K.R. Prabha (00:00): Are folks in danger of losing out business because they are not offering to be in the digital front era? I think yes because more and more of our daily life is getting digital. More and more of healthcare is getting digital. Rae Woods (00:16): From Advisory Board, we are bringing you a Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. My name is Rachel Woods. You can call me Rae. Last week on Radio Advisory we spoke with Advisory Board's John League and Optum's Matt Matousek all about digital change management. And one of the key takeaways that I have from that conversation was that when it comes to incorporating digital innovation in healthcare business leaders, need the right starting place and they need to be relentlessly focused on implementation. Rae Woods (00:49): We know that the digital health landscape is changing extraordinarily fast and leaders are facing some serious pressure to make progress. But actually assessing that progress and that progress relative to the industry can be tricky. There are of course models that exist that measure digital maturity. They exist in the tech field, in the financial sector, but those don't really apply to healthcare, which is why honestly we made our own. Rae Woods (01:16): We're going to tackle this conversation in two parts. First, Advisory Board digital health expert, John League, is back this time with K. R. Prabha, vice president of strategy growth and innovation at Optum. They're going to share more about this new tool they've designed so that health systems can assess their own digital maturity. Later I'll bring Dr. David Ingham, senior vice president and chief digital and information officer at Allina Health to share his own story of how this tool helped their organization realize their digital potential. Rae Woods (01:48): Hey, John. Hey, Prabha. Welcome to Radio Advisory. K.R. Prabha (01:51): Thank you, Rae. John League (01:51): Hi, Rae. Rae Woods (01:54): I know that you, John, and you, Prabha, have been really on the forefront of digital transformation for years now, and you work every day with real health leaders. I want to get your sense of the market. What does it even mean to be mature in digital health these days? John League (02:13): One of the ways that we've expressed this is the difference between doing digital and being digital. In terms of are we digitizing processes, are we automating specific things- Rae Woods (02:26): Point solutions? John League (02:27): Point solutions, or not even necessarily point solutions, but just tasks. Just we want to eliminate this friction point, but we haven't actually eliminated friction from the process. Versus what is possible if we think about the ways that digital could make this a different process? K.R. Prabha (02:46): Digital comes across to us in various forms, whether as an employee, as a member, as a patient. Removing that friction it's all about making it a delightful experience. Rae Woods (02:58): It strikes though that these efforts to do digital aren't necessarily harmful. I'm curious, why is it important to move beyond the kind of digitizing tasks and actually get to I like this definition of being digital? Why is doing digital not enough today? K.R. Prabha (03:20): I'll offer up the fact that what we do in our daily lives everywhere else other than just in healthcare, we're expecting a lot more things to be connected. We expect a lot of things to come together and be presented in a more simplistic way because we know there's so much information and options out there. K.R. Prabha (03:40): One of the things I was thinking of like yes, healthcare is not the same as Amazon, where you go buy stuff and the experience is pleasant and everything's connected. But there are things that digital can bring in which make it more of a connected experience. K.R. Prabha (03:54): An example might be when patients have appointments, firstly, being able to get them online is a big thing. But in addition, some people don't have the means to get to the appointment. Linking a transportation mechanism to it, working with the health plan and the health payer perspective of it together can actually make it more of a digital experience. K.R. Prabha (04:17): Now, you could do them discretely and separately by the person calling for the appointment or setting up the appointment than getting a lift over. But connecting them together is what makes it being digital or becoming digital much more pleasant experience all the way around in addition to saving a lot of good dollars because everyone shows up on time. They get where they need to and all that. Rae Woods (04:41): I'm hearing two kind of reasons why doing digital is not enough. First of all, expectations are so high because of how we interact with digital tools outside of healthcare in our daily lives. Our bar for success is perhaps much higher than where healthcare typically is. Rae Woods (04:59): And then the other reason that I'm hearing is that by moving from digitizing tasks to creating a more connected, frictionless, digital experience can actually help your business because you are adding the connect to Lyft or Uber to get that person actually to come to the appointment so that you get reimbursement for that appointment. It's important not just for consumer expectations, but it's important for your business model as well. Rae Woods (05:25): John, would you agree with that? John League (05:26): Yeah, absolutely. I think one of the big challenges is the difference between flipping a switch. You're not going to simply be able to code switch, if you will, from digital to analog and back and forth as easily as you might want to. There are a lot of places along the journey where we need to be sure that we are connecting people across their care journey. John