Datica Podcast

December 19, 2014

Marc Chasin, MD, MMM, CPE, CHCIO of St. Luke's Health System

Thank you for visiting our inaugural Healthcare Innovation Series interview. We've started out strong with an incredibly insightful participant in Dr. Chasin. We're excited to share this journey with you as we begin to dive deep into how healthcare innovates. Video recordings of the interview are available throughout the flow of the conversation. —Ed.

Catalyze: Thank you Dr. Chasin for joining us today. I know how busy CIOs and CMIOs are, so I can only imagine how busy one who carries both titles is. We greatly appreciate your time to talk with us today.

Dr. Chasin: Thanks for having me.

We learned a thing or two about Google Hangouts—you'll notice Travis is focused for Dr. Chasin's first answer. We're sorry about that. —Ed.

Catalyze: It's the end of 2014. Looking to 2015, I’m curious about your biggest innovation challenge for the next year?

Dr. Chasin: The biggest innovation challenge we foresee is, as healthcare is changing from volume to value, engaging our patients more on their terms. Our teams are working on determining where patients want to seek care, and where they are able to seek care. As you know, healthcare in the current financial model is unsustainable. We now need to start treating patients before they are our patients as opposed to once they do have a chronic illness. What I'm working on with our operations team is how information technology can enable our business partners to drive care into every avenue not traditionally accessed in school or your workplace or even at your home.

Catalyze: I assume you are seeing that volume to value shift?

Dr. Chasin: Yes, we do see that happening more swiftly over the next two years. What we do face is a tribe; there’s people, process and technology to everything we approach, and most of the time technology is already present. We have a people and process issue to change the culture of our clinicians and providers, as well as the culture of how patients traditionally access care – allowing them to access it more in their own terms and in their own way, and be an active consumer and participant in the care that they receive.

Catalyze: Focusing specifically on the patient side, how do you go about working with patients to better understand their preferences for places that they obtain care? How do you leverage technology and tools to help make patients more informed healthcare consumers and shared decision makers in the process?

Dr. Chasin: We're quickly finding out there is an active transformation happening in the environment. Patients have become more educated and understand more of what is available as technologies have become less expensive and more powerful. What we've typically seen is that over the past decade care has been provider-centric. [We’ve heard words such as:] "You have to come to my office." "You have to participate in my charted area." What we are starting to see is that the patient is starting to take ownership and "this is the clinician’s privilege to participant in the development of my record." "I want my data and my information to travel with me where I go."

I do see a pull on each end, a transformation in the way the typical physician is engaging their patients and realizing that the physicians themselves cannot treat all the patients they need to. The physicians' culture is starting to be more team-based, and using more extenders, health coaches, wound care nurses, and others, so they can treat these volumes of patients.

On the flip side, the patient is learning things they weren't aware of because the current health system is very difficult to navigate. It's hard to navigate even as a physician when you have to access care for your family or yourself, let alone someone that does not have any clinical background. We are educating the patients on how to navigate this system, and now they are realizing that we have a lot of redundancies and we are asking a lot of the same questions. "Why can't this be centralized?"

We are educating patients and our clinicians together and I see there will be a symbiotic relationship coming in which we will return to the old gratification as to why physicians went into the field in the first place. They'll see that the patients really have a partner and they'll take ownership in the health of themselves and their families.

Catalyze: It's interesting. My wife and I are both physicians and accessing care is incredibly challenging.

Dr. Chasin: My wife is a physician as well, and when we want to see the pediatrician we have to cut out a entire half day of work. Why can't we just take a picture of the red ear because we know that it's red and have them prescribe something without us taking a half-day off of work?

Catalyze: It's amazing when you look at it from the outside—or the other side I should say, it's not the outside. It's interesting to hear you say that because I think that a lot more systems need to take that approach of thinking through what it's like to be on the other side of a healthcare transaction.

Catalyze: To your point about patients wanting to own their record: You participate in the Idaho Health Data Exchange. What is St. Luke's approach as far as exchanging data with other provider networks and other provider systems? How do you guys approach exchanging data?

Dr. Chasin: First off we believe as St. Luke's, and I've come with the same vision, that the data needs to follow the patient wherever he or she goes. In order to make the best diagnosis, give the best care, and have the best outcome, the clinician needs to have the most up-to-date information at the tip of their fingers no matter what venue they receive care. If we go big on that preference, if we think of the patient first, and what the patient and clinician need in order to make a timely diagnosis, everything else seems to fall into place. So we foster open sharing.

We know there is an interoperability problem in the country and that goes to my participation on the Idaho Health Data Exchange and the Care Equality Trust Framework. Right now we have to engage each and every provider on separate agreements on how the data is going to be shared, how it will be protected and the assurances.

What we'd like to do is have one standardized trust and query framework, so that, if you adopted these, I could connect with you in a matter of hours and I'd know how you're going to use these and know how you are going to protect it. Right now I have point agreements with 40-50 different exchange partners. I believe in a rural state the sharing of that may be of higher importance. I get patients from very rural areas, from physicians that practice within their own community and don't see patients anywhere else as opposed to the large metropolitan area that needs to see what the EKG was last year, or the chest Xray that was done.

We handle as best we can right now with those point agreements, but we fully believe that if we are going to have to care for the community, and we are going to have multiple providers in the community, that are all aligned with the mission and values of our organization. The fact of the matter is that we should all be able to align around the vision of treating the patient with the highest amount of acuity and best diagnostic ability that relies on the right data, at the right time, to the right clinician to make those diagnoses.

Catalyze: When you look at a unified or standard trust framework or protocol framework that you mentioned, are there some emerging open sourced standards, or emerging things that you are seeing from certain vendors?

