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Today on Town Hall

you don't have a brick and mortar facility. You don't have a network that you're managing. . So there's a huge focus on how do we make the day to day lives of our caregivers more efficient in a space in a home. . Where they might not have internet access, they might not have a table to put their laptop in, but that connection to the patient is so

important.  

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 Meditech and Doctor First .

Alright, let's jump right into today's episode.

Hello, everyone. Welcome to one more episode of This Week Health. My name is Karla Arzola, and I'm the CIO at Reckonaut Human Services. Today's guest is Julia Rosen.

She is the CIO at PARA Healthcare, and we will be exploring the intersection of technology and healthcare with a focus on the post acute care space. And we're also going to touch on Julia's experiences with career transitions. Julia, welcome. Thank you so much for having me, Carla. Of course. Pleasure to have you and why don't we start with an introduction?

Why don't you tell us about yourself, your background, your organization, your role?

Sure, absolutely. So my name is Julia Rosen. I am the CIO of Pira Healthcare. The organization I work for is a private equity funded holding company and we own Palliative care and hospice entities across four states.

So I came that way via being the CTO at Centura Health, which was a 4 billion health system here in Colorado and Kansas. And before that, I had a long career in technology consulting and healthcare IT consulting. So, it's been kind of a wavy road to make it here, but love this role. And it's really cool working for a little bit of a smaller company lots of different opportunities and challenges.

Awesome. Thank you for that introduction. And I'm very excited to learn more about your recent transition. You moved from, you mentioned, Centura Health, huge organization now, Common Spirits, and you were an executive for Centura, and then now you are in a smaller organization in the post acute space. And that happened, I believe, over a year ago, more or less?

Yeah, so it was very different. I always use the example of at Centura, I had, I think, 10 or 15 different Microsoft engineers on my team. So when I had a Microsoft issue, I would have all these people to go to.

When I got to my new position, it was just me and one other system administrator. And when there was a Microsoft issue, I was digging into Microsoft and figuring it out myself. So it's, it was a really a huge switch. I think, The benefits, obviously, of being at a larger organization, you have a bigger budget, you have bigger teams, you have more resources at your disposal.

In a smaller organization, from a technology perspective, you tend to have to be a little scrappier, really work with the tools that you have versus always being able to go to market and buy something new. But the advantages of working at a smaller organization, obviously, is that you can move a lot quicker.

There weren't 50 different steering committees that I have to go through to make a decision. It's really just me and my team and I consult my business partners and we decide what's best for the organization and we move forward. So definitely pros and cons to each, but it has been exciting being able to potentially see change at a, at a faster pace due to just, there not being a lot of corporate barriers in the way.

Yeah, you and I spoke a little bit about that because I did a similar move, you get to appreciate your resources it's a little different, like I said, it's just different challenges, both sides are great it's just a little different,

and we

adjust.

Yeah, absolutely. Yeah. And you do appreciate people who have a lot of different skill sets within one person. Having that really great A technology player who knows a lot of different disciplines is super valuable in a small organization, as you know. a hundred

percent. In your experience, not that you're in a completely different setting, what are some of the major differences between the post acute healthcare space and the more traditional acute provider space?

It's a great question. And some of those differences surprised me. think the biggest difference, at least in the hospice space, is how the financial model works. So in traditional acute space you have coding for individual procedures, medications. In the hospice space, you actually receive a daily rate per patient.

So the financial model is completely different. You are totally in charge of managing all of the expenses, the labor, the supplies associated with that patient and in getting that daily rate for that. So there's a different financial model in hospice that really makes the day to day operations different.

And then also in the home health hospital. Right. You don't have a brick and mortar facility. You don't have a network that you're managing. Right. So there's a huge focus on how do we make the day to day lives of our caregivers more efficient in a space in a home. Right. Where they might not have internet access, right, where they're meeting with a patient in an unknown area, and they might not have a table to put their laptop in, but that connection to the patient is so important.

So that's really a big focus of my role right now is how do we enable our caregivers with the tools that they need to document. In a system using devices that's cost effective, that's mobile, that doesn't distract from their work for the patient, and that really works in any setting, regardless of the infrastructure or equipment that's there.

So I think those are two of the major differences that I've seen.

Yeah, so. Similar to us, most of your staff is on the field. Yeah, exactly. You have to enable them with mobility. And I want to talk about what are some of the things that you've done in your current role to enable your staff or the staff on the field.

What are some of the strides that you made? And I'm sure there's still areas of opportunity. Can you highlight some of those as well?

Yeah definitely, definitely lots of opportunities. The other thing I didn't mention, which is impacting us quite a bit the EMRs in the post acute space, very different than those available in the acute space.

And so one of the things we actually are doing now the EMR we have today is not very mobile optimized. So we're still using laptops. So we did start to test the mobile app version of that EMR, but one of the big initiatives is how do we move to an EMR that is more mobile friendly, that uses tablets, where you can use cellular technology for connectivity instead of Having the document offline and sync later.

So that's an initiative that's in progress in terms of what we've done already. We've had great use of mobile apps. So we have a scanner app that we use on our phone so that people don't have to carry around paperwork and just scan documents, scan consents at the bedside. That's been a big deal.

We're currently piling a app to track staff productivity so we can optimize things like driving routes and making sure that we have people going to the right places to minimize travel time. So those are two of the things that we're working on now. And then in addition to working with vendor partners to see on the EMR side.

