Dr. Marc Harrison: Hi, I'm Dr. Marc Harrison, CEO of Intermountain Healthcare. Today I'm with Dr. Derrick Haslem, an oncologist in St. George and the associate medical director for the Oncology Clinical Program. Derrick, thank you for joining today. Please tell us a little bit about yourself and your role.

Dr. Derrick Haslem: So my name is Derrick Haslem, as you mentioned. I'm a medical oncologist. I've been with Intermountain for over 10 years now. My base is in St. George, but the system role of being able to roll out our medical oncology clinics throughout our organization and particularly as it relates to this discussion, I have been tasked with improving our access through telehealth.

Dr. Marc Harrison: That's really great. So Derrick, one of the things I'm fascinated by is this idea that in One Intermountain we can be geographically dispersed, yet you play a really big enterprise role for the organization. Can you talk a little bit about how that feels?

Dr. Derrick Haslem: It's great because when you look at our organization as a whole, we have tremendous expertise and tremendous capability with regards to our healthcare providers and being able to leverage the expertise of our entire organization to be able to get that care to the end of the row and patients who live in some of our more rural sites within our state has been actually really rewarding.

It's also been really fun to interact with people throughout the organization. Oftentimes we get siloed in our geographic areas and don't often reach outside of that and so we get a little bit more closed-minded with regards to what happens within our organization. But when you reach out and see what is happening in other parts, you really can see that there are certain things that are done really, really well, and you can then take that to different parts of the organization and really elevate the game everywhere.

Dr. Marc Harrison: It sounds so simple. It's nice to have friends across the whole enterprise. When you really know people, the assumption that they're doing good work and that they're on task and they're aligned, goes way up. When you don't know people, it's easy to have suspicions, like, "Are they really on board?" Are you finding that those relationships are pretty powerful, Derrick?

Dr. Derrick Haslem: Absolutely. Yeah. We live in a state where people tend to travel a lot and get care in different parts of the state and in different parts of our facilities. So being able to have a providers, colleagues, that you can reach out to and really trust, it just goes so far with our patients to be able to say, "Hey, I know that person and they take really good care of people, and you're going to be in really good hands when you're with them."

Dr. Marc Harrison: It has to be very reassuring for a patient. Talk a little bit about how tele-oncology got its roots and what problem it was trying to solve, and maybe even a story about a patient who you think encapsulates or characterizes the upside of tele-oncology.

Dr. Derrick Haslem: Sure. So a couple of things, maybe a bit of a personal story. I have an uncle who lived out in Vernal, Utah, which is two and a half, three hours from Utah Valley and really a more robust medical care team. He was diagnosed with a gastric cancer and for the last six months of his life, he and his wife traveled between Vernal and Utah Valley 36 times.

Dr. Marc Harrison: Wow.

Dr. Derrick Haslem: And early on they realized they needed to pack an overnight bag just simply because they were not sure whether they were going to have to spend the night or not, depending on what kind of infusions and treatments or scans and stuff that had to be done. When you think about that on a personal level, here's a guy in the last six months of his life who spent hours and hours on the road rather than being around the family and friends and loved ones that he could have, when in reality most of that care that was delivered at our facility ... And he got great care at Utah Valley. Don't get me wrong. But most of the care that was received there, it could have happened there locally in his own hometown.

Well, when you get stories like that, and then we heard one of our hospital facilities in rural Utah in Sevier, actually people were getting diagnosed with cancer, they didn't want to drive two hours north to Provo to deal with the traffic and they didn't want to drive south to Cedar City or to St. George because of mountain passes and the weather and all that kind of stuff. So they would be diagnosed with cancer and then never even really get an opinion from an oncologist on what that cancer meant.

So they approached us a while back, because it's been a few years now, and asked what the possibility of using our Telehealth platform to be able to perform oncology. I have to admit I was the biggest skeptic in the world. Oncology is a very high touch, high feel specialty, and I didn't think there was any way possible I'd be able to deliver high quality care without being able to wrap my arm around a patient and be there to comfort them. But it turns out that because of the technology and the advancements that we have and because of our outreach services and how high quality that is, it ends up being a very, very good experience for not only the patient, but also the provider as well.

Dr. Marc Harrison: That's terrific. So just close the loop with me. In Sevier, do we have a tele-oncology practice there now?

