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Contributors

March 24, 2023: Cletis Earle, CIO and SVP for Penn State Health. Lancaster and the surrounding Penn State Health system provides a myriad of challenges, from catering to the Amish and Mennonite populations to not being on Epic. How do you care for snowbird patients and securely share data with systems outside of your network? How can you continue to adapt and adopt new technologies while still assisting communities who abstain from modern technology? What does it look like to continuously pursue optimization from a clinical adoption perspective?

Key Points:

  • Teaching Providers to actively pursue optimization
  • Adopting new technologies versus catering to local communities and cultures
  • HIE and OpenNotes
  • Vendor tactics in 2023

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Transcript

This 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.

β€Š (Intro) we have such a vast array of patients. we have group of patients, right? And cuz of religious situations that they don't use technology at all.

Right. The Amish community, you can't ignore that, right? So you have. Take a very vast, wide approach of how you're delivering these things, and it's not just always generational, but there are all of these other Social determinants that we have to take into consideration of how we're addressing them.β€Š πŸ“

πŸ“ β€Šall right. Today we are joined by Cletus Earl, CIO for Penn State Health. Cletus, welcome back to the show.

Ah, bill, thank you so much. It's a pleasure being here. It's always great to have a chance to talk to you and your teams and the friends here on this community.

Well, I'm looking forward to the conversation, but we have to start with March Madness. Penn State got in. do you know who the first round game's

against?

Yeah. Texas a and m. So, yeah. This is very happy, but we'll go lions.. Let's

they are they a sleeper?

Do they have a chance of going far or is it a long shift?

Let's just put it to this way. I had them to go a little bit deeper in the bracketology there. So, call it, whether it's Biasness or whatever it is, hopeful. But they've been hot. They've been really hot, lately.

So, even getting into the last set of games they lost to Purdue by two points. So I think they have a hotness, they have the hot hand

right now.

The thing I don't understand is they have such a great football program. They have a lot of great sports programs.

People don't know. Wrestling, Penn State's wrestling team is unbelievable. I mean, it's

Best in the world, right? And it's been like that for decades. So

is that because they get the gym time and the basketball team doesn't get the gym time? Is that what's going on there?

Don't know the details, but yeah. Yeah. Top wrestling program in the country, right? And it's been like that for forever, so, yeah. It's very interesting. Glad you pointed it out.

Yeah. Well, I'll tell you growing up, I grew up in Bethle, Pennsylvania in the shadow of Lehigh University and Lehigh University used to be one of the top wrestling programs in the country, and I don't think people get a feeling for how big of a deal wrestling is in certain areas of the country.

Ohio, Pennsylvania, Iowa. Yeah. Really big 10, I guess

very central, right? It's, it seems to be the central part of the country. It seems to be very popular and very pronounced here. Yep.

All right. So people wanna know if we're gonna talk about healthcare and we are, we're gonna talk.

Yeah. But you know, I always start with the question. Tell us a little bit about Penn State Health to get us started.

Well, I appreciate you asking the question and again, inviting me here. Penn State Health has been on a journey, it's been three years, a little over three years since I've been here.

This is truly an organization that was built in the middle of corner field. And to be honest with you, it is, basically flourished or since, being originally part of The Penn State University, we created College of Medicine and a health system, a facility right in the center of Hershey, Pennsylvania.

And it has just been taken off for many years since the sixties. It's been more of a standalone facility and over the last. Decade or so, they decided to continue to span out and buy and build new organizations. So I always say that we're somewhat in the early infancy stage of a health system to be able to bring together more of an ecosystem, more of a hub and spoke model.

So this is something that we're seeing in this community, probably one of the last few communities that have experienced this level of transition. But the organization continues to understand what research is and what taking care of the patients are from a quality perspective and really offering the best services to the patients that we serve.

So very interesting. We just finished opening one hospital and bringing another in October. So, truly right now we're in the optimization stage as we open those hospitals, we're just trying to figure out, okay, how do we continue to promote systemness in our facilities?

Yeah it's fun to be in the growth mode except when you do acquisitions and whatnot, you have all the m and a activity that goes along with that, which is a fair amount when you're talking. Health systems, no matter how small they are, they tend to have a hundred to 200 to 300 applications.

Yeah. And unfortunately with that comes, technology debt. And as we continue to figure out the system, I've been able to bring on some amazing team members from around the country. We are all just really knocking mountain and tapping into the existing teams that we have here.

