Ask the Expert: Hospital Executive on Interoperability

Q: Michele, I understand you came to Nashville 21 years ago, and you’ve obviously gathered an amazing amount of healthcare experience during this time. Tell us more about your background.

A: I started in behavioral health and Employee Assistance Program (EAP) development product lines. I worked for Psychiatric Solutions doing managed care contracting, marketing, and business development. My responsibilities included restructuring the intensive outpatient substance abuse and treatment program that supported families that relocated here for the Saturn automotive plant, which existed here at that time. That was my first foray into finance and operations, and it was a successful venture, that inspired me to look at career opportunities with a focus on building and turning organizations or service lines into profitable assets.

From there, I took a job at Vanderbilt doing business development, marketing, and determining how you get ROI specific to market-share shifts. We identified some “business unit” issues, and you can’t market something that doesn’t make money — this is not marketing “smartly.” So I got back into operations and finance and built a career at Vanderbilt working with over 10 different specialties, partnering with physicians and administrators, helping them through the use case lens. We worked on market share penetration and financial viability — “Did the marketing spend match the percentage of market share shift?” — partnering with administrators to streamline operations based on referring physician feedback. For example, if you only moved the market share one or two percent, did a million-dollar spend make sense? Probably not. And then you’d weigh the marketing-to-shift ROI with new patient appointments, combined with direct procedures, direct admissions, any downstream revenue with ancillary services such as radiology and labs, feeding to our outreach clinics, and then ultimately, the clinical research enterprise because large organizations usually have some sort of research initiative as well. The skills learned during my tenure have carried forward to other larger hospital systems where a blend of operations, finance, and market strategy have proven rewarding experiences, but most importantly, improved patient access and care in communities.

Q: It’s easy to understand how hospitals, just by virtue of how many different patient needs they must address, are not generally known for their efficient communication practices, coupled with these inherent data silos on the IT side. How are hospitals addressing this?

A: From a business strategy perspective, this is why “lean” and “six sigma” methodologies have become so popular in hospital systems. Originally introduced in the automotive industry, hospitals started adopting these ideas with some success — “Why tackle a workflow in nine steps when you can more efficiently perform in three?”

To understand how these communication functions are nowhere close to hospital interoperability on the IT side, all of these departments or patient-facing services I just mentioned represent different IT systems, if not two to three different systems within each sector. And none of them are talking to one another. This creates duplication of work and increased potential risk for errors in patient care.

Q: Therein lies a real breakdown in communications that costs the organization in various ways. Can you walk us through what hospital interoperability looked like in the ambulatory care world, since you also come from that background? Maybe explain the different processes and data systems at play here, as well.

A: Certainly, it’s both a healthcare “delivery” problem and a “communications” problem at the most cellular, or “data,” level. Keep in mind, the patient is always the priority. So it’s a real struggle to manage their journey from a data perspective. Who follows that patient? Who connects the dots from admissions, all the way to care management with post-procedure care referrals, and then how does all of that get back to the primary care physician, who is ultimately responsible as the patient’s medical home.

From a workflow perspective, how does the practice schedule talk to the surgery schedule? How does the surgical note at the end of the case get back to the practice, so the follow-up visit is already pre-loaded with information about what was treated, what pathology was ordered, what medication was ordered? If services are provided to the patient in their community hospital, you must get that information to talk to the practice system as well.

To look at the different data systems at play, in the Ambulatory Surgical Center (ASC) for example, that would be a scheduling program, an EMR, a billing program, and you need all three of these to talk. For example, in a gastroenterology ASC, there are also anesthesia and pathology programs that all need to share information to effectively provide a quality care experience. Many times, a facility will have 6-8 systems just in the building, all different platforms, different vendors, with proprietary technology. And of course, none of these talk to your financial database, typically. So that’s yet another layer of data integration that’s needed. From my experience, I was constantly working with the physician practice and the ASC to say, “We don’t talk, and we’ve got a lot of patient information. We want to protect HIPAA, we want this to be an efficient, easy process for both the patient and the treating physician to experience. So how do we make that happen?” Some of the critical missing links here deal with data integrations that are sorely needed but not happening.

Q: Why are these not happening? What are the competing factors at play when a hospital executive is aligning budget priorities, then having to execute on those?

A: Hospital executives are held accountable with three different dashboards: patient experience (influences market share and community brand), quality of care (are we meeting the national benchmarks for care with each of our specialties?), and then financial (did the business grow at the percentage that we all agreed upon? did you manage expenses, and did that include any change with Medicare or Medicaid reimbursement?). These dashboard priorities vary from one hospital to the next — what each deems a successful metric, and how they go about prioritizing and accomplishing that. But you can only grow so much with the limitation of disparate systems. If you’re eroding all of your new revenue growth in expense to support IT solutions that don’t “talk”, that makes no sense. With a more streamlined approach to integrations, the data aggregation for dashboard analytics would greatly improve leadership’s ability to align market strategies with growth goals.

It’s a constant juggling act. And the harsh reality is, let’s say a “wish list” for a department includes an integration. Well if an MRI machine breaks, the integration is tabled or delayed. Why? All of the capital dollars go toward the MRI equipment, because it funds downstream revenue for the organization. And the organization is normalized to the process currently used as work-arounds for the disparate electronic systems.

