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Chime 2020 - Navigating the New Normal in Healthcare

Navigating The “New Normal” in Healthcare: Capacity Management and Operational Efficiency Today and Addressing the Challenges of Tomorrow

 

 

The COVID-19 pandemic has stressed our healthcare delivery system and created both financial and societal shockwaves. Healthcare Systems have had to think outside the box to utilize pre-existing systems and new technology to address issues of capacity management, use of resources and other operational efficiencies. Under these circumstances, it is imperative to simultaneously address current needs while rebuilding revenue and business operations, radically reducing costs and reimagining the patient care portfolio.

In this session, Jeff Terry, Global CEO, Clinical Command Center, GE Healthcare Partners and Geoff Martin, Global CEO, Consulting, GE Healthcare Partners will discuss the technology that is enabling hospitals to survive COVID and the tools that they can use to rebuild in a way that helps drive greater productivity and in many cases virtualize care. All at speed, and in real-time.

Carlos Escobar, MBA, CHCIO, Vice President, Market IT Operations & Planning, AdventHealth
Geoffrey Martin, CEO, Global Consulting, GE Healthcare
Jeff Terry, CEO, Command Center, GE Healthcare

More info: https://chimecentral.org/events/chime20-digital/chime20-sessions/

Transcript:

Jeff Terry

Hello and welcome to this CHIME20 Digital Forum. I am Jeff Terry. I'll be joined by Carlos Escobar, who's the CIO of AdventHealth South and Geoff Martin, who is my colleague at GE. I am the CEO of Clinical Command Centers at GE, and Geoff is the CEO of GE Healthcare's consulting business. Our topic today is Navigating the New Normal in Healthcare: Capacity Management and Operational Efficiency Today and Addressing the Challenges of Tomorrow.

Jeff Terry

Format-wise, I'll ask Carlos a few questions, talk about real-time analytics. Then we'll turn it to Geoff Martin to peel the onion a bit further. With that, I want to bring in Carlos Escobar. Good morning, Carlos.

Carlos Escobar

Hey, good morning, Jeff. How you doing? Good to see you.

Jeff Terry

I'm fine. You too. Thank you again for doing this. To get us warmed up, just first question, our audience is mostly CIOs of health systems. You obviously are a leading CIO and have been for years. I know you shaped the role in your team to be both a technical leader and a strategic advisor. My first question, how do you see the role of CIO evolving over the next few years?

Carlos Escobar

Well, thanks, Jeff. Yeah. Those are certainly two very important characteristics of my role. In my nearly five years as the regional CIO for the Central Florida division of AdventHealth, I was very intentional in developing an operating model that moved IT up the value chain, delivering on technology and IT operational performance needed for the business to achieve its goals. That being said, and I'm sure many of those attending this year's Chime conference would agree, the role must continue to evolve beyond simply that of strategist and head of technical operations.

Carlos Escobar

In my expanded role as assistant vice president over IT, market operations and planning for AdventHealth IT, I see our mission as healthcare IT leaders being that of change agents focused on developing the acumen needed to scale our transformation efforts, tapping new and emerging technologies and making the digital enterprise a key pillar of our business strategy. I mean, it really is around moving to this digital business vision of tomorrow.

Jeff Terry

Absolutely. Well, I guess a good segue into our second topic, which is AdventHealth Mission Control, which is a center of gravity that AdventHealth has built for operational efficiency, for capacity management, for patient flow, for artificial intelligence, you've been one of the central leaders of that initiative since its inception. For the audience, AdventHealth Mission Control is one of the largest such health system command centers, if you will, worldwide.

Jeff Terry

Orchestrates care progression, patient flow, end to end, for the campuses in and around in Orlando. Also, plays a transfer and coordination role across all of AdventHealth nationally. Quite a bit of innovation. New real-time analytics, new predictive tools, co-locating different functions like bed management, transfer center and ambulance dispatch and flight. Also, some new roles like clinical expediters and imaging expediters, just a real innovative initiative.

Jeff Terry

Carlos, I'll ask a couple questions about that. First, could you describe the impact of AdventHealth Mission Control on normal patient care operations? Just in day-to-day patient care at AdventHealth.

Carlos Escobar

The operation's impact and the cultural impact has been significant. Clearly we're still learning and growing every day, but now we have a platform that supports the development of second level of learning. Jeff, I think I actually took that term from you once in one of the debriefs that we had had. Meaning, we're no longer limited to core system capabilities.