We're doing some really great things to. Figure it all out together so that we could bring in the new and acclimate the old, and making us all work together as a comprehensive, clinically integrated network.

your priorities to start off:

Well, as I mentioned, optimization is one, right?

Getting us to do some elements of getting us right. But application rationalization you brought it right to the crux of it all. As you do all of these m and as and all of these elements, we have many more applications that we're not proud of. And the key here, To start to reduce those, that footprint, to really maximize our resources so that our teams are not focusing on things that are not strategically aligned to the organization's objectives of the agenda.

So, that's one of the things that one of my team members who's our chief application officer, manager, Walter, she's inherently involved in doing that, but working with our other team members, right? Our CTOs, our CDOs, and all the others. That we have to really help rationalize in a better way so that we can actually start focusing on the things that makes most sense for our organization and our staffs.

Yeah, that the application rationalization's so important. I mean, from a efficiency standpoint, there's extra cost that you're spending. Also a focus standpoint from an IT perspective, but also complexity. Complexity and security. I mean, there's so many reasons to start. To bring down that number of applications because the number drives complexity.

And then when you're trying to do those really cool things, like we're gonna create a clinically integrated network and we're gonna create these dashboards, we're gonna drive quality through these things in instead of trying to connect up. 55 applications, you're connecting up five and it just becomes a lot more doable, I think, for

the whole team.

Yeah. And to your point earlier, hundreds, right? And even the goal of moving from many EMRs to one, we now integrated our. Acute care facilities under one platform, and our goal is to integrate them now into our ambulatory sites, and then at same platform so that we have the best possible care reducing and mitigating the waste that comes with, clinical care.

Ordering labs, testing. We really did a major. Push to focus on interoperability and integration, particularly around our regional health information organization, the health information exchanges, and whether at the local, regional, and state and national level. So these are things that realizing that if we do a better effort to really emphasize on integration and access to the information as well.

Allowing others to see our information, knowing that our patients, we want them to come to us, but they're not always going to, be under our umbrella, the moniker of the brand behind here. We have to be able to take care of them no matter where they are. also understanding that that's most, most important to us when it comes to cure and being able to have things accessible.

When I think about where you're at in terms. Optimizing the platform and whatnot. I think that the question I want to ask is around adoption of the technology and getting the clinicians to buy into the use of the technology cuz you're bringing on new platforms on the acute and ambulatory side.

How are you driving adoption? How are you helping the clinicians To adopt the technology and to utilize technology to the highest level.

Yeah. That's always a challenge. And I would say there's no, Perfect answer for this one. Cuz the people that love one system, they over the other and some challenges and also, so to be frank, some challenges that we have with our technologies at times that we have to really partner with our vendors.

To be able to work at the elbow support, right? Being able to inject our teams doing more rounding, being able to just be at the side of our clinicians to find out and our providers and nurses and all of those others to find out where are those gaps? How do we fix some of these issues?

One thing that we do have, we have some really. Data particularly around the clinical systems, and I would emphasize to people to use that data, we have to stop looking at Previous way of, are they using the E M R for meaningful use?

And I think meaningful use, years ago was, okay, can we get them to start using the system, doing orders and all of that. I think we need to evolve ourselves. and now starting to figure out, well, exactly how many times, right? Like how long is it taking them to do X compared to, some, national benchmarks and state benchmarks.

And then being able to help guide them that way. So once you start to have that level of conversation and then you can really have your at the elbow. Support teams working with those providers to say, Hey we're looking over your shoulder to help you. Not to, criticize, but we're looking to see how we can make your world better and really focus on that quadruple aim element, right?

The burnout. And saying, we are watching what you're doing and we see that you're doing these particular things, extra clicks or different models, but did you know you can do this? And also by using some of the embedded tools within the emr, if the at the elbow people are not available to them, allowing them to.

learn In the record itself. So if there's something that they needed to do, it's a workflow that they haven't been able to click on, they haven't used in a while, having the functionality to have that provider click on that little icon and they can get just in time training. In that particular workflow of that workflow, if they didn't order something, they can click on a particular little icon and they can get training at that point on how to do it.

Again, we just need to keep trying to figure out how do we cater the system and adjust in order to accommodate this kind of new approach of, the system is always gonna be optimized, continue to be optimized, and we have to make sure that we're training people in a more real time basis.

Are you guys a part of the arts collaborative?

Have you gone down that path? I'm just curious.

No, not yet.

Not yet. It's interesting the work that they've done in terms of adoption. . . And some of the stuff you just said just resonated with another interview I did with the team over at class that was working on the arch collaborative.

