While healthcare as an industry has made great strides in patience care and overall customer experience, state of Government supported health systems warrants serious attention. Lack of connectivity and interoperability among hospitals, rising re-entry and trauma cases related costs, inadequate reporting for securing federal funds is a partial list of issues plaguing the systems that need immediate attention. It requires cohesive effort from Government CIOs, Data Scientists, Policy Makers, and Researchers to solve this pressing problem. What is being done in this regard, challenges faced and results of related efforts?
Contributors

1. • Vikram Sobti, CMIO, Norwegian American Hospital
   • Robert B. Steele, Commissioner, Cook County

Transcript

Sanjog Aul [00:00:26]:

Hello and welcome to CIO Talk Radio. To learn more about the show, please visit wwciotalkradio.com as always, we invite you to join the discussion on Twitter Ctrlive and look for this show as healthcare. Today’s topic is Enabling Government Healthcare Systems. And our guests for today’s show, Robert Steele, who’s the Cook County Commissioner. Hello Robert, how are you?

Robert Steele [00:00:51]:

I’m very well, thanks. How are you, Sanjog?

Sanjog Aul [00:00:53]:

Very good, thank you. And we also have Vikram Sopti who is the CMIO, which is chief Medical Information Officer for Norwegian American Hospital. How are you Vikram?

Vikram Sopti [00:01:02]:

Very well, thank you Sanjog.

Sanjog Aul [00:01:04]:

Very good. Great to have you both. Now we have had a number of conversations on healthcare transformation where organizations are innovating and perhaps working towards providing memorable experience to the patient and family almost in some cases they are even using hospitality or getting inspiration from hospitality to how to provide a luxurious and a memorable experience.

Now,on the other hand, we have government health systems which in some cases are struggling to have interconnectivity among hospitals, effective data management and in some cases even basic reporting to get grants, which is the very lifeline for such organizations. So life of those who depend on government health systems are basically equally important and thus it is important that these issues are addressed and what are those issues, what is causing them, who all are responsible and how we are to work together to address them is what we would like to discuss today. With that said, Robert, let’s start with you. If you were to take an inventory of the issues that may be undermining the government run health systems in context of the goals and objectives that it may have.

Sanjog Aul [00:02:15]:

What are those, what are those challenges and issues?

Robert Steele [00:02:18]:

Well, it’s a new start of conversation with us in an area that we are trying to make sure that we have connectivity among the leadership of our organizations to help us to understand how we best collaborate and make sure that we are reaching our patients and so we’re trying to innovate ourselves to the point that we are working with partners in the private sector who are the thought leaders in the process to help us put together ideas and resources that can really make us more efficient and again, the biggest workforce is efficiencies. How do we gather information and share data among ourselves that are really keeping our patients in connectivity with their care providers and make sure that information is flowing around our system. And so we’re keeping up with the tracking systems of those patients to the reporting systems that we have to send information through to the government and so our communication is really the biggest issue.

Sanjog Aul [00:03:16]:

Now from your vantage point Vikram, when you are looking at your organization, I’m assuming is it a privately held or a government health organization that’s a privately.

Vikram Sopti [00:03:26]:

It’s a privately held hospital and a safety net hospital really attracting nearly all medicaid or public aid patients. So safety net hospital of Chicago.

Sanjog Aul [00:03:36]:

So from your vantage point, since you work on the private side of things, how do you look at if you were to benchmark what a healthcare system should look like versus what we are seeing as a state of government run healthcare systems, what would be your take question?

Vikram Sopti [00:03:54]:

Because there’s many metrics you can measure hospitals in and the biggest driver that not only all hospitals sort of follow, but all government mandated issues are from via the joint commission is something called quality and not only quality, but interoperability. So in quality there’s many, many avenues you can go down. For instance, you have to have an EMR, an electronic medical record that is using, that is being used properly in so called meaningful use is a platform set forth by the government stating how you use your electronic medical record properly. Are you inputting all of the medical reconciliation through the patient every day, are you doing a family history, are you following up your patient with portals, etC. So the government is mandating many areas of electronic medical record use. Now these medical record use, it’s robust. There’s over 60 different EMR’s and that’s a small number assessment.

Vikram Sopti [00:04:47]:

They’re not interoperable at all. So a hospital in Chicago may not be the same EMR as a hospital in another part of Chicago and these patients, if they go between these hospitals, their medical records don’t follow them. So for us, when we take a lot of medicaid patients, they may come from every other hospital around the city, maybe from Cook County Hospital, maybe from another safety net hospital in the city. We need to understand what was done for them at other hospitals so we can be very efficient in how we treat them and we can follow up their action plan so we’re not wasting time and effort and energy redoing the CTs that they’ve already gotten, redoing the laboratory values they’ve already gotten and as a private company, as a private hospital, we’re only reimbursed what we’re doing properly. So it’s important for us to be ahead of the step to have a good analytics paradigm, have a good EMR and interoperable technology, to understand where we stand with these patients, to reach out to other physicians they may have seen, etc.

Sanjog Aul [00:05:48]:

Now, when you look at these issues, Robert, if you were to say, okay, these are the issues that we have, and we did talk about leadership and did we talk about technology, what is triggering this? So it’s not that the people are not capable or, yes, we can say the resources are not there, but it seems like some taxpayer dollars are going into funding such initiatives. So what are the bottlenecks?

