Adam Gale, President, KLAS, Chapter 2

Sometimes the best ideas start with the simplest concept. For KLAS, the concept was user frustration with EHRs. Is it as bad as some of the YouTube videos suggest, or is that hyperbole? Why are some organizations struggling with adoption while others seem to have found the secret sauce? To answer these questions, KLAS created a survey that would measure EHR satisfaction and efficiency and benchmark it across the industry. To date, dozens of organizations have participated, and it is already resulting in a better understanding of what works, and what doesn’t, says Adam Gale.

In this interview, he talks about why the Arch Collaborative is so critical and what he hopes it will ultimately achieve. Gale also opens up about how KLAS’ strategy has evolved in the past 10 years, the surprising thing that happens when competitors meet face-to-face, and why he believes it’s no longer enough to focus solely on measuring data.

Chapter 1

Chapter 2

• From measuring data to “proactively impacting the future”
• Tackling interoperability – “I wasn’t sure what we could bring to the table”
• Casual conversations among competing CEOs
• “It hasn’t been a rock-throwing event.”
• Reflecting on 10 years as KLAS president
• Working with vendors to “raise their game”
• Buzzwords like AI – “How do we shine a light on it?”

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Bold Statements

We were shocked at the level of nervousness they had in getting together and being in the same room. It was a lot of, ‘who’s going to be there? If so and so is there, I’m not sure I want to be there.’ ‘What are people going to say about us?’ It was such a politically charged topic, and people were understandably apprehensive.

When we’ve brought these providers and vendors together in an intimate setting, it has not been a rock-throwing event. It has not been an ‘us versus them’ mentality. Most of them have been pretty good at taking off their vendor or provider hats and wrestling over how we can do this better.

We’ve got to apply an appropriate amount of pressure and accountability to these vendors to raise their game. We believe if that happens, everybody wins. The vendor will be more successful as they launch products. The customers will be successful because they’ll have a true partner.

It’s really easy for us to measure how those vendors do in the lab space at Sunquest or Cerner or SoftLab. It’s much harder to start to measure things in a value-based care world, where the definition of the product is fluffy.

Gamble:  Aside from the Arch Collaborative Summit, I know KLAS has held other events focused on areas like interoperability and population health. It seems like this has proven to be an effective strategy in getting people together to talk about key issues.

Gale:  It has. And it’s funny; initially, we didn’t see ourselves as an organization that would do this. That changed a few years ago during a discussion with our advisory board, where we started talking about how we can change our mindset — how we can focus not just on measuring what has happened, but on proactively impacting what’s going to happen in the future. How can we more successfully push forward with some of these initiatives? As we talked about it, we started wondering if KLAS could be sort of a Switzerland of getting providers and vendors together.

In fact, we had an event about three years ago where we invited the Best in KLAS vendors to meet with providers and talk about how we can raise the bar for the industry. We had about a dozen CEOs and top vendor executives come to the event. It was a good day, but it wasn’t phenomenal. It was an amazing group of people who came together, but we were still finding our way as to how to make this truly impactful.

But then something interesting happened. A few of these CEOs pulled me aside and said, ‘look, when we do this next year, let’s have a really meaty topic that we hit and wrestle over together.’ And so when I asked them what topic we should discuss, the answer was interoperability. I remember thinking, ‘Wow, that’s such a huge topic. There are so many groups working on standards and FHIR and HL7 and so many people working on interoperability, and I wasn’t sure what KLAS could bring to the table. What I they told me is that there are two key things. One is, we have the technical capability to do a lot of this, but there are political issues that prevent people from connecting with each other, and we need help knocking down those walls. Two, we need you need to be a measuring stick so we can see the progress we’re making. And we thought, okay, we can do that. We can get people together and we can measure.

The next year, we invited the top 13 EMR vendors to get together and talk about interoperability — we were shocked at the level of nervousness they had in getting together and being in the same room. It was a lot of, ‘who’s going to be there? If so and so is there, I’m not sure I want to be there.’ ‘What are people going to say about us?’ It was such a politically charged topic, and people were understandably apprehensive. But everyone showed up — it was amazing. We had Zane Burke, Judy Faulkner, Girish Kumar, Jonathan Bush, all these folks in a room together. It was fantastic.

Interestingly enough, a lot of the best discussions didn’t happen during the sessions, but rather during the evening breaks, where I’d see a few CEOs chatting by the fireplace. A month later, we’d hear that they’ve agree to work together on interoperability. It was so simple; there were a few political issues standing in the way that just needed to be knocked down. Of course, we still have a long way to go, but it’s fascinating what can happen if we get the right people together in a sincere effort to say, ‘how can we make this better?’ With a little provider pressure to help add to their urgency.

We’ve done events now focusing on enterprise Imaging, population health, and interoperability, and this year we plan to do the same with patient engagement. How do we move the ball forward with creating an easy digital experience for patients, when we’ve been so crummy for the most part in doing that? We haven’t had that type of focus on the patient historically. We’re hoping to help move the needle on that, although I’ll admit it’s a daunting topic.