Yeah. So I know about it. work with the class folks, but again, we are doing very similar elements, but you're right. I think this is the natural pathway. And I think where you're doing the. Quadruple aim. And then, as they talk about the quintuple aim, and we need to do the same thing with that element when it comes to patient satisfaction and consumerism and all of those stuff with our patients as well, because we have to make sure that they start to use the systems in a very adjust way.

So that will be in, in our future phases.

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So Let's talk about your patients. Tell me about your patient's expectations. Are they changing, are they different based on the geographies that you serve?

I wouldn't say they're different, but it's interesting you asked this question because I was just meeting with the team today. My digital folks and the marketing teams, and we were looking at survey information to find out what is it that our patients want, right?

And trying to figure out how do you get there? And I wouldn't say that things are changing immediate. because again, we're in central Pennsylvania, right? We do, we have access to cities and we have some of our facilities in cities. I do think there's a difference between some of our city customers and the difference between our rural customers and what they need in one when it comes to care.

But as far as functionality when it comes to technology I do believe that we are seeing truly a generational. When it comes to what they're looking for and convenience, right? So we are looking at how do we do things in a much more advanced way when it comes to zero touch, right? Being able to make things more accessible via the technologies that we have on our phones and other types of geofencing functionality.

Really trying to mitigate the use of Arduous tasks such as, paper processes for certain generational, like a generational design approach, but then understanding that, hey, we have such a vast array of patients that, we have group of patients, right? And cuz of religious situations that they don't use technology at all.

Right. The Amish community, right. So you take, right, you have to take, you can't ignore that, right? So you have. Take a very vast, wide approach of how you're delivering these things, and it's not just always generational, but there are all of these other Social determinants that we have to take into consideration of how we're addressing them.

But those who do want technology, yeah, we're looking at delivering. Right. New approaches. Again, I'm new chief data officer at Kendall Sims, that's come aboard. She came from Coca-Cola and we're looking at how do we use tools and technologies that you are seeing in the private sector and the for-profit sector and these other industries to really bring it forward to our industry.

It's, people don't think about that. But when you're talking Hershey and Lancaster and those kind of things, it's not uncommon to drive down the street and see the horse drawn uncommon. It

happens all the time. Get stuck behind them, . And,

but you know, if you're caring for that community, and we're talking social determinants and even hospital design, , I mean, you think about all the things.

I mean, each community has, its. Set of variables and factors that you have to take into account if you're going to serve that community. Like I assume you have Amish places for horses when they bring them into your hospital.

We just built a million facility, new hospital, and in the back there's a.

Of course buggy parking, right? That you have to, I mean, think about it. You have to do these things. This is in Lancaster. So, you have to do it. And that's, in my opinion, and I talk about this in other settings too, but that's truly, diversity that's taking in to consider social determinants.

These are all of these other factors that you have to contribute to how you're taking care of the patients.

And they don't use, they don't use technology at all either.

They don't use it at all. Right. And that's where I was going before. So imagine. this Conundrum that we have that you're talking about.

Patient portal this communication follow up.

Online scheduling. They're not gonna do online scheduling.

Yeah. Yeah. They remember this. Some of these communities are not allowed to have phones as well. They have a shared phone some of these communities. One shared communal phone.

So these are the things. It is extremely imperative for us to think about, and we just talked about the Amish and the Mennonite communities in this way, but the same applies. In other communities, right? So in urban settings, right, we have to look at communities of color in the same way and say, okay, what do we have to do that's different that to help accommodate those?

Or if you're in native American reservations and how do you accommodate those particular communities in different, and that's what we as IT professionals, need to figure out how do we start to incorporate some of our technologies and also, Facilities to enable technologies to our customers.

That's basically where the rubber

meet. I I love that call to action. I was in southern California in major cities, right? So Orange County, and whenever you have a major league baseball team, you're in a major city and I remember talking about technology and some of the sisters, cuz we were a Catholic health system, would come up to me afterwards and said, oh, How does this work for the homeless population?

Because our homeless population was significant and growing and how does this work for the underserved? How does this work for, and they were always challenging me on, this is great, but what about those people that don't have those access points that you're talking about? ,

You're spot on. And again, hopefully nobody takes what I'm saying as an easy conversation.

These are not easy discussions. These are not easy solutions. I think just like we know, hospitals are all local, right? Health systems are local, so you can't say will work in others, but I think you need to, Work with your community, understand the various nuances of each community. I think you need to have a diverse workforce, right, in order to understand what it looks like.