Robert Steele [00:06:14]:

Well, I can only share what I’m aware of, and I don’t have all the background, particularly for our hospital system, on what really are some of the key driving points that don’t keep us as effective as we like to be. But I know that our CIO team at the hospital are doing the best job to make sure that we are being innovative. As we just heard from the last speaker, she was talking about the platform that you’re on with these EMR systems. It’s very important that our system is being utilized by our staff and making sure that they’re doing the input every day to make sure that information is online and available to the system itself and where we can share it with other organizations, and particularly within our own system. It’s an adjustment for us and I know that we are doing that job right now and making sure that all of our staff are trained to be on that system and do the daily input that we have to do to make sure that information is flowing throughout the system for each of our patients that we’re caring for and so the ability to get folks trained and get people actively engaged in the discussion as to how this information should be brought online and shared among our staff is really one of our key areas. And so I think that being more aggressive from our internal standpoint and leadership standpoint to get information out there is really the key for us in helping to make sure that we are doing the best job we can to meet the guidelines of federal government and federal regulations that we have to get the compensation for the work that.

Robert Steele [00:07:41]:

That we’re doing and caring for our patients.

Sanjog Aul [00:07:44]:

So, Vikram, sitting outside, what do you think if you were to do, come in as $1,000 per hour consultant to a government healthcare system, how would you go about doing the diagnostics to understand where the issues are?

Vikram Sopti [00:07:59]:

That’s a very good question. So every hospital today sits on a ton of data. The data is in the form of patients, not only patients, but DRGs, disease related groupings and the government is shifting towards a fee for service to a value based system. So rather than having a patient with diabetes continually come into the hospital and every time he comes to the hospital, you bill for him. Now you’re treating his disease as a single entity and you want to keep the cost low because whatever they afforded you in the beginning of the year, that’s all you get to treat his disease. So the analytics around how to keep patients out of hospital, I think the transition is slowly being made that we need to move patients from inpatient to outpatient services. We need to make more of a task force against preventative medicine versus diagnostic medicine.

Vikram Sopti [00:08:46]:

Now that being said, in America it’s very difficult to just shift a paradigm quickly. So I would identify top areas you’re utilizing poorly. For instance, if you note that your readmission rates, which is a patient is discharged from your hospital within 30 days of their admission, that’s called a readmission and there’s a penalty. Some hospitals can pay up to $7 million per year. Small hospitals can pay up to $700,000 per year based on these penalties. Now that’s one of the most easy ways you can sort of remit your payment to the government because there’s areas you can use quality, you can use assurance, you can use home health, you can use many new metrics to keep your patients out of your hospital. That’s one of 50 new metrics that the quality scores and the Joint Commission have put in place to suggest these are areas you would target.

Vikram Sopti [00:09:37]:

So as a full time consultant, if you hired me tomorrow, I would give you the top 15 areas that you are just hemorrhaging money. And these would include readmission rates, these would include catheter induced UTIs, central line associated infections. There’s a whole list of core measures that they’ve elucidated that could be harmful and hazardous to your hospital. But more importantly, not only in quality, they’ll penalize you financially and these are all reportable data based on how your patients are received. And now with the new emr, you have this documentation, I would simply start there.

Sanjog Aul [00:10:15]:

So coming back to Vikram use, I’m sure you would be more looking at this and saying there are a number of issues. So suppose you do the diagnostics and you do find out there are 10 problems that we are dealing with now. What is happening with respect to rationalizing and prioritizing? Because this could be such a big problem that you have to take bite sizes and then solve them. How do you go about doing it in such a situation?

Vikram Sopti [00:10:44]:

So like you said, prioritizing is a huge issue. We can understand the financials and metrics based on each issue. But even speaking on behalf of Commissioner Steele’s Cook County Hospital, which I was trained at and was at for four or five years, even for government institutions, the problem is the regulations are not specific to hospital based, hospital type or public or private. They’re across all. So the Joint Commission will mandate an issuance across all hospitals. So when looking at these major concerns, there’s the top 12 core measures that every hospital has to follow for joint Commission status and then once you get those joint commission status, you’re graded amongst your peers. So I think looking at those top 12 status of the core measures is a very, very easy way to begin your analysis and then from there do a deep dive.

Vikram Sopti [00:11:33]:

So for instance, for every patient readmitted, that’s the same for Cook County Hospital, the same for Norwegian American Hospitals, the same for Harvard on the East Coast. You cannot have readmission rates. Now Cook county has a little different strategy in how they’re going to get their patients not readmitted because they have seven or eight satellite hospitals, while Harvard may have a home health institution so I think all the problems really are looked at the same way. Prioritizing based on your financial need and area of concern is the way I would start.Thank you.

Sanjog Aul [00:12:05]:

So, Robert, when you look at this, the issues that are there, and yes, you can only fight so much with regulations, but what are other. I don’t know if it’s an English term, fightable, but it’s something which you can really addressable issues that are there which you feel got introduced into the system. But what was the trigger and why did it start degrading and how long ago did they start degrading?

Robert Steele [00:12:34]:

Well, we said when did it start degrading? Yes, well, I can’t say when it started degrading. I think that over the past two years we’ve been working very diligently to keep our, to get our system moving in the right direction so we can be online with, working to meet the regulations that we have with Joint Commission and other regulatory bodies. I don’t have a perspective as to, because I’m not a part, I’m sorry that I’m not a part of the CIO direct information line at the hospital system to give you the detail of that at this point. But certainly I know that we are getting the reports from our team at the hospital that we are moving in the right direction to keep things to a level of production at the hospital that is meeting the guidelines to keep us on a regulatory responsibility to our patients care and so we are definitely on the right track at this time to bring things online and make sure our patient’s information is being shared in a way amongst our colleagues at the hospital system and keeping us moving forward so our patients are going to be cared for in a very diligent manner and you know, that’s as much as I can tell you at this time on that particular area now.

