Our Guest: Karen Kobelski, Vice President & General Manager at Wolters Kluwer
In this episode, we sit down with Karen Kobelski, the VP and General Manager of Wolters Kluwer, to delve into the innovative healthcare products offered by WK and their recent strategic acquisition of Invistics Flowlytics diversion software. Wolters Kluwer is renowned for providing clinical technology and evidence-based solutions that enhance decision-making and outcomes across the healthcare spectrum.
We explore the rationale behind WK’s decision to integrate diversion detection software into their portfolio, emphasizing the importance of safeguarding healthcare environments from drug diversion. Karen shares insights into why Invistics Flowlytics stood out among various options and the strategic alignment with WK’s mission.
Tune in to learn about the future goals for Sentri7 Diversion (formerly known as Flowlytics) and how this powerful tool is poised to revolutionize diversion detection and bolster the integrity of healthcare operations
Transcript:
Terri
Hello, everybody. My guest today on drug diversion insights is Karen Kobelski, the VP and general manager of Wolters Kluwer Health. Welcome, Karen, and thank you very much for your time today.
Karen
Thank you, Terri. I’m happy to be here.
Terri
Let’s start by learning just a little bit about you. What is your background and what was the path that led you to your current position?
Karen
Well, I, you know, I came up actually in the financial services industry and worked in an area where you combined technology with business process to improve oversight and compliance and make sure that you were, you know, advancing efficiency. And I moved into Wolters Kluwer about 20 years ago and was always working in areas where I could marry advanced technology with a business process improvement. And about twelve years ago, Wolters Kluwer pivoted and started moving more into applying advanced technology to healthcare. Right at the time when the high tech act was really kind of taking shape and really transforming the way healthcare was going. You know, historically it had been very much on those paper charts, but now you could really bring the power of technology to healthcare. And so I was fortunate.
Karen
I’d always been sort of a healthcare junkie, but not having a healthcare background, you know, it was a little bit of a challenge for me, just like how do I find my way in? But because I had the technology background and the business process improvement background and a general manager background, it was a nice transition when we started to move in that healthcare technology path to join the health division. And so I’ve been in this health division for the last twelve years and been able to work really in the area of bringing these advanced workflow solutions to the clinical workflow and helping clinicians really operate at the top of their license. And it’s just so meaningful you get a chance to really, you know, you’re having an impact.
Karen
I know that, you know, our solutions actually do end up saving lives and making a difference in the way patients are treated and making sure they have the best care everywhere. So it’s super rewarding. And now I’m running one of the three business units in health primarily focused on workflow solutions that actually do bring advanced technology with deep domain expertise to the clinical workflow and been doing that for a while and really love it and excited that we’re adding more and more solutions to our portfolio.
Terri
Yeah, we really have. You’re right. In our lifetime. When I started in hospital pharmacy, every hour on the hour roughly, I would make my rounds, pick up those yellow pieces of paper and learn how to read them right. Because you decipher them. And when we changed to physician order entry, that was an adjustment because, you know, it’s an interesting adjustment because first you’re reading what they’re writing, and so there’s room for error, obviously, and then putting it into the computer, there’s room for error. But I remember very distinctly when we did go to position order entry, my first thought was, how can I trust what they put in, that they put it in, right. And it’s like, what? That doesn’t make sense, you know, but it’s kind of a mind bender people.
Karen
Couldn’T read before, you know?
Terri
I know, I know, but it’s a mind bender. It’s like, well, now, how am I supposed to double check them? They’re the ones putting it in.
Karen
Right? I know. Yeah.
Terri
So we’ve. We’ve really made a lot of changes. So let’s just, before we get into the diversion software piece of it, what are the other products that WK has in the healthcare field?
