The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any other agency, organization, employer or company.
Jorge Grillo is perhaps best known in healthcare information technology circles for his MEDITECH 6.0 diary series on healthsystemCIO. After many years as CIO of Canton-Potsdam Hospital, a 99-bed hospital located in northern New York state, just south of the Canadian border, Grillo now serves as AVP/CTO at Honor Health, a $2B non-profit and community focused health care system in metropolitan Phoenix. In this interview, Grillo discusses the transition from CIO to CTO, his perspectives on prioritization of applications as part of decommissioning, and his broad view of the healthcare marketplace in light of increased consolidation.
In a non-healthcare environment, the CIO is responsible for daily ops while the CTO is responsible for deciding what tech to invest in. However, in healthcare, the CIO is the strategist and the CTO is the operationalist.
Aged technology is one of the factors that impact the high cost of healthcare. From my perspective, every organization has legacy hardware, applications, and data.
If there is in fact a broad move to a form of socialized medicine, payers will be under pressure to diversify into the provider and care delivery arena.
Campbell: After a decorated run as a CIO and MEDITECH 6.0 evangelist at Canton-Potsdam Hospital, you are now with HonorHealth in a slightly different role, as CTO. Can you explain the difference in the two roles, specific to healthcare information technology? How has the transition gone?
Grillo: The hardest transition is from a CIO to a CTO. I certainly benefited from experience from a former CISO role. In a non-healthcare environment, the CIO is responsible for daily ops while the CTO is responsible for deciding what tech to invest in. However, in healthcare, the CIO is the strategist and the CTO is the operationalist. For healthcare specifically, in terms of a military analogy, the CTO is the general in charge of defining strategy and the CTO is the tactician for that delivery. Thereby, the CTO is responsible for legacy debt remediation and technically enabling transformation in the interest of transparency and enhanced patient experience.
Campbell: Speaking of the technical debt that legacy systems present, can you elaborate on your experience with enterprise portfolio management? Are you currently going through this exercise in your new role as CTO?
Grillo: Aged technology is one of the factors that impact the high cost of healthcare. From my perspective, every organization has legacy hardware, applications, and data. We do in fact have an EPMO initiative in progress to retire legacy systems but retain legacy data. We have a cross-disciplined team that focuses on three main factors – retention, access, and compliance. There are many different categories of applications, and the retirement strategy pursued must make sense for the data associated with an application. As such, we have a three-fold strategy we use: First, use VMware to virtualize the application and make it hardware agnostic. Second, use a data archiving platform. Third, put it off network or inoculate it.
Campbell: You mention many categories of applications. How do you go about prioritizing which applications to decommission?
Grillo: First and foremost, it comes down to how long the data must be retained, which for the patient legal medical record, of course, varies from state to state. An analysis of which data needs to be kept must be performed, and it really boils down to a risk analysis. What are the odds that the data will be needed, and in what timeframe will it need to be furnished, balanced against the regulatory requirements associated with that? As part of the analysis, you must determine where you invest cycles and storage. An application is much more likely to be sunset if it is outside of core applications.
Campbell: Shrewd insight in that risk and compliance play just as much of a role in system retirement as HIM and clinical ops. Looking outside of your organization, what are you seeing in the broader marketplace? From your viewpoint, is the exercise of application portfolio management and legacy system retirement pervasive throughout the industry?
Grillo: In my opinion, we are seeing rural and critical access hospitals – smaller hospitals – that can’t afford integrated electronic medical records. As such, they are prime for getting bought, or seeking a hosting arrangement with a larger entity – especially with the rise of Cerner CommunityWorks and Epic Connect. We are also witnessing attrition of hospitals – if they don’t serve as a community safety net, they are not always going to be bailed out by the state. Moreover, the big have gotten bigger. Five years ago, a $5B system was probably ripe to get bought. The threshold has increased, so now it’s a $12B system that is ripe to get bought. This is an artifact of continued consolidation.
Campbell: Certainly. Consolidation is part of the maturation of any market to deliver efficiencies. What is your broader view of the healthcare marketplace in light of consolidation?
Grillo: Well, you are starting to see the insurance industry and other industry verticals (like Amazon) get into the healthcare delivery marketplace, buying hospitals to get at the data. An advantage of an insurer owning the hospital is that they may not have to negotiate rates, its part of the contractual basis. Geographically, insurers have the footprint to make an impact, and with more data, actuaries can improve wellness across the board. Of course, also affecting the insurers’ approach, this being an election year, it could very well be that we see some form of socialized medicine, and, as a result, a change in reimbursement models. Because of this possibility, insurers are investing in the provider space more and more because they are sitting on cash. If there is in fact a broad move to a form of socialized medicine, payers will be under pressure to diversify into the provider and care delivery arena. Payers will also look for ways to stay solvent by reducing rates and increasing transparency. We are already starting to see early movers, but it’s still predicated on the result of the election and policy that may emerge.
Jorge Grillo is AVP/CTO for HonorHealth, a $2B non-profit and community focused health care system in metropolitan Phoenix with 5 (soon to be 6 hospitals), encompassing more than 3,400 expert physicians, 11,600 dedicated employees, and more than 3,000 caring volunteers working in partnership with a commitment to wellness management. Prior to joining HonorHealth, Jorge was CIO at Canton-Potsdam Hospital, cited by Hospitals & Health Networks for being among Healthcare’s Most Wired hospitals in 2017. Prior to joining Canton-Potsdam in 2010 he served as CIO of the Bermuda Hospitals Board for four years. Grillo has written about the Canton-Potsdam’s Meditech journey, his experience working overseas, and the evolving role of the CIO, among other topics.
The University of California (UC) is the premier public research institution with 10 campuses, 6 health systems and 3 national laboratories. Each year it serves more than 270,000 students, conducts billions of dollars of sponsored research, and cares for more than 5 million patients across the state of California. Tom Andriola, University of California VP & CIO, based at the University of California Office of the President (UCOP), oversees the IT function across the UC system, which includes 9,000 IT staff. To foster innovation within an organization of that size and scale, he believes it is key to engage and collaborate across locations, applying lessons learned and leveraging strengths and focal areas. While Andriola’s perspective is shaped by his experience as a global business and technology executive, he is pragmatic in his approach to the pursuit of innovation and collaboration at the university. In this interview, he discusses UC’s continued pursuit of cloud technology, exit from the data center business, and utilization of commonalities across campuses to drive efficiency and scale. He also shares his approach to consistent communication using social media and a blog, and his view on how best to tackle the broad area of population health management.
One of the things that my global experiences gave me was a great understanding of diversity and that environments aren’t better or worse, they’re just different. In all the situations I’ve been presented with, I’ve taken the approach of identifying the best pieces available and putting them together in ways that create unique competitive advantage.
The fact that we have six semi-autonomous health enterprises that are also collective on some level, allows us to collaborate on initiatives while pursuing them in a timeframe appropriate for each institution. We collaborate on vendor selection criteria, but it may be at different points in the road map for each entity. One institution then can pave the road for another, so the others can follow with less friction.
There is also the element of getting that story to the rest of the system and outside world to inform and educate our executives, customers, students, and patients. It reinforces our message that IT is not just a cost center, but in fact is a strategic enabler for the university and its mission.
Population health is not just a way for us to manage care and dollars, it’s also a means for us to find where we need to energize the level of innovation.
Campbell: You come from a background at Philips and joined the University of California as vice president in 2013. You’re very active on social media and very active in the community, especially with the upcoming conference. With that, can you provide background about yourself, what brought you into health information technology and some of the initiatives you are working on?
