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How Providence St. Joseph Health is Moving Along on its Data Transformation Journey

June 18, 2018
by Rajiv Leventhal
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“What health systems need to do is recognize that digital health is here to stay and that data is a foundation for that ecosystem to be sustainable”

A PSJH senior executive discusses the chief data officer role, how the health system is making better use of its data, what’s new on the analytics front, and how challenging PSJH’s innovation journey has been thus far.

At Seattle-based Providence St. Joseph Health (PSJH), innovation and digital transformation are key enterprise themes as the organization’s senior IT executives continue to push forward into new healthcare technology endeavors. To this end, about two-and-a-half years ago PSJH—a health system that includes Providence Health & Services and St. Joseph Health, with facilities in Alaska, California, Montana, New Mexico, Oregon, Texas and Washington—hired Vijay Venkatesan as the system’s senior vice president and chief data officer.

Venkatesan, who before coming to PSHJ was working at Northern California-based Sutter Health as the vice president of enterprise data management, recently spoke to Healthcare Informatics about what the chief data officer role entails, how PSJH is staying ahead of the curve to make better use of its data, what’s new on the analytics front, and how challenging the health system’s innovation journey has been thus far. Below are excerpts of that discussion.

What is involved in your role as chief data officer? What are the core responsibilities?

My role is about how to create a climate for leveraging data as an asset. And what does “data as an asset” mean? Are we able to land information, harmonize information, and then make it available for the various uses of the data that people have? For example, when you think about data in healthcare, it is about connecting the patient experience, how to create that patient experience across the continuum, and making sure it is available for the various data users. And then make sure that by using that information, we are able to drive better care quality and patient experiences on the other end.

Vijay Venkatesan

What is involved in “creating a climate for leveraging data” and what are some strategies for transforming the data culture?

In the healthcare setting, because of legacies or histories for how we have [developed] systems, there are various IT systems. You have multiple EHRs (electronic health records) and ancillary systems, meaning data is all over. So how do you create a cultural transformation of the data? The first thing we had to work on when I came onto the role at PSJH was figuring out how to get people to say, “Can we become shared producers and shared consumers of the data?” So if different data repositories exist across the system, how do you create a way to get that data in one place?

What we did was embrace the big data paradigm. We created a data lake where we invited our other data asset owners to contribute their data into the lake, in exchange for data they want or don’t have access to. So we created a culture of convergence, to bring data in one place and share each other’s information so that the collective organizations benefit.

The second step we are working on is creating a harmonizing data layer—think about it as your iTunes data catalog, where your albums in iTunes are categorized by rock, pop, alternative, etc. It’s the same idea. Now that we have data in one place, how do we create albums from the data? So an album could be a view of the organization’s financials, or a view of the clinical care quality side, or the revenue cycle, or the supply chain, or pharmacy. Think about it as albums with galleries. So that’s the transition we are in around thinking about data as an organizational asset.

Data and analytics is clearly a key part of what you do. In what ways are PSJH leveraging analytics to improve care and for population health purposes?

On the population health side, we have built a platform called Community Pathways to Health, which looks at Medicare and Medicaid populations at-risk, tries to organize them by the level of risk each patient has, and then we [find out], what are the right ways to engage those patients?

In that context, we are also embedding social determinants of health to create a risk score or predictive score to say, how do we look at our limited resources and what’s the best way to apply them across the patient population we have so we can effectively manage their care?

On the other side, we are also building a mobile-first strategy where we are looking at building a no-show app for our clinics, as no-shows are significant in healthcare since there is a big cost burden associated with them. So we built a mobile app running as compliment to the EHR where the urgent care staff can see a prediction on which patients might not show up for an appointment and then call them to try to get them to come in.

And on top of that, we are working on a model to see if we can “double book,” just like airlines double book seats. Can we find a way to effectively manage that slot better? And we are using artificial intelligence (AI), machine learning, and a predictive and mobile strategy to do all of that together. So far, we have reduced cancelations by 10 to 15 percent, which is significant for some of these clinics.

When thinking about this type of innovation and data transformation, how much of a driver is the transition to value-based care?

