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August 17: Today on TownHall Matt Sullivan, MD, Chief Medical Information Officer at Advocate Health speaks with Joe Evans, MD, VP and Chief Medical Information Officer and Dave Torgerson, Chief Analytics Officer at Sentara Health. The three delve deep into the challenges and complexities organizations face in streamlining analytic reporting, particularly in large setups. Dave and Joe share their experiences in attempting to centralize information sources, the utilization of Epic for analytics, and the significance of user experience in analytic platforms. How did Sentara tackle the challenge of providing centralized analytic reporting in a large organization setting? How are they ensuring the security and controlled access of reports, especially when integrating with tools outside of Epic? Why is the user experience a paramount concern for Sentara, and what measures are taken to ensure simplicity and intuitiveness in their analytics platform?

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Today on This Week Health.

I happened to be at a conference, one of the analytics conferences and somebody had presented on their portal, great portal, and, we opened it up for discussion and said, hey, we're going to use Epic to do this.

Like, what? You can't use Epic to do that. It's like, well, no, you absolutely can. Here's why.

Welcome to TownHall. A show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels dedicated to keeping health IT staff and engaged. For five years we've been making podcasts that amplify great thinking to propel healthcare forward. We want to thank our show partners, MEDITECH and Transcarent, for investing in our mission to develop the next generation of health leaders now onto our show.

We'd like to welcome Joe Evans and Dave Torgerson, both of whom are at Sentara. And good colleagues and friends of mine Dave is the Chief Analytics Officer and Joe is the CMIO. I'm really glad to talk through really a problem that I think is one that all of us face, which is where in the world do you go to get analytic reporting?

And how do you do that in an organization of size? And that's very confusing to many of us. So I know you guys have walked through that journey and I wanted to get some insight as to how you did it how you landed it. So go ahead.

Yeah, I guess I'll start. first, thanks for having us, Matt.

It's pleasure to be here. Nice to chat with you and good to be with my good buddy Joe here. In the world of analytics and reporting, one of the, things that, folks yearn for all the time is, I'm getting things from here, there, and everywhere.

I'm getting emails. I have to go here for this and there for that. Wouldn't it be nice if I could just go to one place? and find kind of all the things I need and be able to find them in a way that's really, intuitive, right? So that's, that's the challenge, right? And so, a number of organizations have sort of tacked this systems across the country and most of them who've been successful have kind of built it themselves.

They tend to have pretty robust software development capabilities, and they'll use a web based... They'll just develop a web based application and a content store and start loading all their content into it. They can wrap nice things around it, including search and images and filtering and all sorts of stuff.

It's a nice approach because the advantage you have is you can do whatever you want. You can customize it to the next degree. The downside, of course, is you gotta pay for it, right? You gotta spend a ton of money getting all these people developing software. It's a one off solution, you gotta maintain it, etc.

So, as fate would have it, as we were looking to try and, accomplish this at the time we really didn't have that robust of a software development capability. It's more robust now but at the time we really didn't have the capacity, nor did we have the sort of appetite.

To spend for this particular capability was difficult, to generate the ROI. So we just happen to be sitting with EPIC, kind of going through some of their emerging capabilities, and it kind of sort of flashed past this analytics catalog thing, and I kind of stopped and said, wait a second, go back.

And we started probing it a little bit. So what does this do? Like, how does it work? And, on the surface, it seemed like it hit a lot of the basics you'd want reporting portal, right? the most important thing being, can I get to content that's not in Epic, right? Because most of what we do.

Particularly for executives and leaders, and given that we're an integrated delivery system, we have a health plan in addition to our clinical side. Most of the stuff we produce is outside of Epic. We're using Tableau, or Power BI, or another BI tool, or it's a static report sitting on a SharePoint drive somewhere.

And we needed a way to get all those things into one place. And so we quickly discovered that, yeah, in theory, you can do this with the Epic Analytics Catalog. So without getting into a ton of detail we kind of put it through its paces to say, Okay, well, can I get all content types there?

Yes. Can I do a basic search? Yes. Can I add tags that will allow me to kind of, get to very specific content? Yes. If I have reports that I want to see all the time, can I identify them as favorites and have them persist, knowing who I am? Yes, right? Is there a little bit of a governance wraparound where I can tag these things with metadata and execute a process for both bringing things in and periodically reviewing them to make sure they're current and getting them back out?

Yes, right? So on the surface, it kind of checked all of these boxes, and so we sort of Slowly started kind of going down this road and interestingly enough shortly after we started kind of getting serious about this, I happened to be at a conference, one of the analytics conferences where they bring together, folks like me from health systems, healthcare oriented and somebody had presented on their portal, great portal, and, we opened it up for discussion and said, hey, we're going to use Epic to do this.

