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Today on Town Hall

Switzerland has a very strong technology.

and yet we walk into some of these hospitals and we're seeing paper and multiple systems. And I think what's hard countries to get their arms around is How do you use the electronic patient record to create the best patient experience as well as the best clinician experience?

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health.

Where we are dedicated to transforming healthcare, one connection at a time. Our town hall show is designed to bring insights from practitioners and leaders. on the front lines of healthcare. Today's episode is sponsored by ARMIS, First Health Advisory, Meditech, Optimum Health IT, and uPerform. Alright, let's jump right into today's episode.

 Hello, my name is Jeff Cleveland and I'm the chief medical information officer responsible for ambulatory activities in the southeast region of Advocate Health. And today, my guest for this interview is Mr. Russ Hinz. Russ is the VP of Strategic Partnerships for Advocate Health. Russ, thanks so much for joining me today for this conversation.

Thank you, Jeff. About a year ago, our legacy organizations, Atrium Health in the Southeast, Advocate Aurora Health in the Midwest, merged to form our new company, Advocate Health, and I've been so grateful to work with you, Russ, and many other amazing leaders because of this merger. So, Please give us a fuller introduction of yourself, your current role at Advocate Health.

Yeah, hi Jeff. Thanks for the invitation to have this conversation. And so one of the beautiful things about organizations coming together, there's so much talent that you get to meet that You know, you think about mergers and acquisitions, but it's really about the people and how they come together and work, and I think that's been such a rewarding and powerful thing for our two organizations to come together, and we've met some really fun people, and you're absolutely one of them, so, yeah, I've been with Aurora initially, which was the Wisconsin organization since 2008, and My current role is I manage all of our strategic partnerships.

In that capacity, I do work within EPIC around EPIC Community Connect, or what we call now Connect. And we have about 70 customers that we extend our electronic health record to across Illinois and Wisconsin. Primarily community based primary care and specialists. We also have some large multi specialty organizations, so manage that do strategic work with our community partners, some of our FQHC friends, things that really can advance our health equity strategy in terms of getting those organizations access to our technology.

I work with mergers and acquisitions and technology integration for those so it's super rewarding. It's really shows the power of partnerships and our commitment to do the right thing in our communities and really make sure our patients are well connected to the services they need.

Well, that sounds like a lot of responsibility and opportunity. I'd love to hear how you got to this, place at Advocate Health. This is the third largest not for profit healthcare system in the country and you're leading strategic partnerships, but I believe you trained as a nurse. So how did you get from from there to here?

Yeah, I did. I went to nursing school and worked in the neurosurgeon intensive care unit out of school. It's part of my career path. I had multiple majors in undergrad. I'm very interested in health policy, and so I work not only on the nursing at night, but I worked for the governor of New York and had some really great exposure in terms of healthcare policy and how that impacts the delivery of care.

So I've always been in a health first healthcare person at heart had some organizational opportunities to influence governmental decisions in New York state and in Washington, D. C. doing some lobbying work. Took a little stint as a Imagineer for a while. for the Walt Disney Company doing environmental health policy for those guys, which was super rewarding and a really great exposure to how health is important for a non healthcare organization.

Worked as the chief operating officer for the American Cancer Society, and then did a career re engineering when I saw the digital health. Wave coming and got my informatics degree and then as that occurred we at Aurora were making a pivot to support the meaningful use activities, working with Insurner and our other EMRs, and then a decision was made to go on EPIC, so I managed the entire EPIC project for Wisconsin all of our hospitals, ambulatory and home health deployments, and then had the honor to do the same thing in Illinois.

All right. so I've got a lot of EHR experience behind me. The most important decision I made, the best decision I made was to go to nursing school and to become a nurse and really use that to build my career in what I think is a pretty unique way. And career reinvention is something we should all think about doing on a regular basis.

Oh, that's a great story. Thank you. Russ, you know, within Advocate Health, you have a reputation as a person who can successfully land huge projects and are known for your collaborative leadership. What are some of your leadership priorities or driving principles, however you would describe that?

