Month: September 2022

Technology innovation is about combining unmet medical needs with unmet consumer needs

Season 4: Episode #134

Podcast with David Evendon-Challis, Executive Board Member and Chief Scientific Officer, Bayer Consumer Health

"Technology innovation is about combining unmet medical needs with unmet consumer needs"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, David Evendon-Challis, Executive Board Member and Chief Scientific Officer at Bayer Consumer Health discusses their approach to help consumers adopt digital health tools to manage and improve their healthcare outcomes. David also explores trends driving better self-care among consumers.

Digital health tools are gaining momentum among customers and making better self-care more accessible. However, all these innovative technology solutions must seamlessly integrate into the mainstream healthcare delivery models. David believes that increased interest in health and self-care awareness, affordable healthcare technologies, and people wanting to use more technology to communicate combined will bring the perfect storm for improved health outcomes. He also talks about the current state of digital therapeutics and its relevance in improving consumer health. Take a Listen.

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Show Notes

00:45About Bayer and the Consumer Health Division.
02:08 Self-care has become a big trend among consumers. What kind of trends are you seeing at Bayer and what is driving all this?
04:07 Can you give us few examples of the digital tools that will gain momentum with consumers, specifically in the U.S.?
07:30How much clinically validated is the self-monitored care? It seems like there's a need to integrate all the technology innovations with mainstream healthcare delivery models. What’s your take on this?
10:20What is the current state of evolution and innovation of digital therapeutics in terms of the consumer-facing devices? How are they fitting into the mainstream healthcare context?
12:46Can you talk about Bayer's approach to the movement around self-care and helping consumers with the tools that they need to manage their care better?
15:43 How is self-care different from people just taking time-off, a vacation, go on a diet, or take some me-time? Is there a connotation that you attach to the term?
19:30Where does old medicine, for instance - Ayurveda, fit in this picture? Do you see that as being a part of the self-care movement?
24:11What’s your advice to our listeners, especially those who are digital health startups looking to get their product out in the market in partnership with a global company such as Bayer?

About our guest

David Evendon-Challis is Head of R&D for Bayer’s Consumer Health Division and is a member of the Consumer Health Executive Committee. He is responsible for worldwide innovation and product development, from scoping and ideation through delivering innovation to the market via internal and external development.

David is a British national, with a first class Master’s degree in Biological Sciences from the University of Oxford, UK. Over the past 17 years he has worked across regulatory, communications & public affairs, sustainability and product development. He joined Bayer in January 2020 from RB where he spent eight years in R&D leadership roles of increasing responsibility - most recently heading innovation across the company’s consumer health business. Prior to this he worked at companies including Kimberly-Clark, Salterbaxter MSL and the Engine Group.

He is passionate about creating and scaling innovations that are purpose-driven, human-centric, scientifically robust, and credible.

David is married with two children. He is based at Consumer Health’s global headquarters in Basel, Switzerland.

David Evendon-Challis is Head of R&D for Bayer’s Consumer Health Division and is a member of the Consumer Health Executive Committee. He is responsible for worldwide innovation and product development, from scoping and ideation through delivering innovation to the market via internal and external development.

David is a British national, with a first class Master’s degree in Biological Sciences from the University of Oxford, UK. Over the past 17 years he has worked across regulatory, communications & public affairs, sustainability and product development. He joined Bayer in January 2020 from RB where he spent eight years in R&D leadership roles of increasing responsibility - most recently heading innovation across the company’s consumer health business. Prior to this he worked at companies including Kimberly-Clark, Salterbaxter MSL and the Engine Group.

He is passionate about creating and scaling innovations that are purpose-driven, human-centric, scientifically robust, and credible.

David is married with two children. He is based at Consumer Health’s global headquarters in Basel, Switzerland.

Q: David, can you talk to us about Bayer and the Consumer Health Division?

David: Bayer has been around for a long time; longer than the Queen and I. I joined the company about three years ago. I work within consumer health, which is one of three divisions—pharmaceuticals, crop science, and consumer health.

We’re a leading player within consumer health with 170 brands of which, 15 are extremely large. We focus our innovation efforts on and work across a lot of different self-care areas—allergy cough, cold, pain, cardio, digestive health, dermatology, and supplements—so we have a broad self-care business.

Self-care has become a big trend among consumers. What are the trends you see as Chief Scientific Officer of the Consumer Health Division of Bayer? What is driving this trend?

David: We’ve been seeing, for some years, an increasing interest in a lot of people to take better care of themselves. You become more aware of the impact of things like smoking, watching your weight, exercise, eating the right fruits and vegetables etc. That has been bubbling along, but there’s not been a huge emphasis on real prevention of disease.

