February 15: Today on TownHall. Lee Milligan, CIO for Asante interviews their Director of ITS Enterprise Services, Mark Stockwell. What exactly does a Director of ITS Enterprise Services do? It takes Project Management, technical and leadership skills. Mark gets into the nitty gritty of HL7 interface, transaction engines and serving the medical device integration team and the HIM department including functions, scanning deficiency analysis for release of information plus data governance and the after effects of 21st Century Cures. Plus what is it like coming from a non-healthcare background? How does a leader with extensive IT experience in other industries deal with the shock of the complexity of healthcare?

Today on This Week Health.

With every industry, there's a vocabulary that you need to learn. Right. That is particularly challenging in the healthcare industry. It's a fluent language that healthcare speaks. And so sort of leaping into that was a little challenging. The thing that struck me most was really the complexity of the healthcare environment. That was probably one of the most awe and shocking moments as I introduced myself into healthcare.

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, Hillrom, 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.

Hello and welcome to my first episode as host of This Week in Health IT's new show called TownHall. It's part of the channel called community. The intent is to focus on subject matter experts and peers within the healthcare it space. My name is Lee Milligan and I serve as CIO for A sante Health System. Asante is a three hospital system in Southern Oregon.

We draw from nine counties in Northern California and Southern Oregon. In terms of scale, we have about $1.1 billion a year in annual revenue. We also have about a hundred thousand ER visits between three hospitals today. It is my distinct privilege to welcome Mark Stockwell, Director of Asante ITS Enterprise Services.

He's a certified Scrum master and certified Scrum product owner as well. And prior to Asante he worked at Microsoft, Lucent and Opera in a variety of different circumstances, including technology, leadership, and project management. Upon arriving at Asante he initially served as one of our ITS Project Managers, really getting his foot in the door.

Thanks. Thanks for having me. I'm really looking forward to this.

Great. So let's tackle the big pink elephant in the room. You are the director of Asante ITS Enterprise Services. That sounds like a fake. What do you oversee exactly?

Yeah. Okay. Yeah. Well, it doesn't feel fake on a day to day basis, but yeah. Well I think we didn't have a, really didn't have a better name for it. It's a combination of a number of different groups. I'll just describe them briefly. The ITS integration services team, which largely serves our integrations updated, both in and out of the Asante are HL7 interfaces, our transaction engines, et cetera, as well as our medical device integration team. So supporting the integration of all of our medical devices. Additionally I serve as the director over our health information services department, which includes your traditional HIM functions, scanning deficiency analysis for release of information, et cetera.

So basically medical records and the medical record.

Exactly. Yes. And then our biomedical engineering team which supports the maintenance installation of our medical devices, all of our medical devices across the system. Including our x-ray equipment and linear accelerators down to centrifuges right in the lab.

So a wide variety of equipment. Also the, revenue cycle, Epic revenue cycle team members. So the hospital billing, professional billing and the HIM Epic analysts. Those are sort of grouped together in supporting our revenue cycle organization, and then our data integrity and governance which works are data retention and is the focus of our data governance program, sort of managing our data integrity of the chart, the master patient index, chart corrections but also our legacy data archive and then supporting the overall governance program supporting our governors and our stewards and those involved in that program.

Okay. So look it from the outside. I think some folks might think, wow, that's kind of a, it's kind of a mish-mash of stuff. Can you explain from your perspective whether that works or doesn't and if it does, in what way it kind of comes together?

Yeah I think it, I think it works I think it really works well. I mean, if you looked at it from the outside, you'd say, wow, those are sort of a bunch of disparate teams, but if you think about it in terms of the designated record set, what's at the center of it all. This team really supports sort of the nonclinical staff interactions with that designated record set. Right? So integration services is all about data coming in and, and reaching that medical record or the designated record set through those interfaces. And medical device integration through our medical devices. The bio med team has a close relationship with the medical device integration team.

And so there was a, some synergies there that really offered some great workflow efficiencies. Similarly the integration services team supports our HIS team right. There's a large number of error cues and content that comes into the medical record that they then work together on trying to resolve and find that the root cause, whether it's the concerns and issues that are associated with those.

And then on the billing side, right? It's that whole revenue cycle piece, right? It's all of the back office finance revenue cycle team members were working on those workflows and the interchange of data that occurs between our payers and all of those involved in the revenue cycle process and sort of at the overarching element of all is data, integrity and governence. Right? So all of those things are governed through that program and there's a strong relationship between governance and all of those functions. Right in maintaining the integrity and the other medical record.

