ClinicalIntegrationHollyRimmasch

2016

ClinicalIntegrationHollyRimmasch2016[00:01]

[HollyRimmasch]Thanks Tyler. Thank you this morning for spending a few minutes talking about a reallyimportantsubjectaboutclinicalintegration.Andagain,Iencourage,I'mlookingforwardtoanyquestionsandhopefullywe'llhavesomemomentsattheend.Ifthereistimethatwewanttospendsometimeonquestions,we'llgoaheadanddothat.

Objectives[00:19]Soyouknow, just theobjectivesof thinkingabout today,youknow, it's reallyunderstandingthe importance of having a clinically integrated organizational structure to support thesystematic improvementandsustainability. Andwewanttotalka littleaboutsomeofthosekeyrolesandprocesses.Onething,asyouknow,we'vehadtheopportunitytoworkatmanyhealthcare systems. The understanding is some of these principles are fairly simple butsometimeswe'veforgottenthebusynessoftryingtodoalltheworkthatwe'redoingtotrytosupportcareforpatients.Andso,Iwanttojustspendafewminutesonthat.

[00:54]Justtoremindyoualittlebitaboutsomethoughts,youcanseethesecouplequotesfromkeypeople that many of you know. From Dr. Paul Batalden, that "Every system is perfectlydesignedtogettheresultsitgets."AndanotherpersonthatIthoughtaboutasweweredoingthisisthinkingaboutDemingandthatimportanceoforganizingaroundprocesses.Soaswe'rethinking about our clinically integrated network, one thingwe should be thinking about,weshouldbe redesigningour systemtogetbetter resultsandgetbetteroutcomes forpatients.AndIthinkthat'sreallyimportant.

ThreeSystemsforImprovement[01:31]Aswe'vetalkedaboutsomekindofkeyareasandifyou'veattendedanyofourotherwebinars,youprobablyhaveseentheconceptsof–therearethreesystemsthatweseearereallykey.Now, there are other things that are important but these are really three key areas to getimprovement outcomes as we think about organizing around those, clearly around bestpractices,analytics,andadoption.Andinthesethreeareas,analyticshelpsusunderstandhowwe're doing, best practice is what we should be doing, and adoption is how do we reallytransform to get our outcomes improvement. And aswe talk about it, the area thatwe'regoing to talk about is clinical integration has really wanted these areas that supports theadoptionandhowwesupportchangeandclarifyclearaccountabilityofcareprocesses.

ClinicalIntegration[02:26]So,what is clinically integration? Ifweare ina classroom, I'dbeaskingyouallwhat clinicalintegration is in yourmind, and I've comeupwitha very simpledefinitionofwhat it is, andmaybetoosimple.Asyouthinkaboutit,it'saverycomplexprocessbutit'sorganizingaroundthose clinical processes that facilitates clear accountabilities for care across the continuum.And this is probably a rhetorical question but why is it important? It's because our corebusinessisprovidingvaluethroughbetterclinicalcare.Sothatgivesalittlebitbackground.

Anotheremergingdefinition–[03:05]OnethingIwantedtomention,andmanyofyouonthephone,I’msure,areveryfamiliarwiththe ideaofaclinically integratednetwork,whichhere'sadefinitionfromtheAdvisoryBoard.There is a specific type of legal arrangement that allows for hospitals and physicians tocollaboratewhileimprovingcare.Today,we'renotgoingtospendtimetalkingaboutthelegalarrangement.We'regoingtotalkabouttheorganizationaroundwhatwe'regoingtodo.

TypicalHealthcareSystem?Justsomeexamples…[03:32]So,thisnextslide,thisisjustanexamplebutthisisreallyatypicalhealthcaresystemoraclinicwherewehaveaCEOandmaybewehaveavarietyofdifferenttitlesaswelookatthat.Weare segmented basically into traditional roles. And again, as we go through this, theseorganizationsare importantaswe thinkaboutoperationsofhospitals. So it'snot a conceptthatyouwouldtellthenreplace.

BudgetedDepartments–examples[04:04]Andhere'skindofthebudgetexampleswhichmakesitdifficultsometimesaswethinkofcareacross the continuum because we're separating different budgetary areas. And so, my bigquestion here for all of you in thinking about your organizations andwhere you are, is thatenoughtoprovideclinicalcaretoorganizearoundthesedepartments?AndI'mguessingmostofyouarethinking,no,it'snotenough.

HeartFailureReadmissions[04:28]Andasyouthinkaboutthisheartfailure,youknow,areyouorganizedaroundtheabilitytogetimprovement outcomes, these are just some examples of reducing. You can see this one isreadmitsandthisislookingoutfromtheinpatienttotheoutpatientsetting.

ReducingSepsisMortality[04:46]Theseareresultsaroundprimarilymoreofaninpatientsettingaroundsepsis.

ImprovedACOCareCoordination[04:52]And this is another example about moving along the continuum of care and looking atcollaboration,advancedcareplanning–areweorganizedaroundtheability tocommunicateandmakedecisionsandaccountabilitytodothese.

KeyFunctionsofaClinicallyIntegratedSystem[05:13]Soaswe thinkabout thekey functionsofaclinically integratedsystem, thereare fourareasthatareemphasized.Thefirstoneiscreatingasharedvision.Regardlessofhowyouorganizeand what you do, that is an important aspect of being able to achieve your outcomes ofimproving healthcare. Creating an integrated information system, again going back tounderstanding what are we doing and what is the impact of what we're doing across thecontinuum.Andthisisthepointwe'regoingtospendthemosttimetodayaboutintegratingour clinical and operationsmanagement structures in order to support improving outcomes.Andofcourse, the lastone,we'renotgoingtospenda lotof time,whichcouldbeanentireanothersession,isintegratingourincentivesandourcoststructures.

PollQuestionPleaserateyourorganization.Howintegratedareyourclinicalandoperationalmanagementstructures?[06:03][HollyRimmasch]SoTyler,we'vejustwantedtotalkaboutourfirstpollquestion.I'dlovetohearfromyouaboutyourperspectiveonthisquestion.[TylerMorgan]Alright.Let'sgoaheadandlaunchourfirstpollquestion.Pleaserateyourorganization.Howintegratedareyourclinicalandoperationalmanagementstructures?We'vegotour100%-wearethere,75%-you'rearegettingthere,50%-we'rewellonourway,or25%-we'renottoofaronthejourney,ormaybedon'tknow.So,we'llleavethisopenforafewmoments.We'vegottenafewquestionsinaskingabout–I'dlike to remindeveryone that, yes,wewill beproviding the recordedwebinar, aswell as theslidesafterthewebinar. And I thinkwe'regrateful forthosequestions. I'll remindeveryonethatifyoudohavequestionsorcomments,youcantypethoseintothequestionspaneinthecontrolpanel.

