Platforms and Partnerships: The Building Block for Digital Innovation
Ryan Smith: Welcome everybody. I’m excited to be part of the webinar today. About 10 years ago, I took our youngest daughter to an urgent care in our community for what ended up being an ear infection and it was probably around 9, 10 PM so well after hours, normal physician offices are closed at that point and the waiting area I remember was pretty full. We got checked in at the front desk and we ended up finding a seat right next to a mom and her pre-teen daughter. You could tell that the young girl was clearly not feeling very well and she was sobbing and her mom was kind of embracing her.
Ryan Smith: After saying hello to the mom, she said something to me that’s had a pretty profound influence on how I’ve thought about our industry and the technology that supports it, ever since. She leaned over and asked me, why do they make it so hard to get the help you need at these kind of places? She went on to tell me that she didn’t know if she would … she should have just taken her daughter to the ER if that was an okay place to come and she didn’t know if the urgent care was even open at that point before she left her home and how long the wait would be, questions about her insurance, covering the visit. How much was their out-of-pocket going to be.
Ryan Smith: My guess is that most of us on the webinar today, probably had pretty similar experiences, either ourselves or accompanying a loved on, especially when it’s after hours care et cetera. Well, I’ve got to admit that her comments hit me especially hard because not only did I work for the organization that owned that urgent care, that I was visiting that night but I was also leading the digital business team that our patients depended on to make their health care experience just a little bit easier at that time. Since that night, I’ve made a personal commitment to make sure that I was doing everything possible to improve our patients’ experiences at least from the electronic digital perspective.
Ryan Smith: That really was kind of the early beginnings to what I’m going to refer to throughout the webinar is this framework that I’d like to share with you today for technologically transforming our organizations to really fully participate in the consumer digital age. Let’s start by … I’d like to take a couple of minutes and just contrast our industry with other service industries that are out there and then we’ll talk about some of the technology issues that are seemingly holding us back as an industry, followed by that, I’d like to just share a handful of recommendations that I learned as both an IT leader and as a digital business leader both at Intermountain Healthcare and later at Banner Health.
Ryan Smith: Then we’ll review a brief case study showing how this model was applied at Banner Health while I was the chief information officer there. Then, finally, we’ll have some time at the end for diving deeper into any questions or comments that any of you have and let me just put out there that if any of you kind of have a burning question on a particular slide, please feel free to submit it and we’ll do our best to try to answer it. In preparation for today’s webinar, I decided to just take account of the number of apps and digital brands that I’ve interacted with on at least a weekly basis, at least according to Apple’s new Screen Time feature which is kind of cool. I’ve compiled these apps together and if you just take a second look through some of these, a lot of these are going to be pretty familiar logos to you.
Ryan Smith: Could you imagine how difficult it would be at this stage to get services from these companies, if they didn’t have a digital interaction model as a core part and possibly the only part of how they deliver their business model. It’s really amazing to consider the absolute level of disruption that the combination of things like digital technologies and cloud and mobile and big data head on, on all of these service industries and not surprisingly, the same level of mass disruption is obviously, well on its way to virtually all aspects of health care as well.
Ryan Smith: Our organizations need to be prepared for what surely going to be equally disruptive over time even though a lot of our organizations aren’t feeling that yet today when we look at some of these other service industries, like hospitality or financial services or transportation that I’m showing here, in some of the examples of what their digital interaction models look like but when we also consider service industries like retail or entertainment or food services, maybe the gaming industry, et cetera, you come to understand just how high the bar really has already been set, in terms of what consumers really expect, okay, and these peer service oriented industries have already shaped our expectations.
Ryan Smith: It’s just a matter of time until each of our companies are also going to need to adapt and offer similar levels of experiential, digital experiences or we’re simply just going to be less competitive and less relevant as time goes on. It’s pretty easy to see that we collectively lag virtually, all other service industries and at least in this regard and we still largely think in terms of things like web portals and mobile apps that are vended by our EHR vendor, oftentimes we put those out on the Google Play Store or the Apps Store, side by side with other vendor’s single function mobile apps that we also are offering to our collective patients and consumers.
Ryan Smith: Collectively, these apps provide in totality just a relative small handful of the types of self-service transactions, as well as the type of information that our patients and consumers of health care wished that they did have at their fingertips. We’re typically limiting what we do offer to things like, prescription refills, finding a provider, requesting an appointment, paying a bill, looking at basic portions of your medical record, we’re still pretty limited as an industry to those types of functions. Though there’s hundreds of other types of self-service functions and types of information, patients and other health care consumers wished that they could be getting access to, to be able to stay in the comfort of their home, to get the type of services, et cetera that they need.
Ryan Smith: You contrast that on the right hand side with how other industries have approached consumers with really a brand driven highly interactive a set of experiences providing a breath of transactional capabilities as well as broad access to contextually relevant information that the users want and you can see that we’re lagging. Okay, so with that, let’s jump to our first poll question. I’ll turn it back over to Sarah.
