Season 4: Episode #117
Podcast with Brian Davis, CHCIO, Chief Information Officer, Magnolia Regional Health Center
In this episode, Brian Davis discusses the perfect storm of competition for patients, labor, and medical supplies that even a small hospital in remote Mississippi, such as Magnolia Regional Medical Center now faces. Brian describes Magnolia as a large ambulatory facility that happens to own a hospital. He explains how he uses federal grants and state programs for rural broadband access to drive telehealth and improve technology adoption among patients and caregivers.
As a long-time user of Meditech EHR, Brian talks about their deep commitment to Meditech and their efforts to build mobile experiences for patients and caregivers. He also shares his thoughts on the recent Meditech partnership with Google Health. Brian shares his excitement on the emerging technologies such as voice in making care accessible and convenient for consumers. He also muses on how emerging entrants, less limited by geographic boundaries, could be extremely disruptive to their primary care services and, ultimately their referral path into their specialty services. Take a listen.
|00:27||Tell us a little about the Magnolia Regional Health Center and the populations that you serve.|
|03:42||Tell us how you make technology choices and what makes your challenges unique?|
|06:03||What does digital transformation mean in your context?|
|09:15||When you talk about telehealth, can you give us an example of what you've implemented that benefits your patient population and your providers?|
|10:57||You’re a Meditech shop and they recently signed a partnership with Google. What do you make of that and how will that impact your roadmap with Meditech?|
|16:03||What are the competitive forces you see emerging for a somewhat insulated regional health system like yours and how do you prepare to meet them?|
|19:57||You talked about several technologies that you use to transform the patient experience. What about things like automation? Have you deployed those to address the labor shortage in particular?|
|23:31||What are the challenges that you have to overcome to make sure that the investments are well thought-through, and well deployed while delivering results in the shortest possible time?|
|24:41||What are your big priorities for 2022?|
About our guest
Brian Davis is Chief Information Officer of Magnolia Regional Health Center in Corinth, MS, where he oversees all the information systems for the 200-bed medical center and 21 medical offices. He is a CHIME Certified Health CIO with over 15 years of healthcare IT experience. Brian has been instrumental in leveraging technology at Magnolia in innovative ways to consistently deliver business value, whether by creating competitive advantage, optimizing business processes, enabling growth or improving relationships with customers.
Magnolia Regional Health Center earned a 2021 Most Wired designation for both acute and ambulatory services. He holds a Master of Science degree in Information Technology Management focused in Computer/Information Technology Administration and Management from Western Governors University.
Q. Tell us a little about the Magnolia Regional Health Center and the populations that you serve.
Brian: Magnolia Regional Health Center is a 200-bed acute hospital located in the North-east corner of Mississippi and jointly owned by the City of Corinth and Alcorn County. Our mission here is to improve the health of the communities we serve; one patient at a time. We are a fully accredited joint commission facility servicing a seven-county region including four counties in North-east Mississippi and three in South-west Tennessee.
We supply over 20 service lines to the community, including a level-three trauma ED. Also, we operate around 20 ambulatory clinics that are comprised of primary and specialty care and have a residential-based home health and hospice facility.
Our primary service area has a population of around 37,000 while our secondary service area has a population of around 141,000. We do have a higher the national average or higher than national average median age, and about 18% of our families do fall below the poverty level. So, we do have a higher percentage of governmental payers within our payer mix. We also have a higher average of individuals without health insurance that are under the age of 65. And within those populations, we see about 30,000 patients annually through our ED. We have about 90,000 annual outpatient visits, 10,000 inpatient visits and about 33,000 ambulatory visits. So as my CEO likes to say, we’re really an outpatient organization that happens to own a hospital.
Q. You mentioned several interesting facts about your unique health system. You’re in a unique place, geographically and very uniquely defined by your population. Tell us how you make technology choices? What makes your challenges unique?
Brian: Ultimately, I don’t think this is unique to our organization, but we do like to align our technology choices with our organizational strategic plans so that we’re all driving in tandem with the rest of the organization towards the same goals.
