Join us on this enlightening episode of "Future of Care," where we dive deep into the transformative world of healthcare with two renowned experts, Eric Alper and Shahid Shah. This episode, originally recorded at HIMSS 2024 is focused on the innovative "Hospital at Home" model, exploring its integration with Epic's Electronic Health Records (EHR) system to enhance patient experience and care delivery.
Eric Alper, MD, VP/Chief Quality Officer, Chief Clinical Informatics Officer at UMass Memorial Health, shares his insights on how "Hospital at Home" is reshaping patient interactions and the role of technology in making healthcare more accessible and effective. Shahid Shah, CEO of Netspective Media and HealthIMPACT Chair, discusses the technical advancements and challenges in integrating Epic EHR with home-based healthcare solutions.
We also take a closer look at UMass Memorial initiatives in enhancing inpatient access and streamlining processes. Our guests analyze the outcomes, the lessons learned, and what the future holds for similar programs worldwide.
Eric Alper, MD, VP/Chief Quality Officer, Chief Clinical Informatics Officer at UMass Memorial Health
Shahid Shah, CEO, Netspective Media, Chair, HealthIMPACT
https://www.linkedin.com/in/eric-alper-217570a/
Shahid Shah 0:00
Welcome, everybody to our HealthIMPACT Live. We're here at HIMSS 2024 in Orlando. And I'm sitting here with Eric and he'll describe himself here in a second. But we are talking a lot about this at HIMSS. Today I spent a lot of time with cybersecurity AI, just doing a preview of the vendor booths and other things and the excitement that we saw, like pre-pandemic looks like it's back. So there were a lot of HIMSS ups and downs over the last few years as a bunch of changes occurred. But tell us a little bit about yourself, Eric, and what brings you out to hims 2020 tour and then we'll jump into some of the topics that you're going to cover here in your lectures and
Eric Alper 0:46
It's nice to meet you. Shahid. I'm the Chief Quality Officer and Chief Clinical Informatics Officer at UMass Memorial Health. And I've just gotten here to HIMS, myself joining the Association of Medical Directors of information systems this morning and already hearing some very exciting talks about, again, AI and the future of healthcare in general, just transformation disruption. You know, this is why I'm here is to learn a little bit more about some of the vendors, some of the exciting work that other health systems are doing and to see what we can bring back to the patients in Central Massachusetts.
Shahid Shah 1:24
Ya know, what I love about this HIMSS this year is as I was walking through the booths, we saw lots and lots of our traditional healthcare vendors. But there are lots of non-traditional healthcare vendors here as well. So for example, workday is here on HR and planning Oracle this year after the purchase of Cerner, Microsoft, Google, and just a lot of non healthcare participants are just curious, as you see more and more, let's say horizontal industry players coming in, does that excite you? Or does that make you worried? How do you feel about those kinds of vendors?
Eric Alper 2:00
I think it's a really interesting time in healthcare and so much disruption is coming. I've been thinking a little bit more about the Amazons, and the Googles entering, and Walgreens, and Walmart, and other vendors that are getting directly into healthcare delivery and how that affects traditional healthcare systems. I think they're clearly filling some important gaps in the system. I'm also thinking about how do we use this transformation to deliver the best potential patient care possible?
Shahid Shah 2:39
Now I have a theory point, did I, when I first asked the question, it was more in terms of how do you feel about them as technology vendors, but you made you brought up something even far more important, especially for UMass and the fact that you guys are in healthcare delivery is that not only are there non traditional healthcare entrants coming in, into technology, but non traditional into what is traditional healthcare delivery, actually. So in that respect, now, it becomes even more important for companies like UMass and hospitals like UMass to be in the forefront of technology, because you see external technology providers coming in, they already know that tech. And the question is, are they going to learn healthcare faster than a traditional high quality supplier like UMass, learning the tech side? And so talk about that for a few seconds? What do you think that is? Is it possible for these entrants to learn your job faster than you can learn their jobs?
