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Solution Showcase Live at HIMSS 26’: Fixing Broken Scheduling with Kory and Lindsey Hudson

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I am Bill Russell, creator of this Week Health, where our mission is to transform healthcare, one connection at a time. Welcome to today's solutions showcase on the keynote channel where we spotlight innovations, making real impact in health systems. Let's take a look at what's working today.

Bill Russell: Alright. Here we are from the floor of Hims and we're doing another solution showcase. I am, uh, excited to be joined by uh, Cory Hudson, uh, deputy Chief Information Officer at University Health in San Antonio, Texas, and Lindsey Hudson.

Uh, client partnerships at Nordic. Welcome, welcome to the show. Thank you. Looking forward to the conversation. Um. Corey, we're gonna start with you set the scene a little bit. We're gonna talk about, about access, talk about the, the state of scheduling and access to care before the work with, uh, Nordic started.

Kory Hudson: No, thank you for having me. So, yeah. At, uh, university Health, we, um, you know, we implemented Epic back in [00:01:00] 2020 and we probably didn't do a bunch of, uh, recommendations that, you know, you typically get during an implementation. Pandemic. Yes. We went live during the pandemic. Uh, so it was about July of 2020.

Yeah, that we went live. It was a virtual, uh, go live, which is not, I wouldn't recommend that either. Uh, so, you know, between 2020 to 2023 ish, 24, you know, we didn't stick to foundation. We didn't, we kind of allowed our operational folks to implement, some of those inefficient ways of doing, you know, patient access, scheduling, referrals, authorization.

And so, you know, we ended up with kind of this beast where, you know, we were authorizing first patients would then finally get scheduled, uh, and then the authorizations would expire. And of course you have to go through that whole process again. Um, our work queues that we worked out of, they weren't, uh, built, uh, you know, correctly.

Um, there was like this big bucket where everybody would filter off of. And so, you know, when you start filtering, you know, to whatever [00:02:00] degree. You end up with patients who never actually get that phone call to schedule. Uh, and so we had a huge mess. Patients not getting seen and not getting the care that they needed when they needed it.

Bill Russell: I mean, that's where I was gonna go. What was the patient and the clinician experience like? it's interesting when we had, when we're working through this, they think, oh no, we want to customize it, but then they get the other end of the customization. It's not the experience they, they really want.

Kory Hudson: No, absolutely not. And so, uh, from a clinician perspective, you know, once the patient's in the clinic, I think their experience is fine, but the patient. You know, there were long delays to getting care. Uh, you, you think I, I just saw my doctor and so they refer me to this other specialist and I'm expecting a phone call within, you know, a couple of weeks maybe, but it is months and months and months, potentially nine to ten month delay.

Bill Russell: What were you trying to do? I mean, what, what have you tried to alleviate that problem? So you're three years in. And you're looking at, alright, we know we have a problem, we know we need to find a solution. What, what were you guys trying to do?

Kory Hudson: I mean, ultimately I think we needed to go back to best practice and [00:03:00] you know, it's not just Epic's best practice.

It is industry best practice. And that is you get the patient on the schedule so they know when they're going to be seen, and then you work backward off of that, knowing that, okay, within two weeks of the patient's visit, I will then go through the authorization process. So that one, the authorization does not, uh, get, um, uh, doesn't expire.

Right?

Bill Russell: So what, I mean, what made you decide to bring in a partner and why didn't you just go to Foundation three years in, go to Foundation and, and sort of,

Kory Hudson: well, once you, once you've implemented and you go down the road of a certain ways, um, we also had operational, uh, uh, disagree. Units. Um, so we had two leaders who were on both sides of the fence in terms of, you know, the clinic side and the revenue cycle side, who didn't see eye to eye.

And so we really wanted to, uh, we also didn't trust ourselves to some degree. Right. Um, I think, I mean, my team, who's the epic team, they, uh, they probably knew which way to go, but, um, there was some, uh, there was some, I guess organizational, uh, inertia definitely that we had to overcome. And so. Um, we'd had previous history with Nordic.

