Chad Brisendine CIO from St. Luke's University Health Network joins us in a discussion about Blockchain, changing role of employers in delivering healthcare, and building a customer experience on Epic's APIs.
Bill Russell: 00:09 Welcome to this week in health it where we discussed the news information emerging thought with leaders from across the healthcare industry. This is episode number 23. It is Friday, June 15th. Today we talk about emerging technologies such as blockchain and the priorities of the cio. This podcast is brought to you by health lyrics. Are your strategies constrained by infrastructure or are you tied to the knot of applications we've been in your shoes? We've been moving health systems to the cloud since 2010. Find out how to leverage the cloud to new levels of efficiency and productivity. Visited Health Lyrics.com To schedule your free consult. My name is Bill Russell, recovering healthcare cio, writer and consultant with the previously mentioned health lyrics. Before I get to our guest and update on our listener drive, we've reached 100 of combined new subscribers between Youtube and our podcast outlets, which means we've raised a thousand dollars for hope builders, which provides disadvantaged youth life skills and job training needed to achieve enduring personal and professional success, I've hired their graduates and their stories are nothing short of amazing.
Bill Russell: 01:08 They're very inspiring. Uh, we have nine more weeks, uh, where we're doing this drive where our sponsor has agreed to give a thousand dollars for every additional a hundred subscribers. It's really two wins for the price of one. Listen to great content from industry leaders and give back to the community while you do it. Join us by subscribing. Stay. Tell your friends. Uh, we actually post a new video on our youtube channel every day. We're up to 160 videos. You'll want to check that out. So, uh, so let's get started. Today's guests. Today's guest is one of the clearest thinking cio is I've run across even when he is disagreeing with me. So Chad Brisendine is the cio of St Luke's university health network in Bethlehem, Pennsylvania. Chad, welcome to the show.
Chad Brisendine: 01:48 Thanks for having me, Bill, for today's conversation.
Bill Russell: 01:52 Wow, that's a subdued as I've ever heard you. I can't, I, I hope, I hope it ratchets up a little bit here because usually, usually when we're going back and forth, it gets, gets, uh, gets kind of fun. So I'm looking forward to this conversation. One of the things I want to do before we, we, uh, get into the meat of the show is a, I think it's interesting your career trajectory you've taken as a cio and I think it's interesting to some of our listeners, so you now have frontline healthcare revenue responsibility. Can you talk about that a little bit and what you're doing and what the thought process was there?
Chad Brisendine: 02:26 Sure. I think, um, you know, for, for probably a decade I've wanted to have additional have had additional operational responsibilities in the past but never revenue generating. So one of the things I wanted to have is revenue generating, I think just to, as a cio think differently, come at it both from a cost perspective, which we always do in it. How can we make things more efficient, how can we make things more productive, but also how can we help the company generate revenue? So I'm pretty excited to take on, uh, the supply chain imaging in our emergency management, uh, areas to, you know, not only just have the cost side and the information, you know, management side of being able to bring digital solutions that table, but also think of it from a revenue generation and how are companies and businesses are managing and measuring and, and their effectiveness with more of the customer side of things, a patient customers, if that makes sense.
Bill Russell: 03:21 Yeah, I think that's, I think that's exciting and I think it's unique from, uh, some of the cios that I've talked to in the industry. Give us an idea of St Luke's university health network. Give us a scale scope of what you guys do.
Chad Brisendine: 03:35 Yeah. Great. So we're in the Lehigh valley primarily, but we serve nine counties in eastern Pennsylvania, north of Philly, and west of New York City, about an hour and a half and we have about 350. What's unique about us is we have about 315 outpatient practices and clinics, uh, that pretty much put us all over the map. So if you look at our geographic territory, I think people would say it's pretty unique to see that we have, you know, Primary Care and physician specialty practices everywhere and uh, what we call our urgent care centers and then geographically located around our hospitals. And then we also have our tertiary facility. So a really good footprint within the valley. 10 hospitals, about 14,000 employees and a 2.1 billion in revenue.
