Newsday – A Rundown of Patient Experience and Stories from HIMSS with David Bensema
Episode 4417th September 2021 • This Week Health: Conference • This Week Health
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 That have taken off, there's no way that it would've taken off the way it did. But we also would've been in real trouble if they hadn't relaxed those security requirements going into going into the pandemic because the solutions we did have available to us, a bunch of 'em didn't scale real well when the pandemic hit.

That's why we were doing FaceTime and Zoom and whatnot. So they seem to be the real winner from this. And there was an article in Healthcare IT News, they interviewed. Zoom's head of healthcare. Just the fact that they have a head of healthcare, I think says a lot. And they did a survey and, uh, 72% of the respondents went to attend healthcare appointments, both virtually and in person post pandemic.

And they go on through this interview to talk about that. What jumped out at you on this? What jumped out at me is that that 72% want the hybrid and if that hybrid's going to work, having standalone telehealth providers. Somebody with a random physician or APRN or other available is great until you need that next level care.

And the fact that they want some in-person says people want the next level care. So this is an opportunity for systems to get their act together quickly and develop the collaborative. Approach across their systems so that they can have the initial telehealth visit and then get the referral either into the in-person primary care, or into the in-person that have taken off.

There's no way that it would've taken off the way it did, but we also would've been in real trouble if they had relaxed those security requirements going into. Going into the pandemic because the solutions we did have available to us, a bunch of 'em didn't scale real well when the pandemic hit. That's why we were doing FaceTime and Zoom and whatnot.

So they seem to be the real winner from this. And there was an article in Healthcare IT News. They interviewed Zoom's head of Healthcare. Just the fact that they have a head of healthcare, I think says a lot. And they did a survey. And, uh, 72 per percent of the respondents want to attend healthcare appointments, both virtually and in-person post pandemic, and they go on through this interview to talk about that.

What jumped out at you on this? What jumped out at me is that that 72% want the hybrid, and if that hybrid's going to work, having standalone telehealth providers, somebody with a random physician or APRN or other available. Is great until you need that next level care. And the fact that they want some in-person says people want the next level care.

So this is an opportunity for systems to get their act together quickly and develop the collaborative approach across their systems so that they can have the initial telehealth visit and then get the referral either into the in-person, primary care, or into the in-person, . I'd love to do one from the wood shop with you and get you building that table you want.

Yeah, absolutely. Alright, so let's get to this and we're gonna, we're gonna cover again, we're, we're going back to HIMSS with a lot of these stories 'cause there was a lot of good information presented. Uh, I think a lot of 'em were virtual, to be honest with you, but. Some of these were in person and they were pretty well attended, and the topic really being patient experience.

s, then we'll get into it. In:

It's interesting, I, I almost wanna stop there and say, do we really have choice? Have has things changed in healthcare enough that we actually have choice at this point? I mean, what level of choice do we have? I mean with, with the directiveness of some of our insurances, choices limited. But I think at the same time, there is competition within certain markets and banners, certainly in a very competitive market.

ortant. It was important. In:

All right, so let me go on here. So you mentioned that it's Banner, they're headquartered in Phoenix. They operate 30 hospitals, three academic medical centers, and as you said, there's a lot of competition in that space. Dignity Health is big there as well. Banner. Kaiser was in there and actually got pushed out a little bit out into the, uh, outer reaches of, of the bands within there.

You have honor health there as well, so you have some smaller regional players. And honor health is interesting 'cause they've carved out this little niche in Scottsdale, Arizona, where they're the primary player in that space, even though they are completely surrounded, surrounded by, by banner and . In Common Spirit.

All right, it goes on. Customers are looking for an outstanding experience. She said in healthcare this means having a consistent, consistent experience, so that's a key term there. They mapped out about 25 patient journeys. They wanted feedback that would be faster than hcaps, which is the traditional wave of capturing patient opinion.

Instead, they used real-time surveys and last year began natural language processing of those consumer comments. That's interesting as well. They integrated customer feedback into the C-suite meetings. Also very interesting. Each year they began a new initiative. One year, they increased appointments through traffic on the website.


So, so my take out of this, and the reason I wanted to talk about this one was they've gone to a lot of different sources of information, but they haven't told me how they're validating their information and confirming that their insights are correct. And so that's the next step I wanna see out of Banner Health or somebody is great to use natural language processing to pull insights out of the text data.

but have you validated it? Have you proven that it is an insight that is actionable and net promoter scores are important? I know to the marketing team, to a lot of folks who look at how to retain a population, retain consumers. But is 86 really that different than low eighties? Is it statistically enough of a difference to really differentiate in the market?

So I, my interest is in the natural language processing. It's been such a promise for years and years, and yet it has failed on a number of levels. Will it work here? And so I wanna see the next level research. I want 'em to come back to HIMSS next year and talk about. The validation of the insights. It's interesting when we talk about digital engagement, a lot of it is around that engagement and they, they cite two things.

