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Podcast: Improving Health Care Through Technology | Optum
- Hi, I'm Braden Lang. I lead the dedicated consulting team that Optum has here partnering with John Muir Health. And I'm joined today by John Muir's CIO, Bill Hudson. Bill, thanks for joining us. Can you just give the audience a high-level introduction of yourself in your role?
- I'm Bill Hudson, I'm the CIO for John Muir Health. We're a community health organization in the East Bay, San Francisco.
- You had a long and successful career with a wide variety of different IT vendors in the EMR space, as well. What convinced you to take a role with a provider organization, and why JMH?
- John Muir is a community health organization in the middle of San Francisco. It's a very mission driven organization. It's a very neat organization that really tries to put the community first, in the middle of a giant metropolis. And it's really cool to become part of that. And I talked to Cal Knight, the CEO, and he talked about the strategy for how John Muir was going to be successful in a very competitive market. I looked at that and said, you know, I really want to be part that.
- I know that part of what drives your strategy is that JMH has some really ambitious goals around expanding access to care for underserved communities. Can you tell me a little bit about what your digital transformation strategy will do to allow you to reach those goals?
- This was really exemplified in how we made sure that when we rolled out the vaccinations for COVID that we used data and technology combined with our clinical staff to make sure that the entire community was being served. And what we saw was when we started our initial efforts utilizing digital and analog technologies, to reach out to our patients and community, we saw that those communities specifically were not getting vaccinated at the same rate, whether minorities are prevalent in those communities. But when we took a proactive step of using data analytics to target, to make sure that we were getting the message out to them about the vaccination, about the vaccination that was available to them, the vaccination was safe for them, and making sure they understood that, we saw those numbers increase dramatically.
- Can you tell us a little bit about how you see your digital transformation strategy involving virtual first care delivery models, when you'll get there, how you think they'll work?
- At John Muir, we want to make sure that our patients don't just have access to that digital care for that one digital care type of event, they have care for the entire continuum. I'm not going to start all over again with somebody new explaining everything new. I'm going to continue my same visit with a physician that I have a relationship with, that understands me, that has listened to me, that hears me, understands me. And I think that is a very powerful differentiator that I don't think any of these organizations that are focusing on digital only or digital first can match. And I think that's one of the powers of being a digitally integrated organization that is focusing on consumer experience and, you know, not forgetting the physical component of that. And I think that is a big differentiator for John Muir.
- You are a big believer in a sprint-based approach, having been a sort of key to John Muir Health's success. Can you tell us a little bit about why this approach through sprints, and what that means to you?
- You know, you break off things into these bite-size elements, work with cohorts of physicians that are tightly aligned, making sure you're solving for a very specific problem, don't get it overly complicated and move that forward in a good and safe way, and make sure that you communicate, educate along on the way. And so, one of the things that we've done just recently, which I think is pretty cool, we've implemented translator services for our digital visits. And so, if you don't speak English, and you speak one of 200 languages, we can bring an interpreter in to that call within 30 seconds.
- What recommendations would you have for other health systems, as they're thinking about engaging external partners for supporting their digital transformations?
- You know, when I talked to Cal Knight, and Cal talked about his vision about how we're going to leverage partnerships, it was really a partnership vision. It wasn't like, we're going to do these things, and the things we don't want to do, we're going to give it to somebody else. We're gonna focus on the things that we're really good at. And we're going to bring partners in for the things they're really good at. And those two organizations being really good at their own individual things, is gonna create some synergies where, you know, it's not one plus one is two, it's one plus one is something really interesting, which is we're providing care in a different way.
Improved care through technology and scale
Listen to Bill Hudson, CIO of John Muir Health, provide insights on expanding care.
- Hi, I'm Patty Enrado with HIMSS and I'm with Scott Gaydos, vice president of product for Optum. Welcome Scott.
- Thanks Patty for having me.
- So today in this podcast, we're gonna talk about how enterprise IT strategies can enable modernization for improved care outcomes and enhanced provider and patient experiences. So Scott, my first question to you is, IT can have far-reaching impact on so many facets of healthcare, but what are some of the areas where you feel IT can drive the most change?