Karen
Well, we’ve been in healthcare since 1792. In fact, were the original publisher of brave anatomy. So, yeah, so we go back a long way. Largely started with that medical expertise, you know, nursing education, medical textbooks, really got into. We published many of the journals, medical journals that are out there in partnership with the societies. And most people are very familiar with our up to date and Medispan solutions, really, about bringing clinical decision support to the point of care. But in my business unit, we focus on workflow solutions. So we have solutions related to clinical surveillance. I’m sure you’ve used some clinical surveillance solutions, which in real time, take data in from the EHR and look for patients who need intervention in their medications. And so pharmacists no longer have to go through multiple different reports and systems.
Karen
We can bring it all together and identify patients who need, whether it’s their kidneys are failing and they need their medication adjusted or they’re on the wrong antibiotic. So we have solutions related to antimicrobial stewardship, opioid stewardship. We also have a big set of solutions related to medication compounding, medication safety and medication storage. So really we have a large pharmacy workflow platform and have helped the pharmacy advance their ability to work at the top of their license and be part of that rounding team with the clinicians and be less involved in the day to day sort of paper passing that made it very challenging for them to really be. To have that capacity to work in full partnership with the rest of the clinical team.
Karen
So our solutions have been very much part of advancing the presence and the visibility and the effectiveness of pharmacy in the hospital.
Terri
Yeah, absolutely. Absolutely. So what is Wolters Kluwer’s philosophy, and how did that align with the decision to purchase the Invistix drug diversion software.
Karen
Product formerly known as flolitics, now known as century seven? Drug diversion? But we Wolters Kluwer from a healthcare perspective. It’s about creating the best care everywhere. That’s sort of our mantra. That’s the way that we think about what we’re looking to buy, what we’re looking to build. And the best care everywhere means taking that deep clinical domain expertise that goes back 200 years, marrying that with advanced technology, like the latest AI, the latest capabilities to machine learning, interoperability, natural language processing, to actually make sure that the technology is of the highest caliber. You’re not sort of pulling data off the Internet.
Karen
It’s clinically validated, it’s clinically accurate, but it’s transforming the way clinicians practice medicine and really creating the medicine of the future so that patients get the best care and clinicians are supported with the tools that they need to be as effective as possible. To the second part of your question, why drug diversion? Well, drug diversion actually is an area that was lagging from a technology advancement for a long time. The cabinet makers held patents that limited innovation reinforced those patents. So people who wanted to apply AI and advanced technology couldn’t really do that until the patents expired. And when the patents expired, you started to see companies start to evolve their capabilities and really harness the power of AI. Plus the knowledge of how people were diverting.
Karen
It was kind of a convergence of, you know, the opioid epidemic Covid, where you really saw a rise in diversion cases, and the risk of diversion married with the ability to actually use advanced technology to find it. And so in Vistix, were hearing from our customers for a long time that they would like us to offer a drug diversion detection solution. It would fit nicely into our pharmacy portfolio. We looked and we just, you know, until those patents expired and the technology started to evolve, we really weren’t able to do that. But once it did, and we really started focusing on who are the best providers of this technology out there. And Vistix rose to the top pretty quickly because it had its origins in supply chain.
Karen
So it really looked at that end to end every step in the handling of medication across the entire healthcare system, where many other solutions were more limited to certain areas of the hospital. And medication is handled from the loading dock all the way back to the loading dock and reverse distributor. So they have that philosophy. They were also very much aligned with our mission. They were about making sure that patients, that you detected diversion fast so that you could protect patients, but also that you could get those employees who were diverting and had substance abuse disorder into treatment faster. It was outcomes that were good for the patient and good for the clinicians and good for the healthcare system. And so they were very much aligned with how we viewed what were trying to do in healthcare.
Karen
And they had really, that end to end approach to managing diversion, as well as the clinical validation they had been validated. They had a study done by the NIH that validated the accuracy of their solutions. And customers were telling us that they, you know, our customers who use them were telling us that they were really helping them be effective and changing the way that they were able to identify diversion in the hospital. So it was a logical fit with our platform. So it was.
