Health IT Influencers: Former CIO Craig Richardville, Chapter 2

Few arguments have sparked as much ire (and eye-rolling) than the comparison between the healthcare and banking industries when it comes to consumer engagement, and it’s understandable. Healthcare is extremely complex; the mere suggestion that the same strategies used to manage finances can be used to manage care is ludicrous.

But what if we looked at it in a different way? What if patients were given tools to help diagnose and treat conditions that don’t require an in-person visit? What if, rather than being directed to a message during peak hours, patients can use an automated system to make an appointment? The banking industry has empowered consumers to perform certain tasks, while also establishing parameters and proving human assistance when needed. Craig Richardville, former CIO at Carolinas HealthCare System (now Atrium Health), believes they’re onto something.

In this interview, he spoke with healthsystemCIO.com about the key lessons learned during his 30-plus years in the CIO role, why he believes taking a sabbatical can be extremely beneficial, and his thoughts on where the industry is headed. Richardville also provides advice for CIOs on a number of issues, from the importance of collaborating with leaders outside of healthcare, why IT steering committees should be eliminated, and why optimization “never really ends.”

Chapter 1

Chapter 2

• The patient-provider meter
• Consumer engagement & “misaligned incentives”
• The banking analogy: “We need to start with simple things”
• Robots & chatbots
• The “great learning experience” in taking a sabbatical
• Advice for CIOs: “Leave your door open”
• The value in small companies – “There’s a problem no one has solved.”
• Building a better healthcare environment

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Bold Statements

That’s why you’re seeing urgent care centers and virtual service — things that provide a spectrum of being 12 hours, like 7 a.m. to 7 p.m., or even 24/7 like virtual care. Because those times outside of office hours really are easier for patients.

I think that’s where we have to start in healthcare — with simple things where I can self-diagnose and start a treatment plan without an interaction.

The complexity aspects are still going to require interactions because we don’t have the exact science yet. It’s still, in some cases, an art; once it becomes a science, we should be able to take steps toward automation.

You’re going to get the 80/20 with the larger companies. You’re not going to go wrong. Things are going to be fine, but there are gaps, and unless those gaps somehow make their product or their service market competitive more, those companies are not going to fill the gaps.

The reason why new companies or products or industries are created is because there’s a problem that nobody has solved — that’s why they’re able to come in and have value.

Richardville:  One of the tools I used was a meter that went from zero to 100 that worked as a gauge. I’d put the provider on one side and the patient on the other side. And when we made decisions, we’d ask, who’s it easier for? Is it easier for the provider or is it easier for the patient? And if we’re going to be more patient-centric and focus on the patient, which is why we’re here, then when decisions are made, it’s very easy to say, ‘well, that’s going to be a strain on me as a provider or provider organization,’ but it makes it much easier for the patient/consumer.

A great example of that, going back many decades, is why are office hours typically from 8 a.m. to 5 p.m. at a physician practice? Because it’s easier for the provider to get up in the morning and come in, see patients all day, and then go home. But typically, patients are working as well. It would be easier for them to go between 5 p.m. and 8 a.m. so it doesn’t impact their work schedule. That’s why you’re seeing urgent care centers and virtual service — things that provide a spectrum of being 12 hours, like 7 a.m. to 7 p.m., or even 24/7 like virtual care. Because those times outside of office hours really are easier for patients.

And actually, that’s where we have some misaligned incentives; sometimes even during office hours, it’s easier for the patient to do a mini clinic or a virtual care service. At some point, I hope, there will be self-service options where we don’t have any interaction with the health system. It’s a tool we’ve created for the patient. It’s no different than if I wanted to deposit a check. Historically, I’d have to go to a bank and go to a teller to get it deposited. Then they came out with ATM machines, where I could take my check, sign it, and scan it in, but I still had to drive somewhere. Now I can just take a picture of the check. I don’t have any interaction with any physical asset of the bank at all anymore. No bank, no branch, no ATM machine. It’s just me and my phone.