As you said, the net promoter score for their imaging group went from 80 to 86, and that is one of the things we look at are, are the consumers. Are, are they captivated? Are they enthralled with your service level? And I think in most things, an 80 to an 86 would be considered a significant move. Those are people who are actually recommending your service to others.

e survey platform compared to:

And when we're talking about digital therapeutics, that's gonna be really important. But when we're talking about just getting them to use the app and to engage. Uh, the doctors more through these digital tools or to do more online visits? Do we need that kind of rigor or do we just want that information to know what's being effective rigor at at a higher level than we've had?

I think there's still too much thumb in the wind type things we do. Confirmation bias is a dangerous thing as we see in so many other settings, and I think confirmation bias in this setting really has to be eliminated for. The systems to get great and actionable insights from the data. You don't have to do it at every system for everything, but it'd be nice if some folks were to come out with some stuff that you could say, okay, now if we do this, recognizing that every system is different, but we can extrapolate and say, this had great validity at Banner Health and they proved it.

Let's do it at ours, and we don't have to go as deep to prove it. We can. We can take . Three or four measures that show that we're trending correctly from it. But otherwise, to me it's still thumb in the wind. Yeah, and I'm a huge fan of OCR and other things and uh, but I'm a huge fan of, of saying as measured by, so anytime all these digital initiatives are spending millions of dollars and in some of the largest health systems are spending tens of millions of dollars.

And the least we could have is as measured by, right? So we are going to invest this money in order to accomplish this goal, and we're gonna measure as measured by these statistics that we pull out. And to be honest with you, I mean, you talk about a different level of rigor than what I'm even talking about.

What I'm talking about is holding these things to a standard that says they're gonna deliver some sort of return. Now I understand I'm not gonna measure all these things by ROI. Upfront. We have to, uh, really determine if they're going to be effective at all before we scale them up and really look for the ROI that we're looking for.

But we have to measure these pilots. We have to push these pilots through. One of the things that I talked, I think I talked to directs about two weeks ago is the industry stuck in autopilot and there was a survey of industry leaders, health system CEOs and whatnot, and I, I think a, a better than 50% of pilots are stuck.

They're not forward. They're just sort of in limbo. And I think that that part of that is we don't set clear objectives for those pilots, and we don't measure those pilots, and we don't get rid of 'em if they're not producing. We just sort of let them linger out there. Yeah, I, I think within systems that I've been acquainted with and even worked within historically, there's this fear of failure.

And so by doing a pilot and jetting it. Eight months shy of what you said was going to be its endpoint because you have seen that it's failing systems have a hard time doing that. It's just like people riding stocks down to the bottom, admitting your mistake and cutting your losses. It's gonna be a necessary talent and a necessary discipline for systems going forward that that requires some, I wanna say confidence.

But maturity as a leader, like I had no problem cutting projects and people would say, Hey, even one project where we had spent a million dollars, and I'm like, look, this isn't working. They're like, but we spent a million dollars. We should spend another million dollars to make it work. And I'm looking at 'em like, no, that's not how this works.

How this works is we step back and we say, what worked, what didn't work? Is there a more effective solution? 'cause this one doesn't seem to be supporting the business objective. And instead of, Hey we, we spent this much money on this technology, let's see it through to the end. I understand doing that with the EHR, right?

Because that's not a million dollars, that's a lot of money. But some of these things like a marketing tool. Hey, we invested it in Salesforce. Well, it looks like Salesforce isn't working out for us from ACRM perspective within healthcare. Maybe there's another path to go down. Those are hard decisions to make as a leader.

I mean, you, you do lose some face every time You're cutting some of those things in, in, in at least some people's minds. Well, and I always knew it was important to know whose ox are you going, because every project has an owner. And every thing that we would try had a vice president or a president at, um, one of the, uh, hospitals within the system who's the champion for that.

And before you cut their project or jettisoned their pilot, you really wanted to make sure they understood why you were doing it before you put 'em in a place where they could be publicly embarrassed. And so that's just to your point of maturation as a leader, I think is really important for IT leaders.

To know all the players within their system so that they can avoid creating unnecessary discord or uh, opponents. It's hard enough to be ACIO without. Accidentally, you know, shooting yourself in the Yes. And I still have a couple wounds in my feet from silly mistakes that I made along the way. So no conversation of patient experience would be complete without talking about telehealth.

So our next article, telehealth and other new technologies are putting patient first, improving outcomes and lowering the cost of care. Those are the . The primary things that we hear. So we had Colin hung. Colin Hung is essentially in my business, he's an editor for a journal, Tanya Elliott, chief Medical Officer for virtual care at Ascension.

And Chris Marsh, vice president of engineering at SSR Health, and they discussed. Telehealth. Let me just give you one or two excerpts from this. I realized very early on seeing thousands of patients, there was something special about that patient-doctor relationship through video. It's Elliot who said this.

