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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.

The post-COVID normal looks a lot like the pre-COVID normal, plus a plethora of other responsibilities and activities.

Season 3: Episode #91

Podcast with Mike Restuccia, SVP and CIO, Penn Medicine

"The post-COVID normal looks a lot like the pre-COVID normal, plus a plethora of other responsibilities and activities."

paddy Hosted by Paddy Padmanabhan

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In this episode, Mike Restuccia discusses the state of telehealth in the pre-and post-COVID era and how the overall workload for the technology function has expanded significantly with the onset of virtual care models. He discussed the role of the IT function in the context of the overall mission of Penn Medicine that covers education, research and care delivery.

In this extended interview, Mike discusses a broad range of topics including the role of big tech and EHR companies in the digital transformation journey, his approach to technology vendor relationships, and a governance model for identifying and nurturing innovative startups. He discusses the use of newer data sources such as genomic data in the analytics programs at Penn and the challenges of AI-enabled solutions from the vendor community that overpromise and under-deliver.

Mike also shares how he spends a significant amount of time attracting and nurturing tech talent, and how to support and empower high-performing teams. Take a listen. 

Note: Penn Medicine has published several insightful reports on the IT function’s contributions to the overall mission. These provide valuable insights into the functioning of one of the largest and most prestigious medical institutions in the country. Interested readers can download the reports here.

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Show Notes

00:48What does the post-COVID normal look like at Penn Medicine? What you are working on to prepare for the next phase?
02:52What are the broad trends in the healthcare sector and the changes in the competitive landscape that you are following at the enterprise level to drive technology priorities?
07:41 How have your patients, consumers, and caregiver community responded to the shift towards a digital mode of engagement? programs?
10:33 Have you reached an equilibrium between telehealth and in-person visits? Are you designing the future based on this equilibrium?
12:44 How do you leverage the technology partner ecosystem to drive your enterprise priorities?
15:19 When you realize that your existing partnerships might not have what you need, how do you go about sourcing it from elsewhere or you build it internally? Can you talk about your approach?
18:09 What's your advice for digital health startup founders who want to be a part of your journey and may have something?
22:28What are the challenges that you have had to overcome, especially when harnessing innovation from the marketplace as opposed to innovation from within your existing technology partnerships?
24:21Tell us a little bit about what is the overall mission when it comes to your data and analytics group. How are you supporting - the academic, the research and the health care delivery side of it?
41:10Can you share best practices for the benefit of our industry colleagues on their digital journeys at various stages?

Q: What does your post-COVID, new normal look like at Penn Medicine? What are you preparing for in the next phase, especially from a technology standpoint?

Michael: In many ways, the post-COVID normal looks like a lot like the pre-COVID normal plus a plethora of other responsibilities and activities. So, the post-COVID normal’s more frenetic with things that we’ll see much more of. Pre-COVID we’d been focused on expansion, running, maintaining and growing and all the EHR-type things. Post-COVID, it’s all that plus more engagement, faster expansion, greater monitoring of patients in our remote manor — all big lifts from an IS perspective. We had a pretty substantive role and job as a team pre-pandemic, and post it, it just doubles or triples and there’s no sign that it’s going to slow down.

Q: Interesting observation. Post-COVID, telehealth modalities and virtual care models have gained a lot of ground. What are the top three trends and how do those trends drive your technology priorities?

Michael: I will start with telehealth. Pre-pandemic, we were doing a few hundred tele-visits a month. At its peak, mid-pandemic, over 8000 tele-visits, a day. Now, it’s plateaued to around 3,000 per day, but that’s still significantly higher than our pre-pandemic days. Telehealth is here to stay. It’s an area we need to focus on and from a maturity perspective, we have a pretty good solution in place. But there are other vendors rapidly advancing their telemedicine delivery capabilities into us. Integration with our EHR is critical and getting that done in future will be top priority. Our patients and providers love it.

I had mentioned remote monitoring, a while ago, in the home or in particular within our ICUs across our six-hospitals’ enterprise. We have almost 250 ICU beds, and each is now monitored with a camera connected to a central location. Thus, tele ICU caters to 24*7 monitoring and care. It helps from the delivery of care and responsiveness perspectives and the staffing angle too, because those six hospitals are located in a 150-mile radius which makes staffing, mission-critical.

The third thing I’d speak to is just enhanced patient engagement, which can occur through the patient portal to deliver results, schedule appointments, undertake administrative types of tasks, pay bills, communicate with clinical teams or even, push information and alerts to our patients. That was significant through the pandemic. It was a new opportunity when outpatient clinics were re-opened after having ambulatory clinics, and then again significant with the re-opening of hospitals for non-essential surgeries.

We began an interactive texting campaign that communicated with patients via their phones and asked them a series of YES/NO questions 24-48 hours before they visited us. Based on the responses, the patient would either be cleared, or the employer would be cleared to come back to work. Patients could be cleared to come to the clinic or would be triaged off to a care team. The latter only if patients responded with a list of symptoms, we would not want them coming into the clinic. The care team would reach out to them at that point in time. This is another example of using technology for good engagements with patients.

Q: How have your patients and consumers responded to the shift towards digital modes of engagement? How has the caregiver community responded and what has that experience been like?

Michael: I’ll start with the patients first and this is a bit more anecdotal than scientific. What we consistently heard from the majority of the patients — and there is some differentiation based upon perhaps age or tech-savviness, irrespective — they were thankful. Thankful that we were attentive, concerned for their health and that of their caregivers and other patients in the general vicinity. Overall, it was a big win because of the positive engagement and the way we communicated with our patients.

From the caregivers’ perspectives, it was a big change in the workflow. Now one had to follow multiple steps just to see a patient. So overall, I think the response was mixed or much more positive than negative because interestingly, there was a segmentation of those physicians that were very comfortable using the technology and embraced the concept of using a telemedicine-type approach. This way, they could see more patients, have less downtime, maintain a higher adherence rate to the meeting, resulting in fewer no-shows. On the other hand, there were those that said a tele-visit was OK occasionally, but that patient had to be seen. This meant observing more than just how they were interacting through the screen.

Q: Your telehealth visits went up to about 8,000 a day from a few hundred a month. And then, fell to 3,000 a day today. Is this an equilibrium you have achieved? Are you designing the future based on this?

Michael: I think we’ve reached an equilibrium for now but there is substantial pent-up demand to come back and see in-person, which sort of impacts the decline and that plateauing. I feel there will be another bump in our use of telehealth for several reasons. One is we will have experienced that pent-up demand for in-person visits. Secondly, we’ve learned that not every visit has to be in-person and some balance/ratio of visits per patient can be maintained (one inpatient may have one in-person and two virtual visits, for example or that could be in ratio of 1:3). Thirdly, I think the strength of Penn Medicine lies in the breadth and diversity of care offered and as that expands, it will support more of the telehealth type of engagements.

Q: Penn Medicine, with its historical heritage and as an academic and research institute plus a healthcare delivery organization, is unique as is your mission. From a technology standpoint and your strategic tech partnerships, how does all this drive your mission?

Michael: We believe in few but deep partnerships. We don’t have five different vendors providing 12 different solutions for the same cause because we prefer going with one vendor across the board and implementing common systems that are centrally managed and collaboratively installed. That works very well, across the networking, EHR, telephony sides and other aspects. That’s our approach — standards and systems across the enterprise. We are focused on patient care research and teaching around 121 academic medical centers in the country. It is a unique mission that requires significant integration among those three towers than ever. Our approach towards genomics and leading that into patient care and precision medicine and precision health really makes these times exciting. And that where it gets real exciting with the things that we are doing that is transforming care. But from a partnership perspective, several solutions at most deep relationships that are common across the system is really the attributes that we seek.

Q: While your partners possibly deliver much of what you need, they don’t deliver everything. How do you go about sourcing this from elsewhere or building it internally? What is your approach like in this case?

Michael: Regardless of whether our partners are providing us the proper solution or not, we’re always looking to innovate and that’s within the corporate IS, as well as in partnership with our Center for Health Care Innovation, which is a close ally and very dependent upon corporate assets. So, the Center for Health Care Innovation is a part of Penn Medicine, led by Dr. David Asch and Roy Rosen and their team is focused on what we should be doing next to either improve efficiency, care, accelerate research. They’re quite focused on new technologies, workflows and endeavors and very dependent upon corporate IS for those networks, data, and project leadership in order to advance some of those causes.

How this works is — the Center for Health Care Innovation will identify an opportunity and organize the appropriate constituents because there’s more than IS and big thinkers that need to be in the room. One needs operational assistance, clinical assistance, perhaps research assistance as well. Once that’s organized, a proof of concept is performed to see if the thought really does hold water. If it does, then we try to do a pilot and one that’s completed, we try to determine whether corporate IS should try to scale it across the enterprise. That’s the kind of the approach we’ve taken internally to advance our causes. Often, whether it’s improving access to a particular department, making care more convenient for patients or introducing mechanisms so patients don’t have to come on-site as much and be treated more in the home, are examples of how the Center for Innovation has advanced certain causes.

Q: For digital health startup founders listening-in, how can they reach out to you or someone like you to showcase their solution or capability? Any advice to those who want to be a part of this and may have something?

Michael: People find ways to get to me, Roy Rosen, and Dr. Ashe — no challenge there. We’re pretty public figures. So, we encourage them to reach out and share their ideas and their thoughts. And we look at them all. Whether it’s patient care and engagement or access to care, all of these are things we’re readily looking at on a daily basis to try and improve upon. We’ve made a lot of advances because of the pandemic and there’s more to come. This spirit of being able to introduce things that were once thought to be not possible is amazing — Who would’ve thought you could go from 300 to 8,000 tele-visits? But when you focus on it, you can get it done.

We do have many people that reach out to us and find their way into the Penn Medicine ecosystem. It might be through a friend working here or a Board Member or via some other channel, and it just arrives. The first few times, we took a stab at trying to figure this out on the basis of the recommendations but realized that just because a person says they’re good doesn’t mean they necessarily are. We spent a lot of cycles trying to understand the firm’s stability, their product and their ability to need support, secure any data that we might share with them, their potential for long-term sustainability and had our misses.

So, we introduced a multidisciplinary committee that I Co-chair with Roy Rosen from the Center of Innovation Health Care Innovation, and we call it the New Technology Review. And before we go too far with any new potential partner, we ask them to present to the committee in a one-on-one to better understand their capabilities. This has dramatically lowered our misses, improved efficiency, communication, and efficacy as we move forward with some of these newer technologies and firms. We’ve managed to smooth the waters here and keep people focused on what’s most important.

Q: When you get new solutions, they should be compatible with your overall technology environment which can be quite a challenge. What are the top challenges you’ve overcome when harnessing innovation from the marketplace versus innovation from within your existing technology partnerships?

Michael: It’s the overselling, overpromising and then, under-delivering though some of the firms have been really solid. The sales teams or business development teams have a great vision, but on the flip side, they don’t really have the delivery mechanism tied to it. So, you end up short and that’s where my team ends up having to cover and pick up the slack, because by then, the idea has been sold and budgeted. Leaderships expects some results, after all. That to me is one of the biggest problems we’ve experienced.

Q: You’ve made great strides with your data analytics program and how you’re harnessing genomic. What is the overall mission for your data and analytics group? How are you supporting — the academic, the research and the healthcare delivery sides? What are some of the big successes or learnings you’ve had?

Michael: I’m not the greatest one with vision, but my team is using that construct of a common system — centrally managed and collaboratively installed. If you keep that as the overriding umbrella, then, the spirit around analytics was that we needed a centralized location where we could house patient care data, research data — biobanking, bio tissue, genomic data, and any other types of demographic data. That’s Penn GNP (Penn Genomics and Phenotype). That data is initially loaded in a raw format, so, if someone wants to reach in and grab raw data, they can if they’re savvy enough to do that.

We then move up a tier and we synthesize that raw data and homogenize it into common data definitions – a common data model accessible with common tools and probably a little easier then, for an end-user to reach in and grab what they want at some point. But again, it’s a common location that we’re zeroed-in on.

Finally, what we will do is move that data off into data mart so we might have patient safety and a quality mart. We might have a clinical care art. We might have a research mark that has just that specific domain data associated with it. We do all this now through the Azure Cloud, which we found again makes access to the data even easier through the utilization of standard tools that are accessible to all.

Our goal is to have our end users be less reliant on our data access team and more reliant on themselves through self-service. That may be a big lift for us as it is for many other organizations. How we communicate and educate that end user community and liberate the data for their use so that they’re not as dependent upon us is critical.

Some of the big successes for us are — we were one of the first, if not the first, to begin to take discrete genomic lab results from one of our lab partners and integrate that into our EHR. We put a whole program in place on how to make that work, utilizing our genomics team, genomics counselors, members of our cancer center and then, certainly our end user clinical staff community. We ensured that when these Genomic results showed up in a patient’s chart, the latter was aware of what they had, their result and the implications to the caregiver because many of them could require some level of training and education on how to discern what that variant result might be.

Q: AI means a lot of things to a lot of people. How have you been able to leverage AI, ML, Analytics tools in the context of your data and analytics programs?

Michael: AI falls right under that banner of over-promising and under-delivering and I don’t think I’m the only one to say that. You’re more connected in the industry than I am, Paddy, but I have hope for it because much like innovation was a four-letter word a bunch of years ago, AI is becoming a four letter word since it’s just overpromised at this point with limited, tangible results.

That doesn’t mean that we’re not making strides towards it being more and more beneficial. We are taking a two-pronged approach towards AI. The first is a top-down approach, where we will work with members of the vendor community who claim to have this algorithm whereby if you give it the right data in the right format at the right time and in the right sequence, it’ll tell you something. It might tell you whether — you’re going to have a higher no-show rate, there’s going to be a health deterioration, Sepsis is on the horizon etc. And that’s our top-down approach, where globally we’ll just lay it over the enterprise. We’ve had minimal success with that so far.

We also have a bottom-up approach. I have a team of seven or eight data scientists that work in a more discreet manner with our end user community and some passionate clinicians or researchers who claim they have this great idea. And if only they’ve observed certain things or had data on those things, it could be combined again. In some way, we could develop an in-house algorithm that would bring great benefit to the group. And I think we’ve seen that particularly in at-home care. We see that in palliative care, where we’ve predicted certain occurrences, but that’s in a very narrow tower. It’s not as broad as my top-down approach. So, we will continue on both streams because we think there’s hope. We are big believers, that the answers are in the data or are often in the data and we just have to get better at figuring out how to combine that data in order to generate a proper result.

Q: That’s a very well-balanced articulation of the promise, the potential and the actual performance of AI, today. And like you, I’m optimistic about the future as well. I know you spend a lot of time on your people. How do you ensure that you’re attracting, retaining and nurturing talent within the organization? All this technology is only as good as the people who are committed to making it all work.

Michael: When I joined Penn Medicine 14 years ago, 95% of our IS services were outsourced to third-party vendors. That was done 20 plus years ago for a variety of reasons — cost containment, standardization of delivery capabilities etc. What I was asked to do was help build a team that would in-source the majority of those services, because if you’re going to have world-class clinicians, researchers and educators, you better have world class IS.

In order to enable it — and you’re generally not going to get that passion and commitment from a third party — my job was to rebuild the team, internally. That took about three or four years to in-source, and during that time it gave me and my team, the opportunity to build a culture that was accountable, exceeded expectations, and in which we were viewed as consultative and partners versus just “those folks in IS.”

Building that culture has really put us in a position where we’re attractive to those that we recruit. We want 100% of the people to be doing 200% of the work and be accountable. Our mantra outside of corporate IS is, we always deliver. And it’s not easy to do that and so people do go above and beyond and exceed those expectations. That was a culture we strove to build.

I’ve had the good fortune of working places prior in my career where I saw that culture. I thrived there and wanted to replicate that. Now, we are a USD 280 Mn IS operations business, here. And a big business cannot function properly without really good people. My teammates are great, our leadership’s exceptional.

One of the things that caught me — and I probably haven’t shared this with you before or my team — is despite the fact where you are in Penn Medicine, part of University of Penn trustees, we really didn’t have an internal Managerial Training Program. And if you look at statistics and surveys, one of the top reasons why people come to work every day for that employer is they like working for their manager, they respect their manager, they believe their manager has their best intentions for them with their career and their personal work-life balance.

Well, Penn Medicine has subsequently introduced the Managerial Training Program, but IS did this first, and on our own. We formed a program, educated our managers on how to be not only good technically, but good personally, in their management styles. That to me was one of the best things we’ve done within our organization.

I have over 100 managers and often in a technology world the people that become managers are the best subject matter experts in their technology. Well, I think we all know just because you’re a really good C++ programmer or a really good infrastructure networking person doesn’t mean you’re a good people manager. And we had to bridge that gap and we’ve done that through a series of internal trainings, hosting webinars, team meetings, book readings, book discussions and team discussions, and it’s really elevated our ability to manage. Each of my team has now been through 360 events, twice. So, they’re receiving feedback from all around them — their employees, leaders, colleagues etc. If you invest in people, they’ll respect you, like the culture and in the end, this will account for a really low turnover and really high retention rates.

Q: You also published a biannual and having read the document, I’ve found it to be very informative. For those who are listening to this podcast and watching this, I strongly encourage downloading the documents and learning a little bit about what and how medicine does it.

Michael: I’m happy to share that link with you. Our Benefits Realization is one document that states the financial impact corporate IS has on many of the larger projects. And we do that every two years. In between those two years, we do the State of the Union, which highlights the big projects that we were working on, a little less on benefits, but more on the function of that particular project. And we do that because marketing our services is important so the external community understands our end users, what we’re working on, where that USD 280 million is going to. It’s also really rewarding and refreshing to the employees to see their efforts in print and recognize that. “I worked on that with that department or that center or that entity,” has a ring of a sense of pride, a sense of ownership and a lot of what Penn Medicine is about, is that pride and ownership.

Q: I’d like to conclude this session with one or two best practices or learnings and especially in the context of this transformation that the industry is going through. What would you like our listeners to take away from your experience?

Michael: First, we have to recognize the unique situation we are all in — any individual can make a big impact in some way, shape or form. Within industry or within personal and social lives, anyone can make a big difference. I happen to sit in the seat of the C.I.O. so, I have a bit more influence than most. What I have found is, you need to be bold, selective and pick your shots and go hard at them.

When I joined, one of the goals was to in-source the services, but that wasn’t so bold. It was more something that I needed to do type of thing. I thought some of the boldness way back then was saying we needed to get to an integrated health milestone.

Back then, everybody had their own little pet product or pet solution for filling in. Each ambulatory department had their own car — Orthopaedics or GI — and nothing was connected. The boldness was to get to one and being able to fight off all the reasons that people would give you for not getting to one and continually representing what the benefits could be. Once the approvals were got, then still having energy left and implementing that type of a solution today may not seem like a bold premise. But back then, it certainly was. And it makes a big difference today.

I think when I look at what is there and what’s going to be more of, I come up with more genomics, more data, more engagement – the whole precision medicine. The approach we’re focused on has led us to restructure the corporate team, so we’re focused on maintaining power and doing things on the research side. Now, we have a team focused on bringing those two together, and that’s bold and unique. But as mentioned, Penn Medicine is a pretty unique place.

So, we need to take this to the next level and leverage that position without forgetting all day-to-day activities that have to still take place.

About our guest

Restuccia_2021-profile-pic

Michael Restuccia is the Senior Vice President and Chief Information Officer (CIO) at Penn Medicine. Restuccia has over thirty years of healthcare information technology experience and has worked nearly all his career in the healthcare information technology provider, vendor and consulting services industries.

Prior to joining Penn Medicine as an IS management consultant in 2006, Mr. Restuccia served as President of MedMatica Consulting Associates, a healthcare information technology consulting firm that has been recognized as a four-time recipient of the Inc. Magazine 5,000 Fastest Growing, Privately Held Companies in the US and the Philadelphia region.

While at MedMatica, Restuccia served as the Interim Chief Information Officer for several healthcare organizations, including Phoenixville Hospital, Doylestown Hospital and the University of Pennsylvania Health System. Prior to MedMatica, Restuccia served in leadership roles with several other healthcare information technology firms, including First Consulting Group and Shared Medical Systems (now Cerner Corp.). Restuccia achieved a Bachelor of Science degree from Rider University and earned a MBA from Villanova University.

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.

Our challenge now is using the data correctly to generate actionable evidence and insights

Season 3: Episode #90

Podcast with Dr. David McSwain, Chief Medical Information Officer, The Medical University of South Carolina

"Our challenge now is using the data correctly to generate actionable evidence and insights"

paddy Hosted by Paddy Padmanabhan

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In this episode, Dr. David McSwain, Chief Medical Information Officer at The Medical University of South Carolina discusses the lessons learned in integrating technology into clinical care and its impact on the workflow of physicians, care team members, and patients. He also shares best practices in telehealth implementation from a clinical and operational standpoint. 

David talks about the disparities in access to care among populations with socioeconomic disadvantages and the challenges in implementing telehealth programs. MUSC’s Sprout program, the nation’s first national collaborative telehealth research program, uses evidence and data to support and provide quality healthcare services and influence the adoption of telehealth technology at the physician level.

While designing and implementing technologies, David advises a consumer-focused approach for an improved experience for both providers and patients. Take a listen.

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Show Notes

01:23Can you tell us about the Medical University of South Carolina and the populations you serve?
02:37Did you manage to codify some of this knowledge, learnings, and best practices so that your peers across the country could utilize it?
05:10 The application of telehealth programs and technologies can vary widely. Can you help us parse through it for someone who is relatively new to implementing telehealth programs?
08:34 Can you talk about one of the challenges that you've faced in rolling out a telehealth program?
10:22 Can you talk to us about pediatric research - the Sprout program?
15:24 Are you seeing telehealth platform providers step up to the challenge and introduce the capability to have a translator in the mix every time there is a video conference call?
17:18 Are you harnessing the data that is coming out of the emerging technology platforms like NLP, conversational AI, voice recognition, etc., to improve outcomes of productivity and improve the quality of the experience?
20:03What are some of the biggest challenges when you're going beyond your core electronic health system and trying to tap into some of the digital health innovation or innovative new technology solutions that are out there?
23:46Can you share your thoughts on how providers can improve the way they deliver care and be more productive and not burnout in the process?

Q: Tell us a bit about the MUSC, the population you serve, and your role and responsibilities there. What kinds of programs do you run?

David: The MUSC is an academic medical center in Charleston, South Carolina. We have five campuses throughout South Carolina and serve the entire state. In addition, there are six different colleges, a diverse student body across health professions and disciplines, as well as great research infrastructure. These have contributed to and driven innovation. As the CMIO at the MUSC, I look at the integration of technology especially in clinical care — and how that impacts the workflow of physicians and other care team members — and patient experience and focus on such integration across different types of technology to streamline the practice of care.

Q: How did you codify some of this knowledge, learning and best practices into something that your peers across the country could utilize?

David: Our Centers for Excellence have produced a number of instructional documents and resources on how to implement telehealth best practices, both, from clinical and operational standpoints. We’ve done a lot of work in the spaces of education and training. In fact, several years ago, we opened a state-of-the-art Center, the Telehealth Learning Commons in our main campus through which we’ve hosted different clinicians, administrators, operational personnel and policy makers from across the country to demonstrate the value of telehealth. That space is also used to conduct classes. But all this was largely pre-pandemic, of course. We have, however, expanded on how we approach interdisciplinary education in terms of developing competencies for telehealth across different disciplines and preparing our workforce of the future to be engaged in telehealth as they go out into their chosen professions.

Q: If one of your peers across the country wants to access some of these materials or programs, where should they go?

David: Our website for the Center for Excellence at MUSC.edu is a good resource and to access profiles, there are Twitter and LinkedIn as well.

Q: The meaning of “telehealth” varies — depending on who one talks to, and may be based on demographic profiles, geographies and the type of care being delivered – as widely as the application of telehealth programs and technologies. Can you help us understand telehealth and how best to implement these programs?

David: Well, the key really is to focus on the problem one’s trying to solve rather than the technology. There’s a variety of technology available and the emerging technologies advance what we’re capable of. So, you don’t want to walk around with your hammer looking for a nail. You want to really focus in on the requirements and the gaps. Once you define what it is that you need to do — how to improve patient care, enhance workflow of your providers, coordinate care across settings or across institutions and across locations – and identify the challenges to be addressed, then, the tools will present themselves. These may span a synchronous video consultation, physician-to-physician, physician-to-patient, an asynchronous encounter, remote patient monitoring — there’re so many different tools that it can be a little overwhelming. But the best way to focus in on that approach is to start with that problem.

Q: With regard to synchronous video conferencing or even a phone call and a number of other things, isn’t telehealth just that?

David: That’s actually a really key point, especially now in the pandemic. As we emerge from it, and it gets to the issue of health — of equity and disparities in access to care — some of the research we’ve been doing actually demonstrates that those at a socioeconomic disadvantage, or with pre-existing disparities in access to care, use telehealth as a broad term at the same rate, or that utilization has increased similarly, across those groups. If we look at the distribution of whether it’s video telehealth or audio telehealth, those who are coming from disadvantaged backgrounds or from other areas that don’t have the same access to technology, seem to be disproportionately using audio telehealth. And that’s really important because as we emerge from the pandemic, looking at the ongoing policy debates and the regulations enacted during the public health emergency as they begin to expire or be rolled back, if the reimbursement for audio-only telehealth is peeled back more so than reimbursement for video telehealth, suddenly we’re only actually exacerbating the disparities. And that’s something that must be maintained and focused on.

Q: What are some of the challenges you’ve faced in rolling out a telehealth program?

David: One of the big challenges is access to broadband and it’s been very apparent during the pandemic. Broadband is something many of us take for granted but in rural areas, people may not have access to it. Another important consideration is when you have access to Broadband, whether you can afford to pay for the data that it takes to do a telemedicine consult. Those may be two completely different things. And so, you need to take that into account as you’re rolling these programs out. The other really important lesson learned is to focus on usability both, for the patients and the providers. The first telemedicine program that I developed was a pediatric critical care telemedicine program that provided emergent consultation to rural community emergency departments for critically ill and injured kids that came into those facilities. In such situations, it’s incredibly important for the system to be as easy to use as possible in that rural or community emergency department, because often they’ll have a very chaotic or very least-very high stress situation, on and logging into your system shouldn’t be worrying. You want to just roll the cart into the room and make that connection. That’s how we develop that program and it was one of the really key aspects of that program’s success.

Q: You’ve been involved in some very interesting work on pediatric research — the SPROUT Program. Please elaborate on this.

David: SPROUT is really the nation’s first national collaborative telehealth research program across both, adult or pediatric services. The SPROUT Network was formed because of the recognition that advancing quality telehealth services really requires having the evidence and data to support what it means to provide quality health services. If you really want to influence adoption of telehealth at the physician level, physicians have always been raised on the concept of evidence-based medicine. If that evidence’s missing, it doesn’t matter that the telehealth program sounds like a terrific idea. They need to know that when they’re going to be taking care of their patient, when it’s a change in practice to the way they interact with their patient, that the evidence is there to support it. SPROUT, stands for Supporting Pediatric Research on Outcomes and Utilization of Telehealth, was formed with several very talented folk from across the country who came together and developed the first National Pediatric Telehealth Infrastructure Survey. We collected data from across the country and developed a collaborative of over 140 institutions across the country and in some other countries that develop frameworks and best practices and provide education around how to study telehealth in your particular institution. We got NIH funding back in 2019 for the program through the National Center for Advancing Translational Science. And we’re just getting into the third year of that funding. Obviously as we went into the pandemic, all of our work became critical to the way that telehealth was being practiced, especially in pediatrics nation-wide.

Q: Given the program is now 2 years old with ample data, could you share one or two findings that may be worthy of consideration?

David: One of the things we did very early on during the pandemic was we brought together national webinars to explore how people were utilizing telehealth in the pediatric setting and studied the challenges they experienced. We identified very early on, the challenge for non-English speaking populations in terms of access to telehealth. Now, the majority of telehealth platforms have been designed with the assumption the patients speak English and that bringing in a translator into a telehealth interaction can be difficult. The platforms themselves often are not available in anything other than English. And that was something, as telehealth programs scaled out across the country very rapidly during the early days of the pandemic, that a lot of institutions were really not prepared to address. Thus, SPROUT served as a convener to bring people together and identify best practices to how to approach that and serve as broad a population as possible. We’ve also done a lot of evaluation around how different institutions and different practices have responded to the pandemic and are working on getting published some data on educational approaches to scaling out telehealth services. We’re also working on publishing a policy evaluation stakeholder table or framework that allows one to evaluate programs based on the different stakeholders that may be engaged in moving a program forward. That may be a hospital system, a patient, a provider or even, a policy maker. We really have a very broad array of tools that we’re developing and they’re really coming out.

