Katherine Steinberg (KS):
Hi, welcome to Podcast #3 of Avalere’s Digital Health Podcast Series. I’m Katherine Steinberg, Vice President, in Avalere’s Center for Payment & Delivery Innovation. In this podcast, we will discuss the role and promise of technology in a startup hospital with Sajid Ahmed, Chief Information and Innovation Officer of the new Martin Luther King Jr. Community Hospital, which opened in South Los Angeles in 2015, as one of the most modern hospitals in Southern California. Sajid, thanks for talking with me today. I’d like to start by asking you to share a bit about the mission and vision of MLK and how it’s unique as a community hospital.
Sajid Ahmed (SA): No, absolutely, thank you for having me. Actually, I’m glad that you started offwith mission and vision because that is the first thing, and probably the thing we still think about and still work hard to bring into the culture of the hospital, as we hire all these brand new people to our area and to the facility. So, the mission of MLK is very simple: it’s to provide high quality, high-touch, high-tech care to the underserved population in South Los Angeles and surrounding areas. Our values are very specific. We came up and worked very hard to develop these values with our teams, and we revisit these values constantly and reinforce them: caring, collaboration, accountability, respect, and excellence. The reason why these are so important is the new Martin Luther King Community Hospital is on the same campus as was the old Drew King Hospital, which was closed down in 2007, so the mission and the values in particular are very important to us. They are actually one of our key innovations in establishing a culture that can provide high quality, high-touch, high-tech care. That’s what we call it.
KS: Great. And with a hospital focused on serving low-income beneficiaries and built out of such a publicly-minded mission, can you tell us a little bit about the role of technology and how that plays into the story of MLK?
SA: Well, absolutely. I think from the original design, by both the County of Los Angeles, the State of California and the UC System, and now with us, the Martin Luther King Los Angeles Healthcare Corporation, a private non-profit that was brought into the facility and to run the facility, our goal was to make the right investment. The $70 million that you mentioned was really about half of the startup budget for the hospital and of course, we’ve spent even more than that now, in getting the technology working and supporting the staff. So, the goal was always, we’re making this investment. We being, the county of Los Angeles and the people of Los Angeles, let’s set up the right foundation, to have this hospital be, not only sustainable, but state of the art for a very long time, and set that expectation moving forward. So, you know, our friends at UCLA Reagan, our Cedars Sinai friends, our USC friends, who have these really state of the art facilities, who want to make sure that the community of South Los Angeles had access to the same level of tools and technologies to support high quality care. So we looked at making sure the hospital was set up for telehealth, set up for data sharing, that the electronic health record system was there from the beginning, integrated with all of our bio-medical devices, to support efficient care by the staff, as well as documenting and supporting a high level of care - so that we don’t miss anything - to bring evidence based guidelines into the processes, so that was very important for us. And our goal is, of course, technology is a driver in a state of the art hospital, but it’s not the leader. The people we work with, the physicians, the staff, the nurses, and the workflows and processes they have to deliver care with, those come first. The technology’s there to support that. Having said that though, new technologies, you know, can be challenging, and we did go all out in trying to build a real state of the art hospital, so two years since our opening, we’re now working on those workflows and processes to take advantage of the technology. I will say one side note, I had the unique opportunity in building a startup hospital organization by at least doing one thing - if I’m known for, which is I banned all fax machines at the hospital. So in talking about old technologies, we looked at the fax machine as antiquated technology, as a liability with HIPAA violations, and frankly slow, and not very well to track. So, if I’m known for anything at the hospital, I’ll be known for the guy, who banned all fax machines. We have no fax machines, and all the manual faxing capability that could be there, has been blocked. Everything is electronic faxing, scanning, emailing, or electronic sending through HIPAA secure pathways.
KS: A hospital with no fax machines – that’s definitely innovative. ::laughs::
KS: I’m curious, and that’s kind of a good segue into your title: Chief Information and Innovation Officer. I haven’t heard those put together. Could you tell me a little bit about what your job description is?
SA: I’ll keep it short. Obviously, the first I is for Information. I’m in charge of all the information, technology, information services, and tools we provide to support the hospital. The innovation part comes in, and I put that in my title, to highlight that my work also focuses on supporting new ways of providing care. So not just the technology, but redesigning workflows. Looking at best practices, stealing best practices and borrowing them from the likes of Kaiser, UCLA, across the nation. And looking at, you know, putting in these tools such as mobile care phones, as we call them, mobile devices, phones that everybody uses, but bringing these tools doesn’t mean you’re innovative. It’s about the workflows and processes that support the care delivery. And that’s very important to us. So I think, you know, we’ve done great work, but the innovation part, is about people and process, as much it is about identifying new technologies. I think the people and the process is really where the goal is. So bringing the other I of Innovation was to always remind us that it’s not always about the technology, it’s about what we can do as a staff and organization to support the hospital.
KS: Great – thank you. And prior to joining the leadership of MLK Hospital, you had an integral role in developing an e-consult program here in Los Angeles with one of the largest medi-Cal plans. Can you tell us a little about that and the lessons you learned that you brought to MLK?