At a high level for us, those goals are to engage our teams, provide our patients with high-quality, personalized care, strengthen our financial position, and create a stable future for our staff so that we can continue to deliver our mission to our patients and the community. We are also looking to expand our care by connecting patients with the right care at the right time, delivered by the right caregiver. These are what ultimately drive our technology decisions.
However, being a smaller regional hospital with finite resources, we have to be mindful of the operational impacts of technology and modernization — the costs of both, the short-term, long-term resource commitments to the technology and the associated cyber security implications. We want to provide our staff and consumers with the latest and greatest in technology that helps drive improvements in quality and safety but, we also want to minimize the risks to the organization.
So, we’re constantly asking questions like — Can this technology address multiple challenges intra-organization? Can we leverage existing technology to drive additional product value? Does the technology drive efficiency within our workflow processes? How would the technology complement our existing technology stack? Can we support the solution within the current framework? Do we have the right skill mix in place to support the technology? If not, how much effort will be involved in training the staff to support this? Is there a staff pool available out there for such support? What are the educational requirements for our users? Now, we don’t have a large staff base, but we have to be mindful about it when we’re choosing technology.
Q. What does digital transformation mean in your context?
Brian: I say this year-over-year that, it’s just an exciting time to be in healthcare IT and I may be starting to sound like a broken record to this point, but the level of innovation keeps progressing at a rapid rate, and the insights that are being gleaned from analytics continues to improve and keep pushing the boundaries of what is possible in health care. The pandemic has escalated the adoption of digital technologies.
Despite being in a smaller organization and a smaller market, I’m not sure my answer’s very different from other counterparts or the larger organizations. If you look at our technology roadmap, you’ll see the digital transformation for Magnolia lies in the use of digital technologies to create or transform our processes, culture and experiences from both, our consumers, and staff to enable improved care delivery and potentially, even in a small market, create a competitive advantage.
As far as what we’re investing in right now, if you go back to what drives our technology decisions, we’re looking to utilize technology to expand access to care while improving outcomes and quality. We recently submitted for and received funding as part of the FCC Telehealth Grant to expand access to telehealth services within our region. The state of Mississippi is also investing heavily to make broadband more readily available to residents in rural areas throughout the state. We’re looking to leverage these funds in bringing free methods, provide acute-based telehealth consults for those scarce regional provider resources like infectious disease intensivist and behavioral health sources. We’re also looking to build an urgent care telehealth platform that provides immediate access to provider resources for those non-emergency issues, because, being a smaller hospital, it isn’t easy to get through health care resources within the area as it might be in some or other metropolitan areas.
We’re looking to create a remote patient monitoring platform to help improve outcomes for our patients, post-discharge. We’re also working to develop a richer online mobile experience for consumers with access to self-service tools that deeply integrate with the EHR. Such tools not only provide a better experience for our consumers, but they also provide improve staff efficiencies. However, staffing has become a real challenge within the organization.
Q. When you talk about telehealth, can you give us an example of what you’ve implemented that benefits your patient population, but also your providers?
Brian: We’re using video-based parts with Amwell to provide resources to our clinicians and patients. We had an infectious disease provider on staff but during the pandemic, they moved to a larger area to provide services. That left us with no resources available for our patients. When we investigated if it made sense to continue that to provide those resources locally, we decided instead to utilize telehealth platforms to provide those services. We have expanded on that using the intensivist within our medical intensive care unit and behavioral health. We have an inpatient behavioral health and we’re using telehealth services across parts within the organization to provide those video-based consults for those patients.
Q. You’re a Meditech shop and they recently signed a partnership with Google. What do you make of that? How is that likely to impact/influence your roadmap with Meditech?
Brian: We are a smaller hospital, our EHR is one of the largest financial investments, both from a capital and operational funding standpoint. Here, at Magnolia, we’ve been a Meditech client for over 25 years now, and so, we have a significant investment in the Meditech technology stack.
