Month: February 2021

The biggest challenge in digital engagement and its adoption is shifting to a consumer mindset

Season 3: Episode #75

Podcast with Mona Baset, VP of Digital Services, SCL Health

"The biggest challenge in digital engagement and its adoption is shifting to a consumer mindset"

paddy Hosted by Paddy Padmanabhan

In this episode, Mona Baset discusses how SCL is transforming its digital capabilities to provide a seamless digital patient experience just like other industries – retail, travel, and financial services.

According to Mona, one of the biggest challenges in adopting digital engagement is shifting to a consumer mindset. Health systems are now increasingly focusing on their digital front door initiatives. However, one of the biggest challenges in building a robust consumer app is incorporating both outside and native foundational capabilities, and bringing together a single native app.

SCL is a non-profit healthcare system and focuses on patient engagement and technologies to enable better patient experience. Take a listen.

Our Podcast Partners:    

Q: Tell us about SCL health, your role as the VP of Digital engagement, your responsibilities, and who the role reports to.

Mona: SCL health is a faith based non-profit healthcare system. We’re based in the Denver metro area, and primarily serve Colorado and Montana. SCL Health provides care across eight hospitals, more than one hundred clinics, and areas such as home health and hospice, mental health, and safety net services. My role as the Vice President of Digital Services was a newly formed position when I joined and it is part of the information technology and digital services organization here. I report to our Chief Information Digital Officer, but I really find that my role straddles a few different worlds – technology, marketing, consumer experience, engagement, associate engagement, and innovation. I get to work with a lot of incredibly talented people across all those areas. My team primarily focuses on engagement and the technologies that help enable those experiences. They are responsible for everything from our external website to our internet site, digital marketing and automation platforms, application development, and user experience. There are some new areas as well where we’ve begun to explore and implement like arts and robotic process automation. We find that when people have different ideas or things that they want to do or explore, oftentimes those ideas start with my team and then we can sort of assess them and figure out how to move forward.

Q: Can you walk us through some of the initiatives that you’ve rolled out in the last year and a half, especially in the areas of digital front door marketing and digital patient engagement?

Mona: When I arrived at SCL Health, we had a basic level of digital capabilities in place. We had MyChart, external website intranet, an older CRM instance, and virtual care capabilities. There was a lot of room for improvement to create that wonderful experience for patients, consumers, and even our own associates. We did a quick assessment of the current tools and some basic customer journey mapping. Once that information was laid out, it was easy to see where the gaps were and what we needed to put in place to fill those gaps. We did some prioritization exercises and some mapping exercises after generating some interesting ideas. What we really wanted to do was to deliver an experience that was similar to what consumers are expecting in other industries like retail, travel, and financial services.

We organized the efforts into four streams. One of those work streams is customer relationship management. In that area, we rolled out a new implementation of Salesforce Health Cloud and Marketing Cloud. We finished that up very recently. We are also looking at call center tools and consumer contact center transformation. Underneath that workstream, we are rolling out some different capabilities around automated communications to patients and consumers through text and email and phone.

The second workstream is what we’re calling digital workforce. If you think about that area, it’s really some of the automated tools and processes that we can put in place. For example, chatbots would fall in that area. So, we’ve rolled out a few different types of chatbots focused on different capabilities so consumers and patients can get the answers they need right away without having to wait to talk to someone. We’re also exploring some robotic process automation to help us become more efficient on the backend.

The third workstream is about associate tools. Currently, we have a very large-scale project underway to completely redesign re-platform our internet site for our associates and our providers. That will be rolled out mid-year. We are also looking at different ways to communicate among our associates, some HR focused tools and technologies.

The final workstream we are focused on is consumer and patient experience. This is where you find things like our external website, which we’re constantly improving and updating. That’s where you find MyChart optimization. We rolled out a brand-new provider directory to help people search for providers and schedule really easily. And this is also where we’ve been partnering with our innovation team to roll out a new consumer app that is actually rolling out next week. We’re super excited about that. It’s going to give our patients and consumers a really nice, streamlined way to access our services and information.

Q: With regards to consumer engagement and your role, what do you see as the big challenges in digital engagement and adoption?

MB: Healthcare no longer gets a pass on consumer experience. People are comparing their experiences with healthcare to their best experiences in other industries, and they’re expecting more now. I think the biggest challenge in our industry is really shifting to a consumer mindset. This is something that I think was slowly happening. COVID really accelerated that journey.

For example, prior to COVID, virtual care was available here, but it was slow to be adopted by our providers and our patients alike. When there was really no other option for care at certain points in this pandemic journey, we went from under one hundred video visits a month to thousands and thousands of video visits immediately. Now both providers and patients have experienced sort of the new way of doing things. They can see the ease and convenience and the effectiveness, and they see that they can get things done in the healthcare space, in a virtual way.

While we may not see the huge numbers that we saw at the very beginning, when there was really no other options for care, we will see this virtual care continue. Even after COVID isn’t part of our every thought and conversation, challenges of getting things rolled out while keeping that consumer mindset as a technology organization for healthcare system remains. Our job is really to support that acceleration toward consumerism and put on the table everything we know and everything we can learn to make that happen. We have to take that knowledge and not only be technologists, but we also have to be salespeople and we have to be marketers to be able to show our internal stakeholders and our patients how much better it could be for them.

Q: What are some of the biggest challenges that you faced when it comes to preparing yourself for this emerging virtual care era and digital engagement you just described?

MB: From a career perspective, I essentially grew up in marketing and many years in consumer financial services. When I made that transition to technology a few years ago, the consumer was always the starting point and the end point for me. We’re really taking that approach and are focused on how we can deliver care safely and effectively. We’re offering more types of virtual care than ever before and we’re listening to consumers. We have a patient family advisory council approach that we take and we connect with these patients and their families regularly to understand what they’re going through, what their journey is, how can we adapt to meet those needs? What additional engagement channels can we offer to really empower them to take control of their health journey? And I think so many things are involved in building that strong brand and that high level of consumer engagement is certainly key. The word, or the phrase digital front door is an interesting one, because it almost suggests that there’s just one door, but there are many doors. Our website is one of the digital front doors, our consumer app is another. So, we’re really trying to provide options and as we look at how our website functions, we’re looking at how are consumers expecting to engage with us? What do they expect to find there? And we’re trying to make improvements across the board so they can find information quickly. They can self-service, they can reach out to us if they need more help and just really giving them that full experience.

Q: From a technology choice standpoint, do you start with a bit of capabilities that are available in your system or do you start with a blank sheet of paper and look at what the best-in-class tools are out there and recommend and implement the ones that make the most sense from an impact standpoint?

Mona: I think a little bit of both. We have as an organization, five strategic platforms that we focus on and they really serve as solid foundation for our work. We have Epic for our EHR, Google for communications within our organization, Salesforce, Oracle ERP that’s going to be launching in April, and ServiceNow for internal types of requests. We try to start there and in many cases we have to consider additional capabilities. Obviously, these are very foundational and only do certain things. So we look at both. We are looking at some guiding principles that we use when we’re making technology choices. We want to be sure that we make experiences easy and low effort and want to focus on the user and their needs, not our processes. We want to leverage the small number of connected platforms that are needed, because it’s just much easier to manage. We also want to personalize experiences based on deep knowledge of our users, and we want to provide options to engage with us. We start with our foundational platforms and then when we decide to bring in other tools. Sometimes we do bring in sort of those proven best-in-class big tech solutions.

We’ve brought in a lot of others that are more in startup mode and they may ultimately become best-in-class. I think about some of the recent work we did to completely rebuild our provider directory on our website and all of the chatbot technologies we’re introducing. So, for those we partnered with what I consider to be smaller, really innovative companies that are nimble and creative and just offer solutions that are very unique and partner with us really well. We can almost co-develop solutions with them and it’s worked out great.

Q: When you talk about startups, there could also be risky bets. For instance, what if they run out of money from the venture capitalists or they lose their key individuals because they’re a small team. Have you ever had to plan for that kind of a situation, or have you had to actually live through one of those?

Mona: Thankfully, we have not. We know that is certainly a risk. These organizations are much more willing to partner with us to give us exactly what we need and really fitting into our budgets. As a not-for-profit, we don’t have huge budgets. So, it is a tradeoff and we have not experienced anything yet. We have taken those risks and have been able to deliver some interesting capabilities. I’m pretty happy about that and proud that we have really been able to partner with some great organizations to do so.

Q: How are you leveraging your internal datasets, patient histories and how are you combining that with externally available data sets? What is the framework you’re applying and the infrastructure you’re investing in order to harness the data, and improve and deliver the kind of experiences that the marketplace is looking for?

Mona: Data analytics is such an interesting topic these days. We have so much data out there. I would say it is truly at the heart of the work we do in digital engagement. Epic is our source of record for patient information. We don’t try to recreate that. I know other organizations have sort of challenges with some of that, but we really leverage that data as much as possible so that we truly know our patients. We can customize communications and touch points to them. I will say that in any digital project we have launched, data piece takes the longest. It’s the most complex and requires a lot of thought about data models and how integrations are going to work for our CRM implementation. We spent a lot of time building the right data model and integrations just to ensure that we have the most accurate and recent data available to help engage with our patients. If that information is not correct, then you are not engaging in a way that patients find useful. We are working on a similar project around expanding some automated communications to patients like those who are discharged from hospital. We’re spending a lot of time to make sure data is perfect so that the messages we’re sending makes sense and are relevant.

Q: When you talk to your peers across other health systems, what are some of the best practices? Can you share one that you’ve either adopted from one of your peers or one that one of your peers may adopt from your own experience?

Mona: As I look at what some of my most innovative peers are doing at other health systems, I’ve seen some really interesting implications and tools. I think COVID is top of mind. Some of those COVID related innovations have been pretty incredible, everything from vaccines management to screenings. One of the things I’ve seen more and more health systems working on is delivering on that consumer app approach, what might be called the digital front doors. They’re doing a great job at that. The best ones are addressing one of the biggest challenges in building a robust consumer app, that is, to have a plan for how any new capabilities, including those that might be offered by many different vendors, are brought together seamlessly for the consumer in a single native app. Sometimes your foundational platform just can’t deliver everything and you’re going to have to go outside of that and bring in other capabilities. But how do you make that invisible to the consumer so that they feel that they are just dealing with one organization, one tool, and they’re able to see everything?

I think as far as other best practices go and something we’re exploring and hope to make a best practice is really the use of artificial intelligence, patient engagement. When a consumer or patient doesn’t need to talk to a person and in many cases they don’t want to, they just want to be able to get things done themselves using chatbots and other artificial intelligence, and that’s a good thing for them. We try to leverage some of that and roll things out quickly, especially early on in COVID. So, we rolled out a chat that would allow people to learn more about COVID, take a risk assessment. It really reduced the anxiety that consumers had about COVID and reduce the number of anxious phone calls that came into our care sites, in our clinics. We’ve used similar technology to screen associates before work for COVID symptoms to keep them safe and our patients safer. Recently, we launched some additional chat technology on our website to answer key questions and information that consumers and patients have. We can change that on a daily basis. If we find that people are asking a lot about vaccines, for example, we can do that. So, we hope that will become a best practice going forward.

Q: Do you primarily rely on externally developed solutions for assembling this whole consumer experience? Are there pieces that you take complete ownership of, for instance, the mobile piece, if you do that internally and then have all of the embedded components behind the scenes come from different sources, or are you really looking at buying it all off the shelf where in that continuum are you?

Mona: I think it’s a little bit of both and sort of a hybrid. For example, with our CRM implementation, we purchased a solution for that and implemented it. Our internal team takes that over and maintains it and enhances it, similar to what we’ll be doing with our new consumer mobile app. We partnered with an organization to help us build that from scratch. Then we will be taking on the maintenance, the enhancements going forward. So, I think it’s a little bit of both. In some cases it makes sense for us to be able to have the autonomy to build on a platform and be able to be very flexible with improvements, enhancements in many cases.

Show Notes

09:35Biggest challenge in digital engagement and its adoption is shifting to a consumer mindset.
11:03 Technology organizations for healthcare systems must support virtual care acceleration toward consumerism
13:34 The phrase digital front door is an interesting one; it almost suggests that there's just one door. But of course, there are many doors.
22:11Sometimes your foundational platform just can't deliver everything and you're going to have to go outside of that and bring in other capabilities.

