Q&A with Allegheny Health CDIO Ashis Barad, MD: “We Need to Do the Hard Work of Laying Down the Foundation.”

Dr. Ashis Barad has a vision for healthcare; one in which providers leverage the information they have to guide patients along the journey. One in which a pediatrician, for example, knows right away why a parent has taken his or her child into the clinic. One that works, “simplistically, like a Netflix engine. We surface our recommendations to you. We guide you, and you choose what you want.”

Getting to that point, however, is anything but simple. “In order to guide you, we need to know you. And to know you, we need data,” said Barad, Chief Digital and Information Officer at Allegheny Health Network. And not just data, but an infrastructure that enables it to flow (at least somewhat) seamlessly, a governance structure that ensures the right processes are in place, and a culture that ties it all together.

During a recent interview with Kate Gamble, Managing Editor and Director of Social Media at healthsystemCIO, Barad talked about how having both digital and IT under his purview has enabled him to create “one integrated roadmap,” while also lessening the burden on clinicians. He also discussed how Highmark Health and Allegheny Health Network’s “Living Health” initiative hopes to bolster engagement by breaking down traditional walls; and how he is leveraging his experience as a physician to “bring that voice to the table.”

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Bold Statements

• By placing digital and IT under one umbrella, AHN leadership is able to “make sure anything and everything we do in this digital, virtual health world does not in any way add burden to our clinicians’ experience.”
• “Because there has just been way too much on the plate, legacy healthcare IT has been a ‘no’ culture,” said Barad. The goal is to progress to ‘no, because’ to ‘yes, if’ and eventually ‘yes, because.’
• As CDIO, “my role is to determine how we can surface that to clinicians in a way that they see value in the data that’s flowing back to them, but without data overload and alert fatigue.”
• There weren’t enough clinicians at the table that were representing the voice of the end user and building it into the workflow in a way that made the physician say, this is something I want to use. That’s why I’m doing what I’m doing; to bring that voice to the table.
• In order to guide you, we need to know you. And to know you, we need data.  I think that’s our journey here. Through our partnership with Google, and with having a payer and a provider, we feel like we have all the elements to go down that path with data.

Q&A with Ashis Barad, MD, Chief Digital & Information Officer, Allegheny Health Network

Gamble:  Hi Ashis, thanks so much for taking the time to speak with us. Can you provide a high-level overview of Allegheny Health Network and Highmark Health?

Barad:  I’m happy to do it. Thanks for having me, Kate. Allegheny Health Network just celebrated its 10th year anniversary as a network. Allegheny General Hospital has been around for a long time, but the confluence of the 14-hospital system that is owned as one entity by Highmark Health has been around for a decade. The system does $4 billion in annual revenue, has about 2,000 employed providers, and more than 300 clinical locations and offices. We’re part of a very successful clinically integrated network in the western Pennsylvania region that comprises around 7,500 providers.

It’s a unique situation; Highmark Inc. is a payer; Highmark Health is an enterprise that has diverse business portfolio, including a dental company and a health tech company called Engen that serves the greater blues network nationally. Highmark Inc. is the fourth largest Blue Cross Blue Shield in America with around 6 million members. What makes it unique is that there’s alignment — or, what we call blendedness — between the payer and the provider versus a payer owning a provider. It’s truly a blended operating system.

 

Gamble:  Very interesting. How does having that type of arrangement affect your job as Chief Digital and Information Officer?

Barad:  I’m really lucky to have a lot of the technology shop under my banner. I came here about a year ago, having been with Baylor Scott & White for 11 years prior to that. I came here to lead digital and virtual health. Since that time there have been a lot of changes, which is a big positive. I’m now the leader over all of IT, including the Epic EMR and clinical workflows. And so, not only do I have the digital strategy and the virtual health strategy, I also have the IT, which is running business as usual, and also focusing on what does that look like for the future of an IT shop and where healthcare is going.