League (05:51): And that manifests in a couple of ways. One is, are the on ramps and off ramps to digital and analog all leading you in the same place or does one lead to a dead end? The other element is do we have the push and the pull, right? Are we prompting people to take the next step to do the next task at the right time, whether that's a patient or a clinician or a payer, and are we pulling the information from them that we need to enable the next step in the right way? John League (06:23): And so often what we do is we make individuals, again whether that's a patient or a clinician or somebody with the plan, be the connective tissue between all of those things. It's grossly inefficient. As Prabha said, it's not what every other industry is teaching us about how to interact. Rae Woods (06:42): Yes. Rae Woods (06:43): Okay, I think I've got a sense of the challenge here, and the two of you have worked together to put a maturity model on the table for health systems to react to that is on this very scale from doing digital to being digital. What you've described here is really a journey. Tell our listeners what are the major parts of that journey from digitizing tasks, doing digital, to really getting to the other end of transformation and actually being digital. John League (07:15): When we look at the model itself, there are really two big components. On one side, you have the strategic vision and alignment. How are we aligning the organization around digital to serve the purpose of our organization to meet our goals? And what is the digital foundation that we're going to build all of this stuff on? K.R. Prabha (07:39): John, I was thinking of a visual for that. When we want to say what does digital strategy or digital investments or digital maturity look like, I think of an iceberg. K.R. Prabha (07:49): What I mean by that is you need to have a very strong foundation for an iceberg to be up there. What we've found is if you're just doing digital, they're like all these scattered little ice flows everywhere. Versus you're being digital, you have a very strong foundation which then stand up a differentiated outlook. K.R. Prabha (08:10): The one iceberg looks very different from the other. We know that, but that means that the whole makeup of it is based on a strong foundation which has to be in place before you can figure out where to go or what it looks like. John League (08:25): Rae, that relates back to what Matt Matousek was talking about last week in terms of zero impact. If you want to have something that is zero impact, that is automated, that is effortless, what that will look like to the user is the part of the iceberg that appears above the waterline. John League (08:42): Below that though is a massive buoyant, solid block of digital foundation and strategic alignment that you have to have in order to make that possible. Rae Woods (08:54): Yes, I was literally just thinking about the conversation we had last week and the importance of connecting to purpose and a central business goal or business challenge that you want to overcome rather than the tendency to do digital for digital's sake. Rae Woods (09:11): Let's talk about these different parts of the iceberg. What actually goes into establishing a digital foundation? What do you see in the market is really essential for folks to have below the waterline? John League (09:23): When we look at establishing a digital foundation, there are four components there. The first one for health systems has to be EHR centeredness. Rae Woods (09:33): What does that mean? I have an EHR? K.R. Prabha (09:33): Yes, and more. John League (09:39): How well does the system optimize and align against and with its EHR investment? John League (09:45): Let's remember that for health systems, the EHR is the biggest expense they've ever had that wasn't a building, right? It's the biggest ongoing attention and money sink in their IT experience, right? Most other digital maturity models that could relate to healthcare don't capture the gravitational pull of the EHR that health systems have to deal with. John League (10:12): That had to be there, and it is first. I won't say that it is the only element that you have to get right, but it is an element without which you cannot get the rest of it. Rae Woods (10:23): You cannot have a digital foundation without EHR centeredness not in a health system. This is a metric where we are really focused on health systems' digital maturity. John League (10:34): Absolutely. It would look different for other kinds of works. K.R. Prabha (10:37): John, I would say from an EHR centeredness, what we've also found is while most health systems are, I would say, majority health systems have the EHR, sometimes they don't have them used consistently. I think it's the centeredness which makes it such that it's scaled across the whole system. It's used in the same way. If they have 10 facilities, that they're using the same version of it so everyone who's working with it has the same experience or can expect the same information coming out of it. Rae Woods (11:08): Which at advisory board, we call that system-ness, right? This idea that all of the things are connected across individual locations within an organization, across teams, across people, so that you have this kind of system-wide approach. John League (11:21): That's actually one of the things in the model: system-ness as its own element of the digital foundation. It does matter for the EHR. It manifests there in very apparent ways. John League (11:32): But beyond that, system-ness in terms of what are the ways that we connect all of the disparate parts of our organization together. What are our priorities for that and how do we achieve that in an implementation real-life connectedness sort of way? Rae