Bill Russell: 04:21 Yeah. And uh, actually, uh, you know, full disclosure is my, my hometown. It's where I grew up. It's where my parents live. My parents were actually patients at a St Luke's and I remember when it was just that one geographically constrained hospital on the south side of Bethlehem for the steel workers. Uh, but you guys have since really broken free from that, uh, that one footprint. It's still a thriving hospital, but you've broken free and, and, uh, uh, you know, really expanded a well up until the Poconos in other areas. So pretty exciting. Hey,
Chad Brisendine: 04:55 baseball in your hand and um, you're not in my office, but if you look, you'd be able to see the Iron Pigs Phillies baseball stadium. So we have a minors team from the phillies in our area. Have you ever come to Bethlehem? You can visit the baseball,
Bill Russell: 05:12 the iron pigs. What, what a great name. Um, uh, let me, uh, so here's, here's what we usually do. Every guest we bring on, we just give them the floor for a little bit and say, you know, what's, you know, what's one of the things you're excited about or you're working on today? Uh, you know, it can be anything. Could be your farm philanthropy or things that are going on at work or projects you're doing. What's. So what's, what's something you're excited about?
Chad Brisendine: 05:38 Yeah, so, I mean, I think right now we've been growing a lot, so we have a lot. I mean I'm sure just like many healthcare organizations, we have a lot of m and a activity. So we're actually bringing all of our systems up next Saturday on three of our new acquisitions, which in total is three hospitals. About another 40 clinics and about $300 million in revenue and we're doing that all in six months. So it's been a pretty aggressive timeline to bring them on. So that's got the team buzzing and uh, we had our No go this morning with leadership and everybody feels comfortable about making the switch so that that's what's going on from a work front. And then when I look at general and I know we're going to get into some of the things with technology, but I'm pretty excited about healthcare and where it's going.
Chad Brisendine: 06:22 I think there's a lot of pressure from the outside and we're going to talk about that today with costs rising. Um, a lot of different, um, opportunities to disrupt, to make things different. Uh, and then also look at where technology is going in general. And I'm pretty excited about the speed, the agility and I know we're going to get into some of those things today, but just know we've, we, a cios have always wanted to move really quickly. I think at least I have always wanted to. And I really look at where technology is going and how we can really help the business much quicker and faster and be more agile and nimble and provide information faster than we ever have in the past, which is really at the heart of what we're trying to do with technology. So I'm pretty, pretty stoked about the future of digital and IT.
Bill Russell: 07:08 Well, I'm looking forward to our conversation. I'm going to jump into it because the last two episodes I, I try to tell people we try to do a half hour episode in the last two have gotten up to 45 minutes and I know that you have a hard stop today. So here's what we do on the show in the sound bites and social media close. Those are the three things. So to get started, we each selected a new story tact as a sort of the backdrop for discussion. Uh, you know, I'll kick us off. So the news story I picked up was a fed up with rising costs, a big US firms dig into healthcare. So this is a Reuters story. And let me, let me just read a couple of things here. So, uh, and this is along the lines of the JP Morgan Berkshire Amazon announcement, but just to let people know this has been going on for a while.
Bill Russell: 07:53 So at Silicon Valley headquarters network gear maker Cisco Systems is going to unusual lengths to take control of the relentless increase in US healthcare costs. The company is among a handful of large American employers who are getting more deeply involved in managing their workers' health. Instead of looking to insurers to do it, Cisco last year began offering its employees and plan and negotiate directly with nearby Stanford health medical system under the plan physicians are supposed to keep costs down by closely tracking about a dozen health indicators to prevent expensive emergencies and keep Cisco workers happy with their care. Uh, if they meet these goals, Stanford gets a bonus if they fail. Stanford Pays Cisco Penalty. Cisco said costs for Stanford and the Stanford plan are 10 percent lower than conventional coverage, still used by most of its employees. Chip maker, Intel told Reuters it's saving 17 percent and to Its workers enrolled in a similar plan known as connected care aircraft manufacturer, Boeing and Walmart Inc. The world's largest retailer have likewise hammered out health plans directly with providers. Uh, so This, this has been going on for awhile. Corporations, help, um, some other statistics before we get into some stuff here. So corporations, help pay for healthcare, have more than 170 million americans. Uh, these employers will spend an estimated 738 billion with a b, a on health benefits in 2018. A figure that has been rising about five percent annually. So first let's talk about the model. We'll get into the it aspects of it, but let's talk about the model. Self insured employers, cisco, intel, boeing, walmart, obviously large employers with a critical mass of employees in a single location contracting directly with health systems. Uh, the insurance carrier appears to be the odd man out in this situation. Do you think these models represent the future of healthcare and where we're going?
Chad Brisendine: 09:45 Um, I personally believe that if they're successful, it'll be a major disruptor. Um, and the reason for that I think is that the insurance cost is a large burden on the healthcare from an administrative. So a lot of the reasons why we've been growing from an administrative cost perspective, both on the provider and on the payer side is denial management, preauthorization, all these crazy things we have to do to go back and forth and back and forth that don't add any additional value to the healthcare ecosystem. And so if we can cut those things out, there's a lot of opportunity for cost reduction. And so it'll be interesting to see how these agreements are striked.
