S2E2 Transparency in Clinical Quality and Outcome Metrics (ft. Dr. Mark Weisman, TidalHealth)

Jordan Cooper 0:16
Maryland on the Delmarva Peninsula, with about 360 beds and 800 providers.

Jordan Cooper 0:22
So, Mark, what I'd like to do, you're doing some interesting stuff there.

Jordan Cooper 0:26
One of the things that we discussed earlier was how Title Health is using data to improve ambulatory operations.

Jordan Cooper 0:33
Specifically, you mentioned that you're creating scorecards for providers and executives.

Jordan Cooper 0:38
You tell me more about why you did that, how you're doing it with the outcomes of doing that have been.

Mark Weisman 0:43
Sure.

Mark Weisman 0:43
So there was a little bit of a shake up in the organization and my boss, who's the Chief Operating Officer, got put in charge of the Medical Group.

Mark Weisman 0:52
And so all of a sudden I had a very vested interest in making sure the Medical Group is successful and they have tremendous needs, particularly data needs.

Mark Weisman 1:01
And they're they're very chaotic beasts, medical groups, they're just always all of them.

Mark Weisman 1:07
And I don't think ours is any different than any others.

Mark Weisman 1:09
They just, they're constantly growing and building and adding providers and providers are coming and going, but they're not always very data driven and that was something that the CEO and I wanted to fix.

Mark Weisman 1:22
We wanted to make it better and so one of her struggles was trying to get provider engagement.

Mark Weisman 1:29
And so she felt if we could put a scorecard together for the providers that they could see what is the the the number of visits they're seeing their work RVU's the the referral patterns, the work RV used of divided by the number of visits.

Mark Weisman 1:47
Visits get an idea about how how well their how sick the patients are and so.

Mark Weisman 1:56
He developed a scorecard and we started one at a time.

Mark Weisman 2:00
The informatics team met with providers and we started with primary care.

Mark Weisman 2:04
We haven't gotten to all specialty yet, but with primary care, we're rolling that out and it does take some hand holding it.

Mark Weisman 2:12
There is some resistance.

Mark Weisman 2:13
There is the typical denial, and then eventually you move through the stages of grief and you get to acceptance and they go, OK, they they they kind of dive into the data.

Mark Weisman 2:24
They've also been very helpful.

Mark Weisman 2:25
There's a couple providers who will engage and then that's a home run because they're they want to get into the data and understand it, and then they're going to help tell us, hey, did you know that your data is showing X?

Mark Weisman 2:36
And and we really weren't trying to show it that way and we would go and make changes.

Jordan Cooper 2:41
What are some of the desired outcomes?

Jordan Cooper 2:43
Specifically that X.

Jordan Cooper 2:45
You know what's an intervention and a result of that intervention because it's nice to know, OK, this is my visit.

Jordan Cooper 2:50
Count my relative value units, but what sort of are you the interventions?

Jordan Cooper 2:55
How do you improve outcomes, improve reimbursement rates?

Jordan Cooper 2:59
What actually was the desired end goal and how has that measured up in practice?

Mark Weisman 3:05
Great question.

Mark Weisman 3:07
The first desire was simply getting provider engagement and having them look at data and then asking questions like OK, well, what else can you get at?

Mark Weisman 3:18
So we did start with operational metrics, but we're now building the quality score card and so they know, OK, you could show me how many diabetics I have and what their last hemoglobin A1C is and how many have not had a hemoglobin A1C and now we can start to drive performance improvement through with doctors.

Mark Weisman 3:37
You shine a spotlight on the problem.

Mark Weisman 3:38
They'll go.

Mark Weisman 3:39
Oh, OK yeah, I'm different than my peers.

Mark Weisman 3:41
They don't like that.

Mark Weisman 3:43
So I won't be better than my peers.

Mark Weisman 3:45
And so they they as a doctor myself, I can tell you we we respond to data when it's put in front of us in a digestible easy format.

Mark Weisman 3:54
And we we also found that we wanted providers to understand the the billing that we weren't giving them any feedback about their work RVU's or codes that were denied.

Mark Weisman 4:09
They just were going about their day.

