During the past few years, a number of healthcare organizations have added digital titles to the C-suite, whether it’s a Chief Digital Officer, Chief Digital Information Officer, or, in Bradley Crotty’s case, Chief Digital Engagement Officer. It’s certainly a step in the right direction for the industry, which has notoriously been late the party. But what needs to happen along with assigning an individual to lead the charge, is acknowledging that digital transformation has to be a team effort.

For Crotty, that means it has to be treated as both a “key competency and an area of accountability” for team members. Recently, he spoke with healthsystemCIO about how Froedtert & Medical College of Wisconsin is working to instill that mindset across the organization. He also talked about why Inception Health, the hub that was created “as a vehicle to affect digital transformation,” remains a separate entity; the “low-hanging fruit” that leaders should be focused on when it comes to leveraging technology to improve care; and how Froedtert is partnering with nearby organizations to address social determinants of care.

Key Takeaways

• “We don’t have a lot of tools that can help change behaviors,” Crotty said, adding that digital health can make a key impact in this area.
• By enabling remote monitoring, Froedtert’s virtual care team was able to reach 10,000 patients during Covid and offer a “really nice end-to-end digital experience.”
• Addressing social determinants of health means going beyond digital access and looking at broader issues, which Froedtert is doing by working with NowPow (and other healthcare organizations) to facilitate community-based prescribing.
• One of the critical components in advancing digital transformation is in building a culture around shared accountability, and never putting it on the shoulders of one individual or department.
• Above all else, the “north star” for Froedtert is to create “a much better, much more cost-effective patient experience.”

Q&A with Dr. Bradley Crotty, Part 2

Crotty: Another analogy I’ll use is that we have pharmaceuticals that are changing biology. We have medical devices that are changing physiology. We don’t have a lot of tools that can get in and help behavior. I think that’s a really core area for digital health to be an enabler and manage the behavior aspect.

A report on the county health rankings showed that clinical care — which is access to care and quality of care — accounts for about 20 percent of someone’s health needs.

When you look at the other 80 percent of those determinants, one of those is behavior. I think digital, because of its nature being in someone’s pocket, being able to reach into someone’s home, or being able to stay relevant and timely, can help with that.

We have a really important program around digital prescribing for social determinants. That’s another piece of being able to meet peoples’ needs. We’re trying to move beyond where healthcare has traditionally been in terms of brick and mortar — when you come see us, we’ll give you some guidance and see you back in six months — to something that’s more interactive and longitudinal.

Gamble:  Very interesting. It seems like mental health has risen to the forefront during Covid, and there’s been more discussion around the role digital health can play. What are your thoughts there?

Crotty:  We’ve seen an uptick in referrals to our mental health program, essentially starting last March. We went up about 50 percent in our referrals. Another thing the virtual care team did was enable remote monitoring. We’ve had about 10,000 people go through our remote monitoring programs for Covid-19; it was a really nice end-to-end digital experience. And so, whether you came in digitally or not, if you tested positive, we reached out to you and offered a remote monitoring program where you could either pick up a pulse oximeter, or, once we got the supply chain figured out, we would mail it to people who tested positive so that they had it in their house.

Covid & mental health

Our virtual care team did all of the monitoring for that. Interestingly, what they also did is as they were interacting and engaging with people who are in the midst of their Covid episode, they would also be referring to our digital mental health program because of the anxiety that came with that uncertainty. Do I need to come to the hospital? Is it serious? Will I spread it to additional family members? That was an interesting, organic thing that happened with our virtual care teams, and it was another source of mental health engagement.

Gamble:  You mentioned doing some work with social determinants. Can you just talk a little bit more about that?

Crotty:  Sure. We’ve been very interested in for a number of years in what we could do in the social determinant space. We often think about it in terms of like digital access, but really it’s much broader. And so we began working with a Chicago-based company called NowPow, which does community-based organization prescribing. If there’s a need for food, housing, domestic violence services, etc., we could create a digital referral. We have the social workers out there who can do this; the problem is in how to get people better connected to community based organizations in a much more expedient way.

Community outreach beyond the organization

We really didn’t want to see this as a Froedtert or Medical College of Wisconsin initiative. Our peers in the region also have a stake in this. At the onset, we thought it would be silly if we did this, and then Advocate Aurora built their own, Essentia built their own, and the federally qualified health centers built their own. And so we worked with Impact, a provider of 211 information and referral services, which managed the NowPow implementation and integration. Along with other health systems, we’ve invested and put forth a lot of effort into this project.

