Richard Queen describes himself as a "tech geek", who's spent the majority of his career in healthcare, focused on finding ways to close care gaps, reduce costs and overall, improve patient outcomes.
He joined Memorial Health System, a healthcare provider in Marietta, Ohio, because he was drawn by their innovation. "Their administrative team has an entrepreneurial mindset, more so than any hospital system I've ever seen before," he says.
As an example, he cites the fact that the hospital hosts a healthcare software company MedOne Systems within its four walls. "We call it the ‘innovation center’. They're currently writing a custom electronic medical record application called BOLT, which bolts on to our underlying electronic medical record (EMR). We're rolling this out to all of our ambulatory and inpatient clinics to make provider time more productive. How many hospitals can you say have a tech company within their premises?" he asks.
As Director of Data Solutions, Queen is helping to improve workflow efficiency through a quadruple aim: the provider experience, the patient experience, population health, and reducing cost. "The last two are about value-based care," he says. "That is the focus of everything we design, even from a technological standpoint, including better managing chronic diseases, ensuring patients receive preventative care, and designing solutions to be more cost effective."
Queen has created CareBridge, a piece of software that draws from multiple data sources including the EMR, BOLT, different immunization vendors, the FDA, the US Census Bureau, and CMS Centers for Medicare and Medicaid Services. "CareBridge draws from these external data sources and combines this with our clinical data to enhance what we can do," he says.
Part of its aim is to provide evidence-based preventative care, something that only 8 to 15 percent of Americans receive in full measure.
"For example, people with diabetes need a hemoglobin A1C lab test at least once a year. It's very common for a third to a half of diabetic patients to have not had one in the last 12 months," Queen says. "Typically, in any hospital, it's the insurance companies as the payers who calculate all this data and report back to you on what the patients need. The typical workflow is waiting six to nine months after the point of care to tell you what didn't happen, and then you have to manually try to either get these patients back in, or prove that you did. We’ve turned this data into real-time clinical indicators" he explains.
CareBridge can provide this information directly to the payer or the clinician, and as a result in just six months Memorial has improved point-of-care gap closure from 8.5 to 30 percent. "We've had phenomenal feedback from the physicians, with some saying they can see two more patients a day because they walk into the room knowing what needs to be done."
The intention is to use CareBridge to manage a range of chronic diseases and standards of care such as mammograms for women and bone density scans for people with osteoporosis. Using algorithms, the software stratifies data by risk factor, so physicians can identify the right type of care for each patient at the right time.
Using a cloud-based platform, it's been designed so it's easy to use. "Staff can engage with it in a very visual format, which gives them access to information that was previously difficult, if not impossible, to see from an electronic medical record. Everyone from an administrator to a physician to a secretary with no technical skill whatsoever can very easily get into the system, run advanced clinical queries, and export the data immediately. We've really empowered staff across the organization to be able to get advanced clinical information."
To implement CareBridge, Queen and his team worked with software as a service (SaaS) company Phreesia, a key partner in carrying out Memorial Health's digital strategy. "They have some great educational modules, check-in tools, and electronic registration tools for patients. They're working with us on identifying care gap needs and building an interface directly to Phreesia so that, during that electronic registration process for the patient, Phreesia can show them things our records indicate they need."
Alongside Carebrige, there has been other behind the scenes work such as implementing RPA for repetitive tasks to free up staff and automating scripts for appointment-making.
"We're using open-source Python programming language to write many different algorithms for high-risk patients. Every night we have scripts running to show each patient that has cancelled or not shown up to an appointment in the last 10 days and not rescheduled. That generates reports by provider and inputs them directly into a Microsoft Teams channel, so that when staff come in the next day, they have this prepared in front of them, with patient identification and contact information.
"We've got this big SQL Server database that we're making actionable using Microsoft Power BI," adds Queen. "This has given us the ability to share all this advanced data logic in a way that is very unintimidating and very visual to frontline staff. It's been transformative for our workflow".
Queen adds that none of these achievements would have happened without a great team to support them. "Memorial have really set a vision across the entire organization that value-based care and population health are top initiatives. That sets the expectation across all teams that we are going to have a unified vision, and work towards a common goal of offering first-class patient care at a reduced cost," he says.
It's also remarkable that they decided to accelerate their digital project during a hugely challenging time - the first few months of the pandemic. "What was supposed to be an 18 months to two-year rollout we ended up doing in six months. Memorial chose to use this time of Covid to carry out this rollout throughout the entire organization, knowing that we would have challenges to overcome, but adding tremendous value to the organization and avoiding staff furloughs in a time of lower volumes. Obviously, we're still dealing with Covid, as everybody is, but we've set ourselves up so much better than we expected to be from a digital transformation and technology standpoint. We can now be more efficient at dealing with whatever is thrown at us next."