Health IT Influencers: Former CIO Craig Richardville, Chapter 3

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

Chapter 3

• Call center issues – “If you know you have a peak time, either staff for it or automate it.”
• Balancing patient needs with profitability
• Eliminating IT steering committees – “There’s no reason why I should have a select use of funds.”
• Leveraging voice technology to ease physician burden
• Predictive analytics to “prompt and be proactive”
• Lack of cost transparency
• Consumerism: “The more you fight it, the less you’ll become a significant player.”

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Bold Statements

I have choices. I can do a virtual call with GetWellNetwork or Teladoc, and I can initiate those calls myself. I can go into a mini clinic. I can go wherever I want because I’m pulling those dollars out of my pocket. So why would I pay $150 to go visit a physical physician when I can do it virtually for $49?

We have to find the right balance and let the patient make those choices. We have to quit trying to coerce them with the way we market or advertise, to go down certain avenues that are more financially astute for the system. Let’s do what’s financially astute for the patient or the consumer.

I’ve always felt it was important not to have a select fund for IT, but to compete for it. And if it’s better for the company and for the community to build an urgent care center, then that’s the route that we should take. If it’s better to invest more in telehealth services, that’s the route we should take.

It’s finding the right balance at the right time; but it’s also about the people making and executing the plan we put together. And in many cases, if you’ve got the right talent and the right team, and you have the right leadership, those people will want to move beyond the actual plan and goal you set for them.

The exciting part is how technology is going to enable that to occur; how people are going to obtain real-time access to information, which will lead to more predictable results, greater relationships with providers, and more effective use of time.

Richardville:  It still baffles me. If you call a larger practice or a large healthcare systems on a Monday morning, you’re going to get that message. ‘You’ve called us at a peak time. Please feel free to call us back at a lesser time.’ As a consumer, it makes zero sense to me. If you know you have a peak time, either staff for it or automate for it. Do something. Don’t treat all the hours the same, because they’re not the same.

I think as we start to provide services 24/7 and advertise those services, you’ll see the demand shift, because now I can take care of it on a Sunday or Saturday, or at 2 o’clock in the morning. I don’t have to do it between 8 a.m. and 5 p.m. when you have hours. I can do it at all different levels. I think you’ll see a gradual shift to it becoming less and less the case, but it still bothers me. It’s been that way for 20 years and we still think it’s okay to communicate that ‘Monday mornings are busy, please call back at a less frequent time.’ No, you manage the calls on Monday morning with a higher ratio of resources so you can handle them. Because as a consumer, I don’t want to sit there and wait. I don’t want to call back. And by the way, all you’re doing is increasing the number of calls from the end of that call center, which is backing up more first-time callers.

It’s crazy; sometimes we don’t really solve the problem. We think it’s okay to apologize and just put the monkey on the back of the patient, or consumer. But now, with high deductible plans and things getting to a point where I can self-direct, I have choices. I can do a virtual call with GetWellNetwork or Teladoc or somebody else, and I can initiate those calls myself. I can go into a mini clinic. I can go wherever I want because I’m pulling those dollars out of my pocket anyway. So why would I pay $150 to go visit a physical physician when I can do it virtually for $49?

One of the things that drives me nuts is when health systems are trying to ramp up services like telehealth, the first thing that happens is you get a postcard in the mail advertising the new urgent care clinic. If you have a common cold or flu, come to the grand opening of the new urgent care clinic. And I’ll think, ‘wait a minute — we’re promoting a less costly, more efficient, equally effective method of care by going the telehealth route, and yet the organization is advertising for its physical clinic because it generates more revenue?’

In reality, that isn’t what’s best for the patient. We have to find the right balance and let the patient make those choices. We have to quit trying to coerce them with the way that we market or advertise, to go down certain avenues that are more financially astute for the system. Let’s do what’s financially astute for the patient or the consumer. 

 

Gamble:  Great point. You touched on competition, which can be a big driver when you’re talking about the value proposition. Sometimes when you look at digital or technology strategies, it can be hard to justify the cost upfront. But being able to recruit and retain patients is a big motivator.

