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Lasting A Lifetime: What Supporting Technologies Make a Lifetime Guarantee Possible in Orthopedics?
Episode 5630th August 2022 • This Week Health: Community • This Week Health
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August 30: Today on TownHall Mark Weisman, CIO and CMIO at TidalHealth interviews Michael Suk, Chief Physician Officer, Geisinger System Service and Chair of Musculoskeletal Institute & Department of Orthopaedic Surgeries at Geisinger Health System about their lifetime guarantee for certain procedures. How are they able to offer this guarantee to their patients? What supporting technologies help make this guarantee possible? What are some of the challenges in working with a rural population and how do they overcome them?

Sign up for our webinar: Challenges and Solutions to Unmanaged Devices in Healthcare - Thursday September 8, 2022: 1pm ET / 10am PT. If we had to troubleshoot just a few devices every once in a while, our hospital systems would run as smooth as butter, right? But when missing devices, security issues and friction caused by interoperability hits, we can’t expect a smooth operation. Our webinar will answer many questions surrounding the devices integral to keeping patients healthy.


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Today on This Week Health.

We also learned very early on if you overwhelm patients and they're answering 300 questions in the waiting room, it's not gonna be successful. If I ask a patient, can you walk 10 feet with comfort? You don't have to ask if they can stand up. So we've been able to take about 130 different questions and ask them in about 15

Welcome to This Week Health Community. This is TownHall a show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels designed to amplify great thinking to propel healthcare forward. We want to thank our show sponsors Olive, Rubrik, Trellix, Medigate and F5 in partnership with Sirius Healthcare for investing in our mission to develop the next generation of health leaders. Now 📍 onto our show.

Welcome to this edition of town hall. My name is Dr. Mark Weisman. I'm a CIO and CMIO. And today I have a great guest with us today. I have Dr. Michael. So from Geisinger, he is the chair of the skeletal Institute. He's got a whole bunch of other titles on there. Michael, welcome to the show.

Thanks mark.

Great to be with.

So if you would Michael tell us a little bit about your role and I'm gonna follow that with a question about, well, tell us a little bit about the musculoskeletal Institute. Cause I wanna get into some of the technology you guys are using. That's what we're gonna cover a little bit today about how you're getting these outcomes you're getting, which is what's so important.

So take it away. Michael, who are you and what do you wanna be when you grow?

Well, thanks mark. I'm getting close to being grown up. I think, although I try to stay young, but appreciate the invitation to join you. So I chair the musculoskeletal Institute at Geisinger, which is a integrated health system in central Pennsylvania.

Largely rurally located and the musculoskeletal Institute comprises a large number. Anatomically or physiologically related service lines. So orthopedics physical medicine, rehabilitation, physical occupational therapy, podiatry, and even wound care, all roll into the Institute. And it's designed to act as more of a channeling type of organizational structure so that we can coordinate the care among many different service.

I also happen to chair the department of orthopedic surgery within that Institute, and also have an additional role within the hospital side of our integrated system as the chief physician officer for system services which brings me a lot of ability to bridge the clinical gap and the supply chain.

So it's more along the lines of developing a clinically integrated supply chain to help facilitate both sides of the healthcare.

Great. So one of the things you guys offer is a lifetime guarantee and this is kind of well known throughout, the healthcare industry now that you guys offer this and it's on, I think hip knees and shoulders.

Is that right? The replacements.

Yep. H knees and even revision these at this point too.

So. Tell us about that lifetime guarantee. Why do you do that? And then we're gonna talk about how you do that. Cause that's impressive.

Sure. I think that the, roots of this really start with back in 20 10, 20 11, we are an integrated healthcare system that aligns both the clinical enterprise, the physicians the hospital enterprise, as well as the insurance plan.

And so it allows us to look at both who's paying and who's receiving the. because of that level of integration, we're able to take a certain amount of risk on the equation. So for example, our patients who are insured by us can, there's a certain dollar amount that exchanges hands between two sides of the house.

n care program? It started in:

And they were surrounded around single vessel cabbage surgery in acute care. And as you know, that has morphed into a national type of program with a lot of federal interest and things like that, which has morphed into things like BPCI and things like that. For 90 days, you essentially are at risk for the outcome of most patients today.

