Shn Build: For The Love Of Data! How Technology Sprawl Can Harm Operations And What To Do About It

This article is sponsored by Medtelligent. It is based on a discussion with John Shafaee, CEO of ALIS by Medtelligent. This discussion took place on November 20th, 2024, at the SHN BUILD conference.

Senior Housing News (SHN): I’m joined on stage by John Shafaee to have a conversation about how technology sprawl can harm operations and what to do about it.

I’m excited to share the stage with John. He’s the president and CEO of Medtelligent, where he plays an active role in selling the product vision and technology direction for the company’s flagship product, ALIS. John is a technologist and entrepreneur with more than 20 years of experience building and leading software development teams. He was previously director of research and development at UBS AG, a large international bank, and the director of software development in Hostway, a global internet hosting company. John is driven by a passion to solve challenging problems in the senior learning space.

John, thanks for joining me on stage, and let’s jump right into our conversation. I know we’ve got a lot to talk about. My first question is, I think for a long time, operators have been maybe a little hesitant to embrace technology or held back from doing that by some constraints in infrastructure and things like that. I’m wondering if you’ve seen that shift in the market, maybe as operators are building the communities, renovating their communities, and overall just as maybe the consumer demand and staff expectations have changed as well.

John Shafaee: I think COVID was the finding period and time when things shifted. For the longest time, it took me a while to understand that most operators actually viewed the business as a real estate business, as property management. Once COVID hit, I think there was a dose of reality that actually we are in charge of people’s lives.

We are squarely in the health care business. We’ve seen a very significant increase in both demand and attention to the clinical aspect of what happens in communities. That has essentially opened the door for what technologies, what mix of technologies are going to help me with managing health inside the buildings as well as what I do with all this data now that, before, I didn’t really pay attention to.

SHN: Are providers at risk of going from maybe too little technology to too much? Is that what we’re talking about in terms of tech sprawl?

Shafaee: Absolutely, 100%. Technology is no different than the actual building that people live in except you just can’t see it. You got to think about it in terms of its foundation and different layers. We call that the stacks. A lot of times, when people talk about the tech stack, that’s what they’re referring to. I think a lot of operators found themselves without a proper tech stack. There’s an explosion of aging technology, that’s Aging2.0, HTAC. There is a ton of stuff that happened in 2019, 2020, it was the start of it, and then during COVID, it literally exploded. What you start to see is a solution for everything.

What I like to observe and say is that the room is becoming smarter, the technology is becoming much more ambient. Now, the light switch can now emit data. You have the nurse call system that’s always been there, and then you have fall detection systems, and then you have motion detection across the board, you have smart locks, all of these things want to attach and talk to something and they have data to deposit. The question is, where do you deposit it? All these vendors are coming out saying things will change your life certainly, but not in itself isolated in the rooms. You have to be able to do something with it. The big question I see people grappling with is, “I’ve got all this stuff, what do I do with it now?”

SHN: I guess to that point about the volume of data, can you speak to some of those top reasons why providers do need to consolidate that data?

Shafaee: The most basic one is just a practical situation that when someone moves in, if you have, let’s say for example, an electronic health record, a nurse call system, and a fall detection system. Every time a resident moves in, some poor soul has to go into each one of these systems and add that resident’s name. The same thing happens when someone leaves the building. Something as simple as a resident joining and leaving, the technology has now put pressure on the staff that wasn’t there before. How do you address that issue?

Then you expand that to the light switches and to the Alexas and to everything else, and how do you solve a huge headache that the central office or the management team is not really prepared for or has not really planned for? That typically leads to a couple of problems, the biggest one being security. People forget to do it. You have these resident records that are living in these systems that are stale, that are hackable, that are available to the world, that are available to staff members that maybe they should not have access to.

The second thing it does is it kills the success rate of those technologies. You’ll see operators walk away and say, “Look, that fall detection system didn’t really work for me.” When you look under the surface a little bit and you see that, actually, most people have stopped using them because it became such a burden in maintaining and managing and collecting the data or integrating it into these system workflows.

