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At Wake Forest Baptist Health, What the Mechanics of Clinical Transformation Look Like

August 24, 2018
by Mark Hagland
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Dr. Chi Huang is helping to lead clinical transformation processes at Wake Forest Baptist in North Carolina

Last November, Chi Huang, M.D. came to the multi-hospital, Winston-Salem, North Carolina-based Wake Forest Baptist Health system, after previous positions at Brigham and Women’s Hospital, Boston Medical Center, and Lahey Hospital & Medical Center, all in Boston. Dr. Huang’s title is executive medical director of general medicine and hospital medicine shared services and associate professor of internal medicine He has a background of 15 years’ clinical practice as a hospitalist, along with his physician leadership

Dr. Huang will be participating in a panel discussion at the upcoming Health IT Summit in Raleigh, North Carolina, which will address the question, “Patient-Centered Care and Interoperability: What’s Next?” The Summit will take place on September 27 and 28 at the Washington Duke Inn & Golf Club in Durham. In advance of that event, Dr. Huang spoke with Healthcare Informatics Editor-in-Chief Mark Hagland about the work that he and his colleagues have been engaging in, in order to transform care delivery at the Wake Forest system, which includes four inpatient hospitals (to be five, as of September 1) in North Carolina, and whose flagship facility is Wake Forest Baptist Medical Center in Winston-Salem. Below are excerpts from that interview.

Tell me about your title and its connection to the activities you’ve been involved in and are helping to lead at Wake Forest Baptist?

To begin with, I’ve been a practicing hospitalist for the last 15 years. I started out in practice at the Brigham, and then practiced at Boston Medical Center and finally transitioned to Lahey Hospital. At those last two organizations, I either ran an inpatient unit, or multiple units at several hospital simultaneously, becoming an associate CMO at Lahey, and focusing on patient flow and throughput there. I came here to the Wake Forest Baptist Health system in November, and I’m overseeing inpatient services at most of our hospitals, ensuring that we are focused on operations, quality, teaching, and research and the wellbeing of our physicians and advanced practitioners. My clinical background is as a hospitalist in internal medicine.

Chi Huang, M.D.

What brought you to Wake Forest Baptist in particular?

I came to Wake Forest Health System in order to build on what had already been existing for inpatient care at the 1004-bed Wake Forest Baptist Medical Center in Winston-Salem. I felt that my skill set could further improve inpatient care So my work involves  enhancing our inpatient care system, and how we connect the dots between inpatient and outpatient care, and help strengthen our work in population health. I learned a lot at the Boston hospitals, and I’m applying my learnings from my Boston experiences here.

What are some of the key elements in what you’re working on?

Interoperability is a key element. Some of our institutions have different IT system and platforms.  As with many different other healthcare systems, we have converted all our facilities to Epic. On September 1, at High Point, we’re transitioning to Epic with the 2018 version; all the other facilities have already migrated. And then from a workflow standpoint, we need the physician and advanced practitioner aligned along with our nurses , ancillary caregivers, and our phlebotomists. . And one of the things we’re working on is developing standardized processes for important care delivery handoffs and communications. Let’s say for example that John Doe is an inpatient and needs a surgical consult. At one facility, there’s an automatic notification process in place; at other facilities, the office has to put in the request into an outpatient system, and then the outpatient office manager has to call the surgeon. That’s the kind of back-office cleaning-up of a process that’s needed. But it requires achieving consensus among the surgeons on how they’d like to be contacted in such instances. So a part of my job is to hold listening sessions and help  achieve consensus among the physicians.

So you’re doing process management, including around IT-facilitated processes, and change management?

Yes, and how we make chages in healthcare, as they relate to the need to shift to a population health or value-based stance, and how that all integrates into patient-centered care. I think everyone’s been trying to figure that out.. The auto industry is much farther ahead on value-based care than we are. I can’t get an appointment with my PCP without making phone calls, but I can order an oil change on my Toyota Prius with my smartphone; so we have a lot to learn from other industries.

Healthcare has tended to lag far behind other industries in terms of redesigning core processes, hasn’t it?

Yes. The two industries that have not done full industrial reengineering, are education and healthcare. I’ve become fascinated by process-improvement for decades. And statement two is, the comments that you get of, this is how we’ve always done it and how we’ve always been, reflect the insularity of healthcare. I think it’s good to have companies, such as Amazon/Berkshire Hathaway/JP Morgan Chase, disrupt us, encouraging and prodding us to do better.. There’s this naivete that we’re doing well. But when you look at the data, the number of people who die unnecessarily every year is more than 100,000 lives. If we’re serious about process reengineering, we need to look outside to other industries. When my family and I went  to Disney World, I drove my wife crazy noticing all the process stuff. There’s a reason it’s the happiest place on earth, right? And they have  hundreds of different cultures landing on their campus every day.

