Episode 23 : Early Adoption and Change Management:

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Intro/Outro:
Welcome to Smart From the Start, presented by care.ai, the smart care facility, platform company, and leader in AI and ambient intelligence for healthcare. Join Steve Lieber, former CEO of HIMS, as he interviews the brightest minds in the health provider space on truly transformative technologies that are modernizing healthcare.

Steve Lieber:
Hello, and welcome to Smart From the Start, I'm your host, Steve Lieber, and it is my pleasure to bring to you a series of conversations with some of the sharpest minds in health information technology. We'll discuss the smart directions healthcare companies and providers are pursuing to create smart care teams. Today I'm joined by Hiten Patel. Hiten most recently is head of Product for the Analytics Division of Penn Medicine and was previously the Chief Product Officer at Rush in Chicago, leading both spinout and partnership efforts to diversify health system revenues. During the pandemic, he was also tasked to lead transformation efforts as acting CIO and executive sponsor for LAB and Medical Group Systemisation. Prior to Rush, he was at OPTUM, the advisory board company for 14 years, where he launched several businesses and was lastly the head of Product Management for the analytics platform groups. Welcome, Hiten.

Hiten Patel:
Thank you for having me. This is going to be fun.

Steve Lieber:
Yeah, looking forward to it. You are a little different person than we oftentimes have on the podcast. You've got a business, what I'll call a business background within the healthcare world, focusing on spinoffs and new businesses in places. And actually, I want to start out in your roles at Amazon and the advisory board. You've obviously worked with a lot of different organizations. And so what can you share with us in terms of what you see there? What are the major challenges that systems and in particular as it relates to technology? What are the major challenges facing them? What are they dealing with?

Hiten Patel:
It's really, you know, back to the basics, the consistent theme for the last 20 years that I've been in this industry, where the revenue trend line just isn't keeping up with the cost and inflationary trend line for the provider side of the business. You think of it nationally, we are cost inflation of healthcare premiums as consumers is just keeps going up. Who's getting it? Well it's not the provider sort of pocketbooks or margin profile. And it's certainly winners and losers within the provider space. One of my old bosses, CEO at rush had said, like, you know, the problem sometimes with healthcare payment is it's very local. You can't move your hospital out of the zip codes you're in. If you're in the high-paying market, you're going to do better than the place you're not. So that's sort of like the revenue side. You're sort of stuck with where you're at with the payers. And then that leads to how are you going to keep the margin side of it. You know what I saw on the revenue side, just to close that thought out, is that people are getting more creative on how to go after both organic growth as well as other inorganic opportunities through partnerships or M&A and the organic sides challenge, because the history of profit centers like the Cardiac Service line or Orthopedics or oncology are being challenged by outpatient shift as well as new entrants or even PE in some areas, sort of gobbling up some of those profit centers. So it makes the health system to require them to be more creative on the ways they're going forward. And that could be payment transformation by going after riskier pay contracts or into other care models as well. And that was one of the tasks I had at rush was to find and diversify our revenue streams.

Hiten Patel:
But all of that's a challenge. And then the cost side is the place where people have to start focusing. And that's been, you know, if you go down one layer below the system, CEOs who are primarily tasked to like growth and that side. But when I worked with for the COO of Rush and some other places I've gone, the focus is on how do we do more with less. We know inflation is coming, the revenue is pushed, and it's going to lead to some level of transformation efforts. And the things I was a part of primarily at Rush was the systemization efforts. You know, we had three hospitals that had mostly worked independently. There was obviously systemization efforts and lots of different areas, but not wholesale. The pandemic put a pause on any of that effort just to focus on getting the pandemic done. But what it really showed us that we could work together given that situation. So after the pandemic sort of subsided a bit, there was that huge focus on starting to do that transformation effort. So IT was one of the projects I had, which was to drive towards a system IT office and make decisions at a central level, handed over the reins to the new CIO. And then, I was asked for other departments like lab, which again had been running more or less independently. And so those were the places that we went. And I think that's probably where health systems are going to be focusing is trying to drive the scale that they now have created as a corporate entity. M&a has led to these mega systems. Now they have to find ways to get synergy.