Because when you have the ability to have people think differently, they're able to bring different perspectives on how you address communities in a certain way. And I think that's inherently important to keep in mind.

Let's talk about data sharing. You talked about your h i e, you alluded to your h i e.

Is that one of your primary data sharing mechanisms? And then I assume you're on Epic, so you're probably using. Their platform for sharing data as well.

Yeah. So we're not on Epic.

We're, oh, there you go. I'm sorry. We're on the

only old systems in this region that's not on Epic. We're a Cerner platform,

so data sharing has to be really important for you.

Exactly right, because that's where I was going before. So we don't have that general, epic community connection that you can tap into. So it is imperative to share with our Rios in that sense and be able to a P three N network that's in the Pennsylvania area so that we can share our information with no matter who it is.

And my whole goal is to share everything including the kitchen. And that's my hope thought process, do that and be able to pull it back down as well. And being integrated into the emr and we've worked with our earner customers, a certain partners and others to do so. So I think it's imperative.

We also participate in OpenNotes, right? So there's those elements as well. And every opportunity we have to be able to say, we are sharing information, we're gonna take advantage.

That's that's amazing. So do you end up meeting know that when we were supporting our regional h i e, because we were the largest contributor of data to that portal, I ended up sitting on that board and helping them.

They have a challenging position. I mean, it's no easier for them to get all this data and make it accessible for everybody else than it was for us back in the. Bring it all together. Except they're Switzerland, right? They're not a single entity.

Are you able to do the things like create a clinically integrated network and share that data outside of just your region?

We have the ability now to be able to say definitively that this is the outcome, a result of doing that.

We don't have those areas. I mean, we do have the one-offs, patient scenarios. I do think there, we as an organization and as an industry can do a better job of, helping define that as an example. We participate in common. So that's our major exchange partner.

And by doing that in theory, theoretically, you're able to connect with the Nin and all the other solutions that are out there at the national and potentially international. What we don't have, kind of going back to evidential outcomes to show how is your patient data being showed or used when their snowbird.

they go to Arizona or they're in Florida, or they're wherever, and they're being, taken care of in these particular communities during this time of the year or spring break or something like that when our kids are traveling. We're, unfortunately, again, as an industry not able to understand that globally, holistically what that looks like.

And I think if we're able to do that, it would show such a different level of. Functionality, and I think success would breed more success if we continue to do that. And that's not a real issue, right? That's a global issue. Providers, you because we're in a competition mode.

We don't live in a world of, Hey let's show how clinically integrated information data is promoting to the outcome of mitigating rates or we have a better outcome. So I think that's an opportunity for our entire industry as.

I know living in Florida, I drive down the street and I see the Phillies, the Eagles.

I see Villanova, I see Pittsburgh, Steelers. So clearly there's a lot of lot of people taking some time down here.

one is on CSO priorities for:

We have Eric Decker within our mountain, Shauna Hofer with St. Luke's Health System out of Boise, Idaho, and Vic Aurora with Hospital four Special Surgery. And we are gonna delve into what are the priorities for security? What are we seeing? What are the new threat? What is top of mind for this group? If you wanna be a part of these webinars and we would love to have you be a part of them, go ahead and sign up.

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So really appreciate you guys being a part of it and look forward to seeing you on that webinar. Now, back to the show. πŸ“

β€Š πŸ“

I want to put a future lens on for a minute. Are there specific technologies you're keeping an eye? That you believe might have more of an impact on healthcare over the next five years than we're seeing today?

Is there a specific technology?

I can guarantee you, you ask every CIO now that question and the answer that comes out their mouth is a good portion of them saying ChatGPT and that kind of function , and that's probably a softball to me, right? No. So, absolutely. I think that type of.

Technology, ai, machine learning slash chat function and G P T and all of those things are going to be game changers for us. And the things that I continue to ask my partners is, well, what are you doing right in order to connect with those things? Cause this is not new. We knew this was coming, right.

We knew this kind of feature was coming, but go back to Watson, right? I mean, geez, I think it's since the nineties, right? Or early two thousands when Watson came out. Yeah. And we're hoping to see Watson, I think that Jeopardy match we're hoping to see it used in our industry. I b M chose to go down a certain road when it came to the radiology side of the shop.

Unfortunately they didn't point it at the E M R as a whole. I hope to see that these tools start. Be pointed at the EMR to start learning more so that, we are able to provide complimentary referencing to our clinicians. I'd love to see, these kind of features more chatbot features being used in the patient side at the patient-centered side?