Eric Alper 3:38
I think, again, it's such a challenging time in healthcare right now that there's such demand for high quality, accessible health care, primary care, specialty care, pharmacy services, education, engagement. And I think that the market is ultimately going to decide what is best for health. I've been thinking a lot about this this morning, in terms of where you know, who do patients really trust in the healthcare marketplace at this point. And I think ultimately, patients are going to choose where they go. So I think within the healthcare space, that creates some interesting opportunities that creates needs for partnerships, but also potential competition among the partners. So I think it will be really interesting to see how this all plays out over the next five years, for sure.
Shahid Shah 4:29
No, I love that perspective is that even if it's cheaper, or easier to access? I mean, that's one of the things I think the non traditional participants are providing. What's gonna take them time is to earn the trust that you already have, for example, in your community for many, many years. So that does seem like a big challenge for them, but an opportunity for existing healthcare providers to say can I learn how to do better scale accessibility technology faster than these new entrants? I can learn and gain trust. I think that trust is probably a lot harder to gain than some of our new interests like the Amazons of the world are anticipating. But I guess, like you said, a good place to focus our attention. So for today, let's talk a little bit about you. You're doing a couple of talks here at HIMS. Tell us a little bit about those talks and what the subjects are. And what are you hoping to convey to the audiences here?
Eric Alper 5:25
Oh, great. Well, first of all, I'm going to be joining a panel discussion about healthcare at home, along with Amy Compton Phillips from Press Ganey, and some other leaders across the country who have been very successful in this space. UMass Memorial, we've been very fortunate to have stood up an outstanding hospital home program where we've been able to care for about 2000 patients over the last almost three years now. And we've partnered with Best Buy health, current health to deliver our remote patient monitoring components of that care. And it's been just a fantastic experience for our patients. They love the experience of getting acute care at home. And we've been able to show that we've got really high quality outcomes, safe care, much lower complication rate, much lower frequency that of the time that patients require going to rehab after being in the hospital home program. And I think mostly with that, just looking to spread some of our experience and our passion for this outstanding technology enabled healthcare approach.
Shahid Shah 6:44
So when you think about healthcare at home, there's so many possibilities and so many opportunities. What did you decide to start with? And why?
Eric Alper 6:52
Yeah, we had been toying with the idea for many years, I think. At UMass Memorial, we've chronically had a challenge with inpatient access, we have frequently a large number of orders that are waiting for beds in our healthcare system. And we thought that a hospital at home would be a great way to decompress that to some extent where we had the ability to take patients out of our emergency departments and out of our inpatient beds. And once CMS announced the waiver was available, so that we could continue to get payment for taking care of patients in the home, that became our first attempt at doing health care at home. And that's been, as mentioned, just really, really successful, a very pleasant surprise. We've been able to manage a census of up to 2025 patients at a time. Most of the time, we're running a unit of about 15 patients, but we think that there's probably a lot more patients that are in the hospital that could be candidates for that. But no, we're starting to look at other care models outside of the hospital as well, like we're performing remote patient monitoring of patients who have high blood pressure, diabetes, heart failure, COPD, or chronic obstructive pulmonary disease, or emphysema, and trying to do our best to reduce the amount of care that they need to get in the hospital. We're looking at establishing a rehab program at home, largely leveraging some similar technologies to be able to pull their data into our EPIC Electronic Health Record system, and then to be able to act on that data in real time. So that, you know, we're not waiting in between visits, and we're able to deliver better outcomes in that fashion and greater patient satisfaction as well.
Shahid Shah 8:43
How many beds are in your hospital system?
Eric Alper 8:47
We have about 1000 beds throughout the hospital system. So it's, again, a small percentage of the total number of patients that are to care for in our current system, but we're growing it as fast as we can.
Shahid Shah 8:59
Yeah. And a good way for our audiences to think about that is that, say, your 1000 bed hospital. And you let's say that your patient census grew from 25 to 100. That's a 10% increase in total, quote, bed capacity with no fixed asset acquisition. Right. So you've got to love that. Absolutely.
