HealthIMPACT Live Presents: Innovation Re-evaluating, Reimagining, and Reinventing Healthcare Post Pandemic
Original Published Date: May 23, 2022
YouTube Video: https://youtu.be/1Wwr4C4sLN8
During the pandemic, the rate of innovation in health care increased to levels previously considered impossible. The accelerated pace at which voice, artificial intelligence, cloud technologies, and virtual health were adopted can only be sustained if we are disciplined in our focus on innovations that make a meaningful impact on patient experience and outcomes. As leaders shift attention back to aligning financial incentives and reforming the healthcare policies that impact equitable access and quality, we must apply the lessons learned over the last two years to scale innovation quickly to achieve the continued transformation the healthcare system needs.
How long can healthcare systems continue operating at this new speed? Should they?
Organizational and patient expectations have changed, does this mean the culture of innovation in healthcare is permanently changed?
How are health systems leveraging technology to forge better partnerships with independent hospitals and practitioners?
Innovation in healthcare has always been a matter of life and death, it was only amplified during the pandemic? How do we move forward?
Innovation techniques and approaches to maximize the value and impact across the organization and the population
Innovation lived everywhere during the pandemic, who should own it now?
Shannan Epps, President & CEO, Brightwork Consulting
Shahid Shah, Publisher and Chief Editor, Medigy.com
Shahid N. Shah: Welcome back, Health IMPACT audience, we are so excited to get our Spring 2022 also virtual underway, and for those of you that have been with us for the last 10-plus years, you're going to have a really, really good time talking about innovation from a high level, but really diving in deeply to see if are we over innovating are over-investing in certain things.
And, of course, that is fairly natural now, given that coming out of the pandemic, there are a lot of decisions that we had to make very, very quickly, there were no.
You know, we could look back at things and think that they were mistakes, but certainly not at the time we had no idea where things were going.
And so there are areas where we might have over-invested a lot of other areas where we might have hundred invested, but we've got a major issue which is that all of the money that we have spent wasn't sitting in the bank accounts, so a lot of loans were taken out by hospitals, and health systems bonds were offered by hospitals and health systems, and now many things are becoming do right, then, so our chief financial officers and board of directors are wondering.
Where to invest for both appropriate monetary as well as patient impact and experience needs, so we're going to have a really, really good set of sessions over the next couple of days discussing all kinds of great topics that we already always do.
But today we're going to start with Shannon, who does a lot of work with senior executives, both on the information technology side but also, you know.
Generally, on the healthcare side, advising them about what to do on a day-to-day basis with respect to technology choices implementations and how to deliver technology that can actually be used in some small short period of time, rather than technologies that might take years to implement years to get out.
So we're going to have a great conversation about that, but really where we're going to focus on is.
The accelerated pace that we've looked at over the last couple of years on voice artificial intelligence cloud technologies virtual health.
Lots of buzzwords have been flying around because vendors and solution providers didn't know what hospitals and health systems are going to use.
But now that we've got a couple of years under our belt of what patients really are using, what our payers and employers are willing to pay for, what our networks, labs, health systems, etc need from each other and then, finally, as healthcare it departments within larger healthcare delivery institutions themselves. What has come about on a need versus a desire is around workforce retention.
Getting acquiring new patients that we may have lost, so the world is starting to shift quite a bit, and we need to talk about what that should mean to the technology sector with that, Shannon welcome to our first session of multiple sessions over the next couple of days, tell us a little bit about yourself and what you do.
Shannan Epps: Well, first, thank you for having me I'm Shannon up, so I'm the founder and CEO of brightwork, we are a health advisory firm we do a lot of work. In implementation and, as you said, technology selection, we work with some of the largest health systems in the country, and we also work with some smaller mid-sized Community-based health systems we've been in the space.
Primarily, most of us, myself, our partners, and our VPN come from healthcare, so we don't necessarily come from consulting.
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Shannan Epps: And so we've been in the trenches of some of the big decisions about what to implement where to spend the money.
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Shannan Epps: How does the money benefit the Health Organization, we frequently are asked what's the Roi and we've frequently had to defend that.
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Shannan Epps: Those decisions so lots of experience, making these decisions around innovation and trying to figure out how does technology benefit the organization and what do we focus on and what what What should we not focus on.
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Shahid N. Shah: yeah so one of the topics that i'd like to cover today is this idea of maybe we have over invested in certain areas of innovation, but before we get to that.
