Rachel
Hello and welcome to the Spark, a view of innovation in healthcare. I’m Rachel Schreiber, your co-host, and in this episode, we’re speaking with Dr. John Chelico, system Chief Medical Information Officer for CommonSpirit Health, which delivers care across the system of 150 hospitals and more than 1500 care sites in 24 states. CommonSpirit works with close to 25,000 providers and has more than 300,000 inpatient visits and more than 14 million outpatient visits. I’m also joined by Stuart Hanson, CEO of Avaneer Health.

Stuart
Thanks, Rachel. Wow, what a great statistical introduction for Dr. Chelico. Thank you for joining the podcast with us and welcome to the Spark. We’re really excited to have you join us for today’s discussion. I’ve heard you speak a number of times and it’s always been impressive to me, not only the challenges that you’ve tackled, but now obviously taking that to a system as large as CommonSpirit has got to be really exciting. So let’s go ahead and jump into it. I think just as context, Dr. Chelico, one of the things we always talk to our guests about is healthcare is a really hard industry to make an impact. And I tell a lot of startup, I’m a startup founder myself, I tell a lot of startup founders, if you don’t have the passion for it, go find another industry. It’s way easier almost everywhere else.

It is. The kinetic energy of the status quo is just so great in the healthcare ecosystem and the system is so complex and the multi-payer, multi encounter, the care delivery model, all of the transitions that we’re trying to go through from a consumerism perspective, ai, new technologies, value-based care, it’s pretty daunting. So we don’t have guests without a lot of fortitude on this show, including obviously yourself. But I’d love to hear just a quick version of what inspired or what sparked your passion to tackle healthcare and stick with it because done some amazing things over your career so far.

John
Yeah, definitely. My passion for this really kind of starts early on. I was always a kid that sort of noodled on trying to fix things in my house and that sort of grew to trying to fix things using software technology and other things. And I’m sort of like a software developer in the term physician. In the 1990s, I will say I was sort of a software developer and had the opportunity to become an EMT early on in high school. Really just saw the pitfalls of healthcare and the opportunities that we could do things a little smarter, a little bit faster, a little bit cleaner, and really had this passion to really follow both a career in healthcare, but a career as a software developer, a computer scientist, hardware developer over time. And really that went through all my training and eventually got formally trained in internal medicine and did follow up a fellowship in biomedical informatics.

But really that has led me a career to be a Chief Medical Information Officer for a number of large organizations, including Bellevue Hospital in New York City, NYU, Langone Medical Center in New York City. But then for the past almost 10 years, I was at Northwell Health followed by now 20 months into a job at CommonSpirit Health on a national level. And that passion just continues every day to sort of solve problems that we have in front of us in nuanced ways, sometimes with technology, sometimes with new ways of doing things. So that is really what wakes me up every morning. And I think you think of the pivotal moment, but I think the pivotal moment comes every day in the sense that we have another help to overcome, however it maybe in healthcare these days.

Stuart
Yeah, I think that that feels familiar to me. I mean, one of the things I fell in love with was the complexity and the ability to really impact people’s lives. And like you said, that comes with great responsibility because in healthcare, one solution can create a lot of value, but one failure can also cause a data breach or bad care provision or any of those things. So it’s a heavy responsibility and that I think is why a lot of people don’t carry that spark forward as aggressively as you have in your career. So congrats.

John
I think you have to understand the pain and experience the pain overcome it.

Stuart
And I think in the last, I’d say five to 10 years, I think a lot of people have really personalized the administrative side of healthcare because rise of high deductible plans and all of the consumerism initiatives and telehealth consumers are getting for better, a lot more engaged in a lot of their healthcare decisions. And the downside of that is they’re seeing the bad experiences that result from some of the broken processes and technology debt and complexity of the industry. But I think I get inspired by that every day. So it’s exciting to have someone else on the podcast that gets just as inspired every day with those little challenges as well as the big ones.

So maybe tell us a little bit about some of the ways that your healthcare team at CommonSpirit are tackling, trying to really make an impact and change how things work at CommonSpirit. No shortage of pressures, right? Provider burnout is real. The pressures of the economics of providing healthcare have always been real and are more real today than before. So tell us a little bit about how you guys are moving the needle.