Carlos Escobar

We've unlocked a new set of analytic capabilities that support a higher level of synchronization across hospital operations, where my operations now leverages an analytics engine and a ton of architecture that delivers these predictive and prescriptive at-a-glance decision support. It really does impact the culture. Quite simply, it promotes innovation, process innovation. It's not just about the technology.

Carlos Escobar

Whether it being asset performance management and how we change by transforming that data into actual intelligence or operations optimization by delivering enterprise data visibility across the whole system, providing this holistic view similar to our whole person care model, or whether it be business optimization. Really looking at how by being more intelligent around forecasting, we actually can improve our business decision.

Jeff Terry

Absolutely. What was the role? Because when we built Mission Control, we weren't thinking pandemic. We did talk a lot about hurricanes.

Carlos Escobar

No. No, no. Yeah.

Jeff Terry

I know it's played a role in the pandemic, so talk about that please.

Carlos Escobar

That's really a good question, Jeff, and one that I'm sure is top of mind for all of our colleagues that are on the phone. Mission Control provided us with this real-time decision support platform, as I said before, that really took advantage of predictive and prescriptive analytics at a glance powered by AI. Basically, we were able to leverage the work that we had done early on in developing a core set of analytics to Mission Control and the investments that AdventHealth has made over the years in developing our business intelligence and big data capabilities, and extending them to tackle this unprecedented problem.

Jeff Terry

Part of that early on, March/April timeframe, when everybody's hair was on fire, we actually expanded Mission Control and the role of the analytics outside the EMR beyond Central Florida. Can you talk a little bit about that?

Carlos Escobar

Yeah. Again, the key was having a platform that could scale, to your point. We extended and expanded the platform in a couple of different ways through the pandemic. Expanding the core capacity algorithm, the capacity management algorithm across the enterprise created a big lift for us and provided us with a line of sight across the organization for critical resources that we needed to manage the surge. Not just the 30 hospitals in Florida, but across the company for AdventHealth. We put in a command structure that helped us highly coordinate across the system to better coordinate our response.

Carlos Escobar

So as we matured the algorithm and layered in additional data sources, we were able to really take advantage of that initial investment, whether it be a team member availability, PPE supplies, ventilators, even going so far as to add our real-time location service asset tags for our events, made that information invaluable. We were able to capitalize as a result of our early work and really even deploy beyond the four walls. Meaning, we took this analytic and we published it to our operators in the field.

Carlos Escobar

We were no longer bound by the four walls of Mission Control. We put this capability in the hands of our team members, those that were managing the surge in their facilities.

Jeff Terry

I think that's such an important point by the way. Sometimes the pictures of Mission Control are so impressive and the physical space is important as a center of gravity, that it can be misleading. That gives a sense that this information is up on a wall. This information is pushed to operators at the frontline, care managers, nurse managers, executives, administrators, 24/7.

Carlos Escobar

A CEO on his iPad, being able to see what's happening real-time at his facility, really through the lens of the community. I agree with you, Jeff. That's critically important that the analytic be delivered to the edge.

Jeff Terry

Amen. Let's focus on the real-time analytics themselves. Of course, they are used in Mission Control and they're used everywhere as we've said. When we say real-time analytics, for the audience, I'll just emphasize, that means a software application that's changing as you look at it, like the airport board with arrivals and departures. The information is changing in real time, based on whatever's happening in any software system across the health system. Can you talk a little bit, Carlos, about why real-time analytics are so hard to create?

Carlos Escobar

Jeff, I'd say there are several challenges organizations face in developing and deploying real real-time analytics. It's not just about the technology. Years ago, I remember a colleague summarizing the challenge most of us are going to face moving to real-time analytics in three simple words. Volume, velocity, and variety. I think that they all hold true today in many aspects. The first of these for me, I guess, would be the volume problem. Are we prepared for the volume of data that we collect to actually do something with it?

Carlos Escobar

Not just the size of the data, but the required processing capacity. The volume problem is not just a data processing problem. It's a process challenge. We experience that through the early work that we had done on the design side. Insights equal change and opportunity. Operational change can overwhelm our teams. Now, what do I do with all this data? The philosophy problem is another one that we're all too familiar with. New data is being created all the time, as you referenced. We need to respond in real time. Can our operations actually handle the velocity problem?

