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Welcome to this week at Health It, where we amplify great thinking to propel Healthcare forward. My name is Bill Russell Healthcare, CIO, coach and creator of this Week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. This episode and every episode since we started the Covid to 19 series has been sponsored by Sirius Healthcare.

Now we're exiting the series, and Sirius has stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show's efforts during the crisis. Today we are joined by Tressa Springman. Tressa Springman is the SVP and CIO for LifeBridge Health in Baltimore, Maryland.

She is a phenomenal guest. She has so many great insights. I really, especially like the, the section where we talk about the things she is doing to replicate the culture that they had in the office in a virtual setting. It's a phenomenal back and forth, and I, I really got a lot out of it. I hope you enjoy.

Today we're joined by Ressa Springman, SVP and CIO for LifeBridge Health. Good morning, Ressa, and welcome back to the show. Having me. I hope you're, you and yours are Well, yeah, I, you know, we're doing pretty well. We're in a, I guess you wouldn't call it an urban area. We're more rural area, so it's, uh, social distancing is a little easier and everybody seems to be wearing their masks and whatnot.

But you're, you're in a pretty urban area, right? Yeah, the majority of our facilities are in or around Baltimore city, but I don't know, COVID seems to have leveled out here much quicker than it did for, for you there in Florida for sure. Yeah, and, and Florida is really regional. I mean, if you're in Miami, it's very different than the, the Western Shore, which is where I'm at.

But I, you know, I haven't heard a lot from Baltimore. You know, what's, what's, what had, what, what's the current state of, of Covid in, in your community? Sure. Probably like a lot of my peers, we have daily safety huddles where we talk about the numbers and it was nail biting in March for sure. March and April.

We were running high vent capacity, had some issues with PPE, we were banging it, but we have had quite a decrease and now we're more in a, a stable mode. I think as of this morning we've had the, uh. A hundred thousand positives, not deaths. And things have been, we, we had a small uptick couple weeks ago, but we've been in recovery doing electives, et cetera for the last couple of months.

Sadly, we aren't seeing the same volume levels we did pre covid, and that certainly I think's gonna have an economic impact entail on a lot of us in the healthcare sector. But knock on wood, the social distancing and early masking, I think. Paid off. And although their hotspots were really in a pretty good place, bill, you know, it's, it's interesting.

One of the things I, I grew up in the, on the East coast, and one of the things I used to love about it was, you know, for us it was an hour and a half drive to New York City, an hour and a half drive to Philadelphia, three hour drive down to Baltimore, four hours to DC I mean, you could literally, it's all so close, and that's one of the things I love about it.

But during a pandemic. It's also close. And so when you had that going on in New York City, I mean, you guys had to be sort of stepping back and going, Hey, you know, that's not that far from here. That's right. And, and we were just behind them. I mean, it did get ugly. It just was early and it's subsided and a lot of people's behaviors had to change.

And they did, but to your point, it got very ugly very quickly and, and certainly not nearly as ugly as it did due to the proximity of folks there in the city in New York. Well, you know, we talk about technology here, so you know, just so we don't get sidetracked so people don't confuse us with doctors or giving medical advice or anything to that effect.

You know, we heard from a lot of the CIOs during our field report series about, you know, telehealth and work from home, you know, what was, what was your approach to, to telehealth in your community? So, and I think we've talked about this before, you know, Maryland hospitals have had the benefit of being on a global budget.

And so we really, unlike a complete fee for service environment, we had made a number of platform investments in telehealth. So while I wouldn't say we were rocking it, both remote patient monitoring and interactive telemedicine were investments that we'd made. Ironically. And as you know, uh, it's, it hasn't been about the technology, right?

It's been around the reimbursement environment. It's been around having a burning platform need that encourages providers to, to change and do things differently. And that's what we saw in March and April. We had, just from account perspective, we had 17 virtual visits out of our practices in January and since February we've had 80,000.

Yeah. So it It's unbelievable. It's unbelievable. Now, you know, we do telestroke tele ICU, we do, we use a remote patient monitoring tool. We do IRIS management. We do a lot with telehealth these days. For those virtual visits in the practice space, as you've heard. And, and we had organizational readiness partially because of the reimbursement model here in, in Maryland, but you know, when those things align, it just explodes.

