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Patient Engagement in the “New World”: Getting the Tools in Place

Patient Engagement in the “New World”: Getting the Tools in Place

As COVID uncovers and highlights emerging needs in patient engagement, how can technology leaders quickly adjust to get supporting tools in place? The urgency to adopt a cohesive and comprehensive patient engagement strategy has never been greater. Get insights on how to move ahead from former Intermountain CIO, Marc Probst.

 

Transcript

JUSTIN EVERETTE: Hello, everyone, thanks for joining the webinar, Patient Engagement in the New World: Getting the Tools in Place. We've got a number of people who are still joining and logging on. So I'm going to give them just a moment. But we'll get started very soon. Thanks.

All right, still some attendees joining and that's fantastic. But we'll go ahead and get started. Again, this is Patient Engagement in the New World: Getting the Tools in Place. We're thrilled to have you join us today for the discussion, I'm going to just do a shameless advertisement right at the beginning, oh my gosh, right out of the gate he's doing that. But just invite you to real quickly connect with us, Solutionreach on Facebook, on Twitter, LinkedIn, you'll get a copy of this recording afterwards. So you can come back and look at that, no need to jot it down. 

There's also a PDF of the presentation today in the handout section in GoToWebinar. So you can access that there as well. So today, we're going to be joined by Marc Probst, who's the Chief Information Officer at Intermountain Healthcare, an integrated delivery network based in Salt Lake City. Marc's been involved with information technology and healthcare services for over 30 years now. 

He's a partner with Deloitte Consulting, and Ernst and Young. He's also served as a board member of several healthcare related organizations, including the Federal Health Care Information Technology Policy Committee. That's a mouthful. And as the chair of the College's Health Information Management executives, also known as CHIME. And also excitingly, Marc was recognized by CHIME and HIMSS, the 2019 John E. Gall Jr. CIO of the Year, so a great honor. And we couldn't be more thrilled to have Marc with us today. 

As for myself, that's me on the right, Justin Everette, and Vice President of Marketing SR Health by Solutionreach. And I've been in the patient engagement and patient communication space for a little over 15 years now. And I just love joining forces with individuals like Marc and other thought leaders in our industry, to help them share their experience and best practices in a way that's helpful for all of you. And that's exactly what we've designed today's discussion to be. 

So we're going to pick Marc's brain about how he's approaching COVID and patient engagement from the CIO seat, and we want to make it interactive, as well. And so to that end, also on the call today is Lea Chatham, she's lurking in the background. She's our Director of Content Marketing for SR Health, and she's going to help us out by monitoring the Q&A in the chat.

And whatever thoughts you've got as we're going along again, it'll just kind of be almost sort of a fireside chat between Marc and I. But we invite your questions and your comments. So if we're going through and you've got something you want to ask, please put it in the Q&A or the chat. And we've asked later to interrupt if it's any juicy ones, or Lea said, apropos, I like juicy. If any juicy ones come through, will have asked her to jump in and share those and prompt us with those.

And also on the housekeeping front, just a couple of questions that we know we always get here. So I'll address them right up front. In addition to the slides being here as a handout in the GoToWebinar platform, we'll also plan to send a recording out afterwards. So if you have to drop early, no worries, we'll get you the recording later, or if you want to share it with someone. 

And then also, if you happen to get kind of a choppy audio issue and you're listening through your computer, our recommendation there is always to switch to the phone. A lot of times that'll resolve that for you. So that's kind of a couple of housekeeping pieces and, again, if you've got questions, either technical or content related along the way, we'd love to hear it and address it. 

So here's what we're doing today. We're thinking about how do we do patient engagement in the new world and how do we get these tools in place? And Marc and I as we were talking about what do we want this discussion to be today. And there's really three pieces it was first, what does this changing landscape that's evolving every day? What does it mean for everyone? And everyone's a key word there? It's not just patients but what does it mean for providers to? And so what are some of the implications of that? So we've got a few questions, we'll explore their experiences. And we'll want to hear from you. 

And then secondly, in how that changing landscape is evolving, how have we solved for some of those needs and requirements and demands to date? What have we done up to June 18, to get us where we are? And there's different approaches everyone's taken. And then third, okay, we go forward from here, we know, this is what we've got to go solve for going forward, there's going to be a new approach. Well, how do we approach the new approach? And so that's a structure that we think makes sense for today. 

And we'll jump in and start with that landscape piece. What does that mean for everyone? And we've got a few questions we want to talk through here. And I'll invite Marc in now and just ask, Marc, from your perspective, from that CIO seat what are you seeing within your own organization? And what are you hearing from your peers around what patients are going to expect going forward?

MARC PROBST: Thanks, Justin, I appreciate that. And, first of all, I hope that everyone out there is safe and well, and healthy in this really weird time. I mean, difficult in many ways, certainly weird in someone like me. And I'll just correct one thing, and this is not Justin's fault, I'm sure I gave you a bad bio. I've actually been doing this for about 40 years. And I only bring that up, because we talk about what does this mean for people. 

