Air-Traffic Control for Patient Care

In this episode, we talk with Angie Franks, CEO and President of Central Logic, about the importance of real-time actionable information in healthcare. Angie has extensive experience with healthcare informatics and has held executive positions at Retrace health, The Advisory Board, Healthland, Lawson Software, and GeoAccess. In this discussion, we cover the importance of real-time data in patient transfers, the transition from quantity to quality based care, and the potential for clinical command centers in healthcare. Angie’s insight and bredth of experience make this episode of 4x4 Health engrossing and engaging from start to finish.

Dr. Dave Levin: Welcome to 4 x 4 Health, sponsored by Sansoro Health. Sansoro Health, integration at the speed of innovation, check them out at www.sansorohealth.com. I am your host, Dr. Dave Levin. Today I am talking with Angie Franks, President and CEO of Central Logic. Angie has been a leader at High Growth Technology for more than 25 years. When it comes to Healthcare IT, she has expertise in clinical, financial information systems, enterprise resource planning, telemedicine and software as a service solutions. Her company, Central Logic is a healthcare software and solutions company that focuses on helping healthcare clients achieve meaningful outcomes by converting data to real-time usable information across the healthcare spectrum. The result is a positive impact on patient care and financial outcomes achieved by reducing readmissions, lowering length of stay and increasing patient satisfaction and volumes. I met Angie a few years ago when she and I and Jeremy Pierotti, CEO of Sansoro, squeezed into the back seat of a Camaro to share a ride. I can tell you that it was an entertaining experience but past that, I think we’ve agreed not to discuss the event today. Welcome to 4 x 4 Health, Angie.

Angie Franks: Thanks, Dave. It is so good to be here and actually enjoyable to relive that moment from the car ride.

Dave: Yeah, but I think we should let what happened in the Camaro stay in the Camaro.

Angie: Let’s let it stay in the Camaro, yes.

Dave: [Laughing] Angie, we’re really delighted to have you here and let’s get right into it. I am going to ask you a series of four questions and we’ll take about four minutes to discuss each one. So, the first question is, tell us a bit more about yourself and your organization.

Angie: Sure. Well, as you, so well said at the beginning, I am Angie Frankston, the CEO of Central Logic. We are a technology company that serves the health systems across the United States and we serve them and providing technology for a function within the hospital called the Transfer Centre and the Transfer Centre has played a really important role in ensuring that patients that are in an acute state, and they might be at a rural hospital or at a community hospital or in a physician’s office but they really need to be in the hospital, that we, we have software and technology that helps facilitate transferring that patient to the right facility and our vision statement which kind of sums up what we do really well is right care, right location without delay.

Dave: That’s really terrific and this whole point of this has been a recurring theme in these podcasts and it’s this idea of actionable information and what I liked so much about the description of your company is that, the part where you’re talking about, you know, achieving meaningful outcomes by converting data to real-time usable information. So often I feel like we are collecting data or reporting things but not in a way that folks can readily take action. Does this resonate with you and if so, can you talk a little bit about that?

Angie: Yeah, absolutely. It’s such a great question. So, in today’s world, what we’re seeing, the evolution of the transfer centres, it’s really evolving into the cornerstone for command centres or operations centres within health systems. The clinically staffed call centre where nurses and physicians and EMTs in the moment are making decisions about where to place a patient that’s coming into the health system, what’s the right location for that patient to be at based on their level of care needs, what facility has availability or what bed or what unit has availability for that patient. Real-time connect that sending physician with the receiving or the accepting physician and that is connecting those docs on to a call where the on-call physician that’s appropriate for that particular patient can in the moment get that update on what the status is of the patient, what their needs are and make the decision there to say, yes, I’ll accept that patient and let’s, let’s have that patient routed to this facility in this bed and we will get that patient on to a better, you know, hopefully in the best health outcome possible. So, making those adjustments, making those decisions in real time, using data that is updated. You know, we’re pulling data in from all over different systems and different parts of the health system but it’s giving those clinicians in the moment when the patient is highly acute or in you know, urgent need to be received in a higher level of patient care. We’re giving them the ability to make those decisions at that time. It has great outcomes, you know, for the patient and it’s got great outcomes for the health system as well and ultimately provides a good experience for the referring physician.