Sarah Stokes: All right. Thanks Ryan. In this first poll question, we’d like to know, on a scale of one to five, how would you rate your organization’s effectiveness in meeting consumer expectations for digital interactions? Your options here are one, not at all effective. Two, somewhat effective. Three, moderately effective. Four extremely effective or five, maybe you’re unsure or this doesn’t necessarily apply to you. We’ll give you just a minute to respond to this poll question here. People are voting pretty quick so you’re keeping it easy on them so far.
Ryan Smith: Great.
Sarah Stokes: As a reminder to anyone who joined late, we are recording today’s session. You will have access to the slides after the fact, so just remember that. Okay, I’m going to go ahead and close this poll and share the results, so 15% reported not at all effective. Your majority, 41% said somewhat effective, 21% reported moderately effective, 8% only said extremely effective and 15% were a little bit unsure. How does that line up with what you would have expected?
Ryan Smith: Yeah, so pretty close to what I would have expected and obviously, credit is due, there are certain beacons out there within our industry that have really I think done a great job at moving towards a more of a fully digitally interactive model and it’s taken them years to get there but there’s bastions of light and hope out there but what we see here is kind of a bell shaped curve and with the lion’s share, sort of in that somewhat bordering in the moderately effective, so that’s really great and thank you everyone for your participation. It’s great to see. Okay, so I kind of like this chart that I came across earlier this year from an organization called Circle Square, that you can see on the bottom left there, depicting the journey towards digital health.
Ryan Smith: A lot of organizations mistakenly believe that simply implementing an EHR not that that’s simple to implement but implementing an EHR really is the answer to being, considered digitized but in my estimation, that’s really an antiquated definition of going digital, meaning kind of more moving from either paper records or really antiquated, disjointed EMRs to kind of fully integrated electronic health record. However, the digital health journey is a lot more than just adopting an EHR that you can kind of see on the chart there as number one but that is still a starting point along the journey.
Ryan Smith: As organizations progress along this digital health vision, they need to be able to rapidly aggregate and access lots of additional data types, well above and beyond what you’ll find generated and created in an EHR and be able to derive insights that assist patients in understanding their condition and treatment options, are making it easy for them to access the right care similar to the woman that I mentioned in the story at the first, being able to provide support for the healing process, assisting and prevention and wellness activities and ultimately, fully engaging patients and our plan members and other health care consumers before, during and following episodes of care.
Ryan Smith: Then, finally, using data to really inform innovation and improvement activities that continually improve the overall health of individual patients and the whole population and as we start to enter our way towards that kind of level six, level seven, level eight arena, our organizations are fully immersed and digital at that point to be able to start to get those kinds of outcomes. As we’ll share here in a moment, it’s not easy to get there for a few different reasons. Before we jump into that, let me share that it’s important for technology executives, digital executives, analytic leaders of our respective organizations to really help the other C-suite leaders and other facility based leader understand how data and technology can and really should be helping to enable your company’s transformation goals.
Ryan Smith: I’m listing kind of just four examples here of how organizations often think about categorizing system wide transformation activities and setting strategic goals. You can see things like engaging consumers and their overall health and wellness, enabling care teams so that they have effective collaboration and communication. A lot of what Health Catalyst obviously focus on is around that improving clinical and operational, financial outcomes, that can help deliver optimized and cost effective care. Also, lots of organizations are really focused transformationally of moving beyond their typical business models to really growing the organization through partnerships.
Ryan Smith: It could be through organic growth, through diversification, with … introduction to new service lines, et cetera, as well as really heading down an innovation kind of a path and our job as technology leaders is to really make a clear connection as to how digital directly supports the organization’s broader transformation goals. Here is just an example of how my former digital business and IT teams in conjunction with the marketing team at my last organization, described how we would support these goals. As an example, around engaging health care consumers that we would provide an engaging self-service experience, giving consumers full access to all necessary data and services that promote their health, wellness, dot, dot, dot.
Ryan Smith: A lot of brand loyalty pieces there as well. On down the line and you can see things like being able to connect care teams and members together with their patients and being able to leverage data and analytics to create embedded insights and finally at the end there, even from a technology perspective, harnessing the power of strategic technology partnerships platforms to old data et cetera to help keep pace with organizational growth and business development initiatives because that’s an area that many organizations really struggle in how technology can really help enable them because we’re so far behind in our capacity and capability to help.
Ryan Smith: Likewise, it takes a new technology investment approach to fundamentally change how consumers and patients are able to interact with your services and this becomes a really important part of today’s framework that I’m sharing with you is being able to be more deliberate in designating investments in technology areas and services that are really going to matter to your patients and consumers and if you think about it, most organization’s IT budgets are predominantly allocated to the systems of record that you see down there towards the bottom of the pyramid and these systems and their underlying infrastructure and our data centers often account for 90 plus percent of the overall IT spend in the organization.
