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October 24, 2022: Sherry Montileone, Chief Information Officer Information System at Citizens Memorial Hospital joins Bill for the news. An American Journal of Managed Care study showed that Massachusetts patients prefer getting medical treatment at home using a state program instead of at the emergency room. Patient attitudes towards the mobile integrated health program were very positive. Telehealth has become an integral part of the mental healthcare landscape. Benefits include expanding care access and closing health equity gaps. Addressing healthcare inequities is no simple task. However, opportunities exist to bridge gaps in healthcare by leveraging patient engagement technology.

Key Points:

  • Care in the home is a very important part of rural healthcare
  • When it comes to social determinants of health, the biggest thing is just providing access
  • Addressing healthcare inequities is no simple task. The causes are complex from environmental to socioeconomic factors and it's challenging for provider organizations to address them
  • Citizens Memorial Hospital
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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.

We always are trying to just leverage what we have. We hate bringing new systems in. There are sometimes you have to but the cost of bringing other systems in and we all know, even though integrations come a long way, it's not the same. You lose something in translation with integration.

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. Today we are joined by Sherry Montileone CIO for Citizens Memorial, and we have a lot of news to discuss this morning. Sherry, welcome to the show. I think you will. first of all, before we go anywhere, tell us about Citizens Memorial.

Citizens Memorial is in b Oliver, Missouri, and basically we are a rural healthcare delivery system. We have a community hospital, we have clinics, specialty surgery center. Something that makes us unique is that we have a strong long-term care presence. We have six long-term care facilities, residential care, home care, hospice.

We also host our EMR and our computer system to a critical access hospital in the area, an independent clinic, and for FQHCs, which are federally qualified health centers that provide everything from dental to mental health to healthcare. So we really are kind of the sole community provider in about a 10 county area between us and our partners.

Yeah. So you're you're almost directly south of Kansas City.

We are. Yes. Yep. We're close to Oklahoma, Kansas. Borders, we're south of Kansas City, about two hours north of Branson.

Wow. Yeah, I've driven near you, I've driven through Springfield and I guess there's that area, is it called Four Corners?

That's right there. Mm-hmm. . Yeah. Driven through there on the way to the West. Yeah. That is that's the country. Yeah. when you say geographic area, how much in terms of Miles. East and west are you covering

From the hospital? If you drop a pin, you could, you can basically drive an hour to an hour and a half, anywhere around it in a circle.

And we have all of that area. We also have ambulance services and pharmacy. Services. So trying to remember all of our business lines. I grew up in the area. I moved away. I grew up within our service area. It is very rural. And really I grew up poor. No central here. Air, probably the poster child for today's social determinants of health.

And the area still does have a lot of rural. No broadband low income, no public transportation. Lots of challenges like that.

I appreciate you coming on the show, I love having these conversations. I try to tailor the conversations to the, to the people who I have on the show.

And some people are probably tuning in saying, Hey, are you gonna talk about. The Common Spirit out outage. And the answer is, I'm gonna talk about that, but I'm gonna talk about it with Ryan Whit, who is a cybersecurity expert, rather than try to tax you with that one. I'm sure you're following it, but just not as closely as Ryan is cuz he's associated with cybersecurity and whatnot.

But you and I are gonna talk about the different forms of delivering care, which I think is so important in these rural areas. So the first one we're gonna talk about, there was a study, . So this is Boston Business Journal and the title is Mobile Integrated Health Program preferred by Patients with Option study says patients preferred getting medical treatment at home using the state program when possible instead of at the emergency room, according to a study published. In the American Journal of Managed Care. Now, I would imagine in a, in a situation like yours, it's a lot less about preference and a lot more about just necessity.

I mean, reaching out to geography of that size. So we're gonna talk telehealth. We're gonna talk about providing care and home, and we're gonna talk about patient engagement today. Care in the home is that an important part of rural healthcare?

