Gregg Masters 00:08
Welcome to this special edition of PopHealth Week recorded live in the HealthcareNOW Radio studio at HIMSS 2021 in Las Vegas. PopHealth Week is brought to you by Health Innovation Media. Health Innovation Media brings your brand narrative alive via original or value-added digitally curated content for omnichannel distribution and engagement. Connect with us at www.popupstudio.productions. Welcome everyone, I’m Gregg Masters, Managing Director of Health Innovation Media and the producer co-host of PopHealth Week. Joining me in the HealthcareNOW Radio studio is my partner, colleague, and lead co-host Fred Goldstein, President of Accountable Health LLC. So Fred, with that introduction over to you, who do we have on deck for today’s HIMSS 2021 Special Edition?
Fred Goldstein 00:58
Thanks so much, Gregg, our guest this week is Vik Krishnan, the General Manager of Intrado’s Digital Workflows. So Vik, welcome to PopHealth Week.
Vik Krishnan 01:06
It’s a pleasure to be here, Fred.
Fred Goldstein 01:07
Yeah, why don’t we start once you give us a little bit of your background, and then a little bit of an introduction into Intrado.
Vik Krishnan 01:12
Sure. I’ve been in the digital health space for about 20 years I currently manage Intrado’s digital workflows. Digital workflows, manages and automates mass inbound and outbound engagement workflows for healthcare, education, and utilities customers in the healthcare space, we serve about 14,000 healthcare institutions, those range from large health systems, to large hospitals, to regional hospitals, and ultimately, at the tail end of that health care clinics, where the market share leader for patient engagement.
Fred Goldstein 01:41
That’s a fantastic space. I love patient engagement. Obviously, that’s sort of the key to getting everything solved. We’re trying to do in healthcare today. So when you say patient engagement, what do you mean by that? And how are you doing it?
Vik Krishnan 01:53
Absolutely. So there’s three words, I really want to deliver to the audience here, platform, automation, integration. So we solve patient engagement through a platform approach. I think it’s historically been very common for hospitals to think about engagement, through simple workflows, like appointment reminders, and maybe broadcast, we’ve moved well beyond that. And so our customers, we think about a platform approach in terms of two way, automation of engagement through a variety of workflows, it could be appointments, could be referrals, it could be recalls for Annual Wellness Visits, it could be automating intake of information before a visit, solving for bad prep, and so forth so the whole continuum of every way, a hospital or health system would need to engage a patient and the type of engagement a patient would want with their provider.That’s how we think about it.
Fred Goldstein 02:44
And when you know, when I think about this, there are obviously so many areas you can impact. And then COVID had a little bit of an impact on our ability to communicate with patients. So just sort of initially, could you talk about how maybe it got used a little bit differently, or some ideas around COVID. With that?
Vik Krishnan 02:56
Absolutely. So there was last year, and then there was the first half of this year. So two very different times and COVID. And now we’re probably in the third phase of COVID, although maybe technically the fifth wave. Last year, what you saw was a shift toward telehealth and remote interactions and visits. And obviously a mass reduction in in, in-person provider interactions. So when that happened, there needed to be less appointment reminders, but more communication about what to expect between the provider and their community. More reminders of a telehealth visit more instructions being delivered about how a woman was pregnant, for example, should be thinking about her own care, which is not visiting your provider in person as much. What we saw in the first half of this year when COVID was spiking, but so were vaccinations was an over communication about the specific, I want to say over communication was appropriate, but a lot of communication, but the specific logistics about how to visit a hospital. So our platform was used, for example, to instruct a patient to obviously come to their appointment, but then wait in the parking lot for this time, five-minute reminder to walk in, put your mask on come in. So a lot of SMS-based communications, specifically instructing a patient about how to navigate and literally physically into the hospital and out. You know, while we were going through that February, March, April spike, there was a period of normalcy after that, and then now we’re hitting, you know, I would say third phase, and are actually many of our providers are asking for help, again, in terms of how to drive vaccination rates among that resistant portion of the population who remains unvaccinated and ultimately how to communicate with the community. When ERs are filling up again, unfortunately, and you know, what do we need to be telling our patient community so it’s the third phase, and we’re working with our customers to understand and support.
Fred Goldstein 04:50
Yeah, I love that idea of the parking lot one because that really suddenly goes beyond and you’re suddenly doing a patient safety thing with your platform because you’re not having people sitting in an exam room, etc. So it’s a great way to kind of stage it make it more efficient but also safer at the same time.
Vik Krishnan 05:04
Absolutely. And it’s not just messaging where you should be in when concepts like curbside check-in, automating the intake virtually so you don’t have to show up to the front office of the hospital, fill out a bunch of forms, you know, with a bunch of other people around. So really making all of that virtual, those were all workflows we worked on for our customers during what I would call the first half of this year phase of COVID.
Fred Goldstein 05:25
Yeah, I think about this, I worked in the dinosaur age of SMS text messaging when it was first coming out. But the workflow, you can create that I’ve seen your system do a really fascinating whether it’s around annual wellness visit, etc. Talk a little about it, some of that,
Vik Krishnan 05:39
yeah, so I’ll actually move to the second word, and that the three-word mechanism I had automation, right. So it’s very important for these workflows not to be manually operated by hospital staff, but to essentially code the algorithm have that automatically running. So for example, let’s think about how we solve for bed prep. So our solution Housecalls Pro, is in real-time scanning through a hospital’s EHR database, it knows when patients are scheduled for a colonoscopy, it instructs them automatically. So this is not the hospital contact center staff calling the patient informing them of what they need to do, our system is doing that automatically. It’s also flagging those patients who have reported that they ate a meal that morning, right and that we prevent that patient from coming in, we can refill that appointment. But what happens is a typical hospital will lose millions of dollars a year on bad prep, because the patient shows up. They’re supposed to have a cardiac exam, but they drink coffee, they can’t have it. That healthcare capacity is also lost to the entire community. It’s limited, and it can’t be filled once you discover when the patient presents, that they’re not suitable for that exam. So that’s the automation piece of it. The last piece, I would say is intelligence. Right? So it’s really an algorithmic approach to understanding when a patient should be reached out what they should hear and when that should happen. Right. So it’s making sure right message, right patient, right time, fourth piece as well, actually collecting their response and responding back to them accordingly.
Fred Goldstein 07:11
So in that workflow, as I saw, they can build off the responses to fire or trigger another event.
Vik Krishnan 07:17
Absolutely. So when you think about a post-discharge workflow that we serve to our providers, we can ask a patient and I’m oversimplifying here, are you well, are you not well after somebody had a surgery? If they say, Well, I am having some issues. We can actually conversationally through SMS record how they’re feeling, they may say my surgical site is burning, I have a fever. Based on what they’re saying, we have natural language processing this understanding that feeding that back into the EHR into the care team, we can also suggest that patient call 911 if it’s moderate seriousness, we can immediately link them to through a feature we have called Life Connect right to the hospital contact center, get them talking to somebody, but make sure that that engagement, that what started through simple SMS is closed loop. And it terminates appropriately for the patient. So that the outcome is is as well as we the pride we want to drive.
Fred Goldstein 08:13
And you mentioned natural language processing. So you take both SMS and you can do IVR. Is that correct?
Vik Krishnan 08:18
Absolutely. So we’re omnichannel. SMS tends to be the modality through which most patients want to be engaged. 90% of patients say they want the workflows all through SMS, 70%, say they want generally more communication through SMS, some patients will prefer voice and we can automate those same workflows with the same algorithms through voice, we use email as well, that’s a little less two way, a little less interactive. But if that’s what the patient prefers, we can do that.
Fred Goldstein 08:42
I mean, you walk around, you see everybody sitting there texting anyhow, we all respond to text. That’s what everyone’s looking for. And I know I’ve watched even in my own care how the providers have shifted towards a more text-based approach to me in response to that to do, what are some of the key things you’re seeing the healthcare systems move to now around SMS texting? Are there areas their really focused on?
Vik Krishnan 09:02
So at a high level, what providers are focused on is community wellness benefit, but also financial ROI? Right? So what is the provider thinking about? It’s maximizing patient volumes, which also maximizes their revenue, it’s minimizing their operational burden. So essentially, the costs that staff or contact center bear through manual work. And that is ultimately delighting the patient. If you do those three things, right, you’ll have impacted in a positive way community wellness if you’re a particular hospital serving a community. So there’s a variety of workflows that I could list that help solve those things. But how do you delight a patient? How do you reduce operational burden? How do you maximize patient volumes? It’s by letting patients do what I as a consumer want to do in banking or in airlines so I don’t want to call my airline I don’t want to call my bank bank to solve anything. I want to be able to use my thumb on my mobile and solve those workflows. I’ll be delighted. I’m more likely to do what my bank wants what my airline wants. Same thing in health care. So it’s almost a consumer-based approach. If you can automate these workflows in a way that’s minimally intrusive to the patient and easy to solve, any provider can achieve those three outcomes.
Fred Goldstein 10:10
Yes, interesting. I saw one of the examples, obviously, where you could say, Hey, we need to schedule for you, you for an appointment, but we need to talk to you, please call us between x and y in that text message. And I guess all they had to do was click on that message itself, and it fired back the call when they’re ready to do it.
Vik Krishnan 10:24
Yeah. So let’s think about an appointment reminder, what our platform Housecall’s Pro does, when we remind the patient about appointment, we give them three options, confirm, cancel, and reschedule that’s a little unique among other players out there, the patient says I want to reschedule, we will immediately present them with other options, the patient can even say conversationally, next month would be better this Friday would be better. We’re reading that you’re scanning the EHR in real-time and giving them options. So that patient is not lost. But I don’t want to ask the patient and no provider would want to ask the patient have to call the contact center to solve that problem. However, if it is an emergency based on what they’re saying, it may require an immediate transfer to the care team, to the contact center. What, however, that workflow should be solved. We use the intelligence the last piece of that, that terminology I mentioned, to solve that workflow.
Fred Goldstein 11:16
And you mentioned being linked into these EHRs and EMR examples of some of those that you’re integrated with.
Vik Krishnan 11:22
Yeah so we have real time integration into Epic, Cerner, NextGen, Athena Health other list goes on most of the major EHR is we have real time integration with
Fred Goldstein 11:32
I’m sure there’s a whole boatload of those out there. So it’s great to see that you’ve created those connections, because that’s the critical piece. I also understood that not only could you set up these workflows, but there’s the opportunity for somebody to do some of this in real-time if they need to with a patient.
Vik Krishnan 11:49
Absolutely. So the way Housecall Pro works is that it’s fully embedded into the EHR. So it’s a standard part of that staff’s workflow, they can access this functionality through, for example, Epic, right within how they how they interact with Epic, we have a dialogue builder, for example, so the staff can create their own workflow, the staff doesn’t have to call our support and ask us to initiate a recall campaign for them for Annual Wellness Visits, they can do it themselves of course. If the staff is not comfortable doing something they’d like to talk to our support, we’re pleased to do that. But we have had customers using Housecalls Pro, adding departments into the automated workflows, creating new automated workflows on their own without our support. That’s what we want to serve our customers, if that’s how they want to use it, if they do want our help, we’ll serve them that way, too.
Fred Goldstein 12:34
Right. And when you think about it from a hospital, or even a clinic perspective, you have these, neurology may need a different workflow for their messaging for their office visits versus a surgical case or something like that. And so that can be built within the overall platform.
Vik Krishnan 12:47
Absolutely. So within a hospital or health system to have multiple departments that have different patient needs that have different messages that need to communicate, they have different data capture needs, those are all workflows we can serve at a department level. The department can create them themselves that they prefer.
Fred Goldstein 13:03
And if you’re just joining us, I’m speaking with Vik Krishnan, the General Manager of Intrados Digital Workflows. So it’s great Vik as we talk about this, what are some of the obviously at the end of the day, healthcare systems are trying to become more efficient? It’s become about how we can get our revenue to exceed our expenses. Sometimes the margins are tight. Are you measuring some efficiencies out of some of these programs?
Vik Krishnan 13:27
So for example, one of our customers Kettering Health Network was dealing with a huge manual burden in collecting patient intake data before, with visits, we used Housecalls Pro, an automated workflow we designed for them to solve for that, right through the workflow right through SMS, we could gather the information that was needed from the patient. We saved Kettering a million dollars a year in manual efforts directed at patient intake. That’s one example. There are so many other examples of de-burdening staff D, eliminating manual processes to save money.
Fred Goldstein 13:59
Yeah, I was thinking about one of them. just toying with for years. So when the Annual Medicare wellness visit got in place. It’s something Gregg and I are very interested in I was very involved in Initially, I always thought the way to do that was to text the individuals in advance set up the meeting like you do. And then you can actually begin to gather data required to do the assessment through the text messaging, and feed that into your EMR and be ready when they showed up to actually produce that visit and report.
Vik Krishnan 14:26
That’s absolutely right. So many of our customers use Housecalls Pro to actually achieve two things related to Annual Wellness Visits. One is to use our platform to automatically scan through to determine which patients are eligible for an Annual Wellness Visit. We will reach out to that patient more we’ll let them know that they are eligible, they can schedule that visit through SMS through our platform. And then if they have scheduled a visit, we can then follow up with intake instructions and collect that data. There’s another piece I want to add here and it’s critical if the patient declines to schedule us annual well their Annual Wellness Visit that is reported to. The next time that patient comes in and talks to their doctor, and the doctor knows that they can discuss that with them. Also, this improves quality scores, because it’s very important to capture that you tried to engage the patient, and that they declined so our platform closes that loop, and solves that.
Fred Goldstein 15:14
And that then feeds into the record that they can then pull out
Vik Krishnan 15:16
Absolutely,
Fred Goldstein 15:17
and produce the reports to justify to the payers or whoever else, they’re producing these quality statistics for what they’ve done.
Vik Krishnan 15:22
That’s right,
Fred Goldstein 15:23
that’s fantastic. Do you see any issues going forward where there will be other approaches or new areas where we’re beginning to push this technology into to get patients to do certain things or engage in certain ways around social determinants of health or other things like that
Vik Krishnan 15:38
there are, well as social determinants of health, that actually does remind me of the concept of health equity, which is understanding how to engage different populations in the country. So for example, Housecalls Pro works in over 100 languages, that’s very important to understand. It’s also easier to engage in multiple languages, if you are engaging through SMS, it’s much more difficult for a patient to access somebody at the contact center of a hospital if you don’t have somebody who can speak Haitian Creole, for example. So that’s certainly one way we are trying to address social inequity. There are many others as well.
Fred Goldstein 16:15
yeah. And obviously, it’s one thing to say I’ve got to use an app, which requires me to have Wi-Fi connectivity and a bandwidth and I actually have the service that I don’t overrun my service, whereas SMS texting tends to be ubiquitous throughout the population, a lot more people using it.
Vik Krishnan 16:32
There have been many studies out there that that have suggested that underserved populations, populations that are the most hard to access, to provide care to, prefer SMS. They may not read a physical mail or they don’t want to engage on phone, but SMS will work for them. So we will always tailor the way we automated workflow, depending on how the community is preference, whatever the community’s preference may be, you know,
Fred Goldstein 16:55
I’ll just say I’m a little bit stunned by the 100 languages. The the most we didn’t have an extremely broad disease management program was 65. For the State of Washington, Medicaid. 100 is just covering a huge percentage of any population we have here in United States really fantastic.
Vik Krishnan 17:11
And we’ll, we’ll add to the list of a customer asks,
Fred Goldstein 17:14
that’s amazing. And and so actually, you could, can a, can a staff member, take what they do in English and actually convert that through your system? Or does it they need to then figure out that language itself and then convert it?
Vik Krishnan 17:26
the staff won’t have to manually translate. So our own platform will automatically translate an English workflow into any other language. I mean, of course, the staff, may want to check what that translation looks like. But we haven’t had any issues with how our system translates.
Fred Goldstein 17:40
Wow. And you mentioned Haitian Creole, obviously, that’s one in South Florida. That’s a major issue for any providers working in that area. But when you get into some of these communities, obviously, whether it’s in the Midwest, where people have moved into or the northeast of the or the west coast, where you see a very diverse population, it’s critical to be able to reach him. And typically I remember back in the day Medicaid would say, well, you have to do four languages, you know, it’s English and Spanish, maybe a couple others, but being able to really meet the population where they’re at is fantastic. So, in terms of looking at providers, who are some of the providers you’ve got, can you talk about a few of your systems that are using the platform?
Vik Krishnan 18:15
Sure. Advantage Care Physicians in New York serves, I believe, half a million patients a year. So their their user of Housecalls Pro, longtime user Kettering Health Network, Confluence health, there are many others. But I think what I’d want to emphasize is that there are so many I could spend half an hour talking about them, we serve 14,000 healthcare institutions. I believe there are about 700 large health systems that use Epic EHR, for example, we serve nearly 400 of those 700. Right, so we are the market share leader, there is no player out there that has the scale we do solving these problems for providers and patients.
Fred Goldstein 18:51
What about smaller practices? Is this something they could use or put in for primary care or something like that?
Vik Krishnan 18:58
we serve them and they do use it, their needs will sometimes be not as numerous. So you think about a dental clinic, they’re probably going to use us mostly for automated scheduling, for appointment reminders with real-time reschedule. And for live chat, we have a live chat feature I haven’t talked about where a staff can be manually communicating in real time, it’s actually human to human not not a not an AI to a human interaction. But as you can imagine, the PCP isn’t going to be running a colonoscopy campaign or, you know, a pre or post surgical campaign, right. So there’d be fewer workflows, but the impact of how those workflows function, what they deliver is essential to smaller clinics.
Fred Goldstein 19:39
Absolutely. And you know, getting back to this whole concept of the acceptance of this. I don’t recall the exact numbers, but I remember seeing some studies done on post visit surveys. And if you sent them via SMS text, the response rate was super high compared to I’m going to mail them something or I’m going to email them a reminder to go to my website. ,
Vik Krishnan 19:59
Yeah the drop-off in response rates between having them solved through SMS and giving them a link to go to a website is substantial.
Fred Goldstein 20:07
And these these larger healthcare systems, they obviously have really diverse utilization, or different departments, different things. Are there any unique features you see when you get to them that, that some of them have brought in that you think, Wow, somebody else should take a look at something like that.
Vik Krishnan 20:25
At a high level, I think what’s unique about a very large health system is they probably have a digital care team. That’s, that’s charting out right now, the overall digital engagement strategy that the organization wants to adopt. So without getting too specific, so they all have different needs. But they need providers like us, like Intrado, to essentially drive that strategy forward, support it for them. And I would say our philosophy is if a customer wants us to build a workflow, they have a unique need, we do it, I mean, we have no issue doing that, we will generally find that in talking to our provider, if they have any, the need will exist elsewhere. And it’s an ideation isn’t for us engaging with our large health system customers. But they’re all going through that process. And we are supporting and driving that process with them.
Fred Goldstein 21:07
And the I would assume the majority of them build their own workflows, they take a look at it, they say, here’s what we want to message through. And they do that in the platform fairly easily. As I saw that process setup.
Vik Krishnan 21:18
Yeah, so we have off-the-shelf workflows, they’ll customize it. So a patient never knows that in front of digital workflows exists. So certainly, it’s customized where it comes from the provider, but they may have opinions on the exact wording, what will follow up care, instructions should be thats fine. They can customize all of those things, or they can they can use substantially are off-the-shelf scripts. It’s whatever their preferences.
Fred Goldstein 21:40
And one of the issues we hear a lot about this conference, all these other IT ones is security. Could you touch a bit on that, and how that setup?
Vik Krishnan 21:47
So the integration piece is essential to have this these types of platforms deliver this engagement. The way Housecalls pro solves this is through real time API integration. Our philosophy is that the EHR should be the single source of truth that in terms of hospitals and patient data, many other solutions out there, we’ll use a mechanism called HL7 to extract data from an EHR, it inevitably results in some data being stored outside of the EHR, what we call a parallel EHR starting to exist, that does leave any provider that uses that approach and vulnerable to cyber attack. I mean, so that happens, our philosophy is we don’t want to store any data, we want to act on the data that’s in the EHR, drive a workflow. We’ll put data back end, but we don’t store anything.
Fred Goldstein 22:31
So you’re integrated all the way to that point, you’re not pulling out, I’m gonna pull out XYZ information information, and then I’m going to use it
Vik Krishnan 22:36
Housecalls Pro acts on the information that’s in the EHR, we don’t pull information out of it.
Fred Goldstein 22:41
That’s fantastic. It’s a great way to ensure you don’t have another file that somebody is trying to hack into over time. Where do you see this going? in the future?
Vik Krishnan 22:50
Yeah, I think there’s going to be an expansion to telehealth, right. So I’ve, I’ve certainly discussed how we’re solving workflows through SMS through voice through email. And there’s a lot of players offering telehealth services. But what I have found interacting with customers here over the last couple of days is that they do believe long term that remote visits and telehealth visits and solving care in some way that doesn’t necessarily involve an in person visit is going to be part of their long term plan there’s been an up. There’s been a down a little up again, they expect another down, long term they expect an up. I think that’s the place we eventually want to get into how do we actually support the actual care interaction. I’ve talked a lot about what happens before it after it, and right around it. But I haven’t talked a lot about how we can support it during the actual interaction. I would say that’s something we think about and something that’s on our roadmap long term.
Fred Goldstein 23:42
Yeah, and I look at this whole change in primary care as we’re trying to move this this primary care to a new model. And essentially, when you begin to integrate tools like you have and telehealth and some others, you can really restructure that primary care practice, as you talked about, if you in essence, use your parking lot as a waiting room, you require less physical space, if you can do certain services through text messaging, they may not need to come in, you can create those efficiencies that allow practices to in essence become virtual plus a space, versus adding on just bolting on that type of an approach.
Vik Krishnan 24:19
I think that’s right. I think phase one is when you talk to any clinic, any provider at a smaller practice, how overburdened they are with manual work and manual outreach to patients. So solving that is one that frees up their ability to care for patients. But then augmenting that with some type of virtual care, virtual waiting room, those are things we’re working on and thinking about. I agree.
Fred Goldstein 24:39
Yeah, yeah and I think back to those days with these giant call centers, with 500 people in them, taking the calls from around the country that with so much of this that you can now automate through this process. Well, it’s fantastic. I want to thank you so much for joining us. Before we before we finish, is there anything else that you think of Intrado that sets you apart from the others?
Vik Krishnan 24:59
I think what we’ve done is we’ve I’m going to go back to that the framework I mentioned platform, automation, integration. So if a hospital decision maker head of digital a CIO is thinking about a true platform approach that ultimately increases their revenue, decreases their costs, and delights their patients, they should talk to us. I would say, if you’re a hospital decision maker, you’ll regret not having that conversation with us. We are at the forefront with a leading edge platform driving this transformation and this value creation, both for providers and for patients.
Fred Goldstein 25:30
Yeah, as I look at this from a population health approach, this engagement tool is really the new front door that we need to be able to achieve the triple aim. It covers so many different areas from efficiencies to engagement, to better health outcomes. So I really want to thank you, Vik, for joining us. It’s been a pleasure having you on PopHealth Week. Back to you, Gregg.
Gregg Masters 25:50
And thank you, Fred. That is the last word for today’s special edition broadcast of PopHealth Week recorded live in the HealthcareNOW Radio studio at HIMSS 2021. In Las Vegas for more information on HealthcareNOW Radio’s lineup of live and on-demand podcasts including PopHealth Week go to www.healthcarenowradio.com And finally, if you’re enjoying our work here at PopHealth weekly, subscribe to our channel on the podcast platform of your choice and you follow us on Twitter by @PopHealth Week. Bye now.