, but each of which could be applicable across multiple specialties and multiple areas within the organization.

PP: [00:30:36] We’re coming up to the end of our time here, Dan. One last question. You have obviously gone through a tremendous journey and from all of the examples that you’ve shared with us, it’s been a really eye opening, at least for me. Based on all of this experience, if you had one best practice that you would like to share with your peers in the industry, what would that be?

DN: [00:31:01] I think that I alluded to it already a little bit and it probably goes back to my background as a clinician. I’m a pediatric endocrinologist. And until this transition to MaineHealth that I’ll be taking, I’ve still been clinically active over these years. So, I’m a clinician at heart. I think the advice is that the technology leaders absolutely need to partner closely with the clinical side of the house. I’ve seen so many times initiatives that we ourselves have worked on that were not successful. And the reason was that we did not partner as closely as we needed to with the clinicians who are ultimately going to be using or at least taking advantage of the technologies that we put in place. And so, making that collaborative effort, whether it’s together with your CMIO or CNIO or whomever the clinical areas are, make that connection early, make them co-lead the initiatives with you. If not, lead it absolutely on their own. These need to be led by the folks that are ultimately going to get the benefit out of them. And I think when those things are attended early in the process, I found that the end result is more accepted and more successful overall. So, I guess that’s my one best practice that I’d encourage everyone to remember.

PP: [00:32:29] Fantastic. In fact, that’s a great note to end this podcast discussion with. Thank you so much for setting aside the time once again and thank you for the fascinating conversation. And once again, all the very best to you in your new role.

DN: [00:32:43] Thanks so much, Paddy. I really appreciate the opportunity for chatting to you today.

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

dan-nirgin-profile-

Daniel Nigrin, MD, MS, is Senior VP and Chief Information Officer at Boston Children's Hospital, Assistant Professor of Pediatrics at Harvard Medical School, a senior member of the Children's Hospital Informatics Program (CHIP), and a practicing member of BCH’s Division of Pediatric Endocrinology. He received his undergraduate and medical training at Johns Hopkins, followed by medical informatics training at MIT. He is Board-certified in both Pediatric Endocrinology and Clinical Informatics.

Dr. Nigrin has used his dual training in medicine and medical informatics to advance the state of IT at one of the world's preeminent pediatric institutions. He has led BCH through a dramatic transition from manual, paper-based processes, to digital ones that address many previous shortcomings.

This transformation was recognized when in 2010, HIMSS Analytics awarded BCH its Stage 7 EMR Adoption Score designation, one of only eleven organizations worldwide to do so at the time. With this digitization has come increased risk however, especially in the form of cyberattacks; during Dr. Nigrin’s tenure, BCH successfully defended itself against a hacktivist attack by Anonymous in 2014, and eventually resulting in the capture and imprisonment of its attacker.

As a practicing physician, researcher, and information technology executive, he continues to be in a unique position to put into practice cutting edge technologies and ideas developed by BCH’s Innovation & Digital Health Accelerator (IDHA) and CHIP, bringing advances to patient care practice, quality, and research, but all the while keeping in mind the needs and workflows of busy clinicians.

Beginning in January, 2021, Dr. Nigrin will begin serving in a new role, as CIO at MaineHealth, northern New England’s largest healthcare system.

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.

We must start shifting our mindset from telehealth or virtual care to just online care or online health

Episode #66

Podcast with Craig Richardville, Chief Information and Digital Officer, SCL Health

"We must start shifting our mindset from telehealth or virtual care to just online care or online health"

paddy Hosted by Paddy Padmanabhan

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In this episode, Craig Richardville discusses how they have created an organization within SCL Health to design digital programs for building new levels of engagements keeping the future in mind. He also points to the need to empower patients, one of the most underutilized resources in the healthcare industry, and how one can be part of SCL Health’s digital journey.

At SCL Health, digital is not only about transforming patient experience but also about consumers – those who are not yet patients. One of the key themes for digital programs at SCL Health are the digital front doors. Digital front doors are the entry points for potential patients and consumers into SCL Health’s environment.

According to Craig, it is time to start shifting mindsets from telehealth or virtual care to providing online care, just the way we access other services in our life. The movement for virtual encounters or relationships will certainly continue to accelerate. Digital health startups, therefore, must offer a strategy of ‘low calculated risk with the potential for huge returns’ for healthcare systems.

Our Partner:

Craig Richardville, Chief Information & Digital Officer, SCL Health, Children’s Health in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “We must start shifting our mindset from telehealth or virtual care to just online care or online health”

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, Craig Richardville, Chief Information and Digital Officer for SCL Health. Craig, thank you so much for setting aside the time and welcome to the show.

CR: Thank you, Paddy. I appreciate the opportunity.

PP: You’re most welcome. So, Craig, let’s start with this. Maybe you can tell us a little bit about SCL and the patient populations that you serve.