It's intimate, you're seeing into the patient's home. So that's sort of a modern day house call. This is really great for patients and from a patient access perspective, from an equity perspective, you level a playing field because someone living in a rural area can see a top specialist at the tap of a button.

So she really caps, I love that paragraph 'cause she really captures. A lot of the benefits of telehealth and I, it's interesting that she talked about it being almost more intimate or it's an intimate setting. Getting that video, like right now, I'm looking at your background saying, I'm really jealous because I can see that you're at a vacation home on the coast somewhere and it's, it's beautiful.

And that's what she's really talking about when you get that video as opposed to prior to . Prior to Covid, the number one medium for telehealth visits was the phone, and we didn't get to see anything on the other side. It turns out they just did all this claims data analysis and zoom. Actually beat the plain old telephone for the first time.

So 40 some odd percent of telehealth visits during the pandemic were Zoom, so we're creating this visual that we didn't have before. What are your thoughts as you read her comments on that? So, I generally like Tanya's work. I've been impressed with what she is doing at Ascension, but I have some disagreements with her.

I think the intimacy of being in the patient's home is similar to what you're getting with me. I curated this setting. I mean, yes, it is my real backyard down here. I purposely chose this because it makes me happy and it shows me in a place that I want to be seen in. And I think our patients will give us a blank wall or give us a.

Curated space within the house, so you're not really getting the intimacy of seeing it. When I did home visits as a medical student on one of my rotations, I specifically set up the rotation so I could do home visits, and I saw in the homes you saw what the kitchen looked like, you saw what the bathroom access was, you saw the grab bar or lack of grab bar in the shower for somebody with orthopedic issues.

So that's a home visit that's intimate. What we do on this is you get . Framing and we get specific things we want people to see. So I would disagree with her on that though. I think there is potential if you could get the patients to walk around with it and show you that if you turned it into that type of visit, that's powerful.

But the other comment that I have is the access, the leveling, the playing field. The problem is if you don't have broadband access, that field actually gets a bigger chasm between the haves and have nots. Than we had before. I think there is potential, but you know, my state, Kentucky is rural and broadband access is not penetrating into a lot of areas.

So we still have significant disparities for. Access. So it opens the potential, but we have to act on it. We still have a lot of work to do on the infrastructure and on creating equity opportunities. It's all good stuff. This has jumpstarted the conversation and really moved us to where no one's gonna allow us to drop telehealth anymore.

No one's gonna allow us to drop, push for broadband everywhere. I think those are two infrastructure. Elements, one for healthcare specifically and one for, uh, society in general that aren't gonna go away. It's interesting 'cause you're, I think you're in a pretty rural place right now and our connection is pretty good.

I remember moving to a place where the only thing I could get was a used dish on my roof, and that's how I got, that was my broadband and it was really slow and I couldn't imagine doing a video visit. Across something like that. And there's still a significant portion of the country that lives with that kind of access, but it aren't, we seeing it start to push out.

I mean, because that place where I had Hughes before, I would say within about a year and a half after we moved out there, enough stuff happened that that whole area got broadband access. Yeah, well we are still in Kentucky and actually I'm in the state of South Carolina and there are areas in South Carolina that still have some significant deficits.

m now, I bought this place in:

They talk in at t and some others talk about the last mile. It is wiring the last mile, going in Kentucky, up the hollers to the two houses that are six miles up. That's expensive. And so we have to think about what are the other options for that. What's interesting, I mean, when we, I I, I want to come back to this intimacy thing 'cause I, I think there's two things we've done on previous shows that I want to put in front of you, but when I think of the potential of five GI like its potential in rural areas much more than urban areas.

There's a lot of challenges in urban areas. They're not gonna build it out first in rural areas 'cause of the cost and the benefit, but Right. If you took a small town and put some five G repeaters or whatever the technology name is for it out there, uh, you're not gonna have a lot of the, the challenges that they're having with regard to barriers and the transmission of that signal.

'cause you have a lot of open spaces and five G. Really could be the last mile for a lot of those rural locations. Absolutely. But again, the distance is still, I, the technology's still not completely baked for all use cases. Right. So there's still some challenges and distance. All right. Let me go back to the intimacy.

There's two things. So one. The article goes on and Marsh talks about all this remote patient monitoring equipment if you were able to get more data than just the video, right? So if you're sitting there and they are, uh, stepping on a scale every day and they have a blood pressure cuff and whatever, doesn't that data help to, you're looking at just a blank wall and that kinda stuff, but you're looking at it going.

Yeah, these numbers don't jive with the story you're telling me and those kinds of things. I, I assume it will be a combination of those two things that enable us to really provide care remotely. That's the accelerator of it. That's what's gonna really make the difference is the remote monitoring. And it's interesting you bring it up 'cause I start that in my notes, that the remote monitoring accelerated by the pandemic with the governance processes being accelerated, that's the big game changer to me.