Ryan Smith: We put a lot of time and effort into how we govern those systems down there at the bottom, how we build teams around there, how we try to engage business and clinical support et cetera but I’d argue that we really need to start making very conscientious and deliberate investment decisions that allows to increasingly allocate more funding for these higher value layers above. Let me just walk through these three terms here. Systems of record, I think these initially were Gartner terms if I remember correctly but systems of record are these inward facing massive transactional systems that our employees and workforce members use, typically millions of transactions a day.
Ryan Smith: Then, where we’ve been a lot more patchy is around thinking about systems of differentiation that help us to identify opportunities that help us to maintain a differentiated leadership position in our service regions. Then, at the top of that pyramid, this notion of these systems of innovation that really led us innovate, we call it around the edges to where we can do things that are really engaging to our consumers and other workforce members and if you think about it in terms of life cycle investments, these systems of records, these are typically 10 to 15 year massive capital investments, often 20 plus years, where when we’re talking about systems of differentiation, you look across there, these a lot of times are platform SaaS kinds of services that are delivered more virtually via the cloud, et cetera.
Ryan Smith: It changes the investment cycle, the more of an Opex kind of a model and might be more in three to five year investment life cycles, where as you get up to the top of that stack, now, we’re talking about things that if they’re going to be relevant services, whether they’re … it’s a mobile application or maybe … and a lex integration with an echo device or you’re doing a chat bot thing or virtual reality, whatever. These tend to have much shorter investment life cycles because consumers have such high expectations due to these other service industries at this point. If you put a mobile app out there and then don’t touch it for 36 months, you’re completely irrelevant and doing your patients and consumers a major disservice.
Ryan Smith: You’ve got to be revamping these things. We need to fill fast and again, we’re only talking collectively about maybe 5% of the total spend but as we start looking at this, we really need to start making these investment decisions to increasingly allocate more funding at those upper two layers and you can see the resulting changes to those investment priorities by function. The framework in essence is all about figuring out how you can optimize the lower layer of the stack here while beginning really greater investments in the upper layer so that we can get to these innovative and differentiated experiences.
Ryan Smith: I hope that makes sense and obviously the percentages here, that’s going to be organization to organization and in terms of what makes the most sense for you but just arguing that, we need to figure out how to start freeing up funding to support these higher level functions if we really want to remain relevant to our consumers, our patients and our members. Now, we outlined to go forward architecture and a set of guiding principles that begins to make it possible to deliver brand driven highly engaging digital experiences to our customers in the case of both Banner Health and at Intermountain Health Care back when I was out there about six, seven years ago.
Ryan Smith: In part, this is accomplished by obstructing the back office transactional systems or those systems of record you see down there at the bottom, as well as the myriad of apps that those vendors offer and begin to replace those with modern platforms and digital capabilities or at least augmenting those with digital capabilities to provide the significantly enhanced experience and these upper layers, they kind of break into three things themselves. There’s this data processing layer, that’s where we really think about all the … bringing together and collating all the data, assigning meaning to it, building models around that, that can really drive our analytics and BI stuff out to the right.
Ryan Smith: Also, and as importantly support those upper layers, the digital process layer that now let’s us begin to have direct to customer self-service transactions that can span multiple backend systems of record without the consumer needing to directly interact with a portal or with a mobile app, whatever as delivered by that system of record vendor which is a really important concept. Finally, having this application interface layer that can express itself in whatever form or modality you needed to express without having to redo all your digital process layer or re-munging all of your data, et cetera. This is the basic outline of the digital enablement framework.
Ryan Smith: An example of what this looks like is how Banner’s digital platform and services have been leveraged for building a single highly branded digital experience that … to engage their consumers and patients, that really let those users get access to quickly needed information, be able to participate in a growing number of self-service transactions beyond just the normal typical ones that I mentioned at the first. These single apps services include things like being able to see available time slots at an urgent care and the ability to remotely or virtually get in line at an urgent care location.
Ryan Smith: To be able to single click, talk to a nurse or obviously to be able to access your medical records or being able to find a new doctor but not just a typical yesterday’s find a provider but being able to look for things based on criteria that’s really important to patients. Then on the right, separate application, this is an example of an app that was purpose built for coaches of little league sports, of high school sports et cetera to help assess the likelihood that one of their players has perhaps suffered a concussion. This is all great but again, these couple of examples for many organizations, it’s really hard getting to the point of shedding the myriad vendor supplied apps.
Ryan Smith: To be able to offer this highly branded, highly integrated set of capabilities that begin to really meet the needs and expectations of our consumers. Let’s talk about why is this, okay? Now, this is just sort of a, represented of a diagram I found here but in essence from an IT perspective, we’re kind of guilty of implementing decades of just kind of incrementally added on to monolithic closed system that as I mentioned we’re never designed to enable a new digital world, let alone, that have consumers be able to directly interact with them and these systems were purpose built for employees to transact their business.
