Episode 2 : Healthcare as Part of the Rhythm of Life

Smart from the Start_Craig Richardville: Audio automatically transcribed by Sonix

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Smart from the Start 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 HIMSS, 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 Craig Richardville. Craig is the Senior Vice President and Chief Digital and Information Officer at Intermountain Health, an integrated delivery network based in Salt Lake. As a member of the Enterprise leadership team, Craig's responsibilities include leading all aspects of the health system's information technology and digital services involving strategy applications, operations, information security, informatics, data and analytics, and leading the system's digital transformation and information automation. Prior to Intermountain Health, Craig served as Senior Vice president and Chief Information and Analytics Officer at Atrium Health for more than 20 years, where he transformed the growing company into a national leader in the effective use of technology, utilizing data as a driver, and digital services as a differentiator. Welcome, Craig!

Craig Richardville:
Steve, glad to be here. Thank you for the invitation.

Steve Lieber:
You bet, it's good to see you again. So where I want to start out is at the executive level, and really want to get a sense of, what's the mood today in the executive suite as it relates to health information technology, digital technology in healthcare, that sort of broad area that is your remit?

Craig Richardville:
Yeah, when you look at the C-suite and what's happening across the industry and certainly within Intermountain Health, there is certainly a look, a serious look as to how technology can advance the services that we provide, the experiences that we offer, but many of us have seen in other industries. But also, it's not the panacea, it's not the only answer. There's a lot around people, there's a lot around processes, there's a lot of things that we made complex within our system, so our CEO really is focused on simplicity. So the things that we do, the things that I'm being asked to serve and be part of, really starts to lead us toward creating a more simple environment: a simpler environment for our caregivers, a simpler environment for our patients, a simpler environment for our consumers. And when you look at Intermountain Health and this legacy and where still plans to head in the future, the vision of Intermountain Health is to be the model healthcare system. So with that comes the opportunity then to share the things that we're doing, the things that we're finding across the industry where it may fit for other populations that were not privileged to serve, but others are.

Steve Lieber:
Yeah, you mentioned Intermountain and its legacy and its history, and it has been in the forefront of innovation in technology for my career. It's just always been one we look to. And so this question may not resonate necessarily at Intermountain, but probably elsewhere of, how has it changed in terms of getting buy-in at this executive level for the IT strategic plan? You, what do you have to do? And I say, it may not be so tough at Intermountain, where it's always been a key part of their strategy, but what is it that is different today? Is it easier? Is technology the first part of the conversation instead of the last? How has it changed?

Craig Richardville:
Yeah, what I would say is technology, no matter how you define it, whether it's the artificial intelligence piece or whether it's about even hardware components or all the pieces that go into the definition of technology, certainly, all the software applications, it is part of the conversation. I can't say it starts with that or ends with that, but it is also always considered as we make decisions. And when we look at those investments that we're making, I think for a lot of healthcare systems, but certainly, Intermountain Health had an opportunity to play in some areas that others maybe could not or did not, given the clinical expertise, the markets that they serve, certainly, the profitability that Intermountain Health has had in the past; but the industry over the last three years has got hidden, really, and it's a different mindset moving forward, not being there in the past, but certainly, being there now and plan to be for a while, a long while, is really very focused on our goals, our initiatives, our mission of the organization. And so, we have to have strong business cases where we bring things forward. Those business cases, we rank them in terms of some of the hard or soft savings, or Tier One or Tier Two, or however you're terming it, but we really look at to see, is this something that if it was my dollar, would I put it in? Would I get the return back? Would the experience change? Would our outcomes change? Would our financials change by investing that dollar into whatever initiative that is? But almost everyone has some component of technology that's part of it, some larger than others, and that's really what we look at. We really look at making sure that we're using the dollar wisely. We are an asset to our communities, we want to make sure that we're very thoughtful when we start making our investments.

Steve Lieber:
You mentioned needing the business case, which obviously is the right thing regardless of what we're talking about. You've got to build the business case. I know you spend a lot of time in various places, not just there at your desk at Intermountain. You and I run across each other at various industry events like ViVE and the Chime Fall Forum and places like that. As I hear the conversations, people over the past year or so have really been struggling with the financial environment in the provider setting. So what are you seeing across the industry in talking with your colleagues, or have we weathered through the fear of recession, and things are going to get back to a better place? Have we normalized? Is it going to get tougher? What's the outlook?

