October 8, 2021: End users are getting better about not treating the EHR like a giant post-it note. And we’re seeing much better data quality. Consistently delivering trusted, comprehensive data can create competitive advantages for your organization. Learn how to strategically manage and mobilize data with Intermountain’s Castell Health and Arcadia, who have partnered to elevate value-based care performance. Joining us is David Dirks and Michael Meucci. What are common issues that arise from a poorly managed data supply chain? What is required for data to be trusted and fit for use in healthcare? And how can you master good data governance, strong data provenance management, and effective infrastructure?
Activating Your Health Data Supply Chain with Intermountain’s Castell Health and Arcadia
Episode 450: Transcript – October 8, 2021
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
[00:00:00] Bill Russell: Today on This Week in Health IT.
[00:00:01] David Dirks: We realized the traditional legacy business of healthcare, which is treating people within hospitals needed to be disrupted and either we were going to be driving that disruption or it was going to happen to us.
[00:00:21] Bill Russell: Thanks for joining us on This Week in Health IT influence. My name is Bill Russell. I’m a former CIO for a 16 hospital system and creator of This Week in health IT. A channel [00:00:30] dedicated to keeping health IT staff current and engaged.
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[00:00:48] I ran into someone and they were asking me about my show. They are a new masters in health administration student and we started having a conversation and I said you know we’ve recorded about [00:01:00] 350 of these shows and he was shocked. He asked me who I’d spoken with. And I said Oh you know just CEOs of Providence and of Jefferson health. And CIO’s from Cedars Sinai, Mayo Clinic, Cleveland Clinic and all these phenomenal organizations, all this phenomenal content. And he was just dumbfounded. He’s like I don’t know how I’m going to find time to listen to all these episodes. I have so much to learn. And that was such an exciting moment for me to have that conversation with somebody to realize we have built up such a great amount of content [00:01:30] that you can learn from and your team can learn from. We did the COVID series. Talked to so many brilliant people who are actively working in healthcare and in health IT addressing the biggest challenges that we have to face. We have all of those out on our website and we’ve put a search in there and makes it very easy to find things. All the stuff is curated really well. You can go out on a YouTube as well. You can actually pick out some episodes, share it with your team, have a conversation. We hope you’ll take advantage of our website, take advantage of our YouTube channel as well.
[00:01:59] All [00:02:00] right this morning, we have a great conversation. We are going to be looking at the activating your health data supply chain. And I like this topic. It’s one of those that really interests me. This is part of our ongoing HIMSS coverage. What I did is I went through all the presentations that were happening at HIMSS and I tried to find the ones that I wanted a little bit more information on.
[00:02:21] So today we’re going to look at activating your health data supply chain. We have two gentlemen with us Michael Meucci, the COO of Arcadia and [00:02:30] David Dirks interim CEO of Castell and VP of strategy for Intermountain healthcare. Good morning gentlemen. Welcome to the show.
[00:02:36] Michael Meucci: Hey, good morning Bill.
[00:02:37] David Dirks: Morning. Thanks Bill.
[00:02:38] Bill Russell: This presentation is interesting to me because I think it represents a different way of approaching data. Back in the day when I was CIO we had one way of approaching it, which was to really empty our EHR and other systems and move it all into a single repository. Try to normalize that data, spend a bajillion dollars.
[00:02:55] And it was, it was extremely hard and we did not get really the value out of it [00:03:00]that we wanted to. And we were doing all that for a lot of different reasons. I mean, you could obviously use it in your value based care contracts and those kinds of things, but it was needed all over the place.
[00:03:09] Our clinically integrated network needed things and whatno. And to be honest with you, when I saw this topic, I thought this represents that for way for me to think about this. And so I really I’m looking forward to this conversation. This is straight from your slide deck.
[00:03:22] You’re talking about the compounded annual growth rate of healthcare data is 36%. And that really rings true to me. And [00:03:30] then you talk about this. This idea of demand is growing for near real-time use and information. Talk a little bit about that growth and the use cases that are driving the evolution of how we think about data in healthcare.
[00:03:43] Michael Meucci: Yeah, it’s really interesting. I think when we were at HIMSS, I used this analogy that there was some statistic that in 2018, there were 2 million cat videos on the internet. We talk a lot in data, that data is power and the people who own the data are going to win the competitive race.
[00:03:58] And Dave, and I talk a lot [00:04:00] about this and it’s not the data. It’s both. The information and the data and then what you do with it. There are tremendous numbers of factors that drive this growth in the data captured. Remote patient monitoring the continuing evolution and shift of services to more and more outpatient at home settings, virtual care.
[00:04:20] You look at the last 18 months and almost everyone has had a telehealth encounter. Even people who’ve never considered having one before the pendant. So there’s this [00:04:30] explosion of information. But not all data is good data. And just because you have data doesn’t mean you necessarily need it.
[00:04:36] I think what we’re seeing more and more, and Dave, you likely have some, some very concrete use cases here. But throughout the pandemic there’ve been ever increasing needs to understand social determinants of health, who are the individuals who didn’t have a home to be bound to. And they’re dealing with housing crises and social services are dismantled because there are fewer individuals who are willing to go out and work in soup kitchens or food [00:05:00] pantries.