Let'sgoaheadandlookattheresultsofourpoll.We'vegot2%say100%,11%at75%,33%at50%,and34%at25%,withthe20%don'tknow.[HollyRimmasch]Wethat'sgreattoknow.Ithinkthisisprobablyprettyrepresentativeofhowmostpeoplearefeelingandactually itwouldbereallygreattohearofthemthetwowhoaretherebecauseIthinkthisisdefinitelyajourneyandIthinkwhatyoualsoseeintheseresultsisthatpeopleseetheimportanceofdoingthis.So,thankyou.

OutcomesImprovementOrganizationalStructure[07:27]Alright.Thatreallyhelpedusgiveaviewofwhatpeoplearethinkingandwhereweare.So,aswe think about it, this is really just an example of outcomes improvement organizationalstructure.Andasyouthinkaboutit,again,thenamesoftheseteamscouldbeverydifferentandyourorganizationisverycomplex. Butasyouthinkaboutfromthesimplestformat,thisexecutiveteamthatyoulookatthetop,theclinicaloutcomesimprovementleadershipteam,reallywhointheorganizationisprovidingoverallgovernance,prioritization,andleadershiptothoseclinicalcareaspectsacrossthecontinuum. Now,asyouthinkaboutyourorganization,youcouldbeanacute-basedhospitalandthinkaboutthesamestructure.Butyoualsocould

bean integratednetwork andbe thinking about the same structure–because again it's theimportanceof lookingacross thecontinuum in theseareasand representing theappropriatepeoplethatareprovidingcareandaccountabilityineachoneofyourareaswithinthehospital,aswellasareawithinacommunitynetwork.Asyougodownontheright-handsideandyouthinkaboutguidanceteams,we'regoingtotalka little bit more about guidance teams. These are more domain oversight of areas likecardiovascularorWomen's andNewborns,which they reallyprovidedomainoversight. Andthenthesenexttwoteamsthanareinred,outcomesimprovementteamsandworkgroupsarereallyundertheguidanceofthisoverallguidanceteam.We'regoingtotalkalittlemoredetailonallofthose.Andthenontheleft-handsideofthescreen,theotherconceptandprincipleisthe importance of integrating your data governance into providing support of your overallsystem,clinicalgoals,andcontentandanalyticsteamsthataredoingthat.

ClinicalOutcomesImprovementLeadershipTeamAccountabilities[09:31]Solet'smoveonandtalkalittlebitaboutthisclinicaloutcomeimprovementleadershipteam.Now,myguess is inmostofyourorganizations,youhaveateamthat issimilartothis,doing

similar roles. Andpartof I think the learningexperience is howdoyou integrate these intoyourcurrentstructurestomaketheseeasiertoimplementandsustain. Butaswetalkabouttheseteamstoprovidetheoverallgovernanceandprioritizationandonecorecomponenttheydoishelpingculturallychangeyourleadershipandbreakthroughbarriersandmakeitpossiblefortheseteamstobesuccessful.Another key component is this team establishes the teams, like clinical programs or clinicalsupportservices, thatare theteamsthatareaccountable todothework. Andas theythinkabout establishing these teams as we've mentioned earlier, they should represent thecontinuumofclinicalservicesandrecommendclinicalboardgoalsandreview.Wetalkedaboutreviewprogressremovingroadblocks.

ClinicalOutcomesImprovementLeadershipteamMembershipshouldrepresentkeystakeholdersinsystem(e.g.,acute,ambulatory,MDdivision)[10:38]Oneagainimportantconceptyoushouldthinkabouttheseteams,typicallywehaveavarietyofpeople who have led these teams. And one thing that we have seen over time is theimportanceofhavingkindofthistriadoffolkswhoareleadingthisteam.Oneisyourphysician

lead,yourCMOorVP inMedicalAffairsorhoweveryou'reorganizingyourorganization,andhaving a chief nursing officer/executive or VP for nursing. But the one thing that we havelearnedwith integratingboth the clinical andoperational roles ismaking sure that youhaveyouradministrationoroperationalofficersaspartoftheleadofthisteam.Andthenthereareother key stakeholders that are obviously important, you know, IT, finance, patient quality,safety,populationhealth. Youmayhaveyourphysiciangroupwho's representativeandyoumaybe even have community leaders as part of your network in there. And then the otherimportantpartisleadershiprepresentingthemultipleservicesthatyou'reprovidingcarewithwithyourclinicalservicesorprogramsandyourclinicalsupportservices.

ClinicalPrograms:OrderingofCare[11:50]Going on, aswe talk about those clinical programs, and youmay call them clinical services,thesearethegroupingsthatwe'veidentifiedasyouthinkaboutthegroupingsthatwouldreallyordercare. Thesearepeoplethataredrivingcare,drivingtheutilizationofourservices. So,thesearegroupingsofpeoplewhowouldmeaningfullyworktogetheraroundcareprocessestoimprovecareacrossthecontinuum.We'regoingtoshowalittlemoreexamplesofthatlateron.

ClinicalSupportServices:DeliveryofCareOrdered[12:24]And the other concept again that we talked about, the importance of representing in thisexecutiveteam,areallofthosethataredeliveringthecare. Sothereareplaces like lab, likepharmacy, nursing units, care units that are important to integrate. And as we talk aboutclinical integration, this is one of the key concepts – is integrating those people who areorderingcareandalsodrivingitwithpeopleprovidingcareandcoordinatinghowwesetgoalsacrossthoseareas.Oneoftheclearexampleinmypastexperienceisaswesataroundthetableandwesettheseclinical goals about improving care, one area we had primary care who had set a goal toimprovediabetesandinadolescence.Itwasanareawherewesawalotofvariation,wesawalotofopportunity. Andoneofthecorewaysthattheylookedat implementingitwashavingthedieticiansactuallyprovideeducationtothesefolks.Well,Ihappenedtobeoverourfoodandnutritionareaandourdieticianshadsetawholeanothersetofgoals. Andso,aswesataroundthetableinthisexecutiveleadershipmeeting,werecognizedthatweactuallycouldnotdobothofthoseandweneededtoprioritizeoneofthoseareas.So,theimportanceofhaving

thegroupswhohave keyunderstandingof those careprocessesneeds to integrate tomakesurethosearealignedwiththegoalsofthepeoplewhoareactuallydoingthework.

