Joel Vengco - CIO and Vice President Information & Technology, Baystate Health

Catalyze: We are here today with a new interview as part of our Innovation Series. We have Joel Vengco, CIO and VP of Information Technology at Baystate. Previously, he was at GE and has a pretty deep background in healthcare and healthcare technology and healthcare innovation, which we are going to talk about today. Thank you so much for joining us Joel; we really do appreciate it.

Mr. Vengco: It’s really my pleasure, Travis. Thanks for inviting me.

Catalyze: Excited to talk to you because you guys are really doing some interesting things at Baystate. We’ll get into some of the details here in a second. I want to start by talking a little bit about startups, and your experience about what you’ve seen. Can you give some specific examples of companies coming into healthcare, specifically healthcare technology that have done really well and been effective, and maybe an example or two of things that have not been done well.

Mr. Vengco: Sure. I think a core piece that a startup should know when they go in to engage with a healthcare organization like Baystate, particularly the size of Baystate, is what are the problems that Baystate has an organization? What are the problems that organizations like Baystate are trying to solve?

Additionally, many startups that have successfully engaged with us identify those areas that some of our incumbent technologies aren’t nimble enough to address. They’ve identified the incumbent EHR we have today or the incumbent ERP system and they’ve said, “Well, they can’t do things like predictive modeling on which patients are appropriate to be seen by which providers, because that wasn’t what they were built to do. They have done a nice job at identifying the gaps that we have as a healthcare institution and in the practice and the technology that we have. That’s really what caught our attention and in many cases, we have worked with those startups and even connected them with some of our incumbent technologies and created partnerships there after.

Catalyze: Interesting. So coming in with a sense of what you guys are actually running and maybe what gaps are with those incumbent technologies and looking forward to where healthcare is going are things that companies can do right.

Mr. Vengco: Without a doubt, because there are so many ideas. Ideas are a dime a dozen, so it could be really profound and you are like, “Wow, we should do an OpenTable for Healthcare.” While [OpenTable for healthcare] is really a good idea, that may not be a practical idea.

(And, by the way, that example is a great practical idea – access to a physician’s schedule by a patient or a consumer is absolutely the right way to go. But that’s one of those ideas where it makes a lot of sense, but there may be another thing like a Yelp or some other paradigm that we’ve seen in other industries that may be a great idea in other industries but not necessarily solve an immediate problem for healthcare institutions today.)

Catalyze: That’s a good point and I guess the news for OpenTable for Healthcare is the reason for the recent funding for ZocDoc, now that they are getting as large as they are getting.

Catalyze: On a similar topic – you are at TechSpring right now, and presumably it is actually within the organization – the space is actually physically pretty close to Baystate office space. Is that correct?

Mr. Vengco: That’s correct, and that’s by design actually. Part of the reason why I developed TechSpring was not just to find the latest and greatest startup. Really it was because of a couple of pillars.

One is we wanted to crowd source innovation and find innovators and encourage large companies to come into a space that’s inside of the healthcare organism. So be InVivo when you are developing solutions for problems that we already know exist. Rather than doing it in a corn silo off sight in Kansas City or in Wisconsin, the real sort of invitation was: Come here to Baystate. Be close to our clinicians. Be close to our administrators. Be inside the belly of the beast and help develop solutions that we see everyday and maybe you can even find and solve problems that we have not even yet begun to solve and help solve them because you are inside the environment.

Catalyze: In looking at the TechSpring website and reading about it a little bit, it seems to be the focus and the value for companies coming in, and for Baystate, too, is to actually get them engaged and working within the health system and working within the clinical workflow, operation, or whatever that workflow might be as a pilot and actually start collecting data and testing things out in a real world setting.

Mr. Vengco: That’s exactly right and I think that’s the differentiator that we’re posing to those that are doing things like the traditional incubators or accelerators. Those are great. I think a RockHealth and those types of incubators are tremendous assets to our industry. The difference that we are putting out there is that, “Hey, let’s have you guys come and partner with a health system that may be in a model environment and a model state and also have you be inside of the fray of the organization and the organism, so you can see what’s going on, on a day-to-day basis, and then not just work with the clinicians or the administrators at Baystate, but also with other technology firms who may be part of the Baystate environment, or the regional environment.” There’s that notion of community collision and crowd sourcing of innovation – that’s what we want to try to do, and do it inside the belly of the beast.

Catalyze: I would agree with you completely – other incubators are great, but being able to do it within an organization is a very practical win for a new company, because it’s all about getting a pilot and showing data, based on your OpenTable for Healthcare or whatever it might be.

Mr. Vengco: It’s a really nice environment for those types of companies that are trying to innovate, because you have a bi-directional connect and those that will ultimately be using your product.

