Starbridge advisor and Former VCU Health CIO Rich Pollack join me for a discussion on the 2018 health innovation busts and how to avoid them.  We also take a look at the changing care settings and how to be prepared.

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Bill Russell:                   00:09                Welcome to this week in health IT, where we discuss the news information and emerging thought with leaders from across the healthcare industry.

Bill Russell:                   00:15                This is episode number 48. Today we look at the changing care settings and health innovation busts. This podcast is brought to you by Health Lyrics. Health systems are moving in the cloud to gain agility efficiency and new capabilities. Work with a trusted partner that’s been moving health systems to the cloud since 2010 visit healthlyrics.com to schedule your free consultation. My name is Bill Russell recovering health care CIO writer and advisor with the previously mentioned Health Lyrics today’s guest is a new friend and industry veteran.

Bill Russell:                   00:47                Rich Pollack is an adviser with StarBridge advisors Rich is more than 40 years 40 years Wow! Health care management experience 20 of which were focused on EMR success research and the vice president and CIO for VCU health system in Richmond Virginia. From 2005 until recently prior to that he served two years as interim CIO for Klarion HealthPartners a 2 billion dollar health system in Indianapolis.

Bill Russell:                   01:13                Indiana . Good morning Rich. Welcome to the show.

Rich Pollack:                 01:17                Good morning.

Bill Russell:                   01:19                Glad to be here Bill Wow 40 years of health care management experience.

Bill Russell:                   01:22                I seem to be having these people on this show that have just a wealth of experience. What do you what do you attribute your longevity in this space to

Rich Pollack:                 01:33                Well yeah. Perseverance I guess. But I actually had you know two careers I give my first the career in healthcare was in the field of radiology and I thought I would stay in that forever and I have a 13 years doing that and then I transitioned in the late 80s into I.T.. By happenstance I just happened to hit it at the right time it was beginning to take off especially on the clinical side. And I worked for a couple of vendors and then for a large community hospital and then sort of gravitated through some you know due to some personnel of the inherent banality being toward academic. I’ve gotten three of those the last one at VCU for about 12 years. But I passionate about what I do. I love the industry. I can’t believe the time thats gone by it. It doesn’t feel like forty years to me except when I look in the mirror. Maybe but I see, I see the lines. But the it’s been just a great run. And that continues to be a great run. I just have witnessed so much positive change over that period of time

Bill Russell:                   02:55                So now youre with my friends StarBridge advisors. Give us an idea of what you’re doing with StarBridge advisors.

Rich Pollack:                 03:03                Sure. So I joined them shortly after I retired from VCU and I knew David Muntz for many many many years I knew Sue a little bit less but still knew her, I didn’t know Russ until I joined them I recently completed a six month the senior executive IP advisory engagement at a mid-sized that helped get them up in May. And other than the traveling back and forth from the middle of Janurary which was a little challenging for me I mean Maine is lovely Ive been there many times in the summer and the fall but it was great it was very gratifying. They were big Cerner clients they were rolling out Cerner in the miltary space. They certainly needed help with new governance and road mapping and a whole bunch of other areas a whole new executive team had come into play. So I essentially was a conciliary to the CIO who was very very confident individual but needed some extra help. So that was about a six month gig up there and then after I finished that I decided for some odd reason to go ahead get my right knee replaced. So Ive been spending the summer recovering from a right knee replacement. but it’s doing extremely well. So I’ll be back. I’ll probably be back on the road after the first of the year.

Bill Russell:                   04:33                so it’s an interim interim leadership Ill tell you the New England. My wife and I live in New England for one year we lived in New Hampshire and two stories from that, one is we get one hundred thirty six inches of snow that winter and that was enough to tell me that I was not cut out I was not strong enough character to live in New Hampshire for the long term. That was, that was something else.