Q: Telehealth and the pediatric context is a very interesting space because it’s not just about the minor patient but about the parent, too. Sometimes, both entities may be in different locations and there’s the translator in the middle which can be confusing. But doesn’t this also apply to adult care? Will telehealth platform providers introduce the capability to have a translator in the mix every time there is a video conference call?

David: A lot of people in the industry and vendors have been focusing on this in the last year. Some really creative approaches have now been rolled out. Obviously, multi-party calling is a big part of that — just being able to bring an interpreter into the virtual room when needed, ensuring that the platforms themselves, the education provided there and the instructions are multilingual. Some of the really exciting stuff though involves technologies such as, natural language processing, real-time interpretation and the use of voice recognition — the kind of tools that, when we look back 10 years from now, will reveal how the pandemic really shifted the evolution of telehealth and digitally-enabled health care, in general. The integration of these emerging and promising new technologies into a unified approach addressing those with chronic disease and some of the most challenging patient populations around is possibly where the shift really happened this past year.

Q: Natural language processing, voice recognition, chatbots, Google Glass enabled services – are all based on natural language interfaces. As the CMIO, how do you view the data from these platforms and interactions? How do you harness data streams to generate insights that can improve outcomes of productivity and the quality of the experience?

David: This is one of the key issues that needs focus once we come out of the pandemic especially if we’re to stay focused on the telehealth aspect of things. There’s been such an explosion and adoption of telehealth that our previous challenges around not having enough data is really a thing of the past. Our challenge now is to use the data correctly to generate actionable evidence and insight into what is the best practice. How do you coordinate this across different practices and technologies? How do you develop that hybrid approach to providing either in-person or virtual care by a number of different modalities and do so in a way that is streamlined, that fits into the workflow of clinicians and other providers, and that supports the operations of the hospital in an effective way? Looking at this massive trove of data we have now, one of the things that SPROUT has done is develop a telehealth evaluation and measurement framework that helps folk make sense of all the data coming in. Look at it from the standpoint of a particular program, at a particular stage of maturity, from a particular stakeholder’s viewpoint and the population that’s being served. How do you pull the most meaningful data in the most generalizable information out of the data you’re getting for this service to really advance that safe and effective telehealth service going forward?

Q: What are some of the biggest challenges when you’re going beyond your core electronic health system and trying to tap into innovative new technology solutions? How do you address the integration of different platforms with the main electronic system and more importantly, ensure cybersecurity?

David: People get tired of the term governance, but that’s what’s incredibly important and really generating the alignment. These different technologies often emerge and become central to everything we do in the health care system. Consequently, it’s hard to identify a technology that only impacts one area. There will be overlaps and duplicative capabilities of different platforms. So, there will be platforms that are already in place to do the things for which people are looking at newer platforms. Then it’s important to understand — what your current capabilities are, what is the real gap in what you can do, and how the technology that you have could address those gaps versus what new technology you may need to invest in to be able to effectively address those gaps. That’s a real challenge because, in a health care system — particularly an academic system that has research, education and clinical components — there is a revenue cycle and operational issues and these platforms can be highly integrated. They also cross over into so many different areas that it’s hard to have a good understanding of how your platform and technology decisions impact all the different areas of the institution. Gaining that alignment and that shared decision-making and having that governance in place, is incredibly important.

Coming to the second question, a few months ago, I would have said cybersecurity is an under-recognized risk. But today, I feel like it’s not really recognized anymore. While we have major health care systems now that are being forced back to paper for weeks at a time because of prohibitive ransomware attacks, you have to invest proactively in your cybersecurity. While doing this, you also have to be very proactive in how you engage your cybersecurity team to ensure that they can identify where the risks actually lie. We’re long past the days when a platform could be evaluated based on a clinical need and then handed to the security team to ensure proper fit. The security team must be engaged early on in the process to ensure that you’re not exposing risks that you may not have even recognized were there.

Q: We’re coming to the end of our program now. But there’s one aspect yet to be touched upon. How does one ensure that providers and caregivers can enhance the delivery of care, stay productive and not burnout with the new technologies?

David: I think it’s incredibly important and we all know by now that provider burnout is real. The emergence of technology had and still retains promise, but the ways in which it has, at times, been implemented, has exacerbated challenges and increased workloads on our providers. Organizations like the ONC have taken steps to streamline the electronic health records and there’s some progress there. But increased focus in the health care industry, currently, is on consumerism. There’s certainly a lot of value in that. While there may be some patients that we shouldn’t really think of as consumers because they don’t have those consumer-type choices when they have the significant chronic or complex diseases, still, I see the value in the consumer-focused approach. However, one thing often overlooked when discussing digital health and technology, is that the providers are consumers, too. When it’s a new technology being adopted, especially one that sits in the interface between the doctor and the patient or the nurse and the patient, then there are two sides to that interaction and both are the consumer. When one’s designing, implementing technology or training and supporting it, one must think of the providers, physicians, one’s care team members as one’s customers, because really that’s how they function. If that mindset can be developed around both sides of the equation, then, one can really make a lot of progress in making the experience better for everyone.

About our guest

Dr. Dave McSwain is a Pediatric Intensivist and the Chief Medical Information Officer for MUSC Health in Charleston South Carolina. With over a decade of experience in digital health innovation, clinical informatics, and virtual care, he is an established national leader in telehealth development, research, and policy.

He is the Main Principal Investigator for the NIH/NCATS-funded SPROUT-CTSA National Telehealth Research Collaborative and the Chair of the Section on Telehealth Care at the American Academy of Pediatrics.

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.

In the future, we will see smart adoption of Google Glass technology in clinical use cases.

Season 3: Episode #89

Podcast with Ian Shakil, Co-founder, Augmedix

"In the future, we will see smart adoption of Google Glass technology in clinical use cases."

paddy Hosted by Paddy Padmanabhan

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In this episode, Ian Shakil discusses how Augmedix became the first company to launch a clinical application using Google Glass and a phone to convert the natural clinician-patient conversation into medical documentation.

There has been an increase in adoption for natural language interface technologies for clinical applications in healthcare involving hardware, software, and data analytics. Augmedix works as a tech-enabled remote scribe that processes conversations and distills it real-time into a structured note in the electronic medical record.

Ian also discusses the differences between Google Glass and other conversational interfaces such as voice recognition technology, and how conversational AI tools are evolving in healthcare, specifically in clinical use. Take a listen.

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Show Notes

01:12About Augmedix and the journey about launching the company.
06:08What are the differences between a voice recognition tool like Alexa, Nuance, Siri and what an Augmedix type service does where the hardware is a little different?
11:05 How your technology space is evolving in the context of clinical applications in the healthcare space?
13:49 In the clinical context, what is holding back the growth of these kinds of conversational interfaces?
16:32 How do you see your competitive landscape? Who do you think you're competing against?
18:55 What is the reimbursement environment look like? How do you build a case for a solution like yours?
21:01 What do you see as a big trends emerging as it relates to the moves that big tech firms are making in the market?
26:17What is your advice to digital entrepreneurs and VCs who are getting into this space?

Q: Tell us a bit about Augmedix and your journey.

Ian: I’ve always been excited about healthcare, technology, wearables, and the Internet of Things. So, around 2012, I’d just graduated from Stanford and was meeting some friends from Google. They shared news about some secret hardware they were developing — the Google Glass. In 2012, no one had ever heard of or knew about Google Glass. They let me try this secret hardware but under caution. When asked, “What do you think about this glass prototype hardware?” I said, “Have you thought about doctors? Here’s what you could do in the world of healthcare.” And that was the background.

I got laughed at because they were thinking about consumer applications more like “Dads in the park go pro at selfies” but I stuck to my theory — doctors and enterprise. We agreed to disagree, but I got obsessed enough to find the very first glass company of any sort and create an application for healthcare; for doctors, specifically. With Augmedix, we endeavored to really rehumanize the doctor-patient interaction using technology, such as, Google Glass. Today though, our service has evolved, and we now use many different hardware above and beyond Google Glass.

If you visit a doctor now, it’s a pretty miserable experience as they are typically typing, charting on the computer rather than paying you attention. So, crucial hours of the day are wasted in updating electronic medical record. Fundamentally, we solve that problem. Our doctors put on technology, have phones in the room or use Google Glassand from there on, we are virtually present. Augmedix takes natural doctor-patient conversation and produce EMR notes better and faster than what the doctors would do on their own. In essence, what Augmedix does is, it enables doctors to focus on what matters most — patient care for the patient right in front of them.

Q: Is it that the technology is automatically transcribing the conversation?

Ian: It’s true. But there are a lot of details beyond that. Most of our doctors use smartphone kits, Glass, and the phone. We transmit the visit, the audio and the video to our platform. So, a tech-enabled remote scribe processes the conversation and distills that into a structured note for the EMR. Unfortunately, natural language processing in AI hasn’t reached the stage where an ambient conversation can be processed and results in a perfect note without human involvement. We’re unabashedly human but we skip the chit-chat and focus on what’s medically pertinent and constructive in that conversation to create a note in the EMR — Epic or Cerner – used by the doctor.

This tech-enabled remote scribe at the backend operates within what we call a Scribe Cockpit. It’s a bunch of specialized automation modules that de-burden the Scribe. So, when the note is being constructed, a few clicks and edits happen in our natural language processing Note Builder. This is described as invoking a SR or Speech Recognition modules to create parts of the note in the scrabble and edit those attempts. A marriage of human involvement and technology make a service like Augmedix possible. Yank the humans out of the loop and try to do something with only software, then, it’ll only be something like dictation with the doctor being verbatim throughout the note. That’s been around for a while and isn’t helpful at all.

Q: What’s the difference between what a voice recognition tool like Alexa, Nuance, or Siri and what an Augmedix type service does where the hardware is a little different?

Ian: I’ll segment-out the market and help you understand this. Voice Recognition or Speech Track or Dictation is a whole category that’s been around. A dominant player there, is Dragon. The key marker here is the doctors are basically being verbatim — pressing a button, taking their device and noting their patient presented with this and that.

There’s another category of solutions — in-person, on-site scribes – very like having a third person in the room following you around, computers up, typing, charting, clicking, observing the conversation as it unfolds. There’s no time wasted having to structure, dictate, and review those dictations in this case. The downside is that it’s not scalable – these persons take up physical space, they call in sick and there’s all kinds of quality issues.

We’re in a new category of being remote. We offer all the benefits of that in-person scribing experience but are more cost effective and scalable. We also layer-in technology in ways that were previously impossible. So, like Dragon in-person scribes, and now we’ve got remote scribing or ambient remote documentation.

Q: You were the first company to launch a clinical application for Google Glass and its adoption in the clinical context is still coming along. As a dominant player, what does the rest of the market look like? How far as a technology is this and where is it headed from a broad-based adoption standpoint?

Ian: Google Glass, when it originally launched, was all about consumers. But they ultimately pivoted their glass efforts and refocused them on enterprise applications, of which we are one and certainly the dominant player in healthcare. But within the glass space, there are other very interesting applications and enterprise oil and gas field manufacturing, all kinds of fulfillment, applications of glass and things like glass. It’s a vibrant space but still early. We’re on third-generation hardware now, which is better today than it was 7-8 years ago and the devices last longer, plus Wi-Fi is a lot better. There are more robust enterprise-grade security configurations and settings now so further evolution is expected and smart glass adoption in all of those categories may just be on the rise.

Q: Augmedix went public recently through a somewhat unusual process. Can you brief us on how that looks like?

Ian: Augmedix is now a publicly tradable company under the ticker AUGX. We are listed on the OTC and we are public by way of a reverse merger. It’s a really exciting opportunity for us. For one, we raised additional funding through this process, which fueled our ongoing growth, investment and commercial expansion, investment and technology. We see incredible enthusiasm in the market among all sorts of investors to participate in something like this, which really is a play on burnout, digital health, and telehealth. And so, by being public, we’re able to take in the full spectrum of interested parties and investors that want to participate in Augmedix and prepare for more growth ahead.

Q: While the technology and the clinical applications involve special hardware, software, data analytics, let’s talk about Voice, Chatbots and Glass. How is this space evolving in the context of clinical applications in the healthcare domain?

Ian: Conversational AI is creeping in, in so many interesting ways in healthcare especially with activity such as, patient engagement and interaction. There are many opportunities for patients to be reminded of activities and care goals in remote, asynchronous and conversational ways. Many companies are doing this over text, asynchronous text, SMS platforms. But that’s different from what we’re doing though.

I think our area is white-hot since it’s looking at doctor-patient conversations and deriving structured EMR outputs using technology. We’re the pioneers and the biggest and now, in two key areas. Now, there are other areas where, if you think about it, patients do engage with smart speakers at their bedsides but that’s another aspect of conversational AI and innovation. I’m also seeing applications for communicating with staff, sharing information with family members etc. and there’s a lot of activity there, too.

Q: Patient engagement is critical amidst all the technological advancements. How does your technology handle and manage the patient/consumer side of the conversation in the clinical context? What could be the hurdles here?

Ian: Patient resistance or negative patient reaction was a concern when we first launched Augmedix. But patients are widely accepting the use of Augmedix on phone or on glass in their clinical interactions with their doctors. We always ask the patients if they’re comfortable and ok with the use of Augmedix at the point of care that typically happens on the first visit by the front desk or by the MA. We measure the decline or off rate and 98% of the time, patients are OK and accepting the use of Augmedix in that environment. Patients irrespective of their genders, geographies they come from, age, etc., prefer this new mode of interaction with their doctors.

We also provide the patient with all sorts of assurances around security and privacy. If there is a moment of nudity or anxiety, we go on to incognito mode.

We can juxtapose that with other conversational AI systems, like patients engaging with a chatbot but the difference lies in the marked absence of human insight. Is the human reviewing or involved in high impact decision making? Then there are texts coming from a system that may have a picture of a doctor by that or not. But you’re not verifying with your own two eyes that the humans in the loop qualify. I would expect that the level of skepticism and adoption in that system is higher than the level of skepticism in our system. So, I would advise those companies to do everything they can to indicate and highlight the level of human review early especially for high-impact decisions to kind of tackle that skepticism.

Q: What about your competitive landscape?

Ian: The market is enormous and the vast majority of doctors we encounter are using no solution. They’re toiling away in the EMR looking for a way out. This space is getting a lot more attention with many new entrants. I call them – ‘fast followers.’

A big new entrant here, for example, is Nuance with their DAX product. It’s distinct from their Dictation Dragon product. There are others too, but we are distinct from Nuance. One of the ways is we operate in real-time; we are a live service. Our notes and our interactions are being created literally in real-time as conversations progress, so, that benefits productivity and alleviates memory burdens for doctors.

Another benefit associated with being real time is that we can be interactive and offer you additional services — fire off strategic orders and referrals, remind you regarding HCC and other items etc. All this is possible because of our live and interactive presence.

We also offer a non-real time asynchronous service in that category, with advantages – it’s flexible and affordable.

Q: What is the reimbursement environment look like? How do you build a case for a solution like yours?

Ian: We save doctors a lot of time — two or three hours a day and sometimes more. Doctors can use these savings to see more patients per day. If you’re in primary care, it may take one or two more patients a day to forthrightly pay for the service. If you’re a specialist, the hurdle is even less than that. And if you are being saved two or three hours a day, that’s not so much of a huge ask frequently.

In addition, we see that more revenue per charge is generated when documentation is thorough and accurate, as is the case with us, which is another ROI proposition for us.

Another key thing to mention is we alleviate burnout which is a serious issue. There’s a scarcity of doctors in America right now. Doctors are partially quitting and are leaving health systems. Whenever a doctor leaves the health system or doctor group, it’s very costly, huge productivity loss, plus it’s difficult to find a new doctor and ensure productivity resumption. It could cost nearly a million dollars when a doctor leaves a health system. There’s evidence that Augmedix really rekindles doctors’ love for the practice of medicine, staves off burnout and that’s why a health system would adopt Augmedix.

Q: You mentioned Nuance’s Dragon technology was about to get acquired by Microsoft. What are the big trends emerging related to the moves that big tech firms are making in the market?

Ian: It’s big news that Microsoft and Nuance are now one. As to the thesis behind that marriage, I would argue it’s a little bit of a Rolodex play. We see that Nuance through its legacy products, such as, Dragon is present amongst the majority of health systems and doctor groups. So, one reason for Microsoft’s interest could be so they can upscale into those health systems and doctor groups where there’s just so much market share and access through this acquisition and upscale Azure and Azure-Related Tools and other Microsoft related tools.

Microsoft is also excited about this ambient documentation space and other things that Nuance DAX is doing. Other big tech companies are equally excited and waiting to jump into healthcare because it is such a huge percentage of the U.S. economy. A lot of these tech companies are creating tools and modules that are going to be very useful to Augmedix, such as specialized, medically tuned speech recognition modules, natural language processing modules, cloud hosting and compute capabilities tuned to healthcare needs with the right types of security and compliance aspects. And they’re getting competitive and innovative. But they are stepping back from providing the end-to-end, go-to market and product solutions in those areas. I saw more attempts toward this earlier so that is kind of a trend I’m seeing among these big tech companies.

Q: The one exception to that may possibly be Amazon, which is actually getting into the healthcare services space with AmazonCare. Where do you see yourself in the context of this big tech firm? Do you see partnering with one of these big tech firms in making your technology available?

Ian: Yes. Tech companies are creating more enabling modules versus end-to-end products but this is more around my domain, specifically. In other healthcare domains though, Amazon is jumping into the fray. Over the years, we’ve had significant partnerships with more than one of the big brands, tech companies and we have diverse partnership projects and collaborations with many of them. We use many different enabling tools, cloud systems and hardware — while we don’t make Google Glass, we rely upon Google for their production. So, there will definitely be opportunities for us to get strategically comfortable and focused with just one of those tech companies but presently, that’s not what we’re doing.

Q: You’re one of the first companies launched in the digital health ecosystem. You’ve seen companies come and go, pivot, fail. There’s enough capital floating around and ideas. What is your advice to a digital entrepreneur who is getting into this space now and what is your advice to the VCs?

Ian: Certainly, this space is a lot busier now than it was in 2012. Most of the areas of great pain and need now have a few different venture-backed startups chewing away at the problem, taking different approaches. While that shouldn’t scare anyone away, it creates a situation where most of the digital health innovation is maybe in the mid or later stages and not so much in the very early founding seed stages. There still is an opportunity to found seed-stage digital health companies. The burden of proof is going up now versus previously fair not to get funding and to get initial traction. So, my advice is that the ROI and the validating metrics required for you to get attention and funding and the expectations there, have increased greatly. This isn’t the time to step in with incremental solutions and sort of iterate your way to path forward. It’s time to meet unmet needs with eye-popping ROI benefits that happen pretty quickly. Otherwise, you’ll be passed over in this extremely noisy space.

Entrepreneurs must really focus on clever go to market strategies to scale faster and be data-driven and metrics oriented so that you can prove to all the stakeholders that you’re adding a lot of value. Early-stage entrepreneurs need to invest in the analytics and ROI on day one and overly so to stand out. That’s necessary in today’s environment.

About our guest

IanShakthi-profile-pic

Augmedix Founder, Ian Shakil (pronounced like Shaquille, the basketball player) has an impressive track record of innovation in cutting edge domains such as wearables, smartglasses, global-scale digital health, and IA (intelligence amplification).

In 2012, he founded Augmedix with a mission to harness technology to improve the patient experience and allow doctors to focus on what matters most: patient care.

Shakil holds a BSE in Biomedical Engineering from Duke University and an MBA from Stanford Graduate School of Business.

Before founding Augmedix in 2012, Shakil held a variety of roles at leading healthcare companies such as Edwards Lifesciences (where he still consults), MC10, Intuitive Surgical, and HealthTech Capital. He currently resides in San Francisco.

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.

Technology in healthcare needs a purpose-built solution to solve the problems

Season 3: Episode #88

Podcast with Murray Brozinsky, CEO, Conversa Health

"Technology in healthcare needs a purpose-built solution to solve the problems"

paddy Hosted by Paddy Padmanabhan

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In this episode, Murray Brozinsky, CEO of Conversa Health discusses how conversational AI can complement care delivery models and the need for AI and clinicians to work together to apply these tools to clinical use cases. Conversa’s virtual care and triage platform leverages a 360 view of the patient in real-time to predict clinical pathways and make recommendations.

Murray also talks about the virtual care automation programs that are being integrated to manage chronic care, post-acute care, perioperative to women’s health, cancer, pediatrics, and in the ED. AI can be good at computational decision-making, which can give the best solution when combined with human judgment.

Murray also shares practical advice for digital health startups who are looking to raise VC money. Take a listen.

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Show Notes

01:07About Conversa Health and your involvement with the company.
03:35What is the current state of AI in healthcare?
06:11 Conversational AI tools, especially chatbots, are having a moment in light of the pandemic. What COVID has meant for your company?
09:19 Do you think we are further along when it comes to applying conversation AI in the context of administrative use cases like the ones you describe or do think we are further along with clinical use cases?
11:05 Based on what you're seeing and the work your firm is doing, where is the low-hanging fruit today? Is that in certain types of clinical conditions, for instance, behavioral health?
14:25 Who do you mainly serve – payers, providers, employers? What is your ideal client profile?
16:28 What does conversational AI compete with in the context of a healthcare provider?
20:55Where does the voice fit in all of this? Do you compete with voice-based solution providers like Nuance for instance?
22:49When you talk to your clients, what do you ask them to prepare for in terms of the most challenging aspects of rolling out a conversation AI tool?
25:28What do you see the next 12 to 18 months looking like from the point of view of VC money flooding the market? Also, what is your advice to a digital startup that's on the receiving end of this money?

Q. Can you tell us about Conversa Health and your involvement with the company?

Murray: At Conversa, we are pioneering a new care delivery model – automated virtual care. It sits at the intersection of what is happening in automation and what is happening in virtualization. We think about it as a complement to current care delivery models. It complements in-person, digital, telehealth, remote patient monitoring, etc. It adds a piece of the puzzle that we think has been missing and will be standard of care in the future. I have known the founders of the company for years. We have worked together in different healthcare ventures, and this is my fourth digital health venture. I was involved in companies focused on consumers and patients, providers, and the payer market. I was super excited to join the company to help form the strategy and then take over as the CEO about 18 months ago.

Q. You are a private, VC-funded company. Can you tell us who are your major investors and how much money the company raised to date?

Murray: We’ve raised a little over 30 million dollars at C round, A round, and B round. Our investors are a great mix of supportive investors. We have financial investors, builders, VC, and Northwest Ventures, all the big health system in New York. And then we had other folks who were a combination of strategic investors like university hospitals in Cleveland, Allscripts, Pfive, and other healthcare-focused venture firms in Connecticut. We know the space as well as strategic investors with who we have nice operating strategic relationships.

PP: What is the current state of AI in healthcare?

Murray: The way we think about technology in healthcare, especially digital health, you must build a purpose-built solution to solve the problems. Then in that solution set, see if the applications of AI or machine learning or deep learning make sense to improve what you are trying to achieve. Those tend to be the most successful applications. In image recognition, in radiology a lot of good work is being done with AI. But even there, there is a need to recognize where AI needs to complement actual intelligence from people. There are a lot of studies that show this notion of co-bot. For example, the person working with AI in radiology can identify breast cancer tumors and characterize them. But on the corner cases, we need to have an actual trained professional distinguish and then make a judgment call. So, Garry Kasparov, the chess master, distinguishes between what humans are good at and what AI is good at. Humans are good at judgment, and AI is good at decision-making. Decision-making is computational all the way down, and judgment is knowing what matters and why it matters. If you can get those to work together, I think you have the best solutions. There’s a lot of conversational AI being thrown at natural language processing. If you are modeling physician language well, you can get high accuracy because physicians might use big words, but it’s a very prescribed and precise vocabulary. When you start to step into a patient world, they can say anything, and it can mean anything. You must infer if you are trying to rely on that platform for accuracy to determine whether you need to intervene with the patient, probably not the best approach. So, I think there is a lot of technology in search of solutions and the successful ones have understood the problem deeply.

Q. Conversational AI tools, especially chatbots, are having a moment considering the pandemic. What COVID has meant for your company?

Murray: When you think of conversational AI, there are many applications, but they are mainly administrative ones. For instance, I call a call center, and I am trying to make an appointment and understand my explanation of the benefits. There is some good AI because there’s minimal language, a lot of ability to get you to the right place, and its pure cost savings. It is reducing the number of customer service reps on the phone—a lot of proof points outside of healthcare are being brought in healthcare. There is a category that I would call virtual urgent care where an anonymous patient is walking to the door with symptoms. You need a big database of symptoms correlated with outcomes, and you dynamically update that so that you can decide whether I’ve got COVID or I’ve got a rhinovirus or a cold. There is a bunch of companies doing that. Doctors are primarily skeptical, so they are having success selling the payer market to some employers. The category that we live in is more care management, care coordination, transitions of care, pop health. For instance, you are enrolled in a heart failure program, the AI reaches out to you, talks to you, collects information, and checks how you are doing. It is using an evidence-based pathway to determine whether we can automate the next step, where we need to ask you what the right next step for you is, it’s very difficult to do with AI. The state of the technology is still not there, so we have taken a structured approach. Permutations are enormous, and there could be billions of permutations. Our intelligence is how do I stitch together structured conversations so that it’s personalized for you, and you’ll engage. We can collect the information we need and then use the right nudge, escalate you to the right next level of care. We use the AI/ ML in the prediction piece, it’s not just a chatbot, a chatbot is the user experience, but everything we collect from you could be biometrics, could be Piros, could be informal answers to questions, structured information. We then, in real-time assess that and check what we should do next. We use a lot of AI and ML there to predict if you’re going to decompensate because we’ve seen lung function like this with this characterization from your FEV1 scores and you’re likely not to do well in the next month.

Q. Do you think we are further along when it comes to applying conversation AI in the context of administrative use cases like the ones you describe or do think we are further along with clinical use cases?

Murray: Many things moved forward because of COVID. We’ve got about a hundred and fifty automated virtual care programs running at various large health systems around the country. I would say the clinical has caught up, and the stakes are higher. We strive for one hundred percent accuracy in determining whether a patient can be automated or isolated on the next step. You can’t do that with natural language understanding technologies. It must be a very deliberate and structured approach. But then you have the smarts to understand the status of the patient to make the right decision. Conversational AI in the context of administrative use cases was ahead. But clinical is probably a priority right now, and the opportunity for clinical is enormous. They come together in the mid to long-term future because you would want to have the administrative use cases attached to clinical all via one platform.

Q. Based on what you are seeing and the work your firm is doing, where is the low-hanging fruit today? Is that in certain types of clinical conditions, for instance, behavioral health?

Murray: We’ve conceived this to be a platform, meaning that it needs to work across all the meaningful use cases of a large health system or health plans. So, we have decided to build a platform that can accommodate programs or automated virtual care pathways from chronic care management to post-acute care to perioperative to women’s health, cancer, pediatrics, and in the ED. We have programs in those areas, and we are continually building them. Patients do not necessarily fit easily into one use case; you might have diabetes, hypertension, and suddenly you need a hip replacement. We want to accommodate it, be an extension of the health systems care virtually for patients in a seamless way that has a great user experience and leverages the full 360 views of the patient. So, that is where we are heading. We tend to start post-acute, 30 day, 90-day post-acute programs, and monitor people when they leave the hospital, and focusing on helping them recover and reducing unnecessary readmissions. We want to focus on patients who are walking out of the ED, understanding discharge instructions, picking up their prescriptions, going to their follow-up appointments, really focused on lowering recidivism back to the ED, where it’s not necessarily chronic care management.

During COVID, we worked with UCSF Health in San Francisco and shifted our focus to the vulnerable population. We helped reduce the risk of getting infected from COVID and provide a better experience for patients who could calibrate all the parameters remotely. There are many examples where we have identified decompensating patients, whereas otherwise, they would not have to escalate. And then, like ED, we are also now seeing a lot of interest in targeting both pregnancy and early pediatrics. Behavioral health is another area, it was a pandemic before the COVID pandemic. It is amplified because of that and so that’s another area that we’re getting into.

Q. Who do you mainly serve – payers, providers, employers? What is your ideal client profile?

Murray: We primarily work with a lot of midsize and community hospitals. We are also provider-focused because we want to make sure we understand how to extend a trusted relationship. And we have very high enrollment, activation, and the ability to change behaviors and drive measurable outcomes. So, the way that a patient thinks about it as a health companion. It is a twenty-four by seven extension of my doctor and nurse.