Andriola: As you mentioned, I worked for Philips globally, where I built an IT services group running a global transformation program and running IT operations across three continents. The program was essential, after a series of acquisitions, to bring the business back in-line with profit expectations for their $6B medical device business. From there I moved into a General Manager role leading the company’s largest healthcare informatics business at the time. It was at the point that healthcare finally decided that it was an information-centric industry and started to move away from its focus on better and faster medical devices (in our case scanners) and concentrate instead on the value they were creating for clinicians and patients with the data coming out of the scanner. Then I focused on new business development and built a portfolio of IT software and services businesses in growth markets such as Brazil, China and India. Philips is a very global company, and these roles gave me the opportunity to not just travel the world but live in other places and build teams in completely different cultures.
In 2013, I transitioned to the University of California, the world’s most prestigious public research university. UC is a $33B organization that contributes in the areas of teaching, research, healthcare and public service. It consists of many entities – 10 campuses and 6 health systems, with more than 220,000 employees and 270,000 students, and $11B in patient revenues. It also co-manages 3 national laboratories. My experiences with Phillips provided me with the opportunity to step right in and help the academic medical centers figure out how the digital healthcare world was going to affect them. It also allowed me to show UC how to take advantage of the unique capabilities that academic medical centers have in terms of tertiary and quaternary care for the most complex patient populations and leverage not just technology but also, more importantly, the data to improve the quality of medicine, improve patient access, and drive down the cost of care.
Campbell: I appreciate that background. In terms of your global experience, and coming from the vendor side, how did that shape you as a healthcare leader. You’ve previously shared your philosophy on the importance of communication and collaboration. If you could, elaborate on that and speak to how that’s leveraged in your role with UC.
Andriola: One of the things that my global experiences gave me was a great understanding of diversity and that environments aren’t better or worse, they’re just different. In all the situations I’ve been presented with, I’ve taken the approach of identifying the best pieces available and putting them together in ways that create unique competitive advantage.
In joining the University of California, I have encountered great people and assets in the healthcare enterprise. We have deep domain expertise in the system, and it allows us to leverage that expertise to address our most challenging situations. In response to the challenges in the healthcare industry, we’ve created a coalition allowing six health systems and the Office of the President to come together, and look at things both at local and enterprise-wide levels. For instance, one of our locations has deep expertise in digital health, while another’s focus is on gene therapy. It’s a complementary rather than competitive arrangement, and allows us to approach 3rd party partners by putting forward our best-of-the-best along with the UC brand.
Campbell: It sounds like a unique situation for collaboration, and thus offering a competitive advantage. In fact, a recent article featured how six CIOs connected to the University of California, of which you are the group facilitator, have been producing strong results through broad strategic collaboration. That collaboration resulted in the first time ever that two US academic medical centers have linked up to be on one instance of Epic. Can you provide some background on that project in which UC Irvine Health and UC San Diego Health share the same Epic instance?
Andriola: You hear about moving to the new world of healthcare, moving to the cloud, and getting out of the data center business. We are living it. We have one instance hosted by Epic for UC Irvine, UC San Diego, and UC Riverside. The other health centers – UCLA, UC Davis, and UC San Francisco – are looking at their strategic roadmaps and determining when would be the right time for them to decide about going in a similar direction.
The fact that we have six semi-autonomous institutions, that are also collective on some level, allows us to collaborate on initiatives while pursuing them in a timeframe appropriate for each institution. We collaborate on vendor selection criteria, but it may be at different points in the road map for each entity. One institution then can pave the road for another, so the others can follow with less friction.
Campbell: That’s remarkable – the fact that you are leveraging each other’s strengths and using each other’s experiences to buoy the collective whole. That is what makes CHIME so great, that is, the ability for CIOs to collaborate amongst peers and share best practices. You are doing this on a micro level across the health systems, which is compelling.
Andriola: We do have somewhat of an advantage because there is a single governing body. Linkages, like shared financial incentives, also help align those activities.
Campbell: Absolutely. Shifting gears for a moment, The Huffington Post featured you as one of the most social CIOs on Twitter. You are also an avid blogger, bringing awareness to events, awards and news within UC. Tell me about the importance of having a social media and blog presence, and how it helps you to communicate key initiatives, both raising awareness and also potentially soliciting feedback from the IT staff.
Andriola: Our social media strategy serves both an internal and an external purpose. I’ll start with the internal. We are blessed to have 9,000 IT people across the university who come to work every day and try to make this the best darn research university and healthcare enterprise in the world. That’s part of the reason we use social media – to ensure people know that. We highlight the great work that people do, especially the most innovative practices that are going on. The blog and other communications strategies offer a mechanism for our people to learn from each other. Anecdotally, this could be someone hearing about an initiative at UC San Diego, when they’ve been talking about something similar at their own institution, and so being inspired to engage some UC San Diego folks to help solve the issue they are tackling. It facilitates peer-to-peer learning and reduces the time-to-value of technology efforts.
There is also the element of getting that story to the rest of the system and outside world to inform and educate our executives, customers, students, and patients. It reinforces our message that IT is not just a cost center, but in fact is a strategic enabler for the university and its mission. My job is to make sure that the outside world knows about what we’re doing – whether its healthcare, education, or research funding. I see my role as raising awareness about how UC is one of the most innovative places to work and how technology is a huge part of how we are innovating. The fundamental research we conduct changes the way in which domains are perceived and the way that we take care of patients. I use social media and communications as a means of telling the story of IT and sharing the great work that our people are doing. Everyone likes to have their story told, and that also supports engagement and retention.
Andriola: When I came here almost five years ago and learned that UCCSC existed, I thought it was a great vehicle to drive collaboration. One of the things I was trying to figure out was a good strategy to connect the 9,000 folks we have in IT. At that time, UCCSC involved roughly 200 to 250 people, and was very grassroots oriented. The CIOs didn’t attend. I thought we needed to invest more into the grassroots conversation, but also bolster the impact of the event through executive presence. And so, we really shifted over the last 5 years as we’ve tripled the size of the event, with close to 700 people attending this year, including 11 CIOs. We took it from being a small event for the same people each year to a true communitywide activity, complete with swag.
It speaks to this collaborative fabric we have now across the organization – the realization people have that, “If I’m struggling today, there is likely someone else in the university who is probably struggling with the same thing. How do I connect to them quickly, and how do I extend my network to solve the problem more efficiently and effectively?” While we have tools in place like Slack, which 4,600 of our IT professionals use daily, the conference provides an in-person experience for sharing insights, best practices, and innovation outside of day-to-day tactical issues. This year I challenged the team to use the network to find colleagues and save 30 minutes out of their week. It seems like a doable thing for most people. And at 9,000 people, recovering 30 minutes is equivalent to hiring more than 100 new people. That’s the power of networking.
Campbell: Speaking to this collaborative fabric, an article was recently published on the UC IT Blog providing an overview of the results from a survey UCSB CIO Matthew Hall conducted of the UC location CIOs, asking them to prioritize issues for IT leadership and the university. Can you elaborate on some of those priorities for healthcare, specifically around population health?
Andriola: Population health is one of those initiatives where there is no silver bullet, and it’s not one size fits all. We are moving away from a stance on population health that’s been very individualistic across our UC health enterprise. That doesn’t mean one-for-all population health deployments for all UC institutions. Some of them are multi-billion-dollar enterprises and may have three or four different population health plays. Some extend Epic; others use third-party tools to connect into Epic. We’re trying to take a step back and look at the population health needs in the changing landscape of reimbursement and patient distribution. We are tailoring our population health strategies to allow us to use the data we have, now that we’re fully digital, to make more timely and intelligent decisions. It’s a challenging space. Epic is certainly a large part of it, but it’s not the only part. There are a lot of other systems that have relevant information about patient conditions and experience that we want to pull into repositories so we can generate insights into how to better reach patients.
Campbell: You share the sentiment of a lot of healthcare CIOs, in that they want to steer away from the boil the ocean approach, and instead address specific use cases. There are components that go into making use of the data, access being one of those, but also transforming the data into the format that’s needed and governance as well.
