Latest / Becker’s Healthcare Podcast / Leading Rural Healthcare Forward Through Innovation and Interoperability

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Leading Rural Healthcare Forward Through Innovation and Interoperability · Becker’s Healthcare Podcast

0:00
- Welcome everyone to the Becker's Healthcare Podcast.
0:03
- This is Kathy Turner. I'm the Chief Nurse
0:05
- Exec at Meditek, and I'm pleased to welcome
0:07
- our guest, Doctor. Priscilla Frais. She is the
0:10
- CMIO and a practicing hospitalist at Ozarks Healthcare
0:13
- in West Plains, Missouri.
0:15
- Today, we'll be talking with Doctor. Frase about
0:17
- how independent rural health systems like Ozarks Healthcare
0:21
- drives meaningful change through technology,
0:23
- interoperability,
0:24
- and innovation,
0:26
- all while serving as a critical safety net
0:28
- for their communities.
0:30
- Doctor. Frase, thank you so much for joining
0:32
- us today.
0:33
- Thank you, Kathy. I'm happy to be here.
0:36
- So Ozarks Healthcare serves a broad, largely rural
0:39
- region across both Missouri and Arkansas.
0:42
- Share what it's like being the primary safety
0:44
- net for that community and some of the
0:46
- unique pressures that come with that.
0:48
- Yeah. We serve an eight county region in
0:50
- South Central Missouri and Northern Arkansas.
0:53
- There's around a 160,000
0:56
- residents here. And for our patient population to
0:59
- get to the next level of care beyond
1:01
- the services we provide, some of them have
1:04
- to drive more than two hours to get
1:06
- there. It's a big responsibility
1:09
- to cover such a large area. We have
1:12
- rural health clinics spread out in each of
1:14
- the regions,
1:16
- and we have our
1:17
- specialty services located here and trying to meet
1:21
- the demands in such a wide ranging area
1:23
- with the staff that we have. And the
1:26
- resources that we have can be challenging, that
1:28
- it's one that we like to rise up
1:29
- to as much as we can every day.
1:32
- You know, I know you've spoken previously about
1:34
- the importance of interoperability
1:36
- at a rural health organization,
1:37
- especially as patients move back and forth between
1:40
- tertiary
1:41
- care facilities.
1:42
- I think we all know the importance of
1:44
- having that full picture of care that impacts
1:46
- decisions
1:47
- when treatment occurs outside of your organizations.
1:50
- What is Ozarks Healthcare doing to ensure interoperability
1:53
- with those other organizations?
1:56
- Yeah. A few years ago, we made the
1:58
- decision to participate
2:00
- in Nationwide Health Information Exchange. We started out
2:03
- participating with Commonwealth.
2:05
- And when the opportunity
2:07
- came to switch to
2:09
- TEFCA,
2:10
- based Meditech Traverse Exchange.
2:13
- We, did that very quickly,
2:15
- when that became available.
2:17
- Our community has been hesitant to
2:21
- embrace,
2:23
- sharing of information.
2:24
- And when we first went live with Health
2:26
- Information Exchange nationally,
2:28
- we followed an opt in process where patients
2:30
- had to opt in to that rather than
2:33
- everybody
2:34
- being a part of Health Information Exchange and
2:36
- choosing to opt out if that's what they
2:38
- wanted to do.
2:40
- Out over time, our community started to realize
2:43
- the benefits of being able to
2:45
- have
2:46
- immediate health information exchange with other facilities. And
2:49
- one of our board members had a family
2:50
- member have a major accident in another state.
2:54
- And the ability to get health care information
2:56
- for their family members from our facility
2:59
- to that
3:00
- hospital in another state
3:02
- was pivotal in that person's recovery,
3:06
- and how that trauma team managed their care
3:09
- at that time
3:10
- and provided no delays to that
3:13
- care team at another facility.