Yeah, thanks. It's I think it really boils down to building relationships and And building trust, and building trust is following through on things that you say you're going to do. In terms of large projects, it's all a team sport. And I think how we work together and bring the different skill sets of our different position players, if you will, to the table and make everybody feel valued and heard from, and it's also requires leadership where sometimes, you know, people disagree with me and I'm wrong and I have to admit that I'm wrong.

I am, I'm wrong a lot, but I think having that healthy exchange of ideas in a respectful and civil way really helps move these huge projects along because These things are hard and there are a lot of different ways of doing things and I think hearing people out, really building an environment where doesn't matter what your position title is, if there's a really good idea, like we need to hear about it and act on it.

Whether coming from, you know, a frontline nurse that's kind of, sees how it impacts their care of their patient or from a senior leader with a strategic imperative that we have to take into account for. it's really important. I try to spend a lot of time cultivating relationships and, and trying to seek to understand other people's opinions and viewpoints.

I love that. And I'll just recapitulate what you said, because what I heard was valuing the humanity and ideas of others and humility. And I think those are really admirable characteristics. Thank you for bringing that perspective and encouraging us with that. I know you've been in this role of strategic partnership, if you thought beyond you know, your local community and even the United States, and you've been involved in some international consulting, supporting IT work.

Please tell us about that and what you're developing along those lines at Advocate Hub.

Yeah it's kind of a an interesting way of how we've started getting into this business. You know, when we started implementing electronic health records in earnest in the, you know, say 2010, 2012 time period, we didn't know a lot about how to do this, and, you know, I often think to myself, if I knew then what I know now, So if we knew then what we know now, how would we do it differently and what could we do to make the experience better and easier for the people who are taking care of patients and patients who are using our technology?

I'll tell you a quick story. We were sitting in a meeting with um, A really interesting of people from New South Wales, Australia, last summer. They were on a journey to pick a new electronic patient record, which is what most of the world calls, that we call electronic health record. Most of the world calls electronic patient record.

And they hadn't made a vendor decision yet, and they wanted to talk to an organization that had been on Cerner and then transitioned to Epic, and then they were going to Canada to talk to somebody who was transitioning onto a non Epic electronic patient record. We spent two days with this person.

very diverse delegation from clinical operations to pathology and nursing and physicians. And I was sitting in a meeting and I was thinking to myself, wow, they really are really getting a lot of value in hearing our story of how we struggle through all these big decisions that you have to make as you're making this transition.

And so I got to thinking about it and talking with my colleagues and peers, not only with an advocate but around the country. what we started seeing is that there's a need for a clinical group like us to step in and help others on their journey like we would have loved to have helped when we were doing this back in the day.

So I started thinking about how to do that and that led to meeting some interesting people from the Republic of Ireland. We've hosted a lot of site visits from Europe and London and Saudi Arabia, the United Arab Emirates. And as I thought about it, Over the years, we had hosted about 20 different international delegations on these site visits, and it took the last one of them, one of them, the New South Wales and Australia, to have the light bulb go off.

Maybe we can do something more structured and more strategic on those lines. And so it's really just trying to give back and help. guide people when they need guidance, like we would have needed guidance and would have appreciated it when we started down this path, 13 years ago.

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 Yeah, the need is apparent as you spell it out. Just a follow up question then, a lot of consulting companies that this is what they do, right? They help advise healthcare system in the journey. So, how is it that we at Advocate Health busy taking care of patients, delivering clinical care. How are we positioned to provide this consulting differently than, a large consulting firm?

a lot of respect for those, really good consulting firms that are out there, they have a certain niche We're not trying to fill that niche. We are a clinical Organization that takes care of millions of patients every year using technology in real time in every possible care setting.

So whether you're a radiation oncologist using Varian or ARIA with an interface to EPIC, that level of capability is important. Insight into how the technology works every day is a unique viewpoint that most consulting companies may say they have, but I would challenge others to be able to connect a expert like yourself.

We have an ambulatory medicine and IT and technology with another ambulatory leader thinking about how they're going to make this transition. We can connect real time clinical leaders. With other organizations, clinical leaders, and that peer to peer credibility is a competitive differentiator that we are seeing over and over again with our current engagements.