And I wish I knew, I mean, after doing this for 40 years of technology and healthcare and being involved with large integrated delivery systems I've never seen anything quite like what's happening today. And I think it really is going to make for an opportunity for all of us to learn together. So that interactive component that Justin was talking about. I mean, if you have thoughts, ideas, if you think what I'm saying is stupid, I think it's great. But let's share that, because we're going to learn a lot together over the next... Well, not a lot in the next 45 minutes. But over the next several months, as we're working together, we're going to learn a lot. 

So to get to your question, Justin what are patients expecting as we go forward? Well, I think there's a... I'll just give you my kind of thinking around that. And I'm sure there's better thinking out there. But I don't believe... Patients, what they're expecting, is to have a safe interaction with their healthcare system. And what we're seeing as we start to bring back elective surgeries and bring people in for clinic visits, there is a hesitation. And that hesitation is... And we've seen it in Eds, we've seen people come in that haven't come in with relatively major health issues, because they're worried about getting COVID-19 if they come into one of our facilities, because we're aggregating all the sick people. 

So I think foremost, they're looking for a level of confidence in that interaction, and how they can come in and have good safe care. To break that down just a little bit. I think they're looking for no waiting rooms. And we're seeing that. We're seeing organizations, even internal of our own and elsewhere, that waiting rooms are gone. You're basically they're timed to come in at a time that's socially distanced or socially appropriate. Or you're waiting in your car and you're waiting for a phone call or a text or something to get you in. 

I really think that the waiting room, we've already talked about that prior to COVID of being something that needs to be in the past. But now we're going to have to actually implement that because the patients are going to expect it. The place I've experienced is the barber because I went like three months without a haircut. I looked like I was back in the 70s. 

But certainly getting in line. I mean, they did not want me in that barber shop, until it was my turn to come into that barber shop. And then of course, we had all the masking and those kinds of things. I think patients are looking for a lot less uncertainty about the information, about what they're doing with us. They would love to have opportunities to understand better... We will get to providers in a minute. But why they're coming to see us and do they really need to come see us and are they going to the right modality of care. 

And I think they would like more certainty around that. They would really like... It's interesting, more instant gratification. I've used and when I speak, I've used the example and I call it and I'm sorry for the proprietary nature. And I don't mean it that way. But I've used the term Dr. Google. But what I'm talking about is AI driven interactions that can, again, focus me on what my problems are. And maybe even solve them, maybe I don't have to go anywhere, but to the pharmacy, and they'll deliver the drugs as well to get my prescription.

That they want more instant gratification. And that kind of goes with the certainty aspect of what I talked about. And patients are looking for a lot more... Go ahead Justin, did you have a question? 

JUSTIN EVERETTE: Do you think that's related to COVID? Or is that something we were... Did COVID just kind of accelerate that? 

MARC PROBST: I think COVID accelerated all of these things. I think one of the slides toward the end, we talked about things that we were doing anyway. But I think it accelerated. And also made a lot more people comfortable using the technology. I mean, even our docs that weren't all that old, they weren't using things like telehealth. And they weren't texting and some were, but I wouldn't say in general.

And the patient's themselves they weren't as prone to use a digital connection into their health care provider. And certainly, we've all got the portals and the digital connections into our health system, but they weren't using it as naturally and as effectively as I think they are now. Now that they are, they're looking to get the value out of that. And some of the things that they're used to in non-health care interactions.

Pricing is going to be a big deal. Patients want a fair price. And we'll talk about some of the issues of cost, I think, a little later in this Q&A. Patients really want... I think... Well, I know they do, they want the very best care possible. And at Intermountain, we called it the best practice care, I think that's caught on around the industry. We use care protocols that really assure that across our 28 hospitals and all of our clinics that we practice medicine in a similar way. 

But they really want this in a best practice kind of care. And to do that we've not been successful doing that in a format that was just word of mouth, or everyone researching what was in the journals. It really came down to technology supporting that process. And I think the patients expect it and deserve those kind of things. So those are the things that kind of come to mind. Anything else, Justin?

JUSTIN EVERETTE: No, I think that's great insight there. But I think what I posed to you is kind of the other side of the equation there from talking about patients expecting the best care and the providers that are giving it to them. What are what are some expectations on that end right now? What's kind of emerged in the last couple of months regarding what what providers needs are? 

MARC PROBST: Well, our providers are certainly getting used to telehealth. I've heard statistics anywhere from 30% to 50% of the telehealth volumes that we have now in the midst of COVID, which are 1,000 times larger than they were pre-COVID are going to stick. So I think the providers would like to keep the flexibility, that having things like telehealth and digital interactions are going to provide. But they also are really focused on safety. 

And they love their patients, and they really want to do the best care that they possibly can. So they're going to be looking for us to not just have telehealth as an excuse or an easy way to provide care, but it's the right way to provide it and the right modality at the right time. They want the right tools to do the job. I don't know about all you out there. 

But we brought on an awful lot of technology very, very quickly because of COVID. It forced us to do things from homes, outside of the clinics, have different interactions. I think the providers expect that we will have a good, safe, consistent set of tools. 