[00:05:00] So we’ve seen a growing need to understand the social factors that influence an individual’s ability to manage stress. We’ve seen a lot of novel uses of data from third-party sources, like fair Isaac and TransUnion to try and profile patients relative to their social needs. And then really to you’ve got groups like Castell who are actively managing a really large panel of managed patients needing data from all of the different telehealth vendors and the wearables vendors to try and understand what’s happening with their populations since they’re not seeing them [00:05:30] in person as frequently.
[00:05:31] Bill Russell: David we had Mikelle Moore who was with Intermountain as well as Bill Crim. I think he was with United Way. And when we were talking about social determinants and the work that they’re doing in and around Intermountain. it struck me as what a challenge that is to orchestrate all that data, because it’s a different set of data than we normally deal with.
[00:05:50] But it’s so relevant to the health of the population that you serve. Talk a little bit about about some of those use cases that Michael was alluding to.
[00:05:59] David Dirks: You [00:06:00] mentioned earlier the explosion of healthcare data but to your point we have to look at a holistic view of the person, not only the data that’s being produced from a healthcare perspective but the other things that need to inform care broadly the change we’re trying to affect in healthcare, you think of the way healthcare is operated for centuries is who is coming to me in being seen that has a problem? And then I’m reacting to the problem that they’re coming to me with. What we’re [00:06:30] trying to do is fundamentally change that perspective. So rather than a primary care physician, when she enters the office every day, thinking about, okay, who’s on my schedule today.
[00:06:41] What we’re trying to do is change that and say, who needs to be on my schedule today? Who do I need to see today? And that’s a very different perspective and takes a whole differen approach to data and analytics, to be able to know who do I need to see. So it’s not just healthcare data, but it’s also social [00:07:00] determinants data and forming a relationship with patients to be able to use that data to affect change.
[00:07:07] One of the examples that we like to use that was a real patient, was the traditional healthcare approach to someone needs a colonoscopy is, well, I’m going to call them, I’m going to try and get on a schedule. I’m going to send a mailer to them to try and get them to get a colonoscopy.
[00:07:24] And if they don’t, well, then I really don’t have much of a recou se to get them in and get that preventative care done. What the [00:07:30] approach that we’re taking is to say, well they need to get in to to see a colonoscopy, but we know that they’re probably going to have transportation challenges. We know that they’re probably going to have problems or concerns paying for that colonoscopy. We know that there’s going to be some follow-up issues that we need to have. And so if we have that information at the ready prior to making that call, what we can do is make sure that we’re aligning all of those components up at the time when that call happens and say, Hey, how do we get you in for colonoscopy? How do we make sure you can get to your appointment? [00:08:00] Let’s take care of any of the financial concerns upfront and any of the other exigencies, which may be standing in the way of receiving that care. All of that workflow and workload needs to be informed by analytics and a holistic knowledge of our patients.
[00:08:17] And that’s how we’re using that data supply chain is not to your point, let’s just load as much data as we can, and then hope we can find a use for it. We start with the end in mind, which is what are we trying to [00:08:30] accomplish? What are we trying to get done? And then let’s back into it and say, okay, what are the data assets that we need to line up in order to be able to inform and make those decisions?
[00:08:40] Bill Russell: Yeah. And Michael, I think I teed you up for this a little bit. How have we traditionally approach this problem in healthcare and I think you’re just going to essentially regurgitate back to me exactly what I said. We used to think about, Hey, we can build this ourselves, put it all into a big repository and we can figure it out later. But that [00:09:00] approach has changing isn’t it.
[00:09:02] Michael Meucci: Yeah. And I think it’s exactly right. I think there’s another piece is traditionally there was this interface soup. It was, everything needed an interface. Everyone wanted a CCD or an HL7 or an ADT or a fire interface. And we’re moving to a point where data needs to be a little bit more liquid.
[00:09:17] And that’s not me saying that there’s not a place for interoperability because there certainly is. There’s a ton of use cases that are still served by traditional inter-operability pathways. But where I think. Castelle [00:09:30] and Arcadia and others who innovated around data have really advanced their models is being able to go right to the data lake and kind of normalized data in real time.
[00:09:40] Versus having to go through this protracted process of data aggregation, normalization, construction, into a standard data model, mapping, terminology, mapping, all of that. You bring the business stakeholder, the analytics product owner and I’ll get back to product owner in just a second. And you bring the executives to the table and say what result do we [00:10:00] want?
[00:10:00] And then how do you deconstruct what you need from there? And where I think Castell has done an excellent job in helping to activate their data supply chain. Treating their outputs like products because that’s the other challenge. And the historical way that we’ve handled data is I need a readmission rate or I need to know how many patients need a colonoscopy.