Care-LevelHierarchy[13:57]Another concept to thinkabout is inorder to support that, andwe talkedaboutanalytics intheseteams,isthatyouneedtoclearlyidentifytheaccountabilityofeachoneoftheseteams.So,ifyousawthecardiovascularorclinicalprogram,oneofthethingsthatwe'veworkedonalot andmany organizations have hierarchies. We call them care-level hierarchies or clinicalprogramhierarchiesthatbasicallyarerollingoutthosecodesandprovidingdatatotheseteamsso they understandwhat care processes they're involved in. So for instance, cardiovascularwould be kind of for heart rhythm disorders, vascular disorders, ischemic heart disease andheart failure. Andyoucanseeagainunderthatthere'smultiplecareprocessesandsub-careprocesses that these teams would be responsible to look at improving care across thecontinuum.Onethingtohighlighthere,youknow,forinstance,isischemicheartdiseaseisanywherefromthepreventionofhavingischemicheartdiseasetotheintervention. So it includesthings likeopenheartsurgeryandotherproceduresdonebycardiology.

ClinicalImplementationTeams[15:05]So, I justwantedtooverlaya littlebithowthisworksout. Soyousawtheclinicalprogramsbefore.Thisisjustanexamplewherewehavecardiovascular.Andtheguidanceteamreallyisresponsibleforallofthosecareprocesses,theimplementationteam,whichwe'lltalkaboutinaminute is just responsible for leading the expertise and developing improvement across thecontinuum, and the work groups are really the ones who do the detailed work aboutdevelopingprotocolsandsupportingthesecareprocesses.

CareProcessParetoAnalysis[15:38]So, I just pulled out an example of the cardiovascular clinical program because that's mybackground.SoIknowitbest.Butthishappenstobealist,wepulledaverylargedatasettoshowthetypeofdiseaseprocessesthattheseteamsmightfocusonfirst.Andyoucanseeinkindofthedarkgreenyoucankindofseethespendasawaytolookatit,butitstartstodrive,youcanseefromanoverallperspective.AndI'mgoingtogotothenextslide…

ParetoAnalysis>>Prioritization[16:08]…thatasaleadershipteamhavingthesetoolsisreallyimportanttosupportclinicalintegration– because aswe think about it, this Pareto analysis, and again this varies a little bit by thepopulationyouarelookingat,butweseeverysimilarthatthisParetoanalysis,wherethereisacertainamountofcareprocessesthatreallycountforalargevolumeandaccountforvariationinorganizations.Andwestarttoseeagainandthere'sacertainnumberofcareprocess.Youcanseethenumberhere,40careprocessesaccountforabout62%.

InternalVariationversusResourceConsumption(ExcelExampleshown)[16:43]AndthisiskindoftheParetoAnalysis. Wehave85careprocessesthatrepresent80%oftheopportunities.Soasaleadershipteam,youstarttolookathowmanyofthosecareprocessesfallswithincardiovascularorWomen'sandNewbornsorteamsthatyouhavealreadyexistingwhereyoustarttosay,whereshouldweputourresourcesasasystemtoimprovecareacrossthe continuum. And I think one thing that is highlighted here too is that there are a lot ofdifferentcareprocesses,butwhenyoustarttolookatyouropportunities,thereisagoodareato focus. And for instance, if you are anorganization that has a very highoncology volumebecauseyouhaveabigoutpatientvolume,again, thismight lookdifferentandyou'll say,wewant toputour focus to integrateour resourcesaroundoncology first versusanothergroupwhichhavecardiovascularandthat'stheimportanceoflookingatthisinformation.Thisisjustanotherlookatlookingininternalvariation,whichisanothertoolforthisgrouptosee.Andagain,thisisbrokendown.Youcanseedowntothecareprocesslevel,wecanseethat,again,septicaemiaisoneofthosebubblesthatweseethathashighvariation,youcanseeon the Y axis. In the X axis, you can see it has a lot of resources consumed. And so, yougenerallyseeasaleadershipteam,youstarttosee,okay,howwegotourselvesorganizedandhowweresourcedthekeyrolesinthisareatobesuccessfuloverlongperiodsoftime.

Guidanceteam[18:15]SonowIwanttokindofgodownonestepandtalkabouttheguidanceteam.Weshowedtheslide earlier that talked a little bit about the accountabilities of that guidance team, and theimportanceisunderstandingwhatistheaccountabilityofthisguidanceteam.SoasIshowedearlier, the CV team actually knew that theywere assigned the accountability of these careprocesses.Now,let'ssayyouhavesomethinglikeheartfailureandoneorganizationdecidedtoassign it to cardiovascular. Butanotherorganizationdecided toassign it toprimarycare. Isthatokay?Absolutely.Becauseweknowalotoftheheartfailureisintheoutpatientsettingandtakingcareofthatbutthekeyconcepthere isthatyou'veassignedtheaccountabilitytosomebodytodrive.Now,itdoesnottakeawaytheimportanceasweallknowthatyouhavethe rightpeople sitting around the table. Andas you're looking along the continuum, you'dalways involve the right people. But the accountabilities really start to drive improvingoutcomesalongthecontinuum.Andinadditiontothat,thekeyroleintheguidanceteam,ifthereareareasthatcross-functiona lot, like for instance respiratory, and you're dealing with very high respiratory issue, youwoulddefinitelyprobablywant toconsiderbringing someof thosepeople for (19:36)on theteam.

So this team is really the one that provides the domain oversight we mentioned earlier,recommendstheprioritieswithinthoseareas,andtheystarttorecommendthoseboardandclinical program goals which rolls up to the executive teams we talked about earlier thatactuallymovedthattoaboardgoal.Andtheyprioritizeresourceswithintheirareasandtheydeterminetheorderandtimingofthecreationoftheteam.So,wesawthatoneearlierslideincardiovascular where we had a list of opportunities, and they would determine the timingaboutwhentheteamswouldbeputtingtogether.Andagain,that'snotonlybasedonthecostbut it's also based on leadership availability, external pressures,marketing needs and thosethings.There'salotofthingstoconsiderinthatbutthisteamreallydoesthatandtheyhavetheaccountabilitytodothat.Andtheyensurethatthereisbestpracticesthatarediffusedandsustained systemwide as the leadership team within that domain and continue to removebarriers,asnecessary,withinthegroup.