Within the state of Mississippi, we have eight hospitals that form a CIO collaborative that are Meditech users, and this is kind of a routine topic of discussion for us. If you look at these eight hospitals, it is eerie how similar these organizations are from a technology portfolio standpoint. And I think that’s because there tends to be a smaller vendor pool developing within the Meditech space and Meditech really has a limited number of preferred relationships that they really built deep integration again, into the EHR. So historically, we’ve tried to leverage the EHR or as much as we possibly could, even if it did not provide the exact experiences or outcomes that we were looking to achieve because of that deep integration, keeping our users working within the workflow and the context of the EHR.
Meditech’s been a great partner to us over the years, and it’s really developed some great digital tools and we’re very excited to hear about this next generation of collaboration with Google.
But today we’re taking a little different approach to our selection process. We’re taking a more focused approach to discover what solutions work best for us and our organization, our long-term goals, users, and consumer experiences. There’s been some debate as recent as to whether the EHR should remain at the center of the healthcare digital ecosystem and for Magnolia, the EHR still is our core source for clinical and demographic information. However, we are looking at how we can use APIs, new HL7 capabilities, contextual efforts and launches, and other interoperability standards to create sustainable and scalable solutions around the EHR that continue to deliver on our goals to drive efficiency, quality, and experience.
One example is that we currently are working with Meditech and a vendor of ours to develop a Magnolia-branded app out that will wrap the Meditech-branded portal with necessary integration. If you’re familiar with Meditech, there is a mobile app that has been developed by Meditech that all Meditech hospitals use to provide access to care for patients for functionality. Since it’s a single app for all that, the app really provides no site-specific customization outside of branding. So, this branded experience that we are currently developing in unison with Meditech will be the first of its kind for the Meditech site and give our consumers access not only to their medical records and patient portal functionality, but also, all the other digital tools that we’re looking to offer and provide. So, we’re really looking to balance the digital roadmap to help us achieve our goals.
Q. It’s so interesting to hear that. Now, when we talk about the broader context of the competitive landscape, what are these competitive forces you see emerging for a somewhat insulated regional health system like yours? How do you prepare to meet them?
Brian: The competition for patients is going to be greater and greater. Now, we not only have to continue to contend with the larger health systems around us — the largest health care system in the United States is actually just 50 miles south of us – but we have to continue to contend with those encroaching upon our service areas.
You’re also seeing a growing digital health market with emerging entrants that tend to be less limited by geographic borders. Growth within the telehealth space and offerings like the integrated access to Alexa connected devices make accessing care extremely convenient for consumers.
Services like these could be extremely disruptive to our primary care services and ultimately, our referral path into our specialty services. So, we have to continue to innovate and come up with new and creative ways to set ourselves apart, build upon our foundational relationships with our patients to set ourselves apart from those competitors.
Also, another competitive force is the competition for labor resources in our market. That’s increased drastically over the pandemic, which has driven an increasing number of workforce out of health care industry. Remote workforce capabilities are extending the traditional geographic boundaries of labor pools, and we now find ourselves competing with other industries and non-local organizations for labor resources. This is a big challenge and a big change for an organization like ours who is the largest employer within the region. We’ve historically had an abundance of applicants to choose from and filling our labor opportunities. We’re just not seeing that any longer. So we have to continue to design our talent strategies to create the right culture within the organization that creates employee experience advantages, keeps our employees engaged, and attracts the right potential candidates to the organization.
Lastly, kind of a new entrant into the competition is the competition for suppliers – that has become more fiercely intense due to the limited availability and general disruption supply chain. As a small organization, we have struggled to procure everything from electronics to specimen collection cups and crutches — just things you would have never even given a second thought to about availability. Items that we have historically ordered and had onsite within 14 days are now taking months to deliver.
On top of that, our supply cost is increasing in an alarming rate. So, for an organization that doesn’t have large margins to deal with, we’ve really got to think and rethink some of our operational processes as we continue to move forward. Bargaining power for supply purchases will play a pivotal role in hospital operations over the foreseeable futures.
Q. So you’ve got a perfect storm there. Now, you talked about a number of technologies that you use to transform the patient experience. What about things like automation? Are you seriously considering those or have you deployed those to address the labor shortage in particular?
Brian: Labor shortage has been a real challenge for our organization as it has for a lot of health care organizations out there that are being challenged by shrinking labor pool, increasing operational costs associated with staffing due to higher wage rates and overtime associated with store shortages.