Sanjog Aul [00:13:49]:

So that said, on the CIO side, I totally understand that’s not the responsibility you have when you kind of go up a little. Where we say that these are the people it says CIO needs funding or the regular people who are trying to address this issue. They need the stakeholder permissions, blessing and support and sponsorship. What’s happening in that area? Because many times when we say things are not working right in an organization, we can definitely go back to the leadership and you can usually find some issues there. What could be happening which is triggering or what we can at least point to say this is what we could change at the top for the rest of the organization to follow a positive path ahead.

Robert Steele [00:14:33]:

Mark, with me, I think we’re doing the right thing and making sure that we have a leadership team that’s very open to understanding the needs of its leadership. In our information technology area, we are doing consideration as to what are the best practices out there. We’ve heard from other institutions and other technology leaders on what’s working well and we are open to the consideration of new technologies that we may need to bring into our organization to bring our compliance areas into the right focus and so I think that we are doing the best in consideration of consultants and not just having an open platform for individuals to come into our organization to take advantage of the financial capacity that we can support and financially pay for things but we’re doing that good job of consideration of what works well for us and what’s not working well for us and making sure that we are getting the best practices that are out there and bringing them to Cook County Hospital as a way that we move forward from this point now.

Sanjog Aul [00:15:37]:

So Vikram, in many cases we get inspired by some others we like to emulate some other organizations which have really nailed it and they understand and they are running like a well oiled machine. We’ll take a quick break and when we come back, I’d like to at least present to the listeners what a good healthcare system looks like and which are some of the organizations you can take names or you can choose to take names there, but at least what would be the blueprint that we should have which we look up to and then follow suit? Please stay tuned listeners. We’ll be right back.

Speaker A [00:16:23]:

HP is proud to sponsor this program. Find out how the HP as a Service solution for SAP HANA can help you gain instant, impactful business results without capital investment. By logging on to hp.com transform information into intelligence and a competitive advantage with a full spectrum of SAP HANA products and services from hp, a global SAP hosting partner.

Speaker E [00:16:53]:

Bosch Software Innovations is proud to sponsor this program. Visit www.bosch-si.com Connected Manufacturing to find out how Bosch can help you improve your operational performance and become a manufacturing industry leader in a connected world. Change the way you predict, manage and produce outcomes. Bosch Connected Manufacturing.

Speaker A [00:17:25]:

HP is proud to sponsor this program. Tap into our expertise, innovation and services to bring your most important workloads to the cloud. You are listening to CIO Talk Radio with Sanjog Aul. To learn more about the show, please visit www.ciotalkradio.com. if you have a question or comment, call toll free at 1-866-472-5790. That number again is 1-866-472-5790. Now back to the show. Here’s Sanjog Aul.

Sanjog Aul [00:18:10]:

Welcome back. So Vikram, when we look at the blueprint of an ideal organization, what would that look like? So that we have something to get inspired by and something to follow and emulate.

Vikram Sopti [00:18:25]:

Sure.

Vikram Sopti [00:18:25]:

So there’s a number of ideal organizations out there and what they are is a form of interoperability between not only their home hospital but their satellite clinics, their other satellite hospitals in other areas. And that by interoperability it means that the patient can go to really the main hospital, be admitted, go, then be discharged, follow up at a private clinic near their house where the patient is seen, all the notes, all the labs, all the entry is beamed to that physician. But more importantly, the patient is then privy to all of the electronic remittance that came from the hospital. For instance, all the laboratory values, all of the reporting from the CT, X ray, all the reporting from the notes, etc and all of that should be made able to the patient to be seen. So this system would then allow the patient to be engaged in a universe for that hospital regardless of where or when the patient is and it’s also empowering the patient with their own electronic health information, which is something that not only I strongly believe in, but the government endorses as well. Now, there’s a number, a number of institutions that do this.

Vikram Sopti [00:19:40]:

Well, Kaiser Permanente on the west coast, which is one of the largest institutions, has numerous satellite clinics spanning all of California and Oregon. And what they do is they keep their patients within their universe. But more importantly than that, rather than having the patient guaranteed within their universe, being seen by their physicians, being seen by their outpatient physicians, inpatient physicians, etc. Followed up with their specialists, they keep analytics and what they do is they track this data. How is this patient doing? Do we need to reach them more often? Do we not need to reach them as much? Do we need to send them reminders for their colonoscopies? Do we need to send them reminders for their breast health? There’s a lot of areas that you can use this data once they’re within your network, and once you use the data properly, you’re keeping that patient healthy rather than waiting for them to be sick. And we’ve adopted that method. Norwegian American Hospital is one of the strongest safety net hospitals in the city.

Vikram Sopti [00:20:35]:

And what we’ve done is we’ve created a patient portal in which patients can now sign up once they’re admitted to our physicians group or admitted to our hospital and they can look at their laboratory values or look at their X ray reports or CT reports at home. And they have to have questions, they’re welcome to click a button and they can ask us questions, or they can call in, they can keep connected with our hospital. And this is just one way that that we’re combating increasing costs and decreasing reimbursement. So this is just a model that we’ve taken from large institutions and made it a microcosm of our community.