Like, what? You can't use Epic to do that. It's like, well, no, you absolutely can. Here's why. And so, interestingly, I don't know if we were the first to do this, but we're definitely an early adopter of this capability. And as of now, just to kind of wrap up kind of where we're at, we've got, about 140 pieces of content, dashboards primarily, and adding more all the time.

So we just, we got the largest tranche of content from Our provider side, so a lot of the clinical reporting, a lot of the clinical process improvement type reporting, we're about to roll in big tranche of content from our pair side. So it's a it's full speed ahead.

Well, that's incredible. So tell me, Joe, on the roadshow of what a CMIO does to sort of sell these kind of innovative tool sets that Dave has described, where did you go?

1st is, did you tackle the CMOs? Did you go after the primary providers? Where was the 1st?

Yeah, I mean, I think the beauty of this from the CMO group is that this is accessible not only for people who live in EPIC every day, because, , they're not always linking out to Tableau dashboards, that sort of thing.

But Dave has also made it enabled so that if you're not in EPIC, you can access the same information. So, I mean, I think it's a lot of great content right in our workflow where we live from the provider space. But also

from the leader space easy to get to as well. 📍

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dave, sort of educate us here, because many of us use these tools infrequently or don't use them to your level.

Epic comes with a ton of preconceived reports that are out there, and how do you differentiate these two? You've got your tranche of data that's collated and really... built for that particular user or that group. And then you've got these stock Epic reports. How do you intermingle these things and how do people go back and forth seamlessly?

Yeah, it's interesting. One of the quotes that sort of, I think, guides us here, I think it was Antoine de Saint Exupéry, who wrote Little Prince. I think the quotes attributed him, let's say, perfection is achieved not when, there's nothing left to add, but there's nothing left to take away.

So a guiding principle for this was, , to your point, there is a colossal amount of content in EPIC, and even if you pull the EPIC Analytics catalog, straight out of the box you will find that there's everything's already in there. All your EPIC Pieces of content are already in there, and so the challenge for us was actually the opposite, and that is like, how do we get rid of all that, not get rid of it, delete it, but make it so it's not a default view for our users.

So, kind of your previous question as well, what was really important to me is that, this has to be an excellent user experience. It has to work for the people who are using it, for what they need to use it for. So, our non Epic users are actually the great example here, because these are not people who are in Epic.

They don't much care about the content that's in Epic, with a couple of exceptions. And so the trick is, how do you set up profiles? within Epic so that a user with a given profile gets started down the right path and then can customize to get to where they need to be, right? So our non Epic users, by default, will only see kind of the external content that we've added.

Right, and then they can get to this other stuff, but it's not there right off the bat and the searches in some cases are limited. The more interesting case of going even further is getting our health plan leaders into the portal and that content because those folks shouldn't see any epic content at all.

you know, HIPAA and all, right? And the restrictions we had. So a lot of really detailed security analysis on how do we set up the profiles to make sure that we can very tightly control the content that they see. And there, they'll be able to see what they're supposed to see, and they won't be able to see anything else.

So, so that's good, right? So we really went in the direction of saying how do we, how do we whittle this down to the stuff that's going to be most useful. And then, of course, we have the ability to tweak that over time as people get more sophisticated. particular group of users wants a wider set of things that are naturally available to them, we can adjust the profiles over time to allow them to get to the things That they need, but it's really profile based experience control and then the corollary to that, and it's an interesting nuance to the way this works, is with the content that's not in Epic, and to some degree within Epic, but definitely the content that's not in Epic, the security controls for the reports themselves are actually controlled by the reporting apparatus.

So, for example, if I were to want to access a Tableau dashboard on readmissions, For example, right? If I'm not provisioned to have access to that dashboard in Tableau, I can see that it's there, right? But if I try to click to it, it won't let me get there. And so what's happening over time, and I have to give credit to some of our partners like John McManus out of Sharp, who have helped to press Epic to add functionality to what the Analytics Catalog can do to help make

those type of experiences even more seamless things like being able to add a thumbnail of the dashboard itself, which you couldn't do up until recently in the Epic Analyst Cog. Things like being able to embed additional links and kind of the description of the report. Things like don't have access.

Click here, right? And things like that, right? Pushing forward their single sign on, which is another big thing. How many clicks does it take for me to get from desktop to catalog? The ideal number of clicks is one, right? How close can we get to one? And so we're going to get there, right? So all these things are fine, but it's really for us about, Really managing the experience because with this particular group of users, there's not a lot of grace.

There's not a lot of patience. If their first time through is a bad experience, getting them back again is going to be really hard. So we focused really heavily on making that user experience very tight. Very simple, very intuitive, and when you get there, you see what you expect to see, and it's easy for you to find the stuff that you need.

