The Network’s Vice President of Clinical Intelligence Aims to Pull Together a Wide Array of Data to Improve Patient Care.
Convincing clinicians they need to do a better job isn’t the easiest task. James Barr, MD, had his epiphany when he looked at his own delivery of care about 20 years ago, and wasn’t pleased with his level of consistency delivering evidence-based medicine. He’s out to change that for the 5,000 doctors who practice at Atlantic Health System, especially as more patients are being treated through its accountable care organizations. Data from different sources – external to the organization and its Epic electronic health records system – provide a full picture of patients and their needs, he says. Pulling these different sources of intelligence into a cloud-based environment is the vision for the system, enabling clinicians to break down traditional silos of data. The result will be to create analytics that is both predictive and prescriptive – heading off expensive interventions by meeting the ongoing care needs of patients. In this episode of healthsystemCIO’s Partner Perspective Series, Barr talks with Editor-in-Chief Anthony Guerra about these issues, and much more.
Guerra: Hi James, thanks for joining me today. I’m looking forward to chatting with you about your work at Atlantic Health System.
Barr: Hey great, Anthony. Good to be here.
Guerra: Let’s start out by learning a little bit about your organization and your role over there.
Barr: Sure. I work at Atlantic Health System out here in the northern half of New Jersey. Atlantic Health System is a five-hospital system, actually six if you include the pediatric hospital. We have about 1,800 beds and 17,000 employees. We have about 5,000 physicians on staff; then, of course, we have our accountable care organizations, where a lot of my work has been, and I’ll jump on that in a second. We have about 3,000 doctors involved in those value-based arrangements.
Personally, I’m a family physician, although I just stopped seeing patients in December 2018 after 32 years of being a family doctor. So it’s hard – I still miss those patients. But on the other hand, my role over the last 15 years has really been involved in organizing physicians into better performing units, as far as whether the model was an IPA model, an ACO model or any other model. I’ve been involved a lot in the physician performance realm.
Guerra: OK, very good. I understand that your CEO gave you a challenge around improving the data quality, data maturity and the use of data in the health system. Can you tell me a little bit about that charge, that mandate that you were given and how gone about trying to make it happen?
Barr: Sure. Back in 2012, we started to get the physicians involved in the accountable care organizations – the Affordable Care Act provided us that platform. And we realized that one of the biggest barriers we have is fragmented care – it’s not coordinated, with some people doing better care management than others, so there were the care variances. Then there was the care coordination in these silos, which was making it very challenging. The enterprise, from the health system standpoint, had the exact same issues – multiple pockets of data in in different areas, all siloed off, causing the fragmentation of intelligence, and there was not that culture of everyone using data and information at the level they needed.
So our new CEO, Brian Gragnolati, came in about four years ago, and really said to us, looking at our data we had with physicians that are buying ambulatory practice supplies, he said, “Wow, you have more data on your physicians than we have back at Hopkins. Let’s go with this and really make it an enterprisewide movement to develop that culture of data, that information management platform that’s needed, the governance, everything that went with it. We’ve got to move on this.” So about four years ago, I initiated our clinical and business intelligence team, hired four data scientists and a director, and kind of went step by step from there, going down that road of better information management.
Guerra: And what are some of the other things you’ve done to make that happen up to this point? What are a few of the other things that you’ve worked on?
Barr: The platform that we were using was very similar to many health systems, was that internal data warehouse and keeping everything inside our walls – you know, safe, secure. We realized that we’ve got to take it to another level. So we quickly started looking – and the timing of everything was also that we were just going on Epic at the same time throughout the five hospitals, staging that over a 12-month period. Then, our ambulatory practices that were employed – of our 5,000 doctors on staff, about 1,000 are employed – all 1,000 of those are in our ACO, managing those populations, and those 1,000 doctors were going on Epic ambulatory.
So we had the transactional record of the inpatient and outpatient, the EMR being changed over to the Epic model. We still, though, had 40 different independent EMR versions out there, and that’s just among our primary care doctors. If you add in specialty EMR versions, and you’re up to 70 different versions. So information was very challenging on the doctor’s side, as far as the practice side and the internal side.