3:15
- And that person really became a speaker for
3:18
- us in the community
3:19
- to help us switch to where we now
3:21
- follow an opt out process.
3:22
- And so unless you choose to opt out,
3:24
- that information is gonna be available for your
3:27
- providers to care for them.
3:29
- A few weeks ago, we got Traverse Exchange
3:32
- consolidated
3:33
- medical summary
3:34
- in addition to that service
3:36
- to help with consolidating all of those external
3:39
- records.
3:40
- And we had been testing it and rolled
3:42
- it out to a small group of providers.
3:44
- And within the first day,
3:46
- this viewer
3:48
- showed clinical benefits for our patients that were
3:50
- really quite amazing to to hear about. We
3:53
- have a provider here who does pre op
3:55
- clinic visits for us for our orthopedic surgeons,
3:58
- and she had a patient who had never
4:00
- been to our or our hospital or any
4:02
- of our clinic except for our orthopedic clinic.
4:05
- So she didn't have any of his external
4:06
- medical records, and he had a lot complex
4:08
- medical history.
4:10
- She was able to, using Meditech Traverse, quickly
4:13
- find old cardiac cap report and echocardiogram.
4:17
- And in the same day, seeing a patient
4:19
- she'd never seen before
4:21
- do what she needed to do to optimally
4:23
- prepare him for surgery and get him scheduled
4:25
- for surgery
4:26
- that week.
4:27
- That is the benefit of interoperability,
4:29
- particularly in a rural area like ours where
4:31
- it can be a challenge to get that
4:33
- information and get through to somebody because his
4:36
- clinics his where he had been was not
4:38
- within our state with people that we knew.
4:40
- He was in states that were several states
4:43
- away where you had this information. So that
4:44
- was really neat to see on the first
4:46
- day that we turned this viewer on. And
4:48
- it only took the provider a few minutes
4:50
- to find it because of the way the
4:52
- viewer is set up to consolidate all the
4:54
- information from the 376
4:56
- visits he'd had at places all over the
4:59
- country that were pulled in. And so that
5:01
- that's quite remarkable. And we had another pay
5:03
- ship where I was actually called by the
5:06
- chief operating officer
5:07
- who said, hey. That thing that you've been
5:09
- doing, can you give that access to one
5:12
- of the ER doctors?
5:13
- And, they knew enough about it, but it
5:15
- was just the thing.
5:17
- And,
5:18
- I did. And I said, I can't I'm
5:19
- not available to come in and show him
5:21
- how to use it. And she's like, I'm
5:22
- sure we'll figure it out.
5:24
- So I got in the system, gave him
5:26
- access to being able to see the viewer
5:28
- for Traverse
5:30
- exchange information. And within five minutes, he was
5:32
- able to get what he needed. Basically, we
5:34
- had a patient boarding in the ED who
5:36
- was having challenging
5:38
- disposition decision making,
5:41
- and they needed information from another facility,
5:43
- and they were not able to get it
5:45
- despite reaching out to that facility.
5:48
- Within five minutes of giving them access to
5:50
- health integration exchange via TEFCO exchange,
5:53
- They were able to get the records from
5:55
- the exact hospital that they needed in another
5:57
- state from the exact specialist
5:59
- and make the disposition plans that they needed
6:01
- to for a patient who was in the
6:03
- ER. So those are just fantastic examples of
6:06
- what it's like. And we are a tourist
6:08
- area,
6:09
- so
6:10
- we get people from all over the country
6:12
- that come down there. We're not the biggest
6:14
- of tourist areas that even in our area,
6:15
- we have to be able to take care
6:17
- of patients that don't live here in addition
6:19
- to caring for those that do live in
6:21
- our community. And health information exchange allows us
6:24
- to do that where the focus truly is
6:27
- more on the patient rather than having to
6:29
- do the administrative work to get all of
6:31
- their other information.