Andriola: One of the other things that is of benefit to us is that, as academic medical centers, we have a teaching and research component to our enterprise. Some of the insights provided help inform us about where we should be innovating more quickly, and where we should be doing pilots. Those pilots are leading us to work with different types of partners who support home centric care models, for instance. As such, population health is not just a way for us to manage care and dollars, it’s also a means for us to find where we need to energize the level of innovation.
About Tom Andriola
Tom Andriola joined the University of California in 2013 as vice president and chief information officer (CIO) for the system. He provides leadership across the university working closely with campus and healthcare leaders to explore opportunities for technology and innovation to enhance the UC mission of teaching, research, patient care, and public service.
Andriola brings over 25 years of experience as a global business and technology executive, having served as a business transformation leader for a multi-billion-dollar enterprise, a global CIO with staff around the world, and the first employee of a brand-new business.
Throughout his career Andriola has been a champion of change inside organizations, as well as a leader for innovation in the marketplace, having brought first-of-kind solutions to market and led the creation of several new businesses.
Andriola is active in higher education and healthcare associations and serves on several boards, including the Corporation for Education Network Initiatives in California (CENIC), OCHIN, the Pacific Research Platform, and the Risk Services Software Company.
With his background in technology and innovation, Mr. Andriola maintains relationships with UCSD’s California Institute for Telecommunications and Information Technology, UCSF’s Bakar Institute for Computational Health Sciences, UCSF’s Center for Digital Health Innovation, the UC Berkeley Haas School of Business. He is a sought-after speaker on a variety of technology topics in healthcare, higher education, and the changing CIO role.
Andriola holds a bachelor’s degree from The George Washington University, a master’s degree from the University of South Florida, and completed the Stanford Executive program.
As a community healthcare organization, Metro Health values the ability to engage the community at a local level. Joshua Wilda, CIO, ensures the organization is nimble in its approach to patient and provider engagement, offering innovative solutions by creatively partnering with local employers to offer additional flexibility to the communities they serve. Joshua offers candid and shrewd advice for blossoming healthcare IT professionals as they seek to grow and advance. He also shares acuity surrounding the meaning and importance of health information technology. In his words, “we are not IT professionals in the health care industry we are health care professionals in the IT industry.”
Historically, we have focused on the provider experience which is extremely important. However, if we make the patient experience seamless and successfully address that aspect, providers will have their experience change as well and the entire care team will be able to leverage technologies to drive better patient outcomes and satisfaction.
We evaluate how the technology can be used to manage the care by the entire care team and how that team can support and utilize the information, as opposed to having the burden be wholly on the physician as the entry point and manager of that information. Just as the I.T. industry is tasked with managing big data, providers have been tasked with the entry, management and output. A daunting task when their value is being with the patient. By enabling technologies that allow providers and their care team to manage and interact with the patient at the center, more of the information can be used to better treat our patients.
We must consider what are our payers are going to reimburse us for and that’s been a struggle. There are many technologies that can be leveraged to treat a patient but if there is no reimbursement for the use of these technologies, smaller organizations can be hindered by what they can take advantage of due to cost.
We are not IT professionals in the health care industry we are health care professionals in the IT industry. Metro Health isn’t an IT organization, its focus is and needs to be on quality patient care. I.T. is only a vehicle to be driven where healthcare can go, and I’m all about instilling that mission and passion in my folks.
Campbell: Thank you for taking time out to speak with us. Please tell me more about Metro Health and your background
Wilda: In healthcare, we tend to describe ourselves as the size of our beds. As a community based hospital, we have a 208-bed village campus and we have a large number of neighborhood centers where different services are geared towards outpatient care. Several years back, our organization had the foresight to transition from sick care to health and wellness management, in the communities where the patients live, not solely in a hospital. We have invested in outpatient centers and clinics, specifically with primary care services. We now own and operate 17 outpatient facilities where we have a multitude of services, mainly rooted in primary care and outpatient specialties.
From an IT perspective, we describe ourselves with the EMR that we use. As a small mid-market hospital we understand the value I.T. can bring to the patient experience and have invested heavily in I.T., more than most organizations our size. We were one of the first of our size on Epic, with a full enterprise deployment. We’ve been a Most Wired hospital for 10 years running and have very much made I.T. part of our strategy. We have been a HIMSS stage 6 organization for both Ambulatory and Inpatient for the last 5 years, with our stage 7 assessment coming soon! We have been part of a very large competitive market, and with Metro being the smallest, our CEO focused on positioning Metro to be the top choice in the market. We used technology to help drive that choice, whether it be with our provider base or with our patient base.
Campbell: Metro Health formally affiliated with the University of Michigan in 2016 and it was shortly thereafter that you were promoted to CIO in April 2017. Please tell me what CHIME means to you as a result of that promotion.
Wilda: I’ve been with Metro for the past 11 years and originally came on board as a systems analyst. I started my career working on the Epic implementation here at Metro and got the opportunity to rise through the ranks to now being the CIO. I am an alumnus of the CHIME Bootcamp from back in 2009. Our previous CIO, William (Bill) Lewkowski, is still with Metro Health as our Chief Strategy Officer. Much of what we’ll talk about in this interview is attributed to the framework of what Bill built over the past 23 years, anticipating where healthcare was going. A lot of my strategy is based upon honoring that history and advancing and innovating it to the next level. At 37 years of age, I’m considered a young CIO, and I’m fortunate to have gotten the opportunity to lead a healthcare organization.
In terms of the value of CHIME, it’s such an invaluable resource to be able to ask for advice and perspectives from folks who have been pioneers and peers who are considered future thinkers. Healthcare IT is a vast industry with many facets, opportunities and challenges to overcome. CHIME is a tremendous resource. I considered myself part of the next generation of healthcare I.T. leaders driving what technology means. In attending the CHIME forum this fall, it was interesting to hear where some of my peers are (as far as their career) and to hear their struggles of how they are still trying to get themselves to the table with senior leaders. They are trying to change the perception of I.T. as being a commodity, providing operations and maintenance, and instead having it viewed as a valued capability to driving and shaping organization’s missions and strategies. I am fortunate to be at an organization where they understand our capabilities and continue to invest in our growth. CHIME is a resource which helps me understand what capabilities our team may need to focus on, where we may have gaps and provide valuable resources in how to stay ahead of the curve. Metro focuses on how we can leverage digital transformation to represent the brand of who Metro is to support patient focused services and create loyalty among our patient base.
Wilda: My background and formal training is on the healthcare sciences side. I received a Bachelor’s in Biomedical Sciences and a Master’s in Public Administration with a Healthcare emphasis, I am not the typical information technology professional nor claim to be a true technologist. I’ve had to learn the technology portion of this, so I have a unique perspective there as well. Technology for the sake of technology is never well received in the healthcare industry. We often use the word disruptor. Disruptor, while a well-intentioned buzz term, can have a negative connotation to end users. I like to say technology is a differentiator and a vehicle to drive healthcare to new areas with a focus on meeting the triple aim plus one!
Campbell: When you can bring that multidisciplinary approach, you sometimes have opinions or views that are skewed already. That leads me to a big topic that was echoed time and again at the CHIME fall forum – physician satisfaction & efficiency and EMR usability. Can you touch on that a bit? Specifically, things you may be doing with telemedicine to help alleviate some of the burden on providers?
Wilda: Historically, we have focused on the provider experience which is extremely important. However, if we make the patient experience seamless and successfully address that aspect, providers will have their experience change as well and the entire care team will be able to leverage technologies to drive better patient outcomes and satisfaction
Technology is perceived as a burden on the provider/patient experience, and that is an area we are focusing on. We are gaining better understanding of the relationship and expectations between providers and their patients; crafting a digital experience as a benefit to that relationship rather than administratively burden providers away from their focus on their patients. To that end, we have a program with our CMIO Dr. Brad Clegg and Medical Informatics Directors Dr’s Lance Owens and Srinivas Mummadi around understanding where the physicians are spending their time with the technology. As part of the program, we partner with providers, assessing productivity and providing them with tips and tricks. Another approach is having an appreciation that technology is perceived as a disruption, there is that word, so when we introduce new advances we go to great lengths to provide engagement opportunities and education of how the introduction of new technologies will actually reduce that burden.