Dave: But this is a category of solution that at that I think of is kind of like air traffic control. I imagine all days it’s almost as complex as try to manage air traffic at a busy airport. You mentioned outcomes, tell us a little bit more about what you’ve seen in terms of real-world results.

Angie: Yeah, well time matters when you’ve got a patient in an acute state that they really need to get the right level of care at the right time, every minute it takes to make that patient transfer happen is a minute that has not been spent on, on getting the patients the care that they need. One of the more poignant stories that stand out for me is our company was founded by a physician who had this problem and I think just in general, those are the best technology companies are companies that are formed by people that had actually lived and experienced this problem and he had a patient in a community hospital that and, our, this gentleman, is a hospitalist who he believed was suffering from a dissecting aorta. So, a really critical case and he needed to move that patient very quickly into a cardiac speciality hospital. It took two and a half hours and ten phone calls to make that transfer happen. The patient outcome in that case, ended up being good. The patient got to the right place, they stabilize and handled the cardiac situation, but it was so tenuous those hours, two and a half hours to facilitate that transfer, that patient could have died in his hospital room in front of his eyes and now is really the impetus and the motivation to begin and launch Central Logic. So, those are the types of impact that we see every day and we hear about every day from our clients that are in real time making these decisions to facilitate treatment quickly.

Dave: Yeah, and in addition to the impact on that patient, what I’ve seen in my own work as well a sort of a second-order impact on other patients because if there’s someone in a bed, let’s say in a critical care unit but could be transferred somewhere else, it’s almost like a chain reaction and as you expedite the placement of patients at lower levels of care, it creates capacity in other parts of the system. So, the benefit I think is not just to that one patient which obviously is important as huge, there’s a system effect to it. Do you see that as well?

Angie: Absolutely. When you’ve got a patient occupying a bed, that is not the appropriate bed for that patient to occupy, you’re taking away from the care that someone else that needs that bed more acutely. You’re taken away from the care that, that patient needs. It’s also costly to the health system to have the wrong patients placed in the wrong facilities or in the wrong bed. I think you know, we all understand that a hospital bed is not really an available bed unless it’s staffed, and the staffing is appropriate to the acuity and the level of care of that unit or that hospital. So, to put a patient that could be sitting, receiving, you know, appropriate care in a community hospital to put those patients in a level one trauma centre might not be the best thing for that patient, that could have been in the community hospital. It consumes a bed at the trauma centre, it makes one not available for a patient that needs it more urgently. So, you’re absolutely right. There’s a domino effect across the system and it affects patient care, it affects the physician experience and it affects the financial outcomes for the health system.

Dave: So, obviously you guys are involved in a number of different activities. What’s the most interesting or important thing you’re working on right now?

Angie: Oh, as you know, there’s so many to choose from but I think the most interesting is when, when I consider what, what we’ve just the conversation that we’ve just been having about, about what we do and I think about the dynamics in the market today, so what’s happening in our healthcare industry. We are still predominantly a fee for service driven industry and the majority of reimbursements and contracts that health systems are getting reimbursed on our fee for service-based arrangements. With that said, we are underway in a shift to fee for value and even if that’s a couple percent or 5% or 25% of the revenue coming into the health system, you know, is not a fee for a value-based contract. Bridging that transition and having the ability to make decisions about patient placement and logistics and navigation for where route a patient and accepting the transfer and aligning the appropriate resources inside the health system and adjusting those levels and forecasting and predicting those levels, it becomes more and more critical as we try to bridge this transition. Like I said earlier, it’s going to have a significant financial impact on the health system today. This bridging, this transition from fee for service to fee for value is a significant operational impact for the health system and our transfer centre, that’s really becoming the command centre for the health system as a way for hospitals to operate effectively, make good decisions effectively under both environments and you know, have the impact for the health system of maximizing their financial outcomes and maximizing the clinical outcomes for the patient. So, for me, it’s exciting to be part of helping the health system, navigate through that change and bridge that transition into a world that we’re all going to live in for a long time and that is one where you’ve got to live in fee for service and fee for value simultaneously.