SHN: I think when I’ve thought of data consolidation, I imagine a dashboard. I’m wondering, I guess, A, am I correct in thinking that’s been the trend in terms of how that consolidation has been happening and made visible and useful to people? Then is there a change now that we’re now entering quickly this age of artificial intelligence or AI?

Shafaee: Yes. That’s another situation that you can think very practically about. When we think about consolidating data for the purpose of visualization in data analytics, it’s for human consumption, and humans can connect things and make sense of things. When you think about AI, as much as we like to focus on the I portion of it, of it being intelligent, it’s actually pretty stupid. What AI really depends on is data that’s connected.

Using our example of having multiple systems and you have multiple resident records, if you don’t connect those bits of information together or if you don’t have a system that actually pulls it all together, or a plan for it, a lot of your AI is going to be handicapped. It’s not going to have the intelligence data that it needs.

Something as simple as being able to line up resident records and say, “John S. in this system is the same as John Shafaee in this other system.” That disconnection means that there is a dark spot in terms of AI’s understanding. It is even more important to have good data hygiene when you’re thinking about AI and then AI strategy. Most of the AI solutions that are coming out, they’re either going to be weaved into products that are existing in your building or they’re going to be one-off solutions that are going to come on top.

The latter are the ones that are going to suffer the most in terms of being able to pull this information together. You’ll see it. There’s companies like Scanpoint, who basically will say, “Okay, well, we can do a lot with your data once it’s cleaned up and connected together, or you can pay us to do that for you.” Having some forethought and planning ahead of time for what you’re going to do with all the systems that are generating in your community, very much like you give forethought to secondary systems or security systems, I think, is actually very, very important.

SHN: Given that we are in this maybe new era when providers and their investment groups are pushing for technology adoption, a new solution, and more sophistication, can you speak to some of the top mistakes that you are seeing as people are pushing and making purchasing decisions that do lead to this kind of tech sprawl and ungainly data?

Shafaee: I think the most basic one is asking the question of, A, who owns the data? The data that the system is generating, who owns it? Is it me, the owner, the operator? Second, what do you have established in terms of sharing the data with me as well as with other systems? That’s the most basic one. It’s a good litmus test. It will tell you the maturity of that company. It’ll tell you the maturity of that product. It’ll tell you their philosophy and posture around data sharing.

In health care, it is no mystery that people like to use data to create moats. A lot of the vendors believe that once the data is in their system, they can potentially charge a toll to get that data out. One of the first things we’re going to ask is what I would call, again, a data hygiene question: how open are you to integrate and who have you integrated with?

The second thing is, you have to think about the day-to-day impact on the staff members. Who’s going to maintain this system? Who’s going to add and remove residents, add and remove staff members, and ensure that the system is kept up to speed? Again, integration helps you there. The key word here is really integration, so make sure all these pieces are connected and automated.

Then the third component is that people tend to go after the shiniest object. A new thing comes on the market. I can tell you that having been a vendor in this space for a long period of time and also just have grown through word of mouth, I’ve never been one to stick shame stickers on stuff, but I’ve seen many, many vendors come along and you do a fantastic job of making the product looks so amazing and sexy and delicious. You just want to buy it and put it in your community only to learn that the product is not quite there yet or it is not really designed to support the business as advertised.

The way to vet that portion out is really to test it out, say, “Look, if you’re in a position where you have this thing that works, let me try it in a couple rooms in a small pilot,” and vendors that have actually gone through this process will be able to do that. Vetting at the very beginning is a big piece of it. I see a lot of people just buy things on a whim in a relationship.

SHN: Are your product teams prioritizing interoperability over new features due to communities adopting so many technology platforms?

