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Today on This Week Health.

There's a digital equity problem in the north country where we live. There's a lot of challenges with being able to reach people. They just aren't as familiar with the technology. We've had to spend some time working individually with patients to get them on board. What was a better fit. They're much better than they were before, but it's been challenging.

It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst who are our Newsday show sponsors for investing in our mission to develop the next generation of health 📍 leaders.

All right. It's Newsday and we are joined by Darrell Bodner the chief information officer for north county health in beautiful New Hampshire. Look at that background, man, people who are listening on the podcast, aren't seeing that background, but Northern New Hampshire is beautiful country.Isn't it?

It is absolutely beautiful. Thank you so much, bill, for having me. It's a pleasure.

I'm looking forward to it. I actually lived in New Hampshire for a year. I didn't know if you knew that we lived in Wolfeboro, New Hampshire. Where I got my first job in healthcare and it was cuz there was no other jobs available.

And I got a job at Huggins hospital in Wolfborough New Hampshire. I don't even know if it's there anymore. It was a really small hospital And essentially I took it. I was building houses and doing that kind of stuff. And then I took it to utilize some of my computer things. And then I got there and realized they had no computers.

So they put me in admissions and I was admitting people in the morning and they had one computer sitting there and I'm like, Hey, if I wrote a program, could I admit these people using technology? And they. Sure. I mean, if you sure, if you wanna develop something, so I developed their admission program and we started generating reports outta it. They're like, Hey, this computer thing, this could really take off. This was back in the in the late eighties. So,

oh, that's impressive. Yeah. Yeah. Huggins hospital is still there. We've worked on a couple of small projects together as well through some ACO initiatives.

Well, tell us a little bit about North Country.

it's a great experiment. It was established in 2016 originally, but it's since gone through a few iterations, but it's a collection of three critical access hospitals, similar to Huggins, as you referenced earlier. Insco valley hospital, upper Connecticut valley hospital in weeks medical center. And we also have a home health and hospice branch. And it was we came together collaboratively without a tertiary facility involved. We agreed to be partners. We sort of tore down those competition barriers and came together.

It's been doing great. It was the, the vision of, of many people, but we've got some great leadership onboard that worked in systems before. and it's great. I mean, we service all of cos county in Northern New Hampshire, which the population's about 30,000. But it covers 1800 square miles or so. And we touched the Canadian border from Vermont border and main border.

Wow. That's amazing. And so here's what I like about this. When we have guests on the show, we get a lot of different perspectives. And it's fun to get your perspective. And even some of these stories we may have touched already on the today show, but I wanna get a little different flavor with talking to you. Let's see. Well, we've we've got some interesting stories. Let's start with this one.

So how us healthcare leaders are shifting course to navigate. A changing world. And are you guys feeling a lot of, a lot of change up there? Did the pandemic impact you a lot? And are you feeling a lot of change in how cares deliver.

I think we are now. Initially we were delayed. A lot of the initial challenges with COVID just didn't make an appearances, but they finally did. And we started to see some of the strain on our EDS and, and we of course shut down services like everybody else and went through that process, being critical access hospitals and our reimbursement model's a bit different cause we're cost reimbursed. It sort of allowed us to survive that a little better than some others. But. I think now, as we start to look at some of the relief dollars are starting to to dry up and some of those challenges are starting to be really, really experienced. Volumes are coming back, but not quite what they did before. And some people are still, still, I think, a little nervous about going out and getting care.

Yeah, we're gonna, we're gonna see that in some of the stories today that there's some predictions in terms of the volumes over the next 10 years. And they're a little different, so. I'll give some excerpts on this story health system execs are updating strategies to meet new imperatives Phillips new future health index. 2022 report shows their priorities, expanding digital transformation, managing a human capital crisis and closing the equity gap.

Okay. And so they start with the human capital crisis. they talk about burnout. And technology's role in helping the overburdened staff. And as, as I read this, I'm reminded of another story I saw there's a lot going on around this, around human capital and around people staffing shortages and those kind of things.