A lot has shifted in the last couple of years, so, we know that people want to take much better care of themselves. That’s totally been accelerated by COVID. I found some of the statistics here, super interesting. In COVID, 44% of people started using new devices to help manage their health proactively. About 90% of them had positive experiences, which I think, is extremely high. Over half of the people want to use more tech to communicate with their health care professionals and manage their health.

This isn’t a new statistic but the one that always gets me and continues to blow my mind is the 200 billion healthcare searches on Google, every year. Combining that increasing interest in health care and our ability to take care of our health and prevent disease with more affordable technologies, particularly, things that are already part of our day-to-day lives may just be the perfect storm for better prevention, better self-care. That’s what we’re seeing across the board.

Q: Can you give us one or two examples of the sort of digital tools that will gain momentum with consumers in the specific context of the United States?

David: There’s all kinds of things. You go from the very simple ones but I would still count digital tools as those that help people make decisions about which products they take.

The online health and wellness questionnaires are very basic but these are on the rise. They help people navigate what is quite a complex shelf to choose what to do, what to buy, when to use it, etc. In the U.S., we have majority stake in companies like Care/of. It’s a personalized VMS company. There has been a big rise in using that from a user’s point of view to actually get better products.

There are increasing sales of specialist devices—the things that people carry with them be it their smartphones, Fitbits, or their Apple watches. These are the things that people are starting to get better insights from, and using to manage their health more and more. I can only see that becoming more important in the future as the devices get more sophisticated and better about giving us actionable insights, if not diagnoses. These are the areas that are going to help make better self-care much, much more accessible for more people.

Take my personal favorite. At the moment, for me, sleep is important but I don’t want to wear a special sleep monitoring device. I’m interested, but not that much, in it. However, I will wear my watch to bed and check it every single morning. I will adjust my behaviors based on that, and it will add that into my daily routine. That’s critical as well, having whatever the solution technology might be, something that can seamlessly integrate into your life, and that will always be as easy to be top of mind and enable us to keep doing it. Those are the things that are going to stay.

We know that complicated, unpleasant experiences—even complying with the medication, for example—may make lots of people drop out. Making things super easy and part of people’s lives is part of this.

Q: While there’s a lot you can now do to monitor yourself and take better care simultaneously, how much of it is clinically validated? It seems like there’s a need to integrate new innovation with mainstream health care delivery models. What’s your take at Bayer?

David: I look at it from two angles one of which is, there’re some really promising technologies for things like digital therapeutics, which we’ll see is in the Rx kind of area. I’m a consumer, but I can see that being absolutely relevant for consumer health, as well. In these areas, we could have a debate, although I’m not an expert about the evidence behind some of these. But there is a lot of evidence being generated on those digital therapeutics. From that angle, there’s a huge relevance for self-care and the digital drug is actually helping people to take care and treat themselves.

When it comes to using digital biomarkers to help identify where your problems are, this isn’t just about being able to run a report and giving that to your doctor. It’s about getting better, actionable insights for you to manage your own health. Those don’t always need to be 100% perfect and accurate in order to get generalized insights that can actually help you shift your behavior in a better direction to become healthier. I think there’s absolutely a role for those kinds of things and the two may ultimately kind of meet in the middle.

In the meantime, there’s a lot of value in the more general health, personal health insights that we can get from these different technologies. They can help individuals determine when they might need to see their healthcare provider and actually dig into an issue in more detail. It’s not always the case for things like, for example, my sleep. This is about me feeling better, waking up lighter, and being able to manage my busy job, two small children etc. The kind of insights that I get from my Apple Watch and the app that I’ve purchased are bang-on for that. So, I think it depends on the need.

Q: Digital therapeutics has become almost a mainstream term, now. What is the current state of their evolution and innovation as it relates to some of these consumer-facing devices? How are they fitting into the mainstream healthcare context?

David: Within self-care, it’s coming from all different angles. There are lots of different roles. If you think about this cycle from within self-care, awareness, education, engagement, assessments, diagnosis, treatments, then, in continuing that cycle, there’s this role for different technologies within that.

I’m really interested in things like the symptoms assessment tool. We’ve been working with Ada Health and piloting with a couple of our brands around the world to see what is the role of powerful symptoms assessment to help guide people when they are in areas that are quite confusing, like irritable bowel syndrome, for example, or identifying the causes of some of your pain. Some of these day-to-day things are real issues to people. There are really important technologies that are helping very much with that part of the self-care continuum we’re seeing.

Whilst there’s absolutely going to be a role for self-selection yet the questionnaire-based approaches, complement some of the digital biomarkers which are getting better, and will continue to do so. At one point, I believe, they will become acceptable to the entire health system. In the meantime, I think they will increasingly provide great information and actionable insights.