Carlos Escobar

Again, I think all of these contribute to the challenges that we'll face. That's a question we asked ourselves many times during our design session, sprints for Mission Control. Variety is no stranger to any of us. The necessary big data tools, datasets, core system changes necessary to move along the continuum for real-time analytics is fraught with landmines. An Excel spreadsheet that supports one step and that one core process that was never automated because no one wanted to update the workflow.

Carlos Escobar

Or the source system can't support the change, or perhaps we didn't get the buy-off to change the business process. I can go on and on and on and on. It's much more than just the maturing of algorithms. There's so much around those three vectors, if you will. It's a real challenge.

Jeff Terry

I love it. Volume, velocity and variety. I remember when we started Mission Control and having to make sure that the plumbing, if you will ... The infrastructure that we built to gather and handle 200 messages, maybe per second in the peak time through the day, from pharmacy and orders and lab and cardiology and oncology and on down the line, and make sense of it fast enough and clean enough to provide that prescriptive or predictive insight. That was a lot of work. The beauty of that is it worked, right?

Carlos Escobar

That's right. To not impact the production system, right? The day-to-day transactional system couldn't have a blip. It needed to continue to perform at the high level that it was. Yeah. It was a good challenge that we worked through together, for sure.

Jeff Terry

Challenge. Having that in place enabled us to do what you described earlier, to expand across all of the health system in only a matter of, well, days or a week or two total maybe to get vents and the whole health system up live.

Carlos Escobar

It was a couple of weeks. Again, it was just about adding incremental value. It wasn't waiting until everything was captured. It was, here's a piece of data that we can now add to the algorithm to mature it. Then how does that then continue to feed and grow? It's this maturation that I think is key to our move forward with real-time analytics.

Jeff Terry

Absolutely. One of the things ... Of course, we did a lot of foundational work and we pushed it across the system, certain pieces of it for COVID. You've also, within AdventHealth, the Orlando area, continued to push the boundaries of innovation. Certainly, in our ecosystem, you've done some things that are on the forefront of innovation. For example, with the neuro downgrade work that Mission Control involved with. Could you talk about some of that recent innovation?

Carlos Escobar

Yeah. We are actively working on maturing our analytics engine. AdventHealth has a team led by our chief analytics officer focused on this very thing. Then working with partners like you and GE and expanding our capabilities in-house, we're going to continue to advance our analytics platform, moving from real-time to predictive. Really, this move is predominantly driven by the maturation of these algorithms, which we've mentioned a couple of different times. As an example, we're now predicting the likelihood of patient outcomes on their initial presentation with COVID in the ED.

Carlos Escobar

Convalesce at home or being admitted. We've learned, and the science has learned over the nine months. We've applied what we've learned to the algorithm and helped made it better. The example that you mentioned is a great one too, Jeff. We work together with GE on the neuro downgrade forecasting algorithm. Developing this algorithm helps us forecast readiness for our patients to step down from ICU. What that does is it frees up critical resources, optimizing our patient care pathways.

Carlos Escobar

Our job then as operators is to hardwire this algorithm, and then through Mission Control, use that to alert the right people at the right time. It really is critically important to our future work.

Jeff Terry

Amen. Last question from me, and then I'll turn it to Geoff Martin. Another topic in which you're a leader, Carlos, is AdventHealth partnered with HCA and Tampa General, other health systems in Florida, to create a statewide capacity management system, which is not quite as real-time as the work within AdventHealth, but is near-time. So that across the state, we now have about 20% of the beds in the state live, working our way towards a hundred so that we can see all the different types of beds and surge beds and COVID hospitalizations and vents across all the providers to share capacity.

Jeff Terry

Which Florida, I think is now only one of two states in the country with a near-time automated system like that. Could you talk a little bit about that please?

Carlos Escobar

Sure. Now, I think your question is, how did it happen? We knew we needed to respond to the realities and challenges our state was facing and support the communities we serve during these unprecedented times. Caring for our communities, for all communities, is core to the mission of AdventHealth. By working together with other large health systems in the state, we saw an opportunity to develop a surge management tool. Taking advantage of the Mission Control work that we had done with GE, knowing that it can assist us in a near-time away, to your point.