Woods (11:52): All right, so we've got EHR centeredness and system-ness. What else is important for that foundation? K.R. Prabha (11:58): I think it's also the muscle that health systems need to have around the IT delivery and the talent. Because while IT and technology is not the primary vision or even purpose of a health system, they have to have a strong capability in that area to be able to maintain the centeredness providing the strongest digital foundation. Rae Woods (12:21): Yeah, you need the skills. K.R. Prabha (12:23): Absolutely. John League (12:24): And lastly is in this element of digital foundation is being data-driven, how a system really maximizes the benefits from its data in decision-making. Can we actually harness all of this data we are collecting all the time in a way that makes it valuable instead of just having all of this data be an exhaust that we collect from all of the transactions and interactions that we document in healthcare? Rae Woods (12:55): This kind of baseline makes sense to me as the must-have to build off of. The bigger question that I have is how do you take that foundation and actually connect it to strategy? What are the essential ways that you're seeing sophisticated health systems actually connect that foundation to their strategic vision that you were talking about? K.R. Prabha (13:20): A lot of it, Rae, is about health systems have to define what they are, right? They can define themselves as a community hospital or they can define themselves as this international magnet for certain kind of services. K.R. Prabha (13:32): I think the digital aspect of it has to be aligned very strongly to that vision, right? It's not a digital aspect or digital strategy is something on the side. I think as you think about the other big part of our maturity model, which is around the strategic vision, it is really talking about how can we align with that vision. But how do we make the investments? How do we identify what digital capabilities or initiatives will generate the right ROIs for the investments they need to make, and what is the journey to make that? Rae Woods (14:11): It sounds like perhaps the digital foundation will pretty much look the same system to system. But the strategic vision and alignment, that's where we're actually talking about different areas of focus depending on the kind of organization you are talking to. Rae Woods (14:27): I want to go a little deeper there. Again, you two are out there in the market talking to health system leaders every day. I understand this goal that we have of moving organizations from doing digital to being digital. I am often a pessimist on this podcast. Be honest with me, how many folks are really being digital right now? What's your assessment performance across the market? John League (14:53): I think most folks land in the middle somewhere around what we call becoming digital, so from doing to being, in the middle there there is becoming digital. John League (15:05): I think there are lots of elements here in the maturity model that can help folks think about that journey in a slightly different way. One of the things that we deliberately added on the strategic vision and alignment category was about investment and ROI. I think in a lot of digital maturity models, folks think that ROI is an outcome of being mature and what we are saying- Rae Woods (15:31): Wait, why is that wrong? John League (15:32): Well, what we are saying in this model is that the way you think about ROI and the type of ROI you're able to capture is a function of where you are on that maturity model. It is not an output at the end. It is something that you are thinking about in different ways across all of those stages. K.R. Prabha (15:53): Rae, you're right. We would measure it at the end, but what we've been able to do is to say how do you measure the ROI. That's something that's really hard to do when you have a digital initiative to work through because it's not just about the technology or some new app, but you have to redo the processes behind it. You have to retool and re-skill the people who are going to work on it. K.R. Prabha (16:18): The ROI aspect of it's controlled by factors into many other inputs, which is not just the digital component. But I think planning out what the ROI would look like actually then helps with saying, "Did we achieve it? How do we measure it? What are the things, what are the metrics that matter?" Rae Woods (16:37): Are you saying that ROI is actually possible regardless of where folks stand today on that spectrum doing, becoming, being digital? Obviously we want to move our listeners, our clients, our members towards the right on that spectrum towards being digital, but perhaps what I'm hearing you say is that positive outcomes can happen anywhere along the journey. John League (17:05): Think about ambient documentation. Rae Woods (17:06): I think about that all the time. Yes, please continue, John. K.R. Prabha (17:08): Sounds like your favorite topic then, right? John League (17:11): The results that we see organizations capture around the benefit of ambient documentation is largely to eliminate pajama time, eliminate the time outside of clinic and outside of working hours that physicians have to spend catching up on their documentation. It is not to make them more productive. John League (17:37): Now, sometimes some physicians are able to be more productive because they are spending less time as they go to document, but largely many of the organizations that we talk to are seeing a benefit in measures of burnout, in measures of retention. Potentially you will start to see that benefit also appear in attracting physicians in as much as your ambient documentation solution is easier to use or you have it or more physicians have access to