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August 8: Today on TownHall Jake Lancaster, Chief Medical Information Officer at Baptist Memorial Health Care talks with Claude Pirtle, MD, Chief Medical Informatics Officer at Walmart Health & Wellness. What is it like to be a CMIO at Walmart Health and what initiatives is he involved in? How is it different working there compared to an academic medical center or traditional health system? Walmart Health is in many states, how do they keep track of different state laws and build one instance in Epic that satisfies everyone? What does the future of Walmart Health look like from an informatics perspective?

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Today on This Week Health.

that's why I think Walmart is one of the very few businesses out there. It's uniquely positioned already just because we have brick and mortar already within 10 miles of 90% of the population.

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.

I'm an internal medicine physician and the chief medical information officer at Baptist Memorial Health Care. And today I'm really excited to have on the podcast Dr. Claude Purtle from Walmart. He is the CMI over there. He's a long time friend of mine and a co fellow when I was at Vanderbilt.

Claude, welcome to the program.

be on and really appreciate you having me on.

So, told a little bit of your background, but just share some of your story with the rest of the audience.

So, I'm internal medicine doc by trade from South Louisiana. I went to LSU for everything down there undergrad med school, and then internal medicine residency went to Vanderbilt, as you mentioned, I was fellows with you a number of years ago went through West Tennessee is CMIO and ACMO their largest hospital, which is 792 bed hospital.

And then I've been at Walmart health. For the past coming up on 10 ish months since last year as chief medical informatics officer here at Walmart. So very excited. Been a little transition into industry. But still I think we'll chat a little bit later about some of the, pros and cons and the same, things that are the same and a little bit different.

Yeah, I really want to hear about that. Some of these CMO roles are new in industry. You know, A lot of places had probably had CMOs, especially if they have a health care division for a while now. But what does a CMO do at Walmart? And what are the kind of major initiatives that you're involved in?

Sure. So I mean, I think about it. Walmart Health is relatively new, especially compared to traditional health care. So the chief medical informatics role at Walmart Health is really a unique role compared to traditional health care. Have a lot of, a lot of experience in traditional health care over the past number of years, as mentioned, grew up in academia.

I still am. play in academia working in the non profit community based organization at West Tennessee for several years. But some of the focuses, they're the same, but a little bit different. So once again, Walmart Health really came about in about 2019 and really pushing to provide that convenient, affordable access to care.

So changing the paradigm a little bit, if you think about it. We are uniquely really positioned to deliver that integrated care across a range of healthcare services. So primary care, urgent care, labs, and something that really sticks out. compared to traditional health care is dental services, right? And really having that one area, that one place to go, as you can imagine, the local community, most people do shop in our area.

And, but having the ability to really address the holistic view of the patient. So a lot of work I currently do is a lot of foundational work that you're used to in traditional health care that you've done are doing currently, optimizing workflows, training, focusing on net new openings. So we opened a number of clinics in Florida this year.

We have another. A number open next year in three different states. We want to make the patient's experience seamless and favorable through an easy to navigate website, portal, healthcare experience. Another focus of mine is really provider experience of reducing burnout. How can we make EPICS or EHR the best possible vehicle really trying to produce, make the documentation and the EHR experience the best possible as best as you can get, I should say.

And finally, let's looking at predictive modeling. And also really how we can meet the patient where they are, right? So changing that narrative for more of a reactive, proactive approach and answering that question, how we can better identify the patient's needs and tailor care better to them. So that's kind of the overall scope.

mean, we're doing a lot of traditional health care stuff, but really kind of thinking out the box on scalability and things like that. And really just trying to crisp up workflows and make it That's experience possible for really everyone, right? Patient provider and staff.

So, I guess, very similar to most other places where, that are on the epic.

You're. Role is still optimization of that

you're spot on and we've we were. So just give you a quick background. We switched to epic mid last year, so we're pretty. We're net new epic customer. If you think about it compared to some others, we went from 4 EHRs to two epic. So a lot of that works being done.

You're finishing the archiving. That's pretty much done. Solidifying the workflows, things like that. Gotcha.

It's interesting that you're saying that a lot of the patients, Live in, a community with a Walmart. I think I heard the statistic was about 90% of the U S population lives within, was it 10 miles of a Walmart?