- So a big one that jumps out at me right away is what we'll call sort of digital enablement of customer and employee experiences. It's actually really important to understand what digital is and what it isn't. So digital like Cloud before it and Agile before that, needs definition. So when you think about digital, digital is really about business strategy that's enabled by technology, not the other way around. So when looking to drive digitally inspired change, think about things like completely revamping the patient waiting room experience at a provider, or radically changing the pre-authorization process for a payer. So technology plays a role in that, technologies like Cloud, internet of things, AI, these enable those radical changes, but it's really not like choose the technology and pointed it at a problem. Rather it's how can I radically change my business and then what technology underpinnings do I need to enable that? So when you think about then digital, digital enabling technologies, aren't necessarily always used for digital change either. And that becomes a problem. So it's another example, things like that would be moving an on-premises application, something that's in your data center, moving that footprint rather to a public Cloud that may save money. But that in itself is not actually a digital project, rather consider what was that application for? And maybe we can create automation that completely eliminates 10 manual steps that I did in that application, thereby reducing say my administrative burden by 50% and revamping some long drawn out process. And by the way, all of that powered by some Cloud-oriented API. Now that is a digital business transformation. So as I focus on things like that, digital business, it's important to understand what's digital and what's not. So I would say, properly orchestrated technology projects, explicitly ones that enable digital business strategies, that's the area, right of opportunity for IT going forward here.
- Great, so how important is it for organizations to have an enterprise-wide IT approach specifically across geographically dispersed systems or newly acquired facilities, that drives consistent practices across critical areas like Cloud management, security and technology adoption?
- Yeah, Patty, that's a good one, because every enterprise is a little bit different. We sort of, it's just like digital. We say enterprise, well, enterprise means different things. But what I would say about that is this, is that enterprise strategy needs to be there. It's the thing that establishes the guardrails and the guidelines. And then the execution can be done via a mix of centralization and the Federation of the enterprise. And that's actually the best recipe for enterprise success. So say for example, enterprise strategy, we have a very specific way of securing protected health information and personally identifiable information when we're using the public Cloud. If that's a policy and that's an enterprise strategy that doesn't mean you have to come through central IT to do your project, but rather here are the components to use to ensure your project consumes enterprise, healthcare safe Cloud services. So enterprise strategies setting the policy, setting the guidelines of guardrails, so the enterprise doesn't hurt itself, but allowing the Federation and the business to actually execute. Another example might be, think about things like enterprise level, security procedures and training. How do we get an entire organization centered around just distributed as an enterprise to be vigilant around things like social engineering threats or phishing. These are consistent practices that we wanna make sure everybody does. So what we do today is we might have a once-a-year training course on email security, make sure you go through the entire training, take the test, hopefully pass, if not, take the test again until you pass. It's not that that's bad, but that's not necessarily going to drive that consistent practice that you asked about in the question. So when you think about things like unobtrusive test emails, things are sent by us, by the organization to train and test folks so that they recognize phishing. And then there are incentives for the OSU quote unquote catch the email and reminders for those who don't. This is a way to drive sort of consistency across the organization, far better than the false sense of security, if you will, that we get from that once-a-year test. So this is all about ongoing consistency and adoption.
- So what are some of the most significant barriers to delivering a cohesive enterprise IT strategy for health systems and how to health systems overcome some of those challenges?
- Yeah, this is always tough. Sometimes the answer is, it depends, but I can definitely give a few examples here. So, funding can always be one. It's a very easy one to pick on. There's always, you don't have funding to do X, we don't have funding to Y. But even when funding is available, then it's generally dispersed throughout the entire ecosystem with maybe no guiding principles on how to apply it towards a grander enterprise strategy. So the existence of funding and the executable vision, if you will, to tie it to are both needed for enterprise success. Another barrier is inertia to change. It's frankly it's even a bigger barrier and an easier target than funding. So an organization, if you will, that has a, this is the way we've always done it sort of approach is a cultural killer for a enterprise strategy and especially digital initiatives that are looking to positively disrupt the business. So remember the definition of digital that we talk about. So substantial business change enabled via technology, that substantial business change, it's impossible if the culture is, this is the way we've always done it. And so, how do you handle these things? The first thing is really top level commitment to strategy. And so, in other words, executive level commitment to that strategy and then trust, trust with verification, if you will. That the Federated system is actually executing against that strategy. And those two things together are critical to an over overcoming things like inertia. And then, the last part about this, and we talked a little bit about it in that email example, incentives and disincentives to actually do what the organization is trying to do are very helpful. So organizations and the people in them sort of do what their incented to do. So having incentives or disincentives by themselves seems like a good idea, but just the incentives aren't enough, because they need to be aligned then to the organization and to point it at the goals of that cohesive strategy that you've set forth, otherwise, you end up with a patchwork of incentives and disincentives that might get an individual organization to do what you've asked it to, but it then misses the larger point of the overall strategy. So, a number of challenges, they definitely have ways to overcome them, but there's no singular silver bullet. It generally takes this connection between the enterprise strategy and the execution of the Federation to actually be successful.
