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Even when there was a pullback in the surge conditions, there was still a dependence on telemedicine that was encouraging to us as an alternative form to access clinical care at Scripps. really create an opportunity for us to figure out how can we optimize the experience, both from a technology standpoint? So how do we keep it or make it simple?

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Welcome to the This Week Health Community Town Hall Conversation. I'm Reid Stephan, VP and CIO at St. Luke's Health System in Boise, Idaho, and I'm joined today by my good friend Shane Thielman, who's the Senior Vice President and Chief Information Officer at Scripps Health.

Shane, good to see you.

Good afternoon, Reed. Great to see you.

Okay, couple of standard questions I love to ask guests on this, town hall conversation. Question one, I think people have heard of Scripps Health, but maybe just take a minute and share a bit of, of context and background about who Scripps Health is and where you are.

We're a 4 billion organization. We have a about 300, 000 value based lives that we're responsible for managing and uh, Pretty robust graduate medical education program and, clinical research function and a variety of different partnerships across the San Diego community to help extend our, health care network.

Excellent. And how long have you been there at scripts?

the mission, of course, which is to deliver patient care.

That's a long tenure and I know it wasn't all as a CIO. So maybe just take a minute and just share your education background, your career journey. That led you to the chair that you sit in today.

Sure. Yeah, well, it's been a circuitous path as it probably has been for many.

I, I didn't graduate college thinking that I wanted to be a healthcare chief information officer. In fact, I finished college with a degree in political science and another one in Spanish. I was planning to go back to To school to get a law degree, but knew I wanted to take a gap year or two and strike out and explore things that I felt were of interest to me.

And that took me to, from the West Coast Oregon to South Central Utah and was involved in, facilitating and leading an alternative outdoor therapy program for adjudicated adolescents from Utah and Colorado. I love the work. It was something that I had done throughout my high school and college years, but with different populations, but always in the outdoors and found that that could be really transformational and help create a different type of awareness just through the power of nature and community.

And so, I had really a moment of truth. In that work, I was applying for law school. I had taken the LSAT. I was ready to send off my applications and recognize that that was not the path that I wanted to take and reassessed and, Pursued a master's in health care administration degree, which ultimately took me out of kind of the setting that I was in and brought me to California and more specifically to city of hope for a year as an administrative resident working on operational improvement initiatives.

I learned of scripts health through being in Southern California and found an opportunity as an administrative fellow working in the corporate project management and strategic planning department of the organization, and it was a wonderful fit. I was able to have a lot of different. Experiences and learned about the things I was interested in, and maybe some of the things that I wasn't as well, which was really valuable.

and from there landed in some projects that intersected with information technology and, really had a passion for the work and saw the potential for technology and data and analytics to really improve care delivery and efficiency. And I think ultimately was tapped to help lead a EHR Thank you.

Wonderful team, great organizational support and really importantly, the relationships with our clinical community. I think that really allow for successful I. T. Delivery and support.

Yeah, I love that story that you just shared. I'm curious. So you're Your background and experience as an administrative resident and fellow.

How have those roles helped you in your role as a CIO?

Well, one of the things that I enjoy doing is, serving as a mentor for others. And oftentimes they find themselves in similar roles. And my first bit of advice is, is, say yes to everything. Get as much exposure as you can. And importantly, find what you're really passionate about because what you think you're interested in when you come into health care, regardless of the role that you're in.

If you're relatively new, you really want to allow yourself to move beyond any biases that you may have. And what you may discover is that what you thought you were interested in is actually not what you're interested in. And part of that happens by getting your hands on the work and learning.

And so, that's been kind of an important part of my development. And I was grateful to have exposure to a variety of different business development, planning performance improvement initiatives. And what I really enjoyed was both Doing performance improvement and project management.

But when I was exposed to health care, I really saw that there was great potential to bring all of those aspects together. And it worked well for me and my personality type and how I work with others. And so sort of seemed like a natural fit that I wanted to continue to pursue.

Yeah, I think that's just great guidance.

I was going to ask you, you know, I was new to health care 12 years ago, and I have colleagues now that will ask me, Hey, if I'm, new to health care, like what's the best way to learn? And I think what you said resonates, it's just like, say yes to as much as you can. Just there's no substitute for experience and don't presuppose you kind of, have your career path mapped out, like an enterprise architecture roadmap.

Like it's going to be circuitous to your word earlier and be open to that and be agile. And it's like, you'll be amazed how quickly you start to learn things, but also expand your vision of, what's possible.

Absolutely agree.

Okay. Let's jump into a couple of topics that I want to pick your brain on. Let's start with telemedicine.

And I think you and I were talking earlier, I think it's fair to say that the viability of telemedicine has been proven and I kind of view that we're now at a stage of how can we optimize it and enhance it and figure out, the best way to scale it and mature it. So at Scripps, what are some of the, effective ways that you've been able to optimize your approach to telemedicine?

