Its human nature to draw analogies from past disruptors and apply to parallels in other industries. After all, we take experiences and lessons from the past to derive inspiration for future innovation. It’s in this regard that pundits have pointed to ATMs as a model to solve for healthcare’s interoperability woes, or present MINT.com and Kayak as a model for the healthcare’s move to retail and consumerization. It’s also in this regard that Salesforce is used as an example for patient engagement for healthcare. However, unlike the other industry-specific disruptors, Salesforce’s model fits healthcare as well. But just because it fits on-paper, that doesn’t mean that Salesforce is ripe to disrupt healthcare. There is certainly a lot of inertia to overcome in healthcare information technology, as Chilmark Research was quick to point out after Salesforce Health Cloud was announced
After several years of circling the healthcare market, Salesforce finally announced its intent to formally enter the market this week with the announcement of Salesforce Health Cloud. Unlike other enterprise vendors who have jumped into this market, with Blue Ribbon advisory panels (Google Health), or series of acquisitions (IBM Watson Health, Intuit) or a mixture of both (Microsoft), this announcement by Salesforce had little in the way of any of these attributes to bolster its announcement.
Salesforce is taking a much more tentative and low risk approach to entering the healthcare market and will look to its expansive ecosystem of partners who will leverage Salesforce’s existing tools to create healthcare specific solutions and services.
Salesforce touts Health Cloud as a vehicle to acquire and manage patient data from multiple sources, from electronic health records, to patient generated data through wearable fitness trackers. Salesforce has also positioned the application as a communications platform for patient engagement and care coordination, as well as a dashboard for outcomes management and population health. Sound like every other vendor touting themselves as a PHM solution? Chilmark takes a deeper look into strengths and weaknesses:
Salesforce won’t compete with established transactional systems, but rather be a front end, as it’s not interested in being an electronic medical record provider like EPIC. As Salesforce CMO Dr. Joshua Newman told MedCity News, he sees competition from three places: electronic medical records vendors, startups and analytics firms.
EMR vendors may be entrenched, Newman said, but “they’re never going to be Internet-focused and multi-tenant.” A multi-tenant approach typical of a cloud service like Salesforce helps manage patients seen by physicians with privileges at multiple hospitals, according to Newman.
HISTalk also offered an optimistic assessment of Salesforce, declaring Health Cloud “the most interesting product I saw at HIMSS.” Mr. H from HIStalk noted the following advantages Salesforce Health Cloud offers:
- Existing EHRs and other healthcare software products are way behind the times in meeting new requirements for health systems to treat patients and doctors as customers and to build relationships with them, including patient engagement.
- It lets health systems that are willing to change their relationships with patients and doctors to do so effectively, with strong analytics and communications.
- It’s cloud-based and is purchased on a relatively inexpensive per-user, per-month price with no capital outlay.
- It’s built on the standard Salesforce CRM that has been battle-tested for years, with just those customizations needed to make it work for healthcare.
- It integrates with the EHR and other patient and provider data sources.
- The Salesforce open ecosystem allows using third-party apps when needed.
- It Includes tools that allow users to build their own rules and apps.
- Salesforce is a juggernaut that can force EHR vendors to open up their systems to obtain the data it needs.
- Salesforce isn’t Oracle or Microsoft – they didn’t create a healthcare-specific product from scratch or acquire a questionable one, so they have no incentive to rebalance their product portfolio and walk away from healthcare and leave users hanging as big healthcare toe-dippers tend to do.
Given the optimistic outlook, what does this mean for healthcare startups and entrepreneurs Salesforce represents a good horse to attach your cart to. We’ve witnessed a plethora of companies go at patient engagement with their own custom solution. This approach lacks scale, established technology, and is crowded with competition. Not to mention, the path to monetization and profit is muddy at best. Further, Salesforce has built a rich ecosystem of extensibility via its app marketplace. Some could argue that this is exactly what healthcare needs.
The content presented in the Health Cloud Integration eBook suggests that Salesforce is still in the somewhat nascent stages, with limited adoption outside of pilots. Despite this, HCOs who have implemented the platform, such as Cancer Treatment Centers of American (CTCA) have demonstrated tangible benefits. CTCA now uses Salesforce to improve service in three different areas: physician referral intake; a 24/7 contact center; and, patient communities. The result is a 60% productivity boost for their technical team. One of the benefits to patients is their community platform, built on Salesforce Community Cloud, that empowers patients and families to support one another, join groups, participate in local events, find educational resources, and chat in real time. In turn, CTCA benefits from an enhanced referral process that improves customer loyalty and provides another way to communicate with patients.
There are clear gaps to fill. As the saying goes, “if the doctor doesn’t use it, it doesn’t matter.” Insights must reach the point of care and not be disruptive to existing workflows, but rather enhance it. It’s in this vein that partners are needed build the detailed workflows to support patient and care team communications. Salesforce represents a great candidate to partner instead of going at the crowded patient relationship management and patient engagement space alone.
About Justin Campbell
Justin is Vice President, Strategy, at Galen 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.