I also think that is a role and people are increasingly accepting of drawing blood and providing saliva to actually get more detailed information about themselves. All of these pieces are coming together. Unfortunately, I don’t think we quite have the glue, which is where we, as an industry, need to work together a little bit better, because all of these component pieces are pretty much there but the system isn’t quite working seamlessly yet.

Q: Can you talk about Bayer’s approach to this movement around self-care and helping consumers with the tools that they need to manage their care better?

David: We spend all day doing innovation. When it comes to digital health, versus non digital health and everything that is now in-between, the process is broadly the same. For me, this is within good self-care innovation and it is about taking a broad-scale, medical, unmet need and combining that with a big, consumer, unmet need, adding in the right technology that is going to meet those, layering in your evidence, and giving it a great product experience. That’s my recipe for good innovation. That’s the same for digital health.

So that same process is followed. I do think that technology is making it much quicker for us to get insights to develop the products. Digitalization of labs, prediction of stability, which is one of those pieces within traditional product development, takes quite a long time. We’re using digital almost behind the scenes as well as upfront in the part of the consumer or the user experience to make that whole process better and faster along with how you end up engaging with your consumers. It’s not just about going to CVS and picking up a product and that’s the end of that. We’re now able to unlock better care, better education, better engagement in our communities, all of those so, the same principles apply. But in order to add in the layer of digital, use digital technologies.

One of the things that’s super interesting for me is how all of this is unlocking prevention or the idea of prevention in a much more meaningful way. It’s always been important for people, but many of us included, haven’t acted as much on it. I think it’s human nature we deal with today and we don’t worry too much about tomorrow for a lot of things, particularly, when it comes to our own health. Part of that is because it’s hard to measure.

A lot of these tools that are arriving are actually helping us measure the things that we weren’t able to before—from my sleep score to my biological age and comparing that to my chronological age—all of these things are helping us better our awareness of today and tomorrow, which I think ultimately will help with prevention and unlock a whole new kind of series of innovations that the industry can make.

Q: We’ve used the term self-care quite a bit here. How is it different from people just taking time-off, a vacation, go on a diet, or take some me-time? Is there a connotation that you attach to the term?

David: For me, self-care and consumer health are kind of interchangeable. It’s things like me-time that’s been definitely used as a similar attitude to self-care. Me-time is very important, but for me, it’s not health. Self-care is about evidence-based, credible products and services that are going to improve people’s health. So, there are many different things that play a role.

Alternative medicine can also play a role. However, I believe in evidence-based products and services and that’s really at the core of self-care. It doesn’t mean that these all need to be drugs.

We innovate on herbals and naturals. We have a brand in Europe called Iberogast. It’s had multiple clinicals over many years so, there’s a big body of evidence around treating the symptoms of irritable bowel syndrome, for example. It’s a combination of six herbal extracts so it doesn’t just need to be a drug, but that evidence is really important for me as part of this.

In the last couple of years, I’ve come to the conclusion that there isn’t a great definition of what great self-care looks like. So, along with a couple of colleagues this year, we put down some thoughts on what great actually looks like when it comes to self-care, not in the end product, but how you get there.

That’s really important, particularly when it comes to trust and credibility and ultimately, for us, it’s about combining their real deep medical insights, the science of the human being able to tap into sometimes emerging science and discovering new ways to meet people’s needs with technology, which can be drugs, digital, being able to leverage work within and influence the regulatory environment, which within consumer health is extremely fragmented.

It’s also about things like collaboration and my personal favorite topic, the consumer products experience. This is something which some companies, brands have forgotten a little over the years or maybe never got to. I think sometimes with pharma heritage, there hasn’t been that focus on actually providing a brilliant product experience.

Ultimately, if we want people to take care of their own health, we want them to use something on their own to manage this. It needs to be simple, credible, and work. I need to know and feel that it’s working so that they can continue using that product. I think when you combine all of those different elements, you get really good self-care products. That’s what we’re aiming for.

Q: Where does old medicine for instance, Ayurveda, fit in this picture? Do you see that as being a part of the self-care movement?

David: I think two things—people should do what works for them to manage their health. That’s my general belief. Regardless of what I believe, people need to use their own internal compass, do what’s right for them, feel what works, and go with that.

As much as I might be skeptical about some areas in it, I do think there are lots of areas within alternative medicine and Ayurveda, for instance, has a rich history and lots of evidence. It might not always be packaged in the same way as others but, there are things that are proven to work for many, many people.

That’s incredibly important and needs to play a role within health care, including within self-care. For the areas that have no scientific evidence behind them, it will be much harder for them to enter into that credible health area. There are so many that do.

Q: Health care, at least in the United States, is all about who pays for it. There’s the all-important question of following the money when it comes to health care. How does Bayer approach it when it comes to really driving adoption for some of these health care products that you’re putting out?