The docs want to work... All the care providers, they want to work with the top of their license. And we need to figure out how to do that. I'm going to have my first telehealth visit on Monday. I'm not sure quite how that's going to work out. It's a specialist that I'm seeing. But it'll be interesting. It'll be an interesting learning... It'll be interesting for me to learn from, but this is how the clinicians want to do it. 

Because I know we're open. Our clinics are now open, I could have gone in, but they're preferring to do this first visit with a specialist through telehealth. And again, people can work at the top of their license. Not every interaction with a patient is exactly the same. And now we can start looking at ways of using the technology, using the offices, it's everything to get to the top of the license and make sure we're dealing with the right person. 

I think the providers love the flexibility in their schedule, and they're going to look for keeping that kind of flexibility. And I don't mean that just to make life easier. We've got a lot of capability, we've got a lot of patients, but we tend to work 9:00 to 5:00. And I think right now what we're seeing is no, we can expand that quite a bit to be more helpful to our patients, but also more attentive to our clinicians as well. 

And providers understand it's a team sport. And what we do is a team sport in health care. And they would like to see us figure out how to facilitate that team work better than a lot of the word of mouth or a lot of EMR that we depend upon. There's a lot of things that have to go in that space.

JUSTIN EVERETTE: That's great. That's great Marc. I think that's a good segue to our next question here. Because you and I have spoken about that concept of health care in a team sport, and it's a matter of patients and providers being on the same page. How have you guys at Intermountain approached making sure everyone knows exactly what's going on. And just kind of as a joke on the side, we communicate and over communicate. But even beyond the communication standpoint, I'm curious to know, what your experience has been there and how you approach everyone being on the same page. 

MARC PROBST: I refer to the care practice protocols that we use. I mean, that is a tool that's primarily driven by the EMR. But I don't think that's near enough. And what we do is not ideal today. And we have talked about this before, Justin. We use Vocera so that nurses can talk to nurses and nurses can talk to doctors and nurses can talk to bed control and maybe the environmental services. 

But that's one technology. We use email, to communicate, we use the EMR to communicate, we use texting to communicate, we use cell phones to communicate. I'm sad to say this we use pagers to communicate. And we also use faxing to communicate. And I am sure we look like 95% of all healthcare providers in the world, there are a lot of different pieces of technology that we brought in to enhance and allow this communication to go on. 

And everything I just outlined to you maybe short of like texting and some emails, and maybe a portal. They ignore the patient. I mean, it's how we communicate just within the very complex system that we have. We've got doctors that need to talk to nurses. We need labs, we need pharmacy, we need environmental services, we need therapists. I mean, all these people are important components of care delivery. And the communication between them is just not very elegant. Go ahead Justin. 

JUSTIN EVERETTE: Yeah, I was just going to say, just on the internal side, I think that's pretty fascinating that it's so disparate in so many different channels there. Gotta laugh,  I had to explain to my 12 year old what a fax is the other day. I'm not sure-

LEA CHATHAM: On the communication front--We do have somebody asking a question about... And I feel like this is a communication question, which is why I'm stopping you to throw it out. But essentially what they're asking is, how do we keep our patients safe? With maybe fewer staff in the office or fewer resources. And I don't know if you guys feel the same way about this, but what when I've been doing webinars we've been talking about part of that is about communicating. It's about making sure everybody knows how we're doing that and what the processes and procedures are and those kinds of things. What are some of the thoughts that you guys have about that?

MARC PROBST: I can start. And maybe it's just some broad brush pieces. One we've got to simplify our communication both internally and externally. But what we don't need is just so many modalities of communication out there that make it hard for patients to interact with us. And again, I wish I was a best practicer, I wish we were. But we've got multiple 800 numbers, we've got multiple technologies that people can use to interact with us. 

And I think that makes it pretty complex, and it can make it unsafe. Because maybe we're using the wrong modality to get to them the result of their cancer screening or one of their lab tests. So I think part of it is, we've got to be much more mindful to our patients, as well as our providers, that we need to simplify this. We also need to be really careful, and I probably have notes later in this presentation. But now that you bring it up Lea, we need to keep our communications as close to what's natural for the patient or member, whomever it is, as we possibly can. 

And I'm not anti portals or that kind of thing. But for me, I'd just as soon get a text message, if it's HIPAA compliant and we take care of all the security pieces than it is to walk out log into a different app, which is going into my health care provider, and have to do something really unnatural to have that communication. So I think a big part of safety and quality, is really being aware of how they want us to communicate with them, and keeping it simple. Justin. 

JUSTIN EVERETTE: Yeah, I totally agree with you. Speaking from the point of view. I mean, this is about... COVID's here, but it hasn't changed the fact that I still want convenience, and I still want ease of use. I mean, I've always wanted that, and probably even more so now. But I kind of flipped our slides to the next one. Because I do think there's a safety component there. And making sure I feel like I'm dialed in with my provider, but I still feel like I'm safe. And whether that's from the comfort of my own home, or wherever it is. I think just being able to naturally communicate back and forth through a...

For me, like Marc mentioned, I'm right alongside him, for me, just being able to text back and forth is huge. And for me to be able to initiate that conversation with the text too. So not wait on an incoming text to me and respond to that. But for me to just go, oh, if I've got a question here, and I don't need to pick up the phone call. Easier for me to just fire off the text, and be done with it and start it that way. 