CHIME Fall Forum Interview Series: Daniel Morreale, Senior Vice President/CIO, Hunterdon Healthcare System
Consolidation is big on the mind of the CIO Daniel Morreale, of Hunterdon Healthcare System. After inheriting the multi-system environment two years ago, he has been evaluating a rip and replace initiative, moving to one core system. That’s not the only change Morreale hopes to make at the healthcare system. He’s inspired by the world of social media and the connections it can extend. In this interview, Morreale talks about the “membership model” for healthcare he’s looking to implement; the ups and downs of data archival and storage; and Hunterdon’s current data governance strategy. He also shares his personal predictions for the future of healthcare and bringing the focus away from the toys and back to the people.
Be sure to register for an upcoming healthsystemCIO.com All Stars Panel Daniel is participating in on January 19th: “How to Ensure Your Business Continuity/Disaster Recovery Plan is HIPAA Compliant.”
CHIME Fall CIO Forum provides valuable education programming, tailored specifically to meet the needs of CIOs and other healthcare IT executives. Justin Campbell, of Galen Healthcare Solutions, had the opportunity to attend this year’s forum and interview CIOs from all over the country. Here is the next interview in the series:
If you’re in my system longitudinally, can I get rid of those lab results you had 8 years ago? No, and I think that’s a problem.
Then again we have to ask ourselves, how long do we keep our EMRs and is anybody running an EMR they were running 20 years ago? Chances are no.
But then in the event of legal action, if I have it I have to produce it, it’s discoverable. I would rather only present for discovery that which I’m required to present for discovery. If the data had been purged by policy and no longer there then I’m no longer responsible for producing it.
Most health systems tend to grow by buying physician practices or expanding their market, which is a pretty traditional means of doing that work. However, I think an extraordinarily strong mobile presence and web presence can start to attract the 20 and 30 year olds who aren’t really using healthcare now, who I want if I’m in a shared risk environment.
At the end of the day I’m doing healthcare and that’s about people. How do I make the experience easy for you and me, or family, and deliver quality, convenience, and access?
Campbell: Let’s start with a little background. Tell me about your organization and your responsibilities.
Morreale: Hunterdon Healthcare is the only hospital in the county, [located in Northwest New Jersey]. It was started in 1956, in an effort to improve the health of the population and community. As an organization we kind of have a 60-year head start on population health. It’s still a standalone facility, we have just under 200 inpatient beds, and do just under a million ambulatory visits a year.
Campbell: What are some of the initiatives you’re working on right now? What are some of the reasons that drove you to CHIME in terms of the learnings you expect to hear from your peers?
Morreale: The initiatives we’re working on in the healthcare system right now are dedicated to two propositions. One is to improve usability; how do I make the variety of systems we have more user friendly? And secondly, a consolidation effort; looking across our vast number of software tools and trying to consolidate them. Prior to my arrival at Hunterdon two years ago, every department bought whatever they wanted. As a result, I have 5 document management systems, 6 faxing software applications, etc. We’re trying to consolidate and replace with enterprise level tools when we can. Next year we’re going to start doing core replacements around our financial systems, and that’s going to be a rip and replace. We’re planning an initiative around creating an access center, i.e. one telephone call to concierge level service with the health system.
Campbell: Tell me a little about where archival fits into this. With the systems you look to replace, have you gone through that evaluation of migrating versus archiving?
Morreale: We have not, and for several reasons: A majority of the healthcare tools that are out there don’t have a good process for archiving, deleting, or massaging patient records, at least at the patient level, which is always a challenge. However, we do have criteria for retaining data, predicated on state and federal mandates. Right now everything is in a tiered data structure. Our more transactional data is on a state drive, our deeper archival data is on EMC, some IBM storage in the middle, but my intent is to go pure solid state. This will add cost, but increase retrieval speed and simplify the environment. But even in that environment I’m just continually adding and saving data. I’m never really deleting anything. So there are records that are 25 years old, that I no longer need, and I have no means of getting rid of them.
Campbell: Have you evaluated any archival solutions that are healthcare specific? Tell me about the challenges you see in the vendor marketplace for archival solutions.
Morreale: Well on the technology side, I think there’s a wealth of tools, but their weakness is in the healthcare applications. In my EMR I do not have the capacity to delete a record. I absolutely do not have the capacity to delete part of a record. If you’re in my system longitudinally, can I get rid of those lab results you had 8 years ago? No, and I think that’s a problem. It costs me money to store it, manage it and keep it secure. But then in the event of legal action, if I have it I have to produce it, it’s discoverable. I would rather only present for discovery that which I’m required to present for discovery. If the data had been purged by policy and no longer there then I’m no longer responsible for producing it.
Campbell: As part of the overall portfolio strategy, do you see yourself consolidating applications and migrating from one EMR to another?
Morreale: Eventually I think we’re going to have to, and we’re targeting 2020 or 2021 as the year to make that jump. That is my opportunity, and only opportunity, to clear records.
Campbell: Is there hope that in that time there are some advancements made?