Eric Alper 9:19
And what our data has shown us that we've basically saved over. I want to say it's 12,000 inpatient bed days for patients where patients were at home, not occupying that bed so that if we have 30 patients that are boarding in the emergency department, it previously would have been, you know that many more. Now, those patients are getting outstanding care at home. You know, I think that's part of the reason that we do this is to help to decompress the hospital. But as discussed, we found that we get in many cases even better outcomes, taking care of patients with this technology enabled care.
Shahid Shah 9:58
Yeah, I love the idea of growing past little beds without assets. That sounds exciting. Although it must be challenging because it's already an issue to staff people at a hospital. Is it easier to staff for this health at home model? Or maybe is it harder?
Eric Alper 10:14
It turns out that for us, it's been easier for us to identify caregivers who want to deliver care in this way. It's innovative. Patients absolutely love it. And the nurses who wind up coming to work for our program. Many of them have been emergency department nurses where patients may be, we'll say less than pleasant at times, but they get welcomed into patients homes, they get hugs, they get pets, they, they're so appreciated, and they tell us that I remember why I did nursing now. And I think our physicians are saying the same thing, we have really great retention. And again, it's just really refreshing to be delivering care in a way that patients really want to receive it, not coming into our place where we do things our way. And we make you wear Ajani. And you know, you can only stand up when you call a nurse to go to the bathroom. You know, this is, it's an entirely different way to receive care.
Shahid Shah 11:12
No, I love it. And although we're at a health tech conference, we'd be remiss if we didn't talk about the technology. What do you like about what you're seeing from the current vendors in the space? I know you mentioned Best Buy. You mentioned current, who are the other vendors you're using? And what do you like about what they're already doing for you? That's a nice thing to start with. But what are the areas where maybe you need more help, because there's just no technology available to do the kinds of things you're trying to accomplish?
Eric Alper 11:40
Yeah, for our hospital and program, you got it, we're using Best Buy health, their current health platform to obtain the data, real time data from patients to be able to monitor their vital signs, monitor their steps to, and then that integrates back into our EPIC Electronic Health Record system so that we're able to take care of patients as if they were in another bed, in our hospital. So it we Other than that, the patient's look exactly the same as any other inpatient. I think one of the things that's kind of unique about the hospital at home is just the logistics of providing all that care to patients at the home, the ability, the need for our nurses to transport devices, and oxygen and medications. And the kind of special needs of ordering medications to patients is very different than EPIC has been a great partner in helping us to think through how we can do that even more effectively. But I think helping to handle some of those logistics of care outside the four walls of the hospital is something that I still think we need some help with.
Shahid Shah 12:53
Yeah, if there were any innovators listening to the audience, a lot of our healthIMPACT listeners are in that area. The kinds of stuff that Eric is talking about is if you look at a normal hospital, they can do sub acute, they can do acute, they can do non acute, me, they can just do all kinds of different things, because everybody that you need is in general, in some proximity to each other geographically, because they're in the same building, at least if not nearby each other. Now imagine you have to do all of this, except nobody's near each other. You have no devices, no nothing. And yet you have to deliver better care. So just as an example, the kinds of things that Eric is referring to is when you have a new patient, and the referral has been created, starting from the referral itself, staffing a nurse, understanding what is the actual care that has to be provided, making sure that before the nurse arrives at the home, the equipment is already sitting there. Is the equipment already unpacked? And is it pre registered? And is it connected to the patient? So there's a lot of stuff that even your best web platform is doing great for you. That's excellent. It's connected to Epic, which is excellent. But like you said, there's still a ton of stuff, the logistics part, we kind of gloss over it. But that's really where quality goes to live or die, right? If you don't get the logistics right in here. It doesn't matter if the nurse is friendly. If she doesn't have a device that she needs, the patient is going to be pretty upset. Right?