Mark Weisman 4:11
They'd fill out some codes, they go off into the recycle land and we never hear about it.

Mark Weisman 4:16
So we're starting to show that with the with the providers, they feel like they're part of the team.

Mark Weisman 4:21
They're engaging on the benefits of seeing data and then giving suggestions and asking good questions.

Mark Weisman 4:28
That's what we wanted.

Mark Weisman 4:29
That was the main outcome.

Jordan Cooper 4:30
So I love that you're talking about data driven provider engagement and you actually have a piece of data I wanna share right now with our listening audience.

Jordan Cooper 4:40
That is very interesting.

Jordan Cooper 4:42
So everybody knows that every by every, every healthcare IT conference, everyone talked about provider burnout and alert fatigue in particular.

Jordan Cooper 4:53
And I'm very interested in your efforts to tidal health to improve provider and staff efficiency by reducing alerts through a targeting efforts which has led to a best practice advisory acceptance rate of 40% which is very high.

Jordan Cooper 5:08
Yeah.

Jordan Cooper 5:09
How did you go about?

Jordan Cooper 5:11
Uh, improving engagement, reducing the number of irrelevant alerts and you just mentioned, if we have these scorecards and we have the diabetics and these ones, you know you're seeing 5 today who are diabetic and have not yet having anyone see, then there should be a BPA that fires.

Jordan Cooper 5:29
It says for these guys you need to order that test.

Jordan Cooper 5:31
You know, how did you develop a alerts in real time that have that providers have been responsive to it?

Mark Weisman 5:41
Arrived in 2018 at this health system and they had gone live with epic about a year beforehand.

Mark Weisman 5:47
And they took a lot of out of the box stuff and and turned it on.

Mark Weisman 5:51
And some epic analysts might have said, yeah, you, you should have this alert and it wasn't necessarily a quality driven initiative.

Mark Weisman 6:00
It was.

Mark Weisman 6:01
This sounds like a good idea.

Mark Weisman 6:02
Bouncing around with some people and then it went and they we kind of sustained that for for a couple of years and the next thing you know, when you start looking at the reports and OK, we're firing hundreds of thousands of alerts a month and we're not getting 100 and hundreds of thousands of dollars of of of of value out of this, we're not saving lives by hundreds of thousands.

Mark Weisman 6:24
It's it was a lot of noise and so we went through and started #1 just improving the targeting.

Mark Weisman 6:30
The alert that's meant to hit the doctor doesn't need to hit the nurse, and the one that's meant for the nurse doesn't need to hit the doctor.

Mark Weisman 6:36
So that's just like basic clinical decision support 101, that was we we didn't have that.

Mark Weisman 6:43
We then challenged why we had many of these alerts and so do we really need a alert to hit the doctor to say, hey, the hemoglobin A1C hasn't been drawn, can't the medical assistant order that and tee it up for the doctor?

Mark Weisman 6:57
The doctor just signs it.

Mark Weisman 6:58
Absolutely.

Mark Weisman 6:59
There were many things we found that it's not the Doctor Who needs the alert and get people to work at top of license and we were very successful at reducing the number of alerts that are hitting the doctors and particularly with medication alerts on.

Mark Weisman 7:17
This was a little controversial, so I'm seeing iOS and CIOs wouldn't do this, but we let the doctors choose whether to turn on or off an alert.

Mark Weisman 7:27
And very few actually turned them off.

Mark Weisman 7:30
But they felt better knowing they had the ability to and that is.

Jordan Cooper 7:40
Or.

Mark Weisman 7:33
There are times where, due to their experience and their specialty and you're training, but that'll alert doesn't add value to them.

Mark Weisman 7:41
They know what they're doing and they always use these two ticular drugs.

Mark Weisman 7:45
I think as I always give the example of aspirin and Plavix and a heart patient and the cardiologist prescribing it, they use that every day.

Mark Weisman 7:53
They don't need an alert saying that that increases the risk of bleeding.

Mark Weisman 7:56
They know that.

Mark Weisman 7:58
So we got rid of those lower level medication interaction alerts or let the doctor say you know what, I got it.