At Disney, they understand customer service and process improvement.. And when they say, welcome to Disney, they use their hands, but never point, because they know that pointing is culturally insensitive in many cultures. So they’ve learned customer service far better than healthcare—there’s the Disney way. They’re moving people in 90-degree weather with two kids, through lines, quickly. And that applies to HC. From a process standpoint, it is difficult to swallow  that I can be told my wait time in the hospital can take hours but that I can get a fast pass to get onto a Disney ride in less than a half-hour. There’s a reason that healthcare still has 20 to 30 percent waste in the system. What should CIOs, CMIOs, and other senior healthcare IT leaders be thinking about, in all this?

I think that CIOs should be connected at the hip to the CMIOs. Let’s say I’m a CMIO and I think that something can be implemented. There are certain things that I still don’t know  or fully appreciate that the CIO knows; and vice versa, the CIO knows things I don’t know as a CMIO. Here’s an example: I might want a particular SQL-based report from the Epic system, but the CIO might tell me, well, these are the things that actually have to happen, because it will take two months to produce that report; so you need to tell me your top priorities. Because if you’re spending 60 hours to build a SQL report and it’s only saving $10,000, that’s an issue. But if it’s preventing 100 deaths, then that’s different. So everyone needs to be in the same room, so everyone can understand the competing priorities involved.

And the other tension not yet fully recognized is the tension from the c-suite to the front line. I still spend about 25 percent of my time doing inpatient care. And I need a fellow physician to tell me, Chi, you were crazy to go through a Clarity report on SQL, when what I really need from you or from the CIO or CMIO, is to get a notification in real time of troponin levels (a cardiac enzyme). When the lab tech puts in the result on one of my patients when the troponin level is 5.5, i.e., the patient is actually having a heart attack, I want to be notified at 10:01 AM, through Epic, through a pager system, or through my smartphone, in a HIPAA-compliant way, rather than some abstract measure that’s not as timely.

My wife is a psychologist and educated me on dialectical behavioral therapy which is often employed to treat people with borderline personality disorder.. One of the concepts of DBT is, you have to be able to hold two to three to four opposing thoughts at the same time, and to be comfortable with that, and work through that tension. So from a physician leadership standpoint, I’ve been trying to apply that principle in my practice. It’s OK for the physician to be mad at me because they want X, and another physician leader to be frustrated at me because they want Y. My job is to get all the several stakeholders together in the same room and validate everyone’s emotions, but also confirm that we have only a limited amount of money, time, and workforce and we need to leave this meeting in an hour and say, this is best for the system financially and operationally, and this is what’s best for the patients. And we need to get there, and be OK with not being OK, but this is our strategy.

And some of what you do involves helping your colleagues to hold a lot of different concepts, or even tensions, at the same time, correct?

Yes. I went into healthcare because I feel passionate about patients. It becomes personal when I think about the patients we’re affecting. And I do pre-meetings in order to understand what each stakeholder person might be thinking, and so I’ll say to someone, “You know, John might not see this issue the same way…” And then in group meetings, I act as the shuttle diplomat. And I’ll say, “You know, I’m not sure if Mark is thinking the same way about this. Mark, what do you think?” Or, “Cindy, now what do you think?” And, “We’ve passed 45 minutes in this meeting, can we come to a consensus on this issue?”

And of course, there’s a burning platform, U.S. healthcare system-wide, to achieve success in clinical and operational transfomation, correct?

Absolutely. By 2021, our GDP will not be able to sustain the cost of healthcare. And either hospitals and health systems will close down, or other external organizations will be disruptive, or we’ll make the necessary changes as healthcare organizations.




2019 Southern California San Diego Health IT Summit

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Take the Lead to Deploy Emerging Technologies for Improved Outcomes

December 14, 2018
by Brad Wilson, Industry Voice, former CEO of Blue Cross and Blue Shield of North Carolina
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It is a thrilling time to work in healthcare. As the former CEO of Blue Cross and Blue Shield of North Carolina (Blue Cross N.C.), I have had the opportunity to be at the forefront of using new technologies to improve outcomes for our members. Now as a member of the CitiusTech advisory board, I continue that focus on emerging technologies, such as artificial intelligence (AI), and the potential to accelerate the shift to value-based care and improve the healthcare system in material ways.