it. John League (18:05): But that is not an immediate hard dollar ROI. That is something that is far downstream and the results of which will never appear in a P&L that relates to how much you spent on your ambient documentation solution. When you think about ROI, you have to be thinking about it differently and you have to be thinking about it across all of these stages relative to, are you doing digital? Are you becoming digital? Are you being digital? In this case, I mean are you just implementing it in one place? Are you thinking about how this changes the way physicians are working? How are you using this as a strategic advantage to attract and retain your clinicians? John League (18:49): Those are the kinds of changes that I think we're talking about here. Rae Woods (18:52): John, I think you're getting at one of the reasons why this is so hard for health leaders today. What I couldn't help but think about as you were describing the kind of different ways that ROI can manifest is that especially when it comes to digital, it can be easy to get distracted, right? We talk a lot about it's easy to get distracted by a shiny object. It's also frankly easy to get distracted by I need this hard ROI number on my P&L, or I have just gotten this bump in this metric. Rae Woods (19:22): Why else is this journey hard for health leaders today? I get that technology is not a core competency for most folks in healthcare, but I'd like us to name why else this is difficult because only then can we actually overcome some of those challenges. K.R. Prabha (19:41): I think, Rae, the biggest challenge is the fact that there is a lag between when you say you start doing something more digitally to when you start seeing the outputs of it. K.R. Prabha (19:53): For example, maybe, okay, so I want to improve access. I'm going to go help put up online scheduling. To get there is a long journey, right? The decision to say I'm going to go online and do online access and everyone can just schedule their own appointments is a great message, but sometimes it's a long way in coming. It could be months depending on your system, or it could be close to a year. And patience runs out. People forget or leaders forget. K.R. Prabha (20:21): So where is the ROI? The ROI probably comes the next year, but there's no patience. Rae Woods (20:26): To your point about it's not as easy as flipping a switch, John, I'm assuming that one reason why you're going to tell me this is hard is because of the change management of it all, right? Which is why we dedicated a whole conversation to this last week. John League (20:36): Yeah, I think that is so true. One of the big reasons that this is so hard is that we don't have the workflows and we don't have the culture that are built with digital solutions driving them or enabling them. We are usually dealing with workflows that have digital solutions bolted onto them. John League (21:00): When we think about how we want our organizations to operate, we are often ignoring the adaptive challenges. We are ignoring the culture round what we're trying to get people to do. Operations happen in the context of your culture and culture is based on how you operate. It's this cycle that reinforces itself. And if at any point along that it breaks, either the thing doesn't work, so you can't persuade people that this is worth adopting or they're not adopting for some other reason. You can't get the value out of the thing you just invested in. John League (21:38): All of these things are like a flywheel. Every time you miss a turn on that, it's that much harder to get it started again. K.R. Prabha (21:46): John, one of the things I'll tell you based on my experience working with many health systems is we appreciate operators being innovative, right? They come up with scrappy solutions. They can make it work because in the moment they solve the problem. K.R. Prabha (22:00): Digital on the other hand needs consistency, needs predictability. As long as you can make those processes or innovation stick, digital actually makes it delightful. But otherwise it just makes the experience worse than what it was in the beginning, right? Because you have no human element now to say, "Hey, let me fix it another way for you." John League (22:21): Right. When you attach a new technology to an old system, you don't get a new system. You get an old expensive system. Rae Woods (22:30): Yes. That's a killer line, John. Rae Woods (22:32): Okay, bolting on additional digital stuff to existing systems is I think a perfect example of why so many people are in the middle of this framework that you have described. My question is, what is the feeling you want our listeners to have as they're hearing this and perhaps reflecting on their own digital transformation? Are we saying that folks are in danger if they don't move quickly here? How do you want them to feel? K.R. Prabha (23:04): Are folks in danger of losing out business because they're not offering to be in the digital front era? I think yes, because more and more of our daily life is getting digital. More and more of healthcare is getting digital. K.R. Prabha (23:18): Now it doesn't mean it's seamless or it's delightful, but it is getting there. That is going to be the premise. It doesn't have to be that everyone has to be running at 100 miles an hour. Every health system is not going to go at the same pace. Really, being thoughtful about how are you going to present the health system in the digital world is a very important leadership decision and a choice about where do we want to have the best digital experience. Versus where do we want to have the best human experience, and how can we marry the two such that at the end of the day, we've made it more connected, more delightful experience for not only the