In orthopedics, we not only embraced that idea, but wanted to expand the idea in several different fronts. One is, asking the question why 90 days was the amount and why couldn't we extend it to a year or two and then really going for the gold and saying, why. not Change it and make it for a lifetime.

And I think when we, when I first proposed the idea, almost everybody kind of laughed and thought it was, a joke because nobody can guarantee an outcome for a lifetime. You combine that with the pressures that we see with consumerism and patients who are thinking about, the quality of the care receive and what they expect, not only from the experience, but what they expect for the.

outcome And so tying all of these things together to understand what were the elements of production that ensured quality. And then extending that for a lifetime would create that consumer level assurance that if they stayed within our system, that they would get that. Now keep in mind that the nuts and bolts of this are fairly simple, but they're really intended to require that ability to cross.

Reference all of our elements in the, integrated system. So our doctors have to preserve the surgery. They have to be in our hospitals and you have to be our insured. And so that's really the critical element that makes this thing work.

There has to be some technology though. That's playing a role in this, just in the, and I'll let you decide which way you want to go with this.

Sure. Do you wanna talk about the analytics and the tracking side of how you're showing that you have these outcomes or you don't get to touch these patients for very long, the hip replacements, knee replacement patients. They're only in your four walls for a day. If that. So what's the technology. That's getting you these results that are extending beyond. So you get to pick, pick one of those and go which way you want.

Sure. Well, we were a very early adopter in using some technology to help manage our post-acute episode and also really building on a culture of innovation at Geisinger that really expanded our ability to reach out to people whether it be connecting them through our em, you know, we were one of the earliest EMR adopters in the country and have always maintained a position as one of the more wired or most wired hospitals in America.

And it was a natural extension to look at how we would do that in the post-acute space. And so we use a, software or program early on called force therapeutics that helps us manage the episode after D. Not only in providing both physical therapy avatars or videos to help manage, but also to capture outcomes for our total joint patients.

But more importantly, created a communication stream. So the patients would be connected throughout their journey rather than just at the episodic visits that we would see them in the hospital. As you know, most of the postsurgical visits occurred a two week wound check and then you see them in six weeks and you see 'em at three months.

But we're oftentimes not sure what's happening in between those months. Are they doing their therapy? Have they developed a little redness on the wound? Are they have concerned about their range of motion? What this allows us to do is create a much more longitudinal understanding what's happening. So if something they're concerned about occurs, they'll call and instead of going to the emergency room, they'll show up in our clinic and we can actually walk them through any particular phase.

It allows us, I think, to intervene much earlier than would normally be the case. And that of course enhances our outcomes.

So like my health system, your health system has to deal with rural areas. It's just the nature of the beast of the place that we live. Talk to me about how you're overcoming some of the challenges of that final mile, the communication challenges, cuz it sounds like you have to have good communications for this program to work.

How are you overcoming some of those barriers?

So a couple different ways, I think first of all, I'll share that I was pleasantly surprised that the perception of connectivity in rural areas and the reality is not as great a divide, as I originally thought my initial impression was that there are a lot of rotary and dialup phones still out there.

But it's, remarkable to, kind of see the saturation of what technology has already done. Most, everybody has some form of cell phone connection with additional kind of smartphone ability. Now. That's a good scenario where you have that there are still certain pockets where cell reception and, that type of smartphone activity can be challenging.

So what we do is rely not only on advanced software, but also traditional methods of communication. People still like to call. I still run into people for example, that still write a paper check. I haven't written a paper check in probably 25 years, but there are still people who give me a check and it's on paper.

I'm not even sure sometimes what to do with it. . So there are pockets of that that continues exist in a more traditional method. The other aspect is that we do a lot of formal outreach as well. As we will capture not only the individual's numbers, but we'll capture extended family and where we have questions, our navigators will call make sure everything's okay at home and make the arrangements as necessary to stay connected.

And the final thing I would say is that most recently in the last couple years there's been much greater emphasis on developing a world broadband. And I can tell you, even in our area here, I'm actually the personal recipient. Of the changes the federal government has supported.

So, I moved here 10 and a half years ago, and I've been reliant on cell phone and satellite internet for almost nine and a half years. And then all of a sudden somebody showed up at my front door and said they were installing cable broadband. And that was purely 100% the result of broadband initiatives.

