Jvion COO, Ritesh Sharma, says “Trust and Hybrid” makes Azure the best fit for the health industry

This blog post was co-written by Dr. Dennis Schmuland, Chief Health Strategy Officer for Microsoft US Health and Life Sciences; and Ritesh Sharma, COO of Jvion (pictured left).

At Microsoft we have a unique vision: make AI everyday, everywhere, and for everyone in the same way we sought to bring the benefits of software for computing — previously locked up in mainframes — to everyone. We think that every stakeholder in the health industry should have access to the benefits of AI, including the tools it takes to digitally transform their business and the industry.

Faced with a surge in two-sided risk contracting and operational costs, health & life science organizations are feverishly pursuing innovative and disruptive ways to make care personal, effective and affordable.

And one of the fastest paths to making care personal, effective and affordable is implementing AI algorithms across multiple disciplines–from primary care to surgery to quality, safety, operations, and care team workflow.  AI holds the keys to making healthcare a high reliability industry and reducing total healthcare spend in the US by up to $300B annually, according to Mckinsey. But to realize the outsized potential of AI, health systems will need to put 100’s not handfuls of AI algorithms to work everyday and everywhere.

But there’s a showstopping barrier standing in the way of making AI everyday and everywhere in health: There just aren’t enough data scientists or programmers to meet the rising demand for AI.  To make AI everyday and everywhere, we’re empowering our partners and their data scientists to choose the AI technology, platforms, and tools that work best for them.  We’re honored that Jvion, a Microsoft health partner, has chosen to switch its AI Cognitive Machine to Microsoft Azure.  I recently had a chance to sit down with Jvion’s COO, Ritesh Sharma, to find out what prompted their decisive switch to Azure. Below is a transcript of my interview with Ritesh.

Schmuland: Ritesh, could you start us out with a brief description of Jvion and the markets you serve?

Sharma:  Sure thing. At Jvion, we deliver healthcare’s only Cognitive Clinical Success Machine. This technology uses Eigenspace to make sense of the massive body of healthcare data and turn it into meaningful clinical value. It is not predictive analytics or traditional machine learning. Instead, what we built is designed to serve as a provider’s AI asset that can answer thousands of questions about a patient’s health.  It goes beyond high-risk patient populations to identify those on a trajectory to becoming high risk. It determines the interventions that will more effectively reduce risk and enable clinical action. And it accelerates time to value by leveraging established Eigen Spheres to drive intelligence across hospitals.

Trust and hybrid

Schmuland: Your announcement today about moving Jvion’s business and Cognitive Machine to Microsoft Azure must have been triggered by several convincing signals.

Sharma:  In two words, trust and hybrid.  Compared to other industries, healthcare is behind in moving to the cloud– mostly because of worries about compliance and cybersecurity risks.  But most health systems are now seeing compliance and cybersecurity as the justification for moving to the cloud and they’re realizing that the value of the cloud isn’t about cutting costs as much as it is about becoming a more agile organization, able to do new things in new ways and to respond more quickly to market changes.

So, the question for our customers isn’t “if” but “which” cloud service provider is the best fit for their business.  And the selection criterion that rises to the top is trust.

Our customers tell us that they trust Microsoft more than than the other major cloud service providers because of the safety, security, and reliability of the Azure platform.  Microsoft has more compliance certifications than any cloud provider, many of which the others just don’t have, including some HITRUST audits.  Azure enables us to provide our clients with the privacy, security, and compliance protections that they need and expect, and that alone can accelerate the sales process from months to weeks.

So, most important, running our business on Azure gives our customers peace of mind –and that becomes a differentiator for Jvion.

But the other thing that our customers like about Microsoft is that Microsoft offers them their own self-paced path to the cloud with their unique hybrid model–so moving to the cloud is never an all or nothing thing. Microsoft brings a single unified approach and architecture that spans from on premise to the cloud–so they can move to the cloud at their own pace without adding an additional cloud overhead expense–because Microsoft offers a unified programming model, identity model, security model, and management model for both on-premise and cloud implementations.

Speed to value, our tools, our language

Schmuland: That makes sense from the customers’ perspective.  Healthcare, it’s often said, moves only as fast as the speed of trust.  But what were the specific business advantages that drove your decision?  In other words, why is Azure a better fit for your business?

Sharma: Because Jvion’s Cognitive Machine leverages Eigen vectors, we can stand up our solution without having to re-build new models for every client. This aspect of our machine enables rapid time to market, flexibility and agility. But to realize such speed to value, the underlying platform must be equally as fast and as flexible. With Microsoft’s number one differentiator being speed to value, there is a clear synergy between Azure’s capabilities and Jvion’s. Azure helps us amplify the differentiation of our solution and drive the fastest value for our clients. And Azure is the only platform that enables Jvion’s Cognitive Machine to scale at the speed of businesses so that our clients realize the value of our machine to achieve the biggest possible impact on patient health outcomes.

The second differentiator that matters so much to us is that, because Microsoft supports open source, Azure allows us to use the tools that we prefer and the developer languages and machine learning tools that we prefer and are most familiar with.

Enterprise-ready, AI meets data where it is 

Schmuland: The last question I have for you is, Why now?  Were there a culmination of events or market insights that led you announce the switch?

Sharma: Over the last several years we’ve watched Microsoft aggressively invest in its compliant, enterprise-grade cloud to come from behind in the cloud wars and it’s clear that this investment is now paying off — I recently read that for the first time as of the first quarter, Microsoft now tops Amazon in cloud revenue and added 500 new Azure capabilities last year alone.

And, because of this investment, there’s one unique capability that Microsoft brings to the health industry that makes it such a perfect match.  There’s no AI without data, and in the healthcare industry, most of the data estates are on premise.  And this is where Microsoft’s comprehensive data platform shines. Only Microsoft provides the flexibility we need to quickly access data regardless of where it resides today—on premise, on the edge, in the cloud and everywhere in between. Unlike our prior cloud service provider who required our customers to first move their data to the cloud– with Azure we don’t have to force our customers to move their data estate.  We can meet them where they are – and that gives Jvion a big advantage over our competitors that have placed their bets on non-Microsoft cloud service providers.

The post Why Jvion switched to Microsoft’s Azure AI platform appeared first on Microsoft Industry Blogs.

BayCare’s technology-enabled “culture-first” approach to business transformation

No health system has ever before seen or experienced the waves of technology change now roaring toward them.  And they’re approaching at a pace that few, if any, health systems are equipped to handle.  I recently described these waves as three human empowerment platforms that will empower — rather than burden — clinicians and organizations to achieve this quadruple aim: better health, better experience, lower costs, and improved productivity and work experience for clinicians.  That’s right, these technology platforms will work for clinicians and health organizations instead of the other way around.

These three human empowerment platforms — intelligence, engagement, and collaboration — will pick up where Electronic Health Records left off and drive the digital transformation of existing experience and cost structures for consumers, payers, and providers. For the first time, personal, effective and affordable health and care will be within reach in our lifetime.

But that won’t happen unless health system leaders intentionally transform their cultures to enable these waves to disrupt their organizations from the inside out. I’ve only been able to find a handful of health systems that are taking the steps they need to take full advantage of the speed and tsunami-like force of these waves.

One of those organizations is Clearwater-based BayCare Health System. Why? Because their leadership realizes that the present analog change management methods are no match for the speed and force of change that’s coming. According to Ed Rafalski, BayCare’s Chief Strategy and Marketing Officer, adapting to the coming speed of change requires a completely new corporate culture. The following is a transcript of my interview with Ed and BayCare’s Chief Technology Officer, Scott Patterson.

Interview with BayCare’s Ed Rafalski, Chief Strategy and Marketing Officer and Scott Patterson, VP Chief Technology Officer

Schmuland: Ed, would you mind starting us out with a brief thumbnail description of BayCare as an organization and your future vision?

Rafalski: Sure. BayCare is a leading not-for-profit health care system in the Tampa Bay and West Central Florida regions that connects individuals and families to a wide range of services at 15 hospitals and hundreds of other sites of care, including primary care, imaging, lab, behavioral health, home care, and wellness. Our mission is to improve the health of all we serve through community-owned services that set the standard for high-quality, compassionate care.

“Humanity at Work” is our brand promise that describes our prescription for the future of health care. We believe that the health care model of the future needs to recognize and respect each patient’s humanity and show real compassion and real empathy while meeting the needs of every community and every individual.

Today’s quality & safety culture: No match for coming change

Schmuland: In my conversations with executives at the Microsoft Executive Briefing Center, I routinely warn them that the committee-style cultures they have in place won’t handle the speed and force of change behind the coming technology innovation waves, and how wildly different these human empowerment platforms are from anything the industry has ever before experienced. Most executives are very proud of the culture of quality and safety they’ve built in their organizations over the last decade. I look at those cultures and say, you’re going to need a new culture to handle the coming changes and technology waves. How do you see it?