CR: Yeah, SCL is actually a merger of two healthcare systems. One is the Sisters of Charity of Leavenworth, which is based out of Leavenworth, Kansas. And the other was Exempla Health based out of Denver, Colorado. And thus, SCL is headquartered in Broomfield, Colorado. It’s about a three-billion-dollar Catholic faith-based organization. Just north of Denver, we serve three primary markets. One is the front range market, which is the greater Denver area east of the Rockies. One is western Colorado. So that’s on the other side of the Rocky Mountains, more towards Utah and the last is the State of Montana. We still have several assets in Kansas. Those are more safe haven type facilities. But the three primary markets are front range, western Colorado and the State of Montana.

PP: Thank you. That’s a great background for our listeners. So, let’s talk a little bit about your role, Craig. So, you are the Chief Information Officer and the Chief Digital Officer for SCL. Can you tell us how that title came about and also tell us a little bit about some of your major digital programs that you’re currently operating at SCL.

CR: Well, I arrived at SCL Health in February of last year 2019. At that time, we had some digital activities but really didn’t have a digital executive. So, what I did is I went through our restructuring process evaluating the leadership team. I had spoken with a lot of my colleagues, primarily the chief marketing officers. We put together and developed a Vice President of Digital Services, and we put that position within the IT department. And so, as part of that maturity, we also think that buying the assets of both marketing and IT, but both had heavy hands and put those into the one team. And then both the Chief Marketing Officer and myself and the executive sponsors of our digital health program sit together. The way that title came about was by merging those together we really created a new organization. We call it, ITDS, its information technology. So, it really respects a lot of the history and what it really came up through is information services or IT. We also added digital services – so its ITDS, which is the foundation for our new levels of engagement of what the future will look like. Some of the projects that we put the program together have to do with really several different themes. One is the digital front door. And really the digital front door is a way for us to not only more heavily engage with our patients, but also open up that engagement and that access to our consumers. We also have a digital workforce component. So, we’re using things like RPA and chatbots to automate the services that we provide. We are also looking at Salesforce Health Cloud to be an area to get a 360 view of our patients. So, we do have engagement with our patients or with our consumers. We have many aspects of the relationships that they have, both within healthcare and specifically within SCL health.

PP: That’s quite a comprehensive mandate as far as digital goes, especially from the point of view of transforming your patient experiences. Do you consider any of your IT transformation initiatives at the backend, things like cloud migrations, data analytics? Do you consider any of them to be a part of your digital program?

CR: Yeah, actually, they all do support. We have 10 programs that we actually kicked off. Digital is one, technology is another. For example, Google is one of our partners. What we’ve done is we’ve actually put those programs together. So, they do have a unique set of responsibilities and projects that are led by those programs, but they all are interrelated. So, we have one within our technology that’s called the SCL cloud that will leverage a lot of the Google Cloud Platform, sometimes called GCP. And we’ll also look at the other cloud services and our data center transformation is all being a component of that. So, the digital assets that we’re producing is sending out to both internal customers and external as we will have a more moderate foundation on the back end.

PP: Now, digital itself is a term that has multiple definitions across the healthcare ecosystem. You already gave us a very good comprehensive overview of what you’re doing from a patient facing a digital front door standpoint. Do you define digital primarily in terms of patient experience transformation? Can you tell us about one or two things that define the way you’re transforming your patient experience using digital front door as an example.

CR: Yeah. The way we’re defining digital health is it’s all aspects of our operation. So, one that you mentioned is certainly the patient. It’s a big aspect of how we’re focusing a lot of those resources and those investments on that patient experience and engagement, but also on the consumer side. So, those who are not yet patients, how do we get them into our ecosystem and to be able to deliver services back to them? We also look at it and we have a stream of work that’s headed towards our providers. We’re looking at things like conversational AI, other types of automation that will help the providers be more efficient and effective in their work. Artificial intelligence for us fits within that digital aspect for the provider piece and also for our internal customers, for example, our employees, our associates, or those contractors that do work within our health system. How can we continue to evolve that relationship and continue to progress the engagement in a more effective and efficient manner? We look at the digital front door as a place to have the external patients or potential patient/consumers enter into our environment. With that comes easy access, make it very efficient, start to move things to be more towards self-service. Things that we’ve seen in other industries like finance and in retail, where a lot of the historical clerical type, commodity kind of work gets moved back into the customer hands. Because here they actually can do it better and be efficient at it and can do it any time that they prefer. All these kind of pieces are components of the digital front door as well. We’re also allowing easier access to our providers, more of a roadmap of how to get to the appropriate level of service, whether it is a eVisit or a virtual visit or a clinic visit or an ED-visit. All those different pieces we are building in to make it a lot more precise and a lot more personalized with our relationships.

PP: Right. And I think you alluded to a very important aspect of it, which is ensuring that caregivers and providers are appropriately enabled when you talk about digital programs. And that’s actually a great segue to the next topic that I was going to explore with you. We’ve seen in the last several months, ever since the pandemic hit early in the year, there’s been a dramatic shift towards telehealth modalities that was essentially forced upon us by the pandemic. But it’s also going down a little bit as patients start coming back into hospitals. Do you have a viewpoint on where we are headed with regards to a long-term shift towards telehealth and virtual care models in general?