And I saw this week, peace health cuts, travel nurse budget. Struggles with staff shortages. This is a Becker's story that just dropped in my email inbox this morning, peace health hospital in Springfield. Oregon has begun phasing out travel nurses resulting in staff shortages that have caused emergency room patients to be boarded in hallways because there aren't enough nurses on the floors and whatnot, but I think it's interesting.

This problem is pervasive. Isn't it? I mean, even in your area, it's probably a pervasive problem of a shortage of clinical staff and nurses specifically.

It is, it absolutely is. We've been struggling with it for quite some time nursing primarily, but respiratory therapy. We have imaging, there's a lot of areas that it's impacted. And we've experienced the same thing. And I think that the cost of travel labor when it comes to those is just unsustainable. I think that there clearly probably was some gouging that might have occurred during these processes, people taking advantage of the situation.

But it was a true reality for us. So at the end of the day, we've actually taken a different approach or maybe a similar approach. We aren't necessarily getting rid of travel nurses at the expense of delivering some of the care, but we are looking at new and creative ways to be able To offset that demand. And these are some interesting sign-on bonuses, long-term agreements. We're looking at tuition reimbursement for some of these pieces. Some of them have done elsewhere in the country, but some of them are new. And I think you have to look at the overall cost of what your spends gonna be over a year for travel labor and it's just unsustainable.

Bill

Yeah, and I think that's, that's the thing I've heard. I talked to a couple CFOs and that's the thing I heard is that that line item is just so out of whack right now. And it's pulling the financials for the health system just down across the board.

And so it is one of those things that they're trying to get ahead of. And I like some of the creative things you've talked about at the end of the day, I think this will, this will come back to equilibrium, but it will come back to a higher level of equilibrium for the nurses and clinical areas where there is more. Addressing burnout. There's more thought put around schedules demands during the day, there going to be more thought put around work, life balance and that kind of stuff. And then compensation obviously is one of the things. That that I think we will see a rise and I'm not sure that that rise will ever go back down.

I think some of that might be inflation related if I thought about it, but I don't think that that rise is gonna gonna go back down much either. So let's go back to this story a little bit. So they're addressing burnout. Let me talk to you about this, cuz I'm always curious. They talk about the digital transformation.

And when we talk about digital transformation and we talk about it a lot on the show and you listen to the show when you hear this and you hear, oh, this is what Providence is doing, and this is what Cedars is doing. And this is what New York Presbyterian is doing. How do you translate that into your size organization in your area?

I think it scales to some extent. So you know, we just came off a collapse, I guess it was of three the three hospitals into a single system. We went with Meditech expanse.

So my two thoughts are, is that developing a robust and strong governance over how you bring in technology and how it's implemented is very, very part. We have a what we call a CEO cabinet, which contains all the leadership, including myself. And we make very, very thoughtful decisions on how things are implemented.

And then we also have a clinical group our clinical information management team. Multidisciplinary team of providers, nurses, all sorts of representation. And that's how we roll out technologies. It is agreed upon from those groups. We adopt or we don't adopt best practices. Like I said, new technologies coming in new software packages documentation templates, those types of things.

It's a great group. And I find it that collaborative group that we came together with that originally informed north country. He. Was a big part of that on the side of looking at burnout. We had some great physicians that have gone out, looked at this, have gotten additional training and are part of a group that are working on burnout on all levels, not just on a provider level, but all levels. And I can't, I can't say enough good things about the work that they're doing.

it's interesting. When we talk about an EHR migration. I used to tell people it's, it's like, I take your PC and I give you a Mac or I take your Mac and I give you a PC. And I say, okay, now go about doing what you normally do every day. And there's enough change in it. And it's still a technology it's still gonna print to the printer. It's still gonna get on the internet and that kind of stuff. But there's enough change to it that you have to think about almost everything you're. doing Because the workflow changed, this changed order sets changed you name it on the Mac to PC.