So actually, I think I want to go ahead and move past this question, because we've already talked about this. But I wanted to transition a little bit Marc over to the cost part of things. So how are we going to reduce costs here and given the new environment can we do that? And what are your thoughts around that topic? 

MARC PROBST: Well, it's interesting, because just yesterday, we had a major internal meeting at Intermountain Healthcare. And the statement was made by our CEO that the next acute crisis... So we're in the midst of COVID but the next acute crisis will be affordability. And if we can't get our health care delivery to be more affordable, it's going to be a real problem. 

And so how are we going to reduce costs? Well, we're going to start minimizing the use of buildings as much as we can, because we've learned that we can do that. That doesn't mean we don't have them, we have hospitals, we have clinics, and we will, we got to use them more efficiently. And maybe we can actually close them down as we can become more virtual in the kind of care that we make.

I think there's things like redundant applications, I brought that up just in the space of communication, we have so many different things we're paying for, we're supporting, we're training people to use, we're integrating. We need to get to a more consistent set of solutions. And that's going to take some thought and some strategy. It's not something you do overnight. 

And as you and I've talked before, Justin, I'm a big believer in platforms that allow us to do things versus lots of niche solutions that we paste together. And I think maybe interested in what other people think. But maybe because of COVID, we've learned somethings. I mean, decisions happened so quickly. We spun up a command center in a matter of a day. 

We started bringing major issues into that so that we could get people working at home, so that we could leverage telehealth, so that we can understand what the federal government's doing. All the things I know all of you did. But what we learned was, we can make decisions much quicker and we can act upon those much quicker. We didn't get lost in all the bureaucracy of complex governance. Doesn't mean governance isn't important. I did not say that. 

But what it does mean is when we Have urgency, we can really move and we can do some amazing things and move some mountains. And we've seen that through this process. So I, yeah, capital expense is going to be less, no doubt about it. Operating expense is going to be less. What did we read? I mean, it's billions of dollars a month that we're losing in health care. I don't remember what the statistic was, but it was massive. 

JUSTIN EVERETTE: Wow. So just to put a bow on this part of the conversation, I'd ask you, and also encourage you guys listening, to share your thoughts here. And really, the overall question here, as we think forward, is what does success look like for you? And what does it look like for your organization? And Marc I'd pose that question to you. What does success look like right now, and how does that contrast with maybe what it looked like in the past, if at all? 

MARC PROBST: Well, I mean, a lot of it has to do with the past. But what success looks like going forward is, we need to provide at least the same quality of care that we're providing today, which is pretty high at Intermountain Healthcare. Hopefully, we can provide even better care. And we need to be able to do it more efficiently, we need to be able to do it in a way that's affordable for our patients. 

Going back to that acute crisis, if people can't afford it, they won't get it. And if they don't get it, they're not going to get better, and we're not providing good care. So we've got to be able to lower costs, there's no doubt in my mind, that that's going to be probably the next... That's going to be the biggest issue sitting out there for the next five years. 

Now, as a technologist I believe technology is going to help do that. And so there'll be some investment in the space. But we're going to have to lower costs. We've got to be able to bring the patients into the care process better. And for the last 10 years, I've noticed that we've always put the patient at the center of every PowerPoint presentation, and have everything happening around them. 

The challenge here, is everything is still happening around them. How do we make sure they're part of the decision making processes on their care? How do we note in timely manners what's happening with them so that we can adjust a prescription or an antibiotic or even a physical therapy? How do we know these things in a much timelier basis, simple for our providers to consume and then make decisions and help move them forward.

But I think that's what engagement is. It isn't the kind of engagement that, "Oh, man, Intermountain's got really awesome billboards and stuff on buses and TV commercials." That is a form of engagement. But the engagement we want is with their health, and that they know, and we know we're in together, along with family members and other people that are part of the care processes, that we're all in it together. And we're working together to solve the problem. That's what success looks like. 

JUSTIN EVERETTE: Marc, I'm a marketing guy, I'd like billboards and buses and stuff. [inaudible 00:28:19]. So in all seriousness, that's great feedback. And I said, we put a bow on this section. But I'm about to put a bow on top of a bow here. And this is something that we kind of spoiled a little while ago. And there's just this notion that you and I spoke about, about we were already moving in this direction anyway. A lot of this stuff, we're talking about, a lot of these advancements, we were already moving down in the path and COVID just made us do it faster. It feels like it's forced our hand to do some of these things. And I'm curious to know, your thoughts on that Marc.

MARC PROBST: Yeah, no doubt that it's made us move faster. The challenge I think we have is, we didn't necessarily do it with a strategy. And so we did it fast, maybe not in the most effective or efficient ways. It'd be interesting to see how some of our partners, vendors and those kind of folks, maybe our EMR vendors, if they were... Because they had to solve problems as well. And I don't know this at all. And we're a Cerner user, and I think they're an excellent company. I mean, I love dealing with them. 