Sanjog Aul [00:21:10]:

So Robert, I see that people like Vikram and his counterpart in government healthcare system must be doing or trying to do their job. And I think there is definitely a place for the private and public partnership and there is definitely a place for people like yourself who are able to help smoothen the transition or communication between the government entities as well as the people who are trying to make a difference and create value for the citizens, how all that ecosystem is currently structured for it to provide the best value. Robert, perhaps we lost him again. So coming back, I think while Robert comes back, Vikram, when we go back and say, let’s talk about the accountability side of it, one is that, okay, we know what the right things are that we are supposed to work on, second is to make sure that we have people who have been given the authority and the empowerment to be able to do so, and then at the same time they’re accountable. So all of these things have to be put in place for the dream state to be achieved. What is happening, whether it is you take a private organization or a government healthcare system where all does this lack of accountability or responsibility, etc, occur and what are the reasons for it for people to not be able to execute on the strategy and thus everything starts going spiraling down.

Vikram Sopti [00:22:48]:

So with respect to your question, the first and foremost thing you need from anybody to combat what the errors we just described are is that you need a forward thinking administration. So you need a CEO or CMO or Chief Operating officer, one of the three, to understand the importance of technology and understand the importance of data and analytics, etc. So what was left to the Chief Information Officer many years ago was, you know, they had pagers, they had servers and they had computers and they were doing a phenomenal job because this is all it took. Well, my role, like I said, I’m Chief Medical Information Officer, I’m a radiologist by trade, I’m a diagnostic board certified radiologist, I went to medical school, I did a fellowship in advanced imaging and on top of that I did a fellowship in informatics, which is really the throughput and efficiency in regards to IT as it relates to clinical information. So my role is a new role in the hospital setting. I was lucky enough to meet my boss, the Chief Operating Officer at Norwegian American Hospital, who’s also a fellow of Clinical Informatics from Yale, who understands the importance of using medical technology and medical information technology separately than pagers, bus systems and servers. So when you look at it, there’s a new role being created in almost all hospitals now. If you don’t have it, it means you don’t really understand how technology plays a role in the future.

Vikram Sopti [00:24:17]:

And those are the hospitals that are really, really failing. A lot of the safety net hospitals in the city of Chicago, their hierarchy is really one of a CEO and then maybe a CIO and that’s it. And they don’t understand that. It’s not that technology isn’t important. It’s now paramount. It’s become central to everything you do in a hospital. You need a medical lia, you need someone on the medical side to champion this. And that’s the area where a lot of these hospitals are failing miserably.

Vikram Sopti [00:24:45]:

If you don’t have a proper hierarchy, if you don’t have the proper understanding of how technology can be an important crutch, and if not a Crutch the central aspect, your central standing point of the hospital, you’re going to fail, you’re going to fail and you’re going to fail miserable. So I think the first thing you need is a hierarchy that understands the importance of data and analytics and informatics. From there I think you need to follow a suit and hire, you know, from top down leadership that can otherwise understand and organize this data. And that’s what we’ve done. And that’s why we’re, that’s why we’re probably the most successful facing the hospital in the city.

Sanjog Aul [00:25:18]:

So when the people who have tried, I’m sure everybody has the right intent and they want to do it, where do things fall short? Is it because we don’t understand how to be good data scientists or we don’t know how to interpret the outcome?

Vikram Sopti [00:25:34]:

Great question. Because you know, a lot of people, what they’ll do is they’ll just outsource it to consulting who understand the data is important and then they’ll get a report. And the implementation side is where they fall short. Right. So what will happen is rather than having, so they don’t, first of all, they don’t have put a credence on data, they’ll say, yeah, it’s important, let’s just have a consultant. They’ll hire one of the big four, Accenture, McKinsey, Bain, Huron, and say, why don’t we just get a consulting report? They get the report back saying, you need to do xyz. And now since you haven’t hired anyone to be the operational side, who’s going to implement all the data analytics that they just told you to do? Who’s going to implement all of the new strategies that they told you to do? Because the CEO never placed credence on the data. The CIO is a great, great, great person, but he needs a counterpart on the medical side to understand EMR implementation, patient analytics, etc.

Vikram Sopti [00:26:24]:

So it’s really on the operational side and this is really a problem because funding is a problem for many hospitals. It’s a whole new position being created in the C suite and I understand the reservations being on the administrative side. I understand the reservations is creating a whole new line of hierarchy and structure and how much that will cost. But they have to understand the return on investment is huge and they just don’t believe that it’s the people on the operational side that will make it work. They just believe it’s the technical side that’ll come back.

Vikram Sopti [00:26:53]:

And that’s the area of concern for Instance, if I cannot drive stick shift and you build me the greatest Lamborghini, there’s no point in me driving that car. So it takes both the learner and the technology and the background to understand this. So that’s where I sort of view my role in the hospital. I’m helping it grow , I’m helping operationalize revenue, I’m helping optimize revenue on many scales, I’m helping bring different revenue streams to the hospital which they never thought of, and then my return on investment is going to grow yearly.

Sanjog Aul [00:27:25]:

Now, you mentioned about all of these things, and you said that the people may not adopt. So you’re thinking that in many cases the technology staff might do things, but there’s an inertia or, you know, the fear of the unknown or jumping into an unknown territory.