6:32
- I love those examples, and it's such a
6:34
- testament about how easy it can be with
6:37
- the right tools, but also the impact that
6:39
- really makes on patient care. So thanks for
6:41
- sharing those with us. Beyond impacting patient care
6:44
- and clinical decision making,
6:47
- what other benefits have you experienced because of
6:49
- National Data Exchange?
6:51
- Interoperability is a key piece of us maintaining
6:54
- our independence.
6:55
- Because if we can't connect to other organizations
6:58
- in meaningful ways, not only for
7:01
- us and our care for patients, but also
7:04
- for them to care for the patients that
7:06
- we'd send to them, then it's harder for
7:09
- us to
7:11
- meet the expectations of our patient population.
7:15
- I think a lot of people think
7:17
- you have to be connected to a large
7:19
- organization to achieve that. But one of the
7:22
- beautiful things that I've seen
7:25
- about
7:26
- health information exchange on a national level
7:29
- is that an organization like mine
7:32
- is doing the same stuff
7:34
- that places like Mayo
7:37
- and Stanford
7:38
- and all the large academic and corporate places
7:41
- were doing. I participate
7:43
- in
7:44
- the federal caucus for
7:47
- participants and sub participants around Tefca
7:50
- policy development.
7:52
- And it's been
7:55
- fascinating to me to see
7:58
- how we can do the same things
8:01
- just with the tool
8:03
- that allows us to connect
8:05
- in a standard way
8:08
- with other organizations across the country,
8:11
- regardless of the fact that we're independent
8:14
- in the middle of the Ozarks
8:16
- and two hours away from the next largest
8:19
- hospital. And you talked a little bit about
8:21
- how far some of your patients come to
8:23
- be even treated at your own organization,
8:26
- and it's a well known challenge in rural
8:28
- communities
8:29
- with patients having to travel long distances to
8:31
- get just basic screening or to pick up
8:33
- a prescription.
8:35
- And I know you did a community health
8:37
- needs assessment to really try to get a
8:38
- handle on what the needs of your community
8:41
- were. Can you share a little bit about
8:43
- what those findings were and then what actions
8:45
- you took as a byproduct of that?
8:48
- Yeah. We do the community health needs assessment
8:50
- regularly.
8:51
- And, you know, over time, the biggest health
8:54
- care concerns have been chronic care management and
8:57
- mental health management for our community.
9:00
- But in terms of what patients need and
9:02
- the barriers that they have to receiving care,
9:04
- it is like what you said, the transportation
9:06
- barriers, financial concerns,
9:08
- the long distance they may have to go
9:10
- to to get the specialist in the area,
9:13
- and just even general provider shortages.
9:16
- The number of physicians and, advanced practice providers
9:19
- that we have that can provide primary care
9:21
- in those clinics there. And
9:23
- what we have
9:25
- tried to do as an organization over time
9:28
- is
9:29
- make sure that the opportunities that we can
9:31
- present to help patients
9:33
- are out there. We participate in three forty
9:36
- b program, and we have a specialty pharmacy.
9:38
- And we're able to get highly specialized drugs,
9:41
- very expensive life saving chemotherapy
9:43
- and other agents,
9:45
- for patients who otherwise would not necessarily be
9:47
- able to afford this.
9:49
- One of the things that our board was
9:51
- very passionate about, a few years ago was
9:54
- getting a mobile mammography bus.
9:56
- And we were able to fundraise funds for
9:59
- that
10:00
- and have a mobile mammography bus built out
10:03
- for us. And that goes out to all
10:05
- of our outlying rural health clinics as well
10:08
- as to businesses
10:09
- and churches and other places within our eight
10:11
- county region to offer mammograms
10:14
- to patients and, that need them. And along
10:17
- with that, we will do low cost labs,
10:21
- and just regular check ins that people can
10:23
- have for that. It's been a great asset
10:26
- for the community, and we've come up with
10:28
- ways for patients to be able to schedule
10:29
- for that mammo bus, know when it's gonna
10:31
- be there so we can control who's coming,
10:34
- and be able to provide the service level
10:36
- of service that we need to for that.