Bill Russell: 10:27 Yeah. And when you talk about the, uh, the waste, uh, one of the, one of the metrics I always throw out there, so it usually takes about 12 bills generated and sent to the, uh, to the patient before a health system gets paid. And part of that's just the convoluted nature of you bill cms. Then you bill, you know, the supplement, then you build the, uh, the actual patient. So, and they're getting an invoice for each one of those, it just gets, there's so much in it. So, um, so any kind of reduction in terms of the number of players in that, in that string will make things easier. Yeah. And I think I agree. I think what we'll see, I mean obviously it's a, you know, large employers, uh, it'll, it'll have to trickle down into the, uh, you know, the small mom and pops because again, they, they employ more people than even the largest employer. So,
Chad Brisendine: 11:27 oh, there's a temendous amount of middle people is what I'll call them, brokers, yoU know, insurance folks, and then the provider side. There's a lot of, a lot of layers of complexity there that are probably not necessary.
Bill Russell: 11:41 So let's talk, let's talk about the technology. So I think the more interesting one here for me is intel launched connected care health plan five years ago, 38,000 employees and dependents now enrolled in Arizona, California, Mexico, and Oregon. Uh, technology is critical to curbing the cost. This is one of the people talking in Oregon. Patients are engaged to use video conferencing to speak with physicians when appropriate at $49. The cost is one third of an office visit. Connected care boasts a 95 percent enroll enrollee retention rate a says Angela Mitchell, intel's head of us healthcare delivery. So let's start with telehealth. Telehealth has predominantly been a defensive measure for most health systems, right? You put it in place and you know, let's just see how it works in those kinds of things. Um, I've, I've heard some health systems recently talking about it becoming more of an offensive strategy in terms of market share growth and taking it outside their traditional boundaries. Do you think that's going to take off? Do you think we'll see more a telehealth and, uh, as an offensive strategy to grow your market?
Chad Brisendine: 12:51 Well, I think the answer to that is yes. We've, we've latChed onto, and I know we're going to talk a little bit of a better consumer strategy, but we've been using american well's platform for quite a bit of time embedded within our mobile and web systems. And the challenge with it I see is the, um, the scale is just not there. You know, consumers are not going there first. Um, they're going to the fiscal plant first. So we have about, of our total population, we have 177,000 this last year visits to our urgent cares. Uh, our last year we had about 7,000 e-visits and we've been running that platform for three or so still I think a lot of education and I know people want to use it. But I think there's still a lot of like, how do I use it and what do I use it for? Um, so I do think there is, but the question really is for what diagnosis is or the best to use it for and how do we educate customers on how to use that. They know where to go, why and go to the er, they know to want to go to these minute clinics or, or urgent care locations. The question is will they know how to use the video conferencing capability.
Bill Russell: 13:58 So as we see new models start to emerge, what technologies do you think, obviously we talked about telehealth, but what other areas within the technology world you think we need to get in place to make sure that we're ready for new models as they emerge?
Chad Brisendine: 14:13 Well, I mean, I think when you look at the employer model or the rising cost and you combo that to the article you're talking about so I'll be specific on that. I think we need to provide more data to employers, right? How, how we're managing and measuring their employees, you know, what are we doing for them? What a, now we may not want to get in all the way down to this is, you know, Chad's going to mcdonald's or whatever, but, um, you know, at least let's provide them some, some, uh, anonymized data that they can see. Kind of how the, how we're helping their employees manage cost and control cost as well as manage their health. So, you know, if, if you're an employer and you're providing health insurance, I would think, uh, you know, you, you provide that as a benefit to your employees and you want to make sure that that benefits getting maximized, especially when there's a increase year over year in healthcare costs and a, It's a significant portion of the costs that you have to manage your business. So technologies, data, I think a lot and services that we can provide that, you know, keep your employees in the office longer, whether they're a televisit or a, depending on the size of your company a nurse or some kind of clinical person that may come onsite and, you know, do some care management from time to time or whatever. Those set of offerings look like that, you know, keep your employees engaged in their health and lower the cost.
Bill Russell: 15:36 Yeah. So data will form the foundation for all of these new models. That's makes a lot of sense. So, uh, I'll kick it to you for the next story, so set it up and get us going.