Vikram Sopti [00:27:41]:

I can cut you up there because 100%, the adoption of electronic medical records is only at 50% today. The adoption of electronic medical records is only at 50% today. Currently, the government does not accept any other form of medical records keeping. However, physicians with the inertia are only adopting electronic medical records of 50%. That means to tell me that once they start penalizing in 2017, and they’ll penalize you by about a percent to 10% in that range of your Medicare billings, whether or not you used an EMR. That just proves to me that there’s such an inertia in the physician base. Saying how we can, how we practice is the way we’re going to practice. And that inertia is really crushing because the days of 1970s are gone.

Vikram Sopti [00:28:26]:

This is a new era of 2015 and the ways we treat patients are completely different. The way we get reimbursed is completely different so understanding these nuances is very tough to try and convince a whole breed of physicians that have been trained prior to this change and it’s totally understandable and I actually applaud the physicians that have changed, because once you’re trained in a certain way, for instance, I went to four years of medical school. I did five years of residency, I did two more years of fellowship understanding this, 11 years of my training and then in six years, you’re telling me I have to change the way I train

Vikram Sopti [00:29:06]:

that’s going to crush my soul so I understand that, I completely understand that. I just think the whole purpose of being a doctor is being dynamic enough to take any punch and roll with it. So it’s not that it’s their fault, and I hope it doesn’t come off as that. It’s just that this is what the government has thrown our way. This is a new era of medicine and we just need to be dynamic enough, be nimble enough to change with it. And that’s sort of a problem for many hospitals.

Vikram Sopti [00:29:31]:

It’s a problem not only for many hospitals, but problem for many physicians as well.

Sanjog Aul [00:29:36]:

Let’s take a quick break, listeners. We’ll be right back. And when we come back, Robert would like to discuss about the very partnership between the government entities and of course the researchers and the data scientists and the private organizations and policymakers, all of them, because they all are looking to support a government organization. But all of this has to be brought together and somebody has to take responsibility and lead the charge. Who should those be and how this group can work together? You don’t want too many chefs cooking the broth at the same time. You need a number of sous chefs and chef and cook and everybody else to be able to produce the perfect cuisine that we all are looking for, which is an effective healthcare system. Please stay tuned, listeners. We’ll be right back.

Speaker A [00:30:35]:

HP is proud to sponsor this program. Tap into our expertise, innovation and services to bring your most important workloads to the cloud.

Speaker E [00:30:47]:

Bosch Software Innovations is proud to sponsor this program. Visit www.bosch-si.com Connected Manufacturing to find out how Bosch can help you improve your operational performance and become a manufacturing industry leader in connected world. Change the way you predict, manage and produce outcomes. Bosch Connected Manufacturing.

Speaker A [00:31:18]:

HP is proud to sponsor this program. Find out how the HP as a service solution for SAP HANA can help you gain instant, impactful business results without capital investment. By logging on to hp.com transform information into intelligence and a competitive advantage with a full spectrum of SAP HANA products and services from hp, a global SAP hosting partner. You are listening to CIO Talk Radio with Sonjog. To learn more about the show, please visit www.ciotalkradio.com. if you have a question or comment, call toll free at 1-866-472-5790. That number again is 1-866-472-5710. Now back to the show.

Speaker A [00:32:19]:

Here’s Sanjog Aul.

Sanjog Aul [00:32:21]:

Welcome back. So we did discuss in the first half about all the challenges that we have had and what are we doing or at least what is the attempt and what would be a good blueprint or a holy grail to follow? So coming to the solution side or problem solving wearing the problem solving hat, Robert, when you look at the partnerships that need to be put in place because you cannot simply work on this problem alone, by yourself, I’m assuming, with just the government working alone. You need the help of private sector. You need those research on academia. You need that, that additional technology expertise from the consulting firms or providers and everybody else. And of course, you have to make the case with the other stakeholders within government to make sure all of these pieces come together. So what is being done in that regard? How is this even being envisioned? How is this group being brought together?

Robert Steele [00:33:23]:

Well, the reality of this is, I mean, we’ve talked about one side of this, all this from the medical side of this, but there are so many other partners and so many other relationships that we have to build around the health care system. The issue of patient billing is another portion of this. And we talked about the ongoing profitability or the financing of the institution is one side of it. Inventory control is another. The daily uses of services that are put on the EMR system and how do you track those kind of things? And so there are experts who are around you that you have to lend on their support and their expertise to really help your system to grow and to be managed to be efficient. And so we have a linkage of organizations around us that we are reaching out to that are helping us to understand how do we best categorize those things, capture those pieces of information that we need so we can have that correct billing system in place and that’s a whole other holy grail of things that we have to do.

Robert Steele [00:34:16]:

How do you create that billing platform? So as those doctors are putting the input into the data system on the EMR, how it transfers, and those billing, the coding of the variety of services that are being rendered to the patients that are going on that EMR system for those individuals, that’s a whole nother holy grail. So you need the expertise of many of the great consulting groups that are out there and around us in the region who are helping us to understand better how we do those type of things. And I’m sure each of our hospitals have those issues going on and trying to get the billing systems down for our patient care. And so we are trying to really build that as a very strong platform for what we’re doing here in Cook County to make sure that we’re doing the best job and reaching out to those organizations to give us the best input and doing that wonderful work that needs to be done to capture all those resources so we can get the correct billing for our patients and in order.