Uh, we've had a lot of success [00:04:00] partnering with them and other endeavors and, uh, we reached out and they offered us a, a wonderful solution.

Bill Russell: Awesome. So, Lindsay, I want to, I wanna talk to you, uh, about, you know, these things usually start with, you come in the door and you gotta sort of get in the lay of the land.

Talk about the process a little bit.

Lindsay Hudson: So we started with our own overall assessment, both from an operational and technical side. That gave us a chance to really understand some of the root causes and some of the opportunities university health would have if they went ahead and implemented the suggested roadmap map that we came up with.

Um, I think what really surprised us was the assessment helped quantify the significant downstream benefit that they could gain, um, to really help improve their access to care workflows. In just one example, oh, we found that they would be able to consolidate visit types by between 50 and 75%. Which allows the schedules to more quickly schedule the right appointment, um, and get, get somebody in for care.

Bill Russell: it's interesting when we're doing those builds, they're like, no, this is a different visit [00:05:00] type. No, this is a different one. Right? And they don't realize the downstream, uh, implications of all those things and the complexity that gets created as, as you move down there. Um, what were some of the deepest gaps?

Uh, pre-service workflows, financial clearance, uh, the Epic build itself. What did you guys find?

Lindsay Hudson: So we found gaps in all three areas. As you can imagine. The one that was most significant really was in, um, the operational workflow and in the organizational structures there were was a lot of customization across different specialties.

So there was a lot of work in figuring out what is our standard scheduling workflow that we can all get behind. Um, we also found, uh, on the financial clearance side of things, we found a lot of opportunity for improvement. Between handoffs, between the scheduling, referrals and authorizations team.

Excuse me. Um, and then from a technical perspective, like Corey had mentioned, we really needed to get back to foundation. Um, the, uh, they, it was, you know, like they wanted to kind of build the second story on a house and the foundation that is cracked and unstable. You really need to go back to those basics of looking at the visit types.

Where can we [00:06:00] consolidate them? How can we optimize the provider schedules to open up more slots? Uh, what do we do to simplify our decision trees All to enable that guided scheduling, which helps increase availability of slots, get, get patients seen quick more quickly. And then of course, giving the opportunity for improved on online scheduling, self-scheduling as well.

Bill Russell: So in our industry, foundation has a definition. Epic has sort of made it a, a, uh, a, a noun, if you will. But what does rebuilding scheduling as a foundation actually mean?

Lindsay Hudson: Yeah, I mean, we, we really had to go back to those foundational building blocks that go into creating a scheduling workflow. So we consolidated those, those visit types between 50 and 75%.

Uh, we worked on making adjustments to the provider's schedule, so we actually increase the available appointments by about 10%. Um, and then also simplified those decision trees so that. Everyone was, um, was using decision [00:07:00] trees. Some of them were so complex that we, we weren't getting the compliance from the end users, and the goal was to get that to up over 90% with the, with the redesign.

So it's a lot of those foundational things that, like, as you think about, you know, how do we better use data and get the value out of our data? You gotta go back to, is the data accurate? Do I have a good governance structure? Do I have a, you know, a good data model in place? It's the same, same thing on the scheduling side as those, those basic.

Yeah.

Kory Hudson: And I, I would also add too, that when you, when you kind of undertake all of those steps, it actually creates a much easier patient experience. So, you know, the patient being able to go online onto our portal and then request a, a visit and get to the right slot at the right time. Uh, to me, if you don't have those things in place, the patient can never get to where they need to on their own.

If they were, you know, if they had a mind to go through and do, do their own like. Self scheduling.

Bill Russell: You know, it's, it's interesting when we talk about these things. These things are about this much a technology project [00:08:00] and they are this much an operations project and they're this much an organizational change management project.

I mean, talk a little bit about the organizational change management, um, objectives and the, the process to, to bring the entire. Organization along.

Lindsay Hudson: I'll talk to a couple basics and then I'll hand it to Corey for, for, for what actually happens in real life. Um, two areas we really focused a lot on were operational redesign, working to become much more standardized across different specialties, as well as really look at the roles and responsibilities of everyone on that scheduling registration.