Chad Brisendine: 15:46 Yeah, sure. So, um, so blockchain, um, I pulled up an article, a couple of different articles on a blockchain technologies and this one is from the wall street journal. It's, how blockchain could help lower health care costs. And I know it's one of the major trending technologies that we'll, we'll talk about later. Uh, I've been doing research on this. We're pretty, pretty close to our poc on some blockchain technology, but I thought I'd read a couple components of this. Blockchain by contrActs puts patients, insurers and providers all on the same page with the low costs and decentralized ledger approach to managing information. Blockchain gives all of the parties, uh, in the provision of healthcare, simultaneous access to single body of strongly encrypted data and it creates an audit trail each time it's changed helping to ensure the integrity and access to the information.
Chad Brisendine: 16:45 ExcUse me. So several of the use cases are obviously processing claims, uh, and in january, change healthcare, uh, who has about 800,000 physicians in their network, 60,000 pharmacies, introduced a blockchain system for processing insurance claims. Uh, and while not all the providers are on that, uh, the ledger has encryption, single source of truth to be able to move that forward. so that's one use case provider directories is another one where we have massive issues around provider directories and there's, there's a lot of systems out there that you can purchase it anonymizes or are the aggregate the data together to provide that, but there's no single identifier for, for all this information. And then, and then how do you share that? So, you know, healthcare has been building atm networks called hies for, you know, whatever, the past decade since the meaningful use kicked off and we've, we've put tons of money, both the private and the public sectors have put tremendous amount of money and we still have a lot of the same challenges we have today, which is we don't have an identifier for the data.
Chad Brisendine: 17:52 uh, and so when I look at that and I look at, you know, blockchain technology, what excites me is it's encrypted technology with distributed computing combined. Um, and so when I think you've, you've moved the hype of bitcoin out of the and you look at the underlying technology for really looking at, you know, distributed computing. So will it replace the internet? I don't know, conceptually it could, right? Um, but at least, you know, let's talk about the fake news the second, I don't want to get political, but you know, how do we, how do we, how do we trust the sources of where things come from and I don't think we have source of truth and I think that's where this comes from. And so if we can start building a source of truth. So for example, on identity management, we have the capability that, you know, bill russell comes to us and we take him through the tsa pre current screening test and validate his identity and his background and we do all this stuff.
Chad Brisendine: 18:46 And then now he goes to st luke's and then he goes to another healthcare organization that does the same thing. We get two or three times where we validated the information. Why can't we share that identity information across and say, this is bill russell, we validated it in three times he's been tsa or healthcare pre-cleared. Now let's use him on the chain and then allow that data and identity to be replicated across many. So when I look at the amount of money we're spending into, you know, trying to figure out the source of truth, you know, we really need to do it into the proactive side, which I believe is blockchain. And I know the technology's still evolving and they's smart contracts and there's theory and there's all these different kinds of things. So they would ask you, you know, they'll, what's your perspective on block chain and, you know, where do you think it's at in the ecosystem? Um, you know, your comments.
Bill Russell: 19:35 Yeah, no, I love it. You know, I'm bullish on blockchain, so, um, but I'm, I'm going to go in a different direction on this because I agree with you. Provider licensing and credentialing medical, supply chain, revenue cycle, fraud prevention, all these backend systems I think are a prime candidates. But one of the things I want to, I want to caution people on is this whole idea of, you know, it's going to be the patient record and, um, you know, data sharing and interoperability is a cultural problem, not a technical one. Uh, it really hasn't been a technical one, uh, for, uh, ever since I've been in healthcare, which was around 2010. Uh, it has not been a technical problem. It's been a cultural, uh, you know, in a transaction, in order for a transaction to occur, you have to have two parties that agree to share for a benefit.
Bill Russell: 20:26 And right now the parties don't agree and the benefits not really understood when we, uh, and we actually incubated a couple of companies at my previous employer and one of them was around this data sharing and interoperability. And I remember the Seven principles I sat down with the company that we were, the owners that we were going to work to design this technology. And you know, the first thing I asked them for is the technology needs to be patient centered. Alright? So culturally, this is big difference. It's not health system centered, patient centered, the patient has all the information on their health, they choose whom they share with and when they share it and they know it all times who had shared with. So that's the first principle I gave them. The second is raw data is, uh, is never altered, right?
Bill Russell: 21:10 So you have this transaction log. And actually some of this sounds like blockchain, right? A discrete data is preferred over unstructured data. Nothing worse than a pdf, pdf file cabinet. Hell, if you ever sat behind a doctor who has like a thousand documents to go through a, it's just not efficient. Uh, easily integrated with the workflow was another principle we gave them. You think apple, apple pay for the medical record, you knoW, those cheap devices they walk in, they're talking to the doctor, doctor says, well, do you have any information on that? They just, you know, do the, uh, the id and the information flows into the record so easily integrated into the workflow. No tolls or fees for storing or sharing the data was key. Um, you know, you do not want to become a data broker that's making money off that transaction. A full transparency of the record.