Morreale: I think it would be nice, but I don’t see it happening, I don’t hear any vendors talking about providing tools that do that. Then again we have to ask ourselves, how long do we keep our EMRs and is anybody running an EMR they were running 20 years ago? Chances are no. I think over that course of time we generally take all we can from a product and at some point we start looking for additional functionalities, newer user interfaces, and more bells & whistles
Campbell: Shifting gears, what is your data governance strategy within the organization?
Morreale: Data governance is pretty straight forward. We have our applications tiered for priority, and as a result of that, the data is tiered. We ask the primary departments to be the titular owner of that data, in that the patient is the real owner. We look at IT services as being the police – the ones who stores it, protects it and keeps it under lock and key. When there is a challenge around data, it always manifests in reports: what is the length of stay in system A, is it not the same as in system B? With great effort, a year ago, we undertook building out a data dictionary. To this regard, I know that when I’m using field MX4233 in my EHR, I know it’s a patient address and that it is defined in this way. Then we’ve carried that across to the other clinical systems that have that data. It is by no means complete, it’s a continuous effort, and it’s massive with the 160 different systems. We really concentrated on those items that people are regularly reporting on. As such, when I produce an end of day admission report in system A it’s also the same in system B.
Campbell: What’s the vehicle or mechanism that you’re using?
Morreale: This is one of the examples where we built our own tool. We went out and created a data lake: we’re taking a snap shot of the data, putting in the data lake, normalizing it, and then consolidating all our reporting out of the data lake. So, at least my reports are more consistent than they were prior.
Campbell: Where do you see an opportunity for innovators in the vendor space?
Morreale: I think there’s opportunities in home health, which is pretty much owned by a few big companies with technology that’s a little dated.
I think there is a whole field of healthcare to be discovered in social media. How do we capture that? How do we integrate into that world? How do we use that to attract future patients? Most health systems tend to grow by buying physician practices or expanding their market, which is a pretty traditional means of doing that work. However, I think an extraordinarily strong mobile presence and web presence can start to attract the 20 and 30 year olds who aren’t really using healthcare now, who I want if I’m in a shared risk environment. Use that as a tool to create that sticky relationship between you and my health system so that when you do need our services, we’re the natural choice.
I think the value proposition around that has to be very high, but it’s certainly difficult to compute. We’re putting a lot of effort into that arena. My development team is looking at creating what we’re calling a ‘membership model’ for the health system. It’s essentially taking the concepts around Netflix and American Express: you become a member, and incorporate that into how I deliver care. If I can convince you to be a member, I can give you one telephone call scheduling; I can stop leakage out of my physician offices by scheduling your next appointment as you’re walking out the door; or schedule that x-ray or that minor surgery you might need. I can broadcast educational information to your mobile or home device. I can create social platforms for you to talk to other people with your disease state. I can do all of those things as a background product, but at the same point I’m creating that sticky relationship between you and my health system.
We’re also looking at integrating wearable data. We are fortunate enough to be the in the healthiest and wealthiest county in New Jersey, so we think there’s the capacity to offer the service to our community: let us monitor your Fitbit or your wearable device data, tell you how you’re doing on your health effort, and give you an opportunity to earn points. We have a points program in our membership model – buying broccoli instead of bread; going to the gym – those sort of things. And I think that kind of stuff is going to be more of my future than buying physician offices.
Campbell: There seems to be a diminishing return there or rather a saturation to that model.
Morreale: I think so. How many physician offices can you have in a community? How far can your reach go? If I’m doing it through mobile and social media, my reach is greater. I’m not limited to 20 miles or 25 miles. I can be attracting or engaging people who are 50-60 miles away. I can help you take care of your parents who live in Phoenix or back in Boston, I can do all of those kinds of things. We think there’s some potential there. It’s going to be one of our big investments in 2017 – to further define that model and see if we can make it fly.
Campbell: Certainly enlightening and inspiring.
Morreale: I think it’s just a different way of looking at what we do. I don’t like to get caught up in the technology. I know a lot of CIOs who get caught up in the technology and the toys, and the toys are cool. I mean let’s face it, but at the end of the day I’m doing healthcare, and that’s about people. How do I make the experience easy for you and me, or family, and deliver quality, convenience, and access? I think that’s where a large portion of our future has to be.
This interview has been edited and condensed.
About Daniel Morreale
Daniel Morreale is CIO at Hunterdon Healthcare, a community hospital based in central New Jersey. He has held CIO roles at a number of organizations, including Riverside Healthcare System, Kingsbrook Health System, and Atlanticare. A CHIME fellow, Morreale was the recipient of CHIME’s’ Innovator of the Year’ and ‘Collaboration of the Year’ Awards, and was recognized by Computerworld Magazine as one of the ‘Premier 100 IT Leaders.’ He also received the Safety Net Award from the National Association of Public Hospitals, and the Smithsonian Center of Innovative Technology Honors Laureate Award. Morreale is past-President of the New Jersey Chapter of HIMSS.
About Justin Campbell
Justin is Vice President, Strategy, at Galen 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 and 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.