So it's a, it's a unique offering that is clinical operations focused, and we're not trying to build this huge business, Although there's a lot of business out there, we're really, really trying to live our niche of taking care of patients and using technology. And our reputation is strong, so we're working to build that on a global scale.

Super. Thank you. Well, so you think a lot about what's going on in IT from a national, international perspective. What are some of the trends that you're currently seeing in the U. S.? Challenges, opportunities. What's your perspective?

Yeah and moving really fast. I think one of the things that, there's a lot of focus on the bright shiny objects of artificial intelligence and some of the other really important and critical tools.

And what I think is key Happening that's not so visible is organizations are rethinking their platform foundation. So what you're seeing is on top of mergers and acquisitions, so there's a lot of mergers and acquisitions occurring across healthcare. Different organizations bringing either the same electronic patient record technology, though different Versions or instances, or one organization has one vendor, another organization has another vendor, they want to create a single integrated experience.

So the first thing that's happening that's not highly visible is a lot of what we'll call platform unification. Or creating one single electronic patient record platform that they can build their IT and other cap analytics capabilities off of. So mergers and acquisitions are driving a lot of harmonization of it and EHR systems,

it's hard work.

It's pain. It's painful work, isn't it? We're in the midst of a harmonization right now with one of our market hospital systems as a. An academic setting, and we're moving them on to our version of Epic, and boy, there's a lot of conversation, a lot of compromise, a lot of trying to focus on what's best for the patient in this equation have you got a few sort of recipes for success for that sort of platform consolidation in the midst of active merger and acquisition?

Because we're all about that at Advocate Health over the past few years, certainly.

Yeah yeah, and I'd love to hear a couple of those main pain points and I think the audience would be very get some insight into that. I take a bit of a non traditional IT perspective on this work, I think. I really worry less about the technology.

I feel like the technology, we do testing. I'm not saying you shouldn't focus on it, but testing and making sure the systems work and drop a charge. You know, get a lab and do all that. Make sure all the IT techie stuff works. The secret sauce really is in the change management and the people in process change.

And I think having really good focus around what's changing by individual role and helping that change. We appreciate it and adopt it. So in a couple examples, one would be if you're going from an epic to epic world, which is what Wake Forest is doing right now, the buttons and the workflows that they may have been used to will be epic based.

And some people say, Oh, it should be easy. Just make the transition. No big deal. But actually not, because I think the EPIC to EPIC conversions are harder than non EPIC to EPIC because your muscle memory and people's familiarity with the systems is such that any change will have an impact on their ability to use the technology to care for patients.

So I really feel like process and people changes should be the focus for these integrations and not to. Discount the tech side. Get the tech side. nobody's gotten fired because the technology hasn't worked, because you can fix it. Many people have problems when they don't appreciate the impact on people and process.

And those are, those are orders of magnitude harder to change than the tools and where the button is. That's the real work. we've had subject matter expert work groups with representatives from different markets, try to collaborate and, I'm not going to say it's easy work, but we had guiding principles, and I think everybody does this, and we must do this, and some of our guiding principles are we must make the system patient centered.

Easy to say, we want to make this as painless as possible for our teammates, the physicians, APPs other clinicians that are involved. We don't want the electronic health record to be a master. We want it to be a servant. And so we're trying to make things as easy as possible.

Where the United States is, we're in a really advantageous position vis a vis the rest of the world as it relates to our foundational digital platforms. Challenges for mergers and acquisitions. We do have a high level of strength, and there's been some, I think, really great patient things that have happened in the United States.

I mean, we can control most of our health care workforce. Scheduling, refills, communication with our doctors in the palm of our hands now, and frankly, around the world, that's not the case. And so, well, we have challenges, you know, getting ourselves harmonized. We built a very solid team. foundation, digital foundation, that we can do some very, very powerful things for the patient, as well as help clinicians make better decisions around health care.

And that's one of the reasons I got into this was, how do we use technology to help patients and clinicians make better decisions? That was

yeah, that's a great segue. You referenced some of the things that we take for granted perhaps in the U. S. What are some of these opportunities and, Difficulties, if you will, from your international perspective, how is it different in Europe, for example, or in South America from what you just described as the main issues in the U.