We evaluate how the technology can be used to manage the care by the entire care team and how that team can support and utilize the information, as opposed to having the burden be wholly on the physician as the entry point and manager of that information. Just as the I.T. industry is tasked with managing big data, providers have been tasked with the entry, management and output of that same data; a daunting task when their value is being with the patient. By enabling technologies that allow providers to manage and interact with a care team, with the patient at the center, more of the information can be used to better treat our patients, the providers can focus on the patient and not the technology! We don’t want the physicians to have to manage every single informational input, but rather, we want a team around the patient so we can leverage the collective skillset in managing patient populations. We are heavily focused on unified communications across the care team and remember, patients are a part of the care team. Our focus has been to make sure that the right information is getting to the right member of the team, whether it be the care manager, a nurse, a physician, or a PA/NP and provide communication tools to have the teams seamlessly interact with the patient and each other. This is a current gap. We have siloed technologies implemented, it is now our goal to connect them, increasing patient/care team engagement.
Campbell: Along those lines, Metro Health was one of the early pioneers in delivering remote access, allowing providers to be more efficient and get access to the point of care information in different settings. Can you elaborate on that a bit?
Wilda: Early on, we leveraged the VDI (Virtual Desktop Infrastructure) experience because we didn’t want our organization to be limited by the bricks and mortar of a PC. We wanted the care team and support services to be able to have information when the patient needed them to have that information, not when they had access to it via a bricks and mortar type of workstation.
Campbell: What is your mix of payers and what mix of value-based care is there today with your patient population?
Wilda: Like any community organization we are managing those models with a mix of government, commercial and private payers. This is another convoluted area as each has their own documentation requirements, sometimes overlapping, often having their own nuisances. We are spending too much time designing the system for their needs and not enough time focused on what the patient needs but it is how we stay in business. Just like most in the industry we must consider what are our payers are going to reimburse us for and that’s been a struggle. There are many technologies that can be leveraged to treat a patient but if there is no reimbursement for the use of these technologies, smaller organizations can be hindered by what they can take advantage of due to cost so we need to be tactful and impactful, leveraging the entire investment we do make in technologies. Larger organizations may be able to invest in different overlapping technologies. Often, value is left on the able with a large portfolio of services and capabilities. Metro sustains by being purposeful and understanding we do not have the luxury of best of breed to support all areas of technology but leverage the interoperability and value that comes from best of suite integrated solutions.
We are in an extremely competitive market. Metro’s goal is to remain a community organization which prides itself on the family culture and personal interactions we have with patients. To that end, we strive to provide choice in the market. We are partnering with local employers to do something different to drive down the cost of care. We do not have our own payer program, but we provide direct contracting and risk sharing models with local employers in town. It takes out the middle man and puts the responsibility on us as an organization to keep these employer’s staff healthy. We are directly servicing the community, we are engrained in that community and have put skin in the game.
We all have read the benefits of telemedicine. One of those is providing convenient care for patients, reducing the time away from work, away from families. The employee has got to come into the office to see the provider and often, that requires a day off and less productivity. We are examining how we can, with these direct contracts, put telemedicine into the employer’s offices and make it so that employee doesn’t have to leave or take a day from work or inconvenience their family with a disruptive office visit. It is our belief that having immediate access at their place of business will provide convenient access to employees, increase productivity and decrease costs for employers and ultimately aid in increasing the health and wellbeing of our community. Its sends a message to the community Metro understands what a patient needs to go through to see a provider and we are focused on helping the patient manage that experience, reduce disruption in their lives and can help add flexibility. We feel like this is going to help our patient mix and managing the healthcare experience.
Campbell: I appreciate you sharing the innovation that’s taking place on a localized level. If we could shift gears, I’d like to touch on the topic of population health management and anything you may be doing with Epic’s Healthy Planet module to that regard. Are you currently conducting any sepsis detection or surveillance initiatives or perhaps taking data from the HIE to get alerts about your patient population?
Wilda: We were an early adopter of Epic’s Healthy Planet module. We are one of those organizations that always seems to be on the bleeding edge. From a patient/payer perspective, we partnered with the state of Michigan on programs which gave us a spring board to adopt a progressive care team model around the patient. That model includes a team of care managers and pharmacists which provide support to our providers in managing the wellness of our population. Epic’s module allows us to use analytics to recognize those patients which may be at great risk or need more attention and then act on those patients with greater efficiency and quality. As I stated, technology is a great vehicle to allow our care team’s great accesses, more information and deeper abilities to treat more patients. We’re an osteopathic organization, so population health is ingrained in us, the complete focus on the patient’s health and wellbeing. It’s not just about being sick care but about treating the patient holistically, from root cause to illness to changes in lifestyle. That’s what osteopathic medicine really is rooted in. We are at the table with Epic trying to design the next wave of what that means for a small organization like us to sustain that model.
We also do have a sepsis program though not as robust as a lot of the larger healthcare systems, it is serving our patients extremely well. This is one of the reasons why we partner with the University of Michigan in that we have a lot of great ideas, but we don’t have the scale to do it. Now with the University of Michigan being a partner of ours, we have a lot more access to resources to grow our programs.
We are heavily engaged with our regional HIE, Great Lakes Health Connect. Metro was one of the founding members of our HIE. Around 10 years ago, a number of healthcare organizations came together and agreed while we may be competing for patients, we should not compete on the data around the patients thus forming one of the nation’s most successful HIE programs. Over the past 10 year, Great Lakes Health Connect has grown in its members thus growing the amount of information our providers have access to. Again, HIEs information is being engrained directly into the care workflows, allowing the care team better access, a more robust picture of the patient’s care allowing us for more prescriptive care plans.
Campbell: Very good. In closing, I’d like to ask you a question around your career trajectory. You have a compelling story, having worked on the vendor side for two years and then moving to the analyst side at Metro, being developed and groomed in-house. Folks who have created their own destiny are motivational. That said, what advice do you have for the budding health IT professional? What were the key things that got you to where you were today?
Wilda: One thing I tell anyone who’s starting out in their career is to make your ambitions known. Don’t just expect that by putting in sweat equity, people will know what your career aspirations are. I went out on a limb when I first came here and I scheduled a meeting with the CIO at the time. I told him what my career goals were. Did I envision myself as CIO? Not necessarily, but I’ve have a desire to grow as a healthcare leader and I told him that. He then set a path forward, setting the expectation that he wasn’t going to hand me a seat at the table, it needed to be earned. He knew that I was hungry and gave me the opportunity to succeed and opportunities to fail and learn from my failures. You need to take time to reflect and understand what you want out of your career and make your passions known.
It goes without saying I.T. professionals need to understand their business they support and not think that they are smarter than their customers are. In healthcare I.T., we have many vehicles we support, HR, finance, facilities, direct patient care, and more. It’s a very interesting industry, because we service all those entities and it’s about building the relationships and getting out there to know our customers and partner with them on crafting solutions that increase their services and delivery. You must show that you have emotional intelligence and empathy to understand what their business is, not tell them what their business is. You must really get to understand them and be open minded.
Understanding the people that manage technologies is critically important. We have to understand how to manage people. We often focus on the technology itself, how to manage technologies, but we also must appreciate and understand the inner workings of the organization. We have to put the right team players in the right team settings to make those technologies work. I tell our department all the time, we are not I.T. professionals in the healthcare industry we are healthcare professionals in the I.T. industry. Sometimes, leaders with a pure I.T. background and perspective come at solutions with just taking into account data, the networking, the bare metal, without an appreciation for the healthcare end-users. How will that technology impact, improve, disrupt, delight or disengage the users? It is important the entire I.T. organization of any healthcare system take the time to understand and get to know the business of healthcare.
