Join us for an insightful conversation about the intersection of technology and healthcare with Pallavi Ranade from Intermountain Health and Janae Sharp. In this episode, we explore how healthcare organizations can effectively measure return on investment while keeping patient-centered outcomes at the forefront. From the hidden costs of technology implementation to the promise of AI and genomics, our guests share practical wisdom on navigating innovation challenges, allocating resources strategically, and ensuring that technological advances truly benefit both patients and clinicians. Whether you're a healthcare leader weighing your next tech investment or simply curious about the future of healthcare delivery, this discussion offers valuable perspectives on making technology work for everyone in the healthcare ecosystem.
Pallavi Ranade-Kharkar, PhD, MS, FAMIA, Director of Research Informatics Genomics, Intermountain Health
Janae Sharp, Founder, The Sharp Index
0:01 - Narrator: Welcome to Digital Health Talks. Each week we meet with healthcare leaders making an immeasurable difference in equity, access, and quality. Hear about what tech is worth investing in and what isn't as we focus on the innovations that deliver. Join Megan Antonelli, Janae Sharp, and Shahid Shah for a weekly no BS deep dive on what's really making an impact in healthcare.
0:29 - Janae Sharp: Welcome to Health Impact Live. I'm Janae Sharp, founder of the Sharp Index, and today I have the pleasure of sitting down with my friend Pallavi Ranade-Kharkar. She's a PhD. She's a fellow in AMIA. She's a brilliant data scientist and leader, and she's the director of Precision Informatics and Genomics at Intermountain Health. And Dr. Ranade-Kharkar is a technology and strategy leader with deep experience creating solutions that drive meaningful impact across healthcare. We'll explore how she defines measurement and return on investment in healthcare, not just in terms of financial gains, but improved care, innovation, and long-term system value. And your ability to see that big picture vision with practical implementation is one of the things I like about you. I've enjoyed serving with you on boards and learned a lot from your leadership. So, I want to talk about your passion for patient-centered outcomes and kind of start with your background. Maybe you can introduce yourself to our audience. Tell us how you came to this position and a little bit about your passion in healthcare.
1:48 - Dr. Pallavi Ranade-Kharkar: Absolutely. So first of all, thank you, Janae, for having me. It's a delight to be here today and a delight to be speaking to you today and thank you for the kind introduction. My foray into healthcare happened in a sort of haphazard way. So I have a bachelor's and master's in computer engineering and computer science respectively, and so software engineering was my focus when I started off my career. And I got to Intermountain Healthcare. It was called Intermountain Healthcare at the time, 26 years ago. I joined as a software engineer and my goal was to develop electronic health record systems. And I was gung-ho about it and thoroughly enjoying it. And at the time it was code and outcomes and writing systems and so on and so forth. Then it started to dawn on me that this is far more than code. It is about humans. It is truly about helping humans. Now these humans can be patients, adult patients, little patients, babies. These can be the family members, right, who come there. Nobody wants to be sick. Nobody enjoys being in hospital, unless you're like, you know, delivering a baby or having a baby, and then it is such a joyful event. But most people don't want to be there. They want to be treated and out of there, healthy, and move on to the rest of their lives. It is about helping them. It is about helping our clinicians. Our clinicians go through, you know, diligent and long education to get where they are, and they spend hours and hours and hours of their daily time seeing patients, doing documentation, and if our software systems are not usable, are not useful, are not written and presented in a way that can help them do their job in an efficient and a joyful manner, then there's a problem. Right. And so all of that hit me and I'm like, dude, I want to spend the rest of my career in healthcare. This is beyond just a job now. This is a career and this is where I want to be. And that was quite a few couple of decades ago, like I said, 26 years at Intermountain Health, and here I am now. For those of you guys, your audience, who haven't heard about Intermountain Health, Intermountain Health is a not-for-profit system headquartered in Salt Lake City, Utah, with 34 hospitals, over 400 clinics, 68,000 employees, and a footprint in seven states. In my current role as the enterprise director for research informatics and genomics, I oversee technology, strategy, governance, data stewardship and innovation for Intermountain research and genomics. In my previous life, I have led teams that have developed electronic health record systems, systems that have enabled seamless interoperability of patient data to ensure care continuum, clinical decision support systems, care coordination, data standards for equity in healthcare, so on and so forth. So it's been a long, fruitful and joyful career thus far for me.