David: I think it’s evolving. Over the next couple of years, it will continue to evolve, particularly in the role of those small, premium devices.

In general, there’s a role for expensive, niche diagnostics for those that have the money to use them and are motivated to do so. That can generate evidence that can be relevant for the rest of us who are actually out there self-selecting a product.

So, I think that you can use and it’s not just the halo effect, but it’s the evidence you can generate from an increasingly broad population of people that are buying into the top of your pyramid of world class diagnostics along with say a series of supplements or a different kind of OTC product. You can then use those insights to help everyone else select what would be best for them. I don’t think everyone always needs to buy into all parts of this ecosystem.

There are some real benefits that the more the data we generate about products by the interaction of different products with different behavioral interventions, combining that with different factors—areas where you live, how old you are, etc.—will all give much more targeted advice to the people that don’t want or can’t access that.

But we can give them the great insights to say, actually, for someone like you, this is much more likely to work. That’s a real role. I don’t think there’s the elite versus everyone else but that there’s a huge role in taking the evidence generation that guides everyone. There’s always going to be a role for simple products and good education, with robust evidence behind them that people can opt in at an affordable price to help them manage their pain, their anxiety, whatever that might be.

Q: You mentioned partnerships. What’s your advice to our listeners and especially those who are digital health startups looking to get their product out in the market in partnership with a global company such as Bayer?

David: My advice is, it’s a great time to be working in health care and looking for partnerships because I think everyone has recognized that we need each other. In the many years I’ve been working in health partnerships, I’ve seen lots of great failures as well as some good successes. It’s all about the fit. Finding the like-minded organizations with great people who you can trust is as important as a potential deal or a potential commercial opportunity. It’s something that people like to run into first.

But what I’ve learned is when you take the time to understand where a founder is coming from, where an organization or large corporate priorities are, and you can start to find that common ground, that’s a fantastic place to start.

Then, you start to build a relationship rather than a transaction. This might be a little bit fluffy, but in my experience, that spot works and you get to the deal. You can then be more flexible when you’ve built up the trust.

I think it’s about researching, understanding, connecting, networking, and finding those like-minded companies because there can be a lot of wasted time. We will spend a lot of time researching different technologies, talking to lots of different people, and lots of these things are going to be dead-ends. That’s okay. That’s part of the process. Taking the time to get that fit is right.

And what do you really want? If you’re a small company, are you looking for geographic expansion? Are you looking for fantastic regulatory expertise to scale your proposition? Do you need help with evidence generation that’s going to allow you to skyrocket your growth? Are you looking for brilliant, supply chain expertise to trim out the costs to bring your product to the masses? What are you looking for? What are the skills that your partner or many partners have? That’s the most important thing to me.

We hope you enjoyed this podcast. Subscribe to our podcast series at  www.thebigunlock.com and write to us at  info@thebigunlock.com

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

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.

Consumers are looking for instant gratification with their digital health experiences

Season 4: Episode #133

Podcast with Reid Stephan, VP and Chief Information Officer, St. Luke’s Health System

"Consumers are looking for instant gratification with their digital health experiences"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Reid Stephan, VP and CIO of St. Luke’s Health System, discusses how consumer research drives digital priorities, mobile applications, and other digital features. He also talks about creating a robust technology infrastructure to deliver the superior experiences consumers demand and expect today.

St. Luke’s Health System is a large health system looking to deliver outstanding digital experiences to its patients. Reid discusses three things that significantly impact a frictionless patient experience and talks about how they approach care management, home health, remote monitoring, and more. Take a Listen.

Our Podcast Partners:

Show Notes

01:29About St. Luke’s Health System and the populations that you serve.
03:18 What are your thoughts on the digital health program at St Luke's? Tell us about your current priorities as the CIO in supporting digital initiatives for the organization.
07:33 What are your consumers telling you about what they’d like to see and therefore what might go on your roadmap?
11:41What are some of the common metrics that you track when trying to understand whether your investments in the digital programs are meeting expectations?
13:30Are there any macroeconomic factors that are driving some of your priorities today, either at the national or at the regional level?
15:52 How has the payer mix changed for you and how does that drive your investment priorities?
17:12 How are you using data and analytics to drive access-related initiatives?
19:23How are you setting up your whole IT infrastructure and your foundational platforms to successfully drive digital engagement?
22:27Can you talk about the application solutions? You are Epic first, but how do you choose when enabling the digital features and functionalities that your consumers demand?
24:07How are you addressing providers and caregivers’ expectations?
26:10What’s your approach in care management, home health, and remote monitoring?
28:27What are the one or two pieces of advice that you would like to share, either with your peers or with the technology provider community that wants to be a part of your journey?