10:38
- We do participate with, of course, charitable care
10:41
- for patients that need that help.
10:44
- And we've also tried to work with our
10:46
- pharmacies. We have pharmacies in a lot of
10:47
- our rural health clinics and do we do
10:49
- provide delivery of medications even within our rural
10:52
- area
10:53
- as well as,
10:55
- we started off a program
10:57
- where when we transmit a prescription to the
11:00
- patient's pharmacy
11:01
- or the pharmacy that they choose, whether it's
11:03
- ours
11:04
- or one that's not one of our pharmacies,
11:06
- that they get a notification that prescription was
11:09
- actually transmitted there. So they're not driving to
11:11
- the wrong pharmacy.
11:13
- That becomes particularly important on holidays and weekends
11:16
- when the patient's regular pharmacy may not be
11:18
- open. That's a common thing around here, and
11:20
- so we have to send it to some
11:22
- of the ones that are that are open
11:23
- at at different hours. And to make sure
11:25
- that they know exactly where they need to
11:27
- go to get their prescription
11:28
- is a great benefit for our patients.
11:31
- Yeah. That just that outreach to the community
11:33
- is just so important, and those just sound
11:35
- like excellent ways to do that. I know
11:37
- one of the other areas that rural health,
11:40
- particularly is challenged by is maternal health. And
11:43
- hospitals have been closing labor and delivery units,
11:45
- and access to obstetric care has been shrinking
11:48
- in communities that can least afford it. I
11:51
- know Ozarks Health is is looking at how
11:54
- to manage that and have introduced some midwifery
11:57
- services.
11:58
- Can you talk a little bit about how
11:59
- you came to that decision and the collaborative
12:02
- care model that has been designed as a
12:04
- byproduct of that? I hear stories all of
12:06
- the time about places not dissimilar to ours
12:10
- having to close their maternal care units, but
12:12
- we are one of the only places in
12:14
- Southern Missouri in our region that provides maternal
12:17
- care. And it's something that's very important, not
12:19
- only to us as an organization, but also
12:21
- to politicians in the area that we maintain
12:24
- access to appropriate care for those that live
12:27
- here.
12:28
- And one of the things that we had
12:30
- heard in our community was a desire to
12:33
- have
12:34
- more personalized
12:35
- relationship based maternity care without
12:38
- losing that immediate access to hospital services and
12:42
- a a a big community desire to have
12:45
- midwifery services.
12:47
- And with our ability to recruit several OB
12:50
- GYNs,
12:51
- over the last two years
12:53
- who have a strong interest and support midwifery.
12:56
- We have been able to bring in two
12:58
- midwives
12:59
- who work collaboratively
13:01
- with the OB GYNs that we have and
13:03
- do all of their deliveries here at the
13:05
- hospital.
13:06
- But the rest of the care model is
13:08
- very much what people see with normal midwife
13:10
- reservices.
13:12
- They had started out working in the clinics
13:14
- with the OBGYNs
13:15
- and have transitioned now to also doing deliveries
13:19
- in the hospital system. And within the first
13:21
- two weeks that they were on staff,
13:24
- we had patients that were calling and requesting
13:26
- the midwives to do their deliveries
13:29
- even when they were not on call. And
13:30
- with the enthusiasm that we've had, they've been
13:33
- willing to come in and do that. And
13:34
- they've done over 15 deliveries in the first
13:36
- few weeks of the program, and it has
13:38
- been extremely well received.
13:40
- And it allows us to give patients sort
13:43
- of the best of both worlds, that personalized
13:46
- care that midwifery is known for
13:49
- along with the safety
13:51
- aspects of hospital care and care under an
13:55
- OBGYN.