10 miles. You're exactly right. Yeah. So, yeah. So just kind of going into that, it's really 90% it's right there, right? So 10 miles of a Walmart. And that's why I think Walmart is one of the very few businesses out there. It's uniquely positioned already just because we have brick and mortar already within 10 miles of 90% of the population.

Yeah, so you talked about how it's the same. Tell me a little bit. How is it different than working in a traditional health care system or academic medical center

kind of going to that? So really, scalability, if you think about it. So once again, you actually took my fire a little bit there, Dr Lancaster.

So 90% of that population is within 10 miles of Walmart, right? So that position is a little different if you think outside what you're used to seeing in the regional setting of like traditional health care or really city setting the urban settings. But really our goal. And one push I am looking for right now, is really the using Care Everywhere with EPICS tools.

So, care quality, things like that, through these interoperability opportunities and with the recent mobilization with TEFCA, so a jump towards that universal interoperability, hopefully. We're in multiple states, so really my goal now is to, well, one of the many, is to try to pull that all together, partnering with different organizations, such as state based immunizations data, ADT messages, different groups like that, to Pull that patient journey, pull that patient story into one, because my goal is if you're in Florida or you're in Texas, whatever it is, we're able to see that same record, which you could do. That's why we use one instance of Epic, but really pulling it from other areas, too, right? Because we want our providers to have the most information possible and the best information.

And really, for the patient experience, it's huge. So, as mentioned before, we have one instance of Epic. 40 more locations now, but we're going to be ramping up to 80 at the end of next year and joining three more states. And as you're well aware, it takes a lot of work to, integrate into these state immunization databases, the ADT messages, how do you tailor the ADT messages, just doing a lot of background work to create a foundation that's really sturdy for the, for our organization.

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Yeah, I mean, we're in three states and it's difficult navigating the different telemedicine laws that are coming or are already out there. Everything else. I can't imagine being in 50 states. Goodness. how do you keep track of all the different laws build one instance that satisfies everything?

That's gotta be a big challenge.

No, we have a very large legal team and compliance team. And I mean, the truth is they. It's a large number. I would say 20 plus that basically go over the laws in each state because as you use, you enunciated correctly. I mean, the virtual care laws, which are continuing to change on the federal level and state level but also that's just one piece, right?

So you have to think about the medical assistance. What can physicians do? What can MPs do? What can, what, okay. You know, Immunizations can, so it's all these laws that are state based that the complexity just continues to grow. So yeah, no, it's we definitely have a great thumb on the, correct information, but it just takes time to, to kind of aggregate it all and really make sure everything's in line.

And Epic's been actually a great partner with us just because they know that we are in multiple states and we're unusual to some degree, but it's been a, it's been a good experience.

Yeah, I mean, there's a few other, I guess, organizations that are in all 50 states that may have a similar problem that EPIC has probably already worked with on.

So that's good. I guess that is already out there. Are there any challenges that are different for y'all that I guess that are not there for traditional healthcare system, even just outside of scale? Is there anything else that's different because you're an industry?

Sure. Yeah.

Well, the good news is I don't have to worry about OR workflows as my last position, or anesthesia documentation, or ER door to doc, or the other door to doc kind. Well, as an internal medicine

resident, and physician, as soon as we can get rid of the surgeons, the better. I'm

just kidding.

Like what's the so but the point of it is the challenge is definitely have arisen that are central to our providers and the patient. Once again, we're a young system, so a lot of the things that you may take for granted in traditional health care that in seasoned health care systems that are theirs, which are policies or whatever, workflows and directorships, all these things, we're really creating from net.

Net up, right? So the point is, and that's really good and can be kind of detrimental to some point because we're trying to cover a lot of bases at once and build that structure. So once again, going back to the complexities of interoperability and obtaining the transfer in that data, the appropriate data, really the correct time about the correct person also pair relationships.

Once again, going to multiple states, multiple pairs, as you can imagine, the blue crosses, that means everyone else is a little different in different states. We're fine tuning all those to make sure those relationships are crisped up. But probably the most differentiating thing in for us is dental. I don't know of any really true traditional health care that I've worked in.

