Let’s face it, making sick and injured people go somewhere for care instead of bringing it to them is less than ideal. Greater mobile and telehealth tools are needed to improve care delivery. I think we are at the precipice of some exciting business models leveraging mobile and telehealth. Delivery of care can be more convenient, more accessible, less costly and more confidential when these tools are deployed well. There is simply no reason that we should always have to go to a doctor’s office to be diagnosed with a sinus infection, for example. Progress is being made and I have spoken with many hospital CEOs who see this as a strategic pillar to their efforts. And the opportunities of mobile and telehealth are huge for rural care settings and in mental health support.
Asa part of my interview series with leaders in healthcare, I had the pleasure to interview Milton Silva-Craig, the Chief Executive Officer of Q-Centrix. Silva-Craig has more than 25 years of experience in the healthcare information technology industry serving in executive roles at leading industry companies, including General Electric Medical Systems and TransUnion Healthcare.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
As a student, I was always fascinated about how the use of technology and innovation could make an impact, especially in healthcare. Right out of graduate school, I had an opportunity to join GE Healthcare in the medical imaging systems market. We were developing technologies that eliminated the use of radiologic films by digitizing medical imaging data. The implications were profound — faster access to life-saving images that could be post-processed (i.e., 3D) for deeper clinical insight or delivered over a network in seconds to a field-leading physician who could immediately render a diagnosis. When compared to printing film, it was a quantum leap in positively impacting healthcare. I think the field of quality data management is at a similar place to where medical imaging was in the early ’90s. We have an incredible opportunity to play an important role in helping access quality data that will have an equally profound impact on improving patient care. That makes coming into the office a lot of fun!
Can you share the most interesting story that happened to you since you began leading your company?
I’m always a little astonished but pleased when I hear our Q-Centrix hospital partners say they wish they knew about us earlier. The reality is that we get so overwhelmed with the here and now of what we do that we have little, if any, time to research and consider the best practices that aren’t central to what we do. At the end of the day, we have to be able to answer what our core competencies are and how best to point our resources toward those but also be willing to partner with experts in our non-competency areas. Over time, I have learned that it’s OK to not be the best at every single aspect of the broader process because you can find others who can fill in your gaps — which allows you to focus on what you do best. Q-Centrix is a leading provider of quality data management solutions and that provides tremendous value that our partners have come to expect from us.
Can you tell our readers a bit about why you are an authority in the healthcare field? (2–3 sentences)
“Authority” is a pretty high bar … Regardless of if I meet that or not, what I can say is that I have been extremely fortunate to have worked in three different healthcare IT segments within the hospital provider market — medical imaging, revenue cycle management and quality — over the past 26 years. In each of those segments, I have worked with teams where we have introduced innovation that had a positive and measurable impact on patient care, such as advanced post-processing capabilities that make 3D and other state-of-the-art medical imaging enhancements possible. Now I get to help make an impact in a different way but with the same overarching goal of improving care.
What makes your company stand out? Can you share a story?
At Q-Centrix, we see a tremendous opportunity to improve healthcare quality and lower care costs by enabling hospitals and health systems to unlock the power of their patient quality data. Through developing and implementing advanced information systems, we are making meaningful quality program participation possible for more healthcare facilities.
What really sets Q-Centrix apart from the rest of the industry is how we combine data management technology with an enormous pool of human expertise — a team of more than 800 specialists focused on quality data abstraction and analysis acting as virtual extensions of hospital staffs. This marriage of efficiency and proficiency increases the likelihood that data harbored within today’s electronic health record systems can be leveraged for quality improvement.
The industry already recognizes the incredible potential of quality data, which is driving a major shift from fee-for-service to value-based care. Regulatory quality requirements, innovative insurer payment models, and inpatient clinical data registries are helping to carry this movement forward. Registries include well-established programs like the IMPACT Registry and the Get With The Guidelines — Stroke program, and may very well be one of the most underappreciated resources for improving quality and efficiency in healthcare.
One example of the full potential of these value-focused initiatives involves a health system based in Salt Lake City. The University of Utah Health’s vascular surgery division is one of nearly 400 hospital departments and physician groups submitting case information to a program of the Society for Vascular Surgeons known as the Vascular Quality Initiative registries. Q-Centrix provides data management for U of U Health’s participation in the program. Participants in the registry experience average annual savings in the hundreds of thousands of dollars and reduce stays by more than a day for vascular patients, on average.
Furthermore, pilots of Q-Centrix’s AI-enhanced approach to registry reporting show improvements in data abstraction times of up to nearly five-minutes per case. Considering most hospitals do thousands of these transactions a month, the cumulative impact is immense.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
Healthcare in America is expensive, and the cost is rising at an unsustainable rate. On average, America spends more on medications, imaging, and many of the most common medical procedures than other high-income countries — but with worse outcomes on key public health measures like life expectancy and infant mortality. To challenge the status quo, we as a nation must ensure the highest quality care is being delivered as efficiently and effectively as possible.