13:56
- And it really has exceeded
13:58
- our expectations in the short time, and we
14:01
- expect to continue to see that to grow
14:03
- and are even starting to work on
14:06
- having midwife reservices
14:08
- that can be done virtually
14:11
- during pregnancy so that not all of the
14:13
- visits have to be where patients are driving
14:15
- all the way into our facilities to see
14:18
- them. And so that's next on our list
14:20
- to expand that down the road and and
14:22
- see how we can optimize
14:24
- what we know our patients are really looking
14:26
- for.
14:27
- Yeah. The convenience of that for patients will
14:29
- be so important. And and, really, those patients
14:32
- asking for their midwife, whether they're on or
14:34
- not, is really proof to the success of
14:36
- that program. So congratulations.
14:38
- I know AI is continues just to be
14:41
- one of the most widely discussed topics in
14:43
- health care. How do you manage balancing the
14:46
- clinical and IT decision making at Ozark Healthcare
14:50
- so that frontline
14:51
- providers
14:52
- feel heard?
14:53
- And how do you work on the governance
14:55
- that really shapes those decisions?
14:57
- Yeah. It's a it's a challenge in an
14:59
- organization,
15:00
- of our size. One of the things that
15:03
- I think
15:04
- is a little bit different for
15:07
- places like mine as we don't have departments
15:09
- that look into all of this. It's really
15:11
- those
15:12
- few of us that have taken a strong
15:13
- interest or in the IT area.
15:16
- We, early on,
15:18
- developed
15:19
- an AI governance committee as a subcommittee of
15:22
- our overall data governance committee.
15:25
- And the team is made up of similar
15:27
- people, myself, one of our business analytics, our
15:30
- security person, and then we have a few
15:33
- clinical people on that as well.
15:35
- But we
15:37
- have to be sure that we can safely
15:40
- utilize AI and have tried to look at
15:42
- the use cases
15:43
- that
15:44
- make sense for a place like ours. We've
15:46
- been utilizing
15:48
- ambient dictation
15:49
- for our providers for a couple of years
15:52
- now and have had great success with that.
15:54
- We've also been
15:56
- looking at summarization
15:58
- and clinical decision support with it, but
16:02
- it requires somebody monitoring the output from the
16:05
- AI and trying to work on educating
16:08
- providers about what AI is. Some people just
16:11
- see it as a neat tool and don't
16:13
- realize what what, in fact, a large language
16:16
- model is, what agentic AI is. Everybody likes
16:19
- the the concepts of it, but a lot
16:20
- of our governance has been educating people on
16:23
- what
16:24
- AI is, how it can be used, that
16:26
- it is important
16:28
- for it can be an, a useful tool
16:31
- for streamlining workflows, providing efficiencies,
16:34
- and even providing insights you might not notice
16:37
- if you don't recognize certain patterns. But that
16:39
- it's not something that's gonna remove the human
16:41
- from the loop, whether that be employees at
16:43
- our organization and, most importantly, the oversight of
16:46
- a physician who is thinking through what needs
16:49
- to be done for a particular patient.
16:52
- And we have partnered quite a bit with
16:54
- the vendors that we've chosen to work with
16:57
- to make sure that they are assisting us
17:00
- in the monitoring of AI tools in their
17:03
- output,
17:04
- that the development of the AI tools
17:07
- meets the standards that ensure that there's not
17:10
- bias in the workflows,
17:12
- helping us with the security aspects of everything,
17:15
- and just making sure that we are not
17:17
- jumping on board with something just to have
17:19
- it and are using it safely,
17:22
- thoughtfully,
17:23
- and for the benefit of our patients
17:26
- in the right ways and at the right
17:27
- terms. Yeah. Such an important process in that
17:30
- decision making. So thank you for sharing that
17:32
- with us. Now you have earned national recognition,
17:36
- including the CHIME innovator of the year and
17:38
- HIMSS Senior Executive Changemaker. Congratulations.
17:42
- And you've done that while working within the
17:44
- constraints of a rural health system.
