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

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.

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