Dave: So, I think this is really important and I want to drill a little bit deeper on it because I often feel like when I am in these conversations, we all recognize we’re living with a foot in each canoe right now and I see people get sort of frustrated and flummoxed by that and quite frankly, I don’t understand it because it seems to me that solution like yours can be valuable and effective in either model. Now, I understand that maybe do answers and you may attack different problems or different priorities but the way you’ve described it, it sounds like to me this is exactly what you’re doing. In fact, that it’s a one size fits all but that’s not the approach can be adapted to the current nick. Is this making sense, or you know, you’re free to call BS on me. I encouraged my guests to do that but am I making sense here at all?

Angie: Oh, you’re making total sense is that, that is exactly you know, we help the health system operate effectively with their feet in both pools and while the majority of revenue for the majority of health systems today comes from fee for service-based arrangements. The need for becoming more proactive for reaching out to patients after they’ve been discharged and ensuring they don’t get readmitted for a condition, you know, for their discharge condition or proactively reaching out to patients that have chronic disease that need to be monitored and managed remotely with clinical staff. These are all capabilities that can be handled in this clinically staffed command centre that health systems are today beginning to put in place and operate because they see that at mixed, you know, continuing to shift. You know, at the end of the day, I mean this is my thought, at the end of the day, the way we will operate, when you think about what you need to do as a health system to operate effectively and make a margin and you know, stay in business in a fee for value world is you’ve got to focus on prevention and wellness and keep people as much as possible out of the health system. We see, I think we, we’ve probably have all seen hospitals are starting down this much more decentralized, you know, path where you can go to a freestanding ED or you can go to the CVS free or flu shot or preventative care. You’ve got primary care physicians, you’ve got hospitalists seeing patients inside the walls of the hospital. Pulling that all together and making sure the right decision gets made for the patient whether that’s in the heat of the moment or proactively and preventatively. This is an opportunity for this role of the command centre, the clinically staffed command centre to really help enable the best patient care in a more cost-effective coordinated manner.

Dave: And, as you pointed out, it can work in a variety of settings. You just have to be thoughtful about what your priorities are and how you’re going to attack.

Angie: Yeah, yeah, you know, I think, I think the fee for value is no different than managed care of, you know, the early 1990’s. The only difference is we now have the technology, we have digitized medical record, we have different roles than we had back then. So, we have roles like hospitalists who just take care of patients in the hospital. The role of the primary care physician is different than what it had been back in the 1990’s. So, you still need some fulcrum, some point to help coordinate care and, and decision making for the patient and for the health system, so you don’t have leakage and attrition of those patients and that can all happen out of your command centre.

Dave: I am afraid, I’m old enough to have seen that movie in the ‘90s and I’ve seen some of it, but I agree with you. It looks and feels different to me this time, it feels more solid and more likely to succeed. If you’ve just joined us, you’re listening to 4 X 4 Health and we’re talking with Angie Franks, President and CEO of Central Logic. Now Angie, for this next question, I want to remind you just like I do all of my guests, this show is PG-13, so let’s keep this family friendly but what’s your favourite pet peeve or rants these days?

Angie: Oh boy! There are many of those to choose from as well. Alright, I would say, my favourite pet peeve is probably not changed over many years. It’s kind of human behaviour related and maybe not as intuitive when I tell you this because I am from Minnesota and we get a little bit of a bad rap that we’re kind of passive-aggressive in here in Minnesota, but I am not one of the passive-aggressive Minnesotan. So, I am a very direct person, I don’t like a lot of beating around the bush or you know, game playing, or you know, kind of trying to figure out there read between the lines. I kind of like just having direct conversations and putting it out there and putting things on the table and you know, when people are not behaving that way, it does, it kinds of drives me crazy. I can’t, I hate trying to figure out what people are trying to tell me, it’s like just be direct.

Dave: Yeah. I have to agree with you on that. For me personally, especially in the last five years or so, I’ve really tried to work on just being my more authentic self and being okay with that and I think in some ways it relates to what you’re saying although as my friends remind me, you can be authentic Dave but don’t be an authentic ass. So, I guess you can take it through forward.