About our guest

Reid Stephan is the VP, Chief Information Officer at St. Luke’s Health System. St. Luke’s is the only Idaho-based, not-for-profit health system, with 9 hospitals and 200+ clinics serving the needs of communities across Southwest Idaho. He has over 20 years of experience in the technology space, including serving as St. Luke’s Chief Information Security Officer prior to his current role, and 9 years leading HP’s global corporate IT security incident response program.

He has a Bachelor of Management Information Systems from the University of Idaho and an MBA, Technology Management from the University of Phoenix. He is a HealthCare Information Security and Privacy Practitioner (HCISPP) and a College of Healthcare Information Management Executives (CHiME) Certified Healthcare CIO.

Reid Stephan is the VP, Chief Information Officer at St. Luke’s Health System. St. Luke’s is the only Idaho-based, not-for-profit health system, with 9 hospitals and 200+ clinics serving the needs of communities across Southwest Idaho. He has over 20 years of experience in the technology space, including serving as St. Luke’s Chief Information Security Officer prior to his current role, and 9 years leading HP’s global corporate IT security incident response program.

He has a Bachelor of Management Information Systems from the University of Idaho and an MBA, Technology Management from the University of Phoenix. He is a HealthCare Information Security and Privacy Practitioner (HCISPP) and a College of Healthcare Information Management Executives (CHiME) Certified Healthcare CIO.

Q: Reid, tell us a little about St. Luke’s Health System and the populations that you serve.

Reid: St. Luke’s Health System is based out of Boise, Idaho. Our geographic footprint covers southwest Idaho and a little bit of eastern Oregon and serves the populations there.

Our system comprises eight medical centers and a couple of hundred clinics and centers. We see about three million visits a year between those settings and the population is dynamic. It covers a broad cross-section. We’ve had an interesting change in the last couple of years with a huge influx of folks moving into the valley in the Boise area, in particular, which has shifted our population a bit. Given how it covers a city area like Boise, smaller towns, rural hospitals, and rural areas, it then provides challenges in terms of access and equity of access. So, it’s really a unique market where we have a little flavor of everything, which makes it challenging, but also exciting and rewarding.

Q: Do you have a large rural population that’s widely dispersed in some way as well?

Reid: Large in terms of geography, but I wouldn’t say large in terms of population compared to some of the city urban areas. Certainly, large in terms of just the consideration for digital, in particular. You can assume that they’re going to have broadband access or even a device to engage in some of those opportunities.

Q: What are your thoughts on the digital health program at St. Luke’s? Tell us about your current priorities as CIO of the organization in supporting digital initiatives for the organization.

Reid: I have a love-hate relationship with the word “digital.” I understand it, and it’s the context that’s important, but it’s one of those words that get used so ubiquitously that it can start to lose meaning. Then, you have this Tower of Babel experience where people all hear the language differently.

For me, one of the success measures will be when we just start to talk about health generally, and that just naturally encompasses digital. In my mind, I don’t differentiate between my Amazon experience when I’m on my device ordering something versus when someone physically comes to the door to deliver it. It’s just all Amazon experience.

It’s with that backdrop that we set up a Consumer Access and Experience Program (CAE) a year ago. One of my colleagues and great partners is the VP who leads that. That group’s been tasked with not disrupting for the sake of disruption, but really challenging how we think about things and helping us really start with the question because we think that’s the most powerful tool in the toolbox. Don’t go out and ask users what they might want or expect them to design what that digital health experience might be like, but really, bring questions to bear to draw out from what might be best for them.

There are a few things on which that program is focused on that we’ve helped as an IT shop. We launched an app earlier this year and while it’s still nascent in its development, it’s an engagement, an access gateway, and an experience gateway for the future. It gives us a nice cornerstone then, to build on basic things in place there, now. You can access our patient portal, our website to find physicians and locations, and pay your bill too. We’ve put together a few digital assets into one unified experience, and now we need to really gain insights to understand where to add value and components to that. Where can we reduce friction from that experience?

Another thing that the CAE group has championed that we’ve supported is, an on-demand virtual clinic. Like everyone else, we saw a rapid increase in virtual visits with COVID, so, tapering-off of that last year. But it clearly demonstrated to us that there is an appetite in the market for consumers that want to consume their health care through digital for certain business types and needs. Creating a clinic that’s focused just on that and using it to understand preferences and behaviors, has made us look at ways that we can take advantage of existing capacity. Rather than move right to probably bringing it in and looking at how we’re going to augment and outsource the physician or provider need, we’re looking internally at our capacity in other areas where we can have doctors and other providers who can come in to bear on that need and chip in. I’m excited about just some of the early conversations there.

