Month: July 2021

We’re seeing a lot more proliferation of innovative business models going well beyond just a pure telehealth visit

Season 3: Episode #93

Podcast with Oleg Bestsennyy and Jenny Rost, McKinsey

"We’re seeing a lot more proliferation of innovative business models going well beyond just a pure telehealth visit"

paddy Hosted by Paddy Padmanabhan

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In this episode, McKinsey partners Oleg Bestsennyy and Jenny Rost discuss the findings of their recently published report – ‘Telehealth: A quarter-trillion-dollar post-Covid-19 Reality?’ The conversation highlights the rapid growth of telehealth since the pandemic and explores several important differences in adoption rates based on types of care, demographic profiles, and other factors.

Telehealth can  be a great enabler for delivering innovations that lead to better quality healthcare, member experience, and lower costs. There is a need for continued innovation to sustain and expand telehealth and investment in building seamless consumer experiences, especially in a hybrid care model.

The report provides several interesting charts that inform readers on the emerging landscape of telehealth and virtual care models. Oleg and Jenny also discuss various headwinds that will impact the growth of telehealth technologies in the future. They also share advice for health systems and health plan executives looking to navigate the transition to virtual care models successfully. Take a listen.

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Show Notes

00:43McKinsey just published a report titled Telehealth: a quarter-trillion-dollar post-covid reality? What are the key findings of the study?
04:48The report mentions that telehealth volumes have dropped off from the pandemic peaks. Have we reached an equilibrium or are we still evolving towards a steady-state hybrid model?
11:42 You mentioned one headwind in telehealth adoption, which is the reimbursement environment. What else could be a significant headwind and what is your study indicates?
13:49 Healthcare is behind other sectors like ecommerce, personal banking and faces real infrastructure as well as design issues. Where do you think health systems and large health plans are today?
17:05 You refer to the VC funding levels for digital health which is driving a lot of innovation in the report. What are you seeing at the other end in terms of acceptance and adoption for these solutions by health systems?
19:40 Can you comment on the competitive landscape: big tech firms, digital health startups, EHR vendors? What is the tech landscape looking like at health systems in a virtual care future?
21:38 Do you think employers are going to become a significant force that's going to chip away at a big part of the overall healthcare services marketplace?
28:18What would you advise health systems and health plan executives who are trying to sort through this changing landscape, the shift towards virtual care, and are faced with big investment decisions as it relates to technology

Q: McKinsey just published a report titled “Telehealth: A quarter-trillion-dollar post-COVID reality?” What are the key findings of the study?

Oleg: It’s worth noting that this article ended with a question mark. Is this quarter-trillion-dollar opportunity going to be a reality? The original article, from over a year ago, tried to outline the potential for telehealth. We arrived at a figure very close to USD 250 billion of care that could potentially be shifted given the underlying fundamentals to telehealth. Recently, we looked at it to ask what had happened since the pandemic started and how this had evolved?

The key findings have been – Telehealth accounts for around 13-17% of all office and outpatient visits in the U.S. That is between 30 to 40 times the pre-pandemic levels. This has been fairly stable since June 2020 has been exciting. It’s continued with variability since June though. I must point out here that despite average telehealth adoption, there’s been a lot of variability in specialties. So, we’re equally excited about how adoption of telehealth has differed by specialties.

Jenny: What I would add is to look at some of the drivers here – initially, we saw huge increases in both consumer demand for telehealth and provider demands due to the realities of being in the midst of the COVID crisis. We saw that perceptions have largely stayed very positive and providers, in particular, many of who did not use a lot of telehealth prior to COVID, have enhanced perceptions of it now, than before. Many do intend to continue using telehealth and similar results are evident on the consumer side. What’s really exciting is that there’s a lot more proliferation of innovative business models going well beyond just pure telehealth business or telehealth visit. However, to really integrate hybrid models of care, telehealth must be integrated with remote monitoring. I’m so excited to see how this continues to evolve going forward in a post-pandemic world.

Q: What do you include in the definition of telehealth and virtual care?