Dr. Derrick Haslem: Absolutely. Yeah. So it's where we've had our tele-oncology outreach site the longest and so it's the most developed. And so patients see an oncologist just like they would coming into a bigger facility, into a bigger cancer center. They're referred often by their surgeon or primary care provider. The same intake forms that we use and with our nurse navigation system, we're able to facilitate their visit, facilitate all the tests that need to be done prior to an appointment with an oncologist. Then we have that face-to-face conversation through screens and deliver the message of what cancer is, what it isn't, what the potential treatment options are.

And 90 to 95 percent of the time, 90 to 95 percent of somebody's cancer care can happen in their own hometown. So these patients are not only seeing us for initial diagnosis, but they're seeing us for their follow-up visits and then going next door to the infusion room where they get their infusions.

Dr. Marc Harrison: So Derrick, how many tele-oncology practices do we have now?

Dr. Derrick Haslem: So we have a total of six, two of them are within the Intermountain system and then four are outside the Intermountain system.

Dr. Marc Harrison: That makes me feel really good that we're helping people who aren't historically part of the Intermountain system. It's interesting. This is so different from how referral patterns have historically been developed. Clearly we're doing this in a patient centered fashion and this isn't how revenue is historically generated. I'm proud that we're willing to forgo revenue in the interest of taking better care people. Do you think our colleagues in the system know that?

Dr. Derrick Haslem: Absolutely, and everybody's committed to that same vision. Our line is, "We want cancer care to be taken care of close to home." When we look at we ... We did a white paper early on, on the Richfield experience in Sevier and the benefit to those local communities is quite high. The revenues that are able to be maintained in those local facilities, whether it's through imaging that we're able to perform there, the labs that are being able to perform there and the infusion therapies that are able to be done there in that facility, really is a boon to that whole community economic system.

Dr. Marc Harrison: You may know this statistic, you may not, but 46 out of 50 states have lost a rural hospital in the last several years. Utah's one of the four that hasn't. I'm pretty convinced that our tele-services, in addition to oncology, we have about another 40 services we offer to our partner hospitals, it's keeping them strong.

Dr. Derrick Haslem: Yeah.

Dr. Marc Harrison: Oftentimes, in addition to the healthcare that people receive at these hospitals, it's generally the largest employer in the community. When one of those goes away, it really hurts that town. So I thank you for being a pioneer in that respect.

You may have some colleagues from other specialties who are listening to this podcast. As a pioneer, can you give them some suggestions about how they might think about developing tele-practices?

Dr. Derrick Haslem: Yeah. So, again, I was the biggest skeptic in the world in the beginning and certainly apprehensive in the kind of care that could be done there, but it goes back to our initial conversation where we have really good partners and collaborators on the other end and scattered all throughout our organization to be able to go out and meet them. You get this immediate trust that while I may be giving some direction on how things are done in certain locations, they're going to be able to complete that care and kind of close that loop with those patients.

So I think that the biggest advice I would give anybody is that, number one, it works in a very complex discipline like oncology. It's much more rewarding than you can possibly imagine. The patient satisfaction scores we get from these patients who are being able to stay in their own hometown, not having to travel, is just off the charts. It's a real service that you don't really get to capture unless you try it.

Dr. Marc Harrison: That's awesome. So you think this is something that as leadership, we should continue to invest in this approach to taking care of people?

Dr. Derrick Haslem: Absolutely. I don't see this going away at all. I think that there's a public demand for this really. I think we’re charged with making care in general more convenient for people. There's a reason why it's really hard for me to go into see a doctor because they're not open on Saturday mornings when I'm off.

Dr. Marc Harrison: Right.

Dr. Derrick Haslem: We have to get past these-

Dr. Marc Harrison: We're giving you Saturdays off, Derrick?

Dr. Derrick Haslem: Once a month, once a month.

Dr. Marc Harrison: Okay, good, good.

Dr. Derrick Haslem: We just have to get past this idea that it's bricks and mortar and everybody comes to us. We have the ability nowadays to really go out to people and improve that access and take care of them.

Dr. Marc Harrison: Great. So my only ask for you, in addition to making sure you do take those Saturdays off, is let's scale this up, right?

Dr. Derrick Haslem: Yeah.

Dr. Marc Harrison: We're privileged to serve an incredibly large geographic area. We've got six of these. I'd love us to have 16 or 26 or whatever it takes to serve the region, so go get them.

Dr. Derrick Haslem: Yeah, we totally agree. That's our plan.

Dr. Marc Harrison: Great. I think I'll be down in St. George in a couple of weeks or three weeks and I hope I get to run into you.

Dr. Derrick Haslem: Awesome. Yeah.

Dr. Marc Harrison: Take care.

Dr. Derrick Haslem: Sounds good.

Dr. Marc Harrison: Thank you very much.