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

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