Mark Weisman 8:05
I can shut that one off myself and put the power in their hands.

Mark Weisman 8:08
And they love that and power that led to two things.

Mark Weisman 8:11
One is less alerts.

Mark Weisman 8:13
The number 2 is our class scores the the the measurement of how well providers like their their EHR.

Mark Weisman 8:20
We went from lowest, you know, the 18th percentile up to the 88th percentile over 18 months.

Mark Weisman 8:28
And so a lot of that was giving the providers power and getting their engagements around IT initiatives and they responded.

Jordan Cooper 8:40
Excellent.

Jordan Cooper 8:40
I appreciate your story about provider engagement.

Jordan Cooper 8:44
I love that we began with data driven scorecards and then and to enhance provider engagement.

Jordan Cooper 8:49
And then you actually went out and you engaged providers and saw positive outcomes.

Jordan Cooper 8:54
As a result, I'd like to transition to engaging patients.

Jordan Cooper 9:00
You have improved the first call resolution rate and reduced call abandonment rate at your service desk.

Jordan Cooper 9:08
So when patients call in you, they have a question they want something to be addressed and get it, allowing them to get through, improve satisfaction and engagement.

Jordan Cooper 9:18
So we've already discussed provider engagement.

Jordan Cooper 9:20
Let's shift the story now to patient engagement.

Jordan Cooper 9:32
Yeah.

Mark Weisman 9:24
The scenario that you're describing is typically around my chart issues where patients stuck and they're calling our service because they don't know how to get unstuck.

Mark Weisman 9:33
And so in the service desk is busy.

Mark Weisman 9:36
They're getting lots of calls every day from all over the health system internal as well as from patients calling it, having problems with the patient portal.

Jordan Cooper 9:45
Umm.

Mark Weisman 9:46
We did a couple of things.

Mark Weisman 9:47
Number one, we made it so that the the patient portal provided great information.

Mark Weisman 9:54
Everything's open, open book.

Mark Weisman 9:55
Book.

Mark Weisman 9:56
We did that before the law required, so our patients started to engage and get into the portal and use it because they're adoption helps decrease the the problems they get in it.

Mark Weisman 10:06
They start using this the first time users who tend to call and go.

Mark Weisman 10:09
I don't know what to do next.

Mark Weisman 10:11
We did take some steps to help improve my chart adoption and utilization at the practice level and that helped, like if our service doesn't answer the phones that that's bad, that's a problem.

Jordan Cooper 10:27
Umm.

Mark Weisman 10:27
And one of the things that we did was empowered them with knowledge to answer the questions and answer them quickly.

Mark Weisman 10:35
So we built a knowledge base and now they're bringing up that knowledge base in real time and able to answer patient questions as well as the internal questions.

Mark Weisman 10:44
So they can they can move through quicker before our service desk was a bunch of ticket takers.

Mark Weisman 10:50
That's what they did.

Mark Weisman 10:50
They would take a ticket and pass it to someone else.

Mark Weisman 10:53
Well, that that didn't really feel good to patients when they couldn't get their problem solved.

Mark Weisman 10:57
They wanted whatever they're going in there to do.

Mark Weisman 10:59
Maybe the schedule an appointment, so they wanted to do it.

Mark Weisman 11:02
Now they want to do it when someone else got around to it, so being able to solve their problems, and now we're we're actually close to 65% first call resolution rate and you know we started somewhere around 5% for school resolution rate, so dramatically transforming our service desk gives our employees a better just feel for the for the organization as well as our patients.

Jordan Cooper 11:27
So just really quickly before we move to another topic, you said you helped build the knowledge base among those at the service desk.

Jordan Cooper 11:35
Do you have any concrete processes for how you were able to do that?

Jordan Cooper 11:39
Was it just exposing a digital library or how did you build the knowledge base?

Mark Weisman 11:44
We have to build the digital library right?

Mark Weisman 11:46
Because what we did is we were looking at the calls that were coming in and try to getting a feel for, OK, what's the number?

Mark Weisman 11:52
1/2 top ten calls that are coming in, but we want it to be bigger than that and not just handle the top ten calls.