About our guest

As Vice President of Digital Services at SCL Health, Mona Baset leads digital strategy and transformation, including development and implementation of the digital technology road map. Prior to joining SCL Health, Mona was Assistant Vice President in the technology organization at Atrium Health, leading consumer engagement strategies.

Previously, Mona spent almost 10 years at Bank of America, where she led various marketing and communications teams. Mona holds a bachelor’s degree in English from the University of California at Irvine, a master’s degree in Communications from Cal State Fullerton, and a master’s degree in Business Administration from Wake Forest University.

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.

Our focus for virtual health is making sure encounters are documented in such a way that it is not burdensome

Season 3: Episode #74

Podcast with Katherine Lusk, President / Board Chair, AHIMA

"Our focus for virtual health is making sure encounters are documented in such a way that it is not burdensome"

paddy Hosted by Paddy Padmanabhan

In this episode, Katherine Lusk discusses how AHIMA works at the intersection of healthcare and technology to empower patients with their health information, and ensures to keep the data accurate, accessible, and safe.

Health systems are working towards mapping patient data to the EHR systems so that the frontline care providers have the information readily available to improve healthcare delivery and outcomes. The next step is to standardize the data normalization process and make it interoperable while taking care of patient data privacy, confidentiality, and security.

Katherine says that the industry must now focus on implementing initiatives to reduce social issues such as the digital divide and health inequalities . She further states that AHIMA’s focus is to make sure that patient’s virtual health information is documented in a safe, secure, and convenient way. Take a listen.

Our Podcast Partners:    

Q. What has been your professional journey and how did it lead you to your current role at AHIMA?

Katherine: I think it’s inspiring because if I can do it, anyone can do it. I’m from Gainesville, Texas, which is a small town in North Texas, and I went to work in 18 years of age at Gainesville Memorial Hospital. I worked my way up from a clerk to become the director of Health Information Management. From there, I went to Fort Worth and worked in the Osteopathic Medical Center of Texas, which was an academic medical center focused on the geriatric population, where our average age was eighty-three. Then, I went to Children’s Health System of Texas, which is a pediatric healthcare system with the average age being four. So, I’ve worked at two very different spectrums of healthcare delivery. The documentation and the rules and the governance and the empathy that needs to happen to support patients and families is the same regardless of the setting. Recently, I’ve gone to work for the Texas Health Services Authority with a focus on health information exchange within Texas that includes public health. I’m taking what I learned from the frontline at a local hospital to a geriatric healthcare system to a pediatric healthcare system and applying it at a state level on how we can exchange information in an accurate and complete manner, across the state of Texas to improve healthcare delivery.

Q. We are still in very early stages of harnessing data in a comprehensive way, especially relative to other sectors. Would you agree with that? And what are you seeing across health systems in this regard?

Katherine: I would have to agree and disagree a little bit. I think healthcare is beginning to harness data and efforts to improve patient safety. With clinical decision support to identify duplicate tests and take advantage of tests completed, they’re beginning to map data so that it appears within the electronic health record and allows the frontline care providers to have that information front and center. They are also beginning to look for different ways to streamline the administrative processes. What is curtailing us from doing that is normalizing the data across platforms and organizations. Most organizations in electronic health records have the normalizing data process down using SNOMED and then using intelligent medical objects to translate the very diverse, nuanced clinical data into clinical languages and classification systems to normalize within themselves. So, the EMR vendors have taken advantage of that and they normalize data within their own EMR vendors. But with the care quality and with e-health exchange, that data normalization has occurred on a much broader spectrum. Things are much better than they were even in twenty seventeen. The pandemic forced things to move along at a much more efficient manner and a much faster pace. Before the pandemic there was lots of discussion about mapping laboratory test results across different EMR platforms so that they wouldn’t have to be repeated and using LOINC codes. And it was lots of discussion and hashing with pathologists and with other clinical care providers on how you actually go about normalizing this data. But with the pandemic and COVID-19 people came together and figured it out. I think things are much better than they used to be.

Q. What are your key themes that you’re focusing on, your advocacy efforts this year at AHIMA?

Katherine: We have a big year planned at AHIMA and our 2021 advocacy agenda seeks to transform healthcare by connecting people, systems, and ideas. We’ve embraced three principles that directly align this vision and underpin our work, outlook, and our advocacy efforts – access, integrity, and connection. We’re advocating for the use of accurate and timely data for public health responses and initiatives while protecting confidentiality, privacy, and security of individuals health information. With the pandemic, we feel that public health was not supported sufficiently in the past, and we’d like to focus our attention on making sure that sector of the ecosystem has the information they need. We are firm advocates for the individual’s right to have timely and seamless access to their health information. We had a consumer advocacy pledge campaign earlier this year where we had our members reaffirm our pledge to consumer advocacy on having access to their records. We have been advocating for accurate patient identification to improve patient safety, interoperability, and the appropriate use of workforce resources.

We also understand that with the pandemic and with all of the social issues that we’re currently experiencing, social determinants of health must be the focus to enrich clinical decision making and improve health outcomes. We believe that public health is supported, and health inequities are diminished. We must can gather this information and culturally respect and manner and portray it accurately. We really believe in advancing a complete, accurate and timeliness of data by influencing the development and maintenance of national and international coding standards. Where policy goes, so does the public. We started the Patient Identity Now Coalition, where we worked with six of our partners, the American College of Surgeons, CHIME, HIMSS, Intermountain Healthcare and Premier. There is a coalition of healthcare organizations that are really advocating discussion around a unique patient identifier. So, if you haven’t looked at that, I want to encourage everyone to look at the Patient Identity Now initiative.

Q. Can you touch upon one or two things in the context of telehealth, which obviously in the wake of the pandemic has been on a tear? Can you talk to us a little bit about how this growth in telehealth needs to be viewed in the context of AHIMA’s mission and your priorities?

Katherine: The convenience of telehealth has changed delivery models. Telehealth was being embraced prior to the pandemic, but with the pandemic, it was a wholesale embrace. It moved healthcare delivery from solely brick and mortar into the virtual arena much faster. With AHIMA and our work, we focus on what are the documentation requirements for telehealth, how do we classify the diagnoses that are captured in that arena, how do we make sure that patients have consented to their information being shared in that manner, and how do we keep it safe and secure. Our focus for virtual health is making sure that the patient’s information is safe and secure, making sure that the encounter is documented in such a way that it completely explains the encounter but not be over burdensome.

Q. Where is the challenge in harnessing all the data we receive from different sources? Is it a technology challenge, a better-quality challenge, policies challenge?

Katherine: I believe it’s probably a data quality challenge, because just like all other clinical data, when we began the journey, we had to figure out how to normalize the data. We had to translate the clinical language into SNOMED and accurately capturing that in the electronic health record and then transferring that to clinical language or the classification system. So I believe social determinants of health is our next step on that clinical journey. While they’re not widely used now, we do capture some with ICD 10. Now, are there more that is needed? Absolutely. I believe that as we go through this journey and begin to utilize information and embrace these concepts, data normalization process will only get better and better.

Q. What is the State of the Union today as it relates to a patient privacy? Are there adequate privacy safeguards, especially when we see data being moved to the cloud, or now that we’ve got the final interoperability ruling that’s coming up. And patients are now going to have access to their own data and can share it with anyone they like. What should we be careful about?

Katherine: At AHIMA, we worry the most about is apps, and patients and families using these apps and not really understanding that how their information might be shared. How they have really given away the most personal thing they have, which is their clinical information to an app without completely understanding that information might be sold to someone else, used for marketing, used for a vendor’s personal financial benefit, and it might not be protected. I think that’s one of our biggest concerns now. I personally love an app and I love the convenience. And I’m like everyone else. I have a Garmin and my husband has a Fitbit that we track our health. We take advantage of all those things. We also do 23andme. From a human standpoint, we want to make sure that patients and families and individuals like you and I understand that we are giving away pieces of our very personal information and we want that information to be kept secure and private. The healthcare organizations are ruled by HIPAA and so patients and families and you and I believe that our healthcare information is protected. We’re forced to sign HIPAA requirements when we go to the physician’s office or to an ED or anything like that. So, we’re lulled into this feeling that healthcare information is so sacred and that is so protected. Then when we give that information to an app or a personal health record and a portal, that information is not held to the same standards. We want to make sure that everyone understands that they’re not following the same rules of engagement and to be very considerate of that.

Q. What is your advice for startups and digital health companies that want to go deep into the data and take the data and combine it and use it and analyze it and create new offerings out of it? What is your advice to them to safeguard the data, but also to be successful with it?

Katherine: My advice to them is, be the crane that rises to the top. People will choose to use their apps if they are convenient, useful, safe, and secure. When you develop these healthcare apps, you want to be able to normalize that data and integrate it into the longitudinal record of care. You don’t want to be standalone. These apps need to understand the clinical languages and the classification systems that the big vendors understand. They need to have a depth of knowledge with them. I would also advise that they use standards and look at what those standards are and not be frightened of them, but to embrace them so that they can leverage those standards and integrate with the EHR. They must understand that they are a cog in the healthcare wheel, that we’re all cogs in the healthcare wheel. And we’ve got to figure out how to integrate the data into the entire ecosystem so that it can be shared with everyone. What I would suggest that they do is engage the health information management professionals to help them understand the clinical language or classification system for data mapping and to serve as a guiding hand with patient privacy. This discipline serves in that middle space, and I think it could be very, very helpful to them.

Q. If I were to summarize you here – adopt standards, be interoperable with the EHR systems, but also with other similar applications, take care of patient privacy and protect their privacy with all their applications. And finally, you referred to us being cogs in the wheel. I like to say that healthcare is a team sport, and we are all part of the same team. Do you agree with that?

Katherine: Absolutely. Healthcare is a team sport, and the patient is the captain of the team.

About our guest

Katherine Lusk, MHSM, RHIA, FAHIMA is AHIMA’s 2021 President / Chair. As an active AHIMA member her attention is focused on championing the profession, patient identity, health information exchange, standard development, and information governance.

Her previous leadership roles include serving on Epic’s Care Everywhere Governing Council as Co-Lead, eHealth Exchange Workgroup Member, ONC Patient Identity Workgroup, TxHIMA President, and the Texas Interoperability Collaborative. She is a sought-after national speaker on information governance, standards, interoperability, clinical documentation improvement, patient identity, leveraging technology and promoting the HIM profession.

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.

A lot of point solutions are emerging, but if they’re not integrated into the EMRs, they’re likely to fail.

Season 3: Episode #73

Podcast with Harry Fox, Board Chair, Whitman-Walker Health

"A lot of point solutions are emerging, but if they’re not integrated into the EMRs, they’re likely to fail."

paddy Hosted by Paddy Padmanabhan

In this episode, Harry Fox discusses his role at Whitman-Walker Health (WWH) and how as a community-based health center they are serving a diverse patient population with technology disparity and making healthcare inclusive for everyone.

WWH is a federally qualified health center. A significant part of their patient population is the low-income group and LGBTQ community. Harry shares that half of their patient population is below 100% of the federal poverty level, and around 40% are below 50% of the federal poverty level. This automatically creates an issue of digital divide among them where they struggle with technology. Technology providers are addressing these disparities, and several standalone point solutions are emerging. However, the two major issues – interoperability and integration – still exist in the healthcare space. Take a listen.

Our Podcast Partners:    

Q: Can you talk about Whitman-Walker, your role there, and about your prior experiences?

Harry: Whitman-Walker is a federally qualified health center. It was started back in 1979 to serve the needs of the gay and lesbian community of Washington. Since then, it has evolved with all kinds of services for the growing demand in Washington. About 10 years ago, it became a federally qualified health center. Today, it offers medical, dental, mental health, specialty care, specific youth service, and pharmacy services in multiple locations. Whitman Walker has a division that does clinical research in HIV and hepatitis. It’s got a policy and advocacy arm, and an education arm.

I joined the board back in 2014 when I was still the CIO of CareFirst. Today, I sit on two boards – Whitman Walker Health, which is the federally qualified health center where all the clinical services are, and also chair the board of Whitman Walker Health System, which houses the Whitman Walker Foundation and the Whitman Walker Institute for Research Policy and Education. It has been a fascinating ride. I’ve been in healthcare forever but began around 1999 in what was then called e-commerce, which we now call digital health. I started in the space with PricewaterhouseCoopers, then through Coventry Health Care as their vice president of eCommerce, and then at Kaiser Permanente as the regional CIO. Lastly, at CareFirst, and then, in more recent years, as an independent consultant. All of my work has its anchor in core digital health. I had the opportunity at the beginning at Kaiser Permanente to implement the mid-Atlantic region’s first telemedicine for primary care in certain specialties like dermatology, and then at CareFirst, worked extensively with third party telemedicine vendors to implement that service for our members.