And we're seeing. In a number of systems, folks doing much more robust remote monitoring and having better insights into compliance with medications, compliance with salt intake, utilization of their exercise program, et cetera, that's going to be big. It allows the clinician to have a more day-to-day insight without having to spend minute to minute with the patient.

It's gonna be, how do we integrate that though? How do, how do we build our teams and change our teams? So I liked her other quote that she says. It's just a matter of sharing all that across Ascension and then building it into broader programs. It's just, that's a huge . That's a huge lift, but it's the right lift.

It's what has to be done. One of the things as I looked at all these articles is I kept wanting to say, how many stakeholders are involved in the development of these programs? Are we engaging or are we dictating? 'cause you and I started our careers in the era of top down management. We claim bottom up management.

We claim that we want to have a diversity of inputs. Are we doing that with telehealth and creating the environment that's really going to take in that remote monitoring information, provide the ready access to specialty referrals. Giving an appointment within five minutes on telehealth is only beneficial if you can then also guarantee that next level visit in a timely manner.

If I have to say it's gonna be six weeks for you to see the cardiologist after I saw you on a telehealth visit and determine that you probably have a valvular disorder that needs to be seen. I haven't done that patient any good. I've probably have created a greater frustration with my system. So we have to be careful.

We have to figure out how do we bring all the players to the table? And that takes back to your comment about mature leadership. It takes mature leadership and it takes really integrated systems. So the low hanging fruit, according to every survey I've read is behavioral health. And they're just, it's far and away like.

The amount of telehealth visits were done via around behavioral health. What are the. Primary care is that, I mean, follow up to surgery and uh, post-op and those kind of things seem to be going in there. We talked post-acute, or we talked higher level of acuity in the home with John Halamka. I'm gonna come back to that in a minute, but what areas do you think are the outside of behavioral health?

What's the next two or three that we're looking at? Yeah, I think the top chronic disease categories, congestive heart failure. Because remote monitoring really opens up the opportunity to manage that so much better. A chronic obstructive pulmonary disease, COPD, whether it's from emphysema, chronic bronchitis, pulmonary hypertension, all of the different causes of pulmonary failure can be monitored very effectively through the remote monitoring and home health.

And so telehealth will be huge. Then I think diabetes continues because, just because it's the elephant in the room, it's such a big portion of the population, I think we have to be able to manage remotely. And of course with 24 hour glucose monitoring and some of the other technologies that have advanced, that's becoming more easily available and we can watch our patients graphically.

And have the trick is gonna be, you can't monitor it all with humans. We're gonna have to develop the artificial intelligence, the, uh, algorithms that will trigger when we contact the patient for a change in their patterns. So, Dave, why can't we be more proactive? I mean, and think about obesity, right? And so we know that obesity really exacerbates the Covid 19 diagnosis and those kinds of things.

We know it leads to, uh, diabetes and other things. We see startups circling around this whole thing of really managing diabetes, but we don't really see health systems attacking this community health issue. I wanna say epidemic because, I mean, all you have to do is walk around and see. That a majority of Americans are not eating correctly and those kind of things.

What's it gonna take for a health system to step into that gap? Finding a way to not have it be pejorative. When we start talking about weight management, there's always the risk that somebody's going to think that we're being prejudicial rather than helpful, so we have to be very careful about how we message that.

I think the other is finding the team structure. That is effective. The only thing that has been really well proven to help reverse obesity has been gastric bypass surgeries. The various bypass procedures have been beneficial, effective in reversing it. Dietary means oral medications have had some benefit, but everything needs a continuing program.

And getting that team, that structure together and that group, and then getting the patients to stay engaged and involved, because this is not a, you know, one and done, this is not a gallbladder coming out, this is life. This is the entire lifestyle and, uh, lifelong, uh, adherence. And that's such a hard thing to move.

So we all shy away from it. Yeah, it's a, it's a lot easier to say, I'm gonna treat COPD even though. I came from smoking, and there is some pejorative component to how we look at smoking, but once somebody has the disease, we all seem to be pretty sympathetic to them when you have the disease of obesity, we haven't learned how to be sympathetic to people about their weight in a way that engages them and allows 'em to feel safe and trusting us.

And that's on us as healthcare as a whole. We have not been good at that. And when I talked to John Halamka about their hospital at home program that, that Mayo's doing, and, and now Kaiser's a part of as well, through an investment in a company that they've made, they, they talked about how everybody has to go through an analysis and evaluation of if they are candidates to be in that program of higher level of acuity in their home.

And part of that is. The nature of the home, the family support group, a whole bunch of those kinds of things. Are we going to start getting better at that? Identifying those things. I remember, I remember reading a study where the, the, the greatest indicator of if somebody was gonna be have a readmission was if they had a support mechanism in place and if they had a family member pick them up to take them home, there was a higher level that they were not gonna be readmitted to the hospital.