Care in the home's a very important part of r ural Healthcare. And I guess before I get too far into it, I wanna kind of explain the system that we're running just for the context. So we have the Expanse, the Meditech Expanse emr, and we've been Meditech customers for literally 20 years as of October 1st of this year. We moved to, and I've been there for 22 years.

ology systems to Meditech. In:

So obviously we already have skilled nursing, long-term care, home care, hospice. The newest model that we're gonna go into is this mobile integrated health. So we got some grants that have already started and we're planning on standing up the service in early next year. And it's gonna bridge that gap.

It's not hospital at home, but it definitely bridges the gap for patients that maybe were Ed super utilizers, or maybe they were discharged from the hospital with a condition that has a high readmittance rate and everything proves. And we just know that it will be a success for people to be able to, get care in their home, like I said, it's a rural area. It's a big deal for some of these patients to be able to come in and we think that meeting them in their preferred care setting is gonna be. it's gonna improve outcomes, improve patient satisfaction. It just makes sense. my mom actually is a perfect example. She's a below the knee amputee and it's a big deal for her to get in the car and get to a specialist. This is the perfect kind of of bridge for her.

so you think this kind of study would hold up across your geography. If you did this same study across your geography, you would find a preference towards care in the home.

Absolutely. Yeah. And we did. Our home care business post covid is just busting at the seams. Business is way up for home care because people are delaying. Acute settings and we did a study a few years ago on remote monitoring for our home care patients and the effect it had on readmissions and patient satisfaction and the numbers were very high. There was no question that it was effective.

📍 📍 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 let's talk about this. So what they have in Boston is this paramedics are taking the care out to the individuals in their homes and whatnot. Let's talk about the platform a little bit. So I wanna focus in on the, on the technology.

You already talked about your, your EHR being a key. Platform. So Meditech expands because it is integrated from the home to the clinic, to the hospital. So acute to ambulatory to the home. You have a, a single medical record, a single point of truth. So that's obviously one of the core platforms.

Is there other technology platforms that you are integrating with the EMR in order to deliver this care at.

I don't think so. And that's the really great thing. We've just started deciding how we're gonna actually implement this. But the really nice thing is that we're gonna get to decide do we push this from the acute side, which has care management and care transitions and remote monitoring and te.

Or are we gonna push these visits from the ambulatory side, which also has the same features. So I think right now they're leaning to these being ambulatory visits, but I don't know for sure. The nice thing for us is from a technology standpoint we can support remote monitoring and telehealth from either side and for the providers telehealth, I don't know how everybody's system works. We were very lucky to have telehealth working within Meditech whenever the pandemic hit. So we didn't have to toggle out and use Doxy Me or some other platform. The telehealth visits show up on a provider's schedule just as if the patient was there. They just have a video camera next to them. So it's really nice integrated workflow.

Yeah. So talk to me about the acuity level of the care at home that you're looking at. so what acuity level are we talking about and to what level would we consider, is this more of a chronic condition kind of thing, or is this more of a remote visit kind of thing?

Well, and that's all still to be determined, but right now the model is going to be, I think the target is to reduce emergency room visits as well as readmissions and it could be expanded of course for anything. But initially I think the target is going to be your home, You don't qualify for home care, you don't need to be in skilled nursing.

And we've identified a subset of patients that are gonna qualify. And I think it is like a 30 day period. I, I don't know the details on the patient subset specifically, cause I'm more on the technical side. I just know. We can provide the two.

One of the things I love about your solution is when you don't have an excess of money, it doesn't get confusing. It's like, All right, this is our core system. We have an integrated system from one end to the other. We're not gonna bring this in, and this in and this in We're going to build off of what we have. And a lot of times these conversations go right into rfp, Let's talk to different providers, different solutions, and you guys are just looking at, Hey, this is what we have and this is what we're gonna deliver to the community.

Yeah, we always are trying to just leverage what we have. We hate bringing new systems in. There are sometimes you have to, but the cost of bringing other systems in and we all know, even though integrations come a long way, it's not the same. You lose something in translation with integration, you don't get all the data points. You've got two places to run reports or manage quality metrics or patient safety and so on.