The last thing I’ll touch on is one of the roles of CAE is to just take a hypothesis, experiment quickly, and learn from it. We’re about to launch a medication locker at a local grocery store that doesn’t have a pharmacy. This is just a small test of change to learn and understand consumer appetite, preference, and desire using that omnichannel approach, where we can give consumers a variety of options and then, understand where preferences lie. Subsequently, we hope to guide them to the option that might best be suited for them. I’m really excited about that kind of focus on consumerism.

Q: You’ve mentioned the mobile app and the urgent care initiatives. What are your consumers telling you about what they’d like to see and therefore what might go on your roadmap?

Reid: If I just used one word to describe it, it would be “instant.” They want the same experience they have in just about every other vertical of their life where it’s always on, always available, and there’s that instant gratification or results from what they’re pursuing. Granted, there’s certainly that in health care but, there are situations where that’s just not a logistical possibility. But there are a lot of areas where we can improve that experience, give that access, and that instantaneous result to the consumer.

Some of the things we’ve done to help glean insight from the consumer include focus groups, which are interesting and simple things like going out and visiting with consumers and asking questions. Our CAE group did something fun this year when a group of students from Harvard wanted to do a case study. They came to Boise and we gave them a problem to look at. They spent a couple of days analyzing and undertaking the academic approach and then, generate a report for us.

Interestingly, one of their insights or hypothesis was that one of the challenges you have with something like your patient portal is many of your consumers use it so infrequently. Like I said, it’s based on when they have the need. Compare that to your banking app, the Amazon app, and the social media app that you’re in kind of daily. You develop this dexterity and familiarity with how to navigate there so then, it seems easy. But when you’re just logging on to MyChart once or twice a year to schedule an annual wellness exam or an episodic kind of need, it’s going to feel foreign because you just don’t use it enough.

That’s been a really interesting observation that we’re kind of just churning over and thinking through about how do we ensure we don’t overinvest in building up every single detail of a completely frictionless patient portal experience when the bang might not be worth the buck? Let’s focus in on maybe the one or two things that really, really matter.

Another insight we’ve gleaned is three things that have the biggest impact that we’ve observed on Net Promoter Score. First and foremost is receiving services, which makes sense. Next, our Schedule and Appointments and Finding a provider. And then, way down on the list is Wayfinding. That was interesting because we’ve kicked around Wayfinding for a long time and the thought was how cool this would be. Given we face financial constraints, we had to be really disciplined and ensure that the investments we were making were going to yield the biggest benefit. They were narrowing our focus then, on how to improve that experience for scheduling an appointment to make it as frictionless and as easy as possible? How do we make that experience easy for someone to find a provider? Or even to find out the details they might want to know about that provider?

That consumer insight is really a key for us because that helps us then, to not only meet the consumer need, but be wise stewards of our resources and ensure the work we’re doing is going to have the biggest benefit for that.

Q: Can you share a little bit about what are some of the common metrics that you track when trying to understand whether your investments in those programs are meeting expectations?

Reid: It’s really the pedestrian ones that you would expect. We look at active MyChart users, meaning they’ve logged on some time in the previous 30 days. We do that ratio against our total MyChart user population.

We look at the percentage of patients that use MyChart to schedule an appointment versus those that call our connection, the percentage of folks that use MyChart to refill a prescription request, and that would use MyChart to look at their images or review their after-visit summary in the provider notes. We just really focus on consumption.

One of the things that has been stuck in my mind is, if you accept the fact that the typical consumer then, is just occasionally using your digital health tool and particularly, your patient portal, then, that begs the question that there must be value you’re giving them other than that episodic, specific need they have.

That opens up a whole pantry of opportunities that are really interesting to examine about what we can offer then that would make that app more of a frequent digital stop for that consumer, where they don’t view it as just the transactional experience of St Luke’s, but as holistic within how they’re thinking about their care, whether it’s diet or exercise or preventative kind of regimens. It’s such a great time to be in health care because we own so much of the solution if we can be really thoughtful about leveraging the data we have, gleaning the right insights from it, and then, acting on it.

Q: Are there macroeconomic factors that are driving some of your priorities today, either at the national level or at the regional level?

Reid: Absolutely. I talked to the CIOs on what difference a year makes and that’s the mantra certainly for this last year. Financially, there were two things that really put some headwinds in place for us. We still have a large volume of travelers that are onsite just to fill our critical nursing needs. We have high volumes—the highest that we’ve ever had—but then, we’ve just had this shift in our labor market and there’s this need for nursing but we can’t hire nurses fast enough. To some degree, there is a trickle-down of that.

On the I.T. side, certainly with the labor market and remote work, it’s up-rising but there are challenges that ensure that we’re being competitive, flexible, and agile in order to have a great workforce and keep the culture we want.