Terri
Okay, great. Yeah, that makes sense. Yeah. I was going to ask you, if you reviewed them, I would assume you reviewed them all. It’s a pretty big purchase to make without reviewing everybody. And why in Vistix was selected. So, couple of reasons, it sounds like.
Karen
Yeah. And I think, you know, the, you know, the NIH study, the customer reputation, the breadth of their capabilities, you know, the end to end supply chain, and really, the fact that it was not just limited to just the detection, but it was the entire workflow. It was the investigation, it was the documentation, it was adjudication. And so for us, it’s really about the whole workflow. You just can’t cut it off. And so that was another advantage of what they brought to the table. We did look at them. We looked at them all and really narrowed in on Invistix is the one that we felt was the best fit for our portfolio and our customers.
Terri
Okay. Yeah, that makes sense. What are some short term or long term goals that you have for the product? I know that there was one change made right on the wholesale side of the offering. So that was something that was done fairly quickly. But do you have other short term or long term goals for the product?
Karen
Yes. So I think one of the things we heard immediately out of the gate that customers would like was more workflows attuned to the different users of the system. So the person who does the everyday investigation is not the, you know, is sometimes is not the same as the nurse who may do an investigation, the nurse manager who may do an investigation once a month or once every six months or so. So they needed different, they needed the UI and the workflow to be different and suited to their workflow. Similarly for anesthesia. And so what were, what we did and what we are doing is really looking at the way that our user interface is designed for those different user constituencies.
Karen
And we’ll be rolling out capabilities that are of focused on the nursing workflow, the anesthesia workflow, as well as the pharmacy investigation workflow fairly quickly. The other thing that we did where there were just some areas of the initial dashboard that were a little bit challenging for users to understand, especially if you didn’t use it that often. And so we’ve already rolled out in our new release an updated view of the dashboard, and customers are really thrilled about the way that looks. But ultimately, you know, when you look at diversion, still about 50% of healthcare systems don’t have AI enabled drug diversion detection. And so we’ve got, we have a large embedded customer base who really could benefit from this.
Karen
And so our goal really is to bring that to them and make sure that every healthcare system is actually doing effective diversion using technology like this. And so that’s been a big focus of ours, expanding our sales team, expanding our customer success team, making sure that our customers know that we have this technology. But the other thing that we are looking to do is the fact that we’ve been doing data extraction and data integration from a variety of systems for 15 years with our surveillance platform and with our other solutions. Having a common platform where you can send the data once and it could feed multiple downstream systems, is something that a lot of customers really look for. That one of the complexities of point solutions is that you have to do a, you know, a different integration with each one.
Karen
If you can work with one vendor to have a common source of data integration, and that vendor who has deep expertise in data integration, doing it for years, we know the best way to do it. We know how to monitor all those inbound interfaces. When someone changes an interface, we can do that rather. So part of what we’re doing is really migrating the legacy and vistix application onto our pharmacy platform so it can benefit from that common data integration and standardization layer, so that the deployment process is simplified and accelerated so people can benefit from the software faster. So that’s a huge benefit for us. And then later on, you know, as we get to that, then we can start to, the solutions can start to work together.
Karen
So, for example, our IV workflow solution is an area of drug diversion that’s often it’s often hard to get the data from the clean rooms, the compounding rooms, and that’s an area where people are handling controlled substances and things. And so if we can marry the data that we’re getting and the information about what’s happening from our iv workflow solution and bring that into the or century seven drug diversion solution that will advance, will continue to advance that, and then just AI is one of those areas where you never stop. As soon as you detect one pattern of diversion, someone else figures out a new way to divert medication.
Karen
And so continuing to update our AI models and making sure that as people who divert medications get smarter or find new ways that we’re picking up those patterns, we’re putting that pattern into our software, and we’re able to support recognizing that as fast as possible is another key goal for the solution.
Terri
Yeah, wow, all of that sounds great. Yeah, I didn’t think about, you’ve already got those, you’re already bringing in EHR information, so you should have most of that locked up. If somebody wants to add century seven diversion to what they’re using, it should be pretty seamless, whereas right now it takes a while to get all that done and implemented. Yeah.