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Shahid N. Shah: talk to us a little bit about the starting from the smaller end of your clients going to the higher end.
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Shahid N. Shah: what's the landscape of your you know most routine most common conversations what are they worried about and I asked this in one respect, because.
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Shahid N. Shah: Many of us as quote thought leaders or those that right a lot or speak a lot.
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Shahid N. Shah: We bring up topics in conversations like this that maybe not everybody cares about so having you here is perfect right because you're talking to these hospitals and health systems on a regular basis.
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Shahid N. Shah: What do they care about most when you are being you're being brought in to guide them towards what.
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Shannan Epps: yeah there's always there's always some problem that that need solved right and it's usually.
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Shannan Epps: How, how do we leverage the technology to improve patient care or how do we leverage expensive technology in a financially solvent manner.
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Shannan Epps: And what technologies should we implement to reach our goals, so a lot of times what we.
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Shannan Epps: Do is we spend time working with our clients boards and executive teams to understand what is the organization trying to accomplish right now, what is the goal here what, what is your focus.
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Shannan Epps: In our smaller Community health systems, for example, are working things on things like patient consumerism right turning turning healthcare into more patient consumer.
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Shannan Epps: centric model and getting back to kind of that retail feel for for patients, which I do think that modern patients are asking for.
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Shannan Epps: Our larger health systems and partners have have done that have done much of that already, or at least thinking about that and are probably more in front of the innovation.
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Shannan Epps: pieces, you know doing doing really more modern innovation right that's more focused on Ai that's more focused on on widgets and Apps so it really depends on where the organization is is at.
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Shannan Epps: With our smaller, more Community health systems it's all about making sure that the technology works for the health system right that it is.
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Shannan Epps: There sort of benefit out of the technology, whether that's improve patient care and clear.
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Shannan Epps: clearly defined clearly measured improvements or whether it's going to improve some sort of financial improvement and how do we, how do we draw those lines from implementing the technology to showing the board that there is benefit to this.
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Shannan Epps: This thing and we do a lot of ehr implementations particularly epic, which is an expensive piece of software and So how do we help our clients.
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Shannan Epps: realize some of the gains from that that's the innovation that we that we focus on.
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Shahid N. Shah: yeah that's perfect and, as you start to guide your has built systems towards things like Ai things like more advanced Tele health.
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Shahid N. Shah: voice recognition stuff that's not normal everyday kinds of things, how do you get them to stop looking at the new shiny object and saying look guys you guys have.
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Shahid N. Shah: A lot of technology here, and you use the word leverage several times in your introduction leveraging means that it must already be there perhaps and you're trying to optimize it.
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Shahid N. Shah: versus leveraging it doesn't seem to me to be possible if you haven't had the technology in your environment or am I reading too much into the word leverage you.
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Shannan Epps: Know it's a lot of a lot of times what I tell my clients is try not to get lost in tracking down the shiny objects right pay attention to what is most impactful to your organization and some of our some of our larger clients that have a lot of funding in innovation.
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Shannan Epps: You know don't always do a great job of paying attention to what's already there right.
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Shannan Epps: They implement a lot of technology that has a lot of functionality that's just being left on the table that's just not being used.
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Shannan Epps: So that's that's a that's a big problem, and I think as technologists, and this is, myself included, sometimes we don't always.
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Shannan Epps: Work with the people that are on the ground and really know the systems that are already in place to ask them what, what does the system already do, what do you, what do you what's your functionality that you already have available to you.
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Shannan Epps: So there's problem of redeveloping what already exists in the name of innovation right for for the smaller clients it's again.
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Shannan Epps: What are you spending your money on and how is that going to directly impact your patient in your organization's goals right, how is it going to move the needle towards what you're what you're trying to accomplish and so.
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Shannan Epps: Depending on you know what where that health system is at if they're not measuring.
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Shannan Epps: You know baselines for certain clinical functions like fall risk, for example, when I talk about that piece of Ai right that's a basic piece of Ai right now in in ehr.
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Shannan Epps: But a lot of health systems aren't measuring that aren't using the data to their advantage to understand you know how to set up best practice advisories or how to set up data analyses to.
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Shannan Epps: Give nurses and clinicians the tools they need to help prevent a fall in their in their hospital so that's the kind of Ai that that I typically recommend, on the other side there's a lot of discussion about Ai and how you can.