There’s also the payer mix which has been an interesting shift for us since we’ve seen that move in a way that’s not favorable. That pressure makes it more imperative for us to realize that in an era of constrained resources—this isn’t something that’s going to go away in a month or a year or two—it’s the new reality we’re going to have to get really adept at living in.

In a way, it’s a gift that’s going to force us to narrow our focus and understand that while there are some things that we are good at and can be better with, we only have capacity to do the very best thing. So, we have to get it right. We don’t have the luxury of an Amazon to put ten pokers in the fire and hope one of them works out. It’s a challenge, but it’s also helping us mature in a way that we otherwise might not be able to do.

Q: How has the payer mix changed for you? How does that drive your investment priorities?

Reid: At a high level, we’ve seen a shift in government payer versus commercial payer, and being a not-for-profit health system, thinking of even a small shift can have an impact. But the conversations we’re having are not about, “How do we shift that back?” Because that’s not the right answer. The answer is, “How do we care for this population?” If this shift is causing this kind of financial strain for us, then, we need to innovate and figure out ways to do it where that government payer isn’t such a drain.

There are opportunities to figure out how reduce waste, focus more on the health care side, and avoid readmissions or avoid a hospitalization, in the first place. That’s again an opportunity to do some cost cutting and wait till things get better. In fact, it’s a chance to reimagine how we’re doing things.

Q: With regard to data analytics, can you share one or two examples of how you’re using data and analytics to drive access-related initiatives?

Reid: We are a developing nation in this state. We are fast followers and love to learn and glean from others. It’s not unique to us but we are data-rich and in many areas, information-poor.

So, with our data and analytics team, one area of focus is trying to be very explicit and disciplined with operational partners and really defining when they come to us and understand the job we’re trying to do. Like – why are you trying to hire this data? Trying to understand the outcomes they’re actually after, trying to offer datasets they’re not aware they have access to where they can do some of this exploratory and inquisitive exercise on their own. And trying to get out of the arena we’re in today where some of the capacity is being consumed by requests for dashboards or like – we have a dashboard, but I don’t want to treat to look like this. We’re trying to get out of that kind of service requests.

We take a first-come-first-served approach by an analytical team to really put together a comprehensive data platform that can then be used to answer a variety of questions, whether it’s on the clinical side or the business operations side or a CRM side from the marketing standpoint. It’s early days in that because right now, often, it’s based on the immediacy of the need in terms of how deeply we dive into a request that comes in. But we’re really trying to create something that’s comprehensive, scalable, and positions us for the future.

Q: How are you setting up your whole IT infrastructure and your foundational platforms to drive digital? You’re an Epic shop, so that’s key but what else drives a successful digital engagement?

Reid: A couple of things come to mind. We have a cloud forward strategy. It’s not cloud-first. It’s not cloud-only. It’s just that we certainly look to the cloud, but we are so focused on wanting to move things to the cloud that we then miss the chance to critically think through opportunities as they arise. For example, we’re an Epic shop. It’s hosted on-premise and we don’t have any plans in the near future to move that to the cloud, although going forward, I would expect that may be an ultimate outcome. But there are areas where it does make sense.

Between our colo data center and our data center at one of our hospitals that’s a couple hours away, we have a completely redundant infrastructure to run Epic for the entire health system—it’s expensive, doesn’t scale well and we have to maintain 100% capacity, 200% total in the event that we may need it. Now, if you think about it from a risk standpoint, those data centers are about two-and-a-half-hours apart, so potentially there could be a geographic event that impacts both data centers. Therefore, we’re moving our Epic VR capability to the cloud over the next year so we have the ability to just have a small presence there that can be scaled up when needed.

It’s the same thing with regard to the other solutions—we have a mix of SaaS, public-private cloud, and on-prem things, so, we’re always looking at what’s the best solution for the current state operational need and what can provide the cleanest path for that future roadmap.

One thing that we’ve learned early on is, it was years ago that we used to lead with the cloud and consider the ROI in terms of spend or savings. It’s just not the case now. It’s your dollars kind of spend elsewhere. However, there’s been a couple of transitions, especially with our finance team, to help them understand that you may not get such cost savings that you’ve heard about at the CFO conference so here’s what you do get what’s beyond the savings. You’re going to get all that the company has to bring to bear in terms of expertise, infrastructure, and cybersecurity, built in and baked in. These are things that we may not be able to ever fully do on our own or fund on our own. That’s our mindset.

Q: Can you talk about the application solutions? You are Epic first but how do you choose when enabling these digital features and functionalities that your consumers demand?

Reid: We have a Strategic Technology Investor Committee and our three pillars of our backbone assets. We have Epic for our EHR. There’s Microsoft, which runs our desktop server infrastructure. Then, there’s Infor, our ERP.