Richardville:  You’re spot on with that. When I proposed a project to the senior team—and I’ve been blessed to work with some extremely smart people — I’ve always had business cases and business decisions behind them. I got rid of my IT steering committee years ago, because there’s no reason why I should have a select use of funds to use for IT investments. I should be able to compete with the urgent care clinics, with renovating a hospital, with buying a practice. Whatever the different capital investments are, we should all be looking straight across the portfolio that we have one source of funds, and we’re going to make the right business decisions for the company, and the right decisions for our patients — and not say, ‘Hey, we’re going to spend X amount in IT and X amount on this.’ By removing that committee, we know that if we wanted to compete for funding, we needed to be present and show our business cases on why we think it’s the right time to invest in a certain technology.

What happens in most cases is the investments and the capital share you receive goes up because you do have a lot of great cases. And when you execute properly, you can get those returns and you can accelerate those returns and have an even better business case. From that standpoint, I’ve always felt it was important not to have a select fund for IT, but to compete for it. And if it’s better for the company and for the community to build an urgent care center, then that’s the route that we should take. If it’s better to invest more in telehealth services, that’s the route we should take. If it’s a blend between those two and others, that’s the route we should be taking.

I’ve always positioned my organizations to be three to five years ahead of the adoption curve. For example, at Carolinas, we started using Alexa a few years ago to allow people to have access to our resources via their voice. I’m a big fan of the conversion to voice. First, everybody moved away from the mouse and the point-and-click to the phone, and now you’ve got the phone and swipe. People are using phones for everything, but you have to have your phone with you as well. And now, it’s through voice. Why shouldn’t you be able to use your voice to interact with the system?

Some companies are doing that now to help ease the burden of physicians interacting with the computer in the practice or an exam room, where they can use voice to interact — ‘show me the final lab results or the CBCs or the chart disks’ or pull up a certain record. Instead of hunting around and pointing and clicking and ignoring the patient, the computer can interpret my voice and very accurately start to pull that information up so that I have it available to me. It’s no different than what Alexa is doing in the consumer space.

It’s also similar to what we’re seeing with safety in the car space. With some systems, if you want to use navigation while you’re moving, you have to use your voice to interact with the car. You can’t be distracted by keying in addresses or picking points of interest. You have to use your voice to do it that way. Well, there’s no reason why we shouldn’t be using our voice more often in healthcare.

The next step is being more predictive with that — understanding my habits and my behaviors and be able to bring that up. For example, if every Friday night I look at certain types of values, it will let me know, ‘hey, it’s Friday and you need to do this,’ because it’s what you have done for the last 10 weeks. Those types of things can be learned by the system, which can prompt and be proactive with you.

I’m a big fan of the proper use of technology, but I don’t like divisions of sectors. I’m very big on inclusion. We’re all equal; let’s bring everybody in together. And one of the diversity aspects is financials. When Apple came out with their HealthKit, we saw a few prominent organizations announce their interactions with it — we were ready with that too. But in the end, we opted not to do it, because the people we really need to interact with are those that might use an Android or an alternative operating system, not necessarily Apple. In most cases, the ones using Apple phones are very responsible people. They’re the ones that are taking their medications and showing up for appointments; they’re the ones that are following the physician plans.

The ones I want to make sure we connect with are those who are buying monthly phones. They’re going to Wal-Mart or Target and buying lower-end phones. That’s who I need to interact with. And so, within 30 days, we had a talented team — led by one of my VPs, Pam Landis — develop the Android aspect of this. We were the first in the country to go on the market with both Apple and Android ability to have patient-generated information being consumed within the EMR. From that standpoint, it was a great asset for us, because that’s the population we were targeting. We didn’t want to do it for the press. We wanted to do it because it would have better results with our patients by being able to connect with those that maybe don’t have the ability or sense of responsibility of those who might carry the Apple phone, for example.

 

Gamble:  Really interesting. It seems like it’s been an overarching philosophy for you to try to avoid having too many committees and too many layers in place, which can really impede progress.

Richardville:  It comes down to be being very open and very transparent. I didn’t have my own committee where I could redirect funds. I competed with everybody else who had other objectives, and it was a matter of which ones the company wants to compete in and invest their resources toward. In many cases, I was fortunate to have leaders like [former Carolinas HealthCare CEO] Mike Tarwater, who was very forward-thinking, and wanted to make sure we were well-positioned for what the upcoming market would look like. There are other leaders who look at it that way; but in some cases, depending on your market and your position, you may not have that ability.

