This Week Health 5 Years

May 12, 2023: A Live Webinar featuring Neal Patel (CIO at Vanderbilt University Medical Center), Craig Kwiatkowski (SVP & CIO at Cedars-Sinai), and Michael Restuccia (SVP & CIO of Penn Medicine)discussing AMC Priorities in 2023. What are the priorities of academic medical center leaders for 2023, and how do they plan to achieve them? What areas are ripe for automation and what areas are still in the exploratory phase? How is clinical research transforming with the digital age, and what challenges are associated with it? What is the significance of having a centralized platform for data management in clinical research, and how can data security be maintained? How are employees coping with isolation during remote work and are they starting to return to the office?

Key Points:

  • Automation
  • Revenue cycle space
  • Online patient scheduling
  • Remote work
  • Leveraging telemedicine for better patient care
  • Precision medicine
  • Digital transformation, Technical challenges, and Data management in clinical research

"The Future of Care Spaces" is an upcoming webinar that explores the latest healthcare technologies and solutions transforming care spaces in America. Hospitals, clinics, and at-home treatments are all affected by the advancements in healthcare technology, which can improve workflows, treatments, and patient outcomes. What are the latest remote monitoring tools, advanced telehealth solutions, and other innovative technologies transforming care spaces across America? Join us June 8th, 2023 1:00 PM ET and Register Here.

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Transcript

โ€ŠThis transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Today on This Week Health.

it's a new frontier, I would say. Genomic data informing patient care activities. We know so little about the human genome as it pertains to patient care. That's gonna be an evolution in those that can foster the collaboration between the two I think are gonna be winners downstream.โ€Š

Thanks for joining us on this keynote episode, a this week health conference show. 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 dedicated to keeping health IT staff current and engaged. For five years, we've been making podcasts that amplify great thinking to propel healthcare forward. Special thanks to our keynote show. CDW, Rubrik, Sectra and Trellix for choosing to invest in our mission to develop the next generation of health leaders. Now onto our show.

โ€Š (Main) ๐Ÿ“ โ€Š I wanna welcome everybody. This is gonna be our leadership series, second into our leadership series CIO discussion, and we're gonna talk specifically with three academic medical center leaders about priorities for 2023.

If you've attended any of our. Webinars, we're gonna start promptly at about 1 0 3, 1 0 4 four minutes past the hour. We'll give people a chance to come in. Looks like 50 some odd people have joined already. So it's it and it's going up. So, But one of the things I'm gonna do prior to that, just to fill the time here real quick, I'm gonna ask each one of our panelists an opening question, get an idea of, have them share a little bit about who they are.

Last year's question was first computer. If you want to answer that you feel free to. But this year's question is what was your first job out of college? So we will, you know what, Michael, since you were the first one to join, Promptly at the time. I will. I'll have you start. So first job.

So Bill, thanks for having me participate. Much appreciated. Great to be here with Neil, as well as Craig. So, my first job out of Ryder College, which is now Ryder University in 1981, was as a COBAL programmer. So my skills are still pretty relevant in some industries. But working for a company known as Sperry Univac, that is now obviously part of Unisys.

And my first role was pretty cool. I got to work in Cape Canaveral, Florida on the space shuttle, and we were developing a supply chain system for the solid space boosters, rocket boosters. That tracked each and every part on the space shuttle. So when it flew and came down those parts some could be renovated, some could be reused, some could be thrown away and replaced.

But fascinating, two and a half

years. Wow. Hey I, maybe I shouldn't ask this. Que I was gonna ask if any of your institutions had still had COBAL. Anywhere in the institutions. Oh man. Neil, you're shaking your head yes. Well, that's good. You could call on Michael. He'll get on a plane. Come down there, do a little coaching.

Neil, you wanna go? Go next. So Neil I'm gonna introduce each of you in your health system in a minute. Neil, first job out of first job outta college.

Well, it's kind of tough to stay, first off outta college, cuz I went straight into medical school then residency, but before starting medical school in the summer before that.

And right after I graduated from college, I was a telemarketer who had cold call businesses and tried to sell them toner. And back then before computers, we just had stacks of yellow pages and we would just find. Businesses and then call them and then kind of basically assume, we would tell them we had a computer and we're looking things up and get them to divulge.

The type of copier they had and the model number. And then we would say, oh yeah, you use this kind of toner. Would you like some, I lasted for two weeks. And that was purely due to persistence that I had to make one sale before I would quit.

Wow. And I would imagine that makes you a little bit more empathetic to salespeople over the years having done that.

Craig, how about you?

So, outta school I was studying to be a pharmacist. So my first gig was as a hospital pharmacist, and I moon lit at a retail chain drugstore. But I, my first high school or real job as it were, was I worked at Subway. I was making subway sandwiches as my. My first gig and there was a strange time period actually where I had worked at Subway and then I got a job at the pharmacy.

So people would come to the subway and they'd see me behind the counter there, and then they'd come to the pharmacy where I was a pharmacy tech and I began to appreciate that it might be unsettling to, to see me in both places. So I gifted to pharmacy.

