Q: Before we get started could you briefly describe Metrocare, your history, focus and footprint?
A: Metrocare is a major provider of primary care and mental health services in Dallas County, serving more than 52,000 adults and children annually. We’re in our 48th year of service as a NFP, we have 1,300 employees and we offer primary care and mental and social health services to adults and children in 13 facilities throughout Dallas. We also operate pharmacies in those locations and we address many of the social determinants of health, including housing and supportive social services.
One of the unique differentiators of Metrocare that gives us an advantage as a NFP in a highly competitive marketplace is that we have a CEO that firmly believes we need to run our operations as a for-profit, even though we’re a NFP. He’s created a culture that pushes all of us to find and apply best practices, improve the patient experience and maximize our operational efficiency across every clinic and program. He’s also a big believer and proponent of using technology to optimize our clinical and operational processes.
Q: You’ve now been at Metrocare for just under 3 years. What priorities did you set and what changes and investments have you made since you’ve arrived?
A: When I arrived on the scene about 3 years ago, our CIO and I quickly arrived at the same conclusion: The overarching guiding principle of IT wasn’t empowering people, but rather, fear. Change of almost any sort was avoided because changing out any of our existing systems was viewed as more of a risk than an opportunity. So, risk and fear of the unknown had pretty much paralyzed the organization. For example, one of the biggest complaints I heard from employees when I first arrived was the oppressive nature of our email message encryption policy. We had an outdated on-premise email system tied into an encryption policies and third party software that made it extremely difficult for employees to communicate via email. Everything –and I mean everything– had to be encrypted regardless of the message content or who the recipient was.
So, one of the first things I did was to engage with US Medical IT to help us move onto the Office 365 platform. We also immediately enabled Office 365’s built in Message Encryption. We can now securely access email from anywhere. We also added Data Loss Prevention that proactively prompted employees to encrypt email messages that likely contained ePHI. Both of those tools proved to be huge boosts to employee productivity and satisfaction, especially for our clinicians who visit patients at home and need to submit reports and communicate with colleagues directly from the field. It also immediately saved us around $90,000 a year because it eliminated the need for separate third-party encryption software licenses. And our compliance officer started sleeping better at night because now she has full visibility into what is and is not being encrypted and can quickly identify parties that are not fully complying with our privacy protection policies.
Q: You said your CEO is a strong proponent in the use of technology. What would he say the digital transformation opportunities are for Metrocare to improve primary care and mental health services?
A: Our CEO would say that the biggest opportunities for us is to leverage technology to improve the patient experience, optimize our clinical engagements, empower our employees, and improve operational efficiency across all of our clinics.
First, we’ve improved the patient experience by offering telemedicine services over Skype for Business within Office 365 to enable patients to receive consultations with our specialists without having to travel to a different clinic or wait for a specialist to travel to them. Second, we’re empowering employees to digitally collaborate like they’re in the same room when they’re not with Office 365 audioconferencing, web conferencing, document sharing, and email on any device. And, third, we’ve optimized our compliant operations by leveraging the HIPAA BAA we have for Office 365. Our 1300 employees can now conduct compliant email, file storage and sharing, instant messaging, audioconferencing, and web conferencing, and collaboration — all within Office 365. Online presence functionality alone has been revolutionary in improving patient flow and the patient experience. Every employee can immediately see who’s available—a nurse, a specialist, someone in the finance department—to answer a patient’s questions or take a patient back when patients arrive. This has dramatically reduced the amount of on hold time and waiting room time for patients.
Q: Did I correctly hear you say that nearly all 1,300 of your employees are using email, presence and instant messaging in Office 365? That doesn’t happen overnight or without intentional training. What would you say were your success factors that enabled you to drive usage to such a high level?
A: I’d say there were three success factors that made Office 365 spread virally. We started out by focusing just on presence and instant messaging. The first success factor was that we decided to roll out all of the features with in Office 365 to everyone to empower every one of our frontline employees to find ways to increase their own productivity and collaborate with their colleagues with less friction and latency. Phone calls and face to face meetings have their place but digital modes of communication and collaboration are so much more efficient– and often more effective because they force people to be more crisp and the documentation is usually a byproduct of those conversations. The second success factor was that we replaced our help desk remote desktop sharing service with Office 365 presence, instant messaging, and screen sharing. So whenever an employee needed assistance from our help desk, they could see first-hand how easy and valuable IM and presence was. Based on their experience with the help desk, they could begin to imagine their own use cases for clinical and administrative roles. The third, and perhaps the most important success factor, was that our CEO not only used presence and instant messaging extensively himself, but he proactively encouraged every employee to use it as well. So it he raised the expectation bar for everyone and that pushed many employees out of their comfort zone to use it. He also used the web conferencing in Office 365 to systematically address our employees–and, after each address, we’d publish it to Office 365 Video, which was included in our licensing. It was these three success factors that drove widespread usage and excitement among our 1,300 employees across 13 locations in a matter of a few months. Within 2 months, Office 365 literally united our company — which was a surprise benefit we never anticipated.