I focus on our pure I.T. professionals, taking them for occasional walks around the organization, to get them aligned behind the “Why” of what we do. Many do not understand how the impact of their work, that phone they deployed which they may think is mundane, has a mission, is delivering some critical information to a patient. It might be used to deliver some good news, it might be telling somebody unwelcome news. It might be connecting care teams. But, if that phone isn’t working when that patient needs it to work, it’s useless and you are impacting that patient’s life. That’s the impact we have from the most robust clinical application, the most inconspicuous piece of technology, like a phone.
Metro Health isn’t solely about I.T. Technology is a vehicle to where healthcare can go, and I’m all about instilling that mission and passion in my folks. In fact, it is hard to get away from that mission. My wife is a provider at Metro and I make the joke all the time that not only do I support end-users at work, I live with one and get intimate insight when/how the technology is helping and sometimes hindering patient care. I can’t escape it nor do I want to. It provides for nice dinnertime discussion.
Campbell: What a powerful message around emotional intelligence and empathy. The perspective you bring is truly inspiring. Thanks for taking time to share.
The role of the Healthcare Chief Information Officer is changing. Shane Pilcher, CIO at Siskin Rehab, knows it’s important to be on the front lines and understand how every aspect of the organization operates. As Siskin’s first CIO, he paved the way for IT to have a place at the executive table, and now he’s finding new ways to make sure all technology is optimized to fully meet physician needs. In this interview, Pilcher discusses reassessing workflows when implementing new technology, why Siskin needs more than an acute-care-based EMR, and how telemedicine is affecting rehab. He also touches on the CHIME CIO code and the true importance of peer-to-peer connections.
It has been a wonderful combination for the organization, as we’ve witnessed significant growth over the past couple years that I’ve been here. IT has helped enable a lot of that growth, as well as invested significant effort eliminating legacy systems and to update and optimize existing systems.
The longer you spend with any EMR, the more invested you get, and the harder it is to make a change. But, while you get invested with customized content, optimized processes, and those types of things, when you decide to make a change, it’s important to not get caught up in trying to take your old system and fit it into the new system.
We need to spend time looking at how we do our business, optimizing those things, and then wrapping technology around that to enable it.
Not only is that information really important, but the peer-to-peer relationships that you create are critical. You cannot put a dollar value on that, it’s priceless.
I’ll also say, a good resource to have a provider that’s totally against the system as well. Through the process of engaging them, getting them involved, and making them a part of the building process, if you turn them into a supporter, you have a huge resource that will then help the other physician population come on board as well.
In some cases, I would even suggest that the CIO is very close to having to have the same level of vision that a CEO has in an organization because you cannot focus directly on IT, you must understand the organization as a whole with all of its nuances so that you can help lead them and their technology strategy.
Campbell: Coming from a consulting background, and now working on the healthcare delivery end, you bring a unique perspective to the CIO role. Tell me a little more about Siskin, how you came to be an organization and what your role is today.
Pilcher: We are one of the few remaining, independent, inpatient, acute care, rehab hospitals in the country. We’re just under 200 beds and have been established in Chattanooga, Tennessee for 25 years now. We’re one of the primary sources for rehabilitation care in the area. I came to Siskin in July of 2015. At that point, they had never had a Chief Information Officer, and certainly IT was never part of the Senior Leadership team. It was a fantastic opportunity to take them down a new direction and finally have IT at the table where decisions were being made and strategy was being developed. It has been a wonderful combination for the organization, as we’ve witnessed significant growth over the past couple years that I’ve been here. IT has helped enable a lot of that growth, as well as invested significant effort eliminating legacy systems and to update and optimize existing systems.
Campbell: Very good. If you’ll allow me to inquire, what are the primary clinical systems that you use today within the organization for EMR and potentially care coordination?
Pilcher: We are a McKesson Paragon shop. We’ve had Paragon in place for a little over ten years now. We are actively pursuing a different EMR, and we’ve narrowed it down to a couple of vendors. We expect a significant EMR implementation in our future within the next calendar year, so its exciting times. Paragon covers most of our areas, especially inpatient care coordination, but we also use an outpatient ambulatory EMR called TheraOffice, it’s one of the few out there that is heavily focused on therapy and rehabilitation care.
Campbell: Thank you for providing background and insight into your pending EMR replacement project. You bring a unique perspective, given that you’re a registered respiratory therapist and served in the United States Navy. Given this, tell me a little bit about how that clinical expertise has benefited you in your career and moving into healthcare information technology.
Pilcher: Absolutely. I have definitely had a varied career path. I do things unusually, in most cases, and my career path is evidence of that. I became a respiratory therapist in the Navy. I spent eight years on active duty and thirteen years in the reserves. After coming off of active duty, I joined Erlanger’s Children’s Hospital in Chattanooga and spent a few years there working as a therapist in the pediatric ICU, the neonatal ICU, the ER, and other areas. They had an opening in the IT department. They were just looking for someone with clinical experience that had an interest in Electronic Medical Records and they were willing and open to train that clinical person to build and optimize the system. So, I found my first opportunity in healthcare IT and spent a few years doing that. I then started consulting, and spent about fifteen years doing that. I was doing all sort of projects from, initially, EMR implementations, optimizations, through strategic planning and interim leadership.
Campbell: That reminds me of the career of Dr. Dale Sanders from Health Catalyst. I attended the Healthcare Analytics Summit a few years back and he talked about applying his diverse career, including command posts at the US Air Force, and how that military background can serve some purpose in offering structure to, what can be, a very overwhelming healthcare IT space, so thank you for that.
Can you tell me a little about any IP you have invested in Paragon today? I imagine having it in place for ten years there may be some technical debt in that system in terms of, perhaps, clinical rules, or documentation. If you could elaborate on the challenges of cataloging those different types of IP in systems as you plan on moving. A lot of healthcare delivery organizations today are moving from a system that is more comprehensive to an Epic or a Cerner, and I assume that is part of your decision making process.
Pilcher: Certainly. The longer you spend with any EMR, the more invested you get, and the harder it is to make a change. But, while you get invested with customized content, optimized processes, and those types of things, when you decide to make a change, it’s important to not get caught up in trying to take your old system fit it into the new system. It’s a beneficial opportunity to be able to reassess what you’ve been using for that period of time and determine if that’s really what you want to bring forward. It also allows for evaluation of established clinical workflows that you’re wrapping technology around. One of the key mistakes that organizations have made for the projects that I’ve been a part of, and even here if we’re not careful, is we try to take a current process and wrap technology around it. If the process and workflow is flawed, or inefficient, we’re just going to exacerbate that and make it worse. We need to spend time looking at how we do our business, optimizing those things, and then wrapping technology around that to enable it.
With Paragon, we have a lot of customized content in it, a lot of our assessments are there. However, because of our unique situation, we are McKesson’s only rehab client, at least up until the last year—I think they got a smaller rehab client that they’ve implemented Paragon with. So, while we have required functionality that Paragon provides us, based on CMS’s Data Regulatory Requirement feature, additional functionality really hasn’t materialized in the last ten years. We’ve had to do a lot of manual processes outside of the system to be able to overcome those gaps. While we have a lot invested in the system, it’s going to be easier for us to make that move than other hospitals only because we’ve had to do so many things outside of the system or used bolt-on third party applications to try and overcome some of the limitations within the system. Now we’re looking for systems with predefined rehab content. We don’t anticipate getting into a situation where we’re the only rehab client that the vendor has, where they don’t have specific functionalities for rehab. That’s due to the fact that while we’re an acute care hospital, we’re also rehab, and we don’t do everything like an acute care hospital does; we need something more than just an acute-care focused EMR.
Campbell: Thank you for elaborating on that. Switching gears, a little bit, can you tell me about your payer base in your market blend, and how that may be unique?
Pilcher: We’re very heavy with Medicare/Medicaid, quite a few of our patients fall into that bucket. We have a variety of other insurance providers, partnerships with organizations as well, for their workman’s comp and other injuries.