But if they. Got on a bus to leave the hospital or whatever. There was a really good chance they were coming back and are we going to start making a move where we're. We are sending, maybe not the physician, but somebody into that home to do an evaluation for the longer term care and those kind of things, and building out those kinds of programs that almost see the home as another bed within our hospital.

I think the answer is yes, and we're getting more discriminating in the questions that we ask about the home environment. But I think to your point, it's really gonna be having somebody be able to go in, in a, again, a helpful non-judgmental manner and say. This, this, this, this doesn't exist in your home.

Is it possible for it to exist? If not, then the system really starts to look at how can we provide that? And we've done that with some food insecurities and some other things with some health systems have gotten involved in that. And it's because they know that you have to fill the gaps, identify the gaps, and then fill the gaps in order to have effective programs.

And I think that's where we're gonna be moving is we're gonna get better at identifying the gaps. But I think we're also going to have to create structures that can fill the gaps when they're not able to be filled from the patient's own resources, whether that's human resource or material resource.

All right. Let's just go onto the next, so the next article is interesting to me. Henry Ford Health System out of Detroit hired a new executive vice president, chief marketing officer, came from the outside. I worked for Hyatt and M-S-N-B-C, and, and she was interviewed by Becker's in a podcast. There's a couple questions here.

What, what jumped out at you in this article? Experiences shaped by cultural influences, values and dynamics that come from outside the industry. So her notation that we don't use a separate computer or smartphone to schedule our physician appointments than we do to get my van set up for the care by the dealer, right?

Right. And or, or book my hotel room or do all these other things or buy on Amazon. So all these other structures are there that have shaped our expectations. Health systems and, and I'm not going to beat on portals. Uh, you've talked about portals before. They, they lack, there's a deficit in how my portal looks compared to how my Amazon landing page looks.

And I think we've gotta get to that point. We've got to live up to the expectations of individuals. The other thing that I liked was that. We create the expectations, but then the experience either fulfills or fails those expectations, and we've gotta get better at meshing that together across the system.

And that gets back to my comment earlier about who's at the table, how many stakeholders are we involving as we create these programs and these expectations, marketing expectations for the folks, uh, consumers that we're serving for the population we're serving. How many of our care providers, how much of the care team is actually involved in that discussion about the expectations so that we really do have buy-in to create the experience that meets or exceeds the expectations?

Yeah. One of the things is we used to have a a captive audience with our care providers and clearly. Care providers and I, I don't think I'm saying anything outta school here. They lower their expectations when they come to the hospital, when they're at home, they access their phone, they do all this stuff, whatever.

When they come to the hospital, they're like, okay, I'm in, I'm in. I'm in a different environment. The technology's not gonna be as slick and cool. I'm gonna have to click a lot more times than I do at home, and that kinda stuff. But the reality is now we're talking about consumers. And the consumers. It's the, it's the same screen, right?

So they're looking at it going. Why is it two clicks to book a hotel room and it's 15 clicks to get an appointment set up or a telehealth visit set up? And that's the kind of stuff that we're being judged against. And I think that is, uh, one of the things when you get someone like this from Hyatt or M-S-N-B-C, somebody from the outside and they're looking at it, they're gonna have the same experience I did when I first came into healthcare and my first job in healthcare was as ACIO.

And when I came in, I looked at it and I'm like. Wow, this is, this is really interesting. And now some of it sort of revealed itself over time. The, the structure of the data and how complex the data is. And I sort of minimized that early on, and I now really appreciate how complex the data is and how important it is to get it.

A hundred percent right. There is no, you know, it's not like consumer data. Oh, we. We were off by 1%. Well, if you're off by 1%, people are dying in healthcare. So it's just a different level of thing. But some of the technology I just sort of looked at and shook my head like, my gosh, that doctor took a minute and 30 seconds to log into their computer in the morning.

Nobody, nowhere else in the world would they accept that in corporate America. But in healthcare, we just look at it and go, well, that's just the nature. I mean. Yeah, it's okay to have a five-year-old computer sitting by the bedside. Well, no, it's not really okay to have a five-year-old computer anywhere. I wouldn't have my daughter going to college with a five-year-old computer.

Why would I have my doctor with a five-year-old computer? And that's, that's always been one of my, one of my pet peeve. I'm sorry. This is my rant here. That's always been one of my pet peeves is we buy technology and we don't automatically put into the budget for the refresh of that technology. You're gonna have to refresh it.

You have a good idea of how often you're gonna have to refresh it or upgrade the software or those kinds of things when you buy it. There's a commitment to keeping it current and we don't honor that commitment in a lot of cases. And so we have an awful lot of tech debt. We have an awful lot of doctors running on five-year-old computers, and we have an awful lot of systems.

That we would not put out in front of the consumer world that we require people to operate with on the backend. And I know I took this story in a completely different direction, but that's just what popped into my head. Your comment brings me back actually to the previous article where Marsh said, digital consumer-centric programs are not understood in the same way we understand other investments we can make in the hospital.