Q: How has the pandemic impacted care for Whitman Walker’s patient population?

Harry: It’s been dramatic. When Washington DC issued their stay-at-home order, we shut down for two days. Over those two days plus a weekend, we pivoted completely to virtual services.

Whitman Walker uses eClinicalWorks as their EMR. In a three-day period, they had to bring up the module, test it, develop patient education documents, and develop staff training documents. They implemented DocuSign, because all the forms that you would fill out in the office, now had to be done virtually. Luckily, CMS around that same time made some changes in both repayments. So, if we couldn’t do telemedicine, we could do an audio encounter with a patient who might not have been able to do video services and we can still get reimbursed for it. CMS also lifted some of their licensure restrictions. Earlier, patients came to us in one of our locations in Washington, DC. Now that we serve the tri state area, we have patients in Maryland and Virginia and then a small population of patients from across the country, who come for our specialty LGBT care. Before the pandemic, if you weren’t licensed in a state, you couldn’t virtually see someone in the state. That’s been lifted now, at least temporarily. So, we pivoted over a very short time and opened on Monday morning. Everything went virtual, except for a small number of patients who were still coming in for more serious issues – COVID related and breathing kind of issues.

All the rest went virtual and it’s continuing to evolve. We had started out with everything on the eClinicalWorks. We found that for patients with behavioral health, some in individual and some in group sessions, eClinicalWorks couldn’t handle groups. It handled patient to doctor. So, we pivoted to zoom for behavioral health. Also, the bandwidth demand was better in Zoom with lower bandwidth could still get high quality video. ECW had a little bit higher requirement for that. So, we now operate with eClinicalWorks for all of our medical and dental patients and then we use zoom for behavioral health and substance abuse treatment for individuals and groups.

Q. Were there any unique needs for the LGBTQ populations that you had to take care of while standing up these capabilities?

Harry: As a federally qualified health center, we serve the entire community, and a portion of our patients are in the LGBT community. Because it’s a federally qualified health center, it’s often lower income. So, we have issues of technology disparity where people may have a cell phone but may not have an email. We find our younger clients usually have a phone but often don’t have a PC or a tablet. Our older patients may or may not have a phone, or another device, but often struggle with the technology. I have a 92-year-old mother that I do tech support all the time and I know how hard it can be when you’re trying to get someone to hold the camera a certain way and point the camera here. A lot of people have these challenges. About half of our patient population is below one 100 percent of the federal poverty level and thirty nine percent are below 50 percent of the federal poverty level. We have folks at the other end of the spectrum, too. When you have this tremendous diversity of background, it makes rolling out telehealth ubiquitously difficult. We have patients, living at the lower end of the poverty level, who may not want us to see where they live. They may have access to technology, but they’re uncomfortable having their homes seen. There are these very interesting, unique situations that are not LGBT specific, but are more issues of equity and what people have in terms of education and access to high-speed internet and technology.

Q. What are you seeing in terms of efforts by the technology community to address these technology disparities and making healthcare more inclusive for everyone?

Harry: It’s an interesting question. We got two small grants and we’ve been able to purchase three Wi-Fi only phones. That’s helpful up to a point because the individuals in the community may or may not even have access to Wi-Fi. There is no Wi-Fi in some areas of Washington, D.C. So, it’s useful if someone doesn’t have a phone, but they still have to access Wi-Fi for a virtual visit. There is a lot of point solutions I see emerging, but if they’re not integrated into the electronic medical record, they’re likely to fail. Every time you’ve got a standalone point solution, it is more work. When we’re using Zoom, we have to schedule the patient in the EMR and then schedule zoom separately. We’re using the eClinicalWorks for a virtual visit only and then we’re using them for the digital part as well. It’s all set up within the system. We create the scheduled event, we say that it’s digital. Automatically, the patient gets an email with the link and then later a text with a link. So, there’s some really fast emerging useful technologies in this space. The issue all along has been interoperability and integration.

Q. If you just expand the Zoom versus the eClinicalWorks situation you went through, how you kind of roll it out across a broader ecosystem?

Harry: The larger, well-funded delivery systems have the luxury of having enough cash and can choose best-in-class solutions and integrate themselves or work with the vendor to integrate them. If you’re a CIO of a small clinic, you don’t have that luxury. In Washington, in Whitman Walker’s case, eClinicalWorks is funded by the DC Primary Care Association for all seven FQHC’s in the District of Columbia. So, it’s not a technology choice Whitman Walker made. They wouldn’t have been able to afford that kind of platform without the DC Primary Care Association. So, your ability to pick best-in-class really depends on who you are and what kind of assets you have to invest in technology. The bigger systems just have the luxury of doing a lot better job of picking best-in-class solutions. Although I will say that there’s a thorn there too, because if you let best in class run wild, you have a situation soon enough where vendors get acquired. What was best-in-class this year is not best-in-class next year. And so, you’re pulling things in and out of connectivity around your electronic medical record, which is kind of the heartbeat of it all. So, you’ve got to choose very carefully when you think about going best-in-class. Make sure it’s not going to get acquired by a bigger player because they’re so small right now, because that can also cause a lot of rework and a lot of spending down the road.

Q. Tell us a little bit about how your experience with CareFirst as a CIO of a health plan. How is that different from your similar role at a leading provider was is Kaiser. What are the big points of difference between payers and providers at a broader level when it comes to approaching digital patient engagement today?

Harry: Kaiser has two arms of its company. It has the insurance company, and it has the whole care delivery operations. And because of their scale, Kaiser has the luxury of truly picking best-in-class. And they have been an early investor in EHRs. They really put the Epic chart on the map, and they’ve been a big investor in digital solutions for their patients. When you get to the payer side, it’s a very different world because there’s a lot of intent to help on the clinical side. But it’s really around the edges as far as I see it, because at the heart, you’re an insurance company. So, when you look at the member portals of an insurance company, they are your claims, your explanation of benefits, your annual deductibles, and co-pays. They may have other services like telemedicine, but they are really rolling out telemedicine in support of the clinical community outside their four walls. It’s a different perspective. My observation is that the payers often have more money to invest in technology. The very large clinical delivery systems have money, but the smaller hospitals can really struggle to stay abreast of the technology. Implementing a hospital EMR, like Epic or Cerner, is millions and millions of dollars and a multi-year process. They often make or break projects for the organization. So, it takes a lot to bring up these massive EMR solutions.

Q. How does all the regulatory environments affect the pace of acceleration or pace of adoption of digital health and telehealth?

Harry: United States unlike a lot of countries has healthcare at the local level, rules at the state and often county level. With the pandemic, public health has been in a mess of a rollout because everything is at the local level. In Maryland, for example, we have state rules following CMS rules. Then we have county versions that are different. So, by county in Maryland, when you get your inoculation, it will vary because the rules are different. I say that as a backdrop because reimbursement and regulatory landscape is a little bit like this. When you think of the fact that providers during COVID almost universally are getting reimbursed for telemedicine, whether it’s a private payer or Medicare or Medicaid. Before COVID, they didn’t get reimbursed for a phone call. They are temporarily getting reimbursed for a phone call. If that goes away, it will hurt the lower income portion of the patient population. Same thing with provider credentialing. Whitman Walker Health, for example, wants to serve their communities in Maryland and Virginia with telemedicine services. If the rule switches back to what it was before COVID, that’s going to be a barrier for us. So, the more that CMS, HHS and the states can break down these healthcare islands and barriers through rule making or credentialing. I think it’s going to be critical. When CareFirst was looking to do telemedicine, we were looking to hire a third-party company to be our telemedicine provider. One of the big challenges was finding a company that had providers credentialed in every state and not all the companies did. So being able to learn the lessons of what worked and what didn’t work during this pandemic and be able to carry some of those temporary regulations and make them permanent, I think would be really valuable as we go forward.

Q. Can you talk a little bit about the startup ecosystem in the context of Whitman Walker? What are they getting right today and what are they missing?

Harry: Whitman Walker for the most part is using more established vendors. First, looking at emerging technology in the digital space, the biggest challenge I see is multiple vendors telling how incredible their new thing is. Most don’t understand the complexity of medicine. They don’t understand the complexity of health insurance. So, when you look at the life cycle of a claim insurance you look at the workflow in the clinical delivery side. These are incredibly complex today. Any vendor that wants to make it, must bring in enough clinical expertise that they understand and they’re not naive about how complex the health care world is.

Secondly, I would say going back to what I said earlier, they must be integrated with the major players. So, for example, Whitman Walker is implementing a texting solution called Well. And if you look on the Well website, they integrate with all the major EMR. So, we’re looking to do bidirectional text messaging with our patients. We’ve got to be wary of HIPAA rules, about privacy as we do that. And so, going with a major player, is important, but also going with a major player that fully integrates that into EMR is absolutely critical of the box. So, we’re not creating an island somewhere of information separate from the EMR. So those are two key areas I think are critical success factors.

Q. Big tech companies like Amazon, Microsoft, Google all have their sights set on healthcare. Companies like Microsoft have been in the enterprise workplace collaboration software space for a long. What can we expect from them going forward?

Harry: It’s a great question. On the truly clinical side, I personally don’t think a lot. Microsoft touted its own health record years ago, which is now shut down heavily. I think they’ve all struggled with solutions that rely on deep domain knowledge of healthcare. But if you take a broader view, AWS has done well. It’s not HIPAA certified, but it’s something like that. It’s an area that’s more secure to meet HIPAA regulations. Microsoft and Google have similar parts of their domain. That’s a big area because there’s a lot of fear in the clinical space of what do you put in the cloud. If I put it in the cloud, what happens if it’s breached and what are my liabilities from the perspective? I would say to payers and hospitals and clinics, delivery systems, to look closely at what these three companies call their HIPAA space in the cloud because they take no liability. They offer you increased protection, maybe from their regular everyday part of the AWS or cloud environment, but they’ll indemnify you for very little. But nonetheless, it’s where the world’s going. We are going to see more and more movement to the cloud, but I would also tell the healthcare domain spaces to move very carefully and thoughtfully because there is significant risk at the same time.

About our guest

Harry Fox is currently a Principal at Oak Advisor’s Group, a strategic advisory firm focusing on the intersection of information technology and healthcare.

Harry has broad experience with information systems and over thirty years working in IT leadership roles. He has a strong background and a focus on cybersecurity, healthcare systems, and strategic architecture. He has extensive experience in eCommerce, large scale systems development, data warehousing and business analytics. He has experience developing strategies for cloud, blockchain and big data.

Harry was the Executive Vice President, Chief Information Officer and Shared Services Executive at CareFirst Blue Cross Blue Shield from 2011 to mid-2018. CareFirst is a $9.0 billion not-for-profit health care company offering a comprehensive portfolio of health insurance products and administrative services to 3.2 million individuals and groups in Maryland, the District of Columbia, and Northern Virginia. Harry was the most senior out executive at CareFirst and was the Executive Sponsor for ProPride, CareFirst’s LGBTQ Associate Resource Group.

Harry has also held senior-level positions at Kaiser Permanente, Coventry Health Care (now Aetna), and PricewaterhouseCoopers. He currently serves on multiple boards. He is on two private equity-backed healthtech company boards, Medliminal and Harry also serves on the boards of two not-for-profit organizations, Whitman-Walker Health System, where he is the Board Chair, and Whitman-Walker Health a Federally Qualified Health Center (FQHC), serving greater Washington’s diverse urban community.

Harry is a graduate of the Wharton School, where he received an M.B.A. in finance.

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.

Roughly, 30% of total healthcare spend for provider organizations falls into the shoppable category.

Season 3: Episode #72

Podcast with Bill Krause, VP and GM, Experience and Consumer Engagement, Change Healthcare

"Roughly, 30% of total healthcare spend for provider organizations falls into the shoppable category."

paddy Hosted by Paddy Padmanabhan

In this episode, Bill Krause, VP and GM, Experience and Consumer Engagement at Change Healthcare discusses how the CMS’s price transparency rule will affect consumer’s shoppable behavior, the providers, the traditional payers, and the new emerging payers – the employers.

