Empowering Healthcare Providers With Technology

Transcript

Bryce 

We’re excited to welcome our guest today, Karen Serago, the CTO of Community Technology Cooperative. Karen has worked extensively in EPIC implementations and integration and has successfully led several EHR initiatives. Her experience has helped her company, Community Technology Cooperative, complete 13 EPIC implementations for FQHCs.

She believes that FQHCs can improve health and equity and achieve better patient outcome goals through technology. Before her role at CTC, Karen worked as Director of Applications for Cambridge Health Alliance. She was also a project manager at Partners Healthcare, managing EPIC integration with three pharmacy systems.

She has even worked in other EHR systems and managed various hospital operations. Please join us today in our discussion with Karen as we’ll explore empowering providers and how technology can help providers achieve better patient outcomes. Thank you for joining us today, Karen.

How are you?

Karen 

I’m doing well. Thank you so much for having me. I’m excited to be here.

Bryce 

I’m super excited to have you on. We’ve had multiple discussions in the past with many domains in the industry. Given how big they’ve become, this will be our first touch on Epic, which is important to almost everybody in the space.

Almost everyone in this space is involved in Epic in some way. I’m super excited to have you on board and discuss some of your insights into Epic. Starting with your professional and personal career, Karen, your career graph highlights your work in healthcare technology.

What obstacles and risks do you frequently face in implementing technologies, and how do you migrate them?

Karen 

Yeah, sure. The first thing that comes to mind with our CTC work was our first round of implementations in 2022. That was December of 2022.

We went to live with ten federally qualified health centers. They were all independently owned health centers. They all came together to implement Epic on one shared instance.

It wasn’t very nice to have ten going live at the same time on the same day. If I were to do it again, I’d do something like six the first day and then roll it out more slowly. Having ten separately owned health centers all going live together meant they all had to come together in a shared instance.

They came together to make all decisions for every area of the technology they would be implementing. What we do at CTC is bring health centers together for bargaining power, better contracts, and lower costs by coming together and sharing collectively. We do this across not just Epic implementations but their faxing vendor, AI vendors.

That’s a little bit of a background on CTC. What I found the largest obstacle was that point where they all needed to come together to make all of those collective decisions. It wasn’t easy when you have ten different chiefs of pediatrics, ten different directors of ambulatory, and ten different practice managers for the front desk, and each one, every health center does things a little differently.

To mitigate that, we created a very strong governance process. At the lower level, we had work groups. The work groups looked at the different applications and areas where decisions needed to be made, including two representatives from each health center.

They met once a week to make the decisions at a workgroup level. You had a front desk workgroup, a technology workgroup, physician documentation, a nursing one, all different types of work groups, population health, and a patient portal. And anywhere they could not decide, we had a steering committee, one representative from each health center, and that was more at the director level.

And then, at the top of our governance is our board. We call it the board of managers. The board of managers comprises one senior executive from each health center.

And because of this strong governance process that we had, only a few decisions ever went all the way up to the board, where the senior executives of the organization and the different health centers usually had to come together to make the decisions. But when a decision couldn’t be made and it went up to the steering committee, it would be taken Care of there.

Bryce 

You know, that is, I love that process that you guys follow, and having that continuity between all of them, I’m sure, is a massive detail in making all of this work as well and getting into that next stage of tech solutions for kind of equitable health care and FQHCs. In what way do you see or think new emerging technologies like AI, which is such a hot topic, and even data analytics will help foster health equity and help FQHCs deliver better Care?

Karen 

Yeah, a lot is going on right now with AI. Data analytics has been around for a long time. Any conference you go to, you hear, oh, this is our AI roadmap.

Do you want to hear what we’re doing in AI? So, something that I’m familiar with right now is there are many things we’re hearing about in AI that can help federally qualified health centers. Some of the more interesting ones I’ve seen were the ones that help decrease the cognitive burden on the clinical staff by helping with administrative tasks.

So some of those vendors I’ve seen are writing notes, helping scribes, drafting replies to patients based on what happens during the encounter, and even drafting denial appeal letters to insurance and suggesting medications. So, it’s a lot of really interesting things that can happen even today with AI that we’re looking at, and that will help FQHCs deliver better Care because now they focus on the patient and spend less time on administrative tasks.