What we looked for was a cloud-based environment that could really start to bring in multiple different sources of information, whether it’s the clinical information coming from the electronic medical records, whether it’s inpatient or ambulatory, but then also claims-based data that we get from all the payers, and we manage about 425,000 patients in our ACOs – we have four ACOs that we developed – four because we have varying levels of risk-taking ability inside those.
And we have claims data coming in, lab data, pharmacy data, and we’re bringing in Census Bureau data, everything we can possibly touch from the standpoint of data to give us better understanding of our patients, our populations and our providers and our system. We brought all the data in, and where do you put that? Well, we realized that a cloud environment was the most efficient place for it to be, as far as storage goes, and it was the most efficient from the standpoint of the processing power that we needed.
And then the tools, the analytic tools … we knew, without a doubt, that where things had to go. Most health systems, a lot of times, you’re going to have people concerned about that – is that a secure place, for our PHI? So that you have to come to terms with, and so it took a little time as far as getting people used to this cloud environment. But we did a search, and looked at all the different types of options, and we went ahead with Amazon Web Services and developed that platform. Then we had the data coming in, the modeling of the data, all the different things you have to do with that data.
And then, looked at the same time, in parallel, at what did the users need. We just don’t build it and they will come – you want to be focused at all times. What were the physicians needing? What are the service lines needing? What was home health needing? What are everybody’s use cases, not only for the access to data and the larger amounts of data, but then the intelligence within the data? So the uses cases, the platform, the analytic capabilities, all kind of came together, and then we started to develop some very significance intelligence for people to make their decisions with.
Guerra: So internally, you had to do a bit of convincing to get people comfortable with the cloud? Do you want to clue me in on any of those discussions? Were they with CTOs or were they more with people on the clinical side? What types of positions need the most convincing?
Barr: All of the above. It’s a combination of factors. There’s of course just the element of change is hard enough for people when they’re used to certain workflows and used to their data being in their server, their private server under their desk. And, wow, “I’ve got control over this. Don’t change it.” And so there’s the change element. And then you really have to go right from the top down as far as the senior management has to embrace the fact we will no longer be making decisions based on a whim of what we think is going to happen next. We want to use predictive analytics – not just descriptive – we want predictive, we want prescriptive. We want to go there.
So the senior management was very critical – for them, the biggest issue was, is it safe? Safety is very critical, and of course, cost – you have to have your business model. So between the business model, the safety discussions, then you get the senior management realizing it. And then they saw the use cases, where the business units inside the health system and our clinical lines, had the need for better information. Then, this is a strategic direction that we’re going in. And we need everybody to be on board.
That was the most important thing, getting C-suite, the head of the enterprise and the business units to adopt this. And it takes some time. Each one has their own concerns or needs. So you go through that process of a lot of meetings, a lot of education, and then you try to find your quick wins that you can bring out there as you’re doing that, to say, “Hey, I understand you’re having a problem thinking about taking your data into the cloud and doing some different things with it analytically. But let me show you what this business unit just did, and let me show you what this service line just did.”
And then, all of a sudden, you see the four strategic pillars of the organization – which are, again, growth, performance, population health, and education and research. You see those four pillars being armed by different constituents with really great information and great reports, and all of a sudden you’re achieving your goals. And, whoa, you haven’t been achieving your goals, but you’re also not utilizing the platform. You’re not analyzing data and using the tools. So it starts to become a little bit of transparency and other things to help the convincing process happen.
Guerra: So you’re a physician by training, thirty-something years. Not every physician that moves into a role that you’re currently in would be successful. Sometimes, physicians are not very good at being subtle and taking direction and maybe consensus building. What are the keys to being good at the job you currently have and what kind of individual would be successful in a job like yours? Maybe, who isn’t it for?
Barr: I’ve never been accused of any of those things. (Laughs). Being a physician I think makes it easier. Because I have one thing that matters – the patient. That’s been my whole life – serving that patient’s needs.