[00:10:19] And that’s the deliverable. It’s a rate or a number or a list. It’s not asking the question. What do I do with that rate? That list, that denominator, how do I get it in the hands of someone who can [00:10:30] act. And how do I improve it based on user feedback, maybe we get that readmission rate and we say, we want to layer over it a bunch of social indicators to understand, are there social programs, we can spin up in communities to help impact re-education when patients are discharged to home, so they don’t get readmitted and then we’re providing them the right support. And as we do that does the product you do evolve and it becomes a living and breathing asset that can be integrated into workflows. And that’s one of the areas that Castell has done a really nice job in [00:11:00] is building these assets in their workflows of the people who could impact change and consistently maintaining those and evolving those as their performance evolves.
[00:11:09] David Dirks: Yeah. I would just, I would add to what Michael has said. When we set out to build Castel we made a conscious decision that all of our workflows would be. Directed and informed by data and analytics. Right? All of the choices that we make are wrong. Our process mapping [00:11:30] at each one of those nodes, we knew that we wanted it to be informed by data so that we knew we would have the greatest impact.
[00:11:39] On the population with the least amount of resources being as efficient as possible. And so as we did those very detailed process maps, we said, okay, at each point on the way, what is the data that we need to surface? Who does it need to be surfaced to? And how do we get it there? And that’s why Arcadia has been such a critical partner because trying to do that [00:12:00] on our own without understanding what is all, what are all of the components that need to come together?
[00:12:05] And in order to inform that, that workflow at every point in time, we couldn’t just do that on our own. It takes a lot of work to make sure. Not only that you’re able to get all of that data in, but that people trust it and you can deliver it at the right place at the right time, in the hands of the right person, which is why we like this comparison to the traditional supply chain.
[00:12:27] Because right, if you go to talk to [00:12:30] Intermountain supply chain representatives, that’s their job, right? How do I get the right supply and the right hand and the right person at the right time at the lowest cost? That’s exactly what we think about in the data supply chain. How do we get the right piece of data or insights in the right hand of the right person at the right time. We often don’t think about data that way. At least for a long time, right. It was a retrospective report. We’d spin out a dashboard. We’d sort of provision everyone who might be curious about this data on it. And quite often it never got used because while it was interesting [00:13:00] it actually didn’t inform workflow.
[00:13:02] It didn’t inform the work that we were trying to do. That sort of sits at the core of what we’re trying to accomplish with Castell and why Arcadia is such a critical partner in order to enable all of that.
[00:13:14] Bill Russell: It seems to me the health data supply chain is a different concept and it gives you as agility. And one of the things we just came through with the pandemic is that we recognize the need for agility. At a [00:13:30] pace we’ve never had to experience in healthcare, at least in my lifetime where we didn’t know what the problem was until the problem presented itself. And then it was sort of almost like the demand generated the need. And then we had to figure out how to respond to it. And the health data supply chain seems to me to be a better way of not spending as much time normalizing the data and spending more time actually generating benefit for the organization. Michael, is that, does that capture it and how does it do that?
[00:13:58] Michael Meucci: Well, yeah, I think [00:14:00] that captures the essence and I think what we’re trying to turn on its head is, and COVID is a great example. And we have a great story about how we partnered on that rapid response. You know March of 2020 when there was the beginnings of shutdowns and stay at home orders and all of the changes that we’ve had have become part of normal life over the last 18 months, the conversation that Dave and I and a bunch of other folks had was how do we figure out who are the patients who are most likely to die from this disease [00:14:30] that we know very little about? And where the health data supply chain came in, as we said, well hold on, Arcadia has a reference data set. It’s about 150 million persons that we’ve collected. We do a bunch of research on it and we have customers in Boston, New York and Seattle. Three of the earliest outbreak centers in the United States. This was a time where testing was widely unavailable. You had some skunkworks testing projects going on in different cities.
[00:14:56] But when we did have, was diagnosis data coming in from [00:15:00] ADTs or from EHR. And so we were able to build a little machine learning model. And I say that, and it’s not anything fancy. It was pretty simple at the time to say what symptoms are we seeing that tie to what the CDC is reporting we should be watching for. That tie to the limited number of positive tests that we have. So we can then back into a registry of risk factors and everyone at the end of the pandemic said, Hey, it seems that like, it seems that folks who are overweight or folks with multiple chronic [00:15:30]conditions, elderly, or are more susceptible to complications from COVID, but that was just a hunch. And so we were able to build these models.
[00:15:36] Get them in the hands of Dave’s care, traffic control team, and really rapidly spin up an outreach program to those patients. And Dave can talk about the outreach program, but what was great about the supply chain was like every, like any traditional supply chain, there’s always an effort of supply chain optimization.
[00:15:54] We will take feedback from their calls and use it as an input to the model to help the model get smarter. [00:16:00] So as we continue to build these riskstrata and cohorts, they were getting smarter and more refined each time. And I think Dave can speak to some of the great findings and some of the great support that, that cast Eleanor mountain were able to provide to their patients through these efforts.