- It sounds like a very complicated dance in a sense.
- It can be.
- So how do organizations go about measuring the impact of their IT investments, such as in cost-specific performance metrics, timeliness, and so on?
- So Patty, I like your examples, because what's important there in that detail is different kinds of investments have different goals. And so, if you're measuring costs or you're measuring timeliness, sometimes those are related. Time is money, but they can be different things. So the key is, is that there's not like a one size fits all metric for ROI. It doesn't always make sense. Some of course, the financial models that are created for ROI, they are useful, but not sufficient by themselves. So for instance, if the purpose of an investment, an IT investment that is, is to create efficiencies or cost savings, then that's great have that as part of the ROI model. Measure those cost savings and the efficiencies that are there. But another example, if the purpose of a different investment is to say increase provider engagement at a hospital that's powered by certain technology, then provider engagement is the measure not the cost, that's associated with that. So I think the key there is measure the outcomes you're actually looking for, not an arbitrary ROI, that's blindly applied to all projects.
- Great, so have there been significant advances in healthcare technology or are they primarily systemic?
- That's a great question as well, Patty, so the great news here, is that there are lots and lots of advances in and I'll just say technology rather than healthcare technology. And this is important, because many of the technological advances that we see across IT and technology in general are by their nature cross-market and that's really beneficial to healthcare. So, things like the rapid expansion of Cloud services, especially things like PaaS, Platform as a Service services. So as these are becoming more available, it sort of provides healthcare organizations with this tremendous tooling to out innovate their competitors and provide sort of an ever-evolving patient and/or member/customer engagement. So then you have the technology providers on the other side of that. When they make their capabilities available to the grander commercial audience, as consumable application programming interfaces or PaaS tooling, it creates this incredible, incredibly accessible toolkit for healthcare organizations to leverage. So we see this today, where organizations will use Cloud PaaS tooling to build things like chat-bots or health information-sharing features through their portals or what have you. And that's great. But as organizations get more and more comfortable with PaaS and features like that, then things like complex machine learning can be leveraged at what relatively is a low per transaction cost and embed that technology directly in things like clinical or administrative workflows throughout the enterprise. And that leads to substantial differentiation. So these kinds of things, I know I spend a lot of time on that, because there's lots and lots of technologies, but something as straightforward as all of this investment that various vendors are making in these Cloud PaaS toolings become this massively accessible toolkit for healthcare organizations to use, leverage and springboard themselves to innovation.
- So have you seen the role of healthcare IT leaders become increasingly strategic while still retaining a focus on technology and operational excellence?
- That's a good one Patty, because it feels like those things maybe are mutually exclusive, but they're not. Sort of the way I would characterize it, I would say operational excellence as we termed it there, that's the currency that allows IT leaders to have that necessary voice and authority and things like strategic direction and strategic decision-making. So yes, with IT and this sort of myriad of technologies necessary to power these digital business strategies, it's imperative that IT leaders have a seat at that strategic table, but they won't be invited, or worse, there'll be dis-invited if operational excellence isn't already table staked and improperly maintained, whether it's done internally or with partners. So both of those things, they're not either or right? Both have to be true in order to actually have the right strategic setting to allow IT leaders to have those voices.
- Great, so on that note of strategy, as providers look for our strategic partners to help them accelerate their IT initiatives, what should they be mindful of during their search?