Bryce 

Right. Is it true? As this thing emerges, there’ll be more and more breakthroughs. Is it mostly administrative tasks that we, the AI, are helping with, or are there still some clinical things it’s doing currently?

Karen 

Oh, clinical things as well. The helping with suggesting medications that’s more of a clinical thing. Yeah, definitely.

Bryce 

For sure.

Karen 

Yeah. There’s so much going on right now in that space that it will help with administrative tasks and the clinical side.

Bryce 

Yeah. You’ve seen it so well. You’ve seen how incredible those administrative tasks are and how efficient you can become with them.

I’m so interested in learning what we’re going to be able to do with it on the clinical side in the future. And like you just mentioned, with even just the beginning of prescribing medications, it’s so huge. So that’s very interesting.

Could you share an example of how technology changed how federally qualified health centers delivered Care and improved patient outcomes? Is there just going to be a quick example?

Karen 

Yeah. I mean, there are numerous examples, especially with… Could you ask me that question again?

Let me get down there. And one thing: I still need to answer your question about data analytics.

Bryce 

Where is… Oh, I see that one. Okay, we’ll go.

Karen 

It was just technologies about AI.

Bryce 

Okay. And so I appreciate you sharing that professional and that personal story, kind of getting into the tech solutions for equitable health care in these FQHCs. In what way will emerging technologies like AI and data analytics help foster health equity in FQHCs to deliver better Care?

Karen 

Sure. Well, AI right now is the big buzz. Everything you hear is about AI, what’s going on in AI, and our AI roadmap.

Some of the really interesting ones I’ve seen recently are with notes, being able to help writers write notes and scribes. I’ve seen a vendor that offers to draft replies to patients based on what happened during the patient visit. Another cool one I recently saw, like last month, was an AI bot that looks at what has happened during the last few visits and can help draft denial letters to insurance.

Wow. That’s interesting.

Bryce 

I love hearing about that. That can be a powerful tool.

Karen 

Oh, absolutely. And that’s just a few examples. There’s a lot out there.

I know you also asked about data analytics just now. With FQHCs, it’s so much about data analytics because of the amount of reporting and regulatory requirements that they have. So what I’ve seen that’s been helpful is how data analytics have provided insight into what’s most valuable with health inequities.

So, you can break out race, ethnicity, and language measures to know where to focus your attention. And as you know, health equity is nothing new to FQHCs. FQHCs have their roots in the civil rights movement.

FQHCs emerged in the 1960s as part of the civil rights movement. Looking at data and seeing where there are health inequities is a valuable tool in this landscape for the type of work that an FQHC does.

Bryce 

100%. 100%. And it is so important for them to be able to have that data and use that as a tool instead of operating in the dark, which I feel was happening maybe in the past when it was harder for them to see their outcomes and see their reach, which I love so much.

And those are such an important thing. And if people listening need to learn a ton about FQHCs and their impact on communities, it’s massive. It truly is massive.

So, I love the work that CTC is doing. It’s fantastic. Could you share a brief example of where these technologies change the way FQHCs deliver Care and improve some patient outcomes?

Sure.

Karen 

Let me think. Some of the work that we’re doing is related to the area of interoperability with EHRs. So we have things like in Massachusetts, the Massachusetts Highway, where you’re sharing patient data between healthcare organizations.

By being on a shared instance of Epic, all of our health centers can see each other’s data as if they happened at their location. They can also see patient data from any other Epic customer. This has allowed clinicians to see records from recent hospitalizations and knows they need to do outreach when one of their patients is discharged.

I know one of our providers at CTC, our chief medical information officer, had mentioned that he saw a patient last week who was about to put on a broad-spectrum antibiotic and then noticed in this application called Care Everywhere, where you can see patients’ visits elsewhere, that the patient had just completed a broad-spectrum antibiotic just before. Hence, he knew how to switch it. So that’s a note he would have seen only after having a shared EHR had the patient not mentioned it. In this instance, the patient didn’t mention it.

