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Today on This Week Health.

primary care works really well because that patient is engaged with you in that moment. And once they're out of your purview, once they're out of those four walls there's a huge opportunity missed. So we're, we're hoping that MyChart and, engaging them in these specific ways with MyChart will help to expand the reach of our health system.

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Hey, everybody. I'm Jake Lancaster, a internal medicine physician and the chief medical information officer for Baptist Memorial Healthcare out of Memphis, Tennessee. And today I'm excited to be chatting with Dr. Brandon Harris. Brandon, welcome to the program.

Yeah, I'm glad to be here. Thanks, Jake.

Brandon was a fellow clinical informatics back when I was also a fellow, and that's how we got to know each other.

But for the audience, can you just... Tell them what you're doing and where you're currently working.

Sure. So, I am a family medicine physician by training. Like Jake mentioned after my residency, I did a fellowship in clinical informatics at the University of Illinois at Chicago. I still work at UIC.

I am currently the director of primary care clinical informatics for the health system.

That's great. So as, as director of the primary care informatics space tell us what are some of the projects that you're working on? What are some of the challenges that you see? background helped you address those?

Yeah, so for in the primary care space as a lot of informatics efforts focus really on the hospital. Because that's a lot of where the energy is. It's a lot of where the staff are and the ambulatory spaces it's, it's kind of nebulous in a lot of ways. So we're trying to do at UAC is not just look at the primary care space, but we're also trying to morph into more of the ambulatory, even subspecialty ambulatory spaces.

So right now I'm focusing on, on primary care. And, what we're really trying to do is increase engagement of our patients and really help understand who they are so that we can leverage some of those informatics tools to affect change, , improve patient outcomes and improve some efficiency that we have in our clinical spaces outside of the hospital.

Yeah, no, we're, you know, I'm also the, the CMO of our ambulatory side. And so we're, seeing a lot of the same things and you're right. The inpatient side is maybe a little bit more well developed and the ambulatory side and a lot of ways is the wild West, but getting to know your patients tell the audience about how y'all are doing that or, adding social determinative health questionnaires adding that sort of information.

Is that what y'all are doing? Or there are other ways of looking at it. Thank you.

Yeah, there's a lot of different ways and other health systems have done a great job at trying to leverage some of the functionality that's built into our EHR. So, the EHR that we use and a lot of other systems use is Epic.

And they have a lot of tools to help patients give information and interface with their health system and their clinician and health team. While we're not doing a lot of the patient facing tools yet, we're really trying to lay the groundwork so that when we do turn that stuff on, it's going to not just be information that's being pushed to us, but we really want to have a good pull mechanism so that we're taking that information.

Using it and applying it towards their care and some other hospital initiatives. So some of the stuff that we've done recently is we're really trying to make sure that our data structure is set up so that we can understand, for instance, like race and ethnicity. That's a big 1 that when we started out, we just took the.

Epic foundation system, but we realized that it's not the best way to describe our current patient population. So we've done some work there to make sure that our data models can support some of that data and we can build off of them.

That's great. And you said something that was key a second ago is not just collecting the data, but being able to use it.

That has been one of my challenges is that, yeah, some of our insurers are actually asking us to add certain questions to the intake piece, and a lot of our physicians were nervous about asking certain questions because they don't necessarily have the personnel, the social workers, etc. In order to act on those pieces, and they're worried all of a sudden you have a patient that comes in, you have these patients already, maybe you don't know about their needs for transportation, their needs for.

food insecurity, etc. But now you have this information and as a physician you feel like you need to do something about it, but you don't necessarily have the resources to act on it. So, that was something that we struggled with as far as what we need to ask these questions. It's important. Our insurers are actually looking to us to ask them, but we don't have a way to, to use it.

And so, you know, over the past year we've hired on a bunch of social workers to help with being able to use that data. And that was something that, from an informatics standpoint, we can add the field and epic and, add the question. But it really is that people in the processes you have to have in place.

Have y'all had similar, issues.

Absolutely. And I 100% agree. I think the technology piece it's just one aspect, but there's so much more to make it useful in the real world. So one of the things that we did recently we just turned it on early this year where we have universal social determinant screening for all of the patients that are admitted to our hospital and through the ER.

and, and like you said, turning that on was not too hard. But what we spent a lot of time doing is, is just. Developing the data workflows so that depending on the social determinant and depending on the severity and how high they screen, we have automatic referrals that go to either our social work team or our care coordination team, which can do either an in person or a telephone follow up depending on, on the severity.

So you can imagine someone who screens positive for intimate partner violence. We really want to get to that person before they leave the hospital. Right? You know, that was just a good demonstration of again, turning it on was not the hard part, but just making sure we had all the people in the room, getting the data workflows, making sure that people knew how to access the information.

And then, of course, getting the clinicians aware that this is happening, your patients are getting screened and there's going to be an extra layer of help for people who screen positive.

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That's great. And reassuring the physicians that. Yes, going to be help with with being able to address all of this.

We don't, you're a primary care physician, adding one additional piece onto the primary care, workload it's a big ask. And there always seems to be something, some other piece that somebody else wants to add onto your plate. So being able to reassure them that they have help and this is not all going to be on your shoulders is key.

I think.

Yeah. And I think, yeah. Again, we wouldn't have been able to do it if we didn't have a close partnership with some of that ancillary staff just because like we've discussed, it's, it's so hard to, quarterback all that information and the reality is they're really the best ones to intervene in that position.