[00:16:14] David Dirks: Yeah. I mean, if you think about where we were at that point in time, Right. The delivery system was all reacting to the surge. How do we stand up testing? And it was in a very reactive position by necessity. [00:16:30] And the conversation was how do we begin to get ahead of this? How do we begin to, to some extent, begin to take the fight to COVID and what was happening. And the, one of the key roles that we at Castell felt like we could play because in all of the other components, we felt helpless, right? It was our ICU’s and EDIS and others sort of fighting that battle. We said, how can we identify those folks where that are in their homes? They’re scared. They have a lack of [00:17:00] information. They don’t know what to do if they get symptoms. They’re very concerned. The Arcadia team was very quickly able to generate that list for us that Michael walked through. And then we have resources literally just began making calls and saying, Hey, we’re concerned about you.
[00:17:16] What can we answer? Hhow can we help? What that then evolved into, because we already had that supply chain built is when it became time to get the word out about vaccines. We already had those lists. We already had [00:17:30] connections with those folks that we knew were high risk. And so we were then able to begin to make those connections and say, do you know, now you qualify for that vaccine?
[00:17:38] What questions can we answer and concerns. What we were also able to do is leverage technology through those lessons through Arcadia to do that through a text campaign and through calling. And we were able to get some uptick numbers in the hundreds of people that we were able to call and get a vaccine, but it was in the tens of thousands of people that we were able through that data supply chain to actually [00:18:00] get confirmation on vaccines or at least a message out through texting.
[00:18:05] So because that supply chain was built because we had already had that connection point as COVID evolved, we were able to meet the needs of people all along that continuum as the sort of the disease and the pandemic played out in a very easy way where we weren’t trying to re-engineer things multiple times. And we were very reactive and able to move very quickly based on the changing nature of how [00:18:30] the virus progressed.
[00:18:30] Bill Russell: Yeah. Michael, I’m to come back to you. It’s interesting. As I listened to this Castell, Arcadia Intermountain partnership, it’s essentially a marriage of operations, of technology and bringing those things together. So a lot of health systems are sitting back today, probably going well we have a data warehouse, we can generate some of those insights, but taking them through to the operation and actually delivering on those products. That’s an awful lot of work. And I assume you guys have the workflows and the processes [00:19:00] around there.
[00:19:00] You talked about your care traffic control center. It sounds like a big set of tools and processes that a health system can take and start to run with. Is that pretty accurate David?
[00:19:12] David Dirks: Yeah. That’s the whole idea around care traffic control is literally like an air traffic control. Right. I have visibility to what’s happened and I’m making sure that I’m directing people to the right and appropriate place. And nearly all of what they do is informed by data and analytics. So the layer [00:19:30] between producing those insights and taking those and actually creating action, there are very few layers within care traffic control.
[00:19:37] They’re using those real-time insights. We call them triggers or signals that data platform sort of spits out the signals and data they’re taking that information enabled by number one, a knowledge of the healthcare system. And a knowledge of that particular member and their primary care physician and marrying all that together [00:20:00] to be very effective at meeting people’s needs, whatever it is, right.
[00:20:04] All the way from, I need to get into a doctor tomorrow. I’m being discharged from a post-acute care facility and I need to make sure I’m making that connection to there’s a few food insecurity issue that needs to be addressed. All of that runs through that center with a set of defined. Protocols and workflows that at each point, as I mentioned, is informed by a data point to help make those decisions.
[00:20:28] Bill Russell: I think about the maturity scale, [00:20:30] right? So if you have health systems that are right around a billion-ish, they’re saying, look, we have an enterprise data warehouse. We’re going to rely heavily on our EHR provider and their analytics. But they probably don’t have the capabilities that Dave just talked about.
[00:20:43] Right. They’re trying to figure that out. But then you have the slightly larger 3 billion, 5 billion, $6 billion health systems. From a maturity standpoint, they probably have some data skills, right. So they’re listening to this going, Hey. Yeah we did some of those things during the pandemic.
[00:20:58] We collected those analytics and those kinds of [00:21:00] things. We struggled a little bit to activate them and engage them. But we have some of those skills. How should they be thinking about this? I’ll just leave it a broad question, which is, when we’ve talked about healthcare, it’s a lot of different things. It’s not just integrated delivery networks. It goes all the way down to one and two hospital systems. How should they think about their data maturity? Some of them are relying heavily on an EHR provider or some partner. But they’re not getting the whole picture like we talked about earlier. And the larger ones might be able to get the [00:21:30] whole picture, but don’t know how to operationalize it.
[00:21:32] Michael Meucci: Yeah. That’s a great question. You think about the top end of the market and you’ve got a very, very deep penetration of tools from Epic and from Cerner at the top of the market. And what’s really fantastic about those platforms is the ability to connect insights into the clinical workflow. So my conversation is always, how do you do a capabilities assessment to understand where your gaps are and how do you fill those in? Our mission as a business is not to go to a health system. [00:22:00] I’ll pick on your former employer. I’m not going to go and say, Hey, you shouldn’t use Epic. It’s how do we augment what you’ve invested in Epic? And with Epic specifically, we have app orchard apps that brings some of these insights into the point of care workflow. But at the same time, if you’re doing advanced data science there’s a time and a place for that.
[00:22:17] And that’s in my opinion, not inside of the EHR ecosystem, but what comes out of that data science effort can feed back into it to then feed those workflows. It’s never an EHR or a platform like Arcadia’s. It’s [00:22:30] always an EHR. And then when you get to the bottom end of the spectrum you might deal with some smaller less technically mature HR platforms, much more transactional in nature.
