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November 30: Today on the Conference channel, it’s an Interview in Action live from the 2023 CHIME Fall Forum. On this episode Reid Stephan, VP and CIO at St. Lukes speaks with David Higginson, Chief Operating Officer and Chief Innovation Officer at Phoenix Children's Hospital. They discuss innovative strategies in healthcare, with a focus on home care and utilization of technology according to patients' needs and accessibility. David stresses the importance of gathering patient data between visits and leveraging simple tech solutions, like text messaging, to better identify and resolve issues promptly. The episode also touches on the challenges and benefits of digital patient experience, the role of CIOs as change agents, and the necessity for innovation in healthcare to lower costs and increase quality. Is there a risk in running too quick to full deployment of technology in the home?

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Welcome to This Week Health Conference. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a set of channels and events dedicated to leveraging the power of community to propel healthcare forward. Today we have an interview in action from the Fall Conferences on the West Coast.

Here we go.

Okay, here we are at the Chimefall Forum with another interview in action. I'm Reid Stephan, VP and CIO at St. Louis Health System, and I'm joined today by David Higginson, who is the EVP and Chief Innovation Officer at Phoenix Children's.

David, thanks for the time. Sure, no problem. Maybe just for a second share with listeners a little bit more about Phoenix Children's, just kind of a quick high level overview. And then we'll go from there.

Yeah, so Phoenix Children's is one of the largest children's hospitals in the country.

Obviously, because Phoenix is one of the biggest places in the country. We've been a fairly new children's hospital, only around about 30 years, but very rapid growth. And so we're doing what a lot of children's hospitals do. We're kind of going through that transition from a single big campus downtown, just spreading out geographically, and all the growing pains that comes with that, and learning how to operate as a system.

And so yeah, it's a very exciting time. We're kind of the biggest play in town. And I think nearly 900... Physicians at this point, 7,000 employees. So pretty big for Children's Hospital.

So your accent, I'm trying to place it is that Southern Arizona? Yeah. Well

that's right. Yes. I'm a little bit of Arkansas in there.

So no, I come from England originally. Yeah. Spent about 20 years there and then the rest of the time in the States.

Yeah. Wonderful. So you and I were having a conversation yesterday with the group and you shared something that I'm gonna have you kind of expound upon that I thought was really poignant and just accurate.

So we're talking about home care hospital at home. Just take a minute and share. What you shared about the risk of maybe running too quick to full deployments of technology in the home. Where maybe there's some upstream, lower cost, easier things that will actually drive the outcomes that we're after.

Yeah, it's a great question, and I think you can sometimes get lulled into it by putting high tech in someone's house that's achieved something. Yeah. And in fact, until you get anything back out of it, like, what was the point? And so I saw so many examples of, like, very wired equipment going in, scales and monitors and everything else.

And for our population. 55 percent on Medicaid. Many of those people don't even have Wi Fi at home. But what they do all have is a cell phone. And so our methodology was, let's step back a minute from like the fancy technology and the grants and everything else and say, What is it we're trying to get out of it?

And what we really realized is what we're missing more than anything is the data in between the visits. So we're really good at each visit, collecting a bunch of stuff, figuring it out, but then we always say to patients, come back in three months, come back in three months. And in that three months later, we're just gathering a whole bunch of information.

And we hope that everything's been okay. I mean, it's not just in the interim, but for a lot of our patients that doesn't happen in a linear way like that. So we realized with several of our clinics that what happens in between is really important. And in fact, we can make early and quick interventions if we know that.

I'll give you an example with our headache clinic. So it turns out headaches are one of the most common illnesses we treat in children. It seems strange, but it's true. And what we figured out was there's a handful of drugs and they pretty much all solve everybody's headache, but everyone's headache's a little different.

The dosing's a little off. And so... It takes... It takes about two weeks to get into our headache clinic. The doctor does an interview, prescribes a med, and then says, Come back in three months and tell me how it's going. Well, a lot can happen in that time. Yes, well, it turns out within a week, you know where that medicine's going to work.