S.?

Well, like the United States 10, 12, 15 years ago we had some level of digital engagement and electronic patient, electronic medical records have been around for a while, but there was not necessarily a focus on a single patient record where clinicians only needed to log into one system around the world.

I'll give you an example of London and Jeff, you were in London, you saw the transition. So, Advocate was honored to accept an invitation from the National Health Service to help with a go live I'm in downtown London at six major health care facilities that serve urban London. And what we saw there was, yes, they had technology, but some departments were on paper, some departments had other systems that they had to log into.

I heard stories of nurses having to log into four to six systems a day if they were in the ED or the ICU to take care of patients. So, Yes, technology, but not a really solid integrated single platform where the entire patient record was in one place for each patient. So, bringing people off of multiple systems onto a single platform.

And then adding the patient portal opportunities and patient communication opportunities is something I'm, we're seeing in the United Kingdom, the European Union countries, and in Australia, which are the markets that , we're focusing on at this time. I think another good example is we're doing some work with some folks in Switzerland, and Switzerland has a very strong technology.

Watches, linear accelerators, trains, bridges, and yet we walk into some of these hospitals and we're seeing paper and multiple systems. And I think what's hard for countries to get their arms around is How do you use the electronic patient record to create the best patient experience as well as the best clinician experience?

And those organizations that are thinking ahead in terms of what decisions are going to need to be made when beginning down this journey are the ones that are going to do really well. We've come into a couple projects where it's been well down the road and we're seeing key decisions about who enters an order, what's the role of the doctor versus the nurse in terms of managing orders or how you're going to document.

Those decisions are vendor neutral decisions really at the end of the day and it's really the principle or the identity that that organization wants to have. So I guess what I would say is Europe, Australia, Middle East, Far East. is largely where we were in 2010. And so when we go in there, we have to think about our mindset.

What was it like? And what's cool about what we're doing, I think, and unique is we can appreciate what it was like when we didn't have the expertise or guidance that we can offer. And we can help them learn how to do things faster, better than what we did on our own trying to figure this out by ourselves.

Well, I'd love for you to reflect a little bit on , how to close the gap, because I would argue that we are where we are today, as you say, maybe 10 years ahead of where they are, mainly because of public policy, right? We had meaningful use dollars that were incentivizing healthcare systems to, you know, install and use this technology.

And so does Europe or, any other of our colleagues around the world need to do from a policy standpoint to get there, or will they be able to just leapfrog over that based on the objectives that they have now with the tools that are available?

Great, great question. The European Union has a 10 year electronic patient digitization objective, so there is EU policy and dollars that are being allocated to support a transition, a more rapid transition if it was just very much.

EU member country on their own doing their own thing. So there is some policy objectives happening within the European Union. In the UK, for example, the National Health Service is under tremendous pressure around wait times, queues for long queues to get elective surgeries done. So in that case, There's a patient care imperative that they have to figure out more efficient ways of distributing their resources to take care of an aging population.

So not only is there a policy driven activity at the NHS level, there's a population driven imperative to become more efficient. And one of the things that UK is doing, I would say could they be doing better is they're not thinking as much about a electronic health information exchanges. each trust or each locality is kind of on their own to pick their own system, which creates a whole other system.

There's a slew of challenges when people go from one part of the UK to another part of the UK, so there's a great need for data exchange expertise and the ability to normalize data across platforms so that there can be a better health information exchange network set up, so it's really still kind of disparate, if you will, in the UK.

What we're seeing in some of the other European Union countries is there's a, a trend to try to get to a single platform. So whatever vendor that might be, there is I think some really strategic thinking going on there, but I think the skill sets that are gonna be really needed.

That we in the U. S. can help with is really solid decision making around clinical impact, analytics, data aggregation, data exchange, really basic HL7 stuff that's really important, but we have a lot of experience with it and that's what I'm seeing as a need in other parts of the world.

Yeah, it's, you could probably argue that the HIE.

Platform is a much higher priority than having a single vendor everywhere in Europe and in the world. That's not going to happen, but at least being able to communicate. Across international borders, because in Europe, I mean, you know, the land mass is pretty small. So, somebody can easily get from one corner to the other as quick as I can get from here, Chicago and the ability to.