Mark Weisman 12:00
So we started to get with the analysts and we asked them what do you think like, what are the common things that you think are being I'm being asked and they helped create the knowledge base.

Mark Weisman 12:13
We made it an IT initiative.

Jordan Cooper 12:20
That it's.

Mark Weisman 12:15
Everyone in IT rallied around this and everyone is committed to that first call resolution rate being over 50% is now we're at 55% as a system goal and they they engaged, they felt ownership of that problem of they don't know how to answer the questions and we we show this at our monthly meeting.

Mark Weisman 12:38
We show it in our newsletters.

Mark Weisman 12:40
It's we talk about it.

Mark Weisman 12:41
We put the data in front of the IT team and the managers when they see you starting to drop though OK, what are we missing?

Mark Weisman 12:49
Let's get back engaged.

Mark Weisman 12:51
So the whole teams rallying around this.

Jordan Cooper 12:53
And just in case any listeners are very interested in replicating this effort to build knowledge based on a drill in for one moment more.

Jordan Cooper 13:02
What?

Jordan Cooper 13:03
Like, how would you quantify the resources and timeline between the idea to build this digital library and it actually going live and being used in the in the service desk?

Mark Weisman 13:16
So we're just using plain old SharePoint right now, so nothing particularly fancy for storage of those knowledge base articles.

Mark Weisman 13:21
We are excited to start adding a service management tool that will have a bot that will service it up to the to the technician as they're talking to someone, but we're not there yet.

Jordan Cooper 13:35
OK.

Mark Weisman 13:34
But but that the knowledge base probably took us six months to get to where we really felt sort of good about it.

Mark Weisman 13:39
But it's an ongoing process.

Jordan Cooper 13:41
Right.

Mark Weisman 13:41
So over the last two years, we continue to build that knowledge base #1 our technology changes and #2 the questions change from the consumers of our information.

Mark Weisman 13:53
So we're always updating.

Jordan Cooper 13:55
So on the same topic of engaging patients and veering into the land of artificial intelligence, which is the hot topic of the day, I'd like to discuss the impact of bots talking to bots.

Jordan Cooper 14:06
In particular, I'd like to know what happens when a patient's personal bot starts talking to tidal health hospital scheduling by or where clinical quality control metrics come into the discussion when bots are talking to each other.

Mark Weisman 14:19
This was a wonderful topic that we started to touch on at the Gartner conference with CIO's and started a bat this around a little bit.

Mark Weisman 14:26
It was fascinating to think.

Mark Weisman 14:28
All right, pretty soon I'll just tell Siri or Alexa or whatever it is, schedule my primary care appointment.

Mark Weisman 14:34
It goes off and it will do that and it'll talk.

Mark Weisman 14:37
But we're gonna have bots and the health system side that when patients call that they they're talking to a box schedule their appointment.

Mark Weisman 14:44
So what happens if bots are talking to bots so #1 the interface could be different, so do I need the big buttons that patients need to press for schedule now but don't care?

Mark Weisman 14:56
You know it, it just needs a good API and it can connect and execute.

Mark Weisman 14:59
So it's a different interface which I thought was fascinating, that we need to create that pathway, to make it easy for bots to schedule.

Mark Weisman 15:07
We want people to schedule only come see us.

Mark Weisman 15:09
That's why we're here.

Jordan Cooper 15:10
Here.

Mark Weisman 15:11
So we need to make it easy, and if we're constantly changing where our buttons are and our website when the box are having a hard time understanding where to go, we're putting paint into the system where we don't want that pain.

Mark Weisman 15:23
We wanna make it easy.

Mark Weisman 15:24
We wanna make it more API based and not based on screen scraping.

Mark Weisman 15:28
So where there's that tendency of we move things around on the screen and now the bot gets confused.

Mark Weisman 15:34
Umm the.

Mark Weisman 15:37
The other interesting question that that we started to raise what happens when bots are talking to boxes?

Mark Weisman 15:42
That quality piece is not there.

Mark Weisman 15:45
No one's talking about your clinical quality.

Mark Weisman 15:47
No ones going to your website and looking at hey, you know, we do really well with gastric bypass surgery, you should come to us.