And so rather than that child suffering through the three more months on the wrong dosage, we thought, well, how about we just text message him on a kind of a preset schedule. So two days afterwards, four days afterwards, the next week, and just ask five simple questions. No weighing, no scales, no Fitbits, anything else.

Just answer these questions. And then that comes back to our nurses and we've got algorithms that kind of watch the data coming back. And if we see something fall out of the exception that we know we need to intervene with, the nurse gets a kind of a message that says, Hey, take a look at this kid and we can intervene right away and make a change.

And so obviously for the patient, it's better because they're getting rid of their headache. The insurance company likes it because they're not wasting money on a drug that's not going to work. And for the doctor, it means when we have that visit, which a headache may not need to be for six months now.

There's a meaningful reason. We're not just seeing people to see people and kind of keep going on. And so, in other clinics where we've really been effective on this, we have a long wait list. And so now, rather than having to meet every three months to find out nothing much has happened, we can get rid of those follow up appointments and flip to new.

And so, this kind of data gathering at home, we feel, is a really great way. And tech's first, so very simple. The challenge is, disease by disease, you have to kind of get the right questions. But that's what takes the time. There's no one size fits all. But this platform now is kind of... What we use for all patient engagement and fundamental to making a difference in how we treat patients.

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I love this story. I was talking to someone earlier about digital health. Kind of that, catch all phrase that we hear. And we all maybe have a bit of a different definition of what it really means. And sometimes we can err on the side of, well it means net new technology. Doing something we've never done before.

And it's really, it's not about that. Like digital health is about meeting people where they are. And what you just described is exactly that. So you type... We've talked about they may not have the Wi Fi or the other technology, but most people in this day and age have a cell phone and have basic texting capability.

So let's meet them where they are with the technology they have and improve the experience. And as you were speaking, David, I realized that really when you design experience right, everyone involved benefits. So you talked about the patient, the provider, the payer, they all benefit from this workflow that you've outlined.

And in my mind, that's an indication of good digital health. When you do it wrong, or in the wrong order, it becomes a zero sum game. So the provider experience improves, but the patient experience degrades. Or the payer. And then you suddenly have this conflict. So that, to me, is a lens to kind of measure, are we doing it right?

Because if we are, the experience is broad, and it lifts everybody.

Yeah, absolutely. And, some of these are, I mean, home runs like that, where kind of everybody's happy, and so you don't have to twist anybody's arm to do it. There are other things in digital experience we haven't... Big online scheduling system that we do.

If we have nearly 60 percent of all our visits are now online scheduled and 98 percent of all slots are available online, which is pretty significantly different than just putting primary care, but that is a constant battle, right? That is a constant, really cultural people process about giving up control by maybe by the provider in terms of how they control their own schedule and giving it to the patient and constantly moving that pendulum and what I found in digital experience or patient experience is.

Thank you. You are really giving up control as a healthcare many times and putting it in the hands of the patient. And that's a very hard cultural change to go through. It's not about the technology. It's kind of trivial at this point. But it's one doctor at a time, one clinic at a time, and that is one of those things I think you really have to be vigilant about because I've seen so many people implement online scheduling, say we do it, check the box, and then you come back a year later and there's...

We've got our epic gold star. Yeah. And you ask patients and they're still calling up and waiting an hour on the phone, and so it's a very interesting dynamic. Thank you. It's a lot tougher than just dealing with one group, you have to have all those groups happy at the same time. Yeah, it's such a great


I oversimplify like this idea that the experience, everybody's happy. There are always those things where there's change management involved and you have to bring people along and communicate communicate, communicate. But, if you all start and kind of keep with the why in mind, that can help, I've found.

Kind of smooth over and navigate some of those where people feel like they're conceding. They're really not, they're just maybe adapting, but for the greater good.