That’s a very simple example, and I think that’s where we have to start in healthcare — with simple things where I can self-diagnose and start a treatment plan without an interaction. Because in most cases, when you speak with a provider, he or she is either using their knowledge or they’re using a knowledge database to make a diagnosis. And so, in some cases, especially the more common cases where it’s a cold or flu, it makes all the sense in the world to give a tool to the patient that lets him or her self-diagnoses and self-treat. If after a certain number of days it doesn’t work, you can escalate to someone who can give a more subjective opinion. But if it’s all objective and it’s all laid out, there’s no reason why I shouldn’t be able to do that myself.

 

Gamble:  The argument we’ve heard over the years is that healthcare is so complex, which is why it’s more difficult to do some of the things that other industries do. But by collaborating and talking out these issues, leaders can learn where the opportunities are and how to deal with the challenges.

Richardville:  It’s all an evolution. My example with financial services or the banking industry is a simple one. But there are a lot of tools being developed by people outside of the industry, and it’s mostly the very simple transactions. It’s not rebalancing my portfolio and taking my investments and my assets across several different investment forms and brokerage companies — it’s not doing that piece of it. You may still need a financial advisor to intervene and help manage the whole portfolio.

Healthcare is very similar, in my opinion. We should be doing some of the simple things that way. We should be providing them with tools so that they can do those transactions internally and not interfere with the complex aspects of healthcare, just as we don’t interfere with the complex aspects of financial services. When you do get to those pieces, maybe you have a virtual interaction, or you go see someone to have these things looked at before the provider can intervene. Maybe you have someone monitor you, which no different than if someone monitors you from a credit perspective.

The systems are in place to enable patients to look at things that are happening to you and to notify you when you get out of range — like what happens in banking if there’s a charge that looks suspicious. Your healthcare should be monitored continuously by the system, with interventions only occurring when you fall outside the normal range of where you should be. Again, I think there are a lot of analogies in between the different lines; and as a consumer, I can see that. Those are things that I can see happening within my healthcare. Certainly there’s a difference between life and death and some of the aspects of healthcare, which is on the extreme side, but even on the financial side you have extremes like bankruptcy and debt.

There are things we need to put in place to ensure people stay away from the extreme aspects of it; but if a person can do it, you can train a computer to do it.  And the computer can be trained so that it interacts very socially with a person or consumer in all different types of avenues, because the way you interact may be different from how I interact — different from how my son, my brother, and my parents. Everyone’s going to have some type of variation. That’s where it becomes very personalized.

Now we’re seeing interactions with robotics and chatbots — things like that where there’s a computer in the back interpreting what you’re saying and providing an answer or a direction based upon its interpretation. It’s training people and educating machines to do it on your behalf, because they don’t get sick. They don’t take PTO. They can work 24/7. They don’t require a physical place. There are a lot of advantages in automating some of these tasks, but I agree with you. The complexity aspects are still going to require interactions because we don’t have the exact science yet. It’s still, in some cases, an art; once it becomes a science, we should be able to take steps toward automation.

 

Gamble:  It’s really interesting. Now, to switch gears a little bit, let’s talk about what you’re doing. You’ve been away from the active CIO role for about eight months, correct?

Richardville:  Yes. And I’ll tell you, I almost feel that every 10 or 12 years, people ought to have a sabbatical or take a step back for a period of time, because being outside of the CIO role really has been a great learning and education process for me.

I’ve spoken with probably 40 or even 50 different companies, most of them small or startups with less than $150 million in revenue, and these companies have a lot of great ideas. They have some neat services and products that I would say offer high value propositions. But in most cases, when you’re sitting in the CIO role, especially at a larger healthcare system, you’re not addressing those smaller companies. You’re using some of these same ideas, but you’re working with larger companies, and as the saying goes, larger ships are difficult to turn. I’ve actually have filtered through a bunch of them.

I’m also looking for what my next CIO role will be, and where I’ll spend my last 10 years. I’ve always been a very loyal person; I was with ProMedica for almost 12 years, and Carolinas for 21 years. In a 33-year career, I’ve had two employers. So I have one chapter left — maybe 10 or 12 years, and I want to do that as well. But I’m also working with some interesting companies. I’ve built some great relationships and made some nice assets around the country, and I plan to bring a couple of the CIOs I know, both in healthcare and outside of it, to test the waters with some of these services, because they require very little, if any, investment.