Carlos Escobar

Sharing data and information across the state effectively helps us to respond differently during public health emergencies, just like COVID-19. With the leadership and support of Daryl Tol, the president and CEO of AdventHealth, Central Florida, and his colleagues at HCA and Tampa General, we were really able to kick this program off and are on the road to extending across the state, as you referenced. We really do see an opportunity for so many of our community partners to join and take advantage in support of those that they serve on a daily basis.

Jeff Terry

Yeah. Amen. My sense is that, if there's a silver lining in COVID, it's the creation of tools like that, which will be useful in the future is certainly a silver lining.

Carlos Escobar

It's how do you make a tool like this low friction so that it is easy for others to take and to adapt and to partner with the state? It's been a good learning opportunity and it took lots of folks coming together to make this happen.

Jeff Terry

Absolutely. Inspiring. Perfect. Thank you, Carlos, as always. With that, I'll turn it to my colleague, Geoff Martin, to continue.

Geoffrey Martin

Perfect. Thanks Jeff. Hey Carlos. Great to see you again.

Jeff Terry

Geoff, likewise. Good to see you.

Geoffrey Martin

Maybe we'll shift gears here a little bit. A very hot topic during COVID was virtual care or virtual strategies. Where are organizations going with this? I think we all saw a huge spike in ambulatory visits and all the things that go into that. I have such an appreciation for the decisions that need to be made and the platforms and the hundreds of companies out there that are probably knocking on your door. Do you mind sharing a little bit about how you are tackling that challenge, did tackle that challenge? Also, how you're thinking about virtual care in the hospital and even to the home as you evolve your strategy.

Carlos Escobar

I would tell you, it's funny, Geoff. For us, I have to be honest with you, because of COVID-19, we saw an immediate need to respond. Meaning, we had the foresight to be thinking and actively working on virtual care models, but COVID really forced us to consolidate our work plan. One that had us going from a year plus [inaudible 00:18:01] over some of these core capabilities down to six weeks. At the core of our work was a video visit platform. Once Secretary Azar announced the loosening of HHS guidelines, we had an explosion of requests from our physicians, ambulatory service lines, patients.

Carlos Escobar

We decided at that point that we needed to develop our own deeply integrated platform integration with the EMR. That's work that we invested in early and since then ... And I'm sure my data's probably stale because it's been a few weeks. We've had 300,000 visits since that sentinel work. To quote Secretary Azar, "COVID-19 has led to a healthcare revolution. One that will include a large focus on care in the home." To your point, Geoff, it's so critically important that we address these core capabilities and that we deliver as a health system. What about those of our patients in our facilities?

Carlos Escobar

I can tell you that for us, it was important to create a family connection during the pandemic. We learned or experienced that many of our patients in our facilities were lonely. From a whole person care perspective, we needed to do something. So similar to the work that we had done with virtual visits, we actually within 48 hours or so, deployed a thousand devices to nine states for virtual family visit. Again, continuing this extension to the home, to your point. That was just the beginning.

Carlos Escobar

We've done some work around an ED diversion program, where again, we see an opportunity for telehealth and remote patient monitoring to really be a core capability that has to be delivered in times of a capacity crisis like we've been facing. I would say probably the thing that we've done most recently ... Now this is in the storm. Now, the storm had settled, at least it had in June or July in Florida. Now we're all facing this again, but we knew that we needed to keep our family and our team members safe and so we started a contactless check-in process.

Carlos Escobar

Again, these are programs that we're going to continue to mature. The work is going to continue with our digital platform. Recently we delivered some care and advocacy capabilities within our digital platform that would allow you to engage directly with a care team, to help you navigate the work, the services that we provide in the community. There's a lot of energy that AdventHealth is spending in this space.

Geoffrey Martin

Yeah. Yeah. It's impressive how quickly you rallied and how you stay core to who you are as an organization to really help guide you through this type of transformation. It's incredibly impressive to watch. Maybe I'll shift gears a little bit into AI and the future. I mean, I can only imagine how your phone rings around AI and machine learning and deep learning. I know we've done some great things with the Mission Control around AI to predict census days out and the deterioration for neurological patients that you mentioned in a previous comment here.

Geoffrey Martin

When you think about AI, how do you think about it as a part of your broader strategy going forward?

