Lisa Farren (Host): Hello, everyone, and welcome to Crushing Healthcare; where we explore diverse perspectives regarding the state of healthcare today, and gutsy visions for a more affordable, accessible, equitable, and sustainable healthcare model. I am your host, Lisa Farren. Today we'll be diving into the topic of data, and I feel as if the topic of data and data driven decision making is a mainstream topic these days, not just in healthcare, but I think in all industries and sectors, whether in the world of healthcare, business, or even personal lives, we're all continually faced with making decisions.

And the more informed and targeted we can make our decision making, I think it makes more logical sense and health care is no different. So I'm excited about today's topic. And in thinking about data and the role it plays in healthcare, what it means for patients and providers, our guests today are leaders in this area.

It's my pleasure to introduce our guests today. Both are with Southern New England Healthcare, also known as SoNE Health. Renee Broadbent is the Chief Information Officer and Information Security Officer, and Christine Fulton, Clinical Informatics Leader. Renee Broadbent is a senior level healthcare executive with extensive background in strategic planning, information technology, digital strategy, value based care, and data security.

Renee has held the role of Chief Information Officer and Chief Information Security Officer in both hospital health systems and managed care organizations.

Christine Fulton, RN, is a healthcare leader with experience in population health program development, clinical informatics, EMR implementation, value based care, and strategic planning. With a strong foundation in clinical nursing, she understands the supports, programs, and information patients and providers need to manage care effectively. Christine has served as an RN healthcare leader in both the ambulatory and inpatient spaces within hospital systems, as well as provider led organizations.

So we have some great guests today, very knowledgeable. Hello, and welcome Renee and Christine. Thanks for joining us today.

Renee Broadbent, MBA, CCSFP, CHC: Thank you for having us, Lisa.

Christine Fulton, RN: Yes, thank you.

Host: All right. Well, I'm looking forward to today's discussion. Are we ready to dive in?

Renee Broadbent, MBA, CCSFP, CHC: We are.

Host: Okay. So in past episodes, we've talked a bit about population health. In the case of today's topic surrounding data, it's specifically how it's used in healthcare, particularly with patient populations. I think it might be a good way to start off with the concept of population health and how it relates to data. So can you explain what is Pop Health and what does it mean for patients and doctors?

Christine Fulton, RN: Yeah, so I'll take that. So, population health is really focusing on the health outcomes of a group of people, taking into consideration, not just their medical needs, but also their social, economical, and behavioral factors. So it's really looking at a population and a whole 360 view as to them and their health outcomes.

And so we at SoNE, we work with providers in our community and their patients to ensure that those patients get the best out of their health care that they can.

Host: All right. Awesome. So, in speaking with populations and data, can you break down some of the programs that you deal with at SoNE?

Christine Fulton, RN: Sure, you know, I don't want to get too complicated in terms of how our patients come to us, but we work with a lot of different entities in our area, with the providers, our insurance companies, our hospital systems, things like that. And so as patients seek care in different areas, so for example as patients get discharged from the hospital, we have a team of people that reach out to these patients, ensure that they're getting their follow up appointment. That they're getting their medications post discharge from the pharmacy and they're being taken care of in their home setting. We work with our hospitals and our skilled nursing facilities where our patients are receiving care, making sure that they have great discharge planning and that they're able to get the resources that they need.

And then we also have a lot of interventions with our providers taking care of our super sick patients that need weekly touch bases to see how they're doing, but also some of our less sick, but still patients that need quality preventative screening, such as mammograms or colonoscopies. And so we have a multidisciplinary team at SoNE that works with all of those pockets and is able to provide and coordinate care for our patients, no matter what risk level they're at.

Host: Thanks for explaining that. So it sounds as if, so there's different levels of patients in terms of the amount of care or touch points that they need with the team. Is that correct?

Christine Fulton, RN: Absolutely. So the sicker a patient gets, the more health care navigation they need. They might have several different providers that they work with amongst different specialties. They're having trouble getting their medications. There are still patients who are newly diagnosed. Let's say you're a newly diagnosed diabetic and you might need more touch points than someone who's had diabetes for years and is managing their condition well. We really use all of the, those factors I talked about, the medical, social, economical, and behavioral factors. We use that to place our patients on a risk scale.

So understand what are the needs that they have in terms of how many touch points, what discipline should be reaching out to them. Should it be an RN? Can it be a community health worker? Maybe they have some social drivers of health you know, that they need help with being, getting access to their medications or transportation to their appointments.

So they're on a spectrum both of risk, but also what discipline is going to be working with them during that episode.

