Interviewer (I): We are joined by Michelle Woodley, Chief Nursing Information Officer and Dr. Michael Marino, Chief Medical Information Officer of St. Joseph health system. Michelle and Dr. Marino, thanks so much for taking the time today.
Michelle Woodley (MW): You are welcome!
I: Alright! Really, we really do appreciate it. Why don't we start with you Dr. Marino. Could you give us a little bit about your background?
Dr. Michael Marino (Dr. MM): Sure… Um… I'm a pediatrician by training. I have been the Chief Medical Information Officer at St. Joe's for the last four years. Prior to that was in hospital administration and private pediatric practice.
I: Perfect! And Michelle?
MW: Hi. I am a nurse profession and have been involved St. Joseph Health for over about 20 years. Came up through the ranks and files both in administration and then joint clinical informatics about probably 10-15 years ago.
I: [Laugh] So you joined in on fun
MW: I did!
I: Perfect. Dr. Marino could you give us a 10,000 foot overview of St. Joseph Health System?
Dr. MM: Oh I'd be glad to. St. Joseph Health is based in Irvine, California. We are 17 acute care facilities or hospitals across California and Texas, two foundation medical groups. St. Joe’s health was started by the Sisters of St. Josephs of Orange and has been taking care of the communities for over 50 years.
I: Great! Really interested in you guys’ perspective for where you sit. Everybody’s got a little different somewhat regional but as you guys are really guiding the IT strategy for St. Josephs, what do you seeing as the top three health IT trends for 2016? Dr. Marino, why don’t we start with you.
Dr. MM: I think number one, being able to take all the information that we make clinicians enter into the IT sources over the last 10 years and be able to discern it down so that they can be helped. Predictive Analytics, to the socialization of medicine, there is an expectation from our patients, our consumers or clients; that healthcare will have a feel like everything else that they touch, be able to access it from their phone, be convenient. And I think last, and its partly part… probably part two, number two is Telehealth. There is this expectation that I’m not going to have to go to the doctor. Why do physician offices have waiting rooms? I don't want to wait… I'm busy. Everybody is, you know, doing everything on the fly and there's an expectation that they should be able to get part of their health in that same manner.
I: Michelle, I’ll do a brief follow-up with you may be just on the Telehealth, on our show in the fall I did over 35 interviews with Telehealth vendors and really dug in; and my unscientific analysis is, if you look at the types of visits, there's many types of visits that could and should be done by Telehealth. Is that how you're thinking?
MW: Yeah definitely and you know, we as being clinicians we… we understand that there are times when Telehealth will not work, right? And so helping the populations understand that and… and accept when it will and still take the science of medicine and know when it can be delivered in that round and when its not appropriate.
I: Absolutely! So surgical follow-up visits are perfectly appropriate but if some sort of hands-on intervention is needed obviously you know, Telehealth is not going to work. But it may identify the hands-on and may speed up the process.
MW: May triage them to the right… appropriate care.
I: Good deal. Michelle I will throw this one out to you. First, what are the challenges that are keeping you up at night?
MW: You know one of the things that I think we're certainly committing ourselves to now is, you know we really have spent the last several years, the hard hard work of laying the foundation and putting in EHRs… much to the clinicians and the physicians you know, on their backs, right? And they are doing a lot of with that. I think we're really committed to how do we now start to give back. How do we start to let them use their data transform care and really see a win and this for them? So that's really what keeps us up at night is trying to make sure we can… we can deliver that.
I: Yes. Unfortunately things like meaningful use made us do unnatural acts that were probably taking [Inaudible] to our physicians… I see both of you shaking your head.
I: I am sure there were lots of screaming matches or high voice matches in your offices over the last few years. Dr. Marino, you mentioned predictive analytics. What do you think the role of predictive analytics is going to be in this new healthcare landscape as we move from laying the infrastructure to really taking advantage of what would like?