Yeah, I guess, I guess it would be unsettling.

That's interesting. All right. Hey we're ready to get going. So I want to thank our listeners for being a part of this. And I, and again, I wanna thank our panelists and I will introduce them in a second, a little bit more.

Detail. I would encourage you go ahead and ask questions. You can ask them in the q and a in the chat. As well. We will pick those up and take a look at 'em. This in your registration, there was a line there to put in any questions you might have. We received more questions for this panel than we've ever had before.

I think we have easily over 60 to 60 to 70 questions. We'll see where it goes. As far as introductions, we have Neil Patel Dr. Neil Patel Vanderbilt University Medical Center. And Craig Kwiakowski the newly minted CIO for Cedar Sinai. Are you a year in yet, Craig? Yeah, I'm close to a year.

Formally then informally I'm getting close to two years or as the interim.

Wow. And then Michael Restuccia, Penn Medicine out of Philadelphia, Pennsylvania, home of the Super Bowl bound. Philadelphia Eagles. And we will skip that conversation cuz we already had it. Let's just jump right into it.

So I, I did a previous poll on LinkedIn and I asked just the LinkedIn community what will drive healthcare provider priorities in 2023, I gave four options, financial pressure disruption, and new entrants patient experience or worker shortage. Or worker experience. The financial pressure won that poll by a pretty sizable margin.

Number two was worker shortages, and the other two were laggards, essentially. I'm curious let's start, we're gonna start by talking about the macro trends, and then we'll get into some of the specific priorities. What do you find is driving the priorities for 2023? Michael we'll start with you.

What's driving the priorities?

Yeah,

I think within the healthcare industry, we're all familiar with, more than half of our colleagues throughout the country are gonna run at a deficit in the upcoming year. And those pressures, financial pressures are driven by, as we all know, many things, right?

The covid cost of care escalating rapidly, revenues from payers, not escalating at the same rate turnover. Within, particularly the clinical ranks patients afraid to come back to the hospitals surgeries, generally on a downtrend. So you know what's driving everything is the financial pressure.

Pressure and the immediacy of that. Financial pressure wasn't like there was six years to plan for this. People walked, walked out in droves in a short period of time. Rates increase significantly, and the reimbursements in revenues to us will not come back as rapidly. So a lot of pressure on cost containment, expense management, and trying to do more with less.

Yeah. Neil, I guess, I guess we'll come to you. I assume you're gonna echo some of those thoughts. Anything you would add to that?

I guess the thing I would add, no doubt the financial pressure is, and Michael's absolutely right, supply costs. We all know that from real life and nursing shortage, but the immediacy that we're feeling in that space is, our volumes are through the roof.

We're sleeping 70 to 90 patients in our ED because there's no room upstairs. We have three to six month waiting lists in our clinic. As we're trying to keep every bed open, Because in this community when a ripple happens somewhere else, I mean, we're in Nashville, we're four hour drive from Atlanta, and when the Atlanta Hospital closed, we started getting increased referrals and that was unheard of pre covid.

And so I think we're getting requests for behavioral health patients to be in an, in our inpatient area from all contiguous states. So the pressures that we're feeling in terms of needing to provide more and more care, coupled with what we just talked about with financial pressures and worker shortages and is really creating the perfect storm where the, especially the AMCs are just in the crosshairs.

That, that's interesting. It's interesting that four hours away, Atlanta, but it's also interesting. It's a different state and it's still, there's still ripple effects. Are I guess Craig, we'll come to you. Are you, I mean, you're in LA traditionally a lot of competition, a bunch of academic medical centers.

And are you seeing that same, some of those same kinds of things? Yeah

I don't have much to add. I think Michael and Neil summarized it well. It's financial pressures as escalating cost of care. Patients I think as Neil was alluding to, are sicker deferred care. Length of stay is longer than it's ever been for us.

And we have significant capacity and access issues. And some of those, we hear a lot about nursing shortage, which is absolutely true, but it's also just, folks to answer the phone to make appointments, medical assistants, navigators, all of those things impact our ability to have broader and more real-time access as was described.

I don't. I think Neil said it. We have wait times in primary care. In some cases it's months. And for some specialties a little less so. But these pressures are all real and they're particularly acute on the financial side. In our

case, l Let's talk about technology. So we'll try to focus in on the intersection of technology and healthcare.

We got some questions here that are clearly medical questions. We're gonna steer clear of those, but the intersection of technology and healthcare are, so we have. Worker shortages. We used to say, nurse shortages, but it's, it really is across the board. It's I mean, it could be in the in the cafeteria.

I mean, you just have shortages. Just just hard to hire people. We're hearing that throughout. How, what kind of conversations are we looking at in terms of technology leaders? To alleviate that, to create more hours, to create more capacity. I mean, what kind of conversations are we are we looking at?

Are we having Neil, I guess I'll start with you.