17:47
- It's often the major health systems that get
17:49
- recognized, but your organization has continued to innovate.
17:53
- Can you share with your
17:55
- peers, your, you know, the the rural health
17:57
- organizations
17:59
- as to how you make that meaningful change
18:01
- and how you continue to innovate
18:03
- at your organization?
18:05
- Yeah. That's a it's a question I've been
18:07
- asked several times, over the past few years.
18:10
- And
18:11
- I think a lot of it
18:13
- stem from a belief that just because we're
18:16
- small
18:17
- and we don't have the same resources
18:19
- doesn't mean that we can't
18:21
- do things that are special to and that
18:24
- we can't find ways to be innovative ourselves.
18:27
- And innovation
18:28
- isn't necessarily
18:31
- the brightest, shiny, newest toy that's out there,
18:34
- so to speak. I'm oversimplifying
18:37
- that. It can be something
18:40
- just using what you have more efficiently.
18:43
- It can be
18:44
- jumping into
18:46
- early adopter
18:47
- with certain programs or ideas
18:51
- to see if you can make it work.
18:53
- And sometimes
18:54
- when you can make it work,
18:57
- it's sort of like an moment. This is
18:59
- really neat. You know, we started
19:02
- using ambient listening devices
19:04
- in late twenty twenty four,
19:06
- and I'll never forget the first time that
19:09
- that we were able to do that with
19:11
- a patient encounter with their permission
19:13
- and see the outcome from them. For me
19:16
- as a physician,
19:19
- at first, the documentation of the notes wasn't
19:21
- necessarily
19:22
- what I might want to put in a
19:24
- chart for a patient, that it helped me
19:26
- keep up with everything. So even when I
19:28
- wasn't necessarily
19:29
- getting the full intended benefit,
19:31
- I was getting a cognitive
19:33
- lift where I didn't have to remember everything
19:36
- myself, and it and it was fantastic.
19:38
- And
19:39
- it's really just taking the time to find
19:42
- vendors
19:43
- that are willing to work with you as
19:45
- a partner rather than just offering you something.
19:48
- The scale for a small organization and what
19:51
- you need to be able to to do
19:53
- some neat things.
19:54
- Sometimes smaller is better because you don't have
19:56
- all the red tape to get through to
19:58
- really make some of those breakthrough things. I
20:00
- think you just have to work together as
20:02
- a team, see what you can take on,
20:04
- not necessarily
20:06
- look at things
20:07
- like they're done in large organizations.
20:09
- AI is a great example. You talk to
20:12
- large organizations, they may have or or even
20:14
- data analytics. They may have large
20:17
- data departments. I have one data analyst in
20:20
- my entire organization.
20:22
- They may have teams of informaticists
20:24
- that go out and do stuff.
20:26
- I don't have any formally trained informaticists. I
20:28
- probably fulfill that role more than anybody
20:31
- in my organization.
20:33
- What might be done as a department in
20:34
- a large place is one or two people
20:37
- or a small team in a smaller place
20:39
- that you can still work together and create
20:41
- some magic. And I think the biggest part
20:43
- of it is talking to the end users,
20:45
- seeing what they need most, and finding a
20:48
- way to make it work. Sometimes,
20:50
- some of the most innovative things I've done
20:52
- are the simplest things
20:54
- that basically just give a provider or a
20:57
- clinician
20:58
- what they need when they need it
21:01
- at the time that they ask for it
21:03
- just by listening.
21:05
- Yeah. Exactly. Just, you know, listening
21:08
- and collaborating. You've certainly proven that that makes
21:11
- the difference. So thank you for sharing that.
21:13
- So that brings us to the end of
21:15
- today's conversation with doctor Priscilla Frais.
21:18
- Doctor Fraise, thank you for joining us and
21:20
- sharing your insights on rural health innovation and
21:23
- sustainability.
21:24
- Thank you very much, Cathy.