GuidanceTeam[20:39]Andasyouseeagain,you'regoingtoseekindofsomeofthekeytriadhereagain.You'vegotkey physician, nurse leadership, and an administrator from each of the areas you'rerepresenting.So,justtogiveyouanexample,wecouldtalkalotmoreaboutthedetailsofthis,

butlet'ssayyou'reregionalized.Andyoudon’twantthisteamtobehundredsofpeople.Youdon’twantyourexecutiveteamtobehundredsofpeopleeitherifyou'reinalargesystem.Soyouwant to try to figure out can I have a physician represent a region, can I have a nurseadministrator,andanadministratorrepresenttheregion,andlookatmoreinkindofaclusterrepresenting; or ifwe're in anoutpatient setting, dowe look at clustering different types ofclinicstogether.And then another areas is each one of these teams needs some support and tools andprocesses.Andwehaveidentifiedthisbylookingataknowledgemanagerandadataarchitectandananalyst. Andyoucanseeby lookingat thedata,oneof the reasons it's important isbecauseitgivesthisteamenoughtransparencytounderstandtheworkthey'redoingandtheimpact of the work that they're doing. And obviously, there are other key stakeholders, ITfinance,patientquality,patientsafety,sometimesweseepeoplefromthePIworld inthisatdifferentaspects.Andagain,intheseteams,thereareassignedpeoplethatareaccountabletothisgrouptohelpbringtogetherbestpractice.

PermanentTeamsCharacteristics[22:12]

Sothisisjustapicture.Wekindoflaughed.We'vedonethisinkindofmultipledifferentways.Andyouknow,ifyouthinkabouttheseteams,theguidanceteams,thedriverontheright-handside, thephysician and the clinical opsdirectors are really leading this team. Andagain,wetalked about administrator, but from a clinical perspective, they're driving and providingsupporttotheseclinicalteams.And you can see, this isWomen's and Children, but if I replaced it with cardiovascular, thepocketswouldbeheartfailure,ischemicheartdisease,andtheywouldidentifyleadsinthoseteams, and you can see, again as you think about the integration, about the importance ofidentifyingtheearlyadoptersandinnovatorstodothat.Andthenalongthebottom,youcansee that the roles thatwe talkedabout, theknowledgemanager, thedataarchitect,and theapplicationadministrator,thosearefolksthatwhentheseteamsstarttoworkonimprovementprocesses,theyactuallyhavepeoplethatareassignedtoupdateyourEMR. So ifyouhadtochangeandwesaidweknowthiswouldactuallyimprovecare,we'vegotfiveplacesthatwe'rechartingthis,weneedtochangeitin,one,inyourEMR,thesepeopleareassignedtodothat.So,thesepeoplecansupportmultipleprocessesthatarehappening,butyou'llseeagaincriticaltothat.

CriticalKeyFunctionstoConsider…[23:31]

Thisnextone is, again,oneof the reasons. Soaspeopleon thebottomof the truckare soimportant, and they aren't being driven over. We do want to make sure they're actuallyhelpingsupport–isthattheimportanceofprovidingdataandcapturingdataanalysisfortheseteamsisanongoingpermanentresource.And I'm actually going to go back to the slide a little bit because I missed a couple things.There's one thing different. If you think about a clinical integrated network, one of theconceptswehaveseenoverandoveragainistheimportanceofpermanenceintheseteams.Now, I think on the guidance level team or the clinical service level team, we often havepermanentteamsinourrespect.ButIthinkasyoulookattheteamsbelowthat,theoutcomesimprovements teams and theworkgroup teams, they have the tendency to be very project-oriented,anditdoeshaveanimpactonsustainabilityandtheabilitytoimplement.So,Ithinkwe'vecoveredbothoftheseareas.

OutcomesImprovementTeam[24:32]Sowe'regoingtogotothenextteam,whichistheoutcomesimprovementteams,thatreallyIwouldsaythekeytopichereisthatthey'resupportingimplementation.Andthisisaconcept

anditwouldhavebeenprobablygoodtoputapollquestionheretotalkabouthowwesupportimplementation–becauseimplementationisoneofthesereallyhardthingstodoinaclinicallyintegratednetwork. Asweknow, it'sverycomplexandthere'sa lotofpeople involved in it.But the idea and concept of identifying a team that is accountable for implementation isabsolutelycriticalinthisprocess.Anddoingthat,aswe'llshowalittlebitlaterandsay,workwiththeteamsthataredevelopingtheprotocolsanddevelopingthebestpractices, itallowsthat smaller group to come to a larger broader groupwho can give feedbackwho overtimeactuallysupporttheimplementationbecauseyouareculturallyboughtintotheseprocesses.So letme give you a very specific example. So, let's say you're looking at heart failure andyou'reworkingwitha lotofclinicsandyou'redevelopingprotocolsonhowtobettersupportthesepatients,andyou'retalkingaboutplaceswherewemayhaveaplacewherewe'regoingtodevelopaspecializedheartfailureclinic.Thatsoundsreallygoodbutthenwehavealotofpeoplethatthey'redoingverysimilarwork. Andso, theopportunity forthesmallerteamtocomebackandbeabletogotoabroadersetofclinicsandgetsomefeedbackandinteractionduring that process actually allows for long-term better implementation and a betterunderstandingoftheissuesandchallengesofimplementation.Soagain,thismembershipoftheseteams,youcanseethatit'sprimarilyledbydomainexperts–sophysician leads,nurse leads. AndIwillmentionwhenwetalkabouttheclinicalserviceslater,theseteamsareveryimportantaroundthepeoplewhoareimplementingthework.Somaybeitisarespiratorytherapistandaphysician,maybeit'sapharmacistandaphysicianbutthatsameconceptistrueacross.

WorkgroupTeam[26:50]SonowI'mgoingtoskiptotheworkgroupteam,thisisprobablytheeasierconceptformostofustounderstand.Theyareassignedasveryspecificdomaindiscoveryandinterventiondesignby the guidance team and the outcomes improvement team. And they really do the heavylifting.Theyaremeetingmorefrequently.Theyaredevelopingthecareprocessbestpractices.Theyareworkingwitheducation.Thisoneisreallyaboutgettingtherightpeopleintheroomtogether and looking at analytical and technical experts to support them in their journey ofgainingtransparency.Soas you thinkabout integratedclinicalnetworkagain, as you thinkabout this,okay, sowehave one group that's doing an improvement process on a heart failure patient, we haveanotheronethat'slookingatnormalnewborn,wehaveanotheronethat'slookingatpalliativecare.Anotherconceptthat'simportantasyouarethinkingaboutclinicallyintegratednetworkis do you have consistent processes across these teams andmethodologies for them to gothroughtheseprocessesand improvecare? Because theendof this is itgoes to thepatientanditgoestoaproviderwhoistryingtotakeinformation,maybeaprimarycarephysicianorahospital who is trying to take information from multiple areas, there needs to be someconsistencyonhowwegothroughtheprocess,howtheyintegrateandfamiliaritywithwhat'shappening.