So, When a patient needs to have an experience, they just ask a question and it happens. R P M R P A, all of those things get mapped out automatically to help change their experience, right? There shouldn't be a scenario where a patient needs to create a schedule and they have to jump 20 websites, 20 different pages.

Different clicks in order to schedule an appointment, they should be able to do it via one click. Right? Or, if you look at the Amazon way, right, which Jeff Bezos is gonna lead. If we can make things simple to change the experience I think we need to work on that. I use this example and we, and this is funny that I'm pretty sure you have examples of many other your listeners do when you're at home, Your plumber or your vet or your groomer for your animal, your dog or your cat, they're able to use functions where you know who the person is, you know who the time, you have that kind of automation.

That when my plumber comes, I know who that person is, who's coming to. My website, I know more information about 'em. It's all shared to my phone and it's all digital experience. And then when I'm done, as soon as that person leaves, I'm able to get a bill. I'm able to pay that bill.

I'm able to close that particular case out and also create a review. And that's all done via the CRM arm. And it's done at a very simple phase. If vets and plumbers and all of these other, industries can do that. I mean, goodness gracious, the healthcare sector should be doing that, and we're way behind, and that's something that I think we have to learn and do better as an industry.

Yep. All right. Let me close out with this one. I have a fair number of vendor partners that listen to this show and they listen to it cuz they want to know what you're thinking and what's going. . And I rarely ask this question, but I just wanted to touch on it. So what have you learned about dealing with vendor partners over the years and what piece of advice would you give to those?

Trying to work with healthcare organizations?

This may not be the answer you want, . It's

not the answer I want. It's the answer they want

may not be the answer they want. I've noticed throughout the last three to five years particularly Covid has been one, and I think the answer is subject to not just their industry, but as the workforce as a whole.

Vendors have taken somewhat of a backseat. Their model and approach have changed and it's been more of a what have you done for me lately? Approach from a vendor's perspective. And years ago you used to see a real commitment from your partners, right? True partners to work together to execute a specific, action and create a return on that investment.

I think vendors, Have not been true partners lately, and this is the big ones, right? From small to big. So I've noticed that there's a level of reduced efficiency or reduced return on the investments organizations or people like me do. And we're spending millions, tens of millions, hundreds of millions of dollars in certain things, and we're not necessarily getting the return.

I. Love the day when we can implement, we can buy something. We go, we get sourced out and we go and buy something and we say this is the sow. This is what we we're gonna execute. And I would love the day to see if we can even get to the 80th percent. Of using the tools that we said we're gonna buy that's being executed For that reason, time and time again.

What I notice happens is that when you execute something, you don't execute it to the hundredth percentile. And I know some challenges may be associated, it's not always vendor, but. I would love to be it in world, back in a world where, they deliver what they say they're gonna deliver.

And we're paying for the tools that we know that these systems can actually be able to accomplish because if we're able to do that bill, we're able to truly. Stop some of the waste that's occurring in our industry, right? And we're contributing to that. Let's be very frank.

And we need our partners to, I don't know, maybe it's a kick in the butt of the way we used to do things and start to get back to that and start delivering Now. I know, I get it. The world has changed, right? Our staff members and everything is difficult. I get that. I get it. But if we don't continue to.

We will consistently being realized as a industry that should be in the basement and not at the table, and not, basically contributing to the best bottom line of our organizations. And I mean that from the vendor perspective as well as the business. Yeah. We need to change that game.

Well, Cletis, I always love spending time with you. I appreciate your wisdom and the time that you spent with us to share your experience with the community. And again, hopefully I'll see you at one of these conferences coming

up. Yeah, I'll be a ViVE. I'll be at HIMSS.

Looking forward to seeing you as always my friend. And again, thank you for inviting. always love to have these discussions. And more importantly, being able to just tell people where we are, sometimes it's what you see is what you get with me and my hoping is to be frank so that we could, change the narrative together.

So thank you for giving that opportunity. (Main)

I love the chance to have these conversations. I think If I were a CIO today, I would have every team member listen to a show like this one. I believe it's conference level value every week. If you wanna support this week health, tell someone about our channels that would really benefit us. We have a mission of getting our content into as many hands as possible, and if you're listening to it, hopefully you find value and if you could tell somebody else about it, it helps us to achieve our mission. We have two channels. We have the conference channel, which you're listening. And this week, health Newsroom. Check them out today. You can find them wherever you listen to podcasts. Apple, Google, overcast. You get the picture. We are everywhere. We wanna thank our keynote partners, CDW, Rubrik, Sectra and Trellix, who invest in πŸ“ our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.

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