Yeah, it's, and it'll be interesting to see, I've been monitoring a lot of those stories of, uh, CMS just put out their fee schedule and they're asking for comments, so we'll see where that goes. And, and we saw some numbers earlier this week. Based on claims data, but still it was showing that at our peak, 50% of our visits were in, in, in that March, uh, April timeframe, 50% of our visits were telehealth, and now it's dropped back to 20%.

I, I don't think that surprises anyone, but still that 20%. If, if you had told us last year that we were gonna get 20% penetration in telehealth, I think we would've been ecstatic. Wouldn't we have. We would. Yeah. Yeah. But that's because we were asking people to do something that didn't make sense and it wasn't being demanded of them and they weren't being reimbursed for it.

Yeah. So yeah, you're absolutely right. And in fact, I think that's the number I. I think modern healthcare and I'm, I'm looking around the floor here. I think I have the most recent, um, addition on the floor. They have some nice projections around where they see this landing. And I, I think it's, you're spot on for 20 to 25% of practice-based care.

Yeah. So, so you use my filing system. You have a pile over here and a pile over there is that, well, you know, you gotta take advantage when you have a, a meeting where everyone's 15 minutes late. Well, all right, so let's, let's talk about work from home. You know, work from home was an interesting challenge.

I mean, we've talked about it from a technology standpoint. I mean, it, we had to stand up, you know, VPNs and, and other technologies and ex extend our VDI environment and our. Virtual app and, and those kind of things. But talk about it from a leadership standpoint. You know, it's, it's interesting. How do you maintain culture and productivity and just all the things that we have when we're together in a, in a remote work environment?

I.

Well, let me, I'll start with the tools We had implemented Office 365, but because of the physical nature of where things had been before, COVID tools like teams were just kind of nibbled around the edges and now they have become core to our day-to-Day work where we are convening and collaborating in a virtual way.

Similar to telehealth, that until the environment made itself ripe for that change, it just didn't happen. People would swing by your office or still pick up the phone. From a leadership perspective, I come from a long line of process improvement, and so lean methodology has been really core to a lot of the management system environment that I've been exposed to and I've used in my experience.

That lean methodology focuses so much on daily engagement and making sure there are a lot of open opportunities for communication. Most of my areas, although they do it virtually, they do virtual huddles, and what I found is I needed. To make sure that I was overextending myself and encouraging my leaders to do the same and think differently.

Um, what do I mean by that? Some of the examples I, I'll give you an example that I employ. I have two different sets, one each week and then one each month. And I didn't use them as extensively before covid, but I have virtual office hours, and so I go online. For an hour each week. If anyone, any one of my direct reports has anything that they're stuck on, that they need some advice or direction or wanna know what I'm thinking, uh, they can just hop on, ask a few questions and hop back off.

You know that used to be, oh, well I'll see truss at that meeting. Or you know, I'll probably pass her in the hall 'cause we go to lunch at the same time. Those just don't happen anymore. So you really need to program them in. So this idea of virtual office hours are now part of the mainstay of the schedule of my week.

A second technique. Has been what the team affectionately calls time with Tressa and I I mentioned the tough economic times. I mean, people's spouses are losing their jobs. We have had to employ some furlough activities, especially during the real height of the crisis. And your, your whole world's already rocked.

Now you're rocked to the core and your own confidence. A lot of our reassurance comes from physical presence, and that was just.

Again, this wasn't my leadership team, but anyone in my division who just wanted to know, golly, what's going on? And you know, I heard this about PPE and there's nowhere to park anymore, and when can we come back to the office? And even though we have weekly huddles where I try my best to provide updates, that ongoing ability, not just to hear from me, but to get reassurance and reconnection, not just from me.

From their direct supervisors and the other leadership team members, I think has just been essential. You know, we, we've been looking as many people have at their work from home and what are we gonna do in the grand design? And, you know, we haven't landed yet, bill. We do have some leases that we've given up because we don't believe we need people housed in those areas and we can save money.