And somebody said to me, once he goes, I, I think that's that may be a little bit too stark of a contrast. It's not like you're changing everything. It's more like you take the iPhone and you give 'em an Android device it's not as, quite as jarring of a transition, but one of the things I always tell people.

is we did our physician satisfaction survey the day after, or like the week, couple weeks after the migration. And the reason we did that was to get the benchmark, cuz I knew the benchmark would be as bad as it ever was gonna be at that moment. And then you could, you could grow from there and it's, it does take a hit cuz it's a lot of change to somebody's workflow at the, at that point when you make that that initial change and then it gets better every day after. that that

We came together as three hospitals. So the EMR forced us to align some of those best practices that were individual best practices and to standardize on those as the EMR came into play. And I think that also caused an additional level of disruption and challenges because they had a way of practicing it and they wanted to adopt the new software to those practices. But. Then they also had to get together and collaborate and work together to connect with a solution that would meet the needs of all.

I think they're getting there. We're in the optimization mode now, and the collaborative efforts have been, have been great. The physicians have actually been phenomenal.

📍 📍 We'll get back to our show in just a minute. I'm excited to have Meditech as a partner of this week health. They were a great partner of mine when I was CIO at St. Joe's and we ran 16 hospitals on their platform, and I love their vision for the future. EHRs, have the power to transform care. And with Meditech expanse, you're gonna have all the tools you need to monitor at risk patients.

Use genetic data for better decision making. And deliver prompt, personalized care on the go Cy expands quickly ascended the class rankings to become one of healthcare's top two overall software suites. Visit ehr.meditech.com to learn more. All right, back to our show. 📍 📍

All right. So the next article is hospitals to experience financial strain over the next decade. And this is a, report that said telehealth is expected to resume. It's climb by 2032 account for 27% of all evaluations and management visits.

Talk to me about telehealth in your area. So where were you at prior to pandemic and where were you at post pandemic with regard to te.

I think like many, we were, we were virtually nowhere prior to the pandemic, very minimal use. And then we skyrocketed and then we've sort of settled down. I would say that we're probably not like a lot of the industry there somewhere seem to be around 18 to 20%. We're probably 10 to 12%. Behavioral health being one of the largest, I think in that group it seems to fit that service line extremely well. But there are some, and we do have some challenges.

I think there's a digital equity problem in the north country where we live. There's a lot of challenges with being able to reach people via, what do they have for availability for content plus. Also a level of comfort. They just aren't as familiar with the technology. When we have rolled these out, we've had to spend some time working individually with patients to get them on board. What was a better fit they're much better than they were before, but it's been challenging.

When we talk about telehealth, we talk about anything from phone, all the way up to video to remote patient monitoring in the home and that kinda stuff. Where on those continuum do you guys.

We're doing some of all, probably the majority of it would be video visits. We do do some phone visits, which were permitted. Some remote patient monitoring is definitely in place in a few. Areas. And we do a lot because we're critical access hospitals.

We also do leverage third parties. We have an affiliation with Dartmouth Hitchcock. They do a lot of remote services for us in terms of support for trauma patients, ed, patients that are in there as well as some psychiatric consults.

Yeah. So this story, this story's in healthcare finance and healthcare finance news, healthcare finance news.com. Let me give you a couple excerpts. Hospitals we'll experience, a slowing inpatient admissions, but an increase in the length of adult inpatient stays the ladder being fueled in part by long COVID 19 and a rise in chronic conditions. According to a new report by Viant and its subsidiary SG two, this will lead to greater financial strain due to the rise in patient acuity over the next decade.

That will out pace. Inpatient volume and impact patient length of stay field in part by COVID 19 and its lingering effects. Healthcare organizations can potentially expect an increased number of patients with more complex conditions, creating capacity constraints that may require new strategies for patient care delivery.