The good news is that many health systems and hospitals — through their electronic health record systems — are already collecting data on performance and outcomes needed to improve quality and value of care, and thus curb costs. Information in EHRs offers a treasure trove of quality insights, but unlocking its quality improvement potential is challenging. Compounding the issue is that 80% of EHR data can be in unstructured formats, such as physician notes and additional comments.
At Q-Centrix, we are blazing a trail through deployment of automation and artificial intelligence in healthcare quality. The efforts help ensure hospitals and health systems have the means to meaningfully participate in quality programs. The more healthcare organizations adopt value-focused efforts, the more care quality improvements and cost savings will be realized.
While many people envision artificial intelligence as a robot or computer churning away at some major societal problem, its strength is really in taking over mundane and time-consuming tasks. Its application has led to billions of dollars in saved costs and increased profitability in other industries. We feel it can have a similar effect in healthcare.
More specifically, Natural Language Processing is a type of AI technology that enables a computer or software to understand human language and information patterns natively. In other words, it’s ideal for reducing the time and resources needed for quality data reporting, as well as ensuring accuracy of the information submitted. All this together makes it easier for hospitals to put their quality data to work and join the movement toward value-based care.
Overall, Q-Centrix offers hospitals an alternative to relying on their clinical teams and quality departments for quality reporting, which are often stretched thin to start with. A sensible quality data management outsourcing strategy can make all the difference for those facilities with respect to improving care and saving costs.
Are you working on any exciting new projects now? How do you think that will help people?
The Q-Centrix team staunchly believes that clinical inpatient data registry programs are underutilized in improving healthcare quality and reducing costs. This is why we are taking multiple strides toward bolstering registry participation.
First, we are introducing AI and automation into healthcare quality to lower the cost to participate so facilities can meaningfully take advantage of these quality programs, including registries.
Second, we are expanding our certifications to submit quality data on behalf of hospitals to all major registry programs. These recognitions mean facilities can partner with us to serve as their comprehensive quality data partner — capable of managing the entire registry encounter lifecycle from patient admission and data capture to submission and insights. Today, we are certified for submission to 10 registries across five major registry suites or individual programs.
Third, we spend more time than ever before educating our partners and prospects about the need to view quality program participation, including registries, as enterprise-level strategy decisions. Many hospitals and health systems have multiple departments or facilities reporting to one or more quality programs, yet with no strategy to get leverage across these efforts. When this is the case, and no enterprise cross-talk or common goals are established, it undermines and underutilizes the full power of these programs, especially with respect to registries.
What are your “5 Things I Wish Someone Told Me Before I Started” and why.
- Introducing innovation in healthcare is slower than other industries. Success can be witnessed in years to decades, but don’t give up because it ultimately happens.
- Healthcare’s institutional and regulatory framework requires multiple stakeholders to engage and approve change. Decisions commonly don’t occur through the edict of one person. Consensus building is required.
- Although there are tremendous technologies and opportunities for innovation to be applied in the field of healthcare, you must be deliberate in what problem you are attempting to solve. For example, simply saying natural language processing should be applied across all healthcare means nothing. Rather, we believe NLP can be applied to unstructured clinical data to reduce the burden of abstracting quality data in inpatient registries. That is a specific, tangible problem we will use innovation to solve.
- In graduate school, I was taught your company has to be clear in its intentions to be either a software company or service company or, for that matter a data company. Early in my career, we missed opportunities to apply all modalities to problem solving. Today, I would argue that to be successful in applying innovation to healthcare you must do all three very well — service, technology and data.
- Did I mention, healthcare is slow to change?
Let’s jump to the main focus of our interview. According to this studycited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
This is a pretty complex question, but I would be remiss if I didn’t first begin with the positives of the U.S. healthcare system. We are fortunate to have incredible access to healthcare services. From world-leading institutions to conveniently located ready clinics. We also have a cadre of healthcare service providers, from physicians and nurses to many others, who are committed and passionate about delivering great healthcare. That said, access comes at a high price. Further, the predominant reimbursements model — fee-for-service — which is episodic driven, perpetuates the overabundance of exams and services. This also leads to tremendous variation in delivery of care and outcomes, which can lead to re-administration of services . . . and further expense.
A reimbursement model that is gaining momentum is tying payment to quality outcomes — often referred to as value-based care. The idea, in its simplest terms, is that a healthcare provider will receive a fixed amount of reimbursement for treating a patient condition. If the provider delivers consistent high-quality outcomes, they can earn more. And vice versa: the lower the quality, the lower the reimbursement. Now, this is easier said than done. It requires a couple key elements. First, consistency in care. What is the right protocol to follow that yields the best outcomes at the lowest cost? This is where clinical registries play such a vital role. A key characteristic of registries is expert clinicians and data scientists combining to educate clinicians on how best to deliver care. More physician registry participation is key to system-wide improvement.