ImprovementCycle[28:22]Soagain,thisisjustaPDSAcycle.We'veintegratedalittlebitmoreofthedatacomponentsofthisbutitisimportanttodothataswesupporttheteams.

IdentifyPotentialImprovementsProcessAIMsandOutcomeGoals[28:33]Andthenunderstandingagain,asaleadershipteamandasanintegratednetwork,thatthroughthetransformationprocess,ittakesmultipleworkingsonimprovementcyclestoreallystarttoseetheneedlemoveongettingthiscare.So,generallyweseethattwo-to-fourprocessimprovementAIMsshouldproduceasignificantoutcome. Now,why is this importantaswethinkaboutclinically integratednetworksystemand looking at the organization around that? It's important for the executive team tounderstandkindof theworkeffort thatgoes into that. It's important forallof the teamstounderstand how to set a goal. So if you sit down and set a goal and say, we are going toimprovethemortalityby20%,andyouhavenobaselineandyouhavenoideaaboutthecorestepsthatwe'llgettothereandcommitthattotheboard,thatisareallyhardthingtodoinone year. Usuallywe see these clinical board goals, they sometimes take a year to get thisprocess kind of things fixed before they even understand what the real opportunity is toimproveoutcomes.Andso,Iguessinsummary,thisiscomplexwork.Ittakesalongtimetodo.Thereisalotofintegrationthatneedstohappenbetweenthepeoplewhoaredoingthework,thepeoplewho

aredrivingthework.Andso,don'tunderestimatetheculturechangeandthetimingtocommittodothesegoalsandnotunderestimatingtheresourcesthatareneededinthisprocess.

ActionableVisualizations[30:18]Sokind in theend forworkgroup team, they comeupwith someverydetailedworkaroundactionablevisualizationsandstarttocontinuetolearntodrive.AndonethingIjustwantedtohighlightisthesetabsacrossthetopofthis,thishappenstobeheartfailure,continuestogrow.Andtheimportanceofthesepermanentteams,you'llseeteamsthathavebeenworkingonthisforfiveyearsthathaveinmultitudeoftabsthatcontinuetoimproveprocess,whichwewouldhavelosttheopportunityifwewouldhavesaidwe'rejustgoingtoputthisheartfailureteamtogethertodevelopbestpracticesandthinkthatit'skindofatatime-limitedbasisbecausetheopportunitygoesovertime.

TeamStructureOptions[30:59]I justwantedtohighlight. Wetalkedaboutthe importance. This is justahigh-level thinkingaboutpermanentandtemporaryteams.Therearesomeprostohavingatemporaryteam.Ittakes less time to start initially. It feels lessexpensive to start. But, youknow,asyou thinkabout the pros of having a permanent team, that's something that you really have to thinkaboutinthisintegratednetwork.And theother thingabout thepros, youknow, it's justexpensive. I think the cost is it feelsmoreexpensivebut ifyoulookinthelongrunandyoulookattheoutcomesyouget, ittrulyprobablyisnotmoreexpensiveovertime.Aswe'velookedatthedata,itcertainlyhasprovenout to be one of those things where you want to install the fortitude to put these kind ofresourcesinthere,eventhoughit'sreallytoughanditlooksoverwhelming.Andagain,asyougobacktothatexecutiveteam,that'swhymaybeyouonlystartoneortwoof these, to startwith,andyou start tobuildyour resources. And I thinkwhatyou'll find inmost organizations is these roles are there in most organizations and it requires re-shiftingthose resources to get where you need all the way from the leadership team down to theworkgroupteam.

DataGovernanceCategories[32:14]

DataGovernanceCategories[32:14]Ijustwanttospendjustabriefmomentonthis.Asyouthinkaboutdatagovernance,andthisisawholeanothersetofdetail,wecouldspendalotoftimeonthat,there'sreallykindoftwomajorareasindatagovernanceinthesimplestforms.Oneistheprioritymanagementandtheotherone is thedata stewardship. And in this clinically integratedmodel, the importance isthat the priority management of those resources should be aligned with your clinicallyintegratednetwork.

Content&AnalyticsTeam[32:44]And I would say the same is true for developing the content, developing the care processmodelsandtheanalyticsshouldalsobealignedwiththeoverallsystemgoals.

CareImprovementMapSepsisandSepticShock[32:57]Sothisisjustanexampleofsomeconsistency.Theycreateconsistenciesacrossthesemultipleprograms.Thisjusthappenstobeacaremaparoundsepsisthatsupportstheimportanceofcontentintheprocess.

PollQuestionAreyourdatagovernanceandcontent&analyticsresourcesalignedwithyourimprovementoutcomegoals?[33:12]ButTyler, I think, Iwould liketogotothepollquestiontooandasktheaudienceabouthowwelltheythinkthisisgoingintheirorganizations.[TylerMorgan]Alright.Let'sgoaheadandgetournextpolllaunched.Areyourdatagovernanceandcontent&analyticresourcesalignedwithyourimprovementoutcomegoals?Yes,mostly,sometimes,no,ordon'tknow.We'llleavethisopenforafewmoments.Iwouldliketoremindeveryonethatyoucantypeinyourquestions intothequestionspaneofyourcontrolpanel. We'vegotacouplequestions.Yes,thisisbeingrecorded.Wewillprovidetherecording,aswellastheslidesaftertheeventisover. Therewas also aquestion regarding canweget a certificateof attendance touse forcontinuingeducationpurposes, andunfortunately that'snot something that is availablewithour webinars at this time. While we do focus on educational topics, in all transparency,becauseweareavendor,it'smuchmoredifficultforustoobtaincontinuingeducationcredits

forthesewebinars.Butthat'ssomethingwecontinuetoinvestigateandtry.Soifweareabletogetthem,wewillcertainlyletyouallknow.[HollyRimmasch]Yeah.AndI'llmentionthis,inourAPcourses,weactuallydohavecontinuingeducationhoursattached.[TylerMorgan]That'sright.Andwe'llmentionthoseAPcourseslateroninthiswebinar.Solet'sgoaheadandclosethispollandshareourresults.Alright.Sowehave6%thatsaidyes,14%saidmostly,44%withasometimes,18%no,and18%don'tknow.[HollyRimmasch]That's great. I think I would actually love, you know, to open up a conversation with yourexperiences in that and your understanding of the importance, and this is one thing, is, youknow,tohavetheopportunitytoreflectabouthowcanwedothisbetter.Andagaintheideaisthereisalotofdifferentwaystodothisbuthowdowereallyintegrate.Youcanseeinalong-termsuccessfactor,we'vegottofigureouthowtodothistobesuccessfulinhealthcare.

