"Consumers are looking for instant gratification with their digital health experiences"

Q: Reid, tell us a little about St. Luke’s Health System and the populations that you serve.

Reid: St. Luke’s Health System is based out of Boise, Idaho. Our geographic footprint covers southwest Idaho and a little bit of eastern Oregon and serves the populations there.

Our system comprises eight medical centers and a couple of hundred clinics and centers. We see about three million visits a year between those settings and the population is dynamic. It covers a broad cross-section. We’ve had an interesting change in the last couple of years with a huge influx of folks moving into the valley in the Boise area, in particular, which has shifted our population a bit. Given how it covers a city area like Boise, smaller towns, rural hospitals, and rural areas, it then provides challenges in terms of access and equity of access. So, it’s really a unique market where we have a little flavor of everything, which makes it challenging, but also exciting and rewarding.

Q: Do you have a large rural population that’s widely dispersed in some way as well?

Reid: Large in terms of geography, but I wouldn’t say large in terms of population compared to some of the city urban areas. Certainly, large in terms of just the consideration for digital, in particular. You can assume that they’re going to have broadband access or even a device to engage in some of those opportunities.

Q: What are your thoughts on the digital health program at St. Luke’s? Tell us about your current priorities as CIO of the organization in supporting digital initiatives for the organization.

Reid: I have a love-hate relationship with the word “digital.” I understand it, and it’s the context that’s important, but it’s one of those words that get used so ubiquitously that it can start to lose meaning. Then, you have this Tower of Babel experience where people all hear the language differently.

For me, one of the success measures will be when we just start to talk about health generally, and that just naturally encompasses digital. In my mind, I don’t differentiate between my Amazon experience when I’m on my device ordering something versus when someone physically comes to the door to deliver it. It’s just all Amazon experience.

It’s with that backdrop that we set up a Consumer Access and Experience Program (CAE) a year ago. One of my colleagues and great partners is the VP who leads that. That group’s been tasked with not disrupting for the sake of disruption, but really challenging how we think about things and helping us really start with the question because we think that’s the most powerful tool in the toolbox. Don’t go out and ask users what they might want or expect them to design what that digital health experience might be like, but really, bring questions to bear to draw out from what might be best for them.

There are a few things on which that program is focused on that we’ve helped as an IT shop. We launched an app earlier this year and while it’s still nascent in its development, it’s an engagement, an access gateway, and an experience gateway for the future. It gives us a nice cornerstone then, to build on basic things in place there, now. You can access our patient portal, our website to find physicians and locations, and pay your bill too. We’ve put together a few digital assets into one unified experience, and now we need to really gain insights to understand where to add value and components to that. Where can we reduce friction from that experience?

Another thing that the CAE group has championed that we’ve supported is, an on-demand virtual clinic. Like everyone else, we saw a rapid increase in virtual visits with COVID, so, tapering-off of that last year. But it clearly demonstrated to us that there is an appetite in the market for consumers that want to consume their health care through digital for certain business types and needs. Creating a clinic that’s focused just on that and using it to understand preferences and behaviors, has made us look at ways that we can take advantage of existing capacity. Rather than move right to probably bringing it in and looking at how we’re going to augment and outsource the physician or provider need, we’re looking internally at our capacity in other areas where we can have doctors and other providers who can come in to bear on that need and chip in. I’m excited about just some of the early conversations there.

The last thing I’ll touch on is one of the roles of CAE is to just take a hypothesis, experiment quickly, and learn from it. We’re about to launch a medication locker at a local grocery store that doesn’t have a pharmacy. This is just a small test of change to learn and understand consumer appetite, preference, and desire using that omnichannel approach, where we can give consumers a variety of options and then, understand where preferences lie. Subsequently, we hope to guide them to the option that might best be suited for them. I’m really excited about that kind of focus on consumerism.

Q: You’ve mentioned the mobile app and the urgent care initiatives. What are your consumers telling you about what they’d like to see and therefore what might go on your roadmap?

Reid: If I just used one word to describe it, it would be “instant.” They want the same experience they have in just about every other vertical of their life where it’s always on, always available, and there’s that instant gratification or results from what they’re pursuing. Granted, there’s certainly that in health care but, there are situations where that’s just not a logistical possibility. But there are a lot of areas where we can improve that experience, give that access, and that instantaneous result to the consumer.