What we're having is, technology will fix everything, right? And that's what the, that's what commence sends as the 10 new request every morning to your local IT shop. But seriously, there's two aspects to that. Number one, Can we automate mundane or redundant tasks so we don't need the human in that space anymore or any longer so that the staff we have can do as much as possible and do the work that they have to do that technology can't cover.

The other part is when we have these shortages, the burnout rate of the existing people increases because they're working short-staffed all the time, and underfunded. So how can we leverage technology? To help support and reduce the anxiety of folks that are probably very not as experienced, don't have the safety net of folks around them to help them do their job well, and you're right, it's all the way up and down the line.

Lab tech shortages, respiratory tech shortages. CT scan, tech shortages, surgical tech shortages in the ORs. Any one of those individuals is part of the care team, and if that link in the chain is not as robust, the whole system becomes slow and frustrating. So we're being looked upon. Obviously we can't fit skill issues that you need a human at the bedside for.

What are the technologies we can deploy? Change the model of care. That's something that has been the mantra since the end of the last year, where we're re-looking at how to deploy virtual support, not for care at home, but just even within the hospital. So that the bedside providers get some support instead of just running around chasing things down.

So you just gave us three topics that came up in the questions, and I'm going to use them as a framework right now. Automation support our existing workers and reduce the stress and the burden on them. And then the third being care at home. We talked about capacity issues and those kinds of things.

I want, I wanna start with I wanna start with automation and get kind of pragmatic with the three of you. Craig, I'll start with you as we talk about automation. What areas are ripe for automation? Like, you just look at it and go, this is absolutely ripe. We're going after this.

What areas are maybe in the exploratory phase where you look at it and go, yeah, that's, we know there's potential there. We just haven't found the right technology or whatnot. So what are you looking at in terms of automation at this point? I

think the area that's ripe certainly for us, and probably more broadly is in the revenue cycle space.

We've identified some nice opportunities to maximize our existing tools with within the emr, automate more, and I think, achieve some real measurable savings and efficiency. Things that may sound simple, but you know, making sure we're using paperless statements, we're not, have a manual process for that.

Reducing non-clinical triggered charges, automating. Consecutive accounts dabbling and pushing as far as we can with prior authorization, the holy grail of I think automation or more efficiency within the revenue cycle space. I think where the dabbling, or I forget how you framed it, bill, but you know, not sure.

Category is more so on the clinical side. We are, there's tools and AI like algorithms that we're testing, deploying and using. But, those I don't know, will ever be fully automated, or at least not in the near term. They still require a human to second check, whereas โ€Šsome of the things in the revenue cycle, billing and coding space tend to allow for a bit more

autonomy.

Yeah. And Michael I'll come to you with the same question around automation. What are you seeing or what are you being asked about?

So, I think some of the mundane tasks that Neil and Craig mentioned are ripe for opportunity. Certainly pre-authorization is one of those items that somewhat leverage a tool, and I find it interesting.

They call it artificial intelligence because back in the day we just called it screen scraping. And and my second job at Shared Medical Systems, we had a thing called Alis script. And we used to re-register patients all the time just with a file and re-register and suddenly, now that's artificial intelligence.

So, I find it remarkable what some of the consulting firms and vendors repackage as innovative. But that aside all the things that Craig mentioned, certainly agree with the area that I am most frustrated, where there's great opportunity for automation is online patient scheduling. And it's not that we don't have the technology, it's, we don't have the operational engagement in order to open up those slots.

In some instances we don't have enough clinicians to even have slots. But that is an area to me that if we look at other industries, airlines, rails, hotels, Who wants to speak to an agent? You wanna do it yourself. You want to pick, and I realize some particularly specialties and subspecialties, it's kind of difficult because of the prerequisites, but we do a lot of primary care visits also, as does Vanderbilt and Cedar Sinai and I think that's the biggest missed opportunity and it will address a lot of that issue around access that everyone's mentioned

here.

Red Sketch is pretty interesting to me because I, my guess is if we if we were to look at the number of people that are associated with registration and scheduling in your institutions, that's a significant number of people. You guys are the front lines. I had a traditional idea and I didn't have an academic medical center.

But I just know the stuff we were able to schedule was not the specialties and you guys are just loaded with specialists and they're fairly reluctant to open up their schedules for obvious reasons and whatnot. But that has to represent a significant opportunity in terms of just just manpower and labor that could be saved.

I would think it's also

an area

of significant turnover. So it's a good point of entry and then rapidly move to the next role, either internally or externally. Sorry, Neil,

I think I cut you off. No. I think you're absolutely correct and we're, we have recruited an incredible leader of our access center.

A physician who just loves scheduling and it take has taken her. As a physician to go talk to physicians, and we're embarking on our increasing online scheduling and improved template design to really be robust so that basically you have one call completion if there is a call, but. Robust enough that we can have much as much self-service as possible.

And the technology's there, it's the rules and the algorithms, and you have a lot of religion especially in academic medical centers cuz you know, the right toe specialist does not wanna see any patients that have a left toe issue. And so, the, that, that sort of problems has to be dealt with.