All right, you mentioned social determinants. We're gonna turn to a different story, this one from mHealth Intelligence, and it's why telehealth has become an integral part of the mental health care landscape. Do you guys partner for mental health services or do you

we had telehealth working in:

And so whenever the pandemic hit and we had to go virtual, I mean, it was patients, virtual providers, virtual we had a different challenge every day. And mental health and substance use disorders were, and continue to be our highest. Telehealth usage and it makes sense to me. Like I said, growing up in this area, it just makes sense because it removes all the barriers that would keep somebody from attending a, an in-office visit.

We don't have any public transportation. You might have to drive an hour, an hour and a half. It costs money. There's stigma you've got childcare issues, you're missing work. And so we're really delight. The success of telehealth,

you just captured a whole bunch of the articles, so benefits include greater access for care for the underserved population such as rural communities, racial minorities, even formerly incarcerated people. And this article is from a panel discussion that was hosted by the American Telemedicine Association. Let me just give you a couple quotes from it.

Let's see. I think there's so much value in seeing kids and their families in their natural environment of home, where they really get to understand what their real self is and what their issues are. This is from a doctor who is on the. Who was using Teledoc to talk to some of those patients.

Sometimes that's because they're in a small apartment. There's just really simply no place to go which causes some of those challenges and issues. It's interesting because that is, when we talk about social determinants, That telehealth visit is a window, right? Yeah. It's a window into what we're seeing that they're living.

And obviously it's not perfect cuz it's a window. Like I have no idea what's on the other side of your screen cuz all I see is what's behind you, which is a lovely family by the way. But I, I don't know the rest of the room you're in and that kind of stuff, but it is a window you get to. Some of the things and I think as a physician, that's one of the things they've appreciated through the pandemic with the rise is they actually get invited into the home.

Yeah. It's just a it makes perfect sense to me and it's not perfect. You can't do a physical exam, but it is removing a barrier. And I think most of the patients that are doing these visits just feel more comfortable. I mean, the satisfaction rate's very high for them because you just remove the barriers and they're more comfortable and less anxious, and it's just, providing access.

To me, whenever we talk about social determinants of health, The biggest thing is just providing access. Telehealth is access letting patients have access to their records on the portal. Is access. Doing online scheduling or fast check in? All of that's just access. It makes sense to me. Every other business in the world is doing it.

I, I'm sorry. Are you doing all those?

We are in the process of doing all of those things. The online scheduling right now, we're hung up with a technical issue, but we hope to be live with that soon. Our portal the benefit of having one system across all the service lines is that all of that data goes into a single portal.

So our, our portal rocks. I mean, there's no question that it has all your medical record and it's funny, with all these new regulations on. the 21st Century Cures Act and the information blocking and we had all of that data. We're an open note site, so we had all that data on the portal way before you were required to. 📍

📍 we'll return to our show in just a moment. I wanted to take a second to share our upcoming webinar. Cyber Insecurity in Healthcare, the cost and impact on patient safety and care. Cyber Criminals have shut down clinical trials and treatment studies cut off hospitals, access to patient records demanding. Multimillion dollar ransoms for their return. Our webinar will discuss it. Budgeting project priority, and in distress communication amongst other things. To serve our patients affected by cyber criminals. Join us on November 3rd for this critical conversation. You can register on our website this week, health.com. Click on the upcoming webinar section in the top right hand corner. I look forward to seeing you there.

📍 📍

One of the other things panel discussion talked about is the shortage of mental health and behavioral healthcare providers. I assume you, just like everybody else in healthcare, your system, just like every other healthcare system, is struggling with the shortage, not only of mental and behavioral health practitioners, but also clinicians in, in general. how is technology playing a role in addressing that challenge?

Yes, we are definitely experiencing all the labor shortages. Technology. To me, our, our obligation to our coworkers is to remove all the mundane work and we try. Our goal is to try to do things that will let people work at their highest level license level. I don't want a nurse to waste her time doing something she shouldn't have to do. So Telehealth addresses that because quite honestly, You can leverage one person for many patients. And like with our school based I say we had behavioral health counselors in the schools. We also do school based telehealth where we have a telehealth program.