Some of the things we’ve done to help glean insight from the consumer include focus groups, which are interesting and simple things like going out and visiting with consumers and asking questions. Our CAE group did something fun this year when a group of students from Harvard wanted to do a case study. They came to Boise and we gave them a problem to look at. They spent a couple of days analyzing and undertaking the academic approach and then, generate a report for us.

Interestingly, one of their insights or hypothesis was that one of the challenges you have with something like your patient portal is many of your consumers use it so infrequently. Like I said, it’s based on when they have the need. Compare that to your banking app, the Amazon app, and the social media app that you’re in kind of daily. You develop this dexterity and familiarity with how to navigate there so then, it seems easy. But when you’re just logging on to MyChart once or twice a year to schedule an annual wellness exam or an episodic kind of need, it’s going to feel foreign because you just don’t use it enough.

That’s been a really interesting observation that we’re kind of just churning over and thinking through about how do we ensure we don’t overinvest in building up every single detail of a completely frictionless patient portal experience when the bang might not be worth the buck? Let’s focus in on maybe the one or two things that really, really matter.

Another insight we’ve gleaned is three things that have the biggest impact that we’ve observed on Net Promoter Score. First and foremost is receiving services, which makes sense. Next, our Schedule and Appointments and Finding a provider. And then, way down on the list is Wayfinding. That was interesting because we’ve kicked around Wayfinding for a long time and the thought was how cool this would be. Given we face financial constraints, we had to be really disciplined and ensure that the investments we were making were going to yield the biggest benefit. They were narrowing our focus then, on how to improve that experience for scheduling an appointment to make it as frictionless and as easy as possible? How do we make that experience easy for someone to find a provider? Or even to find out the details they might want to know about that provider?

That consumer insight is really a key for us because that helps us then, to not only meet the consumer need, but be wise stewards of our resources and ensure the work we’re doing is going to have the biggest benefit for that.

Q: Can you share a little bit about what are some of the common metrics that you track when trying to understand whether your investments in those programs are meeting expectations?

Reid: It’s really the pedestrian ones that you would expect. We look at active MyChart users, meaning they’ve logged on some time in the previous 30 days. We do that ratio against our total MyChart user population.

We look at the percentage of patients that use MyChart to schedule an appointment versus those that call our connection, the percentage of folks that use MyChart to refill a prescription request, and that would use MyChart to look at their images or review their after-visit summary in the provider notes. We just really focus on consumption.

One of the things that has been stuck in my mind is, if you accept the fact that the typical consumer then, is just occasionally using your digital health tool and particularly, your patient portal, then, that begs the question that there must be value you’re giving them other than that episodic, specific need they have.

That opens up a whole pantry of opportunities that are really interesting to examine about what we can offer then that would make that app more of a frequent digital stop for that consumer, where they don’t view it as just the transactional experience of St Luke’s, but as holistic within how they’re thinking about their care, whether it’s diet or exercise or preventative kind of regimens. It’s such a great time to be in health care because we own so much of the solution if we can be really thoughtful about leveraging the data we have, gleaning the right insights from it, and then, acting on it.

Q: Are there macroeconomic factors that are driving some of your priorities today, either at the national level or at the regional level?

Reid: Absolutely. I talked to the CIOs on what difference a year makes and that’s the mantra certainly for this last year. Financially, there were two things that really put some headwinds in place for us. We still have a large volume of travelers that are onsite just to fill our critical nursing needs. We have high volumes—the highest that we’ve ever had—but then, we’ve just had this shift in our labor market and there’s this need for nursing but we can’t hire nurses fast enough. To some degree, there is a trickle-down of that.

On the I.T. side, certainly with the labor market and remote work, it’s up-rising but there are challenges that ensure that we’re being competitive, flexible, and agile in order to have a great workforce and keep the culture we want.

There’s also the payer mix which has been an interesting shift for us since we’ve seen that move in a way that’s not favorable. That pressure makes it more imperative for us to realize that in an era of constrained resources—this isn’t something that’s going to go away in a month or a year or two—it’s the new reality we’re going to have to get really adept at living in.

In a way, it’s a gift that’s going to force us to narrow our focus and understand that while there are some things that we are good at and can be better with, we only have capacity to do the very best thing. So, we have to get it right. We don’t have the luxury of an Amazon to put ten pokers in the fire and hope one of them works out. It’s a challenge, but it’s also helping us mature in a way that we otherwise might not be able to do.