Yeah, and especially in these new technologies, you have to have a champion, someone who's willing to roll their sleeves up and, I've always thought the kind of two types of CIOs are the people that just like the technology and slam in a system and go to the next place.

But I've met so many CIOs that really learn the business, right, so they really become experts in that field and over time as they implement systems, they have a really good idea of how the hospital works and if you're passionate about the change, then maybe you can be like the leader that can make it happen because everyone's busy, everyone's got things and I don't think that kind of the VP of marketing is always the best person to convince Operational fields like scheduling, are they need to change?

So, I get always these things, when you build a big change on this, you need somebody who's willing to kind of step out and lead in front and that often is the difference between a really great implementation and the kind of average one later on. Yeah,

I love that idea of a CIO as a change agent and, I think that, In addition, as you maybe move to new roles, one measure is, Is the person coming behind you, can they just continue to build or do they have to like strip it down to the foundation and start over?

Yes. Basically you've done that foundational work, so then again, it creates that rising tide that benefits

everybody involved. Yeah, it's an interesting question, I mean, I, you know, I often, when I talk about innovation things we've done, I often say, oh, the CIO coming after him is going to have a terrible time, and I'm very conscious of that, you know, in trying to really limit our development and innovation to things that are not in the market, and then really the most important thing is once the market catches up, it's throw your thing away, right, it did it's job for three years, it got you a little bit ahead, you learned a lot, but then pick up the bandwidth.

It's more supportable. It's more mainstream. I think letting go of something is actually really a powerful thing because it frees you up to do a lot more work. And gets rid of that tech debt that no one wants to stack up. I've been at the hospital for 12 years. I mean, you could just die under that tech debt if you kept it going forever.

So, I think CIOs and other people being willing to say, Okay, that served its purpose. It really only had to last for 3 years. That's all good. It wasn't a failure. I think that's a really important thing for people to think about. I

agree. Fall in love with your problems, not your solutions. Yes. Great. Yeah.

So, if you're looking for a product that kind of vendors emerges as a commercially viable product, you're usually better served than to outsource kind of the

whole end to end worry of that. Yeah, they have other insights and they've worked at other hospitals more than you could ever know yourself. So, yeah, it's a, but it's, yeah, you've got to be careful.

Yeah, that's great.

Okay, last question. We're at Chime. It hasn't started officially, but it really feels like it. What's a problem, what's something that you're up at night worried about that you're bringing with you to this conference, looking for that flash of inspiration to help you?

Yeah. Yeah, it's a great question.

what I am really interested in as an innovator and in a hospital that doesn't have the most common EMR out there is, how are we going to evolve as a healthcare industry to lower costs and increase quality? Because I think if everyone just ends up doing the exact same thing and we kind of seed innovation to a small group of people, that's great.

They're in great positions to do it. They've got a lot of resources, but we've got to have some people on the edge pushing the boundaries a little bit. And so I'm really interested to kind of... Take the temperature of the CIOs here and see where people are at. I felt maybe in the last five years, this has been kind of, okay, we're really busy.

We've got to cut margins. We've got to make money. Let's just kind of hunker down on what we have and well, that's maybe necessary. I think that has to be innovation coming. And so learning where it's coming from, what people are wanting to innovate on top of, and then what things you just need to lead to a vendor.

That's, those are the problems I'm interested in. And as an innovator, I'm always making sure I have a job. I'm not the one person out there. But yeah I've been. Concerned of people kind of saying we can't do anything internally, right? 20 years ago. Everything was internal. That was too much Yeah, but it's got to be that balance and that tension So that's what I'm here to listen to and see if I can figure out where people are at.

Wonderful, David Thank you for your time. Have a great conference

Another great interview. I want to thank everybody who spent time with us at the conference. I love hearing from people on the front lines. It is phenomenal that you shared your wisdom and experience with the community and we greatly appreciate it. We also want to thank our channel sponsors who are investing in our mission to develop the next generation of health leaders.

They are CDW, Rubrik, Sectra, and Trellix. Thanks for listening. That's all for now.

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