Yeah, I think it's an area of real interest and passion for me personally, and a team of folks in the IS department at Scripps that get up every day and, try to answer this question. And I say try, because I think this is all about experimenting and Going to the GEMBA, going to the frontline and really understanding both from the provider perspective, the care team standpoint, as well as the patient where the value is created.

But what we saw in our organization after we initially deployed was that even when there was a pullback in the surge conditions, there was still a dependence on telemedicine that was encouraging to us as an alternative form to access clinical care at Scripps. And it had always been on our roadmap as an organization that we would have an offer of telemedicine services, but the pandemic and the conditions around it, as well as The relaxation of some of the guidelines and the ability to support the funding and reimbursement associated telemedicine really create an opportunity for us to figure out how can we optimize the experience, both from a technology standpoint?

So how do we keep it or make it simple? How do we make it? easy so that our providers, first and foremost, champion the opportunity to be able to deliver care in that format to patients that they believe are eligible based on the type of visit that they're delivering. And so that's where we started. And this was occurring today.

During multiple kind of periods of surge is really understanding is our configuration appropriate are the tools that we're using, supporting and promoting ease of use. And we learned a lot. We didn't expect it to be perfect at initial rollout , and that was true. And so we did some refinements.

We looked at ways that we could consolidate Into our HR platform and really focused on how do we make it easy? How do we make it simple? How do we really limit the need for additional technical support? And that took repetition. It took time. But I think we, we've accomplished that.

And then really the next iteration was to really look and compare and contrast what's the experience from a provider and patient standpoint with a telemedicine visit as compared to an in-person visit. And we started to see some interesting things in our data. First, we noticed that the overall patient experience was equivalent for a telemedicine visit as compared to an in-person visit.

Actually it was slightly higher which was encouraging. Yeah. And then we started to look at data in terms of adoption. We noticed that in primary care, Over a quarter of our visits continued to be delivered via telemedicine. And so we define primary care as pediatrics, internal medicine and family medicine, which is obviously a high volume set of specialties.

And so that was very interesting to us as well. And then we started to look at individual providers that were delivering disproportionately more care internal medicine. And we started to look at what was contributing and we're allowing them to do that. We noticed that they were actually organizing their schedules to be able to have dedicated time to deliver telemedicine visits and then have dedicated time to do in person care.

And as we started to peel that back further, we started to see, those providers were creating opportunities for themselves, opportunities to have more time to focus on administrative or research activities that were important to them. More time to see more patients if they so chose.

Less pajama time. And so we explored that. And we actually started to build a program around what we call telemedicine block scheduling. And that's really proven itself out. We're growing the program, but we have over about 60 physicians that are doing telemedicine block schedules today.

And we're starting to create some capacity for providers that actually want to do upwards of half of their visits via telemedicine. It's also giving them some more balance in even where they deliver services. So we have some real constraints in terms of space. And what we've started to understand is that when we can create these dedicated telemedicine block schedules is that we can free up exam room space because providers aren't darting in and out of an exam room to see a patient in person and then into an office or into a private space to deliver a telemedicine visit.

And so that's actually allowed us to better utilize our existing in person visits. Physical footprint in the organization, and in certain cases, it's actually allowed us where appropriate to hire on additional physicians to be able to really address a challenge. I think most organizations are facing, which is access and timely access to care.

And and so we think it's really a win win all around. It's a win for the providers. It's a win for the patients, and we're delivering, it's Telemedicine visits in a clinically appropriate way. Of course, they're they are not the only way in which patients can access scripts. But overall, I think it ties back to this whole movement of health care consumerism that was even evident prior to the pandemic, but I think has just been accelerated.

And I think it's really incumbent on providers toe to figure out how best to meet patients where they are. And we know that there's comfort and convenience. There's a, you know, resultant benefit to less transportation time for patients to and from appointments. we really see it playing out and all of the data and the metrics that we feel are important to our overall performance as a health care delivery organization.

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I think it's such a great example of investigating the data, right? Not, Not jumping to a conclusion or to a prescriptive approach, letting the data guide like what you're seeing. And then through that, identifying that, hey, we've got providers who are proving more effective with this approach and the data shows to your point, they're doing this telehealth block scheduling routine to accomplish that.

And then using that to then figure out how do we take that learning and benefit the organization because then, to your point, productivity increases. It's more efficient. I think data shows there's a smaller percentage of no shows of telehealth. It's a better experience for everyone involved. So I think that's just like it's it's simple, but not easy what you just described.

But I think it's a really nice blueprint that you laid out there for how you might approach tackling that at your organization. So thank you. Okay. Next topic. The last one I want to kind of pick your brain on is we've talked about this ambient listening experience. DAX is the common vendor that folks are familiar with in that space.