Rafalski: We’re in total agreement with that. To enable digital transformation to do its work, we first need a new culture of speed, innovation, and collaboration that pervades our entire organization from the top of the org chart to the bottom and side to side. Our strategic vision and growth targets require us to act faster, require team members to have an innovation mindset, and require that we collaborate at the speed of thought — not the speed of memos and meetings. We must turn continuous process improvement into continuous value improvement, because we now must find ways to deliver on better quality, safety, experience, and outcomes, at a lower cost point.

Better change

Schmuland: The founder of VISA, Dee Hock, famously said, “The problem is never getting new ideas into your head.
It’s always getting old ideas out.” How do you go about establishing this new culture of speed, innovation, and collaboration in months when you have an existing culture in place that probably took over a decade to evolve? How do you pull every team member out of their current cultural comfort zone and into one that can move at the speed of thought and challenges everyone to be innovators?

Rafalski: For us, there were two critical success factors that made what we thought would be a hard and long cultural transformation easier and faster than we expected: a new, visionary CEO who started two years ago, and Microsoft Stream, the intelligent video platform included in Office 365. We knew that the old methods of change management — town hall meetings, newsletters, and even email — were too slow and wouldn’t appeal to our growing millennial workforce. Video is now a popular medium for both millennials and boomers, and the great thing about video and Microsoft Stream is that it makes it easy for everyone in the organization to create, find, and share videos securely on the device that works best for them — whether a desktop, tablet, or phone. While other methods of communication are still critical, this adds an additional communication channel to meet the needs of all of our team members that is fast and engaging.

Schmuland: Sounds like you have an innovative CEO who placed culture as a priority. What was his approach?

Rafalski: Immediately, our CEO wanted a way to systematically get out in front of our 28,000 team members to help them understand the “why” behind the new strategy and to make it all personally meaningful for every one of them. BayCare is a 20-year-old federation of separate entities, each of which has its own subculture, and we needed a singular culture. So, we needed a medium that was familiar and accessible to everyone. We launched a monthly CEO video series about two years ago, and now that series has its own channel on Microsoft Stream. We’ve internally branded Microsoft Stream as BCTV, and are creating videos that are not only educational, but also fun and engaging.

Soaring engagement

Schmuland: Are you seeing an uptick in your employee engagement rates with Microsoft Stream compared to your prior methods of communication like email and conference calls?

Rafalski: Since we started embedding videos, we have more than tripled our open rates with emails sent by our CEO to team members and management.

But the impact of Microsoft Stream on employee engagement has turned out to be much bigger than just view rates. I’d say Stream has caught on like wildfire because everyone has seen firsthand the power of video in the CEO series. As a result, we now have eight subscribe-able channels because groups across the company like nursing, mission, and team resources have come to us asking for their own video channel on BCTV.

The most recent one came from our nursing leadership, which wanted help launching a new company-wide patient safety campaign. Their vision is for every quality and safety committee within every organization to use the same quality and safety channel to communicate best practices and they also want a companion group chat forum to make it easy for anyone in the organization to raise concerns and invite open discussion. Two years ago, they would have asked for a newsletter article and an article on the intranet homepage for their communications. So, Stream is not just helping us drive this new culture of speed, innovation and collaboration, but it’s also going to raise our culture of safety to a new level as well.

Schmuland: Scott, with demand that’s spreading like wildfire, how do you support the production, editing, and posting of all these videos? Do you have a production studio?

Patterson: We think of BCTV as our own company YouTube with light quality oversight. We do have a production facility, but we encourage everyone to make their own videos using their high res webcams or smartphones. We give channel leaders a two-page best practices guide and if they want to add slides, diagrams, screenshots, or do a demo of some kind, most of everything they need is built into PowerPoint 2016. To make sure our internal videos aren’t viewed by outsiders, we use the multi-factor authentication that’s built into Office 365. This allows our employees to find and view videos when they’re at home or on their smartphones when they’re mobile.

Thinking bigger

Schmuland: Ed, where do you go from here and how do you build on the success you’ve already experienced? I get the feeling that this is just the beginning of a much bigger vision for streaming video.

Rafalski: The list of ideas and possibilities grows every day. We’re now working on training videos, like proper handwashing technique to reduce hospital-acquired infections.

And we have several new channels on our roadmap. We have a podcast series for consumers on topics of interest to them that we’d like to turn into an external BCTV channel. We’d like to add an internal news channel — like the weekend news — so team members who are on vacation or busy with other things never feel like they’re missing anything because they’ll be able to tune in and catch up using a short weekend segment summary. We’d also like to use it to engage and inform our credentialed physicians, especially those in our clinically integrated network. A majority of our physicians on staff are not employed by BayCare, so we’d like to find a way to make them feel as much a part of the organization as those who are employed. We’re also exploring a BCTV channel for our Emergency Department and outpatient waiting rooms. Another thing we want to do is index the spoken text in all our videos and make them discoverable by voice commands.

What’s also been fun to watch is how team members, on their own, are discovering a lot of other innovative tools inside Office 365 that they never knew existed. They’re coming to us with ideas on how they can use Microsoft Teams and Forms, for example, to collaborate across the organization and improve their team performance.

Schmuland: What advice would you offer to your peers who might be considering video as a vehicle to transform culture and drive innovation and collaboration across the company?

Rafalski: Think bigger about video than just a more modern communication medium. For us, BCTV has evolved into this unexpectedly powerful, multi-purpose platform to drive employee engagement and human connection, and virally transform our culture.

The great thing about videos is that they make everyone in the company, including the leadership team, become more human to everyone else. Videos give employees a true sense of leaders’ personalities, because they see the emotions and conviction that just don’t come across in other media. When people see our CEO on BCTV, they approach him like they know him and often repeat back some of the catchy quotes they’ve heard. Video removes the mysteries and breaks down the walls of the C-suite by showing our leaders as the real and caring people they are.

BCTV is virally transforming our culture because most of the videos that we’re seeing teams produce are tying the purpose of their video — the “why” — in some novel way back to our brand promise, “Humanity at Work.”  This means that our own team members are now organically driving the permeation of our culture across the organization in a way that conventional marketing programs couldn’t. We know that it’s the culture of an organization, even more than business strategy, that determines how the business grows and transforms. So, to deliver on the promise of value-based care, every health system will need this new culture to respond and adapt quickly to change, innovate, and collaborate in new ways that will disrupt their organizations from the inside out.

This blog was written by Dr. Dennis Schmuland in collaboration with Dr. Edward Rafalski, Ph.D., MPH, FACHE; and Scott Patterson.  

Dr. Rafalski is is currently the Chief Strategy and Marketing Officer for BayCare Health System in Clearwater, FL. Mr. Patterson is Vice President and Chief Technology Officer for BayCare.

The post How BayCare is fast-tracking its cultural transformation appeared first on Microsoft Industry Blogs.

The tipping point for value-based care is near

It’s no secret that CMS intends to drive the market toward alternative payment models that reward value, quality, and outcomes over volume. But I think there’s a far more powerful driver that’s likely to make value payment models mainstream faster than CMS: the rude awakening that every health system board is facing—that their expense growth is inexorably outpacing their revenue gains.

That rude awakening is making risk sharing contracts with commercial payers and Medicare’s recently announced voluntary bundled payment program for episodes of care look like the welcome lifeboats health systems need to rescue themselves from the negative margins the CBO is forecasting for 60 percent of systems by 2025.

But just how ready are most health systems to really handle bundled care episode contracts with two-sided risk? By now, most health systems have acquired the tools to stratify patients by risk and generate gaps in care reports for the task lists of care managers. But my guess is that there’s just a handful that really know how well their system will perform—financially and clinically—for CMS’s two-sided risk bundled payment program that spans inpatient, outpatient, and post-acute care settings. And even fewer can track, let alone manage, the clinical variation of every provider and facility involved in those 90-day episodes of care.

My take is that most are nowhere near where they need to be to re-grow their collapsing margins with bundled payment contracts.

Found: A care episode analytics outlier

So, it was a pleasant surprise when I recently came across a health system that had not only designed an innovative solution to manage episode of care risk down to the provider and facility level, but had fully operationalized it: Partners HealthCare System. I was particularly interested in finding out how it managed to quickly and affordably stand up a solution that was scalable and flexible enough to track and manage the full 48 episodes of care defined by CMS.

To find more about what was under its technology hood, I sat down with Partner’s Vice President and Chief Population Health Officer, Sree Chaguturu, MD. Below is a transcript of that conversation.

Schmuland: Could you briefly describe Partners HealthCare as an organization, and your vision for population health and episodic care analytics?

Chaguturu: Partners HealthCare is an integrated delivery network made up of two large academic medical centers (AMCs)—Massachusetts General Hospital and Brigham and Women’s Hospital, roughly eight community hospitals, one specialty hospital, more than 10 community health centers, five major multispecialty ambulatory sites, inpatient and outpatient psychiatric and rehabilitation specialty services, home care, and more than 6,500 physicians.