CR: I think from a general perspective, the movement for these virtual care encounters or relationships will certainly continue to accelerate as well as get a lot more difficult in the types of interactions that we could have. Starting today and more or less with very stable commodity kinds of services, what I would term by the level one, level two, and we start to see some shift, I believe, within the emergency departments where some of that care was actually more appropriate and more cost effective at a lower cost setting. And some of those are actually moving into virtual care, for example, or into a clinic visit versus coming in through the emergency departments. As we continue to mature that and get more part of our job as we get more tools into the hands of our patients or in the hands of our consumers. I think we’ll continue to see that kind of shift. I do like to draw an analogy to things that are happening in other industries. I like to be able to learn from other industries, apply them to our healthcare. I think the reverse is probably true on their behalf, but similar to how we see kind of retail working our way through where you have a large disruptor coming into the market. Not everybody who was not into the online type of service moves into the online service. I think we’ll see a continued progression of how we can advance our services and the access to those services by using telehealth or virtual care. For me that brings up one point. When I refer to other industries, I don’t refer to them as I have a virtual encounter with my banker or my financial advice or virtual encounter with a store. I call it online. It is really the same level of service that I’m getting, but at a more cost effective and convenient manner. So, I think as an industry, we start shifting our mindset from telehealth or virtual care into that just online care or online health. It’s just the way that we access other services in other parts of our life. I think that will be a big mental shift for ourselves as well as our consumers and patients to continue to evolve and advance those services.

PP: It’s interesting you mention other industries. You mentioned retail banking. I just published an article talking about how healthcare is beginning to borrow from the best practices of these other sectors, which are much further ahead in terms of their digital engagement with their consumers. In fact, a lot of healthcare is already online. And with the rise in the need for contactless and low contact experiences, it’s almost going to feel like a drive through experience in some ways. If you don’t have to come into a facility, if you don’t have to come in contact with anyone, you just don’t need to come in for exactly what you need and you move on. It’s an interesting new dynamic that I imagine has developed purely as a result of the pandemic, because a few months ago, who would have thought that meeting your doctor would be a high-risk experience? But here we are. Let’s talk a little bit about the tech. You already mentioned several technology partnerships – Salesforce, Google and some of the others. But when you come to technology choices in implementing digital programs, specifically, let’s say, a digital front door program. How do you go about making your technology choices? And what do you see as the role of core transaction systems, enterprise IT, such as your EHR system? How do you do the tradeoffs and how do you really go about making your choices?

CR: Yeah. So, a couple of things that I think. One in terms of our technology choices that we’re implementing, it’s really big for me to have trusting relationships, utilizing the network that we have built up over a period of time in our careers. And really start to look to see that for focusing upon people who are more in a partnership perspective and not necessarily a vendor. And things that are important are being very agile, being able to pivot quickly. So those kinds of companies are really, very important to how we want to progress and move forward with. We can be at times be a very large vessel for people to steer. Finding people help me turn that vessel at the right time and at the right speed. And hopefully be able to then serve the customers in a way that’s unique and different from my competitors, at least for a period of time until they catch up with that work. So, the partnerships and how we assess who we work with is an important piece for me. As part of that, we actually have five major partners that we do work with. One is that you mentioned was Salesforce another one is Google, big partners of ours. We also have EPIC, which is a big partner. Oracle is a big partner and ServiceNow is a big partner. So, those are the five major companies that we deal with. And we have a lot of peripheral companies that kind of evolved around that. I think that’s part of our job as a partner as well as to be able to educate and help them and be a lot more nimble in certain areas of their work, where they’re also learning to deliver better services back out to their customers. And the Enterprise IT side, that’s not going to go away, that will be with us. And part of our job is to make sure, how do we leverage the data and the assets and the workflows that are built within those large systems, whether it’s the EHR system or other ERP system or your workforce or office productivity systems. How do you get your digital pieces to be part of that? One component is to make sure that you try to work with your partners to help them so that it is integrated and fully integrates into the workflow. And that may be something that may take a couple of years. In the meantime, you may have to work with some smaller, more agile companies that are newer into the industry or in your services. And in some cases, they become a bridge strategy for a period of time, two years or three years, until your major partner can actually catch up. You’ve got to maybe jump out and fill in some gaps that way, or in some cases they may develop to be a long-term partner moving forward. And you help expand their relationships. As you know the advancements that are happening with these investments are quite large and we’re moving toward what would be more of an annual or sometimes every two years types of large upgrades or movements. And because of the cloud services, the software as a service concept, what we’ve all learnt to adjust with our smartphones, updates come very frequently and sometimes a couple of times a day, if not a couple of times a week. Those things will continue. So, for us to move from annual event to that would be called upgrades to things that are updated continually to keep ourselves very current. And with that those investments are coming out to be that at the same time as some of our newer digital assets integrated and the only way to do that is to have a large number of frequent, smaller updates versus large upgrades.