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Shannan Epps: improve processes significantly to reduce costs, reduce headcount in in the organization and you know I think a lot of us are are cautiously optimistic about the future of Ai but also making sure that.
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Shannan Epps: The software there's there there right it's really truly delivering upon its promises, so I hope that answered your question, but it really like I said it really depends on the size of the organization and where they're at in their in their journey.
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Shahid N. Shah: yeah I know it definitely does and it's a complex world right does a $100 million hospital versus a $2 billion health system quite different, but one thing they share in common.
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Shahid N. Shah: Is they they do need some way, whether you call it something as advanced as an ontology or as something as simple as a checklist to say before you go choose a technology or look for an implementation.
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Shahid N. Shah: What should you be going through from an expectations or outcomes perspective so.
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Shahid N. Shah: What what is in the landscape currently today Shannon that you see somebody could just pick up and use as either an ontology or as a checklist etc.
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Shahid N. Shah: To help establish their expectations from which they can derive things like Roi etc, because I don't think that really exists and that's one of the difficult that probably have when you talk to customers.
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Shannan Epps: yeah that's a great question and it's funny that you ask that one of the one of the things that is common among our clients, no matter if they're a multibillion dollar health system or you know, a small community based system.
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Shannan Epps: there's not still a lot of governance in the intake process and in the analysis of all of this technology right, and how does it impact the system just basics of.
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Shannan Epps: It and again it goes back to this following the shiny object thing right and we get everybody in healthcare.
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Shannan Epps: understands this right, you get you get these departments that are siloed that want to accomplish a specific thing, but they don't work with with others to.
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Shannan Epps: understand how this that thing fits into the big picture, and so a really simple thing that that helps to solve that is just an intake checklist right just to just a very simple.
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Shannan Epps: governance process that brings in people like business analysts and clinical informatics and the people from technology that already have an understanding of what the suite of products.
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Shannan Epps: Already are to help determine one or during have this do we already do this does the software that we have already do this.
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Shannan Epps: Number two, what is the cost number three, which is a really big one right now and I talked about this a lot do we even have the resources to implement this thing right, and most of the time we don't.
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Shannan Epps: At least in the timeframe that we want to so following a rigorous process and it can be that checklist can be as simple as you know, 10 items, or it can be you know, a process that needs to go through a much more rigorous.
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Shannan Epps: review and a governance board and but but, starting with some sort of intake before the thing is considered is really key.
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Shahid N. Shah: Sure, and that's perfect advice, in fact, you know, in the non healthcare generally traditional enterprise architecture world.
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Shahid N. Shah: We have these things like business architecture enterprise architecture solutions architecture and there are techniques and technologies available to help catalog.
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Shahid N. Shah: What you have today, I mean generally hospitals think I already have an ehr but an ehr could mean 100 different things to 100 different people, so if that's the case.
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Shahid N. Shah: Is it is it your suggestion that maybe regardless of size of healthcare organization, because even the smallest healthcare organization.
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Shahid N. Shah: Is several million dollars of revenue in size, which means they could have an enterprise architecture approach to the world, so if they had a.
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Shahid N. Shah: Enterprise architecture business architecture traditional stuff from you know decades ago, is that a good start, or is that too much and you're asking for something even less than that.
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Shannan Epps: I think the concept of independent enterprise architecture is a good one, and we do have a smaller client right now, that is in the process of moving, is it organization to a product development and enterprise architecture type of style.
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Shannan Epps: The key is do you have clinical people clinical leaders, as part of that process, do you have informatics that are that are part of the process, because I think when you start to talk about traditionally.
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Shannan Epps: On techie functions like enterprise architecture, I think, as an industry we haven't done the best job of remembering the healthcare side and remembering the clinical side.
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Shannan Epps: of it, and I think that that because you know we've been kind of archaic in our industry right we're we're we're known as being a little slow to the playing field so we're making this big swing towards.
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Shannan Epps: embedding more tech in in the way we think, but at the same time, I think we're forgetting to just go back to the basics, which is patient care and patient care is a clinically lead.
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Shannan Epps: function and so making sure that you have those people that really understand what is in place today, and how are we using it, and then working with your vendor partners as well right there's there's.
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Shannan Epps: Especially when you have a big ehr in place like cerner are epic making sure that you're partnering with those.
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Shannan Epps: vendors, to understand what it is that they offer and what's on their roadmap that's one of the things that things that we do quite a bit we partner pretty heavily with epic to understand.