Craig Richardville:
If I had that magic crystal ball, I'd be a lot more crisp and accurate. I think right now we're looking to see that this is going to be a situation that will be with us for the next two, three-plus years, certainly for the near term, and with that comes opportunities for us to be a lot more focused, a lot more disciplined. When you look at the way healthcare may have been built over the past and the provider segment, as you mentioned, there's a part of it that our CEO shares, it was built on cheap labor. Half of our cost, or someplace between 40 and 60% of our costs are people, and we are a people business. But with that piece, as those labor rates have gone up, the opportunity to bring labor in has become a lot more scarce. So we have less opportunity to fulfill those positions that we need, and when we do fill them, the cost side of our equation has risen dramatically over the last several years. And so we have to start looking to see how do we reduce the dependency, not necessarily only to reduce the cost, but because the availability of those resources just aren't here. So, if we want to maintain and increase the levels of service, and care, and quality that we have delivered in the past, we need a different care model of how we're doing it. You'll see that in other industries. You'll see us certainly leading in moving to how do we utilize technology to be able to improve our decision support, improve our efficiencies. And part of that's going to be, how do we engage our patients even more than what we have in the past and bring that patient engagement piece? I have stated that, in my opinion, the patient is the most underutilized resource. We walk our patients, we handhold our patients through a lot. These are very, in some cases, life-changing events that we're dealing with people and some of the most emotional and dramatic times of their life, and so we do that. However, you've seen other industries start to shift some of that onto with the right tools and the right apps. So me, I am a bank clerk several times a week, if not a couple of times a day. I used to go into the bank to do all that kind of work, but they gave me easy-to-use tools that are accurate, tools that allow me at my convenience to be able to do that work or do that service, and I'm happy to do retail the same way. All the full financial services, not just banking. So, you've seen a lot of industries make that shift, and healthcare is primed now to make that shift. We have the drivers to, not to say force us, but to give us the challenge that we need to overcome, and that's going to be part of what we end up continuing to build and to move forward with. And then the other piece I would say, Steve, and this is, you can't fight the advances that come into place. We saw that 20 years ago with the EMRs, and now, like you mentioned, everybody's got one, but there were a lot of people that don't really want to go down that route, now nobody can escape without it. And all the education for years have now been included with electronic ways of how we automate and utilize our decision support tools. You'll see the same thing with artificial intelligence. One thing I will say is that providers who don't use artificial intelligence will be replaced, but artificial intelligence will not replace providers. It's the combination of the person and the technology creating that process that will be our success. It's not one or the other. We can't do it ourselves, and technology can't solve it either. It has to bring it together. I tell people, it's like the GPS system. We used to try to drive somewhere, and I'm going to Steve's house, I'm going to get there eventually, and I may have to pull out a map and get lost, but now we just rely upon our GPS to get us to Steve's place. Where historically, I'd just go ahead, and I'd figure it out manually. Now, that's just not an efficient way of doing it, nor accurate. And so we utilize me driving and the tool to get to a location. Same thing in healthcare.

Steve Lieber:
Combination of technology and people. One really can't function without the other as well as if they aren't together. So you just threw out a whole lot of stuff there to try to unpack in terms of artificial intelligence, the history of the EMR, and all that stuff. Let me try to pull some pieces together there and hit us down that path of where we've been, so EMRs. And I say, we can think back to a time where, yeah, there was a rare number of you, you weren't there at the time, but at Intermountain, there was a rare number of them that had the foundations, the beginnings of this. If I remember correctly, Intermountain had their own. And then, over time, it was more than the academic medical centers, and now, as I say, everybody. The way I picture it is, EMRs were a great collection of data. The key now is, in order to be smart, and this is where I'm headed with the question of, how do we get smart? What is a smart facility? What are smart care teams? What are you thinking in terms of where you're going so that you do engage the patient better, you help clinicians drive better patient outcomes? All of those things that we know are the objectives, but it's the how to get us there. That really is the question.