Bill Russell: 21:59 One of the things that strikes me is that if we got to the medical record into the hands of the patient, um, they would see that there are parts of it that are sloppy, irrelevant and potentially wrong, and they have the most incentive to change that. And obviously the, the, the seventh thing we gave them with security. Um, and then here's what we thought when we incubated this company, what we thought we would see emerge is If you could get all that data in that form and rally available and you can easily do this on Blockchain easily you could do this on blockchain. A data economy is going to emerge just like the financial industry. If you think about the financial industry, if you go to your phone right now, you probably have mint, venmo, paypal, expensify, a acorns and hundreds of other investment apps.
Bill Russell: 22:47 That same ecosystem could evolve. Uh, we believed if you, if you get this to emerge and then you could have companies that hire doctors, employed doctors, and with each transaction, with your health system, you could actually transfer it to that to that company and they can help you to clean up your data, explain your bill and even discuss your care options. So when I hear health system leaders say, I'm not sure we can give the patient their record because I'm not sure they can be trusted to make the right decisions with it. I, I somewhat agree with them. If you gave me my medical record, I wouldn't understand 90 percent of it, but I could also find, you know, the mint and venmo and paypal of healthcare who's going to help me to, to, to navigate it because a lot of health systems aren't helping me to navigate it. So I, I just sort of dumped on you there. Do you think if, if we continue to push down this direction of blockchain as I do and I think it is a great foundational technology that we will see a transformation in the way that people interact with the, with the health system and are health systems really, uh, are they ready for that and how are they going to adjust to that?
Chad Brisendine: 24:08 I think two things. I agree with you on the cultural change of who ownS the data and I'll answer the other question first. So I don't think it's going to change the way in which we have people own the information. I think it's going to make it where when we do process the information where we're decreasing the risk of duplication, um, sharing of information across multiple entities. So I look at it more of an administrative cost reduction over data transactions and I don't think you're going to transact the entire medical record, especially if it has imaging data and everything else on blockchain and it's going to be for, you know, certain sections of the record that make the most sense where we have the most administrative overhead to identify things that need to be shared. So that's my two cents because I go back to um, I agree with you on your philosophy related to Customer needs to own the data.
Chad Brisendine: 25:02 Um, and I go back to in Mexico when we were implementing electronic medical records. They're one of the things that has always stuck in my head from there as um, people would show up to the hospItal and they would come with their medical record and they would have a full chart. And I was like asking what are they coming with all this stuff? And they're like, well, we don't actually own the record. They do. So they were coming with their own electronic. And I was like, well, do you have data on the rehaB? We kept two to three years worth of operational data, so if they, if they come, we happen, but we expect them to bring their chart and then we know everything about them and if they go somewhere else, they grab that data and they put in the truck. Obviously it Wasn't electronic at the time.
Chad Brisendine: 25:39 This was in the mid, mid to early two thousands, but the cool thing about it was it really got me an understanding that you know what really the patient has to be the owner. It's their information. It's their chart. If they're going to Florida and Pennsylvania and California, shouldn't they have their medication list? Shouldn't they have their clinical history with them? Shouldn't they have all this information that if they go to the emergency room, they get the best care because they know everything about themselves. I just don't think there's. I think there's an ownership issue.
Bill Russell: 26:09 Yeah, and I love to hear you say that. I also heard rod hochman from a ceo of providence at the scottsdale institute essentially say the same thing. He believes that the patient should have the medical record and I love when I hear leaders talk that way and I, I really get a little concerned when I heard the, uh, in the other direction. all right, so let's, let's get to the second thing. I'm going to try to be disciplined on the show. Um, but, uh, so soundbites, one to three minute answers on a up to five questions here. So here's the backdrop. Beckers becker's hospital review published a nash, kpmg cio survey. Now this wasn't a cio healthcare cio, cio is in general and a 4,000 cios around the world, 84 countries and they prioritize eight, eight areas that they are spending money and they believe are the most important emerging technologies. So I'll just list them and then we'll get into the question. So number one was cloud number two, mobile three, artificial intelligence four on demand, five, internet of things, six, robotic process automation, rpa, a virtual reality number seven, and blockchain number eight. And I think just because of where it's at in its emergence in lifecycle. So there you go. Top eight. So this is a general industry cio survey. How do you think these align with the cio priorities? Healthcare cio priorities? Sorry,
Chad Brisendine: 27:41 from my perspective, I would say I would prioritize them a little differently as far as the percentage. I would probably put mobile ahead of the cloud for me at least personally as far as what we're investing in and how much we're putting in a. Although I'm, as you know, we've talked in your working with us on the cloud piece of this. We're very ambitious in that. Um, I would put I guess on demand, would you consider that more platform? Um, yeah,
Bill Russell: 28:08 self service.