Second, it requires access to high fidelity patient quality data and transparency. We, as an industry, are still working through this data clean-up process. Currently, there are lots of different information systems with lots of different people entering the data with lots of different perspectives on what is the right quote-unquote ‘language’ to use. Additionally, they enter this information in unstructured notes, which ultimately creates a massive data fidelity challenge. Q-Centrix is playing a meaningful role in support of curating this data into a clean and useable format, which then can support more registry participation. There is still a long road ahead of us, but we are making progress!
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
Given my background is heavily in data and health IT, my ideas tend to relate to solving problems with technology and information …
- I believe unfettered access to your personal health data is critical to continuity of care and decision making. Patients are not static. They receive healthcare from multiple care givers. Gaining access to your data is a herculean effort. My parents, both in their 80s, have multiple caregivers. When they want to seek a second opinion, getting access to their records is nearly impossible — which makes informed decision making very difficult. This is a big problem and will require government mandates on standards, interoperability and access to solve.
- Greater hospital and clinician participation in evidence-based medicine efforts like registries are key to improving quality, reducing waste, and curbing costs. For example, all cardiologists should have to participate in the top three cardiac registries covering their area of expertise. There is no reason that a physician should not be held accountable to measuring their performance against a peer-reviewed standard. This should ultimately become a licensing requirement. A poorly performing physician costs the patient, the hospital, the insurer and the U.S. health system.
- Building on the commitment to quality, we need consumer transparency in physician performance. By having hospitals and physicians participate and disclose their performance in key areas, the consumer can then make a more informed choice about if the facility or physician is right for their healthcare needs. Thirty years ago, I had ACL knee surgery. My parents took me to an orthopedic surgeon they were friends with. They had no idea of this physician’s capabilities. They simply trusted him and he performed my surgery. Only later, after a second surgery, did I learn that the specific procedure he chose was not the best standard of care. Fast forward, that surgery has led to more knee replacement surgeries. Had I received the best standard of care surgery, my outcome could have been better with fewer additional procedures. This simply has to change.
- Let’s face it, making sick and injured people go somewhere for care instead of bringing it to them is less than ideal. Greater mobile and telehealth tools are needed to improve care delivery. I think we are at the precipice of some exciting business models leveraging mobile and telehealth. Delivery of care can be more convenient, more accessible, less costly and more confidential when these tools are deployed well. There is simply no reason that we should always have to go to a doctor’s office to be diagnosed with a sinus infection, for example. Progress is being made and I have spoken with many hospital CEOs who see this as a strategic pillar to their efforts. And the opportunities of mobile and telehealth are huge for rural care settings and in mental health support.
- Cancer is an area we need to keep focused on. We need greater government and private collaboration in cancer research. It may be high risk for private entities, but it’s also high reward. To put it simply, to super charge the Cancer Moonshot, we need to spend big money. I believe this approach is the best chance for finding considerably more-effective cures and treatments for cancer in the next decade. My father had prostate cancer and had a series of very invasive procedures that, while effective against the cancer, have impeded his health and lifestyle in other ways. He is alive, which I am completely grateful for, but could we do better? Similarly, I have a friend who tested positive as a carrier of the BRCA risk gene for breast cancer and chose to have a prophylactic mastectomy. This was a completely brave and appropriate personal decision for her — but I hope someday soon we can give others facing this scenario a better alternative. Let’s solve for that.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
All of these suggestions, in one way or another, begin with data. We need to — more rapidly — establish a standard of data interoperability and patient data rights. Recent regulatory proposals and changes to improve patient access to their records and advance electronic data exchange throughout the system are steps in the right direction. We also need to incent technology companies, hospitals, and physicians to deploy and promote data exchange and data-exchange standards. Greater access to clean data will facilitate an abundance of new opportunities to innovate and positively impact patient care. I see glimpses of progress every day, but we simply need to go faster.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I am intrigued and inspired by anything associated with behavioral science that gives further insight into how we behave and make decisions. At its core, problem solving calls on diversity of insight, perspective and knowledge. Rational people should be able to coalesce and solve really meaty challenges. That said, our behaviors often get in the way — or perhaps better stated, our misunderstanding of one another’s behaviors get in the way. To the extent we can be better actors through understanding each other more intimately and without judgement, I think the yield can be massive! I recently re-read two favorites on behavioral economics — Thinking, Fast and Slow by Daniel Kahneman and Predictably Irrational by Dan Ariely.
How can our readers follow you on social media?
Connect with me on Twitter: @M_SilvaCraig. I regularly post about issues critical to healthcare quality improvement and data management, and invite conversation on such topics. We also address a variety of different health IT and quality data topics on our news and blog pages at www.q-centrix.com.
Thank you so much for these insights! This was so inspiring!