I think there are two disruptions in healthcare that are noticeable and significant. One is, within health systems, there is tremendous pressure on sustainability—how do we become sustainable in an era of lower reimbursements and value-based care in its truest sense?

On the flip side, we have a lot of industry disruption happening through technology organizations and companies, which is what I call “disruption at the edges.” What health systems need to do is recognize that digital health is here to stay and that data is a foundation for that ecosystem to be sustainable. The majority of care will be outside of your four walls, and though telehealth: we have to meet the patient where he or she is. That’s a real change itself. People who are practitioners of data and analytics must recognize that data itself will be varied and in different contexts, and we have to create a ubiquitous patient experience.

The other side is creating meaningful applications that leverage the analytics at scale. A lot of the analytics you see is very “point solution” still; it doesn’t create interoperability both in the data and technology sense, and it doesn’t create an integrated patient experience. At PSJH, we are very focused on that integrated patent experience, and working backwards from that, what are the right things to do on the data and technology sides to enable interoperability that delivers the integrated experience?

Is PSJH doing more now with AI and machine learning?

On all of these applications that I mentioned, there is a significant component of machine learning embedded in. As for AI, people consume healthcare not because they want to, but because they need to. So we need to make sure that when we introduce concepts such as AI and machine learning, we still focus on that patient-provider relationship. We need to uphold the integrity of that interaction. We try to think about where does AI benefit, enhance, or add value to that experience of the patient-provider relationship? That’s the business we are in. We are very deliberate about AI. You will hear in the industry that AI adoption is low in healthcare; but it’s not that it is low, it’s that we are focused on applying AI to the right places and where it’s appropriate because we want to maintain the integrity of the patient-provider relationship.

Can this innovation journey be challenging for providers who are not used to this type of change?

The way to think about it is, for health systems in general, it’s like Maslow's hierarchy of needs. You have areas in health systems looking for basic information and others that are ready to do robotic process automation. There are extremes and some health systems don’t know where to start. Do you meet the basic needs of food, shelter, clothing, and security, or do you go for that transformation?

At PSHJ, we have taken a deliberate strategy in that we need to both strengthen our core—how we manage our data—but we also need to transform for the future at the same time. This is not a linear discussion. You need to think about it as remediate and stabilize what needs to be stabilized, but don’t ignore the foundation building and the transformation of the future. So we look at the business problems we are trying to solve, and what’s the appropriate way to either advance innovation, advance the foundation, or to stabilize or stop doing something because it’s not value-enabling.


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Making Precision Medicine a Reality at Cleveland’s University Hospitals

September 25, 2018
by Rajiv Leventhal, Managing Editor
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Genomic data—once in consumable and action form—is information that clinicians will be excited to tap into, says one leading CMIO

Earlier this year, University Hospitals, an integrated health system in northern Ohio, took a big step into the world of precision medicine when it entered into an agreement with an Allscripts subsidiary with the goal to bring genomic data into the clinical workflow.

According to University Hospitals officials, the genomic data points were already part of the EHR (electronic health record) system, but with the 2bPrecise delivery program— an offering from 2bPrecise LLC, a wholly owned subsidiary of Allscripts—patient information will be more accessible to physicians allowing for the data to be part of the medical record and subsequently shape and tailor the best treatment or therapy options for patients.

University Hospitals (UH) serves the needs of patients through an integrated network of 18 hospitals, more than 50 outpatient health centers and 200 physician offices in 15 counties throughout northern Ohio. According to UH’s Jeffrey Sunshine, M.D., Ph.D., chief medical information officer (CMIO), the collaboration is another step in the journey to make healthcare as personalized as possible for all patients.

Indeed, Sunshine says that the collaboration “fits squarely in the larger strategy of providing patient-centered health, wellness and care. That’s been our strategy for quite some time, and precision medicine, which is becoming more commonly used, means something a little different every time it’s used for every different person,” he says. And the broader question, Sunshine adds, is “How do we provide the best tools we can for each patient? That [concept] is what’s driving this.”

The new system also will allow UH to use the gene data to better align tests and treatments for patients that have a history of cholesterol or psychiatric markers, as well as other conditions that genomic markers could provide the best treatment avenues, officials have noted.