Campbell: Is there a good mix of value-based payment occurring, specifically with Medicare Advantage? If so, I imagine there might be a focus for you on HCC – hierarchical condition categories.
Pilcher: I see there being more opportunity. We partner with a few of our referral sources and their value-based programs, but as far as specifically, that’s about the only impact that has with us. Due to our payer process we get daily stipends, if you will, a certain amount of reimbursement per day from our commercial insurance partners and from Medicare. A lot of the value-based purchasing efforts in the acute care hospitals aren’t directly impacting us except as we partner with them to provide care to fit into their value-based purchasing programs.
Campbell: Tying into that, you have a state of the art facility that provides treatment for brain injury and stroke. Do you have any initiatives in place for shifting some of that rehab to home rehab, or incorporating telemedicine, or perhaps patient centered medical home? If so, can you elaborate on that?
Pilcher: The type of patients and the overall population that are presenting to inpatient acute rehab as well as our subacute rehab, is drastically changing. The typical orthopedic patients are being shifted to home health and outpatient therapies, and we’re there to help with that. Inpatient wise, we’re seeing patients with higher and higher acuity levels; they’re sicker than they’ve ever been and require a lot more care. While a lot of the orthopedic and nonmedically significant care is being shifted to home health, our focus has been to ramp up our brain injury, stroke, and neuro programs, as we’re seeing a significant increase in demand for that. Also, we have patients coming in directly from the ICU requiring rehab, so we’re seeing sicker patients, and many of those that are not being shifted towards the home health and outpatient environment.
Campbell: Thanks for elaborating on that. That’s a very compelling point, you are acute care so obviously you’re going to deal with those who have an inpatient stay. With that said, is it mainly limited to the surrounding areas or do you get out-of-state patients who seek you out because you’re a center of excellence?
Pilcher: We do have patients who come from across the country. The majority of our patients are locally and regionally based. We get referrals from as far as Nashville and Birmingham, but most of our patient population is more local than that.
Campbell: Shifting gears again, what pop health initiatives are in place today? Do you have any care coordination that’s occurring between the acute care setting and home health, easing those transitions of care? Are there initiatives in terms of referrals and/or handing off your portion of the patient record, perhaps through an HIE or any other means?
Pilcher: All of that is in transition at the moment. We have some coordination with our two largest referral sources, the two largest hospitals in the area. They have some specific population health initiatives that we factor in with some of their patients. For some of the orthopedic patients that are not candidates to be discharged, we have programs with organizations to bring them into our organization. As far as very formal sharing of information, that’s not happening much in this area yet, but our two largest referral sources are in the process. One just went live with a new EMR that would give them that ability, and another one is planning on doing it shortly and would change out their system to a system that would support sharing of data. Then, of course, with ours, that’s a key component to whatever system we put into place, to greatly enhance the sharing of data in our area. As far as a formal HIE, that’s not present.
Campbell: Great. I want to touch on your experience at CHIME as well, and gather some of your impressions from it. I know I personally valued the new clinical informatics track this year, which focused on the topic of physician efficiency and engagement. If you could elaborate on your goals with going to CHIME and how you may approach EMR replacement based upon things you may have learned at CHIME, specifically getting clinicians to use a new system and learning the nuances of that.
Pilcher: I think CHIME is an invaluable resource to CIOs in our market space. I was actually part of the planning committee for the fall forum this year, so I’m very pleased to hear that you liked what you saw. We spent a lot of time trying to make sure that the educational content contained value and I certainly think it did. Not only is that information really important, but the peer-to-peer relationships that you create are critical. You cannot put a dollar value on that, it’s priceless. It’s those individuals that are willing to take your call at a moment’s notice so you can bounce an idea off them, and determine how they handled things. When I was transitioning from the consulting side to the CIO role, there were numerous CHIME members that I had developed relationships with over the years, and they were readily available for me to call at any time—and believe me I did—to be able to get advice from. That’s something that, while we get hundreds of calls a day, and can’t take them all, if a CHIME member calls another CHIME member, that call is usually taken. I really value that with our fellow CHIME members.
Being able to get information on how they engaged their clinicians is key because, as we know, that’s not an easy population to have completely adopt an EMR platform, and having them engaged is critical. My advice is that engaging clinicians from the beginning, early on, and frequently throughout the process is a key piece to that adoption. They have to understand that the EMR doesn’t always bring efficiencies, like it was once touted. In some cases there are some, but it usually takes physicians longer to do what they need to do versus when they did it on paper. Understanding why we’re doing it, the safety implications that come from it, and then making sure that they’re part of the process of designing the system that they’re going to use is key. Finding a physician who is leaning towards being able to use the system well is a good resource to have. I’ll also say, a good resource to have is a provider that’s totally against the system as well. Through the process of engaging them, getting them involved, and making them a part of the building process, if you turn them into a supporter, you have a huge resource that will then help the other physician population come on board as well.
Campbell: That’s a great point, to focus on those outliers and not necessarily the low hanging fruit. I agree with your sentiment around CHIME, and kudos to a job well done coordinating that event. Like I mentioned, I witnessed CIOs who are always so gracious with their time. There’s just a deep amount of trust built up among peers and that’s invaluable especially when you’re in a tough position. As you mentioned, the healthcare CIO position today has morphed, as they are the quarterback and the glue within the organization to tie information technology to administration to. I’ll also mention too that the session Bryan Bliven and Dr. Tom Silva from Missouri Health presented was profound. They shared key insights with the way they engaged physicians, making sure that there’s rounding occurring, ensuring there’s -training that is occurring right across from the break room. Those pragmatic and novel approaches were well received.
Pilcher: I completely agree with you on the rounding part. As a CIO, you cannot stay hidden. You have to spend your time out there and that’s where you are able to develop a lot of trust with your end users and not just your senior leadership team. It can be kind of scary and dangerous to get out there because you’re going to hear what doesn’t work, but if you’re committed to getting it fixed, rounding is huge. Just to follow-up on what you were saying, as far as the transitioning of the CIO role, I know a lot of those educational tracks dealt with the transitioning of the CIO and the role we play. In my opinion we are one of the few leaders on the senior leadership team that truly has to understand every business sector of our organization, every business line – understand what they do, how they do it, why they do it, where their pain points are – so that we can then help them put technology around that. In some cases, I would even suggest that the CIO is very close to having to have the same level of vision that a CEO has in an organization because you cannot focus directly on IT, you must understand the organization as a whole with all of its nuances so that you can help lead them and their technology strategy.
Campbell: Absolutely. It must be multidisciplinary, and you must be able to fortify partnerships with your clinician peers. Thank you for sharing these cogent insights and for providing sage advice.
About Shane Pilcher
Shane has more than 25 years of healthcare and healthcare IT experience. He brings to Siskin Hospital his strong healthcare, military and corporate experience in leading teams to align IS strategy with corporate strategic plans.
Shane became a Registered Respiratory Therapist in 1995 while in the United States Navy where he served as a Respiratory Therapist, Navy Corpsman and EMT. In 2003, he converted to an Intelligence Specialist where he served time in Iraq and was the leading Chief over the Naval Intelligence Reserve Region Southeast’s Reserve Intelligence Training program. Shane retired as a Chief from the United States Navy with more than 20 years of active and reserve service. He has also received his Fellowship designation from Healthcare Information and Management Systems Society and holds a BS in Business Administration.
We often talk about healthcare’s deluge of data in a negative connotation, but Blain Newton, Executive Vice President at HIMSS Analytics, sees it as innovation in the making. Their global guidelines for health IT adoption gives them a unique perspective on the very specific needs of healthcare delivery organizations. The data that comes through these framework-based engagements allows them to inform vendors in a way that nobody else can. It gives these vendors a better understanding of how to position themselves in the market and in-turn results in the innovations healthcare organizations need to better patient care. In this interview, Newton discusses how HIMSS Analytics went from a point-to-point data aggregator to a global health IT strategy organization and market intelligence platform; why understanding brand perception is so important, especially for startups; and why data is only as valuable as the solution it creates. Whether you’re a large healthcare organization or a small startup, HIMSS Analytics has the resources to move you forward.
