A recent survey found that the majority of health systems (57 percent) aren’t reaching their goals when it comes to digital transformation. One of the biggest points of frustration is the fact that there isn’t a senior level role focused how emerging digital technologies can transform the patient experience, because most of the focus is on implementing and optimizing EHRs.
It was precisely this point that came up during a discussion Nick Patel had with HIMSS CEO Hal Wolf back in 2017 – a discussion that ended up transforming Patel’s career. Shortly afterwards, he pitched the idea of chief digital officer to his CEO, and was offered the job. Since then, the role has grown, both in numbers and notoriety, and Patel believes it will continue to do so as digital health becomes a bigger priority.
Recently, Patel spoke with Kate Gamble, Managing Editor of healthsystemCIO, about his team’s core objectives, particularly when it comes to remote monitoring; his thoughts on how disrupters and startups are changing the game; his journey from practicing physician to CDO; and the traits he believes are most important in digital leaders.
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- When Prisma Health was formed as a result of two organizations coming together, Patel pitched the idea for a chief digital officer, provided a description, and got the job.
- The most critical core objectives are to leverage remote patient monitoring and connected virtual care centers to improve patient engagement.
- As virtual visits and chatbot engagements have increased, Prisma has seen a rise in both compliance and patient satisfaction scores. “We’re realizing that we can do a lot outside of buildings that cost millions of dollars,” Patel said.
- Working with startups can be a viable option, as long as leaders are will to do their due diligence, making sure they’re financially sound and have proven results.
Q&A with Nick Patel, MD, CDO, Prisma Health
Gamble: I want to talk about some of the priorities you have, and get your thoughts on where everything is going with digital health. First, can you give us a high-level overview of Prisma Health?
Patel: Absolutely. Prisma Health is the largest healthcare system in South Carolina. We span over 50 percent of state and have about 30,000 team members. We’re an academic institution with two affiliated medical schools. I serve as chief digital officer and vice chair for department of medicine, and I’m a practicing internist.
I’ve been with the organization now 18 years. Prisma was formed about four years ago when Palmetto Health in Columbia merged with Greenville Memorial System.
Gamble: How long have you been in the chief digital officer role?
Patel: About three years now.
Gamble: So you were really on the cutting edge. Now we’re starting to see so many more of those titles pop up across healthcare.
Patel: I think three years ago, there was probably seven of us. Now we’re in the high double digits. It’s interesting; in 2017, I had dinner with Hal Wolf, the CEO of HIMSS. We were going around the table and talking about what we’re doing at our institutions. At that time, I was the CMIO for the medical group. Hal asked me, “What do you want to do with your future?” And we started talking about patient experience, digital transformation, and how we don’t have anyone really concentrating at emerging technologies and innovation, because we’re all focused on EHR and IT. He said, “Nick, you need to come to my keynote.” I had already planned on going. As it turned out, he talked about the chief digital officer role as one of the emerging roles. I remember thinking, checkmark, checkmark, checkmark. He was saying everything I wanted to hear about this person, this role.
So when we became Prisma, my CEO asked me what I wanted to do next, and I pitched the idea of chief digital officer. He asked me to do some research and data around it, which I did. I wrote my own job description for the position, and became the inaugural CDO for Prisma.
Gamble: That’s really interesting. You saw a need and said, ‘This is something I want to do,’ and you were able to make that happen.
Patel: And we have a close-knit community of CDOs. We have a mantra of openness and sharing ideas. I stay in close contact with my colleagues across the country and we share ideas of what’s worked and what hasn’t, so that we don’t make the same mistakes at other institutions.
“Using data to drive care”: RPM & virtual connected care
Gamble: In terms of your core objectives, obviously COVID continues to throw a wrench into things, but what are you most focused on right now?
Patel: I would say there are two things. The first is remote patient monitoring. Like most large institutions, we have a large number of patients in our at-risk program – we actually have about 350,000 folks. And we’re using data to drive care. So it’s about more than taking care of patients every three or six months in the office. We don’t know what happens in between those office visits, and we want to be more engaged digitally in between those brick-and-mortar locations.
We’re looking at three programs: hypertension, diabetes, and CHF. Hypertension and diabetes has already kicked off. We’re getting people to their blood pressure goals better, faster. We see over a million patients at Prisma Health every year, and we’re going to use data to drive care and get people engaged at different levels, whether it’s high-touch or low-touch. If you have a high RAS score, you have a larger group of care coordinators, social workers, pharmacists to help get you to your goals, on top of clinical team members.
It’s our goal to utilize digital as much as we can. So if we start to notice that your readings are going out of a certain threshold or range, we have a chatbot that says, “I noticed that your last three blood pressure readings were high. Are you taking your medicine? Did you miss your dose?” The standard things most nurses would ask a patient when they’re not reaching their goals, then being able to escalate that to either a physician or APP or if needed. Maybe it’s, “I didn’t pick up the medicine. It was too expensive when I got there.”