Dr. Chasin: There's a lot of talk in the environment and the industry about what you would call the "walled gates" of each EHR vendor and how they share equivalents with each other. But once it goes across those boundaries, it gets a little bit kludgy and mucks up the waters. There are a lot of organizations that are realizing the need to exchange data, like providers and doctor's practices. They are making the call to the vendors to start to break those walls.

At St. Luke's we have multiple vendors we engage to build integrations or to build the exchange of continuity of documents. We are having an enormous amount of problems with that. There are five or six organizations that have popped up that are trying to solve this one problem. One of them is Care Equality. Care Equality is developing a vendor agnostic approach to connectivity. It has all the vendors on the panels, as well as the government to figure out a way that we can break this inability to connect and improve interoperability. There's HL7 that has come together at Care Equality. There's CommonWell – all have this intent and I think that we'll start to come together and break down those walls so that any vendor can connect with another vendor to benefit all patient care.

Catalyze: We hear from both enterprises and really big vendors in the space that people are very excited about FHIR and HL7. Looking at that, do you see it as promising in the next three years as an emerging standard for change?

Dr. Chasin: It is and every interoperability consortium I've been a part of has referenced that document and the group that has developed it. I do see the industry leveraging the good work that has been done already and trying to refine it so it can be scaled.

Catalyze: As you focus on patients and clinicians and what's going to fit in this new paradigm of care, are there certain criteria or things that you use from a big health system perspective to evaluate how technologies are going to fit within your organization?

Dr. Chasin: Ultimately our business is treating patients, but we are not going to succeed unless we do fail.

Some clinicians and some technologies are really good in proof of concepts and we entertain any new innovative idea or new technology. We do an ROI on it. We do a proof of concept on it. We try to deploy it in a small test of change.

For every 100 fantastic ideas we have, 99 just don't really scale and either don't benefit the patient from an access perspective, or the clinician from an efficiency perspective. We weigh those by getting the clinicians and traditional health system or hospital operators in the room, as well as conduct patient panels and forums, because many of our employees are also patients of our health system. We have a captive audience that want the best for their families. We go through a rigor of many tests of change and escalating it between specialty and primary care to outpatient departments before we get a technology and fully cascade it throughout our entire system.

Catalyze: Is that the same process for when you evaluate both internal and external products and service technologies?

Dr. Chasin: We do it for both because we have a lot of independent providers and patients that want to see capabilities or functionality in our current offerings. We have to make sure that whatever we offer doesn't deter from the overall experience that we want our patients to have when they engage with our technology and our system.

When we develop a technology or a piece of technology just for a subset of our patient population, we ask Is that going to deter from the overall experience?

What we would like to do in our area is be the hub of healthcare information, of our patient community, so that they think of us first, because we want to develop that same patient experience and ease of access of data to the patient and their care. We put that through just as much rigor as when we develop an internal technology.

For example an ERP system that no patient will see as opposed to to our patient portal where we have about 105,000 patients accessing and making sure that their experience is just as solid as the front line person accessing our ERP system.

Catalyze: It's encouraging to hear someone in your position talk about patient experience and focusing on patient feedback when evaluating new services and technology. For a long time in healthcare there was not that focus. For a long time health systems acted like the airlines do now.

Catalyze: If you were talking to vendors, what type of advice would you give them for approaching a health system like St. Luke's for a pilot?

Dr. Chasin: There are a couple of approaches, and I've thought about this for a little bit.

Appeal to the reason the health system exists in the first place. The health system exists to treat patients and to treat them well, because that will sustain their mission and their vision.

Secondly, the healthcare environment has changed. Tell me how I'm going to improve the health of my community without seeing those patients. We function in the volume and the value model at the same time. We are essentially cannibalizing our business model at the same time. If we deploy a technology that is going to improve the outcomes of our patients and they don't have to come in and see us in the office, then our revenue is going to change. But we all know where it is going. We just have to tiptoe through this and get through this box of two business models.

I've seen some amazing new technologies, but there is no hard ROI on how we are going to get through to that new business model. Looking at those technologies to see how you are going to keep me in the volume world with patients coming in, but will also allow me to be held to the value world and to push your technology out into the patient's hand. I would look at the business model. I would come to me and talk to me with both how you can help me with revenue today, and how you can help me with outcomes in three to four years.

I'm looking for a partner that is going to be with me through the thick and thin as I transform my business and is going to work with me and the technology to accommodate what I need to do to achieve the end goal which is treating an entire population of patients where they want to receive care and how they want to receive care.

Catalyze: How do you empower that organization-wide innovation when you have a health system as spread out as yours? How do you encourage that innovative culture across all of the organization?

Dr. Chasin: The way I approach this is whether you are an end-user, using the technology and seeing the patients with it, or you are one that supports it, you have to feel that you are safe to fail. It's okay to fail and it's okay to try something new.

I try to produce an environment that puts the appropriate white lines on the road so you can't damage someone else's practice while they innovate and see their patients and then we do breakouts. If there's an innovation, I want to hear about it and understand what they are doing. I gather my team together and we look at that and if it is viable, we vet it around and cascade it throughout the entire organization. The key to getting that done is the environment and the feeling of safety that it is okay to fail if you do. You are not going to get innovation if there is fear of retribution. That's how we've done it.

We still have pockets that are growing, but we do have some amazing things that have been done from an innovative perspective, allowing the clinician the freedom to fail and learn new ways and learn how to adopt new technologies.

Catalyze: This has been a wonderful discussion. Thank you for taking the time to talk to us today.