Craig Richardville:
Yeah, I'm going to jump off to the back just to get a little bit of history for you. So, no, I was not at Intermountain when they first, one of the first in the country to develop and put an EMR in place, but it was called the health system. However, I was at a healthcare system called Promedica Health System. And at that time, we actually worked with Intermountain. I remember flying back and forth to Salt Lake City, and we implemented the health system, which was the 3M health system that was created by 3M and Intermountain. At Promedica, back in the day, it was primarily an order entry system. I was part of the first one then, but we actually used it back at that healthcare system nearly over 30 years ago. Amazing legacy that Intermountain has led that, yes, we will be continuing to be a leader as we have for the last several decades into that piece. There's so much that's out there that needs to be tested and trued and brought out through, and it's going to be a combination of clinical and non-clinical. When you look at some of the advances that are coming into play, so again, getting back to one of the financial questions at the beginning, we have a lot of back-end services that can be optimized. So some of these newer technologies that are coming out are being applied toward, we call it intelligent automation. That includes AI, RPA, all these other acronyms, are all part of that work, over 2000 projects that we have implemented as part of those services. That's helping us make us more efficient, primarily on the back-end piece. On the proactive piece from the clinical side, we are trialing the virtual nursing. We're trying the surveillance that's happening within the rooms. We talked a little bit about some of the aspect of getting the patient more engaged by providing them easy-to-use tools, nudges by sending people messages, You got an appointment coming up, It's time to take your medication, things that help people to be able to bring healthcare as part of their rhythm of life, whether that is in one of our facilities or outside of one of our facilities. And we all know, the audience knows, there's a big shift between what's happening within four walls and what's happening outside. And a lot more of that work is being happening outside. But we also know what's happening inside that is becoming a lot more critical, it's a lot more severe, it's higher severity levels. So the things that we are doing now inside, it creates even a lot more intensity of the work that needs to be done. Going back to the human piece that we just can't rely upon and just hire more people, so we've got to put the machines within the rooms. We have to put those electronic eyes, we have to be able to work with people remotely. All those pieces are becoming part of that smart, that more knowledgeable, way of how to take care of patients. We also have a big focus, maybe, in my opinion, one of the biggest in the country on value. We do take financial and political risk in certain populations with certain products. We are learning, continue to learn, so we can hopefully help perfect and teach how you work, but that's more the proactive side. That's for, hopefully, my children and my children's children, that they have a whole different way of how they're experiencing healthcare. We, most of us, experience healthcare on the care side. We get sick, we have to go get fixed. The focus now is, how do you do the health side of healthcare? How do you focus on keeping people outside of needing the need to receive care, or minimizing the amount of their care needed because you did early detection, or getting people with better lifestyles? You understand a little bit more about genomics, and what's good for you may be slightly different for me, better on precision nutrition. All those different pieces that we hope that science will now become part of keeping people healthier and live longer, more fruitful lives.

Steve Lieber:
You mentioned a couple of things in terms of some examples of how you're using developing technology and surveillance in room monitoring, and that was one of them, you mentioned. One of the things that I've picked up on is perhaps a shift, and I want to test it with you, of moving from point solutions, We put a camera in the room, to more of a platform approach, which is, yes, there's a camera in multiple rooms, but there is intelligence laid on top of it to help guide us in situations of, there's something going to happen in this room or happening in this room. So the anticipation, it's the generative AI types of things instead of just a camera, so to speak. Little thoughts in terms of how you see those point solutions evolving into more intelligent tools.