[00:22:39] And that’s where you have an opportunity to engage a partner like Arcadia tip to outsource the entire that supply chain. And when you think about those platform partners. It’s evaluating the points of interconnectivity to say, how do you work well in my ecosystem? And that’s what I think Dave, you and I talk about this all the time.
[00:22:55] We never set out to say, we want to replace Intermountain CDW. We don’t want to [00:23:00] replace the investments made in Cerner and I Sentra. We want to augment and lift the capabilities of all of those platforms and all the folks using those tools on a day-to-day basis.
[00:23:10] David Dirks: Yeah. And that’s why I think this concept of a supply chain is super helpful is that concept of data in the right place. And for Intermountain’s medical group, the best and the right place is in the EMR. It’s in I Centra where they’re doing the documentation and we do that, right. We take those insights and we [00:23:30] make sure that those are embedded for some of our affiliated partners that may be in their EMR or maybe a different tool set.
[00:23:35] So that, that’s where for us has been value of thinking about this as a supply chain, because there’s lots of different places where I need to deliver those supplies, different contexts. And if you think about it that way, that’s That’s where we’ve been able to find the greatest progress is actually delivering something that’s useful and applies to that specific context of the [00:24:00] person that has to use it.
[00:24:01] And that may take a bit. So Bill, to your point if you’re thinking about that level of maturity. COVID was a great example . Health systems did amazing things, right? They were able to pull together teams and accelerate a lot of work. The point I would make is how do you capture that?
[00:24:18] How do you capture what you were able to do and how do you build an infrastructure that allows that to be repeatable right across then a number of different problem statements that you’re having. [00:24:30] And that’s what we’ve tried to focus on. Right? We didn’t have to pull a whole bunch of teams together to do that work when COVID can, cause it was, it was an infrastructure already built. What I would say is starting building that infrastructure, pick your top two or three problems that you want to impact build towards that, but do it in a way that that process is repeatable and scalable. And once you have that are about what we’ve seen as our ability to make change very quickly then and expand [00:25:00] our impact has been greatly improved because we focused on building infrastructure first.
[00:25:05] Bill Russell: Michael, in the middle of this presentation, you have a story of two IT projects. I want you to go through those two slides, cause I want people to identify who they are in this story so that they can maybe see the distinction between maybe where they’re at and what is possible.
[00:25:21] Michael Meucci: Yeah. it’s interesting. So I’ll cover these. I want to quickly just revert back to the supply chain analogy because it overlays nicely. In our [00:25:30] presentation in Las Vegas, we talked about Blockbuster and Netflix. And people use this all the time as a great analogy to supply chain disruption and how new markets are created through innovation.
[00:25:43] But for those closer to the story they know that Blockbuster actually had a direct mail service at the same time to Netflix. The reason why Netflix was more successful was because they innovated around how to deliver product faster. And they were able to get DVDs in the [00:26:00]hands of consumers faster than blockbuster.
[00:26:02] And what it came down to was Netflix had more distribution centers. Blockbuster had three and Netflix had I think 30. So they were able to get a DVD in the hands of a consumer within believe it was two days. Whereas Blockbuster would take three to five days. And if you were a movie buff, where you had a bunch of kids and you were constantly sending DVDs back to Netflix, checking out new ones, checking in new ones.
[00:26:25] They were much more able to meet the user experience. So keep that in the back of your mind as I covered these [00:26:30] two it projects because that’s the grain of what’s different. In the traditional technology project in healthcare, hey, I’ve got a new vendor that I want to integrate with or I have a new report that I need. Maybe your care coordination team need some insights on social determinants of health. So the business submits an IT ticket requests and says, Hey, I want to get the data out of prepare surveys out of my EMRs and maybe some community EMR. And I want it, I want to build a report that shows me the social needs of my population.
[00:26:59] So it [00:27:00] gets groomed into a sprint, prioritized into a queue. You might have to contact your EMR vendor to adjust or update an interface. Maybe add some columns to your enterprise data warehouse map normalize tThat data in build the report. And that process can take 12 to 24 weeks, depending on the responsiveness of your vendor. What other projects are in front of it. If you’re in the middle of the entire upgrade forget it, it might take six months, eight months. So you’ve got that kind of that one project. The second [00:27:30] project is how we start to think about disrupting the supply chain. The first thing is you’ve got a business stakeholder who says, I want to stratify my population by social needs and the product owner, the advanced analytics team the analytics product team says, okay, well what are you going to do with that data?
[00:27:46] What do you want? Do you want to then take that information to make referrals to a community service that has food support program or housing support program, or refer to community partners who help with social and mental health issues. [00:28:00] Oh, you do want to, you want to automate referrals. Great. So let’s think about this product is not just a report. You want an actionable report that integrates into the referral queue in our referral system. So you start to then unpack what the actual end point is. So you’ve got this user experience layer you put on top of the new price. And then second to that, you’re sitting there with the business stakeholder and they say, Hey, we want data from these prepare surveys.
