This Week Health

Chad Brisendine on Blockchain, Employer Led Models, and Building the Customer Experience on Epic’s APIs

Chad Brisendine CIO from St. Luke's University Health Network joins us in a discussion about Blockchain, the changing role of employers in delivering healthcare, and building a customer experience on Epic's APIs. 

Transcript

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 Welcome to this Week in Health It where we discuss news information, emerging thought with leaders from across the healthcare industry. This is. Episode number 23. It's Friday, June 15th. Today we talk about emerging technologies such as blockchain and the priorities of the C I O. 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. Visit Health lyrics do com to schedule your free consult.

My name is Bill Russell, recovering healthcare, c i, writer and consultant with previously mentioned healths. Uh, before I get to our guest, an update on our listener drive, we've reached a hundred. Of combined new subscribers between YouTube and our podcast outlets, uh, 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, uh, amazing. 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.

Listen to great content from industry leaders and give back to the community while you do it. Uh, join us by subscribing today. Tell your friends. Uh, we actually post a new video on our, uh, YouTube channel every day. We're up to 160 videos. Uh, you'll want to check that out. So, uh, so let's get to our today's guest.

Today's guest is one of the clearest thinking CIOs I've run across, even when he is disagreeing with me. So Chad Brizendine is the c i o of St. Luke's University Health Network in Bethlem, Pennsylvania. Chad, welcome to the show. Thanks for having me, bill. Look forward to today's conversation. Wow. That's as, uh, subdued as I've ever heard you.

I can, I, I hope, I hope it ratchets up a little bit here. 'cause Don't worry, . Yeah, 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, Uh, get into the meat of the show is, uh, I, I think it's interesting your career trajectory, uh, you've taken as a C I O and I think it's interesting to some of our listeners.

So you now have frontline healthcare revenue responsibility. Uh, can you talk about that a little bit and, and what you're doing and what the thought process was there? Sure. I think, um, you know, for, for probably a decade, I've wanted to have additional, I've had additional, uh, operational responsibilities in the past, but never revenue generating.

So one of the things I've, I've wanted to have is revenue generating. I think just to, as a c I o think differently, uh, 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. The supply chain imaging and 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 to the table, but also thinking of it from a revenue generation and how our companies and businesses are, you know, managing and measuring and, and their effectiveness with more of the customer side of things, uh, patient customers, if that makes sense.

I think that's, I think that's exciting, and I think it's unique from, uh, some of the, uh, CIOs that I've talked to in the industry. Uh, give us an idea of St. Luke's University Health Network. Give us, uh, scale, scope of, uh, what you guys do. Yeah. Great. So we're, um, in the Lehigh Valley primarily, but we serve nine counties in Eastern Pennsylvania, north of Philly, uh, and, uh, west of New York City, about an hour and a half.

Uh, and we have about 300. What's unique about us is we have about 315. Uh, outpatient practices and clinics, uh, that pretty much put us all over the map. So if you look at our, uh, 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, uh, centers and then geographically located around our hospitals.

And then we also have our, our tertiary facility. So a really good footprint, uh, within the Valley, 10 hospitals, about 14,000 employees. And. Uh, 2.1 billion in revenue. Yeah. And, uh, actually, uh, you know, full disclosure, it is my, my hometown. It's where I grew up. It's where my parents live. My parents are actually, uh, patients at, uh, St.

Luke's, and I remember when it was just that one geographically constrained hospital on, uh, the south side of Bethlehem for the steelworkers. Uh, but you guys have since, uh, 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, uh, well up into the Poconos and, and other areas.

So, pretty exciting. Hey, so I put that baseball in your hand. Um, and I'm, you're not in my office, but if you looked, you'd be able to see our, the Iron Pigs, uh, Phillies, baseball, uh, stadium. So we have a, a minors team from the Phillies, uh, in our area. So if you ever come to Bethlehem, you can visit the.