From the provider side, they think of it as an automated care team member who is helping to reach out to all these patients on their behalf and can practice at the top of their license. So, within that model, we have expanded to work with health plans. Our focus with health plans is where they are acting as a provider. We work with them to create programs used by patients and health systems and then for employers, schools, and the community and this got accelerated during COVID. We have many employers and universities using our COVID programs to screen for COVID to manage people who are positive, monitor people who have been vaccinated, and now deal with mental health from COVID. All of it is delivered through our healthcare partners. Our focus is that the health system in your community should be responsible for caring for the community. We are giving them a platform to amplify that help that they are already providing.

Q. What does conversational AI compete with in the context of a healthcare provider?

Murray: As a company that is positioned itself as an enterprise-wide platform. So, we want to be your automated virtual care partner if you are a health system. If you are using automation for administrative purposes, that is complementary to what we do. If you are using it for a digital front door, virtual urgent care, it’s complementary to what we do. So, you are now managing your patients; you’re enrolling heart failure and diabetes patients into programs. Our platform will compete with point solutions. If someone says I have an app that can help manage diabetics, I can come in with an entire stack device and coaches. So, somebody might want to choose that to work with their diabetic population. We say, hey, you can use the same platform to treat your diabetes and cancer patients. That is pretty compelling because health systems increasingly want to consolidate. Working with one partner is easier, and you start to understand patient IDs across the continuum. We aspire to manage patients across a lifetime, which does put us in competition with point solutions in certain areas in the future. Our challenge is to figure out if there is a perfect point solution. How do we integrate it into our platform, and how do we start to allow other solutions to plug into our platform?

Q. Does your tool sit on top of an Omada or a Livongo kind of platform? You also mentioned about clients wanting to consolidate into a one-stop-shop. We see this in our work with health systems, where they are trying to reduce the footprint of vendors, they must deal with because of all the complexities involved. How do you fit in that context, and how do you help your clients work through the tradeoffs involved here?

Murray: Companies like Livongo have chronic care management for diabetes, hypertension, weight loss, and behavioral health. They have devices and coaches wherever applicable. Because it is a service-based company, it tends to be with payers and employers very successful. Most companies with full-stack solutions are doing it because payers and employers do not have clinical resources and devices. Health systems already have clinical resources caring for patients; we want them to be more efficient and effective. It is purely a software platform where devices are involved. If they have an RPM partner, we are complimentary. In the health system world, they do not need the provider networks of any of those other companies. They are looking for technology solutions, and we excel there. When we go into the world of payer and employer outside of the health systems, those companies become partners. So, like Livongo, we can say that if you want to add the conversational AI and decision-making we bring, we can help leverage the platforms that they have built in the same way we do for the system. So, if you aggregate what they do, they have clinical resources like the health system does. They have the device as the RPM’s do. We can bring the piece to the puzzle that we get that table in that world.

Q. Where does the voice fit in all of this? Do you compete with voice-based solution providers like Nuance for instance?

Murray: We do not offer voice today. However, I demo our platform using voice a lot, but I am just using the native voice on the phone to do text or voice. We have not gone there yet because we are very driven by where the market need is, and the impact that we are having is enormous. When we see that people interact with voice, we realize it is not a big thing to add. You want to make sure that you are designing the voice interface as per the requirement. You are not translating a text to voice because understanding what someone is saying with 100 per cent accuracy in voice is a different design requirement than doing it through a chatbot.

People like Nuance probably have the best-known value out there. But it is not an accident that they’ve chosen to do transcription for wires because when you’re looking at what a provider says and being able to transcribe accurately, you can do that. You get into the patient world where a patient can say or respond to anything in that world. The way you would measure it is precision and recall precision, where the recall rates will be 80 per cent at best, which means the error rates are 20 per cent plus. No hospital system will use that error rate to decide whether they can automate the next step for a patient.

Q. When you talk to your clients, what do you ask them to prepare for in terms of the most challenging aspects of rolling out a conversation AI tool?

Murray: We have a very rigorous process that has four different swim lanes. There’s integration, configuring the pathway or the program. Everybody delivers their care delivery model for diabetes to slightly different guidelines. So, there is an integration pathway, there are best practices on how you enroll the patients, and then there is how we’re going to measure success.

Some of our clients are very sophisticated and want to collaborate. We have taken off the table things like NLU and liability. So, the real focus is on making a program that we have designed and figuring out how to deliver care that fits in your model, works in your workflow, and integrates into your data flows.

Q. What do you see the next 12 to 18 months looking like from the point of view of VC money flooding the market? Also, what is your advice to a digital startup that is on the receiving end of this money?

Murray: Markets, in my experience, always overshoot. They are trying to get an equilibrium, but there is a massive bait on both sides. There are unprecedented amounts of money in digital health, and it is concentrated in certain areas like behavioral health, which is a big problem. Every time that happens, we are starting to see a massive consolidation. To your point, companies go public and use that capital very quickly to acquire. Teladoc, Livongo kicked off a big part of that, and there are others like Grand Rounds and Doctor On Demand. There are tens of hundreds of these deals happening, and many companies are getting funded. I think what we will see is continued consolidation, and there will be a whole bunch of companies that don’t make it above the threshold to be viable or to be attractive to be purchased, and they’ll go out of business, or will be acquired. It will happen quickly, and that’ll make the companies that are above there much stronger.

So, advice to somebody coming in the space is it is always better to start in a cycle where things look horrible because that is how you develop your product. If you are starting a company now and get funding, spend this time developing your product and getting product-market fit. Pick a problem because I think there is a lot of technologies out there in search of solutions. The market will give you an opportunity if you can solve it better than someone else or if it is an unsolved problem. Once the product is available in 18 to 24 months, that is probably an excellent timeframe to come out with a product. I am in a position right now where I am not worrying about generating revenue but worried about just building the product, and I have the funds to do it.

You must be doing lots of things, but it all comes down to the patient if they feel it is important in their care and have better outcomes. The providers can care for more patients and spend the time doing what humans can do; then, you have a winner. Those are the only two things I look at to see if we are successful. I look at what patients are saying and doing with the products, and I look at whether providers embrace it. If we have those two things in place, everything else will go well and ultimately; it will be successful.

 

About our guest

Murray Brozinsky is CEO of Conversa Health, an Automated Virtual Care Platform designed to expand access to care, enhance the patient experience, and improve health outcomes. Health systems, payers, and pharmaceutical companies use Conversa to keep patients on personalized evidence based pathways to better health.

Conversa was recently honored as the Best Remote Diagnostics company at the 2020 UCSF Digital Health Awards. During COVID-19, Conversa has also been keeping people connected without getting infected.

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.

Everyone believes that digital provisioning of care is here to stay.

Season 3: Episode #87

Podcast with Sean Duffy, Co-founder and CEO, Omada Health

"Everyone believes that digital provisioning of care is here to stay."

paddy Hosted by Paddy Padmanabhan

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In this episode, Sean Duffy, Co-founder and CEO of Omada Health discusses their journey as a virtual care company, primarily serving self-insured employers with a focus on supporting chronic disease care. Sean also talks about the thought process behind their newly launched offerings and how they stand against their competitors.

According to Sean, to be successful in digital health, it is important to keep up your learning curve, be patient, and operationally innovate within constraints. Payers, providers, and employer customers all have the same need – digital delivery of care. They all believe that digital provisioning of care is here to stay. This belief is bound to yield a remarkable transformation for healthcare. Take a listen.

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Show Notes

00:41About Omada Health and how the company started.
02:39What kind of enterprises do you mainly serve – payers, providers, employers?
03:53 Omada is a privately held company. Who are your major VC’s and how much the company has raised to date?
06:13 Omada is a pioneer in chronic care management using digital tools. Can you speak about your new services and the thought process behind launching these offerings?
20:04 What is your own view of where we ought to be, maybe 18-24 months from now? What does the hybrid world look like for you?
22:55 We are awash in VC funds at the moment, chasing digital health companies at every stage. What do you make of this abundance of capital and what is your advice to startups?
25:44 Big insurers and employers are beginning to acquire telehealth companies, and we’re also seeing a lot of M&A among digital health startups. What is driving this?
27:41What is your view of the big tech firms and the role they're going to play going forward in how care is delivered in future?
30:24What is your view on where the reimbursement environment is headed today in the market? If there is one thing that you would like the regulators to address, what would that be?

Q. Can you tell us about how you got to start the company and when did you launch it?

Sean: Omada Health is a virtual care company. We specialize in longitudinal disease areas with a particular focus on chronic—those disease areas where you need a lot of longitudinal day-by-day support versus visit-by-visit support. We offer an integrated care suite of services in pre-diabetes, diabetes and hypertension, behavioral health, and musculoskeletal. We think that what digital can do best in healthcare is fill in gaps between visits. The company began as an internal project at IDEO. Prior to this, I was in medical school and was in an MD MBA program at Harvard. I had worked at Google before and between my first and second year in medical school, I took an internship at IDEO and thought I would go right back to medical school. But I sat close to this gentleman, Adrian James, who at that point ran medical products for IDEO. We became best friends. We got a little bit of a time and budget to think about transformational opportunities in digital health, and the result was Omada. Omada was founded in 2011. We just crossed our 10-year mark.

Q. What kind of enterprises do you mainly serve – payers, providers, employers?

Sean: Our primary focus is on self-insured employers. That turns into many relationships with payers as well and we do have many partnerships with providers, especially those who have their own health plans, like Intermountain Health, Kaiser Permanente, etc. Our primary operating model is to go to employers, share our vision on what care can be and how a different approach in the disease areas might benefit their employees, both from a clinical outcome, economic, and satisfaction standpoint. Often, they will see if they could find a way for us to work with their health plan to make the implementation easy and simple. In addition to the employers, we serve many health plan partnerships as well.

Q. Omada is a privately held company. Who are your major VCs and how much has the company raised till date?

Sean: We have raised over two hundred and fifty million dollars to date. It does take a lot of capital to start a healthcare company, and you must ensure that you are doing it in a way that earns the right to commercialize and what many times appropriately, very risk-averse by market. Healthcare is one undertaking that requires capital and enough to get started to the investors that we have. We are honored to have great folks from many, many worlds in the earlier stage side, great firms as venture partners like Andreessen Horowitz, Norwest, and Wellington Rock Springs Capital. On the provider side, we’ve had Kaiser Permanente, Intermountain, Providence invests. On the plan side, Cigna, Humana, Blue Cross Blue Shield of Minnesota. Those folks come from so many different worlds on the moment of convergence that we’re having right now in the US health care system between different disciplines.

Q. Omada is a pioneer in chronic care management using digital tools. Can you speak about your new services and the thought process behind launching these offerings?

Sean: It’s been a really neat moment of transformation and the newest areas – musculoskeletal disorders – was through the acquisition of an incredible company called Physera. The primary reason for expanding it has to do with two things. One, clinically Omada is very interested in disease areas where we think our core capabilities can make a difference and that a digital-first approach is a right approach. Not all, but we can really support people effectively from afar. In most cases, clinically it just felt so clear that there is a huge gap in access and quality and outcomes that digital could help bridge.

Second is the voices of our customers. Every year at our customer summits, we ask our customers what they want Omada to do, how we can serve them better, and what needs they have. We got persistent feedback that they wanted to do more and broaden our offerings to other areas in the benefits to simplify implementation and enrollment. But there is also a lot of clinical comorbidities. So, you can create elegant, coordinated care experiences by having an integrated suite in these critical longitudinal areas.

Q. The mental bandwidth that you need, and the resources and the infrastructure can also be a challenge, especially from a leadership standpoint. Does that, in some sense, distract you from the core mission?

Sean: The guidance that I would provide is that you really want to earn the right to enter new areas, but don’t do it too soon and don’t do it too late. Because it requires a lot of organizational transformation to go from one product line to multiple. It is never a simple journey because you have to rethink how you staff the product organization. You must think about how you train and staff your commercial organization; all the subject matter experts from the clinical team need to become fluent in all these conditioned areas.

Second is what I call selective breadth. So, we are the company that is going to focus on the key needs for our buyers and make sure that within those needs, we’re doing a great job in tying the room together and coordinating all the care between them in an elegant way. But it’s a very heavy undertaking. So, focus is so important for companies as they grow.

Q. From the customer standpoint, they see you as something today and then tomorrow you are a little more than that. You are offering new services when maybe to have existing relationships for those new services. How do you help them make the tradeoffs of the choices, especially as a new entrant into the field?

Sean: Firstly, it’s really important to be flexible. We must be able to support an a-la-carte intention. We share a vision on why all the infrastructure ties nicely together and why it may make sense to deploy more than one kind of program area from Omada. But you must be flexible with configurability, especially in markets where employers may have made some great decisions for them. You must approach it with a sense of humility and really listen to customers and fundamentally work not just to show and describe a potential value prop and why the entire suite in some might be better than the individual parts. Show it in the outcome. Show it in the clinical protocols, the rationale. And then, hopefully, you earn the right to support them in new ways. It is never an either-or, and you do need to remain flexible and true to your original product areas as well.

Q. From a competitive standpoint, one of your big competitors last year, Livongo, was acquired by Teladoc, and trying to offer several different things. What does it mean for a company like Omada Health and how do you see them? Also, what are your thoughts on the competitive landscape where you are?

Sean: First and foremost, we’re in early innings. But if you add up the numbers of people we have helped, about four hundred and fifty thousand in counting. I think for us it’s a little bit more in the prediabetes phase and for Livongo it’s more of type two. I think it was about the same when they sold to Teladoc. But look at the overall disease epidemiology of the metabolic disease. We have done nothing relative to improving the overall health curves and epidemiological curves of the country. So that is a statement on how much room there is to have a lot of players here. If we are taking different approaches in the market, I think both organizations will be hugely successful. We do have a common vision that is integrated care suite can make a difference here. We have our unique approaches and styles, and we are honored to compete with them and hopefully, they feel similarly.

Q. Digital health is having a moment with this billion and billions in venture capital money. They are going through a lot of consolidations. When you look at the marketplace out there, what are the things that you try to keep track of so that you can calibrate your progress against whether you are on the right track or not?

Sean: The number one is what our employers and plans are saying and telling us. My most refreshing and insightful moments are talking to our customers, and talking to our sales reps. We have lived in various walks of industry cycles. It is almost too easy sometimes to get caught up in the excitement of a deal or a merger or financing. I always try to remind our employers that let’s stay just true to serving our customers or members and think how you can do that better and all the rest will follow. If you are not in a position where you can ignore the cacophony and a hype cycle, you are not going to be in a position where you can stay true to your roots. Also, you will not be able to power through a cycle where there’s a critique about the digital health space. This is a multi-decade journey, so hang tight and stay measured and focused on serving customers and members. It’s a very dynamic marketplace and it’s an honor to be serving as an innovator in this moment in the U.S. healthcare system’s transformation because it’s really remarkable time.

Q. What is the one common theme that strikes or stands out that you hear from your employer customers versus your health plan customers versus your providers?

Sean: I think in-person care needs to be option B. Why would you drag someone into a waiting room of a clinic unless you could not solve their needs safely and effectively from afar? You can’t do everything from afar. Like, Omada will not be doing hip surgeries, but there is a lot that you can do remotely. What has happened due to COVID, it’s become an obvious that the digital delivery of care is here to stay. And that is something to be embraced as a fundamental part of the U.S. healthcare system. I think tomorrow’s payers will have network teams that set up networks with digital providers just like they do in network teams that set up networks with in-person providers. For all the stakeholders, it’s very hard now to find either an employer or plan or provider that does not have a digital care strategy that does not think that digital care in the digital provisioning of care is here to stay, and it will yield remarkable transformation.

Q. What is your own view of where we ought to be, maybe 18-24 months from now? What does the hybrid world look like for you? 

Sean: I think what COVID did is it exposed huge opportunity, but also exposed some fissures because you cannot trick yourself into thinking that you can do everything digitally. A lot of my friends are not practicing docs, they are doing asynchronous or synchronous digital, like CareFirst. Think of patients that are in the primary care settings and how many you must send to in-person care, it’s actually a fair amount. So, you cannot accomplish everything afar. Omada is focused on disease areas where we think the bulk of the provisioning of care, the tipping point of 80 percent, can be done from afar safely and effectively. We have learned what does work and does not work, and that’s going to help us get into equilibrium, and it’s going to be a hybrid. I think we will end up in a world where every single health system, it does not matter if you’re UCSF or an independent two-person primary care practice, you will be doing some form of telemedicine – video visits or phone visits. And what is going to happen is companies like Omada will become experts in augmenting the in-person care system and filling in all the gaps. As the operational transformation, the pricing model transformation, the care team, and professional and personnel transformation required to orient toward longitudinal is quite heavy. So, I think some things will be adopted universally at the level of the current provider, and some things will stay in the cloud.

Q. The digital health landscape today has somewhere over 5000 digital health startups in the market, and there is a lot of VC money out there. What is your advice to startups and to VC firms who are getting into the digital space today?

Sean: I think I’d like to see the capital and space have a lot of smart minds run at hard problems and innovate and see what happens. The beautiful thing about the world of entrepreneurship and venture is not all going to work, but some are going to work beautifully. In the U.S. healthcare system, you cannot find a shortcut. You will not be able to disrupt from the side and go around the system like that is impossible, nor should that be the objective. You must learn where the value is, how a dollar flows to the system. You must be able to deal with the complex dynamics of navigating different insurance lines. You must plan a go-to-market strategy almost specific to each state because the state-by-state dynamics are entirely different.

The second is, ramp the learning curve, ask a lot of questions, be OK with that and do not try to judge the system; view it as it is and find a way to operationally innovate within the system constraints.

Q. Big insurers and employers are beginning to acquire telehealth companies, and we are also seeing a lot of M&A among digital health startups. Like Walmart, Cigna, etc., are acquiring companies. What is driving this?

Sean: I think they are listening to the same voices that we hear to. However, Walmart is a little bit different here. In the future, if you are a health plan and serve a self-funded employer, your self-funded employers will need to know what you are doing relative to digital care for their employees. You will then think through the pieces that you want to have in-house fundamentally and bring value to my customers and integrate with my additional services. Also, what are the elements that I want to partner with and find great companies to work with? I think it is an exciting time to be in this space and I love the new entrants. It is fun to watch a Walmart come in to care in different ways. I think Walmart will do extraordinary things to care for the country, as there are many of the plans making bets and innovations here.

Q. Amazon is among the big tech firms a little bit different because they are directly getting into the healthcare space instead of the others who are more about offering the technology enablement to deliver care more efficiently. What is your view of the big tech firms and the role they are going to play going forward in how care is delivered in the future?

Sean: I think what naturally tends to happen is companies end up being excellent at the things that are in the back of their core strengths. Look at Google, for instance, they are the sort of computer science miracles. Their approach to developing incredible machine learning and artificial intelligence models to look at radiological data and help augment clinicians’ interpretations of readings is extraordinary. That sort of deep computer science meets biology work will likely be where Google makes its biggest contributions. On the Amazon side, I think it’s complex, the supply chain and operations. And the acquisition of PillPack in the pharmacy is a great example. And then I put AmazonCare in the same category. It is logistically complex to deliver all care digitally. Amazon has a unique, beautiful approach, listening to the pragmatics of care delivery and recognizing that you need in-person care. Amazon approaches the market with a powerful sense of customer-centricity. They are learning the details and specifics that others have maybe tripped on in the past, and they will be very successful in time. It is not going to happen overnight. But that is a patient business, and that is a business that’s willing to put a lot of capital to work to write out whatever period it takes.

Q. In Telehealth, we have seen some of the waivers come in, not permanent yet, but the hope is that they will be there. We are seeing a shift from traditional payment models like PMPM to slightly different alternatives, emerging models. What is your view on where the reimbursement environment is headed today in the market? If there is one thing that you would like the regulators to address, what would that be?

Sean: My biggest worry is relative to the inability or potential for us to seize the opportunity that COVID presented to transform healthcare. Suddenly, we are doing fee-for-service through video, and we call that success at the end of the day. It is great that clinicians can now do video visit or a phone visit, but that is not the end state. Allowing flexibility in service models can accommodate either synchronous interactions or asynchronous interactions. So, people sometimes forget that a lot of care preference at the consumer’s hands might be the kind of text they email to their care professional. So, they ask for Medicare and regulators to open minds to ways to thoughtfully accommodate. Asynchronous building models and there is a way to do it, you can think through like a care episode where once it starts over 15 days, a clinician is allowed to interact in whatever way possible. Think of it as Medicare Advantage and ask that we align with the scope of services we provide. We have a monthly rate that we charge for providing that, and it includes devices, your primary coach or certified diabetes educator, your nurse or all the services we render inside that. But we retain the flexibility to personalize against the need.

About our guest

SeanDuffy-profile

Sean Duffy is the Co-founder and CEO of Omada Health, a digital health program that combines the latest clinical protocols with breakthrough behavior science to make it possible for people with chronic conditions to achieve long term improvements in their 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.

With innovation, you need to be prepared to recognize that every idea is not a great idea.

Season 3: Episode #86

Podcast with John Donohue, Vice President of Entity Services, Penn Medicine

"With innovation, you need to be prepared to recognize that every idea is not a great idea."

paddy Hosted by Paddy Padmanabhan

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In this episode, John Donohue, Vice President of Entity Services at Penn Medicine talks about their 6-years long, $1.5 billion investment in a hospital of the future to be launched by the health system in their West Philadelphia campus. The hospital features new interactive technology for improving patient care and Disney-inspired user experience design.

John discusses a range of other topics, from defending against the ever-growing cybersecurity threats to finding success with technology partnerships. Their “3C” mantra for technology enablement in care delivery – common systems, centrally managed, and collaboratively implemented – has been a key to their success over time.

John also provides practical advice for digital health startups looking to partner with Penn Medicine in launching innovative solutions. Take a listen.

Our Podcast Partners:    

Show Notes

05:50About Penn Medicine’s new hospital facility – The Pavilion.
10:16Brief about the new facility’s design process.
11:10 How long did it take to design the new facility, the patient room of the future?
12:53 How do you ensure that you have adequate security, data, security, and patient privacy? What additional considerations went into this when you were putting the design together?
15:47 How have you laid a data and analytics layer on top of this infrastructure?
17:11 Are you leveraging the cloud to post your applications infrastructure, especially for this new facility and even more specifically for the data?
20:38 Moving things to the cloud may sometimes end up costing you more if you're not careful. Can you comment on that?
21:29Interoperability has been a work in progress for healthcare. How would you describe its State of the Union across all of your applications in your landscape?
24:25Most health systems try to consolidate all the applications into their core platforms. But on the other hand, they also have to be open to bringing on new innovative solutions. How do you manage this?
26:36What advice do you have for startups that have something interesting to say and want an audience?
28:04A best practice you would like to share with your peers in the industry for someone embarking on a journey to make a billion-dollar investment in a new hospital.

Q. John, what does your title mean in terms of the areas of responsibility for your role? Can you describe the applications landscape as well? 

John: I have worn many hats in the 12 years at Penn Medicine for a long time. I was the infrastructure executive responsible for enterprise infrastructure, component data centers, networks, telephony, video services, storage, et cetera. My role there was focused on resiliency and availability, which is critical in any academic health system where I built the information security team. We went from about four employees to about thirty-two dedicated security professionals in less than four years. However, my focus for the last couple of years has been around what we call entity services, and we refer to as entities, hospitals, and other major functions. Today, we have 13 of those today, six inpatient hospitals, several other areas like primary care physicians, specialist providers, home care, school medicine, et cetera. Each of those entities has an Information Officer and Information Entity Officer. So, the entity services team is comprised of about two hundred people across Penn medicine, delivering services like clinical engineering, platform support, network support. They have just been designed to allow the entities to have some autonomy regarding their priorities and resourcing their needs. My role has been for about ten years now and is part of our special sauce, making our information services team successful. It has personally brought me closer to what we do as an organization in providing world-class healthcare. Many of the different hats across the last several years have given me a unique perspective around what it takes to run a large-scale organization in an academic health system.

Our primary application is Epic or what we have started calling PennChart. We started installing Epic probably twenty years ago in the ambulatory setting. About six years ago we migrated to Epic on the inpatient side of things and have since installed many of their specialty modules, like Uptime for the OR, Cupid for cardiology. We also leverage several of their mobile platforms with tools like Haiku and Rover. Epic customers will be familiar with those terms and we use Epic tools that allow us to work with other physician practices in hospitals, things like what they call “healthy planet” care everywhere community connect. We also leverage some of their modules for the data analytics-based tools. Lastly, we use their patient portal for facilitating communications with our patient population for things like appointment scheduling, test results and medications. 

Q. You are about to launch a new hospital which I believe is going to be the hospital of the future. A lot of new technology enablement aspects are going to make for an interesting and improved experience for people. Can you talk about that? 

John: It is an incredibly exciting project and by far the biggest one I’ve ever worked on in my thirty-five-year career. I think it is the biggest capital project in the history of Penn, which goes back about two hundred and fifty-plus years. Our first meeting on this topic was over seven years ago, and we are set up to be patient-ready by the October-November timeframe this year. It is in our West Philadelphia campus, across the street from the hospital of the University of Pennsylvania and the new building. It’s a $1.5 billion investment that includes about 1.5 million square feet, 500 state-of-the-art private patient rooms, 47 state-of-the-art operating rooms in this 17-floor facility. This innovative hospital facility is designed to support our world-class researchers, clinicians, and faculty. It is trying to create a stage for these world-class folks to do what they do best.

From an IT perspective, we view this as an opportunity to significantly improve our patients’ and our providers’ engagement with technology. We have designed the building to support a fully digital experience with Wi-Fi and cellular coverage throughout the facility and have developed what we call the patient footwall, which has really been around designing the integration of several different technologies that will make the patient stay more comfortable. The technology will also enable providers to engage with the patients during their stay. The hospital will be 5G ready, aggregating nurse call and nursing alerts to a mobile app to reduce nursing fatigue. At the center of this will be a seventy-five-inch TV, a centerpiece for education and entertainment for the patient. A tablet in the room will allow patients to manage the room, the temperature, the shades for lighting, noise levels, privacy, potentially ordering dietary requirements, full integration with our electronic health records. As soon as staff enters the room, the patients will know who they are, their role, and potentially why they’re there. All the environmentally friendly components in the facility will help us be responsible from an environmental perspective and reduce some costs. The common theme for us with this Pavilion on the campus is connectivity. The need to have a patient care facility like this with advanced connectivity is fairly evident. When you think about extending this connectivity beyond just IT and creating a seamless patient experience across the campus with transitions of care, you’re talking about some game-changing improvements in patient engagement.

We’re there to take care of the patients and their needs and focus on them. The intent was to have a highly private facility for our patients that would be comfortable for them and their family members and make it a good experience and have the room outfitted so that it does feel like an improved patient experience. We intend to provide a hospitality experience. We talked to Disney and others so that we could work them into our design.

Q. The tech can doeverything but developing this unique and differentiated experience requires a whole different level of understanding of human needs. Can you talk about design process to design the experience carefully? Also, how long did it take you to design this patient room of the future?

John: We brought in subject matter experts from architecture and design from across the globe. And then built out a half a floor in a warehouse out of Styrofoam, brought in time emotion studies, and made some significant changes to our original design based on actual people, wheeling gurneys through these Styrofoam hallways. We looked at access and traffic patterns and did all kinds of timing exercises of how long it would take to get somebody from the ED to an OR. As fun as the technology was, if you design and implement it right, it’s right. Getting it right from a design perspective is a whole other level and I think we knocked it out of the park. 

It almost took three and a half to four years to design the room from start to finish. We found some slick ways of a nurse sitting at a desk outside of the patient room like we mirrored the patient room such that a nurse could monitor two patients at the same time through these windows. We have done some innovative things in the bathroom and the shower design and brought those in these units by leveraging the city’s views. It was an extensive design process. We have also designed flexibilities into the room to be used for many different purposes. In the old days, you had your normal patient care rooms and then you had specialty rooms. These rooms are all designed with booms to move patients and capabilities that can become more specialized on the change of a dime. Over 500 rooms in this net new building are designed and set up in this way.

Q. How do you ensure that you have adequate security, data, security,and patient privacy? What additional considerations went into this when you were putting the design together?

John: If you think about this patient room, many components are of the Internet of things. Whether it’s the lights or the devices in the room that are more typical Internet of Things type devices, everything that sits on the network poses a potential concern. So, we teamed up with several subject matter expert partners. We set up a lab environment and implemented all this technology in the lab. If you walked into this lab, it would almost look like the patient room to you. We rolled in the monitoring equipment and everything else to be really a good mirror of what would be happening in the new Pavilion itself. Then we made sure that we had the security we were looking for in that room. We did some exercises to try to tap into the network through some of these devices and asked our vendors to work in their labs at their own manufacturing plants. The technology that we have integrated and the standard tools we put in place to manage security across the enterprise is in pretty good shape. But in this business, you need to be vigilant. The threat landscape changes dramatically over time. Health care organizations have really become the focus of cyber-attacks over the last several years. It started with medical records being more valuable to criminals than credit cards and has only been exacerbated with organizations like ourselves that are in the center of COVID research and vaccine distribution. Patient privacy and ensuring that we’re a secure organization are really important to us, so we have redoubled our efforts with this new facility to ensure that we’re in good shape. Devices like network segmentation, network access controls, building profiles can change their behavior; we have a chance to isolate them and pull them off the network in case they could have been hacked or breached and could be a vulnerability. We are making sure that new Pavilion and the rest of our enterprise is secure.