Referrals and authorizations teams to, to look at the work that they do and, and try to reduce redundancy and complexity wherever we can. The other piece that was really instrumental was putting a governance structure behind, um, how these templates and visit types would be maintained moving forward. So it's those two components really making sure we're focusing on the workflow and not just the technology and having the leadership support from some really strong governance moving [00:09:00] forward that really allows it to be more scalable.

Sustainable over time.

Kory Hudson: Yeah, and what I'll add to that is it, it did start with governance. It, it started with putting a structure in place that, you know, you had, you know, my team, you had the operational teams on both the clinical ambulatory side and the revenue cycle, patient access side. And so coming together to really fine tune to make sure we agree on what the workflow should be, uh, making sure that we're sticking with, you know, some guiding principles.

Um, and then, you know, offering a path for any escalation if there are true disagreements on. You know, uh, what's the best course? And, and truly the guiding, one of the main guiding principles was we had to keep the patient at the center. Um, and making sure that what we're designing is going to improve the patient experience and also, uh, uh, allowing patients to be seen quicker than, than what we have today.

So we're, we're also implementing metrics to, to measure. So, you know, to, to keep ourselves held, you know, so we hold ourselves accountable

Bill Russell: and that becomes the next question. Right? What, so what's the. What's the early indications that this is working?

Kory Hudson: Well, we're just in the very beginning of this, but ultimately what we're seeing is [00:10:00] that, um, you know, we are getting patients scheduled before they're authorized.

Um, ultimately we want to see patients, you know, the turnaround time between when a referral is entered and the, and the time that the patient is seen. We're shortening that time, and that's the ultimate metric that we're, that we're measuring. Two.

Lindsay Hudson: I can just say share a, a few specific statistics here. So, so far we've implemented across five different specialties and have a number more to go.

And in the last three months they've seen an increase in, in completed visits of 4,000, um, which is significant, if you look at the whole year, we're anticipating about a 13% annualized increase. And just those five specialties in revenue generating appointments, not to mention the patient experience of being able to get in and get more timely care.

And then in some of the specific areas that we worked on together, um, we expanded new patient capacity by 4% in high volume primary care I had mentioned we unlocked 10% increase in available appointment slots, uh, through template optimization. We [00:11:00] also reduced manual scheduling overrides by more than 80%.

So you can just imagine how. The time involved in doing an override to get something scheduled. Um, and then I, as I mentioned, the online scheduling has increased the adoption there by 26%. So altogether, this, that translates to roughly between 1.6. Some $3 million in annual net revenue. So this is really just the beginning.

Bill Russell: Corey, I'm gonna come to you. What, what, what would you tell a peer CIO who's, who's sitting there with that same problem right now and there's a couple of them that are sitting with that same problem?

Kory Hudson: ultimately you have to build a good governance program. You have to really kind of set yourself up for those disagreements that are bound to happen. Um, you have to understand what you're driving toward, you know, meaning the metrics, you know, what are our business goals, you know, we have a huge backlog of patients who need to be seen, and so we need to figure out how do we get them in the door to be seen by all of our patient or all of our, uh, physicians.

Um, and then two, um, I think, you know, we're, we're a county owned hospital, so we have to be good stewards of, [00:12:00] of our resources. And so, you know, uh, driving to the bottom line, um, I think are, are the key indicators there. So. Um, but ultimately it is about standardization, right? We kind of heard that in the keynote today, uh, when we talk about how do we drive quickly, cheaply, and, and, and uh, uh, for the business.

So, um, I think those are the things that, that you should focus on.

Bill Russell: I love this conversation 'cause I think it's one of the most exciting thing that's, that I'm hearing as I walk this floor and talk to different CIOs is access is becoming a high priority, high. 'em for just about every health system, and that directly impacts the patient experience.

And it, it's, it's an exciting movement. I wanna thank you guys for your time. I appreciate it

Speaker: thanks for watching this solution Showcase on Keynote with me, bill Russell. We believe every healthcare leader needs a community they can lean on and learn from. Discover more solutions and join our community at this week. health.com/subscribe. Share this with someone who could benefit [00:13:00] from these insights.

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