And we've gone through the process where I've said, well, here are all my analytics jobs or my analysis roles. Engineering roles that can all be done effectively, remotely. But there's the role and then there's the individual, right? I might be able to do the job remotely, but are my personality needs gonna be met if I'm so isolated?

And the answer to that's been very different for, for different people. And so I think just to loop back. Really being intentional about communication, creating lots and lots of ways for that to happen. We have weekly division huddles. I have leadership checkpoints now virtually three times a week. I have the virtual office hours, and I'm ever amazed that every one of these opportunities is used.

People take advantage of it. Trust me, I, there's so much wisdom there. I'm gonna have to cut you off at certain points. You threw too many things at me. I love the fact that you're, you're doing the drop-ins. I think that's a phenomenal idea. One, one of the posts and comments I made on my Tuesday show was just that we have to adjust our practices.

We used to have, you know, monthly breakfast with the CIO, which was an informal, get to know the CIO and ask whatever questions. And we had those drop-ins. What I was saying when, when I did that show was we have to be intentional about creating that same dynamic in the virtual world, and we were moving so fast, I was afraid that a lot of us hadn't taken the time to really build that out.

And it sounds like, you know, through interaction with your team and through really thinking it through that, that you've created those, those points that, that create, that, that dynamic environment where people can get their questions answered, can have the interaction with the leadership they need and keep projects moving forward.

A lot of it's just the skills. We know how to deal with crises, right? When that system's been, you know, has crashed and down and you're, you're having to manage through it. But I think what was different here, bill, is as ACIO for a lot of years and a leader, I have a lot of confidence in how to lead, um, in that space.

But during this crisis, I mean, that was affecting me too and my family and my own fears. And I needed to be an example. I needed to be a rock, I needed to be authentic and human, but I also needed, um, to offer some reassurance and stability even when it was wavering a little bit for me. 'cause that's just an expectation of the role of leadership, isn't it?

Yeah. I mean, we're humans. It's, it's, it's interesting because we all have to. You know, the same set of decisions we're making at work. It's like, when do we go back to school? When do we do this? It's, it's a risk reward thing. When do we take those risks and go back and, uh, every family, every person and in every family and in, in your community is having what you have at a corporate level they're having at an individual level and at a family level.

We just made the decision to, our, our daughter decided, you know, Hey, I'm going back to campus for the fall semester, and, you know, that's. That used to be like, oh yeah, you're going back to the fall semester. It's no big deal. That's a big decision now. It's like, uh, okay. How do we feel about that? How is her health?

Does she have any risk factors? I mean, a whole bunch of things went into it, and that's what every family's sort of facing is, right? Common things are, are just a lot heavier than they, than they used to be. A lot more decisions to be made. Yep. Yep. For sure. Well, we're, one of the things I wanted to talk to you about, you are a huge, uh, proponent of platforms at the digital front door, and we've talked about this before actually.

When was the last time you were on the show In the fall, right? You were at the Chime event? Was that the last time we talked? Oh, yeah. Yeah. You were there with your daughter? Yeah. Yes. Was I was there with my daughter, my daughter, who has now graduated from college, so she's, she's leaving me. And, and, and going on to better things.

So I No, no, no. She will never leave you. But I, the mother of all boys, I know what leaving you means. Yes. No, she actually has left, she's in another state. She's pursuing a different career. So I am, I am, I'm, you know, I'm not backfilling her as a daughter. I'm just backfilling her role within the company anyway.

I don't know why I'm explaining myself to the audience like , like, I'm gonna be judged by this anyway. You know, a lot, a lot of organizations threw a lot of technology at this problem, right? Chatbots, telehealth, remote patient monitoring. You mentioned a, a handful of those, uh, right out of the bat, but you're a strong proponent of, of platform thinking with regard to the consumer digital strategy.

What, you know, what, what does that look like and what is, what is different about a platform thinking approach to this problem?