I don't know if you have that have full dental services. So that's a little different of a beast. We have a great DSO. So, Chief Dental Officer, I should say. Dr. Yu, you work with her very closely. We use EPIC's Wisdom module as our backbone for our but we're continuing to optimize those dental work and set patient provider experience and we're working to really integrate that, right?

Because if you think it's hard, especially working in academia, you really don't integrate dentistry without OMFS. It's a different beast, of course, but what does that look like with the patient experience? How do we combine those? How do we really make it the best possible opportunity for the patient?

Yeah, no, that is really unique. I. I don't know of another system that is incorporating dental, anywhere especially in their EHR, I guess, since EPIC has a module for it, somebody's doing it,

but I mean, it was brand new. I was like, wisdom. So, but yeah, there's only a handful of my understanding.

It's once again it's very new. I'd say the last few years it came out. So.

Yeah. So you mentioned that you're having to stand up different things. Does that include governance for, any optimization changes and things of that nature?

Absolutely. Yeah. It's a lot of governance structure. So, kind of your bread and butter stuff, your decision support, your evidence based medicine groups, things like that.

So we're trying to really build all these up because going through all the BPAs, which are best practice advisory, sorry industry agnostic here. But the thing is really. Fine tuning these structures there's a number of other things with formulary reviews and things like that, because once again, I mean, we're on one Epic instance, however, we're in multiple states, right?

So we have to have some type of conduit to understand, Hey, this is working really well in Florida because we want to know everything that's working well or ideas and really percolate those across the enterprise, right? And make it the best possible experience. So we do. Those things are set up, but we're just kind of fine tuning those on cadences and who's who needs to be there and things like that.

And I mean, it's a new experience, but I think we're definitely getting there and it's gotten tons better. But to answer your question directly, yep, definitely a lot of governance structures being set up and really ultimately just making sure we're doing in the right direction. So assume you have a

bunch of.

Physicians or advanced practice providers join these and are helping you out with optimization.

Here's the final one. Yeah, so at every point, I want that feedback, right? I think you know well where I probably get my phone number outweighs too many, too many people but which is good and bad.

But the thing is I want that transparency. I want that feedback. I'd rather know quickly. So hey, look, if there's an order missing in EPIC or the synonym is not there in EPIC, whatever it is. Just to make that as easy as possible for the physician or the in PPA, because that's not their job, right?

We're trying to, you and I's job is to make their experience as best as possible. I don't want them to have to think about, I'm looking for a knee MRI, I don't, they don't need to type that exactly in. I'm on one that's like, is it lower extremity? Is it, whatever that is to make it a little bit easier.

And that's just one example. But to answer your question, yeah, absolutely. We I keep governance with MPs, PAs, MDs, whoever it is, DOs on those groups, mainly because I want their buy in. Number two, it's also a socialization factor. So once that governance group's created, it's approved, they can bring that back to their clinics and also help socialize.

So

nice. Well, I've learned a lot about what Walmart Health is doing. What can you tell me about the future of Walmart Health and from an informatics perspective, I guess.

Well, I think chat a little bit about what states were in, but we're moving to a few other states. We're really focusing on our core culture right now in our communities.

So we're people led tech powered omnichannel retailer dedicated to helping those people save money and really live better, right? So that's our motto live better. And I think we were, we're focusing more on live better piece with Walmart health for obvious reasons. But really, providing that frictionless experience to the patients so they can get that high quality care and the goal is really anywhere, and that's really.

meeting them where they want to be. So we take the on the channel approach to create opportunity for the patients to access that great care. Whoever meeting he or she wants it's pushing to meet, virtually at home at the office, whichever it is. And I think informatics is really that silent partner in the background, right?

So no one really knows what we do, but we do a lot of work. That's good, right? So it's But they don't know who we are. That's a good thing in my mind because that means it's running extremely well. It's frictionless. And they're really getting their needs taken care of. So really, I think to answer your question directly, it's the next step is really pushing, solidifying what we have now and really pushing to the next step in those other three states next year.

It's all very exciting. Well, thank you, Claude. It's always good catching up with you and thank you everybody for listening to another episode of This Week in Health IT.

Absolutely. Appreciate you having me. Thank you, Jake.

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