Having an Effect on Patient Care

University Hospitals is no stranger to precision medicine initiatives with the most common uses cases currently taking place in oncology, Sunshine notes. In oncology settings, when suitable, “We will take advantage of markers of the patient or the tumor to make best recommendations of appropriate therapy, or preventive measures, based on who you are, our ability understand your genetic code, and/or what’s growing in ill form. And that is precise to the circumstances for the patient. Precision medicine not only means genetically modified care, but it’s most often used in that context right now,” he explains.

Sunshine specifically points to three areas he believes this initiative, and precision medicine more broadly, will have a positive impact on patient care. The first involves when there is a specific disease for which something in a patient’s genetic markers might let clinicians know that either the patient has that disease and has a genetic marker that says he or she should be treated differently because of that marker; or the patient is at high risk for something bad and a preventative measure could be taken, he explains.  

What’s more, he notes, there is already evidence in oncology, and growing elsewhere, that “not everyone will respond the same to the drugs we might recommend for you, and we all understand that. But there is starting to be a growing experience that certain genetic markers can definitively predict for certain drugs that the drug won’t work or that it’s the wrong dose, so it could help us be very specific about the drug or dosage you should get,” Sunshine says. And that’s not limited to oncology; it crosses lots of domains. For example, he offers, there is growing evidence in the psychiatric domain that for certain gene markers, certain drugs won’t work, or that the dosage should be changed dramatically.

The third area that Sunshine points to is in preventive screening, where one might find through genetic markers that a certain patient is in a class of patients, who without that screening, clinicians wouldn’t have known are at a much higher risk for a disease. “So we should screen you more,” he attests. “And maybe that screening test has a certain cost that no one thinks we can afford for all U.S. citizens, but for 1,000 patients in the U.S. who need it, it’s a perfectly rational use of healthcare dollars,” he says.

To this end, speaking to the increasing pressure to lower healthcare costs, Sunshine believes that more personalized healthcare will be a big step in the right direction. “We've gone almost as far as we can on doing the same thing for everyone the same way, and now we have to figure out how to do it uniquely for the individual, because everyone doesn’t need everything, and we can’t afford to do everything for everyone." Therein lies the opportunity to be smart about it, Sunshine says, and figure out who needs what, at what highest priority, and what’s the best thing to do for that person or group of people. “And that opens a wide-open universe,” he says.

From an industry-wide perspective, Sunshine believes that CMIOs at integrated health systems like UH would say that they are doing “some form of precision medicine.” But it’s an ongoing development everywhere, he notes, adding that right now, precision medicine is probably not a top-three priority in in any organization’s broad outlook, but if narrowed down to a patient-centered care or patient engagement perspective, then it ranks high on that list. “With everything happening around EHRs, there is a lot of short-term attention on that, so some organizations are more or less along the strategy or momentum phase, but no one has a fully mature [precision medicine] model out there,” he says.

Going forward, Sunshine feels that to be successful in precision medicine endeavors, a continuous improvement culture will be needed—or as he explains it, “the culture that wants you to focus attention on having to do tomorrow different than today; a ‘get us to the future’ mentality.”

And perhaps even more important than that is making this data available and actionable for the front lines of care—a task that Sunshine puts squarely on himself and others in his position. “Primary care [physicians] would be excited to know if there were markers that could be obtained so they can alter their pharmaceutical approach to high cholesterol, hypertension or cardiac prevention for that patient,” he says. “If we, or anyone, who wants to do this can deliver that in a consumable and actionable form, the excitement and curiosity is waiting to be tapped.”

 


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Town Hall Ventures Close First Fund at $115 Million

September 20, 2018
by David Raths, Contributing Editor
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Adds Landmark Health, Bright Health, Strive Health to Portfolio

Town Hall Ventures, an investment firm built to address the healthcare challenges of the most vulnerable Americans, has closed its first fund at $115 million.

The founding partners — Trevor Price, Andy Slavitt, and David Whelan — announced the firm’s formation on May 7, 2018, at the HLTH Conference in Las Vegas. Their goal is to help build companies to improve care in Medicare, Medicaid, and risk-based care, and in addressing complex conditions and social determinants of health.