One of my criteria when I’m working with these companies is zero investment, because people don’t have access to cash like that. I want it to be only upside risk for the company, and no downside risk. I want zero investment coming in, and I want to be able to show a value proposition of a double-digit return somewhere between 10 and 25 percent, and have them start realizing that return in 12 months or less. That’s a win-win deal. There’s no downside. It’s someone who has a very strong specialty or a niche and bringing that in, whether you’re talking about analytics or other services. There are a lot of really bright people out there.

We have a company that starting soon called Stryv. Stryv is a company that will go nationwide, providing a variety of different services — brokerage services, resource services, and talent management services across all industries, but primarily focused on technology industries (and I consider healthcare to be a technology industry), and take these types of services back out to multiple people. And these are things that can be done in sync with a CIO role. For me, these are investments. I certainly have a larger portfolio of assets now than what I had a year ago. So from that standpoint, some of those assets I want to share, and some of those assets I’ll bring with me into a new role.

 

Gamble:  Are there issues that you see in a different light since stepping away from the CIO role? Maybe things you think about differently now?

Richardville:  That’s a great question. Probably the biggest thing is for people to leave their doors open and to engage on a very personal level with some of these smaller companies. You’re going to get the 80/20 with the larger companies. You’re not going to go wrong. Things are going to be fine, but there are gaps, and unless those gaps somehow make their product or their service market competitive more, those companies are not going to fill the gaps. There’s not enough of a return to fill that gap unless it buys them a new customer or wins over a decision.

So I strongly advice that leaders take a step back and to scan the market and to look at some of the smaller companies as opposed to always pinging on the large ones. Over time, some of these companies will be acquired, or maybe they will fill that gap at some point, but right now, it’s there. So when you go to conferences and events, don’t just gravitate to the large companies, where you go in and get treated nice — everything is first class. I suggest you start visiting some of the small companies, even the little 10 x 10 displays, and take a serious look at a couple of things there, because there are some nice nuggets that offer tremendous returns.

One service I’m looking at is with a company called Honor My Decision (HMD), where 100 percent of the profits and contributions goes toward a foundation for community service. That’s why we’re in the healthcare business to begin with — to give back to the community. Plus, you need to be financially viable, and this is certainly a big return on that. A company like Honor My increases your revenue, increase your net margin, and contribute back to a foundation. It’s a nice win all the way around.

And yet, if you ask the majority of your colleagues, they’ve never heard of — and would probably never open their doors to — these smaller companies. You need to take time out of your schedule, and not always delegate it out, to investigate some of these companies. If you find one that’s a winner, it’ll definitely be worth your time.

 

Gamble:  One of the biggest areas of focus in healthcare is transitioning to a digital industry. This seems like an area where some of the smaller, more nimble companies can start to make an impact.

Richardville:  Yes, it is. As a matter of fact, it’s funny you mentioned the word ‘nimble,’ because one of the companies I’m working with is actually called Nimble. They offer a new methodology of going at risk for managing a certain part of your office automation services. It’s similar to what the healthcare industry is doing to go at-risk with managing populations.

They’ve developed an expertise where they can say, ‘As opposed of you doing volume-based work, let’s go ahead and go at risk. I understand your environment, and I’ll go at risk for controlling that environment for you and lowering your cost by 15 percent. The same thing is happening in healthcare—it’s that mentality of, let’s take on risk for that population to be able to stop increasing costs, or maybe realize cost savings and have a better product and service at the end.

I think that’s happening across the industry. And the reason why new companies or products or industries are created is because there’s a problem that nobody has solved — that’s why they’re able to come in and have value. But when you look at some of the larger companies, that’s not happening at the same rate. Obviously a few exceptions, such as Apple, Google, Microsoft and Amazon, which can fill some of these small niches and make it happen. They’ve been able to prove that they are very nimble in how to manage certain pieces, and the whole organization doesn’t have to shift. They just need to have a culture that allows them to jump in and take care of that.

I think it’s great for patients and consumers of health and healthcare services. We want to build a better environment for our grandchildren, not a better environment for the healthcare systems or the providers, unless it contributes back to the mission of the organization.

I think you’re starting to see a shift. Historically, people were directed to where they needed to get care. They were referred to certain places and it all was managed by either payers or by the providers. Now there’s so much information available, and if we can provide the tools, patients will be able to direct themselves. The consumers will be able to make those types of decisions.

Chapter 3