Being a wholly-owned subsidiary of a global, cause-based not-for-profit allows us a different lens than you would get as a traditional, commercial organization.
Through the relationships, engagements, and conversations that we have all over the world, and because of these standards of excellence, we’re able to speak intelligently to the vendor and consultant community, who are trying to fit the needs of these organizations, about what providers are looking for.
These go-to-market strategies penetrate the noise. For startups, it’s even more important. If you’re an Epic or a Cerner, you have a market position, you have a voice, you have a platform. In the startup community, there’s a lot more clutter and noise.
There’s an 80/20 rule at play here where the single source vendor will likely maintain that large footprint, but may not dip into their niche fringes.
One word of caution: as these technologies are becoming more ubiquitous and more known, we’re seeing a shift towards enterprise buys, as opposed to disparate departmental buys.
Making sure that whatever solution you’re bringing to market is not an extra click, or two, is critically important. It needs to be presented and served up in a way that does not further tax the time or research constraints of the clinicians.
Some of the bigger players have whole teams dedicated to working with our data, but a startup doesn’t have that luxury. Because of that, we’ve begun offering what we call Managed Services, which is essentially an on-call market research team.
Campbell: Please tell me a little bit about yourself and your organization, HIMSS Analytics.
Newton: I’ve been in healthcare software technology for – hard to believe now – almost twenty years. I started on the financial side with Arthur Andersen then moved through the vendor community, at GE/IDX and Allscripts, both here and in Europe. I’ve basically worn every hat; I did finance, accounting, operations, professional services, support, product development, and strategy. I eventually rolled off as CEO of a small market research company that was acquired four years ago by HIMSS and consolidated within the HIMSS Analytics business unit. HIMSS Analytics is a wholly owned subsidiary of HIMSS, which is a global, cause-based not-for-profit, focused on better healthcare IT. We are the market research arm of HIMSS. The role I’m in now is essentially CEO of HIMSS Analytics. We’re responsible for not only market research to support the mission, but market research and intelligence to support our clients, and a suite of maturity models that we use as a framework to help healthcare organizations and health systems around the world understand how to adopt and implement IT to achieve the best possible outcomes.
Campbell: You live on the nexus of healthcare delivery organizations and health IT solutions. How does your value proposition fit into that?
Newton: That’s a great question. Being a wholly-owned subsidiary of a global, cause-based not-for-profit allows us a different lens than you would get as a traditional, commercial organization. We provide value through our maturity models, most notably through our EMRAM model, which has become a global standard of excellence for how to adopt and implement EMRs and related systems. Our analytics maturity model is helping the new age of understanding and making sense of data within the health system and how to use it to improve care, financial outcomes, and patient engagement. Lastly, our continuity of care model acts as a guide to ensure the right technologies, processes and people are in place so HDOs are effectively caring for the patient. Those frameworks are helping individual healthcare systems all the way up through ministries of health understand how to adopt, implement, and leverage technology across multiple care settings.
It gives us a unique perspective on the very specific needs of the healthcare delivery organizations. Through the relationships, engagements, and conversations that we have all over the world, and because of these standards of excellence, we’re able to speak intelligently to the vendor and consultant community, who are trying to fit the needs of these organizations, about what providers are looking for. We gather data on every hospital and health system in the country, about 350,000 practices in the US and Canada, another 16,000 or so entities globally, and growing exponentially. A lot of that data comes through these maturity model based engagements and allows us to inform the vendors in a way that nobody else can. The relationships we have with the provider community are incredibly important. Being at the intersection of helping providers understand how to adopt and implement allows us a view into the true needs of these organizations. That helps us inform the software vendors, the hardware vendors, the consultants with: how they should position themselves, how they should build out their product lines, who they should be talking to, what value propositions they should be bringing to the table, and helps improve their go-to-market plans because of this unique, intimate knowledge we have of the health system.
Campbell: That’s truly profound. Given the audience of HealthIT & mHealth is more startup-based and entrepreneurial – companies in their nascent stages – how can they use LOGIC™ to intelligently approach a market and differentiate their offering?
Newton: LOGIC™ is an integral part of a bigger puzzle. LOGIC™, a market intelligence tool with hundreds of millions of data points provides users data intelligence on who has what technology and how they’re using it, who they’re looking to replace, who the decision makers are within these healthcare organizations, what their financial status is, unused budget, things like that. This market intelligence in combination with an understanding of brand perception, how to position a brand, and how to create tactical go-to-market strategies is where our market insight, thought leadership and research arm comes into play to help complete the puzzle. These go-to-market strategies penetrate the noise. For startups, it’s even more important. If you’re an Epic or a Cerner, you have a market position, you have a voice, you have a platform. In the startup community, there’s a lot more clutter and noise. Even if you look at telemedicine vendors, we’ve seen the number double over the last three years that we’re covering within LOGIC™. Similar story with analytics vendors. Part of that is because these organizations are targeting very niche plays. For example, they’re only covering a very specific type of telemedicine, and telemedicine is a big world. Using LOGIC™ and some quantitative/qualitative research, leveraging the relationships we have, you can begin to cut through the clutter and noise to start to more clearly articulate the value proposition that resonates with the buyer. For a startup, domain knowledge and domain expertise is very important. Our relationships afford us access to the type of domain knowledge that can help a startup’s message resonate in a way that maybe others aren’t. It’s the combination of LOGIC™ and market understanding, with some managed services-type work, which we offer, that can help startups rise above the fray and create a platform and a voice that is heard beyond buzzwords.
Campbell: Absolutely and that brings up an important point. As I talked with several CIOs, as part of our CHIME Interview Series, and got their perspective on what seems to resonate with them, what differentiates in the startup community, the consensus seemed to be that there’s an endless number of vendors approaching the buzzword markets: patient engagement, precision medicine, and the like. These CIOs felt there was an opportunity at the fringes where big vendors like Epic may not have their focus. You see these off-shoots, these companies that have employees—like Galen—that have members who used to work for the large EHR vendor organizations. That said, what do you feel are the best market opportunities if you’re just entering right now? What are the areas that may be in their nascent stages, where maybe they’re investing too much energy prematurely? What are the hot areas around the fringes?
Newton: That take from the CIOs at CHIME is exactly what we’re seeing too. There’s an 80/20 rule at play here where the single source vendor will likely maintain that large footprint, but may not dip into their niche fringes, like precision medicine for example, as you mentioned. It’s a buzzword that everyone’s excited about, but we’re not seeing as much organizational readiness to fully engage at the healthcare organization level. It’s more of a hub and spoke model because of the cost of setting up a truly effective precision medicine program in the workflow. As such, it’s still in the early stages. The point being, as that starts to ramp, there’s opportunities to play in the niche areas. There’s a big focus on cancer and the Cancer Moonshot. That’s an incredibly important piece of work and one that IBM Watson has put a lot of money, time, effort, and resources into, and they’re doing great work around it.
There are other areas precision medicine and genomic medicine can help too. I talked with some folks in Orlando at the HIMSS Annual Conference that are focused on mother-baby precision medicine, and understanding the neonatal/postnatal impact of genetic medicine, targeting that niche. I think it’s safe to say that, that level of understanding, domain knowledge and expertise to drive care in that area is likely not something the Epics and the Cerners of the world will get to.