Steve Lieber:
Yeah. Let's peel that one back a little bit. Obviously as a system brings in new hospitals as it acquires new, you know there's significant opportunity to find synergies and systemization and that sort of thing. Are we getting anywhere near a place where, okay, strategies have got to change? There's just no more there, there in terms of standardization, systemization, economies of scale and that sort of thing. Or are we headed towards a couple of huge national systems, and there's still a lot more systemization savings to realize.

Hiten Patel:
I think there is systemization saving. Beings realize across lots of different areas. I mean, the thing, the things that have gone first are probably the easy ones supply chain, purchasing power, revenue cycle, back office functions. Those are the types of things that we've seen for the last ten years or more happening across the enterprise. But there's still like opportunities even in that when you have a mega system merge and you're on two different EMRs or 20 different EMRs, how are you getting from point A to point B on getting the best efficiency possible? Some colleagues I know are at health systems that are early in their EMR sort of journey, so they're going to rip out everything and go to epic and have a central source of truth. But you know, the day that fails is the day they buy the next hospital. That wasn't a and they got to do it all over again. So there's that challenge. And so there's going to be back to your question. Is there opportunity in all of those historic things? I think so, especially the ones that are more operationally driven, that have data inconsistencies that then lead to lack of scale. So I think the investments in AI and the new technologies on the data side will start to get us there places, probably less areas of squeeze that that have been the easier ones, like supply chain. Maybe there's less areas space there. You know, even at when I was at rush, the thing that we always talked about is physician preference items are the big last mile. And that's really about clinician alignment and less about deal making with the salespeople. If you get someone to standardize, well, you're going to get some savings if you don't standardize. So you can think of a big mega system, all standardizes to one hip vendor, you're going to get some savings there. But how are you going to make that happen? Is not a technology or management problem. It's more a physician alignment and clinical quality.

Steve Lieber:
You mentioned AI and so let's go into technologies now. So the environment is changing in terms of what technologies people are looking at. They're looking for that advantage, whether it's improved patient care or reducing costs. I mean motivations are generally the same everywhere in terms of what people are trying to accomplish. So let's start at sort of the investigation stage of new technologies like AI and machine learning and the like. How do you advise your peers as you work with different systems of how to evaluate what's out there?

Hiten Patel:
Oh, geez. I mean, I think there's.

Steve Lieber:
Going to be an easy.

Hiten Patel:
I know. So I'll put one hat on. I had for a while was like, uh, sort of trying to work with our purchasing process at Rush. As we got out of the pandemic, I was the acting CIO, and we had sort of a Wild West purchasing, buying the IT department bought what they needed to for most of the invisible stuff, usually the servers, you know, all the things that are behind the scenes now, the clinical technology, we had a culture where every person who had budget authority was allowed to shop. And when you have everyone shopping, they might not know everything. Or and I think this goes back to the scale question. They're shopping for their individual need, which is ripe for the salespeople out there who have a one-trick pony, a bot that does one thing. And will that scale? No, it'll probably solve that person's problem with a lot of effort and a lot of IT implementation time, a lot of change management. But will you have really materially changed or transformed the enterprise? And I think that's the place that I tried to advise folks is like, hey, think about these vendors.

Hiten Patel:
What technology are they employing? What is the broader category of problem space you're in? And can you start the dialogue at the CEO level and say, like, hey, we want to go after conversational AI, what are all the places that we could leverage it? Let's talk about those areas. Pick the ones that are highest value. That might be the access center and the calls coming in from patients and making sure every patient that calls gets served. But there's probably 50 other use cases. And if I only buy a chatbot that does the call center, I'm going to start all over with these other things. So those are the places I went was like, let's start at the top of the technology space and then pick a couple of use cases. But with the IT sort of playing sort of the architect say, how are we solve the broader space together with 1 or 2 of the stakeholders saying, okay, we'll give on-point solution X, we'll go after enterprise solution Y, it'll cost us more to do the first one, but we'll be able to solve the rest over a 3 to 5 year period.

Steve Lieber:
So in that conversation, is it pretty easy to get people off of point solutions and think about things more broadly in terms of systems or platforms versus solving the one problem? And it kind of goes back to if everybody has their own shopping cart and own budget to buy technology, you're in a tough spot from the beginning as the CIO, trying to piece all of these things together. So, you know, how tough is it and what are the sort of the strategies you employ to get people off of just solving their problem to thinking about the organization more broadly? And it goes.