ExecutiveLeadershipTeam,GuidanceTeam,BroadTeams,andSmallTeams[35:32]Alright. I think I'm justgoing tosummarizeacoupleofkeyconcepts. And Iput theseslidestogether,Ithink,whenwesendouttheslides,sothatthereisavisualwaytolookatthis.Butagain, aswe takeoverourorganization, you know, the ideaof theexecutive leadership andtheyarebasicallyprioritizing thesystem, theguidance team,which isprioritizing innovationswithin the domain. And you can see we've got these cute little people on the side thatrepresent aWomen's andNewborns team. Thenwehave these small teams that are reallydoing a lot of thework. They are iterating, they arebilling theDRAFTs. And thenwehavethese broad teams that support implementation across your systemor across your hospital,dependingonthescaleofwhereyouaregoing.And I thinktheother thing– that thisslidehasa lotofdetailactually. Youcanseewehaveactually tried to identify some of the key subject expertise in there. You can see we havesubjectmatterexpert,datacapture,dataprovisioning,anddataanalysisthathelpsupportalltheseteamsonalllevels.

KeySuccessFactors/LessonsLearned[36:44]Andfinally I justwanttokindof justendwithaslideaboutsomeofthethingsthatwehavelearnedaswehaveworkedwithmultiplepeopleacrossindifferentorganizations.Again,someoftheseseemverysimplebutitissocomplexthatitishardtorememberandseetheforesttothetreessometimes.Andoneiskeyleadership.Inordertodothis,youreallyhavetohaveyourleadership.Andyoucanseeyourclinicalleadershipalignedwithyourmanagementleadershipiscritical.Youhavetohavethatsharedvision,youhavetohaveaprocesswhereweunderstandwearegoingtoalignourresourcesaroundwhatwearegoingtodo,anditishardbecauseweareprioritizing,andtherearealotofthingsoperationalthatwillneedtobedonethatcannotgothroughthisteambutweknowthemostimportantthingswe'reactuallyresourcing.Next, that idea of integrating the technical, clinical, and operations. You can see theimportanceofthatintheabilitytohavesustainabilityandlong-termoutcomes.Anddedicatedresources.We'vetalkedaboutthat,theimportance.AndI'lljustmention,youknow,theclinicalleadership,howareyourphysiciansorhowareyournursesorhowareyouradministratorsincentivizedtoparticipateinthisprogram?AndIthink,

you know, again, you might actually go through the level of many organizations who haverevised their job descriptions or the position summaries to require participation for keyphysicians, nurses, that they are actually measured on their participation in these types ofteams,thatyouactuallystartthinkingaboutpullingoutphysiciantimethatisreallyfocusedonproviding the leadership in these areas, not just as a side bar of you've got a really goodposition,you'vegotareallygoodnursewhocandothis,but for the long-termsustainability,thereneedstobededicatedtimeandresourcesintothat.

WetalkedaboutthepermanentstructureandIwouldsaythatoneofthechallengeswetendtolookatischangingfroma"project"to"thewaywelive".Thisistheprocesswelookat.Thisis the thingswe live by. This is thewaywe set our goals. This is thewaywe prioritize theimportance.Andobviously,developingthatcultureofqualityandimprovementandconsistentmethodologieswetalkedabout.

Transparency–everyoneseeseveryoneelse'sstuff.Inthisprocess,physiciansseethingsthatmaybewemayhaveavarietyofdifferentcomfortlevelsofseeingsomeofthedataaswegoalong,butthattransparencyhasbeenonewithsuccessfactorsaswegoalong.

Integrating your key concepts into current work teams or structures. We mentioned thatearlierwhereifyou'vegotaprocessthat'sworkingandyouhaveteamsthatareworkingthathaveagoodrepresentation, thenchangetheircharter.Changetheiraccountabilityorclarifytheiraccountabilities,thattheyreallytrulyareaccountableforthese.

Andfinally,therearealotofwaysyoucanputthispuzzletogether.Thisisjustoneexample.Thereareotherteams.There'sotherpartiesoftheorganizationsthathappen.Sothis isnottheonlyorganizationalstructurewithinhealthcaresystem.But it is reallya journey.Andasyou start to accept these accountabilities, you start to see opportunities and improvementsthat you never really imagined and it becomes easier and easier because you've set upstructuresandprocesstoclinicallyintegrate,again,whatwe'regoingtoworkonandhowweimplementthoseprocesses.

Sothat'sreallythewrap-upoftheformalpresentation,Tyler.AndIdon’tknowifwehavetimeforsomequestionsorifthereareanyquestionsthatpeoplewouldliketoask,orcomments.

[TylerMorgan]Wellwedohave somequestions coming in,and somecomments,andwe'lldefinitelyget tothose. Beforewegettothose,wehaveonelastpollquestionthat'ssomewhatconnectedtosomethingthatHollyhadalludedto,whichisourHealthCatalystUniversity™.

So, our webinars are meant to be educational about various aspects affecting outcomesimprovementinourindustry.Andourtopictodayisactuallyoneofthemanythatwepresentin our Health Catalyst University™, which is an accelerated practices program thatprepareshealthcare teams to accelerate outcomes improvement. So if you are interestedin having someone from Health Catalyst® reach out to you to talk to you more about ourHealthCatalyst

University™,pleaserespondtothispollquestion.Andwearegoingtogoaheadandleavethisupwhilewestartwithsomeofthequestions.Howaboutthat?

[HollyRimmasch]Okay.Soundsgreat.

QUESTIONS ANSWERSWhere is the quality control to ensure data sets arereliable?