A better functioning healthcare marketplace requires transparency in access to information provided to consumers during their healthcare decision-making time. With COVID accelerating digital health, organizations supporting digital transformation can now drive the digital first approach and provide a seamless digital experience to consumers. Consumers’ journey to care begins with the awareness of their need, understanding the options of where they should go, and knowing their financial responsibility. This is the core of any digital transformation agenda. Access to information regarding price will drive consumer shoppable behavior beyond just going to a provider’s digital front door.

Bill states that, because of the new emerging payer in the marketplace, i.e., the employers, roughly 30 percent of total healthcare spend for providers fall into shoppable tests and procedures. He further projects that this is poised to grow in the future. Take a listen.

Our Podcast Partners:  innovaccer-logo-black  

Q: Change Healthcare will be now a part of Optum from what we see in the news. Is that right?

Bill Krause: We expect the transaction to close in the second half of 2021, subject to regulatory approvals and other customary closing conditions. Until that time, we will continue to operate in the market as separate entities. That means, for now, it is business as usual from both the Change Healthcare and Optum sides.

Q: Since we spoke on this podcast, you have continued to focus on payment, transparency, and solutions for healthcare consumers. What is driving that focus from a marketplace standpoint, and what is the emerging need you are trying to serve?

Bill: Several factors are going into this, and the government has also provided a fair amount of commentary around their rationale for putting forward the regulatory changes. From a customer standpoint, the provider and payer experience underneath it needs more information to be available at decision making time to inform consumers on their healthcare journey.  There is tremendous friction today with consumers in understanding their financial responsibility at points in time when they can manage and make decisions to address whatever those needs are. This friction in understanding has a ripple effect for provider organizations because it’s challenging for the revenue cycle departments to function at a high performance given the challenges. From a more macro standpoint, better-functioning markets require transparent access. This plays into the government’s objectives to create a more functioning health care marketplace.

Q: The CMS had announced the hospital price transparency rule in May 2019. The deadline for compliance is already up. Can you tell us more about that?

Bill: The CMS price transparency rule became effective on . The rule requires providers to post on their websites all prices in a machine-readable format and prices for a select group of shoppable services in a consumer-friendly format. That has changed the dynamic as it relates to making information available. The rule went much further than previous iterations of transparency rules requiring publishing providers’ chargemasters. Now, providers must put forward the negotiated rates for services that they have established with all the payer organizations that work with the providers.

Q: As a consumer, I should see some degree of price transparency, which allows me to exercise some choice. With digital transformation, I should see all this information online, make choices, and make payments before taking the service. How does this fit into the notion of a seamless digital patient experience?

Bill: It fits in a very critical way through a lot of the research that we have done with consumers around their top needs and friction points in healthcare. Among the very top is understanding consumer benefits and their financial responsibilities. When provider organizations are laying out their strategic priorities to transform digitally, financial management and financial information are among the top areas providers are looking to address first. For a consumer, the beginning of that care journey begins with awareness of what they need and then considering in more detail where they should go, their care options, and financial responsibility.

Q: Change Healthcare recently launched a solution to meet this need. Can you talk a little bit about that?

Bill: We had previously rolled out Shop Book and Pay™, which is the solution to create digital storefronts for provider organizations. You can brand and put forward into the public square shoppable tests and procedures. Last year, we decided to enhance the solution further by meeting regulatory requirements for price transparency. Many hospitals have adopted the solution to comply with transparency, host, create and host the machine-readable files, and meet other requirements around both tests and procedures in a consumer-friendly, self-service searchable format. So that’s part of our connected consumer health and patient engagement portfolio. It is an area that, as a company, we have been making a lot of investments and innovation.

Q: How are hospital administrators responding to the Shop Book and Pay™ solution? As consumers, are we going to see the level of transparency that is intended through this ruling?

Bill: As of December, the estimates were that about 60 percent of providers were still not compliant with the rule. The smaller providers are more likely to be compliant, probably because they cannot afford the three hundred dollars per facility per day penalty. For large hospital organizations, achieving that transparency is on the agenda, but they have not yet gotten into compliance with the rule. Across the US, there is varied adoption of the rule while many are still working towards it. The work itself requires a fair amount of detailed analysis of their contracts with payers and efforts to bring that data into a format to comply with the rule.

Q: What impact does it have on the business of the health systems?

Bill: According to the initial assessment, there has been tremendous interest from all parties in accessing this information to incorporate it into decision making, beyond just informing consumers. Many providers are just beginning to integrate ways to communicate the availability of the tool in a language that a consumer can understand. When you compared this to the situation prior to the CMS rule on transparency, there have been select examples in different markets throughout the country where transparency information was made available through a few contracting cycles.

Right now, among the top issues are the providers and payers thinking through what this means for pricing strategy for shoppable tests and procedures, which then will come back to consumers. It, however, will be driven more from provider and payer strategies than it might be from direct consumer shopping in the immediate term.

Q: Consumers who are covered by employer-based health insurance do not care who pays and how much. What would be driving this interest in increased transparency among consumers? Are there specific types of procedures that are now transparent to consumers, and is it making an impact in the way they make their choices? Is there a certain type of demography among consumers taking advantage of this more than the others?

Bill: The government has specified the everyday services and tests to be included in the consumer-friendly requirements of the rule. Things like physical therapy visits, office visits, and simple lab tests are the highest volume areas and have the largest everyday care needs across the broader population. In the case where a patient has purchased care prior to a service, the demography is typically a female in her early forties managing a household, and thus taking care of healthcare needs of the household and demonstrating a real tendency towards shoppable behavior. This demography is going to pursue shopping more frequently. The other thing is, there are many organizations that are growing quite rapidly in the arena of care navigation and support. When you think about the consumer holistically, the influences, and their healthcare experience, they will have other resources such as navigation services that an employer or organization may license for the consumer to use. There are other ways that steering and price shopping can show up and drive consumer behavior beyond just a consumer going to the front door.

Q: How did the pandemic impact consumer attitudes for healthcare services in general and price shopping? Has it accelerated the price shopping behavior?

Bill: It is accelerated the movement to digital healthcare journeys. There is a dramatic shift toward telemedicine behavior. The general behavior of interacting with a digital-first channel of care is the primary driver. This also supports the digital transformation initiatives of companies putting information transparency directly in front of the consumer. With the most recent rollout of price transparency, it is really in the first innings. It has not yet shown up from a shopping standpoint so much as just the general shift in the use of the digital-first approach to care, which is a precursor to shopping for care services and using transparency and further.

Q: We see more employers contracting directly with providers, taking control of healthcare costs, and funding something themselves. What do you make of this trend, and what kind of impact does it have on consumer behavior and price transparency and choice? Is there a correlation between this trend and what you see as the demand for your offerings in particular?

Bill: I see a correlation between those trends. Employers are taking an active role and driving our health care industry to be a more value-based care system. [9.9s] Direct contracting is an example of things that provider organizations, associations, and others representing the self-insured employer segment are helping to facilitate. There have been many examples of centers of excellence, strategies of large employers contracting with health systems for certain services, and more. Direct contracting strategy for price transparency and a focus on shoppable testing procedures is probably poised to grow even faster. For example, according to data shared by a payer customer, there’s a vested interest on both the provider and the employer organization to find new ways to direct contract to include shoppable tests and procedures. Previously, this interest might have been focused more on certain surgeries, service lines, and centers of excellence.

About our guest

Bill Krause is the Vice President and General Manager, Experience and Consumer Engagement at Change Healthcare. Serving the healthcare industry for over 12 years, Bill Krause leads innovation and solution development for patient experience management at Change Healthcare. In this role, Mr. Krause is responsible for the development and execution of strategies that enable healthcare organizations to realize value through leading-edge consumer engagement capabilities

Previously, Mr. Krause provided insight and direction into new product and service strategies for McKesson and Change Healthcare. He also managed business development planning, partnerships and corporate development across a variety of healthcare service and technology lines of business for those companies.


Prior to McKesson, Mr. Krause worked at McKinsey & Company as a strategy consultant, serving a variety of clients in healthcare and other industries. He received his MBA from Harvard Business School and his undergraduate degree from University of Virginia. He also served as a lieutenant in the United States Navy.

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.

Solutions that meet patients, where they are and where they want to be, has tremendous legs in 2021 and going forward.

Season 3: Episode #71

Podcast with Colin Banas, MD, Chief Medical Officer, DrFirst

"Solutions that meet patients, where they are and where they want to be, has tremendous legs in 2021 and going forward."

paddy Hosted by Paddy Padmanabhan

In this episode, Dr. Colin Banas discusses how they are uniting different stakeholders in the healthcare space through their concept – HealthiverseTM – and providing actionable solutions for a better healthcare experience and outcome to all.

According to Dr. Banas, the overall spend in the U.S. healthcare market in medication management and adherence space rose from 10 percent to 20 percent over the last few decades. In future, the opportunity lies in the solutions that meet patients’ needs wherever they are and where they want to be.

DrFirst serves hospitals and health systems, individual clinics, offer e-prescribing platforms, provide patient-focused price transparency solutions, and much more. Take a listen.

Our Podcast Partner: PAUBOX_blue-250x25

PP: [00:01:02] Hello again, everyone. Welcome back to the podcast. This is Paddy, and it is my great privilege and honor to introduce my special guest today, Dr. Colin Banas, Chief Medical Officer of Dr. First Colin. Thank you so much for setting aside the time. And welcome to the show.

CB: [00:01:20] Thank you for having me. I’m honored to be here.

PP: [00:01:23] You’re most welcome. Thank you so much for that. So, let’s get started.

PP: [00:01:26] Tell us a little bit about Dr. First and the market need that the company is trying to address.

CB: [00:01:33] Yeah. So, Dr. First is a pioneering health technology company that’s been around for over two decades. In fact, we just hit our twenty first birthday on January 1st. And what started as an e-prescribing company, a medication management company, has morphed and evolved over these decades to include more and more solutions. And what we’re trying to do is unite all the different players in the health care space and break down the silos. So, we have this concept of the healthy verse. This is because there are so many different players in the health care universe that we’ve coined the term, the healthy verse. And we like to put the information in an actionable way in front of the key players at the moment of care so that we can provide better outcomes and better experiences for all of them.

PP: [00:02:27] So would you then call yourself a more of a data management and a data services company? Or are you offering solutions that use the data? Which side of the aisle would you see yourself more in?

CB: [00:02:45] Yeah, I love the word solutions and we are a solutions company, so putting actionable solutions in front of those key players is really where we sit.

PP: [00:02:54] You mentioned that the company’s origins are a prescription medication management that I imagine continues to be at the core of what you do.

PP: [00:03:04] So let’s talk a little bit about what are the biggest gaps that you see in this market today as you try to unite the data sources using the Healthworks concept that you talked about? And what really is the size of this opportunity? What are we talking about here?

CB: [00:03:20] Yeah, so I’ll start with the size question. I think it’s an interesting question, depending on how you define the medication management space and all of the various pieces and parts.

CB: [00:03:31] But what I’m reminded of is, if you look at the overall spend in health care in the United States a few decades ago, the medication management in its totality was probably 10 percent of the spend. And of course, the rest of it was 90. And over the course of these decades, it has inched up to the point where medication spend and all things related to it is closer to 20 percent now.

CB: [00:04:01] And so depending on how you want to visualize the pie of opportunity, it could be quite sizable. And when I think of medication management, I think of the lifecycle of the prescription from soup to nuts. The decision to initiate therapy and write the prescription all the way to getting it filled at the pharmacy to adjudicating the potential claim all the way to medication history services. So, when you’re seeing the patient back in the clinic or back in the ER or for an admission and trying to figure out patient adherence at that time. So, here’s really a whole lot of those places where our solutions intersect and can provide value.

PP: [00:04:45] Yeah, I’m familiar with the medication management and the medication adherence problems, and it’s a multibillion-dollar opportunity or a problem depending on how you want to define it.

PP: [00:04:56] And I imagine that, among other things, the life sciences companies, the pharma companies in particular are very interested in how to address those gaps because there’s some real revenue implications for them. So, who are your primary target markets for this? Are you serving life sciences companies? You’re selling providers. Who are your target clients?

CB: [00:05:19] Yes, to all of the above but really, I think the biggest opportunity and our biggest success stories are in the clinical space, health systems, hospitals, individual clinics and the solutions that again, surface robust medication histories. Price transparency could talk on about that and solutions that are patient focused and centered around patient activation. And so those are the things that really get me excited about the work that Dr. First is doing. We do have relationships with the payer community as well and trying to bring meaningful data from them into the workflow for our clinicians.