And that's not a technology or a CIO job that requires. Really us supporting the operational people to be timely and responsive when they get hard work done and work through all those details.

The first group of CIOs were from IDNs, and a question came in terms of ROI for projects, and I'm curious if we're gonna coalesce around the same thing.

What. When you are presented with a new project right now, what timeline are you looking for on an roi? Just real quick answer on that. Michael, we'll start with you.

I think in the past we were a little bit more patient. We're looking for more immediacy in ROI at this point. That could be up to six months, 12 months, but, We're looking shorter term right now because of all the financial pressures we had indicated before.

Yeah. Craig, similar for you guys or? Yeah,

similar. I'd say, probably one to two years. I don't know that we've ever really developed amazing discipline around ROI and cost, value assessments and, for better or for worse maybe in the category of not wasting a good crisis.

This is really forcing those conversations and Causing us to be a little bit more deliberate about it, more real, and making sure that, this is a thing. And it's certainly a factor that we're considering as we considering with more intentionality perhaps than we have historically.

At Neil? One, one year, two

years. Actually, it's kind of interesting. Just like Craig said, the discipline on ROI is difficult to do and you can always, play to the game per se. So we're really focused on the total cost of ownership. That's a discipline that we don't do. Everybody comes with their project and whatever cost the vendor told them, but not the true cost of what it takes to implement and maintain.

And so over the past four years, we've really worked hard that every project, every new contract, we really need to know the three year cost of ownership and what it's impact is gonna be in terms of capital dollars as well as ongoing opex. Then the choices can be made and once the choice is made, the leaders who make those choices, Have to decide whether it's worth it to do or not.

And so I worry much less from an IT point of view of the roi.

It, it's interesting cuz that's the That's the alley that you end up with. The trap that you end up with is you buy something new, the costs go up, and then next year they come to you and say, Hey, we need you to reduce your IT spend by 5%.

And you're sitting there going, but my IT spend just went up by 10% with just the stuff we bought. So how am I supposed to cut 5%? I mean, it's now you're talking 15% essentially is what you're, anyway, it just. It gets to be a little bit of a trap. We I'm gonna get to the user questions cuz they're quite interesting biggest.

Biggest challenge facing, and I'm not gonna ask all of you to answer this. I'll probably just bounce around and have you guys maybe take each, take one of 'em and if you want to comment on somebody else's answer, by all means jump in. Biggest challenge facing academic medical centers from an IT perspective.

So focusing in on academic medical center, the things that are distinct. Biggest tech what did they say it challenge from an IT perspective, biggest challenges facing? Craig, we'll go to you on that one. What's the biggest challenging facing in academic medical center today? I think

it's, it thematically, the demand for IT services exceeds supply.

I think that's maybe the broad macro sort of thing. So it speaks to a little bit of what we've talked about already in terms of prioritization and ROI and such. Digital and consumer expectations have never been higher. I think that's certainly a priority for us. And costs are outpacing reimbursement which is applying the pressures we've talked about earlier.

I think the thing people that may not understand about AMCs is projects can initiate from just about anywhere. I mean, they just, Hey, I got a grant. Hey, we've got this extra money over here. Hey, we've got this. It's just, that might seem like a good problem to have, but it's also a challenge from a governance standpoint.

Michael, is it am I saying that right? I think you

are. It's also represents though one of the most exciting opportunities when you can marry that research and that patient care in the form of personalized care, precision medicine, what, whatever you wanna call it that intersection is pretty exciting.

It's, we're at the forefront of it. It's a new frontier, I would say. Genomic data informing patient care activities. I don't know. There's much smarter people on this call than me, but we know so little about the human genome as it pertains to patient care. That's gonna be an evolution in those that can foster the col collaboration between the two I think are gonna be winners downstream.

That, really is gonna be a differentiator because, standard, the standard of care today is a hundred times better than it was 20 years ago. What's the next differentiator? It needs to be this intersection between research and

patient care.

Is Neil, I'll come to you. Is there a digital transformation of clinical research?

Is clinical research transforming as, as well as we speak Absolutely.

On variety of ways. And I'll kind of lead into it with the first question cuz research is a space in terms of technical challenges at academic medical centers. You know when you have a research grant, you have a free pass to do whatever you wish because in a sense it's your own little budget and your it is just supposed to support it.

And what that resulted in is a bunch of things that are orphan sitting in under people's desks that never really got have any sort of central coordination. Cuz every place has this app or this machine, et cetera. So that technical debt just. Builds and now the financial pressure leads to maybe the support personnel that we're local, not being there anymore.

And then all of a sudden you just are being asked to adopt a lot of kittens. And With that, there's also the movement of how can we do clinical research at scale. And so everybody wants access to data. They want access to data immediately, but they don't have the local expertise in their shop to actually help them get to the data.

So from a technical side, not only do we have to create. The right aggregation and warehouses for data so that people have the underlying infrastructure, but then also the intermediaries who can serve as the exports, whether it's analysts or statisticians or others who can help them manipulate it. Yeah.

