With six years of experience as a chief nurse informatics officer, Kristin Wolkart knows how to speak tech. And as nurse, she’s equally as comfortable putting things into perspective for clinicians. That background serves her well as president of St. Francis Medical Center in Monroe, La., where she’s focused on pushing more services out into the community. Wolkart has led the organization since March 2014. She recently spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.
MH: You are embarking on a plan to revitalize some of your medical campus, right?
Wolkart: Correct. We have a short-term investment strategy of about $80 million over the next four years. And a longer-term master facility plan, which will probably take somewhere between 10 and 20 years. So we’re engaging architectural firms to help us with our long-term mapping of the facility in downtown Monroe.
MH: What are some of the areas you are looking at as St. Francis shifts to meet the needs of both the community and the changing economic dynamics within healthcare?
Wolkart: A big focus for us in the last few years has been growing our outpatient volume, working on growth within our medical group, hiring primary-care physicians and other providers, and strategically assessing where in the market we need to put access to service. So really focusing on access as it relates to primary care. We have 19 locations across northeast Louisiana and continue to focus on growth as well.
For our long-term strategy, we need to continue to focus on growing our book of business outside the walls of the downtown hospital. And then strategically understanding how big do we need to be downtown and what does that need to look like? Should we focus more on critical care, more on women’s and children’s, more on cardiovascular?
MH: What’s your initial sense of how big you need to be downtown versus some of those outlying areas?
Wolkart: When you look at healthcare right now, I believe that there will always be a need for a hospital in the future, but I think that hospitals will be smaller and more focused on critical-care medicine. I believe St. Francis in the future will be more consolidated and focused on intensive-care beds or beds that can go from critical care to telemetry to discharge. And then growth in the outpatient business. We will have more medical office buildings where folks can go in and see their primary-care physician, get their lab work, their radiology work, maybe simple procedures all done in a walk-in place that’s close to home.
MH: Your background as nurse informaticist plays into this transition a bit. Now as president, how do you utilize that IT knowledge as you lay out St. Francis’ strategy?
Wolkart: Everything we do today touches technology. When I think about consumerism, what our customers want, technology is a big piece of it. How do we make access to healthcare easier through technology? How do we help patients monitor their healthcare through technology? And then how does that technology connect back to your healthcare providers?
That’s probably still the biggest challenge that we have—connecting all those different devices and making them speak in a way that’s meaningful to the patient and the providers.
Every device that we purchase—a new radiology device, a new cath lab, a new MRI or CT machine—all of that information is connected through the internet and servers, and those images need to be downloaded into the electronic health record and to repositories that can track it and report it and pull those images up in the future. It’s important to at least have a base understanding of how your technology works and how the data flows.
The biggest advantage from my six or seven years working in information services is the ability to challenge and ask questions; not assuming when you are looking at a demo of a product in a test environment that it’s going to function the same once it’s in a live environment.
No. 2 is the fact that I can have a conversation with our information services team when we’re having upgrades or, like right now, moving to Windows 10 and what does that mean when something’s not Windows 10 compatible and not being afraid of tech speak.
They don’t mind coming to me to talk about challenges that they may be having with technology within our organization. And being a nurse, I can speak clinical language. I at least have a fundamental knowledge of the technical language and being able to bridge the gap, particularly for our physicians.
MH: Looking at IT policy, what are your thoughts about proposed rules from the CMS and the Office of the National Coordinator pushing application programming interfaces as part of the solution for interoperability?
Wolkart: I’m hopeful that we’ll make things easier in the future. Having a standard template with APIs appears that it would help solve some problems. I would say that it remains to be seen. I’m not 100% certain just because of the complexity of healthcare. And you’re talking about massive amounts of data points and diagnoses and codes and each EHR is built on different backbones. I am hopeful the more that we can standardize the better.
MH: One of the things that’s raised concerns involves privacy issues with APIs and third-party apps. HHS officials have suggested that if it’s not a provider-based app, there’s no promise of HIPAA protection. But patients may not fully understand that. Would you want to see some more rigor behind that?
Wolkart: Protecting people’s data should be the No. 1 priority and every day you hear more and more about healthcare data being stolen. I personally would be a big fan of seeing at a minimum a business associate agreement just for the protection.
MH: The state attorney general was at St. Francis last month to talk about opioids and mental health, right?
Wolkart: Yes. Jeff Landry visited northeast Louisiana. We were the host location and he brought in a couple of community pharmacists as well as a couple of physicians. I was asked to join the discussion. He has a lot of concerns about the opioid crisis and what can be done and certainly around mental health issues. It was a good robust dialogue about some of the challenges across the state of Louisiana, but with the focus obviously on northeast Louisiana.