Q. You have a ton of data that’s going to be available by observing the way these devices and the software of the services used by patients or caregivers and how the devices interact with one another. Can you talk about how you’ve laid a data and analytics layer on top of this infrastructure? 

John: We started to make investments in our data analytics group from the last three years and have continued to make those investments. With this additional information, we will focus on how we turn that into knowledge, with that data, people can make informed decisions. So, we have matured our efforts on the data analytics side, but we are still trying to identify the best way to use all this data. We are excited by the opportunities and looking at how to make future investments in this informatics to make sure we’re leveraging all this information. Through this data, we make sure our clinicians and executives are aware of what’s available and then optimize it based on that information.

Q. Are you leveraging the cloud in any significant way either for posting your applications infrastructure, especially for this new facility, and for the data?

John: I call our cloud strategy – opportunistic. From a Gartner perspective, what they call a fast follower. Cloud technology is not new by any stretch, but we need to make sure that we have business associate agreements in place with the cloud vendors. We spent a significant amount of time building out our private cloud capabilities using hyper-converged capabilities. We have seen some great efficiencies there and been able to move a significant amount of our workload from different vendors, storage and platforms that are computing. Our focus has been on the HIPAA conversion private cloud. We have also been leveraging SAS applications wherever possible. Many of our applications are cloud based in addition to things like Office 365. We’ve made some investments in the infrastructure applications, but we know that in a long-term perspective, we need to leverage private cloud, public cloud, hybrid clouds so that in any time of the day we can move our enterprise workload to the least cost and in the most secure environment. We continue to work with Azures and the Googles and others out there to make sure that we’ve got the right agreements in place. We have got a rather large high-performance computing that’s used on the Research and School of Medicine side that we’re looking to move to a cloud environment. We don’t drive things to the cloud just to drive things to the cloud. We do when technologies at the end of its life where there is an opportunity to be more efficient. I would say today we probably have close to eighty five percent of our workload in some type of a cloud environment. 

Q. So, over time you have moved a significant amount of enterprise workloads to the cloud. But you look at everything on a case-by-case basis and it’s not a default decision to just drop something into the cloud just because that is where you want it all to be in future. How do you do the tradeoffs?

John: We look at the workload itself and look at what kind of data is on those workloads and then what we’re doing today. If it’s in a hosted environment that we’ve outsourced, we look at what’s the cost of that environment, what are the pros and cons of running it in that environment, speed to market, the way they secure their environment, and so on. We look at it from a cost benefit standpoint and start to check what are the things that would make us more responsive, more agile to get things time to market. We also look at the ways that can take our resources and focus them where we want them to be focused versus running our own data centers and setting up servers and managing the servers and storage. We look really at return on investment and risks.

Q. I have heard often that moving things to the cloud may end upcosting you more if you’re not careful. Can you comment on the ROI part of it? 

John: I think we found the same thing, particularly with our high-performance computing capabilities. It looked attractive on the surface, but the devil is in the details. Once you start to pick up things and move it over, you learn quickly that there’s some hidden costs. There are times where you’ll accept those costs because it reduces investments and resources that you need in other places. But we have learned the hard way that sometimes the cloud is actually more expensive.

Q. How would you describe the State of the Union as it relates to interoperability across all your applications in your landscape?

John: We have taken a three C approach to applications that stands for – common systems, centrally managed, and collaboratively implemented. It is one of the mantras we use in IS, and it’s been key to our success over time. In the last 10 years, we migrated many small applications into these large suites that I talked about earlier, like Epic. It’s allowed us to be efficient in our spending and resources and drive a lot of cost out of the system. As we look at integration or our ability with new applications, we lean on those standard systems first. And then see if they can work for us versus adding in a new best-of-breed type of application. 

Secondly, the legacy there is centrally managed. So, pulling everybody together into a corporate IT organization has allowed us to eliminate most of the shadow IT in some organizations. Shadow IT resources are the ones that in many cases introduce new applications that are hard to integrate or hard to interoperate. Between those two things, we’ve built a pretty effective corporate organization that can deliver the standard solutions fairly quickly and economically. 

The last C, which stands for collaboratively implemented, is our secret sauce. We have business projects that involve technology which means that both IT and the operational folks are at the table with skin in the game. This has really delivered very good results for us, because as things start to go wrong, we lean heavily on each other to make sure that we get good results. This strategy has really helped us eliminate overhead and eliminate the need to integrate and interoperate platforms that may be a challenge. 

Q. Most health systems try to consolidate all the applications into their core platforms. But on the other hand, they also must be open to bringing on new innovative solutions. How do you manage this?

John: On the one hand you must keep your network and clinical systems up and running twenty-four by seven. That requires a certain strategy, mindset, and skill. It’s not an easy job but getting there on time takes some work and focus. At the same time, you must have an innovative mindset to stay ahead and leverage these new capabilities. This requires a whole different strategy, mindset and skillsets. Leading teams that are responsible for both can be a challenge today. With innovation, we feel like you need to be prepared to recognize that every idea is not a great idea and failing fast if you are not going to be a winner. But our environment, where a learning organization, we see many entrepreneurs on campus, comes out of Warton, other schools, and is incredibly bright. We have a place on campus that is called Pennovation – a lab space. Their tagline is ‘where ideas go to work,’ which encourages people to come to Penn to do innovative work and to do emerging technology work. So, we often see people knocking on our door saying, “We work for Penn or we graduated from Penn, and now we’re part of a startup. So, we see a lot of these technologies. And I would say one out of every 10 to 12 has got some real value here. It is addressing a pain point that we have, and it’s something that we can’t go to one of our established partners and ask for the capability. So, we have set up a new technology review board that looks at all these and uses a governance process to ensure that we are fair and consistent. So, not only do you need to keep your legacy applications up and running, but you need to stay focused on innovation where it can be a game-changer for you as an organization.

Q. What is the advice you have for startups across the country that have something interesting to say and want an audience? 

John: I think there are two things. One is timing. You must have robust technology that is ready for prime time. People knock on our door many times, and it’s a concept and we don’t have the cycles with everything else we have going on to work through the concept and spend those kinds of cycles there. Timing is key and it’s got to be close to being ready. Another essential part is finding an internal sponsor, a champion, somebody who is willing to be the representative internally around that technology and speak to its benefits. Look at the cost benefits, ROI, and a partner who will help design functionality and capabilities. Also, find the sponsor, the internal person that can champion that.

Q. Is there a best practice that you would like to share with your peers in the industry? 

John: The best practice is to engage with others. What we learned with the Pavilion was that looking outward was a game-changer for us. This sounds simplistic, but we have brought to the table several technology partners and several integration partners and said – “we want you to partner with us and do development on your dime and later you’re going to be able to talk about how you partnered with us.” Getting the right spirit of partnership and getting the right ability has been a game-changer for us. The best practice for us was as big as we are and as talented as the people we have, both on the IT and clinical sides, partner with folks that has significant resources themselves.

About our guest

John-Donohue-profilepic-may2021

John P. Donohue is the Vice President of Entity Services at Penn Medicine, Information Services. John is responsible for leading the Entity Services group; which includes a number of seasoned technology executives, as well as the onsite teams that support Penn Medicine’s many entities. These entity technology groups are responsible for managing the business and facilitating the technology relationship between Operations and Information Services. Each entity group is comprised of an Entity Information Officer and resources that support clinical engineering, platform, and network technology at the entities. Additionally, John is the IS executive driving technology innovation for the construction of the new patient pavilion project, which is expected to open in late 2021.

Mr. Donohue is a seasoned health care IT Executive with over 30 years of experience which includes: extensive senior executive and customer interaction, understanding complex business requirements, identifying technology solutions, developing and executing IT strategic plans. He is recognized as a proactive leader who builds and develops high performance teams that are committed to excellence in the delivery of IT services and solutions.

Prior to joining Penn Medicine, John held IT vice president roles at both Covance (a $4 billion Clinical Research Organization) and Children’s Hospital of Philadelphia (Number one ranked Pediatric Hospital in the country). John holds a BS in Business Management from University of Phoenix.

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 must utilize AI to change the way healthcare is delivered and how patients can be more engaged in their care

Season 3: Episode #85

Podcast with Sachin Patel, Chief Executive Officer, Apixio

"We must utilize AI to change the way healthcare is delivered and how patients can be more engaged in their care"

paddy Hosted by Paddy Padmanabhan

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In this episode, Sachin Patel, Chief Executive Officer of Apixio, discusses how data science can help solve critical healthcare problems and empower individuals, providers, and health plans with reliable, actionable intelligence. Apixio is a healthcare AI analytics company that was recently acquired by Centene Corporation.

Today, more than 1.2 billion clinical documents are generated each year in the U.S., but there is very little analysis of the unstructured information. The Apixio platform uses advanced analytics to generate insights from unstructured data to deliver significant improvements in financial performance.

Sachin also discusses the big opportunity areas in AI today and the challenges in increasing adoption levels for AI in healthcare. Take a listen.

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Show Notes

04:20Where do you see AI in healthcare today, and what are the big opportunity areas?
07:48Your products are focused mainly on administrative efficiencies, specifically revenue and payment operations. How do these solutions create value?
15:59 Recently, several emerging data partnerships have been announced – Truveta, Mayo Clinic, Highmark-ChristianaCare. What are your thoughts on this trend?
18:40 Does your relationship with Centene preclude you from doing business with their competitors? How do you manage any concerns that may arise from other clients in this regard?
19:44 What are the big challenges for AI that the healthcare industry needs to address before we can realize its full potential?

Q. Can you brief us about Apixio and your interesting journey to how you got here?

Sachin: At Apixio, our mantra has always been to achieve better healthcare through data insights. Apixio has created a proprietary artificial intelligence platform that’s able to render computable data from clinical, administrative and other notes. The text in these documents, the unstructured data, contain 70 to 80 percent of the information about an individual’s healthcare, most of which is not captured in claims or other administrative data. Certainly, you need both pieces, the structured and the unstructured data. We pride ourselves on being able to tackle both of those. What we can do with that data is assemble patient phenotypes from the smart aggregation of various insights that are generated from the two data types. Our artificial intelligence platform can then provide these insights for a variety of different use cases which we can get into.

Prior to Apixio, I was with a healthcare services company and the value-based care space, and prior to that I was in investment banking, a way back when I started my career as an engineer.

Q. Apixio was acquired by Centene late last year. Can you brief us about that?

Sachin: Centene had been a recent customer of ours. They acquired WellCare, who was one of our key customers and they had seen the direction that we were taking our platform and the potential that we had – to use the artificial intelligence capabilities, to improve value-based care, and other activities that are important to a health plan. That was a perfect fit for our next chapter. And importantly, we have had the benefit of having seen 40 plus other customers data inform the quality of our insights that are gathered. Now we have access through Centene to twenty-five million patients’ worth of additional data from which to train our algorithms and develop new capabilities.

Q. Centene is one of the largest health insurance companies in the country with a specific focus on the Medicaid population. Is that right?

Sachin: That’s right. They’re largely focused on Medicaid, but with the acquisition of WellCare they have a pretty significant footprint in terms of number of lives covered in the Medicare space as well.

Q. Where do you see AI in healthcare today and what are the big opportunity areas.

Sachin: In the last handful of months and the last few years, a tremendous amount of buildup in different organizations, plans, providers, analytics firms are utilizing AI to change the way in which healthcare is delivered and how patients can be more engaged in their care. That’s really where the sizzle or the interest lies in any company pursuing their activities within the healthcare realm. So, getting closer to that point of care, getting closer to the patient, that’s where you can really drive some of the changes that are being looked for. But you can’t leave behind the administrative or the plan administration side of it as well that sometimes doesn’t get talked about much. The ability to have a technology platform that works across all those areas and be effective in terms of the access to the data, the analysis that you conduct on it, and mining all of the different pieces of information to form a holistic view of what that care journey looks like for both the payer and the provider. And to the patient as well, as that is how you unlock all of the value. The big opportunity lies is bringing that all together. So, you have got certainly a continuum of folks that operate in different parts, but you want to be able to bring that all together and then have that bear out in the type of care that’s delivered.

Q. The money that’s being made today from applying AI directly seems to be a lot more in the administrative functions where you can see a very direct correlation between what you put in and what you get out of it. Is that right?

Sachin: I think that is spot on. Certainly, with appropriate focus on where we all would like to see healthcare go as it relates to the provider and the patient side of it. No doubt that is where we all want to see improvement. Because if you think about what is caused a lot of the abrasion within healthcare delivery in the US, it’s the burden of those administrative activities that prevent the providers from being able to provide the right type of care. So, we all have an eye towards that. But as it relates to where you also need to have important business focus, it is on that administrative side. And I would say you’re right, certainly in terms of being able to demonstrate a clear ROI and then importantly, as you think about value based care and how those contracts are structured and how you drive the action that is desired from all parties to that set of activities, that’s where you want to make sure that you’ve got the administrative software as well, with the benefit of efficiencies gained from artificial intelligence platforms or other technologies, especially when you look outside of Medicare Advantage and think of the other lines of business that typically don’t have as robust a margin profile.

Q. Tell us how Apixio is bringing about some of these improvements in administrative efficiencies by applying AI in the context of revenue and payment operations.

Sachin: In simple terms, if you’re looking at a series of hundreds of pages of a patient’s chart and you’re a human, let’s make it this area that we’re talking about and particularly our primary use cases within risk adjustment activities. If you’re looking at hundreds of pages of charts for thousands of patients over the course of months, you’re likely to get tired, fatigued, very naturally. It might miss a detail or make a decision that may be as inconsistent with a decision you might have made around two weeks prior with the AI platform. AI type capabilities can allow you to, instead of looking at all 200 pages in this document, see eight pages that matter for what you are trying to do in this activity. It doesn’t have to be a risk assessment, could be anything. It could be a quality initiative and a variety of other activities. And if you’re only looking at those pages and you’re generally guided there and making either a confirmatory decision or you’re saying, ‘hey, actually, I don’t agree, because for our plan X, Y and Z matters a little bit more for whatever that uses.’ You can then make that change and being a lot more efficient with your time. And that’s really where I think you gain those efficiency of scale. Also, if you’re only looking at claims data, you may find 20 to 30 % of the information that’s really rich data. It is the record of truth as it relates to payment. When you think further down into other areas where you would want to expand those capabilities, as we were talking about, point of care, clinical discovery, things of that nature, that’s where you do want to look at the unstructured data. That unstructured data certainly has important details, but also has a richness of data and depth of data from the physician’s notes. So, the physician may code at a certain level and say that I have these two conditions, but they may also add in their notes because they don’t necessarily want a bill for that. But the patient also has these other symptoms that we may want to keep track of. That’s what you also want to know and so that’s where we think the entire profile is important, especially as we talk about things like value-based care.

Q. So, from what you have described, you are primarily talking about natural language processing, is that right?

Sachin: That’s part of it and then there are other techniques as well that can be used to combine for insights.

Q. Did you build the technology on your own? Can you brief us about the evolution of the technology and how you got it to where it is today?

Sachin: Yes, we did build everything. It was purpose-built and was in-house for risk adjustment initially. Certainly, we have used a variety of NLP and machine learning techniques. Think about our platform as it has a core capability of being able to find these insights. You can tune the algorithms to find what it is that you are looking for in a chart. It does not have to be this risk adjustment case. I can then tune those algorithms to find other information, whether it’s a quality initiative. I just want to maybe search in a simple way for all diabetes patients who have had an eye exam or something else. You can do all of those activities by upfront, tuning the platform to run those different use cases. That’s really the way in which we envisioned it. So, think of it as there is this base layer of capability and then on top of that, you build out different applications for different use cases. So, as it relates to risk adjustment, an important area for us to select, certainly because there’s a tangible benefit that folk see right up front in terms of being able to appropriately deliver care for what may be a more higher acuity patient population. It also gave us the richness of data over time. We noticed this after we crossed 10 million patient records from across the U.S. and now we’re worth of 20 million. This diversity of data in the risk adjustment function allows you to have confidence in a narrow confidence interval, in the insights that you’re delivering. That’s really important because you’re going to not only believe in the decision that you’re making as a health plan, but you also want to believe in those decisions being made as a provider to ultimately drive adoption of these technologies.

Q. What you’re really talking about is being compensated for the care that you provide and more specifically making sure you’re not leaving money on the table by missing something in the coding process that could be a legitimate claim for a payment. Is it a fair statement?

Sachin: That’s correct. On the other side of it, one of our important full solution capabilities from a compliance standpoint, you also want to look through and review those same charts and make sure you haven’t previously submitted something that shouldn’t have been. In that case you can proactively flag and note it so that payment is essentially recouped or taken out from what you may be finding for other more higher acuity populations. So, it’s important to do both activities.

Q. So, one of your clients, Centene, puts in a dollar of investment in this technology. What can they expect to get out of it in terms of order of magnitude of returns?

Sachin: So, I think typically from an efficiency of workflow standpoint, customers would typically look for is something in the 4-7 times return in terms of efficiency, of effort, of what’s being done by their folks. And from a dollar perspective, it’s a wide range and it depends on what the initiatives you’re doing. I am not speaking broader to some of the other things that we work on with customers beyond risk adjustment, that can vary a little bit more.

Q. Recently, several emerging data partnerships have been announced – Truveta, Mayo Clinic, Highmark-ChristianaCare. What are your thoughts on this trend?

Sachin: In the last handful of months, I think most of the health systems have come to the realization that the path for them is to have a partner that can help them get there faster rather than perhaps developing the capability in-house. The challenge through all of this is going to be how do you keep that data integrity at a high level? There’s certainly some compliance type of steps that need to be held there, especially as it relates to HIPAA. But if you can clear all of that, then you’ve got high integrity of data and then you need to very specifically define what is the success for this activity that we’re pursuing. I think that is generally alluded to in some of the partnerships that you’re referencing and grow into it over time so that you have confidence that the decisions that you’re making, using those technologies are ones that you can feel really good about. They are not going to either impact you from a financial viability standpoint, but more importantly, that are going to be good decisions for you in delivering care for patients. In one of the organizations that you mentioned, the Mayo Clinic in particular, they referenced that they’re going to be utilizing some of these wearables, technologies and other types of data. I think that’s really exciting and interesting.

Q. One of the things that we see when it comes to applying AI in the context of clinical outcomes, algorithms require a lot of retraining. All the variables need to be adjusted when you are moving from one population to another. So, if you have an NLP algorithm that can scroll through charts and surface opportunity areas, it’ll work just the same in any hospital, any health plan across the country, you don’t really have to do a lot of tweaking to it. Is that a fair statement?

Sachin: It depends. Certainly, there’s different guidelines for each type of organization that you’re working with, plan or provider group that might matter to how you approach each situation. So, there might be custom tuning, but as a general concept, your comment is fair.

Q. You’re a part of Centene now and I guess it is a whole different feel from being a native company. Does your relationship with Centene preclude you from doing any kind of business, especially with their competitors?

Sachin: No, it does not. That is the short answer. So, part of the focus of this transaction, and in particular one of Centene underlying thesis, was that we would continue to sell externally and focus our efforts equally there. The simplest way to do how Optum operates within United in serving both the parent company as well as the broader market. So, we continue to work in that regard to win and have won new contracts with other players in the market.

Q. What are the big challenges for AI that the healthcare industry needs to address before we can realize its full potential?

Sachin: I think there is the widespread adoption or the way in which you drive this fast or appropriately with what are the privacy requirements and what is covered under HIPAA and what other considerations do you need to be aware of? There are other government task forces around this that need to be kept in mind. So, it’s the appropriate attention of how fast technology firms would want to move to say – ‘yeah, give me all the data and I’ll run it through, and we’ll get you that much more high-quality insights and analytics.’ But on the other side, you have to move at the right speed. I would say that the ability to get there should be picking up pace as you start getting folks comfortable that you are able to maintain the integrity and security of the data. That happens with more and more players now. Sometimes a big situation that comes up at some point in the future and there’s a breach. Someone is exposed and that becomes a concern. So, with more firms being focused on that as a table stakes item to be successful in winning new engagements with plans and providers, I think it drives some of the discipline even more so around that. When you think about the different axes of how you propagate or become competitive in healthcare analytics with the use of AI, there are three different vectors: there’s the quality of your data science, which you have general control over; there’s the quality of data volume or the quantity of data volume. This is when you have enough diversity of patient data from which to feel comfortable, or can certainly say – ‘hey, for this case, I don’t want to have too much of a bias in this direction or that direction.’ And then there’s the data liquidity piece and it’s really the data liquidity that’s going to be a rate-limiting factor here when you think about those three vectors, because that is driven by not only decisions by health systems and providers, but also from a regulatory standpoint.

About our guest

Sachin-patel-profilepic1

Sachin brings broad experience across both healthcare and technology, spanning a variety of leadership roles, including operations, finance, and development. Sachin joined Apixio in 2017 as Chief Financial Officer and later served as President and Chief Financial Officer before taking his current role. Sachin has extensive experience working with value-based care provider groups including Vantage Oncology, a national leader in community oncology, where he served as Vice President, Finance, and Chief Financial Officer of Vantage Cancer Care Network, an innovative model for managing cancer populations.

Sachin has also held positions with Citigroup Investment Banking and began his career in engineering roles with Cisco and IBM. Sachin holds a BS in Electrical Engineering from The University of Texas at Austin and an MBA from the UCLA Anderson School of Management.

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.

Medical records must become a living record that pulls in data real-time, follows your health, and displays it back to a physician in a useful form

Season 3: Episode #84

Podcast with Grace Kitzmiller, AWS and
Dr. Michael Snyder, Stanford University’s School of Medicine

"Medical records must become a living record that pulls in data real-time, follows your health, and displays it back to a physician in a useful form."

paddy Hosted by Paddy Padmanabhan

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In this episode, Grace Kitzmiller of AWS and Dr. Michael Snyder of Stanford University’s School of Medicine discuss AWS’ Diagnostic Development Initiative (DDI), a two-year, $20 million commitment that uses cloud computing to scale up diagnostic innovations.

In the wake of the pandemic, Stanford University School of Medicine’s Healthcare Innovation Lab developed a smartwatch-enabled alarm system powered by AWS cloud, designed for early detection of COVID-19 by identifying increased heart rates prior to the infection. Dr. Snyder explains how the application works by pulling heart rate information from the smartwatch, applying an early detection algorithm, and pushes back the signal to a smartphone to set off alerts for possible infections.

Grace shares three gaps that AWS strives to address through the Diagnostic Development Initiative: accurate detection, reprioritization of diagnostic research, and scaling up computing power for machine learning and analytics. Take a listen.

Note: Those interested in participating in the Stanford COVID-19 wearables study can sign up here.

Developers interested in the AWS Diagnostic Development Initiative program can apply here.

Our Podcast Partners:    

Show Notes

02:42What are the gaps AWS is looking to address with the Diagnostic Development Initiative?
04:49About Stanford’s smartwatch-based diagnostic app for COVID-19 detection alerts.
08:16 What has been the predictive power of these smartwatch-based diagnostic algorithms and how they hold up across populations or regions?
12:27 How do the wearable device integrate with Epic or Cerner and make it a part of the longitudinal patient record for diagnostic and treatment on an ongoing basis?
14:58 What about patient privacy? Even in the research phases you're putting some guardrails on what happens to the data. How is Stanford protecting patient’s data?
17:33What has been the response so far for AWS’ Diagnostic Development Initiative? What kind of research projects are we likely to see, with a focus on healthcare?

Q. Dr. Snyder, can you tell us about your role at Stanford?

Dr. Snyder: I am Professor and Chair of Genetics at Stanford University’s School of Medicine. I also run the Center for Genomics and Personalized Medicine, the innovation lab there, and we do a lot with big data in health.

Q. Grace, can you brief us on your role?

Grace: Paddy, I lead Solutions Development for the AWS Disaster Response Program, which focuses on how technology and the cloud can assist organizations that are active across crisis such as the COVID-19 pandemic or across the lifecycle of natural disasters.

Q. Amazon has recently been in the news for several healthcare-related initiatives, and one of them was the Diagnostic Development Initiative. It was targeting COVID-19. Grace, what was the gap or need that AWS was looking to address with this initiative?

Grace: AWS Diagnostic Development Initiative is a 20-million-dollar commitment that we made last year to support customers and accelerate their diagnostic innovations. We provided this support in the form of both cloud computing credits and technical support from AWS experts like our solution architects and our AWS professional services team. These AWS experts helped those organizations that were part of the Diagnostic Development Initiative to use AWS services to either stand up or scale their COVID-19 diagnostics projects. As COVID began rapidly spreading around the world, there were a few reasons diagnostics really bubbled up to the top. First, accurate detection is the tip of the spear for any effective pandemic response strategy. Secondly, diagnostics research has historically been underfunded and largely de-prioritized when compared to vaccine or treatment development. But realistically and thirdly, organizations working on diagnostics also need access to reliable and scalable compute power, which AWS could deliver along with things like analytics and machine learning to help researchers process and analyze some of those large datasets that were being generated and iterate more quickly. So, in the first year of the program, we have been excited and seen some inspirational results from customers like the wearables work that Dr. Synder’s research team is doing at Stanford. It’s really been great to see how these projects are pushing the boundaries of diagnostic innovation. 

Q. Dr. Snyder, Stanford has been one of the early participants in the program. And you have launched a smartwatch-based diagnostic app for the COVID alerts. Can you tell us about the app and some of the results that you have seen so far?

Dr. Snyder: Several years before we found that you could tell when people are getting ill from Lyme disease, as well as respiratory viral infections using a smartwatch. When the pandemic came along a little over a year ago, with Amazon’s help we have really been able to scale this thing up. So, we first showed that we could detect COVID with a smartwatch. It turns out, on average, four days before symptoms and for some people, as much as 10 days before symptoms, we can see when they are getting ill because their heart rate jumps up on a smartwatch. So, we first showed you could do that and recently, we have rolled out this app that alerts people when their heart rate jumps up, which does happen before you get ill with COVID or other things. It can happen with other lifestyle events as well, for example, you drink way too much. But it certainly seems to work for infectious disease about 73% of the time, according to our latest work. It is a simple app that you download on your smartphone that integrates with the smartwatch. It works for Fitbit; Apple Watch and we are trying to work it for other watches as well. Basically, they are following your heart rate, will transfer the information over to the phone. We use the cloud to pull any information, and then we compute using our algorithm. When we see a jump up in heart rate or other abnormalities, it will send off a signal which pushes back to your smartphone and it’ll set these alerts. Right now, we have just launched the second phase of the study where we are sending the alerts. As I said, it sometimes picks infections, and it does pick up COVID infections as well as asymptomatic cases. We think this is going to be very powerful. It absolutely requires the cloud for this to work because you need to be able to access people all around the world. The study is global, and you can compute everywhere. You keep the costs down actually by running some of the computing areas that are less busy and then distribute the load, so to speak, in the more cost-effective fashion. That’s probably the only way you could do a project like this that uses the cloud and it’s totally scalable. 50 million people in the U.S. wear a smartwatch and right now they could all have an alerting function for COVID-19 if they tuned in to this program. 

Q. This is a global program. So, I imagine that your application has been downloaded globally by people onto the smartwatches – Apple or Fitbit. You mentioned that the elevated heart rate could be a result of various potential activities and not necessarily just COVID. I imagine that the algorithm in some way adjusts for different likely causes and then combines it with other kinds of wearables and so on. What has been the predictive power of these algorithms and how do they hold up across populations or across regions?

Dr. Snyder: We’re going to need more data to answer the last question because the numbers are so small. That’s why we want to have more people join the study. We’ve had several thousand people signed up. We’ve had something like 70 positive cases so far. So, we’ve picked up seventy-three percent of them from different parts of the country, and we’re still improving the algorithms. We want to get that Seventy-three percent up to ninety-five percent or better. We can do that as we pull in more different data types focused on resting heart rate steps and sleep. We pull in different kinds of data; we can improve the algorithms, so we are trying to get as many people signed up as possible. We can detect COVID from different ethnic groups. I’m optimistic it should work for everyone because when people get sick, their heart rate jumps up.