PP: Yeah, and I imagine that technology firms are going to be listening to your comments and are going to take careful note of what you just said. It seems to me that you’re looking at the marketplace in a way that gives you the option to swap out technology providers if you need to, especially the ones that are young and maybe innovative today. But they need to scale up and they don’t scale up or one of your strategic partners comes up with a solution that is superior and integrates better with your internal ecosystem, that maybe the direction you go. So, that obviously raises some very interesting questions and some implications, both for your internal organization as well as for the startups. So, does this mean now that you’re going to be entering an era where it’s going to be plug and play easy to replace and that’s going to be the order of the day? Is that what’s going to happen in the next two or three years?

CR: I think, if you look at it some other aspects of our life like an automobile for example. There’s components of the automobile that really work well together. And in some cases, those different components themselves may not be the actual best in class for that piece. But when you look at the whole workflow together, it actually is what I want to go ahead and to be able to utilize, for example, GPS. When GPS first came out it was very nice, easy to use but also very dated. Some of the maps you were getting on your GPS were couple of years old. So many of us bought like a Garmin to stick on, something to put on your windshield. It was not as large, it wasn’t integrated, when somebody called on the telephone, it didn’t tone-down, the speaker would still work. So, there was a piece that we put in there for a ridge. And then what we started seeing as in the digital aspect, the smartphones and Google Maps, etc., a lot more currency happening on your phone. So, what they did, they took a lot of the infrastructure that was built for your maps, that was built into your GPS system that you paid a lot of money for. And then now they take the agility of what was built within your smartphone. And now you’re connecting the two together. So, you are using the features from Google or Apple. Now, the things that are most current and are right on my phone, I can now bring that kind of guidance in that kind of intellect into my GPS. So, I no longer have this little one sitting off to the side to help me navigate better. I’ve actually taken now something more modern, but still rather small and personalized and something more what I would call industrial strength, both into the car and now I linked them together and put that in place. And I like to use GPS as an example to just kind of like artificial intelligence. So, many of us know in our mind where we want to go from point A to point B, but because of weather, traffic, other type of considerations that will happen throughout the day they will reroute you and take you to the most efficient way. And that’s a simple way for me to explain what is artificial intelligence? Well, just think about your GPS or another way for me is to think about what happens when you listen to music or Netflix, they offer you other programs that is similar to what they’re learning from what you listen to or watched in the past. All that we already have within our personal life, we don’t need to think twice about it in many cases. So, as we start to build that kind of knowledge and that intellectual capital into the workflow of our professional life, I think the outcomes are going to be tremendous.

PP: Yeah, I love the analogy of the GPS and how different generations of GPS devices and applications and generations we’ve seen in a relatively short time. And even in the context of the car, that’s a fantastic example. You mentioned AI. So, let’s talk a little bit about emerging tech. What excites you today about the emerging technologies out there? What kinds of technologies do you think are going to make a difference in the way healthcare is accessed and delivered in future?

CR: Well there’s a few that we are certainly very engaged with and probably others will be coming down the road that I can even think of. But at the moment, there are several ones that I would highlight. One is voice. I do think the voices can continue to be a great user interface. We use it today at home, with our Amazon’s Alexa or our Google Home to be able to use our voice to build an interface with other network systems, for example, whether it’s your shades or your climate control within your home. Everything can happen through voice. I do think the digital workforce is a big piece to keep an eye on, and that really is kind of taking a lot of the lower commodity type services and automating those and allowing to free up those human resources to do more advance type of work. So, I think that whole piece will come into play. With AI we’re just scratching the surface of what AI is, and I think some people have certainly different versions of what that is. But there is a saying that was said to me a couple of years ago, and it really stuck with me. I think the evidence so far really supports that artificial intelligence, which is really intelligence, but it won’t replace providers, but providers without artificial intelligence will be replaced. So, artificial intelligence by itself is not going to be the top outcome, providers by themselves, the humans by ourselves know it’s not going to be the top. But if I can overlay both of those together, so I get the best of both worlds. The results of an outcome of something AI may be filtering through or after a provider some more AI comes out on top and does more of a peer, check the automation. All that kind of stuff I think will end up with a higher outcome on the backend. I do have a big belief that I’m not a big fan of customization, as many people know, but I am a big fan of personalization. And I think as we get more precise with our medicine, so things like what’s in your DNA and your genetic makeup might be different than mine. So, those kinds of ways that we treat you, even though we have the same disease type, the other determinants, whether they’re social determinants or genetic determinants, will actually may be have a different way of how I’m being treated. And I also think the same is for nutrition. So, I think things of how we do to stay healthy and well, that may be different for you than me. That’s how we get more science around some of this art. So, it’s a lot more specific, a lot more precise and also a lot more personalized.

PP: Yeah. So, Craig, you and I we live in the world of technology. We get excited by all this stuff. I believe that voice is going to be huge in future. So, AI, voice, automation, RPA and we’ve talked about all chat boards. We talked about all of that. What about the end user? What does it take to really make sure that they are just as enthusiastic in adopting technology solutions, in their access to care or in delivering care, whether it’s a patient or whether it’s a caregiver? How do you make sure that all this technology really helps them do their jobs better? We hear a lot about what the EHR systems did over the last 10 years. And I don’t want to go there, but I’m just curious to know your thoughts on this.