Baseball. Yeah. The, the Iron Pigs. Uh, what what a great name. Um, uh, let me, uh, so here's, here's what we usually do. Um, every guest we bring on, we just give them the floor for a little bit and say, you know what, what's, you know, what's one of the things you're excited about or you're working on today? Uh, you know, it could be anything.

It could be your farm, uh, Phil philanthropy or things that are going on at work or, or projects you're doing. What's, so what's, what's something you're excited about? Yeah. So I mean, I think right now, um, we've, we've been growing a lot. So we have a lot, and 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, um, in total is three hospitals, about another 40 clinics, and, um, about 300 million in revenue. And we're doing that all in six months. So it's been a pretty . Aggressive timeline, uh, 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 a switch.

So that that's what's going on from a work front. And then, you know, when I look at general, and I know we're gonna get into some of the things with technology, but I'm pretty excited about healthcare and where it's going. I think there's a lot of pressure, uh, from the outside. I know we're gonna talk about that today with cost rising, um, a lot of different, um, opportunities to disrupt and make things different.

And then also look at where technology's going in general. And I'm pretty excited about the speed, you know, the agility, and I know we're gonna get into some of those things today. But just, you know, we've, we as CIOs have always wanted to move really quickly. I think at least I've always wanted to, and I really look at where technology's going and how we can really help the business much quicker and faster and be more agile and nimble and provide information faster.

uh, 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, uh, digital and it. Yeah. Well, I'm looking forward to our conversation. I'm gonna jump into it 'cause the last two episodes, I, I try to tell people we try to do a half hour episode, and the last two have gotten up to 45 minutes and I know that you have a hard stop today.

So, uh, here's what we do on the show in the news, soundbites and social media close. Those are the three things. So to get started, we each selected a new story to act as, uh, sort of the backdrop for discussion. Uh, you know, I'll kick us off so, Uh, fed up with rising costs, uh, big US firms dig, uh, into healthcare.

So this is a Reuters story, and let me, let me just read a couple things here. So, um, and this is along the lines of the, the JP Morgan Berkshire Amazon announcement, but just to let people know, this has been going on for a while. So at Silicon Valley Headquarters network systems, 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 a plan and negotiated 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.

If they meet these goals, Stanford gets a bonus. If they fail, Stanford pays Cisco a penalty. Cisco said for Stanford, the Stanford plan are 10% lower than conventional coverage. Uh, still used by most of its employees. Chip Baker, Intel told Reuters it's saving 17% and its workers enrolled in a, uh, uh, 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, have plans directly with providers. So this, this has been going on for a while. Corporations help. Um, some other statistics before I get into some stuff here. So, corporations help pay for healthcare of more than 170 million Americans. Uh, these employers will spend an estimated 7 38.

Billion with a b, uh, on health benefits in 2018, A figure that has been rising about 5% annually. So, uh, 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. Uh, do you think these models represent. And the future of healthcare and, and where we're going. Um, I personally believe that if they're successful, it'll be a major disruptor. Um, and the reason for that, I think is, um, that the insurance cost is su.

A large burden on the healthcare from an administrative. So a lot of the reason why we've been growing from an administrative cost perspective, both on the provider and on the payer side, is denial management, pre-authorization, 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, um, there's a lot of opportunities. For cost reduction. And so it'll be interesting to see how these agreements are striked. Yeah. And I, um, I, and when you talk about the, uh, the waste, uh, one of the, one of the metrics I always throw out there is it usually takes about 12, uh, bills generated and sent to the, uh, to the patient before a health system gets paid.

And part of that just the convoluted nature of, you know, cms. The supplement, then you bill 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, uh, the number of players in that, in that string will make things, uh, easier.

Yeah, and I think I agree. I think. We'll, we'll see. I mean, obviously it's, uh, you know, it's, it's 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, uh, yeah, there's a horrendous amount of middle, middle, 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. . So let's talk, let's talk about the technology. So, uh, I think the more interesting one here for me is Intel launched connective care health, uh, plan five years ago, 38,000 employees.