Q. If you do get a million people signed up, what’s the end goal here?

Dr. Snyder: My end goal is to put a smartwatch on everyone on the planet, seven billion people, so they have a health monitor for every single person. That cannot happen today, but that is the long run. The only way to do it is to be following your health in real time, not doing PCR two days later when they get symptoms. You want to be following people while they are healthy in real time, seeing when you see and detect an abnormality and catch and push it back to them as quickly as possible so they can act on it. In the case of a pandemic, if they get one of these alerts, we want it to be as sensitive as possible and as specific as possible, we want them to ultimately self-isolate or get checked right away, before they spread it around to one hundred other people. 

Q. Grace, one of the outcomes of these programs is that you are going to get a lot of data about patients, about consumers and so on. Do you have any plans to harness insights from this data in any way, let’s say, for public health in this case?

Grace: No, that is not the programs intent. AWS is vigilant about our customer’s privacy and data security. Our technology and program policies are really designed with that security and privacy in mind. So, for customers like Dr. Snyder at Stanford and others retain ownership and control of any data and content that they store on AWS, along with the ability to encrypt it, protect it, move it or delete it in alignment with their security policies.

Q. Dr. Snyder, how do the wearable device integrate with Epic or Cerner and make it a part of the longitudinal patient record for diagnostic and treatment on an ongoing basis?

Dr. Snyder: Right now, we’re in the research phase and testing these algorithms, seeing how well it works, and optimizing them. You would have to have a follow up test for that to go into in the record. That’s where we stand now, but in the future, these things will get better validated and they’ll have to get FDA approved, which is not hard to do for simple devices like thermometers. And that will be the case for smartwatches. I think they will be able to get validated and you’ll be able to pull information from them and aspects of that will be in the medical record. Now, my own view is the whole medical record needs to change. Right now, it is not useful to most doctors. It’s hard for them to access information from the record. I’d like to see the record become a living record, meaning it pulls in your data in real time, follows your health, and then can displays it back to a physician in a very useful form in which they can see how is your cardiovascular health, how is your metabolic health, how is your other forms of health? So, I think we should transform the whole medical records system to make it in a useful fashion. An example of this is when they measure your heart rate in a doctor’s office, it’s all over the map and it depends on whether you drove by bike there, what stress is going on, all sorts of things. But you can pull a pretty accurate heart rate right first thing in the morning from someone and get a much better picture of their health. Imagine incorporating that kind of information into a health record for a physician to be able to see what is called a longitudinal record so they can really follow what is going on.

Q. Dr. Snyder, what about patient privacy? In the research phases I guess you are putting some guardrails on what happens to the data, how are you protecting patient data and so on. Can you talk about that?

Dr. Snyder: That is a big concern. So as Grace said, we encrypt everything as it comes. It gets encrypted as we compute it, and we compute encrypted data. As these alerts go out, they get pushed back so that everything is stored. One thing that is important is we do try and pull the data and share it in an anonymized fashion and Amazon has been fantastic for helping. People use the term data lake, but I want to make it a data ocean where we have all these data for people to be able to access again in an anonymous fashion so that we can improve our algorithms and be able to detect disease much better. I think this kind of platform is going to be powerful well beyond the pandemic, meaning you can pull other kinds of information from your smartwatch. You can pull other kinds of health measurements from a smartwatch like dehydration. So, by having data that is accessible, researchers can improve this health monitoring system, I think we can really transform the way people’s health is followed. So, I like to think healthcare instead of sick care, so we can then follow people and better manage their health.

Q. AWS is offering millions in credits to developers worldwide as a part of this program. What has been the response so far? What kind of research projects are we likely to see with a focus on healthcare?

Grace: In the first year of the Diagnostic Development Initiative, we supported around eighty-seven organizations in 70 countries. The organizations included customers that are startups, non-profits, research organizations and businesses. We provided cloud computing credits and technical support to really work backwards from the needs of these researchers to understand how technology could help accelerate or scale their work. In addition to the work that Dr. Snyder’s team has been doing around wearables at Stanford, we’ve also seen organizations focusing on looking at uncovering clues about how COVID-19 presents in individuals and what are some of the impacts or what are some of the outcomes that they’re seeing based on characteristics of their immune response networks been done by the Institute for Systems Biology. Our biology team uses machine learning to try to quantify the silent spread of COVID-19 for those with symptoms. Organizations look at using smartphone cameras to provide accurate and reliable diagnostics within 30 minutes of doing a test. One of the things we are doing this year is broadening the scope of the Diagnostic Development Initiative to cover not just diagnostics but also three new areas. First, early disease detection to help identify outbreaks and trends at both the individual and the community level. Also, prognosis to better understand disease trajectory. And then last for public health genomics to bolster genome sequencing worldwide, which is becoming more important as different variants of COVID-19 emerge.

About our guests

GraceKitzmiller-profilepic

Grace Kitzmiller is a Principal and Senior Product Manager for AWS Disaster Response Program, Grace leads strategy and execution for product development by working backwards from the needs of organizations active across the disaster and crisis lifecycle to learn about the biggest technology challenges they encounter, while preparing for, responding to, or recovering from disasters and crises.

Grace works across AWS people, services, information, and technology, and AWS Partners to build or extend solutions and proofs of concept that can solve those challenges. Grace has been with AWS for over five years and was previously Senior Product Lead for AWS Educate, Amazon’s global initiative to accelerate cloud learning to better prepare students for the cloud workforce. Prior to joining AWS, Grace held leadership positions at a graph database start-up and at a consulting firm focused on using technology to develop solutions for state and federal environmental protection agencies.

Dr.Snyder-profile

Dr. Michael Snyder, Stanford W. Ascherman Professor and Chair, Department of Genetics and Director of the Center for Genomics and Personalized Medicine in the Stanford School of Medicine, is a world-leading expert in genomics, personalized molecular profiling, and precision medicine. Dr. Snyder's Lab has been a pioneering force in the field of precision medicine, including establishing many foundational methods in the field of genomics. He was recruited by Stanford in 2009 to chair the Genetics Department and direct the Center for Genomics and Personalized Medicine. Under his leadership, U.S. News & World Report has ranked Stanford University first or tied for first in Genetics, Genomics, and Bioinformatics every year for the last decade. Dr. Snyder was the first to apply personalized health tracking using multiomics in coordination with wearable devices to predict and prevent disease.

Dr. Snyder also established the first longitudinal integrated multiomic (genomics, proteomics, metabolomics, lipidomics, transcriptomics, microbiomics, and wearables) profiling of humans for personalized health and medicine. This project has produced the most deeply profiled cohort in human history. Most recently, Dr. Snyder has launched Stanford’s Personal Health Dashboard, a novel research app using wearables, currently in exploration for the very early, real-time detection of COVID-19. Additionally, Dr. Snyder has co-founded 13 biotechnology companies including Personalis, Qbio, January AI, Mirvie, & SensOmics.

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 are seeing virtual care and telehealth as an important tool in the toolbox for ambulatory care practices

Season 3: Episode #83

Podcast with David Cohen, Chief Product and Technology Officer, Greenway Health

"We are seeing virtual care and telehealth as an important tool in the toolbox for ambulatory care practices"

paddy Hosted by Paddy Padmanabhan

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In this episode, David Cohen, Chief Product and Technology Officer of Greenway Health, highlights the need for RCM service providers to scale up to meet the revenue cycle needs of the larger healthcare practices. Greenway Health is an electronic health records (EHR), practice management, and revenue cycle management solutions company serving more than 50,000 ambulatory practices.

The RCM services is witnessing M&A and consolidation to find the efficiencies of scale. David points out that sophisticated RCM software must develop automation capabilities, robust analytics, and machine learning models to help reduce the overall cost of these practices to collect and improve financial outcomes for practices.

David advises medical practices to stay on top of regulatory changes and be aware of the changing payment roles and cycles. Take a listen.

Our Podcast Partners:    

Show Notes

02:50The current state of the RCM services provider sector and drivers of M&A and consolidation in the sector.
04:48The impact of pandemic on Greenway Health’s clients.
06:42 What has the shift to virtual care meant for Greenway Health’s clients in terms of reimbursements and cash flow, specifically telehealth visits?
12:32 There is a highly fragmented market of digital health and telehealth technology providers. What does it mean for practices that are running stand-alone platforms and how should they address it?
15:47 What kind of performance indicators should practices examine in the current context?
17:51 What role do the front-office, clinical, and back-office staff have in RCM, and how can these groups work together efficiently to enable patient care and improve the quality of care? What are the best practices for providers to improve their practice’s RCM?

Q. David, can you tell us a little bit about Greenway Health and your role? 

David: I am the chief product and technology officer at Greenway Health, and Greenway is a leading provider of health care technology, solutions, and services. Our clients represent about 50 thousand ambulatory health care providers across multiple specialties, and that equates to about several million patient lives cared for using Greenway solutions. I’ve worked in this intersection of health care and technology for over 15 years, and it’s been a very exciting and dynamic space to be focused on, particularly seeing the level of impact that we’re able to have in helping practices better care for and manage patients and also improving the health of the communities that they serve.

Q. What is the current state of the RCM service provider sector and what is driving M&A and consolidation in the sector? 

David: Greenway provides EHR, practice management technology solutions to our clients, and we are a leader in the RCM services space. I agree that there is a lot of M&A activity happening in the market and the major driver for that is really efficiency of scale. So, being part of a larger organization has several advantages. One is sophisticated RCM service providers, like Greenway, develop automation capabilities, robust analytics and machine learning models that can help to reduce the overall cost of practices to collect and improve financial outcomes for practices. And these are capabilities that smaller companies would struggle to develop on their own. It’s also the reason why we’re seeing more and more ambulatory practices turning to revenue cycle services providers to help them with their RCM operations. We also see larger RCM service providers getting better financial outcomes and results for clients, and that can result in better contract negotiations. And the third thing is around scalability. 

Q. How has the pandemic impacted your clients, the ambulatory practices? 

David: It has been an interesting up and down year and a half for our clients. So COVID, at the early onset had a significant impact on ambulatory practices throughout 2020. We saw spikes in COVID cases and hospitalizations putting immense pressure on healthcare staff and resources, which resulted in steep declines in non-COVID volume and sharply reduced revenues. So, at a macro level, reports show that visits to ambulatory care practices declined by almost 60% last year, with primary care practices experiencing significant revenue losses across the board. In 2021, we are starting to see things stabilized quite a bit, but practices still need to consider adding new revenue cycle resources and added support to improve their financial stability.

Q. There had been a shift to virtual care across the sector, both in the ambulatory and inpatient space and remote patient monitoring, telehealth, telemedicine. All of that has sort of accelerated by an order of magnitude from everything that we see now for your clients, specifically in the ambulatory space. What has this shift meant for your clients in terms of reimbursements and cash flow, specifically telehealth visits?

David: Before COVID, virtual care and telehealth was the most talked-about least adopted technology in the industry. Obviously, there were reimbursement rules that were driving that quite a bit. But COVID was just a tremendous catalyst in the industry that saw significant adoption uptake in telehealth. What we are seeing now is that having virtual care as an additional tool in the toolbox for patient care, it really has a double benefit of keeping patients healthier, as well as helping practices to stabilize financially by giving them an additional source of revenue. The 2021 CMS fee schedule that extended reimbursement guidelines for telehealth visit, it made many of those changes permanent, is exciting for the industry.

A lot of our practices are having glad to see that happen. We believe that telehealth is here to stay. Where it stabilizes is kind of the question now, but it is absolutely important. We are advising practices to start to define and understand how virtual care fits into the services portfolio that they offer, including which visit types will be eligible to schedule virtual care visits as part of that practice strategy. Virtual care is a great way for practices to reach out to underserved areas of their population and they should be thinking about how they can extend the reach of their practice into the communities. Beyond telehealth, we also are seeing increases in opportunities to support remote patient monitoring as part of that overarching virtual care strategy. And it is important for practices in terms of managing patient chronic conditions, particularly when patients are not physically making it into the clinic as frequently with telehealth becoming so accessible and available. So, we are seeing those great improvements to patient outcomes and seeing virtual care telehealth as an important tool in the toolbox for ambulatory care practices, but then also using virtual care telehealth as an important catalyst and additional revenue opportunity for practices.

Q. From your comments, it’s very clear that the providers have to invest in the technology in order to handle virtual visits or provide remote patient monitoring, chronic care management. So, there is a technology enablement aspect to it and a cost related to that as well. How are they dealing with it right now? And does that mean that you are also changing your business model to become something different, something more to your clients than you were earlier?

DavidAt Greenway, our clients absolutely look for us to stay ahead of the curve in the market. And that is something we really view our role as trusted advisers to our clients and understanding where the industry is going, as well as obviously keeping abreast of the regulatory changes and dynamic regulatory landscape. Last year we saw things start to emerge, Greenway responded by bringing to market a proprietary or home-grown telehealth product. We also extended some of our existing services to offer our clients virtual care and remote patient monitoring capabilities, so certainly I think this industry shift towards virtual care has put Greenway in a position to pivot on behalf of our client, to be able to offer them the services and technologies that our clients need for them to be successful. 

Q. We find that there is a highly fragmented market of digital health and telehealth technology providers, and many of these solutions are not well integrated. What does it mean for your clients, the ambulatory practices, that are running stand-alone platforms and how should they address it? 

DavidAt Greenway, one of the things that we will always do is give our clients choice. And our marketplace has several telehealth partners that our clients can leverage. And certainly, we are seeing in the industry a lot of new virtual care players emerging. Greenway went down the path of developing our own telehealth product, because what we saw was that a lot of products on the market were missing the mark with our clients in terms of what they are looking for and the level of integration with their core EHR practice management systems. That lack of integration created a lot of inefficiency in practice workflow. So, we focused on, as we were building a product, things that are important for practices to consider. Number one obviously is being HIPAA compliant and security conscious first and foremost. As many practices were taking a shotgun approach to telehealth adoption, we saw practices out of the gate adopting nonstandard telehealth products. And I would really encourage practices to consider the security aspects of the products that they are leveraging. Number two is the level of integration that practices are expecting from a core product with their existing EHR practice management solutions. And that can come into play in terms of how a telehealth and virtual care product integrates with their scheduling systems, their registration systems, as well as their billing systems, all things that are important in terms of having a seamless practice experience. For example, with our product we have the ability to see virtual waiting room directly within the practice management system. So, it’s one stop shopping for practices and provider. Another integration capability is a real patient flow tracking within the EHR practice management solution. So being able to see when a patient is virtually checked into that waiting room and ready to be seen by a clinician is important. And then when that virtual visit ends up being able to automatically check patients out of the encounter as well, so we know that encounter is closed. There are several areas and points of integration that I think is important for practices to consider as they are adopting different telehealth technologies.

Q. From an ambulatory practice standpoint, what are the new performance indicators that practices examine in the current context? Can you also maybe talk about how you might be enabling them with analytics capabilities in better managing their cash flows and the revenue cycle operations? 

David: So, like everything in business if you can’t measure it, you can’t improve it. And that is one of the top mistakes that I think practices make, is trying to run their business blind. So measuring and baselining medical practice financial performance is absolutely the best first step that practices should take in managing their financial health. It also helps to be able to benchmark performance against known best practices. That is something a revenue cycle partner can help with. So, some of the more important revenue cycle, key performance indicators that we focus on with our clients in our Greenway Revenue Services business are things like clean claims rate, days in A/R, percentage of claims over 90 days, collections per visit. We have a series of financial metrics that we track with our clients. It is also important for practice to establish tangible goals for improvement, and that includes setting monthly annual targets. Oftentimes, just by measuring and observing trends of these key metrics, practices can quickly see what’s working and what’s not. So, for example, when we trim days in A/R by aging bucket, it can help to tell a practice how long they’re waiting to collect on balances, and we’ll tell them that their collection strategies are working or not. So, we work directly with our clients to measure those different key performance indicators, baseline them against best practices, establish tangible targets, and then work on improvement plans and strategies against them. 

Q. What role do the front-office, clinical, and back-office staff have in RCM, and how can these groups work together efficiently to enable patient care and improve the quality of care? What are the best practices for providers to improve their practice’s RCM? 

David: Revenue cycle management absolutely requires shared responsibility among the office staff and team members. They must work together to ensure patient information is complete and accurate from the initial scheduling of an appointment and all the way through clinical documentation. It’s important in any practice that everyone understands the overarching financial objectives of the practice and how their unique function contributes to achieving those goals. So, each function must understand what part they play and how crucial their function is to the overall success of the practice. Once they know that, in identifying the obstacles or blockers to inefficiency becomes much clearer. Having well-defined documentation of these policies and procedures are extremely important for each functional area, as it is defining how the handoffs are going to work across those teams. So, for the front office, for example, over half of claimed denials can be attributed to front-end issues, but most of these denials can be avoided. It is extremely important that the front desk staff is reviewing captured patient information, for example, for accuracy during the patient take process. And that they’re verifying health insurance coverage in any authorizations that may be required prior to service. For clinicians, it’s extremely important that visit documentation is adequately meeting payer documentation requirements. Having clearly defined EHR documentation workflows can help to streamline that process and ensure clinicians are efficient with their time and maximizing the time spent with their patients. In the back-office, staff remains the central point for billing and collections, as well as interfacing with payers to ensure claims are accepted and paid. So, staff should focus on validating accuracy of build procedure and diagnosis codes and ensuring that those codes are correct and valid for data service. Staff should also ensure the effectiveness of their implemented claims scrubber and ensuring high quality play metrics. All the different parts of the practice play an important role in revenue cycle operations and collections and ensuring everyone understands what their role is and what those handoffs need to look like is extremely important for practices.

My top piece of advice for practices to really stay on top of the regulatory changes, stay on top of the changes to payment roles and payment cycles. If there’s one constant in healthcare, it’s changes in practices need to continually stay on top of those changes in the industry, whether that’s things like billing codes or documentation requirement changes, such as the recent easement of documentation that’s necessary for E/M billing coding. That is one of the reasons that Greenway recently launched a new service offering that we’re calling JIRA select, which is a highly customizable revenue cycle offering that’s designed to meet the unique, individualized needs of healthcare practices. And that is something I would encourage practices that are looking for a revenue cycle management partners to really look for that can complement the things they’re already doing and doing well and really identify where they need help and make sure that they’re selecting a partner that can offer them help in the right areas. 

About our guest

David is passionate about technology solutions that allow practices to thrive. As Greenway’s Chief Product and Technology Officer, he brings more than 20 years of enterprise information technology leadership experience to the role, with the most recent 15 years focused on healthcare

Prior to joining Greenway, David was responsible for artificial intelligence and machine learning initiatives at Cerner. Before that, he developed custom software solutions and contributed to Agile software development methodologies as a Senior Consultant at ThoughtWorks. Service is core to David’s philosophy. He is committed to serving as a trusted partner to clients and helping them address the healthcare needs of their patients and communities.

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.

One of the lessons learned as a result of COVID is we have to create a more resilient supply chain

Season 3: Episode #82

Podcast with Mike Alkire, President & Incoming CEO, Premier Inc.

"One of the lessons learned as a result of COVID is we have to create a more resilient supply chain"

paddy Hosted by Paddy Padmanabhan

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In this episode, Mike Alkire, President & Incoming CEO of Premier Inc., discusses the ongoing vaccine roll-out and the lack of resiliency in the medical supply chain for U.S. healthcare.

He discusses how Premier is expanding their data analytics capabilities, such as AI and machine learning to make the supply chain infrastructure more resilient and support better clinical decisions. Mike believes that the changing competitive landscape of healthcare and the entrance of non-traditional players is unleashing innovation in the industry. He also shares three leadership lessons from his long and successful career. Take a listen.

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Show Notes

02:49Some significant lessons learned as a result to the COVID virus is we have to create a more resilient supply chain.
05:16We need technology to really support the federal government and public health officials around syndromic surveillance.
16:28 Approximately 30% of our healthcare systems cost is wasted and we want to help them with evidence based, AI-enabled guidelines embedded in their workflow to drive that waste out.

Q. What are you seeing as a big trend driving the healthcare industry in the wake of the pandemic? What are you hearing from your major customers?

Mike: I think along with the public, our healthcare systems are really focused on getting as many shots and arms as possible. Our first focus area is to bring in efficiency to the supply chain of the vaccine. Second focus is getting back to normalcy. Healthcare systems obviously have been really caring for the COVID patients and our focus over the last few months is really helping our healthcare systems think about what does the new normal look like and leveraging some of the silver linings in the cloud that was covered.

We had some significant lessons learned as a result related to the COVID virus. One is we must create a more resilient supply chain. What happened was there was this huge demand-supply balance and Premier had to go out and stand-up additional capabilities to secure additional masks, isolation gowns, gloves, and drugs. We found that this supply chain that was being utilized by U.S. healthcare was not resilient enough. And so, we got a big focus on trying to diversify that. We partnered with several our healthcare systems to create domestic production of N95 masks. We have also partnered with them down the lines for manufacturing isolation gowns domestically. We are going to continue down that path from a supply chain standpoint. From a technology standpoint, there were a few lessons learned as well. One was that we did not have the technology to ascertain what the inventory levels look like across the healthcare system. And we’re right now working with a few agencies or organizations within the federal government to leverage some of our technology that would potentially help them in the future pandemic to dynamically allocate product. Because what has happened in the last few months or the last number of months is that everybody is trying to create stockpiles and it’s creating an incredible inefficiency in the market. We believe that if we could leverage technology, we could understand inventory levels and we could dynamically allocate product where it was needed so that not everybody was going out and trying to create these stockpiles. With the technology, we created a science of predictive capabilities on the onset of the virus, where we use both public and our data. And as the virus progressed, we built out some models based upon utilization of PPE and generic drugs to forecast where those products were going to be needed, depending on where the virus spreads. The knowledge about the onset of virus in demographic areas and the utilization or resources accordingly are, I think, very critical. We also need technology to really support the federal government and public health officials around syndrome surveillance.

Q. I understand that you’re talking about supply chain lacking resiliency because we are over dependent on certain types of sources. What are you referring to there?

Mike: I think we had way too much dependency on China in Southeast Asia for these critical products. What happened is that when the pandemic hit, there were all sorts of instances of constriction of supply products from where we historically gotten products and a lot of cases like this was China, but we contract manufacturer for PPE, we probably do six billion or so gloves a year. We set up production in Taiwan for N95 facemasks as well. When we needed it the most domestically, we were unable to get it out of the factory that we had contract manufactured those products for. And all that product was for the most part, shipped to mainland China. That’s just one example. Another example is during the peak of the virus, filtration media is critical to N95, it’s primarily produced in China and India, China embargo the shipment of all that filtration media. So, all the production of N95s were happening in China and nowhere else in the world. And that created a big issue. There are other instances where I am not saying it was right or wrong, but I am just saying we had an overdependence on one country. And the other area that I have been talking about this since basically 2011, if not earlier, is we have way too much over dependence on China and other Southeast Asian places for generic drugs, especially those that are chronically in short supply, as well as those active pharmaceutical ingredients that go into those drugs.

Q. Can you talk about using data analytics technology to bring out additional efficiencies and get better with the distribution processes. How have you driven that kind of transformation for yourself as well as for your clients?

Mike: Over the years, the clients, the customers, and our members really asked us to continue to invest in technology enabling the supply chain. That really was the notion of bringing AI, machine learning, predictive technology into the supply chain setting. So, think about as you are making a decision, a clinical decision from a supply perspective, they want the ability to look at clinical outcomes as it relates to the utilization of specific products. So, they want that kind of data. They want the data on appropriate utilization. Should they use one or two per procedure and what is showing the best outcome in those kinds of things? So that tie between the clinical and the supply chain data is critical as our healthcare systems are continuing to figure out ways to transform their supply chain. We also made some significant investments just prior to the pandemic. But then during the pandemic, I’m really building out an e-commerce platform to help the non-acute side of our customer base get access to product. During the pandemic, New York City and Seattle were hit hardest first. Seattle sort of exhibited itself in nursing homes and long-term care facilities. Historically, those kinds of organizations did not have a great deal of access to PPEs. So, our platform called stockdTM is a platform that has reliably sourced products. Organizations in our acute setting buy products on that platform. But we open it to provide access to non-acute folks that were affiliated with Premier to allow them to get access to these products. We have reliably sourced and had a strong chain of custody, which is obviously really, important to protect the caregivers who are caring for those patients. So that’s number one. Number two, we recently made an investment in a company called IDS. And what IDS does is it is all about e-invoicing and e-pays. And we believe, along with our ERP and our front end stockdTM program, that we now have an end to end procure to pay technology ability truly all the way from the purchase point on the e-commerce platform all the way through e-invoicing and then through e-payment plan, we believe by leveraging the IDS technology, our healthcare systems can centralize the whole invoicing function across their health system and the accounts’ payable function. So, we are incredibly excited about integrating all those data assets and bringing all the efficiency to our health system.

Q. We talked a great deal about the syndromic surveillance, last time when you were on my podcast, tools and the algorithms that you were using to get early indications of who is likely to be contracting COVID. We are now at a moment to roll out vaccination across the country. Have you been able to use some of the same tools to repurpose them towards the vaccine distribution effort?

Mike: We took a technology that we were utilizing to help our healthcare systems manage for PAMA, which were the CMS Medicare guidelines for high-cost imaging utilization. We were looking at the unstructured notes of the electronic medical record using natural language technology, natural language processing, to obviously create the mechanism for using appropriate utilization of images and we pivoted that very quickly. And because we could get that the unstructured notes, the unstructured data, we could actually look at symptoms of the disease and we could identify where there were surges or where there was a significant part of the disease. That is something we do think that various health officials should really begin to think about. As what it allows is, because the data is at a zip code level, for public health officials to create different models to protect populations depending on where the submerges are where you did not have to shut the whole state down. You can look at various zip codes and determine where are the resurges and those kinds of things. For the same kind of technology, we have been having dialog with different parts of the federal government about looking at the success rates of the vaccines and looking at the clinical efficacy of the vaccine and those kinds of things. So, we are primarily just in conversations because it was so quick upon us if we weren’t able to get the product out. We are certainly in the discussions to save for future events. Not just Premier, but there are a number of organizations that the technology is underpinning and could truly support them as they’re either developing a new vaccine or as launching one. 

Q. You have been a part of this journey for the past 18 years at Premier and have seen it all unfold in front of your eyes as you take on the role of CEO. Can you share with us what new areas do you anticipate are going to take up your time and attention?

Mike: Yeah, I think they fall under two broad buckets. One is I think we have got to leverage all the technology and capabilities that I’ve been talking about to really accelerate value to our members, our partners, that also then obviously accelerate value to our investors and shareholders. I think accelerating the utilization of that technology, getting it implemented, helping our healthcare systems get back to normal and truly delineating that value, is going to be critical. The second area falls under three principles. One, we need to help our healthcare systems reduce the waste in healthcare. Approximately 30 percent of the cost is waste, and we want to help them with evidence based, AI-enabled guidelines embedded in the workflow to drive that waste out. Number two, we want to modernize, and tech enable the supply chain. We think that there is a ton of manual tasks. There is a ton of data that is not being utilized at the point of decisions. And we want to make sure that we are bringing that information transparently to the decision makers. We have got to continue to build out more resiliency in that supply chain, look for more opportunities to domestically manufacture products, especially those that are highly automated and generic drugs, as well as some of the APIs. We need to be thinking about how to do that more domestically as well as nearshore. And then finally, we need to continue to evolve our technologies to help our healthcare systems truly thrive in a value-based care economy. So, those kinds of capabilities include clinical decision support, which obviously we believe is going to be important. As you know, healthcare systems are going to be on the hook to deliver high levels of care, high quality care by both employers as well as payers, and then obviously at a patient level as well.

Q. The shift towards value-based care is perhaps not as fast and not as rapid, not as deep as we might have expected, and we are still in a predominantly fee-for-service environment. However, the marketplace has its own way of recalibrating the market for products and services. We are at a moment when we have big technology players like Amazon, for instance, getting into core care delivery. We have got digital first companies that are delivering healthcare in a more digitally enabled, digital first kind of way. And we have got all the non-traditional players like CVS and Walgreens and Walmart looking at the healthcare space. What does it all mean for your clients and consequently for Premier?

Mike: There’s always going to be new competitors, given that healthcare is such a significant part of the gross national product of this country. So, we happen to believe that competition is good as it unleashes innovation. And ultimately, at the end of the day, it provides better levels of patient satisfaction and obviously more innovation becomes online. It provides more choices and obviously a better overall system. Our health systems, specifically the ones that are tied with Premier are embracing the challenges and the demands of all this innovation, and we see it every day as they are building out new capabilities around telehealth and virtual health. And our clinical decision support capabilities are an important underpinning of that so that you can drive a level of consistency. As you think about all these virtual visits, you think about our health systems as they are building out more models around hospitals at home and mobile clinics and the need for all that clinical decision support, patient engagement tools are going to be critical. We believe that vertical and horizontal integration is going to continue. So horizontally, healthcare systems coming together to create more scale. Vertically, you are going to see them get into other areas of service that is outside of the four walls of the hospital to include areas like post-acute pharmacy and integrated primary care.