Bill Russell:                   04:57                And in the second thing was the after a while I was driving around with a friend and I’m like you know just kind of lonely up here. He said, he said Bill look out the window of the car to your right what do You see I said trees. He said look out your window to your left what do you see? I said Trees. He goes, Bill, People move to New Hampshire because they love trees more than they like people He goes if you like people more than you like trees. You might want to go somewhere else. That was my wake up call it might be time to get out of New Hampshire. And we did after one year. Oh yeah it is so cold and Maine is the same thing its just so cold up there. But yeah great friendships great people up there. So Let me take us through the show we have two good news stories and well actually before we get to our news stories let me just hit on you know I was looking through the news and we had so many to choose from.

Bill Russell:                   05:55                Some just came up on my feed this morning. So one is Apple in talks to give veterans access to their electronic medical records. That’s a huge story that’s in the Wall Street Journal. I think this morning. So that’s interesting maybe well talk about that in the future. Another one for backers AI for precision medicine top of mind in coming years health system exects in fact they list top 10 in number one and number four. Both AI One is AI imaging diagnostic skills, AI prescription medicine And then you know the one I think we talk about a little bit on the show before, but theres a story that says hackers are not the main cause for health data breeches. I think we’ve known this but they did the research they went back and looked at all the breeches and it turns out that most of the data breaches were due to mistakes or security lapses within healthcare organization. So those are three stories we’re not going to look at this week but we might look at in future episodes Just wanted to highlight those.

Bill Russell:                   06:53                So I’ll kick us off for the first one. the seven most valuable health tech start ups that failed in 2018. So we’re getting close to the end of the year. We’ll do a lot of these retrospectives kinds of stories and we’ll see them towards the. And also we’ll start to look at predictions for next year. For whatever they’re worth here are the top you know I’ll give you a couple of the top seven most valuable health care start ups that failed obviously number one is Theranos blood testing technology company Silicon Valley nine billion dollar valuation you know completely gone. Number eight medical simulation number nine ReVision optics 12 candescent health and 13

Bill Russell:                   07:41                Paieon, Paieon well probably start with a different name would have been better number 15 Winx a sleep therapy system and number 22 Claritas Genomics You know I’m not out side of maybe one or two of these to Im not overly familiar with too many of them. Are you familiar with some of these

Rich Pollack:                 08:01                well yes with a few not not all of them certainly. Theranos is kinda interesting you know I was before I was with IU I was at M.D. Anderson in Houston. I was in Houston for about seven years and I was there During the Enron. This Tharanos Situation kind of reminds me of Enron, a house of cards and phantom values built upon also fraudulent claims insufficient vetting and validation up front. But lots of folks taking in with the promise of something that’s literally to good to be true. So that that it’s an analogous to me in my mind with Enron. Yeah just let’s let’s create something when there isn’t anything there.

Bill Russell:                   08:50                Well that’s I mean that’s a pretty big statement there. Actually I agree with you.

Bill Russell:                   08:55                The lure of the company was they you know they were able to the increase fee to get to the result. Decrease costs maintain the same level of accuracy so that was their claim to fame. And if they had been able to do that would have been a game changer I think that’s how it got to 9 billion dollar evaluation. But you know clearly

Rich Pollack:                 09:23                No question about it. You know it was built, Based and built upon fallacious information. And so which took a while to come out. This speaks to our I dont know I guess our culture of it sounds too good to be true we want to believe it. So as opposed to questioning it.

Bill Russell:                   09:47                Well let’s talk about that so it take a while for that to come out off and a lot of health systems are talking about innovation.

Bill Russell:                   09:55                There’s a lot of innovation models within health care there’s VC models private equity some health systems are incubating companies some are acting as wet labs for start ups and obviously others are partnerships

Bill Russell:                   10:08                So lets talk through these. What are some of the things you could do to vet these companies or these technologies to make sure that we don’t end up in a partnership with the you know the group that ends up on this list in 2019 or 2020. How do we make sure that

Rich Pollack:                 10:28                I think you need to have some sort of independent vetting and validation you know cross reference lab you know is there peer reviewed research that’s been validated you know not just 100 percent relying on what the company is telling you but can you go you know are there ways for you to go to validate that whether it is from an outside source or even a competitor or from your own academic capabilities if you’re a university or a research institution and have the wherewithal to do that. So you’ve got that it’s got to be some sort of vetting and validation that is beyond just what the company does.