The fund and its limited partners represent multiple large nonprofit health systems and payors, along with entrepreneurs, executives and investors. 

Town Hall also disclosed investments in three companies:

• Landmark Health LLC, which provides home-based care to high-acuity Medicare, Medicaid, and Dual Eligible populations who are frail and chronically ill. Landmark’s new CEO, Nick Loporcaro, was recruited by Trevor Price and Oxeon Partners, and the company is backed by General Atlantic and Francisco Partners.

• Bright Health Inc., a technology-enabled health insurance plan that is built in partnership with leading health systems. Bright’s CEO is Bob Sheehy, former CEO of UnitedHealthcare, and the company is backed by NEA, Bessemer Ventures, and Flare Capital Partners.

• Strive Health LLC, a leading provider of chronic kidney disease solutions, focused on transforming healthcare and patients’ lives through early engagement, comprehensive coordinated care, and expanded treatment options. The company's co-founder and CEO is Chris Riopelle. The concept for the business was developed with the co-founders inside the Oxeon Venture Studio and backed by lead investor NEA.

Existing investments include:

• Cityblock Health Inc., which provides primary care, behavioral health, and human services to address unmet health and social needs in urban populations.

• Somatus Inc., which provides treatment and new models of care for patients with chronic kidney disease and end-stage renal disease.

• Welbe Health LLC, a provider of integrated medical and social services to frail seniors who qualify for PACE. 

• Aetion, Inc., a provider of real-world analytics and evidence to help biopharma companies and payors better understand how drugs work in the real world to enable value-based care.

Town Hall also announced that Ann Hickey has joined the firm as a vice president. She previously worked at Audax Group, Oak Hill Capital Partners, Castlight Health, and, most recently, Archimedes Health Investors.

Town Hall is led by Andy Slavitt, former Administrator of the Centers for Medicaid and Medicare Services (CMS) and Group Executive Vice President of Optum; Trevor Price, Founder and CEO of Oxeon Holdings – the parent company to Oxeon Partners, a retained executive search firm – and Oxeon Ventures, an investment firm and venture studio; and David Whelan, Managing General Partner of predecessor firm Oxeon Ventures and former General Partner and CFO of investment firm Accretive LLC.

 

 

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At Partners HealthCare, Bringing Digital Transformation to Clinical Care

September 18, 2018
by Rajiv Leventhal, Managing Editor
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Last spring, Partners HealthCare, founded by Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital, and California-based software company Persistent Systems, announced a strategic collaboration to develop a new industry-wide open-source platform with the goal of bringing digital transformation to clinical care.

Indeed, with the digital platform, Partners’ leaders hope to enable greater exchange of information across healthcare providers everywhere, and make available open source applications to any health system. At the time of the 2017 announcement, officials said that the co-developed digital platform will be based on Substitutable Medical Applications & Reusable Technologies (SMART), an open, standards-based technology platform along with Fast Healthcare Interoperability Resources (FHIR). “The platform will enable provider systems across the country to rapidly and cost effectively deploy industry-leading best practices in clinical care across their ecosystems,” according to the announcement.

Healthcare Informatics Managing Editor Rajiv Leventhal recently spoke with Sandy Aronson, executive director of information technology at Partners Healthcare, about this collaboration, its specific goals and outlook, and how things have come along so far. Below are excerpts of that discussion.

What would you say is the greatest significance behind this collaboration?

I have been at Partners for about 15 years, and the first 13 of those years were primarily focused on the clinical use of genetics and genomics. In that space, we created a suite of applications that was architected differently than health IT applications are typically architected. These were applications that helped with the generation of interpreted reports for genetics and genomics sequencing test results. So, where normally in health IT applications you create a transaction system and then try to bolt a knowledge base on top of it to the extent you can, we decided to architect this in the opposite way.

We built a knowledge base that deeply modeled the tests that a laboratory offers, the genes that are covered by that test, variants known to exist in these genes, variants that are learned over time, and the state of knowledge linking those variances to clinically relevant facts—so disease states, drug response, drug efficacy, etc. So we built this deep knowledge base and built a transaction system on top of it, and made a rule that you can’t report out test results unless you keep the knowledge base up-to-date and consistent with your test results. And that enables you to automate the generation of reports.

