America’s Opioid Crisis: How IT Enables Better Care

In this episode of our series on opioid abuse in America we talk with Debra Bauman, VP of Technology Services and Chief Information Officer at the Hazelden Betty Ford Foundation about how her organization is harnessing information technology to enable better, more efficient patient care. With over 30 years of experience in Technology Services in a variety of industries, Deb is a seasoned, accomplished leader and trusted advisor. Her insights about how to get the most out of IT will benefit anyone engaged in leveraging technology to combat the opioid abuse and can be generalized to a wide range of clinical and operational IT opportunities.

About the Series

America is in the midst of an Opioid abuse crisis. In 2017, more than 28,000 Deaths were attributed to overdosing on synthetic opioids. The steady rise in the number of people misusing opioids and the migration of some patients to street drugs like heroin and fentanyl when they can no longer get legitimate prescriptions has resulted in a genuine public health crisis and an “all-hands on deck” moment for healthcare. In this special series of 4x4 Health our guests share their views on this crisis as we look at the current state of diagnosis and treatment as well as the role technology can play in enabling better care.

Dave: 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’m your host Dr. Dave Levin. America is in the midst of an Opioid Abuse Crisis. Consider some of this statistic reported by the US Department of Health and Human Services or HHS. It’s estimated that in 2017, more than 28,000 deaths were attributed to overdosing on synthetic opioids which translates to more than a 130 deaths every day. Us of great concern is to study rise in the number of people misusing opioids for the first-time. In 2016, two million people misused prescription opioids for the first-time and reflecting the fact that patients often move on to street drugs when they can no longer get legitimate prescriptions, 81,000 people used Heroin for the first time. This is a genuine crisis and an all hands-on-deck moment for healthcare. In response HHS has proposed a five-point plan that’s designed to lead to better prevention, treatment and recovery services, enhance data collection and research, improve pain management and increased targeting of overdose reversing drugs like Naloxone. In this special series of 4 x 4 Health, our guests share their views on the crisis as we look at the current state of diagnosis and treatment as well as the role technology can play in enabling better care. Today I’m talking with Debra Bauman, VP of Technology Services and Chief Information Officer at the Hazelden Betty Ford Foundation . Deb joined Hazelden Betty Ford Foundation  in 2015, bringing with her over 30 years of experience in technology services. She served in a variety of roles in different industries including Group President for Bremer Bank, Vice President for Target Technology Services where she was in charge of Financial Services, Technology and target.com and Chief Information Officer for Sun Country Airlines. Deb is also a trusted advisor. She’s been a Member of the Strategic Advisory Board for FIS Global Solutions, a board member for several startups and a Member of the Advisory Board for the Sophia Fund and Angel Investment Firm. She’s Chairman of the Board of the Non-profit Bridge for Youth and also serves of the Board of the Women’s Health Leadership Trust. As you can tell from this introduction, Deb has a wealth of experience in Information Technology and the leadership skills that enable her teams to get things done. I’ve had the pleasure of working directly with her and can affirm she also has the courage to pursue her ideas even when they don’t square with a conventional wisdom of today’s Health IT. She possesses vision, strong leadership skills and the diversity of experience and knowledge that we need in the mix to help us reinvent the US Healthcare System. We’re glad she’s here today. Welcome to 4 x 4 Health, Deb.

Deb: Thank you Dave, it’s good to be here.

Dave: Before we get into the Opioid discussion, I’d like to ask you my usual opening question. So, take a moment and tell us a little bit about yourself and your organization.

Deb: Well, as Dave mentioned, I’ve been in technology for several decades and what led me to technology in the first place was that I was actually a Business Major, a Marketing Major in college. But I started to understand that really enabling technology is more of a business problem and bringing a business perspective to it. It has really enabled me to be successful in my career over the years. So, I tend to have a little bit different view in some cases than some of my colleagues when looking at technology and potential technology solutions.

Dave: That’s really interesting. And of course, as we said in the intro, you really, you started in other fields. I’m always interested in why people gravitated to healthcare at some point in their career. So, if you don’t mind sharing that, how did you end up at healthcare?

Deb: Well, my career took some twists and turns and I went from industry to industry and that was not a planned roadmap for my career, it just sort of worked out that way. I was approached by a recruiter and Hazelden Betty Ford had merged and they were looking for a leader that could bring broad experience into the organization and I had always wanted to work in healthcare, it just the opportunity had never presented itself in the past as well as being an experienced executive and looking at how do I want to end my career, I really wanted to focus on an organization that I could feel very strongly about their mission and what they’re doing to improve healthcare for our country and the world and Hazelden Betty Ford is exactly that organization. So, I was drawn to it once I learned the opportunity. I’ve been thrilled to be here and have enjoyed it almost four years that I have been here.

Dave: Well, we definitely need a mix of people in this and this has been a theme of the podcast about looking for this right mix of new ideas and old ideas and people that are marinated in healthcare and people that are new to it. And the theory of the podcast anyway is that, it’s through that mashup, something good is gonna happen. So, it’s great to have someone of your experience involved. Take one more minute and tell us a bit more about Hazelden Betty Ford Foundation  and their mission.

Deb: Hazelden Betty Ford Foundation is an amazing organization. I really didn’t know the extent to which they serve people in recovery as well as other constituents, other people that are trying to learn more about recovery. And being from Minnesota, I was surprised about all the aspects of our organization. So, in addition to our core recovery services offerings, we have an accredited graduate school in addiction studies, we have a prominent research division that does a lot of important research and connection with organizations like Mayo and we have the world’s largest publisher of Addiction Literature in Products and Services that we sell across the globe. So, all of that from Hazelden Betty Ford Foundation  Headquarter in Minnesota to me was a surprise when I first started learning more about the organization.

Dave: So, your role is to, among your many roles is to bring technology that enables that mission and we’re gonna drill in deeper specifically around the opioid abuse crisis. But tell us a little bit just in general, how you’ve approached that mission, what you see as some of the key pieces of technology and specifically Information Technology that enables that mission today and the way you look at it in the future?

Deb: I think that as we’ve grown, a lot of what I just talked about in terms of our operating model has been more siloed in terms of how they operate and how they communicate in an enterprise level and what I have been stressing and bringing to the table and the whole organization is actually evolving to understand that all of the work that we do is integrated and together at an enterprise level as we look at all these different businesses, there’s a lot of overlap and a lot of commonality. And what we can do to make us even more effective as an organization is to extend beyond our traditional brick-and-mortar sites, our websites and really look at delivering our products and services and extending our reach to a number of different constituents, third-parties, hospitals, clinics, doctors, educational systems, and we can deliver the expertise that we have to support these other organizations in new and different ways. So, my job as a Technology Leader is to figure out how to bring that all together.

Dave: Well, and it’s, this is another theme that’s been of interest to me and we’ve talked about this some on the podcast. To me this is that bucket of virtualizing care, of ways to extend resources, ways to minimize the barriers of time and space and it’s a problem across healthcare. My impression is that, it’s a particularly acute problem in behavioral and mental health. Number one, because there’s a substantial disease burden. We don’t always recognize it or deal with it but it’s there and the other is just a general shortage of skilled providers in the area. Have I got this right? Please feel free to call BS on me at any time during this podcast.

Deb: Ha, ha [Laugh]. No, no, you’re spot on in what you’re describing. And we have a great opportunity to leverage technology in a way that we haven’t done so before to extend our reach and our services. We’re very, very involved in looking at virtual delivery models, a telemedicine, telehealth and there’s a variety of ways in which we believe we have opportunities to leverage that technology, the internet of things, all of the technology that is really, readily available, now, in other industries are taking advantage of are things that we are looking into. And I’m strategically incorporating into our model going forward.

Dave: One of the areas of particular concern in healthcare information systems in general but I think particularly when we’re talking about sensitive areas like, mental health, addiction, behavioral health issues is privacy and security. And it’s a general challenge across our industry and one that we have much work to do, I think. But you’re in a, I think in a situation where it’s particularly important. Could you speak about that for a moment, the way you look at that issue and any particular activities at Hazelden Betty Ford around safeguarding the privacy and security of patient data?

Deb: That is something that we are super focused on. You know, this is a highly regulated industry. I’ve been in highly regulated industries in the past including banking and airlines but healthcare and on top of that behavioral health is extremely regulated. We are subject to additional regulations in addition to the traditional healthcare HIPAA regulations. We have something that’s referred to as 42 CFR Part-2 which is an additional layer of security on top of HIPAA that further restricts and protects the information of the patients that we serve so that does create constraints for us in terms of how we can leverage technology and not risk violating any of those regulations. So, we spent a huge amount of time at making sure that we don’t do that.

Dave: Well, we may have to have you come back for a deeper dive into that and maybe a comparison of the regulatory burden across different industries but we’ll save that for a future discussion.

Deb: Okay.

Dave: What I’d like to do now is turn our focus more specifically to the opioid abuse crisis. And my first question to you is really a personal one. You know, in your role at Hazelden, how did this arrive on your radar, how did you become involved and what has your journey been in support of their efforts to address this?

Deb: The opioid crisis was really coming to ahead right about the time I joined the organization and Hazelden Betty Ford had already done some ground-breaking work in developing a program called Core-12 and what Core-12 does is incorporates our more traditional treatment model for alcohol along with what’s called medically assisted treatment are the use of additional medicine to help an individual get through to recovery from opioids. Opioids are tricky business, they’re harder to treat and it’s a tough journey for the patients that are going through recovery. So, how I became involved is trying to help enable technology that can help measure the outcomes of different forms of treatment and their corresponding outcomes and what is the more positive treatment path versus another path in helping our providers to understand what is most effective in treating an opioid patient. It’s a different model, it’s very different even though it’s still addiction medicine, it’s different, it’s the tough one to treat.

Dave: Well, that’s a really interesting. Let’s go a little deeper on that. So, if I heard you correctly, you’re collecting outcomes measures, helping your clinical team evaluate different treatment approaches and the results you’re getting with different patient populations as a clinical research that allows you to refine those approaches as you go forward. Did I get that right?

Deb: Right. So, what we do is we have a feedback informed treatment model that we apply and that model then allows us to provide assessments and questionnaires and different tools to patients to help them share where they’re at in their recovery journey and then from that our clinicians are taking that data and they’re analyzing that data and it allows them also to become more proactive when they see warning signs or signs of relapse that they can jump in and react more quickly. And it’s a closed-loop kind of a treatment model where they are continually refining their treatment plans based on the information they’re receiving. So, they need a technology solution that supports that entire closed-loop process. So, we are providing that.

Dave: That’s really terrific. The other thing you brought up was medication assisted therapy and the medication assisted treatment. And this is recognized now I think as one of the cornerstones of recovery. There’s been a challenge because there’s a severe shortage of credential providers that can provide this service. My understanding is that this is one of the places where virtualizing care could be helpful. Is that something you’re looking at or that you guys have put into place and if so, what have you learned from that experience?

Deb: We are working very hard to partner with organizations that can provide the medication that’s required for our patients once they leave us if they still need that medication ongoing. So, we are establishing technology tools to help in capturing partners that we can work with that can provide the service so that when a patient does leave us and we can refer them to qualified people to continue their care.

Dave: So, so far what we’ve talked about is a couple of things, sort of care paths and the ability to collect outcomes and then adjust treatment based on that. We’ve been talking little bit about virtualizing care, technologies that allow us to spread the resources more efficiently or more effectively. What other key areas are you working in or what challenges are you trying to address right now?

Deb: One of the key things that I’m trying to help enable the organization to do is to be able to provide more of a 360-degree view of our patients. What we don’t know right now is we can have a patient that’s gone through treatment. They may have taken courses at our graduate school. They may have donated money to us and they could be an employee and they could have worked with us in other ways, they could have been a referral or referred to us. So, there’s all these additional ways to have a relationship with us besides our traditional treatment. Yet, all of that information exists in all different areas and all different systems across the foundation. And I am working with the business leaders to pull all that information together. So, we are aware of any and all ways that a patient may interact with Hazelton Betty Ford and that, by doing that, then we can continue to have a relationship and we can also strengthen the relationship that’s already there by an understanding of how they are reaching out to us.

Dave: We’ve been discussing the opioid abuse crisis with Deb Bauman and, Chief Information Officer at Hazelden Betty Ford Foundation. If you’ve just joined us, Deb just hit a hot-button issue for me personally because I think what you’re describing is bringing CRM, Customer Relationship Management to healthcare. You and I talked about this recently. I think I got up on my soapbox and gave up an unwanted speech about this but I want to go deeper on this and I just wanna connect it to something you said at the top of the podcast about bringing a business view to this world and to me this is a really good example of that, really thinking about the, what is the business problem or opportunity here, how’s it been addressed in other industries and how might that map onto healthcare. I might be out over my skis a little bit here but like you I see real promise in adapting the tools and techniques of CRM that are primarily used for marketing today to the business of healthcare and to clinical practice. So, before I go off on my own rant about this, tell us a little bit more about, you know, what you see and what you think the possibilities are there.

Deb: Yeah, I think you described it very well and coming from other industries, particularly coming from Target and understanding the importance of that CRM analysis to understand your customers or your patients and the power of that. And the fact that healthcare is really, you know, and I’ve worked in financial services and airlines and all those other industries that, you know, that is paramount to be able to understand that. And so, for healthcare, I just see this is as an enormous opportunity for us moving forward to provide better healthcare and to provide more personalized individual care because we’ll have all this additional information.

Dave: Well, I agree with you completely and I think that great customer service if you will and great patient care can very much align and reinforce each other, they don’t have to be in conflict. And that providing better service and a better experience, providing a more personalized experienced as you’ve described it, it’s not only gonna be more pleasing to patients but I predict that it’s gonna allow us to deliver even more effective care. So, this is the point where my colleagues usually look at me like I’m nuts and that might be true but I could still be correct and you know, the way I’ve tried to describe it to them is, you know, modern marketing has developed really powerful tools to micro-target. Essentially are these very tight cohorts of individuals that share common characteristics. They understand these cohorts and what they respond to and they message us appropriately. When I compare that to the way we do this in healthcare, you know, we talk about diabetics or on a good day we might talk about Type-1 and Type-2. There’s a much further refining to be done here to understand patients and what motivates them and how to take advantage of that, leverage that for successful treatment. So, two diabetics, there’s a difference between the one that shops at Walmart and the one that shops at Target and what Zip Code you live in and all these other things. Again that, you know, on the one hand you might say, well that’s just marketing stuff, what does that have to do with healthcare? Well, what it has to do with is, is this is the leading edge of really personal [Unclear] in my view. So, I’m sorry, I know I did go kind of on a rant there but when I meet someone else that kind of sees what I see there, I get excited about it. So…

Deb: I do too, I do too.

Dave: Where do you think you’ll start? Because, you know, when I’ve talked to people about this idea, there’s so many different ways you could apply it to healthcare. What are your thoughts about where to get started with it?

Deb: Well, we actually do have a strategy around how to get started and it’s kind of goes back to what you touched on where you know you start to look at a certain type of individual that has diabetes, that has common characteristics for us. What we wanna do is start doing something called risk stratification. So, if we can start collecting this information, you know, and then start to analyze the information, we will be much better prepared at the very onset when someone approaches us for treatment, that we feel that we can draw upon that information, compare it is to that individual and their profile and target more effective treatment. We believe right out of the gate based on having that base of information to compare to. So, that’s the first thing we see and then we also as I mentioned, when you’re in treatment with us, there again, we can use that information we believe to be more effective in the treatment plan that we put together for you. So, we just think it has enormous potential.

Dave: Well, I do too. I mean, I have this really fundamental view that most of healthcare is about behavior change whether it’s adopting healthy behaviors to prevent illness or adopting the behaviors you need to care for a chronic disease or acute illness. And I just don’t think we’re very good at that in healthcare and that there’s a lot we can learn from industries that are good at it. The two that always interest me are marketing and behavioral economics. They seem to be fields that have, they have more insight into what motivates human beings and how to take advantage of that for their benefits.

Deb: Mm-hmm.

Dave: I see we kind of share that view.

Deb: The other piece that I didn’t mention which is going to be very important, it is very important for behavioral health is that we are going to be required to do more measurement-based treatment and that’s going to be across the behavioral health industry. So, I think we are on the leading edge. I’m already thinking about how we’re going to be able to do that using data and technology. So, it feeds right into what is going to be an expectation of the industry as a whole.

Dave: My next question might be a little bit of a curveball but one of the things that I’ve learned from my own experience with addiction and recovery is that this is also about the family and the social unit. It’s a disease of families really in a way. It’s not just about the individual. So, I’m curious, are there things that you do with technology at Hazelden that relate to that specifically or and I guess you can look at it both ways in engaging families and also, you know, dealing with privacy issues. So, hopefully that was a good question in there somewhere.

Deb: Yes, and we do believe that, that is a key part of a successful outcome and we want to do more around that because we realized that we have a number of different constituents that we work with. We do have a family program, it’s a very formalized program. But we also have a children’s program. So, it’s for children of parents who are in treatment. So, there’s a lot of different areas that we touch upon it but what we wanna do is part of our strategy for the next few years is to figure out how do we put together a more formalized program around all of the people that are touched by the individual that’s in treatment.

Dave: The next thing I’d like you to talk with us about is some of the challenges that you face and we’ve touched on this a little bit around security and privacy but in addition to those concerns, what are some of the biggest challenges you face in deploying and using Information Technology?

Deb: I think for us in behavioral health it isn’t, you know, it isn’t always a straight forward as acute care or getting a knee replacement. You know, every person is different and, every person is going to go through the experience here differently and trying to apply technology that’s can scale and be standard, yet individualized enough to be effective in the course of treatment is a balancing act. And that’s I think for me and technology and trying to provide the best technology for our clinicians and our providers, that’s been a challenge.

Dave: Give us a specific example of one of those challenges.

Deb: We recently implemented a new EHR, Cerner and we have 14 different sites across the country. And each of those sites is staffed differently, provides a different combination of programs because we have residential, we have intensive outpatient, outpatient day treatment, silver living and then based on the type of providers and clinicians we have, they can vary from site-to-site based on what we offer there. So, trying to put it in place standard technology and standard processes to create, you know, a good experience, yet do it to support all of the various sites and their different configurations. It’s been a challenge for us trying to figure that out.

Dave: And it’s in balance, right. I mean, there’s no one right answer here, it’s mostly the balance.

Deb: And then every state has their own regulations which are different. And we’re in nine different states. So, then we have to make sure we’re adhering and based on what we talked about earlier, our strict privacy rules and then addressing the individual state regulations as additional complexity.

Dave: So, what I heard and there are a couple things. One is that where we can in healthcare. We wanna standardize things, we like heaven pads and we like to be evidence based where we can. There’s always variations though. Some of those are just doodled local circumstances. How many people work here, what kind of rooms do we have, what services do we provide? So well, they can be personal tastes and preferences although I think increasingly in healthcare, we’re becoming a little more disciplined around those things and using evidence. You’ve also compared this to a joint replacement which is also interesting to me and I’m gonna speculate here a little bit. The typical joint replacement patient, it’s a pretty predictable course and series of, of that. So, not that there’s not some variation in there and, but it’s relatively predictable. I would speculate that in the patient population that Hazelden serves, there’s a lot more variability, there’ a lot more of two steps forward, one step back and that variability also presents a bigger challenge in this sort of customizing within a standard framework.

Deb: It does and because the great majority of the time if there’s a substance use disorder. There’s usually some associated psychological issue as well and so peeling the onion if you will to get to the root of perhaps what caused the addiction in the first place could be varied and could be complicated. And so, how to address individual by individual, everybody’s different in terms of their particular situation.

Dave: My last question around technology today is, are you looking at any of the cutting-edge innovational stuff, you know, I don’t know if it’s gonna work or not but it looks interesting. So, things like, gamification, chatbots, some of these technologies that at least their hints that they might be useful in healthcare and that they might be particularly useful in the arena of mental health and behavioral health. Any of that on the radar or is that too fanciful right now?

Deb: We have a clinical innovation team. I sit on that team; our Chief Medical Officer sits on that team as well as representatives from across the foundation. We are getting approached on a regular basis with technology offerings where they think that, you know, might be beneficial to us. So, we evaluate those and we go through on a regular basis. We’re always looking at the new things that are coming out on the market. And keeping sort of in the back of our mind where we think this may fit, you know, our overall strategy. But we’re not, you know, we’re probably more like, we wanna be a fast follower. You know, and some of that I think is where I would position us if we can be.

Dave: Well, that makes sense. It’s true, seems like everybody’s got an app for that now and yet we lack a lot of evidence and basic proof that these things are effective. I’m not discouraged by that; I just recognize that as we have work to do. Anything you’ve seen recently that you went, wow, this might be actually pretty cool?

Deb: Well, we’ve seen a number of things that we think people really have some great solutions. But your earlier point, are they going to be effective, you know, there isn’t any proof. So, but it is, you know. There’s, it’s amazing when people come and present some of the ideas that they have. Even the one that we had was a virtual, putting a, you know, the virtual glasses and then putting you in a bar setting and then walking you through and then training you on how you would react. You know, if you’re in recovery and you walk into a bar and this is what comes at you because you’re with friends, how do you react? I mean, you know, when you think about it, that’s a real situation, right?

Dave: That’s really interesting. I mean, you know, it’s a classic triggering situation. And so, perhaps there’s a role for a virtual reality and practicing that and learning how to navigate through this. So, that’s fascinating. Well, you’ve got, as you said, decades of experience in the field and now you’ve brought that to bear on healthcare. You’re at ground zero for one of the most important ongoing health crises in the United States. My last question to you is given all of that, what’s your most sage advice for us on these topics?

Deb: Well, I’m glad to see that we’re talking about this and how technology can really help address something that is a critical situation in our country. And opioids, if we get opioids under control, there will be something else because there will always be addiction and different forms of addiction and I love the fact that it’s becoming less taboo behind the curtain to talk about and in more open so that’s progress.

Dave: That’s a really important point, that last one and it’s come up in this series multiple times. One of the if you will, silver linings here is that because opioid addiction has affected such a broad swath of the population and it doesn’t seem to respect any kind of socio-economic boundaries. It has brought a lot more focus to these problems and as you say, I think it has begun to address some of the stigma that gets in the way of us recognizing it and seeking help when it’s needed. We’ve been discussing the Opioid Abuse Crisis with Deb Bauman, Chief Information Officer at Hazelden Betty Ford Foundation. Deb, thanks again for joining us today.

Deb: Oh, my pleasure Dave.

Dave: You’ve 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.