Carlos Escobar

Geoff, that's a great question. I'll tell you that we see it as core to our strategy and something that will actually provide a competitive advantage. We believe that AI is going to continue to drive diagnosis and treatment pathways, not just within the four walls. Moving outside of our walls into the community and engaging with our consumers in new ways to include conversational AI, as people take more control of their own health, is going to be critically important.

Carlos Escobar

Digital therapeutics, again, we've all played with our devices and so digital therapeutics are going to be AI-empowered. I mean, look at the Apple Watch. I'm sure probably 50% or more of those that are going to watch this have an Apple Watch. We predict that this space is going to be explosive and the next three years are going to be probably even more telling than the last three.

Carlos Escobar

The research studies like the one that Mount Sinai had done, where they use AI to analyze COVID-19 patients, looking at how lung disease and combinations with symptoms and age and blood work and contact with those that may have been infected, really was used to predict much more than we could do before. There are so many similar stories that we've all heard around radiology-based [inaudible 00:23:15], algorithms for early detection. Our organizational approach is going to be a simple one.

Carlos Escobar

It's built around having the patient at the center. We're thinking about scale. How do we scale across 51 hospitals? About how we can improve the communities that we serve. Then about creating an improved patient experience that again, we think is really going to provide us a competitive advantage.

Geoffrey Martin

Yeah. Yeah. It's absolutely the way of the future. I just think about the new skills. People learning Python and C#, and just an entirely different workforce. What I'm excited about is I see healthcare moving at speed alongside other industries where in the past maybe we lagged a little bit. I really see us building momentum. It's exciting, and I hope there's innovation that comes out of healthcare that's a step function into other industries in this space.

Carlos Escobar

Yeah. I would agree with you. Earlier I had shared with your colleague, Jeff, the work around process innovation. We focus so much on the tech, but even with AI, there is so much around in workflow, in life as part of a platform for me. How am I connected in such a way that you're improving my whole mind, body and spirit? Again, very aligned with our thinking of whole person care and how we see that being really something where we can bend the cost curve and the quality curve for so many of our patients.

Geoffrey Martin

Yeah. Yeah. No. You're right on. Maybe I'll transition to our last topic and then we'll wrap up. With all of this, what are the considerations around software platforms? We've seen a lot of trends and it seems like in our industry, what's old is new and what's new it becomes old over time. We saw this transition to the EMR and a monolithic platform. Now we're seeing cloud-based services, SaaS-based models. How are you thinking about your platforms as an organization and how do you see the evolution of that over time?

Carlos Escobar

Geoff, this is a tough question. I would offer up that healthcare really needs to get smarter about platforms. We've seen an explosion and the realities are that most of these only address about 1% of the whole. How do we progress from an ecosystem of connected systems to an actual platform? Is there a platform of platforms? To your point, I think that is one of the big struggles that we're trying to navigate. Clearly, we've made some large investments with some great partners.

Carlos Escobar

We still struggle with the interconnection of these systems and the lifeblood of that is data. If you go back to the AI conversation that we had, the work that we're doing with Mission Control, the challenges and vectors that we have around velocity and volume and variety, it all comes down to speed and agility. How do we organize around a platform such that it provides that for the benefit of our patients and our health system? I mean, we want to be more efficient.

Carlos Escobar

We want to deliver a higher quality product. We want to engage with our consumers in new ways. It's difficult when there's so much fragmentation out there. It is definitely a big, big problem. One that several of my colleagues in AdventHealth are thinking through and again, making some significant investments in that space.

Geoffrey Martin

Absolutely. Well, on behalf of Jeff Terry and myself, I certainly want to thank you for the time today. I think we covered a lot of ground and really appreciated your insights on the evolution of the CIO role. When we get into mission controls and command centers around how that's changing the culture and the empowerment, how real-time analytics are just game changers for our industry and not only in the hospital but out of the hospital, and working with patients, and the way that we're becoming more predictive not just real-time, but getting to be predictive.

Geoffrey Martin

It's amazing how you and your team responded to the virtual care challenge and the journey that you're on. Thank you for sharing that. I think we agreed AI is the way of the future and it was interesting to hear your perspective on how you were thinking about that. I think you've given a good challenge to all parties that are listening to this, is, how do we get better with these platforms and really evolve and be leading in healthcare? I just want to thank you for your time. I think it's great insights.

Carlos Escobar

Thank you. I appreciate you and Jeff and the partnership with GE. Thanks again. Good catching up.

Geoffrey Martin

Good catching up. Take care.