- Yeah, this is always a tough one, because we just said, we were talking about, hey, you can go it alone. You can do partners. The great news is that there's a ton of ever-advancing technologies that healthcare organizations can leverage to help with their initiatives. The challenge though, of course, is properly applying those technologies in the healthcare setting that we all care about. And so, it takes a deeper understanding of how providers, payers, life science and bio-pharma organizations operate. So what I would say is finding partners who can successfully apply that tech in healthcare is a primary search criteria. So another one I would say is flexibility. So in other words, look for those technology or service providers who can flex their offerings to meet those changing needs of your organization rather than a this is how this product or service works, take it or leave it. So, if it's healthcare expertise first, then a second criteria I would say is flexibility as a close second. And I guess, a third criteria is probably warranted there. So we have a kind of a top three. So a third one would be what we'll call sort of a follow the sun model. We're always talking about how technology and IT advances. And just today, how properly, we just talked a little bit about how leveraging IT is imperative to enterprise strategy. So you wanna be as close to possible as based in this what I'll call an always-on model. 24 by seven technology supported by 24 by seven services. So these criteria are critical for healthcare operations. So when you think about healthcare expertise, flexibility in products and services and this sort of always on support and operations model. Those three things are crucial to picking partners and helping healthcare organizations have success with IT in their IT investments.
- Great, so what do you think will change most about IT services or strategy over the next five years?
- So Patty, this is crystal ball stuff. And crystal ball is always especially hard, especially in technology, super-dangerous. Try and make accurate predictions. But I do think there are important trends that are worth noting and frankly, organizations shouldn't ignore them. The first is this COVID-19 pandemic that we're all still presently living through. It's taught us that things like remote work and remote customer interaction is a huge part of our future. So business strategies, technologies and processes that cater to that, will be extremely important, even as society feels like we do now, that things are starting to return to normal. But remote staff and remote customers are going to be there in droves. And so, they require proper enablement and experiences for continued success. So this is an important trend that we don't lose sight of. Another one, and one that's worth mentioning is vendor and partner management in IT. Now that sounds like super-boring, 'cause it's not like some tech crystal ball thing. And it sounds super-non-technical either. But the reality is most organizations already have a large number of partners they work with that deliver their technology needs. And that number is only gonna grow rapidly. And frankly, the varying directions from which technology-based solutions come just exponentially increases the amount of partners. So to that end, whether or not you do this yourself, or you have some partner that helps you do this, doing proper security, business strategy and technology management of the sea of providers and partners, an organization uses to execute its IP strategy through technology is only gonna get more complicated, not less. So vendor management's another key. I think the last thing that I would say in this space is I'll reiterate one more time actually about this technology-enabled business strategy and not the other way around. There are more and more technologies that will constantly come out and there'll be very cool, but they may serve absolutely no purpose whatsoever in the execution of the business strategy that you have. So that's not to say that organizations shouldn't experiment, because there's actually, there's absolutely a place for banding about experimentation. We don't have any idea if this thing means something to us, but we can experiment with it. However, when we make corporate commitment then to enabling technologies, those should be those emerging technologies that align with and are in direct support of that overarching enterprise business strategy that we talked about before. So again, that's a quick look into my crystal ball without trying to be too committal against things that change pretty frequently. But these are trends that are important for all of us.
- Great, well, Scott, you said a lot of really meaty stuff. So if I could distill our discussion today, you talked about, business and enterprise strategies and how we really have to really turn quickly as we saw in the last year with COVID-19 how we had to stand up a lot of technology, how we really had to transition to different ways of delivering care. But to your point, you talked about, technology-enabled business strategy, not the other way around. So when you think about all of the business and enterprise strategies that organizations have to create that we have to be really mindful of the technology that we put into place to support that not the other way around as you had talked about, the technology isn't the thing. A new technology comes around, we put it in that we really have to think about: What are our strategies? What are our goals? And how does technology solve those problems and meet those goals?
- That's right, that's right. No, you got it and that's the why, the last thing that you said that was so important Patty, because that it's why. Why are we doing this thing? It goes back to what you asked about how do we measure that? It's we have to measure the why we're doing it at all. Otherwise, it might end up just being an experiment and not really go anywhere and serve the purpose as to why we even make these kinds of investments. But yeah, you hit it. That's great.
- Great, well, this was a great discussion and thank you so much for your time, Scott.
- Patty, thanks so much.