[HollyRimmasch]Thatisareallygoodquestion,andwecouldprobablyspendalotoftimeinthatarea.ButIthinkgenerally,as we think about that's the importance of the datagovernance, being attached to the overall goal. So Ithinkwhenyouthinkabouttheoverallaccountabilityofthedata,thatreallyfallsunderthedatagovernanceITprocess. Andthosedatamanagersthatwesharedwiththataresittingonsupportingtheclinicalteamsinthedomaininthismodel,thosefolksareaccountableforthecleanlinessofthedata,theyareaccountabletomake sure the data collection is happening the rightway, they are the people who really understand thedata, and they work with the data governancestructure to support the overall group. So hopefullythat answered your question. That's a pretty simpleway to talk about it. But I'd say it's integrated intothose teams, but in the overall structure, from theaccountabilityfortheorganization,it'sunderthedatagovernancecomponent.

[TylerMorgan]Itreallysoundslikeoneofthewordsthatyouusedalot today is accountability. Accountability.Accountability.Setaccountability.Giveaccountabilityand make sure that's a sign. That really seems likethat'sabigpartofthis.

[HollyRimmasch]Itis.AndIthink,asImentionedbefore,accountabilitymight be more important than, you know, if you'veassignedthewrongaccountability, itusuallybecomesapparentprettyquickifit'snotright.Butwhatisgoodaboutitispeopleunderstandwheretheyarefocusingand they understandwhere they canmake decisionsand where they should be driving the process. Andagain, if it's wrong, we learned that in a coupleprocesseswedid, Imentioned the one aroundheartfailure.Wedidthesamethingaroundkindofstroke.Itwas such a big process,we just started it from – Ican't remember where we started. We probablystartedfromheartandthenwerealizedthatitendedup in some way totally different, but we started it.And I think that's important. And I think, again,

accountability for the data and the support, theaccountability for the implementation, those are allthingsyouwantpeopletowakeupinthemorningandthenthinkabout,howdoIdothisbetter.

Theclinicaloutcomesimprovementteamneedstobeled by physicians with admin leader and moreprovidersonthis. Teamprovidershavepoweroftheordersand/orCPOEandthedifficultgrouptogetbuy-in.What'syourtakeonthat?

Yeah, I would say, you know,when you look at thatteam, that the representations from each clusterregion, or again if you're hospital-based or if you'recommunity-based, really do need to bemore of theclinicalperspectivebecause theyaredomainexperts.So you would want to pull in physicians from keyareas.And again, just as I think the person who asked thequestion understands, it is harder to get buy-in. Iftheyareapartofthatprocess,thenthatworksbetter.For example, if youhave aprotocol that's developedandyouhavethisreallygreatwayyoucanimplementyour EMR and all that kind of stuff, and it wasdeveloped by the largest hospital grouping or thelargest community grouping, there's always a naturalresistance to say, gosh, you know, is this right? Andagain, it may be totally evidence-based, but thatability to be part of that process is why thesepermanentteamsareimportant–becauseitneedstohappenconsistently.Andwhenwestarteddoingthis,we actually made thatmistake where we developedand we had really key experts in these workgroups,theyweredoingphenomenalwork, andwe cameupwith really great protocols and processes, but wecould not get it implemented becausewe had neverhadthatconceptofthe implementationteam,wherewewentbackandsaid,"Hey,whatdoyouthinkaboutthis?"Becauseweactuallyhadabetterprotocolandbetter processes when we had the implementationteambecausetheysoughtfromdifferentperspectivesand that really helped us in the long run. Weweremore successful implementing and it was somethingthat people were bought in and we were able tosustainit.

Isoralhealthcareexcluded?

Well that's a good question. I think that oralhealthcare is absolutely a part of, you know, as youlook at care processes, is part of all of us. And weprobablyhaven'tintegratedthosetypesofcommunityresources as well into these communities. Inparticular, when you're talking about certainpopulationsofpatients,youknow, I think thatwouldbeaconsideration.Andso,Ithinkthat,again,it'snotexcluded.Wehaven'tdoneaverygoodpieceandit'snotcriticalasmuchsometimesintotheinpatientkindof settingbutwhenweget to theoutpatient setting.

So I think that'sanopportunity to figureouthowweintegrate that. I'll mention that at the same time Ithink in these teams, another good thing to bethinking about is howare you integratingpatientsorcommunity members to these teams? And I thinkfromaclinicallyintegratednetwork,you'restartingtosee around the country people taking risks andbringing people into some of these goal settingmeetings and developing protocols. And so, I thinkthat's a little scary because we think about we'reshowingalotofourworthinprocessesthroughthat,butsomeofthegroupsthatwe'veseendothathavehad an incredible support from their patients andcommunitymembers.

Towhatextentdoorganizationsutilizeadepartmentofevidence-basedmedicineorclinicaleffectivenesstoestablish or manage best practice utilization toaccomplish the improvement goals across theenterprise? Would that be equivalent to the clinicaloutcomesimprovementleadershipteam?

Well, I think, again, there's multiple ways to take alook at this process. I think, first of all, as we talkabout that content team, content analytics team,that'soneoftheareaswhereyouseeevidence-basedmedicine. You may develop a team and we do seeorganizationsaroundthecountrywhohavedevelopedthese evidence-based medicine teams who supporttheentireorganization. Sotheydevelopedprocessesaround how to do it best, they have developedmechanismsandcommunicationpatterns. Sothere'soneway thatwe've seen it. And then also I've seenwithintheseareas, let'ssayforcardiovascular,wherethey have developed those teams within their ownareas. And I think that there'sprobablyamix that isimportantbutthechallengewithdevelopingthatnotinasystematicwayisthenyouhave11differentwaystolookathowwelookatevidence-basedmedicine.SoIthinkthere'sareallyimportantroleforthat.Oneoftheclientsweworkedwithdoesaphenomenaljobat having this evidence-based medicine group,developingprotocols. And again, they arepulling in,thecoreworkisdonewithintheclinicalarea,buttheyarepullingtogetherbetterprocessesandasystematicwaytolookatit,andIthinkit'sreallyquiteeffective.

Whatadvicedoyouhave forphysicians thatwant tobe more involved in this kind of work? Whatresources canweuse to gain a better understandingof care processes and the process of processimprovement?