Craig Richardville:
Yeah, great point and great example. You're spot on. Obviously, the camera itself is a hardware component, and what I try to educate people on is, as you start building the intelligence that uses the camera, don't tie that intelligence to the camera so I have to buy that camera to do this, because there'll be other intelligence software being built that just needs a camera, and if yours becomes proprietary as a product, as a standalone, that need to interface, versus something that is a platform that is either already integrated or that I can easily integrate with other things, that allows me to be more effective and efficient with that camera. So historically, yes, the camera in the room for a virtual visit or a virtual caregiver allows more, like you and I, more of a personal experience that we're going back and forth. The camera typically can zoom in, zoom out. You can do calls with family members. But now that camera now can also be used with the software behind it to watch the room to see where you are, that surveillance ... So you are now leaning more toward the bed, and you have a fall risk. I can now alert somebody because there's abnormal movement that's happening or movement that I have sensed as part of using that hardware piece. The software behind it helps me to be able to do that. Similar to when people are doing some things with handwashing, is monitoring the amount of time that a caregiver is standing in front of a sink. There's a monitor that the patient or the caregiver is actually washing their hands, not to that level of detail. Certainly, they can sense movement and things of that nature, but the fact that you're standing in front of a sink for 30 seconds, one could logically assume you're probably washing your hands. And so those kinds of things, yeah. So utilizing that one tool and make it a platform behind it so that you don't have to buy three different cameras to do each of those different functions increases the cost, the complexity, the ability for it to fail and break down. You got to have backups with the one, but I don't need three separate units. That's a simple example, but I think a very good example of how we have to leverage those investments that we've made in order to be able to provide more cost-effective and integrated, or a platform-level type of service, for our patients and for our caregivers.

Steve Lieber:
So you've talked several times about value and the financial picture and such. And I would expect, and I don't know what the count would be, dozens every week or more than that of new products, new approaches, and that sort of thing. How do you filter through that? Because, as I say, I expect as a CIO at the level in the organization, you are dozens, hundreds of different possible applications and platforms and different things. How do you separate out what isn't ready for prime time? What is, it's almost like, how do you not only filter, but where do you start?

Craig Richardville:
Yeah, for me, it comes down to people, and the people is how I filter things in and out and through. So, for example, if something is presented to me, looks interesting, I can reach out to dozens of people within a matter of seconds. Has anybody heard of this company before? Has anybody used this product before? Has anybody done a tear sheet on this product before? Something that gives me some additional intelligence on that. So, the networks that we have all created throughout our careers is a great way to try to look through that. We also have a venture arm, and so our venture arm looks at hundreds of companies, and they have great information, great intelligence. I can ask our venture arm because they have a different mission there. They're investing to get a return. Not necessarily that investment may impact what Intermountain does. There's certainly sometimes where we overlap. But have you looked at this before? And if so, was it worthy of an investment or not? And if it was or wasn't, give me some of the factors and when that happened and that kind of stuff, and that can help you a little bit smarter when I'm having the conversation. And then when it comes down to actually who's behind the product or the service that we're looking at. What firm would maybe venture or firm is backing it up that has made an investment into this company or into this person? Many people have great backgrounds that we can learn to see how they've been successful or not successful. So I think really it's just that networking of looking at the people that we have worked with over the years, looking at inside Intermountain Health, and also looking at the people that's behind that product or service. Whether I'm buying a product or buying a service, to me, it still comes down to people. If I have to revert to a contract, that means that you're a vendor, you're not really strategic, we just aren't able to work together that well in the future. But in most cases, you're really able to talk to people and figure things out rather quickly because there are a lot that are coming this way. But once you get on the list that it is something that's positive or you get some feedback that leads you that way, that will lead me then to, let's get on this thing as soon as possible, given our capacity constraints and things of that nature. But we do really quickly be able to bring things in and ascertain the value proposition that the brain and can we help expand that for our populations. And again, is it applicable that we can then share to others? And get those things all the time, so it's really a really nice networking piece.

Steve Lieber:
We started off talking about buy-in at the C-suite executive level. Let's go to the other end and the front line. What are you sensing today, and what it takes to get buy-in at the frontline level for change and innovation?

Craig Richardville:
Yeah, we're, we really rely a lot on engagement. We really look to make sure that people understand the reason that they're here, that they have input to the things that we're doing, that they're engaged, involved, versus maybe some people or places that look at people more like contractors, like you're replaceable, and I just need that talent, but I don't really need to have you be part of our family. And I like looking at it more as a family type of thing, like we're all in it together. I've got your back, you got my back. You tell me when I'm making a left turn, it should be a right. I'll tell you the same. This just makes sure that we work at this together. So, for me, it's really the engagement piece, making sure that we are open, that we're transparent, that we're truthful, that we're as proactive as possible. But you also are part of the solutions that we're developing. You just don't throw a problem over the fence. You're part of getting that problem resolved and pulling in the right people that work all your way through. We can't do it ourselves, so we really need people who are doing a little bit more of the hands-on work to be fully engaged and to be empowered, to be able to bring things up to the right people at different parts of the organization or outside the organization. They've got that capacity, that talent, that skill set. They don't need permission in order to do it. They need to go ahead and just take the proactive stance, and that's really, for me, is a big thing is making sure people want to be in our part and contribute to your success.

