 From Orlando, Florida, it's theCUBE. Covering ServiceNow, Knowledge 17. Brought to you by ServiceNow. Welcome back to Orlando, everybody. This is theCUBE, the leader in live tech coverage, and we're here in Orlando at the Knowledge Conference, Knowledge 17, Service Now's big customer show, and that's one of the things Jeff and I, Jeff Frick, my co-host, and I'm Dave Vellante, like about knowledge is we get to talk to the practitioners, the customers, the doers, Noresh Samlala series, the director of mobility and process automation at VITAS Healthcare. Thanks for coming on theCUBE. I'm glad to be here, thank you for having me. You're welcome, tell us about VITAS. So VITAS is the largest hospice and palliative care provider in the country. What's unique about our business is that our patient care staff is really in the field, they're not bounded by four walls as compared to a typical healthcare provider. So our nurses, our chaplains, physicians and so forth go to the homes of our patients. And being in hospice, we truly believe that your best care is delivered in your own home. And so that's VITAS' directive is to really deliver that care in your home, which really creates for a unique setting in managing logistics and the staffing around that whole solution, but we've done it really well for 30 years, and we're looking forward to a great future with that. Well, it's a really important service. Obviously, families and loved ones could be together and gather in very difficult times. Now, in the past 30 years, technology has changed quite a bit. How has that affected your business? Yes, that's a great question. In many ways, technology at VITAS had not changed. And so a lot of things that we have done historically and still today, there's many things that are still the same because that's what works. And at the end of the day, despite leveraging technology, this sensitive time in someone's life really needs that personal interaction, and technology can't substitute that. However, we always are challenging ourselves to make that interaction more efficient with technology. So most recently, actually last year, we completed a deployment of 8,000 mobile devices to our patient care staff. So our nurses, prior to this rollout, walked around with 25 pounds of paper, right? They were traveling from their homes to our patients' homes, to our offices, back and forth with paper. They didn't have access, real-time access to patient records like they do today. We replaced an entire binder with a mobile device. I was going to say, these things change the world, right? So how many stops to the, you know, just a little bit of the kind of their workflow? How many stops a day do they make, kind of, so what's kind of the scope of that? That's a great question. They may, they'll have a starting point in a day. They know where their first patient, they don't know what the last patient or how many they're going to see that day. So it could vary. It could be, you know, five, it could be up to 10. And it varies based on the need, based on what that visit calls for. So it really varies. And in being able to have real-time information now and be more flexible and more efficient with these devices, we're really able to allow them to give better care and more care, quite frankly. Right. So take us through the sort of case example of how you brought in service now, what was the driver and how you changed your organization? So there's quite a bit of efficiency. And I talked about how the business has not changed very much over the course of the time. But mobile devices, as it relates to mobility and VTAS, we really saw an opportunity to leverage the staff that we have to do more with them and give them the ability to give better care and not have to worry about the administrative aspects that come with that. So for example, today they're able to access our EMR. So they get patient data right on their mobile device. They can order drugs for our patients right on their mobile device. They can enter their time, their traveling, all of these logistics that they weren't able to do. They had to literally leave their home, go to a patient, go back to our main or program office in that location, scan any documents that you scan, enter any time, do some administrative stuff, go back out, right? That's kind of what did they look like. And so now with these devices, we're able to free them up from having that extra travel, right? There's obviously a lot of cost saving opportunities around that, but it really allowed for and allows for a nurse and a patient caregiver to maybe be able to see a patient, one patient more, two patient more that day, right? So that really transforms our business. And really at the end of the day, it's really going to allow VTAS to provide care because we believe we provide the best care in hospice and palliative care. There's, we feel that if you're not with VTAS, you're not getting the best care. And this really allows us to really see that through and position ourselves to deliver more. So where did you start with ServiceNow? So ServiceNow was actually introduced on the ITSM side. So we brought it in to really fix our ticketing system, get it up to where it needed to be at the very least. And out of that, there was a parallel opportunity for asset management. So mobility was in its very infancy at the time. We knew we wanted to do it. We knew it could happen. We knew the benefits of it. But the reality of it was a little bit far fetch, right? And so ServiceNow combined with a few other partners that we work with really bringing that together and finding that secret sauce and finding the right recipe for making that work allowed us to do this. One of the biggest things with managing so many devices and them being physically off our premises is not knowing where they are, right? These, you know, they don't actually hold patient data, but there's some risk around security and exposing that. So losing these devices, them getting in the wrong hands was really important for us. So we really needed to, first and foremost, know where all our devices are