5:50 - Janae Sharp: Well, that's great. I mean, not everybody can say that in healthcare. Not everybody's super happy. And I also think it's really blessed. It's really interesting, especially, you know, right now, people, there's so much hype about AI, about genomics, about the potential that data has to bring more value to patient lives and to bring better insights into what people need. And it's great to see the people who are, you know, making that possible. Today, we wanted to talk a little bit about the patient value. And really within the context of healthcare right now. I'm sure most of the audience, by the way, knows who you are, knows Intermountain Health, you know? We know you guys. We know everybody's, yeah, everybody's heard about Intermountain. I think they might not know about all the stuff that you're doing in genomics because you're actually doing a ton of really significant research in that space and getting insights, you know, from an area that cares a lot about ancestry, cares about where we come from, and cares about, it sounds like getting value from that data. So maybe we can talk about some of those projects and also as we share this podcast we'll share information there where people can learn more about your work and about the important research too. I want to talk a little bit about the current landscape that we have right now and about leadership. I've talked to a lot of people who have some anxiety about funding, about, you know, innovation in general, about how fast technology is moving and really a role, it comes down to something, you know, return on investment. It comes down to where do we put our energy with people, where do we put our energy with money? How do we measure what value we're getting from this? And how do we make sure that we're building something that's mindful and thoughtful and not just chasing shiny new things. So, I wanted to ask you, like, from your, you have years of experience and you have a lot of expertise, like what is return on investment in the context of healthcare for you?
7:59 - Dr. Pallavi Ranade-Kharkar: Oh, that's a great question. So return on investment in the financial world, it is a tool, very different. It is a tool that captures profit. It's a tool that captures financial returns on monetary investments. It is used as a metric to evaluate performance of an investment, right? The healthcare world is very different from the financial world. In healthcare, ROI maps to a few different things. As a construct, ROI is the value generated through one or more significant outcomes for stakeholders in the organization. A simple way to think about it is ROI in healthcare is the value generated. It could be monetary benefits and non-monetary benefits. Monetary benefits are easy to understand—their profits, money, yes, no, right. Non-monetary benefits in the context of healthcare are, if I were to give an example, it would be, you know, provider satisfaction or patient engagement. I like to use the term return of value. Return of value captures what is important and worth measuring. It is the return of value to the patients. It is return of value to the providers, to the communities we serve, and to the healthcare organizations themselves.
9:30 - Janae Sharp: Right, and healthcare organizations kind of have to decide, like, how do you measure what matters and why. I mean, I've seen some people who have had struggles with that, you know, with knowing what to measure. Why do you think it's important and what, you know, what kind of metrics are you? Maybe we should start with that. Like why, why do we need to measure that? Yeah, the why behind it, because a lot of people say, you know, it's healthcare, we're supposed to be saving lives, we're not supposed to just be, it's not supposed to be a for-profit, you know.
10:04 - Dr. Pallavi Ranade-Kharkar: Correct, correct. And that is true. It is about the humans. It is about the humans we serve, without a doubt. So why calculate ROI? Why is that important? As consumers of healthcare, we know, and some of us have experienced it, that healthcare comes with a high cost. Yeah. The portion of US GDP, the gross domestic product GDP of US, spent on healthcare, it is projected to be around 19.6% in 2031, which will exceed $4.5 trillion with a T. That's a lot of money.
10:45 - Janae Sharp: Honestly, when you think about it, I don't think we get better outcomes than some of these places, you know.
10:49 - Dr. Pallavi Ranade-Kharkar: That is absolutely right, Janae. No offense to us. I love America, you know. Yeah, we do, I mean, at Intermountain Health, the quality of healthcare we offer is very high, and there are many healthcare systems across the nation that do have similar outcomes. High quality healthcare at low cost is our aim. The high costs of healthcare, however, are unsustainable. On top of that, there is clinician burnout, clinician shortages, rising consumer expectations. Patients want more connected care, for example, and there are so many other demands. Healthcare organizations are looking at artificial intelligence enabled technologies, AI technologies to address these issues. Current state organizations face mounting pressure to integrate AI solutions into their clinical workflows, financial, administrative, operational workflows. However, there are many barriers to overcome. Many AI tools have yet to deliver consistent and scalable results. Based on industry averages, hospitals and health systems spend anywhere between 1.5% and 6% of their revenue on technology. That can equate to a few million dollars for a smaller organization to hundreds of millions of dollars for larger organizations. If you think about it, that is significant capital that can contribute to advancing the strategic goals of the organization. In the coming years, more than two-thirds of health systems are expected to increase their spending on digital health. So we know that health systems invest large amounts of resources in implementing and adopting technology. To be good financial stewards of our resources, it is absolutely crucial to ensure that these resources are utilized to generate value and meet the needs of our patients, of the humans involved, of our patients, providers, and communities we serve. So that's why I think thinking about ROI right off the bat as we think about implementing new technologies, it's very important to start thinking about ROI right off the bat. And ROI doesn't equate to monetary only. In healthcare, it does equate to monetary and non-monetary outcomes.