Bryce 

Yeah, that’s so huge because in the past, you’d have to call, and either the patient would have to call and get records sent over, or they just would not get sent over at all, or the clinic has to have a med tech or a medical tech spend that time to try to chase down those records. That is one of those things where it’s just like a no-brainer, where it’s like, how do we not be doing this sooner? Even if you want to look at a different domain in criminal justice, it was a long time before the FBI and the CIA started sharing information and how much it helped.

And it’s the same thing in the healthcare world, where you’re trying to help have continuity of Care, except you need information about past Care. It truly doesn’t make sense. So that’s a great example.

I love that.

Karen 

Yeah, thank you. And even with another example of technology being able to empower the patient. It’s rare that you, as a patient, need a patient portal option.

And then with the amount of work that’s been done in patient portals, that’s a place where now patients can request their medications, request refills, fill out medical questionnaires if they think they have something like the flu or COVID and be able not to have to be seen because they filled out a questionnaire that allows for remote diagnosing. They can request appointments or even direct scheduling into their provider’s schedule. Another thing that we’ve seen is that patients who have diabetes can take their measurements at home and have them automatically sent to their providers through the portal.

Bryce 

I did that last week with my provider, my tandem, and my Dexcom. And it’s the first time I’ve done it. It was so seamless.

I have an email, and they have a clinical ID. I just entered that clinical ID into the Dexcom app, which sends everything. The doctor looked at it right there on her iPad, and she gave me a call. It was so, so incredible.

That’s a first-hand experience on that. I love that.

Karen 

It’s wonderful.

Bryce 

Yeah. So OSP, we’ve also worked for FQHCs earlier, and we understand that the data privacy is; I don’t want to call it an issue for them, but it definitely could be an issue. How can FQHCs approach leveraging patient data while maintaining privacy?

Privacy is such a huge thing in these worlds, and data protection and ensuring your security are also important.

Karen 

Absolutely. Data privacy should always be at the forefront of my mind. It’s incredibly important.

At CTC, for example, we, because we’re on a shared instance, don’t in any way want to hold back any health center from being able to access all of their data. So please do not hold back any access to their data. What we’ve done instead is we have customizations built into Logic and into our databases that only allow health centers to access the data for their specific health center.

Because we’re a shared model, we don’t want one health center to be able to pull data incorrectly from another health center. So what we’ve done is we’re, again, not in the business of restricting access to their data because that’s the data they needed. But just put safeguards in place so that they’re not seeing any other health center or patient that isn’t there, mostly for privacy reasons, and also so that they’re not reporting anything incorrectly.

Bryce 

Yeah. Yeah. That’s a fine line because the goal is to share as much data as possible and have these clones work together, which is a seamless process.

But at the same time, you also have to be so careful that you have data privacy and protection for your patients. So, it is an important topic. You are getting into emerging technologies and personalized Care.

In the current healthcare landscape, personalized Care is quite essential. It’s the new thing in medicine right now. How do you think technologies like AI and machine learning effectively make more Care personalized? How do they do that?

Karen 

There’s an example that comes to mind when talking about AI. The AI thought we looked at appointment trends and patient demographic factors. So, like, when I say demographic factors, has the patient’s address changed more than once or twice in the last three months, things like that, to identify patients that should receive further follow-up like a phone call, a reminder, offer them alternative times to reduce missed appointments. So, personalized Care is something where you’re leveraging an AI tool to identify patients most likely to miss an appointment, for example.

Yeah.

Bryce 

Please share a couple of specific examples of CTC leveraging such technologies.

Karen 

Yeah. I mean, let me pause on this one. Hold on.

You’re fine. No problem.

Bryce 

Karen, could you share a brief example of some future technologies that CTC is looking to leverage to help FQHCs improve patient Care?

Karen

Sure. We’re currently working on an enterprise agreement with a speech-to-text vendor that will help our providers with churning. We’re trying to do that at the enterprise level to provide better bargaining power for our health centers.

So similar to what we had discussed before, this will allow for more, less time documenting, more time with the patient.

Bryce 

Yeah. I would like to know. I’m not a physician; my wife’s a doctor, but I’ve never really asked her that question: how much time do they take to sit back and go in with the voice recorder and sit in that office and dictate their notes and how efficient that is because there’s got to be some better ways to do that. And you’re right, like being able to spend even ten more minutes with a patient, maybe about that 15-minute appointment that they will always look like they’d love to squeeze you into sometimes into 25 minutes because you don’t have to spend that extra 10 minutes dictating is huge.