Dr. MM: Yeah. I think it’s going to be an evolutionary path to Michelle's point. You know, we spent 10 years entering data you know, you have EMRs in the ambulatory environment, in the acute environment, people are entering health care. How do you bring that together and be able to say, you know with this set of symptoms, with this history you're likely to have this problem in the next six months, in the next three months. With your history of filling prescriptions, with your demographics, you know you're more likely to be readmitted than the guy across town. Because we have limited resources in US health care and you don't want to go and blanket the resources across to everybody when they're not needed for one segment of the population and you need twice the amount of resources for another. So just to make us smarter in healthcare.
MW: And really, right! Really add to that you know, you know the retail markets and those sorts of things for years now have… have known how to look at a lot of data outside of that and health care has been pretty siloed in looking just at our data. And I think it's that… it's that bringing all that together, that knowledge about the individual that will help us treat them better and… and help keep them safe.
I: Good deal. I am going to go off-script a little because we did this telemedicine series and ask you guys from your perspective as a health system, one of the things I discovered through all these interviews is, some of the success that we're having as a country in Telehealth is really disintermediating … what I call disintermediating the health care system. So we're furthering the doc-in-the-box, we are furthering services are provided outside of what you provide; which might be convenient at the… at that point for a patient but they don't… for example, that doctor doesn’t have access to the EMR that he worked so hard to lay down and they don’t have the history of those kind of patients. What’s your perspective and does that give you… are you feeling some of that and does that give you added incentive to get your Telehealth services really so that people can shop off the convenience of active Telehealth?
Dr. MM: Well, I think you laid out the landscape perfectly. If Telehealth is only in a retail space like urgent cares, we’ll have the same problem we saw 10 years ago with urgent cares as people go there for episodic care and then nobody would remind them that they needed a mammogram or colonoscopy. Or myself as a pediatrician people would take their kids there for the colds because it was easier than getting into our office. But then they would show up a year later; year and half later and go oh you missed vaccines, we didn't do a developmental screening or hearing screening. So I think mainstream healthcare needs to embrace Telehealth; so it becomes part of the continuum, so that we give the convenience to the patient or the consumer but still do that overall management of their care and not just make it a retail experience where you run in and buying the cookies or running in and getting your cold fixed, but you are not seeing the big picture of your overall health till its too late.
I: Michelle, I’ll throw this one to you. What are the top three or four things you guys think of as you sit down each year and you're kind of putting a touch up on that next Three to Five-Year plan for your IT… system?
MW: Certainly I think the… the things are going to look forward to is certainly predictive and probably even more so prescriptive analytics, right? Really, how do we get that predictive analytics in the workflow of the clinicians so that they can truly use it? So those are big ones for us and then I think, continuing to optimize any of the systems we've already put in place, in some cases we try to make things more complex than they need to be. So how do we keep that… keep that complexity out. And then as Dr. Marino said, really the… the customer facing part of our business making sure we have good relationships with those patients. Those are all key you know, how do we communicate with them, how do we communicate across to all of our clinicians.
I: Good deal! Dr. Marino, this one is really one of particular interest to me. As you find these new technologies over the next couple years or even over the past few years, what is your approach to making sure you get the best adoption you can of new technologies?
Dr. MM: Yeah. It… it's a great question and I think it's something the industry has struggled with in the past. We’ve taken small numbers of people and run around and bought something that was flashy. Versus making sure and you know, in healthcare our healthcare providers going to have two consumers; the people actually rendering the care; because you want them to use the new tool. And does it meet the patients needs? And healthcare systems, hospitals, large medical groups have been a little parental and decided what they think meets those two customer base needs. And it really has to be a conversation between what is the patient expecting, what can the clinicians use to be able to meet those patient expectations and not be decided in the boardroom, with a vendor which is where healthcare IT has been for a the last few decades.
MW: Yeah, I think as we’ve been meeting vendors here at HIMSS or whatever, I think we tried to continue to educate them that it's great to come up with these new things that will put something else in front of a clinician, but ask them, and challenge them to really think about yes - what is in for the patient, but what's in it for the clinician as well. And then you know, ultimately like you said put that triad together and you know have our vendors work for both the patients and the clinicians.
I: Yeah like a triple aim, right?
MW: Yup. Yup.