That one pediatrician in our clinic can see patients in any of the schools. To me that's an efficient use of their time. Our providers can be remote if they need to, and of course during the pandemic, that happened quite a bit. It would be. I'm positive with Covid, but I still wanna see all my patients, so we're gonna move them all to virtual.

And so we work all the time on trying to add value to what we do so that we can make the people we have work at their highest level.

it's really interesting that challenge of, Not enough caregivers for the communities that we serve continues to be a I don't know. Increasingly difficult problem to solve. Yeah. And clearly technology isn't the only solution to that. But it is going to be a solution to it in that in every other industry we've seen efficiencies and gains. When we've redone how processes are done and it's, it really is stepping all the way back and saying, We've taken the paper and we've, we've turned it into these processes, but we've never really re-engineered the processes for a digital world.

And yeah. And that's what's going to, I think, take some time. But I love the stuff you're talking about because Again, I just go back to, and I, I hope it's not offensive, but you, you're not a, you're a rural health system, so you're not overfunded. It's not like you're, but you're still delivering on all those same things that we talk to very large health systems that they're struggling with too.

Getting to the online scheduling across the various practices. That's a challenge for major health systems, mostly cuz. Different EMRs and it's, right, it's, it's hard to aggregate that the patient record getting ready for 21st Century Cures having a conversation with you is almost like having a conversation about what the future of healthcare could look like.

Oh, that's awesome. I mean, it is really, It really is fascinating. All right, last I wanna talk to you about patient engagement technology. So this article came from health data management.com and it's patient engagement technology can lessen health disparities, health data management.

so let me just give you a couple excerpts addressing healthcare inequities is no simple task. The causes are complex from environmental to socioeconomic factors, and it's challenging for provider organizations to address them. However, opportunities exist to bridge gaps in healthcare by leveraging patient engagement technology, remote patient monitoring staying connected with patients outside the traditional medical setting.

And they go in and talk about, let's see, connecting patients with resources. Many poor and disadvantaged people do not always know how to seek care, which can lead to uncontrolled chronic conditions, unnecessary visits to the emergency department, poor outcomes, and worse sms. Text based communication is widely accessible for or worse period.

I should stop there. SMS text based communication, cuz SMS text based communication, quite frankly is one of the best ways that we have found to communicate with this population cuz almost a fair number of 'em have, have phones. A fair number of 'em have text based access to text messaging.

Is widely accessible for almost all communities and is a very effective way to reach people and build trust in for healthcare providers. And by automating a series of messages that combine different content, including videos and easy to understand handouts, healthcare can become more holistic and less episodic.

I assume you're, you're dealing with socioeconomic all over the board. I had this conversation with, I was presenting to a large group within our health system, and we covered every socioeconomic Demographic you could think of. And the sisters, cuz I was with a Catholic health system.

I remember them saying your technology plan is great, but what about this population? And and it was interesting cuz over time we've done studies and I, I'm not saying everybody has a cell. , but the numbers are staggering in terms of Yeah. Even amongst the disadvantaged population, how many of 'em have cell phones and access.

how do you guys view this? I mean, obviously you have to have omnichannel, different ways of reaching people. How do, how do you view this challenge of equity and reaching the entire community?

I, I do agree with you on the cell phones. I mean, I think that most patients have cell phones at this point, and even though we do have some service areas where cell phones service is still a little spotty almost everybody's got a cell phone, and I really think it is, We consider it the primary computer for most people.

I mean, lots of households don't have computers anymore. Almost everybody has a cell phone. So we're just trying to again, just remove the silly barriers and make ourselves as accessible as Amazon or some of these other companies. Cuz quite honestly, I, I think that's part of our competition.

We have to be as good as them. we push the portal, every patient gets enrolled in the portal. They don't have to use it, but they all get enrolled. You can message over the portal, should soon be able to do an online scheduling. We promote filling out your questionnaires ahead of time and that makes the office visit more efficient.

So if my first five minutes isn't answering some lengthy questionnaire in the office where maybe I'm less likely to give a truthful answer I can answer that beforehand and when I show up for my visit, they can consume it into the chart. But for us, really, it's just all about removing barriers and we think a lot of that is gonna be on the mobile platform.