at any given moment, right? Coupled with a few other pieces that work well with ServiceNow, we now have that single pane of glass that we can really know exactly where devices are, manage them in real time. We are able to tie our financial data right back to them so we're able to really get the full visibility of what mobility looks like. And ServiceNow is at the core of that. They're at the center. We bring everything back into ServiceNow. So we have one place to go, manage our data, share, and really be effective with it. So the data, the patient data lives in the cloud, is that right? So essentially, yes. So no data actually lives on the device. It's all a matter of device being able to access the cloud. So through Wi-Fi, if they're at a hospital or if they're at a patient's home, or LTE coverage. And it used to live in paper that somehow got scanned. Yeah. Right? Yeah. I can't imagine. Because they don't know what their route is. So now I assume they go to their first stop. It's got all that patient ABC. They finish, check in, I'm done, and then where am I going next? Well. Get the data. I'm glad you brought that up. So today they're able to access that information. I think part of the next step as to where VTAS is going is to really systematically tell them, okay, this is probably your next stop. And they're not with a phone call to find out if they're available to do that. But systematically know that they're available when they're going to be available and set them up with that information. And so that's really where we're looking to next for informability and technology. Right. What about all the compliance? Well, the Affordable Care Act, I mentioned EMR, meaningful use. I mean, all these things that you have to wear, HIPAA, maybe the potential unwinding of the Affordable Care Act or maybe the evolution of it. I mean, all these things you got to keep track of. Where does that fit? So another great point, you know, one of the things, one of the things is hospice is, or end of life care really consumes about 30% of one's cost throughout their life. Most people don't realize that. That's your most expensive time in your life, in your cycle that's going to go towards healthcare. And so, and that's where VTAS is very sensitive. The other thing to note is that the average patient with VTAS is with us for two weeks. So timing is everything. Two weeks. Yes. Right, so. And how many visits was the average number of visits in that two weeks? So we have 16,000 patients on our list. I mean, for that particular, I mean, what's kind of your average visits per patient over that two weeks? That may vary, depends on the patient. And this is average, right? So that may vary. Sometimes it's 24 seven care. Other times it may be a couple of times a day. Other times maybe once a day. It really depends. It's typically at least once a day, right? At least once a day, right? So that's not uncommon. So going back to your question, these things all come into play where as an organization, we feel the effects of regulation changes, right? And that impacts our financials as well. So bringing mobility to the table with the help of Service Now and these other players that we make this work really helps us realize these efficiencies, which at the end of the day, this is how we're able to really stay afloat in those areas and really not feel the impacts, quite frankly. And if you look at our last quarter, we thrive. Yeah, I mean, get paid on time. Absolutely. And not have to go back and forth, back and forth. Absolutely. Please don't like audit, I would imagine. I mean, does the GPS data that demonstrates that your people were there figure back into audits and all kinds of stuff, I would imagine. And we are heavily audited with our devices as well. I mean, they're very sensitive. And you got to think about it too, mobility and such a paradigm shift for a company like VTAS was and is, you know, very scrutinized, right? We spend a considerable amount of money in this program. We also see a lot of returns in it. But it's a very different approach for folks that have done things a certain way for a really long time, right? So you talk about audits, going back to financials, Service Town really allows us to stay really close to that, be really tight and speak with confidence when we provide our data, right? So our CFO is very sensitive to that. And in a moment's notice, we're able to respond to his request for, you know, last week's financials, last month, what are our loss rate? You know, things like that just wasn't, we didn't have access to that type of data before. And quite frankly, it's not something that's very common. So most organizations see mobility, I would have to say more as a luxury compared to how VTAS uses it today. Today, this device is the clinical workstation at VTAS, right? This is how our patient care staff works. This allows them to be productive. It's not a luxury. And how often do they come back to the barn just to come back to the barn assuming that they're in the field most of the time actually working? Yeah, so at the very least, they may come back. They'll come back once a week now for a team meeting versus much more frequent or administrative work, right? So that's had a tremendous impact on them. And how long ago again, did you kind of roll out the solution? So we completed the rollout to the full audience at the end of last year, so Q4 of last year. So we've been at full fleet for two quarters now. And that really was setting the stage for what's to come next, right? So we're in the middle of rolling out an application right now which is going to allow our patient care staff to order drugs so our physicians and nurses can submit the request for drugs and like the items to treat our patients. Whereas before, what that looked like was them having to leave the patient's house, run to the store, come back, or do a mail order request for drugs. So today- And will that be in the service now app or using service now that kind of manage everything and that's a separate kind of an app? Did you guys develop that app on top of service now? So