Skilled nursing providers cannot consider technology in a vacuum if they hope to invest wisely and implement solutions that help their organizations meaningful goals, whether clinical, financial or otherwise.

That’s according to Tom McClelland, VP and chief technology officer with CarDon & Associates.

“Technology is really seen as a tool, but to me, it’s all about the people, processes and technology,” McClelland said during an interview for the Skilled Nursing News RETHINK podcast. “So putting that one tool in place, if it’s not thinking about the whole ecosystem and how people use it, what business functions are, if it’s not attempting to help support that, then it kind of makes it hard to invest in it.”

In addition to considering the big picture, providers face a choice in whether to develop technology in house or partner with vendors. CarDon has focused on building its own systems – an approach that demands a level of scale and resources but that is paying off the provider, McClelland said.

The following transcript has been edited for length and clarity. Listen to the interview in its entirety on iTunes/Apple Podcast.

SNN: In light of the ongoing staffing shortages in the skilled nursing sector, what innovative approaches have you adopted to attract and retain employees? Are there technologies or partnerships that have proven effective in addressing these staffing challenges?

McClelland: When I look at how technology partners with the business … I think it’s important to recognize we’re trying to make hard jobs feel less difficult and more human. So many times, folks want to put another piece of software in front of somebody and ask them to do more work. How do we reduce that friction? The tools that we want to put in place help reduce a lot of that administrative burden, mainly to help our staff know that they’re there to predominantly take care of people, not work on computers.

Also, how are we continuing to train them and give them a better experience? We’ve partnered with building custom in-house tools to help with our learning and development teams, to help grow … All the tools we look at are focused on reducing administrative overhead so that you can actually come to CarDon to do what you want to do – take care of people.

What types of technology is CarDon investing in currently?

So much. We’re taking an approach with myself and my team that’s more focused on building on a foundation we’ve laid and continuing to build on that foundation internally. We’re looking at how we do that in a very secure, smart and scalable way.

We’re investing in areas like revenue cycle automation. We’re really leveling up our predictive analytics capabilities. Obviously, everyone’s looking at AI-driven tools, trying to use AI not just for AI’s sake, but how it can benefit us in some of these core areas of boosting efficiency of our staff and our workflows, increasing patient outcomes, and then – looking at all of that – help with the reimbursement challenges we have. We’re looking at continuing to modernize our infrastructure with a high-level focus on cybersecurity.

You mentioned several areas where you’re investing in technology: reimbursement improvements, staffing efficiency, revenue cycle management and predictive analytics. With these four areas, are there any metrics that you’d like to share?

On our revenue cycle piece, we spoke last year about the work that we’ve been doing in that space. We really looked a lot at cost avoidance, we shared a lot of cost avoidance metrics there. Getting to “yes” faster, taking decision times down from 45 minutes to less than 10 to 15 minutes. Our cost avoidance metrics that we’ve had with a lot of our automation and tools that we’ve done in house have been well over $2 million of cost avoided in that space.

What criteria do you evaluate [to] select technology solutions that align with value based care goals, with Medicare Advantage requirements?

There’s a lot of opportunities there. If it doesn’t help us deliver better outcomes and get [us] paid fairly for it, maybe it’s something that shouldn’t be worth our time. A lot of the tools we’re focused on improve documentation, that whole workflow. The time that it takes to do some of these things is just astronomical, and if we can help provide better information, better insights, better decision making, those will lead to better outcomes. Things like reducing hospitalization rates, as you mentioned. And how to support our care management and quality metrics.

… Technology is really seen as a tool, but to me, it’s all about the people, processes and technology. So putting that one tool in place, if it’s not thinking about the whole ecosystem and how people use it, what business functions are, if it’s not attempting to help support that, then it kind of makes it hard to invest in it. We try to think about the whole picture and not just bring in a new piece of software. In my time at CarDon, we’ve often had a solution that we think was going to be great and it became just too hard to maintain, so then folks don’t use it.

If you can, think of an example recently of something that you tried and it was too hard for people to maintain, or on the flip side, it was quick to implement.

We’ve … tried to roll out a kind of a more family focused portal … It seems great, but holy cow, that was hard to get staff to buy in to. When you have all the locations that we have, when it’s seen as kind of secondary, I think that’s when it’s challenging and not a direct support. You have nurses; they’re there to take care of people. So when you add yet another tool in there that forces folks to step away from that core job and do something else, it’s seen as a challenge. So that was one rollout that I don’t think went that well.

Now, not saying we [have] stopped that mission, but those types of products have been hard. I think internally, what’s been successful is our focus on learning and development and building internal products, which, what we’re finding more and more, is controlling our own destiny and building our own products. And so we’re building our skills and capabilities internally to do more of that specific to how CarDon works and not what others tell us how we should work.

When you say building internally, you’re building your own technology, or are you utilizing solutions that are more catered to your internal problems?

Both. It’s leveraging tools. Like I mentioned, with the automation piece, there’s a lot of robotic process automation that we’re doing. We’ve done that for five years. With AI solutions, we are building our own solutions, maximizing our own capabilities in that regard, not necessarily waiting on vendors to tell us how to do it.

Speak a little bit about that. What kinds of AI tools are you talking about?

With our focus on the revenue cycle, scrubbing of patient records information to help better understand daily progress notes and changes to our residents throughout the day, how we can surface that information quicker for our clinical teams and staff. There’s just an example.

