HIStalk Interviews Bill Grana, CEO, HCTec

Bill Grana, JD, MBA is CEO of HCTec of Franklin, TN.

Tell me about yourself and the company.

I started my career as a lawyer with the largest for-profit health system in the country. Since then, I have been a tech entrepreneur since for close to 30 years, mostly in software. HCTec is my first stint in a pure services business, but I have run enterprise software companies that had exposure to healthcare.

HCTec is a 12-year-old, Nashville-based IT services firm that is focused exclusively on the healthcare provider sector of the market, so hospital systems and other providers. Our people have specialized skills in different areas of healthcare software and technology. They provide services according to the needs and circumstances of our clients.

What is the labor dynamic in healthcare today?

It is fascinating on one level and maybe terrifying as well, depending upon your perspective. A lot of what you see in the media centers around clinical labor and staffing challenges, which continue to be significant. But I would say that those challenges also extend into non-clinical areas of healthcare, including IT. The great resignation has changed the workforce of our clients. Certainly in compensation, where there has been significant wage inflation over the last two years. We’ve seen that within our own business and with our clients as well.

The dynamic of remote work certainly has had a big impact. In certain type of roles, remote work is here to stay. For those that require of face-to-face interaction and collaboration, hybrid is the model. For many of us, I don’t necessarily see a full-time return to the office the way that it was before the pandemic. As the leader of a business, I’ve had to adjust my thinking. I’m very much a face-to-face type of person who feels that teams are most effective when they can be face-to-face on a regular basis. But I also recognize that the world has changed, and so leadership thinking has to change as well relative to the work environments of our team members.

How will your business change as your clients increase their use of remote work?

I would have expected more of a transition, or at least an increase in the level of open-mindedness, over the past couple of years to outsourcing certain functions within our clients’ IT organizations.  We are seeing that in certain areas, particularly the help desk and service desk arena. But many others that are necessary but not strategic are ripe for partnering with a firm like ours. Because of our scale and focus, we can typically do those functions at a lower cost and a higher level of quality. 

Application support around the enterprise EHR would be one area. The daily care and feeding and maintenance that is required of an enterprise EHR is a perfect opportunity for outsourcing. PC and desktop support is another arena. Provisioning applications, and system provisioning, is another area. We aren’t seeing that trend develop the way that we would have predicted and continue to predict, so that’s an interesting dynamic.

How much business impact are you seeing from Epic’s move to Hyperdrive?

Hyperdrive is the move to a pure browser-based interface. We have seen some opportunity from that, but not a tremendous amount.

What types of consumer-facing technologies are providers considering?

Obviously telehealth, which the pandemic really catalyzed. Usage is down, but still much higher than what it was pre-pandemic. I think it’s fair to say that telehealth is here to stay, certainly for certain use cases. 

Patient portals are playing an even bigger role in how health systems give the patients what they want in terms of access to their information and scheduling and that sort of thing. We’ve seen a huge demand on the help desk side for patient-facing support, much of it related to supporting patient portal applications. We’re doing some remote patient monitoring support as well. As we look forward five years, we think we will be doing a lot more of that. We all know that technology doesn’t always work as designed, and sometimes users don’t understand how to use it and need channels to reach out to get the support that they need.

How has system training changed?

Training continues to play an important role in the ability of users, whether clinicians or patients, to take advantage of the technology that’s in front of them. Most of the patient-facing technology is fairly simple, but depending upon your demographic and whether you grew up with smartphones and computers, training is critical.

How will support needs change as systems are more widely rolled out to patients and caregivers in homes?

That is happening as we speak. Within our help desk capability, we have a specific offering and specialty geared to patient-facing support, recognizing that there are some nuances and differences to how you support a patient end user versus a doctor or non-clinical provider user. The support experience is always important, but for a patient who is calling in or chatting in, that experience is even more important. These are the customers of the health system and their experience with the clinician and the care they receive is obviously critically important, but the experience that they have with supportive technology is equally important. 

Some health systems understand that very well and deeply. Others are getting there with their thinking. We are huge believers that patient experience is critical for these providers, and that isn’t just about clinical care, that absolutely is about their experience with the technology that is being put in front of them.

Several big health system IT and revenue cycle outsourcing deals were signed in the past couple of years. How will that trend progress?

Financial stress is a driver. We are seeing that play out in real time right now, with half or more of health systems operating in the red, partly because the cost structure and partly because the of the revenue side. I’m not sure that things are ever going to return to normal, at least with respect to the cost structure of both labor and non-labor related items. That will force systems to think differently about how they do labor resourcing in certain areas.

Back to my comment earlier, health systems don’t necessarily have to build large organizations of IT professionals to be effective as an IT organization. There are plenty of opportunities to outsource aspects of IT, those things that are necessary but non-strategic or where it’s hard for individual health systems to build real competency. Part of this is a bias, because it’s a big part of what we do, but I believe that there is going to be a trend to more outsourcing within hospital IT functions. It’s going to be more surgical in nature than if you look back 15 or 20 years ago, where there was wholesale outsourcing of IT functions. It will be limited to certain aspects of a hospital’s IT organization.

What are health systems doing strategically after putting plans on hold for the pandemic?

We have a lot of dialogue occurring around help desks and service desks, and much of that around patient-facing support. The pandemic also spurred the notion of patient-centered thinking and the related technology investments that support that. The shift out of inpatient settings and their heavy fixed assets and into light asset settings — with the home being the lightest that you can imagine — is a big trend. That is creating opportunities for us, both on the staffing side as well as the outsourcing side.

What will the company’s strategy focus on in the near term?

In the environment that we are in, it’s important to have a long-term vision. It’s hard to do strategic planning much more than a year or two out given the amount of uncertainty that exists. We are heavily focused on our own team and making sure that we are positioning ourselves as an employer of choice. We have seen some turnover in parts of our business that is higher than we have ever experienced, and we are not alone in that. But we think and talk a lot about how to source new team members for our business more effectively, how to train them to be successful in their jobs, and how we continue to make HCTec in an attractive place for them to stay.

Interestingly, pay is typically not the most important thing. We are finding that the most important thing for keeping people is around is to define clear pathways from a career and professional development perspective. 

We made an acquisition in July 2021 of a company in Winston-Salem, North Carolina called Talon Healthy IT Services. That was a fantastic acquisition for us. It bolstered our capabilities in the help desk arena, but also gave us new capabilities in the ambulatory and smaller provider space, where we have the capability to be the outsourced IT function for those providers. We are continuing to look for other complimentary businesses to expand our service portfolio and to increase our market presence and footprint. That’s a big part of our strategic focus, and where I’ve spent a lot of my time.

We are now back to where we are actually seeing our clients in person after a two-year hiatus where not a lot of that occurred. We are staying close to our clients; looking at their demands, needs, and opportunities within their organizations; and making sure that we are delivering high quality services and staying ahead of those needs.