individual who's coming to get care, but everyone who's providing that care as well? K.R. Prabha (24:04): I think this can be refreshed every three to five years. You have to evaluate where are you as a system, how well are you digitally mature, but also do you need to do something different because everyone around you, your competitors are also going along the same journey. Where do you want to be differentiated versus where do you want to just be I'm bare basics and that's still good enough because that's what my patients and my caregivers ask? John League (24:32): Rae, I think there are two things here. One is usually when we talk about technology, we get wrapped up in a conversation that is informed by startup tech, bro-y kind of approaches around fail fast. John League (24:45): Failing at- Rae Woods (24:46): Yeah, break things. John League (24:47): [inaudible 00:24:48] in healthcare is not acceptable for obvious reasons, but the thing we need to set ourselves up to do and the purpose of fail fast is actually to learn fast. I don't think most health systems are set up to learn fast at all. John League (25:05): The challenge with that becomes that when you sign up for digital transformation, you are not signing up for one single big bang implementation that you can put all the wires and terminals in and flip a switch, and then you're done. You are signing up, as Prabha said, to be reevaluating yourself over time for years and years and years and years. If you aren't set up to learn fast, you won't be able to make that transition. Rae Woods (26:32): Prabha, you've been boots on the ground not just assessing health systems' digital maturity, but also really trying to be at their hip and helping them implement the changes identified in the model. I think at this point in the conversation, we should make this real for our listeners. Which is why Prabha, I want to turn to an organization that you've actually worked with to help them assess and ultimately refine their digital strategy. John League (26:58): Rae, Let me interrupt. Prabha has done some very interesting work here with Allina, so I'll let you and Prabha catch up with your guest, and I'll catch you later. Rae Woods (27:10): Prabha, I know you know this person very well, but I'd like to take a moment and introduce him to our listeners. We've got Dr. David Ingham. He is the senior vice president and chief digital and information officer at Allina Health. Rae Woods (27:23): Dave, welcome to Radio Advisory. Dr. David Ingham (27:26): Thank you for having me. Happy to be here. Rae Woods (27:29): Dave, I'll admit. Prabha gave me the heads-up on some of the work that you all had done together, but I want to hear directly from you and let our listeners know how this partnership actually started. What's the origin story of this work? How did you realize that digital transformation was something that needed to be evaluated and that you needed to define a new path forward for Allina? Dr. David Ingham (27:53): I think it probably started roughly a year ago as I started becoming more and more involved in all things digital for the organization. It really came out of people asking me, "Dave, what are we doing in digital? What are we working on?" What I realized quickly is that it means something different to every person. Rae Woods (28:16): Probably not what the chief digital information officer wants to hear, that it means something different for every person. Dr. David Ingham (28:20): Yeah, good one. Yeah. Yeah, I didn't have digital in my title then, so that's [inaudible 00:28:26] fortunately. Dr. David Ingham (28:27): But I started realizing we needed to define things a bit. For some folks, it's that very consumer-facing experience, what that means. Other folks, it's like what digital tools are you using to make patient care more safe or more effective and so forth. And then others, it's, how are you going to automate my supply chain processes? How are you going to make this more efficient? Dr. David Ingham (28:50): It really meant something different to every person. I realized we really need to start with how we're approaching it and recognize that there are different spaces for it to fit in. As we began partnering with Optum in both the IT and revenue cycle space earlier this year, opportunity came up to at the Advisory team to help us with that digital vision and really help gain some cohesion around what we're doing in I'd say all things digital as an organization. Rae Woods (29:20): And so you took this assessment based on this digital maturity model that Prabha had developed. How did you do, and how did you do compared to how you expected to do? Rae Woods (29:33): Prabha, make sure you're keeping Dave honest here. Dr. David Ingham (29:36): Well, I always like to have be five out of five stars and decidedly we were not. But the thing is, it's not a competition. It was not designed to benchmark us or show us how we're doing against our peers necessarily. It's really intended to be an internal tool, and Prabha keep me honest, where we can see where we are somewhat relative to the industry or what best practices are. Dr. David Ingham (29:59): But we'd then be able to use that tool in the future to calibrate how we've advanced, where we are accelerating, where we still have a lot of work to do. And so that actually took some adjustment for me to wrap my head around, and a lot of my leaders and colleagues were a little bit uneasy with not having that direct comparison, that direct information against some benchmark or some industry standard. It took some adjustment to really have it focus in on that internal piece. K.R. Prabha (30:29): What I have seen along the journey is yes, that initial view of really, we are in more in the doing and becoming digital. Why aren't we all the way