When I was at GE, the thing that I desired the most, as the Vice President of this organization that managed many of their innovative products, was I wished I’d had a partnering organization that was in my backyard, or that I was in their backyard. On top of that, I wish I had an organization that I could also partner with to impact the region or that sort of community that they were servicing, because that is also a large part of healthcare. It’s not just what happens in the hospital, it’s also what happens in the region that hospital or health system services.

Part of what I saw in bringing TechSpring here was that we could not only allow the doors to be open for innovators to come in and be part of the health system, but they also become part of the community, in such a way where I do believe the microcosms that we see are broadly or more pervasively applicable to the larger inner healthcare industry. I think that’s an important component of what we are building and what we have built at TechSpring.

Catalyze: To me, it’s very intriguing as a company, and you talk about some of the profiles of the companies that you work with, whether it’s a new company or a venture outside of healthcare that is bringing something to healthcare. It seems like a fantastic avenue, if you can get in and participate.

Catalyze: When you set up pilots or assess an internal tool or technology, can you talk through how you set up what outcomes you are actually for, and is it based on the stage of the company? How you go about doing that so you really get a clear picture when that pilot is done. Like, do we want to take this to scale? Do we want take this regionally? How do you guys set that up from the beginning?

Mr. Vengco: That’s a great question. An important part of this is we select the mid-to-late stage startups, because right now we don’t really dabble in early-stage startups, because there’s not a lot of capital that we are currently investing in the class or the pool, if you will, to engage with us. A lot of it is that organization coming in and investing their time and some capital to engage with Baystate.

The focus for us is to identify those startups or businesses that are providing solutions that meet our strategic objectives as a health system. The idea is many health systems share strategic objectives, whether it is value-based purchasing, or patient engagement or quality and safety functionalities or capabilities, or perhaps even regulatory requirements, so there are many things that we share as health systems.

These are the pillars that we put up there and say, “Of these problems that we have identified or these strategic objectives that we’ve identified – who is going to create solutions for those problems? How do we better engage our patients?” We look for startups or solutions that can help us solve that problem.

Then we wrap metrics based on our own strategic objective metrics around a pilot with those startups. For example, let’s say our patient engagement strategy calls for better access; i.e. improve the accessibility of your physicians so that in 24 hours, the patient can have access to an appointment, rather than the next three days, or the next three weeks, which is typically the case. We use that as a measure of – did the pilot go out and actually decrease the wait times, or via the next appointment time for that patient? Many of the metrics are there based on what we believe is the success criteria that’s going to be for the strategic objectives. That is a pretty straightforward way of taking what we have in operations and identifying them for these innovators to try to address or achieve.

Catalyze: That makes a lot of sense; it’s aligned with exactly what you guys are trying to accomplish as an organization.

Mr. Vengco: Many of the things that we have as strategic objectives are often process and people focused. Technology can help us automate some of those things. Innovators come in and say, “You know, you really don’t need a team to do better access for patients. Maybe you need a different technology or a different process and technology, and we believe we can do that for you, and we believe we can impact those metrics for you.” That’s when we have that kind of engagement with those innovators.

Catalyze: Two questions came out of what you were just saying. The first is, at a high level what are those strategic initiatives that you are hoping that TechSpring might outsource some of the innovation to help you guys with those initiatives?

Mr. Vengco: These days there are so many strategic objectives. We laugh because you should really only have a handful, but because of what we are forced to do we end up having four plus another 20 underneath it.

Having said that, patient engagement is absolutely one of the tops for us, so that’s one big deal for us. Also the delivery of care and the delivery of care models are a huge focus for us, and that includes population health, management of digital delivery of care. We are also very focused on giving our patients or consumers high value care and that has everything to do with healthcare reform obviously, in terms of the expense of care delivered and so I’d say those are a few of our big strategic objectives that we have.

We also, of course, want to make sure we are focusing on research. We are an academic medical center, and so academics are a big part of our tradition and that also helps us progress as we deliver care and innovate on clinical care for our regions. Those are a few things that we are really focused on, but patient engagement, patient experience – that’s a big deal and we really are looking at many different types of technologies and innovators to help us with that part.

Catalyze: Patient engagement is obviously a huge topic and it’s a topic that we’ve talked with several individuals on these interviews – most recently with Simon Jones of Blue Shield of California and he was talking about that there is no one-size-fits-all solution or there is not going to be one-size-fits-all solution for patient engagement. The division of patients is so varied in terms of what they are looking for and the ways they are looking to be engaged and the types of things that will keep them engaged, whether that be social, financial, or whatever it might be – competition. And so, I’d be curious if you guys have had any early lessons learned – things that you’ve found to be effective and specific tools that you guys are leveraging to engage patients are to go about engaging patients.

Mr. Vengco: I couldn’t agree more. I think we are in a world where consumers expect that there’s going to be a sort of a personalization the way they are going to get engaged by any market player, whether it’s in healthcare or in retail.

In fact, we are so used to retail and the ways that all other industries are engaging with us that we are going to expect that more and more from healthcare. The biggest lesson that we’ve learned is that the patient portal is not an engaging tool. I’m just so happy that we got past that whole Meaningful Use mumbo jumbo. That was just a useless target, honestly, right? Patient portals are just billboards that don’t really gain anything for patients. That’s not engagement.

As I like to tell the story, you can only tell someone they’re fat once and they’re not going to come back. You want to make sure that they have ways to take action on that, maybe get competitive and do something about their condition, so the patient portal is a vehicle for us. We actually call it the patient engagement platform, because the portal in its first phase is not where we want to end up. We don’t want to just be a billboard. We want to have a landing space for patients to do a number of things.

We are starting to pilot e-Visits for them, using the patient portal. We are targeting a variety of different service types, whether its pharmacy education to therapy to speech pathology to behavioral health and also primary care, so we are using our engagement portal to have that kind of e-Visit capability. We are also using that to provide them with an app store at Baystate, which is an evolution and still growing, but this is addressing that topic that you just mentioned about not one-size-fits-all, right? So, how many different apps and functions can we give patients to choose from so they can view their data, engage with us in different ways, maybe schedule appointments, refill their prescriptions. Believe it or not, they want to refill their prescriptions in different ways. Some of them want to use a refill request. Some of them want to use apps. Some of them want to use a phone call, so we want to give them very different ways to do this.

We want to be a service provider that is convenient for these patients, because it’s going to be about convenience. You’ve got the CVSs, Walmarts, and Walgreen’s of the world. They are going to become more convenient than we are and in order to really engage our patients and get loyalty, we have to do better. One-size-does-not-fit-all, we’ve got to give patients the best service possible.

Catalyze: There was so much good stuff in that answer you gave, and I was wondering when CVS, or Walgreens, Walmart or Target were going to come out, but anytime you talk about convenience in healthcare, it’s hard to beat 9,000 locations from a convenience perspective. And you guys don’t sell Snickers bars so that makes it even harder.

Mr. Vengco: Yeah, that’s a problem. I told the CEO that we have to sell Snicker’s and KitKats, you know? Without that, we are dead in the water.

Catalyze: We work with a few telemedicine providers and I even imagine that for specific types of services you might be okay with telemedicine, but with other types of services, you might want the convenience of setting up an appointment online, but you might still want an in-person appointment, like for a pediatric visit, for example. So even within telemedicine, I imagine there are variables in terms of personal preference for what people are actually looking for to engage with.

Mr. Vengco: I totally agree. In fact in the telemedicine realm we are piloting two to three different types of telemedicine scenarios. There’s of course the physician-to-physician consults so the patient can stay in their local community hospital and then their physician can consult with somebody in our tertiary facility, with a specialist, for example. And that helps with patient experience. We are starting a pilot with a large kiosk that you can walk into and it almost looks like a port-o-potty, I don’t know why I always think that, but you go in there and have a telemedicine visit with a provider. We can drop those in different places, maybe at the local mall or in the airport or at the university setting. And then there of course is the “go on the portal and use your iPad to connect with a physician” approach.

Catalyze: That’s one of the interesting things to me. There’s been all these different models that have emerged recently, when it comes to telemedicine. I think what drove it initially were things like telestroke, which were kind of mandated, if you didn’t have a stroke specialist. It’s fascinating to me when you have companies that have used the more synchronous video now, but you even have companies like Zipnosis that are doing asynchronous, where you just fill out some documentation and you are able to get some physician response pretty quickly. There’s all these different forms now that telemedicine is taking, which are particularly interesting. And again, you guys seem to be taking an approach of: We’re going to offer the ones that make sense for the breadth of our population. Obviously, these things are clinically effective, but if they are, then these are the things that are going to work for our patients and we’ll deliver them in as many avenues as we can. I haven’t talked to many systems that say that, so that’s great.

Catalyze: You have a company that comes in. I assume not everybody comes in through TechSpring, but other companies that are coming in and potentially doing pilots. They find a clinical champion – pediatrics is sold on this pediatric curbside tool for pediatricians to consult specialty pediatricians. What do you see as the major challenges going from that buying champion, in this case the clinical champion, to actually getting it installed and running and existing as a pilot at Baystate?

Mr. Vengco: That’s a great question, and it’s and important question, too, because finding a champion is certainly a challenge, but that’s A#1 – you’ve got to find a clinical champion, because, operationally, if you want to have something be adopted, or even for small or short term pilot or test to be used, you have to have a clinical champion—and a senior one at that—who is also willing to take time to use it. That’s one challenge.

The second challenge is of course IT. Owning the IT shop, I know what the challenges are – you need deep interfaces for your pilot and without them you will be out of luck, because everybody is doing things like merging hospitals and doing Meaningful Use and all these things require engineer time, which is very rare. If you’ve got deep integration needs to do the pilot, you’re going to be in deep do-do, right? That’s another thing.

The third thing is that you’ve got to have project management, a project manager on an innovation project. We don’t call them pilots. If you go through TechSpring, we call them an Innovation Project, but in a sense, it’s a pilot. Having a project manager that knows the timelines, who knows who all the players are, who knows how to move this along is really important, because certainly the technologists won’t push this along, and the clinical champion is just waiting to use it and do something with it. You really need a project manager to push this along. And those are really the three key pieces to doing a successful pilot.

Oh, and the fourth piece is, you gotta have good success metrics. You gotta be able to show how this really succeed in the short period of time and did it actually achieve the effect and the objectives that this new pilot or new technology was looking to achieve.

Catalyze: Yes, that’s a nice four-point strategy. Most people think you are right – the clinical champion is central, but it really is just the first piece. And then there are a lot of potential speed bumps and road blocks in the way to get a pilot off the ground.

Catalyze: Looking specifically at one of those steps – the technology piece for a company coming in – are there things that you initially look for as to what will work or not from a technology perspective?

Mr. Vengco: One is always what kind of data they are requiring. The integration piece is a big deal, but also to me, it’s the use of the data and the requirements for the data are a good indication of whether their solution is actually going to work.

I’ll give you an example: An analytics solution. They can come in and show you all these pretty graphs and they often do, and the visualizations get better and better, whether they are 3D or 4D, but at the end of the day when you ask some specific questions about data terminologies or harmonization or any of the things that you need for data liquidity, as I like to call it, many of them don’t have good answers for how you are really going to source those pretty graphs, so that’s one sort of major red flag.

That doesn’t stop at the analytics firms. We talk to care management firms or care management innovators. They talk about showing a holistic record to a patient, or to a physician. Many out of the gate don’t know how to do that. Or they say, “We are going to deal with it, because your EHR system will have all that data.” But that’s not the right answer. People have to understand where the data models lie, where the data sources are, and how to deal with the data, because information is really the key to innovation in the future. That’s the biggest red flag for me is how they deal with the data and how do they deal with this information.

Number two is security, obviously. Cyber security, information security, network security – even if we are doing a pilot, we want to make sure we know where and how our patient data is being used, accessed and protected. That’s really a big deal for us in IT.

Then third is just architecture and how does that play with our own architecture, our own environment. Is it a modern architectural code? Is it sustainable? We certainly don’t want to have someone come in with cobalt or any of those older technologies, right? Kind of makes you scratch your head. Those are things that we tend to look at first, and say this looks like it’s going to be a good technology that will progress to the next level.

Catalyze: That was incredibly helpful. I think we’ve covered a lot of what we wanted to cover. Is there anything else you want to talk about?

Mr. Vengco: The last thing I would say is that this is such a great time in healthcare, particularly healthcare technology. I’m really excited about the possibilities of working with innovators, thought leaders like yourself, thinking about how we get to the place where we are starting to solve many of these problems, or at least facilitating the solutions for many of these problems through the use of technology.

In the old days, and that was not that long ago—I’d say that was about five years ago—is that we would build things without really any notion of usability and scalability, and we actually never really had a notion of what will we do with that data after the data gets put in there. Now we have the ability to sort of pick and choose from a variety of different technologies from other industries that have already experienced these types of solutions, so we say, “What if we mashed up all these different technologies and created a solution for some of these problems? What if we invited folks from around the globe and around other industries to come in and try to solve some of our problems?”

TechSpring was developed specifically to crowd source innovation and to develop something special and unique for many of some of the hardest problems in healthcare today. We just opened the doors of TechSpring back in November and we’ve already seen some really great success stories, and I’m excited to see more success stories come out over the next several years. A lot of our sponsors have been terrific, as well. Some of our big sponsors and big companies that you would know, because obviously they are household names, but they have been fantastic in their belief of TechSpring and their support of TechSpring, and so we are excited about that. There are going to be a lot more press releases coming down the pike from some of the innovations, and also the sponsors and also the partners that we’ve partnered up with at TechSpring, so I hope you look forward to that.

Catalyze: Yeah, we’ll definitely keep up. What you guys are doing is really interesting. It’s the first time I’ve heard of someone really aligning the strategic initiatives of the organization with the innovation group and using those to sort of assess these innovations and projects, so sounds like really exciting stuff, and as you guys progress. And you guys are not even a year old, so I’m sure you’ve learned a lot.

Well thank you so much for your time Joel.

Mr. Vengco: Thank you again for inviting me on. This was fantastic.