And what I found out – this goes back 20 years ago – we were doing really well in my practice, the whole managed care thing was going well, and we were doing well in our performance, but then when I really said, “You know, performance compared to my peers, OK, I’m doing better, but how am I really doing if I put myself up against evidence-based guidelines of what I really should be doing?” So when I took five different factors of evidence-based care guidelines for diabetes, I did a chart on it, and found out that my practice was only 40 percent compliant when you do the composite of all five. And how many patients had all five things done? Only 40 percent of them. I was failing. I was failing myself, I was failing my patients.
So that drove me to say – it isn’t all the doctors’ fault – there are some doctors that could be much better at what they do. The majority of all doctors want to be good doctors. But the EMR was failing us, the different types of tools we were given, the reports were failing. And so we didn’t give them what they needed to really go to the next level. And that’s where I said, “OK, I’m going to start to organize these docs better into a platform environment to take them where they need to be.” That’s the same thought process I have when I go to our enterprise and the senior management I work with. It’s are we doing the right thing for the patient? And if you keep that focused, everything else can go away.
There’s going to be people who are scared of data; scared of a new platform. They’re thinking that, “Oh, this is going to infringe on my turf” or “Gee, do I have job security here? What’s happening here?” There’s a lot of things like that, but if we constantly look at the opportunities that this process is giving us, nobody has to worry about their jobs; there’s so many things that we can do. Nobody has to worry about their turf – it’s all of our turf together, working together and we’re going to develop the best outcomes for the patients.
So I think it was something that carries me through a lot of this, and there’s definitely a lot smarter people here than I am, from the standpoint of whether it’s financial and legal and all of the other things, so you have to be a team player, and some docs are not used to doing that. Team play is very important, but it’s for the right reasons. That’s what counts.
Guerra: It sounds like you have good support, the support you need to carry out some of these missions that you’ve been given. Let’s talk a little bit about COVID. Has some of the work you’ve done to improve data put you in a good position to deal with the COVID influx?
Barr: Yes. The team at Atlantic has done just phenomenal job. As you know, in being from New Jersey, we’ve been hit hard. Our daily census at one point was over 820 beds filled with COVID patients. And a large number of those were on ventilators. It was maybe not as challenging as the middle of New York City, but it was still challenging.
So the team really came together, and from a data standpoint, yes, the predictive models – we had like our business team was doing three or four different models to help us keep an eye on where they thought it was going, what the surge is going to look like. When do we think it’s going to peak? So we had a lot of descriptive reporting for us on a daily basis – how much testing, how many were positive vs, how many people were under investigation. We did a lot of our capacity planning as far as PPE supplies and everything else. Transformed floors from critical care bed floors because the ICUs were just totally overrun.
So we did all that, but the unique thing that we did, especially on our new platform, was we took the patients where we had more information on them, beyond just maybe the clinical record, and because a lot of our doctors are not on the Epic system, we don’t have access to all the data in the clinical records. So we took claims data and everything else, and we did utilize some of the AI algorithms that were available out there on predicting which patients who got COVID were going to be the sickest the COVID Vulnerability Index is what we used.
In that way, we were able to do more aggressive, proactive outreach to all those patients who had the high scores on their COVID Vulnerability Index, and then we were able to say, “Hey, you know what, don’t go out – they’d be on the phone and we’d be feeding the telehealth interventions, all the new technologies for how to reach these people and interact with them. And we were able to say to some of the other people – some would tell us, “Hey, I’m running out of food and I’ve got to go to the store.” We’d say, “No, no, no, don’t go. We’ve got a community health person in your area. They’re going to go to the store; they’re going to get your groceries.” With things like that, we were able to take that surge that was going up and I think we did, it – we made a difference in flattening that out quicker rather than going up into a really dangerous area. So that worked out, and now, quite obviously, right now, we’re on the mend.
Guerra: So there’s connections there between that type of work – the ACO work you’ve done – it’s all managing risk, data, analytics and improving care. Anything more you want to say about the ACO programs?
Barr: The key with the physicians – we’ll come back to them for a second – as far as our accountable care organizations, the physicians would say, “I don’t have enough information.” Now, it’s like, “I have too much noise … way too much noise.” And again, this has been one of my very focused agendas is to take the noise out of the physicians’ workflow – and not the just physicians, the care team.