Our guiding principle is, we’ll look to these vendors first—not always, not only. Previously, it used to be, “Hey, I went to a conference, found this great tool, and I want to use it.” Before we knew it, someone acquired it so we’d be trying to figure out how to integrate it into interfaces and then, it’d have duplicative capability we already owned.

We’ve been able to redirect that now to facilitate good conversations. People have varying opinions of Epic based on where they are, what they’ve been listening to, or reading, lately. What we’ve learned through this is, it’s helpful to enable people understand the significance of the investment we’ve made. This is a choice that we made as a system for our EHR, and it is no small investment. If we ever do something outside of Epic, we have to then, do it intentionally. We have to make that decision that we’re going to add incremental costs for whatever reason—either Epic doesn’t have it or it doesn’t meet our needs the way we need it to. But we try and use an 80-20 rule in those conversations. If we can do this at Epic, Microsoft, or Infor and it meets 80% of the need and is not introducing any kind of unacceptable risk or safety issue, then, that’s what we’re going to start.

That’s been very effective and ensured we certainly have avenues for complementary solutions in areas where we really don’t.

Q: What about providers and caregivers? What about their expectations? How are you addressing those?

Reid: Well, they’re fatigued and they’re tired. What I hear most from providers is, “I just want to treat patients. I just want to talk to my patients.” I go see my provider. He knows my role in the organization and he always has a list for me, which is great because he’ll take care of me and then, I try and take care of him. But his number one thing is, “I don’t like that even for a second I have to take my eyes off my patients and be typing on the keyboard, update something.” It doesn’t have to be that way.

We are looking at some ambient listening-type experiences that can augment that. In-basket, the providers view that as a burden. So, we have a project and a way to figure out how we can automate or bring in other resources to offload some of this burden because it’s for our providers and nurses. It’s a risk to their well-being, to the capacity to care for patients, and for their commitment to the profession—for some of them, long-term. That keeps me up at night, just trying to think through all the opportunities in that target-rich environment. How do we really define that? What are the one or two things that we should be all in on that are going to make the biggest impact for this population?

Q: What about digital in the context of care management? What’s your approach in care management, home health, remote monitoring?

Reid: We have what we call a virtual care center as a 24*7*365 digital telehealth hub and a dedicated team of expert physicians, nurses, allied health professionals, and I.T. folks. What it does is offer three key services.

There’re Virtual Care Centers for Clinic Consultations. If a patient at the clinic sees their doctor and then, has some need for a specialty or some kind of advance discussion, we can virtually bring in someone from the virtual care center. That can all happen in that single-visit location with the patient, rather their referral. They then, have to actually sit down after the fact.

We do a Hospital Consultation which is the same kind of concept where the hospitalist then can, through a telehealth video visit, bring in that expert that might be needed.

We also have Telehealth ICU monitoring that really expands the capacity that we have, to monitor patients in an ICU.

With regard to Home Monitoring, we certainly have programs that support patients at their homes. We provide them the devices that collect relevant information, send that back to the virtual care center, where cross-functional teams receive, assess, and intervene as needed before updating appropriately that patient chart.

I’m really proud of that work and excited for this foundation that sets us up for the future. That emerging space is so important and this Hospital and Home is one of our key initiatives to try and really make some headway there. Because our evidence shows that patients are more comfortable in a home, it’s no surprise that a lot of cases heal, recover, when their care is better delivered at home.

Q: What are the one or two pieces of advice or best practices that you would like to share, either with your peers or with the technology provider community that wants to be a part of your journey?

Reid: We could do a whole show just on that but I would say this, and this is not a technical answer at all, that it is really an important grounding principle for me. Don’t ever be embarrassed by where you’re at your journey and don’t be afraid to start because of where you’re at.

There’s so much great content out in the community. There are folks who bring on their thinking, expertise, and where they’re at, that it’s like light years ahead of where we are. It’s easy maybe to start to think, “Oh, I guess we’re just not smart enough” or “Man, we’re never going to be as good as that person or that system.” I think that’s the wrong mindset.

We’re all where we are for a variety of reasons, but we all have the same opportunity, even if it’s just incremental, to improve that experience whether it’s for the patient, a provider, a colleague, or just within the operational work of the hospital or system where you’re at.

I would just say, as you’re empathetic, curious, and as you engage in rapid experimentation, you’ll be surprised at the progress you make. No matter how unsophisticated you might think you are, the work you do, matters. That makes a difference. Don’t ever let that comparison or your own ego get in the way of that.

We hope you enjoyed this podcast. Subscribe to our podcast series at  www.thebigunlock.com and write to us at  info@thebigunlock.com

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

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.

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.