CR: Yeah. If you look at the healthcare ecosystem similar to some of the other analogies we did in the past with other industries, the patient is probably the most underutilized resource. He or she given the right tools, will make a lot of the great decisions as opposed to a provider at a more expensive rate to make those decisions. And we see that in other things with the retail or financial services, etc., a lot of that stuff. Given the right tools to use he or she wants to be engaged, wants to be involved and necessarily want to be an order taker. They really want to be engaged and they want to be part of the conversation. I think it’s our responsibility to give them the right tools, to allow them to become a lot more engaged, access to their own data to allow them to be a lot more informed about what data is being used. If you look at it when you get right down to a health care provider, we’re really what our product is really data. We produce data, tremendous amount of data, and then we inform people make decisions based upon the data that we produce. We don’t produce them a car or vehicle. We don’t produce a widget, but we actually produce data. And then all of our decisions that is driven through how we best utilize that data. And the more access we have to the data, the better decisions that we’ll be able to make. And I think that when it goes to going back to maybe some of our resources on the provider’s side or on the systems support side, those are our associates. Very similar, part of our job is to get people to really look at their contributions and how much they’re actually delivering to the service. So, if I can take away some tasks or automate or provide better decision support that will have better outcomes at the end, that’s my responsibility to help make their jobs easier, more effective and more efficient.

PP: When startups who are listening to this podcast want to know or come and ask me how do I get to be a part of Craig’s digital journey? What is your response to them?

CR: Well, it’s very interesting. There’s probably still a lot more of an art than a science for sure. There are a lot of forums out there now. I think a lot of our virtual stuff has increased the amount that we can attend and be part of whether somebody like myself who might be a purchaser or partner of those services are sitting on a panel or part of a certain association. I think they’re engaged in a support of what that is, ask good questions, provide good answers and insights that maybe will get us start thinking a little bit differently. It only takes one little piece of something to catch somebody’s eye to get that kind of glean where it’s like ‘I want to learn more about them,’ and because of the volume coming in and the time constraints, we quickly say no. But it is a very competitive landscape. There’s a lot of people offering similar types of services. So, you got to somehow be able to show me how you are unique, distinct, how you can help provide something quick for us. These are not like “long-term investments.” I need a quick contribution. A quick return for these kinds of things may mean that you have to offer something that in the long-term business model may not be great at all. But to get yourself there, to get a positive client, a great case study, I think there’s several of us, certainly in the industry that are very acceptance to that kind of, “low calculated risk with the potential for huge returns.” So, just trying to continue to pursue, don’t be a pest, but you’ve got to be persistent.

PP: Oh, that’s great. That’s a great quote. And I’m certainly going to use that. Well we’re coming up to the end of our time here, Craig, and I want to ask you one last question. You’ve already accomplished quite a lot within a short time I can tell at SCL, as Chief Information Officer and Chief Digital Officers. You now have a unique perspective on the digital transformation journeys as seen from point of view of a health system executive. If you had one best practice that you would like to share with your peers in the industry, what would it be?

CR: Well, I will share two!

PP: Go right ahead! Go ahead! I’ll take the bonus.

CR: So, the first one for me is that these aren’t projects, these are programs. Projects have begin dates and end dates. In your programs, you really continue to evolve and mature and you’ll have many projects that are part of these programs. So, this is not something that if you reach a certain point, they’re successful, that’s just the launching pad for taking what the next point is. So, the digital piece for me is a journey that will continue to evolve and mature. You must accelerate and have proper governance and measurable outcomes. Sometimes some people can get lost in the actual work itself and yet we don’t get reward on best efforts. We get rewarded on our contributions, the outcomes that we influence. And that leads me to the second one, which is some people say what is your digital strategy and I’m like, I don’t have one. That’s the same answer I had 20 years ago. There’s just one strategy, the strategy is that of your company, your system. So, I have a strategic plan that was approved by our board, developed by our senior team, it has imperatives and initiatives. What I am is actually an accelerator and a contributor to helping to move that work forward and achieve some of those results. So, I am just a tool to help our strategy. End of itself, I am not a digital strategy and I don’t have a digital strategy. I am here to support the healthcare system strategy that has been put together. I think that’s a clear distinction that you are not the end game. Again, tying back to the first note. You’re here to support the patient, support the providers and your communities. And part of all that comes into you contributing to the company’s strategy. But you’re in and of itself are not the strategy.

PP: That’s so beautifully said. Well, I guess we’re going to have to leave it there for today. Craig, thank you so much for setting aside the time to talk to us. And I look forward to staying in touch. Thank you once again.

CR: Thank you. Paddy, I appreciate the conversation and looking forward to our future.

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

Craig Richardville is the Senior Vice President, Chief Information & Digital Officer, at SCL Health. His responsibilities include leading all aspects of the health system’s information technology and digital services strategy, operations, information security, and analytics assets in leading the system’s digital transformation and information automation.