to the right? To then switching to what will it take, how far to the right do we want to go and how do we invest in it? What are the specific things, whether it's in service lines or it's in supply chain or it's in the consumer apps that we want to do? K.R. Prabha (30:53): Have really appreciated seeing you and your leaders go through that discussion and then really come up with what do we want to do and what can we pace it because that's important. You can't do everything in the first year. Rae Woods (31:06): Yeah, you absolutely can. Rae Woods (31:07): That's exactly where I was going to go next, Prabha, right? I imagine that the assessment showed some certain pockets of innovation, even advanced innovation, other areas where you need to have a little bit more focused effort. Sometimes that can be hard for executive teams because they go, "Wait a minute, there's too much for us to do." How did you then decide or who did you involve to help you decide where you prioritize and what Allina does next? Dr. David Ingham (31:37): Yeah, we broke it down into a number of different areas that really tried to get at that very question. Some of these were how we were doing in terms of our EHR, how we're doing in terms of just our system-ness, how we're doing in terms of our various data, data sources, and data warehouse, and how that is connected in with different pieces, how are we doing on governance and management. And so that was all part of the assessment. Dr. David Ingham (32:06): As you point out, we were at different levels of maturity on each of those. With some of the stakeholder feedback and interviews that Prabha and team brought, it was very interesting to see the varying understanding of where we were and varying opinions of where we are. Folks that came in more recently had distinctly different views of our current maturity level against folks who'd been around for a while, and some of that was really helpful and did elucidate where some of our opportunities are. Dr. David Ingham (32:40): Coming back to the priorities, that's where we are continuing to work to understand within these different pillars or domains, what will it take, what investment level is needed, and then what specific projects and areas of focus are needed to advance within the various domains. Rae Woods (32:59): I'm thinking back to the origin story that you mentioned at the top of this conversation, which is that you can be digital and take different focus areas. The consumer focus lens, right? The outcomes focus lens, the rev cycle lens. Did this help you as a leadership team prioritize and focus the strategic vision for what being digital would mean for Allina specifically? Dr. David Ingham (33:27): Absolutely. We're constantly calibrating against what the enterprise strategy is, so where's the organization trying to go? What are we trying to emphasize either areas of growth or consumer segments that we want to emphasize for patient care and so forth? And so we were always adjusting the digital assessment against or calibrating against what we're doing as an organization. Dr. David Ingham (33:54): I'd say that has very much informed what priorities we're now starting to delineate both from a broader three to five-year strategy perspective, but also what do we need in 2025 to build the foundation to tee us up for success into the future. Rae Woods (34:13): So what are some of those? What are some of those top of the to-do list things for next year? Dr. David Ingham (34:18): I like to break it down by the to-dos and then what I call the strategic enablers, and so some of those are having robust, strong EHR foundation. Dr. David Ingham (34:28): Our Epic we installed 20 years ago, and back then it was the best of the best. We had all the bells and whistles, but over 20 years you get some barnacles on there. You've got custom configuration and it's not the latest and greatest shiny Cadillac coming out of the garage. And so we're working with our Epic colleagues to pull out some of the custom code, custom configuration. That'll be key for setting up a foundation on which we can put the latest technology, the latest Epic functionality and other tools that plug into the EHR. Dr. David Ingham (35:00): Similarly, within Allina, our core network backbone is outdated. And so updating some of that core architecture in the network space, upgrading the hardware, those are very expensive propositions and long-term tasks. Those are the base layer of what we need to then do some of the more exciting pieces that involve all the buzzwords, the AI and machine learning and these things. Rae Woods (35:26): But I really love that real talk of you've got to get the digital foundation right before you can go to the shiny object and start talking about those big buzzwords. K.R. Prabha (35:34): Dave, I think one of the things that you and your leadership done is to say, "Can we get one backlog?" I know it doesn't sound sexy, but one backlog of everything that's been qualified as digital but being run either out of a facility or anything into a central way so that you can deprioritize things which are not going to feed into your 2025 being digital vision or going up to your 2030 vision as well. Dr. David Ingham (36:01): Yeah, absolutely. That prioritization has been key. Dr. David Ingham (36:04): One of the things the team did for us that was really eye-opening and interesting was an exercise where we had all the different initiatives that we're contemplating for, let's say, the next one to three years and signed. I think they said dollars. Everyone had $100. You need to put some dollar amount into the different initiatives, and I of course wanted to pull out a credit card and said, "Prabha, can I start charging extra and take this back later?" Dr. David Ingham (36:30): But