So we have, social workers stationed in the hospital, ready to go. It's just making sure they're getting to the right person at the right time.

What about being able to track outcomes? You know, So we're collecting this data. We're doing something with it. Are you able to show any effects?

Well, again, we just started a few months ago with this specific initiative. But we really are trying to track that. And we want to know if we're seeing any patterns in the types of patients that we're seeing because we haven't done universal screening in the past. And, the big thing is we want to move this to the ambulatory space.

Like you had mentioned, there's a little bit more complexity when you start pulling things out of the hospital, but we think there's a huge opportunity just because the volume is so much higher. But we have some services that we're going to need to build up in order to, to make sure that we can provide some resources to all the patients that, that will screen positive.

We've got some early evidence, though, that. People are screening higher and in some metrics that we really didn't anticipate. So we're trying to be really intentional when we're stretching this out.

Can you share any of those unanticipated metrics that you're finding?

Well, one for sure is food insecurity.

you know, that's something that some other health systems have tackled just with blanket efforts. I know there's some in other places in the Midwest where they just started delivering foods with, without even asking patients if they're food insecure.

But we're, we're trying to take a little bit of a different approach and, and making sure that , we're getting to the right people at the right time, because food insecurity is something that. Fluctuates just like housing insecurity. You might be food insecure one month and secure the next. So making sure that we're catching people in the moments where they need the help.

And then also partnering with some food pantries in our neighborhood. In Chicago, we really have a lack of food pantries that will actually deliver food. Because identifying somebody who requires additional nutrition assistance is one thing, but then let's say if they go home, they live 30 minutes away they might not have close access or transportation to a food pantry.

So making sure that we're coupling it with the right resources is, is another aspect.

Yeah, no obviously access to healthy food is something that, we counsel patients on all the time in primary care, trying to eat more fruits and vegetables, but if they can't even their food insecure, and they have to choose between eating and refilling their, their medications, it's really hard to get somebody healthy in a situation like that.

But how do you, use that data, I guess, and take that burden off the primary care physician? Because, you know, you don't necessarily want the doc calling and arranging for a food pantry to come over. That's just another thing that really, they don't have time to do.

Yeah. You know, and, I agree with you. We don't want the, the doc having to. Do a deep dive and all of these things with every single patient. Not that we don't know it's important, but there's just so many other things, right? So, having the right players and getting the screen done at the right time.

I think in the ambulatory space. Currently, we, we have some room to grow in terms of. The right people screening at the right time. Because we do have medical student trainees and we have ancillary staff trainees. So we have a lot of people who may be doing a screening at an asynchronous time in the visit.

And sometimes the physician is getting that information before the visit, during the visit, after the visit, when I think what we really want to do is have a uniform space and time where we can get that information. And then do that referral and have that be in conjunction with the physician's awareness, but not necessarily waiting for their response.

So, yeah, there's a lot of work we still need to do, but I think we're, we're doing a good job understanding where our problems are.

Yeah, and like you said, being able to surface that information, because, you know, as a primary care doc, I want to know that, but I want to know it at the right time, some places have had great success with doing, like, primary care huddles in the morning, going through the patient population that's coming in, that seems like a great time to share that sort of information, but have you thought about how to present it back to the physician so that they're aware in the right context?

You know what, Epic does have some recent functionality that allows you to see social determinants metrics on the storyboard, and that is something that we've, piloted with our family medicine clinic, and it's not health system wide for all physicians, but with our family medicine physicians, we did say that, you know what, we want to at least look at it.

We want to know how to get there. And we're trying to see what's the best way to actually leverage it from the clinical side because we have our students. We have a couple of pilots where students are actually filling out certain aspects of that. But we don't have as much coverage as we need to with some of the referral services.

So. That is one piece of the visualization. The other is thinking about how we can get patients to tell us this information asynchronously, which has its own complexities, right? There's my chart surveys that can be filled out We haven't turned those on just as yet because we know that we still have a disparity in the way that our patients use MyChart and engage with it.

So, we want to make sure that that gap is closed up. So we're working on a couple of other projects to increase blanket engagement with, MyChart, but also target the demographics that really have a hard time not just signing up, but also using it because we know that even though we have a disparity in signup, we have a much bigger disparity in usage.

yeah. I mean, those are all very important pieces. I know, we're running short on time, but can you tell me any future directions that you're going with informatics and social determinants of health?

Yeah we, we're, we're on the verge of launching a digital health hub that , we're using, like I mentioned for, for that, my chart engagement piece.

So it's a physical location that leverages community health workers and we're. Engaging patients face to face, showing them this is why you want to use my chart. These are things that you can use it for. This is how you engage with your clinicians. And then we're using that as a launch off point to, to do social determinant screening.

And we're working on a model that can be expanded to multiple clinics. So, we're piling it at one primary care site, and we're hoping that that'll be a model we can port over to our different clinics. So that we can get people captured and engaged because engagement, I know I've said that word a lot, but it really is the key, right?

That primary care works really well because that patient is engaged with you in that moment. And once they're out of your purview, once they're out of those four walls there's a huge opportunity missed. So we're, we're hoping that MyChart and, engaging them in these specific ways with MyChart will help to expand the reach of our health system.

Yeah, very well said. Thanks again, Dr. Harris for coming on and thank you everybody for listening. Please tune in again.

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