We were fortunate that we had our best years, year after year, when I was there. Teammate engagement was very high. The teammate engagement score within my divisions were in the 95th to 99th percentile in the country. Some years we were right in the top one percent in the country of people being totally engaged; in my worst years, we were in the top five percent. It all goes back to not only a leadership team that’s engaged, but being a servant leader and being able to tie the business objectives to the work that we’re doing. And when I was able to say, ‘the company is going to invest into this for us,’ they understood why, and they knew we were investing in things that other healthcare systems typically were not.

It’s finding the right balance at the right time; but it’s also about the people making and executing the plan that we put together. And in many cases, if you’ve got the right talent and the right team, and you have the right leadership, those people will want to move beyond the actual plan and goal you set for them. Again, for me, once we knew we were going to do something, I needed to get it done so I could clear the plate. I didn’t care if there were more things coming that I’m not part of or weren’t aware of — in the industry, or technology, or in our communities. I need to have that capacity created. So once we knew we needed to do something, it was to everybody’s advantage to get it done quickly and properly so we wouldn’t have to redo any of the work, and so we could move forward with the next potential opportunity that comes our way.

 

Gamble:  Right. So the last question I have is a big one. When you look down the road, what intrigues you most about where the industry is headed?

Richardville:  I think what intrigues me most is the patient/consumer, and how the work will be self-directed and self-managed so that people will have the assets they need to access information and make good decisions on what’s important to them.

It’s a huge expense for many of us, and it’s one of the expenses where, in many cases, we don’t have a lot of transparency into what it’s going to cost, what I can expect, is it going to be a continuous cost for me, etc. We keep all of that hidden. It’s such a large investment, yet we never really know going into a practice or going into a hospital what it’s going to cost.

Now, you can get approximate charges, but who’s going to buy a car that will cost ‘approximately $30,000?’ It’s 30 or 33 thousand, plus the maintenance plan. We make a huge investment out of our pockets in healthcare, yet we don’t really know how much it’s going to cost. We don’t really know the outcome. I think that’s shifting, and everybody gets it. It was all so self-directed in the past with the way the incentives were set up.

For me, the exciting part is how technology is going to enable that to occur; how people are going to obtain real-time access to information, which will lead to more predictable results, greater relationships with providers, and more effective use of time. I think the upside to what we’ve created over the last few decades is going to be very exciting. And so what the future is going to look like is hard to predict, but it’s amazing what it could be, especially as we get our incentives aligned properly, get people focused on the right outcome for the patient, and give up control and give that control back to the patients and consumers to make well-informed decisions that are important to them.

Because given the exact same criteria, what you say, what you decide to do or how you decide to do it might be totally different from how I do it, and yet there’s a lot that’s the same. So it’s got to be very personalized. It’s got to be fitting. One size doesn’t fit all. I think when we look at the care delivery aspects that are happening, the research that’s going on, and the consumerism sector putting control back in the hands of patients and people, I think the next 10 years are going to be quite exciting. And I hope that as this next decade unfolds and comes to an end, you’ll start to see a very dramatic difference in healthcare financing and healthcare delivery, with better outcomes for all.

I think, as an industry, we can do it. I think as the industries mesh together and we start learning from each other, we can do it. I think you’re starting to see it becoming more and more real, and as more of these other nontraditional companies enter the fray, it’s no longer a competitive game. This is something we’re doing for the right reasons and for the right people.

From that standpoint, I think this is a way to be very collaborative in the discussions. How do you work with CVS or Aetna? How do you work with Apple or Amazon or Berkshire Hathaway — how do you work with these companies to be part of that ecosystem and not just preserve what you built historically, because what you built historically is not going to be what people want in the future. And the more you fight it, the lower your chances of being a significant player. I think you’ve got to embrace it. You’ve got to engage. You have to want to be part of it. So let’s remove some of the historical protections of the past. Let’s open it up and let’s make this the best healthcare delivery and finance system in the world.

 

Gamble:  Well said. There are so many interesting aspects of healthcare and healthcare IT, and it’s really fascinating to watch it unfold. Thank you so much for taking the time to provide your insights. It’s been really interesting.

Richardville:  I really appreciate the opportunity, Kate. You do great work, and I hope it helps. Thanks very much.