Chad Brisendine: 28:10 Exactly, exactly. So for me, I mean the top three or four combined are cloud, mobile self service slash platform as a service. So those are the top three or four for us. And then underneath that I would say that artificial intelligence, if you break it into more than just the word artificial intelligence, you know, when you look at the underlying underneath of it, there's different subsections of how far and how advanced it is. So, you know, we've been doing predictive models which are not necessarily artificial intelligence, but we're leveraging that and the true artificial intelligence, I believe is, you know, three to five years away, depending on the type of artificial intelligence we're talking about, but were we, healthcare is already leveraging ai in many of the systems and that's what's making these applications smarter. So whether we're bUilding it ourselves from leveraging platforms and systems and third parties that have ai built in it, um, we're already doing that and we have multiple platforms that we're using a ai embedded within it.
Chad Brisendine: 29:08 Um, in the, and the applications are getting smarter. So those were, there were what I put up at the top. I think blockchain for us, you know, we're, we're an early poc iot, same kind of category a rpa. We actually are leveraging a several components of rpa today and I'm actually very ambitious about the rpa. I think I may actually shift it up a little higher in the short term. And the reason why is I think it has a tremendous capability to lower costs, administrative costs and burden. So I don't know if that's specific enough for you, I can get to use cases, but
Bill Russell: 29:44 that's great. One to three minutes, you just to the high level,
Chad Brisendine: 29:47 In three to five years. I think the, the underlying technology that we need to be leveraging to transform the next three to five years.
Bill Russell: 29:56 Alright. So, um, yeah, and I'm, I'm talking about people about rpa just from a perspective of quick wins. It's a uh, it's a mature technology. It's been around for a long time and it's been proven. So
Chad Brisendine: 30:10 just to comment on that. I had an automation team doing this stuff with scripting and stuff like that seven years ago. So these are just more aDvanced tools and we looked at tools like blue prism probably five years ago and it had been making progress, but our team thought we could still develop faster with what we're doing at the time. Now we're able to leverage some of these technologies. We were actually doing this with ocr and nlp stuff around our scanning processes. And, um, this is, you know, there's, there's other use cases and there's probably 15 companies that we did a, a kind of an rfi on, around us to see each one of them have used cases that they're going on. So we're, we're looking at each one of those, determining what the value of those would be.
Bill Russell: 30:52 So, you know, how do you go about linking these emerging industry and technology trends with the business needs of the organization. So obviously we have these eight things and it could just go off and start doing their pocs on blockchain and ai and those kinds of things. But, uh, at the end of the day, we're in the business of healthcare and, and, you know, cost, access and whatnot are important. So how do you, or within your system go about linking those two things?
Chad Brisendine: 31:21 So, so for us, and I think, um, we're unique in this because we put a lot of energy into this, we do benefits realization on our projects. The underlying technology is not as important, but it's not really what sells us doing what we do. So if we're going to build it into self service registration or scheduling platform or we're going to, you know, automate scaning the business, that's really what we're talking about, the underlying technology, what I would say is allowing us to be able to even have those conversations. So in the past I couldn't probably talk to you and say we're going to completely automate registration without committing to seven years in my life and, you know, first born to be able to make something like that happen. But now the technology is just more capable of being able to say we're actually going to do that and we're not talking about a piece of the job we're talking about like the full thing, which is what we used to do in the past. So I think, uh, we're a cio is you're able to commit to broader strategic business cases, if that makes sense.
Bill Russell: 32:21 Yeah. And we like to, we like to go to shows and talk to people about, hey, we're doing artificial intelligence, rpa, we're doing a virtual reality, we're doing all those things. Uh, but at the end of the day when you're inside the business, you're really talking about, hey, we're going to drive down to administrative costs, were going to improve access, we're going to expand reach, we're going to help our growth numbers. We're gonna improve the physician experience. That's the conversation, right?
Chad Brisendine: 32:46 Encoding, aUtomate clinical documentation improvement, automate scannIng.