13:31 - Janae Sharp: Yeah. And it sounds also like the burden of stewardship and healthcare is higher. Like, when you're actually caring for people's lives, that does matter. Let's talk about some challenges that you've seen. I don't know if you can say specific examples, but like, what have you seen that has led to, you know, measuring ROI better and what hasn't, you know?
13:55 - Dr. Pallavi Ranade-Kharkar: Yeah, yeah. It is difficult to quantify ROI in healthcare, return of value in healthcare because healthcare is complex. There are multiple parties involved, there are multi-dimensional processes, actually. Janae, I read somewhere that tracking ROI is like trying to find a needle in a haystack, except the needle keeps moving and the haystack is on fire. So it is very challenging to measure ROI. I feel like it's a multifaceted problem. So first and foremost, the total cost of ownership is not fully understood or appreciated. Cost is often thought of as upfront cost that we, you know, pay to buy a product or to build a product and then maintenance over the years, a few years, 5 years, 10 years, whatever. What is often not counted towards the total cost is the cost of training and education and the time needed to gain optimum efficacy in a particular technology, and that can vary from person to person. Here is the kicker, changes in workflow to make technology work. There may be additional time and effort needed from clinical or administrative staff to ensure uptake and consistent use. This is often overlooked, and this is something I have experienced recently. There is also change management that is often needed, and there's a cost to that. So the total cost of ownership encompasses all of these different expenses associated with the product, over its entire life cycle, from implementation all the way to adoption. Secondly, healthcare technology investments often yield benefits over multiple years, so there could be, you know, high upfront price. Your financial reports happen every year, but in healthcare that doesn't, it doesn't always work that way, and the benefits of the investment are realized over the long term. So it makes it harder to measure shorter term results and returns. Thirdly, technology investments may affect multiple parties in different ways. The intent of using technology and the value it generates may look different for a patient versus a provider versus a payer versus the, you know, C-suite of a health system. This complicates the calculation of who benefits and how. There's also a lack of standardized tools and streamlined processes in healthcare to measure return on investment or return of value. Sometimes there are data limitations. Data can be incomplete, as we know, data can be inconsistent. That can affect measurement, yeah. All kinds of different ways to capture the data and sometimes that just leaves gaps. There's also a lack of resources to consistently measure ROI. We tend to implement a new tech and we want to move on to the next project. What is also important to successfully and consistently measure ROI is buy-in, is support from senior leadership and fully understanding and comprehending the why of measuring ROI or return of value and then making sure that that understanding gets all the way, percolates all the way to the front line.
17:48 - Janae Sharp: Yes. Yeah. Educating people, workforce, management, those are huge things. Those are huge metrics. Let's talk about what other metrics, and then I want to ask you what things you're excited about. Like, especially in genomics. I want to hear, you know, how we realized value on some of these things. But it sounds like the human element, clinician engagement, the ability, you know, an ability that clinicians and also healthcare workers have to use a tool, those are some things that you use to measure return on, return of value. What are other things that matter? Like if you could give us a list?
18:31 - Dr. Pallavi Ranade-Kharkar: Sure, sure. So there is, like I said earlier, monetary and non-monetary, right? So, the metrics are also going to be non-monetary and monetary. As a technologist and not a finance person, I want to simplify the metrics so that calculating it is not onerous and it actually happens. So let us start with the costs. There are capital costs and there are operational costs. Both of these costs can be one time or recurring. These costs are incurred typically by, you know, purchasing and implementing the new product. These include the usual suspects like license fees and hardware costs and things and some special stuff like maybe there are professional services involved. Next are labor costs for technical implementers and support personnel, clinicians, administrative users, whoever is part of the project. There's a degree of detail that one needs to go into, what is the role of the person, how many hours will they be spending, what is the projected hours per week, per month, whatever, and what is their approximate per hour rate. If clinicians are going to be involved in the design of the product or the operational workflows, that needs to be captured. If the clinicians or administrative staff will experience change in the workflow to ensure product uptake, then that needs to be carefully and thoughtfully captured. Next, let's talk about savings. So, these may include cost reductions due to replacement of low performing technologies. We could be doing that, replacing low performing technologies. There could be gains in reimbursements. There could be new or increased revenue generated because of the new technology. There's also cost avoidance, which is different from cost reduction. Right. So all of that is monitoring, and what is needed is a playbook, an ROI accountability tracking playbook to capture all of the aforementioned costs and savings, and I've created one actually for some of my projects. Then there are non-monetary benefits. Examples are provider satisfaction, patient satisfaction, patient engagement. These can be quantitative as well as qualitative. For example, for patient satisfaction, you may have, how satisfied are they with their personal health record system? What is their view on ease of coordination of care, because that can be a pain point for many patients. So the metrics that I've mentioned thus far, Janae, are the important ones and the most common ones. What each technology project or initiative will need would depend on the unique needs of the project, as you can imagine. So that is definitely something to keep in mind.