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Shannan Epps: what's available from them now and what's on their roadmap and if if their roadmap includes some functionality that our client is thinking about.
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Shannan Epps: Implementing and we we've kind of pushed them in that direction, because they're already paying for it they're already licensing for it it's not a shiny object.
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Shannan Epps: yeah.
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Shahid N. Shah: Great and and and before we get to the overinvestment question there's just one other key problem that we have that maybe hospitals and health systems can't exactly solve but those of us that help.
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Shahid N. Shah: guide them could solve, and that is working to bring multiple partners together so in other industries as something as complex as Defense, for example, or nuclear or avionics.
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Shahid N. Shah: Everybody knows that there's a supply chain, there are integrators there are consolidators there are solution providers.
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Shahid N. Shah: But in healthcare we don't actually have those nice disciplines broken out what are your thoughts Shannon about using you know companies like yours to say look cost will help system, yes you're going to need more than happy.
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Shahid N. Shah: me saying that is like you know obvious statement of the year.
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Shahid N. Shah: But what they might not know is that there are nine partners that work really well with epic because you already have epic you want to use nine partners.
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Shahid N. Shah: Rather than these other 90 which you do might be awesome as well, but they really work well with cerner.
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Shahid N. Shah: If you don't have cerner it doesn't really help you to have these other 90 partners, you want these nine because they work with epic how much of that do you believe is your responsibility as a tech guidance leader.
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Shahid N. Shah: versus leaving it up to hospitals and health systems to kind of like Cabo their own integration strategy together.
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Shannan Epps: that's a big part of what we do and a big part of what we market actually we try to see ourselves as kind of a middleman a shepherd right.
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Shannan Epps: To help guide our our clients through this very noisy environment because there's so much tech available, right now, and you know there's a lot of investment going into.
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Shannan Epps: Health tech innovation, right now, and so it's really difficult for a CIO and healthcare who's just basically mostly trying to keep the lights on right.
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Shannan Epps: Trying to keep their resources happy and staffed and trying to answer the call of.
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Shannan Epps: Their stakeholders, because you know, a CIO typically doesn't have the luxury of going out and shopping for innovation, without some sort of pressure from from the organization right their stakeholders are asking for.
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Shannan Epps: For a million things so it's really difficult to understand what's available what's meaningful.
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Shannan Epps: What what what has a good reputation and what doesn't so so we spend a ton of time going, I mean even starting in January we go to CES.
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Shannan Epps: And really start to understand you know CES as cutting edge health technology, you know we spent a lot of times on and hymns on the floor really understanding what.
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Shannan Epps: What is available what's coming available, what do our ehr vendors support and and recommend, and how are they looking at that that integration among technology so So yes, we really do think that that is part of our responsibility to understand.
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Shannan Epps: The big picture and where should our clients be investing their dollars and where, should they wait right because some of the innovation is just maybe a little bit too soon for for health care providers.
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Shannan Epps: So we have to, and like I said before, every client is different right, just like each of us we're all in a different place in our own personal journey, so what is going to be meaningful and impactful for one client is not going to be the same for for another.
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Shahid N. Shah: Now that's a great advice, and in fact that just as a slight editorial to our health system senior executives.
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Shahid N. Shah: What you want to start to do is add you're always going to get inundated with a variety of different solution providers etc coming to you saying they've got the next best thing and and oftentimes they are right.
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Shahid N. Shah: What you really want to ask them is that's great, how do you work with our partners ABC and D.
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Shahid N. Shah: yeah because if they don't figure it out for you, you have to figure it out for them, and why do the work for them when they're willing to do it for you, for free so here, it becomes your job as a CIO cto.
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Shahid N. Shah: CFO CEO to say hey, let me make sure that Shah head if he's got a great new idea can connect with Shannon who is already in our shop, let me get those two guys off on their own, but.
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Shahid N. Shah: That introduction coming from the health system is meaningful for a small company if I created something to work with a bigger company let's say you work for epic, for example, Shannon that tie in to connect.
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Shahid N. Shah: From the hospital or health system, who might be the ultimate buyer can save them a lot of time.
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Shahid N. Shah: And I think that's something we need to.
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Shahid N. Shah: Practice, a lot more in the industry is pre partner connect up and then go to the health system together.