Bill Russell:                   11:19                Yeah absolutely. You know I was as a CIO I was asked to be a part of the team supposed to look at Theranos to for our health system how we might partner with them and what not. The hardest thing for us was they were not overly forthcoming with information. Not only was potentially the information that they were putting out there not valid but they weren’t overly forthcoming

Rich Pollack:                 11:49                right

Bill Russell:                   11:49                luckily for us you were a little bit of a late adopter. So at that point some of the things started to unravel a little bit. So we didn’t get caught up in it. But you know that is the risk the risk is you know not being early enough to market and not taking the risks. Obviously in hindsight you look smart cause you didnt jump into something like that. but know one these could be a disrupter. And so you know when I think about vetting these companies I’m gonna throw out some different from different things we looked at when we were vetting companies you know love to get your thoughts on it. So the first one for us was always the leadership. You know. When we met with the leadership you know how did they operate the company what was their vision how were they thinking about that market. Do they come across as somebody that was in it for the You know the glory or did they come across as somebody that was, you know cause somebody that was in it for the glory is in it for money and if they are in it for the money that’s a tough foundation. But if there in it for to really change health care you pick that up. Generally when a leader tells a story that resonates and you start to interview some of the people in the company and their stories resonate. That’s the first we look at is leadership. I mean what do you look for in leadership of a start up lets assumed there’s a new start up coming to you at VCU you know when you’re talking leadership what kind of qualities are you looking for.

Rich Pollack:                 13:26                Well I think you’re looking for. Well I would be looking for a couple things. One I would be looking for that. Like you indicated, passion to change the game change the industry change, You know the delivery of healthcare in a very positive way so the passions got to be there but there’s also got to be a tremendous intellectual prowess there. They really are you know doing something unique than whether it’s the person that the founder or his co-partner or somebody in that organization that got some significant intellectual prowess that has really broken through in a new way. and can articulate that and can explain it without giving away the companies trade secrets but really be able to you know lay out on a whiteboard. Architecturally This is what’s so different. And this is how I came up with that.

Rich Pollack:                 14:24                So that may be both of those things may be co-contained within the same individual or they may be you know as I’ve seen often two partners or or you know the CEO has their you know their chief science officer or what have you and then you know we we in an academic institution will have equal intellectual capability there to question and try to punch holes in that and see in fact what you know what’s real what’s not. And we certainly have we certainly have done work with startups with companies that are like I characterize the three guys in a garage type of thing. So and that has its own challenges but if we see that there is some value there we kind of you know go along and baby it along and hope to see it through to maturity.

Speaker 8:                    15:21                Well I’m sorry my arms are folded here. My family’s I actually traveled for Thanksgiving I’m in a very cold climate and they kicked me out onto the porch so I wouldn’t be too loud. So I’m freezing.

Bill Russell:                   15:34                Just transparent.

Rich Pollack:                 15:38                But I think one of the one of the other products thats on your list of medical simulation and now that may be overhyped and maybe a Gartner’s peak but nonetheless we use it extensively at VCU we have a series of simulation labs in the medical school, the School of Medicine that you have been there since I think 1838 or some crazy time there but that’s been very successful for VCU in training and developing multidisciplinary teams to work together that that is has been very very effective tool. So while it may have been over and may be over. I’ve said that at Marathon the peak at the Garden Hype cycle. But nonetheless I think that got Promise. If you put in the resources and the commitment to do that we certainly had were they did optics I have no idea on value that.