Independents now enrolled in Arizona, California, New Mexico, and Oregon. Uh, technology is critical to curbing the cost. This is one of their people talking Oregon. Patients are engaged, uh, to use video conferencing to speak with physicians when appropriate. At $49, the cost is one third of an office visit.

Connective Care boasts a 95% Enro enrollee retention rate. Uh, says Angela Mitchell, Intel's head of US Healthcare Delivery. So, te uh, let's start with telehealth. Telehealth has predominantly been a defensive measure for most health systems, right? You, you put it in place, um, and, you know, let's just see how it works and those kind of things.

Um, I've, I've heard some health systems recently talking about it becoming more of an offensive strategy in terms of, uh, market share growth and taking it outside their traditional boundaries. Do you, do you think that's gonna take off? Do you think we'll see more, uh, telehealth in, uh, as an offensive strategy to grow your market?

Well, I, I think the answer to that is yes. We've, we've, um, latched on to, and I know we're gonna talk a little bit about our consumer strategy, but we've been using American Wells platform, uh, for. Spend a bit of time embedded within our mobile and web, uh, systems. And, and the challenge with it I see is the, um, the scale's just not there.

You know, consumers are, you know, not going there first. Um, they're going to the physical plant first. So we, we have about. Of our total population, we have a hundred seventy seven, a hundred seventy 7,000. This last year visits to our urgent cares. Uh, our last year we had about 7,000 eVisits and we've been running that platform for three years.

So still I think a lot of education. And I know people wanna 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 are the best to use it for, and how do we educate customers on, on how to use that?

They know where to go, why to go to the er, they know, to why, to go to these minute clinics or, or urgent care locations. The question is, will, will they, how to use the, uh, video conferencing capability. So as we see new models start to emerge, what, what technologies do you think, uh, obviously we talked about telehealth, but what other areas within the technology world do you think we need to get in place, uh, to make sure that we're ready for new models as they emerge?

Well, I mean, I think when you look at the employer model or the rising cost, Austin, you, you combo that to the article you're talking about. So I'll be specific on that. Um, 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 I. Now, we may not want to get all the way down to this is, you know, Chad's, Chad's, uh, gonna McDonald's or whatever. But, um, you know, at least let's provide them some, some, you know, uh, anonymized data that they can see kind of how, how we're helping their employees, uh, manage cost and control costs 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 wanna make sure that that benefit's getting maximized, especially when there's a increase year over year in healthcare costs and, uh, it's a significant portion of the cost that you have to manage your business.

Yeah. So the technology is data, I think a lot and services that we can provide that. Keep your employees in the office longer, whether they're a televisit or, uh, depending on the size of your company, a nurse or some kind of clinical person that may come on site and, you know, do some care management, uh, from time to time or whatever those set of offerings look like that, you know, keep your employees engaged in their health and, and lower the cost.

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, uh, and get us going. Yeah, sure. So, um, so blockchain, um, I pulled up an article, uh, a couple different articles on, uh, blockchain technologies and, uh, this one is from the Wall Street General.

It's how blockchain could help lower healthcare costs. And, uh, I know it's one of the ma major trending technologies that we'll we'll talk about later. Uh, I've been, you know, doing research on this. We're pretty, pretty close to our p O C on some blockchain technology, but I thought I'd read a couple components of this, um, uh, blockchain by contracts with patients, insurers, and providers all on the same page.

With the low cost and decentralized ledger approach to managing information, blockchain gives all of the parties, um, 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, uh, au uh, access to the information.

Excuse me. Um, so several of the use cases are obviously, uh, processing claims, uh, and in January, change healthcare. Who has about 800,000, uh, 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, The ledger has encryption, single source of truth, uh, to be able to, uh, move that forward.