Our population health journey started back in 2011, when we were selected to participate in the CMS Pioneer ACO model. The next year, 2012, we added commercial risk contracts covering over 300,000 patients and Medicare risk contracts covering about 100,000 patients. That quickly pushed us from a shared savings arrangement toward a population-based payment model. So, it didn’t take long for us to realize that improving our clinical and quality performance would be all for naught if we couldn’t measure, track, and deliver feedback to every provider and facility on their clinical and financial performance for each episode of care. But what made this particularly challenging was that the at-risk episodes for each ACO participant spanned the entire continuum, from inpatient stay in an acute care hospital to post-acute care and all related services up to 90 days after hospital discharge.

Schmuland: I understand that you chose Health Catalyst to partner with you to design and implement your episode analytics solution. What was the process that led you to select Health Catalyst?

Chaguturu: To get our arms around our total clinical and financial performance across the continuum of care, we knew we needed a comprehensive episodic care analytics solution that could pull and join performance data from multiple sources that were never designed to be joined together: data from hospitals, providers, and patient claims. Data on each individual patient wasn’t sufficient to give hospitals, post-acute facilities and providers feedback on their performance for each episode of care. We had to pull together performance metrics across a representation of cohorts to get an accurate view of performance by facility and provider. Unfortunately, there were no packaged solutions to be found. So, we had to find a partner that could quickly design and stand up a data warehouse that included clinical, quality, and financial data from diverse internal and external sources, and then chunk that data into care episodes and report performance by cohorts.

Schmuland: That’s an immense scope—and a risky undertaking for any organization. How did you break this project up into stages and quick wins?

Chaguturu: Our enterprise data warehouse (EDW) today incorporates more than 27,000 data objects from multiple disparate sources—EHRs, clinical and financial systems, claims, EMPI, and external sources—so we had to break it up. The first step—which we saw as foundational—was to pull the disparate sourced data into an EDW in a way that would enable us to build products as we needed them on top of the EDW. Health Catalyst enabled us to do this with their Late-Binding EDW model, which enabled us to focus on getting the data in first, rather than trying to clean and structure the data before adding it to the EDW. This allowed us to house common financial and clinical data from the beginning within one centralized repository and use common linkable identifiers to join patients and provider data later as needed for each product. If we had used the more conventional atomic model where you define the data model in detail upfront, we would have had to invest an enormous amount of upfront time and labor in data definitions, acquisition, cleaning, structuring, and integration.

With the foundational warehouse in place, we were able to quickly create data maps and visualizations to gain insights into care episodes by patient, facilities, providers, and cohorts. We can see the big picture but also detailed views into the true cost and utilization of all aspects of care related to a clinical event, whether that care is delivered within Partners HealthCare or externally. And we’ve built in graphs of the average spend per bundle across service providers and sites of care, stratified by categories of inpatient, outpatient, professional, additional, and others.

Schmuland: Has the solution given your providers any new insights into their performance?

Chaguturu:  Yes. It’s now easy for any service provider to select two or more providers and compare their average spend and potentially identify opportunities for improvement that could be gained by standardizing care approaches, diagnostic testing, supplies, or even equipment used for a group of patients. This gives Partners the ability to identify and reduce unnecessary variation in the care routines of providers and see how much outcomes actually improve when patients receive the best evidence-based practice interventions.

Schmuland: Looking back through the rear-view mirror, what would you say was the critical success factor for the project?

Chaguturu: Governance with the appropriate representation (clinical, technical, revenue cycle) was key to this process. We invested quite a bit of energy in designing and socializing example use case analyses to rapidly gain buy-in at the executive level of each organization. The use case analyses also helped us identify which databases and data sources needed to be integrated to provide the highest value insights. Once the data was in, we were able ask the right questions, standardize datasets, and present insights to stakeholder groups. We also had the opportunity to leverage an internal demand management process which enabled us to source priority areas that had been identified across the enterprise.

To be successful, we knew we had to address the needs of all of our entities, from our Academic Medical Centers to our community physicians; we needed to deliver value to all stakeholder groups. We also opted for a self-service approach model, which, while requiring an investment in training, has helped reduce burden on our data analysts, further engage operational leaders, and provide overall performance transparency across service providers. The EDW is highly utilized today by nearly a thousand users with roughly 7.2 million database queries since inception in 2014.

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The decisive shift toward value-based care and population health requires health systems to reach beyond their four walls and into the medical neighborhood to proactively coordinate care and improve population health.   But that requires a new community-integration capability that complements their existing EHR investments.  Think of a “CHR” (community health record) as a modernized health information exchange (HIE) designed to support value-based care.  

To coordinate care, CHRs have to do more than merely exchange information between facilities.  They must also empower the clinicians accountable for care to digitally communicate with each other, easily and instantly, around a common care plan that’s continually updated based on the ever-changing needs and health status of each patient.     

In as much as I’ve talked about the merits of a CHR like this, I have to admit that I’ve never heard of one that’s fully operational – until I recently had the pleasure of interviewing Wesley Combs, CIO of Holston Medical Group (HMG).  As he described how their 41 sites of care from Tennessee to Virginia are using their HIE, it became obvious to me that the platform HMG is using from health IT leader, Allscripts, is no ordinary HIE.  Unlike most HIEs operating today, this one was designed for virtualized care teams of the future, not the past.  Not only does it move information from point to point, it truly empowers clinicians to collaborate with each other and coordinate care in real time across the medical neighborhood.  The following is a transcript of my conversation with Mr. Combs. 

Schmuland: Before we get started, could you give me an overview of your role and the vision and scope of services at Holston Medical Group?  

Combs: I’ve served as the CIO of HMG since 2012 and when I arrived, I was challenged with providing a communitywide system that enables providers to execute in a value-based world while maintaining and improving the fee for service execution that pays the bills.   

Holston Medical Group is a multispecialty practice made up of 165 practitioners that serve more than 200,000 patients at 41 sites across a 100-mile radius in northeast Tennessee and southeast Virginia.  Founded in 1977 by Dr. Jerry Miller, the practice grew from 5-6 providers to one of the largest multispecialty groups in the southeast and the first level 3 NCQA recognized patient-centered medical home (PCMH) in Tennessee.  We believe it is important for physicians to remain independent so they can fully focus their time and resources on their patients. Our strategy is to give our physicians the tools they need to remain independent. 

Schmuland: How far along on the journey from fee for service to fee for value would you say that HMG has come?   

Combs: With an increasing number of incentives to move toward risk-contracting, approximately 20% of our contracts are risk-based with more than half of those including downside risk.  Value-based contracts encourage physicians to think harder about the cost and quality of the care provided.   

Schmuland: It sounds like HMG is a large federation of independent physician practices that are sharing risk as a clinically integrated network, right?  But to share risk in Clinically Integrated Networks, each practice needs a friction-free way to share records and communicate to coordinate care and ensure care continuity.   By now, most practices in CINs have organized and integrated under a local hospital system to exchange medical records and coordinate care plans.  Is that the case with HMG?  

Combs:  Not at all – at HMG it’s just the opposite. We’ve leveraged a community record for the medical neighborhood – the dbMotion Community via OnePartner– that’s available not only to physicians practicing within HMG, but it’s open to all physicians and healthcare organizations throughout our region, including the hospitals. Currently, we have 1,820 providers contributing records to the system and nearly 1,000 of those have access to the information at the point of care.  From a workflow efficiency standpoint, access to the community record nearly eliminates the staff’s time and frustration of hunting down medical records.  Now, they are able to access these records instantly. Physician users can deliver higher quality care that’s also highly efficient and cost effective. 

Schmuland: At a time when most physicians seem to be selling their practices to regional health systems, HMG seems to be bucking that trend by enabling physician collaboration.  What are you providing to these groups that’s keeping them independent?     

Combs: Independent single and multispecialty practices are inundated with clinical and financial reporting requirements thrown at them by nearly every payer contract – and they’re not consistent across contracts.  The Medical Group Management Association (MGMA) issued a study last year reporting that physicians and their staff now spend about 785 hours each year dealing with quality reporting measures alone, mostly consumed by entering data.  If you translate that into time taken from patient care—it’s about 9 patients per week that physicians have to surrender to administrative reporting.  The cost of lost patient care for each physician amounts to $40,000 per year, not to mention the access issue it creates for patients.  And that was before MACRA, Medicare’s new Quality Payment Program, which we believe could double the work burden.   

We help other groups with their IT integration, data reporting and value-based contracting models. This allows these groups to maintain their independence in light of the increased complexities of the business of healthcare. Most independent physicians want to do what they went to school for – taking good care of people.  Our team can help them refocus on doing exactly that with improved tools to help them succeed in the world of value. 

Schmuland:  How did you go about finding the platform you needed for your community record—and how did you manage to build the business case for each practice and facility to make the investment?    

Combs:  When we started our search five years ago, we knew that we needed real data to identify risk on patients, manage their costs, measure quality and tightly coordinate the care that required multiple specialties.  We needed near real-time interfaces with nearly every type of EHR in the neighborhood.  That’s where costs, complexity, and vendor lock-in can break the bank.   