Jenny: For telehealth specifically, and that is what we did our claims analysis on, it would be virtual and telephone-based visits that were coded as such in claims data. Broadly, virtual health would expand to include remote monitoring, digital therapeutics, asynchronous and synchronous visits. So, it’s actually a wider set of ways to receive care, not in-person.

Q: When you published the report last year, telehealth volumes had dropped off a little. Yet they are still higher than pre-pandemic levels. Are we in an equilibrium or are we evolving towards one?

Oleg: When we think about the equilibrium, let’s ask what is the true future potential? The figure that was put out was USD 250 billion. What does it mean? Part of it means that a quarter of all of the visits in the future can, in theory, potentially be done virtually. When you compare it to where it is today — 13-17% of claims — it’s a big positive surprise that it’s risen so high so quickly and close to the outlined potential.

But then, we received feedback a year ago that 25% was on the lower side, that the potential was much greater. So, I hope that we’re not in equilibrium and the situation actually improves. But I’d like to make this provocative statement that, telehealth as a videoconference between a doctor and the patient quickly becomes commoditized. Sure, it improves convenience and access and becomes a great enabler of – innovation, better quality, better member experience and lower potential avoidable costs and better delivery of healthcare but it begs the question — Can you combine telehealth visits with remote patient monitoring applications to deliver better care at home for the elderly? When we look at this, we hope that spurred by investor activity, consumer and provider adoption, there will be more innovation leading to greater adoption of telehealth.

Jenny: I’ll play the devil’s advocate here. There are trends that could evolve and cause it to go down again, so there may not be an equilibrium by any sense. Continued innovation will be needed to sustain and expand the applications as it becomes easier for people to see their doctor in person. It has to be really convenient and offer seamless user experience. So, there’s a noticeable push towards not having telehealth as a siloed experience with the provider you see once, but really having integrated data and care so it’s really used to help you manage your care. On the provider side, will reimbursement stay, is a big question. Can this become a more seamless part of provider workflows too, especially as we think about providers who may be offering a hybrid model, not just a pure virtual health offering? I think there’s still lots of ways this could evolve that could push it in both directions

Oleg: Just one thing and I’ve alluded to it before — when you scrutinize telehealth adoption by specialty, there is a lot of variability. When you see Psychiatry visits or substance use treatment disorder visits, the level of adoption is much higher than average. More than half of all the Psychiatry visits, as we look at claims right now, are conducted using telephonic or telehealth means, which means greater access to a mental healthcare. I think, the innovations that Jenny is talking about, are going to evolve in the microcosm for different kinds of specialties, too. In the future, we’ll see a lot more happening in the space of tele-behavioral health than some other specialties.

Q: There’s plenty of differences between how the adoption rates play out based on the types of care. The rural versus urban setting, within urban areas – the inner city versus the more affluent sections, socioeconomic factors, the demographics, etc. What does your study show when it comes to breaking this down along these multiple dimensions?

Oleg: Even though we did not touch upon figures in the report, our colleagues have analyzed the data, and there seems to be a higher adoption level in the rural setting where the access issues are also much more prominent and pronounced than in the urban settings. There’s also considerable research going on right now in terms of how does telehealth help or maybe set back the question around health equity, access to health and the equal high-quality opportunities among the various strata of the population across socioeconomic backgrounds. The effect is still unclear but I do believe that technology — telehealth and virtual health, in general — espouses great promise to not only innovate around care models and care delivery, but also make a significant step forward to better health equity across the society, irrespective of geography, demographics or socioeconomic backgrounds.

Q: You mentioned one headwind — the reimbursement environment. In healthcare, everything is about following the money. What are the other significant headwinds from your perspective?

Jenny: Great question! There’s probably a few. One would be — just how seamless is the experience? We can do almost everything online today, but some are easier than others. So, is it one click to access all my data and then get a readout? Or is everything really fragmented? I’m probably much more likely to continue using telehealth if it’s all seamless and that’s the management populations with complex conditions need. Data integration is critical too. There are also some questions that are still being worked out around quality — What are the right sets, the conditions or symptoms that really do suit themselves well to a telehealth visit versus an in-person one? As providers work through the clinical models, that will impact what’s done telephonically, by video versus in-person, I think, some of those are the pieces that we’ll see continuing to be worked through.