Telemedicine is another area, and Care Management, especially as we see the shift to value-based-care in the US Market. Healthcare organizations that are at risk with their patient pool or have health plans within their organization, and are part of or have set up an ACO, are prime targets. We track that data so we understand what health systems that pertains to. Those organizations that are ahead of the curve in the shift to value based care are more likely to be buyers of a niche. An example is a telemedicine vendor to manage chronic disease states. Diabetics for rural patients for instance, to bring down the long-term cost of care. Understanding, as a startup, how your solution fits within a given healthcare organization’s mission is critically important. Filling in those niche plays, where you can help reduce the A1C levels, for example, for a rural population of diabetics through innovative care management and chronic disease management could be something of importance. One word of caution: as these technologies are becoming more ubiquitous and more known, we’re seeing a shift towards enterprise buys, as opposed to disparate departmental buys. You can no longer just create a relationship with the head of endocrinology, for example, for a diabetic management tool. It’s now becoming a larger play.
Understanding your path through the decision tree at a hospital, who the right people to talk to are, is becoming more and more important, as is understanding who the likely buyer for your product/solution is. The scatter shot approach is a hard one to take, especially as a niche startup. You need a clean value proposition with a clear understanding of who you should be talking to and when, to position your product appropriately.
Campbell: You brought up several key points there. One, around the enterprise buys – that inherently solves interoperability issues. As these organizations are risk adverse in the terms of the complexity they face and the transition from fee-for-service to value-based care, they don’t want to introduce another point-solution that they’ll have to interoperate within the enterprise portfolio. Another point you mentioned, PHM, population health management, is seemingly a popular buzzword. You gave several use cases of how that can be addressed in the startup community. One of the resounding sentiments or thoughts that I heard at HIMSS, that I thought was very compelling, was the notion of: it doesn’t matter unless the data gets to the point-of-care. Yes, you can do all these fancy analytics and machine learning, artificial intelligence insights, but what does it matter if you’re not reaching the point-of-care? That’s something organizations should think of as well, so thank you for elaborating on that.
Newton: You hit on an incredibly important point. I saw, for the first time in years, some interesting ways startups are finding to embed themselves intelligently and innovatively into the clinician’s workflow, so that the data’s there when you need it. I used to work at Allscripts, and they had a saying at the time: “if the doctor doesn’t use it, it doesn’t matter,” or something along those lines. It’s so true. Making sure that whatever solution you’re bringing to market is not an extra click, or two, is critically important. It needs to be presented and served up in a way that does not further tax the time or research constraints of the clinicians. It’s a very important point to look at and it can get lost as you come out with a fancy new solution that may be the greatest thing ever, but if a doc must go three steps out of their workflow to get at it, it probably won’t get seen. It’s a huge point to consider and an area of opportunity for startups to look at how they can cleanup workflow; some of these systems have been assembled in strange ways over the years.
Campbell: Sound advice. Tell me about the innovation that’s taking place at HIMSS Analytics to increase vendor market intelligence, productivity, and efficiency.
Newton: We have, over the last four years or so, transformed HIMSS Analytics from a point-to-point data aggregator to a global health IT strategy organization and an on-demand, workflow-integrated, market intelligence platform. That platform under the umbrella name is LOGIC™. Underneath that, we have created a very robust set of tools to understand what opportunities you should be targeting, and what territories you should be looking at. You can break that down even further by several factors. You could look at how many procedures a facility does, as it pertains to the problem you’re trying to solve for, so you can target those facilities. There’s a very robust set of customizable tools for you to dig into.
Beyond that, we understand the need to fit into a workflow, especially for a smaller organization that doesn’t have a team of market analysts that can dive into the data. Recently, we launched a Chrome extension called LOGIC Discover. It’s available for free on the Chrome Store or through our website. It allows you, within the workflow of your browser, to understand a hospitals footprint. Through this extension, we share with you the key stats you need to know about a hospital before you make a phone call or send an email. Even though startups are consumer-oriented, we’re still seeing the buyer mainly being a payer or a hospital, as we consolidate the market into this hub and spoke model. That might shift, but right now there’s still a pretty high percentage of buying at the hospital or payer level. This Chrome extension allows you to understand what’s happening in your workflow, rapidly, without having to navigate to another tool. We also have a mobile app in beta that is location enabled. So, if you’re in the Boston area and interested in a certain organization, you can quickly and easily use your mobile app to learn the key facts about them and understand if they are actively interested in solving for a problem which your solution fits.
Additionally, we have some exciting stuff happening with our predictive analytics solutions: understanding where the markets headed and who’s likely to invest in technologies. We’re looking at ways to break down the volume of data and gain further insight. I know I’m treading into buzzword territory myself talking about predictive analytics. It’s overused at times in the health IT space, but being able to sort through data and glean insights, especially for a startup, is key. Because of the volume of new entrants in this space, making sure you’re in front of the right person at the right time is more important than it’s ever been. We’ll have more news on that in the next month or so.
One of the key things that we’ve come out with is due to the recognition that younger organizations may not have—and I say that full knowing that they probably don’t—a team of market researchers at hand. Some of the bigger players have whole teams dedicated to working with our data, but a startup doesn’t have that luxury. Because of that we’ve begun offering what we call Managed Services, which is essentially an on-call market research team. If you’re getting ready to do a big presentation in front of a payer or hospital board buyer, and you need a couple of slides to show market trajectory; or you’re getting ready to put something in front of an investor and you need to show market opportunity; or you’re simply trying to know who your prospects should be but you don’t quite understand the space well enough; make a quick call to us. We can put together slides for you, we can walk you through how you should be talking to folks, and who you should be talking to. Our Managed Service offering is not innovative from a technology perspective, in fact it’s kind of retro, going back to a time when one arm, one service was important. We’ve seen startup clients get a lot of value out of that. That’s an exciting thing that we’ve been doing in the last several months too.
Campbell: Simply fascinating. Such value for organizations that are looking to enter a market given that they can leverage the authority and credibility that HIMSS Analytics brings. It offers a turnkey solution for these groups. No longer do they have to climb up this mountain themselves, there’s just great resources out there. You mentioned the Managed Services organization and reaching out to them, how else can a budding startup or entrepreneur get started with HIMSS Analytics? What other resources are available publicly to learn more?
Newton: Our newly designed website has a lot of good information on it. We consistently hold webinars. We have a syndicated research publication that’s low cost and high value, called Essentials Brief, on hot topics in the industry. There’s at least one a month, if not more. Those are also available on our website. With the investment in one of those – $1500 – you get time with us to walk through the findings and talk through what’s out there. As a not-for-profit, part of our mission is to ensure that all stakeholders in the health IT landscape, whether they’re healthcare organizations or solutions providers, are well informed. It drives efficiency through the system. We’re more than happy to just have a conversation and spend time working with organizations trying to get into the space. It doesn’t necessarily need to lead to a sale. We need innovation, so the more we can do to offer up guidance, the better. We had a client mention to me at HIMSS in Orlando, that they would describe the way we operate as “approachable intelligence.” We are very invested in the success of our clients. It’s not just a transaction. We get involved and try to find a way to lead you forward. Whether it starts with a basic conversation, the Discover Chrome app, the mobile app, or the Essentials Brief – whatever it is, there’s multiple points of entry. You can find them all on HIMSSAnalytics.org, but again, we’re also happy to just take a call, answer questions, and give some thought and insight.
Campbell: Blain, thanks so much for your time today. Some truly compelling initiatives taking place at HIMSS Analytics. You’re really pushing the healthcare industry forward one insight at a time.
About Blain Newton Blain Newton serves as Executive Vice President of HIMSS Analytic. Prior to his current role, Blain Newton served as Senior Vice President and Chief Operating Officer of the business unit, with overall responsibility for strategy, sales, and operations for HIMSS Analytics product and service offerings. Blain can be found on Twitter at@Newton_VT and LinkedIn.
Formerly CEO of CapSite, a Burlington, Vt.-based healthcare technology research and advisory firm acquired by HIMSS Analytics in 2012, he has more than 15 years of experience in the healthcare technology industry. He has held leadership roles in finance, solutions management and operations in the US and internationally at companies including IDX Systems Corporation, GE Healthcare, Allscripts, and Arthur Andersen.
About Justin Campbell Justin is Vice President, Strategy,atGalen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration, is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at@TJustinCampbell and LinkedIn.