After conducting due diligence on nearly every vendor that came close to our criteria, we chose the dbMotion Community via OnePartner.  There were two big advantages of the Allscripts dbMotion™ Solution that made the decision easy:  First, it had the best and most scalable and flexible approach to connecting clinics—because a community record doesn’t matter if it isn’t connected.  Second, it must work within a physician’s existing EHR workflow. Their EHR Agent Hub floats on top of the EHR and allows for single sign on for the physician user, negating the need to go outside their existing workflow to “hunt” for information.  It will alert the physician user if there is new information, outside of their local EHR, within the Community Record, which may be of interest to them at the point of care. Custom physician designed analytics tools also exist within this platform and they are really geared towards population health strategies that physicians know will work. 

Schmuland:  Everyone says that selling technology to physicians is hard, let alone persuading them to use it.  How did you make the business case for your physicians?   

Combs:  That wasn’t hard at all.  Our physicians know that data is key in the new world of healthcare. When 20% of the patients they see are chronic complex patients under risk contracts, and are consuming 80% of the money they are at risk for, they quickly realize that this is the sweet spot of people to influence to execute on those risk contracts. By having the data, they can execute on key opportunities to engage the patient face to face on steering them to cost effective specialists, places of services and medications just to name a few. This year alone the technology has helped HMG move their risk score up by 10 points, put HMG’s admits per 1000 20% below market and helped increase ambulatory E&M visits by 4.2%. These factors help lead to better Fee for service payments and larger Value based gain shares. Add to that the patient’s satisfaction of less hospital visits and a more engaged and personalized primary care experience, we believe this is a big win. 

Schmuland: It looks like you’ve turned the conventional HIE model upside down where, instead of the medical neighborhood facility as a spoke centered around a hospital system hub, the patient is truly the hub and every facility is a spoke.   Do you have any hospital spokes?  

Combs: Yes, our community record is integrated with the regional hospital system –so notifications of admits, transfers, and discharges are sent straight to the point of care via the EHR Agent where care providers are notified of what happened along with other metrics like LACE, Risk Score and Stratification level.  Before implementing the solution, we struggled to even identify all our patients in the hospital and had a hard time hitting the 14-day mark to perform the transition of care. Now the average transition of care time is down to 5 days on 100% of identified discharges which is huge on the patient front because they are surprised we called so quickly. It led to more service revenue that wasn’t being captured and helped in some quality measures. 

The post Holston Medical Group Transforms Teamwork with Modernized HIE appeared first on Microsoft Industry Blogs.

In my last blog, I talked about how Austin Radiology Association moved their 3D tomography data storage platform to the cloud to radically expand their storage capacity and reduce costs. In this blog, you’ll hear Bon Secours Health System’s story of how and why they’re using NucleusHealth’s cloud-based image sharing service to drive their image sharing and delivery costs down and their delivery speed and referring physician satisfaction up. This blog is a transcript of my interview with Winnie Bernard, Bon Secours Health System’s Enterprise Radiology & Imaging Systems Manager, who tells Bon Secours’ journey to the cloud story.

Schmuland: To provide readers with some background on Bon Secours, could you briefly describe your role, the organization, and the areas you serve?

Bernard: I’m responsible for all enterprise radiology imaging systems at 15 Bon Secours hospitals. Bon Secours is a not-for-profit health system that owns, manages, or joint ventures 19 acute-care hospitals and numerous other health care facilities and services. Bon Secours’ more than 23,000 caregivers help people in ten communities in six states, primarily on the East Coast. Sponsored by Bon Secours Ministries, Bon Secours is known for providing compassionate and innovative care for the whole person and building healthier communities through our community outreach efforts.

Schmuland: In your move to the cloud, can you talk about your top challenges as well as the advantages you saw in moving to the cloud?

Bernard: Stewardship is a part of our mantra. People think straight away of cutting costs when you mention stewardship. But, for us stewardship also includes our time management and customer service. Our big three challenges are security, improving customer service for both clinicians and patients, and reducing costs, in that order.

The security of patient data is paramount to being compliant with all federal, state, and local regulations and laws. For example, unencrypted CDs, if lost or stolen, can compromise patient privacy – so they need to be eliminated.

When we looked further into what new things we could do with the cloud that we couldn’t do on-premise, we found several completely new opportunities to improve the experience for our patients and our referring clinicians. We found we could reduce our turnaround time in delivering images and reports to our ordering clinicians—which meant that the images they ordered would always be there before the patient returned. Our referring clinicians would also be able to access and view our radiology images within the convenience of their offices using any web-enabled browser. In the past, we’d send CDs out to our referring clinicians by mail. Not only did that delay delivery by a day or two but every now and then a CD would somehow get scratched—which required us to re-burn and send a replacement out via courier. That frustrated us and our referring providers.

In radiology, one of the high-cost areas for the enterprise is the cost of replacement equipment and the cost of maintenance agreements for our equipment. When equipment ages out and needs to be replaced, we always ask ourselves the stewardship question, “What’s the opportunity here to decrease the cost of equipment replacement and maintenance?” Even better if, at the same time, we can make the imaging experience better for the patient and their team of care providers. That opportunity came up last year when the time came for us to replace our CD burners.

This time around, replacing our CD burners was going to cost us far more than in the past because we needed to add encryption and key management capabilities – which was going to cost us 3-4 times what previous replacements cost us, not to mention increased maintenance costs and ongoing courier costs to deliver CDs. So, the savings alone were enough to justify moving our image viewing and sharing application to a cloud-based service.

Schmuland: Your move to the cloud seemed faster than most I’ve seen. How were you able move so quickly from CD-based image-sharing to a cloud-based solution?

Bernard: We chose a partner that was agile, compliant, and met our tough requirements. We looked at the options available on the market today, and after an extensive evaluation process, we selected RadConnect from NucleusHealth. RadConnect is a HIPAA-compliant, cloud-based image-sharing service that enables us to share and view diagnostic-quality images among our medical staff, outside clinicians, and even patients through just a browser on any web-enabled device.

Schmuland: What was it about RadConnect that you found so compelling, above all the other options in the market?

Bernard: First, RadConnect was the solution that best met the cloud privacy, security, and compliance criteria that our security committee required. RadConnect easily passed our security review because they ran their service on the Microsoft Azure cloud and they encrypted all images at rest as well as in transit. Second, what’s unique about the RadConnect solution is that it works without needing to download and install a browser plug-in of any sort. And third, NucleusHealth really listened and responded to us. We had a lot of one-of-a-kind processes and complex workflows that they had to handle uniquely. For example, we serve facilities that have non-standard PACS systems, which made the process of sharing images and information extremely complex even within our own organization.

What’s really impressive is now when a patient or physician needs an image set for an urgent reason, we can say “we can have that for you within the hour.” And even beyond streamlining the sharing of patient data, NucleusHealth also enabled us to pull together all that historical data with images and deliver a more complete patient imaging jacket to our referring providers.

Schmuland: At Microsoft, we’re seeing the term “digital transformation” being used quite loosely and are concerned that, if we don’t hold ourselves and our partners to a higher standard of the definition, the term will quickly degrade to a hollow corporate cliché. To keep this from happening, we’ve defined digital transformation in health as “technology-enabled care, health promotion and disease prevention that advances the triple aim.” Could you say that the NucleusHealth solution is enabling Bon Secours to achieve the triple aim—better health and better care at a lower cost?

Bernard: Yes, I would definitely say that this solution is enabling us to achieve the triple aim.

In terms of better health for our patients, we anticipate that patients will be treated sooner, care will be better coordinated, and we’ll see fewer negative outcomes since we can now deliver images in minutes rather than hours or days—when we had to express ship CDs across the country.

In terms of better care experiences and outcomes, I can cite a couple of examples. First, the mother of one of my team members has extensive small cell lung cancer…inoperable and no known cure. She finishes her last chemo treatment in 2 weeks. We could just sit and pray it comes back slowly but now with RadConnect we have a better way to find other options to possibly extend her life. What we’ve done is gathered and uploaded all of her studies from everywhere into RadConnect so that we can quickly cast our net across the country to find the specialty oncologist or clinical trial that might be able to save her. Having all her images and reports available in one place to securely share instantly means that her daughter will be able to focus her energies on her mom instead of spending hours gathering, shipping or hand-carrying CDs or heavy and cumbersome jackets of films.

Another example I can offer you is a recent patient who called us on his way to Washington State because he had forgotten to pack his CD. We used RadConnect to send the images electronically to the physician he was scheduled to see. That patient was ecstatic because his images were already there when he arrived.

In terms of reducing costs, we based our business justification on hard cost avoidance by eliminating CD-burning equipment, materials, and labor– which made it possible for us to move forward as an act of stewardship. The costs related to CD burning and processing add up quickly, especially when you calculate the costs across 15 hospitals. We could confidently project savings of over $300,000 per year, or about $20,000 per hospital. But even beyond our own hard cost savings, no more lost, forgotten, or damaged CDs means that patients will be able to avoid the cost, inconvenience, and radiation exposure of having to repeat imaging tests. If RadConnect can avoid the need to repeat even 1% of the 1.2 million imaging tests we do every year, we can reduce the cost of care for the community by over $2 million.