So that's one use case. Provider directories is another one, uh, where, you know, we have massive issues relying provider directories and there's, there's a lot of systems out there that you can purchase that anonymizes or, or that aggregate the data together to provide that, but there's no single, you know, identifier for, for all this information.

And then, and then how do you share that? So, you know, healthcare has been building a m 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, the, uh, 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.

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, we're 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, um, let's talk about the fake news for a 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, this comes from. And so if we can start building a source of truth, so for example, on identity management. If we have the capability that, you know, bill Russell comes to us and we take him through the T s a pre recurrence screening process and validate his identity and his background, and we do all this stuff, 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 information. Why can't we share? Identity information across and say, this is Bill Russell. We validated him three times. He's been t s a or healthcare pre-cleared. Now let's use him on the chain and, 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 there's smart contracts and there's Ethereum and there's

All these different kinds of things. So maybe I'd ask you, you know, bill, what's your perspective on blockchain and you know, where do you think it's at in the ecosystem? Um, you know, your comments. Yeah, no, I love, I, you know, yeah, I, I'm, I, I'm bullish on blockchain, so, um, but I'm, I'm gonna go in a different direction on this because, and I agree with you.

Provider licensing, uh, and credentialing, uh, medic medical supply chain, revenue cycle, fraud prevention. All these backend systems, I think are, uh, prime candidates. Um, But one of the things I want to, uh, I want to caution people on is this whole idea of, you know, it's gonna be the patient record and, um, you know, data sharing and interoperability is a cultural problem, not a technical one.

Uh, it, it really hasn't been a technical one, uh, for, uh, ever since I've been in healthcare, which is around, you know, 2010. Uh, it has not been a, a technical problem. It's been a cultural. 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.

And right now the parties don't agree and the benefit's not really understood. When we, uh, and we actually incubated a couple companies at my previous employer, I. One of 'em was around this data sharing, inter interoperability, and I remember the seven principles I sat down with, um, uh, the, uh, the company that we were, the owners that we were going to work with to design this technology.

And, you know, the first thing I, I asked them for is, uh, the technology needs to be patient centered. All right. So culturally this is a big difference. It's not health system centered. It's patient centered. The patient has all the information on their health. They choose whom they share it with and when they share it, and they know at all times who it's shared with.

So that's the first principle I gave them. The second is raw data is, uh, is never altered, right? So you have this transaction log, and actually some of this sounds like blockchain, right? Uh, discreet, discreet data is preferred over unstructured data. Nothing worse than, uh, P D P D F file cabinet. Hell, if you ever sat behind a doctor who has like a thousand documents to go through, uh, it's just not efficient.

Uh, easily integrated with the workflow was another principle we gave them. You, you think, uh, 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, 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, you do not want to become a data broker that's making money off that transaction. Uh, full transparency of the record. One of the things that strikes me is that if we got the, the medical record into the hand 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 was 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 readily available, and you could easily do this on easily, you could do this on blockchain, a data economy, a data economy's 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, uh, acorns and, and, and hundreds of other investment apps that same ecosystem could evolve. Uh, we believed if you, if you get this, uh, to emerge, and then you could have. Companies that hire doctors, employee doctors, and with each transaction with your health system, you could actually transfer it, transfer it to that, to that company, and they could 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, the patient their record, 'cause 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% of it, but I, I could also find, you know, the Mint and Venmo and PayPal of healthcare who's gonna help me to, to, to navigate it because a lot of health systems aren't helping me to navigate it.

So I I, I just sort of dumped on you there. Um, do you think if, if we continue to push down this direction of blockchain, As I do, and I think it is a great, uh, foundational technology, um, that we will see, uh, uh, transformation in the way that people interact with the, with the health system and our health systems really, uh, are they ready for that and, and how are they going to adjust to that?

Yeah, I think, I think two things. Uh, I agree with you on the cultural change of who owns the data. , uh, and I'll answer the other question first, so I don't think it's gonna change the way in which we have people own the information. I think it's gonna make it where when we do process the information, we're

We're decreasing the risk of duplication, um, sharing of information across multiple entities. So I look at it more of as administrative cost reduction over, you know, data transactions. Um, and I don't think you're gonna transact an entire medical record, especially if it has imaging data and everything else on blockchain.