That then goes into clinical research. Where can you. Attract patients through the portal, through different ways, through patient engagement to be able to get in there, because now we want that data to come in seamlessly into the database cuz they don't have people to hand enter whatever the patient submitted it.

And

if I could just add from a resourcing standpoint, well, we've tried to do, and I don't know that we've hit the perfect sweet spot. But to your comment earlier, Neil. The division of resources is challenging or the lack of division of resources is challenging.

And so, what we've tried to do is organize a little bit more centrally around the folks who truly support research from applications, data infrastructure, compute, storage, all of that really under one vertical. So those resources are competing against themselves, the community of users for those resources, whether it's grant funded or otherwise.

Are competing for, that tho those resources are not competing against operationally focused resources. It's not perfect, but it has helped a little bit and has helped to separate that service catalog from the operational focused service catalog.

Yeah. By the way if you have a little time in between me asking you questions, if you want to hit some of these q and a's that are coming in here, I think there's four questions in there.

If you guys want to type some things back, by all means do that. I'm gonna keep working through the questions we received in terms of the data. It's data for clinical research. Has that, is that a function that clearly falls under it to aggregate that data, source that data, clean that data, and make that available?

And are we looking at different technologies in order to I think Neal, you said the word scale, but to do research at scale and to make that sort of a common platform for all researchers to hit. Neil, I'll start with you cause you're shaking your head. Sure.

No I think it's an and conversation.

Everybody wants all the data together, but now we have to deal with security issues of how do multicenter people get to the data in a safe way and only get to the data that they're entitled to. I mean, you now have the problem of easy access. But now the security issues and all those other issues create a problem of you having to restrict things.

And at that tension point, we're still trying to figure it out in that space.

Yeah. Michael, how about a pen? What how do you approach the data, making the data available for researchers?

A little bit more of

a 80 20 rule? I think. We try to address the majority of needs through a standard platform.

We happen to call that platform genomics, and it's populated with some level of patient care data, but then all that other data that exists in the research environment, like bio-banking, biospecimen data, and genomic data, and other types of things that aren't standard in the patient care world. So we try to create that platform and then allow the researchers to Neil's point, reach in with security, pull out what they need, and then add their other sources of data, whether it's coming from pumps or surveys or trials or whatever to meet their need.

But it's kind of an 80 20 rule there.

We'll get back to our show in just a minute. I am excited about our webinars this year. They have been going very well. What I've done is I've gone out and talked to people in the community and said, what works in webinars?

And they came back and said, look, this is what we want. We want a webinar that is not product centric. It's really focused in on the problems of health care. And we want people on there that are actually solving those problems. And so we have done that. And the response has been fantastic this year. We have another webinar coming up.

It is the future of care spaces. Where care is being delivered is changing rapidly. Even the care spaces within the hospital themselves are changing. Technology is being added in different types of technology. A. I obviously computer vision and whatnot is changing that modality as well as what's going on in the home and whatnot.

So we're gonna have that webinar June 8th at one p. m. Easter time. We usually have it on the first Thursday. Happens to be a little too close to my anniversary. So we're going to do June 8th at 1 p. m. Eastern time future of care spaces. We would love to have you be a part of it. If you are interested in being there, go ahead and hit our website.

Top right hand corner. We have a card. You can click on that card and go ahead and fill out the form and get registered today. We would love to have you join us we look forward to seeing you there. Now back to our show.

I'm gonna modify this question a little bit. Question is, given the persisting issues with provider staffing, patient access, and healthcare costs rising across the board, what solutions are you looking at to solve this? On top of that, do you see any solutions to the market that can address all these?

I guess the question I would ask around that is, Are you looking for solutions in the marketplace to solve that? Or are you being more I don't know more at the ground level, just trying to address, workflow issues and the normal lean processes and that kind of stuff. Are you looking for solutions or are you may maybe taking a efficiency approach as you look at that?

Craig, how about I'll go with you. Yeah, I

guess I'd say it's more the latter for us, bill. It's maximizing use of existing tools and commitment to simplifying and optimizing optimizing scheduling. Scheduling, as we talked about, is critical using contemporary tools that are in other areas of the world outside of healthcare.

Consolidating and standardizing to single platforms were possible rather than adding net new boltons and, new capabilities which complicate our lives and in some cases have a carry forward of technical debt As Neil described earlier. I don't think net new tools and more ways of doing things is the answer.

I think simplifying the world for our providers, our staff, and our patients is really the way to achieve some of those

economies. Michael, is simplification something you're looking to do as well? Yeah, I

share

with my team and with, similar industry events like this, the three Cs, it's common systems, centrally managed, collaboratively installed.

And if you can have that platform in place, leverage the tools you have, work collaboratively with operations. I think the three of us are all on the same E M R platform. We know what tools we have. Those tools continue to evolve. Adding more to the mix at this point in time isn't gonna move

us forward.

All right, so let me put you on the spot then. The three of you. I'll ask you this question A year from now, will you have more applications than you have today? And Michael, I'll start with you.

Going, our fiscal year begins in July and we're already beginning that budget process.