Q: The fragmented nature of the healthcare experience is not new. There are some real infrastructure issues that make it hard to create that seamless experience – interoperability, design etc. Where are the health systems and large health plans, today? Is there a real difference between the financial performances of those who’re ahead in this game and those a little behind?

Oleg: In general, there is a lot of variability in how much different investors are investing in the underlying capabilities or how seriously they are treating this space. A lot has to go into data enablement, aggregation and interoperability capabilities. But all the capabilities related to working seamlessly with EMR, within the EMR or across care provider boundaries, need strategic investments. These will come with innovations around the way they approach the day-to-day workflows — a virtual only model, a virtual first model or a hybrid model that is seamlessly integrated offline and online experience for members.

Also, like with lots of other spaces, a lot of innovation today, is driven not so much by large systems, large health plans, but actually by smaller startups that are trying to find a niche to innovate around and try to scale it. I’m quite glad to see the high levels of investment and excitement around this space because I do hope that all of these investments ultimately result in better competitiveness and truly disrupting some of the care models to enhance care for everybody.

Jenny: We’re starting to see large players, payors, big health systems and value-based providers signing up for or currently being inundated by a lot of different point solutions and saying, “OK, we signed up for such a condition and such a convenience, for this segment of our members. So, how do we actually create the ecosystem?” That’s a more curated experience.

Q: In your report, you refer to the VC funding levels for digital health as driving a lot of innovation. It’s one thing for startups to get funded and drive innovation and another thing for health plans and systems to adopt solutions and make them work. It’s different altogether for consumers to really use it and make a difference. How much of this is hype? Or are we in some kind of a bubble here?

Jenny: I don’t have a number but if you look at some of the moves that really big players are making, you’ll see large retailers are making lots of acquisitions and big tech companies are expanding and innovating while broadening their portfolio of service offerings in this space. So, it isn’t just a startup game.

Oleg: We’re already starting to see some real innovation in telehealth technology itself. It’s a video conference that is HIPAA-compliant and one can now launch a telehealth visit without even downloading an app, just in one’s browser. When I look at innovation broadly, I see that for some conditions, there are truly remarkable ways in how care has changed compared to even a decade ago where you’re combining AI-driven behavioral nudges that are automated to the member with great member experience, behavioral coaching and remote patient monitoring packed all in one seamless end-to-end offering to really make a dent in the care and the outcomes for a condition.

So, investments lead to innovation. It doesn’t mean that all of these investments will play and pay out. But it does give me hope that some of this leads to true groundbreaking innovation and we’re really on the cusp of it in the next few years.

Q: Let’s talk about the landscape of big tech firms, digital health startups, the private, mature digital health companies. In terms of the opportunity landscape, where do you see the most traction? How are your clients, health systems looking at this technology landscape and making the tradeoffs?

Jenny: There’s an almost bifurcated value proposition that’s emerging. A series of solutions that are forming around convenience. For healthy populations that need convenient access to more routine care, this can be the triage symptom checkers that feed into a telehealth visit that connects to deliver your prescription home or in some cases even accommodates home visits as needed. So, it’s built around convenience. That improved experience often may be more targeted towards large employer health offerings.

Similar levels of innovation may also be seen more around chronic conditions, behavioral health or specific populations that have more complex needs. It’s about how you integrate the technology into those care journeys to improve outcomes, cost and quality of care. So, we’re seeing those two models play out across different types of players, investment areas and health plans and systems as well.

Q: Is there a real possibility that a lot of the business is now going to fall into the hands of the employers who are emerging as a buying force? Are some of the mature companies actually targeting them as a primary market segment — what do you think of that trend?

Oleg: We’re already observing they indeed are becoming a big force. From the purchase of some of these innovative solutions to the point of bifurcation that Jenny has mentioned, there is a lot happening.