 

Gamble:  That should make for some interesting conversations. It seems like what’s been a critical component is to learn from these summits in terms of what works and what doesn’t in creating the best environment for collaboration.

Gale:  Yes, definitely. It’s all about creating that environment. I’ve been impressed that when we’ve brought these providers and vendors together in a fairly intimate setting, it has not been a rock-throwing event. It has not been an ‘us versus them’ mentality. Most of them have been pretty good at taking off their vendor or provider hats and wrestling over how we can do this better. It’s been amazing for me to watch the caliber of people and their ability to solve problems by putting aside their individual goals and thinking about things in different ways. It’s been a really pleasant surprise.

 

Gamble:  I can imagine. Switching gears a bit, I’d like to talk about your role. You’ve been president of KLAS for about 10 years. When you look back at the past decade, the industry has changed so much. What are your thoughts on how healthcare, and KLAS, has evolved during that time?

Gale:  It’s evolved a lot. It’s funny, when you’re inside the evolution, you don’t see it happening so much. It’s like watching your own kid grow — you were just two years old, and now you’re becoming a teenager. How did that happen so fast?

One of the biggest things we’re trying to do is to go beyond just publishing information that’s interesting and that brings transparency. We want to do that, and we’re very enthusiastic about doing that. But we want to take things to the next level where we influence the market more to be more successful, kind of like how the driver of these summits was to question how we help move the industry forward in a better way and not just measure what has happened.

Let me give you an example. When we measure a new system that’s been launched by a vendor, we’ll talk to the first 10 or 20 customers that are live, and we learn a huge amount from doing that. Now, we want to make sure we talk to the vendor first to make sure the problems we’ve run into can be fixed. It’s not enough to just send them the report and say, ‘here’s what we found from your customers.’ Now, we want to have a face-to-face sit down with the person who heads up that product or the CEO and say, ‘for your customers to be successful, here are some changes that need to happen before this gets rolled out.’ That hasn’t been something we’ve done because we felt that we provided a lot of clarity in those initial reports. Now, we feel that’s not enough. For providers and health systems to be successful, we’ve got to apply an appropriate amount of pressure and accountability to these vendors to raise their game. We believe if that happens, everybody wins. The vendor will be more successful as they launch products. The customers will be successful because they’ll have a true partner, or at the very least, products that they know will work to the level they need them to. It’s raising the bar for KLAS internally to not just cheer when we publish something, but to cheer when the market itself understands, adapts, and improves. It’s an energizing thing internally to see providers make different decisions because they see what will help them be successful. And so we’re changing our goal from publishing data to changing the market in a healthy way.

 

Gamble:  It certainly seems like a step in the right direction. As far as your own journey, I’m sure there were a lot of lessons learned, particularly in taking on the role of president. Is there anything that stands out to you as a really valuable lesson or an ‘a-ha’ moment?

Gale:  The list is very long. The good part about lessons learned is that they usually come from something that did not go well, or at least a scar that reminds you to do it differently next time. Hopefully, that means that KLAS can continuously improve. One of the things we’ve been trying to do — and it probably ties to what I’ve described before — is sometimes we just keep measuring the same things we’ve always measured because it’s comfortable, and it’s a space that we understand. Take Laboratory Systems for example. They’ve been around forever, and everybody knows what a Laboratory System is. And so it’s really easy for us to measure how those vendors do in the lab space at Sunquest or Cerner or SoftLab. It’s much harder to start to measure things in a value-based care world, where the definition of the product is fluffy, because it changes. We’re trying to go tackle some of these spaces, like the convergence of providers and payers. What are those tools called, what do they do, and how would you categorize them together? That’s a real challenge, because they do different things and they’re called different things. Some of them are services with software. Some of the hard things to learn are, how do you go tackle a new space like that in a logical way that the market can understand, when even the definition of that thing is unclear?

One example is artificial intelligence. That’s a buzzword that everyone throws around. It was the theme of HIMSS in 2017, and now a lot of the vendors say they have AI in their tools. What does that mean, and how do we shine a light on it? It’s much more challenging than one might expect, but we’ve skinned our knees enough on it that I hope we’re getting better.

 

Gamble:  We’ve heard CIOs echo that same sentiment with population health, where vendors say that their tools can help achieve it, but there are questions as to how exactly that happens. It seems to be an ongoing theme.

Gale:  I absolutely agree. The challenge is, if everybody says they can do it, then the ‘it’ probably isn’t nearly clear enough. What a vendor defines as ‘it’ and how you define it may be two very different things.

 

Gamble:  Exactly. Well, I think that about covers what I wanted to talk about. I’ll be very excited to see what KLAS finds in terms of patient engagement. It’s such a huge topic, and there’s a huge need for discussions and collaboration, so that should be really interesting. We’ll keep an eye out for that. Thanks so much, as always, for taking some time to speak with us.

Gale:  You’re welcome. We love to read what you guys put out there. It’s very thought-provoking. And I’m sure we’ll be in touch soon.