And so we need to get them in touch with a care coordinator or pharmacist to help them through that. I still practice internal medicine and I can tell you that what happens is at the next visit, they’ll say, “Dr. Patel, I didn’t take that medicine. I figure I’d just talk to you now.” Well, you’ve had six months of high blood pressure since I saw you. I wish I would have known about it before.”
The second big thing is setting up a virtual care center that’s centralized and incorporates other operational units like the ICU into one center that can have RPM data coming in, 24×7 virtual urgent care and virtual primary care, and dedicated FTEs from a provider perspective to take care of those patients. You add automation as part of that, and become connected to all your brick-and-mortar locations, where you need radiology, labs and other services. We’re trying to make this a digital continuum of services to augment office care, but also to provide care 100 percent virtually for those healthier patients that don’t need a higher touch point.
Covid as “a catalyst for digital health”
Gamble: I imagine it has really made a difference in the past year or so that you had already started down the digital path.
Patel: It absolutely has. If there’s a silver lining with COVID, it’s definitely been a catalyst for digital health. Typically, we’ve always met a lot of resistance on the use of telehealth and all these advanced tools, because it’s hard to move away from centuries of traditional healthcare delivery. Covid really forced us to do that. We’ve seen more than 172,000 chatbot engagements. We’ve seen more than 700,000 patients via virtual visits, and the count continues. It’s interesting how we see a correlation between increase in virtual visits and chatbot utilization that goes up in almost in a linear fashion to the way Covid surges.
We’re also seeing compliance go up. We’re one of the first health systems to do hospital at home. We’ve had over 200 patients taken care of at home for chronic conditions, and we’ve had amazing patient satisfaction from that and very little to no readmissions.
We’re realizing that we can do a lot of stuff outside of big buildings that cost millions of dollars. There is a paradigm shift in the population; millennials outnumber the baby boomer population, and they expect on-demand, easy access and different way of healthcare delivery.
Disrupters in the market
There are also a lot of disruptors in the market. There are a lot of companies out there that have sprung up. We’ve seen M&A action, with companies consolidating and getting bigger and offering virtual primary care nationally and things of that nature. Health systems have to be aware of this and what those disruptors are, because they could potentially take away a lot of the commercial payer base. And so you have to be able keep up. But I love the disruption that’s happening, because it’s a catalyst to start to get health systems to pay attention and change the way we deliver care.
Working with startups
Gamble: I completely agree. What about working with startups? What has the approach been?
Patel: We do our due diligence. We look at KLAS research. I call my colleagues. I look at the marketplace and the literature that’s out there in the marketplace around AI, automation, digital platforms, and digital front doors. Interestingly, my first project was to institute our online schedule physician directory as part of our digital front door strategy. It was actually a perfect project to start off with because it allowed us to unify our provider directory bringing in two new health systems into one. We also sunsetted a lot of legacy credentialing software and others when we did that. We continue to march forward from there to online access to automation and other things.
The way we look at this is yes, some of them are startups, but they have a good backing. We look to make sure they’re financially sound and look to see what other equal-sized clients they’ve worked with. So we don’t shy away from the startups. Obviously, we don’t work with a lot of companies that are on day one, but eventually, what I’d like to do is partner with some of these folks. And we do have some partnerships. We haven’t done investments, but we’ve helped in the development of solutions and shared IP around that. I think that’s extremely important.
The other thing is that, like other health systems, we will probably be moving into the venture arm of things and investing in some of these companies that we believe in, and growing companies within our organization.
Gamble: You mentioned the word diligence. I’m sure that has to be such a big part of this, because there is the potential for a bubble with startups.
Patel: Absolutely. One of the biggest concerns I have is a lot of these companies that are just springing up do just a little bit of the turning. It’s like a jigsaw puzzle you have to put together, and these startups just do one niche. They may just do front door. They may only just do online scheduling, but they don’t do the intake. Or they do the intake, but they don’t actually integrate that data into Epic or do the physician directory piece where they get to know who the providers are. If you look at these different major components of digital front door – telehealth, automation, AI – at the pixel level, there are probably 10 companies or more that do a little piece of that pie.
And so you have to be careful, because you don’t want to end up with a massive solution portfolio and have them all integrated with separate APIs. What we see in the market now is that companies that do consolidation are forming singular platforms so you don’t have to buy all these separate siloed solutions to complete the picture. They’re trying to complete the picture with you and reduce the number of integrations required. I think that’s something a lot of health systems and myself are looking forward to, because it’s hard to integrate all these different components.