When IT folks are handed just about any situation, they find solutions – it’s in the DNA. So it’s not surprising that when Mike Mistretta, SVP & CIO at VHC Health System, was handed finished plans for a new outpatient building, he and his team went to work outfitting it with the latest and greatest technology to make the vision of a no-wait, one-stop-shopping outpatient experience a reality. But that doesn’t mean Mistretta would have refused an invitation to sit with the architect during the planning process. It’s simply a fact that it’s never too early in the process to include IT (and its cousin, IT security). At HIMSS this year, Mistretta will present his vision for the seamless outpatient experience. While there, he’ll also meet with vendors that offer solutions to his specific problems. In this interview with healthsystemCIO Founder & Editor-in-Chief Anthony Guerra, Mistretta talks about his presentation, how he likes to engage with sales folks, and how he’s handling the industry’s new dueling-conferences dynamic.
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So we had to come up with a process to streamline that registration flow and, basically, we blew up our registration and scheduling processes out there to accommodate the building architecture.
… a better design becomes better adoption, which becomes better ROI, which becomes a better patient experience at the end of the day. So the further we get involved on the front of these things, the better the answer is for everybody.
So to me, that’s part of the key – building that relationship, understanding capabilities, so that when I do need somebody, that’s there. But I don’t need someone sending me an email once a week for the next six months trying to get something in. That’s probably the biggest turn off, to your point, of how not to get in the door.
- Session Title: Opening the Digital Front Door to Transform Outpatient Care
- Day/Time/Location: Wednesday, March 13 • 4:00 PM – 5:00 PM Eastern Time; W204A
Anthony: Welcome to healthsystemCIO’s HIMSS conference preview interview with Mike Mistretta, SVP and CIO with VHC Health. I’m Anthony Guerra, Founder and Editor-in-Chief. Mike, thanks for joining me.
Mike: Thanks for having me, Anthony.
Anthony: All right, very good, Mike. I reached out because I know you are speaking at the upcoming HIMSS conference. Your session is “Opening the Digital Front Door to Transform Outpatient Care,” which is interesting, as it’s specifically on outpatient care. So let’s talk a little bit about that.
Mike: Yes, so where this initiated for us is we had an imperative where we were actually building a new outpatient pavilion building. And the architects, in their infinite wisdom, looked at the building and actually built it with a “digital design” in mind. So, what does that mean? There’s no patient waiting rooms or anything like that in there. So the flow of these facilities needs to be pretty seamless and streamlined out there, so that we don’t get patients backed up in the lobby. It’s a five-acre complex that has all the outpatient services – physician offices, outpatient surgery, radiology, lab, all the things you would do in an outpatient center – that’s in that building that’s there.
So we had to come up with a process to streamline that registration flow and, basically, we blew up our registration and scheduling processes out there to accommodate the building architecture. With the mass migration of services to an ambulatory setting, to an outpatient setting, I thought it was pretty timely to be able to put something like this together and share with my peers.
Anthony: Very good. So let’s dig into that a little bit. You mentioned architects. Were you, as a CIO, involved in discussions with the architects at all?
Mike: Well to a high-level degree, but the actual design of the floor in the building, not so much. That was more of our facilities management people and the clinicians who actually designed a lot of how they wanted things to go and look. So by the time we got involved as an IT organization, that footprint was set. So it was then about how do we deal with this to be able to give them the flow and throughput and the cycle times for the patients and the data access so they actually can know what’s going on, on their floors and in their units.
Anthony: I’m just trying to think through the chicken or egg thing here. So you’re saying the design spoke to a more seamless flow of patients. So the design did not include a waiting room, is that what you said?
Mike: Correct, there are no waiting rooms in that building at all, that’s it.
Anthony: So the concept was that things had to function differently.
Mike: Correct.
Anthony: And do you suppose that the idea was they knew enough that this will work if the proper technologies are put in place? Is that the idea? I mean, I’m thinking best practice here may be for Mike not to get this after it’s set. For Mike to get to talk to the architect and the physicians and everybody, to sit down and say, “okay, what do we envision here?”
Mike: Yes.
Anthony: So tell me was there a little bit of you getting handed something and then having to work with it? It may have been more optimal if you were involved earlier. Does that make sense?