Q: What came next, after you had everyone using presence, IM, web conferencing, and Office 365 Video?
A: Several requests came in asking to record training sessions to allow those who missed the session to replay them on demand at a later time. That prompted us to think, “What if we distributed video cams and microphones so anyone could deliver or attend a training session from their PC or laptop from wherever they were.” With Office 365, there was no longer any reason that need to be at their desk to present or attend a training session. So we rolled out videoconferencing for conference calls and training. All I heard was, “This is so easy to use!” and “It’s so convenient!”
Q: So, I can imagine that, once everyone was familiar with videoconferencing, you then moved on the opportunity to introduce telebehavioral health services over Skype for Business in Office 365.
A: That’s right. We had received a request from our Chief Medical Officer to look into telebehavioral health as a way to extend our services to underserved areas, address health disparities, and reduce the time and cost for psychiatrists to travel to multiple sites across our 13 locations. So we reached out to US Medical IT and asked them to equip two office locations with mobile patient carts with Surface Pro tablets running Skype for Business. It had to be easy enough to use for any on-site assistant to operate. Clinicians on the other end used a Surface Pro 4 tablet, Skype for Business, and a flat screen for the EHR. And the system worked flawlessly from the very beginning. Patients appreciated the convenience, the expanded appointment choices because they no longer need to restrict their appointments to the times the psychiatrists were physically present in the clinic. They also appreciated the personal, high resolution video experience and the reduced waiting time. What US Medical IT did for us was an engineering feat for about one quarter of what we would have to have paid for a conventional telemedicine outfit.
We’re especially excited about the fact that Skype for Business on these telemedicine carts is enabling us to embed telebehavioral health in our primary care clinics. You’re probably aware of the recent comparison study in JAMA that showed that when you embed telebehavioral health in primary care you can reduce ED visits by about 25% and reduce your hospital admission rate by about 10%. So we see telebehavioral health as a differentiating advantage in the highly competitive fee for value Dallas market. With telemedicine over Skype for Business we’ll be able to address health disparities head-on by making primary care and behavioral health services more accessible to residents in underserved areas and to those who lack transportation.
These carts have also proven to be one of the best tools to attract and retain top internal talent. For example, one of our most experienced psychiatrists had announced her plans to resign so she could spend more time at home with her infant daughter. The time she was spending traveling from clinic to clinic, crisscrossing across Dallas was at odds with her desire to be at home with her daughter. With telebehavioral health we were able to convince her to stay because she could conduct her consultations from home instead of spending her day driving across the city. Our patient continuity also improved under this new care model because she could carry out virtual visits three days a week instead of just the one day a week she was physically on site. She told us that Skype for Business actually reduced her commute time by over 9 hours per week! She was now able to spend this time caring for her young child and completing her case review and charts. She realized another benefit too that surprised both her and us. One of her responsibilities is supervising residence physicians. She noted that because she now supervises via telemedicine rather than being physically with the resident, her residents have a much higher degree of autonomy and confidence because it gives them the sense that they’re the only physician present with the patient.
When I visit other clinics, most of the telemedicine carts I see are standing idle in rooms or hallways. In contrast, our Skype for Business carts are in high demand and almost always in use.
Q: What advice would you offer to your peers who might be considering moving their messaging telecollaboration platforms to a trusted cloud?
A: I’d say enable your staff with the best cloud collaboration tools and liberate your clinicians with Surface Pro 4 tablets so they can move room to room or office to office while staying stay connected. Roll out Office 365 to every staff member, start with IM and presence, then introduce web conferencing & video for training and collaboration, and, if telemedicine makes sense, ask US Medical IT to provision several telemedicine carts with Skype for Business and Surface Pro 4 tablets. Then you can step back and just watch as employees start to innovate and improve. I tell my colleagues to think of Office 365 like leasing a car—but instead of using the same one until the end of the lease period, your car is always shiny and new, with the latest and greatest features.
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