that is, it's isolated from ServiceNow today but we're standing it up as is. However, that's something that we're actually considering looking at ServiceNow to see how we can play in that space as well. Because ServiceNow has done a lot for us, right? We know it's a fantastic tool. We've used it in ways that are unconventional and we continue to do that. So part of a lot of why we're here this week is to really capitalize on how they help us too. And so we're embarking on the journey program with ServiceNow to really look at how we can transform our business even further. And opportunities like this really play a role in today. And so are you developing apps on ServiceNow? So we do have custom apps on ServiceNow. Today, they're very, you know, they're quick wins internally. They really don't extend to our business. They're more internally to IT. But that's really what the next phase of what we're looking at is how does ServiceNow really impact our business and our business processes, right? That's really our next step. And we can, can we differentiate this from my own edification? Custom apps versus custom modifications, right? Those are two different things, right? Custom apps. Configuration. Yeah, custom apps, you're building an app on top of the platform. What about custom mods? Are you avoiding those at all costs? So I can't say we're avoiding them at all costs. And you really can. You have to have some customization. We try to limit those so we can take on upgrades and take on and be swift with all the new features that they bring on. So we're one version behind by design. And so we're able to consume that as fast as they're able to release it because of our light customization. We try to stay out of the box. When you upgrade, do you, so you're what, N minus one? Right. Always upgrade to the next version? Do you sometimes leapfrog? I have not had to leapfrog yet. So we've been pretty good about that. And I plan to stay current to that. So help us understand, so maybe advice for other customers is you don't really want to leapfrog if you don't have to. But sometimes you have to because you're too late in the upgrade cycle. Is that right? Yeah. Okay, so. I mean, it's not ideal because you introduced a lot of unknowns if you have to leapfrog, right? And service now, let me say this too, the upgrade process with service now has been unlike anything, any other upgrade process I've been through of any software. In what sense? It's been smooth. We've had very little issues coming out of it. We do full regression testing, but our findings are always very minimal. But the actual upgrade process is short. It's effective. It works very informative and they're getting even better at that. So for, you know, that gives us a lot of peace of mind that we have a stable platform that we can really build and thrive on. How many upgrades have you gone through? We've done three so far, okay. What is short, Nuresh, like how long? I've, you know, I've done, I've seen inside of an hour at Kimes, you know. And so our instance, we're two years into service now. So we don't have, you know, massive amount of data like maybe other companies do. We have substantial data there, but they're pretty quick. I've seen an hour to do an upgrade. And how disruptive is an upgrade? Not at all. Here's one of my favorite parts about the upgrade is I don't have to announce that we're doing an upgrade to the general population. Okay, they don't even know. They don't even know. They're actually working in it while it's being upgraded. They log off, log back on. New version. Right? So I've been able to consume these upgrades as fast and as easily as I'm talking about. Largely, so I did one thing that was probably different than most people are doing. I'm suppressing the UI upgrade and taking the platform upgrade. So the look and feel stays the same. And so we're in the middle of a program right now to relaunch service now with a new look and feel, new branding, just give it a whole new, you know, facelift. That's when I'm going to release the new UI. That's when we're going to give it. But do you really separate the skating and the UI from the underlying platform? And you're allowed to do that, right? Right, right. What are the good parts about it? I mean, the UI changes not on every cycle. Is that correct? I mean, it changes periodically, right? Periodically. There's been subtle changes and then there's been full revamp for the better. But for the most part, we're able to consume it and stay current with it because we can contain it that much. Yeah, but it's different. And the user says, oh, I mean, even my crappy Gmail when it changed the UI, I was like, oh, it's new. You got to learn it all over again. You don't like it, it grows on you. Well, we can control that now. We'd have to react to it every time. And the strategy to be N minus one is can you explain that? And what's the logic behind that? Yeah, no, absolutely. So there's constantly a ton of new features. Service now is learning from us and from many customers and really being reactive to that. And so I want that whatever we have and we're trying to do, we're getting, we have access to the latest and greatest. And best of all, we don't have to go build something if I know it's there, right? It also helps us identify and plug gaps in our system in our processes. So for example, we may know we have a host of different things that we need to really work on. Consuming an upgrade and it being so simple as just turning something on or just start using it means I can get to being more efficient quicker rather than having to put that on a priority list and get focused and get a project going and get a team behind it. It's just more consumable that way. And we're able to be more agile and improve quicker as well. So that's one of the reasons I like doing upgrades and staying current with it. All right, Noresh, thanks very much for coming to theCUBE. Appreciate it. Thank you so much for having me. You're welcome. All right, keep right there, everybody. We'll be back with our next guest. Thank you, right after this short break.