Bill Russell: 32:52 Yeah, you actually went through all the technology. So I'll skip question number three. We'll just go straight to four. Uh, you know, I tell the story of coming to an intersection in bethlehem and on three of the four corners, there's a st luke's building and each of them is a specialty or practice each with ample parking and easy navigation for the patient. I've seen other systems sort of dabble in this but not as pronounced as what st luke's has done. Um, so, and I still remember this conversation where the cvs, cmio was giving a talk and uh, he was essentially saying future of healthcare is cvs and whatnot. And it was to a whole bunch of providers and one of the providers raised his hand and said, you know, I have a question for you. What makes you think you can beat the provider? And his answer was parking and, you know, sure. Short answer was convenience. Uh, so, you know, let's talk about that a little bit. So how important is the patient experience to your organization and what role does it have in making that experience a reality?
Chad Brisendine: 33:54 Yeah, so, I mean healthcare is a very physical plant at a kind of mentality. I mean a lot of bricks and mortar, right? So I think it's tying the bricks and mortar to the digital piece, right? So when you go into our urgent cares or to our primary care specialty clinics, making that experience more digitally capable, whether that's us putting our kiosk in place or having mobile check in and all the different things. So our goal, our whole goal is to make all those administrative processes the least amount of burden possible so that when you fly through the practices and through our clinics that you have a seamless end to end experience. So really tagging onto those journeys and looking at when I'm at home and I need to know is it a scheduled appointment or is it a non scheduled appointment and what's that workflow look like?
Chad Brisendine: 34:42 So for us it's been really making sure that mobile mobile's first for us so that you can start in the home, uh, and really get that workflow started and then come into our practices and have a good experience whether that's going to our urgent cares and clocking in or checking in before you actually even get there to let us know you're coming and that we have an available, you know, urgent care visit in the next hour based on the closest location to your house. Um, or that's, you know, checking in for your physician appointment that you had scheduled. Um, you know, tomorrow.
Bill Russell: 35:10 Yeah. So let's talk about your, your, uh, mobile and web consumer experience. You an epic shop you chose to build your experience on top of the epa kpi's. Give us an idea of what that experience has been like. A lot of people go, just go to my chart route, here's my chart. And away we go, but you, you really broke it down into its components and built on top of that api set. How's, what, how has your experience been with that? And then what was your thought process behind not using the out of the box and, and, and going with a more customized experience for your, uh, for your consumers?
Chad Brisendine: 35:46 So I think the first thing that we wanted to do is really find out what our customers needed, right? So we, we leverage customer focus groups to talk to them about what would really help them the most and they're actually part of our prioritization process. So we're rUnning another one fairly soon on our backlog of requests and new ideas and um, those things may be in the top line of things that are capable of epic or not capable of epic, right? But it's really making sure that we have what our customers want and showing them what's possible. So I'd say that's first and foremost to us. So being able to prioritize as second, you know, when I think about epic and I think about the ecosystem of software, um, I think you have to splIt things into front end and back ends, right? Uh, you have many things that are back end and you have a, you know, you want to keep the front end single pane of glass and I think by a lot of folks have gone to a single electronic medical record is because physicians and staff and everyone don't want to be working in two, three, four systems and so you don't want the same experience for your customers.
Chad Brisendine: 36:47 So how do you create that, that single pane of glass experience. And that's by leveraging multiple products. So, you know, epic doesn't have the capability to do price transparency. Epic doesn't have the capability to check you in to an urgent care, that's not prescheduled, uh, it doesn't have the capability to, and it's coming out within the next release, but geo location. So what, what we're doing is basically leveraging the best of what epic has to offer when they have to offer it. and when they don't have to offer and our customers wanted ahead of time, leveraging third party vendors like american well or you know, find a doc or whatever those capabilities are and those are all the backend technologies, but we're really controlling that a front end ux ui and, and to make that experience the most optimal and really leveraging our customers to help us get feedback on the, on it to make sure that it is the most optimal.
Bill Russell: 37:41 now I can hear some other cio's saying, well, what do you have a team of 100 developers. So that kind of stuff. And now I know the answer to this, but I'm just going to ask it. How big is your development team?
Chad Brisendine: 37:53 Um, three people. Yeah. And Some partners and some partners. But you know, we haven't spent $40 million on this and I won't tell you how much we spent. But um, it's, it's a lot cheaper than what people think. And in the reason is, we're not building back end technology, we're building front end technology and that's, that's really I think smart, right? We're leveraging back end where possible. And, and creating the right, if we have the right architecture, which is a challenge right then, then we can do this. Um, and I think that's, and you know, this bill in your, in your working environment that, you know, the, uh, healthcare has got along way related to integration in our operability and architecture and um, you know, it will evolve, but it's a, it's a very complex at this stage.