Ryan Smith: Simply put, kind of here’s the conundrum of moving from this to getting to something that’s more elegant that they can really begin to meet our consumers and other user’s needs. We either have to kind of take this approach and proverbially put lipstick on the pig and often times, in early phases of consumer facing digital initiatives, this is kind of our only option to be honest with you. We ultimately had to do a lot of this in the early days at Intermountain Healthcare with a lot of proverbial duct tape, baling wire, twine, band aids, et cetera. It requires large of amounts re-engineering and re-factoring of legacy systems, a lot of systems integration work, a lot of moving data around to where you need it, creating new databases that can be more real time in terms of consumer direct access et cetera.
Ryan Smith: As you can imagine, if this is … where we have been, and you’re putting lipstick on the pig, in essence, what this means is even a more complex architecture with the added brittleness that you might come to expect when a company is such a mess or conversely we can start planning for a more holistic next generation approach but that doesn’t happen overnight and hopefully that’s kind of obvious everyone. Let’s transition to some lessons that I’ve learned along the way, mostly learned the hard way to be honest with you with lots of failures along the way but I’m going to share these lessons learned in kind of the form of five recommendations for moving towards a more holistic approach so that your organization can be ready for the digital revolution that’s right at our doorstep.
Ryan Smith: Regarding digital itself, it’s important to define what we’re actually talking about and obviously, this is a word that like many other words is a way overused buzz words in our industry. I mean, you could put it right up there with terms like Cloud or AI or big data or telehealth virtualization et cetera. To be sure, digital means different things to different people. What I’d like to do is kind of move past the basic definition of just digitizing paper records. Let’s start first with the definition of digital bell that you’re going to want to avoid at all cost. Yet, I’m seeing it increasingly being kind of subconsciously adopted in a lot of health care organizations and it’s this here.
Ryan Smith: My tip is that if your organization defines digital, either directly or the inferred definition is any new technology investment and it defines IT as the continued investment needed to just maintain and support your legacy technology, then as tech leaders, we ought to be really worried about our future in the organization. We need to kind of go on the offensive and manage these terms and as technology leaders, we need to start getting our arms more around what can and should digital mean and how do I and my IT organization play a role in that, okay? Along these lines, we’re seeing a lot of new titles like chief digital officer and chief innovation officer, chief experience officer, dot, dot, dot.
Ryan Smith: I’d argue that sometimes not in every organization but oftentimes along with these new roles, sometimes come shadow IT functions that have their own separate technology budgets. Now, if we want to continue to perpetuate the mess I show a couple of slides ago, by all means, let’s create a lot of shadow IT functions in our organizations that are just buying more and more disparate non-integrated technologies. I think on the right way, we need to work really hard organizationally to ensure that technology is managed and designed in a way that it’s integrating our health care organization and not causing further fracturing like we talked about a few minutes ago.
Ryan Smith: Let me share with you my definition of digital and I’ve developed and have used this at my last two organizations, not always word for word but very similar to this. Here’s how I put it in. It’s a little wordy so bear with me. The innovative meshing of new technologies, data intelligence, re-imagined workflows and organizational leadership, all aligned to achieve a sticky and optimal experience, inviting end users to virtually access all relevant information while offering a breadth of interactive self-service capabilities available anytime day or night using any preferred device from any connected location.
Ryan Smith: Well, okay, kind of wordy as I mentioned and obviously, it’s okay if your organization opts to use something different but what’s important is that you agree on a definition so that you can start working with more of an end in mind. I found that this particular definition and admittedly though kind of long, is still just succinct enough and conveys an image that even non-technical folks can get onboard with and it’s broad enough at the same time that it doesn’t just work for your patients and consumers but this same definition can also work for your employees and other workforce members, your physicians and other digital audiences that you need to interact with.
Ryan Smith: That’s kind of my first recommendation is let’s really define what we’re talking about in our organizations around digital. Now, in reality, it might take the next five plus years to fully implement a transition to an infrastructure that broadly supports digital initiatives in a more easy integrated streamlined way so here’s my next recommendation. That’s let’s develop some guiding principles then that are going to act as a north star as we’re out doing RFPs, as we’re procuring technologies, we’re thinking about vendors that we want to work with, as we’re thinking about all the legacy technologies and data systems that we have in our organizations.
Ryan Smith: These kind of break down … and I won’t’ read all of these but here’s an example, the principles I put into place to try to help steadily move the organization towards digital enablement. One thing here is we need to help our respective organization to understand that this is a longer term strategy play and each procurement decision and each build versus buy decision and every time we head down the path of deciding, we’re going to build something or buy something, that is either going to help move your organization forward or it’s going to take a step further backwards with each new procurement that happens if we’re not working towards a plan.
Ryan Smith: You can see some of the things in here like, let’s create fully integrated platforms that are modern and open and standard space. Let’s be pursuing a cloud first strategy. It’s clear that even our industry, the one that’ll … last to adopt, we’re moving there. Let’s think about buying technology versus building it, again with the caveat, when possible. Let’s build out strategic vendor partnership that are committed to our successes as clients. By the way, number six there, let’s have these strategic vendors have them partner with their partners to integrate their technologies so we don’t have to have massive system integration teams ourselves with all the duct tape, baling wire and twine to bring data and capabilities together.