[00:28:23] You have your data and analytics team go right to the lake where all the information you’re capturing from your transactional systems from your third party [00:28:30] systems is already sitting. It’s not transformed. It’s not normalized. We were able to dive into and start to say, okay, here’s what information we have coming out of these services.
[00:28:37] Is it enough? Is it the right data? What other data do we have in the lake available to support this? Maybe we have Lexus Nexus or Fair Isaac or some other SQHC that we can bring into this that you can then merge into the same theory. So the difference is the connectivity of the business, the technical stakeholder, and focusing on the ultimate outcome.
[00:28:58] Netflix’s outcome was [00:29:00] more movies in the hands of consumers. Blockbuster’s outcome was, we want to change the way we deliver movies to our consumer. They didn’t answer the question of how do we make the experience better. As a matter of fact, there’s a lot of nostalgia around the Blockbuster experience.
[00:29:12] People remember roaming through the aisles, picking up candy, the smell of popcorn. And that’s, that’s gone. And Blockbuster had that experience cornered and Netflix, netflix took that, that male experience and made it better. And then they disrupted it again when they started delivering content over the internet public utility.
[00:29:29] And then [00:29:30] they’ve disrupted again, as they’ve opened their own studio to control the entirety of the content supply chain. And so what I think and Dave can talk through this, but I think where innovative healthcare organizations are really disrupting the supply chain is not just thinking about user experience but thinking about how do you make multiple disruption hops? Not just one.
[00:29:47] Bill Russell: As I’m listening to that story, the two questions that pop into my head. One is data quality. And anytime we were, we were always worried about having people access the data lake or in our stories the enterprise data [00:30:00] warehouse directly because we needed people who understood the data. Length of stay was was an interesting term that had a lot of different definitions. And so we were always concerned about that. So how do you manage that specifically? And then Dave and Michael I’d like for you to answer that.
[00:30:17] And David, I’d like to come back to you on health. And how this gets applied to really addressing health. Because when you talk about experiences Michael, and I’ll come back to this question later because [00:30:30] Michael, I really want you to answer that one around data quality. But when I think about experiences today, we’re thinking about traditional experiences.
[00:30:36] But in the future, we might be thinking about completely different experiences of actually keeping people out of the hospital and keeping them healthy. And I’m wondering how this drives that, but I’ll come back to that in a second. Michael, data quality, are we making progress? And how do you give people that kind of access without worrying about the data quality?
[00:30:53] Michael Meucci: Well, that’s why you partner them with someone who can kind of control for it. When you’re going to write at the lake, there is inherently quality issues. [00:31:00] You haven’t mapped, you haven’t normalized. You haven’t transformed. Maybe the data hasn’t been through your NLP engine, but that’s where the analytics product owner becomes so critical to being part of the solution because they understand, Hey, we’re going to go dive in the assessments outputs table. That’s a messy table. There’s a lot of free text. So you can set expectations appropriately. You talk about length of stay. And this is actually one of my favorite examples of data governance problems.
[00:31:26] We have customers who ask us for length of stay calculations and they’ll say, well that [00:31:30] doesn’t match what you know, my, my internal team is saying, and you say, well how are you defining length of stay? Well, we’re defining it this way. And you’re like, okay, well we’re defining lenght of stay another way. It should be a simple concept.
[00:31:41] It’s like how many days elapsed from the point that a person hits, the head hits the bed to the point that the head lifts off the bed. But there’s a bunch of different definitions. It’s some of it’s payment related. Some of it’s for reimbursement. There are a number of reasons you get these governance issues and that’s why that analytics lead in the middle is important.
[00:31:58] Overall, the industry is getting much [00:32:00] better with data quality. We were doing this work in the wild west days of meaningful use back in the early 2010s. And data quality was really questionable, but EHRs in general have become a little bit more. User-friendly. End users are becoming much better about not treating the EHR like a giant post-it note. And so you’re seeing a much better data quality at the point of capture. And at the same time NLP and OCR technology has gotten so much better. And so you’re able to use a bunch of transformed technology to make the [00:32:30] unstructured data in the EHR, much more reliable as structured concepts. But it’s a, it’s a journey. And that’s part of this feedback loop on the product and user experience. And also understanding why you need to know that output. On those COVID risk registries that we talked about a few minutes ago, that we spun those up and in a matter of days, and the conversation was, we don’t know what we don’t know. So you’re going to find patients in here who we think are high risk, who aren’t high risk and it’s triggering some algorithm we’re going to, we’re going to learn from that.
[00:32:57] And so set that expectation that this is what you can [00:33:00] expect. First is hey, I want to pay a list of patients who are diabetic at this point in time. That should be a pretty locked down list from a data quality perspective.
[00:33:08] Bill Russell: So David, I love going to the JP Morgan conference and listening to your CEO and your CFO stand up there. First of all, you guys have some of the best financials in the industry. Second of all they’re always really pushing the envelope. And when he was talking about stories, when Michael was talking about stories of Netflix and Blockbuster. I think if anyone’s really going to change what healthcare looks [00:33:30] like, it’s probably Intermountain given the parameters around what you guys operate in those markets and the partnerships that you have and whatnot.