Enterprise IT strategies for optimization: HIMSS and Optum
Scott Gaydos, VP at Optum, shares how IT enables efficiencies and clinical advancements across a health system.
- Hi, I'm Patty Enrado with HIMSS and I'm with Dr. John Kontor, Senior Vice President, Provider Technology Services for Optum. Welcome Dr. Kontor.
- Thank you, Patty. It's really great to be here with you.
- So today in this podcast, we're gonna talk about how EHR's has grown from a workflow and billing application to a critical tool supporting the achievement of strategic goals. So Dr. Kontor, my first question is as a physician, how was your view of the EHR changed since its early days, and how has it shifted from administrative tool to a clinical tool?
- Thanks Patty. And I'm gonna date myself a little bit with the answer to this question because I was around in the early days of the transition from paper to EHR's and unlike many folks, I think going through that struggled, initially. And EHR's were pretty cumbersome, a lot of the promise of what they were supposed to help with in terms of efficiency, driving quality, et cetera, was really difficult to kinda feel palpably as a provider in the trenches. And I think we've come a long way in terms of functionality, the major EHR vendors have evolved significantly. The workflows are more effective. Also, I think we've all gotten better and more used to using those tools, where it's really become sort of standard part of providing care now. But I'll still say though, I think we have a lot of challenges ahead and I think 'cause we've all also experienced the complexity of both care on the business side of medicine, documentation, interacting with outside entities like, payers, et cetera. All of that I think is placing increasing demands on providers and increasing demands on the EHR's that we use. And I think still sometimes it feels like the EHR's have not really kept up as well as they should have.
- Great. So how has the clinical process design and the clinical culture, both of which can be impacted by the EHR has how's that shifted?
- The capabilities of the EHR's to promote, reduced their, what we call adverse variation in care. So it eliminate or avoid mistakes and provide more common approaches to best practice care, provides really great opportunity. But I think it's also forced us to be a little bit more intentional as individual providers, as leaders of provider organizations and for outside entities to be more intentional about how we construct and optimize our tools like the EHR and embed the right sets of information, the right rules, and the right workflows to most effectively promote that critical quality we've all been striving for. And to get really, a specific example of that, I think, we started out back in the early days of EHR's trying to be very controlling about some of the critical content EHR's many provider organizations, had tons and tons of clinical decision support rules, and strict care pathways that folks had to follow and so forth. And we reached, we saw a ton of resistance from providers to that sort of saying, Hey, I'm not here to practice cookbook medicine and what, you're often wrong. And then I think we saw a little bit of a J curve where a lot of provider organizations kinda backed off and said, all right, we're gonna sorta let providers do what they want now and I think we're now starting to come back towards, I think, a much more effective kinda middle ground of those two spaces where we're providing structure and some really great tools, which I think we can talk some more about that can provide guidance and advice both to patients and providers, but still give providers the flexibility that they need to practice what is still in the art of medicine.
- How have leading organizations optimize their EHR's to give them insights to drive decision-making, can you give some specific examples?
