Q&A with Northeast Georgia Health System CIO Chris Paravate, Part 1: “We Have to Support Operational Flow.”

For healthcare leaders, improving the experience for both patients and providers has become a top priority. Patients want seamless; they want to schedule appointments online and submit medical information through a portal. But no matter how much resources health systems have invested, simply implementing the technology – and training people on how to use it – isn’t enough, said Chris Paravate, CIO at Northeast Georgia Health System.

“If we don’t actually go into the clinic and support the operational flow, we won’t be able to make that connection,” he said in a recent interview. He knows this from experience, which is why one of his most pressing priorities as CIO is to iron out the kinks that exist and create better processes to be able to leverage technology. During the discussion, Paravate spoke with Kate Gamble, Managing Editor, about the importance of ensuring clinical and operational buy-in with digital initiatives; the challenges organizations face in navigating mixed care models; why he believes patient experience doesn’t have to be a “trade-off”; and the one aspect of healthcare he’d like to eliminate.

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Key Takeaways

• As part of its growth strategy, Northeast Georgia Health System is focused on “being deliberate and strategic about understanding what’s happening in the market, how communities are going, and how to be able to support them.”
• Based on their own technical merits, digital tools “are relatively easy to implement. But in their operating domain, they can be pretty disruptive,” which makes buy-in a critical factor.
• “We can implement systems and train people, but if we don’t actually go into the clinic and support the operational flow, even the office managers wouldn’t be able to make that connection.”
• In a mixed model environment where physicians work in clinics and also hold virtual visits, it’s critical for leaders to “sit down and talk through how the day is going to flow and what it looks like.”
• Contrary to popular belief, improving the patient experience doesn’t have to come at the cost of making more work for clinicians of operational staff, Paravate said. “It doesn’t have to be a trade-off.”

Q&A with Chris Paravate, CIO, Northeast Georgia Health System, Part 1

Gamble:  The last time we spoke was before Covid; obviously a lot has changed since then. But first, how long have you been with the organization?

Chris:  It has crept up on me. I’ve been here since 2010, so about 12 years with the organization. I took on the CIO role in 2015. It’s crazy how quickly 8 years has gone by.

 

Gamble:  And you were in the chief applications role before that. That’s definitely not a typical career progression, but I imagine it has benefited you.

Paravate:  I’ve spent a big portion of my career driving projects and implementation. And so, I’ve had opportunities to touch just about every aspect of IT and delivery. I think that predominantly really helped me to get that bird’s eye view of everything that needs to be supported.

 

Gamble:  Right. So, in terms of your biggest priorities, I noticed there’s a lot of growth happening within the organization. Can you talk about what it takes to sustain growth at a healthy rate?

Paravate:  I don’t know what the keys to success are, but I know that growth keeps happening. We’re very fortunate to be in an area of North Georgia that continues to grow. We’ve also been really focused on being very deliberate and strategic about that growth and understanding what’s happening in the market, how are these communities growing, and how to be there to support them as they emerge.

We have several big initiatives and a lot of construction, but we’re also putting a lot of technology behind that. We’ve made some big investments in our digital roadmap. We’re trying to create a user experience; a patient experience that is more contemporary, and at the same time make sure we don’t put more burden on the clinical and operating staff. That’s a real balance.

Bringing digital tools to life

A lot of times digital tools on their technical merits are relatively easy to implement, but in their operating domain, they can be pretty disruptive. Getting strong clinical and operational buy-in and helping those operational leaders think through how to bring those tools to life, and then supporting them through that transition, is really the key to being successful.

Even things like virtual visits. On the surface, it’s easy — we should be doing that. It’s important. But if you’re running a clinic or a series of clinics, and they’re running at capacity or over capacity, who’s going to take those virtual visits? How do I decant some of those office visits to virtual visits? What’s the stafffing and the manpower? I can’t just say, ‘in room number 3, you’re going to find a video conference and room 4 will be a patient.’ There’s a little bit more choreographing that goes into those visits.

That’s been a focus, along with leveraging our patient portal to really improve that experience and remove as much waste from the process as we possibly can.

 

Gamble:  Can you talk more about the workflow aspect when it comes to digital transformation? What are you doing to limit disruption?

Paravate:  Sure, I’ll give you an example. We all like the idea of going to a patient portal to schedule an appointment, filling out what our chief complaint is or what we need to be seen for, completing our registration and co-pay, and checking in without seeing anyone or talking to anyone, and then being magically called back to patient room and being seen immediately. And of course, providers understand what we submitted, ask additional questions and then complete documentation and place the order. We then go downstairs to the pharmacy and our medications are ready, and we go on our merry way.