It's gonna be for . Certain sections of the record that make the most sense, where we have the most administrative overhead to identify things, uh, that need to be shared. So that's my 2 cents. Uh, 'cause I go back to, um, I agree with you on your philosophy related, the customer needs to own the data. Um, and I go back to in Mexico when, uh, we were implementing electronic medical records.

They're one of the things that, uh, has always stuck in my head from there is, Um, people would show up to the hospital and they would come with their medical record and they would have a full like chart. And I was like asking what, why 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 them? Yeah. We kept two to three years worth of operational data. So if they, if they come, we have it, 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 chart.

Obviously it wasn't electronic at the time. Uh, this was in, you know, the mid, mid, uh, two early two thousands. Um, but the cool thing about it, Was, it really got me 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, um, 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? 'cause they know everything. About themselves. And I just don't think there's a, I think there's an ownership issue. Yeah. And I, I love to hear you say that.

I also heard Rod Hockman, uh, from, uh, c e o of Providence, um, at the Scottsdale Institute essentially say the same thing. He believes that the patient should own the medical record. And I love when I hear leaders talk that way, and I, I really get a little concerned when I hear it, the, uh, in the other direction.

Alright, so let's, let's get to the second thing. I'm gonna try to be disciplined on this show, um, but, uh, So soundbites one to three minute answers on, uh, up to five questions here. So here's the backdrop. Becker's, uh, uh, Becker's, uh, hospital review, uh, published a Nash, K P M G C I O survey. Now, this wasn't a C I O healthcare cio, it was just CIOs in general and, uh, 4,000 CIOs, uh, around the world.

84 countries. And they prioritize eight, eight areas that they are, uh, spending money and they believe are the most, uh, important emerging technologies. So, uh, 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 au automation, r p a, uh, virtual reality number seven, and blockchain number eight. And I think just because of where it's at in its. Emergence and lifecycle. So there you go. Top eight. So this is a general industry c I o survey. How do you think these align with the C I O priorities? I mean, I think they're, I think healthcare, healthcare, c i o priorities, sorry.

Um, from my perspective, I would say I. 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. Uh, although, um, as you know, we, 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. Yes. Uh, self-service. So patients coming in self service. Exactly. Yeah, 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, we're leveraging that.

And 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 we're . 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 ourself or leveraging platforms and systems and, and third parties that have AI built in it, um, we're already doing that.

And we have, you know, multiple platforms that we're using, uh, AI embedded within it, um, in the, and the applications are getting smarter. So those were, they were what I'd put up at the top, I think. Um, Blockchain, uh, for us, you know, we're, we're an early P O C I O T, same kind of category, uh, r p A. We actually are leveraging, uh, several components of R P A today, and I'm actually very ambitious about the R P A.

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 cost, administrative costs and burden. So, I don't know if that's specific enough for you. I can get to use cases, but No, no, that's, that's great. One to three minutes.

You, you just get the high level three to five years, I think, um, the, the underlying technology that we need to be leveraging to transform the next three to five years. All right. So, um, yeah, and I, I'm, I'm talking to people about R P A, just from a perspective of quick wins. It's a, uh, It's a mature technology.

It's been around for a long time, uh, and it's been proven. So, um, yeah, I had a, um, just a comment on that. I had a automation team doing this stuff with scripting and stuff like that. seven years ago. So these are just in more advanced tools and we looked at tools like Blue Prism probably five years ago, and, and it had been making progress, but our team thought we could still develop faster with what we were doing at the time.