How do we increase convenience of access to healthcare for our employee base? How do we look at it not only from the perspective of what leads to reduction in avoidable medical expense, but also how to better members’ experiences? Can this be used as a talent retention and attraction mechanism and what leads to better productivity and happiness?

That is kind of a byproduct of some of the solutions. So, I think we’re already seeing an increase in the levels of purchasing and spending on different kinds of solutions in the space. Some of them are targeting well-being, tackling anxiety and depression, or things related to convenience of routine care and low acuity, access to care by keeping the waiting rooms etc.

Going forward, this will continue to increase and employers will continue to be or become even bigger voices. On the other side of the fork, when you look at the employer base and people who have employer-sponsored insurance, there is great need for solutions that address the chronic care needs of the employee base. Some of the planned procedural base – telehealth, virtual care, and remote patient monitoring can go a long way in making that experience better and hopefully, leading the front line to reduce avoidable medical exacerbations.

Q: You’ve got access to care — a big area of digital health innovation — and on the other side, is the actual care delivery. Where are you seeing more traction?

Oleg: I’m happy to take the time to think about it. It was interesting because when the initial spike in the pandemic hit in late March-early April, telehealth was almost extensively used. One could not visit the doctor who one typically visited regularly, so one needed help to connect to anybody available and talk to them. That led to the growth of the space we call virtual urgent care — connecting to a random doctor on a low acuity, or some level of acuity with urgent issues that one needed to resolve right then and it helped solve the issue of access.

It was not so much about convenience. But what’s been analyzed in the original report, the potential value of that virtual urgent care as a use case is actually a small part of the overall total potential. The bigger part is around what may be described as it’s delivery component — innovation around care models and how that may be done.

Having said that, I think the lines are blurry and gray. So, there’s this category, which we call near virtual visits. For the sake of convenience, while the visit parts here are virtual, yet, some of the services need to be in-person, such as drawing blood or a lab test. Can these be combined to create both, a convenient aspect but still an innovative way to deliver care? Those are some of the interesting use cases that I hope to see grow, scale-up and proliferate going forward as well.

Jenny: There are some interesting questions about how to give access to more and more people. They now want it with their doctor, not just one through a telehealth app. So, how do we use technology to create better access to the care that people want or what they’re familiar with?

Q: What would your advice be to health systems and health plan executives who are trying to shift towards virtual care but are faced with big investment decisions related to technology and transforming organizations?

Jenny: Identify the sources of value from that virtual health that your organization can drive. That’s going to look quite different if you’re a large health system or a payer or a risk bearing provider group. But there’s so many solutions and strategies out there that could be pursued. One must understand what’s being optimized for patients or members — access, improved outcomes and cost or improved convenience and having that North Star to focus on and help cut through the chaff.

Oleg: I agree with Jenny. Viewing virtual health as a tool in the toolbox can break the mold on what and how you deliver care and generate value. It need not shift from one end of the spectrum to the other, but this is one component where it can deliver true innovation to patients and consumers and achieve the triple aim goal.

So, what are the components of the triple aim goal that you’re trying to achieve with virtual care? And how does it fit into your current and existing care delivery strategy? How are the two tied together? This then begs the question around use cases — How do you go about selecting these? Which solutions do you double down on? The one exciting part about the market is that it’s very fragmented. There’s a lot of change happening at breakneck speed with little clarity on how those various parts will emerge. But this is also where health systems and health plans can view themselves as shapers of what the future destiny can become, with some of them setting themselves apart from the competition.

About our guest

Oleg_Bestsennyy_profilepic

Oleg Bestsennyy is Partner at McKinsey & Company and leads McKinsey’s Next Generation Care Models domain.

Oleg has extensively served payers, providers, and private equity firms on a range of topics related to care models, including topics of telehealth, broader virtual care and care management.

Jennifer is leader at McKinsey’s healthcare practice and focuses on serving payers, providers, and healthcare technology players to develop innovative models to improve healthcare outcomes, experience and affordability. She co-leads McKinsey’s capability areas in value-based care and virtual health.

