During the past few years, a number of healthcare organizations have added digital titles to the C-suite, whether it’s a Chief Digital Officer, Chief Digital Information Officer, or, in Bradley Crotty’s case, Chief Digital Engagement Officer. It’s certainly a step in the right direction for the industry, which has notoriously been late the party. But what needs to happen along with assigning an individual to lead the charge, is acknowledging that digital transformation has to be a team effort.
For Crotty, that means it has to be treated as both a “key competency and an area of accountability” for team members. Recently, he spoke with healthsystemCIO about how Froedtert & Medical College of Wisconsin is working to instill that mindset across the organization. He also talked about why Inception Health, the hub that was created “as a vehicle to affect digital transformation,” remains a separate entity; the “low-hanging fruit” that leaders should be focused on when it comes to leveraging technology to improve care; and how Froedtert is partnering with nearby organizations to address social determinants of care.
- Inception Health, the hub created in 2015 “as a vehicle to affect digital transformation,” was created as a separate structure for a simple reason: “It’s very difficult for legacy organizations to disrupt themselves.”
- Having a full-time remote monitoring and clinical team housed within Inception Health enables Froedtert to roll out digital solutions without burdening local care teams.
- During the pandemic, the need increased for Crotty’s team to be “an evangelist for how we make digital more available in different aspects of administrative and clinical operations.”
- When used right, digital tools can improve the care process by “integrating data across devices and getting them into a central location where they can be accessed.”
- From a clinical standpoint, the biggest opportunity for digital health is in helping those with chronic conditions manage day-to-day care.
Q&A with Dr. Bradley Crotty
Gamble: Let’s start with a brief overview of the organization — what you have in terms of hospitals, how it’s structured, etc.
Crotty: Froedtert & Medical College of Wisconsin Health Network is probably best described as an academic community health system. It’s based in Southeastern Wisconsin. We have three full-service hospitals: Froedtert Hospital, which is the academic medical center; Froedtert Menomonee Falls, which is also a teaching hospital; and Froedtert West Bend Hospital.
We’ve just entered into an affiliation agreement with Holy Family Memorial Medical Center in Manitowoc. We have two other affiliates and three community hospitals in different areas around Southeastern Wisconsin to make receiving care more convenient for people instead of having to come to one of our bigger hospitals. We’re about a $2.6 billion health system.
Gamble: And in terms of the Medical College of Wisconsin, is that a partnership? How would you describe it?
Crotty: It’s a strategic partnership. That’s how we brand and run our clinical enterprise. It’s a combination of efforts between Froedtert, which is the parent healthcare organization, and Medical College of Wisconsin, which is the academic university. It’s a free-standing, private medical school.
Gamble: I want to talk about your role as chief digital engagement officer, but you also have the title of CMO of Inception Health, which is the digital health hub. Can you talk a little bit about that?
Crotty: Absolutely. Inception Health is a wholly owned subsidiary of Froedtert Health. It was created in 2015 as a vehicle to affect digital transformation and digital change. The reason we created a separate structure and space for it is because it’s very difficult for legacy organizations to disrupt themselves and essentially get out of their own way when it comes to digital transformation. In the Clay Christiansen model of disruptive innovation, there have been very few examples in which a legacy organization is able to effectively adapt enough to be resilient against insurgents. What we’re seeing is that technology is leveling the playing field how we’re able to advance healthcare.
The virtual-first movement: “No single system has the solution”
Right now, several different companies are developing virtual-first healthcare. We see it with Amazon, and we see it with primary care offerings, like One Medical and 98Point6. And so we created Inception to tackle that area of virtual care head on, as well as to be a conduit to external organizations and to signal to the market that we are receptive to being a partner with this dedicated organization. It was our philosophy that no single system would have the solution to how to really do this really well; that a combination of partnerships are needed to move healthcare to where it needs to be.
We have been board members of the AVIA Innovation Network based in Chicago. We’ve worked with a number of startup and early stage companies as we both invest in, and implement, technologies and solutions to be part of our digital landscape. We also manage the corporate venture arm for Froedtert Health.
Remoting monitoring in-house: “We don’t have to push that down to the local level.”
Crotty: Another important piece is that we actually have a 24/7 remote monitoring and clinical team that’s physically housed within Inception Health. That means as we roll out different digital health solutions that require remote monitoring, for example, we’re able to use our staff here to do the monitoring, do the escalation, and do the group view as opposed to pushing all of that onto our local care teams.
We started it with the virtual ICU, which many healthcare organizations have done. And then we pushed out that competency from the ICU more into hospital coverage, and then we pushed it further into ambulatory services. That’s been a key area of flexibility for us; when we’re trying implementing a solution, doing a proof on concept and doing a pilot, we don’t have to push everything down to the local level and require all of that change management.
Gamble: That’s really interesting. I’m sure it made an impact, especially during the early part of COVID when everything ramped up so quickly. Did you have that in-house staff prior to the pandemic?