Ryan Smith: Let’s figure out how to get rid of, where possible, it may take some time to sunset, these non-integrative vendors and legacy apps, et cetera. Of course, we’ve got to always keep security and privacy out at the forefront of everything that we do, dot, dot, dot. These are the kinds of things that we have put into place at my last organization so that we can kind of benchmark to say, so for this next procurement or this next technology or this next thing we’re going to build, how does it work with these, because again, it doesn’t happen overnight. It’s like putting a jigsaw puzzle together but we’ve got to have that end picture in mind. All right, let’s jump to our second poll question. Sarah back over to you.
Sarah Stokes: All right. I’m going to go ahead and launch this poll. In this poll question we’d like to know, on a scale of one to five how well is your IT infrastructure, systems, data and technology architecture positioned for enabling full digital capabilities in the near future, short to midterm, in the next 12 to 36 months. Your options are one, not at all positioned. Two, somewhat positioned, three moderately positioned, four well-positioned and five again, maybe you’re unsure or this doesn’t apply to you. We’ll give you just a few moments there and again, if you joined late, we are recording today’s session. You will have access to the slides, we’ll make sure that you get those in the … we’ll email you a link to those items tomorrow and we do want to encourage you to submit your questions for Ryan. We are about half way through today’s time so please do submit those when they become top of mind.
Sarah Stokes: All right, I’m going to go ahead and close this poll and share the results. It looks like 8% said not at all positioned, 31% which is your majority here by just a little bit said somewhat positioned, 21% reported moderately positioned, 14% reported well-positioned and 26% were just kind of not sure.
Ryan Smith: Okay, all right. Well, what do I make of that? First of all, I’ve got to say, as I mentioned a few minutes ago, that there are some real beacons of light and hope out there with organizations that have really been working hard on this for more than a decade now and maybe that bears out by nearly 15%, they’re saying they’re well-positioned. That’s actually a little bit surprising to me that the number is that high and I’m really pleased to see that and everybody else is trying to start to make that shift. Somewhere between number two and number three there and naturally, we’ve got some laggards that aren’t positioned well at all and potentially is going to make some more crucial conversations with board members and C-suite members et cetera to really start getting on that bandwagon.
Ryan Smith: Okay, thanks Sarah and thanks to all of you that responded. Okay, this next recommendation has to do with categorizing the IT capabilities and formally managing each of those categories as a true portfolio of interrelated or highly integrated technology and then building a governance framework around each of these portfolios. In IT we’ve talked about portfolios for a long time. Here’s the basic model that I like to use. Again, your mileage will vary, your organizations may have different needs but I defined 10 primary categories of IT capabilities and again, it kind of vary somewhat on your organization’s needs like whether you have an integrated payer company or not.
Ryan Smith: As much as possible, each of these top layer ones, these seven or eight up at the top, should really be created to best align with how the business really does operate in your organization. In each of these portfolios or suites, whatever you want to call them, can be benchmarked against how well they support your organization’s digital vision and architecture and then, road map to ensure that they tightly align so just as an example of this, I would gather that if we ran a poll right now and said, how well are you managing your clinical applications suite, your revenue cycle suite and your business administrative suite that’s often like your ERP system as kind of fairly tightly managed portfolios.
Ryan Smith: I think we would probably have a very high percentage that people are taking those ones and really managing them as portfolios but I would probably also see that if … it might be news that some organizations are really managing their data management and analytics as a corporate asset, that’s managed as a portfolio. A lot of times, data and BI and analytics kind of grows up as point solutions and homegrown data warehouses, dot, dot, dot. I’d argue also that the consumer digital suite might be kind of surprise. That’s another area that in many organizations, as we talk about at the first webinar have just been bold on, et cetera.
Ryan Smith: Information security is another one of those that tends to kind of be all over the place, depending on the organization and so with my direct reports, when I was at Banner, we were very clear as IT executive stewards of these portfolios, there was absolutely a responsibility and an expectation that each of these were managed as portfolios that we had strategic roadmaps and plans in terms of how we would get to those 10 guiding principles that we referred to earlier and look at cross portfolio integration where needed and we’ll talk a little bit about that in just a moment.
Ryan Smith: One of my probably most important learnings as CIO has been around the establishment of these dyad partnerships for each IT portfolio and this dyad relationship is how you implement business driven or clinically driven IT governance in a really pragmatic way and I’m not going to cover all the details on this slide but let me suffice it to say that this is a rock solid way to get C-suite and board level buy in for major IT investments and to really engage your business and clinical stakeholders and ensure that your IT organization is highly aligned with the overall directives of your broader organization.
Ryan Smith: In just a nutshell, the way that I like to position these dyads that I’ve found tremendous success, if you’ve kind of look at Batman and Robin up there, is just representative figures, super heroes obviously but that we have a strong business or clinical champion that we designate as the Batman partnered with an IT champion, typically an IT executive that takes more of the Robin role and despite the fact that most of these major IT initiatives in these different portfolios are going to be 99% funded out of an IT budget. I have personally found that when we can build this kind of dyad and that this Batman kind of persona that’s a business or a clinical champion, that’s not in IT nor reporting up through the CIO, can be the point person, can really be the pitch person out to their representative stakeholders.