Additionally, I’m essentially acting as Chief Medical Informatics Officer as well, creating all the workflows inside the EMR to make sure that anything and everything we do in this digital, virtual health world does not in any way add burden to our clinicians’ experience, because we know where we are with clinician burnout. We know where with are with staffing shortages and people leaving healthcare from top to bottom.

Adding to the burden

It’s extremely important that we’re not adding to the burden. Unfortunately, however, when it comes to digital transformation, up until this point I can’t say that’s the way it’s been done. I think many clinicians would say it’s additive. You haven’t really removed any burdens, friction, or pain points for me — you’re just now asking me to do extra.

The fact that I have the digital shop, which includes virtual, along with the IT shop and the Epic shop under me, allows me to create one integrated roadmap that is connected and is thoughtful around how each piece connects with the others. I look at that shop, and I look at my colleagues and their roadmaps, and make sure that there’s alignment at all levels. If we can do that and connect all the pieces in that way seamlessly, that’s incredible work.

 

Gamble:  When you had IT added under your umbrella, that was obviously big. How did you approach that?

Barad:  Great question. I took a deep breath. That’s the first thing I did. There’s a lot going on in the digital and virtual world, and it is advantageous. To give some context to that, digital culture is very different from legacy healthcare IT culture. Because there has just been way too much on the plate, legacy healthcare IT has been a ‘no’ culture. Not always, but sometimes. If docs went to IT to ask for something, it started with a ‘no’ and you had to convince them to get to a ‘yes,’ because we have so much going on.

The next progression of that journey is to say, ‘no, because.’ For example, we have all of these things in front of us. It makes them start to think of their portfolio and what they have on their plate, and why they can’t necessarily do the extra work.

Step three of that journey for me is ‘yes, if.’ We’re listening to you and hearing the voice of the customer. Maybe it’s ‘yes, if there’s a budget,’ or ‘yes, if I had resources’ or ‘if I had the team,’ and so on. It’s getting into that thinking where you’re not automatically starting with a ‘no,’ but instead, saying ‘yes, if I had XYZ.’ The holy grail is to get to ‘yes, because.’ We want to be able to say, ‘yes, because it’s important to our strategy.’ Because it allows us to move to a consumer-centric view. The ‘because’ is important because it doesn’t mean yes to everything. There’s a strategy behind it.

An infrastructure for digital transformation

Going back to your question, by having IT underneath me, we’re getting into what we really need to do in healthcare, which is the infrastructure. The infrastructure is not currently where it needs to be for digital transformation. That’s what I learned from other places I’ve been. We need to do the hard work of laying down the proper foundation and infrastructure to do digital transformation. We all want to get to digital transformation quick and fast.

Part of my career journey here was a moment of saying, ‘I want to do the really cool innovative stuff right now.’ We certainly are still doing some of that, but it was that moment where you take a deep breath and say, we really have to fix the foundation so we can move to speed later. It’s not exciting. It’s not going to make podcast listeners salivate, but it’s so essential and so crucial.

AHN’s Epic refuel

Once I took on that role, I realized that we had to do an Epic refuel which is what we’re doing right now. and we’re just starting to kick that off. We came together really quickly as a health system. It needed to happen because there’s a lot of history that led to non-standardization — one instance of Epic but no standardized workflows, no standardized registrations or scheduling. How do you do digital transformation if every clinic and every hospital is registering patients in different ways with their different workflows? And it’s all within Epic, but we know it’s not the same workflow. You can bypass workflows.

We’re doing that so we can digitize now and digitalize later. It’s not a static ‘we have to do this before we can do that.’ We can still do some other things from a digital transformation perspective. I always say, ‘you can’t personalize until you standardize.’ And so, to your point, the standardization work is really what’s happening on the ground, day to day.

 

Living Health

Gamble:  That’s interesting. While you’re doing this, there are digital initiatives that you can push forward. The standardization piece is so important in being able to leverage some of the data and digital tools to be able to do the cool things that everyone wants to talk about.