PP: [00:06:00] So, let’s pick any one of these constitutionalists, say health systems, for instance, how are they using your solutions? And then you walk us through maybe an example of how they use it and how the values created and abstracted. In other words, you’ve got a solution that helps them address their medication and hear those gaps. How are they using it? Are they using it for population health management as an example? How do they justify the investment in the solution? Is that a reimbursement component or Is the whole economics involved? Could you walk us through maybe an example using one of your prime journeys?

CB: [00:06:39] Sure. One of the ones with the most legs would be in that medication history, medication reconciliation space. So, we actually have a solution. And then layered on top of that is a patented AI and LP engine that we affectionately call smart. And I’ll tell you how this works. And so, we’re able to provide our clients with a robust medication history.

CB: [00:07:03] We give them a feed of the medications that were prescribed in the medications that are filled. And we actually fill in the gaps, perhaps, of what you may be lacking from our traditional medication history feed. Because we’ve been able to create relationships with independent pharmacies and payers and pharmacy vendor software systems. And so, we were able to augment the existing feed that you may have. And then we take it a step further and we use this AI engine smart to clean up that data, to duplicate it, to prioritize it etc. And then we can actually bring it into the electronic medical record structured. And then we can land it in the appropriate fields without having the clinician, whether it be the farmer or the nurse or the physician who is doing this interview to gather the medication history. We can land it in the appropriate fields so that you don’t have to re-input things. Believe it or not, even though we have all of these mandates for structure and for codify data when we’re transmitting prescriptions. A lot of times when we bring it back into systems, it comes in as free text. So, we’re actually able to solve the data cleanliness problem in a variety of venues. And what we’ve seen is by doing that, you can make the clinicians a whole lot more efficient. And so, we’ve seen client examples gaining efficiency from fifteen to twenty five percent in terms of the number of medication histories and medication reconciliation’s they’re able to get in a particular shift. And more importantly, the data they’re bringing in is accurate and actionable. And so, you can imagine that not only efficiency is important to whomever you’re talking to, but me wearing my safety hat, I actually like to think that the safety side of the equation is even more important. The fact that you’re not having to re-enter data that should flow seamlessly and potentially fact fingering some of those values can really help improve the safety side of the equation. One of our success stories and Covenant Health were in that 15 percent improvement in terms of efficiency. They saw a massive increase in the accuracy of the medication lists on the order of like thirty five percent improved accuracy. And by their own math, maybe we were able to claim a savings ROI of six hundred and fifty thousand dollars in a year. And that’s just one success story from one small piece of our solution set. So, you can imagine as I get the opportunity to describe other solutions and layer them all together, you can get this synergistic effect of improvements in the health care outcomes and the return on investment.

PP: [00:09:50] So that’s helpful to know if you put a number on the benefits system.

PP: [00:09:54] Twenty thousand dollars a year is a sizable number, I imagine, for how sustainable the other side is that you’re talking about.

PP: [00:10:05] When they approach this kind of situation, do you provide any commitments or assurances to them that they are going to achieve a certain threshold level of returns? Or how do you help them really make the decision? What conceptually it’s very straightforward that, yes, if we can improve medication, adherence and manage accuracy and medication and saw the benefits are obvious, it’s fairly straightforward.

PP: [00:10:29] But putting that into action and really helping your clients, specifically clinicians, pharmacists, to sell the idea internally and to gain approvals for budgets and so on and so forth is important. So, hoes it work today?

PP: [00:10:46] And what is one of the top things that they look for in order to feel reassured that this is actually going to deliver?

CB: [00:10:54] Yeah, it’s a great question and it’s become even more relevant in the current era that a return on investment wasn’t always top of mind when trying to pitch these solutions. But even more so now, things like automation and ease of implementation as well as return on investment have become increasingly important. So, one of the things we’re able to do with the solution I just outlined is we have a pretty robust return on investment calculator. And that calculator is based not only on industry standards, industry publications, but also success stories that we’ve been able to see with existing clients. And so, it’s an ever-evolving calculator that we’re able to provide and walk our health care partners through as these are the things you can expect to see. We also have a pretty robust applied clinical research arm at Dr. First. I’m happy to have that up with one of my colleagues. And, we’re constantly looking for partners who are wanting to study those things, just like you said, in order to as twofold. One, we want to give back to the research domain. We want to be able to show positive impact with the things that we’re providing. And then two, we would like to be able to tell those success stories to other partners and other potential partners out there. So, we do have a sort of a one to approach being able to help clients and potential clients with that return on investment.

CB: [00:12:21] So there’s other solutions in the medication management space, things like price transparency tools. So, showing the doctor what the co-pay will be for the patient at the time of writing the prescription so that you can make a more informed decision. Also, maybe, you can even select an alternative. Yet another one being able to provide patients after the moment of prescribing actionable text messages that can show them coupon cards or the prices that they can expect to pay again, as well as education. And so those things were also able to show our clients just through raw data. You know, this is the utilization that you’re getting from these particular solutions. And in the example of that patient facing solution, we’re also able to study adherence rates. And so, we know that when you get an engaged patient who is able to get those secure texts, we know that there are twenty five percent more likely to go pick up that prescription. And so that’s the kind of data that we can feedback. And ultimately, as you pointed out, these are the things that help build the case so that you can continue to layer on solutions with your partners or go extend solutions to new partners.

PP: [00:13:38] You mentioned depending on the focus on the ROI has become even more intense than it was before. Has the pandemic impacted the demand environment in any way, positively or negatively? Can you talk to what has changed for your company as a result of the pandemic?

CB: [00:14:03] Yeah, a couple of things. So, one, our own internal data shows us on the medication management space that adherence took a dip during the pandemic. Possibly due to cost concerns or patients losing their employment and thus their insurance status, perhaps.

CB: [00:14:21] And so back to those solutions that can help point out prescription benefits or help to activate patients so that they can see education, coupon cards, costs out of pocket. Those things actually have had a bit of an uptick in terms of interest in adoption. And a couple of things come to mind in terms of the impact on our company and our solutions. One, I even made mention to this a second ago, the ease of the implementation or the size of the lift seems to matter a great deal during the pandemic. And what I mean by that is there isn’t a lot of appetite nor time for multi month implementations that perhaps we had the luxury of before. But a lot of the solutions that we are able to offer up, especially in the medication management space, are very light lift. In fact, they’re often sort of unplug one and plug this one in and you’re good to go. And I think that has benefited us greatly in terms of being able to keep the momentum on a lot of our solution sets. So, we’ve actually some increases in our medication history space, our price transparency. This is again, unplug or perhaps an addition of our service to one you may already have. Go ahead and plug that in. And we’re talking light lifts for these things or under 20 hours for some of them. And that actually seems to be an appetite for that. So, you couple the ROI with the fact that you are not going to engage a whole lot of your internal IT talent. In fact, a lot of the lift is being done by us as the company. This seems to be a winning combination during the pandemic and even more than it was pre pandemic.

PP: [00:16:07] Medication management has been a target for quite a while by a number of different players in the industry.

PP: [00:16:14] And I imagine that the pharma companies obviously are tracking it from the point of view of their own products.

PP: [00:16:21] And I imagine that PBM would be another category that are really looking at the medication out in space and building solutions to create incremental value for their clients.

PP: [00:16:33] You talked a little bit about the competitive landscape. Do you compete with PBM’s, for instance, are you competing with an entirely new class of solution providers?

PP: [00:16:43] You talk a little bit about the competitive landscape.

CB: [00:16:45] I wouldn’t say that we compete with PBM. If anything, I’d rather use the word complement. And so, if you think about the traditional PBM relationships, they function in claims management for the most part. So, they have these relationships with pharmacies, with payers, with health plans. But again, traditionally they’ve had trouble getting upstream in the medication lifecycle to where the actual decision to prescribe something is being made. And that’s where we come in. We are leveraging relationships that we have at the point of care relationships with providers through our e-prescribing platforms, with our price transparency tools. And then also with the patients, again the solution I keep referencing about patient activation and patient engagement is called our e-inform. And it’s pretty revolutionary stuff in terms of being able to activate our patient base. And so again, I like that word complement the PBM’s. In terms of the competitive landscape, I would say there are other players in these spaces who are trying to skate to the same place. Or I can say independent solutions in terms of the ability to show price transparency or other prescription platforms and prescribing platforms, for example. And so I think that’s the competitive space that we’re playing.

PP: [00:18:05] And what do you see as the outlook for 2021? I know you said big technology firms getting into this in a big way. Amazon comes to mind. Obviously, their ambitions in the pharma space are fairly out in the open now.

PP: [00:18:20] What do you see as the demand environment going into 2021?

CB: [00:18:24] Yeah, you know, it’s always been interesting to keep an eye on quote unquote, the big guys for the past few years. In terms of their ambitions, I’m still not sure what to make of the Amazon play. But I do know, and I do think that there’s enough room for all of us. I guess, this is a good way to say it right now. And I do think that the outlook, at least in terms of things that are meeting the patient where they are in the name of consumerism. And I’m not a big fan of the term consumerism when it comes to patients, but I do think it fits. And so, the space to the extent of a solution that meets the patient, where they are, where they want to be, has tremendous legs in 2021 and going forward. And I think that’s the space that we’re filling nicely.

PP: [00:19:12] That’s fantastic. So, I guess we we’ll leave it there.

PP: [00:19:17] That’s a great positive note to end the podcast conversation on that column. Once again, it has been a pleasure having you on the podcast.

PP: [00:19:26] I wish you and Dr. First all the very best going into 2021.

CB: [00:19:30] Oh, again, thank you for having me so much. It really has been an honor.

[00:20:00] We hope you enjoyed this podcast. You can reach us at with your feedback and questions.

[00:19:44] This podcast is brought to you with the support of our partner mailbox and secure email for modern health care right out of the box.

About our guest


Colin Banas is an Internal Medicine Hospitalist and the former Chief Medical Information Officer for VCU Health System in Richmond, VA prior to stepping down after 15 fulfilling years to pursue consulting. He is proud to have testified before the U.S. Senate and the Office of the National Coordinator (ONC) on the topic of Health IT and the Meaningful Use Program and is a former Health IT Fellow for the ONC.

His interests center the role of big-data and analytics on patient outcomes and on novel forms of Clinical Decision Support, those that are outside of the realm of traditional rules and alerts, and include real-time dashboarding and intuitive usability designs.

He also helped spearhead the VCU effort to participate in the Open Notes initiative, where patients have access to their clinical documentation in real time. In 2017, Dr. Banas was humbled to receive the HIMSS-AMDIS award for Physician Executive of the Year from his peers.

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.

Financially, you can’t just buy the best-in-class, so we look at our legacy systems and tools first

Season 3: Episode #70

Podcast with Pamela Landis, VP of Digital Patient Engagement, Hackensack Meridian Health

"Financially, you can't just buy the best-in-class, so we look at our legacy systems and tools first."

paddy Hosted by Paddy Padmanabhan

In this episode, Pamela Landis discusses how they brought together a ‘digital ecosystem,’ a.k.a. a digital front door strategy. She also talks about how they engage patients at every major touchpoint of their journey by providing a seamless digital experience that is intuitive, consumer-friendly, and easy to use.

Healthcare is changing fast and patient needs must be addressed in a more front-facing way. While it is easy to look at best-in-class tools, financially they may not always make sense. At Hackensack Meridian, they first look at their legacy systems and tools to check for available core solutions to handle the digital patient engagement journey from a technology standpoint.

Hackensack Meridian plans to invest more in transforming themselves into a digitally-enabled organization and serve the patients in a digitally-enabled way that is consumer-friendly, like Amazon. Take a listen.

Our Podcast Partner: PAUBOX_blue-250x25

Pamela Landis, VP of Digital Patient Engagement, Hackensack Meridian Health in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Financially, you can’t just buy the best-in-class, so we look at our legacy systems and tools first.”

PP: [00:01:02] 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, Pamela Landis, Vice President of Digital Patient Engagement at Hackensack Meridian Health. Pamela, thank you so much for setting aside the time and welcome to the show.

PL: [00:01:22] Thank you so much for having me here.

PP: [00:01:38] So, maybe you could start by telling us a little bit about Hackensack Meridian Health and the populations you serve.