And so when I, read and hear something like that, I hear that the pandemic may have shifted things the way we. Think about care, the way we deliver care, but there was also some trends already in place and in play, which is the baby boom generation has impacted everything. That the sale of strollers back when they were actually having the babies to the sale of baseball bats as their kids were getting ready to play baseball all the way through now, they're impacting healthcare as they're getting older.

So there's some trends that were already in play. There's some trends that were impacted by COVID. And I think that the two are sort of coming together to say, Hey, we've got, we've got a challenge and we may need to look at different ways of different ways of delivering care moving forward.

And some of those things, the natural thing is to just gravitate towards telehealth and remote health and all those technologies. When you talk about the digital divide, it's interesting in your area, cuz I'm looking at your background. It's mostly trees, trees, and mountains. I mean, is there a significant digital divide in, in, across north country?

There is, there is. I truly believe there is, and it is cultural to some extent, but yeah, there's some technology challenges. Coverage for things like cell phones are very limited in spots. Getting better. There's a lot of initiative to deliver technology and be able to provide the connectivity that's required for some of these, but there are challenges.

And like I said, there's also an educational gap on how to embrace it. But I think, I think we're closer than we were definitely two or three years ago and things have moved and there's been a lot of infrastructure build out and that continues to occur on part of a couple of groups that are sort of spearheading in terms of getting 'em, but I do agree entirely that we are gonna be faced with some, some significant challenges going forward on the, on volumes of inpatient care. I'll be curious to see how hospital at home comes into play. I think that there's an opportunity there, but it's all based on reimbursement and what's sustainable.

Be honest with you, bill. I don't know. I don't know what it's gonna look like it's in its early stages.

when I think about the so. Couple of directions I want to go here. One is the digital divide. Is that something that I would assume that's something that gets addressed by the state or by the federal government?

I mean, that's one of the areas to look at because the financial model of putting up towers and whatnot in your area is probably not there for the Verizons and the AT&Ts of the world and the state government and whatnot has to probably step in and push that initiative. I would.

They do they do. I think a lot of it comes from the state. A lot of it comes from federal subsidies. that will go into play because there's just not a market to be able to address it there, to be able to justify the cost. I think that there's a significant push out to at least get some of the local towns.

Now we still have towns in the north country that do not have have high speed connectivity. Therefore populations that are served by those towns. Certainly.

wouldn't

Yeah, that's that's definitely something we need to address in order to not only move healthcare forward, but also education and all sorts of other things that are available on the internet. It's just amazing to me. The amount of education that's available on the internet today? I can attend MIT classes. I can download all sorts of just great content that used to only be available to a select few. But now is available to anybody in north country at this point. It's pretty amazing.

Yeah. My son is in his second year of college and has never stepped foot on campus. It's just, it's just impressive to think about what's available.

Yeah, I got my MBA without stepping foot on a campus. It is interesting how things are changing. when you think about technology outside of telehealth, and this is I'm gonna stretch you a little bit.

Outside of telehealth, I mean, how do you approach this change? How do you talk about the technology that's gonna be required to approach this change in the coming years with higher acuity and volumes

I, I, I think it's, I think it's gonna be a real test for healthcare and the creativity behind it. I think there's gonna clearly be some casualties. We've seen a lot of casualties already of hospitals, particularly community or rural hospitals that are challenged and have closed, but I think you've gotta get creative on your patients and the relationships with them on delivering the technology and work with them.

And Honestly bill that could be helping deliver technology to the home, which is why I'm very, very happy that we have our home health branch, because we can leverage that in some of these cases. I think you have to be very, very close to that patient population. I also think you need to look at new and creative ways for revenue generation things that may be aligned with your organization.

we, we. It at north country healthcare. We haven't had a durable medical equipment line, but we are now we're doing centralized warehousing so that we can do distribution to all of our facilities. We have, I think, 22 different locations now, very, very expensive to get deliveries to. So we're gonna take that onto ourselves, but another challenge we have, and I think it's, it's prevalent everywhere. You have a challenge with recruiting staff, providers, nursing staff, but we have a huge housing shortage there. There's still, the market , is just there's no, there's no inventory available. We could be looking at doing investments in real estate.