To get care wherever you are by having visibility would be huge.

If you don't mind, let me ask you a question, Jeff. You've been doing some really cool work with us with our friends and the InCel group in Switzerland. also you had an opportunity to come with us to London and, and visit the University of Missouri.

Just give me your insights into what you think is happening Among your peers in those areas.

Well, you know, these are healthcare systems that have a reputation for excellence, for research, for development. They have led the world in some instances in you know, novel procedures, surgical interventions, et cetera. And I think that they have ambition to lead in this space as well. And I'm very encouraged by that.

I, I do think for example, the Incel group, they're really smart folks, and they've got the, the energy and the insight and the talent to do this. And now I think they are embracing a platform that will allow them to do it. I think the challenge is just what you said a minute ago about not the technology, but the workflow and the people and processes.

So, for example Reimbursement in much of Europe is different. We saw this in the Physicians and APPs aren't getting paid differently if they say something generic like heart failure in their Note versus if they give a very specific, diastolic heart failure modifier ICD 10 and we're busily trying to make sure that our diagnoses and problems that we charge for and that we document in our notes are as specific as they can be to accurately reflect to our payers the level of severity of our patients.

They don't do that. they're not reimbursed that way. And so the idea of going to the trouble to have very specific diagnoses and problems in the electronic health record is a new concept. They typically just free text dictate in their notes. And so what we've seen both in London and in Switzerland is the note as the final.

source of truth, which is true for that moment, but probably not true a week later or a month later or a year later. And so, I think the opportunity for them is to get that vision of the dynamic electronic health record with problems, allergies, medications that are updated by people across the continuum.

So that you can see in real time what's going on with your patient rather than having to try to find the last 3 consult notes, dig them up and read them to see what somebody was thinking. But that'll require a shift of mentality and using the tools differently. And so going from unstructured consult note based.

way of thinking to a structured dynamic tool. That's the opportunity and I think they'll get there. We're still getting there in the U. S. Don't miss, I want to say that with humility because I think we still have opportunity to use the tools more dynamically as I've outlined to achieve better patient outcomes, but we're further down that road.

We've been forced to think that way and those are different systems that they have in, in

Yeah, yeah, that's good. I think what that brings to mind is, as advocate continues to do work like this we can help others think about what are the key decisions that need to be made early on, even before they pick a vendor.

What are their guiding principles? What are they trying to achieve with digital transformation? I think we would have probably had a different viewpoint of that had we had some better expertise back in the day. And so, that's one of the reasons that we're doing some of this work. But I think another reason is that sharing is a really great human experience, and we're learning a lot as well.

So when we went to London, I think we came back with maybe seven or eight really important things that the National Health Service is doing better than we're doing. One is they have super concise notes. There's no note bloat. There's a lot of things that are happening with physician notes that are cleaner, more efficient, maybe not as structured, but not Their patients leave their facilities with all the medications and home health needs that they have. They can't leave until all those things are in place. Another one that was really cool was the surgical checklist that was mandated to be run not by the surgeon but mandated to be run by a different tech level person on a rotating basis.

So, Everybody was equal in that checklist and it was properly documented within the electronic patient record. Cultural difference there, right? Different things and how the organizations are structured. So we benefit as an organization and our patients benefit by having a, A broader view of how health care can be.

That's a great perspective. Again, your humility comes through and we can learn that way. So thanks for leading us in that. Thanks for the time today. This has been really fun for me to hear your reflections on these international experiences. And you know, I think to take the, the parable of the new wine and old wine skins, right?

We need to elevate our thinking and the people that you and I are consulting with, we don't want to use technology to try to replicate what we did in the paper world. Or, today in America, that's not so much the dilemma, but it's the old processes that don't get us as far down the road.

I think we just need to think bigger and the tools are getting there to allow us. To do more for the patient and for our teammates than we've been able to do in the past. And leadership like yours will help us get there. So thanks.

No, thank you, Jeff. It's a privilege to talk with you, and I can't wait to continue to work with you on stuff like this.

Thanks so much, Russ.

Thank you.

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