Angie: I think you’re exactly right. I mean, there’s always ways, there are always ways you can deliver a message and you can deliver that message you know, in an uncaring inconsiderate way or you can do so in a caring and considerate way and so, I think I would tend to always advise people to at least lean towards affability, right. People do want to be like, you can be direct and be well liked or respected at the same time. So, I think that’s a really good point.

Dave: Yeah and I think you know, this applies to personal life as well and I’m a typical guy in my relationships. I tended to avoid the conflict or the difficult discussion with my wife or whatever and then wait and then eventually you blow up over it and I’d like to think in that area too. I’ve made some progress and what I’ve learned is, it’s just better to confront the issue. Again, you don’t have to do it in the heat of the moment but don’t let it fester either and I think that’s true both in our personal and our professional lives.

Angie: Yeah.

Dave: So, well that almost sounds like sage advice. So, let’s, let’s just kind of roll right into that. It’s our last question today. What is your most sage advice?

Angie: Well, you know, it is a little bit a part of the sage advice. I do think, I think people, I think a lot of times in the business world, the smartest person in the room sometimes can have a style or an approach or a lack of likability and I’m, I’m a firm believer in affability is really a key to success. People like to work with people they like, they like to interact with people they like, they like to buy from people they like and so, affability is a key criteria for success, for anyone that kind of build off of that pet peeve comment. My sage advice was actually going to be a little bit different and that was really my advice would be related more towards business decision making, especially in a world where, you know, we sit here in healthcare with plenty of problems to solve. There’s a lot of opportunity and a lot of business issues and you know, unsexy processes that could be improved upon with technology and other services. You know, I think it is absolutely key. I’ve just seen this play out a million times in my career. Use data to make decisions of data-driven decisions and build products and solutions and services that are market-driven, meaning get lots of feedback across the industry from different constituents and take that input and help that shape your product design and use that input every step of the way and you’re going to come out with something much, much better on the back end than you ever will if you just take your idea and hunker down and design and build something and hope people like it. So, the data-driven decisions and market-driven products.

Dave: Well, boy, that’s a ton of sage advice there. We better have you come back just to unpack that a little bit further. I have learned that lesson the hard way a few times myself and I have the opportunity to see a lot of new and interesting things and very often they’re kind of cool ideas, but you look at him and you go, there’s no market for this. Who’s going to actually pay for this as an example?

Angie: Yeah, right.

Dave: Or how will this actually work in the real world? So, I think your advice is really spot on. You know, it is my podcast, so I’m going to take the liberty here and throw a bonus question at you if I may.

Angie: Sure.

Dave: You are a successful woman in an interesting space. You’re in start-up, you’re in health care, you’re in IT. You’ve had to raise, I assume at some point some sort of a capital venture funding or otherwise and this is an area of interest of mine. It should be an interest of everyone, you know, which I guess in its simplest form is about promoting diversity but in understanding the challenges of making that happen and so, if you will forgive me for asking a question based on gender, I’m really interested in what your experience there has been and what’s your advice is to all of us, men and women about these issues and how best to navigate them?