Karen
And so we’re working through that transition now and that migration onto that platform so that we can simplify and streamline that data act. You want to be able to work with us one time and know that you’ve done that implementation one time, and it feeds multiple solutions that the next time, the next solution that you buy from us doesn’t require the same level of data integration and support.
Terri
Yeah. And the it resources that seem to be so scary, so minimal. Exactly. In all the places. Yeah. And in terms of the AI adjusting itself when there’s a case, and I know, you know, I’ve used your product quite a bit, there’s a mechanism to put it back in and say, okay, this person was confirmed diversion. I don’t know how all of that works. And, like, I don’t put it in every transaction that we thought was suspicious, I just, you know, picked two or three. So I don’t know, actually, if that’s enough, I should probably talk to your team about that. What should I be putting in there so it can use? Does it just take that user and then globally kind of say, okay, this user, so let’s look at all that activity.
Karen
It confirms the pattern. Right. The more times you can confirm the pattern, the more confident that you can be that you are detecting, that you’ve detected diversion and that the mechanism by which you weight that pattern in the score, in the risk score for new providers who might be just demonstrating that behavior pattern is captured. And so we really do end up adjusting the weighting of different types of diversion based on the ability to confirm repeatedly that this is a pattern that is continuing to happen. And you should elevate when people are behaving like that. You should weigh that more heavily in your risk assessment as you’re presenting a potential person to investigate. So that’s one area where, when you do that, validating that is diversion that feeds.
Karen
So that feeds that model to help it, you know, improve its accuracy and improve the weighting. But, you know, ultimately, it’s about continuing to work with our customers. We spend a lot of time on site. We have a large clinical team that, you know, you’ve been supporting us, but we have clinical employees that work with our customers. And so as they identify new ways that maybe aren’t in our. In our, aren’t a pattern that we currently have and they tell us about it, we can rapidly build that into the application just the way that our application is architected and likely already have many of the data elements that are necessary to identify those patterns. So that’s really the areas like our close connection with our customers.
Karen
And when they do identify something new that maybe isn’t detected by our solution, being able to add those new ways of diverting to our solution. And so even like I was, you know, one of the areas that, you know, that we’re looking at is, you know, the way that people might be, you know, wasting medication, and how can we optimize the sort of the analysis and the pattern recognition of different ways people are interacting with waste? And are there other patterns that we can build into the application that would even identify more? That’s an area where it’s very easy for somebody to. When you don’t have the ability to analyze all the waste or you don’t have the ability to, you know, validate that somebody had a witness where people can really divert.
Karen
So if we can find, if there’s other ways that we can sort of detect that, we’ll look to build that into the. Into the models.
Terri
Right. The waste, yeah. And I am looking forward to seeing more with anesthesia. That’s a very difficult space. It’s so, you know, every procedure, you’ve got all of your patient specific markers that will depend on how much drug you give. And so, and I know there’s some stuff in the software, but I’m waiting for the day where there’s more, and it kind of weeds it out for me, instead of me needing to open up all these charts and like, well, let me see, how long did this go? And, you know, how heavy was this person and what were their other, you know, what was the procedure that was done and that kind of thing? So I’m sure that must be somewhere on the horizon.
Karen
It is on the horizon, yeah. We actually. We are working with somebody who’s a very senior doctor, anesthesia doctor, who is retiring and has a real passion for detecting diversion in anesthesia. And so he’s helping us understand where the areas of risks are so that we can build those additional models into the application. There’s a lot on our plate. We want to do the data integration. We want to update our user interfaces. We want to update the models, and we are committed to investing in this. We believe it’s. This is an area where you can’t be too careful and you can’t be too comprehensive in protecting patients. It’s a $70 billion area of risk for health systems. And it’s not just the patient harm and the harm to the employees who have substance abuse. It’s the reputational harm.