it was really interesting to see how folks with different perspectives within the organization emphasize different digital initiatives. Digital hospital, not surprisingly the CNO's indexed heavily on that. But others indexed more heavily on that consumer experience, and so they brought their lenses. It was interesting how some folks allocated their play dollars in spaces. Rae Woods (36:55): What I like about this story is that there is of course the scoring and the priority setting, which everyone needs to do, but I love how you're articulating how different people with different goals in mind are coming up with a different purpose, which is why you have a job to try to bring all of that together and set the stage for what's next for the organization. Rae Woods (37:18): What I want to ask you is, what will success look like for Allina on this journey to being digital? What would make you look back at this conversation and say, "Rae, we did exactly what we set out to do"? Dr. David Ingham (37:34): That's a great question, and partly I don't quite know totally what success looks like. I think it's still foggy. I can see somewhere in the distance with all the vision work we've done. I think it certainly looks like a cohesive, integrated patient experience that is focused on certain care journeys, certain care experiences, if you will. Really, also accelerating that care delivery space, particularly in the hospital and leveraging the digital tools there. Dr. David Ingham (38:05): But it looks like, I think, us pulling together a lot of the different tools that we already are using or are in development and having them actually be connected as opposed to being very siloed and very separated. I think that'll be a definite success point. Dr. David Ingham (38:22): I think when we are in the hospital space, truly keeping patients where the best site of care is for them, I think that will be a point of success. When we don't need to transfer as many patients from regional hospitals up to our metros, when we can keep more patients in the home, leveraging digital tools, digital monitoring, all these types of things, I think that's another sort of out there vision of success. Don't quite know the path, don't quite know where we need to turn to get there, but we're starting to see that. Again, it goes back to those foundational pieces. Dr. David Ingham (38:57): And then in '25, what are the core tools and tech that we need to have in place to support and get us little more into the fog a little further along so that we can get closer to what that vision is? Rae Woods (39:09): The word that comes to mind, to summarize the conversation we're having and the conversation that Prabha, John, and I had is the word journey, right? Organizations are on a journey to being digital, and that journey looks different for different organizations or perhaps for different leaders in one organization. Rae Woods (39:29): I want to give each of you an opportunity to speak directly to the Radio Advisory audience for a moment. Dave, given your experience on this journey so far, what recommendations do you have for other organizations who are maybe just starting to assess and make progress on their digital maturity? Dr. David Ingham (39:49): I would say delineating what you mean by digital is really critical. As we talked about earlier, it means something different to everyone. That has been really helpful. Dr. David Ingham (39:58): It helps focus conversations both within our vision team, our strategy team, in terms of, okay, what part of care are we actually talking about. Helps when I'm talking with colleagues and customers, I have found a lot of help with the expertise of the Advisory team beyond just creating discipline and accountability. That expert voice and guiding where we should be looking, where pitfalls are, it's really been instrumental in helping us at least to get closer to what that final product, that final capability set will look like that enables our vision. Rae Woods (40:33): Prabha, as the expert and person who's helping to guide these organizations, what do you want our listeners to do next? K.R. Prabha (40:40): I will say that not every health system will have the exact same digital journey because it's a function of the leadership team and the organization's appetite for change and being able to go along the journey. It's important to go along the journey and finish it more than we want to have this grand vision that's going to happen next year. Rae Woods (41:04): Well, I'm so excited to see what your partnership does next, and we'll make sure to add some of the details on how to get in contact with you Prabha in the show notes. Thank you for coming on Radio Advisory. K.R. Prabha (41:15): Thank you. It was my pleasure. Dr. David Ingham (41:23): Thank you for having us. Rae Woods (41:23): I have two big takeaways from this conversation. First, there are a set of foundational principles that every health system needs in place in order to make progress their digital journey. But the end goal of that journey might look different organization to organization, and that's okay. At least it's okay as long as you're making progress and moving towards being digital. Rae Woods (41:48): Like I say, at the end of every Radio Advisory episode, we really are here to help. We've added some links to the show notes, and we'd love for you to get in touch with us. Rae Woods (42:21): If you like Radio Advisory, please share it with your networks. Subscribe wherever you get your podcasts and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Rae Woods, as well as Abby Burns, Chloe Bakst, and Atticus Raasch. The episode was edited by Katy Anderson with technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Leanne Elston and Erin Collins. See you next week.