Angie: Yeah. Well, yeah, I, you know, I have been fortunate and lucky in my career and have had incredible opportunities all throughout my career. No, I, I would say that I’ve probably never really approached anything thinking at all about my gender. I think it was never, it’s never been really on my mind. It feels way more in the topic of conversation and on the mind of and I understand why it is and I, and I think that there’s lots we need to do and in the business world to help build up more leaders and more female leaders. At the same time, I feel like, if I were giving advice to women, I would say be yourself, take chances to speak up, don’t hold back and I think women have some, we do things different than men and sometimes that can be limiting. We might sit there in the room with some ideas and hold back from speaking out cause we, you know, we don’t want to say something stupid or say the wrong thing and so we might hold back to let those ideas formulate. You know, my advice would be take risks, take chances, speak up, participate, you know, have a, have a place at the table and I think things work out as a result. I do think and I have experienced in seeing this, but I will say, this is probably falls into my pet peeve category. I’m not a, I’m not really big on the whole victim thing. Hopefully, this doesn’t offend, doesn’t probably offend some people but I don’t believe, I believe we’re only victims of our own, like behaviour, especially when it comes to this kind of stuff. Look, if you don’t like something, you got somebody that’s being, you know, inappropriate at work or really biased against women. Go somewhere else. You’ve got smarts and skills and talents and abilities and go pack up and go somewhere else and take your skills but don’t be victimized by it. You know, like I said, take your skills somewhere else. I think sometimes because women have a little bit different style than men, that, that can be perceived as non-aggressive or non-assertive or maybe not as competitive and not as hungry, women aren’t maybe quite as chest pounding and Braggadocious as sometimes men can be in, that can look like, oh, maybe they’re not as confident. So I think, I think for men, you’ve got to also understand that women have different styles and, and you might spend a little more time drilling in and asking questions and you might find you’ve got some unbelievable female talent, leadership talent and you’re, in your ranks that step up and, and do things that you, you may be unconsciously didn’t think were possible. So, I agree we’ve got a ways to go in the business world, but I would just say from my own perspective, I’ve never, I know, I have never really approached anything thinking, well I’m a female leader and, I’m a, you know…

Dave: Right, right.

Angie: You should need more females in these roles. So, give me the job because of those, probably more of a thought of why would you not give me the job? Like…

Dave: Right. Well, your advice about, you know, don’t play the victim and you know, if you’re in a situation where it’s just not working for you and you have options, exercise them, I think that applies to all of us.

Angie: Yes.

Dave: And, what I would add is that I am a huge believer in the power of diversity that none of us has a lock on truth. None of us has a perfect style and that it’s really out of the discussion and the debate and those different views that we get closer to what the truth is and so, I very much believe in actively cultivating this and not just gender but age and you know, life experience and all the rest and my experience has been that if you’re mindful of this, that it can just pay huge, huge dividends for everyone.

Angie: I completely agree. I think it’s, I don’t know, maybe it’s all part of our natural aversion to change management when something’s different than what we expected, or things are changing. We may be kind of want to dig in our heels a little bit and go, oh, I kind of liked the way, the old way things were working. I had an experience where I was working in a sports technology industry for a period of time, not long a year and a half. The company was dominated by probably 20-year-olds that couple of years out of college. Their way of thinking and their ability to multitask and work on a ton of different things and adapt technology, it was so exciting for me to see and so enlightening because it’s just, it was just something I hadn’t experience in other, other settings and a, it was a breath of fresh air, but I think it easily could have been, you could squash it by all these, you know, young people that have their headphones on at all times or four different devices out, aren’t paying attention. No, they were actually getting a crapload of stuff done.

Dave: I couldn’t agree more. I really find it disturbing people. Well, anytime you lump a group and say, those millennials.

Angie: Yeah, exactly.

Dave: Well, first of all, that’s not true, it’s a diverse group and second, you know, this is like our parents saying turn down that rock and roll, you know.

Angie: Right.

Dave: Every generation, we seem to do this, and we don’t seem to learn from the experience.

Angie: We haven’t learned, exactly.

Dave: No, I think you’re right. There’s some human nature here. Again, for me, I try to just be actively aware of that and recognize it when I had those feelings or thoughts and, and then kind of talk my way through it or think my way through it. So…

Angie: Right.

Dave: Well, thank you for indulging me on this bonus. I think you’ve shared a lot of tremendous wisdom here. I want to thank you for your time and for the work you’re doing with Central Logic and, and again for sharing some of your insights with us today. Let me give you the last word.

Angie: Well, I just want to thank you, Dave for the opportunity to join you on this podcast and it was really a fun discussion and important topic for the industry. I think it’s a good thing that you’re doing and thanks for having me on.

Dave: Angie, thanks for joining us today. We’ve been talking today with Angie Franks, President and CEO of Central Logic. You have been listening to 4 x 4 Health, sponsored by Sansoro Health. Sansoro Health, integration at the speed of innovation. Check them out at www.sansorohealth.com. I hope you’ll join us next time for another 4 x 4 discussion with healthcare innovators. Until then, I’m your host Dr. Dave Levin, thanks for listening.