Now we're able to leverage some of these technologies. We were actually doing this with O C R and N L P 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. Kind of an r a light r f i on around this to see, and each one of them have use 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. So, uh, 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 can just go off and start doing their, uh, POCs on blockchain and AI and, 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, uh, access and whatnot are important. So how do you, uh, or, or within your system, go about linking those two things? So, so for us, and I think, um, we're unique in this 'cause we put a lot of energy into this. We do benefits realization on our projects.

Um, the underlying technology is not, is, is important, but it's not really what sells us doing what we do. So if we're gonna build in a self-service registration or scheduling platform, or we're going to, you know, . Automate scanning the business. That's really what we're talking about, the underlying technology.

Um, 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 gonna completely automate registration without committing to seven years in my life. And, you know, firstborn 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 gonna do that. And we're not talking about a piece of a job, we're talking about like the full thing, uh, which is what we used to do in the past. So I think. We're able, CIOs are able to commit to broader, um, strategic business cases, if that makes sense.

Yeah. And we like to, we like to go to shows and talk to people about, uh, you know, hey, we're doing artificial intelligence, R p A, we're doing virtual reality. We're doing all those things. Uh, but at the end of the day, we, you're inside the business. You're really talking about, Hey, we're gonna drive down administrative costs, we're gonna improve access, we're gonna expand our reach, we're gonna help our growth numbers, we're gonna improve the, uh, physician experience.

That's the conversation. Computer assisted coding, automate clinical documentation improvement, automate scanning. 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. Uh, and each of 'em is a specialty or a practice, uh, each with ample parking and easy navigation for the patient. Uh, I've seen other systems sort of dabble in this, uh, but as pronounced.

So, and I, I still remember this conversation where the c uh, the c v s, uh, C M I O was giving a talk and, uh, he was essentially saying, future of healthcare is c v s and whatnot. And there 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, short answer was convenience. Um, so, you know, let's talk about that a little bit. So how important is the patient experience, uh, to your organization and what role does it have in making that experience a reality?

Yeah, so I mean, you know, healthcare's a very. Physical plant, you know, 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 or 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, end-to-end experience. So really tagging onto those journeys and looking at when I'm at home and I need to, you know, is it a scheduled appointment or is it a non-scheduled appointment?

And how, what's that workflow look like? So for us it's been really making sure that mobile mobile's first for us so that you can start in a 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, um, in the next hour, um, 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. Yeah. So let's talk about your, your, uh, mobile and, and web consumer experience. Uh, you're an epic shop.

You chose to build your experience on top of the Epic APIs. Give us an idea of, uh, what that experience has been like. A lot of people go, just go the MyChart route, here's MyChart, and away we go. But you, you really broke it down into its components and, and built on top of that a p I set. How's, what, how's 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, a more, uh, customized experience for your, uh, for your consumers. So I think the, the first thing that we wanted to do is really find out what our customers needed, right? So we, we leveraged customer focus groups to talk to them about what would I.

Uh, really helped them the most and they're actually part of our prioritization process. So, uh, we're running another one fairly soon on our backlog requests and new ideas. And, um, those things may be in, um, 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 . That's first and foremost to us. So being able to prioritize those. 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 backends, right? Uh, you have many things that are backend and you have, you know, you want to keep the front end single pane of glass, and I think.

Why 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 2, 3, 4 systems. And so you don't want the same experience for your, your customers. Uh, so how do you create that, that single pane of glass experience? And that's by leveraging a.

Multiple products. So, you know, epic doesn't have the capability to do, um, price transparency. Epic doesn't have the capability to check you in to, um, an urgent care, uh, that's not pre-scheduled. Uh, it doesn't have the capability to, um, and it's coming out with the next release, but geolocation. So what, what we're doing is basically leveraging the best of what Epic has to offer when they have to offer it.

When they don't have it to offer and our customers want it ahead of time, leveraging third party vendors like American Well or, you know, find AOC or whatever those capabilities are. And those are all the backend technologies, but we're really controlling that, uh, front end UX ui and, and to make that experience the most optimal and really leveraging our customers to help us.