And it's the whole IT world is not understood in the same way because we are very unit based in our thinking in most hospital systems. By being unit based, we're always looking for an ROI within each unit. And every program you put together has to have an ROI or an IRR that's positive. Well, the truth is there are some things that cannot, and it is a support within everything.

And yeah, you can allocate to each of those departments and then say, okay. Orthopedic floor, you get this much of the IT budget assigned to you. You gotta bring revenue stream in to handle that. But the reality is we have to think differently. We have to think about how does it cover the whole system, how does it benefit?

And then how do we sustain, maintain, and advance it? Um, which. No different, different than buying your house. You better have, uh, 4% of the value of your house aside every year for covering incidentals, repairs, et cetera. You may not spend it this year, but you're gonna spend it one of these years. You're gonna, you know, spend 15% of the value.

The other thing that came to me in this article, bringing it back to the Becker's, um, article in . The insights. She started talking in terms that made me think about when you and I put in IT systems, new EHRs, one of the things we spent a lot of time on was the or, right? 'cause it's the revenue generator.

Yeah. What was one of the most complex parts of the OR for you? For me it was the surgeon preference cards. You know, we needed to get it right so that their trays always had the right instruments so that they got notified at the right time. One surgeon wanted to be notified when the patient was in the or.

One wanted to be notified when they depend induced. One wanted to be notified because of how they ran their own schedules, and so we had preference cards and they were incredibly complex and detailed. We don't allow patients to have preference cards. What's your favorite, uh, method of being contacted?

You get this with all your other consumer products, so what's your favorite method of being contacted? Where do you wanna get your pharmaceuticals? Where do you wanna get your home health from? Know it in advance. Allowing the patient to have some input into how they're going to receive their care and where they're going to receive their care in advance.

That would help us. It would streamline our processes. It would help to unclog. Some aspects of our care because eventually if you don't give patients their preference, they default to the ED and we gotta get 'em outta the ed. You can do that with con consumer preference cards. No one's done it yet. It it'd be an interesting one to take on.

That's really interesting. There's an interesting pull that happens in it. If you go back 15 years when I was really learning it, 20 years when I was learning it, it was. Take the, really take the variability out of the equation as much as possible because when you added complexity and variability it, it was hard and it broke systems and that kinda stuff.

But then the advent of the consumer digital age. It's about preferences. It's about an N of one, like how can you serve that one? Now we look at that and say, it systems still are prone to break, and those kind of things if we add in a lot of variability and a lot of complexity. But what you do is you build that into the software, but even then it's still kind of challenging.

There's still this push, I I, I think of a lot of these cloud applications to the cloud platforms. And they get kudos for what they are, but they all have limitations, right? I go to one and I'm like, I want to do this. And they're like, sorry, we don't do that. No, we don't do that . And it's just, okay, so what do I do?

It's like, well use a different, a cloud application and we've created hooks to that application, and now you can start hooking these cloud applications together and build the workflow. Well, now you're increasing the complexity and sometimes those hooks work, sometimes they don't work and. Z works sometimes and doesn't work.

The APIs work and don't work, and so we are entering an age where we really have to think about the IT systems a little differently. They have to be more flexible and more open to customization, but we also have to be aware of that level of customization has a tendency to. Put strain on the resources and break things.

Absolutely, absolutely. But I think if we know preferences on the.

Easy to have that come forward with the patient. And the patient is the one who went back to your desire for the patients to have increased control over their records and other things. Patient has control over their preference card, and so it only changes when the patient goes in and says, you know what?

My hours of availability are now this rather than this, um, changing shifts at work, so now you can call me during these hours. That kind of preference being put in front of clinicians, being put in front of schedulers, being put in front of anyone who accesses that patient's record without them having to do anything without the a staff member, team member having to do anything.

'cause it presents as you access Mr. Jones. I think that has some real benefit to helping us have insights and not put options in front of the patients that don't work. I mean, how many times have you. Schedule, try to schedule an appointment and they give you a list of three things that are totally undoable and had they known how your schedule works and that by 4:00 PM you better be teeing off, then they wouldn't bother you at 4:00 PM right?

They wouldn't offer you the 4:00 PM So I think there's a real opportunity to. Be both consumer centric and simplify a lot of our front end processes with patients if we allow them that same thing that Delta and everyone else gives me. So you are, uh, former CIO. So you're, uh, and I'm gonna cheat a little bit here.

I, I might hit the last two stories, but the, I wanted to ask you, we had lost. Really two months of revenue last year from elective surgeries, and this year with the surge going on, I'm reading a lot of hospitals are again, struggling financially as a result of having to shut down. Those elective surgeries.