The goal at the end of the day is to have a community resource for Milwaukee county, Waukesha county, and Washington county — at least those three counties. We may be able to expand in the future to the Southeastern Wisconsin region, but for now, we have a shared database of community-based organizations that can send referrals electronically through the EHR.

We’re also interested in being able to extend that within our digital engagement platform and our app for people to be able to do self-service. That’s our vision. But for now, we do screening within our mobile app and our EHR, and we’re able to summarize that through our EHR and send out referrals through the NowPow integration.

Gamble:  It’s interesting what you mentioned about Froedtert not wanting to do this in a vacuum. That was the tendency for a while in healthcare, and to see organizations moving away from that is so important.

Crotty:  Absolutely. It took quite a while to try to get the whole thing right—and I don’t know if it is entirely right. But from our perspective, it was really worth having the community own this, as opposed to our health system owning us. We’ve invested a lot of time and money into seeing it succeed.

Gamble:  Right. I read a piece you wrote last year where you said leaders should think of digital as your job, and not someone else’s. That mentality hasn’t always been the case. Can you talk more about that?

Crotty:  We’re trying to add digital as a key competency and an area of accountability. Because if it’s just our team leading this, it doesn’t get internalized—it’s not part of the working culture. And so we’re trying to provide empowerment to people. We regularly meet with operational leaders to coach them and make sure we’re in sync, and we’ve looked at created educational opportunities.

Before the pandemic, we had a whole immersion day on digital design thinking where we encouraged all of the staff across the organization to participate. Right now, we have different measures of accountability, whether it’s online scheduling or check-in, and making these available as targets that leaders can opt into.

So the accountability isn’t just sitting on me. It’s a shared accountability for the digital or digital transformation. Our CEO, Cathy Jacobson, is also asking, how can everyone else become accountable digital transformation? That’s what we’re working on; building that culture. We’re moving from seeing digital as a shiny, nice-to-have tool to ‘this is the way we’re doing business.’

“Digital by default”

We’ve had a saying since before Covid, which is digital by default. And that means, don’t just do digital; be digital. That’s the way we’re going to conduct business. We’re going to schedule things digitally. We’re going to offer virtual care where it’s appropriate.

We want people be digitally engaged. We want people to use our digital services. What that does is free up our time and energy to provide a service to those who those people we see who aren’t as digitally enabled. It is by no means our only way of interacting, but we want to start there, and make sure it’s available for people who need additional guidance.

From doing digital to being digital

Digital by default is a mantra we’ve been working to for the last two years. And the culture piece is an important part of the work we’re doing. How do we spread that culture? And so we’ve drawn a line between doing digital, which is ‘We have an EHR and a patient portal,’ to being digital, which is everyone across the organization — whether you’re a patient service representative or an executive — thinking about digital and using it. We’re aware of it. We speak a common language; and it’s part and parcel of the work we do.

Certainly in an academic health system, it’s not the same as building something from scratch, like Amazon, but we have a lot of potential to provide digital services. As we look at scheduling, how can be adapt that digital by default mindset? As we onboard a new patient with a clinic or a mode of care, how do we bring that digital experience?

We’ve had wins. Prepping for a colonoscopy, for example, is a now a digital experience where we mail you the supplies and provide a short-term remote monitoring patient education solution so that people know what to do. It’s a digital experience that we can package and provide to our patients. That’s just a small example; now we’re looking at how to bring that forward into other care streams.

Gamble:  Right. You touched on culture, which can definitely be a barrier that’s difficult to get past.

Crotty:  Yes, and culture is tricky. It’s tricky to change. We’re really trying to be disciplined around it. Usually everybody knows why this is important. They’re aware of it and have the knowledge to be able to incorporate these skills into their work and see where it fits in. What we’re working on — and I think we’ve done a good job with it — is incorporating the voice of the customer along the lifecycle of any project we take on. And so, whether it’s telehealth or remote monitoring, we’re able to get feedback on how people perceive the experience and then feed that back to the, to the staff so that they can see these, these wins and the differences that they are making.

It’s challenging because there’s a lot of day-to-day work that needs to get done, and sometimes the technology is finicky. And so we’re trying to make it as easy as possible for the technology to just work. Sometimes things are going to be bumpy, and so we have to make sure our organization has the resilience we need to get past those bumps.

We know why we’re doing this. We have our north star of making a much better, much more cost-effective experience for people. Care quality and care experience is our guiding light, and we will smooth other over any bumps in the road with our operational teams and frontline teams with digital transformation. There will be bumps that we encounter. We’re all working together to smooth them out and take an all-hands-on-deck approach until we get it working.