Hiten Patel:
Back to this question you had earlier about, is there more scale to be had? Of course there is, because this is not just a multiple hospitals doing different things. This is within hospitals and departments doing different things. And so the tactic we took, and I think it's the thing I've seen at a couple places, I didn't do it out of thin air. I like to talk to other organizations about and. Is basically having a governance process where we coupled purchasing with the implementation project and the change management project that had to come along with it so that it was visible as not a, hey, I'm just going to make a Po for some random software. I'll throw it over the fence for it to deliver, like one of the classic statements. You know, Wayne, who was the CEO of Russia at the time, you know, had this insight that he just kept driving, which is every project's an IT project. So, like, at which if you're going to do something, it's got to be there because you're gonna make a change to system X or Y, or you're going to buy something and implement it. So, let's make sure we take a look at it. And so the approach we took was instead of what are you buying and putting a PO through supply chain or legal, who would see it as a contract or a request for a PO? They would throw it over to our governance team to say like, hey, where's the project that's been approved to implement this, whether there's a PM or not, we'll figure all those things out.

Hiten Patel:
But it's has this project been approved? Does the Co. No, no. Okay. Does the chief operating officer of the medical group or wherever the functional leader should be. And a quick questions okay. We don't even know what this is for. Let's talk about why are we doing it. And then maybe that bubbles up like oh chatbots. Okay look why are we doing a chatbot for like the infant and mother department? Like we should be doing a chat pod for this and then that team will get one in due course. So that's how we got there. It was hard to sort of have a functional no at the end of the day, but it was a thoughtful process of like, why? And then the nodes were like people sort of nodded their head and got it, but they were not happy with it. That's the change of like going from point solutions to more of a enterprise solution for some of these areas. And some things are point solutions. They're so specific to that clinical area that like, okay, that's not going to be useful for anybody else and go for it. Yeah.

Steve Lieber:
Yeah. You touched on governance and I think that's a critical piece here that there's a message from the top down. In all honesty, in terms of we have a process that we need to go through, and we have a group that are going to review these things and give system wide guidance. To me, it just makes a lot of sense. And do you find that to be a pretty common approach nowadays, or are we at a place where, you know, people recognize you got to have system wide governance on it?

Hiten Patel:
I think people get it. I think the pace at which those governance processes go is if I was leading it, I was very sort of having been a product person like, okay, who's a customer? It's like all these requesters, we have to like circle back pretty quickly on. Yes. No. Why? So they can make adjustments to whatever they had planned for. That was the change part over that first year, which is budgets went in the impact of that purchase and that project plan was already baked into their plan. And now you said no. It's like, well, that ripples through some of the other plans they had. So the governance process for us had to eventually get to pre-budget like now. Like that project's not approved. Therefore the budget doesn't need to be there for that project versus what we were catching up with was planned projects by that silo having to then and then then forced us to go quickly. And so we had basically two month cycles of first pass, investigate, get to the second pass, make a decision. And the answer is sort of yes or no or maybe or put it on the back burner. But if you go fast enough, I think everybody can get there. I think the biggest challenge we had was this first part, which is people have already planned it as if it's like happening, and now you have to say no to and.

Steve Lieber:
Already way down that road and you got to reel them back in.

Hiten Patel:
Or they've already done 50 vendor calls or two vendor calls, or maybe one with their friend's company, like who knows?

Steve Lieber:
Yeah. Let's go into one specific area in our last set of questions here. And that's around ambient monitoring, virtual nursing. It's an area that a lot of people are talking about using broad terminology like smart hospital. What are you sensing in terms of where people are in looking at virtual care? And here we're talking about virtual care in the institution, not traditional telemedicine and that but really, how are things changing around providing what we'll call human guided but somewhat autonomous or semi-autonomous monitoring, listening and care?