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Shahid N. Shah: And, of course, the big boys, you know, like the dissenters and the epics that are much more difficult to do that with, but there are lots of medium.
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Shahid N. Shah: sized players that are more than happy to work with smaller players to say okay let's work together i'll take my fault detection Ai connected with your.
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Shahid N. Shah: Information blocking technology and records release process to connect them together, and then we can go to hospitals and health systems, would you recommend that to do smaller providers the innovation providers to pre partner.
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Shahid N. Shah: Before going.
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Shannan Epps: Absolutely not only to pre partner, but to to work with the bigger vendors, if you can, and there are there are definitely ways to do that.
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Shannan Epps: You know I mean if you're going to him just walk up to the epic booth walk up to the cerner booth and have some conversations with with people about what you're trying to do that we do this, we do the same thing we have a couple of.
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Shannan Epps: widget solutions that we that we provide and we try to align with the larger vendors, to understand what it is that that.
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Shannan Epps: they're trying to accomplish and and what it is that we're doing does it align to you know their goals as well right, I always joke around never get misaligned with the mothership.
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Shannan Epps: So that's cool number one.
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Shannan Epps: But I yes partnering vendors partnering together coming up with a consolidated solution.
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Shannan Epps: That that meets the needs of the health care system and truly meets the needs right don't make an assumption that your software is the greatest thing that ever existed right that that your health system target is going to need that thing.
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Shannan Epps: You really got to think critically about whether or not it is truly going to benefit the health.
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Shannan Epps: system that you're that you're going after and and I personally think that there is a lot of tech, there are a lot of vendors out there that have this assumption that their thing is the greatest thing.
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Shannan Epps: And don't do the critical thinking to realize, is it the right thing for this customer right because it might not be the right thing for a particular customer.
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Shahid N. Shah: perfect and, in fact, that you know just as a quick anecdote I talked to startups and solution providers fairly routinely, and this is my one piece of advice to them is, if you have to go to your customer and ask them how you could help them.
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Shahid N. Shah: you're not actually giving them any help right is this is what they do, they go i've made this great thing can you introduce me to someone at a hospital, where I can talk to them about how we might be able to help them do I was like.
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Shahid N. Shah: dude if you have to ask them how you might be able to help.
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Shahid N. Shah: You have no idea whether you can help them or not and they're not going to give you time, some of them are very nice they're kind people, but why bother them.
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Shahid N. Shah: Go talk to.
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Shahid N. Shah: Their partners, the ones who are already there don't bother the hospital yet.
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Shahid N. Shah: bother the other vendors, because you can help the vendors make more.
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Shahid N. Shah: money.
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Shahid N. Shah: In case retention add more licenses to their products, etc, so it's it's a really good piece of advice to say you know, especially on the pre partnering side.
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Shahid N. Shah: You know vendors and solution providers might want to reach out to you guys to say Okay, how do we help pre partner and get into hospitals and health systems.
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Shahid N. Shah: To help with this one area, and I know we promised about talking we've got a few minutes left before we finish up but let's talk about that area of potential over innovation over investment in innovation.
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Shahid N. Shah: You know, you said a few minutes ago that sometimes we're slow to the party, so the idea of seems like an oxymoron to say that a hospital health system is.
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Shahid N. Shah: Over invested in innovation, but that may have actually happened any color commentary about where you see maybe hospitals and health systems have spent more money in certain areas that they shouldn't have they need to pull that back and redeploy it and other areas.
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Shannan Epps: Absolutely, I think over innovation is definitely a problem in our in our space right now and.
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Shannan Epps: In and I would say that it goes back to what I talked about earlier in our conversation it's it's over innovating and developing solutions that already exist with the software that you're using today that's the problem so.
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Shannan Epps: You know, in the case of epic and cerner when our health care clients are spending millions of dollars a year and maintenance and licensing fees.
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Shannan Epps: It doesn't do that health system, and then by default the patients and the community that that health system is supporting to develop new tech that already exists that's money that could go into optimizing the existing software and improving the existing software so.
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Shannan Epps: You know it's it's a it's a weird.
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Shannan Epps: dichotomy I think right, we need to, we need to over innovate in a way right, we need to make mistakes in in technology in order for us to make progress.
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Shannan Epps: But at the same time it's it's tricky to understand where that where that line is right, where are we spending too much money and the larger healthcare systems in this country, I think, are doing a good job in kind of.