Jennifer is passionate about making the healthcare system work better for individuals in need of care. She has spent over a decade leading work with clients to develop and implement value-based care models, including incentive structures, data analytics and technology systems, and support mechanisms to enable providers to succeed in the transition away from fee for service medicine.

She also leads client service and the Firm’s research on virtual health, with a particular focus on bringing advances in digital and analytics to further innovate care delivery and improve healthcare value. She has published and spoken externally on the opportunities for virtual health and the future of care delivery.  She is also an affiliated leader of McKinsey’s Center for Societal Benefit for Healthcare, bringing expertise in virtual health to address under-resourced areas in healthcare, such as mental health and rural health.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

We’re deep in the throes of implementing several foundational technology platforms

Season 3: Episode #92

Podcast with Matthew Roman, Chief Digital Strategy Officer, Duke University Health System

"We’re deep in the throes of implementing several foundational technology platforms"

paddy Hosted by Paddy Padmanabhan

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In this episode, Matthew Roman discusses how Duke Health is implementing a number of foundational technology platforms for effective patient engagement and care delivery over the next couple of years. 

A clinician by background, Matthew describes the collaboration model among a diverse group of technology and operational executives to implement digital health programs at Duke Health. He gives us a hint of the one single question he wrestles with every day as the Chief Digital Strategy Officer. He also explains why they choose to “tread lightly” in offering clinical advice through artificial intelligence.

Matthew describes several challenges digital health startups must be prepared to face, even if they have remarkable and game-changing technology solutions. Among his words of advice? Don’t oversell. He also shares a few learnings from his experience for peer group executives in health systems. Take a listen.  

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Show Notes

01:17About Duke Health and the patient populations.
02:34Tell us a bit about the digital programs currently operational at Duke Health, maybe touch on telehealth in particular.
05:07 Talk to us about your top foundational platforms, any ones that you used to execute, and also your whole strategy. Are you using one or you are using multiple platforms for different things? How do they all fit with your other tools, especially the EHR platform? programs?
07:25 Have you been using chatbots more in the context of clinical chats or more in an administrative context for enabling access and providing patients with information on self-service tools?
09:27 Where you are in your CRM journey and what your focus areas are with the CRM platform?
12:09 In the context of a chronic disease, most of the deployments have been from RPM standpoint. How is it worked so far, especially the aspects where you bring back the data from the devices and the sensors and you try to combine that with the patient longitudinal records in the EHR?
16:11 How are you driving data and analytics program at Duke Health and how you are harnessing emerging data sources and tools such as AI?
18:12How are you structured to drive digital strategy? can you share your org model for driving digital transformation?
23:29What is your advice for tech firms, especially startups and innovators who want to be a part of your digital journey?
25:49Can you share a couple of best practices and operating principles for success with digital health programs?

Q: Tell us a bit about the populations you serve at Duke Health and your role in the organization.

Matthew: I’m the Chief Digital Strategy Officer for Duke University Health System. It is a medium-sized yet a very high-quality academic medical center located in the center of North Carolina. We’re pretty proud of the quality of care we offer through our three hospitals — a flagship academic hospital and two community hospitals — along with a large series of clinics, both primary care and a large specialty faculty practice. I report to the CIO and we support the academic mission through the Schools of Medicine and Nursing, as well as the health system functions.

Q: Can you share an overview for some of the digital programs currently in-flight at Duke Health? Telehealth, for instance, has been a big growth area for most organizations. Which one has it been for you?

Matthew: Our Digital Strategy Office was formed about three-and-a-half years ago as envisioned by our CIO, a physician himself. We are responsible for consumer-friendly, patient-facing technologies to help with our patients’ attempts to engage with us as a health system. We’re deep in the throes of implementing a number of, what I would call, foundational technology platforms on which, over the next couple of years, we will build hopefully more effective and broader reaching use cases. So, these platforms include programs, some of which are fully embedded already, some of which are in-flight.