It can make a bigger impact, not only on the physician and being able to garner more information, but also on the client and the patient and feeling more connected with the physician. And that’s just like a, maybe such an easy way that I don’t think a lot of people think about having to go back and spend that time to dictate their notes and how long that takes and having an AI tool that does that efficiently is, really, really interesting. I love that.

Karen 

Yeah, dictation has been around for a long time. I remember that from the early 2000s; I guess what’s great about what’s going on now is that because of AI, it’s filling out charts correctly. It’s going in, filling out the questionnaires for you to know which question to jump down to, basically moving through the patient appointment with the provider.

So it’s different from the tool we’ve been using since the early 2000s when that was the other big thing. Yeah, there were a lot of improvements down there.

Bryce 

Yeah, I love that. Getting into some personalized and personalized Care is becoming more data-driven as we have the tools to collect this data and follow a multidisciplinary approach. How will technology foster better provider collaboration to deliver personalized Care?

I know we’ve briefly touched on that earlier with the healthcare highway; I believe you had mentioned them being able to share that data. Are there some other examples?

Karen 

Building off that, it’s what’s really, let’s start over. Sorry.

Bryce 

No, you’re good. I am getting into more of the talking about data, data-driven technologies, and whatnot. Hold on; I just got a phone call about that, too.

So, getting into personalized Care and the data being used, personalized Care is more data-driven as we have tools like the Massachusetts highway you mentioned earlier. Correct me if I said that wrong, please. But how do you see technology fostering better provider collaboration to deliver personalized Care?

Karen 

Sure. I think it’s the access to large data sets.

Bryce 

Yeah.

Karen 

Yeah. One of the things that we now have access to through our EHR is a data repository of de-identified patient data. So now we have something like grant writers, analysts, and specialists who can access this large data set that includes all Epic customers.

To me, that’s something revolutionary. One recent use case that I saw highlighted was for suggesting that providers should collaborate because they treat patients with the same rare diseases separately. That’s just one use case, but having access to large data sets and seeing trends going on all across the country means there will be so many different things that can come out of that.

Bryce 

Yeah. Yeah. That’s such an important tool for researchers like you were mentioning, and that’s, I feel, how we’re going to make these improvements in these chronic diseases and some of these illnesses like diabetes that we’ve come a long way with. Please don’t misunderstand me; we can still take that next step.

So, here are just some final thoughts, wrapping everything up. As we’re moving towards a patient-centric model of Care, what do you most anticipated technology trends will empower providers and boost patient care? Are there some trends that are starting to emerge themselves that you guys are seeing?

Karen 

Now that patients have more access to their data. There are laws in place, like the 21st Century Cures Act, that allow patients transparency into their medical records and where their data is being shared; this is an area where I see where it will boost patient care. This will empower patients to decide exactly who sees their data. When, as well as let patients have access, I guess not access but allow them to have a say at the granular level, which will be important, especially with the ongoing threats that we have going on across the country to reproductive freedoms and now the difference between states and the laws around healthcare data.

Bryce

Yeah, and it seems like it’s giving these freedoms and this responsibility back to patients and having them be, which is so important because the adage is that you can lead a horse to water, but you can’t make it drink. The patient has to be bought in and involved in that Care. It needs to be a 50-50 or not 50-50. I can give on that, but there needs to be that input and that buy-in from the patient side, and that involvement is what I’m looking for, which I agree with.

And I think having these data-centric models and having people like to take back some of their choices with the Cures Act and other things is so important. And I appreciate you taking the time to share this insight with us, Karen. Thank you so much.

Karen 

Absolutely. Thank you for having me.

Bryce 

Yeah, no problem. Your insights on tech and empowering FQHCs are enlightening. And many people in this space will not be listening. Of course, everybody knows what FQHC is, but getting into some of the meat and how these work and advance is so important.

So, thank you for joining our podcast today. I’m super excited to see what’s next for CTC. Stay in touch with you and ask for the listeners. You guys keep innovating and transforming, and we look forward to speaking with you soon.