Barad:  One of the reasons why I’m here is that Highmark Health within AHN has an enterprise strategy called Living Health. So again, we’re not putting a pause or stop button on any work we’re doing within Living Health; but at the same time, we’re building the infrastructure.

Changing payer levers

To give you an idea, Living Health, at its very core, states that as a payer, Highmark is not going to utilize the denial of care as its main lever to decrease total cost of care. Most payers have leveraged utilization management and authorizations as their main lever to basically deny access to care.

Highmark Health has recognized that — and I applaud them for it — and is going to pull a very different lever, which is actually improving the health outcomes of our members. Improving health outcomes will lead to a sustainable decrease in total cost of care for those members.

That’s a really tough place to get to obviously because it means we do have to move upstream. We do have to develop curated solutions for that member who is surface engaging with them at the right time and who wants them to be engaged. That’s a tough ask; people aren’t really used to engaging with their healthcare providers on a continual basis, right? People seek out care 2.1 times a year on average, and now you’re trying to get that to daily or weekly. It’s a tough problem to solve, but I think it’s absolutely the problem that we need to get to.  How do you do that with a payer who has a lot of levers that they can pull to engage members and a lot of ability to engage, while recognizing that it’s a payer reaching out? The reality is, sometimes when payers reach out to you to engage in your care, you may not have as much trust as would if your personal doctor is doing that, or your care team that you trust.

Engaging through clinicians

Highmark’s Living Health premise is that the path to engagement is through our clinicians. Of course, we want to go direct to members and consumers. We know it’s not always through clinicians, but we are absolutely going to look at how we can build engagement tools and curated products in a way that it surfaces through your care team and everyone of these could be double clicked on. But if it’s built in a way that’s just adding burden to the care teams by having more alerts put in front of them, you’re not going to get that engagement.

By having Epic workflows under me, my role is to determine how we can surface that to clinicians in a way that they see value in the data that’s flowing back to them, but without data overload and alert fatigue. We need to do this in a way that they see value in patients sitting in front of them or using MyChart messaging; that they want to enroll a patient in a smoking cessation program for COPD, because not only is it going to improve their care and their outcomes, but I’m going to be able to see them through their journey. I’m going to engage them in the proper formats in which they want to be, whether that’s digital, virtual, in person, hospital, or asynchronous, so they feel like I’m connected to them.

That’s a big part of the Living Health strategy; connecting members and clinicians at the center of that journey. If we do it that way, our theory is that engagement will go up and that will then in turn improve outcomes and decrease total cost of care.

 

Gamble:  That’s really interesting. I want to talk about the fact that you’re a physician — how do you think that affects the way you think about and approach some of these things.

Barad:  Sure. I’ll tell you a little bit about my kind of trajectory and why that question is so important to me and at the root of who I am. I was a full-time pediatric gastroenterologist and Chief of Pediatric Gastroenterology during COVID. I’ve always been inside the intersection of IT, virtual health, and digital health but as a doctor, we tend to do things on the side. I was practicing 100 percent and leading a division and I loved it. I love clinical care and providing care to my patients. Digital and virtual care was something I saw could solve the problem, which was how do I get to my patients who can’t come in to see me as a specialist? There aren’t a lot of pediatric gastroenterologists in the country and when you need one, you need one. If your kid has Crohn’s disease, you can’t wait 8 months to see a gastroenterologist. Access is really important.

At that time, I was in Texas, which is the second largest state in the US. I had a lot of patients driving 8 hours to come see me who had Medicaid, Tricare, or were self-pay, and didn’t have access to care. I got into virtual care because it allowed me to meet my patients where they were — and this was before that term was thrown around a lot. That was a decade ago; 2013 was when I did the first video visit for our health system. I built it inside Epic because it was being done on Skype by some docs here, but nobody was building it inside the workflows of our docs. It helped people recognize that workflows matter. That’s where I started.