Because very early on, back in 2010 or 2011 or so, we embraced the patient-centered medical home model, the full care team model – it’s not just the physicians only, it’s also the clinical teams, the receptionist, and then it extends beyond that practice to specialists, all the clinical coordinators, the care managers. So our teams need to know the information that is going to make the biggest difference at that point of care, in as real time as possible to be able to make the impact on the patient, and then clean everything else out.
So if I’m going into an examining room, first of all, the patient in the next examining room might not have been there unless my information systems realized that, “You know what, this patient hasn’t had a visit in six months, their A1c is out of control – anybody with A1c out of control, we see every three months until they get under control – if all those rules are in there, the key thing is, first of all, the patient who should be in the next room but isn’t, now we get him in. I don’t even know that’s happening – my receptionist, my clinical coordinator, my office manager, they’re the ones getting the patients in that have to see Dr. Barr or have a telehealth session to see Dr. Barr. So we feed the right person at the right place of care for that person’s needs.
Then, I’m going into the next room – and I didn’t realize that all these patients have been brought to me proactively through the intelligence – and I’m thinking, “Oh my God, I’ve got to search through this EMR and find the right information and put it all together and figure out what’s going to make me go in this direction.” Now, OK, it’s this patient’s chronic diseases all look good, these three out of the four, but this fourth one – even though they’re coming in for low back pain, you make sure you address that fourth condition because we have a prediction here that that’s going to end up in the emergency room or a hospitalization real soon. So if I can have that, be that kind of decision support, decision science behind our decision support, then that’s going to help us get where we need to be and efficiently using the doctor, efficiently using the right type of care and place of care, all of that. That’s where we’re going with the ACO movement – a strong emphasis on information helping us get to where we need to be.
Guerra: So you’re a VP of clinical intelligence, correct?
Guerra: What do we think of when we think of clinical intelligence? Do we think of clinical? Do we think of IT? If not, what’s the relationship with IT? What should it be?
Barr: I’m actually glad you asked that question. VP of clinical intelligence doesn’t mean that I’m intelligent. It’s a title that was chosen because clinical intelligence means more knowing just clinical evidence-based guidelines of care. It’s not just care variance.
That’s part of it. In addition to the intellectual intelligence, it’s emotional intelligence, and that’s where I think clinical intelligence really is the right term. Because if you’re a clinician and you’re not using emotional intelligence, not using social determinants of health intelligence, community intelligence, spiritual health intelligence, all of these things to understand the patient’s fears, their concerns, cultures, the barriers to care, if you don’t do all that, I don’t care how much intellectual intelligence you have, you’re not going to service that patient the way that you could.
So clinical intelligence is a combination of different intelligences that really come to a better clinical outcome. So that’s the one part. The second part of your question, as far as IT – yeah, IT is a critical partner in all of this. You have, of course, the enterprise IT system to keep the inpatient and service lines, home health, everything working as efficient as possible. But then, our IT team really helps us gather the information into that longitudinal patient record.
So anything that’s happening to the patient, whether it’s from our enterprise … let’s know about it and then, of course, supplement it with all the other information that’s coming from outside our enterprise, so that we have the best understanding of that patient. So IT is involved in gathering the information, wherever possible. It’s also very much involved in our security; they are the ones that govern what’s going on, along with our compliance and legal team and everything, Governance of data; it’s very critical for you to understand and manage. So IT is very much involved in that role every step of the way.
And then the exciting part, I think, for IT is a lot of the new technologies. How do we embrace different things inside our enterprise, our ambulatory practices – how do we integrate remote patient monitoring and all the sensors, patient wearables, Fitbits, whatever it is. How do we bring that information in? That’s what what the IT people really help us find, how to aggregate information and use the right technologies. You combine that with your data team, your data science, your analytics and reporting and, wow. That’s where you really shine.
Guerra: It all comes together – it blurs, at some point, right?
Guerra: Because there is no clinical care without IT. All the advanced things we’re talking about? They are IT, so it’s just a big blur in the middle.