Bill Russell:                   16:44                Yes. So when you think about medical simulation I agree with you it’s on top of the Heights cycle. But it sort of goes into the next couple of things that I would vet you know one need for the product or position in the market. Are there alternatives. the Challenge with medical simulation right now is There are a bunch of emerging new technologies that could displace whatever is there now. so that’s going to be space that’s in flux over the next couple years just because of the pace that AR and VR are moving along.

Rich Pollack:                 17:14                Right.

Rich Pollack:                 17:15                So yeah I think that’s that’s a good point Bill because we don’t we were not using VR in our simulation labs we were using some very multi feedback dummies you call simulated patients and the sort of the equipment around that in those lab to those teams to work together in clinical situations simulated clinical situation. But I do think the advent of virtual reality headsets that are going to change the game at some point in time is there. You know there’s no substitute for that you know human interaction. That’s what really happens in team based health care delivery. So it’ll be interesting to see how that that factors in.

Bill Russell:                   18:11                in what we do currently with simulation.

Bill Russell:                   18:12                Yeah, at the exponential medicine conference I saw a couple of videos with augmented reality where you know a physician a surgeon with goggles actually overlays a whole bunch of data right on the patient themselves. I can only imagine where thats is going to go. Obviously some of the others things we look for Financial models technology fit and those kind of things. but you know I love that discussion. I think You we’ll have to keep an eye on that the changing landscape. But lets kick it to the next story. This is your story so I’ll let you set it up.

Rich Pollack:                 18:54                Sure yeah. You know I took a look at this one in the news consumers seeking care in new settings for lower cost so because has gotten a lot of play in the last couple of years of retail clinics particularly VCU we partnered with the Kroger department stores and have reach out clinics out there and other folks who are doing the same. So I look at it as retail clinic versus traditional urgent care versus virtual care model. So as I see those three sort of somewhat competing virtual care is actually moved out there out in California with Kaiser. Huge number of huge percentage of their outpatient visits are now virtual visits. Similarly in Pennsylvania UPMC has deployed a tremendous program for virtual visits across the state and others are doing you know doing likewise. But you have to keep in mind that right now most of these are focused on low complexity convenient to consumer care.

Rich Pollack:                 20:07                So by that I mean the sore throat its the rash its the ear ache its the brain its the stomach virus that kind of thing a you know although there’s technically a need for that no question. And there is an advantage in not, a cost advantage I think in not burdening our multimillion dollar facilities with waiting lists of people coming in to see a primary care provider in a clinic setting for a sore throat that could be done either in reach out clinic or or virtually. So there is advantages to that. But there is a complexity curve here. And although the urgent care model because they typically incorporate labs x ray capability that the reach out models don’t have they can move up the complexity curve a little bit further. However, What strikes me that people are forgetting or not paying attention to in this is remember that 5 percent of our patients consume almost 50 percent of our cost so that you know if you’re going to really affect the cost curve you really have to deal with the chronic disease complex care population with multiple comorbidities.

Rich Pollack:                 21:29                These are fragile diabetics that Madec kids etc. and they typically require multi disciplinary team mental health social work pharmacists vision nurses ect. Approach virtual visits that you know combined with home monitoring may play a key role in then intra clinic management of these patients with better outcomes lower costs. But I just don’t see the minute clinic or urgent care being positioned to deal with this. And that’s where we kind of when we were at VCU we put a lot of effort into setting up complex care clinics that deal with that small population that incurred a huge financial burden.

Bill Russell:                   22:14                Yeah yeah. Yeah I understand you’re saying but I was feeling the retail players are sitting back and that’s fine.

Bill Russell:                   22:21                You can have that business that high risk high complexity patients you can have the well let you have it. Here’s what we want do the low risk high volume business we want to take the place of primaries care we would like video visits are nice but I think you know the Walgreens the Wal-Mart CVS’s of the world would prefer the walk in visits because the walk in visits mean that they’re come in they’re going to pick up their medicine and they’re gonna make money on their core business and their core business obviously being you know retail items that they sell within the store. I thought it was interesting that you know the two examples you get UPMC Kaiser are both payer providers. So UPMC with Heimer and Kaiser obviously is an internal kind of model and so you know the tele visits, Yes the they’re going through the roof but they’re the incentives aligned for them. So they’re already getting paid on the insurance side.