So now we're not gonna talk about Covid, right? We're gonna move over and I'm gonna talk about digital as a platform. Uh, I, I think so, unless you want to talk about it in the context of Covid, but I, I just wanna talk about, you know, that whole idea. We had a lot. I, I mean we, I, I, every day I, I pull something up that says, Hey, our health system used the chat bot here and our, our health system used telehealth here and remote patient bot.

And I'm looking at all these solutions and I'm going. Okay. I don't know how you're gonna control that. Control is maybe not the right word, but I don't know how you're gonna orchestrate a common and cohesive experience across all these things. Right Now that we've implemented 50 things. Right? Well, so look, this isn't a new idea, right?

If, if I take a lesson on the journey that even you've been through, whether it was our ERP systems, which originally were a chart of accounts and a payroll and an AP system. Hey, let's get 'em integrated and call 'em a platform. The same was true where a lot of us started with homegrown or best of breed and interfaced clinical systems, only to see that as it played out and the products became more integrated, that we could get scale with a platform.

I, I truly believe that starting when the end in mind is no different and it's more of a vision than a physical concept. But I've been kind of, um, pounding that topic, which is start with the end in mind and really assume that your digital strategy needs to be a platform play and not a product play.

And, you know, it had nothing to do with healthcare, but in fact. As all of us know, you know, what does Amazon become? And I can buy things off the Amazon website that Amazon themself doesn't even sell because they've created a platform instead of just a product. And we've seen this with so many other organizations from a digital perspective, and I'm starting to hear consistent voices in the industry.

There was an Allscripts event that I wasn't able to attend. And they sent the slides out, bill, on what the delivery was regarding, and I know Ed Marx has talked about this as well, but the very first slide, and it was in my inbox today, is that patients today are inundated by disjointed technologies. And you know, digital, the digital platform is no different.

Multiple welcome message messages, various activations, depending on where you're touching a healthcare system. Or what conditions you have having completely different digital user interface experiences. So I guess my hypothesis is we saw the way of the ERP, we saw the way of the EHR. In fact, we lived through providers.

Who, and I'm sure you remember this, oh my god, you want me to log into all these different things and I can't even find half of them and why don't they talk? And that's where I was gonna take you. It's not only the experience for the cl for the, for the patients. The clinician experience was awful. I remember sitting there going, yeah, we're gonna put in a password manager.

'cause they had to remember so many passwords 'cause they were logging into so many different systems. That's right. And you know, we front-ended that, that made it nicer for 'em. But at the end of the day, if, if you knew what was going on behind the scenes, you're sitting there going. Why did they have 25 passwords to do their normal patient visit?

That makes no sense. But Bill, we are still gonna see some of that, you know, in this arena of innovation. You know, there's good news, bad news about the big giants, right? Even in the EHR space and as the market evolves in the digital space, we don't wanna crowd out the nimbleness and the in innovativeness of the smaller place.

But when you're sitting in a $2 billion healthcare system as I am, you don't want a confuse, disengaged patient or consumer and you don't want 700 diabetes apps they that, you know, it just starts to not make sense. So very similar to other platform plays, if you put together guiding principles and have intention, you aren't necessarily looking for someone, a single someone to solve for all.

You wanna be conscious, um, and constant about guiding principles around the user experience being as singular as possible. You wanna make sure when you're really pressing the buttons with these digital vendors, that they not only say, but can demonstrate their commitment to API interoperability, so that at the end of the day when you enlist this consumer in the journey.

They don't know very similar to the old clinical days that they're moving on and off a digital highway, when in fact they're just context sharing with other applications because of the nature of that interoperability that exists. So it's as much a concept and a strategy and informed by guiding principles and intentional decisions than just saying, I'm gonna go buy this, this one thing that's gonna solve for everything.

I will say in our own experience, and maybe it was just luck of the draw, we've been very happy. We have found a vendor that is not gonna be all things to all people, but because of their vision and their commitment to interoperability and their philosophy that we don't believe that we, uh, are the only solution for every single one of your consumer digital needs.

That has paved the way for them to be more of a universal user interface as we enroll and and move a patient through their journey. And this solution automates, let's say 40% of it and the other 60% I have the ability to AP enable different junctures coming on and off that digital. So again, with end in mind.