- Sure thing. So folks oftentimes, when they provide organizations in particular, when they make a big investment in EHR, which is now typically, a hundreds of millions of dollars or more, and sometimes they're surprised to find out, six months or a year later that the folks are going back to the board and saying, Hey, we need some more money to do more here. And oftentimes, we hear executives or board members saying like, Hey, wait a minute. I thought all of this was gonna be included out of the box. And it's really painfully obvious to those folks who have lived through the transition to any of the mentioned EHR's that you really have to continually invest in the ongoing optimization nurturing of these complex tools. And part of that is to keep up with changes in medicine over time, but part of it's also just to figure out how to make the tools work better for you in your particular organization and the environment, the culture, et cetera, that your providers live in. So a couple of best practices that we see are that one, you do continue to invest that you have dedicated infrastructure and staff into that ongoing optimization process. Two, that process includes direct interactions with people who are on the ground providing care, physicians, nurses, pharmacists, also with a more diverse set of folks on the finance team, legal team, compliance officers, et cetera. And it's through that intentional ongoing improvement process and the inclusion of, and direct attraction with many of those other voices that we see folks really be the most effective. I think the other, I'll give you some examples here, but the other thing to keep in mind is that the organizations that do this the best, really from a physician perspective, focus on a couple of things. And this is sort of a trite analogy I realized, and it's what we've used for a long time, but you say you've got to pay attention to the hearts, minds, wallets, and watches of physicians. And more broadly, I think the care team and from the heart perspective is you've got to optimize these tools to allow caregivers to do what really most of them got into healthcare for and what keeps them in healthcare, which is they really want to be effective carers for the people who trust their care to us, so allow us to be really good providers of care. Secondly, on the minds, most folks in health care to some degree or another and our scientists, and the optimization of these tools has to embed evidence-based care and keep up with the evolution of the science of health care. The wallets part is obvious. We have to make sure that these tools support the effective ongoing operations, both of organizations, a for-profit or for non-profit care organization, but also for the individuals. So how do we let the providers, the nurses, the pharmacists, et cetera, also feel like they've got and are able to maintain a rewarding career as well. And then watches is really important. And I think, sort of post pandemic, we're all really feeling and seeing this now as a priority more than ever, is we want to be able to provide folks with real work-life balance and the tools that we use at a minimum can't make hard are getting through the day process, more challenging, and ideally can get us home sooner, so we can spend time with our loved ones and enjoy the stuff that really makes our life worth living. We've seen lots of examples, especially really over the past five to seven years of organizations who have gotten really good at ongoing optimization of checking some of those boxes of what really makes effective ongoing optimization of the EHR. And I'll give you one example, one of the really difficult changes in the reimbursement side of healthcare for frontline providers is the shift to value based care. And specifically, they shift towards reimbursement based on the complexity scores, the risk adjustment scores of patients. And in previous days as a provider, I would focus on those conditions when I was seeing a patient that I thought were most clinically relevant to the patient or that they voiced as a priority. And that's what I managed, and that's what I documented. And under the some of the new reimbursement approaches, it's critically important that at every visit, we take the opportunity to address all of the assortment of problems and conditions that contribute to the overall complexity picture of the patient. And that's a real change for providers. And sometimes that means we've got to address stuff that you might defer to the next visit in other circumstances or document on conditions that may not be sort of the most critical priority for you or the patient at that time. But as difficult as that is, that's a great example where we've seen organizations use some of these technology tools and integrate them into the EHR, to really make that process much more accurate and much more efficient. So identifying for providers, all of the conditions that in care gaps that are suggested by a myriad of data that we can pull both for the EHR or payer systems, from natural language processing, looking at notes from predictive analytics, et cetera, and then serving them up to providers in a way that integrates with their workflows in the EHR. And I think if you look at organizations that have done that effectively, they've not only boosted their bottom line significantly. And by appropriately really capturing the full picture of complexity on their patient populations, but it's made a big difference for individual patients because that same process oftentimes identifies care gaps that providers might otherwise have missed in that old world that I've described. So it's a really good example of how you can use technology, not just to kinda get through your day faster, but also to provide better care and get the appropriate reimbursement along the way.
- Great. Thanks so much for that. So Dr. Kontor, what is the most significant barrier to tapping into everything that EHR can do?
- I think no question the most significant barrier to date has been around interoperability. And I think there's some good news there though and the answer to that question, which is that I really believe we've reached now, sort of a critical momentum on interoperability. And we're still, I think in the painful transition phase and as some of the new regulations, and rules take place that promote or require, interoperability for technology vendors, for payers and for providers, and we're gonna pretty quickly see, I think, an evolution towards that Nirvana of truly interoperable ecosystem evolve over the next sort of three to seven years, and I'm really, really excited to see that. And as we look forward to that day, I think that also will drive the other big change that we've all been anticipating with the EHR's, which is the empowerment of individual patients to be able to take more direct control of their data, or at least be able to orchestrate who can see that data, who can use it and take in, on having an advantage of a whole ecosystem that can utilize it. I think there still are some other issues though, that are persisting and probably are going to become more challenging in the near future. And some of that's technical challenges, the amount of data that we're producing is mind boggling and it just keeps accelerating. As we get into really get into genomics as these interoperable data sets starts merging, and we're trying to use AI and machine learning approaches to manage that data, we've got to continue to invest in core technical capabilities to be able to do manage that data at scale and with speed, and reliability, and with data safety, and I think we've still got some challenges there. And lastly, I think cost is still going to be an issue, it costs hundreds of millions of dollars for health system to implement these systems in the interoperable world. We're gonna be adding on new partners that can provide value added clinical, operational financial services, and effectively work with us collectively with our patients or directly with patients. All of those tools are also going to cost money. So I think there's gonna be ongoing cost pressures that we all have to deal with, but hopefully we'll continue to see as we have in other areas of technology, the sort of overall costs of technology start to trend down over time, but near term, I think we're gonna still face some challenges there.