Bill Russell:                   23:31                If they can do a lower cost model which they are obviously with the tele-visits and in a follow up visits they’re actually going to do better financially. And so when the financial incentives align I think you find that the behavior of the health systems align. Now this year, I think it’s going to be a banner year for most health systems. There’s no reason that should any tiers form but I think what we are gonna see though is more more and more pressure. You’re going to see regulatory pressure changing the game. You’re going to see retail players come in and they’re not they’re not going after again. that high risk, high complexity they’re going after the low risk high margin business and they’re going to keep nibbling around the edges as well. You know outpatient surgery centers were checked for years. You know outpatient imaging which has taken revenue away from hospitals for years. And so that trend is going to continue, you’re going to see more and more of that business go that way. How do you think,

Rich Pollack:                 24:42                I agree I think. I think that. Yeah. I’m sorry go ahead.

Bill Russell:                   24:47                Well you know as I was looking at this story you know here’s a couple things from it, so it says consumer views on health can change rapidly attitudes towards such things as openness to seeking care in a retail clinic and to sharing health data with pharmaceutical companies have changed in just last five years analysis of the HRI Consumer Survey reveals. the institute wrote Many consumers are ready for health care to mirror other parts of their lives in terms of convenience choice and presence of affordable options with predictable pricing. The report added. Companies that invest in deep data driven understanding of their customers will be able to develop tailored products and services. So there’s a lot of things you know there’s a lot of things competing for our mindshare. When you’re sitting in the CIO chair you’re sitting in the executive chair. How are we going to prioritize. You know we’re not prioritizing good and bad we’re prioritized good and good. So how are you going to elevate sort of the consumer mindset of how do we how do we create more options more cost effective options for the patient consumers that we have out there as opposed to maybe working on the EHR optimization or RPA and other efficiency programs, again all good programs but how do we how do we elevate the consumer work that that’s going on?

Rich Pollack:                 26:13                yeah I think yeah I think they’re absolutely has to be a focus today more than ever on what the consumer wants, the consumer convenience because they are voting with their feet and they are going to retail clinics they are going urgent care and and even in our small marketplace virtual visits are taking off with a lot of our competitors.

Rich Pollack:                 26:35                So you know we have as I think a lot of other organizations kind of no room at the at the end our 100 clinics and 800 providers or So we’re you know it wasn’t like they’re waiting for patients the waiting list even for primary care was in a matter of weeks and for specialists is a matter of months.

Speaker 10:                  27:01                So if we can partner with a you know virtual care partner if we can partner with retail clinics as we’ve done with Kroger then we have a chance we open up new channels to have these patients and retain them integration into you know what they’re going to come to us. Hopefully when they want their knee replaced or something more significant but were able to retain their loyalty retain the data in terms of a single electronic record and and still provide the kind of at home convenience that people want I mean you know here’s Black Friday and it’s going to be probably more people shopping online than actually going to the store. So that’s just the reality. People want to do things that we do so much online at home and being able to do virtual care I think is going to potentially overtake some of the some of those retail clinics, the retail clinics are convenient you’re there shopping you’ve got an issue you roll right in. But you know it’s typically, I’ve got a problem and it manifests itself on 11 o’clock on a Friday night. I think Virtual Care has a significant role that yet to be unraveling and deploy at this point. And that’s where I think health systems need to put a lot of focus on. And it’s disruptive force in terms of our clinician community. they have to think differently about how they organize their work and their day to day and their workflow to be available for that virtual. If you’re going to use your own clinical staff for your virtual visits as we’ve done. So it takes a little bit of work to work through that.