How do we find a technology or develop a technology, co develop with our partners that is more mobile friendly and can use cellular technology instead of traditional Wi Fi or offline documentation.

Nice. Do we touch upon some of the potential opportunities?

EMR is a huge opportunity. I could talk about that for a long time.

There's really, although maybe some of my vendor partners would argue with me on this, there's really no EPIC of the post acute space. EPIC does have a hospice module, but that's really designed for organizations that have A large acute setting with a hospice add on, right? In terms of a standalone post acute EMR there's really kind of two camps.

There's sort of the old legacy on prem applications that are well developed and have a lot of market share but those aren't very advanced. Not very mobile friendly. And then there are some of these new EMRs, the SAS based ones, the ones that are more modern, but they haven't been really well tested in the market.

So we're sort of at this really interesting in between space in the EMR front from a post acute setting standpoint and that we're trying to kind of balance which do we go with? Do we go with tried and tested? Or do we kind of experiment with something new or is there somewhere in between?

So, if you're listening to this and you are an EMR vendor in the post acute space, I do think there's a ton of opportunity to really optimize the technology for what our providers need today.

Thank you for calling on the partners to come up with solution to help us out, figure out that challenge that we still have in terms of having systems aside of the hospital setting.

So let's talk about some of those regulatory changes that are coming. And can you just. help us understand how is the impact going to be on the post acute space?

Yeah, I mean, obviously no one has a crystal ball and no one knows exactly what's going to happen.

I do think that One of the trends right now at least in the hospice space, 98, 99 percent of hospice is still paid for by Medicare. , and that's great, right? Because most folks, either if they are elderly or if they have an advanced disease or disability do qualify for Medicare but one of the things that has been talked about is potentially the shift to having more commercial payers pay for hospice based on some of the, some changes that may come from a regulatory or government standpoint or just based on, the direction that the country is moving.

So, I think that opens up a lot of interesting discussions. When we talk about Commercial payers paying for hospice, now we're getting more into the space of things like value based care, right? And commercial payers potentially wanting more data that they can use to optimize costs when they pay out these providers.

So, I think it's going to be interesting. I do think as we move more towards that world a big thing that will be requested of hospice is sending more data to payers, sending more data to the government. leveraging data to again, in hospice, we don't talk about optimizing outcomes, but definitely talk about optimizing cost, optimizing length of stay on hospice.

So I think the emphasis like everywhere in healthcare will be on getting more data around how to optimize care and optimize the financial side of healthcare. So in terms of how we're preparing we've already built a data warehouse on top of our, Legacy EMR and some of our other systems, so we can be set up for the future just to have access to the data.

And then I think like every organization, we're really going to be focusing in the next year on how to leverage that data to produce insights. Again, to optimize productivity, optimize length of stay, optimize expenses associated with the patient. So I think in the post acute space, that will become more and more important the regulations potentially change in the future.

Thank you for that. I super appreciate you sharing your predictions and what you're learning in your industry. And we can definitely do a follow up as things continue to change.

Yeah, it'll be interesting. Yeah, it'll be super

interesting. But I do want to ask you something on a more personal front.

Because you've you've navigated, you get, you have been through a few career changes you went from consulting and to industry, and by the way, you're not unique, to do making the changes but I want to learn from your perspective, like, what would you advise to other professionals, you Who are navigating this major career change?

All of us manage changes differently. I want to learn how do you do it? How do you do? Yeah. How do you, How do you go for you? Well, I'm not an expert.

It hasn't always gone super smoothly and I've definitely you know, made some, some mistakes that I've had to overcome, but I'd say the two biggest things that I think of is You know, number one don't be afraid to lean into and lead into a space where you may have limited technical knowledge.

I think the core skills of knowing what questions to ask, knowing who to hire, knowing how to link a business problem to a technical solution, those will apply to any role that you have. And I think, and I'll say this , you know, some people might get that from you for this, but I do think in particular women tend to be intimidated when faced with a role over an area that is highly technical that they haven't been exposed to before.

When I joined Senkura, I took over the network engineering team. I'd never run a network before. I'd never run a data center. I knew about all those concepts and, you know, understood, understood a lot about them. But I think if I had let myself be intimidated that I'm not going to be able to run a network engineering team because I've never been a network engineer, I think that really would have blocked my progress in a role.

And it really comes down to if you have the right experts under you and you know how to lead a team, You know how to ask the right questions. You really know how to poke when something doesn't sound right. You're willing to do your own research and learn. I really think that any technologist can lead any type of technical team and be successful.

So I think a lot of it is really just being open to challenging yourself and lead into areas where you might not always be an expert.

Well, thank you for

sharing

that. That I. I appreciate you and I admire your work and your passion to help others and to continue to grow and we're just excited and happy and lucky to have you as part of our tech community.

I, the Colorado Health Tech community is just great as you know, brought me and Carla together and forming a great professional relationship, we learn from each other, and it's just such a tight knit, close community that I really benefited from, and I know you have as well.

A hundred percent. A hundred percent. So, I, again, appreciate your time, learning about you, learning about your space, and there's a lot more to learn and a lot more to come, but anything else that you want to add to close the segment?

No, just thanks for having me, Carla. Thanks, and I've learned so much from you already, so thanks for throwing the time.

And if there's anyone out there in the Colorado tech community or more broadly who wants to talk about technology in the post acute space or anything, I would love to connect with you all. Awesome. Julia. And we'll be talking soon. Take care. Awesome. Take care. Bye.

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