AI is starting to make a distinct impact in helping providers deliver more effective care, lower costs and create a more consumer-friendly healthcare system. Blue Cross NC recently piloted the use machine learning, a type of AI, to identify spikes in prescriptions for a costly medication. The company reached out to doctors who had been prescribing the medicine in significant numbers. Alerting just one particular physician practice to a generic equivalent brought estimated annual savings of $750,000 for Blue Cross NC customers. The potential of AI is not measured only in dollars, but cost savings are an important consideration.

Machine learning works by applying sophisticated algorithms to rich datasets from electronic medical records (EMRs), patient-reported data, claims and a host of other sources. To be successful, this requires both access to data and significant investment to support the depth and breadth of data analytics capacity and capability.

Yet, historically, one of the biggest barriers to value-based models has been providers’ and payers’ possessiveness of their own data. There is a good business reason for that possessiveness: competitive advantage. The different parts of the healthcare system do not want competitors to use shared data to steal business. But the guarding of data drives healthcare costs higher and, more importantly, makes delivering better, more personalized healthcare more difficult. In the past, power came from hoarding information; today, there is power in serving as an information hub.  Healthcare providers and payers are starting to understand this and there is more willingness to work together in sharing what has traditionally been closely held information.

As consumers’ voices gain in numbers and decibels, it’s clear that analytics technologies that can lead to better care at lower cost are desperately needed, particularly for payers. But the entire healthcare industry needs to move more rapidly. Health plans need to enrich, deepen and widen their analytics capabilities as quickly as possible. If they don’t, we will continue to see disruptors like Google, Apple, and Amazon enter the healthcare market—companies that have a demonstrated ability to be nimble and maximize the impact of their data.

For both providers and payers, forward-thinking organizations recognize that building their own data analytics solutions is not always the answer. Often there is not enough time, resources or enough of the right talent to deliver the capacity and capability required. Fortunately, robust turnkey solutions coupled with deployment expertise are available to efficiently and cost-effectively integrate data and analytics within an organization’s clinical, financial and administrative processes.

As health plan executives map out their strategic plans, look to these emerging technologies as accelerators for leveraging data to manage risk, optimize performance, engage consumers, enhance population care, and improve clinical outcomes to reduce readmissions and further drive evidence-based medicine. The opportunity is here to transform healthcare delivery in significant ways. Success will go to those organizations that understand the potential of these new technologies and take the lead to deploy them effectively—today. 

Brad Wilson is former CEO at Blue Cross and Blue Shield of North Carolina and is a member of the new CitiusTech Advisory Board. Mr. Wilson joined Blue Cross NC in 1995 as General Counsel and held a variety of senior-level positions before being named CEO in 2010. Under his leadership, Blue Cross NC grew to a $9 billion company serving over 3.8 million customers. Mr. Wilson has also served as Director of the BCBS Association, AHIP and numerous other national and state healthcare organizations.


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Investors Have Strong Interest in HIT Sector, Despite Valuation Concerns

December 13, 2018
by Heather Landi, Associate Editor
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Healthcare IT remains a hot investment sector despite concerns about these companies being overvalued, according to KPMG-Leavitt Partners 2019 Investment Outlook, a survey of health care investment professionals.

Looking ahead to 2019, more than a third of respondents (34 percent) said they were most interested in investing in health care IT, followed by care management (31 percent), home health (23 percent), retail-centric medical groups (22 percent) and primary care practices (21 percent).

New York City-based KPMG and Leavitt Partners, based in Salt Lake City, surveyed 175 respondents online from corporations, health systems, investment banks, venture capital and private equity firms between September 17, 2018 and October 21, 2018. Of those surveyed 32 percent were C-suite executives; 29 percent were principal, partner or managing director; 32 percent were vice president or director; 6 percent were analysts/associates and 2 percent held other titles.

“We are not surprised by the great deal of interest in health care IT and care delivery outside the hospital,” Governor Mike Leavitt, founder of Salt Lake City-based Leavitt Partners and former Utah Governor and U.S. Health & Human Services Secretary said in a statement. “As health care continues to march toward value, the emphasis on moving care to lower cost sites and enhanced coordination will continue, and those who can increase quality and lower cost will win.”

According to an October report from Rock Health, 2018 is already the most-funded year ever for digital health startups. Digital health funding in this past third quarter soared to $3.3 billion across 93 deals, pushing 2018 funding to $6.8 billion, already exceeding last year’s annual funding total, which was $5.7 billion, by more than a billion dollars.