Bill Russell:                   29:07                Ill let you have the last word on that. You know we’ll transition into the sound bite section so during the sound bite section. I typically toss out questions in your direction.

Bill Russell:                   29:17                One to three minute answers. Not looking for elaborate answers, sometimes people asked me why didnt you let them talk more about it? Well you know this sanction really to give the quick hit answer to some of these things, if You go longer than that I’m not going to cut you off.

Bill Russell:                   29:35                And if you want to throw questions back to me feel free. I may have answers I may not. We’ll have to see. So lets start number one. So you’ve been CIO for several organizations have been interim CIO as well. What are you looking to in the first 90 days of your tenure.

Bill Russell:                   29:55                I realize Those two are different so let’s say the first 90 days of your tenure as a new CIO your first starting as a CIO vs interim. What are you looking to do in The first 90 days.

Rich Pollack:                 30:08                Sure. Good Question first listen and learn make rounds of staff and caregivers begin to establish trust relationships with your new boss with your peers with your staff. I try to create an atmosphere of openness and being approachable. I think it’s very important to do that right from the beginning. And finally I would identify the most immediate and critical needs and address those via collaborative action plans with staff and stakeholders so it always you know something you don’t want to be you know step into a big pothole on your first 90 days. You really do need to identify are there some really critical issues out at the front of you That would required immediate attention. Often there are now you set yourself up for the next 90 days by gaining an understanding of the organizations direction and goals. And where I.T. is aligned or is not aligned. So I think that’s kind of what my thinking in those first 90 days is about. So it’s about establishing trust relationship. It’s about doing a lot of listening and learning and making rounds and being very open and approachable. So you’ve got to be a sponge you’re going to try to absorb a lot of information. A lot of history a lot of culture that’s been there for who knows how many decades.

Bill Russell:                   31:33                And I like the idea of identifying the urgent items. I know when I took over as CEO for health system within the first 30 days we had a reportable breach and you know you just you think I have some time to sort of get up to speed but you have to identify those those emergency items. So the second question would be we talked about full time CIO How does your approach to an interim CIO role. How is that distinct. What are you looking to do there as opposed to full time CIO role.

Rich Pollack:                 32:09                it’s much the same. However I’ve found that those roles provide me with a sense of objectivity that presence when my concerns include long term sucess it’s easier to confront and challenge established norms and culture as a quote independent source you’re not you know you know I could tell you that. It just it gives you a different feeling. And especially if you’re in a very challenging. And I’ve been a very challenging environments where just the ability to you know the end of the week say you know what if they continue to just piss me off that much I’m not coming back on Monday. They give you a kind of a freedom in terms of being able to speak your mind and offer a very candid and perhaps not really look for advice but that needed to be heard. There is an independence of thought that you know maybe you should be there ideally in the permanent position but frequently were you know we couch that we mellow it out a little bit because we were concerned about you know the long term ability to work and stay with this organization and be nice with the folks over that long term. When you’re in an interim it’s really much much more cut and dry and you know that this is what you’ve got to do and you know cough up

Bill Russell:                   33:50                do you find so a CEO might look at you and say I guess there’s two schools of thought one would be hey just keep the seat warm.

Bill Russell:                   33:58                We’re doing a search process were bringing somebody in.

Bill Russell:                   34:01                I don’t find that to be the case so much anymore as the other which is hey we’re doing a search we’re bringing somebody in. but We’d like for you to really analyze this environment.

Bill Russell:                   34:11                Give us that independent party and you know if there are changes we need to make between Now and the person starting were willing to make those changes and I find the CEOs to be more in that camp. You know just keep the seat warm

Rich Pollack:                 34:26                absolutely. I mean that’s my experience as well. So it’s been more of you know we want you to keep the seat warm but we also want to really really take advantage of your experience and your capabilities to take a fresh look at everything we’re doing here. And you know does it make sense or not. So yeah I would I would wholeheartedly agree with that.