And I guess my question to you is, what was successful for you from a cost cutting standpoint when you were approached with, Hey, we need to reduce our costs. What was the most effective way that you went about doing that? Eliminating redundancy across the system? We were at the time a, uh, seven hospital, 240 care care site system, and we.

One-off it products, um, in our portfolio. So eliminating that redundancy was my lowest hanging fruit. And where I couldn't get the presidents or the Let's talk radiology, we had seven different radiology.

Image sharing products. I wanted one. And I had two of the lead radiology groups who just refused to come to the one that the other five had agreed to. And at that point, I went to the board and I said, this one's on, you need to tell folks that the majority's gonna rule on this. And so that was still low hanging fruit compared to then cutting personnel.

But we did, we created, um, strike teams so that when, for certain acute issues, instead of fully staffing at each of our hospitals to handle those, we had strike teams and we could have 'em on site within three hours. So we didn't leave anyone really stranded for long if there was something major, but I didn't have to maintain that expertise across the system.

So that would be my other low hanging fruit is go to strike teams for certain specialized areas in it. But the biggest one was reducing the redundancy, which, you know, once you've done that though, you then you have to really look at the hard ones. Yeah. And one of the things that we did is we were always looking for cost reductions.

So we created a culture where I. We celebrated where people found cost reductions. I remember one of our data center people came back with a new way of doing our pdu, our power distribution units, and it ended up saving us three quarters of a million dollars while we celebrated that person. But we created that culture where they were always like looking, trying to find those kinds of things.

And so it was never a, Hey, we have a cost reduction thing coming up. We were just in that mode. At at all times. And uh, and a lot of it has to do with you. You talked about low hanging fruit. We had 800 applications. I just looked at the guys, the team and said, look, we have 800 applications until we're down to a hundred.

We have a lot of work to do. And they would look at me like I. Hard that's gonna be, I'm like, I absolutely realize how hard that's gonna be. I, I sat with the cardiology groups and tried to get them all to agree on a common system, and I know that, that that wasn't gonna happen in my lifetime or any lifetime.

They had too much, uh, well, too much revenue tied to 'em and too much authority within the health system. And there was nothing I was gonna say to, to move that off the dime. We, we had a lot of success with the culture of stewardship. That within our IT department, we talked about being stewards, that we and everyone in the system was a steward of the resources that the patients brought to us.

And yes, I know the most of it came through the insurance companies, but patients had copays and other things where it truly does come out of their pocket. Ultimately. I mean, it's deferred compensation. If you're getting insurance through your company, whatever. It's ultimately you have to show good stewardship.

You have to show people that you are respectful of the dollars that come in and in doing that culture within it, we actually became a leader within the Baptist health system for stewardship of resources and it became part of the culture of the organization. As I was moving through. I was really proud of the IT team, 'cause it wasn't me, it was the whole team that created that and expanded that across the system.

So. What, whatever way we phrase it, cost cutting versus stewardship. It's the same idea that we're gonna get the most valuable use out of every dollar spent that we can. It's a good way to approach it. All right. We'll do highlights of the last two stories. So OIG G is looking closely at telehealth, which they should it, it spikes so much and during the pandemic, so that now they're gonna be looking at it.

What are your thought? I'm sure they're gonna find fraud. I mean, that's what they're looking for, right? My think on that was simply that when you have this rapid expansion just as one we rapidly expanded across the, uh, north American continent, you then develop a lot of gaps in oversight and it becomes the wild west.

And I think right now we're gonna see with particularly the inappropriate prescribing of DME, which has always been a, uh, great place. And Florida has had these back alley DME providers for years. The OIG is found through the paper sources. Now they're gonna have to find it through the telehealth sources.

It's just we're gonna watch the Wild West for the systems. No health systems trying to inappropriately submit visit codes, whether it's a 9, 9 2 1 3 or whatever. They're not inappropriately submitting that. It is the nefarious actors out there who are gonna take advantage of this telehealth. Surge and get people on bad actors, whether that's a physician or somebody else, and get ADME prescribed 'cause that's where the money is.

So I think that was my take on that. I just, I, I just thought that we have to be mindful that there's gonna be a lot of fraud out there. Our patients are going to be subjected to it, and particularly our susceptible individuals, those who. Might be ready to fall prey to that. We as clinicians, and now I'm putting my MD hat back on, I should, as a clinician, be talking to my patients about the fact that telehealth from a known provider, trusted provider, don't accept random telehealth any more than you accept random telephone calls, but unfortunately.

There's a population out there that's rife for somebody talking nice to 'em and telling 'em the line. And getting 'em hooked. Yeah, and I think we're seeing that in the statistics. Getting telehealth from your local healthcare provider is far and away the most trusted source, and I think it's over 80% of the calls are going in that direction.

Zoom was the big winner, and this is our last article. We'll close here. And, uh, zoom, uh, again, they, I, I think they were the big winner just because they had the process baked. I've done this show now for four years. I think I've had maybe two people that had trouble getting on a Zoom call in those four years that the ease of use was baked.