I don't think any of us, and I know some people already have, and e even I'm undoing some of these decisions, but no one wants to find ourself four years from now with having done nothing more than completely confused our digital consumer with what our, our healthcare, um, products are and made it that much harder to have access to care.

So begin with the end in mind is, is a great principle, but that leads to your guiding principles. You want a uniform experience for the, uh, consumer across multiple platforms. And you want, I, I assume there's, there's clinician interaction principles that, that get formed through that. What, what are some of the principles around how the clinician interacts with a.

Or a digital platform strategy, or a digital front door strategy? Well, you know, it's very similar to the old school EHR decisions, which is, well, heck, think about this. When we implemented CPOE, we asked really, really smart people with really good education to do something that they've been doing very successfully forever, and to do it with really crummy tools.

Were very immature and had no immediate benefit for them. I mean, that was CPOE summed up in its early days and I, I think as we navigate the digital world, we've got to, um, have that similar understanding with our providers. They don't all have the same level of comfort with technology, and we've got where possible to allow them have.

Get the technology right, bill, and if we can pick vendors who are committed to interoperability in, in a real true way, then our clinicians have the ability to decide on which one has the best clinical content. And so that's where the, and I think that's important. So that's where the, that's where the platform comes in.

What, what kind of, so you, you've mentioned this a little bit, what kind of conversations do you have with your vendor partners? So you're saying, Hey, we, we've got this platform and this is how you're going to plug in and this is how you're going to interact, uh, across the LifeBridge, uh, ecosystem. Um, how do vendors respond to that and, and how do they, well, I guess how do they respond to that, is the question?

Well, it hasn't always been easy because as you know, some vendors believe and want to solve it all. And so if you are not buying every one of those widgets objects and, and use case tools from them, they don't wanna play. That's one end of the spectrum. The other end of the spectrum. Folks who are just pure tech companies and they have no content.

And so when you have a gap in content, they don't even have a default standard for you. So they've been, I mean, they're interesting conversations and there hasn't been a one size fits all. We've been doing a lot of navigation in this space, and it's hard because you might have a vendor that's got the best clinical content for your digital journey.

Yet they are very immature from their interoperability perspective and really don't have the technical capability to fit into your ecosystem. And so I think that's where there just needs to be both a flexible and an innovative mindset, meaning that sometimes you have to accept in the short term that you're going to make a decision.

Along something that's more proprietary. As long as your contractual construct creates an expectation that the interoperability that, that your vendor partner will commit to the interoperability coming along and that there are mutual risks and rewards if that does or doesn't happen. You know, as technologists, we can't just come up with our little requirements document and say, if you can't meet any of these needs, you can't play in my space.

We could do that. But then we might lose the value of the richest content for the context and the reverse is true, which is if you've got something that's highly appropriate based on content and absolutely will never fit into your interoperability ecosystem, then it really can't be a singular or close to a singular user experience.

Yeah. So they're tough conversations and not a lot of people. Get me . You know, when I'm having these conversations with point solution vendors, they just wanna tell me what a great job it does for C-O-P-D-C-H-F Telehealth. Just fill in the blank because they don't care about or understand the broader context that we're hoping to manage with the digital strategy.

Yeah. And this is, this is where they fall down. And, and, and so I, you're right, I have had some of these conversations and here's what we're asking for. It's like, all right, from the CIO perspective, the organization is asking me for experiences. They're not asking me for apps anymore. They used to ask me for apps.

They don't ask me for apps anymore. They ask me for experiences. Can you orchestrate a patient experience? Can you orchestrate a clinician experience? So with that being said, I'm gonna, that's what I'm delivering now. But what that requires is I really like. Sections of your app. And I want the, I want the, the partners and the vendors to think about their app in terms of a bundle of services that could potentially be broken apart and say, I want that one to plug in.

I want this, I, I love your content over here. I like how you orchestrate, uh, care at home or carry a distance. And I would like to incorporate those two components into our platform. And, but a lot of 'em look at you and say, yeah, but you have to have the whole app. And, and what I'm saying is. Look, I'm almo.