21:41 - Janae Sharp: Yeah. Yeah, I'd also love to hear, like, what are some projects that you've seen where the value is being recognized and what are some that are more long term? Like when we hear, there's so much hype right now about technology. Like, what do people need to keep in mind when they're, you know, a lot of our audiences tech, they're technology experts, you know, they're from health systems of various sizes, like, what are the projects that you feel like have, and technologies even that are bringing value already and which ones are more long term that you've experienced, you don't have to speak in general, but—
22:17 - Dr. Pallavi Ranade-Kharkar: Sure, yeah. So EHRs, electronic health record systems, they are a big, big undertaking implementing those. They're hard. The effects though can be short term and long term. Right. So that is one example that kind of has both aspects to it. Short term stuff includes once people have gained efficacy in using your new EHR, the overall satisfaction can really, really go up. Gosh, I wasn't able to do this before, or I used paper to do this. Now, it is a matter of two clicks and I'm there. I love the clinical decision support alerts that I get to remind me, gosh, did you forget something here? And I love that. So those are both, you know, sort of monetary and non-monetary. I mentioned the non-monetary ones, but the monetary could be, you know, I'm just able to do my work faster. And so maybe as a physician, I might be able to take a few more complex patients in my roster or see more patients, things like that. Now there's a lot. I mean we can do an entire podcast on that.
23:45 - Janae Sharp: Yeah, that's absolutely right. Oh yeah, as we wrap up, maybe you could, we could close with you telling me what you're looking forward to then. And we'll, maybe we'll meet again and talk about all the different things.
23:57 - Dr. Pallavi Ranade-Kharkar: Absolutely. What I'm looking forward to are so many things. I think we're at a juncture in our journey and, you know, maturity in implementing electronic health records where we have started seeing the benefits to it. It's no longer like a new thing. More than 80% of health systems actually have EHRs, and that hasn't happened overnight. It has been, you know, happening over the past couple of decades. What I look forward to see is, you know, these promising AI enabled technologies, getting to a place of maturity in a responsible way, in a way that is explainable, transparent, responsible, reliable, and really making lives of humans, again, coming back to the humans, patients and providers, a lot better. And bringing the joy in healthcare, it should be more than, you know, just a job, just a thing that we do. Oh, I can't wait to go home, finish what I'm doing and wait to go home. I hope that our technology enables people to do what they do, to do their jobs in a much efficient manner, in a much simpler manner, in a much joyful manner, so that they can get their creativity and their joy back and just make life better.
25:37 - Janae Sharp: I love that. What a great way to close. I want to thank you so much for your time today and just for sharing, sharing your joy and sharing that vision that brought you to healthcare. Thank you so much.
25:50 - Dr. Pallavi Ranade-Kharkar: It was a delight to speak to you, Janae, and all the very best and hope we talk again soon.
25:58 - Janae Sharp: Absolutely.
26:01 - Narrator: Thank you for joining us on Digital Health Talks, where we explore the intersection of healthcare and technology with leaders who are transforming patient care. This episode was brought to you by our valued program partners: Automation Anywhere, revolutionizing healthcare workflows through intelligent automation. Nara, advancing contactless vital signs monitoring. Elite Groups, delivering strategic healthcare IT solutions. Cello, securing healthcare identity management and access governance. Your engagement helps drive the future of healthcare innovation. Subscribe to Digital Health Talks on your preferred podcast platform. Share these insights with your network and follow us on LinkedIn for exclusive content and updates. Ready to connect with healthcare technology leaders in person? Join us at the next Health Impact event. Visit HealthImpactForum.com for date and registration. Until next time, this is Digital Health Talks, where change makers come together to fix healthcare.