You know, this has affected our organization on multiple levels — from our entry-level positions all the way through our skilled labor force. It really doesn’t seem to be slowing down anytime soon, so, we are looking at multiple avenues to counteract these challenges.
One of the avenues is to leverage technology to drive efficiency and effectiveness in workflow automation and repetitive task production and keep our staff members working at the top of their skill set. So, we’re leveraging Microbots and Robotics to perform processing of repetitive tasks.
We’ve also invested in new bedside monitoring platform and nurse cost solutions to integrate with the EHR and eliminate manual tasks and automate workflows within the care environment.
Another area that we’re focused on, is improvements in mobility and communication platforms to complement workflows by providing our clinicians with access to information when, where, and how they really need it.
The goal of these technologies is to remove those friction points and improve satisfaction by keeping our staff doing what they enter the workforce to do in the first place – serve people.
And I touched on it a little bit earlier, but another area that we are leveraging technology in is, within our patient self-service tools. We’ve already begun giving patients access to tools to schedule appointment, complete paperwork online prior to arrival, and for which we’ve received really positive feedback in our satisfaction surveys. But we’re now evaluating giving our patients access to additional tools, unify that experience between prior-to-arrival and point-of-service. This strategy helps streamline that registration process that satisfies patients and aligns the process for our registration staff while eliminating some of that staff burden there as well.
Outside of technology, we’re reevaluating the way we operate by centralizing access to resources and eliminating shallow pools of resources to help drive additional efficiency within our labor force. We are creating some flexible staffing positions and implementing safe scheduling opportunities to give workforce more control over their schedule.
We’re also looking for opportunities to expand our remote workforce capabilities in order to potentially expand our labor pool outside of our normal geographic footprint. But we want to do that in a manner that keeps that workforce healthy and engaged in the organization.
Q. What are the challenges that you have to overcome to make sure that the investments are well thought-through, and well deployed while delivering results in the shortest possible time?
Brian: One of the biggest things is to keep the technology engaged with our organization. We’re working with our leadership, end users, frontline staff members to understand their challenges and making sure that we’re deploying technology that fits their needs and is the best fit for the organization.
Keeping those conversations going is probably the top priority there and probably also one of the biggest challenges because of the reduced staffing across the environment. We’ve got a lot of our leaders pulling frontline shifts just to keep the organization rolling. So, not only is it probably the biggest need is probably also one of the biggest challenges to ensure that we’re deploying technology in the right manner.
Q. What are your big priorities for 2022?
Brian: It’s kind of a loaded question because we have so many priorities right now that when everything’s a priority, nothing’s a priority. So, if I was to break it down into a few areas, I would say that talent recruitment and retention is a big priority for us. You know, we’re seeing people leave the workforce and the industry like never before, and the competition for people and labor has increased dramatically.
So, some of the questions that we’ll continue to evaluate over the near future is how can we increase workforce support and decrease burnout? How do we utilize our digital technologies to improve productivity, automation and collaboration? How can we leverage hybrid remote workforce as a recruitment tool? What can we do to create a more meaningful employee experience that really reinforces the individual’s connection back to the organization and our mission?
Secondly, I would say that we’re doing a lot to upgrade and improve our digital infrastructure in a manner that positions ourselves to be more nimble and better prepared to react to the changes in the marketplace and is really a primary priority for us. This allows us to continue to evaluate moves to digital automated processes and away from those manual processes.
We also continue to evaluate opportunities to leverage cloud infrastructure for scale and within this area, it helps that there’s intense focus on improving our customer experience.
And last, but not the least, I would say cyber security remains a top priority. The attack surfaces for health care continues to expand. So, be proactive with our security measures to protect our systems, and our patient data is probably one of the biggest challenges for our organization and one I’m sure that keeps a lot of CIOs across the country, up at night. So, you know, how can we better leverage our technology to identify risks and better position our users to make good sound decisions? It’s going to continue to be a focus area for us.
We hope you enjoyed this podcast. Subscribe to our podcast series at www.thebigunlock.com and write to us at firstname.lastname@example.org
Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity
About the host
Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.
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