I'm willing to pay you the same amount of money. I just need you to break it down because you're not gonna be able to orchestrate the experience across the LifeBridge health system, right, the the way I need you to do it. So we're gonna provide that construct, and then you just provide us the services that we can plug in, and I'll give you a whole nother argument to that, which is, if you don't start with the end in mind, and if you don't manage to the extent you can.

A digital platform experience. When you start trying to leverage your CRM, your customer relationship management, if you are having to do that across a fragmented, diverse set of applications, it will be infinitely harder. How does ACRM inform that? Tresis Springman the patient. Is very comfortable with urgent care being done virtually, but primary care, wanting to be in person or how does the CRM understand to push content in, in this diabetes app?

Because my brother's a diabetic and I have a history of it in my family, but I really don't have any interest in child rearing classes 'cause my kids are older. If you really start to see, just like in the Amazon play, that if you don't have some fundamental baseline shared content as part of that digital enterprise, that those bigger plays around CRM or the, the personalization of someone's healthcare.

They're just not gonna happen. They're just not gonna be able to take advantage of those powerful technologies. Yeah, that's so true. Uh, and Andress always thank you for your time. I, one last question for you is, so Covid has changed a lot of things. You talked a little bit about the financial crisis that follows the fighting of the pandemic and the fact that we had to step into this.

You know, in a couple of weeks I have the opportunity of teaching at the CHIME Bootcamp on one of the success factors. So I've been really. Doing a lot of contemplation on change management and man, we have just been in the throes of it, haven't we? Where there have been such environmental changes? Well, first of all, we don't, we, we wanna make sure irrespective of how we emerge, that we absolutely capitalize on the innovation that this recent situation, this crisis has brought us to.

What a shame it would be if we couldn't carry all those learnings into the future. I don't know about you, but um, consumers are demanding this type of choice and now we're seeing it and that's why it may not be 80% virtual, but 25%. But if we want to continue in our commitment to improve the health of our communities, that includes allowing them adherence and compliance to their own wellness path.

And you know, the best way to do that is meet them where they are. And that's about choice. That's a lot of reasons why people cancel the appointment or don't follow a certain path on their own healthcare journey. So yeah, bill, we absolutely are looking at ways, uh, to be more creative and to do more with less.

As we head into the next year, we do believe through the strength of our own balance sheet as well as what we're seeing in the market, that while there are going to be some tough times. Healthcare may look different, it'll become delivered in, in new and unique ways, but we're gonna stay the course. Our community desperately needs this.

Uh, you know, the, the pandemic didn't solve any of the healthcare conditions or crises that people are still, um, struggling with. So we remain committed to the community. I think we are gonna continue to grow our strategic service lines, but make no bones about it. One of our new strategies is to finalize and give as much focus on a digital strategy as an oncology strategy because this is gonna be the new norm.

I'm excited about it. I think it's a way that we can continue to enable better delivery and more cost effective delivery of healthcare. But. I think there are very few of my peers who have had the benefit of going completely unmarred, at least from a financial perspective on, on what's been going on here in the industry.

And I, I think, you know, technology and, and those changes, they're gonna help. And I hope the reimbursement encourages us to remain innovative and to allow things to, to stick that work and that our consumers want. I, I love how you, you, you frame up the silver linings of this. Yeah. covid is, is pandemic and it's, it's been a significant challenge for healthcare, but we had to develop so many new things.

So, so many new muscles, so many new, uh, strategies and approaches, and those things will go with us into the future and, and, and change healthcare. So it's, you know, it's. Are, there are some silver linings coming out of this. There's still some challenges ahead as well. Ressa, as always, it's great. Uh, it's great to catch up with you and I, I appreciate you coming on the show.

Thank you, bill. That's all for this week. Truss is such a great guest. I really appreciate her coming on the show. Don't forget to sign up for clip notes. Send an email, hit the website. We wanna make you and your system more productive. Special thanks to our sponsors, our channel sponsors VMware, Starbridge Advisors, Galen Healthcare Health lyrics, serious Healthcare Pro, talent Advisors, and Health.

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