Yeah. That's, that's a really good explanation of it. I think kind of the framework you just described in place is really what allows it to kind of come together and really make sense. And I agree with you. I think, I think it works for us really well. We first launched this and kind of moved forward we did have a few raised eyebrows.

Yeah. Well, I'll say first of all with every industry, there's a vocabulary that you need to learn. Right. And so that, that is particularly challenging in the healthcare industry. Right. So that was a bit of a, just the acronyms and it's a fluent language that healthcare speaks. Right. And so sort of leaping in into that was a little challenging. I think the thing that struck me most was really the the complexity of the healthcare environment, right.

That, that was probably one of the most awe and shocking moments as I sort of introduced myself into healthcare because of the complexity of all of the integrations, right. There's so many systems in use in a typical healthcare system. And even though the EHR, right. Has provided some consolidation right of, of systems. There are still a whole host of them supporting a number of different processes and your procedures, outpatient and inpatient across the system that all need to sort of talk together right to ensure there's a solid patient experience. So when I joined as a project manager and I recall one of the first projects I had was the replacement of our then antiquated cardiology system. I was just in shock at the complexity of bringing in the modalities and trying to support the interfaces. And it was just, it was just quite a shocking experience.

I think that bit of it introduced me to this sort of work culture, right? Sort of the type of culture that healthcare has and the complexities of working with providers at the same time, while you're trying to satisfy operational staff within the hospital. And, and then trying to drive a project forward with very, sometimes very ideas of what success looked like right. From a provider perspective we're done, but yeah. So trying to bring some of those structure in from outside added in a whole level of stakeholder engagement that I wasn't totally prepared for.

So when you brought some of those concepts into, how was it received by people who perhaps were in healthcare IT and they've been in and they're good at healthcare IT, that's what they do, but that's all they've ever done. How did they how was that received? Is it, was it in a kind of an easy message or, or is it a difficult message to, to share?

I think it was a little difficult. I think some of the things that we tried to introduce were a little bit more agility in terms of how to respond to the market and build build into our per projects and programs, a little flexibility and agility.

And that was the most challenging piece right is that healthcare had kinda been marching along at its own pace and with the advent of high-tech and a variety of regulatory pressures and government programs healthcare was being rapidly pushed forward, right in trying to adopt new things, bring new technology in. And I think that that allowed those conversations around agility. And what have you to sort of be more thoroughly considered because we knew we had to be flexible and change and be able to adapt to what was being asked of us from, from the government and just from our competitive and market pressures.

Yeah. In your role, I think given all of the things that are under your tent 21st century cures Certainly impacted you I'm sure. Can you talk a little bit about how Asante approached 21st century cures and kind of where we're at on that journey?

Yeah. I mean, obviously that was a big deal for all of us in healthcare. That was a significant change in terms of what we needed to provide our patients and our other community providers in terms of sharing information. Information blocking probably was the most complex piece of the 21st century cures act that, that everybody was kind of split up about for some time.

I think we did a really good job. First thing, the first thing we did is we got in there early, right. We sort of recognized early that this was, this was not going to be an easy lift. There was a lot being asked of us and in terms of sharing of data and changing a policy and procedure. And sort of long standing practices.

And so we established a council of across cross-functional council that include compliance and legal and it, and a number of different team members to sort of thoroughly think about what, what was involved right. In trying to get the cures act in place from all of those dimensions.

And there were very robust conversations, right? There was a lot of complexity. There was. The cures act itself was a fairly substantial read. So we needed to have somebody to sort of decipher it for us and figure out what, what we needed to take action on and what we did. But at the end of the day we sort of prioritized. What we felt were the most important things that we needed to do really around centered around what was best for our patients, right? Not just in meeting the regulatory regulations, but how do we want to leverage this to better serve our patients and provide better content and make accessibility to their health record information easier. And so that drove a lot of our improvements to the program into my chart and into our release of information practices and our interoperability practices, et cetera.

Right. Well said, well said, I want to pivot a little bit to your work in data governance. I kind of glossed over this with a single sentence, but you did stand up and create arguably one of the best data governance programs that, that I know of. And of course I'm very biased because I have got a chance to partner with you and be part of it. But the reality is a lot of this work was non technical.

It was procedural and policy driven and accountability driven across the organization, not just EHR databases. Can you talk a little bit about when you first came on board, what the framework was that we put in place for you to initially do investigation and discovery and to research that, and then kind of what you ultimately were able to put in place here at Asante.

You're a part of this since, since the beginning. We did have a first attempt at data governance and largely s temming from the fact that we were going to start to ingest additional information from outside the system.