Through our telehealth platform — our patient portal – we are trying to improve patients’ experiences. A CRM strategy around conversational AI and chatbots does exist but it’s important to reach out to the patients to learn from them what they want from us. We’re doing this through a virtual Patient Advisory Council. Some others have done this as well along with remote patient monitoring, both, in support of the telehealth platform and both supporting continuing care via virtual visits. Even if that care is initially delivered in-person, we’re able to — through these remote patient monitoring strategies — capture data points in much greater frequency to support clinical decision-making and predictive modeling.

Q: How have your patients and caregivers responded to Telehealth? What were your platforms and strategy for execution? How do they align with your EHR and other tools involved in delivering a seamless experience to patients?

Matthew: Our experience was like most others. We had a pretty small telehealth footprint. We had some early adopters and really impressive work, pre-pandemic, like our Movement Disorder Clinic. It had a Neurologist who was a very early adopter of telehealth. His patients were A-listers with tremendous movement and mobility disorders, and it took an army to bring them to our clinic. He had a pretty wide capture rate or geography and so, we were able to work with him to enable video visits to these patients. We had the same hockey stick increase in volume as everybody else did in March 2020. We went from 100 visits a month to 2000 visits a day, much like everybody else. The truth is, our highest month volume since the start of the pandemic was March 2021 and then, we’ve started to tail off just a little bit. We continue to have pretty high volume in some specialties or behavioral health and psychiatry clinics have remained very high adopters and high utilizers of our primary care clinics and certainly some of the specialty and surgery clinics as well. We have a primary platform that’s embedded in our EHR. And we have a backup platform, too. This way we’re able to capture patients even if they don’t have an app on their devices or face connectivity issues. Then, we can rescue or salvage that by sending a rescue link. We have two active platforms that we’re working with currently.

Q: You also mentioned the chatbots. Have you used them more in the context of clinical chats or in the administrative context to enable access and provide patients with information on self-service tools? Or are you doing both?

Matthew: This is a great question! We’re in the relatively early stages of implementing our chatbot and we’re cutting our teeth on administrative functions. We will tread lightly in offering clinical advice through AI, more from risk tolerance and quality assurance perspectives than anything else. I think that we’re starting from an administrative place to access some instructions, directions, wayfinding, touchless arrival, etc., and then, we’ll branch from there.

Q: Is your approach to start small, establish adoption levels and make sure that the chat works effectively and people feel comfortable before you get to the more complex, high stakes, high-risk kind of functions?

Matthew: That’s right. We’re also working hard with these platforms but the connection between them is what’s really so intriguing to me. For instance, if the patient had a remote monitoring device at home or when monitoring their BP via home checks, they engage with us via chatbots, our response is informed by the fact that the patient is being monitored. So, we could be smarter in our response and answer the patient differently via AI.

Q: Where are you in your CRM journey? What are your focus areas with the CRM platform?

Matthew: We’ve implemented an enterprise level CRM in our marketing strategy. So, that was our first stretch into CRM many years ago. Since then, at our Duke Clinical Research Organization, a large CRO, we have an installation of the same CRM tool that helps manage multicenter trials, not just site-based research into a bunch of work in the CRM but in the unit, too. Now, we’re in the 11th hour of our implementation of the CRM tool and our Access Services Center with its multiple hubs to serve our primary and specialty care providers.

What we are hoping to do is get a little smarter in our engagement, knowing who the patients are, who’s calling and their call history, which right now we don’t have much insight into but which we’ll be able to add this year. I can, very easily, envision patient acquisition thus.

From the marketing effort within the CRM tool and creating journeys from the time we acquire a patient to when we actually schedule that patient for the needed/requested services to then linking them to the portal and other things that we have downstream to continuously push engagement — clinical and administrative – so as to reduce friction and lower the barrier for entry.

Q: With regard to the last foundational platform — remote monitoring — in the context of a chronic disease, where most of the deployments have been from RPM standpoint, how has it worked thus far? Any learnings you’d like to share?