But did they have to do things quicker than they would have liked to? And now, is there going to be this period of time where we've got to kind of pause and take a look and say, "What did we actually do? What worked really well? And then how should we best move forward?" But yeah, we were on almost all of these paths. Everyone on this phone call was involved in much of this. 

JUSTIN EVERETTE: That's great. And that's a perfect transition to what I wanted to get into next, which was out how we tried to solve for these to date. And you and I were talking in preparing for today and we were really kind of talking about three different scenarios or approaches. And, Marc, I'd love to get you to talk about this, this notion of niche solutions. You were speaking to it a moment ago, I think, with regard to even just internal communication. But would love to get your thoughts here. 

MARC PROBST: Yeah, and I am probably going to sound a bit like a broken record. And I'm sorry for that. And maybe I'll just take one step back. I've been in the industry a long time, like I said, and I've seen the pendulum swing, swing between best of breed niche solutions that are highly integrated to a single solution, kind of vendor products. And that pendulum's gone back and forth three or four times. 

Prior to COVID, we were very much as an industry focused on implementing EMRs. And in that kind of phase, we really went with it... And we're going to talk about EMRs here in a second, I know Justin, but I will try not to get too far ahead of myself. But that was, we had the stimulus package that helped fund that for us. And we worked really hard to get those EMRs in place, so that we'd have data and be able to provide care and all the things that we talk about. 

But COVID has kind of pushed that back down toward niche solutions, because the EMR does a tremendous amount, but it certainly doesn't do everything we need within the health system. And so this is where we're getting lots of niche solutions. And it was offered to us in so many ways. I mean, how many vendors came to us and said, "Hey, we'll give you this for free. Just use it, this will help you with what you're doing with COVID."

And we brought in a lot of these things. To me, that's been helpful. I really appreciate our partners for doing that. They're really good companies. But now we are caught up in this, "Hey, everything doesn't integrate really well. The data that we're getting all these things certainly isn't normal, normalized, where I can do all the analytics that I'd like to do. And so I've got to take a look at this picture."

There's place furniture solutions, and a lot of the really forward looking companies have very niche solutions. But in the long run, particularly if we're talking about communications and closing the gaps and communication, those kinds of things. It does create this potpourri, that's difficult to integrate and difficulties. 

JUSTIN EVERETTE: And so Marc, as you mentioned the lack of integration there and that potpourri and what's your feeling on what's the impact on the patient and their not only their care, but their experience with this potpourri of maybe engagement outreach and communication with them. 

MARC PROBST: It's disjointed, it's difficult for them, if they have to continue to move between apps or move between modalities. It's better than it was. So I am not complaining about what's been going on. But we can do it better, we can make it seamless, we can make it really easy for them to access the right level of care. And that's going to take some thought.

JUSTIN EVERETTE: Yeah, that's great. You mentioned the EMR. And we included that here as well. And this idea of trying to go, you use the EMR to check a lot of boxes or meet a lot of the needs, of those patient and provider sides of the coin right now. Where have you seen difficulties and even strengths with an approach like that today? And again beyond Marc, if you guys have thoughts here, chime in. I think, we'll share a poll here in a minute. 

But Marc, could you reflect on where you've seen that the EMRs have their strengths and weaknesses in this respect to date?

MARC PROBST: Yeah, I mean, the EMRs are really integrated. And that's nice. They're generally a single platform, particularly the major ones that are out there now. And so data moves really quickly in a standard format between all these different functions that the EMR does, and I think that's great. I think our docs like the messaging systems that are inside the EMR, because it fits within their workflow of what they're doing right. They're spending so much time on it, it's easy to see where my messages are and the things that I need to do. 

And probably easier to respond because you can take data right out of the EMR and move it around. So there is definitely an integration advantage to the EMR and a standardization advantage to the EMR. Where it gets a little hard from my perspective, is I mean they're really big, heavy technology. I mean, they're big systems, millions of lines of code. Lots and lots of tables that have to stay synchronized with one another. And so making changes to those EMR systems to really focus on the challenge of communication, let's say, between the various parties within the care process and of course, the patient and the family and all those types of things, it becomes pretty different or difficult.

And the security aspects of that raise some interest too, because you have so much PHI and you've got the whole record for that patient in there, and you're doing a lot of work to secure it. So they have huge advantages. I'm a real fan of our EMR and the EMRs that I've seen out there. But there are things that it's just kind of hard to make them move on a dime. And I think in some of these newer areas, it might be difficult for the EMRs to keep up. 

JUSTIN EVERETTE: Yeah, I get what you’re saying. And the third one I wanted to talk about here was based on a comment you've made me about the approach you guys have had at Intermountain which was, and I'm paraphrasing Marc Probst here, but it was, "If we can't find it, we'll go out and build it." And we'd love to hear some of your experience there on how you've done that so far. And again, what the positives and the negatives have been there? 