Drilling down into respondents’ predictions for investment activity in 2019, in the health care and life sciences market, 96 percent of respondents see either a lot or a moderate amount of investment in health IT and data next year, while a similar percentage (90 percent) see significant or moderate investment in outpatient services. Forty-four percent forecast a lot of investment in post-acute care services, 39 percent predict significant investment in provider services and about a quarter of respondents believe there will be a lot of investment in managed public programs, payer service providers and pharmaceutical and biotech manufacturers. Eighteen percent believe there will be significant investment in medical device and diagnostics and medical equipment.

The survey results indicate there is concern that health IT is overvalued, yet investors believe there is some room to climb.

The majority of investment professionals see health care IT investments as an overvalued sector (64 percent), yet 40 percent expect the valuations to increase in 2019 while 51 percent see them staying the same. About two-thirds of respondents (62 percent) think the health IT sector will grow faster than the market in 2019, and three quarters of investment professionals see increasing competition in the health IT market. Investors also estimate that the average purchase price multiple, in terms of EBITDA, will be 12.5 for the health IT sector in 2019. Survey respondents expect ongoing demand for tools to help with consumerism will impact investment and deal making in the sector, according to the survey.

About four in ten respondents believe the healthcare market is experiencing a “moderate bubble,” while 9 percent believe the bubble will likely burst.

Care management solutions for risk-bearing providers, a highly competitive sector which helps coordinate care of the chronically ill or seriously injured, are expected to be the second highest sector for investment behind health care IT, similarly driven by trends of consumerism and increased focus on early care interventions.

Looking at potential drivers of M&A activity in the health care and life sciences sector in the coming year, 64 percent of respondents cited cost consolidation and economies of scale, while 45 percent cited accretive acquisition strategies. Forty percent of respondents see changing payment models as a driver of M&A activity, and 38 percent cited pressure from competition. Other drivers cited by respondents include expansion/divestiture of service areas (25 percent), geographic expansion/contraction (24 percent), revenue synergies (22 percent), need to deploy cash on balance sheet (17 percent), and regulations and legislation (13 percent).

“Deals are largely being driven by the need for savings, economies of scale, and improving cash flow or accretive earnings per share,” Carole Streicher, Deal Advisory leader for healthcare & life sciences at New York City-based KPMG, said in a statement. “Secondarily, there is a bit of a defensive posture motivating investments as health care organizations contend with competition and reimbursement models connected to quality and efficiency, as well as the entrance of tech firms investing in the sector.”


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Report: Massachusetts General Hospital Targeting Various Blockchain Use Cases

December 7, 2018
by Rajiv Leventhal, Managing Editor
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Massachusetts General Hospital (MGH) researchers are partnering with MediBloc, a Korean healthcare blockchain company, with the aim to improve patient data sharing and storing, according to an article in CoinDesk.

Per the article, the Laboratory of Medical Imaging and Computation by MGH and Harvard Medical School will be escalating research in a variety of broad areas “from medical image analysis to health information exchange by leveraging our cutting-edge technologies such as blockchain, artificial intelligence and machine learning,” according to Synho Do who is the laboratory’s director.

Do specifically told CoinDesk, “In collaboration with MediBloc, we aim to explore potentials of blockchain technology to provide secure solutions for health information exchange, integrate healthcare AI applications into the day-to-day clinical workflow, and support [a] data sharing and labeling platform for machine learning model development.”

Interestingly, MGH won’t be using any real patient data for its research, but rather simulated data, according to officials, since the various institutions that have the real patient data keep it in a way “that can’t be shared securely and often is in various incompatible formats.”

MediBloc’s CEO noted that the company is not only developing a distributed ledger for storing and sharing medical data, but also working on a tool that would convert data now held by hospitals from existing formats to a universal one, per the article.

For this initiative, MediBloc has already gotten partners across Asia, including eight healthcare organizations and 14 technology companies, officials said.

Earlier this year, a testing environment version of the blockchain was launched, and the network is expected to go live before the end of the year before becoming fully functional in the second quarter of 2019. Furthermore, there are also apps in the works that are planning to go live next year, with one of them, currently in a beta testing phase, “designed for patients to sell the information about their symptoms and the prescriptions they get to MediBloc. After that MediBloc will analyze that data and sell the analysis to pharmaceutical and insurance companies,” according to the story.

In the end, the main goal of the blockchain project will be to let patients independently decide what to do with their information.

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