Previously, he served as Owner and President of Richardville Consulting LLC, and served as Senior Vice President & Chief Information and Analytics Officer at Atrium Health for more than 20 years where he transformed the growing company into a national leader in the effective use of technology, data, and digital services as a differentiator. Craig notably earned the prestigious 2015 John E. Gall, Jr. National CIO of the Year Award in healthcare. Mr. Richardville was also awarded in 2017 the Charlotte CIO of the Year and in 2020 Colorado CIO of the Year for his continued impact using technology and digital assets.

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.

For a successful digital journey, health systems must connect with different parts of their organization and focus on the core mission.

Episode #65

Podcast with Anshul Pande, VP and Chief Technology Officer, Stanford Children's Health

"For a successful digital journey, health systems must connect with different parts of their organization and focus on the core mission."

paddy Hosted by Paddy Padmanabhan

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In this episode, Anshul Pande, VP and Chief Technology Officer at Stanford Children’s Health discusses their digital journey and covers digital programs such as remote monitoring, telehealth, and how to make data useful and readily available to the clinicians.

Anshul states that for a seamless digital front-end experience, back-end IT infrastructure must be in place, and it is important to understand how the software layers are designed. Both of these helps deliver a better experience for the provider and patient.

COVID-19 has led the healthcare industry towards ‘fail fast and get comfortable with the experimentation’ approach. Anshul advises health systems to engage with different stakeholders within the organization and focus on a single mission. Take a listen.

Our Partner:

Anshul Pande, VP and Chief Technology Officer, Stanford Children’s Health in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “For a successful digital journey, health systems must connect with different parts of their organization and focus on the core mission.”

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, Anshul Pande, VP and CTO of Stanford Children’s Health. Thank you so much for setting aside the time and welcome to the show.

AP: Thanks, Paddy. It’s great to be talking to you. All the good work you’ve been doing has been well received. Appreciate it!

PP: Thank you so much. So, let’s dive right in. Could you give us a little bit of an overview of the digital programs that are currently operational at Stanford Children’s?

AP: Yes. Our digital journey has been there for many years now. We were in the forefront of what was happening from a digital perspective for pediatrics. Some of the things that we did made us realize very early on how to start investing in terms of thinking about how to do remote monitoring, how to get the data, and then how to make the clinician’s life easy in terms of being able to use the data that was coming from digital monitoring programs. Right now, like everybody else, telehealth expanded considerably for us. And the work right now has been around ensuring that we still retain very high levels of telehealth post-COVID. There’s a massive group behind the scenes to understand what happens post-COVID and what will be the barriers for us to stay at high levels of telehealth. And then how do we eradicate those barriers? Whether they are regulatory barriers, billing barriers or experience and equity barriers. So that’s really huge for us. And then besides just the telehealth and the remote monitoring portion, there’s a ton of work going on in terms of process improvement and process optimization. Also, new business ideas are emerging in terms of how we use digital to take care of patients in a different way and to integrate and connect and attract patients from all over the country, if not the world, for things that we do better than anybody else. And after that, once they have had the procedure to be able to take care of them remotely while their local physicians take care of their day to day needs as the case may be.

PP: Being a children’s hospital your population is a little bit different from adult populations. What makes your population unique when it comes to enabling care, using telehealth and remote monitoring and other digital health tools?

AP: Yeah, one of the interesting things is that kids overall are healthy. So, all the things that we as adults have that are usually tied to how we take care of our bodies or did not take care of our bodies or genetic factors, kids usually don’t see that. So, the biggest challenge is that the end for us is really low. I’ll give you an example here. We’re working on a program to be able to do electrocardiograms at home and we could give that machine to a parent and say: “you get us these images remotely.” And the end for that program is probably twelve or fifteen at most in a year. So the programs are really unique in terms of the size which also makes it more complex because the biggest challenge we have faced is that a lot of the devices are really, especially on the home monitoring front, not made for kids because the financials don’t work out for the monitoring companies to develop them. So, we are kind of an afterthought, which makes some of these things even more challenging for us to build, design, and develop.

PP: It’s interesting you say that in many ways, even though your patients are children, the users of the technology maybe the parents. You’re designing both for the children and for the parent and that makes it a very unique dynamic I imagine.

AP: Absolutely and it’s a fidelity issue too. So, if you think about just a simple thing as a weighing machine, the fidelity we’re looking for is a newborn where we’re looking at grams of fidelity, not pounds of fidelity as an example. So, that’s interesting and challenging itself. And then to ensure that a parent can handle that and then the data can be sent from a remote device back to us. So, yeah, definitely some very unique challenges in terms of getting all of those pieces to work together.

PP: Let’s talk about the technology itself. In your role as the CTO, how do you go about assessing your technology choices when you’re implementing digital programs? And what do you see as the role of the enterprise IT system, the EHR system as an example in your digital roadmap?

AP: It’s not just the EHR, probably five or six core technologies are our basis for almost everything. And any time we have a unique problem that comes from our business or from clinicians to say: “look, we want to do X,” one of the first things is to say: “okay, how do we design for X and how do we solve it?” But more importantly, with the solutions that we have with us, whether it’s the EHR or the ERP system or our telehealth platform is to say: “can these things somehow provide that solution?” And then the next part comes in, say, if the answer is no, then who can do it? At that point, it’s buy versus a build decision and in a lot of cases it is: “yes, we think this vendor can provide the underpinnings for it, but we may have to build a brand-new connector that has never been done before.” But the thought process again is use the core technologies that are available today with partners that we have had long relationships with or find a new partner and then subsequently looking at what we have to build in-house by our own developers.