Ryan Smith: There’s so much more credibility and trust. Likewise, when the dyad shows up to executive team meetings, to board meetings and they’re both on the same page, saying the same thing that we need to do X or Y or Z and here’s how we’re going to do it and here’s how we’re going to do change management and get buy in and how we’re going to implement, things just go so much more smoothly, okay, so I’m going to leave it at that but if you take away nothing else from today’s webinar, I think this slide is really an important hard lessons learned on my part of what really does work at the end of the day for how to think about governance structures, how to think about these portfolios and how to get business directly aligned and helping to lead IT governance, okay?
Ryan Smith: Several years ago, I was preparing for an upcoming board meeting. I was actually pretty new at Banner at the time as CIO to explain our strategy for how we were going to build out an enterprise digital capability and the CEO asked me to meet with one of our board members that kind of viewed himself as more kind of what I’ll call the technology representative of the board, though he wasn’t really that. He wanted me to review in advance my presentation with this particular board member and he encouraged me after we sat down and look through it. He said, “Look Ryan, you need to kind of boil it all down into simpler terms that the other board members could understand, you know that there are people from different backgrounds and clearly not technical backgrounds and oftentimes, not even from healthcare.”
Ryan Smith: After thinking about his challenge, I decided to use a solar system analogy which ended up actually resonating pretty well, so here’s how it works. In this model, the sun in the center of the solar system, it represents a single highly strategic vendor partner who’s fully integrated and hopefully modern platform, provides a lion’s share of the business or clinical functionality within that portfolio. I think we’ve all been around the block that no one vendor can really do it all even within a single portfolio. A small handful of secondary vendors are selected based on their certified integration. Kind of use that in air quotes, to the core partner’s platform. This could be like, at Banner, we were a large Cerner shop for our clinical applications suite.
Ryan Smith: That represented into that 60 to 80% of all the required clinical capability that we needed. They couldn’t do it all and so, we look to partners of theirs, like 3Ms around their coding products or Nuance, around their transcription products that could tightly integrate without our teams having to do a whole lot of additional systems integration work. Then, finally, even with your core and your secondary partners, you’re still probably at best around 90, 95% of the way to meeting all of the business needs and capabilities there. You also have a number of non-strategic vendors or self-developed capabilities that are carefully selected to fill the remaining gaps.
Ryan Smith: These are typically going to be HL7 interface solutions and not integrated. The goal is over a pre-committed period of time, is to try to the extent possible to sunset all other applications and systems into portfolio, so that you can really relay significant cost savings and operational efficiencies and you can and should probably go as far as to model a full financial performance Pro Forma, showing what the needed investments are as well as to project the sunsetting or the cannibalization of these older non-integrated technologies. In my experience, this approach, typically for an organization the size of Banner, will yield tens of millions of dollars in savings per each major portfolio over seven to 10 period of time.
Ryan Smith: This is fundamentally how we start to get our systems of records spend down into the sub 70% level of IT expense, if that makes sense. Okay, now, let’s play this out then, so how does this apply to the other … all of the other portfolios? Well, in essence, they all become their own solar systems to a sense but you obviously have, in several cases some of these portfolios can be combined from a single vendor, easily Epic can be revenue cycle and clinical apps as an example. I’d argue that you probably still want to maintain separate business driven governance structures even where you have a common vendor. Let’s move on. Now, let’s take a look at how we contrast a true partner from just mere vendor types of relationships.
Ryan Smith: Most of us, as IT executives, a different stages in our professional careers have either taken a mindset that we try to develop partnerships with some of our vendors or we learn how to pound them into submission and make them bleed, whatever is remaining in the turn up to get whatever cost we can out of them et cetera. Why argue, that we’ve talked about the importance of developing a handful of these core IT vendor partnerships and so key takeaway here is to partner for success and really make the partnership model a key requirement of the relationship, ideally before even contracting with the vendor. Now, that’s not always the case. In some cases, we might have more of a standard vendor relationship but we’re on a vendor’s platform and have been for a long time of what we still want to be our goal forward, platform for that particular area.
Ryan Smith: When that’s the case, then we need to kind of reopen up the partnership level conversations with these vendors and try to get them to come along for the ride. We also need to be truthful enough with ourselves that we’ve got to recognize that not all vendors can play at the strategic vendor partner level, even if they meet that integrated platform requirement. Some of these vendors are so focused on their quarterly financial results or in other words, are so focused on themselves and their investors that they’re never going to make a good partner, no matter how good their technology is. We just had to be careful in those areas but we can’t always avoid that.
Ryan Smith: Whenever it’s possible to kind of triangulate and find a vendor that’s has that fully integrated platform build on to modern technologies, seize the value in building a strategic partnership, then we’re going to really enjoy a much higher degree of success in that portfolio area and I’ve seen that happen time and time again. If you look down the right hand side, I won’t read through these but these are the kinds of things that really elevate a vendor to a strategic partner and I would argue that that’s what we really want to go after, when we’re talking about the center of that solar system and those larger orbital planets. We really want to get those vendors at a strategic partner relationship.