There’s a lot of products here and vendors here that are selling those same types of things. But I think our team, over the years, has demonstrated a lot of willingness to really work on solving these challenges ourselves. They’re willing to put in the time and energy to do that, and they feel that’s more valuable sometimes than trying to roll out a new product and help another company make their product better.

Do you think other organizations are applying the same sort of approach here in terms of developing their own tools, like you are at CarDon, or is it difficult for organizations to do that?

I think depending on your size, obviously, in our industry, it’s probably harder. But I would say we made a choice, five years, six years ago, when I joined CarDon, that we were going that direction then, and we continue to grow skill sets and capabilities on my team, we continue to have a lot of buy in, with me sitting with the other senior executives, I’m in all decisions and all discussions. So technology is at the table every single day, not just seen as an afterthought. I think that’s been very important. Technology is seen as a foundation for a lot of what we do going forward.

I think we’ve demonstrated a lot of success internally. For that to happen, we’ve gained a lot of trust, but I think – now I’m guessing – large organizations have plenty of resources at their disposal, but I don’t see that a lot in Indiana. Traditionally our industry has seemed to focus on hardware, networks, security, and then go find a vendor, or go look at this product. So I think we’re doing it a little differently.

How do you ensure that cybersecurity remains a top priority when assessing or implementing new tech tools, especially in light of high profile breaches, such as what happened at Change Healthcare?

Oh, yeah, we were definitely impacted by that.

For us, security isn’t just a feature, it’s not something we just add on. It’s really a prerequisite for us.

With all of our vendors, we ensure that they meet strict standards and guidelines. We abide by the NIST framework, we follow HIPAA security and privacy rules, things like that, that we take into consideration. It is very much a focus of ours. I do have a chief information security officer who reports to me. He’s responsible for really moving us forward in this area, and we have worked really hard at investing in our security platforms, both from a software side but then also network infrastructure side. The tooling and capabilities we’ve had over the last two years, we’ve modernized all of our tools. We continue to do that.

We have a couple of strategic pillars in our framework, as we think about how technology enables our business, security being one of those, [as we’re] working on some of the software development we’re doing, and then obviously the data, information analytics and AI capabilities.

We touched upon the role of AI and remote monitoring tools a little bit. Can you describe some of the remote monitoring tools in your current or future strategy to improve reimbursement clinical outcomes?

I think for us … we really think about how it’s extending our reach but not our staff, and think about how we invest in these things from that perspective. Our focus on AI is to help identify and help us manage some risk.

I think patient care needs to be the focus of some of these tools, and the remote monitoring piece is interesting; there are a lot of opportunities there. I would say we’re still searching out some of those things, figuring out how it fits, whether or not the investments make sense.

When you think about … vital sign monitoring and the cameras and technology that can be on the walls and AI tools to help with fall analytics and things like that, those things are all great. They’re also very expensive. So, we’re monitoring and paying attention to those things. I think when the opportunity is right, we’ll move forward. In general, probably a little ahead of the curve in most technology areas. We’re willing to take a little bit more risk in some of these areas, because we have someone like me on the team that can make sure that we’re thinking through all this stuff. But then sometimes we want to make sure that we’re not at the forefront.

The reason being?

[We want to] make sure things can be proven just a little bit more. When you think about security and privacy in some of these technologies, how is that stuff protected? You got new vendors popping up all the time. Is that vendor going to be here a year from now? What does that look like? What happens with our patient data? So, we’re thinking through all those things.

AI can be a black box, now. What are you doing with all of this stuff? How are you training? Do you have proprietary data models? Are you just using standard large language models? … So you want to be smart, and I think a lot of it is why we’re doing some of that in-house, so we know that it’s secure and controlled in our environment.

How do you evaluate whether a pilot tech solution has been successful enough to scale across your entire organization?

I think for us, it’s really about trying to tie that technology to outcomes. And if it’s not really moving the needle, why continue to do it?

If our readmission rates are down, is that because of the software, or is that because of the 17 other things that were put in place to support that software? Did we just hire the right nurse practitioner at that one location? Or is the medical director doing better at their job, which helped us to keep folks in house? Maybe it wasn’t directly because of the technology. Now, technologists would always tell you, “It’s because of the software.” I think that’s our next evolution at CarDon, really making sure that the tools we invest in [pay off], especially as every vendor is telling us that they have these new AI tools and they want to charge more for them.

There’s new vendors every day coming to our door wanting to sell us a new product. So now we have to be even more mindful and more disciplined about why we really want to do that. So I think it’s asking that question up front, what is the job we’re trying to do? What is the outcome we’re trying to achieve? Do we have a metric that’s not just a standard metric? Readmission rate is too broad. What are we really trying to do with this piece of tech? And I think that’s hard, but that’s going to be my challenge over the next few years is to make sure that’s how we’re thinking about it and approaching it.

What is something that you think leaders in the nursing home sector need to rethink, perhaps, regarding your expertise here in technology, but anything at all?

At CarDon, and I think in general, we should not just be chasing new shiny objects and tools. To me, AI and some of these things are just tools that you can either use to build a marvelous house or it can sit on a shelf in your garage and barely be used to its full potential. You can take that same saw and do so many things with it. So for me, I think my recommendation is, leaders should really think about how they’re using this technology to build their foundation for how they invest in serving their people, strengthening operations and really moving their organization. I think that leads to everything else. If you can ground these decisions and your technology investment in those things, I think that’s extremely important.

Click below to listen to the entire RETHINK episode: