Intermountain CTO: Patient experience ripe for transformation

By Jonah Comstock
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visi-productsIntermountain Healthcare, a Utah-based hospital system with 22 hospitals and 185 clinics, has worked extensively with digital health companies -- most recently upgrading their pilot with wristworn vital signs monitor company Sotera Wireless into a full partnership last month, and teaming up with MModal in February to develop a speech-enabled computerized physician order entry system.

This week, MobiHealthNews caught up with Fred Holston, Intermountain's chief technology officer since 2008, to discuss the Sotera deal and its other digital health initiatives. Holston also oversees Intermountain's Healthcare Transformation Lab.

Intermountain discovered Sotera when it was in its early stages and started working with them right away.

"What we went searching for were a couple of things," he said. "There's a section of data we were missing, the more continuous vital monitoring in healthcare. What happens when you're not in an ICU, you're not in the ER, you're just in the general part of the hospital? ... And then things happen and you don't have enough information maybe to understand why. We also have nurses running around with all these devices, and every few hours they check all these vitals and write them on the piece of paper in their hand, and then go back and sit down at the nursing station and spend an hour filling out nursing documentation with that information. And we believe there are better ways to do that."

But Sotera also has another benefit, beyond the clinical advantages. Holston believes one of the biggest areas where hospitals can fall down is not focusing holistically on patient experience.

"Being in a good mental state is also a feeder into good healing," he said. "And when people sit and think about how much they hurt all the time and then you ask them their pain scale -- 'It's a 10! All I do is think about how much I hurt all the time.' Versus having their mind engaged and not thinking about that. And Sotera's part of that, part of the role of Sotera is to get all the wires on their body so they're free to move about or go to the bathroom or walk the halls or go sit in a chair, and not be so tied down. Because that is also a healing piece."

As another part of keeping patients engaged, Holston sees a lot of potential in consumer-facing apps and data-collecting devices. (Intermountain inked a deal with Kony last year to build some patient-facing apps.) But Holston listed a number of problems that need to be overcome before apps and consumer devices can be effective parts of the healthcare system.

"You've got all these cool applications and people are throwing data in a lot of cool places, but who sees it, what does it mean?" he asked. "I think that's something we have to figure out. As people who deliver healthcare, who understand healthcare, who have the protocols for healthcare, understand what the data is or have the means to understand what the data is. How do we bridge that gap between all these apps that are out there that are part of healthy living that are going to non-health providers, consume it, trust it, evaluate it, understand how to distill that so your physician or any physician can understand that?"

The responsibility for solving these problems is spread between several interest groups, Holston said.

"The people who are collecting that data need to find strategic relationships with real healthcare providers who can make sense of that data, but I think it's also incumbent on the health systems to see how do we trust and consume it," he said. "Today I would dare say that the funding models, the reuimbursement models don't really lend themselves to that either. As health systems we're going to have to figure out what to do with that and how do we do our part."

Although Intermountain is an innovative establishment, Holston warns against innovation for innovation's sake. For instance, although Intermountain is working with MModal on speech CPOE, that's a carefully chosen and targeted mobile use case. In other cases, he's not convinced mobile is a benefit.

"Everybody loves the new bright shiny device and they're getting smaller and lighter and everyone's going 'Why wouldn't I carry it?'" he said. "Well, be a nurse. Carry tapes, an IV bag, scissors, the water someone wanted, half a dozen other things, and then try and carry a tablet or a small phone around and try punching around on it. It doesn't necessarily make sense in all situations."

What healthcare really needs, he said, is not just innovation, but transformation.

"If you look at Merriam Webster, one of the definitions of innovation is a novelty. Transformation is defined as real change. I agree that innovations will be needed, but we need to look at the transformations of healthcare. And for me as a technology geek, sometimes, absolutely new technologies will be those innovations that are part of tranformation. But that isn't always the case. And we can't start by saying how do we make this device fit? It's 'What is it we need to accomplish?'  What change could we drive most? I hope what my lab is doing is trying to listen to the people who provided the care, whether that's a doctor, a nurse, or our clinical program, and say 'What transforms healthcare? What could really make change?'"