Being “the virtual guy”

But getting back to Covid, as a frontline doctor during the pandemic, we transitioned to virtual overnight. I remember that day very vividly. I was at Baylor Scott & White, a 52-hospital system spread out across multiple cities. Everyone knew I was the virtual guy, and so everybody started reaching out and saying, ‘how do I do this,’ and ‘what do I do,’ ‘I don’t know how to do this.’

I became a grassroots helper and started teaching and helping others during my off-hours — whatever I could do to allow my fellow physicians connect with their patients. Because as we know, it wasn’t just Covid. People still had heart attacks. People still had diabetes. People still had COPD. How do these patients access care when they’re scared and we’re closing down clinics?

“Telling the story”

There weren’t enough clinicians at the table that were representing the voice of the end user and building it into the workflow in a way that made the physician say, this is something I want to use. That’s why I’m doing what I’m doing — to bring that voice to the table. I’m also a pusher; I push my fellow physicians to think outside the box in terms of being consumer centric.

And it’s not one sided. I still practice, which is really important because I have some credibility; I can go to the clinicians and say, it’s really important that we move upstream and offer these services because there are disruptors coming into this to intermediate that care. It’s telling the story but doing so in a way that helps them understand. Asking them to do one more thing that will remove administrative burdens is lot more appealing than just adding one more thing.

 

Benefits of being part of a payer

Gamble:  Of course. Because you have walked in their shoes, I’m sure that it means more and that they trust that you’re not going to give them something that doesn’t fit into the workflow or that doesn’t make sense with the way that they do things.

Barad:  That’s right. It’s very nuanced as to how you add and change things in the workflow. I was a full-time physician for 14 years inside Epic; I’ve done three Epic go lives. I know it well. You do have to have some in-depth knowledge to make sure you’re doing it in a way that makes sense.

Being part of a payer organization also has advantages because we can tackle prior authorizations. Why do they exist? Why do they have to be here? There are initiatives I can do here being part of the payer that I couldn’t do in a provider-only system. We’re able to tackle those things and remove things from our doctors’ workflows. I guarantee you we can add digital tools to workflows if we removed all prior authorizations from their lives.

 

Gamble:  Sure. And the fact that you’ve been through three Epic implementations is pretty significant.

Barad:  Absolutely. I grew up as a trainee in the era when everybody was going to an EMR. I don’t remember the exact numbers, but I believe that in 2011, only 10 percent of health systems had an EMR. I think we sometimes fail to really take into account the short amount of time in which EMRs have been in the picture. In the whole scheme of things, they really haven’t been part of our world for long.

I happened to come up as a doctor during the shift from paper charting to EMRs. Back in the day, nobody knew how to do go-lives. So what do they do? They turned to me and said, ‘hey, you’re a resident, you’re a fellow, you’re young — why don’t you do this for us.’ That’s the way we did things back then.

 

“The buck stops with me”

Gamble:  Based on what you’ve said, you don’t mind being a leader, even if it means having to push people sometimes. I would think having that personality and being willing to drive things has helped you a lot.

Barad:  I agree, 100 percent. Again, having the IT and Epic shop under me is big. Just being in front and trying to do digital without being able to affect and improve the infrastructure, I believe it would take much, much longer to get where we need to go, and I’ve seen that. If you look around the ecosystem, you probably recognize that the Chief Digital Officer’s roadmap isn’t always synced up and aligned with the CIO’s roadmap, which isn’t always synced up and aligned with the CMIO’s roadmap. There are opposing roadmaps, and there’s always the essential battle of, ‘the EMR can do that — why are we looking at a vendor to do the same thing and get a small 5 or 10 percent improvement? It’s a constant battle.

Now, it isn’t necessarily unhealthy to have those robust conversations, but sometimes it can lead to an impasse where the right thing isn’t always done, because there’s a battle around what’s our path? Which technology platform are we going to use? By having those under me, the buck stops with me, at least to some degree, and I can make a decision and move forward.