The question about how to afford integrations then becomes, “How do you still hit your growth targets and advance your business, while also putting technology and electronic processes in place?” To keep the business running, you’re constantly competing with being able to have enough capital funds available to support integrations that improve workflow, increase job satisfaction, and ultimately, improve the patient experience.

Q: Yet we keep hearing from CMS and the ONC, that the healthcare industry not only needs to keep chipping away at interoperability, but that we need to speed up these processes — formalized with some fast-approaching deadlines that were put forth in the latest rules. Why is hospital interoperability or data transparency important from an executive’s business perspective? Bridge Connector has a broad mission to change the way healthcare communicates, but break this down for us in terms of the specific value, or what is the ROI, that their solutions bring to the hospital care setting?

A. Disparate systems not talking means there’s constant fragmentations and unreliable data, that as a business leader, you’re called upon to use to make significant decisions. So if you don’t really see the whole puzzle, it’s hard to make strategic decisions and be an innovator or ahead of the curve for your industry.

For example, if you’re a large physician practice and you own some additional assets — let’s say you own an anesthesia company, an imaging/radiology company along with your practice, and of course you’re providing community care in a partnering hospital. That’s five business entities with three to eight electronic systems that don’t talk or share information. How do you really know your relevance in the market? And how do you decide what your business projections will be? You’re relying on an analyst who’s doing the best they can with the data they have. But as the adage goes, “garbage in, garbage out.” An analyst is only as good as their data resources provide. And this is all before we explore the most important benefit when we connect disparate systems — sharing data to predict quality of care metrics that improve patient outcomes.

I used to get so frustrated when I’d see an IT budget, thinking, “It cannot cost us that much.” “Integrations” has almost become a dirty word — like it’s a black hole that siphons budget dollars without much in the way of “returns” — because of how expensive, time-consuming and ineffective these have been, historically, at the enterprise level. The beauty of what Bridge Connector does, is that we start making these systems “talk.” We approach it differently, from a “workflows” perspective, which flips the traditional thought process around integrations’ expense and lead time on its head. And when you start making systems “talk,” you accelerate the hospital’s or ASC’s ability to provide seamless care for the patient.

Q: Your experience is so relevant to what Bridge Connector does, because you very much felt the pain points associated with a lack of healthcare data integration, how that could end up costing an organization. How did this most affect your roles in various healthcare settings?

A: The number one thing that would frustrate me in every budget hearing is when the team would come and present, and over and over, I heard the theme that more budget was needed for integrations and IT solutions. We would fund an integrations project, and it wasn’t sustainable because of system upgrades, which led to more financial resource support. So the next year, we would try again with a different approach, allocating more budget to fund projects that should have shown ROI. It was funny how the cost to support disparate systems typically grew at a similar rate as growth projections. This placed more pressure on the organization to find operational cost savings opportunities in other areas, and at some point, potentially impact patient care. This doesn’t work mathematically and isn’t sustainable. So when David (CEO of Bridge Connector, David Wenger) told me the idea that Bridge Connector was founded on — that it provided seamless, turnkey integrations, that’s “smart to version changes,” implemented more quickly and affordably than we were used to — I thought, “This is phenomenal. Where have you been, and how quickly can I learn more?”

Q: You came on board with Bridge Connector in November 2018 as Chief Compliance Officer. Tell us more about what sorts of issues you manage for the organization.

A: Compliance covers a host of issues and touches many parts of the organization, operating from a “solutions” standpoint. My working relationship with our sales and delivery departments, for example, is multi-disciplinary, in terms of how we work together. Before certain meetings can even take place, we work to understand the business question we are solving.  We work together on contract terms and deal structure opportunities. I support our sales engineers when they begin scoping projects for implementation, sometimes requiring contract adjustments. Then as we’re forming partnerships, it’s also my role to consider how that deal is structured — what are each party’s needs today, but also how will this partnership need to function in the next phase. As our volume of customers increases, we continually examine our internal workflows, to ensure we deliver on our mission — timely, cost-effective data integration solutions that meet our clients’ needs.

Industry certifications are also a huge area where I support the internal team, ensuring we meet HIPAA, HITRUST, and other regulatory minimum requirements. I’m responsible for ensuring the governance, policy, and procedure structures are in place from a security standpoint — how we’re protecting what we’re selling, how we’re protecting clients’ data, so we can instill confidence with every client.

Intellectual property also falls under my purview. Bridge Connector is unique and really on to something big here, and I work very closely with our attorneys, from a legal perspective, to protect that. We are fortunate to have a bright, innovative team that is bringing to the forefront new approaches to addressing disparate systems, and improving the clinical management of patients in all communities.

At heart, I’m really a problem solver, and I never think “no” is the right answer. I always think, “How do we get there creatively and within the regulatory limits?” I live in “gray” most of the day and really try to be flexible and creative, so at the end of the day, we’re successful and we are a leader in changing healthcare, and ultimately, improving patient care.

Sort of upending what most people think of when they hear the word “compliance.” But then again, that seems yet another variation on the theme that Bridge Connector is doing things differently, changing the way healthcare communicates on even these sorts of levels.

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