MARC PROBST: Yeah, sure. So in the 70s we either built the first or the second EMR, it depends who you talk to. It was called Help. At the same time, we were building Help and I use weave liberally because I wasn't here. I was in let's see, junior high. But we built this EMR called Help. And there wasn't one out there. And so Intermountain has had this attitude for a long time, and capability. And I can tell you why we're as blessed as we are. Because there's some uniquenesses that Intermountain has. But we went out and we built these things. And so through our history and financial systems weren't really available in healthcare, we build our own financial systems. For years, probably until seven, eight years ago, well, probably 10 years ago, everything was built. Our ERP system, you name it, revenue cycle, the whole nine yards. Well, we switched like everyone else. And now there's good products out there, where we were using mostly vended products. 

But as we looked at digital communication with our patients, we decided we needed to build basically a digital front door. It's not what we call it anymore, we call it My Health plus, which is... My Health is our portal, My Health plus is the digital the mobile version of it. It's pretty powerful and pretty nice. And we started this four years ago. And when it was there, there just weren't any good solutions. I think, as we look at it now, and it's built in a very modular fashion, so we can bring in products and plug it into it. I think there's a lot more in the market now that folks don't have to do it. 

At Intermountain we build it. I don't suggest it, it's really expensive. I have a very large IS organization, about 1,300 people. So it's a big IS organization in the need that to do the build, to do the maintenance, all the things that come around having that kind of product. But the market wasn't there. 

Now I think the market is catching up. And just like in EMR space, no one would use Help. Help was ASCII green screen, characters had certain amount level of functionality. When you get big vendors like Cerner, Epic, AllScripts, they've got huge R&D, and they've surpassed what we can do. That's what's happening in this space as well now around digital communication and engagement of our patients. 

JUSTIN EVERETTE: That's great. Lea, are you still out there? I know you have a poll question. We were wanting to launch here.

LEA CHATHAM: Yeah. Yep. 

JUSTIN EVERETTE: I'll let you take-

LEA CHATHAM: So we just wanted to kind of get a sense of what experiences have people had with the same kind of thing. Using niche solutions or using whatever happens to be in your EHR that's available to you are trying to build your own solution. And we thought it would be sort of interesting just to see what people have tried previously, and then we've got a follow-up question to that about how that has worked for you. So we'll give everybody just a few more seconds to fill this one in and then we'll push out the other one too. And we'll share the results. 

And it's funny Marc, as you were talking about these sort of DOS-based old things. I started my career and anyone who's been in the industry for more than 20 years will be familiar with them, with medical manager health systems, which was one of the first and earliest practice management and EHR companies, which, of course, was all, DOS base. And our biggest competitor at the time was [inaudible], which also was all DOS based, everything was flashing, little cubes on the screen. 

So within a minute, I'm going to push out the results on this one and share those for a second. And definitely seems like and I'm not surprised but most people are using like a lot of different solutions, or are using kind of whatever's been handy in EHR. So I'm interested to push out the next one. I'm going to hide this, and then we'll push out the next one, which is were those or are those methods effective? 

Have they given you kind of what you needed or what you wanted? Have they been effective at improving communication and engagement? 

JUSTIN EVERETTE: It always takes a minute for these things to load, that's [crosstalk 00:41:21].

LEA CHATHAM: I know. Well, and sometimes it's funny. You notice that like, sometimes, some people can see them, and some people can't. We often get people who say like, "I'm trying to answer the poll, and I can see it, but I can't answer it." This technology. As we're talking about technology, technology is a challenge.

JUSTIN EVERETTE: Yeah, I could see the numbers kind of growing as a presenter here, and there's a lot of sometimes. It's not a definitely yes, definitely no. There's a lot of, "Yeah, kind of." And sometimes. [crosstalk 00:41:51].

LEA CHATHAM: Yeah, I'm going to push this one out, too, because we're almost at a minute here and just share so that other people can see it too. Definitely the majority is in the sometimes. 

JUSTIN EVERETTE: Marc, would you say that's pretty true to your experience? 

MARC PROBST: Absolutely. I mean, absolutely. 

LEA CHATHAM: This might be a good time, we've had several people... So I'm going to hide the poll. And it'll go back to Justin stream. But there have been a lot of people Marc who've been saying what do you do? Or what are some recommendations from both of you, Marc and Justin around how do we do a better job of bringing patients into these how we make decisions or get their feedback around whether or not things are working? What are some of the thoughts and suggestions you have from what you do at Intermountain, then Justin, just from our experience around working in this area. About how to engage patients more and get their feedback and understand their experience better? 

JUSTIN EVERETTE: Sure, I mean, from my perspective [crosstalk 00:42:59].

MARC PROBST: You go ahead, Justin.

JUSTIN EVERETTE: [crosstalk 00:43:03].

MARC PROBST: No, you go ahead Justin.

JUSTIN EVERETTE: That patient feedback loop has got to be there in terms of how we're serving patients and getting that real time feedback or after the fact. And Marc, how have you guys done that an Intermountain? 

MARC PROBST: Well, I would just say that nobody wants meaningless communication. I mean, it needs to be relevant, and it needs to be appropriately focused. And we also don't want the four different people calling us for the same thing, whether it's a lab result or scheduling a visit, or whatever it might be. So coordination becomes really important. At Intermountain, we've always felt, at least for the last 10 years, we felt, I guess, that transparency with the patient is incredibly important. 