Steve Lieber:
Yeah, I really like that, engagement and empowerment. You really are telling me my participation has value. I can contribute value to this. That's great. You know, you gave a, in a sense, an answer that was a great piece of advice, and that's about professional networking a little while ago in terms of trying to find out has anybody else heard of this, done this, that sort of thing. I want to close with your practical piece of advice, the crowd that are our listeners are CIOs, CMIOs, CNIOs, and such; what's Craig got to share in terms of your experience with this that you think might be of value to them?

Craig Richardville:
Yeah, I guess there's maybe a couple of things. The first thing I would say is if you think at all, then you don't know, right? You just got to be humble and just realize that you don't. Many of us learn that really fast, hopefully, earlier in your career than others, but once you realize that, then you realize, okay, now I really need to network. And I do believe networking is where there's a lot of things that are out there. I've not only belonged to the network of healthcare, I've been engaged with healthcare for 30 years and have a lot of people I rely on that are still working in some not working anymore, some have moved to even other industries. And that brings to the next piece, I also look a lot outside. So for the last ten years, a lot of my growth has been outside of healthcare and there's a great organization called Inspire CIO, they just had actually their annual event last year or last night. In that event, I was their first healthcare CIO of the year, went across the industry. The year after that, which was Chris Ross from Mayo Clinic. Then last year it was, last night it was a lady from the payer side of healthcare. But those, what I interact with people that are going through all ... healthcare maybe is 5%, 10% of that group. And so getting involved with those, because they have the reference banking or reference retail; there's so many other industries that have great solutions that aren't specific to healthcare that could assist or you could reapply to it. So going back several years ago, in a previous life, I was talking with the CIO of an energy company and we were just out there, and ten of us that gathered every month and we were just sitting there talking. I was like, How come you send me all this stuff about energy, about putting in the insulation, changing out my lights to more efficient lights? So don't you want me to pay you more? And you're encouraging me to use you less. And it was like, we really want to conserve the resources that are out there, we're really in it for you, we don't want you to pay unnecessarily, and it really became almost like a value proposition, what we're doing in healthcare. And he said, Oh, by the way, when we send you your bill and we do care about you, you have a propensity to pay a much higher than where we're just sending you a bill, I'm going to send you to collections if you don't pay it. It was like, boy, we're going to take that same thing and put it on our statements. Here's, you have an appointment coming up, you're overdue for your mammogram. Things that really are meaningful, and we do care about you to put that in. People want to then now become part of your healthcare system and receive their services through you, because there is this two-way communication, and we want to help you just as much as you need to be part of our healthcare system to receive the best care possible. I really think the networking piece is invaluable to how, the answer is in the room somewhere, you just got to be bold enough to ask the question, and people will offer it.

Steve Lieber:
Yeah, and as you pointed out, sometimes it's in a different room than you think you ought to be looking. That was a great Comparison there with the energy world in terms of making sure that the patient/customer feels valued and that you care for their interests are your interests, and that absolutely carries over to us here in healthcare. Craig, great insights. I really do appreciate you being with us today. It's always a treat to see you and chat with you, and I really do appreciate your contributions to Intermountain and to the healthcare industry at large. So thank you very much for joining us today.

Craig Richardville:
Thank you, Steve. And I will say you have a wealth of information and great experience, and I hope one day I'm able to interview you because you have so many answers you could share and help the audience.

Steve Lieber:
It's been it's been a great career, and I've had a lot of great conversations and learned a lot from folks like you. So thank you.

Craig Richardville:
Thank you.

Steve Lieber:
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.

Smart from the Start 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 SmartHospital.AI, and for information on the leading Smart Care Facility platform, visit Care.ai.

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