Q. All this potentially expands your own addressable market and opens brand new market opportunities for Premier. Is that a fair statement?

Mike: It’s very fair and that’s the reason we’re so focused on the technology enablement of both sides of our business, both the clinical as well as the supply chain, because as they vertically integrate, it’s going to be extremely important to ensure that information flow is seamless and accurate as we’re caring for patients across the continuum. So that you have the right clinical data, the right safety data, and the right supply chain data so folks can make decisions along that entire vertical integration. So that it just goes back to our primary premise, which is why this technology enablement is so critical, especially using advanced technologies like a machine learning, natural language processing and technology. 

Q. Are there any potential other implications? For instance, you talked about the horizontal integration of health systems looking for economies of scale and what that potentially means is that service providers or suppliers such as Premier, for instance, might feel a little bit of price pressure. So, you have to stay one step ahead by making your own operations a little bit more efficient so that you can protect your margins while continuing to be of value in the emerging landscape? Is that a valid assessment?

Mike: Well, that is a very fair statement. But I think we are so fortunate in that as we have this incredibly strong network of innovative healthcare systems that I think constantly push us to innovate and bring us ideas around how to create more efficiency for them. So, they as opposed to each of them building out the clinical decision support and the technology for global payment, they’re coming to us and saying, can you build those kinds of things as opposed to each of them blockchain enabling those sophisticated invoicing and payment systems are saying, can you build that out for us? So, we look at it as an opportunity as all this technology continues to advance and the shifting landscape continues to evolve, because of that tight connectivity we have with our health systems, we’re going to be able to innovate right along with them and create technology and services to help them become more efficient.

Q. Mike, you’ve had a long and successful career and many of my listeners would want to know a few lessons from you. Maybe talk about one thing that you wish someone had told you when you were younger?

Mike: Firstly, the notion of diversity and the exposure to diversity. When I talk about diversity, I’m thinking of every sense of the word. I think it is important for folks to have that sort of thinking because it provides you insights and perspectives that you might never have seen before. So, diversity in terms of people that come from different walks of life that are trained differently. On the other side of that equation, it also gives you a bit of compassion and empathy and understanding of what others are going through. Right on my podcast, I talked quite a bit about the word humanity. And what I mean by humanity is getting to know everybody as an individual as opposed to a label or something else. That exposure to diversity is important. I think number two is just understand and appreciate. You are going to make bad choices and bad decisions. And to me, the most important thing throughout your career is how do you recover from decisions that did not go the way you want it. And so, I’ve always sort of built a process or an internal process, if you will, of how to sort of recover very quickly from decisions that you have made that have not gone the way that you want. And it is really important to have that perseverance to bounce back and come right back at it with some great learning because of a decision that didn’t go the way you wanted. I also think that one of my strengths was the ability to get onto the next thing faster. Whatever that issue was or whatever the strategy was, it was critical in my development that I did not just harp on a bad decision or a bad strategy. I fixed it and moved on and got into the next thing. And then the last thing is this notion of an inverted leadership structure. Sometimes people call it the inverted pyramid of leadership. I think that is critical. All that means is that I’m here to support my next layer of leadership and to take out the roadblocks that are inhibiting them from growing and accomplishing their jobs. And their job is to do the same thing for their people. I think we have got incredibly talented group of people at Premier. And one of the things I asked my leadership team to do is make sure that you’re helping your leaders manage folks and provide leadership to people in the most effective way possible and to just unleash their brilliance. So, I think that notion of the inverted leadership structure is real as well.

 

About our guest

Michael J. Alkire is the President of Premier. As President, Alkire leads the continued integration of Premier’s clinical, financial, supply chain and operational performance improvement offerings helping member hospitals and health systems provide higher quality care at a better cost. He oversees Premier’s quality, safety, labor and supply chain technology apps and data-driven collaboratives allowing alliance members to make decisions based on a combination of healthcare information. These performance improvement offerings access Premier’s comparative database, one of the nation’s largest outcomes databases.

Alkire also led Premier’s efforts to address public health and safety issues from the nationwide drug shortage problem, testifying before the U.S. House of Representatives regarding Premier research on shortages and gray market price gouging. This work contributed to the president and Congress taking action to investigate and correct the problem, resulting in two pieces of bipartisan legislation.

Prior to serving as President, Alkire was president of Premier Purchasing Partners, which offers group purchasing, supply chain and resource utilization services to hospitals and health systems. Premier remains among the top group purchasing organizations in the industry as the value of supplies purchased through its contracts has increased to more than $56 billion. Upon joining Premier in late 2003, Alkire worked closely with the Purchasing Partners team to develop and implement a three-year transformation plan designed to dramatically increase returns to the alliance’s shareholders while building stronger relationships with members and suppliers.

Alkire is a past board member of GHX and the Healthcare Supply Chain Association. He recently was named one of the Top 25 COOs in Healthcare for 2018 by Modern Healthcare. In 2015, Alkire won the Gold Stevie Award for Executive of the Year and in 2014 he was recognized as a Gold Award Winner for COO of the Year by the Golden Bridge Awards. He has more than 20 years of experience in running business operations and business development organizations at Deloitte & Touche and Cap Gemini Ernst & Young. Before joining Premier, he served in a number of leadership roles at Cap Gemini, including North American responsibilities for supply chain and high-tech manufacturing.

Alkire graduated magna cum laude with a Bachelor of Science from Indiana State University and a MBA from Indiana University.

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.

Inserting data back into the workflow to make it useful is the number one challenge

Season 3: Episode #81

Podcast with Jim Beinlich, VP and Chief Data Information Officer, Penn Medicine

"Inserting data back into the workflow to make it useful is the number one challenge"

paddy Hosted by Paddy Padmanabhan

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In this episode, Jim Beinlich discusses the current state and maturity level of data and analytics in healthcare.

Healthcare lags other industries when it comes to using new technologies. The industry still needs to apply standardization, governance, and ensure data quality to get the right data at the right time to the right person. Jim states that one of the challenges with data is inserting it back into the workflow to make it useful. One of the important use cases of Penn Medicine’s data and analytics program has been the transition from traditional analytics to cloud-based tools and leveraging data lakes to unlock self-service data models.

Penn Medicine is one of the very few healthcare organizations to integrate genomic testing results into the EMR. Jim shares their extensive protocols for integrating genomic data into patient records for diagnosis and treatment. Take a listen.

Our Podcast Partners:    

Show Notes

05:00Being able to share data more easily can always be good. I think the challenge is going to how do you balance that against privacy and security.
14:21Data quality is the foundation for any of the programs. If people do not trust the data, they don't trust the results out of any of the systems or technologies.
25:54 We're able to take data and stratify patients and take our low-risk population and say that those people can get a remote follow up.
34:15 My advice would be talk to your EMR vendors, cloud vendors, understand what tools are available to you so that you don't have to hire highly technical staff to build it.

About our guest

Jim Beinlich is the Vice-President and Chief Data Information Officer of Information Services at Penn Medicine. He has responsibility for the Data Analytics Center and the Project Management Office within Corporate Information Services..

He has over 30 years of experience in healthcare operations and management (hospital and physician practice), research computing, information management and technology. He is a certified Project Management Professional and holds an MBA in Health Care Management from Widener University.

Jim has significant experience with large, complex health systems in the areas of strategic planning, process redesign, project management, IoT, and operations improvement. He has consulted for large organizations such as the US Department of Defense, the National Institutes of Health, and Catholic Health Initiatives. He holds adjunct faculty appointments at Temple University Graduate School of Health Information Management and Widener University Graduate School of Business

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 hard part isn’t the technology piece but making sure the experience is right enough for patient engagement

Season 3: Episode #80

Podcast with Kash Patel, VP and Chief Digital Technology Officer, Penn Medicine

"The hard part isn’t the technology piece but making sure the experience is right enough for patient engagement"

paddy Hosted by Paddy Padmanabhan

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In this episode, Kash Patel discusses his role as the Chief Digital Technology Officer at Penn Medicine and provides an overview of their digital transformation initiatives covering all aspects of the institution, including research, academic programs, and patient engagement.

According to Kash, the hard part with digital transformation is not necessarily implementing technology but ensuring the patient experience is seamless with the technology and they feel positive about it.

While making technology choices, Penn Medicine’s first and foremost preference is to make the maximum use of their existing EHR infrastructure. Kash also describes the governance process that includes their leadership and subject matter experts to make technology decisions about newer digital tools and platforms. Take a listen.

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Show Notes

05:04We are creating a roadmap for the journey to digitize our research platform that allows us to do all the prejudgments of the clinical trials, human subject trials, and ultimately manufacturing.
10:40The hard part wasn't the technology piece, but making sure that experience was correct and right enough for engagement.
11:03 We bring a lot of technology to the table and figure out what is the level of detail that a patient will tolerate, adhere to, engage with and feel positive about the experience.

About our guest

Kash Patel is the Vice President and Chief Digital Technology Officer at Penn Medicine. Kash has over 20 years’ experience in technology leadership ranging from startups to multi-national corporations and is a seasoned leader in healthcare with a strong focus on innovation and building great teams.

At Penn Medicine, Kash is leading the world class Pearlman School of Medicine Information Technology team. He supports the areas of research, clinical trials, manufacturing high performance computing, informatics, genomic science and many others. In addition, Kash is responsible for all of bespoke software development.

The team has been credited with several innovations that are streaming the complex business of healthcare. In 2020 there is a large focus on COVID-19 activities, working with Microsoft, Google and Apple to develop novel solutions that reflect Penn Medicine’s outstanding reputation.

After graduating in engineering from Sheffield in the UK, Kash gained valuable experience in building business driven software solutions in various industries. His earlier career started in consulting in the UK. He has managed global delivery teams for fortune 100 companies and started a new venture that created leading edge communications technologies.

In healthcare, Kash was the vice president for population health and analytics at Mount Sinai Health System where he led the technology strategy to support the institutions business shift from fee for service to assuming more risk. In addition, Kash was the IT lead for Mount Sinai’s New York DSRIP Program, involving over 250 partners led by Mount Sinai with over a $100M technology investment plan. He also managed health systems analytics and data engineering functions where he developed analytics as a service using advanced technologies.

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.

Our role is to support community health centers and getting members educated about the vaccine

Season 3: Episode #79

Podcast with Dr. Rich Parker, Chief Medical Officer, Arcadia and Jennifer Polello, Senior Director of Quality and Population Health at Community Health Plan of Washington

"Our role is to support community health centers and getting members educated about the vaccine"

paddy Hosted by Paddy Padmanabhan

In this episode, Dr. Rich Parker and Jennifer Polello discuss their vaccination distribution program, challenges around vaccine hesitancy, and how they have overcome this. 

Community Health Plan of Washington is a not-for-profit health plan that caters to the underserved and non-English speaking communities. Their role has been to support the community health centers and getting members educated about the vaccine. One of the most successful vaccination outreach programs has been their text messaging campaign, with a nearly 80% success rate.

Arcadia works specifically with data aggregated from disparate data sources like claims, EHR, lab, state health information exchange, social determinants of health, and others. This longitudinal record of each member helps them risk stratify and identify gaps in care, thereby helping them with their vaccination outreach and distribution priorities. Take a listen.

Our Podcast Partners:    

Show Notes

04:36In terms of getting ready for vaccine distribution, our role really has been to support our community health centers around getting members aware and educated around the vaccine.
09:25 Having access to data, the demographic and EHRs combined with all of that other data, gave us actionable longitudinal picture of the member and enabled us to assist our community health centers for needs they might have.
16:41 We had nearly 80% success rate from our text campaign.
20:09I am very enthusiastic about using data to help push the vaccination rates up as high as possible.

Q. Jennifer, can you tell us a little bit about the Community Health Plan in Washington and the populations that you serve.

Jennifer: Community Health Plan of Washington is a not-for-profit health plan. We were founded by 20 federally qualified health centers almost 30 years ago. Now we’ve got approximately two hundred fifty thousand members through our Medicaid, Medicare, which also includes special needs population, and then Cascade Care, which is a new line of business for us that we started this year. Our network consists of one hundred hospitals across the state and one hundred and seventy-four clinics. We have more than twenty-seven hundred primary care providers and over fourteen thousand specialists. The thing that really makes our organization unique is that we believe in the power of community and our mission is to serve our members and our communities across the state of Washington.

Q. Can you start by telling us how long ago you had to start planning for the vaccine. Tell us about the program itself and what have been some of your challenges in rolling out the vaccine to populations?

Jennifer: The planning around vaccine distribution started well before we had an approved vaccine, in terms of looking at eligibility, what would be available and how we were going to roll this out. Our main emphasis was providing support to our community health centers across our network and trying to help them with any logistic challenges or education and awareness need. That’s where our partnership with Arcadia really took off. In 2020 we had great success using the Arcadia outreach module when the pandemic started for things like what exactly is coronavirus, where to go for testing, which evolved to benefit reminders and connections to our community program teams for referrals to social service needs for things like food security. So, we kind of laid the groundwork for all of this in 2020 when the pandemic started and using all of these resources and distributing that information via the outreach functionality within Arcadia. In terms of getting ready for vaccine distribution, our role really has been to support our community health centers around getting members aware and educated around the vaccine.

Q. Rich, tell us about your analytics and about your involvement in the vaccine outreach effort with Community Health Plan.

Rich: Arcadia is a company dedicated to assisting healthcare networks and to some extent, payers, mostly commercial payers, deal with all the disparate data that is out there. So, getting all the data together from different sources, whether it is claims data, electronic health record data, lab data, state health information exchange data, social determinants data, and aggregating it, cleaning it up, making it useful. And then we have a set of analytics that sits on top of that data for each of our customers, allowing them to succeed in what we call value-based care, basically improving the health of the community.

As for vaccines, I have always been interested in vaccines since I started medical school and fortunately, we have these fantastic vaccines available so quickly to help deal with this epidemic. Arcadia has worked with many customers in helping risk-stratify patients. That is figuring out who is at risk for COVID, educating patients as to when they should ask for care or when vaccines are available, where can they get them? And then also looking at gaps in care. So, if people who should have had a vaccine didn’t get it, we can identify those gaps and help our customers fill them.

Q. Where are you getting all this data from? Can you share a couple of insights that you were able to get from the data that helped you to enable Community Health Plan and Jennifer’s team to drive better outcomes or outreach?

Rich: Our main sources of data are from the electronic health record. We get a download of data that’s extremely up to date and we get it usually on a monthly basis and the claims data. Which means that every time a patient is seen either in a doctor’s office or in a hospital setting a claim is generated. That information comes back to us and we can use that to figure out what’s going on with the population. And so that information, for example, at CHPW where Jen works, it would allow us to understand, which zip codes are doing better with vaccination, which are doing worse, and where do we have to focus our efforts more accurately and intensively.

Jennifer: We relied heavily on our Arcadia Analytics platform during this time. We have 20 cases connected to the Arcadia platform. We have got our data from  all those organizations. We have also added ADT data, which is admin discharge transfer data. So, we get information from the hospitals and we also have a separate lab feed. So, all that data really allows us that longitudinal picture of what is going on with the member. This really allowed us to help the community health centers know, who has got care gaps, who hasn’t been seen, who’s at risk for COVID.

We got almost an 80 percent success rate with our outreach efforts, which is high considering we’re dealing with Medicare and Medicaid members that typically are a little bit harder to reach. And so, having access to that data, the demographic and contact information in the EHRs combined with all of the other data, really gave us that actionable longitudinal picture of the member and enabled us to assist our community health centers in reaching those numbers for whatever needs they might have.

Q. Can you tell us about the insights that you got from the platform and the added tools that Arcadia may have deployed? Anything that came out that surprised you or was in some way unanticipated and helped to really improve the outcomes that you were going after?

Jennifer: We’ve got lots of different registries available to us in the platform. And one of the most utilized is our patient registry and being able to sort that registry by members that are at most risk. So, we can sort by the highest risk members, we can sort by members that have a lot of care gaps or chronic conditions. All that flexibility within the platform allows us to tailor different outreach methods within the CHPW language preferences. That was one thing that came in handy over 2020 because we relied on Arcadia for outreach and translated into lots of different languages, which was helpful and used the accurate contact information and targeted those messages by zip code. So, there was not any one thing that stood out. It was kind of a combination of all the different functionalities within the platform that we were able to tailor to each of our centers’ needs at the time.

Q. Can you tell us about some of the challenges that you have to deal with when you’re pulling all these data sources together and what you’ve had to overcome to make your algorithms and your risk stratification models meaningful?

Rich: There are some countries that have a single health record for everyone in the country. And that, in retrospect, seems like a really good idea. But it’s not what we have in the United States. We have many EHRs and still have some people on paper, but most people are on some computer system now. And since it’s healthcare data, it has to be very accurate. Now, sometimes we have challenges with getting corrupted data or incorrect data that could come in the form of a claims file from a payer that has a problem in it. We have very sophisticated tools where we’re usually able to identify the issue with the data and quickly fix it. Healthcare data is complicated, but we have years of experience doing this and the analytics are only as good as the data source that sits underneath it. We spend a lot of time and effort to make sure the data is correct for each customer.

Jennifer: We have a team that works directly with the Arcadia team to ensure that data quality is up to speed and the integrity of the data is there. We have got lots of different connectors just in the EHRs alone. There’s 20 different data points and data connectors there which are with 20 different organizations and each time they make a change to their workflow, it could impact how the data gets back to Arcadia. So, it’s a constant management of the data with our centers to make sure that data quality and data integrity is first and foremost.

Q. You’re addressing a population that may not be as technologically enabled, especially if you are talking about lower income populations. So, what kind of modalities do you use in your outreach as far as the vaccination program goes?

Rich: One of the big learnings for us is that text outreach is the best way to go. In the old days, we were sending letters, then we were making phone calls, and then a lot of people switched from landlines to cell phones and then a lot of people got a lot of junk calls and stopped answering their phones. But we have learned through experience that most people look at texts on their cell phone. We have now sent over three million text messages out to patients on behalf of our customers, all healthcare related, a lot of it around vaccine education, gaps in care for text messages. The messages are short. And the other thing we have learned about text messages is we can embed a URL. So, for example, if there’s a longer message that wants to get out to its patients, they can put a URL in there and the patient or the customer can click on that and get the website that CHPW wants them to see.

Q. How does that work for you, Jennifer?

Jennifer: It worked exceptionally well. As I mentioned, we had that nearly 80 percent success rate and that was from our text campaign. So, I completely agree with Dr. Rich that text is the way to go. We had very good success rates in reaching our members, and the ability to embed additional information was helpful, because you can send a real short message and then have links for additional information. In terms of vaccine, education, and awareness, we were able to a link to our state’s Phase Finder to help folks understand when it was their turn to get the vaccine. And then over the last year, it was great for driving folks to testing locations and benefit reminders. It was invaluable in terms of directing members exactly where we wanted them to go.

Q. We very often hear about vaccine hesitancy and a significant percentage of the American population do not want to be vaccinated or have concerns. Is that a problem at your institution?

Rich: Absolutely. Vaccine hesitancy is a big problem. Probably right now, about a third of people in the United States are reluctant to get the COVID vaccine. We know that people that are over the age of fifty-five are more likely to accept the vaccine. Younger people are less likely to accept the vaccine. And we can use our data to figure out where the gaps in care are.

Jennifer: I think we we are pretty much in alignment with that as well. We serve the underserved and a lot of those communities are non-English speaking and have different cultural beliefs. So, there’s a lot of education and general awareness that needs to take place. Our strategy has been to reach out to those community leaders as potential models or potential leaders that can help distribute vaccine education and awareness information.

Q. Can you share one best practice for your peers in the industry? One each based on your experience, especially around vaccines.

Rich: I am very optimistic, very enthusiastic about using data to help push the vaccination rates up as high as possible. I would say that without data, you are just operating in the dark. You have no idea what is going on with data. With data, we are not going to get perfect compliance, but we will find out who has been vaccinated, who still needs vaccines, and then we can target our outreach to the people that are still outstanding so we can do the best possible effort to get as many people vaccinated as possible.

Jennifer: Dr. Rich, I completely agree with that. Arcadia platform and access to this integrated data and access to this longitudinal record of our members, the ability to sort by risk and look at care gaps to find out who had the first vaccine, who needs the second one, all those different functionalities really allow us to be in the forefront and at the top end of the curve on reaching our members. I think the key is that we got timely data and data that really connects us back to the needs of our members and our communities.

About our guest

Dr. Parker serves as Chief Medical Officer for Arcadia with overall responsibility for the design and implementation of clinical strategies, input into the roadmap and development of Arcadia’s technology and service programs, thought leadership in support of providers transitioning to value-based care, and strategic advisory work for physician leaders at Arcadia’s clients.

Previously, Dr. Parker was an internist with a 30-year history at Beth Israel Deaconess Medical Center. From 2001 until 2015, Dr. Parker served as the medical director and chief medical officer for the 2,200 doctor Beth Israel Deaconess Care Organization. He oversaw the physician network evolve from a fee-for-service payment system to a nationally recognized global payment pioneer Accountable Care Organization.

Dr. Parker’s other areas of expertise include end of life care, medical malpractice, care of the mentally ill, electronic medical records, and population health management. Dr. Parker served as assistant professor of medicine at Harvard Medical School. Dr. Parker graduated from Harvard College in 1978, and the Dartmouth-Brown Program in Medicine in 1985 Dr. Parker is an in-demand speaker to associations, companies, and academic institutions on the topics of population health management, electronic health records, value-based care, and evolutionary, medical and business impacts of stress.

Jennifer serves as the Senior Director of Quality and Population Health at Community Health Plan of Washington. She has over 20 years of extensive experience across the healthcare continuum in the areas of public health, chronic disease management, quality improvement, health policy, population health management and clinical informatics. She has exercised this experience from several points of view across the health care environment and has demonstrated expert facilitation skills in leading teams of clinicians, nurses and physicians through the transformation process of patient care in the ambulatory setting.

Jennifer has worked on regional health information exchange projects and assisted in the design of a clinical decision support tool for patients with type 2 diabetes. She has also served as an Adjunct Clinical Assistant Professor mentoring PharmD candidates at Washington State University.  

Jennifer is currently leveraging her knowledge and expertise as the Senior Director of Quality and Population Health at Community Health Plan of Washington where she leads the company’s quality improvement strategies, population health and clinical data integration programs across the Network of 20 community health centers that operate more than 130 clinics across the state.

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.

Tech firms must build software that aligns with patient demographics, is usable for them, and delivers outcomes.

Season 3: Episode #78

Podcast with Josh Goode, Chief Information Officer, SCAN Health Plan

"Tech firms must build software that aligns with patient demographics, is usable for them, and delivers outcomes."

paddy Hosted by Paddy Padmanabhan

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In this episode, Josh Goode, CIO of SCAN Health Plan, discusses their digital programs, the patient population they serve, and how they evaluate digital technologies and deploy it at every stage of the care journey for improved outcomes. 

Being a Medicare Advantage plan, SCAN Health deals with the senior population. They strive to address the digital divide in the elderly by implementing software that aligns with their requirements, is easy to use, and delivers improved outcomes while taking care of patient privacy and data security. The technology considers the social determinants of health by implementing a robust data and analytics program that has helped develop AI models to predict chronic conditions. 

Josh also talks about person-centered design processes and how it helps deploy the right digital technology by looking at the patient’s journey touchpoints. Take a listen.

Our Podcast Partners:    

Show Notes

06:39There's a lot of technology and capabilities out there that we can be deploying. But how do you know you're deploying the right one?
07:25 We are very focused on person-centered design.
10:33 When you're dealing with Medicare, the senior population, you got to design the experience with that population in mind.
17:29I think it's our imperative to use data to help influence care, and help improve the service experience as well.

Q. Can you tell us about SCAN Health Plan and the populations that you serve?

Josh: SCAN Health Plan is a Southern California based Medicare Advantage plan and we have been in this business for about 40 years. SCAN Health started out as a social HMO and now we are the third largest Medicare Advantage plan in California. Although our firm is a regional plan, but we do have a strong national presence. We are a leader in a lot of the Medicare Advantage metrics. Our scores are usually near the top of the industry. As per customer satisfaction, we have a strong performance in the star rating and are pretty active from a policy standpoint. We recently got a new CEO Sachin Jain and he came on board about seven months ago. And when you look at such incoming on-board SCAN Health Plan, we’ve had a good foundation, really stable, solid company to the metrics. And now we’re really looking at how do we capitalize on that? How do we build up on that and expand upon all the good work we’ve been doing for seniors across California?

Q. How many lives you cover today approximately and what kind of digital programs have you rolled out in the last couple of years at SCAN Health?

Josh: We’ve got about two hundred and twenty-five thousand listed.

In the last couple of years, we have been focussing on consumer-facing technologies and how do we improve that consumer experience. When I joined SCAN Health, we were more focused on a technology modernization program, a lot of our core admin systems were outdated. They were no longer supported by vendors. Also, our primary core admin systems that does a lot of our administration was written in a programming language RPG. We were hundred percent on premise. So, I put in place a technology modernization program, replacing all those core systems and moved to a SaaS-based model. As all the systems are now moving into a cloud environment, we pivoted our focus more on the consumer facing technology.

We have also built our self-service capabilities, to try to minimize the amount of phone calls we get. To enable our members and our seniors, we have provided online channel options to use. Also, we’ve been doing a lot around data and analytics, advanced analytics. Interoperability has been something we have been doing a lot around last year. And with the new CMS interoperability rule, we are excited. We are really trying to unlock data sharing and trying to focus on our contact centre, our touch points with our members in driving innovation and using technology and data to support those areas of our company.

Q. On the provider side, as well as on the payer side of the business, for instance digital front doors, can you talk about what kind of specific high impact features or functionalities or solutions you’ve launched? How is it making a difference, how do you pick what to deploy, and how do you track whether it’s working?

Josh: There’s a lot of technology and a lot of capabilities out there that we can be deploying. So how do you know you’re deploying the right one? The answer is we like to do journey mapping. Looking at what is that member experience, that constituent experience and looking at what are those touch points that we have, what are the areas that have pain points. We call them – the moments that matter and we look at how we can apply the technology to help solve the issue.

Also, we are very focused on a person-centred design. We use our member advisory committees to give us guidance on things that we need to be working on and have our members, our seniors inform us on the things that we think we need to be working on and focusing on. Then we always have a heavy focus on caregivers and really increasing their abilities has been an area of focus for us.

The other thing that had come up around our members was multifactor authentication on our member portal that is protecting their data. To look after this concern, for us, it starts with that journey mapping of looking at what is the experience and what are those pain points that we can solve with technology.

We have a fully integrated broker portal and we look at their experience of interacting with SCAN Health Plan. By streamlining that, we are making it easier to do business with us from a broker perspective. With our providers we are trying to provide them with better experience as well. So, to sum up, our providers, and our brokers, both can provide our members with a better experience.

Q. You are serving multiple constituencies and your population might not be ready for some of the digital technologies and tools. Can you tell us about one or two unique things about your population that you had to take into consideration while designing these solutions and experiences?

Josh: It’s really not a one-size-fits-all. When you’re dealing with the Medicare and the senior population, you got to design the experience with that population in mind. How do you make it simple? How do you make it easy to utilize those technologies? And that’s something we strive to do with our website and any of our touch points with our members, whether it be telehealth, whether it be doing a virtual visit and even getting that virtual visit invite over to our members.

One of the things we’ve seen in particular with COVID-19 is digital adoption skyrocketed even among the senior population. We saw our member portal registrations go up over 30 percent and these are not one-time registrations. We have also seen our virtual visits, our video conference visit dramatically increased. When the pandemic hit, me and my team brainstormed for solutions and tools to help solve the digital divide with seniors and quickly rolled out a member technology support line. We were able to get it up and running for about three weeks but then after the pandemic really kind of took hold as everybody started going into our virtual environment. And the success out of that is when you look at what happened with the pandemic, you and your members were really thrust to get into a digital environment and some of them were ready for it. You can’t generalize the senior population, some are very digitally savvy and some were not ready for it.

I will never forget our first call which was a forty-five-minute call and was very impactful. It was with a 92-year-old member who was calling. His provider health system had sent him a text to do a virtual visit and you need an email address to register to do it. He never used email and we helped him set up an email account and walk him through how to do that virtual visit. We’ve had a number of stories since then, but it’s something that we’ve been proud of to help solve that digital divide.

Q. In the immediate wake of COVID-19, everybody saw a spike in virtual visits. But now all the data points to the fact that virtual visits are flattening out as patients start going back to clinics and hospitals and there’s a slight of pent-up demand. What are you seeing?