Crotty: We did, and we definitely used them to the fullest capacity during Covid. Some things, of course, changed on a week-by-week basis. As part of that remote monitoring through Inception, we’ve managed the majority of COVID testing, particularly anything coming from the outside — meaning that instead of being ordered by a clinical office as part of an encounter, it was patients calling in or doing electronic transactions with us to request testing or manage symptoms. So yes, that was a huge asset we were able to leverage.
Gamble: Who makes up that team? Is it largely clinical?
Crotty: It’s made up of critical care nurses, many of whom have been on the floor or in the ICU, and so they have a lot of experience and they can guide the next generation nurses.
We also have digital health techs as part of it. That’s the other end of the spectrum. They may do tele-observations. They may do our digital care. They may do health coaching. And so it goes all the way from ICU RN experience down to the digital coach level. We also have advanced practice providers to help with hospital coverage.
Marrying Two Roles
Gamble: It really makes sense how you’re able to marry your two roles. Can you talk more about that?
Crotty: In terms of its structure, Inception has a very small governance board. Our board of managers includes the health system CEO, CIO, CMO, CFO, and chief experience officer. That enables us to take direction from key leaders within the organization around what our priorities are, and how to move forward. Inception is its own entity, and many — if not all — of these areas have to intersect within the health system at some level. That’s where my other role comes into play. Within the CDEO role, my responsibilities are to manage the governance of our digital health processes and oversee the strategy for telehealth; this was pre-pandemic.
“The need ramped up to be an evangelist for digital.”
During Covid, the need rally ramped up to be an evangelist for how we make digital more available in different aspects of administrative and clinical operations. We manage a growing formulary of digital therapeutics. We manage it similar to the way a pharmacy and therapeutics committee would manage what medicines we have as part of our formulary. And so my office manages what we put out as part of the digital therapeutics formulary, meaning what can be prescribed through the EHR. We’re also charged with growing and continuing the care quality program with virtual and digital health. That’s how the two roles merge together.
“Creative knitting” required to incorporate digital services
At Inception, we also have an engineering shop. When it comes to like developing our mobile application for the health network, and different aspects of our digital services, much of it is creative knitting between the EHR and our telehealth platforms, of which there are a few. It’s integrating those solutions with the data and the personalization directions that we need in order to move forward in the healthcare space.
That engineering shop rolls up to me. It’s based at Inception, and it manages the mobile application and all related backend structures for our digital engagement platform.
Administrative aspects of digital health: Making it easier to receive care
Gamble: In terms of digital health, we saw such a huge transformation over the past year or so. When you think about digital, what are the big opportunities that healthcare organizations need to focus on?
Crotty: I’m going to separate that out into a few different areas, starting with the non-clinical aspects. How can we make giving and receiving care easier, less stressful and even enjoyable? It’s the process of scheduling and cancelling appointments, and understanding where to go for the next steps in your care. It’s also knowing what services I should be using, what would be helpful for me, and how do I integrate data across different devices and get them all into a central place where they can be accessed.
Those all fall into the administrative aspects of digital health. Many of them have clinical tentacles, but a core part of that is knowing how to update our business in healthcare to be much more accessible to people — more flexible — and be there on their time. It’s everything from scheduling appointments at any time of day, to being able to transact when you need a preventive care such as a mammogram, and being able to schedule a colonoscopy when you’re ready. All of those aspects roll up into the digital health space. That’s part of the business transformation.
Clinical aspects of digital health: the “low-hanging fruit”
And then in clinical realm, the way I look at digital health — and particularly digital therapeutics — is that we now have the ability to help people follow through with care plans or to advanced diagnostic or treatment capabilities in peoples’ homes on their own time, and not built around the clinician’s schedule. And so I think some of the low-hanging fruit is in being able to manage the day-to-day care. Hypertension is a really good example. Historically, we don’t take blood pressure very accurately inside the four walls of the clinic, where patients are almost always stressed out. We really should be managing it at home.
And so the low-hanging fruit is in being able to provide education and give people management plans that may include adjusting medications and monitoring labs to help them reach their goals. It’s providing all of that data in a way that can be reviewed and check-marked to make sure the care plan is being followed. All of that can be done outside of the visit structure. That’s a big piece of what we’re looking to do.
Mental health: “We need better options”
Mental health is another really important example. We know that it’s really hard to access a therapist. We need better options for people where care is more accessible and can be done on their own time, which may not be during the typical business hours of psychiatrists and psychologists.
For a number of years, we’ve been using SilverCloud, a digital therapeutic tool designed to provide Internet-based CBT (cognitive behavioral therapy) from home. Patients can check in, get some education, do some journaling, and do some reflection while being guided by one of our health coaches who are based in our virtual care team. That way, they can at least receive some skills while they’re waiting for an appointment that’s far out, or if they’re doing this in conjunction with other medications. It’s an important adjunct, and we’ve seen some really good results. We published a paper in peer-reviewed literature earlier this year showing that it can reduce anxiety and depression scores by 20 to 25 percent. And this is a low-touch program; there’s a support person who checks in every two weeks, but people do it on their own time.