And I know I will have less applic

applications.

Well, a year from July, you will have less than what you start with

My my Core

vendor four platform will

provide that service.

Craig,

I would lean towards less, but I think it'll probably be close to flat with some Gibson puts.

Are you trying to retire some stuff?

Yeah, we have some systems and we've just gone through a significant m and a activity with a hospital in the area. And so we've got some decommissioning that's gonna happen there. Then we have some other priorities of bigger implementations mainly around the E R P that's gonna reduce the broader footprint.

Yeah. Neal more or less applications a year from now. Plus,

We went live on our E H R platform five years ago. We got rid of 120 applications. Our E R P go live is coming up here in April. That will get rid of over another a hundred applications. And given where we are, we need to consolidate onto common footprints and we're actively working in that direction.

Yeah, it's a it's interesting. It's a it is definitely definitely a goal is to reduce the number of applications, get onto more platforms and and I think we're hearing that across the board is the Let's see, how are they asking this? Do you feel the CIO plays a role in delivering exceptional customer experience?

Is there, are you guys hearing a lot? Are you being asked a lot about the customer experience and improving the customer experience? We'll go in the other direction. Neil customer experience.

Absolutely. And being a clinician, that's how I got into this game. Was because I yelled about how much it didn't work, and they made me come to community meetings.

And I, we lead a group committee called the Patient Engagement Technology Committee that our Chief Medical Officer and I lead specifically because customer experience is everything. And in Nashville it's a small enough community that you hear about it very quickly from your community in different locations.

If your customer experience isn't where it needs to be, and so absolutely, it's totally front of mind. Yeah.

So Craig I know you guys think a lot about customer experience cuz you're in that beautiful and actually Philadelphia would fall in this category too. You're in that beautiful place that has so much competition that cus the customer experience really.

Really does matter in that LA and Philadelphia and probably every market now, especially the urban centers. But Craig what are you seeing? What's next in terms of the customer experience? What are they asking for? Yeah, I think

it's it's staying ahead or at least keeping up with the sort of entrance in the market and our competition.

I think usability, ui, ux, look, feel all things and really that our customer facing are prospective, patient facing. They have to be our priority, and they are our pr, they are our priority. We have UCLA agents down the road and to our south, a number of organizations and in, in every direction.

And so that's certainly a priority for us. I think internally our customers was, I think, Neil was speaking to. I feel like the chief health help desk officer many times that, really there's And I think it's a good thing. There's no problem too small that I occasionally hear about.

And it forces us to really look at the way we do things, the way we serve our internal customers, our clinicians, our staff, our caregivers. And that's a critical priority for us. And excellence is a foundation of that.

The Michael, I'll change the question, come to you just slightly, which is.

Are you utilizing, I mean, we talked about getting onto common platforms and that kind of stuff. Are you just us utilizing the tools that your vendors are providing to establish that customer experience? Or are you starting to branch out and create experiences, say, with some of your COBAL programmers over there?

wish I had more COBAL programs. They're good. Good guys, good ladies. We're branching out. So, I think our platform has a lot of functionality and we all use terms like low friction and, engagement with our patients but leveraging some of the tools, whether it's a a texting solution.

To augment our scheduling system is one example. I think a broader example is, and you mentioned the Philadelphia, Los Angeles, Nashville, they're, urban centers, they're hard to get to. And three of our major hospitals are downtown and it's frustrating. And so that experience already has two strikes against it because they had to sit in traffic.

They had a fine parking, they had to find their way to one of our buildings. And now how do we make it better from there? So you're always trying to reclaim that in-person experience. So more tele type of experience adds to the the benefit and pushing more to the home. It's certainly a big initiative for us, cuz that'll do two things.

One is it's generally where people wanna be served from a care perspective if they can. Secondly, it'll reduce the census population that we're all dealing with and provide the opportunity to get truly those sicker patients into the hospital. So to reduce that stress level

also. There's about five questions here, do you think q and a is I'm sorry. Sorry. Q and a. Do you think m and a is going to increase? There's question around prioritizing partnerships With with players as you increase your reach, there's a question about how do AMCs determine which community hospitals to work partner with?

And I guess, somebody just mentioned this I, Craig, I think you just mentioned this. So you guys are doing some of this work. Is there And you can't really speak about m and a, but talk about partnerships, talk about community partnerships that are going on and how you're expanding your reach and your.

And your influence in that LA market.

Yeah. And so we we look, from a strategic standpoint at who would be a good partner based on, the geography, the patient populace where we don't already have existing services or. Reach, and those are markets that we move into.

Certainly more complicated of that when you get down to the nuts and bolts and some of the behind the scenes sausage making. But that's the general theme. We're looking to broaden our reach to better serve the communities around us. I think from a, technology standpoint, we try to, partner with our Potential affiliations early to really understand where they're at and what their needs might be.

And we see how we can further support any future integration needs prospectively. And then once we join we do everything we can to assimilate and support each other so that together we're stronger. It's complicated for sure, but it It has lots of opportunities and lots of potential, certainly in the application rationalization space.