Shafaee: 100%. We work in pods. A pod has three to four developers and has a product manager and a QA. We have two pods dedicated, basically two integrations. We are actually one of the, I think, maybe second to PointClick here. We’re one of the only other ones that actually has an App Store marketplace. We have 110 active partners in that marketplace. These are folks that have actually spent dollars to build on the ALIS solution.

On top of that, we don’t monetize it. We don’t charge for it, mainly because it becomes a barrier to data exchange, right? We don’t charge the partners, we don’t charge the communities, because we want people to actually embrace and integrate. I firmly believe that it’s a really terrible experience for some staff members in the community to have to, every day, go to another system, remember to log in, jump in to get two bits of information just so they can report back to management or the team members. Data related to a resident should live in a longitudinal file, and we very much invest in that.

SHN: I know we don’t want to turn this into a commercial, but it might be helpful if you could just explain a little bit more about what ALIS is and does.

Shafaee: Oh, for sure. We are an electronic health record, purpose-built for assisted living, memory care, independent living. We do not do home health or skilled nursing, and we go deep in the space that we’re in.

SHN: How do you overcome the planned obsolescence of technology? It seems that every few years, our big investment has become obsolete and more investment is needed.

Shafaee: You want to look at companies that have a track record, number one, for constantly evolving. Looking at it’s a bit of software, in some ways, they’re somewhat protected because software is malleable and you can change it. You want to look at the track record of how often they do releases and what are in those releases. Asking for the last three releases will tell you if there’s any significant evolution that’s happening on a software solution.

When you’re looking at hardware, you have to be a lot more careful. It’s a huge capex to get hardware in, but very similarly, you want to look to see which generation of that product you are on. Are you on first gen, second gen, third gen? Asking questions in terms of volume of deployment will also be key. There’s nothing wrong being in a first gen version of a hardware product. The question just becomes, what parts are being upgraded? If the entire unit is becoming smaller or if the major chip is actually changing on it, you want to find out what the refresh rate on that is.

The easy rule of thumb on that is however often you change your phone, you can think about hardware expenditures in a similar way. Some things can be very simple and commoditized like nurse calls. You can essentially ensure that it will outlive the duration of the building. Other things that are newer, let’s say, latest sensors, bed sensors, and things of that sort, those are still yet evolving.

SHN: Given how often I replace my phone, I would be working on, I don’t know, IBM mainframe from 1965 or something. I think that’s a good tip. This is a great question that we get a lot, I think. It’s a two-parter. How can new technology streamline operations and boost ROI? I guess I would maybe add, how do you think about proving out ROI for a technology investment?

Shafaee: You have to have an actual measurable KPI. You have to have something that’s measurable. I hear, a lot of times, people talk about length of stay. I love length of stay. It’s conceptually simple to understand is, how long did the person live? The problem is it’s nearly impossible to measure, because you have to deal with active residents, right? Folks that moved in yesterday versus folks that moved in nine months ago that are still there. You can’t get a strong read.

Second, there is an estimated calculation to convert length of stay into dollar amounts. Instead of length of stay, think about loss of vacancy. That’s easy to measure on a daily basis. If a product says, “Look, we’re going to increase length of stay.” Say, “Hey, why don’t we measure it as a decrease in loss of vacancy?”

You have to have a very specific KPI in mind, and you have to have a conversation with the provider or the vendor of what dial are they actually moving. You can apply that as a general rule across the board, but it’s a good rule of thumb, because it’ll at least ensure that whatever one mission you had to achieve with that solution, you did achieve it. It’s not necessarily the things that folks that are creating the product are telling you.

SHN: What steps do you recommend that companies take to gauge their technology sprawl and I guess the potential risks.

Shafaee: A very easy thing you can do is just ask, how many times do we have to add a resident to a system? The count of that number, if it’s more than two, you probably got a sprawling situation.

Medtelligent makes ALIS: purpose-built software for assisted living. They understand your clinical, billing, compliance, and operational reporting needs. To learn more, visit: https://www.medtelligent.com/.

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