Host: That's great. So I imagine in all these touch points, in caring for the patients, you must use data to do this. What type of patient data do you see?

Renee Broadbent, MBA, CCSFP, CHC: So I'll take that one. You know, data drives everything that the population health management team does to help treat these patients, determine where on the risk score they end up landing. And we get data from lots of different sources. So a primary source of data is our healthcare claims.

So patients that are under our management, the payer provides those claims to us and we get medical claims, facility. We get information on their pharmacy, as well as anything related to DME, which is durable medical equipment, demographics data. And we see clinical opportunities through reports that we get from that data, like high utilization, quality gaps, what their med adherence is and all that.

The other thing is we also get data from EHRs. EHRs are electronic medical records. And we get things like appointments data, medication, orders, vital signs, labs, clinical notes. And that information kind of gets all mushed together into our data warehouse. And then that information is output to the clinical teams.

We have other systems that we feed it to, and that helps kind of churn all that different data into meaningful reports and statistics that give the um, PHM team and actually other teams in the organization, the ability to look to see how we're doing, how we're treating patients, where they are, where the risks are, where the spend is.

So data is very, very important for helping managing our different populations. Another area that we get data from is what we call ADT, which is admit, discharge and transfer data. So we can see when patients have been admitted or discharged from say an ED or an inpatient unit, or maybe they've gone to a skilled nursing facility.

That's super important because we do a lot of treatment in skilled nursing facilities. So we take all this data from there and other sources too. Many years ago, it was very difficult to get lots of different data sources to kind of get that 360 view. Because of all the changes and regulations for interoperability, it's becoming easier and easier to do it.

What we focus on now is trying to get that data as near as real time as we possibly can, so that it's meaningful for the clinical practices. And then to the next level, we try to integrate it directly to, say, their EMR, where they're actually working with the patient. And so we get a lot of information and we have to get it from lots of different sources to sort of cobble it all together and to make it meaningful.

Christine Fulton, RN: So essentially, though, all of the points that Renee reviewed in terms of getting claims data and getting real time data; we really use that to put into our risk score algorithm. So that's one way I would say it really helps.

And as you spoke to before, having real time data such as ADT. So knowing when a patient hits the hospital or the emergency department and then discharged is really helpful for us to not only understand their risk score, but to get in contact with them in a timely manner. So if we only had our claims to rely on, you know, I would find out about that hospitalization three months later.

So in order for me to be able to call that patient the day after they get discharged and review everything that's needed, we really need that real time data. But also when you look at claims and ADT data and understanding a patient's risk score, that's extremely helpful in order to prioritize the population that you're outreaching.

The other thing that's really important that we mentioned is, getting pharmacy data. So medication adherence is something that's extremely important and it's a driver of health outcomes. So understanding who is, you know, maybe a late to fill and, is really not taking their medications as prescribed, or maybe they can't afford the medication.

And so we're able to sort of prioritize and flag those patients for outreach so we can help in any way we can.

Renee Broadbent, MBA, CCSFP, CHC: The other thing I'd like to add too, about the data sources is as time goes on, other data sources are really important and they are also, there's some regulations both at a state and a federal level that are requiring you to collect this information. So for example RELDs data, which is race, ethnicity, language and disability.

Those are important. Why are they important? Because there are specific inequities in healthcare and certain populations do not receive the proactive healthcare that they need. They're less well than other populations. This is a data set that we want to incorporate, so we have a fuller picture and that we can actually target some of those areas to ensure that they're, say, going for their annual wellness visits and other things that'll, a, actually have healthier outcomes down the road. So as we evolve in the data world, we take in more and more information that creates a more unified picture of that particular patient or a population and how to address those needs more specifically.

Host: Wow, thank you both. So it sounds like there's a lot of data. It's coming in from different sources. It's giving you all sorts of information and it's helping you with, as I understand it, prioritize the patients, optimize their care. So it sounds like there's a lot to it. Ultimately, how is this helping optimize patient care? Do you see that?

Renee Broadbent, MBA, CCSFP, CHC: We do. We see in a couple areas, and I'll, Christine's our clinical person, so she can speak to this better than me, but one of the areas that, you know, once we, clean the data, we scrub it, we get accurate data, we are able to see some things and we're able to address it. So if we say, like Christine's point before, like medication adherence, or if there's high utilization or, repeat trips into the hospital, you know, those are some of this baseline types of things that we can get from the data so that we can find effective ways to manage it.

And Christine, do you want to add a little more to that? Cause you're the clinical person.