- Great. So with costs is sort of segues into my next question. So how do organizations measure the ROI of EHR investment in maintenance and how do leaders justify the value?
- That's a great question, Patty. And I think one of the things that we see happen a lot is organizations spend a lot of time and effort choosing an EHR and deciding how much to invest, calculating what the return on investment will be. And many times, unfortunately if you go back a couple of years later, people sort of forget that whole approach. And they just continue to pump money into these systems and not hold themselves and their vendor partners accountable to achieving the ROI that they signed up for when they made that initial investment. So I think a really intentional approach to achievement of both clinical ROI and hard dollar ROI is really important. Sometimes it seems difficult to be able to quantify some of that ROI and there are some non-quantifiable, I think, benefits of EHR and other other technologies, but we shouldn't let that challenge kinda be a path to not try to quantify ROI. And if you look at really specific areas of ROI on the financial side, you can look at charge capture, which seems sort of simple thing, but how much of your charges do you actually end up getting. Getting reimbursed form, if you think, if you look at the risk adjustment example that I used earlier in the conversation, how accurately are you capturing the overall risk profile and the full risk profile of each of your patients and for your entire populations. And on the efficiency side, is the EHR making your providers and care teams spend more time per patient, or are you actually driving efficiency and letting them see more patients through the day, or get home earlier and spend more time with their families? And on the clinical side, I don't think we should be afraid to really a big mirror and say, we expect to see functional improvement and reduce mortality. And some of the really lofty goals that we've been searching for in clinical medicine and demand that our use of technology actually, demonstrate positive movement on those big clinical numbers as well.
- Great. Well, Dr. Kontor, you mentioned earlier, this is sort of an ongoing project. You don't just plug and play the EHR. So my next question is, how can healthcare organizations retain and attract the talent they need to drive EHR projects in a massively competitive market?
- Yeah, I think really over the, especially over the last five years, we've seen the market for talent in this space really get tight and in the post pandemic world, it's getting worse. So the healthcare technology workforce, like many other sectors in US health and the US economy, has seen folks in our workforce get used to working from home or from really nice spots away from home, and spent in traveling less, spending less time, locked up in a basement with no rooms someplace. And there's this simultaneous massive explosion in the number of healthcare technology companies and everyone's competing for the same workforce. And I think we're really getting to the point now where that's going to be a limiting factor for both provider organizations and technology companies. So we've got to invest in the growth of the healthcare technology workforce and promote increased diversity in the healthcare technology workforce and for individual organizations to be a provider org or a technology company that's competing. If you're gonna be successful, we've gotta figure out a way to maintain a high level of performance, maintain a culture of an organization, but still allow our workforce to have a lifestyle that will keep them employed and keep them in healthcare, and in healthcare technology, and I think there is gonna be, we are already seeing increased pay demands from this stressed workforce. And until we can solve some of the supply side issues, I think that's gonna be an ongoing challenge. You know, if you look at all of those difficulties together for a particularly for kinda a small to mid-size organization, it can be really, really hard to compete. More and more, we're seeing that the development of creative partnerships help relieve some of that pressure on especially small to mid-size organizations. And I think we're gonna continue to see the growth of managed services partnerships broadly for healthcare technology, specifically for EHR services. And that will come in in two guises. I think one is some of the shared instance approaches that some of the EHR vendors do where a health system can become a vendor for some of their regional partners and supply technology services. But I think more and more too, you're gonna see the re rise of managed service relationships with large technology vendors, supporting the EHR and other technologies for provider organizations.
- Great. And so that segues into my next question is, how do healthcare organizations manage the burden of the EHR maintenance, let alone new innovations and specialty workflow?