PL: [00:01:50] Hackensack Meridian Health is a relatively new company. It’s the result of a merger of two mid-sized health systems in New Jersey. We are now the largest health care provider in the state of New Jersey. It’s a really traditional looking health system where you have hospitals and physicians and other care entities all under one umbrella. We basically serve people from northern New Jersey all the way down the beautiful coastline in South Jersey. So, from here, you’ll probably find a Hackensack Meridian Health property. There are 17 hospitals in our network right now, and we actually have a mix of private and employed physicians and we have nine thousand physicians who are on our staffs.

PP: [00:02:43] That’s quite a large health system. It’s obviously a very well-known and prominent name in New Jersey. But thank you for that background and context. So as the VP of digital patient engagement, how do you define your responsibilities and who does it all report to?

PL: [00:03:02] I report to our Chief Strategy Officer and our CIO here, so it’s a dual report. And when Hackensack Meridian Health created this role about a year and a half ago, I’ve only been here a year and a half and came from Atrium Health and Prior to that Henry Ford Health System, where I worked on digital engagement tools and services to find health institutions. When I came here, Hackensack really wanted to say that we’ve got a lot of work that we need to do and we need to bring together a digital ecosystem.

So, it’s not just about websites, it’s not just about mobile applications. It’s not just about a patient portal, but it’s all of those things. And it also includes what I call our contact management. And our contact management is more than just taking phone calls. Our contact management is how we engage with our patients, our consumers and our teammates in all forms of online and offline tools and how do we build this ecosystem underneath. So that when you contact us, whether it’s through a website or through social media or through a forum somewhere or even through a phone call, we know who you are. We know what your needs may be, we understand how you want to be communicated with, and what answers that we can provide you. And so that’s basically what we’ve been building for the last year and a half. Some things around COVID have accelerated that process and something have actually decelerated that process. Because you’re so busy caring for a surge of COVID patients. Some things like you have to put on hold, but other things that you’ve been waiting to do, get unleashed very quickly.

PP: [00:04:58] And it’s often been told over the last several months that what was expected to take five years has now been accomplished in something like five months. This is because of the kind of urgency that COVID-19 created for us. You described at a high level what we would typically refer to as a digital front door strategy. So, it’s all of the above right patient portals, it’s about patient contact centers, and about digital patient engagement, which is why you define your role.

PL: [00:05:31] It’s how we do customer relationship management using modern tools and leading edge tools. And that’s where the crux of matter lies. So, there are some foundational pieces that is your EMR, you might have a CRM solution, some business intelligence tools, a patient portal or call center technology. And what my job is to nip those pieces together. Also, to make sure that the consumer experience is seamless, so it doesn’t matter what doorway they come in, they understand it. It’s intuitive and easy to use. It doesn’t take us to do all kinds of education up front. It’s just as consumer friendly as using Amazon and nobody’s there yet in health.

PP: [00:06:29] Healthcare, as you alluded to, has traditionally been behind other sectors with regards to consumer engagement, digital consumer engagement in particular. The Amazon experience is not there yet in healthcare. And one might see this as the opportunity really to up the game in many ways. And you talked about all of the foundational pieces, CRM platform, the EMR platform, the call center technology and others. And then, of course, there’s a lot of new solutions that are available to really create the best-in-class experiences that would create the sort of seamless consumer experience that you referred to. So how do you approach this and the creation of this experience? How do you approach it from a technology standpoint? I know it’s a two-part question, but can you walk us through one program where you’ve really transformed the experience.

PL: [00:07:28] I have been doing some of this work since 1995. And when we would say, we need to build a website to do X, Y and Z and it’s going to cost X amount of dollars. My leadership and I, working with over the years at all the institutions would say to me, that’s a lot of money. And so, I go back to like what healthcare did in the late 90s and early aughts. They were really investing their capital in foundational solutions, revenue cycle, EMR and also in clinical tools. Proton beam therapy is expensive, robots are expensive. And so, when we would come and say we need to do a digital patient solution and it’s going to cost five hundred thousand dollars. So, an executive might look at that and say, I could get some new 128-bit imaging slicers into my hospitals for that amount of money or I can hire four more nurses. Those were hard decisions to make. And so, a lot of times what healthcare was doing was investing in some of that foundational infrastructure. So, yes we’re behind. We in terms of a digital solution for patients have made very strategic decisions that we were going to invest in people and cutting-edge technology to deliver world-class care. Those are hard discussions to have and so you have to really make your case. I think, in the last 10 years what we have seen is an embrace at the executive level that is the model of healthcare is changing in a way that we have to now start addressing patient needs in a more front facing way than we have previously. So, what we’re starting to see, is the understanding among executives who said, I get it because I’m using these tools because my health system isn’t as easy to use as an Amazon or another tool. They now get a look at the financial services industry who have made a really successful pivot into digital tools. The health care leaders across the country are saying we need to do the same thing. So now, the work and the emphasis is going into that transformation. But it’s going to take a while because we still have a really important legacy tools that we need to optimize to be able to handle the digital patient engagement journey.

PP: [00:10:22] In that context, you have to your point, the legacy investments in some of the core platforms like your EHR systems, for instance. Now you are transforming the enterprise into more of a digitally enabled organization that can serve patients in a very digitally enabled way. And so, it requires a whole different set of perspectives on technology choices. So, when you look at transforming the patient experience, do you start with your legacy platforms from a technology standpoint, and do you look at what’s available? And then roll it out and make the most of it, or do you say, I’m going to look at what’s best in class out there and then I’ll be back into what I think is the right solution for our enterprise. How do you approach this?

PL: [00:11:12] How we do it here is we look first at our legacy systems and our tools. What we have here in our core solutions, you have to rule those out first. I mean, financially, you just can’t, like, buy a best in class. You just can’t do everything at once and then hope everything integrates that creates a long-term maintenance and support challenge that you want to try to avoid. So, the first thing you got to do is, for instance, here at Hackensack, can Epic do this? Can Oracle or Google do this? And if they can’t, then it’s time to say, there are wrap around services and tools that can integrate easily. And have API services available to integrate to an Epic or Oracle or a Google cloud platform. So, I look at those things first. And so, I try to look at our core solutions. Then we say, if they can’t meet it, are there companies that have relationships with those core solutions that have done the integrations? And if not that, then I go to the best in class.

PP: [00:12:29] Let’s say you’ve got some native features in Epic and they will do the job for you. But at the same time, you know that there are other tools out in the market for those same features that we plug and play easily with Epic and have a superior interface or a superior set of features. What do you do then?

PL: [00:12:57] Yeah, and that actually happens a lot more often that people probably understand. Sometimes you see much more elegant solutions in that third party market, and you have to prioritize which one is going to give you the biggest bang for your buck. Can you live with the way Epic open scheduling works today? Or do you need a layer on top of it from a company like Kyruus? And I think that those are individual business decisions that have to be made, understanding what you’re trying to achieve, what your goal is. Can you live with the 80-20 rule or do you have to say no? What is so important that we actually have to go outside.

PP: [00:13:41] That is a great example actually, that you just mentioned. And I’m sure that when you look at all the digital engagement touchpoints that are available to you, you could probably come across several in the category where you have an elegant solution that performs better than a native feature in your platform. Now, let me switch to the back end of the technology infrastructure. All the front end experiences that you describe can work seamlessly only if you have a robust backend. And that means that you’ve got to have your data centers or your cloud policies like the orders and infrastructure, your wireless infrastructure, all of the above. And you mentioned that your role has to do a report into the CIO as well as a chief strategy officer. So, I imagine you get very involved in a lot of these back and transformational initiatives that are going to help you deliver the kind of experiences that you seek to deliver. Can you talk a little bit about what are the top two or three things that you think are absolutely critical table stakes for you to be able to deliver the experience you seek to deliver?

PL: [00:14:51] Yeah, so as we’re recording this, we’re doing our vaccination rollout and we’re doing online vaccination scheduling. And so, we knew that we were going to get hit hard on our Web sites. And so, we at the front end engaged our partners in this. In this case, it was eight of US and in Epic our data center folks say, we’re going to get some traffic that we’ve never seen before. And all through COVID, we’ve seen traffic to our external websites at a rate that is unparalleled. So, let me give you one example. This time last year, we were getting about three hundred and fifty thousand visitors a month to our website, and now I’m doing about three million consistently. And so we started scaling up and we made sure that our backend was able to handle the load. On this vaccination scheduling, we actually understood that with Epic we had as much horsepower to handle all of that as possible. And there are moments during the day when you’re trying to schedule an appointment, you get the busy signal on the server, you don’t get it often, but you do get it. For example: A week ago on Friday, we opened up scheduling at our mega site at the Meadowlands and we opened up slots for people to make appointments. And we’re working with the state of New Jersey in the New Jersey State Police and the National Guard who are helping our staff at that site. But we’re managing and operating that site and using our scheduling tools. So, we had thirty-five thousand people scheduled within four hours. That’s a lot of traffic to our servers in that time and it went fast. And so the site performed and we were ready for it. We were monitoring it during the whole time, but every single slot was taken within four hours. And so, it’s always about planning and thinking that I’ll just double it. Well, you probably need to triple or quadruple it when you think that you’ve got enough and you probably don’t. And you’re going to need more in these particular use cases. I think that they’re extraordinary and off the charts for a while. But that’s what we’ve learned over the last year.

PP: [00:17:21] That is such an interesting anecdote here, Pamela. Eight months ago, everyone was talking about having to deal with a 10X and 15X increases in telehealth visits and what kind of challenges they represented for IT executives. How they are trying to scale up the infrastructure to make sure that the line doesn’t drop? You’re able to log in, you have high quality video and so on. And now we are talking about vaccines. So, it’s a very interesting change in tone, if you are talking about dealing with COVID-19 related virtual visits and not talking about vaccines. And I imagine that through these experiences, the ability to scale and also the potential for emerging technologies, specifically cloud, since you mentioned AWS will do it in a way that you’re able to meet the expectations of your constituents.

So, switching back to the digital front doors and switching back to digital patient engagement, you’ve been here for about a year and a half, but you’ve been doing this longer. So just looking at your Hackensack experience, what does your data tell you about the adoption levels for digital engagement tools among your patient population? And what is sense of the change in consumer preferences today?

PL: [00:18:47] Yeah, so here’s one piece of data. We saw MyChart usage in terms of activation. You always want to have people use MyChart as much as possible. But we were not, unlike many health systems across the country where adoption wasn’t as high as we want it to be. In the year of COVID, we increased MyChart activation to 68% and that was without doing one IOTA of marketing.

PP: [00:19:18] How does the benchmark with best in class, in your view?

PL: [00:19:22] So I would say that we are probably under best in class. We were probably in the bottom quartile of health systems around the country. When I look at some of the best ones around the country, like a Kyruus or somebody that has very high adoption rates or a Providence, Saint Joseph’s out there in Seattle. I would say we’re in the top quartile now. We’re not just in class, but we’re getting there.

PP: [00:19:47] Well, that’s significant improvement.

PL: [00:19:49] And if you think about it, Paddy, we didn’t tell anybody about it. It was just consumer demand that drove it. And that’s where I think we have a lot of learnings that have come out of this. People are now ready. Another anecdote was, there are still important tools like your phone lines. During this vaccine, when we started doing vaccinations, one of our phone lines, for example, would normally get about one hundred and fifty calls a day. It’s now running fourteen thousand calls a day. And it was like, to find a doctor and to hook people up to the right doctor in their area. The demand around health care services is exploding and it’s basically about the vaccine. Our challenge will be, how do we keep and capture those people after people are vaccinated? How do we make sure that they stay with us in care, that we start not only just vaccinating but caring for them through their life.

PP: [00:20:59] How does the profile of the population that you serve play in the adoption rates? Within New Jersey, do you see differences between one part of your area versus another?

PL: [00:21:15] Yeah. So, where I’m seeing the difference is if we’re thinking about the digital divide, here are two areas that I worry about in the digital divide. And I don’t have great answers and I would love for someone to give me the great answer. How do we help people where English is a second language and where they’re not native English speakers as much of our work is still in English only. And that worries us in some ways. And the other one is for those that are seventy-five and older, where digital adoption is lower than in other age groups. It’s still pretty decent, but it’s not where it needs to be. And when I think about the people who are most at risk having serious complications from COVID, those people who are 75 and older, and people from minority communities or people of color, I need to make sure that when we build these systems, we address those needs too.