And if you're going to have them become engaged in their care process, we need to be providing relevant information to them in a timely basis. And then we need to allow the interchange to happen. And nothing's more frustrating than getting a lab result, a PSA or whatever it might be. And we can send the nice text document that says, "This is what it means. And this is the range." But you know what you really want to do, particularly if you're out of range is you want to talk to somebody. 

And I think we've been a little bit "Hey, it's okay, just to push it out. Our docs are real busy. And our MAs are real busy, so we don't want to bother them." And that is just exactly the wrong attitude. We need to be able to provide this information to our patients and whoever they suggest, their family members or whoever that they would like to have as part of that care process. 

And then we need to allow for very simple, very timely interchange. And then they're going to get engaged. It's like you and I talking Justin, we're talking to one another and that happens naturally. If it were not so natural it would make the discussion harder. And I don't think we'd get to the points we want to get to. So those are my thoughts. And that's what we're doing. We're just surfacing hopefully good information to the patient. 

JUSTIN EVERETTE: Yeah, that's great. So kind of the last piece that we wanted to do for the group here and again thanks for all those questions you guys, got a good number of them in there. Is what knowing what we need to do, knowing where we've been, and Marc walk through a few of those quote, unquote, solutions today. And we heard from everyone here, in terms of how they've been approaching it is a few thoughts on how do we move forward. 

And one of these, that I think is really good is here we are at, depending on, when this became serious area of focus for you, you were kind of at the three month mark here. So, it's time to kind of step back and take a deep breath and Marc, share your thoughts on that. Because you had some good ideas, when we talked through this before. 

MARC PROBST: Yeah, I mean, we just had to move so quickly. So there wasn't a lot of time to plan or to really think through how everything was going to integrate? Were we going to use Zoom? Were we going to use Teams? Were we going to use something else? And we just did it. 

And to me, what is it, measure twice, cut once is what the carpenters term is. And we weren't doing a lot of measuring, we were just cutting and doing stuff and getting it done. I do think it's... Either it's right now, and maybe too hard in some places. But I think we're getting to the point where we need to step back and really measure twice. What is it we're trying to accomplish here? What are we trying to accomplish with our providers? What are we trying to accomplish with our patients, our members, whatever it might be, and take a breath and say, "Okay, how are we going to do it? Are we going to use the technologies we just deployed, or are we going to look for different solutions?" 

And it's going to be a combination of things as we look going forward. And this bullets in here, because of me. I just think platforms are a more elegant solution. And I don't need every solution handed to me, what I need is the technology in place, and then someone that's smart enough to help me use that technology, to do the integration, to do the communications and those kinds of things. 

And, frankly, that's why we all went to EMRs. And frankly, that's why we have had integration engines and now we have new products to support what we're doing. But I do think it's a good time to just step back, take a breath and figure out what's out there? Good grief, I got to believe 200 companies were formed over the COVID time. Well, what do they have? We need to take a look. So that's what I think, we're going to do.

JUSTIN EVERETTE: Yeah. And another point you made was. And surely this is not the first and or even the second or third time in your career, you approach things this way, but just kind of learning from the past and learning what you've been through here. And you mentioned that you guys, Intermountain you acted quickly, and you had a plan that you had to enact in really short order. And it wasn't it wasn't strategic. It certainly was, but maybe not the long term solution there. Any reflection on that Marc? 

MARC PROBST: Yeah, it's what you just said, we all have to learn. And you know what, I didn't put it in there, we didn't talk about it in the take a breath, but kind of be really proud of what you did as well. I'm proud of what our industry has done. I am proud of my peers and comrades in arms in the CIO world and in healthcare IT and healthcare of what we did do. And now let's go learn from that, and let's go see how to do it better. And, anyway, I like that concept. And I'll leave it at that. 

JUSTIN EVERETTE: Yeah good way to live our lives anyway. And then the third thought here that you and I discussed was just around the technology lands landscape and that it's kind of along the same theme of where we've been a little bit already in the discussion today, but around thinking through, okay, well we had some short term solution stuff we had to do quickly and I think I put this in here directly from something you'd said, duct tape and baling wire. But how do you balance that versus the longer term view. And so curious, again, to get your thought there. 

MARC PROBST: And we've gone through it a few times. But we did bring in a lot of short term solutions. We also had some interesting changes from a regulatory perspective, government relaxed things around security and using some of the products that were out there. We all have to understand that's not going to last. Some of it will go, I think some of the payments, some of the cross state line, regulatory changes that were made, will likely stick. 

But I certainly believe the things around security and privacy, we're going to see that get locked down again pretty quickly. And so we got to look at what we did, we got to see how... And because we were allowed to be a little more flexible, it was okay. But like I said, going forward, we're going to pay attention to it, we're going to have to make sure we have things that are highly secure, meet those regulatory requirements. And that way we won't get fined and we'll get paid. So yeah, and then technology is changing so rapidly, so it's hard to keep up with it. But it's important for us to have people that are focusing on keeping up with it. 

JUSTIN EVERETTE: That's great. And so we'll get to some questions too, in a moment. But I'd be remiss if I didn't invite you guys to continue that discussion with us. And that can be through continuing to ask some questions here in the forum, or even sending us an email at info@SRhealth.com, for SR health, if you're not familiar, that's our new brand with Solutionreach. 