SA: Well, I’ll try and be brief, because I can talk about that for a very, very long time. I consider e-consult a telehealth tool but it’s also a process. E-consult, the electronic curbside consult, you know, the conversation between a primary care doctor and a specialist, in this example, but other providers can talk to other providers using this tool and process, was a very important innovation that LA Care helped sponsor. Los Angeles, LA Care is the public health plan of Los Angeles County and when I was the Executive Director there, I got to be a part of a team, I didn’t do it independently, to launch this, and it was great. What was really great about e-consult was that it replaced how referrals are done in a healthcare setting. And in our managed care setting, especially with prior authorizations, this was a very important innovation. It reduced those unnecessary visits to specialty care offices, and by reducing those unnecessary visits by providing the virtual care through e-consults, it opened up those appointment slots for those people that needed those specialty care visits. So, all of a sudden your wait times to specialty care appointments are reduced, no show rates are reduced, and everyone is getting access to care, and high quality care, because these specialists are talking to their partners at a primary care level, assisting them with diagnoses, assisting them with treatment options, or in one term, just providing that collegial feedback that most PCPs, especially in a managed care environment, aren’t getting. So this has been a great tool, and I foresee its spread throughout the US and all settings in the next few years.
KS: Great. And I’m curious your perspective in kind of taking that experience with e-consult and broadening it to a larger telehealth space. What are you seeing working most effectively in the community hospital area?
SA: Well, so, for us, even though we’re in South Los Angeles, you know, MLK Community Hospital, we’re not a rural hospital. We’re an urban hospital. And most telehealth applications were originally designed for those rural providers, for those hospitals, and other provider settings, that were in the rural area, to provide patients access to specialty care, that wasn’t necessarily available in those settings. With Martin Luther King Community Hospital, though it’s right there, ten minutes south of Los Angeles, it’s in an urban setting. And yes, it’s serving 1.3 million people, but it feels like we’re in a rural setting because we’re in a medically underserved and a professionally underserved designated area. What that means is that we roughly have about an 1,800 physician shortage – both specialists and primary care. So for us, when we opened the hospital, we had to have telehealth right away for call coverage, to get specialty consults for our ED patients, and even though we’re a small community hospital, we see twice as many ED visits, sometimes as high as three times as many than our counterparts. We have more beds than established hospitals. The reason for that is a lack of access to primary care in our area. So everyone is using our ED as that primary care. And as an example in 2016, we saw about 72,000 visits through our ED for just a 131 bed hospital. And this year, we’re analyzing close to 85 visits already. So establishing new primary care is what we’re focused on, but without telehealth, without the ability to contact these specialist, to help triage these patients, help provide care to these patients, MLK would not be as effective. And the care, and the quality of care we provide, wouldn’t be as high. So establishing that telehealth infrastructure, even in our urban setting was very important. And yes, the county of Los Angeles is fully using e-consult as their primary referral process approach, and we use that process with them for DHS patients to communicate with their specialists. So telehealth has played an important role. And we do have a vision at the hospital because we try to be innovative as part of our culture, we’re looking at hospital-at-home programs, that was initially built out of Johns Hopkins. And they have a toolkit that we’re leveraging to get these really, really sick, chronic patients that we have in our community to keep them at home, so we can provide that remote telehealth monitoring and remote health access to care, and that’s our goal.
KS: Yah, that’s great. And clearly, telehealth can help with some of those access issues that you were describing. I’m curious if you can, kind of as a concluding question, just briefly share with us, what you see asthe main barrier to implementing some of these telehealth technologies?
SA: Well, I think the barriers are common to everyone that’s deploying telehealth. It’s my opinion that we will stop calling it telehealth – that it will just be healthcare. Very similar to how when we purchase something on Amazon or Google, we don’t call it e-commerce anymore. We’re just shopping online instead of shopping at a brick and mortar place. So instead of seeing care and having care delivered to you in a provider setting or in a hospital or in medical office, you’re getting care at home. So I think the barriers are that in many of these urban and rural settings, there needs to be high speed bandwidth out there to access. I think that’s one barrier, Also the misperception of how malpractice insurance should be handled for the provider, how the legislation requires that first face to face visit with a provider and establishing that relationship. In an era when we live in, we can Facetime our friends across the world, text or email our physicians already, I think the new generation, the Millennial generation as we call them, I think their expectations and demands will be, “Why can’t I talk to my doctor on my phone and use my Facetime or Google Video or whatever to have him or her look at my rash or to communicate that care to me?” I think that’s what we need to prepare for.
SA: So the legislative and other barriers need to be removed, and reimbursement is the other final barrier. Reimbursement for those primary care docs, for those specialists and mental health providers for this live consult or asynchronous consultations, like e-consult, emails or text, that should be reimbursed for every provider. And I think that care is moving into that virtual space.
KS: Thank you, Sajid. Thank you for your time this morning and for everyone’s time that is listening to this podcast. Again this is Katherine Steinberg, and I appreciate you tuning in. Please feel free to reach out to me at any time if you’re also interested in exploring new payment and delivery models and the role of technology in achieving the unmet needs of patients and consumers. Have a good day.