PP: [00:22:18] It’s interesting you bring that up. One of my recent guests on this podcast is the CIO of Health System in Southern California that serves Medicaid populations, mostly Latin communities. They’re one of the things that you mentioned was very relevant in their context, which is the bilingual capability to whenever you turn on a digital solution. And, of course, the one thing that in their case, they had to deal with was serving low-income population. They had to really make some of their digital solutions backward, compatible with earlier generations of devices. And this was something that was counterintuitive to me. Maybe we’re on the latest version of iPhone. But their population are two or three or even earlier generations. To make healthcare inclusive for them, one of the big things about the digital divide is to make sure that the solutions reach everyone, not just certain parts of the public. That’s what I’ve heard from that vision. Sounds like that’s what you’re saying too.

PL: [00:23:26] Yeah, I am seeing the same thing. And a lot of folks say to us and when I look at the data in the state of New Jersey, they assume that those people of color or other groups don’t have access. They might not have broadband laptop access in their homes, but they certainly have phones. And here’s the other sensitivity. We need to be sensitive about how much we’re using in terms of their data plans. And I need to make sure that whatever we deliver is as efficient as possible so that we’re not sucking down a lot out of their data plans.

PP: [00:24:00] That’s another very important consideration as well. You worked in Atrium, you mentioned and prior to that Henry Ford Health System. And so, my guess is you’ve seen a lot of best practices from your peer group, health systems, both by virtue of your own experience, but also through your network in your community. So, can you talk about what you’re seeing as some of the best practices? Maybe one or two best practices that you would like to share with my listeners and maybe one from your own experience?

PL: [00:24:33] I think that a lot of groups are doing some things really well. So, when I go back to my former coworkers, the Atrium Health, I think some of the work that they’re doing there around the vaccine is just like a huge event at Charlotte Motor Speedway where they inoculated sixteen thousand people. We were really surprised by seeing the work that they were doing there and how they had really figured out the efficient way to manage those folks through such a large operational endeavor. Kudos to them for doing that work. I think that there are some folks across the country who have taken different approaches to it. Some of my colleagues around the country, their health systems are inoculating only. For instance, their own health care workers and a small cohort of patients. We at Hackensack Meridian Health are not only going to do our own health care workers, but we’re going to start servicing the public, too. It is hard work to take on that piece too, but we would be able to do all of this getting as many shots and arms as possible, not just for ourselves and not just for our own patients, but also for the communities we serve at large.

PP: [00:26:08] That’s so wonderful and thank you for sharing that. We are at the end of a time here, and I guess we’ll have to leave it at that for today. But I’m fascinated by all of the anecdotes that you’ve shared. And thank you so much for setting aside the time. I look forward to staying in touch with you.

PL: [00:26:25] Thank you, Paddy. I’ve enjoyed this. Have a great day.

We hope you enjoyed this podcast. Subscribe to our podcast series at and write to us at

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

About our guest

Pamela DeSalvo Landis is vice president of digital engagement at Hackensack Meridian Health Network, a $7 billion integrated network in New Jersey. She is responsible for the strategy and implementation of all voice, AI/ML, mobile, web, unified communication, engagement and collaborative technologies for patients, consumers, physicians and employees. Her team leads technology and development efforts around making it easier for patients and consumers to get access to healthcare services, particularly online and on the phone. Her team is building a 24-7 digital network operations center where all consumer traffic will flow.

Prior to joining Hackensack Meridian, she led digital efforts at Atrium Health in Charlotte, N.C. and Henry Ford Health System in Detroit, MI.

She is a graduate of Ohio University in Athens, OH and earned a master’s degree in health informatics from the University of Illinois-Chicago.

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.

In any healthcare organization, integration of third-party apps with your digital solutions can either make you or break you

Season 3: Episode #69

Podcast with Ray Lowe, SVP and Chief Information Officer, AltaMed Health Services

"In any healthcare organization, integration of third-party apps with your digital solutions can either make or break you."

paddy Hosted by Paddy Padmanabhan

In this episode, Ray Lowe discusses the multi-year digital “overhaul” at AltaMed and the challenges they faced while driving adoption of digital solutions in the organization.

AltaMed predominantly serves a low-income population and underserved communities. There is a digital divide that exists out there. AltaMed strives to address those challenges while connecting with their patient populations electronically.

Ray also discusses the drivers of technology selection at AltaMed for building digital front door tools and mobile apps, and engaging with their patient populations. Take a listen.

Our Podcast Partner:

Ray Lowe, Senior Vice President and Chief Information Officer, AltaMed Health Services in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “In any healthcare organization, integration of third-party apps with your digital solutions can either make or break you.”

PP: [00:01:08] Hello, everyone, and welcome back to my podcast. It is my great privilege and honor to introduce my special guest today, Ray Lowe, SVP and CIO of AltaMed Health Services in California. Ray, thank you so much for setting aside the time, welcome to the show.

RL: [00:01:26] Thank you for including me today.

PP: [00:01:29] Thank you. Can you tell us a little bit about AltaMed Health and the patient populations you serve?

RL: [00:01:40] Sure, I’d be delighted to. So, I’m Ray Lowe, CIO and Senior Vice President for all of the health services. I’ve been with the organization for three years and in this time period, we actually have completed a ‘digital overhaul’ of the enterprise, including technology applications, patient engagements. AltaMed serves over three thousand patients at over 50 locations and the greater Los Angeles and Orange County areas with over one million visits per year. We provide services to the Medicaid, underserved populations that are primarily Latin, multi-ethnic, and many of those are 200 percent below the poverty level and 40 percent are pediatrics. Some of our services include primary care services, women’s services, pediatrics, HIV AIDS outreach. We also have programs for all-inclusive care for the elderly. We also have two other companies. One is the ALtaMed Health network, which is a strategic ______

again, focusing on Medicaid internal product, as well as a managed care organization known as Alterra.

PP: [00:02:48] Thank you for that background. I am obviously interested in learning about the complete digital overhaul that you referred to, and that will be the focus of our conversation. But before we jump into the digital transformation journey and AltaMed, I understand that it is also a pioneer in the use of the patient centered medical home concept, the PCMH concept. Could you talk a little bit about that experience and how that has worked for your population?

RL: [00:03:22] Sure. So, I just started PCMH or patient centered medical home until it actually started this in 2011. So, you have a bit of time working on this. We started with our pediatric populations in joint co-operation with Children’s Hospital, Los Angeles, and we also utilize the PCMH approach on our senior services. At its core, what PCMH is, it’s a way of coordinating care for our patients. It also means adjusting our processes and care to treat the whole person. Within our PACE program, we have nurses that manage patients ensuring they receive regular treatments, required medical equipment, special referrals and other type of clinically related activities. We also provide PT/OT, dental, and socializations to help them vibrant. We expanded this even further, including interdisciplinary care, which is our social aspects and social determinants of health. So, for our PACE seniors, our teams work to address both the clinical, the social interdisciplinary and any type of SDOH things that can impact them and their overall well-being.

PP: [00:04:35] You’ve been practicing this since 2011, so you would have been one of the pioneers in this concept. I imagine that you have a wealth of data and you’re utilizing that to drive improved outcomes for your population. So, you mentioned about coming out of a three-year digital transformation, digital overhaul. Can you tell us a little bit about that? What were the top priority areas for that program and what kind of programs are currently operational at AltaMed?

RL: [00:05:10] Yeah. Our priority is really providing quality care without exception. And from a digital health perspective, that really means patient centric care where, when and how they want it. AltaMed provides care for essential workers. Many of them are low income and underserved communities, this is a patient population that has been inadvertently left behind. I would say due to the digital divide that does exist out there. As we plan our strategy, first and foremost, we want to have a global strategy that provides care with flexible walls both inside and outside of our brick-and-mortar facilities. The second thing that we do with our digital health strategy is that we leverage our Epic MyChart. We call it MyAltamed portal for patient interaction and messaging. We went live with Epic in October of 2019 in a 10-month implementation cycle. And the interesting thing is we’re barely five months ago from a pandemic yet. And the digital solutions that we built – telehealth, remote patient monitoring, patient engagement strategies – are all centered around MyAltaMed in MyChart of Epic. So that we can have the rich clinical information and stay in good contact with our patients around them. In March of last year, if you draw that as a starting date, we had on our roadmap the virtual health, the tele visits and RPM and my diet partner and we were evaluating who would be possible candidates that we should be looking at. And for instance, on the RPM side Vivify, Livongo, VitalTech, McKesson and other ones that we were having conversations with, we had not selected one. And then even in terms of the televideo, we’re having conversations with American Well, Vidyo, Cisco extended care. In other words, what would be the right solution for the organization?

In our digital journey, we learned quickly through the pandemic that we had to be able to deliver a televisual platform around that. The third area we’re looking at is transitions of care and managing our patients in the hospitals and beyond our hospitals as a case management. This is all about data interchange and being able to mine the data so that we can have timely data and we can do the proper kind of interventions. A fourth area we’re looking at would be in our women’s services and their pregnancy journeys. What is the type of handheld app that can help on the mother baby journey. Be Babyscripts, be it mommy or others that help our pregnant moms as they’re going through their different trimesters and their wellness checks and then again, continuing expanding our care on the walls for our PACE participants. The pandemic has really reduced the amount of participants that can actually come to our centers. And so, we’re looking at how do we continue to have the seniors be vibrant, receive the same amount of care in a technology supported method. And often you’re dealing now with a population that may not be the most technically savvy, but we want to make sure that they are not afraid of the technology, how to use it. And lastly, again, looking at the wage aspects on the care and helping our patients access to services.

PP: [00:08:45] Well, that sounds like a really comprehensive digital transformation program.

You cover pretty much everything that would be considered a high impact area. So, you talked about telehealth, remote patient monitoring and mobile applications for the populations. The question that comes to my mind is you mentioned that you serve predominantly low-income populations, and you also mentioned the digital divide that is out there. So, in that context, what kind of unique capabilities or unique enablement do you have to plan for and put in place for your populations to get the same access to the same quality of care as anyone else?

RL: [00:09:28] You really hit the nail on the head. That’s one of our most significant challenges, an area that AltaMed strives, which is to be culturally sensitive. Rather, the majority of our patients are Spanish speaking. They may only have a third or fourth grade education. So how do you communicate with them when you start even at the top with Epic systems in Verona, Wisconsin, as we launched our Epic MyChart, our cultural and linguistic folks know the Spanish translation. And so, we work jointly with Epic to really enrich a Spanish translation so that users can understand it more easily. Again, we are working here in East Los Angeles, a very heavy Latino area versus folks in Madison that may have more a Google translation of Spanish, but that’s a big key area around there. The other thing that we’re seeing is there are a lot of folks building apps that may work on an iPhone 10 or something new or maybe an iPhone 8. But when you’re dealing with the underserved and low income, oftentimes they may not have that latest iOS system. They may not have an iPhone 6 or 4 because they can’t afford to get a new iPhone. With this patient population, they’re making decisions on whether they pay their cellular bill or whether they’re putting food on the table or the real decisions they have to make every day in terms of how they spend their valuable dollars. So, when we look at the technology solutions, we require the language diversity, backward compatibility on different types of iOS systems and ease of use. And you would really be amazed to hear that many folks don’t think about it as they’re delivering and bringing things to market.

PP: [00:11:22] Wow. That is something really counter intuitive. Having to plan for backward compatibility. And a lot of us are looking at the next version of the iPhone as opposed to an iPhone that is three or four generations ago. But it’s a very real problem that you’ve described. I think this is what healthcare is all about, making sure that it’s inclusive and it serves the needs of all populations. You talked about a lot of technology choices here and all the different platforms that you would consider Livongo and so on. When you assess technology partnerships in your technology choices for implementing digital programs for the population, what are you looking for? What are the top two or three things that drive your decisions, especially as it relates to digital front door tools and mobile apps and engaging with your populations?

RL: [00:12:18] So we rely heavily upon Epic through either the user groups, what we’re seeing in the App Orchard, because it’s really so strong and sharing the best practices we’re able to learn from UPMC, from Cleveland Clinic, Kaiser Stanford in terms of their journeys. And they make it available so your learning can be faster because they’ve proven what technologies can work. Speaking more about the App Orchard, in any type of healthcare organization, the integration of third-party apps can make you or break you. And further it will tell how well that digital solution will integrate. Granted with enough time and money, you can make many things work, but when you’re doing a digital transformation in a matter of months. And which is really the pace which most of us are going now versus years of kind of playing with ROI and fed and interfaces etc. You really need to be pretty clear that it’s going to integrate very easily, stacking them together just like Legos so that you can turn something on in a couple of months versus looking at maybe six months or eight months later. And part of innovation is failing quickly. So, you can learn around that. And by taking that approach, you can easily see the results before you’re so committed to a program or to an approach. The other things we’re evaluating is now e-console platforms are really becoming very interesting right now in terms of how we help our providers. And we’re looking also ambient voice for provider productivity and ease of use. And then on the patient side, kind of looking at our elders and some of the other areas is can we extend tablets out to them that they’ll find easy to use? And again, kind of addressing that inherent digital divide so that they can be connected electronically to AltaMed.