Mike: Yes, it’s a hybrid situation. All of our practices are what we call Virginia Mason model. So what does that mean? Basically, it’s a throughput mechanism for the patients and how the physician sees the patients and it’s one-stop shopping for the patient. So as they design their footprint, the exam rooms, for example, they have entries and exit points on two sides. So there’s a corridor for the clinicians to come up and down and there’s a corridor for patients to come up and down. So they do all of their things. It’s one-touch shopping. So when the patient comes into the building, they are greeted by what we call an ambassador, we’ve termed that.
We know because of digital technologies that we put in place that they’ve actually arrived on campus, and we know they have a tablet, and they can see that the patient’s there. If they’ve done their homework as we call it, in other words, the patient uses their app or portal to fill out their registration forms, do their pre check-in, all of that stuff. They basically go straight back to the exam room at that point in time. The physician, as they’re going through, they see the patient there in their room and there’s a board, a tracking board, in each one of the places so they know when the patient is in the room or where they are in the status. It’s just like an emergency department. Although it’s in a practice – in this case or in radiology or wherever it is – that they’re doing it. They have tracking boards that are there.
And they do whatever they need to see the patient through the visit. They do the documentations in the room with thin client devices that are there and access to our systems. And then, before the patient leaves, someone comes in and does all of their follow-up care scheduling. So they have printers in the room. They bring in scripts. They do anything that’s there. It’s all in the room-based care that’s there. If they need to schedule a referral out to an orthopedic surgeon, for example, for something or a cardiologist or whoever they did, that’s all pre-scheduled for them, or those requests are at least sent in, and they have a record of it and print it off, hand it to the patient when they’re done. They’re escorted out and they’re gone at that point. The check out is actually in the room. The check-in is basically dynamic when they come in if they’ve done their homework. So the flow is pretty seamless where they go back and forth in between.
Now, that architecture of the building was given to us, all of the workflows there we had to figure out how we’re going to develop and what we’re going to do to get to some of those. So we’ve used technologies that aren’t typically in most healthcare systems to do some of this, facial recognition, geofencing, things like that, as a part of the solution that’s there. And some things that we’ve stolen from some other health systems, bits and pieces, and put it together so we had a comprehensive solution to be able to meet the needs of what that new facility is.
Anthony: Very interesting. It’s a re-imagining of the whole patient experience process in an outpatient setting.
Mike: 100 percent.
Anthony: With a lot of technology peppered on.
Mike: 100 percent, yes.
Anthony: I still think, listen, you know how important technology is. Technology is healthcare and again, you have a pretty greenfield environment but, to get even greener on the field, I like the idea of the CIO sitting down with the architect and the clinicians so we can all reimagine this together because there could…and I’m not saying there’s anything wrong with what you’ve come up with, I’m sure it’s an excellent thing, but we want, we always talk about this – in many different respects – you have to involve IT at the beginning. Involve IT security at the beginning. Get everybody in at the beginning. Don’t hand us something half-baked because then we got to work around it, work through it. We’ll make it work because we’re IT folks…
Mike: That’s what we do.
Anthony: … we know how to solve problems is what we do – not me, but you guys. And I still think that…hey, listen in a perfect world would you say it would have been nice for you to sit down with the architect and the other folks? Would that have been even better?
Mike: Huge, yes. Even with a design that we had as we went live the first week, we did our technical dress rehearsals and stuff like that, there were changes that were being made just because there were things that we didn’t know that were built into it. And had we been in with the architect – where some of the medical gases and stuff like that are in some of the rooms for the outpatient surgery, some of those kinds of things would have changed probably some of our flow and some of our design.
So yes, in the ideal state, absolutely, I’d love to be on the front end of a building process where I can pre-design a DAS system so I have ubiquitous wireless throughout and it works with cellular at the same time and all that stuff. I want you to come talk to my board, so I get that opportunity next time (laughing).
Anthony: Here’s what they have to understand, and here’s what people are coming to understand, is that, ‘I’m going to help you make it better,’ right? ‘If you bring me in at the beginning, I’m going to help you make it better.’ What they need to understand is that for the true CIOs, the true executives, we’re going to make it better. ‘I’m going to give you guys ideas you didn’t even think of.’