John
Yeah, no, I mean I think one of the biggest challenges, and I think we had spoken about this a little earlier, was we are in a very high revenue, low margin sort of situation in healthcare. I went from Northwell Health was, I said 15 billion without a penny to spend. And now I’m in an organization with 35 billion without a penny to spend. And I don’t take that lightly in the sense that that is a major challenge we need to overcome and a CommonSpirit health. Really the forming of what was Dignity Health and Catholic Health Initiatives in and 20 18, 20 19 really brought together an opportunity to trying to create economies of scale to overcome and do more with the limited resources that we have. And I think that’s how we’re going about doing it and really understanding standardizing workflows, standardizing the vendors we work with, standardizing the care that we deliver, is that we can sort of now develop and see, develop some economies of scale and allow us to again, do things with the limited resources we have and maybe do things a little bit different than the resources we have.

One of the things that comes to mind is our connection centers answer the phones for many of our doctor’s offices across the country. We are not a hundred percent there with every single doctor’s office, but now all that work that needs to be done in the doctor’s office doesn’t need to be done by the person that’s sitting behind the desk that’s trying to interact with our patients on a day-to-day basis. Many of the sort of prescription refills, rescheduling of appointments and other things can be offloaded to a team that’s sort of centralized, that can actually see things across the board, maybe get patients to the right place and understand that, but spend the right amount of time doing the right things for the patient. And I think doing that more in a centralized fashion actually helps in a global scale in the organization as we kind of look at 14 million outpatient visits, how do you interact and have that personalization for the patient, but at the same time, at the same time, make them feel like they’re still talking to their personal doctor’s office and that they’re doing that.

And those are the sort of things we have to sort of overcome in understanding that. But it is technology in the background that can really kind of tell us, Hey, this is the patient calling, this is their caller id, this is all their information. Pull up all their EHR information and understand, hey, I know you’re calling today to schedule or reschedule an appointment or do a medication refill, but your doctor, last time you had a conversation with him asked us that we had a conversation about your colonoscopy. We’d be interested in scheduling that visit with a gastroenterologist or for your cancer prevention or other things. So the ability to again, do things smarter in a much more cleaner way were things that we probably couldn’t even do a one-on-one interaction in the office practice. So that’s again, just, and nothing that complicated. It’s almost things that in other areas, in other industries, it’s just sort of become commonplace.
Rachel
And that’s a great point about other industries. Are there other industries that inspire you when you think about how healthcare could run more automatic or you could have the right people doing the right work and really revise workflows? Are there other industries that really inspire you?

John
I’m inspired every time I pick up my smartphone and look at the top 10 apps that I’m using in travel, in shopping. I mean, why do I count on some of these apps to do my day-to-Day? Things like grocery shopping and picking up a taxi or just basic sort of banking. I’d rather deal with my banking app than I would deal with the teller. It’s just so much easier and I have so much more confidence in the process. It just self-service that inspires me. I mean, I think that’s what people want. And I’m not saying, we always say, oh, that’s not what older people want. Well, I have parents that are sort of looking forward to doing that on the phone in much more confidence than they were ever before and they never laid their hands on a keyboard in front of a computer. And I think that’s really inspirational in the sense that that is doing more much in a much smarter way in a way that our consumers want these days. So that’s very easy to find many other ways where we can sort of improve upon what we’re doing on a day-to-day basis.

Rachel
What’s challenging about that? What kind of barriers come up when you’re implementing or considering those types of processes? What kind of barriers pop up that you have to address?

John
I think one of the major barriers for us for innovation is that healthcare systems as they exist today, have been the result of a lot of mergers and acquisitions. We have multiple platforms, we have multiple EHRs, we had multiple revenue cycle systems. I remember at Northwell Health, we sat down to say, Hey, we’re going to do the digital front door. Well, one of the things we want to do is self-schedule. How many ways a patient schedule in this health system, oh, maybe 20 different ways, do we present that to the patients? If you are a patient of this and that you go to this button and you do this, this and that, you go to that button or even simply, Hey, we’re going to have them pay our bills, right? Well, how many different ways you pay your bills?