PP: Let’s talk about a specific case. Today, EHR systems have evolved over the last several years and they now offer a lot more functionalities that would be considered digital functionalities. So, when you’re left with a choice of using a “native capability” from your core EHR system, is that your default or do you look at alternate solutions that may be best in class standalone solution that after all you’re in Silicon Valley, there’s no dearth of standalone solutions, innovative solutions. How do you make those tradeoffs? Where do you begin? Could you walk us through a little bit of the thinking of when you come to this kind of situation?

AP: Absolutely. I’ll preface with an example that we just brought online a few weeks ago. One of the things we were struggling with telehealth was that the whole structure around telehealth was built on a patient getting a message through the patient portal, which means that they have to have an email. And one of the things we found out from our patient community was from an equity perspective, a lot of people have smartphones, but not every smartphone owner have an email address. So, how do you ensure that you can still send a telehealth visit information or a starting URL on text. So, our answer is, well, let’s go to the EHR group and find out. Have they done something like this before? Is there a solution that they have available? And the answer is no, they don’t. I said, okay, let’s go to our telehealth group and find out if that vendor has a solution for it. And the answer was no, because if you think about it, the vast majority is using email as a starting point for a conversation, including you and me talking about it today. And then we start saying ok, we have to send text. Let’s figure out with our text messaging system provider. And they said, yes, we can, but I need this information from you. And finally, we ended up creating our own bridge. Within EHR today, a provider can say, I have a choice to start my telehealth visit by sending a message to the patient and their families via email or via a text message. That required all of that work to happen and some amount of development from our side to actually make it into a reality.

PP: Wow, these are some of the assumptions that we live in. I would never have thought that you could have a section of your population that owns smartphones but does not have an e-mail ID that is just simply beyond my thinking at least. But it’s very illustrative and informative because implementing digital health solutions, from everything I hear, is about all these small things. And you’re trying to cover everyone in your population not just sort of a section of your population and you have to take care of everybody. Coming back to the topic of the technologies that you talked about, the fact that you’re looking at four or five technology platforms as the core, including the EHR platforms. When you talk about digital experiences and creating the digital front-end experiences, there is a lot of tools that either are native to EHR or you’re getting it from the outside or you’re building it yourself. What about the back-end infrastructure that needs to be in place for all of these solutions to work well, work seamlessly for the user, whether it is a caregiver or a patient who feel like this is all intuitive, easy to use and is working.

AP: Yeah, that’s a huge problem. When we started on the telehealth journey several years ago, one of the things we were realizing very early is that this is the first time we are actually going out of our comfort zone of our clinics and our hospitals where we could actually manage that experience. We were managing the network. We were managing the device. We were managing prioritization even within the network to say this traffic should go first and we were reaching to a point where we don’t control half of the journey. We absolutely don’t control the patient’s device. We don’t control what network they are on. We don’t control how buggy or busy that network is and how many other things are running on it. And so, there are really two thought processes out there around solving it. One is on the core infrastructure side. It’s like, what can you do to make it better? And how do you solve that particular problem? And we did a lot of work on our own infrastructure side to say, okay, how do you scale up? What happens when you have to have instead of 20 visits a week to thousands and thousands of visits happening a week. Can your network and your substructures actually scale up to it? But then the second part was a conversation with the software vendors to say, how do you handle network drops? What happens when a patient moves from Wi-Fi to a 4G to a 3G? And how do you gracefully handle that experience for a provider as well as a patient? Because there’ll be frustration on both sides. If you’re not able to have an optimal experience, a lot of work went into just understanding the differences in terms of how the software layers are designed.

And it led to us actually changing our telehealth platforms midway through COVID because we saw one platform performing much better than our existing one. But those are things you have to continue to do there. There are software companies that are leapfrogging each other, and you got to take advantage of it. And it’s more so than ever in the virtual cloud space where the speed of innovation has increased tremendously. And at the same time, the options that are available are more too.

PP: Let’s talk about some of those emerging technologies. What excites you now? Both when you talk about the front end, that is the experience layer and at the back end, which is that the infrastructure layer?

AP: Front end there’s been quite a bit of work, I think on the device side we were super excited with our partnerships with Apple. They’re doing some really interesting things, including dropping their device prices. That makes it more palatable for us to be using them within our systems. We are super excited with what we are doing with Zoom on the telehealth side. They have really created a platform that has not only caught the public’s attention, but it’s actually very usable, scalable and robust from a telehealth perspective. We are also looking at a number of groups, whether it’s “Automationanywhere” or “Uipath” or “Oliveai” which provide different frameworks for RPA and AI-based RPA which is getting to be very exciting. And then some of the things that are coming from Twilio Amwell in terms of the patient engagement side and the connectivity with the patient across multiple platforms is super exciting.

PP: What about voice? Are you using voice in any meaningful way?