Q: How has the payer mix changed for you? How does that drive your investment priorities?

Reid: At a high level, we’ve seen a shift in government payer versus commercial payer, and being a not-for-profit health system, thinking of even a small shift can have an impact. But the conversations we’re having are not about, “How do we shift that back?” Because that’s not the right answer. The answer is, “How do we care for this population?” If this shift is causing this kind of financial strain for us, then, we need to innovate and figure out ways to do it where that government payer isn’t such a drain.

There are opportunities to figure out how reduce waste, focus more on the health care side, and avoid readmissions or avoid a hospitalization, in the first place. That’s again an opportunity to do some cost cutting and wait till things get better. In fact, it’s a chance to reimagine how we’re doing things.

Q: With regard to data analytics, can you share one or two examples of how you’re using data and analytics to drive access-related initiatives?

Reid: We are a developing nation in this state. We are fast followers and love to learn and glean from others. It’s not unique to us but we are data-rich and in many areas, information-poor.

So, with our data and analytics team, one area of focus is trying to be very explicit and disciplined with operational partners and really defining when they come to us and understand the job we’re trying to do. Like – why are you trying to hire this data? Trying to understand the outcomes they’re actually after, trying to offer datasets they’re not aware they have access to where they can do some of this exploratory and inquisitive exercise on their own. And trying to get out of the arena we’re in today where some of the capacity is being consumed by requests for dashboards or like – we have a dashboard, but I don’t want to treat to look like this. We’re trying to get out of that kind of service requests.

We take a first-come-first-served approach by an analytical team to really put together a comprehensive data platform that can then be used to answer a variety of questions, whether it’s on the clinical side or the business operations side or a CRM side from the marketing standpoint. It’s early days in that because right now, often, it’s based on the immediacy of the need in terms of how deeply we dive into a request that comes in. But we’re really trying to create something that’s comprehensive, scalable, and positions us for the future.

Q: How are you setting up your whole IT infrastructure and your foundational platforms to drive digital? You’re an Epic shop, so that’s key but what else drives a successful digital engagement?

Reid: A couple of things come to mind. We have a cloud forward strategy. It’s not cloud-first. It’s not cloud-only. It’s just that we certainly look to the cloud, but we are so focused on wanting to move things to the cloud that we then miss the chance to critically think through opportunities as they arise. For example, we’re an Epic shop. It’s hosted on-premise and we don’t have any plans in the near future to move that to the cloud, although going forward, I would expect that may be an ultimate outcome. But there are areas where it does make sense.

Between our colo data center and our data center at one of our hospitals that’s a couple hours away, we have a completely redundant infrastructure to run Epic for the entire health system—it’s expensive, doesn’t scale well and we have to maintain 100% capacity, 200% total in the event that we may need it. Now, if you think about it from a risk standpoint, those data centers are about two-and-a-half-hours apart, so potentially there could be a geographic event that impacts both data centers. Therefore, we’re moving our Epic VR capability to the cloud over the next year so we have the ability to just have a small presence there that can be scaled up when needed.

It’s the same thing with regard to the other solutions—we have a mix of SaaS, public-private cloud, and on-prem things, so, we’re always looking at what’s the best solution for the current state operational need and what can provide the cleanest path for that future roadmap.

One thing that we’ve learned early on is, it was years ago that we used to lead with the cloud and consider the ROI in terms of spend or savings. It’s just not the case now. It’s your dollars kind of spend elsewhere. However, there’s been a couple of transitions, especially with our finance team, to help them understand that you may not get such cost savings that you’ve heard about at the CFO conference so here’s what you do get what’s beyond the savings. You’re going to get all that the company has to bring to bear in terms of expertise, infrastructure, and cybersecurity, built in and baked in. These are things that we may not be able to ever fully do on our own or fund on our own. That’s our mindset.

Q: Can you talk about the application solutions? You are Epic first but how do you choose when enabling these digital features and functionalities that your consumers demand?

Reid: We have a Strategic Technology Investor Committee and our three pillars of our backbone assets. We have Epic for our EHR. There’s Microsoft, which runs our desktop server infrastructure. Then, there’s Infor, our ERP.

Our guiding principle is, we’ll look to these vendors first—not always, not only. Previously, it used to be, “Hey, I went to a conference, found this great tool, and I want to use it.” Before we knew it, someone acquired it so we’d be trying to figure out how to integrate it into interfaces and then, it’d have duplicative capability we already owned.