Josh: Something as an industry we have been able to demonstrate through the pandemic is that we can operate in a virtual fashion, but obviously not all care can be delivered virtually. But we have built that trust with our members and our patients, that there are effective ways to service those individuals virtually. And so, we are seeing that it is still running at high levels, but not as high as the peaks that we’ve had in pre-pandemic. So, as we start to open more, those numbers will continue to drop. But what we’re seeing and hearing from our member patient population is that they will continue to use virtual services for select interactions.

Q. Can you talk about your data and analytics program and how you’ve harnessed some of the social determinants of health?

Josh: Data and analytics is something that has always been one of the strengths for us. Under my purview, we manage the architecture, the data infrastructure, the tools and the healthcare informatics department. When you look at our role as a payer, we’re really a data aggregator where we’re getting all the data and we’re using that data to help influence care and help improve the service experience as well.

Also, we’ve got a centre of excellence that we run and enable all of our different business departments around the company and give them the tools to develop their own analytics. So, they can have data at their fingertips to make decisions and serve it up to the leaders in their departments. Also, more recently, we’ve moved into advanced analytics, leveraging AI, machine learning, where we’ve been selective on the use cases we target with AI. It takes more care and feeding as compared to traditional analytics. To make sure you’re focusing on the right use cases for AI and having the right processes in place, we need to be very focussed on our use cases to really improve our ability to leverage data and gain insights on data.

Social determinants of health have always been a priority focus of ours. So, starting out as a social HMO, we were really focused on SDOH. We use a bit of the external sources but have always maintained a good history of information and had the ability to collect that information directly from our members through a variety of means. We’ve been able to develop a pretty rich repository of SDOH data that we’ll leverage across the board. Those clinical models are very effective in looking at predicting some chronic conditions and potential clinical outcomes. We’ll be able to improve the care we deliver by using that data and then coupling it with the robust analytics program.

The last thing I would say on analytics is something we’re really focused on is real time analytics. But with the advancements of technologies, the replication technologies and with the CMS interoperability rule, we need to more tightly integrate with our provider network. This is because we are getting real time data straight from our health systems provider network. And we’re able to take that data and feed it across a rich and robust analytics program to really drive more outcomes as well.

Q. What is your advice to the tech firms and start-ups who are looking to be a part of your journey?

Josh: My advice to those start-ups and tech firms around is, make sure you’re building software that is aligned to your demographic population. As a Medicare Advantage CIO, I see it all the time that we present the software that is not geared towards the senior population. So, make sure you’re engaging that demographic using person-centred design, organising workshops with them, getting their feedback etc. Also, make sure you are building the software that’s going to be usable for them and is going to deliver outcomes.

The last thing I would say is, as a healthcare CIO, we’re all under attack from a cybersecurity standpoint. And even today, you still see a lack of adoption around information security. In the near future, if you’re not a high trust certified vendor, you’re going to have a tough time operating in the market. So, make sure you have a security focus as well.

Q. How did your consulting background prepare you for the CIO role? And what advice do you have for others in the consulting world who want to make a transition?

Josh: So, my background before becoming a CIO was exclusively working in the consulting industry. What really made me a well-rounded individual in my career is learning strategy work, which helped me understand how I need to develop strategies for organizations. Also, I learnt a sizable amount of system implementation work, leading a large system implementation and designing the operating model.

The thing that the consulting background really prepares you for is having that mindset of being able to design an operating model where you can put people in place to be successful and allow them to be able to execute on the strategies that you developed.

About our guest

JOSHGOODE-profile-pic

Josh Goode is Chief Information Officer at SCAN. He provides leadership, direction and support to the company’s information technology (IT) areas including Digital Strategy, Business Intelligence, IT Infrastructure, Project Management, Electronic Data Interchange (EDI) and Application Development. Under Josh’s guidance, SCAN is leveraging its technology investments to meet the individual needs of seniors now and in the future.

Prior to joining SCAN in 2013, Josh worked for Accenture, a multinational technology and management consulting firm. During his 15 years at Accenture, he worked with several health plans throughout the United States, including PacifiCare, CIGNA, Express Scripts and UnitedHealth Group.

His experience includes analyzing, planning and implementing a variety of technological improvements and leading large technology programs, such as systems implementations and IT transformations.

Josh holds a Bachelor of Science in Business Management from the University of Tennessee.

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 best way for patients to interact with us will be through voice technology opposed to any other UI

Season 3: Episode #77

Podcast with Dr. Stephanie Lahr, CIO of Monument Health and Peter Durlach, Chief Strategy Officer of Nuance Communications

"The best way for patients to interact with us will be through voice technology opposed to any other UI"

paddy Hosted by Paddy Padmanabhan

In this episode, Dr. Stephanie Lahr, CIO of Monument Health, and Peter Durlach, Chief Strategy Officer of Nuance Communications, discuss voice recognition technology, its demand and adoption level in the marketplace, emerging use cases, and the next stage of improvements in the technology.

Dr. Lahr believes that voice recognition technology is the best way for patients to interact with their providers as opposed to any other user interface in the future.

Nuance is eliminating the burden on clinicians by powering virtual consults with voice-enabled clinical documentation. According to Peter, other aspects such as scheduling appointments, preparing for a doctor’s visit, medication adherence, and other clinical and non-clinical use cases can improve patient experience through personalized voice-based interactions. Take a listen.

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PP: Tell us about the voice recognition technology marketplace and the environment for adoption of the technology. What have been the broader learnings so far and what are the next round of improvements likely to be in voice recognition?

Peter: The move from directed voice where you say exactly what you want of a more intelligent listening system, that we call ambient, is really the next generation of technology. In healthcare, long before we had the COVID pandemic, we have had the pandemic of administrative burden, overwhelming clinicians, as you probably know, they spend roughly twice as much time taking care of administrative requirements as seeing patients. This has resulted clinicians feeling burnt out, depression going up, and people retiring. It has really been a crisis for healthcare. What they all want as part of the solution is why cannot they just focus on the patient, have a conversation with the patient and use that conversation in the encounter, whether it’s in a physical setting or a virtual setting, and then have the technology to create the documentation for them and do other things like coding and things that they see as taking away from taking care of patients. We have a solution called the Dragon Ambient Experience that we launched right before COVID that does exactly that. We are still early in the journey around ambient, but it’s a very exciting area. In terms of the learning so far, I would say that different physicians have different requirements. So, we roll this out by specialties because you must build these ambient models by specialty. And we have learned that for some clinicians the technology fits in extremely well. For others, they may be looking for the technology to morph in a little way based on the workflow that they have. So as time goes on and as the technology matures, I think you are going to see more and more physicians across a wide degree of specialties really adopt. The results so far in general have been quite good. We are generally, on average, seeing a reduction in clinician burnout for those who are using it. Dropping from about 72% to 17% and freeing up about six minutes per encounter for an average panel size of twenty to thirty a day. That’s a couple hours a day. So, as the technology gets better and better, faster and faster, and needs less and less human involvement in reviewing the note, I think you’re going to see higher adoption and also the development of more automated things coming out of the note like coding and quality abstraction.

Stephanie: I will just add a couple of comments. This is one of those fun times when as a CIO and CMIO, I get to deliver a tool to my clinical colleagues that they are excited about and really makes their lives and their interaction with the patients better. I mean, it’s unfortunate, but true. A lot of the things that we have done and had to do over the last decade or so add to that burden that Peter referred to. And again, this is one of those times where I have a waiting list of people who are excited to try this. I do think that there are certain specialties where this is going to lend itself more to, at least early on, because there are some workflow elements of this. We see our colleagues really being able to take this and fly. And that is great for them, because to Peter’s point, if at the reduced time and documentation and some of those other things, gives them more time to do procedures and be in the operating room and do those things that really impact the improvement of the lives of the patients. The other thing I would say is we are still helping our patients get used to this construct. Most patients are very accepting of this idea of the conversation happening and then the note being created. They are accepting it because they’re anxious and excited to get the intimacy of their relationship with their provider back. But it is still an education point that we must help our patients understand kind of what this is about and what it means and what it does not mean.

Q. So, for the non-native English-speaking populations, there could be an issue with the technology. That is certainly the case with a lot of personal tech. Is that something the technology is beginning to overcome and what are the pros and cons?

Peter: Yeah, that is great. So, the core product in this space for the non-radiology clinician is a product called Dragon Medical One, which is a cloud-based dictation system which approximately 60 percent of all physicians in the U.S. use. The product already supports over twenty-five languages with incredibly high fidelity. It’s sold worldwide today on that front. In terms of the ambient part, as we do these more colloquial conversational stuff that’s earlier in the journey. So, we’re in the process now of morphing that into support. Multiple languages today that is focused on English. But we have a lot of demand, as you would expect, to start penetrating other languages like Spanish, et cetera. So that’s on the roadmap today. So, depending on which product you’re talking about, we either have wide coverage of that or we’re on the early stages for the newest ambient piece.

Q. What are some of the high impact, high value non-clinical use cases for voice recognition?

Peter: One of the hot areas which crosses both clinical and non-clinical is in the patient engagement space. As you know, like many industries, healthcare is now taking this idea of using digital technologies to redefine what is often called – the digital front door. So, how do you access care and how do you follow up on care using technology? From Nuance perspective, we are a leader in what’s called omni-channel virtual assistant technology. We power these sophisticated applications for companies like FedEx, Disney, American Airlines, when their consumers interact over our telephone line for an interactive voice response system or a chatbot or on a social system like Facebook Messenger. So, we have started to bring all that into the healthcare arena for healthcare providers as they look to do things like manage booking your appointment. Did you prep for your clinical visit? Are you taking your meds? All of these are both clinical and non-clinical use cases.

We are the leading provider of voice biometrics technology for user identification and prevent fraud. This has generally been used in the banking financial services industry for obvious reasons, and we’re bringing that into healthcare now. So that’s a non-clinical thing that we’re seeing. And the last case, which is clinical but is exciting, is there is a whole set of companies that are building technology to use voice to help with diagnosis of clinical conditions. There are companies that are using voice for clinical depression screening, for example. You may have seen recently some COVID screening. So, this idea of using the acoustic signal to predict or screening is at the early stages but is something super exciting for us. We are looking at expanding the capabilities of what voice can do beyond the core use today, which is really for documentation of the clinical encounter.

Stephanie: Authentication passwords and the security of our systems is one of those things that a CIO does keep you up at night. There are just too many systems we all have to be in and out of and so we take shortcuts on the utilization and how we reuse and those kinds of things with passwords. So, I love the idea of voice for authentication on the clinical delivery side. On the patient side, for example, in their homes, as we are looking at that, breaking down of the boundaries of where care occurs and trying to identify that best location to help some of our patients in their home. The best way for them to be able to interact with us will be through voice technology as opposed to any other user interface that may just not be conducive based on some of their limitations. We’re already seeing things where people can set up medication, reminders and things like that, but taking it to the next step of really almost having an attendant at home, a healthcare attendant at home and leveraging voice in that interaction. I think these are some of the exciting pieces in addition. We are starting to utilize the elements of IVR and texting to help improve some of the patient experience elements that are high volume and allow us to be more efficient within the utilization of our in-person resources. And we really see it as a blend. Again, to maintain that intimacy of the relationship. We could start off with some of these automated tools. If they are voice driven, that is then more personal than something else. And then we can hand off to a real person when we get to some of the more complex related things. So, lots and lots of exciting opportunities, I think, with voice.

Q. Peter, you’ve been on an acquisition spree, and most recently you acquired this company, Saykara. Tell us a little bit about where that fits into your overall product roadmap, generally in your acquisition strategy?

Peter: Recently, we had a new CEO come in about three years ago. Historically, we had done a lot of acquisitions and we slowed that down a little bit. But we did acquire Saykara and its really interesting. So, Saykara was founded by a guy named Harjinder Sandhu, who is a close friend of mine. He used to be the healthcare CTO at Nuance about a decade ago, a very sharp guy. And after he left Nuance he went off and started a patient engagement company with a partner of his and then kind of came back to his roots, which is really around the clinical documentation space. They started a company called Saykara to really try to do things like what we were doing with our Dragon Ambient Experience. So, we have been keeping in touch with our agenda over the last couple of years. And recently as they were about to go for their next round of financing, we discussed with them together what happens if we try to combine forces because we really all have a passion for solving this really big problem to help our clinician friends and clients, which is this idea of taking a colloquial conversation and turning that into a highly accurate, structured summarize note with a set of extracted data using a language that often wasn’t even discussed in the conversation explicitly, is a really hard technical task. There are very few people in this world that actually have experience trying to solve this problem. Harjinder’s team had relevant experience. So, for us, it was really an attempt to take our incredible team that we have with DAX and supplement it with the great team that Harjinder had put together and combine that into one journey together with a common mission. That’s how we came together to do this. And so, all the Saykara team are going to be working on our combined DAX effort and we’ll look to integrate components of their technology where appropriate and really try to attack this really important moonshot that we’re all after this in this ambient world. So that’s really what the purpose was of that acquisition.

Q. How has COVID-19 impacted the demand or the adoption for voice-based solutions?

Stephanie: It’s been a really interesting journey over this last year. I think from a technology perspective, one of the silver linings of this pandemic has been the rapid deployment and adoption of a variety of different technologies, some of which was telehealth. We all saw this massive uptick in telemedicine. And we did it in a constructive way. Most of our organizations, for a variety of reasons, didn’t have a ton of experience or a deeply embedded telemedicine infrastructure before that. It really is a different way of delivering care to a patient. It takes practice and experience and a little bit of a different format in order to have a high-quality telemedicine experience with a patient. So, one of the things that we saw was that we had a provider who was sitting in front of a computer, sometimes in front of two computers or multiple screens. Depending on whether the video was integrated, they still needed access to the EHR. They wanted to look at the patient. They needed to create their documentation. And the patient was sometimes looking for additional assistance and kind of how to maneuver through this. It was overwhelming at times to be able to figure out how and what to concentrate on. So, for example, with DAX, it was a great use case. We already knew that it was going to be amazing to take this ambient technology and have a conversation in the background in an in-person interaction, because we want to solve the problem of the documentation burden. But the documentation burden was compounded in this telemedicine environment where we did not have a good way to be able to look at the document, talk to the patient and use the technology at the same time. If the documentation was writing itself while we were having the conversation and I was managing the technology with the patient, what a huge win that was. So, definitely we saw that in telemedicine. And then the other piece, I think was huge was we saw really rapid and sometimes very difficult to predict changes in demand. For example, our nurse call center would at times get a hundred calls in a day and then the next day, with the same staffing plan in place, would receive seven hundred calls in the day. We don’t know exactly which day is it going to happen. One hundred or the seven hundred. It was variable depending on everything else that was happening in the environment, what was coming out in the news, all of those kinds of things. So we began to see that maybe automation with voice was a tool set that we could use to help us get through these high-demand periods. Again, allowing the people who needed to do the in-person work to be able to focus on the highest and most complex elements of DAX and let the voice and other elements maybe be able to help patients who didn’t need that higher level support. And so lots and lots of use cases started to come out around where we could leverage voice to get through this high demand situation where none of us had enough resources.

Q. What have you been seeing in the rest of the healthcare ecosystem?

Peter: On the voice side, specifically, the two big things that have exploded are exactly aligned with what Stephanie did. One is that the clinicians, docs, nurses, et cetera, are not in great shape from a burnout perspective before COVID. And obviously it has been absolutely overwhelming for them. So the demand for anything that could help them get through the day has really exploded, whether it was DAX, our dragon ambient product, or even with our dragon cloud moving more expansively of that. I mean, we had things where a lot of these field hospitals, we work with Epic and others to stand up a whole voice enabled system for field hospitals and a few days in multiple cities. So, there was that whole sort of tools for clinicians to try to reduce as much of this other stuff as possible while they were trying to take care of patients. Stephanie also said the inbound flux of patient requests around prepping for a telehealth visit, trying to log into their portal now about getting a vaccine, have just overwhelmed the [health systems. Most health systems don’t have the infrastructure to deal with it. And as Stephanie said, they certainly don’t have the dollars to fund people to do that. So, our digital patient engagement technology that allows you, just like the website or text channels provide these automated systems to do a lot of the basic lifting for them, both on inbound interactions and outbound. We just also signed deals with several large, major pharmacy chains in the country that are rolling out the covid vaccines now and doing centralized virtual assistant front ends to their scheduling system so people can call up, find out what vaccine are they eligible that actually book an appointment. So, all of that sort of exploded both on the provider side, but also on the health plan and retail pharmacy side as a result of COVID.

Q. What is holding us back from a faster adoption of voice recognition in healthcare? What do you think are the big challenges that we need to overcome?

Stephanie: I think the documentation is amazing. We want to do that and help improve that area of the satisfaction of our providers. But now we got to go further than that. One of the challenges that we still need to overcome is the amount of medical information to understand, digest and then utilize in the care of patients is increasing exponentially. We need tool sets that can help us access the relevant information or even provide reminders. So, I really want to see us go beyond documentation and doing things. For example, the relationship between our EHR vendors and the voice recognition side of things so that we can completely eliminate any kind of user interface with our providers that requires a keyboard that is the ultimate goal. Get rid of the keyboard altogether and let me have an interaction, a voice based interaction with the patient and a voice based interaction with the technology. If I need to know when the last CT scan was, let me ask it instead of typing and looking it up. If the system is listening and thinks there’s a piece of relevant information that I should know about as I look into placing an order or creating a plan, tell me about it proactively or alert me that there is potentially a clinical decision, support information that I need in order to make those things happen. The integration between the EHR which now sits at the center of these tool sets and the voice recognition side is an absolute requirement.

Peter: I think Stephanie really hit it on the mark. She really touched on two critical points. So, in terms of driving adoption, obviously the core technology from folks like us has to be good enough to be use number one. I think we have done a good job of that. There’s obviously room for improvement. And certainly, we’re still early on the journey of ambient world. But the early indications are positive. As Stephanie mentioned, there’s two other key points. One is we integrate into other systems. So, the more integrated and more natural the integration is, the better the adoption will be. We’re working with folks like Epic, Cerner, Meditech and others. All these virtual assistant technologies they’ve launched under the names like Hey Epic, Hey Cerner, Hey Meditech are all powered by Nuance technology. So, we’re working with the major EHR vendors to integrate that. So we can do exactly what Stephanie said, which is to basically have a virtual assistant. Every physician and all of us would love to have an intelligent virtual assistant or a physical assistant that works with us. What we’re trying to do is we’re not going to mimic everything a human can do, obviously. But there are a lot of tasks that if you had an assistant, you would really be much more productive. So, this idea of being able to ask what’s the latest CT scan or queue up in order or send a follow up note to the primary care physician, they should be able to do that very seamlessly by voice, as if they were telling their assistant to go do that. Number two, this idea of turning the system into an intelligent system. And for clinicians, generally, what intelligence means is you don’t have to ask it for something. It’s going to recognize something and tell you. So, Stephanie’s example of clinical decision support is a clear one if we’re listening to the conversation of the patient and we know their clinical history, we know what their primary diagnoses are and we hear something, why shouldn’t the system be able to say, oh, it looks like they may be discussing “X’ based on the clinical indicators. This might be a good thing for you to talk to the patient about. That is what’s going to come here as more AI gets deployed to predictive analytics and predictive to clinical decision making. That is really the holy grail here, which is you’ve got a virtual system that can do tasks for you, but it also provides you clinical advice as if they were like a resident or a fellow working next to you.

Q. If there is a best practice that you’d like to share with you as an industry, we’re listening to this podcast. What would that be?

Stephanie: I think the key here is think about the challenges that you are facing organizationally on the front end and the back end. There are so many use cases for this and ask yourself if voice could be a solution for that to help in the efficiency cetera of solving the problem. There are a lot of places that we could leverage voice driven technology that is going to be different than our typical construct. I think it will be effective if we’re willing to be open minded and ask ourselves that question, could voice be part of the solution? And I say part of the solution as my second best practice, which is if voice can lend to the improvement of a situation, it does not mean it has to be the complete answer. So I think the example that I gave earlier about an IVR, having an initial interaction, authenticating a patient, confirming what it is that they’re asking for, and then potentially handing that off to a live person for the more complex parts of what might need to be done is a way to be able to move forward in increments and really start to see progress, knowing that we don’t have to solve the entirety of the problem with one solution, but it might be one of the building blocks. So, think about voice, but don’t expect that to have to be all end all of everything. It may be a component.

Peter: Pick problems that are important to solve and then really get clinician owners and champions inside the organization. In healthcare, there’s a lot of technology promises. And often if you don’t set yourself up for success, no matter how good the tech, it’s not going to be successful. So, I think best practices is having alignment internally, goals we are trying to achieve, metrics we’re trying to drive. Some of this stuff also involves some business process changes and integration with the how to optimize these things. I think having both the supplier of the technology and the internal stakeholders aligned on the objectives, the internal alignment of what we’re trying to drive through and then sort of end-to-end view of how we’re going to solve this, including things that may not be voiced, is really critical so that when you do that, we can absolutely drive meaningful outcomes. We have thousands of examples and material improvements in physician and nursing, satisfaction reduction of administrative time, better financial outcomes, better patient experience. So, if you do it right and you focus on a problem that we can solve with the tech, we can make a difference.

Show Notes

02:36The move from voice to a more intelligent listening system that we call ambient is really the next generation of technology.
08:30 Healthcare is really now taking this idea of using digital technologies to redefine what's often called in healthcare, the digital front door.
11:47 We're already seeing things where people can set up medication, reminders and things like that on voice technology. The next step is having a healthcare attendant at home and leveraging voice in that interaction.
16:19I think from a technology perspective, one of the silver linings of this pandemic has been the rapid deployment and adoption of a variety of different technologies, some of which was telehealth.
28:59In healthcare, there's a lot of technology promises. Often if you don't set yourself up for success, no matter how good the tech is, it's not going to be successful.

About our guest

Stephanie-Lahr,-MD-profile

Stephanie Lahr, MD is the CIO and CMIO at Monument Health, a South Dakota healthcare provider operating clinics, regional hospitals, senior care, surgical units, institutes, and acute care. Stephanie works on the strategy, implementation and management of technologies within the health care system.

Stephanie graduated from The University of Texas Medical Branch at Galveston, completed an Internal Medicine residency, and is board certified in Internal Medicine and Clinical Informatics with an additional certification through CHIME as a Certified Healthcare CIO.

Peter Durlach is the Chief Strategy Officer at Nuance Communications. Peter holds a pivotal role in advancing the portfolio of healthcare solutions to align with industry pressures and shifting needs of healthcare clients. He helped create the Healthcare division and drive significant growth between 2006 and 2011 and then briefly left the company to act as the Entrepreneur in Residence at the University of Pittsburgh Medical Center.

Prior to Nuance, Peter worked as a consultant, president of Unveil Technologies, Inc. and vice president of marketing and business development at Lernout and Hauspie. He graduated from the University of Vermont with Summa Cum Laude honors where he received his B.S. in Business Administration.

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 pace of innovation and development of AI tools is outrunning the FDA and other regulators’ ability to stay on top of AI innovations

Season 3: Episode #76

Podcast with Casey Ross, National Technology Correspondent, STAT News

"The pace of innovation and development of AI tools is outrunning the FDA and other regulators’ ability to stay on top of AI innovations"

paddy Hosted by Paddy Padmanabhan

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In this episode, Casey Ross, National Technology Correspondent at Stat News, discusses his recently published report on FDA-approved AI-enabled tools. These are Software as a Medical Device (SaMD) tools that work as decision support tools to supply patients’ data to physicians and help them diagnose and treat the patients. Data is the core ingredient that AI tools use. As per Casey, one of the major issues prevailing in the industry today is that there are inadequate disclosures on data sets used by many medical devices and algorithms approved by the FDA. To improve healthcare outcomes, transparency and disclosure in date sets must be the central agenda in future. He further states that the pace of innovation, development, and building process of AI tools is outrunning the FDA and other regulators’ ability to stay on top of the AI innovations. Take a listen.
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Q: Can you talk about the report you recently published highlighting the possibility of racial bias in some of the FDA approved AI enabled products and devices?

Casey: I built a database of all the FDA cleared AI algorithms to date. As a reporter, I’m always getting press releases from companies talking about the clearances that they’ve gained from the FDA. But there is no real systematic way to look at those products. There is no database that identifies them to look in totality about what has been approved. So, I took a step further after identifying the products and looking at the level of validation that was done on them, like what was the size of the validation sets? What were the methods used? What is in those data sets? How diverse are they by race, by gender? Where were the data sets gained to get a sense of what level of information was disclosed? What is publicly available? And what I found was that it’s really all over the map in terms of the sample sizes that are used to validate these algorithms. And there’s also really very little information about the demographics of the data sets in a way that raises questions about the ability of these products to generalize across populations. And I found that variation happening even within products that are designed to do the same thing, like assess patients for intracranial hemorrhage or stroke or even things like breast cancer.

Q: What kind of products we talking about here? Are these medical devices, software products, and how many of them did you really scrutinize?

Casey: The category is sort of software as a medical device. These are used as decision support tools that supply data to physicians on patients, that helps them make decisions and helps them diagnose and treat those patients. There were 161 products that I identified within specific product codes. You can search the FDA’s databases to try find these and figure out what validation was done on them. I have read medical studies that suggest there is up to 220 of these products and these are all deep learning AI products. So, it is machine learning technology which have all been approved. We see a vast amount of innovation going on in that area over the past six years.

Q: On your reports you focus on the breast cancer related products. Can you talk about that?

Casey: Yeah, that was an area where I’m especially interested in looking at because diversity really matters, and breast cancer varies so widely among patients. And it’s particularly important to have diversity in those data sets so that any AI system that might be advising a doctor or a physician on how to care for these patients sees enough patients and can give good advice so that its conclusions can be generalized to broader populations of patients. What we’ve seen over time with a lot of medical products and algorithms that have made their way into the market is that they’re not tested on diverse groups of people. And instead, their recommendations, their reliability mainly exists within European Caucasian populations, which shouldn’t be acceptable to patients or medical providers.

Q: So there is reason to be concerned about the lack of a standardized validation process and a lack of disclosure specifically around the data that is being used to develop these algorithms and there is a real potential for racial discrimination. Is it correct?

Casey: I think that’s right. It’s the lack of standards there and in particular, disclosure of the contents of the data sets that is troubling from that point of view.

Q: Based on all your reporting, do you think the challenge lies in the quality of the data or maybe even the sufficiency of the data? Or is it more to do with the deficiencies in the algorithms or is it both?

Casey: I think the biggest issue is the quality of the data and the access to the data such that you can have really, truly representative data across populations and have enough of it to be able to train an algorithm to adequately perform the task you’re asking it to perform. There have been some studies done that suggest that the vast majority of data supplied for AI research comes from institutions in three states in California, New York, and Massachusetts. That’s missing a huge part of the places that we sit in now. So many people in so many communities end up getting excluded from that. This is the major hole right now that this ecosystem needs to figure out how to remedy.

Q: You make a very provocative statement at the beginning of one of your reports – ‘AI is now a lawless frontier in medicine.’ Some people might say maybe it’s just a little bit harsh, perhaps because it has had some success in other areas in healthcare, like administrative functions, revenue cycle operations, claim management, fraud and abuse, or even in chronic disease management. What would you say to those who feel that?

Casey: I’m making a comparison to sort of frontier development, like the development of the American West. I’m sort of making that comparison because I’m trying to crystallize the notion that the sheriff isn’t in town yet, that the pace of innovation, the pace of development, the pace of that building process is outrunning the ability of the FDA and other regulators to stay on top of the questions that innovation is raising. That is a big concern right now. I think the FDA is trying very hard, but I think it’s under-resourced and it can’t keep up with the very important questions that this is raising. The other part of that metaphor that is worth diving into is, does that mean that there are a bunch of bandits out there that are a bunch of evildoers who are trying to gather data and do bad things with it? By and large, from the companies and the people that I’ve talked to, I would say no. I would say that most of them are very well-meaning and altruistic. But there is still the issue of unintended consequences that may arise from the use of products that are not fully and carefully vetted. I think once that process begins to fully mature and catch up with the innovation, everyone will be better for it.

Q: You made a comment a little bit earlier about not been enough data available to do a rigorous training of the algorithms. There is a vast amount of data available in the form of images, more so than other forms of healthcare data. What can we do with the large amount of data available, especially the data sitting in our systems, for instance, in hospitals?

Casey: It’s very hard for researchers to come by to aggregate that data to do anything meaningful with it. EHR data is notoriously siloed and kept in environments where it’s just very difficult to access the data and make use of it for meaningful research and purposes that could really benefit people. I think it’s very difficult to harness that data, even though there is so much of it. And about the imaging data, I think a big question for the industry and a big problem right now, is the issue of transparency. Where are those data sets from? What is in them? We need to know the ingredients of these algorithms. We need to know who these people are, where they come from. We don’t need to know their identities. I don’t mean to suggest that, but we need to know how these algorithms are being built on what data so that there can be some confidence in these products, that they can generalize and do what the developers intend.