And I think this is a capability that's it's certainly been feasibly proven function. It works. I think that there's demonstrated desire by clinicians to want to use it. I think for me, like the viability of it, like financially, does it really pencil out is still available. In my mind, that's still something that's being proven.

If you're an organization that uses scribes, it seems to me there's a clear kind of path to ROI. But if you don't use scribes, and St. Luke's is in that camp, I think Scripps is as well, then the ROI path, I think, is a little not quite as, mature or clear, so maybe just kind of share what you've learned and experience of scripts and how you've calculated if there's ROI here and how you arrived at that conclusion.

Yeah, absolutely. Well, and I'd say we're still early in our journey. We're just about a year in to the month. We do not. Use scribes across the organization. So our objective was really to introduce a technology that we felt would address. One of the burdens that we hear from our physicians routinely, which is the the burden of documentation that takes away from other time that can be directed to care delivery or other value.

Added activities, recognizing the documentation is necessity and critical both for the purpose of the longitudinal record of care, but also to support reimbursement. And so if we could attack this challenge of really the computer competing with the patient for the physician's time and attention, could we.

Create an opportunity for the provider to be able to have an unfettered interaction without the keyboard getting in the way of the exam room? Interaction with the patient? Could we improve documentation quality and integrity as a result of using ambient experience? And then as well, could we improve patient as well as, I think, importantly, provider satisfaction?

And so recognizing that we believe that there would also be an efficiency that would be generated in terms of allowing the provider see more patients. And so we went into this without necessarily a clear or concrete set of measurable outcomes or targets, but rather a framework that as I just described, that would help us understand if our hypotheses were accurate and correct.

And we learned it. A lot. In this first year, we've had actively about 40 providers live with the first cohort dating back now a year. We've seen some really impressive statistics in terms of the types of efficiencies that are being created for physicians that really commit themselves to using DAX consistently.

Dax is not necessarily appropriate for all appointment types. And there's a variety of different factors that can influence that. But if we could achieve a utilization rate of 65% or higher after 90 days, we saw physicians that were able to actually demonstrate consistent efficiencies in terms of the amount of time and notes and documentation.

Those physicians more often than not, we're able to see at least two more patients a day. and then what we did from a financial modeling perspective is we obviously accounted for the incremental volume that was with the provider was able to see. But we also looked at the downstream revenue that was generated from a typical time.

based on the specialty of the physician that was participating and using DAX. And so we know that oftentimes based on the needs of the patient, there are ancillary revenue streams that are generated as a result of, the principal or primary visit that the patient has. And so we looked at that as another added benefit associated with the provider, being able to see Incrementally more patients throughout the course of a given week and so or a given day, I should say.

And so those all became factors that we use to really model the return on investment associated to DAX. We also learned, I think, importantly, that DAX is not a fit for every provider, that there are certain criteria and there's really, a need for a willingness. And both a willingness and an awareness that it actually requires workflow and process change from the provider standpoint in terms of both changing their note templates, but also getting accustomed to those changes that result and what they do in the exam room that's different than the way that they worked previously. And so there has to be an appetite, but also an understanding for those changes. And that there is a shakeup period, and that can take up to 3 months before there's really a level of benefit that's realized by the individual physician.

But what we've learned through that is that we then need to have really uh, a mechanism, both in how we select providers, that we think are going to ultimately be able to realize results both to their benefit and I think to the benefit of the patient community that they serve and that they also need to commit beyond just being selected to being engaged in a routine process during the first 90 days where they're interacting with experts from the IS team workflows, going through Q and a sessions and actively participating in the change process.

Thank you. And when we have that level of commitment, we typically see that we're able to well exceed our expectations in terms of some of metrics that I mentioned previously.

Yeah, and I loved how you kind of tied that into like the return on value because you're right, you know, you got to look at the experience, like putting the patient back in the center and the computer to the side, the quality is there the provider is likely more satisfied being able to directly interact with the patient, and that's critically important.

I'm also just like looking at it through the lens of the reality today, and this licensing is not inexpensive and so my mind goes to okay. Yes, I want to deliver all of that. But I also want to have an ROI with it as well for the CFO. And so I think what you outlined is it can be there like there's additional business that can be accomplished in this efficiency and the physicians that motivated for that as well.

So I think that's great. I think that I would love to continue to pick your brain on this as we kind of launch our DAX pilot as well right now. And I just really curious to kind of see how this space unfolds going forward. I think there's something there. Just trying to figure out the right pace and the right way to scale and scope it.

Yeah, agree. And happy to be a resource. We've learned a lot and we're willing to share. And that's, I think how we all learn and how we make good decisions about how the types of investments that we make. So absolutely agree.

Well, Shane, always a delight to talk to you. Thank you so much for your time today and just wish you the very best going forward.

Likewise, Reed. Thank you so much. Take care.

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