And so I think it's getting better. I think that infrastructure investments are helping a lot, the pandemic. Really spurred that because people were trying to get educated at home and the rural areas really suffered. So I think that's gonna catch up to us now, but shorter answer to your question ultimately is we rely on families.

We rely on the connection that we have with the patients and the extended support network, traditional communications, and where possible will use the smartphone and cellular adaptive access.

We'll get back to our show in just a moment. I wanted to take this opportunity to invite you to our next webinar "Challenges and solutions to unmanaged devices in healthcare." This is where we're gonna take a look at the tools that are integral to keeping patients healthy in what we're doing to secure those tools and find them in some cases, guests will be leaders from children's hospital of Los Angeles Intermountain. And we're also gonna have representatives from mitigate by clarity on the call as well. And they're gonna share their experiences in maintaining these devices. And just some of the success stories, some of the challenges that they've had as well.

We're gonna do all that on September 8th at 1:00 PM. Eastern time, you could register on our website this week top right hand corner has our, upcoming webinars. Just go ahead and click on that love to have you register for that. You could also give us your questions ahead of time.

I can give them to the guests and we can make sure that we talk about that. On the webinar. So your topics get addressed before the webinar, we're going to be having a briefing campaign, five short episodes on the channel about this important topic of securing your unmanaged devices in in the hospital setting. You wanna check those out as well. You can also check out those on this week So look forward to having that conversation. Love to have you join us now back to our show.

Let's talk about outcomes cause that's what matters. And a lot of health systems struggle with outcomes.

If I went to many different health systems and said, Hey, tell me how many of your knees fail at one year, at three years, they won't, they don't have that data. It's complicated perhaps, because they're in a area that's so saturated with healthcare, that there's a lot of leakage.

And so they can't see, what's not in their own electronic health record. And maybe you have some benefits of geography. Talk to me about how you're collecting those outcomes, what tools you might use to do that. And then what kinda outcomes do you guys.

Yeah. For sure, I will tell you, we take advantage of our geographic area and our population capture that we have within our area.

We tend to see generations of families within the same system. So that is certainly helpful. It certainly helps with our knowledge and cultivation of genomic data for which we have a tremendous database. I think that there are a couple things about outcomes that are important.

So one is the clinical measure of outcomes to say, did the clinical performance turn out well? And also the patient reporter outcomes aspect, both of which we collect on patient visits as they come in and again, electronically. you know, we're one of the early pioneers in the area of kind of iPad related We've changed our operational algorithms so that patients aren't necessarily seen by the clinician or clinician until those outcomes assessments are done.

We also learned very early on that if you overwhelm patients with too many questionnaires and they're answering 300 questions in the waiting room, it's not gonna be successful. So we've been investigated in using computer adaptive technology. For example, you can fill out three forms that ask similar questions by asking just one question.

So, as an example, if I ask a patient, can you walk 10 feet with comfort? You don't have to ask if they can stand up. And so that eliminates that question. So we've been able to take what is about 130 different questions and ask them in about 15 and all of a sudden replicate our ability.

Understand their performance within a patient reported outcome a little bit differently. So operationally we've changed our ability to do this. What we're expanding into now is, offering the ability for those patients to do so at home, speaking to our, smartphone access is that sending a QR code to patients who are in asking them to scan it and then fill out the questionnaire before they come in so that they can be seen in a more timely basis.

These are the operational things that I think are the new challenges that we have in, he. You know, as far as tracking them, they all got integrated into our EMR. And we have a running dashboard with all of the outcomes that we see. In fact, we're in the process. It's been five years in the making to have developed a dashboard process with collecting a tremendous amount of data that.

Input it into the EMR that will ultimately look at complications and infections, surgical sign infections and things like that. So, as an example, the holy grail of this type of data collection and understanding whether it's artificial or augmented intelligence, whatever the buzzword of the day is, is you wanna know that if patient has had surgery in your hospital and they develop a deep surgical site infection, six weeks later, Do you wanna go back to that and say, what room were they in?

What was the temperature in that room? Who was the anesthesiologist in that room? How many people came in and out of that room during that day? What was the implant? When did it arrive as a loner tray or did it arrive as a loner tray? How was the sterilization process? Right. All of things that, for example, most surgeons would sit there and say, here are all of the inputs that are related.