Schmuland: In an earlier conversation you mentioned that this move to RadConnect was a just a small first step in a bigger, longer term cloud strategy to drive costs down and the patient experience up. What’s next up in the cloud for Bon Secours?

Bernard: We see an even bigger long-term opportunity to extend our NucleusHealth partnership to cardiology and from there to other “ologies” like dermatology and pathology. We believe that we’ll see incremental improvements in care quality the more we can empower patients to share their images and results through a trusted and compliant cloud.

For more information on how health organizations are using Microsoft Cloud solutions, check out our cybersecurity in health e-book.

The post Bon Secours moves images to Azure to drive costs down, delivery speed up appeared first on Microsoft Industry Blogs.

Schmuland: To provide readers with some context, could you tell me a bit about the business of Austin Radiological Association and your service area footprint?

Thomas: Sure. ARA is the largest outpatient imaging services provider in central Texas. We operate 17 outpatient imaging centers–offering everything from mammography to MRI–and serve 21 area hospitals throughout Austin and Central Texas with quality imaging services. We have roughly 750 employees and 100 radiologists and our commitment is to ensure access to high quality imaging technologies while delivering excellent patient satisfaction to our community.

Schmuland: In a few sentences, how would you describe your unique customer value proposition in the fee for service and fee for value payment models?

Thomas: Our value proposition is the same, regardless of the payment model. We go out of our way to make the exam experience for the patient as easy, smooth and positive as possible. Our outpatient clinics in the suburbs provide better access and convenience for patients that don’t live near a major hospital. This means we’re frequently able to schedule imaging tests where it’s most convenient for the patient. We also expedite the registration process to enable patients to get back to doing the things they’d rather be doing. And we hire top radiologists to make sure our read quality is the highest and we maintain high service level agreements with our health system customers.

Schmuland: ARA appears to be an outlier in that your move to the cloud was swift and decisive at a time that many health organizations are still reluctantly inching their way to the cloud. What were the factors that compelled your leadership to leap rather than dither your way to the cloud?

Thomas: We saw three sharply rising trends that made it clear to us that moving to the cloud sooner rather than later was an absolute necessity, not an option: image size, quantity, and storage costs.

First was the explosive growth in image size. As image quality gets better and better for modalities like CT, ultrasound, tomography, and MRI, the image size on the disc also gets larger and larger. For example, when you move from 2D mammography to 3D the size of each image increases exponentially, by about 20-fold for 3D mammography.

Second, the quantity of images per study is increasing exponentially. CT slices are getting thinner and thinner. So, the number of images per exam on disc is growing exponentially. There is also 3D reconstruction of these images, which is not a part of our normal radiologist workflow today, but with the increase in workstation compute power, will become more common. Storing those 3D reconstruction models will take an immense amount of storage space.

Now couple these two trends with spiraling growth in the cost of on premise storage and cooling. This was the writing on the wall that made it clear to our leadership team that moving to the cloud wasn’t optional for us. It just made complete business sense.

But it wasn’t just our never-ending capacity headache that made our decision to move to Azure easy. Moving to the cloud also enabled us to focus our limited time and resources on growing, running, and transforming our business, rather than running an ever-expanding datacenter.

We first came to fully appreciate this two years ago when we launched 3D tomography to our community and realized we’d have to go to the board to get approval for another 150 terabytes of in house storage space. By now this had become a recurring event –every 6-18 months we’d have to get board approval for the new capital needed to expand our storage capacity. The problem was that we knew we didn’t have another 6 months of storage capacity because demand was going through the roof—by 2020 we were projecting to be at 1.5 petabytes of mammography image storage. So this time we turned to Nasuni, a virtual and on-premise storage service built on Microsoft Azure, and asked them how quickly they could add 150 terabytes. When they said, “How about tomorrow?” and then went on to prove their performance to be better than their competitors through performance benchmarking, we knew we had our answer.

Since then, Nasuni has greatly simplified our storage provisioning and made storage management much easier. Moving our 3D tomography images to the cloud has protected our capital budget from large and lengthy storage procurement requests every two to three years. Now, rather than focusing time and labor on these refresh cycles we can focus our resources on growing our business and improving the quality and end user service excellence for our patients. In the first year alone, we estimate we saved approximately $1.2 -1.3M in storage costs with the Nasuni/Azure solution.

Schmuland: Were there any other reasons you chose Nasuni as your go-to cloud partner over other alternatives?

Thomas: As I mentioned earlier provisioning additional storage with Nasuni was easy and on-demand. We also liked how Nasuni’s pricing model is both competitive and predictable. Plus, they also offer integrated backup and disaster protection for patient files and they let us hold our own encryption keys–which means that neither Microsoft nor Nasuni can access patient data. The other major reason we chose Nasuni is that they built their solution on top of Microsoft Azure, which gives us the level of security, geo-redundancy, and disaster recovery, as well as compliance documentation to be confident that our data is secure.

When it comes to retrieval, we are able to ensure clinicians have rapid access to images without cloud latency using Nasuni edge appliances, which intelligently cache files locally. We are also able to pre-load large, historical file sets if they are needed for a patient visit the next day into the Nasuni edge appliances. Overall, Nasuni/Azure provides a very comprehensive cloud solution.

Schmuland: Many health organizations, like ARA, understand the business justification for moving to the cloud, but unlike ARA, many of these same health organizations are delaying their move to the cloud because of security and compliance concerns. Did your leadership team have concerns around security and compliance and, if so, how did you address them?

Thomas: Sure, there were concerns at first, until we understood that the Nasuni/Azure solution we were looking at was completely HIPAA compliant. Along with the business case, I shared several analyst reports like a recent one from Gartner stating that cloud service providers in the health industry are in most cases more secure than healthcare providers’ internal IT services. Knowing that Nasuni’s Azure-based solution was secure and compliant by design gave our leadership team confidence to move to the cloud. At the same time we knew that, for our clients that weren’t yet ready to move to the cloud, we could keep their storage on-premise until the time came when they were ready to make the move.

Learn more in our Cybersecurity in Health e-book.

The post ARA’s swift and decisive move to Azure. Why and how they did it. appeared first on Microsoft Industry Blogs.

The more I meet and interact with health systems and insurers across the US, the more I’m seeing the emergence of two approaches to innovation. One is conventional wisdom, the other is, well, much more innovative.

The conventional wisdom approach

The conventional wisdom, knee-jerk strategy taken by most boards happens something like this. The board tells the executive team “We need to be more innovative. Let’s fund the creation of a new innovation department staffed by innovation experts and pour large sums of money–even 100s of millions–into startup accelerators and incubators. Everyone else is doing it and, if we don’t do it too, the market is going to view us as an old school dinosaur.”

The upside to this approach is that it will make your company stand out. Even more important, your company will look cooler to your customers and employees. It may even attract millennials and top talent away from chic startups. And it’ll give your employees bragging rights because your company is positioning itself, at least from a PR perspective, as a company that’s ready to reinvent and digitally transform itself. Your company is telling the market that it’s determined to adapt to any change the market is willing to throw your way.

But there’s an important downside to this approach. Compared to the innovative approach, this one’s low leverage, high cost, and slow. To me, that word combination spells “u.n.s.u.s.t.a.i.n.a.b.l.e.”. Ironically, creating an innovation department and funding accelerators is the most un-innovative approach to innovation.

To be clear, these two models aren’t mutually exclusive. They can and, in some cases, should co-exist.

Don’t misunderstand me here — innovation departments play an important role in cultivating start-ups and creating safe and risk-tolerant design and test spaces–away from the pressured, protocol-driven care settings.

But innovation departments and incubators are also expensive, low in leverage, and the time to value and diffusion tends to be long. Unfortunately, most of the organizations I meet with that have invested 10s of millions in innovation departments and incubators have snubbed the innovative approach.

The innovative, radical and sustainable approach to innovation

By now you’re probably saying to yourself, “Who’s taking this innovative approach to innovation that’s high leverage, low cost, and fast?”

An outlier like Orlando-based Adventist Health System. Instead of investing 100s of millions in accelerators and setting up internal innovation consultancies, they’ve crowdsourced innovation to every one of their 60,000 employees across the 45 hospital campuses over 10 states. They’ve crowdsourced innovation by equipping their frontline teams with the process redesign tools of Office 365 and challenged them to digitally transform their clinical and non-clinical processes in a way that saves time, reduces waste, inefficiencies, and errors, and maximizes team performance.