And it just goes to that point of was, well, we have to fix this foundational thing before we actually build the front end of really what we’re developing to the consumer. So it’s not that we don’t want to have patients do all these things easily online, but in the end of the day, we still have to fix the foundational things. Why are all our doctors scheduling their appointments on the same schedule or on the same platform? How come I can’t really get a list of all our providers in a region in a single platform? And I think we do it in pockets, but I think we need to sort of again, expand upon that. So that’s a big sort of hindrance in that, in the sense that, and then it comes back to the fact that it takes a large investment to do these things and create these foundational things that our consumers, our doctors, our healthcare workers, do not see at the surface.

I think it is also the IT infrastructure because of lack of innovation. I mean, sometimes someone say, well, why can’t my EHR work like my smartphone or whatever new technology. It’s like, well, I don’t have the same budget. The EHR companies don’t have the same budgets to develop in their user interfaces that some of these technology companies have. And I think that’s something to kind of put in context is that we would love to innovate. We’d love to move as fast as some of the sort of other industries. But I think the fact of the matter is that we only have a slim 1% margins on 35 billion, a couple percent margins on tens of billions of dollars doesn’t really hold very well when you also to maintain buildings and infrastructure and air conditioners and elevators and other things and defunct radiology machines or whatever the case may be, these things are expensive and I think we have to make those investments in order to get to the next level. And that’s why you see smaller health systems sometimes easier, more nimble to innovate or push things across the line. But CommonSpirit health, I think we’re going to be there. We’re going to get there. Just give it a little time. We are getting to a spot where we able do this a little bit more nimbly. Yeah,

Rachel
That’s the nature of the challenge of disparate organizations coming together and achieving innovation at scale. That makes a lot of sense.

Stuart
We have a wide range of listeners, Dr. Chelico on the podcast. And I know some of them are coming at this from an outside perspective, from the tech startup or the small company space, really trying to make an impact. But it’s very difficult from the outside in obviously. So any advice that you typically give? I know you talked to a lot of startups, you talked to a lot of tech companies. Any advice you can give them in terms of how to make their solutions more adaptable to a large organization like CommonSpirit?

John
I often tell healthcare startups and other things, put yourself in the healthcare, the provider’s shoes, the administrator’s shoes, understand that perspective, understand how they come to it and the skepticism to it. I’m a tech guy at heart. I’ll always sort of be excited at any sort of tech innovation. And oftentimes I’ll tell folks and be like, Hey, I’m excited. I’d love to do this. Help me sell this to the 10 other people I need to sell this to in my organization. And I think that’s the crux of it, is that you do have many masters and you do have many people that are trying to do the right thing for the organization, all well intentioned, but the pitfalls of understanding an IT security breach that could shut down our healthcare organization, a breach that could cost us tens of millions of dollars. And not only that, the impact to our patients that we serve, right?

Ultimately the legal implications of understanding where our data goes and how our data goes and what it gets done gets done with it. All of those things have major implications and understanding that and the nuances to, again, training a workforce of 150,000 people to change the way you’re doing things. It is not easily to change on a dime. And we always to say we’re not a little speedboat, we’re more like an aircraft carrier, but I feel like we’re more like a continent in health. Understood. But the reality is that I think that you have to understand it from that. And I think we are trying, the thing is oftentimes technology partners come in and very excited about fixing one little point solution. We’re oftentimes looking for enterprise solutions. We don’t want to work with, currently we have, I don’t know, something like 2000 Bolton vendors to our EHR environments or our revenue cycle environments. We’d like to sort of work with less and do more with more

With them then have a million different point interactions. And I think that’s the other thing is like, Hey, I have this wonderful solution to solve this one little thing about your one little piece of your patient population in one market. And I think you have to understand that more on a global level. And that’s where I think sometimes healthcare innovators outside of healthcare don’t understand, or people coming from other industries don’t understand. I mean, we’ve seen this on and on with companies with lots of deep pockets. Your Microsofts, your Googles, your Amazons of the world, they have a rough time at it.

Stuart
It’s harder than it looks on the surface, right? Yes. Yeah, it is funny. I had someone a few weeks ago express frustration. They’re like, Hey, my watch told me that my heart rate spiked when I was shoveling snow, but my doctor didn’t call that my prescription. I hadn’t gotten a prescription refilled. I’m like, well, that’s not that easy. There’s a lot of reasons for that, and some of those are protection of your data. But I do think that there’s a lot of ways that we can unlock a lot of value from these new innovative technologies. But I think data is important, infrastructure is important. And as you said, scale of process is obviously a really big challenge. Anything specifically you’d like to highlight in terms of things that you all are tackling at CommonSpirit over the next 12 to 18 months? What’s your biggest idea or your biggest opportunity you think?