Karen
It’s the trust in healthcare providers, risk of lawsuits, all those things that we’re hoping to prevent.
Terri
Yeah, no, there’s a lot. So you’ve talked about a lot already in terms of challenges. Are there any other specific challenges in the space where technology is used to address diversion that you see that you guys are facing and have talked about?
Karen
Well, it’s. You know, there’s still. Unfortunately, as much as you’d like to think that technology has reached every corner of healthcare, it has not. There are still many areas where medications are handled, where they’re handled on paper logs that people are logging and things in and out. And unfortunately, you can’t take a paper, piece of paper and put it into a system. Right. So that’s the area where we’re trying to figure out how we can bring technology into places where there are still paper logs. You know, whether it be the. You know, some of these ancillary clinics where they’re. They’re still. They don’t have the advanced cabinets, they don’t have the ability to track these things in more sophisticated pharmacy management systems.
Karen
And so figuring out, is there something we can add to our platform that can make it easy to collect that data so that we can really expand our eyes and ears to every place that medication is handled? I think that’s one of the biggest challenges for us, as we know that there areas that are still very manual and places where you just. You don’t have the data. You know, things like handling sharps containers. Right. Like working with the safety department and making sure that, you know, you’re understanding how those transactions are being handled. Those are not often not recorded on technology. So it’s. It’s a little bit harder to identify patterns of diversion when you don’t have the inbound data to help you identify those, for sure.
Terri
And the. The paper stuff, I mean, do you find. I mean, from my perspective, it seems it’s all a matter of finances, right? I mean, they do it on paper because they can’t or don’t want to spend on. Yeah, yeah. And especially if there are smaller locations, it’s maybe not financially worth it to them. They need. There needs to be solutions that are more affordable for the smaller.
Karen
Exactly, exactly. It doesn’t always make sense to put a, you know, an omniscient cabinet, not a big cabinet, but even the smaller ones that are in some of these ambulatory clinics, in a smaller clinic. And as this technology gets adopted more and more, you’re going from those leading academic medical centers that did have the resources to do all that automation into more of these hospitals that don’t have that. And so how can we help solve that problem? What can we do to do some lightweight data capture to expand the ability of. Of our solution to detect aversion everywhere medication is handled?
Terri
Right? Yeah. Yeah. That’s an interesting idea because it’s within your scope, but it’s also out of your scope of what you normally do. You just want the data, but how can you get the data and help?
Karen
Exactly. Exactly. Are there ways that we can. Ways that we can create some data collection capabilities, lightweight, inexpensive, but still support the larger mission of direct aversion across the health system?
Terri
Right. Yeah.
Karen
Right now, yeah.
Terri
Okay. That sounds good. Something to look forward to. Do you, is there one thing that you think sets your diversion software product apart from. I mean, if this was your moment to appeal to all the people out there that don’t have your product, what do you think sets you guys apart from the rest?
Karen
You can’t limit me to one thing, but.
Terri
Okay, more than one thing. Go ahead.
Karen
I think it’s that clinical domain expertise. It’s the ability to bring people who really understand drug diversion and the way drug diversion manifests itself in healthcare system, feed that into the solution so that we can continuously improve having that. Not so many health systems are at sea they just don’t know where to begin with a whole drug diversion detection program. They are really looking for our guidance and our help, and so being able to bring that clinical partner to the table. So it’s not just a technology. Technology is one part of a three legged stool. Right? It’s people. Do you have the right dedicated people and do you have a process in place?
Karen
And helping them come up with that process, helping them sort that out, is part of our mission of trying to figure out that’s where we can bring value added to what Invistix has built. From a technology perspective, we do have that deep pharmacy bench, clinical pharmacists who can partner with our customers to help deploy the solution effectively in their facility. And not just the technology, but actually all the processes that wrap around it. I would think, number one, that’s what we do. We’ve done it for 200 plus years. But I think the other area that really is differentiating is that common data integration platform and the ability. People don’t necessarily look at drug diversion as a standalone thing. They’re looking at opioid stewardship and drug diversion in concert.