[00:33:38] And I’m wondering as you guys are looking at it, we went from Blockbuster, go to the store, Mail-order Netflix then essentially online and now being the complete. And I think about healthcare and what it could be. And I’m tapping into your VP of Strategy here. Healthcare can really be different. We can keep people healthy. We can keep them out of the [00:34:00] hospital. All these things get talked about every year at the JP Morgan conference. Data becomes a integral part and these kinds of operational systems become an integral part. What could healthcare look like if we continue down this path with some of the things that we’ve talked about today?
[00:34:15] David Dirks: Yeah. Bill, Intermountain, we began this, this journey really 10 years ago about doubling down, saying, okay, we’ve got to transform healthcare. It’s way too costly. We’re treating illness [00:34:30] rather than understanding how do we keep people well and how do we keep them out of our hospitals?
[00:34:35] And we doubled down on that. We really accelerated that when Dr. Mark Harrison came the CEO and we realized the traditional legacy business of healthcare, which is treating people within hospitals needed to be disrupted and either we were going to be driving that disruption or it was going to happen to us.
[00:34:57] Oh. And probably more important than that [00:35:00] is doing the right thing for the right patients where we should be focused. So what we realized though, is that causing that disruption within the context of a 23 bed hospital system wasn’t going to happen. We were sort of running into each other. And so we restructured the organization into two different divisions. One was our community-based care division, which their charge really is how do we keep people well and out of the hospitals and then our specialty based care group, where when people do need care, how do we [00:35:30] provide it in the most convenient, least restrictive, least costly space possible?
[00:35:36] So with that separate business, where you know to some extent, we take this seriously and say, what we need you to think about every day is how do you put our hospitals out of business, right? And the best possible scenario for us it’s that we never need another hospital again, because that means people are healthy.
[00:35:54] They’re not getting sick, they don’t need that higher level of care, what that did in sort of [00:36:00] creating a very clear, sort of separate component of our business where we could say we’re going to align the financial model, right? We’re going to align the incentives in the right way. We’re going to allow people to innovate very quickly on how do we keep people?
[00:36:14] Well we’ve seen a massive transformation around just moving from the traditional healthcare environment. So if you think about where healthcare has had and where Intermountain is trying to be out in front of that is how do [00:36:30] we leverage digital and virtual tools to meet people where they are and provide all of the care possible in a virtual digital environment, right?
[00:36:38] How do we make it so that people don’t even have to leave their home for most of health care or if they’re on the go, they can get their healthcare by the pound. So we’ve made huge investments in our digital front door, which really is all things that you need in order to be able to interact with the healthcare environment.
[00:36:55] If you do need care, if you do need to go somewhere in bricks and mortar, we’re making [00:37:00] massive investments in care delivery models that are actually outside of the hospital, right in an ambulatory setting. So that if I do need in-person care, it’s super convenient. It’s low cost. And then we’re beginning to look at, okay, what do the hospitals of the future need to look like?
[00:37:16] And the answer is they look very different than what they look like today because so much of what is done within the walls of a very expensive hospital today, you actually can do in a different way. And even the traditional hospital interaction. [00:37:30] We have a hospital at home business. There’s lots of other groups that are moving towards hospital at home.
[00:37:34] We’re finding the opportunity for patients who are traditionally inpatient acute. We can actually care for them very effectively in their home, in a home-based setting. So what we hope healthcare looks like in the future is you have a level of convenience and service that you expect from Amazon or any of the other USAA or any of these other companies that are known [00:38:00] for a seamless, extremely convenient, high quality experience. We expect it to be much lower costs because now we’re able to leverage tools and technology and assets in a way. They’re much less expensive. And how do we make it frictionless while at the same time? People don’t like to be unhealthy if you go to people and say, do you want to be unhealthy? Question is no. So you have to think about, well what are all of the barriers standing in the way? Is it education? Health education? [00:38:30] Is it financial barrier? There’s a myriad of things and humans are complex. Those factors are different for everyone.
[00:38:37] A combination of them. So what we’re trying to do is how do we understand each person as an individual and what their individual needs are, and then tailor our approach. And what they need. So we recently added equity as one of our strategic imperatives. And while that’s certainly important for a lot of reasons outside of strategy, from a [00:39:00] strategist perspective, equity is important because if I can understand each individual and their individual context and deliver them a set of tools that helps meet their health needs.
[00:39:10] Then just purely from a strategic perspective, I win right now. It also turns out that it’s really great for society and making sure that wherever you live and whatever your ethnic background that you’re getting the best care, that’s the outcome we want. It’s also profoundly strategic. And to bring it back to this conversation, the only way I can [00:39:30] understand people at that level and tailor those services is if I have a very effective, high performing data supply chain in order to inform that.
[00:39:38] Bill Russell: Yeah. You need to get to an N of 1. And as you are talking, I thought I would much rather pay for health than I would pay for insurance. It seems like I’m not paying for the right thing. I, I want to be healthy. I want to live a healthy life. And yes. I mean, I do understand that there will be acute care visits in my future.