Matthew: We’re taking an approach that RPM has two really big buckets. The first bucket is to replicate what’s happened over generations. When we walk into our provider’s office, we get weighed, core temperature, height, blood pressure and heart rate measured so we can replicate that when the virtual visit occurs by remote capture, just to continue to be able to capture the same sort of quality data that we have for generations. More importantly, though, this is so that when our providers are being asked to make clinical decisions based on a single data point or very precious few data points over a long longitudinal time point, then we don’t make under-informed decisions.

We’re structuring it so we send patients home with whatever the appropriate biometric kit might be — be it blood pressure, glucose monitoring or pulse oximeter, etc. Bring these data into a lake or a repository short of our EHR where we can analyze the data and apply rules to trigger alerts. These will be alerts to the provider and care teams. If there’s a either a series of or a sequence of progressively out of range numbers or an alert or a value that’s particularly high or low, that’s somewhat dangerous and we may want to intervene or send alerts to patients.

And these might be an alert to patients because we haven’t received a value in a few days or because the values are trending well and we want to send them a nudge that says -“Congratulations! Good job! The work you’re doing is effective and your blood pressure is becoming under control. You’ve lost five pounds or the reverse.”

If the trends are actually going in the wrong direction, we want to send encouraging messages to help them get back on course and nudge the provider to maybe change the course in one way or another. The long game is once we capture enough of these data points across a broad enough segment of our population, it’s representative enough. Then, we’ll get smart about what normal recovery looks like after a procedure and know what normal or well looks like when a variant in the data is actually meaningful or when it’s a predictable variant that’s innocuous.

We’re blessed to have really tremendous data science people around to look at these big data sets and find the pearls. So, we’ll be able to set up predictive models to understand when data are mandating action be taken. This also has, workflow utility, because it can help us give patients a heads-up on events, they can expect to occur somewhere between day 4- 6 after they are back home. So, there’s some workflow utility as well. That’s our journey.

Q: How are you driving data and analytics? How are you set up to serve the multiple needs of the enterprise? What do your structures and successes look like?

Matthew: I’m a consumer of these very brilliant people I work with. One of my peers is the Chief Analytics Officer, whose team’s responsible for all the structure. They’ll explain this better but remember the lake I mentioned earlier? That was built for us to pile-in multiple data-streams. In the near future, we may make informed clinical decisions based on things beyond just the very rich EHR data. That alone is incomplete, of course. So, in this lake or repository we’ll have RPM data, social determinate data, expense/spends as well as location data to facilitate our remote monitoring journey. All of this, of course, with the consent of patients for they will be its greatest beneficiaries.

Q: Your role reports to the CIO. What’s the organization model for driving digital transformation? How did that start?

Matthew: While I report to the CIO, I’m not a deep technician nor an engineer. I come at this from a clinical angle because I’m a clinician, first, and a strategist and digital health person, second. I have a small but diverse team with broad backgrounds — from clinical informatics to physical therapists — including a nurse and a physician, who’s our Medical Director that’s responsible for our portal.

We work very carefully and closely with our colleagues in the health system — clinical and operational leads — to understand the opportunities that our clinicians can have. Our budget is also through our IT shop so we do try to make clever use of technology to ease workflows and enhance abilities of clinicians to engage with patients and empower them with information and tools to supplement their care between clinical encounters.

Our operational colleagues are critical cogs in this wheel that help implement workflows, set appropriate impact metrics, have baseline days against which to compare. I call them impact metrics because it’s not just about numbers of adoption on our portal account; it’s to understand what difference we may have made.

Q: How do you approach technology choices for your transformation especially when it comes to the risks?

Matthew: That’s a question that, candidly, I wrestle with every single day. We have invested significantly in our EHRs – both, dollars and effort. We have a very mature installation of enterprise EHR but it’s our transaction tracking and our medico-legal record keeping system. And that’s important.