Sanjog Aul [00:35:10]:

And in order and that is a great vision that you’ve laid out, Robert. Now, in order to execute it well, who do you think you would need to have in place within your organization and who would you need from outside to approach you so that you can make that cohesive group which can solve this problem together?

Robert Steele [00:35:33]:

Well, internally it really takes our leadership organization in terms of nursing care and a variety of our doctor care organ individuals who are in leadership positions, our management team who are our Chief Operating organization leaders, our Chief Operating Officer who’s helped to lead us and guide us down these parameters, who has to guide this process for us have been the targeted group who we’re working with. But on the outside portion of this, there are a variety of different groups out there who have actually done this with us in the past and there are a variety of groups like Oracle has been one of those, Lawson is another group who we’ve worked with in the past just to name a couple of those who are helping us with this system. But there are variety of different smaller consulting groups who are actually on the platform implementation side of things that are really taking us to a new highlight of how we need to take a look at this billing side of things and I can’t name all of those groups, but again, we are on the platform right now where we’re doing the great job of capturing this data along with our medical team and our medical doctors and our assistant staff who are nursing teams and then we have those the training of our billing coders that’s been key for us is really getting those training of those individuals who can actually get the right information into the system where we can do this capturing of the services that have been rendered to the patients.

Robert Steele [00:36:52]:

And I’m not sure what’s happening in other hospitals, but that’s been a challenge because those codes change and we have to keep up with government changes that are happening on these codes as they have moved for the past two or three years, many of the coding scales and coding ability has changed in the regulations that we’re following here in government right now. So we have to keep up with those changes as well and the retraining of our staff to make sure we’re getting the right information into our system.

Sanjog Aul [00:37:16]:

So, Vikram, when you look at, suppose we bring this ecosystem together and this is not a problem we will solve in two days or two months or even two years, this has to go. It has to spend multiple years. That means while you have the intervention strategies in place, anything that you fixed could also be subject to regression or degrading if you do not watch it properly. So what kind of a governance model as we Go about transforming the healthcare organizations is needed for us to be able to move ahead. We’re taking two steps ahead, but not taking four steps backwards.

Robert Steele [00:37:55]:

Sure.

Vikram Sopti [00:37:56]:

So one of the biggest fears that a lot of smaller hospitals have is when you make changes based on reimbursements, you run the risk of being in trouble. When you make the changes based on quality, you have a longer length of stay. So in this, I mean, how are you treating your patients? If you can prove to the government that you are decreasing your readmissions, thereby decreasing the cost. If you are proving to the hospital that your length of stay has gone from 18 days in the hospital down to seven. If you can prove to me you have no infections once they come into the hospital and all the infections they have were present on admission, if you can prove to me that you have your quality at an A+ score in the Joint Commission’s mind, which essentially is tied to your reimbursement, you won’t have longevity. The area that people get really, tricky on is that when they make these sweeping scale changes on tech, purely for reimbursement purposes, so they’ll put an electronic medical record poorly in their hospital, roll it out just so they can get meaningful use dollars, which is an incentive grant from government to the tune of maybe $700 million over the last seven years. And then when it comes time to actually attesting to proving, what have they done with this EMR, where did you go with this? And if they can’t prove that I use it for quality and properly, then they’re going to get that money taken away and that’s happening to a bunch of hospitals today.

Vikram Sopti [00:39:23]:

So I think you should, I think it’s very tough to say because, you know, hospitals need to keep their doors open. Obviously, I’m very cognizant of the idea of the strife that is being in hospital administration but more importantly, you can do it the right way. Patient quality and quality of your hospital is intimately tied to how well your hospital does. So if you build your hospital up from a quality standpoint, which Norwegian American Hospital has done, it never focused on the fact that we’re going to close our doors tomorrow. It always focused on the fact that we need to build our quality, and once we do that, the money will flow. So it’s similar to a resume builder.

Vikram Sopti [00:40:00]:

You can make tons and tons of money right off the bat, but then after a while, you may not make any money. If you build your resume through years and years of experience, money will follow you. And that’s our model, that’s the tradition we follow for the last seven years and that’s what we’re and frankly our revenues are stronger now than they ever have been. And that’s purely because we’re now a quality hospital in the city of Chicago. Patients will come, physicians will want to refer more patients to this quality hospital and it’s really a snowball in the proper way. The snowball shouldn’t melt because the quality is at the center of the snowball rather than we’re just trying to make money.

Vikram Sopti [00:40:37]:

Does that make sense?

Sanjog Aul [00:40:38]:

Definitely it does. So Robert, coming to assembling this whole ecosystem of partners and of course your own internal staff and leadership to make the, to get to the end goal. Now, just because a person exists, an incumbent, if you will, is not automatically entitled and is not automatically qualified to be able to take that position of responsibility and given, you know, the charge. So if you were to be in that so called hiring committee, if you will, for the whole group which is going to work together, what in your mind would be a great qualifying criteria for anyone to get inducted in, whether it’s an individual or an organization, which is to partner with you.

Robert Steele [00:41:25]:

Proven track record I mean, I think we have to start taking the evaluation of where have you proven the ability to have delivered on some of the resources and services that we’re looking for, your skills and your ability to provide for our organization. What’s the track record of that proven ability? Making sure there’s the quality of, as we’ve heard of the services that you’ve rendered or that you’re rendering as an organization or as an individual. Those are some of the criteria that I certainly want to look at and make sure that we’re capturing. When you’re looking into what you want to bring to strengthen your organization moving forward, you have to have those individuals who have a scale of innovation, I believe, particularly with this technology that can really help think through all the assets that you currently have, but how you build upon those assets to get the best qualifying resources out of those. So you have a scaled model that can really show that you are bringing some new qualifications to this organization that we did have in the past, but that are really data driven, that you can get some real results out of what you’re trying to move forward with and so that’s most important is getting those quality assets out of those organizations, those individuals that you’re bringing on the team and so I really want to focus that attention on those who have those proven skills and ability to deliver and so that’s very important for us.