Well,firstofall,it'sexcitingbecauseIthinkphysiciansare core to thiswork. And as you can see, aswe'vetalked about it, I think there's opportunities inprovidingleadership.There'sleadershipinalllevelsoftheteam,fromphysicianswhowanttobeinvolvedinit.Andyouknow,intheorganizationIwasprior,firstwe(49:19)physicianstobepartofitbecausetheyaresobusy.Towardstheend,whenwehadsetupkindofthe standard mechanism, we had 10 physiciansinvolvedandwantingtoapplyforthisposition.Soweactually went through a very formal process in

bringingthemin.SoIthinkthere'salotofopportunityforimprovementforphysiciansthatwanttobemoreinvolvedandlearnabout kind of actually doing that. It seems some ofthe tools, again, as I went through kind of theworkgroup tool about bringing the data and havephysiciansbeingpartofthatprocesstoactuallydrivethe development of improvement process. I think ifyouwant to havemore informationon learninghowtodomoreaboutthat,Tyler,Ithink,oneofthethingswe have internally, but there are a lot of differentopportunities across the country, where there arecoursesonimprovement,processesandmechanisms.Ithinktheotherthingisthereareusuallypartsoftheorganization who are doing this really well. We'veseen pockets of it in every organization. And oneother opportunity is actually to work with thosepocketswithinyourorganizationto learnmoreaboutthat.So there's both formal, informal, and I hope Ianswered the question well enough on that. But IthinkitiscriticalandIthinkit'sactuallyreallyexcitingthat you would want to be more involved orphysiciansmaywant to bemore involved in processbecauseIthinkitcan'tworkunlesstheyareinvolved.

Howdoyougetyourproviderstobuyintotheconceptof taking time to invest in meetings to establishprocess?Sincetheydon’twanttotakeanytimeawayfromtheirpatientcare.Youhadsaidinitiallyyouhadpeoplewhoweren'tinterestedbutthenyouhadmanypeople applying. I'm guessing time was part of thefactor,butwhatelsewasitthatreallystartedtomovethat?

[HollyRimmasch]I think there's a couple of things. One is you'restarting this journey, one is identifying those peoplewho are innovators, and there's innovators in alldifferent disciplines, people, you know, physicians,nurses,administrators,whoarewillingtodowhateverneeds to bedone regardless of thepersonal price oftheirwork-lifebalancebecausereallypeoplearereallybusy,andphysicians,inparticular,areextremelybusyand they are doing really important things. So it'stakingawayfromcarewhenwedothat.Ithinkthat'snotaverygoodlong-termstrategy.Ithinkitcanworkforawhileand I thinktheotherway is toreally,andthis is really hard, but to really set aside thoseresourcesandworkwithinyourorganizationtosay,soonaverageontheseguidanceteams,we'dseeaboutaphysiciantakingabout20hoursamonthtohelpleadtheseteams.Now, the nurse operator positions generally are full-timewhen you get in a larger component. And if itwasareallylargeareathatwasverybroad-spectrum,again you might need more time. But we actually

went through and said, okay, to lead theimplementation team, it takes a physician around 10hoursamonth.That'swhatwehadsetaside.Andfora workgroup, we set our 10 hours. I think we didabout 5 hours a week, so it was more intensive,dependingontheprocess.Buttoreallysetasideandsay, this is part of the job description or the jobsummary of this physician's role. So they are doingclinical work as much time and then they have 20hours amonth to actually do thiswork. Wedid notgetashiftinourabilitytoreallyprovidethephysicianleadershipor theother leadershipand those supportrolesuntilweactuallysetasideandsaid,thisispartofyourjobandthisisimportantpartofyourrole.And not only on the executive leadership but whenwe'regettingtotheworkgroupandwe'regoingtotheimplementation,when you're saying, here's a clusterof clinics or here's a cluster of hospitals or here's aregion, those people need to have some time to dothat work because they are the ones who areresponsibletogetthisstufftothatbottomoftheroadthere.Whentherubbermeetstheroad,theyneedtohelpfacilitatethatculturechange.Soit'sareallyhardconcept, it feels reallyexpensive,but in the longrun,again, I think it's less expensive. It is much moresatisfyingforphysiciansandnursesandfolkswhoarein those teams because that is part of theiraccountability.[TylerMorgan]Sowith that accountability, you're readjusting actualjobroles,descriptions,paymentstructures,andthingsaround all of that and their expectations andaccountabilitytowardstheprocessimprovement.[HollyRimmasch]Yes.Right.[TylerMorgan]That seems like it takes quite a commitment by theorganization.[HollyRimmasch]Itdoestakealotofcommitmentbytheorganization.And I think the other thing is in these teams, youshould have a chart or you should have a clearaccountability of those teams and you should take ittothestepwhereyou'veactuallywrittenitdownandtalkaboutwhoisonthatmembershipandthenbringit down to the next level and say, okay, thatmembership that is on this team, making sure it'sintegratedintotheirregionalortheirhospitalortheir

clinicjobdescription.Soitisabsolutelycriticaltothesuccessofthis.

Howwelldothemodelsyouhavepresentedadapttomultiplecultureswithintheorganization,bothamongthestaffandpatients?

I'm trying tomake sure Iunderstand thisquestion. Ithink there is a lot of different cultures in ourorganization.Andactuallywhenyougofromhospitalto hospital or clinic to clinic, you have multipleorganizations,and I thinkthat'swhy it'sso importantto have a systematic process, a systematic way thatwe're doing things. And it's important, I think, thatthese leaders that are doing this are really good atlisteningand reallymaking sure that theyaregettingfeedback, so that makes that transition a little biteasierwithculture.

Wheredoyouseepainmanagementinthisprocess? I see pain management is one of those horizontalclinical support services. In my previous (55:38),actually pain management was one of those thingsandIseethemintegratedintomanyteamsacrossthecontinuum.Butyet,theyhaveaneedtoimprovepainservices,sotheyhavetheirownseparateteamaswellasbeingintegratedacrossthecontinuum.

Atwhat point should you bring patients directly intothe discussions and decisions about processimprovement?

Well, like I said, it's kindof a scary thing. I thinkwesee more and more organizations bringing them inearly on as they start the teams. Generally kind ofwhat happens is you get these teams together andyou feel like your team is kind of gel first and thenbringinginthepatientandcommunitymembers.Youwould just want to make sure you have kind of afunctioningteam.Butonceyoustartgettingcomfortlevel into putting these teams together, you see anearlierandearlierentranceintothat.

ThankYou[56:40]

[TylerMorgan]Alright.Wellwewouldliketothankeveryoneforjoiningustoday.Thankyousomuch,Holly,for sharingyourexpertisewithus. Iwould like to leteverybodyknowthat shortlyafter thiswebinar,youwillreceiveanemailwithlinkstotherecordingofthiswebinar,thepresentationslides, and the poll question summary results. Also, please look forward to the transcriptnotificationwewillsendyouoncethatisready.

SoonbehalfofHollyRimmasch,aswellastherestofushereatHealthCatalyst®,thanyousomuchforjoiningustoday.Thiswebinarisnowconcluded.

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