And we are, Marc spoke to that single platform approach. And that's what we're trying to do and bring that to the table to meet all these emerging patient engagement and communication needs from both the patient and provider's perspective. So feel free to... I think there'll be a survey as you leave the webinar here in a moment, where you can request some more information, we'd love to just have a conversation with you and tell you more about it and show you where some of your peers are seeing success with that today. 

So again, just email us at info@SRhealth.com. If we've got more questions, feel free to fire away, we've still got a few moments. I know, we want to respect your time, and we'll plan to cut it off at the top of the hour. But if there's more out there, let us know. And Lea if you're seeing anything that you want to bring out.

LEA CHATHAM: Yeah. For sure. I mean, there's definitely a couple of additional... Quite a few additional questions, but a couple of clear themes in the questions. Following up on the stuff we kind of talked about around trying to engage patients and get that patient feedback and have the patient involvement in the process. We've got a specific question for you Marc, about Intermountain, but Justin, I think you could probably add to this to around how to try to ensure that you're engaging patients with a lot of these other things in mind. Like social determinants of health or education levels, language, those kinds of things. What are some of the strategies if that's something you can chat about really quickly that you guys use. Or Justin if you want to contribute some of the suggestions we make around those things.

MARC PROBST: I think short of a technology discussion, which I'm a CIO, so I can gravitate there pretty quickly. But I love... The whole social determinants of health... At Intermountain Healthcare, we have what's called the executive leadership team, that's 12 individuals that really lead the whole organization, that includes the CEO, and a lot of those folks. One of those people is community based. And their whole focus is around engaging the patient along with our communication people, and looking at things like social determinants of health, and really understanding it.

You'd think someplace like Salt Lake City, it's relatively small, relatively wealthy, not as diverse as some parts of the country, that we would have good parity of care across our whole state and all the places we serve. We have huge discrepancies in care. So I think part of the answer is dedicating the energy in what you're trying to do. It's easy to take care of language, changing the language within any of our technologies. Well not any of it but a lot of the technology today is a relatively simple thing to do. 

We got to pay attention that, we ought to know which languages we should be focusing on. And that's having people and data to focus on it. And the same thing on social determinants of health. We need to understand what the problems in our community are, again, kind of looking at Utah, you think maybe... Well, maybe you don't, but I think "Wow, this is kind of a really special place." But we have huge problems and things like younger people and suicide. And it's not a really well understood issue, but we've dedicated our organization to reducing that number. 

And because we put the focus in it, we've used the technology, we used communication, we did all these different things, we actually have been able to impact that statistic pretty well. So it's definitely what are we going to focus on and do it. 

JUSTIN EVERETTE: I think just to add to that, with a little bit of different perspective, I tend to think of this from how I approach my role as a marketing professional. And that's the idea of not being stubborn about how we communicate. I think about how we communicate to own customers, at SR health, Solutionreach. And always having just the spirit of experimentation with that, and changing the way we say things and testing different messages and testing different modalities, and just being open minded about how we do that and not set in our ways and not tied to one specific way we say things all the time. So how do we build in ways to test which maybe, which outreach to a patient is more effective than another? And just making sure we're staying open minded there to act on impact. We have time for-

LEA CHATHAM: [crosstalk 00:56:10]. Well I was going to make a comment too, that there were some questions too, about how do we increase confidence among patients to come back? And I think some of these same things apply that we've been talking to. And whoever asked that question, I just wanted you to know. I think these are the same things that we've been saying about communication, and really being aware of where people are right now and the better you can communicate and kind of target your communication and be thoughtful about what patients need to know about what you're doing and how you're keeping them safe and those kinds of things. That's obviously a huge piece of that. 

But the last question for our last two minutes is definitely a Marc question. And it's from someone sort of saying, "With all of these technologies, and all of the things we're having to do right now, how do we balance, making sure we can get the care to patients and engage them and do all of that with ensuring that we're still being thoughtful about security?"

MARC PROBST: Wow, that's a great question. Well, security is a very complex situation. And keeping on top of regulatory change, keeping on top of the security tools and practices that are out there, that is a full time job. I've got about 27 people that that's all that they do. And I'm really blessed to have that. I think in smaller organizations where you don't have all those people and all that focus, you got to lean very heavily on your partners to help you filter through the things that are important, and making sure that you're meeting those requirements. But it takes brains and it takes lots of them, and it takes some investment. 

JUSTIN EVERETTE: Great, thanks, Marc. Lea, I think we're just under the one hour cut off here. So let's go ahead and call it here, you guys. But again, if you have questions, I'll leave the panel open for a moment so you can submit anymore. And again, you can... let's see if I can get back on here. You can always email info@SR.health.com. But before we go, I just want to mention again, thank Marc so much for the time, just brilliant insight and so appreciative of him. And Lea as well for helping us moderate today's session. And thank all of you for attending. And that will wrap it up, we'll send the recording to everyone and we'll hope to chat with you next time. Thanks and have a great afternoon. 

MARC PROBST: Thanks. Bye now.