Barr: Yes. And again, IT needs to transform. It’s not just the data warehouse with storage of information and “Let me give some support to your software vendor that’s come in and helping you with this.” It’s got to be more forward thinking about how do we use technology to be more efficient, more secure, more capable of bringing all the data in that we need.
Guerra: Right, very good. So speaking of IT, you mentioned that Epic, you’re an Epic shop, but I understand you’ve gone outside of Epic to do some things – tools, data analytics. I don’t think that’s extremely common – most people stay within the four walls of Epic, so to speak. Did you do something unusual, and why did you?
Barr: The challenge is that when you’re bringing in non-EMR type data. Epic, and any EMR, you’re entering data during a transaction, a visit with a patient, a call with a patient, whatever. So you’re doing transactions that are bringing data in – some of it’s clinical data and very useful, some of it is financial, whatever, billing, collections, scheduling, all those things. So a lot of transactions are occurring. But when it gets to also bringing in claims data and other data sources, a lot of the EMR systems are limited in their flexibility and the ability to apply different types of analytics.
A lot of things in the ACO world – you’ve got attributions of patients, different methodologies for different payers and then you have roster changes in your physicians and which practices are attributed or aligned with you. And if you try to keep all these changes mastered in one place, nobody can do it all in one software system. You need to realize that you need to bring in data mastering capabilities.
Take, for instance, a master patient index – when you’re bringing in multiple data sources from different locations, that patient demographic can be one character off, and you are not matching the right patient’s information with the other information. So whether it’s dupes or other issues, this is where data mastering is a very critical part of your platform that you’re setting up. And we actually went ahead with Verato to help bring in external referential databases, that we could take the data from Epic or from claims or from other areas and be able to say, “OK, which patient is this really?” You develop that single source of truth, so that’s very important whether it’s on your mastery of patient information, your provider rosters – again, different sources are going to tell you that this doctor is different from that doctor, even though it’s the same doctor. Then facility mastery – all three, patient, provider, facility – you have to master all those to keep things, as far as the integrity of the data that you have, and then the refinement of it and the publishing of the reports. If you don’t master from the start, then you’re going to have a major headache.
Guerra: And then being on an “enterprise vendor” like Epic, that does not get you away from needing a master patient index. There’s always other data that’s going to come in. Is that right?
Barr: Yeah. Inside Epic, they have their patient identity methodology, which is good, but it’s when you’re trying to combine multiple other data sources. If you’re only going to worry about the clinical care workflows inside your Epic clinical record, and you’re really not interested in other information, fine. Choose a good EMR and go ahead.
Guerra: How would you describe your philosophy about cloud and your cloud journey in terms of your thinking. Are you sort of a total cloud convert, like a lot of the CIOs we talk to are, you know, cloud first? It’s not in every single case, but they’re very pro-cloud. Everything that they feel is appropriate to go there, they want to go there. I’ve heard large, large files mentioned, imaging studies or things like that, or genomic things, but everything that could go should go. Is that your opinion?
Barr: I would say, from the standpoint of the enterprise, the cloud comfort is still evolving. But from my standpoint, I’ve seen it. I’ve seen projects that were a simple running of a simple report; that would normally take about four hours, it took us two minutes and 15 seconds. I’ve seen more complex projects where you have to bring in a lot of different data and match it all up and attach everything together and produce a report. Your estimate is that it’s going to take a full week, and now I see it done in four hours. The ability to automate, the power of the processing, the efficiency that that gives you, and then you throw the analytic tools that are available inside the cloud environment, it’s cloud first as far as I’m concerned.
Guerra: There you go. We all know that the kind of ironic thing that’s happened to health systems with COVID is that they’re completely flooded with patients, which in any other business would be a good thing, but with hospitals, they had to cancel all their elective surgeries, which meant a huge financial hit – not to mention the people that didn’t get their surgeries and needed them. I love the word “elective” – my mother needs a hip badly and just got it rescheduled, but you can barely walk, what do you mean it’s elective? But hospitals have to recover financially, right? Which means you have to make people feel safe to come back. Talk about that – has that involved you at all? The work that hospitals are doing to get ready to welcome people in post-COVID, to get people comfortable. Has that touched clinical intelligence at all?