Eric Alper 14:20
Absolutely. And I guess one other use case I mentioned. We've gotten, what 10 minutes talking now and we haven't mentioned AI but I think identifying the right patients to come to hospital at home is one of it's been one of our biggest challenges so that we can get as many patients who are really candidates for the model to be evaluated and ultimately to be accepted into that program. And again, right now we've been working with some algorithms that Epic has been helping us to build. I think that others are also looking at ways to use AI to be smart about how We identify patients. But it's not only about the algorithms, I think it's also about helping patients to understand and families to understand that a hospital home is a really viable approach to receiving care. Even the physicians and the other caregivers in the hospitals make sure that they also are comfortable that patients can get outstanding quality of care in the home. So I think that it's partly education. It's partly marketing. It's partly just spreading the word but it is about prioritizing the right people to receive these types of care models.
Shahid Shah 15:37
Yeah. So as we get close to wrapping up here, tell us what are some major myths or misconceptions about hospitals at home, that you see a lot of your senior executives or physicians or nurses thinking about that you have to correct? And then on the flip side, what can you not do at home? Like for example, you're not doing any open heart surgeries at home anytime soon. So where is that? Where does that spectrum land about what you're willing to do at home at the moment? Due to maybe the myths and misconceptions? Or maybe just because it physically can't happen elsewhere?
Eric Alper 16:11
Yeah, no, absolutely, there certainly are things that we're never going to be able to deliver at home. But there's quite a bit we can do. We're not doing critical care at home. But we can do, we can have patients on significant amounts of oxygen at home, they can be on IV medications at home, they can be on. We've just started, I think we're the first program in the country that will be administering blood transfusions to patients at home. And that, that'll open up the possibility particularly for many of our oncology patients who may require sometimes frequent blood transfusions to receive care at home. That's something we couldn't do in the past. I think the patients who aren't good candidates are those, like you said, patients who are going to be needing to undergo procedures in the near future, patients who are going to be having repeated radiology studies. So they need to be on site to receive that CAT scan or the MRI. But we can bring an x ray machine into the home, we can do an ultrasound of the heart in the home, we can and we can even do postprocedural patients in the home like again, one thing that we just started doing at UMass and we think that we're the first to do this is to take patients who have had severe infections, back home the day after their procedure, provided that they had an uncomplicated procedure. So we are able to provide pretty diverse care, if patients need to go back to the hospital that we get them there. And we you know, we either call that escalating them back to being in the regular health care unit. Or if they just need to have a procedure done, or they, you know, then we can transport them to the hospital for the procedure, then bring them back home again. But those are the kinds of logistics that we are we think through as we think about whether or not someone's a good candidate from,
Shahid Shah 18:04
That's great. And so as you talk to senior executives, there's very little that they would be able to give you right now, especially if you're coming out of VR unless you go and track down that procedure. So maybe that's a good way to think about it if it's a procedure, don't even think about it yet. But post procedure, definitely think about it. And for any CFOs listening, a great way to grow your business without getting more fixed assets, health at home seems like a perfect candidate. Are there any kinds of health at home? suggestions that you would make for more rural areas? Or maybe suburban hospitals? You guys live in a you're in a you're in a very medically heavy environment in the Boston area. So you're very, very lucky. Obviously not everybody has that. So is this? Is this only something that somebody as sophisticated as UMass can pull off? Or can others do it too?
Eric Alper 18:54
No, I think you can do it pretty much anywhere. But yes, you do need to have that Hub and Spoke kind of model. So as long as you have a hub that's probably within, you know, 2030 miles of the patient, then you're able to get care out to patients, we have patients who are in very rural areas in Central Massachusetts that are still able to receive this service. So as you know, UMass Memorial has four hospitals soon to be five. And again, with each hospital that you have in your health care system, you could in theory have that be a hub where you can get the medications, you can get the supplies, so that can expand your reach even further.
Shahid Shah 19:34
Nice. So just in the last couple of minutes, then tell us a little bit about your two talks, one was on health at home, we spent a lot of time on that. But the other one was on patient engagement. What was that about?