Feedback on the, on it to make sure that it is the most optimal. Now, I, I can hear some other CIOs saying, well, you know, what, do you have a team of a hundred developers? That kind of stuff. And now I know the answer to this, but I'm just gonna ask it. How, how big is your development team? Um, three people.

Yeah, so we've leveraged, you know, and some partners. And some partners, but you know, we haven't spent $40 million on this. Uh, and I will tell you how much we spent, but, um, it's, it's a lot cheaper than what people think. And, and the reason is, is we're not building back in technology. We're building front end technology.

And that's, that's really, I think, smart, right? We're leveraging back in 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 a long way related to integration and interoperability and architecture and, um, you know, it will evolve, but it's, uh, it's a very complex at this stage.

And, and, and that's not to paint the picture that hey, these three people and some partners had no roadblocks. Obviously there's the maturing of the Epic APIs as you were developing this over the last three years. And people know App Orchard's great and the direction is good. Uh, but you know, again, all these APIs, including fire and whatnot, just need to mature a little bit more before we're just.

Doing this stuff, uh, very easy. I agree with you. The 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 with.

Yep. Architecture, uh, you know, I'm, I, my, my new phrase is architecture is that invisible force which keeps health healthcare from doing what they need to do. And it's the, it's just that constant thing that if you don't have good architecture, you can't do the things you wanna do. If you have good architecture, you can, uh, you can progress.

And, and the way I explain that to our internal folks, 'cause they don't understand what that means is when we go build a hospital, Would we do it department by department and then figure out what the end result's gonna 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 this side that has an elevator that's at a different level and . You know, all these things. So, you know, when you look at the old hospitals and the new hospitals, people are looking at it and say, you know, we don't wanna build this where we can't expand it.

And the IT architecture has to be the same way. Absolutely. I didn't ask you for a social media close. Do you happen to have one or should I just share mine? You go ahead. All right. So I'm gonna go back to the one I shared last week that I, I sort of ran outta some time. So, Sarah Richardson, uh, previous, uh, show guest shared Dwayne Casey, n b a Coach of the Year, who was fired, uh, from the Toronto Raptors.

I, I just wanna read part of this. So he wrote a letter in the newspaper, uh, to the, to the, uh, fans in Toronto. It says, thank you to all basketball fans across the city. And the country of Canada who supported the Raptors and welcomed my family with open arms during our 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 packed Jurassic Park, even in the cold, cold, and rain watched.

The games from home and offered their undying support, uh, as we traveled this road to relevancy together. Thank you for teaching our 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. 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, uh, its words, actions, and laws that all people deserve basic human rights, a chance to reach their goals through education and hard work.

As you know, I'm not gonna go into the political ramifications of that. I just wanna 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, uh, returned them to relevancy and did not, uh, lash out.

He was not the victim. He just, I. Uh, thanked, uh, everyone for the opportunity and I think that's a great, uh, role model for all of us, uh, 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 you write anything? I'm sure they don't want it, but if they do, um, , I'm on LinkedIn.

That's where I probably do the most posting and sharing and stuff like that. So if they wanna follow me, follow me there. Awesome. Uh, all right, so, uh, you know, on, uh, we're, I'm on Twitter at the patient cio, uh, health lyrics website, uh, for some more writing. Uh, don't forget to follow the show on, uh, on Twitter at this week in h i t.

Check out the website this week in health it.com. And, uh, you know, one of the things I tell people is if you, if you're not gonna listen to the complete podcast, The videos, the one to three minute videos. We break this, these, uh, 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.

Uh, to learn more about what Chad's saying about, uh, blockchain, what Charlie Lowe said a couple weeks ago about blockchain. Uh, what Halamka saying about, uh, artificial intelligence and others. So, Um, try to break 'em into bite size 'cause we know that it is busy. So, thanks, uh, thanks for coming on the show.

Thanks for having me. Me, please come back every Friday for more news commentary and, and information from industry influencers. That's all for now.

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