Mike: That’s right. And then you layer on top of that, a better design becomes better adoption, which becomes better ROI, which becomes a better patient experience at the end of the day. So the further we get involved on the front of these things, the better the answer is for everybody.
Anthony: Right, and I’m also going to bring up things you didn’t even know existed. Because I’m in the market and I know about this stuff. So they say, ‘oh we’re going to do this manually,’ and you go, ‘hold on a minute. I think there’s something out there that I’ve seen.’ So anyways, I’m preaching the choir.
Mike: You’re right, 100 percent.
Anthony: Let’s keep preaching (laughing). Well, that sounds like an excellent session, and I hope people will go to that. So we’ll definitely direct people to it.
Let’s talk a little bit about the conferences, in general, you go to a show like HIMSS. You’re going to talk, that’s maybe the main reason you’re going, I don’t know if you would be going anyway, but since you’re going, what are your other objectives, maybe some other things you want to accomplish? I’ve heard people say, “well, we’re going to check out some new vendors, or I’ve got some meetings set up with existing vendors, or I’m going to catch a few sessions.” What are you going to try and do when you’re out there?
Mike: It’s a mixture of all of that. You take advantage of everything that these shows have to offer. For us, I have existing vendors. We have projects that we’ve got going on. I’ve been doing this long enough now where the show has evolved, for sure, in the last 20, 25 years that I’ve been doing this. And it used to be I could have my project list, and I could go to HIMSS, and we could sit down and meet with each one of them and sketch out the year. Unfortunately, the vendors aren’t bringing those types of people to the shows anymore. They’re bringing predominantly more of the demo and salespeople. The technical people and the project managers and things like that aren’t necessarily going. Now it’s more of, okay, I have a problem set of things that are pain points.
One example I’ll give you is faxing results back in. So when I go out I’m looking for people who can help with a solution for that. Give me a solution on how I can better manage my fax pool for a 200-250 physician practice that’s out there, and how do I get those results routed efficiently to them.
So last year we found a vendor on the floor that we’ve now implemented, actually in the last couple of months that’s doing that, and the initial results are phenomenal. We were looking for problem solutions, I guess, as we’re looking for vendors, not necessarily specific vendors. So it’s interesting how it’s evolved out there. If there are existing vendors and projects that we have going on, and we have pre-arranged meetings, we’ll do that there as well. And then, of course, a lot of my staff go for the education-type sessions and things like that.
Anthony: So it’s interesting, you mentioned a specific problem that you’re trying to solve for and you’re probably, people listen to this, you’re probably going to get outreach from people that have that type of solution, which is good in a way. For 100 percent of the vendors out there, they’ve got a solution to some problem. And they don’t particularly know who has that problem, so they try and get in front of everybody to see.
Mike: That’s right.
Anthony: And that’s why you get hit with a lot of outreach, and that can be difficult to manage. And the show’s another thing where you’re in person on the exhibit floor, you may be trying to walk through, walk around, some people are more aggressive than others. I don’t know. What do you want salespeople to know? Let’s talk about online and in person.
Mike: For me, everybody’s a little different with this, but I like a lot of exploratory discussions. So show me what you have to offer, show me what your solution set is that’s out there – great, if I have something, I’ll let you know. If I have more than one or two of those with you and I don’t have a need right now, then I’m going to at least keep you in my Rolodex. I’ve had decision support vendors, as an example, that I’ve known for years. I’ve done business with them a couple of times, a couple of different health systems, but they may not necessarily fit today where I am, but I know what they have, I know what they can help me with, and I know that they’re there. So to me, that’s part of the key – building that relationship, understanding capabilities, so that when I do need somebody, that’s there. But I don’t need someone sending me an email once a week for the next six months trying to get something in. That’s probably the biggest turn off, to your point, of how not to get in the door. That’s probably it.
Anthony: Over persistence.
Mike: Absolutely, yes. If I’m interested and I know your capabilities, we’ll be in contact, we’ll be there.
Anthony: But Mike, there’s no way, there’s too many vendors out there for you to give everyone a full hearing.
Mike: Absolutely.
Anthony: What do they need to understand? You just said like, “yes, I want to hear what you have and then I’ll know what you have going forward.” But you can’t do that, it’s impossible. There’s too many.