Mark Weisman 15:55
That conversation is not happening when it's boxed.

Mark Weisman 15:58
Talking to bots, so as a doctor, as a CIO, as a CMIO, I'm trying to think about.

Mark Weisman 16:05
No, I want patients to pick their provider based on good outcome metrics, which requires us to put those metrics publicly facing and we don't do that as a here system across our country or lousy at that, try to figure out how good your surgeon is.

Mark Weisman 16:23
Good luck if this information you cannot find easily, but we have to and we have to put it in there such that when someone asks a question, he scheduled me an appointment.

Mark Weisman 16:34
That Siri's gonna ask.

Mark Weisman 16:36
Do you want the best doctor based on quality or number of Google Stars or something about quality, not just first available?

Mark Weisman 16:45
Do you really want the first available doctor?

Mark Weisman 16:47
Maybe.

Mark Weisman 16:47
Maybe you do.

Mark Weisman 16:48
Maybe that's what awesome if someone got Open Access.

Mark Weisman 16:50
Or maybe they're really not the great doctor, and no one wants to see them, and that's why they have lots of appointments available.

Mark Weisman 16:57
So we we want a better experience for the patient when they arrive and box talking to bots creates a new dynamic that CIO have to think about.

Jordan Cooper 17:07
I appreciate what you've done with bots talking to bots, certainly figuring out how AI fits in the healthcare arena is something that's top of mind for many of our listeners.

Jordan Cooper 17:17
We are approaching the end of this podcast episode and as I reflect on our conversation, I hear basically a theme that more transparency is good.

Jordan Cooper 17:27
Exposed data on provider performance and on visits and referral patterns.

Jordan Cooper 17:32
Provider metrics 2 providers and scorecards that leads to improved engagement.

Jordan Cooper 17:37
Uh.

Jordan Cooper 17:38
Go provide increased engagement and and knowledge and power about how billing codes are being affected by provider behavior and how best practice advisories can be managed in that improves provider engagement in the EHR and enable patients or even bots to get exactly the information they want as quickly as possible and as simply as possible in order to improve the experience is also something that I've I've I've heard you talk about.

Jordan Cooper 18:10
So I'd like to open the floor to you now.

Jordan Cooper 18:12
Are there any closing thoughts you'd like to add to our listeners about this theme of improving transparency and access to data at Title Health in order to improve engagement and outcomes?

Mark Weisman 18:24
It's not easy.

Mark Weisman 18:25
All CIO's know that finance might not want the providers to know their work.

Mark Weisman 18:30
Our views.

Mark Weisman 18:31
I can't imagine why that, but that that battle it has to happen to say, look, we're gonna get great outcomes from this trusted try a small pilot getting that data out of the silos.

Mark Weisman 18:43
So if it lives in an Excel spreadsheet on some financial analyst desk, that's not gonna be useful.

Mark Weisman 18:50
So the CIO has great opportunity to bring the data together into a place where others can see it and digest it and use it.

Mark Weisman 18:58
Those are things to see iOS and CMM iOS can take a very central role on and just get started.

Mark Weisman 19:03
Just pick something and start to drive on it and just watch the magic start to happen.

Mark Weisman 19:08
It is a long process.

Mark Weisman 19:11
It would be wonderful to wave the magic wand, and I like that I'm a wave.

Mark Weisman 19:14
The magic wand.

Mark Weisman 19:15
Kind of person.

Jordan Cooper 19:18
Yes.

Mark Weisman 19:15
It just happens this takes a lot of effort, a lot of commitment and a lot of partnership.

Jordan Cooper 19:25
1st.

Mark Weisman 19:22
So as all CIO know, it's about the relationships and you're gonna be successful or unsuccessful with most of your initiatives based upon the relationships you've made.

Jordan Cooper 19:32
For our listeners, this has been Doctor Mark Weisman, the CIO and CMIO of tidal health in the Delmarva Peninsula, based in Salisbury, MD.

Jordan Cooper 19:40
Mark, thanks so much for joining us today.

Mark Weisman 19:42
Thanks Jordan.