AP: That’s a good one. Voice has been something that we are still looking at to see how it plays out. It is one of the most interesting things of the population we are in. So, there are two languages that really dominate the market. We are in English and Spanish. But then right after that we have another 30-40 languages where we have populations from all over the world and therefore are just as important to communicate with the patient and have that conversation. And that’s the piece where voice has become an interesting conundrum for us to solve. Is that do we bring an interpreter most of the times into the conversation or is there a better way of handling it? We haven’t really solved that problem yet from a communication perspective. So, it’s an ongoing issue and journey in terms of how we are pushing and prodding our software providers to say, how are you going to help us solve this part of the journey. It is really important to actually have that meaningful communication between the provider and the patient.

PP: Yeah. What about the risks? Now, we talked about all the companies that you mentioned, some of them are very mature at one end of the spectrum. The others are very young companies and, in many cases, possibly seed funded. And it comes with the challenges of financial and technology risks. How do you manage them?

AP: Yeah, that’s a good question. I think it goes into part of when we are doing the selection process, we are looking at understanding will these companies be sustainable? We are not innovation harbor where we actually provide the seed funding and stuff like that. Several of our partners are doing it and great organizations are doing it. Cedars have a phenomenal program. Providence has a phenomenal program. Cleveland has had a program for a long time around it as well. So, that’s not our M.O. We are not looking for it unless it’s a very unique one-off solution to be looking at that earlier stage. But that comes into the conversation when we are selecting a partner to say: “what’s your sustainability like? Can you actually continue to support for multiple years and mature with us?” Especially if you’re looking at an emerging area. And there are conversations around, what is the financial stability or viability of the organization? What’s the excitement level of the market around it too? So, all of those things get into that decision-making process for sure.

PP: Alongside these kinds of risk mitigation aspects that you just talked about. What about the financial side of it? Have you changed the way you look at building business cases for these kinds of tools, considering where you’re headed as a digital first or predominantly digitally enabled organization? Are there tradeoffs you need to make today from a strategic perspective as opposed to a hard ROI? Has anything changed?

AP: Yeah, that’s a good question. It has changed a bit. So, COVID has done a few things. One, it has allowed us to experiment much more rapidly. It’s also allowed us to fail much more rapidly and move on rates or ‘fail fast and get comfortable with experimentation.’ And that’s been wonderful. Without those two things happening, I don’t think we could have made the number of useful changes from a technology perspective in the organization. Regarding the ROI piece, I think that’s the other interesting thing. Certain things are now considered obvious and part of how we need to run our business. In fact, our entire executive leadership team is very gung-ho on digital first across the board rate. So, they have bought in. And our boards are bought in. And this was before COVID from our own journey perspective. So, the discussions are slightly different. I think the discussions are not always about ROI. And when ROI comes into play there’s no question about it. But ROI comes into play when we are looking at a replacement of X to Y. I think in other cases, ROI’s are discussed when we are looking at a brand-new idea to say: “Ok, if we have to really push this idea, how much does it have to scale before we are actually making money on it?” So that gives you at least a clear line in terms of what the adoption has to be, what the usage has to be for something to be actually meaningful and valuable, which is always a good thing from a business perspective. But here we are experimenting a lot more and there’s a lot more thought to saying if it is a good idea, let’s invest in it.

PP: Yeah. And you’re right there in the middle of Silicon Valley where you have ample opportunity to experiment with new technologies. If nothing else, I’m sure there’s a lot of people who want to experiment with you. We’re coming up to the end of our time here. I’m sure this has been fascinating. I want to leave you with one last question here. If you had to share one best practice with your industry peers who are on their digital journeys, what would it be?

AP: That’s an interesting one. I think engagement is important. So, connect with different parts of your organization and come up with a single mission for your organization. That has helped us tremendously. It gives a lot of clarity when your CEO is providing the vision of what digital means and what digital could look like for your organization. And it also helps you through the peaks and valleys. It’s a long journey and you will have peaks and valleys. But having that commitment from the very top helps tremendously with that.

PP: We’re going to have to leave it there. It has been such a pleasure speaking with you. Thank you so much for setting aside the time and all the very best for you and your team.

AP: Likewise, Paddy. It’s great talking to you.

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

Pande,-Anshul-profile

Anshul Pande is Vice President and Chief Technology Officer of Stanford Children's Health, the only health care system in the San Francisco Bay Area—and one of the few in the country—exclusively dedicated to pediatric and obstetric care. Mr. Pande is responsible for all aspects of technology selection, deployment, and delivery for the health system. Before joining Stanford Children's Health, he was Vice President and Chief Technology Officer of ProMedica Health, a 12 hospital, 900 provider health system where he completed a multi-year technology transformation including an Epic deployment, two mergers and a divesture.

Mr. Pande also worked at Epic for 10 years in various roles including Director of Technical Services and Chief Patient Safety Officer. While with Epic, he worked with leading healthcare organizations throughout North America and Europe. Mr. Pande earned his Master of Science degrees in both Manufacturing Systems Engineering and Industrial Engineering at the University of Wisconsin - Madison. 

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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