And are you guys saying anything with remote patient monitoring at this?

We are, we've done remote patient monitoring in the home health setting, and then we have remote patient monitoring via Apple Health share right now. So we were one of the first sites to go live with. Our API allows you to connect to our system via Apple Health, which is cool because you could pull all of our data into Apple Health and you could aggregate it with.

Other sites that participated with Apple Health and have a, a longitudinal record across facilities, then Apple Health Share is the next part of that. Any of the wearables that I've got connected to Apple Health, I can actually give permission for that data to be available within Expanse. So whenever my doctor opens my chart up, it shows I'm an Apple Health Share user, they click on it and it does a contextual launch over to what I.

Decided I wanted to share with them my sleep, my steps, whatever, my weight, whatever. So with this mobile integrated health, I'm sure we'll be doing remote patient monitoring. And thankfully we can step that all up in the system to where you set up basically your prescription for the mobile monitoring and any kind of out of band would set up an alert and somebody would get involved.

We talked about how powerful texting is. Do you have texting integrated into your patient communication channels?

The portal lets you message back and forth within the portal and it's secure messaging between you and your provider and the offices.

We do have texting for appointments. So you get texted a reminder and press one to cancel or two to confirm. We do not have real time texting like with a bot or anything yet. We're looking at that because I, I do believe that that's the next step. It's like you said, it's really what people are used to.

Sherry, is there anything we didn't cover in terms of what you guys are doing? I mean, this ended up being more of an interview cuz I'm, I'm really fascinated. I tell people this story from time to time I was on a panel and now I had 700 people in my I 600 something IT staff and over a hundred contractors in my IT organization.

And I was on this panel and there was three of us and we were talking about how we. Kept pace with regulatory environment. And the woman sitting next to me, who is my hero had a staff of I think like five to 10 people, I think. And she had, she had all the same stuff I had to do. I mean, regulatory requirements, you name it hipaa, 21st Century Cures, and she was just rattling off.

It was like, here's how we do this, here's how we do this. And I. You are my hero. I can't, I, it's amazing. Yeah. I'm always amazed with the ingenuity of organizations like yours and leaders like yourself. And how are you able to get so much stuff done? It's amazing.

I appreciate that. I think sometimes it is actually easier. We are a flatter organization. I came from a larger Cerner shop. I've been at at CMH for 22 years, but I was 13 years at a larger Cerner shop. And when I came to cmh, I was. Only gonna be there temporarily. And then I stayed 22 years because I loved the, it was just a very strategic, flat organization.

We can move quickly not worry about punitive damages. There's no two year cycle on a decision process. We can literally just all come in with our best ideas and say, You know what, let's try. And, and I liked that.

So when I rolled out my portal, I had to go talk to five physician groups, and each physician group had veto power.

You could, you could imagine how much fun that was. It was like, Hey, we don't like the way you're positioning the medical record. Can you change this? Can you change? Okay, so we change it. Go to the next medical group and they go, Why'd you change that to this? It should be this. You'd be like,

I, That's where I came from was the ER physicians wanted T sheets and the surgeons wanted surgical information systems and all those systems are great, but there's a big heavy load on getting them integrated.

We just had a dermatologist start and he quite easily could have demanded. That he get his own dermatology emr, cuz they're very nice, and so we sat down with him, we did the demo with the dermatology emr and we said, Here's the deal. All of our patients are in our emr. And while they say there's integration, it's not perfect.

You don't get everything. You're gonna have two places to go and Meditech's gonna be the mothership because that's what we, that's just our strategy. And so we said, We're gonna build templates, we're gonna let you take photos and automatically import them into the record. We're gonna try to do everything this other system does.

Will you please work with us? And and he did, and his office did. And they're successful on Meditech and we're tickled pink that we're not supporting another system.

Yeah, absolutely. Well, Sherry, thank you again for your time. Really appreciate it. And yeah, look forward to doing this again sometime.

Thank 📍 you.

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.

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