To try to to try to offset some of those costs or to lure people in transportation services. You could open up gyms. There's a lot of different things that we're, I think we're gonna have to look at in order to generate revenue that are aligned with our healthcare mission

wow. That's really interesting to think about the different paths that you can can take there. And it. Does lead us to one of the other stories here. The next story we had, and I think I'm gonna skip it, which is 12 hospital skilling back care.

And the reason I'm gonna skip it is because that really lends itself to what you were saying. I mean, there's a lot of decisions you have to make in terms of what can we deliver and where do the financials really make sense? Where do they not make sense? And we are seeing a lot of health systems look at it and go, you know what, even on things like like labor and delivery, they're saying, look, there's another hospital down the street that can do labor and delivery.

We're gonna, we're gonna stop doing that. But the creativity that's gonna be required in areas like yours in terms of reaching that population, thinking outside the box durable medical goods gyms and those kind of things. that's interesting to me going into the homes though, that's that really is a that really is a challenge.

We started that process back in 20 12, 20 13 in Southern California. And what we found is that once you've gone into one home, you've gone into one home. And once you've worked with one patient in the home, you've worked with one patient in the home. And so we put we create, we had a partnership with a startup and they were playing around with different technology in terms of how to put it in the home that a person could step on a scale. It would report back and it would give us all this information. And we found a handful of, we, we learned something every day we were doing. One is you can't put an iPad, no matter how much it's locked down, you can't put it in the house and expect it not to move. They just move. And so our first model iteration of this, the iPad collected all the information and then moved all the information up into our environment.

And invariably, at least two or three times a week, somebody had moved the iPad. Somebody. Not plugged it in, unplugged it, what you name it, something happened. So we had troubleshooting stuff around that. The other thing we found is that the most important thing in some of these at home things is the call center.

Because a lot of these people. Are isolated and lonely and just want to talk to somebody. And so we would end up with 20, 30 minute phone calls and we, we learned that it was important to call these people on their birthday and just say, Hey notice, it's your birthday happy birthday. It's it's so interesting the things we learned going into people's home. That we didn't anticipate prior to doing that. It is such an interesting advancement for us.

Yeah. I, I think our home health and hospice agency has done a fantastic job and, and they are really excelling this year. The volumes that they're seeing, they they're one area that's just increasing are exponentially and, and it's impressive, I think somewhere in there lies what the future will hold is in that care delivery model. I agree with you on the technology being in there, and a lot of that telemetry that you collect, I'm not really sure how you're gonna digest, consume and put that into meaningful data for an already overburdened provider workforce that, that has to look at this.

They're just, you have to somehow use the technology to automate some of their workflows and then to also take some of that information and present it to them in a way that's meaningful, as opposed this volume of additional data.

I'm gonna pull from this last article and we talked about this last week, how are the leading CIOs dealing with the perfect storm in healthcare?

And we didn't get to the bottom half, which is the half I want to talk to you about. And so they talk about collaboration with industries being something we're gonna see more and more from healthcare. And the second thing they talk about is wellness solutions. And you touched on this a little bit.

When we think about wellness, how do you think about wellness in, in your market? How are you addressing wellness in your market?

Are we talking bill about patients? Are we talking about provider wellness wellbeing or everything as a whole?

Yeah. I'm more thinking it aligns in terms of patients and the population that you serve.

So we've got some ACO initiatives that we've worked with to try to look at some of the data that's out there, claims data, but also social determinants and try. Bring that information together and that's all, that's all very, very helpful. And I think that's a positive move, not because of the reimbursement model, but I think generally in wellness of a patient understanding the entire patient.