Leading health system innovators like Adventist share three things in common that give them an advantage over their competitors by expanding their capacity to innovate fast and frugally across the organization. First, they equip both clinical and non-clinical teams with the process redesign tools in Office 365–like Skype for Business, OneDrive, OneNote, SharePoint, Power BI, and Yammer–to innovate. Second, they challenge them to use those process redesign tools to reinvent both clinical and non-clinical processes. And third, these health systems look beyond their core systems and EHRs to digitally transform their processes both within and beyond their four walls. And because they’ve deputized their frontline teams to innovate, these teams can prove the impact and almost instantly implement those innovations within their live work environments, bypassing the lab where most innovations languish and eventually die.

More on how Adventist crowdsourced innovation in our recent webcast here: How Adventist Health System democratized innovation

The post It’s time for healthcare to innovate how it innovates appeared first on Microsoft Industry Blogs.

Because telemedicine rarely pays for itself when the bulk of compensation to providers is in the form of fee for service payments.  The problem is that the nearly 95% of payments to providers today are still in some form of discounted fee for service.  Under fee for service, providers are paid to deliver care, not improve the access or speed of care, or, reduce the cost or need for care—the value that telemedicine typically delivers.  So there’s no reason to expect telemedicine to go mainstream in primary care until the majority of payments to provider come in some form of fee for value.

That is, unless there’s a telemedicine service that pays for itself regardless of whether the bulk of provider payments are in the form of fee for service or fee for value.   Last month while on the road meeting with partners and customers, I found one when I ran into IRIS, short for Intelligent Retinal Imaging Systems.  It’s retinal telemedicine — high resolution retinal photos taken in primary care clinics, enhanced, and interpreted by remote retinal specialists.  During my road trip, I sat down with Jason Crawford, the CEO of IRIS to look further into why so many primary care practices are integrating retinal telemedicine even while the bulk of their payments are fee-for-service.  Below is a transcript of my conversation with Jason.

Schmuland: Jason, how is it possible that retinal telemedicine is a win for all three stakeholders–providers, health insurers, and patients—regardless of whether the patient’s health plan is a fee for service or fee for value payment model?

Crawford: With retinal telemedicine, every stakeholder involved in the care value chain benefits–and the benefits that each stakeholder realizes is in weeks, not years.  Primary care providers benefit because they get reimbursed to do in-office evaluations and their quality performance metrics improve because more of their diabetic patients actually get their required annual retinal examinations.  Ophthalmologists, retinal specialists, and optometrists benefit because their volume of appropriate referrals goes up because the patients referred to them are pre-screened in advance of their appointments.  Health insurers benefit from improved margins because they can achieve five-star HEDIS ratings and reduce their costs related to treating retinal disease since early conservative treatments cost much less than later stage interventional treatments.

“Everything is handled and processed in Azure because the wealth of tools available in Azure has eliminated any need for us to maintain our own servers or software.  This means we have zero infrastructure on premise.  And when I say zero, I really mean zero.”

Of course, diabetic patients are the biggest winners because they can avoid blindness altogether through early detection and treatment.  Today only about 50 percent of at-risk diabetic patients undergo retinal evaluation largely because of the barriers of cost, inconvenience, lack of awareness, and even procrastination.  Primary care retinal screening removes these barriers because patients can easily get this done while they’re visiting their primary care doctor for any reason.

The post Cloud-based retinal telemedicine pays primary care to achieve Triple Aim appeared first on Microsoft Industry Blogs.

In the last post, Collaboration-enabled healthcare enterprises. Part 3  How Advocate Health democratized innovation, I talked about the urgency for health systems to find and rapidly implement high leverage innovations across the organization to gain share and reduce waste to mitigate their contracting margins.  I also talked about how the conventional knee-jerk boardroom strategy to accelerate innovation is to fund the creation of a new innovation department.  But the time and scale limitations that those innovation departments suffer from limits them from generating the volume of process innovations necessary to expand their margins.

I also stated that I’ve found several leading health systems that have overcome the limitations of the innovation department and found a way to democratize innovation across their enterprise.   These leading health systems had three things in common.  First, they’ve empowered their frontline teams to reinvent both clinical and non-clinical processes by challenging them to leverage the content, communication, collaboration, and analytics platforms within Office 365 to reinvent productivity and reimagine teamwork.  Second, they’ve deployed Office 365 across the entire enterprise to empower both clinical and non-clinical teams.   And third, these health systems think differently about their EHRs.  While most health systems look to their EHR vendor to support team communication, coordination, and team-based care, these leaders look beyond their EHR for higher leverage innovations.  As a result, the frontline teams of these health systems are not only generating the volume of innovations to improve quality and remove waste and inefficiencies, but they’re also proving the impact of those innovations within their live work environments. 

In the last blog I showcased Advocate Health Care as an example of a health system that’s liberated innovation from the confines of the innovation department and democratized innovation across the enterprise.  This blog spotlights Adventist Health System as another market leader that’s achieving surprising results by democratizing innovation.  I recently had the privilege of sitting down with Herb Keller, CIO for AHS-IS, Adventist Health System’s IT department, to find out how they were leveraging Office 365 to drive organic innovation across the enterprise and what innovations from their frontline teams may have come as a total surprise.  Below is a transcript of my conversation.

Schmuland: Could you briefly describe Adventist Health as an organization, your footprint and your journey to becoming a collaboration-enabled healthcare enterprise?

Keller:  Adventist Health System is a faith-based health care organization headquartered in Altamonte Springs, Florida, with 44 hospital campuses across 10 states.  Our 78,000 employees maintain a tradition of whole-person health by caring for the physical, emotional and spiritual needs of every patient.  To-date, we’ve now empowered 60,000 employees with Office 365 in every one of our 44 hospitals across those 10 states.

Schmuland:  While most of your colleagues and competitors seem to be dragging their feet on their journey to the cloud, it appears that Adventist Health is fully embracing the cloud and leveraging Office 365 in ways that other health systems haven’t yet begun to imagine.  You’ve managed to exploit the advantages of Office 365 as a platform to support team communication, coordination, and team-based care alongside and in conjunction with your EHR.  And, unlike many of your competitors, you’ve aggressively rolled Office 365 out to both non-clinical as well as clinical associates.  Since your enterprise-wide roll-out, have you seen any innovations come from the frontline that surprised you?

Keller:  Yes, we have seen quite a few innovations from the frontline that we’d characterize as pleasant surprises—in three areas:  the speed and efficiency of patient flow, elimination of duplicate technology, and real improvements in the productivity and coordination of clinical teams.

Schmuland:  I’m interested to hear what you’ve done to improve the speed and efficiency of patient flow.  When most health systems think about improving patient flow, the first thing they turn to is what’s often referred to as “EHR optimization”.  What has your approach been?

Keller:  Our outpatient teams quickly picked up on the value of using IM to improve patient flow.  For example, IM and presence now enable them to have ad hoc conversations throughout the day from wherever they are– so they work in sync better as a team and depend far less on the phone or overhead page–which reduces the number of times in a day they’re interrupted.  When physicians need a test, assistance, or are finished seeing a patient they IM their assistants rather than stepping out of the room to find them.   Patient flow is faster because team members can now find each other more quickly and make handoffs to each other within seconds instead of minutes.

Another area we saw flow improvement was in inpatient imaging.  In the past, if a physician ordered an MRI scan, the patient would automatically be scheduled, only to find out when the patient arrived in the imaging suite that they weren’t even eligible for the scan because that had a contraindication like clips or metal implants.  Now a nurse brings an iPad or a cart with Skype for Business in the patient room to allow the imaging team to remotely interview the patient for contraindications using videoconferencing without needing to leave the imaging suite.  As a result, the imaging department has reduced the cost of late cancellations and patients are discharged sooner because the right alternative test is now ordered instead.  This makes the entire process much faster and more comfortable for the patient.

Schmuland:  You mentioned that your Office 365 deployment has enabled you to eliminate duplicate technology in surprising ways.  Could you expound more on that?

Keller:  Sure.  We’ve eliminated duplicate audio, webconferencing and 1-800 long distance costs by standardizing on Skype for Business as a single enterprise-wide platform for audio and webconferencing.   Plus we’ve reduced some of the hidden costs of video conferencing because we no longer have to use a central scheduling desk to reserve rooms.  We’ve also been able to eliminate the need for a technician in the room when videoconferencing is needed.  It just works.

And I can’t overemphasize the unexpected value of making the most current capabilities of Office 365 available to every end user.  Because of our large and varied environment, we’ve traditionally found it challenging to keep our Office products current.  But once we moved to Office 365 it gave us the ability to roll out the most up-to-date features and security protections to our 44 campuses across 10 states.

Another example is in the realm of virtual health. Several of our facilities are now using Skype for Business for psychiatric evaluations, which allows the evaluations to hit the chart sooner and the patient to receive the care they need more quickly.  In the Chicago area our behavioral health teams are using Skype for Business for telepsychology sessions to avoid the delays in scheduling and travel—for both the patient and psychologist.  And in Kansas City, they’re now conducting behavioral health consultations within the hospital from the remote offices of our psychologists.