Barr: First let me mention that the health system has done a tremendous job from the standpoint of safety – of course for the patients, but also for our staff, the front-line heroes. I just can’t fathom how strong the team has worked and done a great job. I feel personally, if I was going to be a patient, I would not hesitate if I had a certain need right now to go to Atlantic Health System.
Now in the midst of the high surge of COVID patients, certainly everybody’s going to be afraid to go to the emergency room or the hospital, and the thing is, right now, those fears persist. And so what we’ve been doing – not as much on the clinical business intelligence side, I’ll get to that in a second – but more from the standpoint of the messaging to the community and the patients and the providers – we have webinars every week for our providers in our ACO networks – and in giving them really specifics on, “Here’s our protocol for when you come to one of our practices.” And back when it was more intense, it was, “Look, we’re going to screen you by phone first, and then you’re going to come to the parking lot. You’re going to text us when you get here and you’re going to stay in your car; we’re going to come out and check your temperature. And then, when you pass that screening, you’re going to stay in your car until we know that the room is ready, because we don’t want you standing or sitting in a waiting room. So when your examining room is ready and clean, then we’re going to text you to come in, and we’re going to take you right to the examining room. But we’re not going to stop at the reception (desk) on the way out and do your billing and everything; we’re going to do that all on line.”
So giving specifics about protocols and how you’re going to be managed as a patient coming in, whether it’s to our health system for a surgical procedure or whether it’s our practices – really getting down to the point of showing them that this is what we do, we do this for every patient because each of you is so important to us. So doing that is something that … and then you have to keep repeating it, over and over. And we’ve been aggressive with helping all the different departments or physician offices, with the supplies that they need to manage, because that was always a struggle with the personal protective equipment. So I think we’ve done a nice job.
On the intelligence side, what we did again is, from a standpoint of getting people back into the schedule that have a demand for care but are afraid to come in. And really, we’ve identified – again, using our predictive analytics – that these are the patients that haven’t had a visit, haven’t had a touch in any way, whether it’s a telehealth visit, any kind of interaction, and yet they have five chronic disease states and in their notes, it shows that they were getting ready for a hip replacement. So don’t sit back and react for that patient, wait for that patient to call you up – you’re calling them up, and saying, “How are you doing with that hip so far? And how’s your diabetes and hypertension doing? Do you feel safe enough to come into the office? Now here are some of the things that we’re doing,” and once you keep working your way toward that comfort level, “Hey, do you feel comfortable enough to operating room to get this fixed?” It’s a matter of a lot of education, but our intelligence is kind of driving and prioritizing who is the next one that we should be calling and proactively outreaching to.
Guerra: What’s the next big thing on your agenda, on your strategic goals? What’s the next thing you’re working on that you’re not done yet, but this is a big one?
Barr: OK, I just actually gave a webinar to a couple hundred doctors before we got on together, and it was about coming back from COVID. Most of these were primary care doctors on this webinar. It was about coming back and the new norm.
None of us have ever seen something like this before, and the most important thing is, number 1, let’s do this together – physician to physician, ACO to practice physicians, and health systems to physicians. Let’s all do this together, number one. And number 2 is find the ones who have the greatest need right off the bat from the standpoint of physicians, the ones that are financially thinking, “I’m closing up. I’m gone.” If they were ready to retire, fine, but there are practices out there that are really having a hard time. They haven’t secured any of the SBA loans or anything else. And they’re just having a hard time. Obviously, take care of those that have the greatest need right now.
But my real project is coming back to rebuilding physician practices – the new norm – in a way that I mentioned during this discussion, in a way that uses technology much more than what we’re used to. We used to struggle to get a doctor to do a telehealth visit, and now it’s like, no, it’s going to be demanded. The public doesn’t want to see you face-to-face. They’re still afraid, OK? But the telehealth visit at least allows us to have some interaction face-to-face, even though it’s through technology.