But going forward, some of the wellness initiatives that we've put into place are part of our primary care rollouts. So when we have primary care, we are working with those patients. We're trying to be proactive. But it's a, it's unique to each patient, to be honest with you from what I've my experience clinically of course would be limited, but just seeing the rollout of how we've done it, it's patient to patient, family, to family. And I think it's the only way to truly get wellness completely covered.

So when they talk about collaboration with industries I think this is easy when you're talking about Boston Chicago and those kind of things. You have a lot of employers and whatnot. You're collaborating with. You have a lot of industries that are looking to Perfect their technology before they go to market. And those kinds of things. What do partnerships look like in rural America?

For us, they're very limited. The populations, they might be good for pilot tests and we've worked with vet tech to do a lot of pilots on new software and new models that we've looked at service services that they're offering.

And we've been sometimes on the on the leading edge of. But those are small role. Also. Those are small pilots, real beneficial collaboration with industries outside of group purchasing organizations or things like that are very, very limited here.

It's interesting. When I moved to New Hampshire, our first year of marriage and I started looking for jobs, I realized living in Wolfborough. I was gonna, my wife had a job in Alton bay, New Hampshire. Which is, it's just beautiful area, right on lake win. Psaki it's just amazing. But it is a it's exactly what it sounds like. It's a vacation spot, right? So all the people from Boston come up and they have places on the lake and it's just, it's gorgeous.

And the winter and the summer it's, it's gorgeous. But the town swells to like, Six or seven times its size during the summer, as it is in the winter, even though they have skiing and that kind of stuff. But I learned early on that for me to get a job, I was gonna have to drive at least 45 minutes from there.

If the job wasn't gonna be construction or Or working in the grocery store or that kind of stuff. I was gonna have to drive 45 minutes for a tech job or something to that effect. And I just wanna give people a picture of what we're talking about here. When you say partnering with industry, a lot of the employers and whatnot in that area are, are significant large employers. There's probably a handful, but there's not there's not a Boeing. There's not a there's not a massive employer. I remember defense contractors were big back. When I lived there but I would have to go all the way down to Portsmouth, which would be an hour and a half drive to get down to the defense contractors.

And it's just a different, it's a different thought process of how do you deliver care to that population and how do you get them connected? And because we know that social determinants, one of those things is employment. One of those things is education. And so there's an awful lot associated with wellness and the challenges of reaching that community. I'll give you the final word here and then we'll, we'll be out.

No, that's that's great. No, we're you're absolutely right in Northern New Hampshire we are the largest employer. That's it in the entire county, our collection of facilities. That is it. So you get an understanding of how important the hospitals are to this area. The industry is very limited. There's some pockets of it, but most of it's based on tourism definitely a challenging area. But it's a great place to be like, as you stated before, it's a beautiful, beautiful part of the country. And we've got a lot of great things that we can do here. So it's a privilege to be here, to be honest with you.

Yeah, and it looks it does anyone who's not watching on YouTube is not getting the picture. Are you actually north of the white mountains? Aren't you?

We are, we are, we have one hospital that sits on the Canadian border.

Wow. we used to go to the outlets at the white mountains. I don't know if those are still there, but the LL bean store was was something else. It was,

yep. That's still there. Keep going north. We're another 45 minutes north over there.

Keep going north. I didn't, I assume that was the end of the country, but evidently there's a whole world just above the white mountains. That's fantastic. Darrell. I wanna thank you for your time and thank you for the conversation and thank you for the work that you're doing up there.

Bill. Thank you so much for having me. It's been a pleasure and it's always great to listen 📍 to.

What a great discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to show just like this one. It's conference level value every week. They can subscribe on our website thisweekhealth.com. They can also subscribe wherever they listen to podcasts. Apple, Google, Overcast. You get the picture. We are everywhere. Go ahead. Subscribe today. We want to thank our news day sponsors who are investing in our mission to develop the next generation of health leaders. Those are CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst. Thanks for listening. That's all for now.