Karen
How are my prescribers prescribing and then how am I, you know, in what’s being, what’s happening at the actually the administration part of it and the handling of the actual prescriptions once they’ve been prescribed, those two things come together. We have an opioid stewardship solution on our platform. We have a drug diversion solution on our platform. Being able to bring those two things together and have them feed each other is something I don’t think other solutions actually can provide.
Terri
Yeah, it’s a good point. And, you know, that’s one of the things I tell people that are trying to mitigate their diversion. It’s like, well, what do your order sets look like? You know, you put everything on the order set and it doesn’t all need to be there. And it’s a one thing to put it on at the beginning, and then it’s another thing to keep it on exactly after, you know, the patient tells you, no, I don’t take that. I don’t want that. Well, get it off.
Karen
Exactly.
Terri
And so is all the stewardship part and the, how often is the prescribing of opioids done when it doesn’t need to be done? I worked with a hospital that they decrease their opioids, you prescribing, and I like to say judicious prescribing, because it’s not, you don’t want to just take it away if it doesn’t need to be taken away. Right. But by a very large percentage, once the physicians and the residents were educated to these, some of these patients that are coming in, they’re, you know, they.
Karen
Know how to get prescriptions. That’s one of the things that our surveillance software does is it actually identifies prescribing patterns across providers. And so you can look at all your doctors in a specific, maybe a surgical unit of a hospital, and you can find the outlier who’s maybe prescribing a lot more than their peers, and you can actually work with that person to adjust what they’re doing.
Karen
That’s the benefit of having a platform like this where you can not only detect a version because you’re identifying where things can go missing, but you’re preventing it by reducing the number of prescriptions upfront and judiciously, as you said, making sure that you optimize those prescriptions, that you’re not just adding them to an order set because they’ve always been part of an order set, or you’re identifying those providers who may be a little bit excessive in the, in what they order and how frequently they order it. We can benchmark against other health systems. And so it’s really, it is a value of our platform that you can bring those two things together and look at it holistically and not just sort of, this system does one thing and this system does another thing and they don’t talk to each other.
Terri
Right. Yeah. And I was just thinking, too, I mean, if you have a prescriber in the ED or an urgent care, let’s pick on those that do tend to prescribe liberally. Well, guess the nurse that is diverting one time orders, right? Oh, this patient needs. Guess who they’re going to go to. So now you’ve got, you know, those two things that are very much connected.
Karen
Yes, exactly. Yeah. So that’s the, that’s the cool thing about what we’re seeing is just the ways that we can combine our solutions together. And I do think it’s a differentiating capability that a lot of the other sort of point solutions when they’re just doing drug diversion aren’t able to bring to the table.
Terri
Yeah, that makes perfect sense. All right. Thank you very much. This was insightful. And I learned something about WK today that I didn’t know. And I will ask you, is that somebody’s name Wolters Kluwer? Is that where that came from?
Karen
There was a Wolters and a Kluwer, and they. A couple of businesses came together. So, yes, there’s not one name. There’s not one person named Wolters Kluwer. It is two last names that came together. But, yes, it is a name.
Terri
I figured it had to be names because it’s like, what is that?
Karen
Yeah, you know, we are, you know, at origin, a dutch company, but we are, you know, we have 20,000 employees around the world. And so, you know, we. Even though we’ve got the legacy dutch name, but we are really a global. A global solutions provider. And, you know, marrying kind of like our whole raison d’etre, to use a fancy french word, is marrying that deep domain expertise with advanced technology. And then we do that in healthcare. We do that in financial services. We do that in legal services and tax and accounting. But I’m fortunate enough to work in our health division and excited by the solutions that we’re able to bring to the table.
Terri
Yeah, they sound great. All right, thank you very much, Karen. Thank you, listeners. And, Karen, you have a great rest of your week.
Karen
Thank you, Terri. Bye bye.