Then you combine that with the patient data. She has a BMI, or he has a BMI of 34.8 as a hemoglobin A1C of X started out with hematic creative Y right. You matched that with whether or not there was a bear hugger in the temperature, in the room. And now you start to begin to see this holy grail of, information that can help pinpoint quality improvement, right.

Going forward. We're on the cusp of all that, because frankly speaking, we have all that. And the exciting part of it is being able to take all of that and put that together and then predict, make analytical predictions about who may or may not be affected. This is a really awesome exercise for us to go through this very manual in, creation.

But the end result. Is going to be, I think, game changing and then even going further than that. And this is where I get also excited is the fact that what if we then connected that with our supply chain and looked at cost. Now you're really looking at the total definition of value. And this is where I get very excited about.

Things that we're doing here at Geisinger starting with not only management of the longitudinal episode but taking advantage of our own infrastructure to be able to really change the game, not just in a warranty for a lifetime and ringing the bell from a consumerism standpoint, but really pinpointing the elements of quality on an individualized basis.

Not a, peer reviewed publication with generic statistics that say X people of this weight tend to have more complications. I think that's not directional for.

So it starts with the data collection. I know you guys are an epic shop. Are you using MyChart to collect those questionnaires or do you use a different tool?

No, we do. And so, part of the beauty of what we have is that we're not only capturing the outcomes through a variety of resources, but they're all inputted back into my. So that then becomes the repository for anyone else to potentially see. And as MyChart becomes more ubiquitous or interoperable.

Now you can see the advantage of a larger population understanding of those inputs.

That makes sense to me, cuz you're taking advantage of the technology you guys already have and then your analytics, I suppose, are gonna be in the epic repository clarity or caboodle that's right.

Data analysis. Do you have a data science team that takes a look at this? Do you have access to those kind of. Research type people. What do you use?

Mark's a great question. I think that if I'm gonna predict the hot jobs of this century are gonna be data science analytics people, because I think they're hugely in demand.

We have a robust and really awesome team when it comes to that. But I will tell you, they are working. To the bone, because almost everything we do, there's an ask to understand the data better. We're lucky in MSK. We do have some dedicated resources to do that. And I think that it's a crossover language that physicians, clinicians, administrators need to understand because that I think is gonna be so important to our future.

It's not only to, just to have raw data. Haven't analyzed correctly, but viewed through a clinical lens is gonna be a really exciting stuff coming up.

So let me see if I can summarize the secret sauce here. You you're taking advantage of the tools that you have. You've invested a ton of money probably into epic, like the rest of us.

And you're using that tool. You are collecting data. You're getting that information from the patients so that you have patient reported outcomes, and then you are driving quality by analyzing that data. You're not letting the final mile challenges limit your ability to collect data. You're overcoming those in any which way that you can.

Yep. And you're putting your money where your mouth is. So that you know, everyone's aligned, everyone's committed to this. It sounds like that this is a strategic initiative at an organizational level, not just one doctor with a vision, trying to drive something here everyone's bought into this.

Is that a good summary of how you guys are, where you are? What would you add to that? Did I miss anything?

No, I think that's, a really good summary mark. And I would just say that the key component to kind of driving this type of thinking and maybe change. Is having a system that's amenable to allowing that kind of flex, right.

I mean, hearing no 15 times is still going forward, right. Is not based on anyone's bullheadedness, but it's based on the idea that being persistent and being transparent and being consistent I think can really. Encourage people to move the ball in a different direction to make a quantum leap and not just incremental change.

I always tell people that I honestly believe I have the best job in orthopedic surgery. And not only did I get to lead a, tremendous group of clinicians and do great work from a clinical standpoint, but really looking at the modes and ways that we deliver Musco, skeletal care and having that opportunity to push the envelope and see where we.

So I TA mark, I think you summarized it. Well, I would just add those things and I'd love to collaborate. And if there's anyone out there who wants to talk more about this, I'd love to talk to

Michael. Thank you for joining us today. I think there's gonna be a fair amount of CMIOs out there with some envy who are gonna be jealous about the data that you can get that outcome, what we all want for all of our programs.

And you guys have really put the focus to it, the dedicated resources. I heard some of that as well. Thanks for coming on the show and sharing. This is really good tactical stuff that we need to hear as CIOs and CMIOs this is where we need to go.

So thank you.

Thanks mark. I appreciate it. Great to see you.

See you. Bye.

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