Now they had tons of things that got vetted early on in terms of their security. Because they never had to have this level of security and they stepped up to the plate very quickly. They came out with updates and whatnot. And if, if the regulatory had not been relaxed, zoom would not have taken off.

There's no way that it would've taken off the way it did. But we also would've been in real trouble if they had relaxed those security requirements going into. Going into the pandemic because the solutions we did have available to us, a bunch of 'em didn't scale real well when the pandemic hit. That's why we were doing FaceTime and Zoom and whatnot.

So they seem to be the real winner from this. And there was an article in Healthcare IT News. They interviewed Zoom's head of Healthcare. Just the fact that they have a head of healthcare, I think says a lot. And they did a survey. And, uh, 72% of the respondents want to attend healthcare appointments, both virtually and in-person post pandemic, and they go on through this interview to talk about that.

What jumped out at you on this? What jumped out at me is that that 72% want the hybrid, and if that hybrid's going to work, having standalone telehealth providers, somebody with a random physician or APRN or other available. Is great until you need that next level care. And the fact that they want some in-person says people want the next level care.

So this is an opportunity for systems to get their act together quickly and develop the collaborative approach across their systems so that they can have the initial telehealth visit and then get the referral either into the in-person primary care, or into the in-person specialty care seamlessly.

Without creating an additional effort on the part of the patient, if they can do that, they can, health systems can capture that business and retain their patient base without fear of the. Intermediaries, but you and I know that the intermediaries move quickly and they will exploit this opportunity. I don't blame 'em.

That's their business model, right? To come into new opportunities and gain access to the market. But health systems, if they would work collaboratively, and that's the hard part. We talked about this earlier. If you can see me in five minutes on a Zoom session, but then I need to refer you to the cardiologist.

To be timely as well. There has to be that collaboration, that willingness to be timely. We could run into volume issues quickly if you don't. Think proactively and prepare your system in advance. I'll tell you one of the things as I think about this. Uh, health systems have to build their brand and they have to be conscious of their brand and quality has to be the first and foremost.

If your brand in your community is not known for quality is a health system, you have very little to build on, and the minute that a another provider comes into your market with telehealth. I'm in Florida, so Mayo could pop in here tomorrow. I mean, they're already in a couple markets down here and they say, Hey, we're gonna start doing hospital at home and, and we're gonna start doing, uh, remote patient visits.

Am I gonna go to NCH Health or am I gonna go to Mayo Clinic if I have the access to those physicians? Well, I'm gonna go to Mayo Clinic, uh, every day of the week if I have that choice and that option. So you gotta protect that brand. That's gonna be what you're going to build from. And so. Do not pass. Go.

Your quality programs are really important, and that's what you have to build on because we, we can talk about it all. We want CVS, Amazon, Google, whatever, whatever they're gonna do in health. They're not standing up hospitals, they're not gonna do that. High acuity care, they're not gonna do that. And so they have to partner.

And so to a certain extent, health systems enjoy that. That space that they've carved out, it's theirs. And now they can, if they're doing that effectively, they can build these other programs around it, but they have to do both. They have to be really good at what they do and then build those programs around it in order to protect that business long term.

Otherwise, how they'll lose it is somebody will come in and partner with somebody else. They'll come in and say, Hey, we'll provide the. Telehealth telehealth, and we're gonna partner not with NCH, but we're gonna partner with physicians regional, in which case now they're funneling all the patients over there, and NCH is in trouble.

So the onus is on the systems to develop a pool of professionals for referral that's diverse enough and represents a variety of cultural fits and personality fits to be attractive to the patient population. You don't wanna say, well, your only choice is, or you have to go to. People want choice and they want somebody that fits them, whatever that fit is, and they want to be able to define that fit.

So I think systems have to figure out how to expand their pool of professionals that they can bring into their telehealth presence and the referral presence. And to your point, keep the quality up. You gotta have the quality. You're right. Without that, you, you cannot sustain. Yeah. Hey, I, uh. Really appreciate you coming on the show and appreciate you being an advisor.

You're one of the advisors to the show and you guys helped to steer the ship and keep me from going off the rails, which I really appreciate. And yeah, again, thanks for taking time out of your retirement to uh, to join us. Always a pleasure. And I like being an advisor 'cause I get to interact with not just you, but with the, uh, diverse group that you've put together.

You've got some, uh, really great people working with you and I appreciate that opportunity. Thanks again for your time and enjoy South Carolina. Thank you. Take care. What a great discussion. If you know of someone that might benefit from our channel, from these kinds of discussions, please forward them a note.

Perhaps your team, your staff. I know if I were ACIO today, I would have every one of my team members listening to this show. It's it's conference level value every week. They can subscribe on our website this week,, or they can go wherever you listen to podcasts. Apple, Google. Overcast, which is what I use, uh, Spotify, Stitcher, you name it.

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