We work hard because our clinicians are extremely busy people. In keeping with a concept shared with me by our previous CTO — a classic single pane of glass – I must say we have a fairly high bar in the EHR; high enough for us to tell our staffers, clinicians and administrators to go to another application for a particular purpose. When we want to bring in another application, we try to allow us to be able to launch it from within the primary health record, the place where our staff are working. We insist on single-sign-on, being able to preserve contextual awareness. So, our pendulum swings all the time between high level enterprise solutions and fit for purpose. And it’s an internal struggle. All this is to say that I know I’m not answering your question clearly, but it is maybe the unanswerable one.

Q: When it comes to innovation and innovative technologies, how do you parse through all that’s happening now in the market to find that little nugget that will stand the test of time?

Matthew: With startups, some of this advice is welcome. However, for a complex organization like ours, the sales cycle is longer than you, the startup or I would like it to be, but it’s just the reality. We work very hard to shorten it, but it’s complex. I’m not saying that’s right, but it just takes a long time. So, be patient.

I think that the point that we made a moment ago about respecting the single pane of glass as much as possible is important, even if that widget is just simply remarkable and game-changing. If we can get it in front of the users and the best clinicians, the patients, then it won’t matter.

In other words, there is a tipping point where we can put too many applications on a patient’s device and then it becomes noise rather than signal. For a patient who has comorbid conditions — and we have three or four really magical applications that could change that patient’s course if we could elegantly get that patient to interact with that application — it’s somewhat meaningless.

So, the integration of patience and single pane of glass should be easier over time because of FHIR standards, smart application capabilities in these sorts of things and the underselling and over-delivery. If it’s a niche product, it’s what it is. But the other side of that continuum is the large company or the or the medium-sized company who comes into an organization like this one and says we can solve all your problems. That’s somewhat of an oversell.

Q: That’s good advice. You’ve been in the role for a few years so you’ve had success and times when things didn’t go your way. What’s your advice or best practices that you would like to share with your peers on similar transformations?

Matthew: I love the question and I would answer it by saying — be persistent, tenacious and don’t stop. I won’t tell you that I have better practices because this is a personal semantic question for me. I don’t like that term because it implies that I already have what’s best and it can’t get better. To me, the answer is tenacity.

Try something carefully, monitor the impact, make a change, try something again. That, I happen to think, is the key. Don’t be afraid to try something new, be obviously cautious and judicious in these changes because we’re talking about patient safety. But where possible, the classic fail-fast mentality to me is wise. And then once you’ve failed, you change, learn and reapply,

About our guest

MattRoman-profile-pic

Matt Roman serves as the Chief Digital Strategy Officer for Duke University Health System. He is responsible for developing and deploying consumer-focused digital strategies, implementing innovative technologies to better engage patients and families, and extending our health IT footprint out into the community. Matt is passionate about building an optimal care experience for patients, so they can maximally engage in their health and wellness during and between clinical encounters. As a clinician himself, Matt is empathetic to needs of providers and strives to improve efficiency in care delivery while also improving clinical outcomes and supporting research.

Matt’s teams are responsible for initiatives to include digital health, remote patient monitoring, CRM deployment, patient experience, the patient portal, and utilization of conversational AI in enhancing patient experience, among other strategic initiatives.

Matt has extensive experience in hospital and clinic operations.  He ran the enterprise command centers during the health system’s electronic health record go-live, partnered with clinical and operational leaders to establish enterprise IT governance, and worked closely with community leaders to bring our EHR to non-Duke clinics like our local FQHC, Lincoln Community Health Center.  Matt has partnered with the clinical community to optimize clinical workflows and maximize the utility of our EHR for busy clinicians.  Matt is responsible for designing and deploying technologies to support patients through their health care journey and for working with providers and health system leadership to derive maximal value from our investments in health information technology. 

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

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THE HEALTHCARE DIGITAL TRANSFORMATION LEADER

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Sign up to get Paddy’s Newsletter that is personally curated by Paddy along with analytical notes on the developments for the week.

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THE HEALTHCARE DIGITAL TRANSFORMATION LEADER

Sign up to get Paddy’s Newsletter that is personally curated by Paddy along with analytical notes on the developments for the week.