 

“It’s all about data”

Gamble:  One of the common themes we hear is that it’s all about data. Everything comes down to having data and leveraging data, which isn’t exactly a simple concept. Can you talk a little bit about that?

Barad:  Absolutely. And I’ll give a nod to our Chief Analytics Officer at Highmark Health, Richard Clarke. But yes, it’s all about the data. By having payer-based data, having provider-based data, and having a Google partnership — and as part of that, the capabilities they bring around data and creating what the healthcare data engine they’ve built with Mayo Clinic — it’s pretty incredible what that data fabric can achieve to create curated solutions personalized to that member, to that patient, to that consumer at the right time in their journey. That then allows us to orchestrate care, the proper way and really drive people, engage with them properly on a regular basis and be able to guide them to the right next best action that they need.

I’ll give you an example. Let’s say you have a three-year-old child who has had 5 ear infections in the last 2 months and had a perforated ear drum. And so, you went to an urgent care clinic or used a virtual care provider. And let’s assume you weren’t just living inside one healthcare system, but rather, sought out care in different modalities and different places. We should have that knowledge.

Let’s say your 3-year-old has a pediatrician in a healthcare setting. That pediatrician should then be able to guide you and say, we think your child should have an ENT appointment based on everything that happened to her. And it should happen proactively so that you, as a mom, don’t have to ask whether you should go to an ENT. We should guide you. We should say, ‘you need to see an ENT.’ Because based on what we know, we believe physical exams are needed. You don’t have a device in your home, and so, virtual care isn’t the best option. Even though I love virtual care, this one might be best in person. We have an appointment at 3 p.m. tomorrow or 5 p.m. on Friday. We surface those to you, and you click a button. You choose what’s best for you and your lifestyle. You click and it’s all there; the authorizations are done on the backend. You show up, and we know who you are. The pediatricians are well-versed. They don’t say, ‘why are you here? Who sent you here?’ They know exactly what’s going on.

That’s the world we need to get to. Simplistically, it’s a Netflix recommendation engine. We surface our recommendations to you. We guide you, and you choose what you want based on what works for you.

I think sometimes we foolishly say it should be 100 percent patient choice. Well, if you have a hernia and you need to be examined, virtual care may not be the best setting. We should guide you and tell you that in this case, maybe in-person care is best. But for these other 10 things, virtual is a great tool. Or it could be asynchronous care, where we have a chatbot engage with you, but it’s guided by a physician.

In order to guide you, we need to know you. And to know you, we need data.  I think that’s our journey here. Through our partnership with Google, and with having a payer and a provider, we feel like we have all the elements to go down that path with data.

 

Gamble:  That scenario really resonates with me. I had twins who were born early, and my son came home on an apnea monitor. All of the pieces were so disconnected — the monitor company, the pediatrician, the NICU. Nobody was talking. To have had a connected model would’ve been a game-changer.

Barad:  Right. But, as you know, the infrastructure is not there to enable us to do that. We need to do some of that basement work; to lay down the pipes that we need to be able to do that, and create partnerships. Because the NICU may have given you a monitor, but is it the right monitor? Is it the right vendor?

We need to create those partnerships, and they all need to be connected in a way that helps patients. I’m a pediatrician, so I know that you had a really tough journey to come out of the NICU, where you have 24/7 nursing, and come home and feel alone. It’s traumatic.

And now, the alarm is beeping incessantly, and you don’t know when it’s a problem and when it’s not. You’re left to figure out when the alarm means something and when it doesn’t. It should have been the health system doing the monitoring — and I’m not blaming the health system. But that’s where we need to go. The health system should be monitoring that and saying ‘hey, this one is real,’ and instructing you on what to do.

We have to get there. We all want to get there. It’s hard work, and so we’re working on the infrastructure that we need to have in place.

It’s exciting. We know where we want to go to; now it’s just working backwards to build all the components.