Christine Fulton, RN: Yeah, absolutely. I mean, that's exactly right. I mean, I think that not only are we able to segment patients into buckets of high risk or moderate risk or preventative management, but we're also able to navigate the patients who need our help the most, right? And so I focused a lot on super sick patients, of course, but we're also talking about our baseline low to moderate risk patients.

And in order for them to prevent them from falling into more moderate to high risk buckets, we need to make sure they're also getting the care that they need. So, are they getting their annual wellness visit every year? And are they, adhering to getting their mammogram, and their colonoscopy and their flu shot and things like that?

And are they connected with their providers? And that's a lot of our job as well is that really, really helping our high risk patients, but also trying to prevent any disease progression by following our quality standards. So, we're very lucky. We have wonderful team of clinicians on our team.

We have RNs and LPNs, and we have community health workers, and we use this data to help steer patients to the correct team member. And we, I don't want to, you know, miss out on our pharmacists and our quality team as well. So we have such a multidisciplinary team of that use this data to understand, okay, I need to follow up with this subset of patients, and they're using emergency department a lot.

And sometimes we identify, they don't have transportation to get to their doctor's office, but they live right down the street from the hospital. Or, they live in a food desert, and they're you know, eating canned foods cause that's all they can get their hands on. And can we connect them with a food pantry in the area and get some healthy foods and things like that.

So, we take care of patients all across the spectrum and the data really helps us to do that.

Host: That's so great to hear that really you're dealing with all patients. And, I especially appreciate, as you mentioned, sort of how you stratify patients from the low risk to the high risk. And it's great because, we're all healthcare consumers. We all have to see our physicians and we're all on a different health journey, if you will.

So I'm going to play a little devil's advocate now. Like I imagine I think it's all great, but I imagine as data breaches are so common in the news, everyone is so concerned, and rightly so, about their, protecting their data. So given that, how do we safely, how does SoNE safely consume the data and use it in such a way as to protect, obviously, the patient population?

Renee Broadbent, MBA, CCSFP, CHC: So, it's what I think about from the time I get up to the time I go to bed about how we can do this, right? So there's lots of different standards. There's lots of different ways that you can protect data. So the first line of defense, honestly, in any data that you consume is educating your population and your workers, right?

The people that work for SoNE. Really providing them the education because all it takes is one, one click on a phishing email and they've got the keys to the kingdom. So really having a strongly educated staff. We have a very robust education program in place for all of our, employees at SoNE. It's required monthly training, reinforcement, and the like. Our staff is actually really good. In addition, we have to comply with certain regulations regarding HIPAA, right? And so, one of the security options is that all data we receive has to be encrypted when we send it.

It has to be encrypted when it's at rest, right? And SoNE complies to all of those. The other piece is engaging with technologies that put the extra layer of protection on it. So, we are a cloud based organization and we fully leverage all of our provider, um, we're a Microsoft Azure shop and we leverage all their security tools to protect our data, to protect our endpoints.

We also put in policies and procedures within that program to limit what people can do with the data. So for example, you can't save tons of patient data on your desktop. We'll just use that as an example, but we put all these boundaries and parameters around things to ensure the data. And of course we get people on our staff certified so that they understand what the latest regulations are saying, what are the latest technologies that we can take advantage of.

We also do real time monitoring. We, SoNE does not have like tons of systems, but we have a few, a few critical ones. And we use real time risk management tools that is constantly monitoring these vendors out on the network, out on the public facing information to see, you know, if they're at risk and it feeds us reports when they have broken credentials that we can contact them and say, you need to fix them.

So it's a constant 24 hour working with different vendors, working with staff to really develop that protection. And then also considering what's on the horizon. Like what are the next level security protections we want to put in place? And we also do annual audits and risk assessments, right?

We pay an auditor, you know, someone who's completely arbitrary has no skin in the game for SoNE and does an audit of our systems to identify any areas that we could do improvements in. We also have a business continuity plan and we also have strong breach language for our vendors that we do business with.

So security is not only protecting the data that you have and you consume and you send, but also building the programs around it, a sound data security program around it to continue to support it.

Host: Okay, yeah, I think you've got that covered. That sounds really impressive. All right, it sounds like you're tackling it from every angle, so that's good because, awesome. Well, like we know, it is important to protect data. So thank you for sharing all those different touch points on how you're tackling that.

And thank you both for sharing some information about data. I think this was a really great conversation. I look forward to continuing it in the future. You both bring an interesting perspective. So thank you Renee and Christine for sharing your expertise and thank you everyone for joining us today.

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