Yeah,

I mean, only because I was in your market, I, so you have Torrance Memorial, you have Huntington, and you even have something, you have something with Providence too. We do. We have,

A roughly 50 50, 49, 51 ownership model with Providence Tarzana over in the Valley. And so, there it's primarily Providence Tech that's in that space, but we have.

Partnered on a number of things, including some imaging capabilities across our orgs.

So Neal I'll come to you next. Any, like, how do you partner, how do you reach the broader community around Nashville?

So around Nashville, I mean, I'll I can say in terms of past m and a we've acquired three community hospitals in the past four years.

And. That was, those were the first hospital acquisitions that Vanderbilt had ever done. And we brought them all onto our same instance of our EHR and standardized them on the B M C platform and end mainly so that the provider experience and the patient experience is seamless, so that if they go anywhere in the system, it's it's seamless.

So what we're trying to do is we know, and just like Michael said, Nobody wants to come to downtown Nashville. They want, they, they'll come here for their surgery. Yeah. But they'll come here for a hyper specialist. But everything else, they want local. And so what we need to figure out is either having the community presence there, whether it's a big box a s c or a community hospital that wants to be within the Hamburg Vanil system, but we also then have affiliates that we try to partner with where we do an extensive share of.

Best practices, ideas, and coordination of transfer of patients appropriately because for Vanderbilt, we don't make money if we bring in low C M I patients, which is the case mix index, which are less complex patients because our cost of care and the downtown campus is just too high, and so we do better.

With the complex patients and allow the less complex to be well cared for in their local settings. So unlike in the past when volume was everything, now I think it's the right type of volume being in the right place, and that's how we partner with affiliates and increase our presence away from the central hub.

Yeah I'd rather drive to downtown Nashville than go down the SKU Hill Expressway. Michael if you guys have ever been on that it is, I don't think it's ever wide open, but Michael what about you? I mean, you guys are predominantly downtown, but I mean, you have huge communities all around you, including into New Jersey

and we

do have three community hospitals that service the region and.

I do believe there's only two independent hospitals left, so I'm not sure that they're, opportunities for us. But I'd put a little different spin on this and get the group's feedback and ask the participants to think about. It also is, if you look at health in general, it's always three components.

It's pharma, it's payer slash insurers, and its providers. Providers are struggling at this point. Pharma and payers have all the money. And I see more and more relationships and partnerships, at least for us, with at least the payers, and trying to find that synergy around more value-based care, more targeted care, more arrangements in that respect.

So I'm not sure there's an acquisition, certainly not an acquisition of a academic medical center of a payer, but I do wonder. If there's gonna be more payers acquiring the providers in order to link that care together. And I don't think I see any pharma doing anything other than

what they do best, what they do best.

I'm gonna, I don't know if this is softball or not, it feels like a softball. I wanna talk to you about work from home and your staff and whatnot. Is that changing at all? I read a wall Street Journal article. This week, in fact, I think it was Monday, and they said that the number of remote jobs is actually going down.

And they were citing the number of jobs on LinkedIn, number of jobs on Indeed and whatnot. And fewer of them are saying, Hey, work from anywhere and that kind of stuff. Healthcare tends to be slow to adopt. These things, and we have workers working from home now, and we've definitely adopted that and will probably be slow to come back from that.

But is there any intention, has the nature of work changed? Is there any intention to come back from that? What does it look like? Does someone want to volunteer to start this one off? I don't wanna put anybody on the spot. I

can try. It's a, it's an interesting question

that, oh you know what?

You should try, I've had to drive to Cedar Sinai. That could be the hardest place to get to in history, right?

10 10 miles can take you an hour and a half. For sure. It, I think for us I don't foresee a changing in the near or intermediate term. It's been a win for us for, the reason you stated bill and our ability to recruit outside of our, even our drivable area, drivable, however you wish to define that.

And so we've got folks working in other states, which has been great to get high quality talent that. Can do the work that needs to happen. Whether they're on site or remote, that's reserved for, specific roles. And I think we'll need to continue that.

I think where we haven't quite settled out yet is really in the hybrid roles that our local. Nearby that are drivable, that occasionally need to be on site and occasionally or more than more often than not are working from home right now. I think that'll primarily be driven for us by the way the organization shifts.

We're still really not doing in-person meetings or not doing in-person meetings beyond. I think the latest guidance was 50% capacity in the rooms. And so a lot of that really is just driving the way we interact with our customer base.

So, biggest positive. I'm gonna go do the other Neal, I'm gonna go to you and Michael, I would come to you biggest positive of remote work and the thing we miss most because of remote work.

Neal, I'll go to you.

The biggest positive is I don't have to get up at six in the morning for a 7:00 AM meeting where I have to have my button, the chair in the middle of campus. But, and that's awesome as well as late meetings. The biggest negative I'm in my office. I like the change in context.

There's hardly anybody else here. And it's lonely.