We were going to start to share more data outside the system, and we really had concerns about how, how certain are we of the quality of the information we're going to share the data we were going to share. And that prompted us to think about governance as a structure we needed to have in place in order to ensure we could deliver quality data and manage the receipt of quality data.

So our first attempt was largely academic and we learned from that experience, as you were part of that original original team, but then following that when you and I got together to talk further, How we would, how would we do this again? I think one of the smartest things we did was to spend some time really researching and understanding what we wanted to get out of data governance.

It's a big domain. If you were to go out and look at the internet and search on data governance, you'll find any number of models with any number of elements that are supporting data governance. But at the end of the day, when we did our research and spend some quality time doing that research and talking to people, talking to other healthcare systems, other governance organizations outside of healthcare we came to the conclusion that really we needed to focus on just a few things without the size of the system we have.

We really only needed to focus on a few things and we, we identified these as our pillars. And they really around us around accountability for data assets across the enterprise. The proper use of our data assets within and outside of the enterprise quality. The core elements of quality for data and lastly movement, right?

Because there's a risk both in and outbound with data coming in and out of the system. So we sort of built our program around those four pillars. And as we went further down that path, And started to bring news cases in that were, that were within those quality movement or properties domains, we realized that they weren't really for equal pillars.

Yeah. Accountability was really at the center of it, right? You had to have accountability in place in order to resolve any of these concerns that were coming from any of the other domains dimensions. And so we really spent some good time putting our structure together and started at the top, right with our executive team, identifying them as our data trustees, and then working our way down to having them engage in creating our domains and assigning our governors and ultimately getting them involved and working down to stewardship and right through the program.

Do you remember those initial meetings where we're meeting with the our highest level executives in order to talk them into this? Remember the list is you, me and the executive having this conversation and trying to describe the why behind it? Part of it, I think is you made it very practical. Do you remember some of the, can you talk about some of the initial kind of, I'll call it a testing SQL queries that you, that you built.

Yeah. From a concept, right governance was hard to imagine. Right. And when you think about that in terms of those three dimensions, the quality of the movement and the proper use piece, you could kind of talk about it, but as you said, it was, the executives were, were challenged with trying to figure out how it was going to work.

So we brought some real examples forward. We, we did we did some SQL queries against our epic database to identify some of the nomalies associated with the data quality that was existing inside those tables. And we identified ages, right? Patient ages, we had we had, I can't remember the exact numbers, but they were the in the thousands of patients who were over 120 years old and our database and still active and alive. Right.

Maybe we're a blue zone that's right. Or.

That's right. And so we ran a number of those different kinds of queries using different areas of the database to query on the quality of the data. And we discovered quite a few things that sort of represented I recall specifically as talking about some of the measures for and some of those being just out of the bounds of what what could actually be considered a normal range. Just physiologically.

And so there was a number of those things we brought forward in this sort of started to get the executive team realizing that, oh, wow they're actually potentially issues here. The other things that we attacked really were more around just the definition of stuff, right. I remember the long and robust discussion around length of stay.

And how it was used differently from an operations perspective, from a clinical perspective and how the two numbers didn't match. And when you show those two reports, they were different and people were kind of clued into, Hey, there's something not right here. So that fit our proper use model to say, Hey, we're not properly using that term across these two, these two reports. And so we had to spend time disambiguating what is the operational length of stay from the clinical and documenting the differences in the definition and the difference in the algorithm applied to calculate the two. And so we went through a series of a number of those types of things.

So simple things, as you would think, like there's a lot of beds, there's a lot of different types of beds. And so when you look at census and whose heads in what bed, governance played a big role in sort of disimbiguating that for us.

I think find a good mentor. Find a good quality mentor. I was very fortunate. Tthat I think made all the difference, right. Having the ability to work with somebody who understands the space. Has been in it for some time who can help you do with the translations. Help you understand the culture and kind of how things work in healthcare.

And then who's also open-minded to listen and, and recognize opportunity and see if there's a chance to introduce new ideas into the existing frameworks. So that would be my advice. I think it was invaluable to me in terms of surviving. Had I not had that it would have been very difficult.

I recall you sharing with me some of the things that your mentor told you that I learned from as well. So I appreciate the fact that you, that you did that. Listen, Mark, it's been terrific talking to you today. I feel like we scratched the surface. You are a pleasure to have on the team. I feel very fortunate to have you here and for all the things that you've taught me over the years. Mark Stockwell, Director of Asante ITS Enterprise 📍 Services.

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