Sanjog Aul [00:42:48]:

Let’s take a quick break listeners. When we come back, Vikram, if you were to start this process, which would be the top three things that you would like to attack so that we are picking the most important pieces first which when resolved then create a good foundation for rest of the remediation strategy. Please stay tuned listeners. We’ll be right back.

Speaker E [00:43:17]:

Bosch Software Innovations is proud to sponsor this program. Visit www.bosch-si.com ConnectedManufacturing to find out how Bosch can help you improve your operational performance and become a manufacturing industry leader in a connected world. Change the way you predict, manage and produce outcomes. Bosch Connected Manufacturing.

Speaker A [00:43:49]:

HP is proud to sponsor this program. Tap into our expertise, innovation and services to bring your most important workloads to the cloud. HP is proud to sponsor this program. Find out how the HP as a Service solution for SAP HANA can help you gain instant impactful business results without capital investment. By logging on to hp.com transform information into intelligence and a competitive advantage with a full spectrum of SAP Hana products and services from hp, a global SAP hosting partner. You are listening to CIO Talk Talk Radio with Sonjog All. To learn more about the show, please visit www.ciotalkradio.com. if you have a question or comment, call toll free at 1-866-472-5790.

Speaker A [00:44:53]:

That number again is 1-866-472-5790. Now back to the show. Here’s Sanjog Aul

Sanjog Aul [00:45:04]:

Welcome back. So Vikram, if I were to request you to outline top three areas you would have tackled in order to enable healthcare system which is government supported like the one which we are referring to here. Which ones would those be? So that we of course tackle the most important pieces first and secondly that automatically makes the foundation strong for us to do the rest of it.

Vikram Sopti [00:45:29]:

Sure.

Vikram Sopti [00:45:29]:

So the first thing I do is have an undertone of quality. What this is is we get a joint commission staff list of all the things that are important to making a hospital an A in quality and attack them each using my technology, using my data, using my dashboards and scorecards on all of these factors. For instance air pressure monitors in your OR system, for instance readmission rates, for instance length of stay, central line infection, catheter associated infection. These are all areas that I would have data hard set data on. How many of these are we getting? What is our turnaround time? What is the time that it takes for a patient to come in the door for our emergency room and sent upstairs to our admitted private Practices group. What is the time it takes for a radiologist to get the image, read it and then give it back to the physician? These are all areas and metrics that are all intimately related to quality. Once these are all optimized, once these are all fine tuned and the car is running smoothly, then the next thing I would do is liaise my physician. I would reach out strongly and wholeheartedly to all of my physicians, both referring and practicing, and say, we are now dedicated to quality.

Vikram Sopti [00:46:39]:

If you’re going to send us your patients, we will treat them with the utmost quality but number two, we expect you, once we send them back to you, to treat them with the exact same quality we did. We expect you to have the same metrics that we had when we were creating our quality scorecards and dashboards. We haven’t had one infection in our hospital. You should keep your patient diabetes free and well controlled under hemoglobin A1C, which is the measure of how well their hemoglobin is being tracked for the next 10 years. Because if we’re held to that standard and you want to work with us, you’re held to that standard, too. The final third piece that I would strongly leverage is my patients. Now, I’ve said we’ve treated you with quality.

Vikram Sopti [00:47:20]:

We have physicians that are seeing you monthly, weekly, whatever it needs to be. We’re keeping in touch with you based on quality. We expect you to have that same quality. We’re going to give you the tools to see all of the lab results we have. We’re going to give you the tool to see all the reports we have. You are now the stakeholder and the most profitable shareholder of your health. Once we give you that, it’s your job to keep that in check. If your health goes down, that’s your volatility, that’s your loss, because you are now the primary stakeholder in your health.

Vikram Sopti [00:47:52]:

Once we can leverage these three components, the quality of the hospital, the technology of the hospital, the innovation in the hospital, leveraging the physicians who refer and treat, and then finally the patients themselves. This ecosystem lives and grows. Remember, it’s an evolving thing patients will be a marketing tool, physicians will be a marketing tool. Reimbursements will continue to go down, but your volume will go up so it shouldn’t matter about the reimbursements in financial institutions of Cook County or Norwegian or anything. What matters is this ecosystem I’ve just outlined, and it’s one of three things. It’s really the administrative hospital technology and core measures and quality to physicians that are referring or practicing, and then finally to the patients.

Vikram Sopti [00:48:34]:

Once this ecosystem is robust enough and self sufficient, now you can look at other strategies to grow, maybe build your practices elsewhere outside of the city of Chicago, et cetera. So I think that’s an avenue that at least Norwegian has taken and it’s been phenomenal for us and I think that’s a model we’ve followed from many, many, many powerful hospitals.

Sanjog Aul [00:48:54]:

So Robert, when it comes back to building that partnership, etc, what are some of the pitfalls that we need to watch out for? Because of course this is again going to be a work in progress. And as we go about doing it, which would be the top three areas that you would like to make sure our focus is on in order for us to successfully build that ecosystem of partners and internal staff and leadership?