I: Perfect. So we are here in Vegas. Think of a roulette table. And we are going to put our money down on one of these emerging technologies that somebody here is showing. If you had to place a bet and say we really got to commit to this thing, or 3 to 5 years down the road, we are going to be a lost market share or be out of business, we are really going to be affected. What do you think that one thing might… might be? [Pause] Dr. Marino?
Dr. MM: I think its Predictive analytics. We hear time and time from the clinicians is we're adding more and more information that they can't take it and process it by themselves. You know, its like oh we found this and we're going to deliver to you and the doctor just saying no… you gotta deliver this stuff that's important but I can't see the other hundred items because it's just overload. And we really have gotten there and health IT at this point, there's so much information that a human being by themselves cannot comprehend for one patient the amount of data points that are in the picture
MW: Yeah and I would say also predictive and prescriptive analytics just because you know, we’ve… those of us who've been in this industry for many, many years, we've done all the hard work, right? We put in those systems. We’ve utilized the data. You know we’ve got it on dashboards and those sorts of things. But we all hope before we leave our careers, that we get an opportunity to see it truly transform care and I think that's the roadmap for predictive analytics.
I: Well I'm glad you said that. If we had a way to do a sort here in Vegas and put all the m-health vendors in a place, they’d probably fill the hall we are in here in exhibit G. And I think that's their challenge, you know you got Fitbit data, you got data that will connect your heart, your watch. Umm if we… if those vendors who’ve been talking for years about having interesting applications to give that data to a physician, in their work flow, in a way that helps him treat those patients; it's just interesting data, right? And you might find one or two physicians that say oh… I love to have it and I'll dig through it and do all the spreadsheet work and, but you gotta really give it to them in a way they can act on it and they can have a meaningful conversation with their patients, right? Who might look at all the data, but the physician just doesn’t have the time to sift through all the data that comes through every single time.
MW: Or they might miss something, right?
I: Exactly right! One question I love to ask each guest as we get close to the end and I'll ask each of you. Start with you Michelle, what is on your must-do list while you're here at HIMSS, what do you have to have to accomplish while you are here?
MW: You know, this year we have set out to meet with a couple key vendors. I think more so we are just really trying to hone in what is it that we might be missing in our tool chest. So you know, certainly were looking at Predictive Analytics, things with population health. And any kind of newer… newer item that might just be you know, fitting into a niche of where we feel you know, some communication tools and those sorts of things. That's kind of what we're looking for.
I: Good deal. Dr. Marino do you have anything to add?
Dr. MM: I think the other thing to add is clinical decision support in real time. You know the breadth of data, the breadth of medical knowledge is literally changing by the hour in the world today and you know, the average physician in the United States is in their mid-fifties. So they're trying to stay up but how do you stay current you know 30 years out of medical school. Or for the patient that you see once a year, or God forbid even worse once every five years, being able to take the big picture and then quickly look up the specifics to provide the best possible care is what a computer should be able to do. I mean, its what we do in non-healthcare, right? You quickly look things up you know, it's there in real time. I’ve used the example of my house. Nobody loses an argument any more without facts because everybody pulls out their cell phone and goes its not my argument, its right here and you show it to them, right?
I: I love it. I love it. Wonderfully said. Thank you for that. Michelle, we're winding down here. Before we let you go, where can people go to learn more about St. Josephs.
MW: Probably the best place would definitely be our website. It’s rich and has a lot of information, key contacts with that and certainly feel free to reach out to Dr. Marino or myself.
I: Perfect! Well Dr. Marino and Michelle, thanks so much for joining us and for sharing your insights and wisdom. We really appreciate it.
MW: Thank you!
Dr. MM: Thank you Joe.
I: Oh it's our pleasure for sure. And that wraps this broadcast. Once again we want to have a quick shout-out to our sponsor Jvion. But on behalf of our guests Michelle Woodley and Dr. Michael Marino, I am Joe Lavelle and Intrepid HealthCare coverage from HIMSS16, we'll be right back.
- Intrepid Healthcare’s exclusive coverage at HIMSS16 sponsored by Jvion