Telestroke is another area where we’ve eliminated duplication.  For remote neurologist consultations for possible strokes in the ED and even stroke observation, we used to roll in a customized telemedicine cart.  Now we just use an iPad or a laptop with a front facing camera on a cart and our centrally located neurologists and neurosurgeons use Skype for Business for their consultations.  Because we’re already licensed for Skype for Business, we can now offer telestroke and telepsych services to more of our rural hospitals without incurring the high costs of custom telemedicine cart solutions.  Patients really appreciate getting specialist care without needing to schedule another appointment or needing to go to another facility.

Schmuland:  Health professionals today must know more, do more, and manage more patients, cases, and complexity.  This means that, to do their job efficiently, safely, and effectively, health professionals have to quickly and easily find and tap the expertise of others, often while they’re on the move in a fast-paced work environment.  How have your clinical teams improved their efficiency and ability coordinate care with Office 365?

Keller:  As I mentioned earlier, we’ve standardized on Skype for Business for all of our IM, presence, audio, and video conferencing across our 10 states.  This means that our employees and teams can easily schedule recurring and ad-hoc meetings and share their desktops anytime they want.  Presence and instant messaging has now been adopted by every business division including clinical, finance, and operations—so everyone can now find each other faster and almost effortlessly and get the messages out or the help they need within seconds.  We’re also seeing a rapid uptake in web conferencing by physicians reaching out to other physicians all over the country.

Another productivity consideration for our clinical staff has been the growing volume of administrative meetings, training sessions, job candidate interviews, and calls they have to attend.  For clinicians, every meeting potentially takes away from patient care time—and clinician time is costly.  With Skype for Business we’ve been able to convert many of those in person meetings and trainings into virtual meetings and reclaim a lot of that administrative time for patient care.  Instead of getting in their cars and driving—and then parking and walking–to these meetings, our clinicians can attend or start a meeting with a single click from their phone while in their car or laptop if they’re at work or home.

You mentioned that clinicians have to know more and do more than ever.  That’s definitely true.  And to know more and do more they need to be able to tap the expertise of others, in real time when possible.   Many of our physicians are reaching out to and tapping the expertise of their physician colleagues all over country using audio and videoconferencing in Skype for Business.  And we have a group of cancer researchers that are collaborating with each other by using OneDrive for Business with rights management to securely access and share files across their various devices.  OneDrive for Business has saved them the time, frustration, and compliance risk of using unauthorized consumer cloud file shares.

We’ve also improved the productivity of our patient sitters.  In the area of simple patient observation, Skype for Business is enabling our patient sitters to observe more high risk patients at a time from a central location, eliminating the need to locate physically in the room with each patient. We’ve also improved the productivity of our IT help desk teams by using desktop sharing to troubleshoot issues or assist with application navigation or feature issues that our clinical and non-clinical staff have across our 44 campuses

The post Collaboration-enabled healthcare enterprises – Part 4 appeared first on Microsoft Industry Blogs.

Collaboration-enabled healthcare enterprises
4-part series

How Advocate Health democratized innovation

In Part 1, I made the point that two disruptive shifts are threatening to disrupt the HIT industry because, together, they’re changing the focal purpose of technology from delivering information to empowering teams to empowering mobile, interdisciplinary teams, centered around the patient, to work together both virtually and physically as one team at scale.

The first is a disruptive shift in the product of the practice of medicine. The second is a disruptive shift in the value currency of health and care.

What’s becoming clearer to every health system that’s transforming itself to operate in the outcome economy is that the current bumper crop of technology solutions we have today–HIS, LIS, RIS, EHRs and HIEs–were never originally designed to meet the needs of the outcome economy.  In this consumer-centric, outcome economy, technology has to take on a much bigger and challenging role than its past role of organizing and presenting information to decision makers. Now it must help us bend the cost curve. And to do that, technology has to empower the people best positioned to bend the cost curve: health professionals and consumers.

There’s the infamous macroeconomic cost curve, the inflationary curve of rising national health expenditures that’s threatening our nation’s solvency–which continues to rise at least 2% faster than our GDP growth year-over-year. And then there’s the cost curve that’s threatening the solvency of health care delivery organizations where price cuts, slowdowns in volume, and growing operational costs are shrinking margins at a pace never before experienced by the industry. In the past health systems were able to raise prices and increase their volumes to stay ahead of their operational cost growth.

But to empower health professionals to bend their own cost curve, technology has to do more than connect them to just information.  Connecting people to information is, of course still a necessary requirement for technology, but it’s no longer sufficient.  It now must also intelligently connect people to the people, teams, insights, guidance, and complex processes both within and beyond their four walls–and intelligently reinvent and automate as many portions of those processes as possible by working on their behalf and help coordinate those processes in a way that improves the quality, outcomes and experience of care at a lower cost.

This time health systems have no choice but to innovate their way out of their collapsing margins because the quick fixes of the past are no longer enough. Raising prices and increasing volumes no longer works in the outcome economy where prices increases are no longer an option and outcomes are becoming incomes. Booz & Co has forecasted a 15-25% decline in prices through the remainder of the decade. So health systems can’t cut operational or labor costs fast enough to reverse their collapsing margins. So the C-suite has no choice but to find new innovative ways to improve the quality, outcomes, and experience of care and remove waste and inefficiencies.

This unprecedented margin squeeze has elevated innovation to an urgent and mission critical priority in the board room of every health system. But there’s a twisted irony in how most health systems are approaching innovation. Most are actually approaching innovation in the most un-innovative way possible–by creating an “Innovation Center”. Don’t misunderstand me.  Innovation centers play an important role in creating safe and risk-tolerant spaces away from the pressured protocol-driven care settings for creative design and conserving limited resources by prioritizing demands for support and development.

But, at the same time, the Innovation Center approach constrains the organization to handle only a few carefully chosen, usually high profile projects at a time, forcing the organization into making a few big bets rather than a large number of small bets that could add up to make a much bigger impact. The Innovation Center approach also shifts the responsibility for innovation to a small elite group of “innovation experts”, leaving 99% of associates disengaged in the innovation process. Of course everyone is invited to “submit their ideas” to the innovation center, but this creates a lottery-like experience for employees because winning tickets are rare and the cost and emotional disappointment of submitting ideas that don’t make the cut quickly extinguishes the initial excitement of each idea submitter. At the end of the day, it’s no different from the tired suggestion box model.

The Innovation Center, of course, is expected to stand up a world-class innovation ecosystem within the enterprise because some of the greatest ideas for innovations come from associates on the frontline, especially those who interact daily with patients and suppliers. But the challenge comes in finding a cost-effective and scalable way to empower the masses to engage in the innovation process without pulling them completely away from their day jobs. Is there a cost-effective way to drive organic innovation across the enterprise by empowering frontline associates and teams to easily pilot and prove their ideas for improving the quality, outcomes, and experience of care and removing waste and inefficiencies. And, of course do this without needing to engage the innovation center or incurring additional costs?

In my travels and meetings with customers across the US, I’ve stumbled upon several market leaders that have found a cost-effective way to drive organic innovation across the enterprise–in a surprising way and getting surprising results. And they all seem to have one thing in common. They’re all leveraging the content, communication and collaboration platforms of Office 365 across the enterprise to empower their frontline teams to reinvent both clinical and non-clinical processes. And what they’re finding, as a result, is that these frontline teams are not just coming up with new and even surprising ways to improve the quality and experience of care and remove waste and inefficiencies but also proving them out by testing the uptake and impact of them within their live work environments. 

Advocate Health Care is one of those organizations that’s found a way to democratize innovation across the enterprise. While many healthcare organizations limit their processes to workflows within the confines of their EHR, Advocate Health Care has rolled out Office 365 to every clinical and non-clinical worker and challenged them to find innovative ways to improve communications and processes with the adaptive tools in Office 365, like OneDrive, PowerBI, Skype for Business, OneNote, SharePoint, and Outlook. They’re using Office 365 alongside and in conjunction with their EHR to reinvent clinical and non-clinical processes in ways that their EHR can’t or was never designed to do as well. EHRs are great at connecting people to information, but not nearly as good at connecting people to people, teams, insights, guidance, and complex processes both within and beyond their four walls. That’s where Office 365 shines.

I recently had a chance to talk with Rance Clouser, Vice President, Field Services at Advocate Health Care to find out how they were leveraging Office 365 to drive organic innovation across the enterprise. I wanted to learn about innovations that they were seeing from their frontline associates and teams, and which ones came as a total surprise.  Below is a transcript of my conversation.

Schmuland: Could you briefly describe Advocate Health Care as an organization, your footprint and your journeys to the cloud and becoming a collaboration-enabled healthcare enterprise?

Clouser: Advocate Health Care is the largest health care organization in Illinois, with over 37,000 associates, 12 hospitals, over 1200 employed physicians practicing at 250 sites of care. We cover a large geographic area which has challenged us to find new and innovative ways to communicate and collaborate.