- All provider organizations have also, and I actually think this was exacerbated by COVID, but experienced this really losing the battle of trying to keep up with the demands of day to day technology operations, keeping up with evolving clinical care, evolving federal requirements, evolving reimbursement schemes, and then at the same time, still being able to do all the cool stuff that you really wanna do and special projects. And again, I think we're reaching folks start to shift to is to say, look, we're gonna trust a lot of the nuts and bolts to a third-party. The stuff that we are, as a care delivery organization is not our core mission, but find trusted partners to be able to manage some of the kinda day-to-day nuts and bolts stuff. And that allows us to take our critical resources, both money and people, and invest them on some of the things that really drive our core mission around improving care, serving, being good fiscal stewards of our financial position and looking to the future, especially thinking about how we're gonna prepare for a world where patients are demanding much more personalized care, the clinical technologies around personal medicine, like CAR T therapy and other personalized cancer therapies, gene therapy, and therapies, et cetera. All of that I think is really were organizations are gonna want to continue to focus their critical resources on and create partnerships to manage some of the underlying fabric, day-to-day stuff.
- Great. So now Dr. Kontor, my last question is, so pull out your crystal ball, what's the future for EHR over the next five to 10 years?
- Yeah, this is a super interesting question. And I actually think this is the most exciting and interesting moment in healthcare technology. I've been doing this for oh gosh, decades now. And I think there's, it's a really critical juncture for the EHR vendors. I don't think we're going to see a rapid massive disruption of the current major EHR vendors if for no other reason because they manage a lot of the day-to-day workflows that are required, both clinically and financially, that would be hard for any disruptors to really totally to take over quickly. At the same time, as data really becomes interoperable, I think EHR vendors are going to be at risk if they don't embrace that interoperable ecosystem future. And the folks I think they're gonna be really effective, longer term are gonna be the companies that most effectively allow both providers and patients to interact with lots of different third parties around shared data sets. And I also think that's what's gonna be best for the care of our customers, our patients, and for ourselves. So to me, I think, again, this is gonna be a super interesting time to see, how all this plays out, but I remain hopeful. I think a lot of the major EHR vendors have been successful because they're good people with good mission and lots of smarts behind them. And I remain very hopeful that they're going to embrace this new world and get us to a really new and exciting place over the next five to 10 years.
- Well, Dr. Kontor, you said a lot of great things and I wanna give our listeners some key takeaways from our podcast. You know, EHR's have dramatically improved since they first came into the market to now, there's still, a lot of challenges that they need to overcome, but given all of the things that they can now do, healthcare organizations, can't really just plug and play the EHR. You talked about being really intentional about how we, how healthcare organizations use their EHR. And you have to continually invest in the optimization. You have to personalize it to your particular needs and you need dedicated infrastructure, and staff, to be able to optimize the EHR. And you talked about, being intentional with who's using these EHR systems, it's the clinicians. So we wanna be able to support the clinicians and also, being able to embrace interoperability for the long-term. The other thing that you had mentioned was a lot of healthcare organizations really need to stick to their core mission. So they need technology to help them with that core mission and where there are limited resources, or even when they're aren't limited resources that healthcare organizations really need to develop these partnerships with the managed service providers so that they can lean on them so that they can do their work, which is improving patient care. Is there anything that I missed, Dr. Kontor in what we talked about today?
- I think you've covered a lot of it there. And the last thing I would say maybe is, be demanding of yourself as a provider org and of your vendors, EHR vendors, or any of the other third party technologies that are interacting with them, digital solutions, et cetera. And really, don't just sort of accept high expense and status quo with your technologies, but really be demanding of yourselves and your partners to make things better, to improve the quality of care, to make the processes more efficient and more effective. And lastly, strap in, because I think as challenging as it has been to date, this interoperable world is gonna get even more complex and more challenging and more interesting. But again, I have full safe that it's actually gonna take us to a much better place and more effective, to not use of technology for all of us.
- Great. Well, thank you so much for your time, Dr. Kontor.
- Great. Thank you, Patty. It was a pleasure to be here with you.
HIMSS and Optum talk EHR strategies
Dr. Kontor of Optum shares how EHR can drive strategies.
The partnership has enabled impactful COVID-19 responses, analytics decision-making, telehealth stand-up, and results-driven remote work.– Bill Hudson, CIO, John Muir Health