[00:39:58] But I’d still [00:40:00] rather pay for health all along the way. And then hopefully I have somebody take care of me when we get to that. Michael, I want to ask you a question. The shows is This Week in Health IT. I have a fair number now of students who are watching the show and they send me notes from time to time and say, Hey, when you have these smart people on, can you ask them what I should be studying in school?
[00:40:22] If somebody is listening to saying, Hey, I want to be Michael when I grow up, what should they be studying? What should they be diving into in college? And maybe even their master’s [00:40:30] program.
[00:40:30] Michael Meucci: I mean, so personally I studied economics and I had a focus in business entrepreneurship. I don’t know how much of that translates to healthcare. But when I’m hiring today for Arcadia, we typically look for are kind of two or three different profiles.
[00:40:46] The first is we do a lot of hiring in the liberal arts schools. Mostly on the business side of our organization. So the account managers, implementation managers. We look for people who have a well-rounded skillset [00:41:00] in with knowledge domains across a number of different sectors, as a means to say, Hey, you’re smart and you can solve any problem.
[00:41:07] And more so in the generalist category, we look for folks who are excited to solve a bunch of different problems and get their hands dirty. And the technology side of our business analytics our BI teams, our engineering. We cannot hire computer scientists, folks with engineering backgrounds fast enough. It is an extremely hot labor market. If you’ve [00:41:30] got a comp sci degree and you’re looking for a job I’m sure you can find my contact information through Bill’s podcast would be, we’d be happy to chat with you. When I talk to students who I mentor at my Alma mater, I’m always encouraging them.
[00:41:41] If they don’t want to study computer science, at least get your feet wet. Take the one-on-one course, understand how systems work. It’s a really valuable skillset. Almost everybody on my generalist side of the team, we send to a little bit of a schooling on sequel just to understand how data works because so much of our world is going to be driven by data [00:42:00] and informatics.
[00:42:01] And then I think that’s the last area is informatics. How do you bring data together and and pull it into insights and present it the way to motivate action. So I think those are the areas that we’re, we’re commonly looking for.
[00:42:11] Bill Russell: Fantastic. I have my economics degree as well, and my son got his economics degree. He said, dad, what should I study? I’m like, well, I mean, you can study anything, but if you learn economics, you’ll learn how to solve problems and look at things in a lot of different, you’ll be able to yourself just take on the different lens and look at different things. And [00:42:30] I find it to be a pretty good background on a lot of different things. I don’t know how we ended up in technology, but we do. David, if somebody is listening to this saying, say VP of Strategy for a integrated delivery network, I mean, is there a path to get there?
[00:42:46] David Dirks: No, not, not a traditional one. What I would say is what we look for increasingly as someone who sort of can live at the intersection of native thinking and critical thinking, right.
[00:42:57] What we’re trying to accomplish certainly at [00:43:00] Intermountain are problems that have not been solved before. There’s no playbook. There’s no way you’re going to learn this. And so we do need people to be extremely creative about developing solutions. But we also need that ability to have critical thinking.
[00:43:14] So some of the people that a lot of the folks that we have on our team come from a variety of backgrounds from economics to English, to philosophy, to political science, and then gone to get an MBA or a Master’s of public health or healthcare administration to get that knowledge, but whatever it is [00:43:30] that’s going to give you that ability to number one, think creatively as well as critically and how do we work through problems and bring solutions. If you can mix that in with a little bit of analytical and financial ability as well that’s helpful, but those are the two things that we look for. And again, what I’ve found is there are a lot of different pathways that people have taken in order to be able to get those things.
[00:43:52] And so part of it is what’s going to allow you to get that, but also make you energized every day to kind of go to school and learn and be able to [00:44:00] apply them.
[00:44:00] Michael Meucci: Actually, I think it’s a great point. One of our most talented leaders in the business majored in Russian. And so I think it’s that it’s really, you gotta be motivated. You have to be interested in what you do every day, but I liked the way Dave said, it’s this intersection between critical and creative thinking because that’s what we need. We’re charting into a lot of unchartered territories and that’s a really important skillset.
[00:44:23] Bill Russell: Yeah. In just about every industry. Not just healthcare. iIt’s really interesting. Gentlemen, thank you for your time. [00:44:30] So Castell and Arcadia and Intermountain Healthcare, great partnership. And if people are interested in more information, they can just hit the show notes and we’ll have some information down there for you maybe a link to the presentation that we’re referring to and some contact information. So thank you again for your time. Really appreciate it.
[00:44:48] David Dirks: Appreciate it.
[00:44:50] Bill Russell: What a great discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a [00:45:00] CIO today, I would have every one of my team members listening to this show. It’s conference level value every week. They can subscribe on our website thisweekhealth.com or they can go wherever you listen to podcasts, Apple, Google, Overcast, which is what I use, Spotify, Stitcher. You name it. We’re out there. They can find us. Go ahead. Subscribe today. Send a note to someone and have them subscribe as well. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders. Those are VMware, [00:45:30] Hill-Rom, StarBridge Advisers, Aruba and McAfee. Thanks for listening. That’s all for now.