Managing a “mixed model” of patients

In some cases, we’ve really achieved that. The key to achieving that is starting early with the clinic and asking, how are we going to exist in a mixed model where one patient may completely do all of those things and the next patient does not? How do we fast track those patients that have done all that work because that visit or that encounter can be quicker, and talk through what that looks like?

It’s making sure that the front desk understands that when someone does self check-in, they can see them in the queue, and they can see them on their screen, but they don’t need to do anything, but the next person who walks in may not have done any of those things. How do you get them to the same state? You might have a situation where one patient has an appointment at 8 a.m. and the next patient has one at 8:15 a.m., and the 8:15 person may have done all the work online and might even pass the person with the earlier appointment.

It’s making sure the front desk staff understands first of all who is coming in the door and what state they’re in, and getting them ready to come back into the clinic. And if they’ve completed their medical history, then you’re not collecting it — you’re just validating it. How do we choreograph that material to look a little bit differently on the screen; to look more like a review than the same documentation? With each step the patient moves through, we want to carefully think of not just what patients can do in the portal, but how the clinic will react to that information differently.

“A real dissatisfier”

Several years ago, we went live with Epic. We provided the option for patients in the imaging center to complete that documentation online, but they were still asking the patient to complete that information again on paper when they presented. We realized how much of a disconnect it was between what we had built as capability from a patient-facing perspective, and how it presented at the clinic. It was a real dissatisfier.

My wife picked on me because she went for a mammogram and I said, ‘If you fill out everything online, you won’t have to do it when you get there.’ Of course, when she went for her mammogram, they handed her a clip board and asked her to fill out the same information on paper. And so, she poked fun at me and said, ‘Wow, you did a great job implementing that system.’

It just made me realize, we can implement systems and train people, but if we don’t actually go to the clinic and really support the operational flow, even the office managers wouldn’t be able to make that connection. They won’t be able to solve that; we really needed to go a little bit deeper into that deployment.

“We have to go deeper”

And so, as we think about video visits or virtual visits, and as we look at online scheduling, completing documentation, and answering questions, emails, and messages from patients, we’re finding that we have to go a little bit deeper into designing the clinical architecture of how that work will get done. We assumed that the office manager should know how to make sure it gets used—well, that hasn’t been the case.

It’s the same thing with virtual visits. If we’re doing a mixed model where physicians work in a clinic and do some virtual visits, we really need to sit down and talk through how that day is going to flow and what it looks like, and really engage with that individual over the next couple of weeks to say, is that real? That’s a big component of it.

As we’re building new facilities — and I do try to advertise our growth, because it helps in so many ways with recruiting — we’re looking at the design of those facilities and seeing how are we bringing the intersection of that digital consumer strategy with clinical operations.

 

Gamble:  That’s a really critical point. You want to drive these digital initiatives, but you need to pay attention to the clinical architecture and make sure all of these areas mesh.

Paravate:  I have a fundamental belief that making a better patient experience does not have to be at the cost of making more work for the clinicians, providers, or anybody in operations. It doesn’t have to be a trade-off. And so, as we think about design integration, and particularly around how do we make that digital experience or clinical operational experience match, there are a lot of technologies we’re employing to improve that experience.

One is smart room technology, which includes smart rooms, smart televisions, and electronic whiteboards. Those are enabling technologies, along with RFID.

And then there’s effective patient technologies. For instance, the idea that someone could flip from an outpatient to an inpatient, and the patient application would recognize that and start to cater to their inpatient needs. Often when a patient is in the hospital, there’s someone who is either very interested in their care or overseeing their care; ensuring those care delegates can interact with the clinical staff is important. It’s also the enablement of RFID in tracking patients so that those caregivers or care overseers can see that, for example, mom is not texting me right now because she’s getting a CT.

Choreographing patient care

That’s also effective for the provider. We’re actually experimenting with AI right now to prioritize clinical activities. People often struggle with length of stay and capacity issues — we certainly do. And so, we’re looking to prioritize patient care and choreograph that in the right sequence.

For example, if I need a chest x-ray to write a discharge, and I want to see that chest x-ray, it’s moving that up as a priority so I can free up that bed, because I know that at 11 a.m., somebody is coming out of the OR and will need to go to an inpatient room.

You start to layer all these activities that are going on in the hospital. Using AI, we sequence that to optimize our length of stay but also our clinical staff usage.  The idea being that if a patient is having a CT, but also has a cardiology consult, that the cardiologist on their rounding report says, ‘don’t go see that patient right now, because they’re not there.’ It’s sequencing, consult orders, rounding, and then also utilizing RFID to facilitate transport.

We’re implementing centralized transport; it’s very much like Uber. If I know that someone is on the third floor with a wheelchair and there’s a patient on the second floor that needs wheelchair assistance, we’re able to leverage our mobile platform to dynamically assign that person to complete the transport.

Part 2