Ryan Smith: Now, there’s some risk that need to be mitigated in this approach, largely due to having far fewer but much more highly integrated vendors in each portfolio. Bottom line, it’s really important A, that the vendor is going to be around for a long term and so you have to do your risk analysis on these vendors. They’ve got to be dedicated to your success and they’ve got to be able to provide a modern open scalable approach to their technology. Especially as it relates to enabling your digital success over time. Okay, let’s take a couple of minutes now and we won’t have time to take a deeper dive into each of the 10 portfolios but let’s just drill into one of them as kind of an illustrative example.
Ryan Smith: You’ll see how you can kind of take a similar approach to each of the other portfolios in your own strategic roadmap plans. Let’s look at how the model we’ve been talking about today maybe applies to that enterprise data and analytics suite. For this example, we’re really talking about this level in our digital enablement framework and as I mentioned earlier, not that this layer is not only treated as a portfolio to drive your enterprise BI and analytics capabilities, that are kind of shown to the right of that layer but it’s also a foundational layer that’s supporting the digital process layer and application interface layers above it as well as being really a data aggregation layer for those systems and data generators down below it.
Ryan Smith: In this case, as in any of the other 10 portfolios, you need to provide context for where you are in your journey and where your organization desires to be and for this particular portfolio, when I was still at Banner, I used a prior version of this analytics adoption model that’s shown here to help the company understand and its executives how a data management and BI and analytics portfolio aligns the business and clinical improvement. This then kind of becomes the basis for establishing our vision in this particular portfolio area. This particular adoption model is kind of … I’ll call it, kind of standards based even though there’s a few other models like it that are out there, we have to choose this one.
Ryan Smith: It becomes a measuring stick to track our progress year by year as we work to evolve to … system wide, the levels five and above. It was also important to demonstrate the need for focus at the lower levels less all of our BI and analytic resources get tied up, always have the hunt for and gather data manually for each analytic initiative and of course, executives in particular, clinical executives, they wanted to jump right to level five and so that puts a lot of burden on analyst to try to support level five, waste and care of variation reduction initiatives when you’re working with a really substandard set of data platforms and systems and tools.
Ryan Smith: Organizations that don’t get levels one through four working pretty well, and pretty smoothly, typically find that their analyst are required to spend an excess of 80% of their time finding, prepping, fixing, hunting, whatever for data before they can really start to produce even basic reports, let alone meaningful analytics in that limited remaining time that they have. This become kind of the barometer for this particular portfolio or suite of highly integrated products for our roadmap. Now, along with getting buy in around the business driven governance model for the portfolio, I shared with our senior leadership team how the solar system approach would drive the search for our core strategic vendor partner, along with a couple of certified integrated secondary partners to begin to really drive the bulk of our data management and analytic capabilities.
Ryan Smith: Not all but the bulk as I mentioned. From a vision perspective, again, we recognize no one vendor can do it all, when I was at Banner. This includes being able to access virtually any type of data from any source and being able to rapidly aggregate and manage all of that data and then being able to produce and deliver meaningful insights in any delivery format needed and then finally and ideally being able to inject those insights back into broad business and clinical workflows at the frontline, whether that’s back into your EHR, whether that’s back into a separate revenue cycle system, the front line revenue cycle folks are using.
Ryan Smith: Whether that’s even back into contact center agents where maybe their system of record is a customer relationship management platform like Salesforce or something like that so these are all options. This kind of identified, hey, here’s what we want the broad portfolio to do and have that all be built on this foundation of governance, policies, process that the whole company could get its arms around. In summary, here’s a couple of takeaways, let’s carefully define digital in our organizations and let’s figure out how to tie our digital vision to each of your organization’s key transformation initiatives or goals.
Ryan Smith: Let’s rework how we’ve traditionally invested in IT to enable funding for digital initiatives. Third, let’s implement business driven technology governance to get buy in and alignment with our business and clinical partners throughout the organization. Finally, let’s pursue a strategic partnership approach to implementing these highly integrated platforms and focusing on some of those higher levels of the pyramid and the stack that are really going to enable your digital roadmaps. I’d argue that if you do that, you’re fundamentally going to start to transform your technology infrastructure and layers above that to really support what’s going to be meaningful to your business and ultimately to the members, to the customers, to the patients and other consumers of your organization’s services.
Ryan Smith: That if we do that, you’re going to be successful. It’s going to take time. This doesn’t come easily, it doesn’t come cheaply but I’d argue that done right, as I talked about those financial Pro Formas, there’s immense cost savings in going down this route but it requires investing upfront to get those down the road much larger savings and that ROI, you end up with systems, both internally facing and externally facing that are much more highly integrated and are going to be much more of a pleasure and a good experience for both workforce members to use as well as for your paying customers to interact with your services.