Yeah. Isolation is one of the things I've heard from people is not all employees like, Being in their home. Some actually do like interaction with other people, so I guess they can go to coffee shops. Michael?

Yeah, I think the biggest positive has been resulting in our maintaining our high retention level of our employees.

And to Craig's Point, being able to recruit from outside the region it's been really strong for us. We have a solid plan to continue to be A remote organization, we've begun to shut down some of our least and rental spaces that housed it staff before. So we're sending all the messages we're performing all the actions that indicate we're gonna stay in a remote type of environment.

But I do believe over time some employees, to your point about loneliness and isolation have begun to filter back. And each day I see more and more folks in the office. Not that we're exceeding more than 15% of our staff each day unless there's a get together reason. But I have seen people voluntarily begun to come back to the office because they miss their colleagues.

They want to have team meetings. They want meet face to face. I think the biggest downside to all of this is less happy hours. I miss them.

Here's an interesting one for you guys. And I was with a CIO a week and a half ago and we were talking about this cuz he was the CIO of the university and the CIO of the of the health system and medical center.

And somebody asked the question here, do you think you'll see some of that consolidation? Come across there. I'll just ask one of you to answer that question. I think the person I was with would say they're two very different jobs, but I'm curious what you guys think. Yeah, I

would just tend to agree.

They're very, our priorities are patient care research. Their priorities are registration, class, attendance, those types of things. And. There are some platforms that maybe there's a E R P that might overlap and be an umbrella, but I meet regularly with the CIO of the university and we're talking two different languages

often.

Yeah. And that is one of the things he said, he goes, a university meeting is very different than a health system meeting. I mean, it's just in its context and it's urgency and it's an approach. It's just a very different approach. And I'm just pulling this one out. This is mine.

Public health emergency. Coming to an end in May, I think is what we're, what's being signaled, and that's part of what the Biden administration said coming in, that they would give us 60 to 90 days notice before they ended the public health emergency. So I think it will probably come to an end in May.

Does that change? Anything with regard. I mean the telehealth will continue because that was part of the omnibus bill. I'm trying to think what other things really, but how will that impact, do you have an idea of how the end of the public health emergency is going to impact you? Michael, I guess I'll start with you, or unless you're hoping I have a call on somebody else.

No.

I think the biggest. Topic we've seen a number of patients that might be left without any type of insurance right at this point. And so they'll have no coverage. And then how are we going to address that? And did we go back to some state sponsored plan, federally sponsored plan?

But other than that, maybe Neil or Craig have more insights, but I think that is a concern of ours, and particularly in urban areas that is a

concern. Yeah I know. I just remember, I'll speak about our health system. We lost money on Medicaid. We tried to break even on Medicare, and we made money on commercial.

Right? And now we're losing money across the board, having more people show up. And by the way, there's a ton of care that was just given away because we had. We had Southern California, we had a ton of people who were undocumented and didn't give us social security numbers and they received a lot of free care and whatnot.

So there's a lot of free care that gets given out every year, and that's okay when you're making, numbers, but if you're not making numbers, that even exacerbates the problem more. So, yeah, I, I can understand. And they did talk about that. In the in the release, they expected an increase of 20 to 30,000 people added to the Medicaid rules moving forward.

So

I would add to that Bill. The issue is not just the, yes, all of us in AMCs provide uncompensated care, right? A lot of this is part of our mission in many ways in the local region. The greater difficulty lately we've found is that even the payers we have contract with are delaying. And we had this with Medicare Advantage programs where, we were supposed to get paid and we're still not getting paid.

And so it's just the friction overall in every direction, I think is what's grading.

Let me ask the question a little differently. Public health emergency comes to an end. Yes. The Omnibus Bill's gonna continue. The telehealth. Has telehealth become ingrained enough that it is just part of the structure of how you deliver care moving forward?

Craig, how about in la? Is it just, it's just already baked in now and you feel like pretty confident it'll continue?

I

think so.

I think we've started to hit a post pandemic equilibrium of sorts. There's specialties and. And not that have self-selected or their patients have self-selected, what that what that baseline will be.

I think we see our telehealth numbers range from, next to nothing to, in the twenties in terms of a percentage of total visit volume. Leaning, skewed more heavily towards primary care with the higher numbers. We also have made available a more real time, video visits now capability, which has helped decant some capacity and access issues away from urgent care in the ed, which has been great.

But I think it's here to stay and I'm not sure what would need to happen in terms of payments and changes in the regs that would shift that pretty dramatically.

Yeah I have a feeling what we're gonna see is that the federal government's gonna, they have a ton of data now.

They're gonna be able to look at it and say, Hey, this worked, this didn't work, this did work. And they'll hopefully adjust the funding to match what actually increases access and improves outcomes. Gentlemen, I want to thank you for your time and I wanna thank you for participating in this.

The let's see. I wanna thank everybody who who came onto the call. It was a great turnout as and all the questions that you gave, really appreciate that. Gentlemen, thank you very much. Really appreciate your time. Great. Thanks, bill.

Thanks for having me. Pleasure being here.

Thanks.

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