Bill Russell:                   34:51                So third question EHR useability one of our favorite topics In fact I think next week we’re going to be talking to people in class about their research on the subject so EHR usability has been challenging for clinicians. What are some of the projects or tactics that you use to make clinicians experience with the EHR better?

Rich Pollack:                 35:13                Yeah absolutely Im glad you asked that we’ve had great success at VCU over the years. Recently scored a Davies award as you may know and to a great extent that is a result of us creating a very unique office of clinical transformation that’s wholly focused on proving the physician experience and his ability to deliver high quality care the Triple Aim you know high quality care. This was the brainchild of our first CMIO Oscar published in JAMIA back in October 2011 if anybody wants to look it up. It was a considerable investment well over a million dollars a year and informatics Docs informatic nurses at the elbow trainers ect. It was hard to pick up about a year to make the case myself and CMIO together and in the end it was actually the dean of the medical school that coughed up three million dollars of the money for three years. Get this off the ground but it was usually successful after that and the organization began. The board recognized that success ect it really was a secret sauce as our current CMIO would say. Real world examples of that success were real time dashboards that addressed the early warning in the ICU patient safety blood usage and just a higher level of satisfaction among the medical staff. Not that everyone is in love with the EMR. I think EMR is between the ideal user interface usability system that are out there in the world and our EMR there is a big gap in the way they’re designed so there’s no question about that. And they need still need a lot of work needs to be done but nonetheless with that kind of focus on the clinicians that that clinical transformation office provided us and some significant skill set within the EMR itself.

Rich Pollack:                 37:25                So we are very adept Cerner developers and users within our team that could really make the system and other things within pages and therefore develop in and improve physician documentation. So there are absolutely incremental improvements that can be made all across the board. If you’ve got a mechanism to link in your clinician community and as a collaborative force to do that

Bill Russell:                   37:58                interesting. So office clinical transformation if people are interested they could reach out to you on that sounds like an interesting conversation. So fourth question, so ROI is an important part IT when I sit down with operations people and finance people they are always saying you know how do you measure ROI or how are you able to attain positive ROI on IT projects what are some of your thoughts on measuring ROI within IT any tips on measuring it and reporting back on it

Rich Pollack:                 38:29                actually not many if you’re talking about financal ROIs much more so in terms of improved outcomes patient safety reduced that no that reduced near misses that we’ve been able to document that return on value. Maybe not necessarily a traditional financial return on investment. You know any and even those you could not lay that 100 percent at the feet of the EMR because EMR is part of an ecosystem changes that affected that the other work processes that were put in place. Individuals training a variety of things that affect those changes. but The EMR and our ability to build guard rails and tools absolutely affected those improvements and outcomes. One easy financial ROI I was ever able to nail down was patient keeper project which is a mobile system. Still in use we’ve had it for many many years that collect and present clinical data to the provider but it also allows them to document their their encounter with the patient and with the appropriate coding for billing purposes and they replaced. Many years ago the little three by five index cards that they had in their pocket where they would write down Level 3 visit or what have you. And because that previous paper process was so fraught with loss and you know people unable to interpret position what they were documented there we literally documented millions of dollars within the ROI return.

Rich Pollack:                 40:26                people initially didn’t believe it until we ran a pilot with it and then their mouths were agape they didn’t realize how much money was being left on the table in provider encounters remember. As an academic medical center. Our positions are salaried so it’s not like thats necessarily in their self-interest to be diligent about this stuff. So that was the one positive financial ROI that I could put down in a book somewhere. Yeah absolutely take this to the bank but then I can’t remember too many others of those

Bill Russell:                   41:03                Well Ill tell you what we’ll keep moving on the last question I have for you is lets talk about contractors consultants I get this question every now and then from CEOs and some other where you found the best place to utilize consultants within health IT. and Where would you avoid using them as a CIO.