We’ve been able to redirect that now to facilitate good conversations. People have varying opinions of Epic based on where they are, what they’ve been listening to, or reading, lately. What we’ve learned through this is, it’s helpful to enable people understand the significance of the investment we’ve made. This is a choice that we made as a system for our EHR, and it is no small investment. If we ever do something outside of Epic, we have to then, do it intentionally. We have to make that decision that we’re going to add incremental costs for whatever reason—either Epic doesn’t have it or it doesn’t meet our needs the way we need it to. But we try and use an 80-20 rule in those conversations. If we can do this at Epic, Microsoft, or Infor and it meets 80% of the need and is not introducing any kind of unacceptable risk or safety issue, then, that’s what we’re going to start.

That’s been very effective and ensured we certainly have avenues for complementary solutions in areas where we really don’t.

Q: What about providers and caregivers? What about their expectations? How are you addressing those?

Reid: Well, they’re fatigued and they’re tired. What I hear most from providers is, “I just want to treat patients. I just want to talk to my patients.” I go see my provider. He knows my role in the organization and he always has a list for me, which is great because he’ll take care of me and then, I try and take care of him. But his number one thing is, “I don’t like that even for a second I have to take my eyes off my patients and be typing on the keyboard, update something.” It doesn’t have to be that way.

We are looking at some ambient listening-type experiences that can augment that. In-basket, the providers view that as a burden. So, we have a project and a way to figure out how we can automate or bring in other resources to offload some of this burden because it’s for our providers and nurses. It’s a risk to their well-being, to the capacity to care for patients, and for their commitment to the profession—for some of them, long-term. That keeps me up at night, just trying to think through all the opportunities in that target-rich environment. How do we really define that? What are the one or two things that we should be all in on that are going to make the biggest impact for this population?

Q: What about digital in the context of care management? What’s your approach in care management, home health, remote monitoring?

Reid: We have what we call a virtual care center as a 24*7*365 digital telehealth hub and a dedicated team of expert physicians, nurses, allied health professionals, and I.T. folks. What it does is offer three key services.

There’re Virtual Care Centers for Clinic Consultations. If a patient at the clinic sees their doctor and then, has some need for a specialty or some kind of advance discussion, we can virtually bring in someone from the virtual care center. That can all happen in that single-visit location with the patient, rather their referral. They then, have to actually sit down after the fact.

We do a Hospital Consultation which is the same kind of concept where the hospitalist then can, through a telehealth video visit, bring in that expert that might be needed.

We also have Telehealth ICU monitoring that really expands the capacity that we have, to monitor patients in an ICU.

With regard to Home Monitoring, we certainly have programs that support patients at their homes. We provide them the devices that collect relevant information, send that back to the virtual care center, where cross-functional teams receive, assess, and intervene as needed before updating appropriately that patient chart.

I’m really proud of that work and excited for this foundation that sets us up for the future. That emerging space is so important and this Hospital and Home is one of our key initiatives to try and really make some headway there. Because our evidence shows that patients are more comfortable in a home, it’s no surprise that a lot of cases heal, recover, when their care is better delivered at home.

Q: What are the one or two pieces of advice or best practices that you would like to share, either with your peers or with the technology provider community that wants to be a part of your journey?

Reid: We could do a whole show just on that but I would say this, and this is not a technical answer at all, that it is really an important grounding principle for me. Don’t ever be embarrassed by where you’re at your journey and don’t be afraid to start because of where you’re at.

There’s so much great content out in the community. There are folks who bring on their thinking, expertise, and where they’re at, that it’s like light years ahead of where we are. It’s easy maybe to start to think, “Oh, I guess we’re just not smart enough” or “Man, we’re never going to be as good as that person or that system.” I think that’s the wrong mindset.

We’re all where we are for a variety of reasons, but we all have the same opportunity, even if it’s just incremental, to improve that experience whether it’s for the patient, a provider, a colleague, or just within the operational work of the hospital or system where you’re at.

I would just say, as you’re empathetic, curious, and as you engage in rapid experimentation, you’ll be surprised at the progress you make. No matter how unsophisticated you might think you are, the work you do, matters. That makes a difference. Don’t ever let that comparison or your own ego get in the way of that.

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