But as a result, we wound up with this continually-updated knowledge base, so based on that we created what would now be a SMART on FHIR app that plugs into the EHR [electronic health record] and provides clinicians with alerts if something new and potentially clinically relevant is learned about a variant previously identified in one of their patients. So it created this notion of a knowledge base alert being interjected into clinical care.

We studied this and found that clinicians liked it, but the rate at which this learned was dependent on the number of transactions that flow through the system, because that’s how geneticists would gather the data that would enable them to improve their assessment of variants. So we registered this as a medical device, distributed it outside of Partners, and networked the different instances together, so it could learn not just based on our volume, but other folks’ volume as well. Ultimately, we sold that to Sunquest [Information Systems]. The thing we feel was most important was creating this infrastructure that facilitated new clinical processes and captured, shared, and federated data in a way that enabled learning to care.

After having done that, we took a step back and said OK, what should we do next? The infrastructure we built was very specific to issues where genetics and genomics are the major components to deciding what to do for a patient. So we wanted to look at all of the things that made that infrastructure hard to do, and build a platform to make it easier to build things like GeneInsight [an IT platform company owned and developed by Partners], and then distribute that platform, so that in addition to building examples of a similar infrastructure, others can build those examples, too. We wanted that platform to make it easier to distribute apps that are created by different folks in different organizations, ultimately with the goal of networking those apps together.

We are at a unique point in time where you have these new data types coming online that can be helpful to the care delivery process, you have algorithmic-based medicine starting to come into use, both machine learning-based and not, and you have people looking at transformative ideas on how to alter clinical processes where in order to incorporate these new data types and incorporate algorithmic-based approaches to care, you need new kinds of IT support in order to enable these transitions to occur. And that creates an opportunity, not only related to the specific transitions, but also to start collecting data for specific clinical problems in a much finer-grained way that lays the groundwork for these networks that can build the data that’s required to underlie continuous learning processes.

All of this is happening in a time with incredible cost pressure in healthcare, which does constrain internal investment but also makes organizations far less resistant to change. The goal here is to fundamentally enable clinicals to evolve their practices, their care, new data, ideas, and techniques in ways they haven’t done in the past.

Sandy Aronson

And how are you working with Persistent Systems on this, specifically?

We are building this platform together. The platform is called HIP, or health innovation platform, and the platform itself will be open-source, and it sits on top of the current clinical IT ecosystem. You interface it to underlying systems, and then it handles things like some aspects of security, authentication, and HIPAA, but also access to data as well as incorporating shared algorithms.

The goal is having different places hook up the platform, and once it is hooked up, it should create a uniform surface on top of the platform so that apps built on top of the platform become more shareable and distributable. We are now focused on both building the platform and building certain apps. And the apps get interjected to the EHR as SMART on FHIR apps.

Can you give some examples and details of the apps that are being built?

One example is that we have been working with BWH’s cardiology [department] on this program that they have, where if you look at heart failure, which affects about 2 percent of the population and has a very high mortality rate with a great deal of costs associated with it, there are guidelines that have been shown to really be helpful, yet very few people are treated in a way that actually adheres to guidelines. And that’s because the process of getting them to guideline-based care involves this drug selection and titration process that requires a lot of interaction, some of which can make patients unconformable.

But as it turns out, you can instantiate a process where you use patient navigators to take patients through this drug selection and titration process, interacting with them far more frequently than a cardiologist would ever be able to, to get them to guidelines. It’s a data-intensive process. So we are providing support for that program through the HIP platform today and we are really focused on deepening that support.

What are your goals in the next 12 to 24 months regarding this partnership? What would you like to see happen?

The ideal world is that our group and Persistent Systems will continue to add more capabilities to the platform, and that the platform is reducing costs. So many clinicians have ideas on how to fundamentally improve care but they can’t put those ideas into use without these kinds of IT interventions.

One thing I hope is that this will continuously reduce the cost of building those interventions and as a result, our team, and others, too, will develop more of these apps. We hope to see some cross-institutional adoption of apps built here and elsewhere, that the sharing will begin at the app level and ideally, in two years or so, we will be having real conversations about how we can get the networking between apps really going.


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