Rich Pollack:                 41:29                Yeah. I found a couple of areas where I where I have used consultants one was to mentor and develop certain directors or managers that needed it and focus more than I could provide because they’re moving into new roles. So in the case of our when we we tap a young individual to be our Director of Analytics in a newly developing analytics operation the varmint brought in a well known analytics expert in healthcare to spend some time one on one with him and it was usually successful Likewise for a new associate CIOs. So I think in those that’s been helpful to me the other is taking on new projects that exceed our internal bench strenght is more contractors than consultants if you want to the subtlety of the terms. So not a word. We our CFO for many years at VCU was all about minimizing headcount. She didn’t have any issue with spending a lot of money contractors and bringing them into to address our project but she simply didn’t want to add head count when she retired a new CFO came in with a 180 degree different philosophy.

Speaker 10:                  42:56                We began to shed those contractors and build up the bench strength and the headcount Within IT. I think that that was one area. Depends again what the philosophy is but with all the projects typically coming in front of a CIO it’s a rare department that actually has the bench strength to man all of those projects from a subject matter experts project managers through you know report writers what have you the other areas very specific skill sets that might be missing. So when we were in the throes of meaningful use especially the stages we run on project managers that had exceptional skills and understanding in regulatory climate and all of the rules and regulations associated with MU at that time. So that’s one or we would bring on a remote HL 7 programmer experienced with a specific interface and because we needed more capability and they just were hard to find in the local area. So those are those are examples where contractors or consultants have been useful in the past to me

Bill Russell:                   44:10                Absolutely. Well that’s all the questions I have for you. you have Any for me or are we good to go.

Rich Pollack:                 44:20                So Bill, Digitization in healthcare is getting a lot of play and you know it’s all over the map it’s everything from a precision medicine through consumer devices at the home. do you think of being overhyped at this point now.

Bill Russell:                   44:40                No. I mean it’s being hyped it’s really hyped and it’s not be enough. you know we talked earlier about how as soon as the financial models change everything is going to change.

Speaker 13:                  44:55                You know people want convince they went online bill pay online scheduling they want you know telehealth visits or you know my son’s inside right now he thinks he has tonsillitis well it’d be nice to just get on online with this provider and have a conversation have them say hey you know whatever because we’re not even we’re not even local to the market where he’s at right now.

Bill Russell:                   45:16                So you know I think that’s going to change it. AR, VR, AI, machine learning. I mean these things are right around the edges and really have the ability to really transform a market so I don’t think that’s being overhyped. It has the potential of what I think the thing that people underestimate is how long it’s going to take. Because of the fact that our incentives are aren’t aligned and the organizational change management that’s required to move these multibillion dollar organizations even in some small hospitals people are surprised when I say you realize that’s a two billion dollar company and they go “you’re kidding” its like no. Even small hospitals are multibillion dollar twenty thousand employee organizations and there is a lot of different entities out there that are that have agendas have a voice in the community so if that does slow it down but it doesn’t change the environment. the use of data the use of just the emerging technologies is going to impact healthcare.

Bill Russell:                   46:29                You just I’ve found every one of my predictions to be about half as quick as it actually takes so I say I think it’s going to transform healthcare in three years it’s usually six so try

Rich Pollack:                 46:41                right.

Bill Russell:                   46:42                So hey Rich Thanks on Black Friday. Thanks for coming on the show. Appreciate it. What’s the best way for people to follow you

Rich Pollack:                 46:54                They can go to the starbridge advisers website they’ll see some blogs I have there. they’ll see my contact information there as well and can email me through that for any any further follow up Or information. Happy happy to stay engaged just came back recently from time and so a lot a lot of old friends.

Bill Russell:                   47:21                Yeah that’s great. So you can follow me on Twitter @ThePatientsCIO you can follow the show thisweekinHIT our website is thisweekinhealthit.com In the short cut to the youtube channel is thisweekinhealthit.com/video

Bill Russell:                   47:39                That’s all for now so please come back every Friday for more news information and commentary from industry influencers.

 

 

 

 

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