Bill Russell: 38:39 Right? And that's not to paint the picture that, hey, these three people and partners had no roadblocks. Obviously there's the maturing of the epic at apis as you were developing this over the last three years and people know apple orchards great. And the direction is good, but you know, again, all these apis including fire and whatnot just needs to mature a little bit more before we're just doing this stuff.
Chad Brisendine: 39:03 And last comment I'd make is, you know, out of all the vendors that we have in the space, probably epic's the best at integrating with us on this. And I know everybody thinks they're not good at this stuff, but they, you know, when we needed to build out and leverage their front end to back end, we had to take away some vendors in our healthcare space and I had to have some conversations with our internal folks and just said, look, they don't fit in our architecture. We can't have them in this. Uh, so we had to get rid of some vendors and um, epic was actually once we went through this and it's early for them to do these things, but they were actually really good to work
Bill Russell: 39:34 architecture. Uh, you know, um, my, my new phrase is architecture is that invisible force which keeps healthcare from doing what they need to do. And it's just that constant thing that if you don't have good architecture, you can't do the things you want to do. If you have good architecture, you can, uh, you can progress.
Chad Brisendine: 39:53 I explained that to our internal folks because they don't understand. What that means is when we go build a hospital, would we do it department by department and then figuring out what the end result's going to look like or would we spend a lot of time saying this is what the building's gonna look like, this is what could happen over the next 30 years. Here's the possible scenarios. Let's make parking really nice. Let's make sure that we have plumbing. If we want to add on, if we want to be able to scale it top, let's not make another unit to the side that has an elevator that's at a different level and you know, all of these things. So you know, when you look at the old hospitals in the new hospitals, people are looking at it and say, you know, we don't want to build this where we can expand it and the it architecture has to be the same way.
Bill Russell: 40:34 Yeah, absolutely. I didn't ask you for social media close. do you happen to have one or should I just share? Mine. You go ahead. Alright, so I'm going to go back to the one I shared last week that I sort of ran out of some time. So Sarah Richardson, a previous show, guests shared dwayne casey, nba coach of the year who was fired from the toronto raptors. I just want to read part of this. So he wrote a letter in the newspaper, uh, to the, to the fans in toronto. It says thank you to all basketball fans across the city and the country of Canada who supported the Rapters and welcomed my family with open arms during your seven years here. thank you for all the fans who cheered us on at air Canada center while we built this program into a playoff contender pack, jurassic park, even in the cold, cold and rain, watched games from home and offered their undying support, uh, as we traveled this road through relevancy together.
Bill Russell: 41:25 Thank you for teaching. Are all american family the canadian way that being polite and considerate to one another is always the best way. The diversity, that diversity is something to be embraced and celebrated. That taking the time to learn about each other's cultures is the surest way to find common ground and understanding. Thank you for making our children feel safe, valued and comfortable in their own skin. We cannot express how important it has been to build the foundation of who our children are as human beings in a country that shows that through its words, actions and laws that all people deserve basic human rights and a chance to reach their goals through education to hard work. As you know, I'm not going to go into the political ramifications of that. I just want to focus in on. The guy was fired and he has such a high level of emotional intelligence that that's the letter he writes. Um, you know, again, coach of the year he had just made the playoffs a return than relevancy and did not a lash out. He was not the victim. He just thanked everyone for the opportunity. And I think that's a great role model for all of us moving forward. So, Chad, thanks for coming on the show. Is there a way that people can get more Chad online? Uh, do you do write anything?
Chad Brisendine: 42:37 I'm sure they don't want it. But if they do I'm on linkedin, that's where I'd probably do the posting and sharing and stuff like that. So they want to follow me, follow me there.
Bill Russell: 42:46 Awesome. Uh, all right, so, uh, we're, I'm on twitter at @thepatientscio, a health Lyrics website for some more writing. Uh, don't forget to follow show on a, on twitter @thisweekandhit check out the website thisweekinhealthit.com. And uh, you know, one of the things I tell people is if you, if you're not going to listen to the complete podcast, the, uh, the videos, the one to three minute videos, we break this, these things down on the youtube channel, I think it's great not only for you but for, uh, the staff, uh, of your it organization to learn more about what chad's saying about blockchain with charlie Lougheed said a couple of weeks ago about blockchain a, what Halamka's saying about artificial intelligence and others. So I'm trying to break them into bite size because we know that it is busy. So thanks. Uh, thanks for coming on the show. Please come back every friday for more news, commentary and information from industry influencers. That's all for now.