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Shannan Epps: Moving the needle right pushing pushing the boundaries, but for the smaller health systems that are just thinking about how do I improve my network right, how do I stay independent right how you know how do I.
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Shannan Epps: Make sure that I have enough patients coming in to you know stay viable it's really critical to lean into existing software where where it exists and make sure that you you're not trying to develop something that is already in place.
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Shahid N. Shah: yeah and if we can give in the last couple of minutes that we have Shannon a framework for thinking for our senior executive so assuming you're a health system.
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Shahid N. Shah: Which is going to be in the healthcare delivery business, a lot of people are trying to get out of it and do other things, but let's assume you're in the healthcare delivery business here are your quick framework ideas so number one, what do you need in order to attract and retain patients.
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Shahid N. Shah: Right, so you say okay well if I, what are the demands of my patients that are making them walk away that's a great place to innovate on and there's not always a.
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Shahid N. Shah: Quick feature, you can turn on an epic to make that happen perfectly reasonable to look at that, then there are things that payers and employers need to help pay you for the work that you are doing.
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Shahid N. Shah: So if you need fundamental technologies.
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Shahid N. Shah: That would help you aggregate data prepare that data better for claims processing watch your claims to make sure that your claims are being paid appropriately, those are also very, very good and sometimes they are so unsexy.
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Shahid N. Shah: that one does not think of them as an innovation is just as much as an innovation to improve how an invoice looks to a to a person with a visual impairment.
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Shahid N. Shah: So that they pay.
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Shahid N. Shah: Their darn bill that's just as innovative and in fact we're going to cover that topic here at health impact about how to make software more accessible, so that people can pay you easier right.
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Shahid N. Shah: And then there's the issue of your network participants, you know health systems connect with labs and images and imaging centers and.
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Shahid N. Shah: Pharmaceutical companies, etc, what are the innovations that you need to improve that supply chain are are very, very good to be thinking about.
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Shahid N. Shah: Are those the kinds of ways that you're advising clients, you know, setting up these kinds of frameworks to help them and say.
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Shahid N. Shah: Look, he got to think about these areas and the way you said it was perfect, is what what are you trying to accomplish this year, your board is probably already given you the goals.
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Shahid N. Shah: If every piece of technology that you're buying is not aligned to that goal, probably not a dotted line I mean a straight arrow to that goal, it may be over investment is that is that about right.
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Shannan Epps: I think that's about right and you laid out of really a really good framework right and it is, it is truly about getting back to basics right what.
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Shannan Epps: What are we trying to what are we trying to accomplish where everyone is trying to make sure that they attract.
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Shannan Epps: and retain patients and then take good care of patients right so it's not just about attracting and retaining customers it's about attracting retaining and then providing the care.
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Shannan Epps: On the network integration piece, you know we're still we're still pretty far away from being an integrated health system.
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Shannan Epps: Just you know payer and health system integration it doesn't totally exist right now, and there are a lot of systems that are thinking about that and starting to starting to do things there so.
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Shannan Epps: that's a great area for clients to to focus on.
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Shannan Epps: is just just that integration and then, as far as the Community network partnership goes there's again there's a lot of good processes and technology that's already in place there to build upon the networks that.
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Shannan Epps: That exists, so I think that's a perfect framework should eat and a good place for for organizations to start.
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Shannan Epps: I think you know that that middle one that network integration payer and provider integration, no matter how innovative the health system is that's an area that really needs improvement, so that's an area that that health systems should focus on.
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Shahid N. Shah: perfect and so we're out of time, right now, but as you guys heard with this will be talking about all these topics, the rest of the day, today and tomorrow, please reach out to Shannon and her team.
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Shahid N. Shah: there'll be very, very helpful as as you saw on this call, they know what they're doing and.
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Shahid N. Shah: could be quite useful from a prioritization perspective and as you've often heard is, if you have.
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Shahid N. Shah: 100 priorities, it means you have no priorities right so bring in experts like Shannon to come in and help you prioritize time to your.
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Shahid N. Shah: to your things that your board and your senior executives need and and your technology decisions become a lot easier because of that alignment so with that Thank you so much Shannon for.
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Shahid N. Shah: giving us your precious time here and hopefully i'll stick around with us for the rest of the day, as well.
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Shannan Epps: Absolutely i'm looking forward to the rest of the conference Thank you so much, everyone all right great.
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Shahid N. Shah: Okay megan Jeanette sound good.