As you mentioned Dennis, we have rolled out Office 365 to the organization in order to address a clear need for communication and collaboration tools that would allow our associates to connect in order to share experience, ideas, and best practices.  Aside from email and calendar, we have enabled our associates to connect with Skype for Business and SharePoint.  Prior to implementing Office 365 we had stand-alone implementations of SharePoint for collaboration at each hospital and support center.  But with our implementation of Office 365 we migrated all of our stand-alone collaboration sites into SharePoint Online and built a governance structure and a self-service portal to allow associates to set up and manage their own collaboration sites to address project and team needs.  To date we have over 5000 sites created with over 15,000 associates participating.  Recently we have begun a project to move our intranet to Office 365 SharePoint Online.  A lot of consideration was taken in making this decision and at the end of the day we went with SharePoint Online because of the cost savings to the organization (startup cost for an on premises solution estimated to be $400,000), the built in responsive design, and the advantage of search across not only our intranet content but also the collaboration and team sites.  We are beginning our migration this month and will be complete by the end of January.  With all of this activity we have also recently began working with L3 and Microsoft on moving our Office 365 traffic from the Internet to a dedicated circuit through ExpressRoute.  Moving this traffic away from the internet will make for a safer, more reliable experience and the ability to continue the expansion of the Office 365 tool set.  I would also like to mention that in the process of moving the intranet content to our new SharePoint Online home we have enabled our content owners to collaborate and learn together via Yammer.  Imagine trying to coordinate the learning and questions with over 100 site content owners across the system through a small central project team.  With Yammer we can leverage the entire team of site content owner, folks with questions can post and anyone from the group can answer.  We do monitor the responses but it has taken off organically and definitely unleashed collaboration and speed of adoption of the new intranet platform.

How to improve care quality, reliability, outcomes and experience

Schmuland:  It’s been nearly 15 years since the Institute of Medicine’s report To Err Is Human: Building a Safer Health System shocked the healthcare industry out of its state of denial.  Yet, 15 years after patient safety became a top priority goal for every health system, all we have to show for our noble efforts are pockets of limited success.  Hospitals find continuous process improvement difficult to sustain and most suffer “project fatigue” because so many problems need attention.

On any given day, about 5 percent of inpatients are still affected by a healthcare-associated infection; among chronically ill adults, 22 percent still report a “serious error” in their care; and nearly 30 percent of Medicare inpatients are harmed in the course of their care. How is Office 365 helping you innovate in the areas of quality, safety, or high reliability care and what surprising innovations have come from the frontline?

Clouser: As you know, high reliability care in our industry remains elusive except for small silos of success within a few organizations.  The pace of improvement is just too slow–in both breadth and depth. Even the leading high reliability care organizations have difficulty scaling success in one department or hospital into another. In its work with thousands of hospitals on quality improvement, The Joint Commission has concluded that there are two key barriers standing in the way of safer care: culture change and one-size-fits-all solutions that fit few because each unit and facility can have unique root causes and contributing factors to safety issues.  And so we’re teaming closely with the DNV-GL to transform every affiliate of Advocate Health Care into a high reliability organization by removing those two barriers.  Office 365 is helping us remove those barriers in several ways.  First, we’ve built High Reliability Leader (HRL) rounding dashboards with SharePoint and embedded PowerBI reports on process and safety baselines and improvements in those dashboards.  Our HRLs capture safety and variability issues across departments and sites in Excel by issue, unit, director, date, and time.  Feeds from each unit roll up into PowerBI PowerPivot reports in the HRL rounding dashboard so that both leaders and teams can see their performance relative to other units and their progress over time against themselves as well as others.  Beyond just the value of insights on high reliability-related events alone, these dashboards have helped us establish a top to bottom organizational culture of relentless process improvement, agility, and laser focus on reducing variability.  The second way that Office 365 is helping us is in overcoming the one-size-few barrier because it’s easy to adapt PowerBI, SharePoint, Excel, and Skype for Business to meet the unique process improvement needs down to the unit and even team level.

Hand hygiene compliance is one of those absolute requirements for us in our journey toward high reliability.  According to the CDC, one in every 25 patients still contracts a hospital acquired infections during a hospital stay and yet so many of these could be prevented with simple hand washing, which still only happens about 50% of the time at the national level.  Driving hand hygiene compliance across an organization like Advocate Health Care, with more than 250 sites of care and acute-care hospitals, requires a hand hygiene enforcement and tracking solution that can not only scale across every facility but also adapt to the unique needs and contributing factors for hand hygiene non-compliance of each unit and facility.  To do this, we’ve used PowerBI and PowerPivot to track and enforce hygiene compliance across the enterprise with our Speedy Audit application.  Observers at the various sites enter their compliance observations, how many times the clinician washed or sanitized their hands per patient interactions, for example, into the Speedy Audit app.  All of that data is rolled up into PowerPivot to enable us to track compliance by clinician, by unit, by month, and see up or downward trends. Feedback to the units and clinicians is immediate — which creates just in time education opportunities and broad awareness that this is a non-negotiable clinician performance requirement.  Plus, since we’ve recorded our in-person training courses with Skype for Business our education and ongoing training is available on-demand to anyone at their convenience.

Our residency programs are using SharePoint to proactively manage the handoff process between shift teams.  Each resident ends their shift by signing off on a checklist for each patient that includes status of each patient, test results pending, what needs to be done, signs to watch for, quality checklist items, specialists involved, and anything the incoming team should be aware of.  This reduces the risk of errors and delays related to things like missed warning signs that incoming residents weren’t alerted to, action items agreed to verbally but never completed, important data points scribbled down but never communicated, and overlooked messages buried the forest of others in the EHR.  This SharePoint handoff checklist is reducing length of stays and keeping patients from falling through the cracks during the single most critical times of the day during their in-patient stay.

How to remove waste and inefficiencies

Schmuland: With downward pressures on pricing and volumes colliding with rising operating costs every health system executive I talk to is looking for new and innovative ways to remove waste and inefficiencies. Most have squeezed out as much as they can from their supply chains and are now looking for new ways to improve clinician productivity, team communication, collaboration and performance, and take out costs and waste. Is Office 365 helping you innovative in any of these areas? Any surprising innovations from the frontline?

Clouser: PowerBI has produced a few of those surprising inefficiency-removing innovations for us.  Insights and reports that used to take days to weeks can now be delivered and put to use in minutes to hours. But even more important, we’re able to use that data to optimize the use of the limited resources we have. Take, for example a simple case like knowing where and how our interpretive services are actually needed versus actual utilization across the enterprise. There are never enough interpreters so we have to make sure that they are being optimally used 100% of the time. With PowerBI we know precisely what interpreter interactions are occurring by languages, by patient, age, gender, ethnicity, by location, by time, and by unit. For example, behavioral health is currently our top unit utilizer and signing is our top language. The need is high for sign language and having the data and information to support this helps us match the resource to the need.

Another surprising innovation that’s enabled us to optimize the use of the limited resources we have is using Skype for Business video conferencing between the staff intensivists at our eICU central facility and the ICUs of some of the smaller hospitals. By equipping our eICUs with one-click videoconferencing, our intensivists can hold inter-disciplinary rounds on the ICU patients at any hospital without needing to get in a car and drive there. This innovative practice allows for us to hold these rounds regularly which are necessary in order to ensure quality, coordinated, and safe care is maintained with our ICU patients. These rounds also ensure that the patient care plans are up to date and the patient is on the quickest and safest path to discharge from the unit.

And within our own IT department, we’ve leveraged SharePoint to drive out waste and inefficiencies in how we manage our IT contracts. We’ve configured auto-notifications, workflows and the content management features in SharePoint to eliminate the need to manually track renewals and, as a result of that, are able to be proactive in reviewing and renegotiating contracts well in advance of their expiration dates. Having this visibility in a centralized tool also allows everyone interacting with each vendor to contribute their feedback and asks well in advance of the re-negotiation process. This alone has improved our negotiating positions and also enabled us to get more out of our contractors with each renewal.

How to integrate

Schmuland: What has your experience been like with integrating Office 365 with other applications and with outside entities that you partner with or share risk with? Has Office 365 made it easier for you to communicate and collaborate with outside organizations? Any surprise innovations here?

Clouser: Skype for Business has been a driver for collaboration and communication both within and outside the organization and we continue to see our clinical and support staff users find innovative ways to use the tool. As a starter we have federated our Skype for Business solution with our EMR vendor, Cerner Corporation, as well as Microsoft, which really extends the team and support for the products. Our Cerner technology is remote hosted with the vendor and having access to the Cerner support and implementation teams enables us to move at a faster pace. In addition to the vendor community we have federated with other health systems who are utilizing our eICU program. In this scenario the federation of Skype for Business allows our clinicians to communicate asynchronously for non-urgent updates. This communication allows care givers at both sites to minimize interruptions which is a known contributing factor to safety issues.  In the future we are looking to integrate our Skype for Business solution to our Cisco Telepresence rooms extending the reach of video conferencing to the desktop. Overall, we feel like we’re at the very beginning of this journey to collaboration-enable our enterprise and continue to be very excited about the next wave of innovations that our associates will dream up with Skype for Business.

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