John
I think our biggest opportunity, like I said earlier, is just trying to do things a lot more virtually with our patients. A lot of the things that we are dealing with staff shortages everywhere in healthcare, it’s front desk staff, frontline staff, physicians, nurses, all the above. We need to do, again, the theme here really is to do more with less people. And I think the fact of the matter is that you don’t need an army of people to sort of do some of the things that you need to do. So a lot of the things we sort of set out a year ago, and we’ve accomplished it, is that everyone should have a virtualized visit. All that interaction that you do prior to you walk into a doctor’s office where they collect your information, sign your consents, collect your copays forms, and other things can all be done prior to you getting to the office.

And most of it can be done on your smartphone. And we’re trying to shift that so that we can actually do that virtualized care all prior to the patient actually coming to the office. And oftentimes we’ve got the process to a point where even if you’re in the office, so rather you go do it on the phone and waiting room because it’s such a cleaner process, our ability to copay and other things is just more facile using the technology. And I think that’s one thing that we sort of pushed and pushed ahead. And now doing that, I do have to do it. And currently in about six different EHR environments. And I think that’s a nuance. Different vendors, different products and things like that. And I think as we get smaller and smaller number of products that we deal with on a day-to-day basis from that perspective, that makes that a lot easier.

I think we’re also sort of saying, hey, we’re not going to be on a single platform tomorrow. We’re not going to be able to do this. So we have different ways by which we accomplish this in different places. So in some parts of the organization where we have, and I’ll let the EHR companies names to be obscured, we have to use a third party to actually do that virtualized visit in some other places. We can do it with the core technology and we will, I think that’s the patient portal that has the ability to do all that stuff, has the integrations to do rev cycle and other things that you’re trying to do to that. We also looking an eye towards robotic process automation. Our clinical standards group has really made it a point to really improve cancer screening throughout the organization. I think it’s the right thing to do for our patients.

It’s the right thing to do for our even downstream revenue as we get more patients to get their colonoscopies and get their low dose CTs for lung cancer screening or maybe even get their mammograms and things like that. It’s a good thing for the patients and getting patients into our system to really have the proper workup if things should come positive or whatever. You doing that and sort of doing that in multiple different environments using robotic process automation has really kind of taken us to another level. And that’s something that I look forward to. We have a couple bright spots where we’ve piloted, not just piloted, but put this into full operations. We’ve taken that to two or three regions, but now we’re trying to say, how do we do this to scale? And we are, I think the ability to sort of use that technology that almost writes fit to almost any platform, I think is where we’re pushing this and working with a number of homegrown solutions, vendor-based solutions.

But the technology, someone to put hands on keyboard where we would need thousands or maybe hundreds or thousands of people to do to go through a chart and put an order in for a cancer screening on a day-to-day basis, can now be done in the middle of the night. We can tee up things for the providers and the care team. And I think it’s really kind of amazing how we, again, just think a little bit differently. And again, nothing kind of drastically from a technology perspective, amazing. But at the same time, major impacts so that healthcare we deliver.

Rachel
I’m hearing the words automation and really making that happen and it’ll result in a better patient experience through their lifetime. So as a wrap up, what key phrase really describes the vision of what you’re creating at CommonSpirit?

John
Good question. The one I always dwell on always is just to be humble, understand where the organization has been, understand why the organization is where it is. I think it is to kind of understand that you’re coming into an organization not having all the answers, but working together with that part of our organization to actually get to a better spot. And I think that is probably something I can probably share with any of my colleagues, but any of my folks that I advise or work with in healthcare startups and other things is they just be humbled at understanding why things are the way they are and why things are so different. And have a little patience and really kind of understanding that. And then you’ll get yourself the better, deeper conversation of how to get your technology to be implemented in your organization.

Rachel
Well, thank you for sharing that. And as a healthcare industry, we need more innovators like you who are challenging the way healthcare operates and putting the patient at the center and identifying ways that the patient experience can be better. So thank you for that. And thank you for joining us today, Dr. Chelico.

John
It was an honor to be here. Thank you.

Stuart
Yeah, really appreciate it. Thanks a lot.