Ryan Smith: That’s kind of how I’ve gone about trying to sell this type of an approach and I hope that you all have found some value on that. I’m going to go ahead now and turn it back over to Sarah.
Sarah Stokes: All right. Great. Thanks, Ryan. Before we move in to the Q and A, we have a few giveaways for complimentary Healthcare Analytics Summit registrations. This is an annual event with more than a thousand provider and payer attendees occurring this year September 10th to 12th in Salt Lake City, Utah. The event is going to feature brilliant keynote speakers from the healthcare industry and beyond and this slide just gives you a glimpse at some of the speakers that we’ll be featuring this year. Let me go ahead and launch our first poll question here. If you know that you’re able to attend and are interested in being considered for complimentary passes for a team of three to attend the Healthcare Analytics Summit, please answer this poll question.
Sarah Stokes: We’ll give you just a few moments here and as a reminder, we are about to dive into the Q and A so if you have questions, now is the time. Go ahead and submit those and we’ll be sure to address them with Ryan in our remaining time. Okay, I’m going to go ahead and close that in three, two, one. All right. Then, again, on that same note, we have one other giveaway. If you know that you’re able to attend and are interested in being considered for a complimentary individual pass to attend the Healthcare Analytics Summit, please answer this poll question. The Healthcare Analytics Summit is just right around the corner now.
Sarah Stokes: This is an exciting event that we hope you’ll be able to join us for. Okay and we’ll just give you a few more moments here. All right, we’re going to do a countdown, three two, one. I’m going to close that poll and I’m going to have one final poll question that I’m going to launch and we’ll leave that out during any Q and A questions. While today’s webinar was focused on building blocks for digital innovation, some of you may want to learn more about the work that Health Catalyst is doing in this phase or maybe you’d like to learn more about our other products or professional services. If you would like to learn more, please answer this poll question. We’ll go ahead and leave that open as we dive into our questions.
Sarah Stokes: It looks like Marianne had kind of like a twofold question here so maybe we’ll take them one by one. She ask, what are your thoughts on these issues and the first was, how EHR and documentation is contributing to physician burnout?
Ryan Smith: Okay, great question, thank you. I’d say there’s a clear linkage to EHR, EMR documentation and physician burnout. All of us, due to Macron, so many other federally mandated kind of CMS efforts have really pushed so much more burden to our physicians and also, I think oftentimes the way that we have implemented our electronic health record systems has further contributed to it, enough so that even at Banner Health, they had to kind of start tracking what was called pajama time as a formal metric for measuring how much work, physicians in particular primary care physicians are having to take home at night with them, to finish up documentation requirements et cetera.
Ryan Smith: Yeah, this is a real issue and it’s one that as an industry, we have to really figure out how to get our arms around. Okay, and second question, thoughts around major problems with security and privacy and IT hacking, et cetera, leading us to moving back to paper records. I think gone are the days that we would have a return to paper records. There’s just too many efficiencies around documentation, around billing, around quality measures, everything else that come out of having data in an electronic format but it really ups the ante in our industry just like it has in the financial sector and other industries, banking et cetera to make sure the security and privacy is getting the level of investments and having the level of resources dedicated to us so that we can be safer and it’s a big challenge. Thanks for that question.
Sarah Stokes: Right, next question comes from Benjamin who asks, how does Ryan see the function of enterprise architecture contributing to digital transformation in a healthcare organization?
Ryan Smith: Yeah, great question. Thank you so I think enterprise architecture plays a huge role in digital transformation. The spaghetti mess diagram that I showed in my slides, it’s not an exact representation of any one of our organizations but it’s a real issue, with the number of siloed antiquated approaches that we’ve taken that have just build up over time and so, enterprise architecture has got to be able to see the picture of the whole puzzle put together and when all pieces are currently part of it where the gaps are in the puzzle and to start to fill those out. The answer is, double thumbs up in terms of enterprise architecture’s contribution. They need to be highly involved.
Sarah Stokes: Right. The next question comes from John who asks, how do build versus buy solutions and success rates vary between small and large organizations?
Ryan Smith: Great question. I don’t know that I know the exact answer to that. I’ve worked for two very large organizations, that are both highly integrated delivery networks, that span acute operations and ambulatory clinics and urgent cares as well as payer components et cetera. I can tell you both organizations had a predominant build mindset, especially in their early stages but over I’d say the last five to 10 years, I’m seeing that begin to pivot really significantly to try into buy solutions et cetera. Now, how that varies again between small and large, I can’t exactly say but I would argue that there are not enough time skilled resources and investment dollars to try to build all this stuff on your own these days.
Ryan Smith: It gets back to, let’s take a partnering kind of strategy. Let’s get really strategic vendor relationships that are there and have our backs. Let them take on a lot of that heavy systems integration work both within their own platform as well as with their certified partners and let’s have that really be the catalyst for our digital enablement such that we then can deploy our teams in smaller numbers to do true innovation around the edges of that and not have to be so deep in the bowels of these systems. That would certainly be the hope.