Eric Alper 19:44
That's right, we're working on a number of different patient engagement strategies that you know, some of which of course, are always based on our electronic health record, like using our my chart platform within epic. But there are some things that We find that we want to use in ways that are not part of the electronic health record at the current time, we're working with a company called get well and delivering some inpatient education, entertainment, through the, into one of our new inpatient buildings, that's going to be available to patients soon, they'll be able to see their care team at any time, they'll be able to understand more about their health conditions. We also use get well for things like educating them about upcoming procedures, educating them after their procedure, allowing them to contact their care team directly through their platform, called loop and also using a platform called navigate, which is going to allow us to send text messages to our patients to identify social determinants or social drivers of health, to understand if there are things that we could be doing more effectively to connect them with resources in the community, and even to have virtual care navigation for when they require that. So we're very excited about all those different ways that we're helping our patients as well.
Shahid Shah 21:07
Now, that's what's so what you're teaching us here is that it's very, very important to look, quote beyond the EHR, unquote. And as you look beyond the EHR, that doesn't mean your EHR doesn't have significant value, or you're not using it? Well, it just means there are many things that don't have to do with the healthcare record, which is the EHR score. And so as you see yourself using things like loop and navigate, is that, did that come into need? Immediately, because you were in the hospital? Or what did you have other needs, in addition to that,
Eric Alper 21:37
We've been reaching out to patients for their procedures through this vendor for probably five years now. And we've gradually expanded the number of use cases for I think that the EHR, as you know, continues to expand the kinds of things that it can do as well. And I think that we, in this case, we found that this particular vendor had, you know, a lot of content that had already been built and was easily available to us and was kind of faster to deliver to our patients in our community. And similar to them with the Navigate platform, I think the secret sauce here was not just the ability to send text messages to patients, but it's that ability for virtual care navigators to then interact with the patients and to, to help to close some of those gaps that we find. So I think as always, it's a matter of using the best of your electronic health record system. And then also complementing that with other platforms, if and when needed.
Shahid Shah 22:44
Yeah. And as you think about the if, and when needed, here are the two principal needs: even if you have an EHR, which handles all the purely technical aspects, somebody still has to fill it with content. And that content could be video, it could be a two minute audio, it could be a phone call that goes in and checks up on something that connects to AI. And then we integrate people into the human in the loop platform side. So there's a lot of things that EHR is just not just today, but we have to remember that an EHR's purpose is well understood inside a hospital. And there are lots and lots of things that can happen outside, and I often talk to people, and they seem almost shy to say, oh, yeah, we have to go beyond our EHR. No, no, you should be like Eric, and don't be shy about it. I mean, there's a lot of things. It's just like, if you're trying to go work with your bank, you don't say, Does my bank work with my EHR? Like, who cares, you need banking, and you need an EHR, they don't have to mix. So not everything that has to connect to a patient has to go through your EHR as the core requirement. So learn quite a bit about what you're doing here. Eric has a good look at your two talks, and it's gonna go really well. And we'd love to have you in future health.
Eric Alper 23:57
And if I could just add one more thing I, you know, I think Epic has been an outstanding partner as an electronic health record system vendor. And I frequently think about and talk about the fact that the electronic health record, is that the term itself is probably anachronistic at this point. It's not really a record, it says so much more connects us to one another. It's communication tools, and, you know, I think no, two EHR systems, even within the same vendor are the same because of all the different ways that you implement their tools, but also in the way they integrate other platforms into them. So I think of electronic health record systems more as a healthcare operating system. It's just the way that we deliver care at this point, and it can't do the care. But again, it's probably as I was, we were talking about earlier today, it's probably it's table stakes to have that kind of base functionality. But then how do you innovate to put things on top of it that ultimately will help to distinguish what you do from the next place?
Shahid Shah 24:58
Awesome. No air It just was a fantastic conversation. And I think the main thing I learned from this conversation is, if you just think a little bit outside the box like you guys are doing, then you go search for the vendors, whether your current vendors or future vendors, they'll just work much better. When the hospital UMass itself knows what he wants to accomplish, which in this case was to allow you to continue care where you didn't have any bets. Right, that that would. That's a massive outcome. And I think it's a great place to start. All right, well, we'll see you at the next healthcare impact event in Houston. But in between then we have lots of other HIMSS talks that will be coming your way.
Eric Alper 25:40
Thanks so much. It's been a pleasure.