Hiten Patel:
We were an early adopter of the nuance product in 2018 at rush, and it was an early sort of product, and they were first to market and some of these things, and it was some warts and pimples as we moved from a human behind the scenes, actually doing the note to a computer doing it, they got there. It was actually being a really good technology product, but the fun for us was on our side. You know, obviously they were on the tech side of the partnership was the change management. How do we deploy it? Who do we engage, how are we going to pay for it? And what I generally found was figuring out the why we had the why of that was theoretical, which was it'll be better physician satisfaction and experience for the patients. Those were like the talked about wise. What it became pretty quickly was, oh, we're going to pay for it by having more efficiency with the doctors. Do two more cases. And I was like that just like led this down, this rabbit hole of like, well, the why became we're going to pay for it instead of the why was like the original whys. And I think that's the place where if we start thinking about it as like classic start with y type of topic, I feel like that was the place where if you're going to go down this path, what are we trying to accomplish at the higher order? And that's going to be like puts and takes and financial risks that you're going to take along the way. But as long as you're starting with like these sort of transformational projects of incorporating these technologies, then I think you're in a better place than jumping right to, oh, this is an efficiency thing. So let's add more caseload. It's like, well, then no one wants to really participate in that pilot project if you if you put it there.

Steve Lieber:
So you touched on focusing on the why and that sometimes the why changes and it may actually need to be brought back to the original. Why is that an important starting point on technology projects? Yeah.

Hiten Patel:
And we started one very briefly before I refresh was on the inpatient care redesign work and the work. Where does it start? Where did that project and why did that project happen? Was labor rates were going through the roof, all the nursing shortage, all the ripple effects of inflation and that you could see coming. And the you're asking the CNO and the team to figure out ways to keep delivering on the volumes and the care that we need. And if all the solutions are, well, give us more money to hire more premium labor. It's not going to not a long-term winning enterprise. Uh, and so the discussion of like, what can we do? Let's start benchmarking. What are other organizations doing? Can you use technology to support the team in different ways? And that sort of led to a much more foundational question of keeping that why front and center. It's like, look, we can't survive if we keep the staffing ratios the same forever. Yes, we can't. We're not going to whipsaw these and change them tomorrow. But how can we move the ball forward and test out a new technology or a new way of staffing the team and see if it works? Prove it to ourselves. Learn from other organizations, have gone before and then slowly go up that adoption chain. But it all came back to the ultimate why? Like we won't survive if we don't change.

Steve Lieber:
Excellent. So to wrap up, we always like to close with a fairly broad question. Our listeners, are folks like you CIO, CIO, CIO, digital officers, innovation officers and the teams that work with them. So a takeaway, Heaton's insight that you've gained that you think will have value to the broad audience?

Hiten Patel:
I think my biggest thing I keep harping on is that this is like 90% or 80, 90% change of the operations with technology to support the art of the possible versus it being technology sort of first driving everything. And so how does that manifest? This isn't like the one hit wonder technology it's going to put on top. It's okay. What are our new operating models. And that could be a full investment of new technology to support those operating models. But what are we actually trying to change. And I think that's the place where operations looking to it of like, hey, your technology doesn't work. It's like, well, we got to do this together. We can make the technology do whatever you need it to do, but are we going to fundamentally change? One great example I heard was we have a great digital front door to a brick wall. That's not a great patient experience. If we don't have I've got to.

Steve Lieber:
Remember that one. That's a good one.

Hiten Patel:
So I mean that was like that. We did this all this work to implement a digital front door. And we actually probably scared away patients because when they got through this other side, we didn't have a human to take the call or whatever the transfer was. So that whole operational flow and the patient journey there wasn't thought through. We just added the tech and thought. It would work and like, well, it doesn't. And that's across lots of different areas that if it's not a full operational thought through patient journey, customer journey, whatever you want to call it, with tech being behind the scenes or doing their part, it's not going to work.

Steve Lieber:
Excellent. Great insight. Heena really do appreciate your time today. This has been a great conversation with some significant insights really to appreciate you taking out the time today to chat with us. Thank you. You bet. And to our listeners, thank you for joining us. I hope this series helps you make healthcare smarter and move at the speed of tech. Be well.

Intro/Outro:
Thanks for listening to smart from the start. For best practices in AI, in ambient intelligence, and ways your organization can help lead the era of smart hospitals. Visit us at Smart hospital.i and for information on the leading smart care facility platform, visit care.i.

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