PP: [00:14:27] One question that comes to mind when you talk about a range of digital solutions that you’re trying to implement is how do they pay for themselves? There is a reimbursement component to it, a ROI component to it, and obviously there’s a cost component to it for the patients as well in terms of the devices or bandwidth access and a range of other things. How do you go about looking at this from a business standpoint?

RL: [00:14:56] That’s a great question because you need to look at why are we innovating? What is the business outcome? There may not always be a financial reason, a financial payback. And when you look at the quality and doing what’s right for the patient and so that by extending solutions to them is the right thing to do. Honestly, I would say, again, we went live in October of 2019. And before that, if you wanted to come to AltaMed as an essential worker, you’d have to take a day off. You may have to take multiple buses to come in. You could not auto-register etc. And when you look now in 2021 in January, we offer both telephonic or tele video visits. We provide this with the ability to bring in language translation services to the mom with that kid that could be sick or somebody with the URI, which is very prevalent. People are very concerned and able to address those needs. So that’s really about doing the right thing for the patient, because nobody wants to go into a hospital and nobody really wants to go to a clinic, but you still can provide that care for the patient at the right time.

So, I look at a lot of that. ROI is what’s the right thing we need to do for the patient. How do we need to do about quality as well? You mentioned reimbursement. That’s always a tricky topic because now we’re talking about the feds and how the CMS guidelines are reimbursing or not reimbursing. And that could be complex sometimes. It does affect timing sometimes in terms of what you introduce for your digital solutions. But I think ultimately keeping what’s at the best interest of the patient is where we need to be. And I think the other part of it is when you’re implementing, you need to understand what is the provider workflow change will look like and what will the patient look like? You can put in some very cool digital tools, but if it’s not adopted, you won’t be successful with the outcomes you need.

PP: [00:17:08] That leads us to obviously the big question, how do you get people to adopt to it? And at this point, we are not just talking about patients, but we’re also talking about caregivers. What kind of training, what kind of enablement do they need? How do you make them change their workflow or their daily problems? So, this is not new to you. This is a universal challenge across all of healthcare. Can you talk about one or two things that you consider a success in this regard in driving adoption?

RL: [00:17:39] I can use a language and I can use a tele-video as both example, because they’re all very new. Again, if we go back, it was April 8th of 2020, the CEO came to me and he said, give me a video solution. And I’m like we didn’t even have anything instantiated. And then CMS was dropping their HIPAA requirements. It was making it much more open. You could do some video, other areas to address it. But we want to make sure that what we talk is still a HIPAA compliant approach. So, we didn’t expose anything accidentally or put anybody in a breach type of position. So, we actually selected two, which was Doxy and Doximity, which is widely used in healthcare with an eye towards a long-term solution which should be integrated with Epic, launching out of Epic etc. It’s a change moment, right. We got it to work. We try to be the correct flows and templates inside of Epic. We trained the providers and yet there was a lot of confusion because they really didn’t know and patients didn’t understand on personal care going into a black room. It was really very challenging in terms of driving the adoption.

So, what we did is we reset, and we created a digital center of excellence within two of our clinics where they would primarily focus around the televisual experience. This includes language and other requirements that we would have so that we got really good at it. And then we’re able to share those best practices across the other two hundred plus providers in all time so that it’s much more standardized. The other thing I did, as well is that from a training perspective, my training team was certainly conducting a lot of distance training, web training as a norm and we weren’t getting the results. So I said, you need to meet the providers where they are. And we could do Zoom training, Webex training all day, but they’re not quite getting it. So, we really doubled down, tripled down on the hand training with the folks and they had hours working with them. The clinics up there, again, able to be much more comfortable with the usage of the tool.

PP: [00:20:00] Yeah, those are very interesting examples. You talk about innovation; you talk about it few times that you’ve accomplished quite a bit within a very short time given the pandemic and everything. And possibly because of the pandemic in the sense of urgency that created around the implementation of some of these programs. Does the other side of driving innovation rapidly? You refer to it in passing when you talked about failing fast and learning quickly and moving on? So, how do you manage the risks of innovation, especially the innovation that comes to it in the form of a solution that’s been developed by digital health startup? And what is your advice to startups who are looking to engage with you and be part of your innovation journey?

RL: [00:20:50] That’s a multipart question. So, I think it’s actually cited in your book. From an infrastructure perspective, have a sound foundation in terms that you can go ahead and sprint and look to leverage your technology backbone to deliver these resources. There are so many different workshops or data center processing activities hosted solutions that can cause many problems to fail, technical debt etc. And there was quite a bit of technical debt here. I remember I heard there’s a great quote from Warren Buffett that when the tide goes out, you discover who’s been swimming naked.

PP: [00:21:40] Yeah, I’ve heard that one too.

RL: [00:21:44] Yeah, I love that quote. And a lot of folks, that have been ignoring their technology infrastructure, just putting it off, extending the life they were caught when the tide went out. So, the investment of understanding the life cycle and the technology that you’re building. Again, we kind of did almost a wholesale upgrade from our data center to our networks that are happening out there. And part of that is building really strong partner relationships. I selected, of course, AT&T and heavily with Cisco, NetApp and partnerships with Presidio networked connection. And I had to leverage those technology partners. And the thought leadership where I had gaps in my own team’s ability to deliver. But the net sum of the parts just delivered superb results. I like having executive briefing sessions. And again, at Cisco, there’s a girl, Catherine Howe, who’s the director of their healthcare, and we had an EBC with her. And I was putting all of the Cisco products and we went through an exercise that was actually able to determine for what we wanted to deliver, that I have actually made all the right technology choices. And so, I was like, OK, turn the afterburners on, we can go even faster. And that occurred about at the end of 2019. So that was a good way to start from a technology perspective. But then you ask me, what do you share to startups, what would you tell them? You know, there’s so many great ideas and companies that are out there. I manage the risk by having a joint review of my diet partner, Dr. Eric Lee. He’ll look at the clinical expertise and how the workflow is and the experience and what is seen.

So, we’re able to assess it from a clinical perspective. And I look at it from overall systems perspective, interoperability, security, how it works in the overall ecosystem, whether it’s a sound business decision, etc. And ideating between the two of us, we really kind of come up with a very solid solution that we’re very confident as we move ahead. But other startups, I think they have a very clear vision of what problem they are trying to solve. I know some folks say that they will do RPM primarily for diabetes management and they will be moving to a CHF type platform or COPD or other type of chronic disease states. I appreciate that honesty. They tell me what they’re really good at and where they’re going to go. I know where the baseline is from or I get a little more perplexed when people tell you they can do it all that is also known as advertising, but not in line, I think what they say is very disappointing.

And then people also underestimate the integration activities, or they don’t have good technical resources to make it easy for the health system to ingest the product and to start getting results, ultimately you want us to be your evangelists of why this product is the best thing, sliced bread. And this is the outcome of what we’ve been able to achieve by them.

PP: [00:25:01] I think that’s great advice to start ups. You mentioned that you have a clinician, a partner with whom you work very closely in determining how to roll out these programs, what programs to learn, how to roll them out and what kind of technology foundation you need to have in place and so on. Can you talk a little bit more about your governance model? What is the governance structure for driving these initiatives? Do you have a board level, C- level approval?

How do you prioritize? Can you talk a little bit about how do you fund, how do you prioritize it and implement?

RL: [00:25:46] Sure. The term digital is a very broad term. Who you talk to, it means different things. In AltaMed we do have a structured governance process that is overseen by our Executive Governance Leaders Committee of which I’m a member of. It is basically the C-suite where key decisions are made. But then when I look at, there’s really four areas that you drill down into. One part of it is the digital engagement or the patient front door, which is your website, social media and CRM patient engagement activities. Another key is going to be your clinical digital, which is tied to your EMR and the related applications and how that’s working. We try to leverage as much as we can out of Epic and the MyChart as versus looking at third party apps to have to be built on because Epic is very rich. The technical digitalization, which are many of the hardware vendors, also want to talk to you about that data center or ______

. And those are managed primarily under my direct purview. And then as we look at innovation and destructive areas, there is business strategic oversight with as I spoke earlier on, women’s health RPM and how we can leverage other types of services. So, each of these four contribute to digital. I may have left out a few other areas that are out there. But it’s a top 10 list that I review with a CEO so that I stay aligned with the CEO’s plans and what we’re supposed to be executing. The budgeting and prioritization is an art. There are lots of apps that come up and there are lots of shiny coins that are thrown out there. But again, through maintaining focus on one of those top trends and other things come up, perhaps we can put them under a sub project of one of those ______

. But as you look at something with a significant investment, we look at what is the total cost of ownership, what’s the ROI and what are the KPIs that we will be achieving. And are we going to be achieving those for a very large investment, say, over 10 million? We may bring in an outside consultant to help us get through it. So, we really understand how we’re going to be achieving those type of KPIs. But it ultimately has to make good business sense, good financial sense. And we really should not be doing it just for technology purposes. We need to have a direct business outcome to it.

PP: [00:28:25] That’s very comprehensive. We’re almost out of time here. I want to ask you just one final question here. If there’s one best practice from your experience with digital transformation and augment that you would like to share with your peers, what would that be?

RL: [00:28:42] Yeah, I would say this. I mean, I met late on my journey on this. And as I’ve been able to review your guys book, it’s really good. I mean, thank you. It lays out the steps, the technology, the approach. So, I think if you’re trying to figure out where and how to go your digital journey, if you use your book as a reference, it will be very helpful.

And the second part of that is, again, you need to have a solid understanding once the solution is implemented that you keep both a provider and a patient centric view. You cannot keep an eye view because that would ease the adoption and accelerate the overall benefits. Yeah, don’t make it an IT project, right?

PP: [00:29:27] That’s correct. All right. Thank you so much for those kind comments about the book. And I will be sure to pass this on through ahead as well.

PP: [00:29:38] Well, I guess we’re going to have to leave it there for today. It’s been such a fascinating conversation. Thank you so much for taking the time to share your experience, your insights, best practices.

PP: [00:29:50] And I look forward to following all your successes going forward.

RL: [00:29:54] Thank you. Thanks for inviting me today. I really enjoyed our time.

We hope you enjoyed this podcast. Subscribe to our podcast series at and write to us at

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

About our guest


Raymond Lowe joined AltaMed Health Services in January 2018 as Senior Vice President and Chief Information Officer. He is an accomplished healthcare Information Systems (IS) & Information Technology (IT) executive with extensive experience in complex system delivery and operations. At AltaMed, he is responsible for all aspects of IS and IT for the organization, including strategy, innovation, delivery, operations, cybersecurity, data reporting, health plan and clinical applications, and merger and acquisition activities.

Among his many accomplishments at AltaMed, Mr. Lowe has been integral in the organization’s clinical systems transformation from the legacy system to EPIC, implementing the new Electronic Medical Record (EMR) platform system-wide,  while meeting strict timeline and budgetary parameters.

He also spearheaded the establishment of foundational infrastructure, cybersecurity enhancements, and application stabilization required to support the enterprise organization. Prior to joining AltaMed, Mr. Lowe spent several years with Dignity Health as their Senior Director of Technology and Infrastructure. There he was responsible for the strategic design and delivery of IT transformation and optimization, including their Data Center, Network Consolidation, Unified Communication, and application rationalization. He also served as the Senior Director of Clinical Applications and Implementations for the Cerner EMR at seven Dignity Health hospitals.

Mr. Lowe has more than 20 years of knowledge and experience in healthcare IS/IT leadership including roles with Providence Health Services’ California Region and as Chief Information Officer for Kaiser Permanente Information Technology – Los Angeles Metro Area. Throughout his career, Mr. Lowe has been recognized with such distinguished honors as Becker’s 100 Top CIOs to Watch in 2019 and 2020, and BT150’s Most Transformational Leaders in 2019 among other noted recognitions.


M.S. Engineering Management, University of Southern California
B.S. Electrical Engineering, University of Southern California


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.

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.