It sounds like with that work with payers and trying to get the securities right, that you've actually set yourself up very well to do things like employee health and other things that require a box that's pretty tight as it relates to reporting. I'm thinking about Connect sites that may not be fully affiliated with Sinterra, but you might be operating Epic for them and allow those folks through those changes to actually say, ah, this may, I can't get at this report, but this may be a report that I'm interested in looking at for my own, whatever that box is.

Where are you going next with this? I mean, it sounds like you've done some great work. What are your next steps here?

Yeah, so it's the primary thrust is increasing the scope of the content that's actually in the catalog. So where we started was with our, what I would call our enterprise analytics.

So that's the team that I run, which is most of reporting and analytics in Sitara, probably 80, 85% of all things that are done. We started with our content on the provider side of the house. So a lot of our hospital ambulatory, post acute, those type of reports, broader clinical performance programs etc, right?

That's and I call that approach kind of breadth approach, right? So if I'm a hospital administrator, for example, you're going to see all the content from enterprise analytics. What you don't necessarily see yet is all your finance reports or a strategy as the reports. So that's kind of a depth play.

So our broad strategy is, alright, increase the content and from a breadth perspective and a depth perspective. So step 2, as I mentioned, is a breadth play where we're getting our content from the payer side. And then simultaneously, we're circling back. And executing a depth play in each of the service areas, you know, our queue and our service lines and our clinical process approver programs to say, okay, are we getting everything you need?

Now, ideally, what we wanted to do was really just go depth, say, okay, hospital administrator community, hospital leader community, let's get everything you need. But not everybody besides us was quite ready to jump into that pool. So, we're getting the content in, in the most expedient way possible, whatever.

But that's kind of thrust one and then thrust two will really be. A lot of those new capabilities that Epic is driving into the platform will be coming online for us in, I think, March of next year. So there'll be a big wave of enhancements that we put in place to take advantage of these new capabilities and improve the experience.

And then it's really just, at that point, it really becomes a stabilized process play, where we have a very tight. and efficient process of getting content in and out of the catalog, so it's constantly refreshed. We have checks to make sure everything's working, and that it continues to be a really seamless type of activity as new content is created, as old content is retired, and it becomes just, everything's always there.

Everything's always there. Everything's always there. That's kind of the end state, vision.

Well, Dave, you've certainly tackled and talked us through sort of a challenge for all of us here around an analytic catalog. I really love it. Last question before we conclude here and wrap it up, pitfalls, what would you do differently again if you had to do it over?

Because I think a ton of our listeners are going to think, gosh, I really want to do that. What would you tell them to avoid?

Yeah, I mean, it's, what would I do differently? It's hard to say. I mean, we had a few occasions where we were sort of two steps forward, one step back, but that often had to do with changes that were sort of coming down the pipeline.

So, for example, when we started this endeavor, The functionality within EPIC was such that if I were to click on a Tableau report, for example, it would actually come in the frame of the EPIC window, which is super convenient because I could still go to the navigation capabilities with EPIC. I could go back and go to something else, but the support for that in the chain kind of broke down.

that kind of decreased the quality of the experience in that now you get sent to a different window. So it took us sort of a little step farther away from ideal. Not sure we could have done anything differently to avoid it, but it was sort of a little bit of a setback. You know, What I would say is, if I maybe twist the question just a little bit, is You know, getting your security and your profiles right for this is absolutely paramount.

Communication and education strategy is paramount, right? So what I didn't talk about really is accompanying all this on the side is a very purposeful sort of We have a very consultative model when it comes to analytics, so we have client relationships with folks in our ambulatory area, our acute area and everywhere we serve.

We know the folks and we're speaking to them directly saying, OK, what do you need, right? on something like this, we're saying, hey, we're building this. It's coming. Who wants to be a pilot tester? Who wants to be a beta tester? We run through beta testing, identify anything, we'll find the experience, and then when we roll it with, okay, here's what's happening.

Here's communication. Here's a video that shows you how to access it. Here's the steps you need to go through if you have any problems, yada, yada, yada, right, including sort of the technical steps behind the scene, because the way we access Epic now, because we don't have full single sign on, we're not using hyperdrive yet, is we have a sort of a application launch that needs to happen as opposed to just going to URL.

So that required us to kind of push this icon to the desktops of all our users in advance so that it would be there when we needed to train them to go use it. And of course that requires some orchestration. It's like, why did this thing pop up on my computer? So that's what I say is.

The, like, the tendency is to get really focused in on the technicals and making the product work, but the product rollout, the how you bring it to the masses, as we know, in all things clinical, right, is really where the rubber meets the road and paying attention to that in the same way we would pay attention to, how we're going to treat patients.

That's the way I would recommend that folks approach this. Really be mindful of the stakeholder you're serving and what their needs are and let them help you guide the experience. Well,

Dave and Joe, thanks so much for talking through this. This is incredible work, and I appreciate you being very honest and open with your approach.

And hopefully a lot of us will follow your lead. Thanks again. Thank you. Thanks, Pat.

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