So using technology, like the telehealth and the portals and chronic care management technologies, remote patient monitoring technologies, chat bots, symptom checkers – I can go on and on about different technologies that we should be incorporating into our practices, into our workflows, into our staff roles and responsibilities. And really helping people learn these new technologies, these new ways of doing it.
Because in the end, we should have better outcomes, and we shouldn’t have 30 to 50 percent of everything we do be evaluated as being useless, or actually harmful. Everyone knows about the Commonwealth studies and everything. Thirty to 50 percent of what we do should not be a waste. It certainly shouldn’t hurt anybody. So we can take that out; we can make healthcare affordable if we can take away the noise and the less impactful work that’s just getting in our way. We can make physicians and providers of care re-establish relationships with patients that are healing relationships, not transactional relationships. That’s kind of where I want to see it go – technology and information taking us to a new level of relationships in the healthcare delivery system.
Guerra: Those excess things you’re talking about are requirements put on either by the government or insurance companies, or even the health systems themselves? Is what you mean about that 30 to 50 percent?
Barr: As far as administrative inefficiencies?
Guerra: Those things you’re saying, the 30 to 50 percent of what we’re doing is a waste of time or harmful – what are those things coming from? Are they coming from government, insurance companies – “Check this box,” all these things?
Barr: There are a combination of things. There’s a lot of administrative burden that’s put with no impact to patient outcomes, and it has bogged down the practice of medicine and the delivery of medicine. So, yes, there’s administrative inefficiencies. But there’s also a significant amount of variance in how we treat people and how we use different procedures, tests and use information. Why are we doing four different things to a patient when if you look at the information that you have the right analytic tools, there’s only one thing they needed.
So again, it’s doing the right thing, using the right information, can really take out the variances, the variances in care, making clinicians more aware of what’s actually making an impact vs. not. Why are we treating them with these drugs when all of a sudden we find out that those drugs did nothing? More information about, especially some of these very expensive drugs – we need more information inside our decision making, again coming back to decision science. We need more information in there for both clinical and financial decision support to take away that 30 to 50 percent.
Guerra: Final question Dr. Barr. I’ve kept you for a while; I appreciate your time. Advice for other people in your position at other health systems. So people in the same roles, similar roles, trying to do the work you’re doing. Based on your experience, any advice you can give them on things you’ve found that helped you be successful.
Barr: Two things. One is when you’re embarking on this journey of improving your information management throughout the enterprise, the culture is so critical. You’ve got to have it embraced as I said before – top down, everywhere. It has to be a cultural change. And there will be resistance. But you really have to hold steadfast to it and set goals – strategic pillars, we’ll call them – that everything we’re doing going forward has to be aligned with this and you have to use information to show that you are aligned, that the outcome has advanced toward that strategic goal. So some type of a performance framework that’s built within a culture of information, that’s one thing.
The second thing I’d recommend strongly is to really follow the recommendation of form follows function. We have multiple functions that I’ve just described, and I told a lot of practices today on the webinar, that what’s your form that you’re going to use to satisfy the function of understanding the patient better? What are you going to use to collect social determinants of health information? What are you going to use to get, with remote patients that are home, the data coming to you about their weight, about their blood pressure? When you say what are you going to use, that’s the form. The function is what do you need to make the patient better? What do you need to prevent the disease? So what do you need – that’s the functions we have to be performing to get the better care, and form needs to follow that.
It’s always been top-down, what is the insurance company, the government, somebody else telling us what we should do. No, it’s got to be flipped upside down. What does the patient need, and the function has to serve those needs, and then what’s the form going to be. I’ll finish with again what we put as our motto at the ACOs. We were kind of figuring out that, if you had to give an elevator speech, real quick because there’s only one floor, what are you going to say when they ask, “What do you do with your ACO?” And our response to that is that we care better, and by that I mean we help physicians and providers care better for their patients. We help patients care better for themselves. And if we do a really good job in getting into the communities where these people live, we’re going to help people care better for each other. So care better is what we’re all about, and I thank you for the time today.
Guerra: Very good, Dr. Barr. Thank you so much; I really enjoyed it.
Barr: Great, thank y