Mike: It’s not just me that can get the briefings. I have staff too. When we go to HIMSS, I have, I want to say four directors that are going with me, and each one of them has their areas that they’re looking at as well. And it’s the same principle. So there’s some trickle down, let’s take a look, depending on how you look at it, what’s there. But it’s impossible to hit everybody, you’re correct, that’s there. But at the same time, I only have so much time to spend with folks. So usually, it’s going to be around a problem that I either perceive or that someone’s told me about. And so I’m going to be looking at those multi-faceted solutions – they will get higher play. So if I can repurpose a solution for more than one thing or more than one problem, that’s a huge win.
Anthony: You just said that multi-faceted solutions get higher play. I did an interview the other day with someone who said one-off niche solutions are really not usually going to work. ‘I need things that are integrated with other things I have and if you come to me and tell me you pre-integrated with things I have, that’s a lot better.’ Does that make sense?
Mike: That’s absolutely correct, yes. I mean, niche has its market. It’s out there, but they’re usually going to be small point solutions that you’re going to be solving a very, very specific problem for, if there’s no other option. We actually made the decision – I want to say about six years ago, at least at this health system – that integration will override functionality every time.
Anthony: Yes, yes. So the message there for the vendors is, I guess when you’re trying to get your hearing with you, so to speak, be patient, be respectful. If you get that hearing, you better put your best foot forward because you’ve got one opportunity, so don’t blow it. Don’t send somebody junior.
Mike: That’s right.
Anthony: Don’t waste my time. Don’t not show up. These are all basic things to be successful.
Mike: And just as much, know your audience. An example, we had a vendor in a couple weeks ago, cool product, but honestly, they’re a little bit of a startup and they didn’t understand how to demo to healthcare. So it didn’t play well with the clinicians and staff.
Anthony: That’s what I mean about putting your best foot forward. If you mistake the value of this, and the one-time element of this opportunity, you likely won’t get another chance.
Mike: Yes, pretty much, pretty much.
Anthony: This is life. We have to learn. We have to learn that people’s time is very valuable. Alright, final question because I don’t want to keep you too long today. The HIMSS, ViVE, dynamic – this is new. You had one big show with HIMSS. Everybody went to it every year. It was a no-brainer unless you couldn’t travel for some reason. Now, we have two within three weeks of each other, two big, big shows. So from your point of view as a CIO, my assumption is that very few people in your position can go to both considering how close they are together, some can but not too many. If that’s the case, then you’re in a position of having to pick and there could be different factors you take into play when doing that, but your thoughts on this new two-show dynamic.
Mike: It is a shame, let’s put it that way, that the worst happened but it happened, so it is what it is, now we’re dealing with it in this industry. And I am finding them to be – and last year I did both for the first time, just to check them both out and see what is there. I’m actually doing both again this year, but I’m not sure that’ll continue to your point of availability. But certainly, I look at the ViVE end of it as more of a digital, true digital solution set. And when I say that I’m looking for things more portal and app-oriented and things like that that are there. When I look at HIMSS, I’ll call it more of a heavy lifting, core functionalities, EMRs, things that are integrated there, integration engines, things like that that are the bigger things. That’s how I see the two shows right now.
ViVE also tends, at least last year, had more startups and people just trying to figure out the way they should go and how they get into the thing. They have that – I call it the speed dating piece – and I know HIMSS trying that this year for the first time. But that was very interesting because I got a lot of startups and a lot of people who are just trying to figure how to get into the business and try to figure out how to get into this market and stuff.
In some cases, venture capitalist’s people that are trying to figure out what they should be looking for. Things like that versus HIMSS is more established I think and the vendors that are there are, like I said, the larger ones typically that you’re looking for, for different products. So there is a little bit of a differentiation I see between the two right now. Even the vendors, when I talk to my vendor friends and partners, they say they pick teams. I’m either going this way or I’m going that way. Because a lot of them can’t afford both shows because those shows are very expensive for them to exhibit at. To some degree that’s my mental model, anyway, when I talk about how they differentiate.
Anthony: I know we’re going to catch up after the show and that’ll be after HIMSS and ViVE, so we’ll get your updated feelings on whether or not you still have the same opinion on the differentiation, and we’ll see how they went.
Mike: Sounds great.
Anthony: Mike, I appreciate your time so much. This was perfect. Thank you.
Mike: Thanks, Anthony.
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