Robert Steele [00:49:19]:

Well, you know, I really want to compliment my colleague who’s on the phone speaking from a medical perspective and understanding the role of that medical professional as a CIO. It really leads to what I just heard was some great results as to what you should be looking for as your top quality performance measures and having a great ecosystem in an institution and I really want to compliment him on some of the things you shared, but as far as in terms of our partnership and some of those things, I think many of the comments that he’s made were on point looking at how we treat our patients and from the medical side of things as institution and referring that back to the primary care side of things to make sure things stay on point as we’ve met the metrics of giving patients the best care is really important but in terms of our partnership side of things and having a great organization that is reviewing great data and using the data as a key formal review of where we are going in the future of our management of our patients is really key to us and how we share that data and make sure that we have a great platform of review of that data and sharing that with the team of individuals who are providing the care is so important for us that it’s I guess, the primary piece of the puzzle for us. Beyond that great performance of that platform, I think the ability to watch and manage our resources that we are using in terms of the capacity to keep our patients updated and informed to what they should be doing themselves and the care once they’ve been released and back into their own performance of management of their own healthcare system is so important to us. So we don’t have the repeat of individuals coming back into our healthcare system and so that kind of keeps our admissions down and keeps our emergency care down, which keeps our expenses down and so that’s important to us as well and that actually meets the quality of care measurements that we have to do on the federal side of things.

Robert Steele [00:51:32]:

And then the ability to keep that, our ability to make sure that our platform of customer base out there is aware of the great services that we’re doing. So they know that they can get the best quality of care in institutions like ours where they can get the services that they need that can get them back onto their normal track of life in a very experienced role and having those indicators around us so we can best make sure our patients and our team of providers are communicating in a very good way. So how do those people use the platforms? Telecommunication is a new platform that we’re trying to move to in the very near future and so we’ve not talked about some of those resources that may be coming our way for our patients to take a look at the ability to do managed care of their pharmaceutical services electronically on handheld devices and those types of things are ways of us educating and keeping our patients informed and keeping our doctors and their providers informed as to the care of our patients and taking their medications and so there are a variety of different new measures that we are looking at into the future of what’s going to be coming on our platform very shortly to keep our team of individuals in communication, but also our patients in communication with our providers and their care systems and so there’s new measures that are coming our way very shortly.

Sanjog Aul [00:52:50]:

So one last question for you, Vikram. If you were to give a message and, or appeal to the constituents who will form this ecosystem, what would you like them? So it’s like, you know, help me help you with that in mind. What would you like from them? If you were to suppose support, suppose you were wearing the hat of a CMIO, of a government help system, what would you have appealed to the constituents?

Vikram Sopti [00:53:17]:

So number one, and most importantly, I think the only way that I can make this work is for them to understand that I walk with each of that ecosystem as the Chief Medical Information Officer, I’m working with the quality officers, as the administration, as a wonderful staff CIO, I am one of them. I work as an administrative tool, I understand mandates, I understand project management, I understand quality assurance and project improvement, I understand all this stuff. On the medical side, I’m a physician, I’m a board certified radiologist. I was trained through medical school, I did my residency, paid my hardships and understand the hardship that it is to be a physician today with the masks, with the mask problems that we have to face with more importantly, the areas that we are controlling, a lot of patient information that we are controlling patient’s health. I understand that the pressures that come with the physician, I would like them to know that I share their patients finally as a patient.

Vikram Sopti [00:54:10]:

I’ve been a patient too and I only demanded the utmost top respect when I was a patient as well. So I think that the area that’s been lost for many, years on physicians is that there was a divide between not only physicians and patients. I am a physician, I will treat you, you’re my patient, you do as I say. But on physicians and administration, some suit up in the C suite is telling me how to run my practice when I know how to treat patients.

Vikram Sopti [00:54:37]:

And I want to just break those walls down tomorrow and I do this in everything I can that I walk with you in every light of the way and every step of the way and every light of the tunnel. I am with you in each of those situations. I know what it’s like to be a patient, I know what it’s like to be a physician, I know what it’s like to be an administrative tool. So I understand that these are areas that are usually predefined in each institution. I would knock those down and make it more of a family, more of a group that’s leading towards in the same goal rather than a mandated character stick method to say let’s lead this group.

Vikram Sopti [00:55:14]:

So I think it’s very important for my sense to say this is what we have to do.

Sanjog Aul [00:55:19]:

On behalf of our show and our listeners, thank you so much again, Robert and Vikram for sharing your thoughts on how we can work together to enable an effective government healthcare system.

Robert Steele [00:55:31]:

Thank you for having me.

Sanjog Aul [00:55:32]:

Thank you so much again and listeners. Hope you enjoyed it. Please like us on Facebook, search for CIO Talk Radio and be sure to follow us on Twitter. And don’t forget to join our newsletter so we can keep bringing you some interesting insights and thoughts on what we are covering on CIO Talk Radio. Thank you again for listening to CIO Talk Radio. This is Sanjog Aul your talk show hosts till next week. Take care and God bless.

Speaker A [00:55:55]:

Thank you for tuning in to CIO Talk Radio. To learn more about the show, please visit www.ciotalkradio.com. please join Sun Joke all next Wednesday at 7am Pacific Time, 9am Central Time and 10am Eastern Time for another hour of CIO Talk Radio on the Voice America business channel.@

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