Q: What are you hearing from policymakers and industry executives, especially tech firms, on how they’re wrestling with the ethical use of data and how they’re moving forward with this?

Casey: Over the past six months a lot of companies are realizing that this is an issue and they’re bringing it out into the light and wanting to talk about it at industry conferences and on virtual gatherings and so forth, to be able to set forth, OK, well, you know what? This is an issue for us in terms of optics. We want to be inclusive companies. We want to emphasize that. And you’re seeing a lot of those companies’ fund research and hold events to talk about it. But there isn’t yet sort of a consensus that emerged on the best way to accomplish this. What are the set of practices that ought to be used to ensure that these products are inclusive and don’t unintentionally discriminate against certain groups? So, I think there’s kind of a recognition that these issues need to be addressed. But how to do that really has not been agreed upon, there really aren’t any clear best practice standards that have been identified. There is just a process that’s beginning to confront those issues.

Q: Is this a question for the FDA or is this more for the industry to self-regulate and self-governance and come up with the best practices and hope that the outcomes are good? What is your thought?

Casey: That is really the big question right now. Whose responsibility is that? Where should that vetting process take place? Should it take place at the FDA before these products get onto the market? That is not happening right now. Some of the people I have talked to, executives of companies say, the FDA clearance, the 510 K clearance that’s granted to most of these products has never really filled that role for any kind of product. So, usually what happens is there are follow up studies done at conferences and by clients of these products to bear out their efficacy. And there is a process that takes place normally in the private market to verify that these products are the best things for patients. The responsibility lies on the health systems to adopt products that are really going to benefit the people. Data is the main thing that these products use in order to deliver services, to help inform physicians to provide care to patients. You wouldn’t say to somebody – ‘you should just take this drug. Don’t worry about it. We don’t need to talk about the ingredients or where it came from or what’s in it. Just take it, OK? It’s fine.’ You would tell them the ingredients. It would be studied rigorously. You would know who is in those validation data sets, you would be able to analyse it in all the different cohorts and how it affects different racial subgroups. That’s done now in public at the FDA for drugs. Now, drugs have a different risk profile. Hence, the data analysis should be rigorously done and must have transparency.

Q: We’ve recently seen some initiatives, especially the one where several health systems come together and formed Truveta, that is going to pool patient data from several leading health systems and use it to analyze it for insights and help improve healthcare outcomes. There are also some other initiatives like the synthetic data challenge that the ONC has come up with. All are looking to address the same problem that there isn’t enough data for us to really analyze or train the algorithms and come up with some kind of heuristics or benchmarks for us to drive the outcomes. Would you care to comment on these initiatives? And is that an alternative? Is this a viable alternative that is taking shape?

Casey: It’s a timely question. I’ve been talking to the executives and stakeholders that founded Truveta over the past week or so to talk to them about that initiative. I think it is interesting in something that the industry, by and large, has just failed to do to date, and that is aggregate a large amount of data that comes from health systems all over the country and not just health systems that are on the coast. Those 14 health systems that are gathered in Truveta represent patients who are spread throughout 40 states all over the country. So, I think that’s really exciting and potentially provides a really great resource that researchers can tap to be able to gain access to large amounts of representative patient data. There still are a lot of questions though with that because we all know about controversies that have arisen from, say, given the hospital system, working with a tech company and sharing their data with that tech company because of all the privacy questions and questions of economic exploitation that might arise from that. It is like you’re using data from the patients that got care at your institution. Then you are selling that data to another entity to do research on it to build a product that that entity will profit from and not necessarily the patient. So, there are issues of consent that get raised in that. There are questions that should be raised and talked about so that there can be a consensus or at least an open public discussion about how to get access to that data, who does it benefit, how to do this in a way that respects the patients and all of the stakeholders?

Q: What are the top two or three items of the unfinished agenda in harnessing data for us to really make a difference in healthcare outcomes? One is interoperability. Can you share your thoughts on this?

Casey: I think interoperability is a key issue and that issue is part of developing data sets at scale, large enough data sets that can be used by researchers and companies to be able to build meaningful and generalizable AI products that will benefit everybody. I think the biggest issues in my mind about that are really transparency, disclosure and some of those regulatory questions. I think it’s really important to think about the nature of these products, which are machine learning. It’s a computer that is able to comb the contours of a data set to form conclusions on its own without being explicitly sort of programed. I think when you have a system like that where it might be somewhat of a black box about how it is reaching the conclusions that it’s especially important for people to know what is going into those training sets. How is it being tested on what data is it being validated? Are these things at the end of the day going to improve care or are they just going to layer on top of care an additional level of cost without providing the benefit that they advertise? And I think that process just must unfold in a meaningful way so that, before we start paying for these things, before they get into the market and start providing care for people, we know that they are fair. We need to know that they are safe. We need to know that they stand some chance of improving care to people. So, I think those are the things that sort of need to be front and center questions that are addressed over the next few years.

Q: To sum it up in one word, would that be transparency?

Casey: I would say that would be the word I would choose as the one word that the industry needs to sort of focus on in the next couple of years.

Show Notes

04:52It's important to have diversity in data sets so that any AI system advising a doctor / physician on how to care for these patients can give good advice and conclusions that are generalizable to broader populations of patients.
09:07 The pace of innovation, the pace of development, the pace of that building process is outrunning the ability of the FDA and other regulators to stay on top of the questions that innovation is raising.
12:07 A big question for the industry and a big problem right now is the issue of transparency in data sources.
21:42The biggest issues while harnessing data are transparency, disclosure, and interoperability.

About our guest

casey-ross-profile-pic

Casey Ross is a National Technology Correspondent at STAT and co-writer of STAT Health Tech, our weekly newsletter on the growing digital health industry. His reporting examines the use of artificial intelligence in medicine and its underlying questions of safety, fairness, and privacy..

Before joining STAT in 2016, he wrote for the Cleveland Plain Dealer and the Boston Globe, where he worked on the Spotlight Team in 2014 and was a finalist for the Pulitzer Prize. A Vermont native, he now lives in Ohio with his wife and three children. When he's not with them, he's in his cornfield, cultivating some of the sweetest bicolor in the Midwest.

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 biggest challenge in digital engagement and its adoption is shifting to a consumer mindset

Season 3: Episode #75

Podcast with Mona Baset, VP of Digital Services, SCL Health

"The biggest challenge in digital engagement and its adoption is shifting to a consumer mindset"

paddy Hosted by Paddy Padmanabhan

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In this episode, Mona Baset discusses how SCL is transforming its digital capabilities to provide a seamless digital patient experience just like other industries – retail, travel, and financial services.

According to Mona, one of the biggest challenges in adopting digital engagement is shifting to a consumer mindset. Health systems are now increasingly focusing on their digital front door initiatives. However, one of the biggest challenges in building a robust consumer app is incorporating both outside and native foundational capabilities, and bringing together a single native app.

SCL is a non-profit healthcare system and focuses on patient engagement and technologies to enable better patient experience. Take a listen.

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Q: Tell us about SCL health, your role as the VP of Digital engagement, your responsibilities, and who the role reports to.

Mona: SCL health is a faith based non-profit healthcare system. We’re based in the Denver metro area, and primarily serve Colorado and Montana. SCL Health provides care across eight hospitals, more than one hundred clinics, and areas such as home health and hospice, mental health, and safety net services. My role as the Vice President of Digital Services was a newly formed position when I joined and it is part of the information technology and digital services organization here. I report to our Chief Information Digital Officer, but I really find that my role straddles a few different worlds – technology, marketing, consumer experience, engagement, associate engagement, and innovation. I get to work with a lot of incredibly talented people across all those areas. My team primarily focuses on engagement and the technologies that help enable those experiences. They are responsible for everything from our external website to our internet site, digital marketing and automation platforms, application development, and user experience. There are some new areas as well where we’ve begun to explore and implement like arts and robotic process automation. We find that when people have different ideas or things that they want to do or explore, oftentimes those ideas start with my team and then we can sort of assess them and figure out how to move forward.

Q: Can you walk us through some of the initiatives that you’ve rolled out in the last year and a half, especially in the areas of digital front door marketing and digital patient engagement?

Mona: When I arrived at SCL Health, we had a basic level of digital capabilities in place. We had MyChart, external website intranet, an older CRM instance, and virtual care capabilities. There was a lot of room for improvement to create that wonderful experience for patients, consumers, and even our own associates. We did a quick assessment of the current tools and some basic customer journey mapping. Once that information was laid out, it was easy to see where the gaps were and what we needed to put in place to fill those gaps. We did some prioritization exercises and some mapping exercises after generating some interesting ideas. What we really wanted to do was to deliver an experience that was similar to what consumers are expecting in other industries like retail, travel, and financial services.

We organized the efforts into four streams. One of those work streams is customer relationship management. In that area, we rolled out a new implementation of Salesforce Health Cloud and Marketing Cloud. We finished that up very recently. We are also looking at call center tools and consumer contact center transformation. Underneath that workstream, we are rolling out some different capabilities around automated communications to patients and consumers through text and email and phone.

The second workstream is what we’re calling digital workforce. If you think about that area, it’s really some of the automated tools and processes that we can put in place. For example, chatbots would fall in that area. So, we’ve rolled out a few different types of chatbots focused on different capabilities so consumers and patients can get the answers they need right away without having to wait to talk to someone. We’re also exploring some robotic process automation to help us become more efficient on the backend.

The third workstream is about associate tools. Currently, we have a very large-scale project underway to completely redesign re-platform our internet site for our associates and our providers. That will be rolled out mid-year. We are also looking at different ways to communicate among our associates, some HR focused tools and technologies.

The final workstream we are focused on is consumer and patient experience. This is where you find things like our external website, which we’re constantly improving and updating. That’s where you find MyChart optimization. We rolled out a brand-new provider directory to help people search for providers and schedule really easily. And this is also where we’ve been partnering with our innovation team to roll out a new consumer app that is actually rolling out next week. We’re super excited about that. It’s going to give our patients and consumers a really nice, streamlined way to access our services and information.

Q: With regards to consumer engagement and your role, what do you see as the big challenges in digital engagement and adoption?

MB: Healthcare no longer gets a pass on consumer experience. People are comparing their experiences with healthcare to their best experiences in other industries, and they’re expecting more now. I think the biggest challenge in our industry is really shifting to a consumer mindset. This is something that I think was slowly happening. COVID really accelerated that journey.

For example, prior to COVID, virtual care was available here, but it was slow to be adopted by our providers and our patients alike. When there was really no other option for care at certain points in this pandemic journey, we went from under one hundred video visits a month to thousands and thousands of video visits immediately. Now both providers and patients have experienced sort of the new way of doing things. They can see the ease and convenience and the effectiveness, and they see that they can get things done in the healthcare space, in a virtual way.

While we may not see the huge numbers that we saw at the very beginning, when there was really no other options for care, we will see this virtual care continue. Even after COVID isn’t part of our every thought and conversation, challenges of getting things rolled out while keeping that consumer mindset as a technology organization for healthcare system remains. Our job is really to support that acceleration toward consumerism and put on the table everything we know and everything we can learn to make that happen. We have to take that knowledge and not only be technologists, but we also have to be salespeople and we have to be marketers to be able to show our internal stakeholders and our patients how much better it could be for them.

Q: What are some of the biggest challenges that you faced when it comes to preparing yourself for this emerging virtual care era and digital engagement you just described?

MB: From a career perspective, I essentially grew up in marketing and many years in consumer financial services. When I made that transition to technology a few years ago, the consumer was always the starting point and the end point for me. We’re really taking that approach and are focused on how we can deliver care safely and effectively. We’re offering more types of virtual care than ever before and we’re listening to consumers. We have a patient family advisory council approach that we take and we connect with these patients and their families regularly to understand what they’re going through, what their journey is, how can we adapt to meet those needs? What additional engagement channels can we offer to really empower them to take control of their health journey? And I think so many things are involved in building that strong brand and that high level of consumer engagement is certainly key. The word, or the phrase digital front door is an interesting one, because it almost suggests that there’s just one door, but there are many doors. Our website is one of the digital front doors, our consumer app is another. So, we’re really trying to provide options and as we look at how our website functions, we’re looking at how are consumers expecting to engage with us? What do they expect to find there? And we’re trying to make improvements across the board so they can find information quickly. They can self-service, they can reach out to us if they need more help and just really giving them that full experience.

Q: From a technology choice standpoint, do you start with a bit of capabilities that are available in your system or do you start with a blank sheet of paper and look at what the best-in-class tools are out there and recommend and implement the ones that make the most sense from an impact standpoint?

Mona: I think a little bit of both. We have as an organization, five strategic platforms that we focus on and they really serve as solid foundation for our work. We have Epic for our EHR, Google for communications within our organization, Salesforce, Oracle ERP that’s going to be launching in April, and ServiceNow for internal types of requests. We try to start there and in many cases we have to consider additional capabilities. Obviously, these are very foundational and only do certain things. So we look at both. We are looking at some guiding principles that we use when we’re making technology choices. We want to be sure that we make experiences easy and low effort and want to focus on the user and their needs, not our processes. We want to leverage the small number of connected platforms that are needed, because it’s just much easier to manage. We also want to personalize experiences based on deep knowledge of our users, and we want to provide options to engage with us. We start with our foundational platforms and then when we decide to bring in other tools. Sometimes we do bring in sort of those proven best-in-class big tech solutions.

We’ve brought in a lot of others that are more in startup mode and they may ultimately become best-in-class. I think about some of the recent work we did to completely rebuild our provider directory on our website and all of the chatbot technologies we’re introducing. So, for those we partnered with what I consider to be smaller, really innovative companies that are nimble and creative and just offer solutions that are very unique and partner with us really well. We can almost co-develop solutions with them and it’s worked out great.

Q: When you talk about startups, there could also be risky bets. For instance, what if they run out of money from the venture capitalists or they lose their key individuals because they’re a small team. Have you ever had to plan for that kind of a situation, or have you had to actually live through one of those?

Mona: Thankfully, we have not. We know that is certainly a risk. These organizations are much more willing to partner with us to give us exactly what we need and really fitting into our budgets. As a not-for-profit, we don’t have huge budgets. So, it is a tradeoff and we have not experienced anything yet. We have taken those risks and have been able to deliver some interesting capabilities. I’m pretty happy about that and proud that we have really been able to partner with some great organizations to do so.

Q: How are you leveraging your internal datasets, patient histories and how are you combining that with externally available data sets? What is the framework you’re applying and the infrastructure you’re investing in order to harness the data, and improve and deliver the kind of experiences that the marketplace is looking for?

Mona: Data analytics is such an interesting topic these days. We have so much data out there. I would say it is truly at the heart of the work we do in digital engagement. Epic is our source of record for patient information. We don’t try to recreate that. I know other organizations have sort of challenges with some of that, but we really leverage that data as much as possible so that we truly know our patients. We can customize communications and touch points to them. I will say that in any digital project we have launched, data piece takes the longest. It’s the most complex and requires a lot of thought about data models and how integrations are going to work for our CRM implementation. We spent a lot of time building the right data model and integrations just to ensure that we have the most accurate and recent data available to help engage with our patients. If that information is not correct, then you are not engaging in a way that patients find useful. We are working on a similar project around expanding some automated communications to patients like those who are discharged from hospital. We’re spending a lot of time to make sure data is perfect so that the messages we’re sending makes sense and are relevant.

Q: When you talk to your peers across other health systems, what are some of the best practices? Can you share one that you’ve either adopted from one of your peers or one that one of your peers may adopt from your own experience?

Mona: As I look at what some of my most innovative peers are doing at other health systems, I’ve seen some really interesting implications and tools. I think COVID is top of mind. Some of those COVID related innovations have been pretty incredible, everything from vaccines management to screenings. One of the things I’ve seen more and more health systems working on is delivering on that consumer app approach, what might be called the digital front doors. They’re doing a great job at that. The best ones are addressing one of the biggest challenges in building a robust consumer app, that is, to have a plan for how any new capabilities, including those that might be offered by many different vendors, are brought together seamlessly for the consumer in a single native app. Sometimes your foundational platform just can’t deliver everything and you’re going to have to go outside of that and bring in other capabilities. But how do you make that invisible to the consumer so that they feel that they are just dealing with one organization, one tool, and they’re able to see everything?

I think as far as other best practices go and something we’re exploring and hope to make a best practice is really the use of artificial intelligence, patient engagement. When a consumer or patient doesn’t need to talk to a person and in many cases they don’t want to, they just want to be able to get things done themselves using chatbots and other artificial intelligence, and that’s a good thing for them. We try to leverage some of that and roll things out quickly, especially early on in COVID. So, we rolled out a chat that would allow people to learn more about COVID, take a risk assessment. It really reduced the anxiety that consumers had about COVID and reduce the number of anxious phone calls that came into our care sites, in our clinics. We’ve used similar technology to screen associates before work for COVID symptoms to keep them safe and our patients safer. Recently, we launched some additional chat technology on our website to answer key questions and information that consumers and patients have. We can change that on a daily basis. If we find that people are asking a lot about vaccines, for example, we can do that. So, we hope that will become a best practice going forward.

Q: Do you primarily rely on externally developed solutions for assembling this whole consumer experience? Are there pieces that you take complete ownership of, for instance, the mobile piece, if you do that internally and then have all of the embedded components behind the scenes come from different sources, or are you really looking at buying it all off the shelf where in that continuum are you?

Mona: I think it’s a little bit of both and sort of a hybrid. For example, with our CRM implementation, we purchased a solution for that and implemented it. Our internal team takes that over and maintains it and enhances it, similar to what we’ll be doing with our new consumer mobile app. We partnered with an organization to help us build that from scratch. Then we will be taking on the maintenance, the enhancements going forward. So, I think it’s a little bit of both. In some cases it makes sense for us to be able to have the autonomy to build on a platform and be able to be very flexible with improvements, enhancements in many cases.

Show Notes

09:35Biggest challenge in digital engagement and its adoption is shifting to a consumer mindset.
11:03 Technology organizations for healthcare systems must support virtual care acceleration toward consumerism
13:34 The phrase digital front door is an interesting one; it almost suggests that there's just one door. But of course, there are many doors.
22:11Sometimes your foundational platform just can't deliver everything and you're going to have to go outside of that and bring in other capabilities.

About our guest

As Vice President of Digital Services at SCL Health, Mona Baset leads digital strategy and transformation, including development and implementation of the digital technology road map. Prior to joining SCL Health, Mona was Assistant Vice President in the technology organization at Atrium Health, leading consumer engagement strategies.

Previously, Mona spent almost 10 years at Bank of America, where she led various marketing and communications teams. Mona holds a bachelor’s degree in English from the University of California at Irvine, a master’s degree in Communications from Cal State Fullerton, and a master’s degree in Business Administration from Wake Forest University.

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.

Our focus for virtual health is making sure encounters are documented in such a way that it is not burdensome

Season 3: Episode #74

Podcast with Katherine Lusk, President / Board Chair, AHIMA

"Our focus for virtual health is making sure encounters are documented in such a way that it is not burdensome"

paddy Hosted by Paddy Padmanabhan

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In this episode, Katherine Lusk discusses how AHIMA works at the intersection of healthcare and technology to empower patients with their health information, and ensures to keep the data accurate, accessible, and safe.

Health systems are working towards mapping patient data to the EHR systems so that the frontline care providers have the information readily available to improve healthcare delivery and outcomes. The next step is to standardize the data normalization process and make it interoperable while taking care of patient data privacy, confidentiality, and security.

Katherine says that the industry must now focus on implementing initiatives to reduce social issues such as the digital divide and health inequalities . She further states that AHIMA’s focus is to make sure that patient’s virtual health information is documented in a safe, secure, and convenient way. Take a listen.

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Q. What has been your professional journey and how did it lead you to your current role at AHIMA?

Katherine: I think it’s inspiring because if I can do it, anyone can do it. I’m from Gainesville, Texas, which is a small town in North Texas, and I went to work in 18 years of age at Gainesville Memorial Hospital. I worked my way up from a clerk to become the director of Health Information Management. From there, I went to Fort Worth and worked in the Osteopathic Medical Center of Texas, which was an academic medical center focused on the geriatric population, where our average age was eighty-three. Then, I went to Children’s Health System of Texas, which is a pediatric healthcare system with the average age being four. So, I’ve worked at two very different spectrums of healthcare delivery. The documentation and the rules and the governance and the empathy that needs to happen to support patients and families is the same regardless of the setting. Recently, I’ve gone to work for the Texas Health Services Authority with a focus on health information exchange within Texas that includes public health. I’m taking what I learned from the frontline at a local hospital to a geriatric healthcare system to a pediatric healthcare system and applying it at a state level on how we can exchange information in an accurate and complete manner, across the state of Texas to improve healthcare delivery.

Q. We are still in very early stages of harnessing data in a comprehensive way, especially relative to other sectors. Would you agree with that? And what are you seeing across health systems in this regard?

Katherine: I would have to agree and disagree a little bit. I think healthcare is beginning to harness data and efforts to improve patient safety. With clinical decision support to identify duplicate tests and take advantage of tests completed, they’re beginning to map data so that it appears within the electronic health record and allows the frontline care providers to have that information front and center. They are also beginning to look for different ways to streamline the administrative processes. What is curtailing us from doing that is normalizing the data across platforms and organizations. Most organizations in electronic health records have the normalizing data process down using SNOMED and then using intelligent medical objects to translate the very diverse, nuanced clinical data into clinical languages and classification systems to normalize within themselves. So, the EMR vendors have taken advantage of that and they normalize data within their own EMR vendors. But with the care quality and with e-health exchange, that data normalization has occurred on a much broader spectrum. Things are much better than they were even in twenty seventeen. The pandemic forced things to move along at a much more efficient manner and a much faster pace. Before the pandemic there was lots of discussion about mapping laboratory test results across different EMR platforms so that they wouldn’t have to be repeated and using LOINC codes. And it was lots of discussion and hashing with pathologists and with other clinical care providers on how you actually go about normalizing this data. But with the pandemic and COVID-19 people came together and figured it out. I think things are much better than they used to be.

Q. What are your key themes that you’re focusing on, your advocacy efforts this year at AHIMA?

Katherine: We have a big year planned at AHIMA and our 2021 advocacy agenda seeks to transform healthcare by connecting people, systems, and ideas. We’ve embraced three principles that directly align this vision and underpin our work, outlook, and our advocacy efforts – access, integrity, and connection. We’re advocating for the use of accurate and timely data for public health responses and initiatives while protecting confidentiality, privacy, and security of individuals health information. With the pandemic, we feel that public health was not supported sufficiently in the past, and we’d like to focus our attention on making sure that sector of the ecosystem has the information they need. We are firm advocates for the individual’s right to have timely and seamless access to their health information. We had a consumer advocacy pledge campaign earlier this year where we had our members reaffirm our pledge to consumer advocacy on having access to their records. We have been advocating for accurate patient identification to improve patient safety, interoperability, and the appropriate use of workforce resources.

We also understand that with the pandemic and with all of the social issues that we’re currently experiencing, social determinants of health must be the focus to enrich clinical decision making and improve health outcomes. We believe that public health is supported, and health inequities are diminished. We must can gather this information and culturally respect and manner and portray it accurately. We really believe in advancing a complete, accurate and timeliness of data by influencing the development and maintenance of national and international coding standards. Where policy goes, so does the public. We started the Patient Identity Now Coalition, where we worked with six of our partners, the American College of Surgeons, CHIME, HIMSS, Intermountain Healthcare and Premier. There is a coalition of healthcare organizations that are really advocating discussion around a unique patient identifier. So, if you haven’t looked at that, I want to encourage everyone to look at the Patient Identity Now initiative.

Q. Can you touch upon one or two things in the context of telehealth, which obviously in the wake of the pandemic has been on a tear? Can you talk to us a little bit about how this growth in telehealth needs to be viewed in the context of AHIMA’s mission and your priorities?

Katherine: The convenience of telehealth has changed delivery models. Telehealth was being embraced prior to the pandemic, but with the pandemic, it was a wholesale embrace. It moved healthcare delivery from solely brick and mortar into the virtual arena much faster. With AHIMA and our work, we focus on what are the documentation requirements for telehealth, how do we classify the diagnoses that are captured in that arena, how do we make sure that patients have consented to their information being shared in that manner, and how do we keep it safe and secure. Our focus for virtual health is making sure that the patient’s information is safe and secure, making sure that the encounter is documented in such a way that it completely explains the encounter but not be over burdensome.

Q. Where is the challenge in harnessing all the data we receive from different sources? Is it a technology challenge, a better-quality challenge, policies challenge?

Katherine: I believe it’s probably a data quality challenge, because just like all other clinical data, when we began the journey, we had to figure out how to normalize the data. We had to translate the clinical language into SNOMED and accurately capturing that in the electronic health record and then transferring that to clinical language or the classification system. So I believe social determinants of health is our next step on that clinical journey. While they’re not widely used now, we do capture some with ICD 10. Now, are there more that is needed? Absolutely. I believe that as we go through this journey and begin to utilize information and embrace these concepts, data normalization process will only get better and better.

Q. What is the State of the Union today as it relates to a patient privacy? Are there adequate privacy safeguards, especially when we see data being moved to the cloud, or now that we’ve got the final interoperability ruling that’s coming up. And patients are now going to have access to their own data and can share it with anyone they like. What should we be careful about?

Katherine: At AHIMA, we worry the most about is apps, and patients and families using these apps and not really understanding that how their information might be shared. How they have really given away the most personal thing they have, which is their clinical information to an app without completely understanding that information might be sold to someone else, used for marketing, used for a vendor’s personal financial benefit, and it might not be protected. I think that’s one of our biggest concerns now. I personally love an app and I love the convenience. And I’m like everyone else. I have a Garmin and my husband has a Fitbit that we track our health. We take advantage of all those things. We also do 23andme. From a human standpoint, we want to make sure that patients and families and individuals like you and I understand that we are giving away pieces of our very personal information and we want that information to be kept secure and private. The healthcare organizations are ruled by HIPAA and so patients and families and you and I believe that our healthcare information is protected. We’re forced to sign HIPAA requirements when we go to the physician’s office or to an ED or anything like that. So, we’re lulled into this feeling that healthcare information is so sacred and that is so protected. Then when we give that information to an app or a personal health record and a portal, that information is not held to the same standards. We want to make sure that everyone understands that they’re not following the same rules of engagement and to be very considerate of that.

Q. What is your advice for startups and digital health companies that want to go deep into the data and take the data and combine it and use it and analyze it and create new offerings out of it? What is your advice to them to safeguard the data, but also to be successful with it?

Katherine: My advice to them is, be the crane that rises to the top. People will choose to use their apps if they are convenient, useful, safe, and secure. When you develop these healthcare apps, you want to be able to normalize that data and integrate it into the longitudinal record of care. You don’t want to be standalone. These apps need to understand the clinical languages and the classification systems that the big vendors understand. They need to have a depth of knowledge with them. I would also advise that they use standards and look at what those standards are and not be frightened of them, but to embrace them so that they can leverage those standards and integrate with the EHR. They must understand that they are a cog in the healthcare wheel, that we’re all cogs in the healthcare wheel. And we’ve got to figure out how to integrate the data into the entire ecosystem so that it can be shared with everyone. What I would suggest that they do is engage the health information management professionals to help them understand the clinical language or classification system for data mapping and to serve as a guiding hand with patient privacy. This discipline serves in that middle space, and I think it could be very, very helpful to them.

Q. If I were to summarize you here – adopt standards, be interoperable with the EHR systems, but also with other similar applications, take care of patient privacy and protect their privacy with all their applications. And finally, you referred to us being cogs in the wheel. I like to say that healthcare is a team sport, and we are all part of the same team. Do you agree with that?

Katherine: Absolutely. Healthcare is a team sport, and the patient is the captain of the team.

About our guest

Katherine Lusk, MHSM, RHIA, FAHIMA is AHIMA’s 2021 President / Chair. As an active AHIMA member her attention is focused on championing the profession, patient identity, health information exchange, standard development, and information governance.

Her previous leadership roles include serving on Epic’s Care Everywhere Governing Council as Co-Lead, eHealth Exchange Workgroup Member, ONC Patient Identity Workgroup, TxHIMA President, and the Texas Interoperability Collaborative. She is a sought-after national speaker on information governance, standards, interoperability, clinical documentation improvement, patient identity, leveraging technology and promoting the HIM profession.

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.

A lot of point solutions are emerging, but if they’re not integrated into the EMRs, they’re likely to fail.

Season 3: Episode #73

Podcast with Harry Fox, Board Chair, Whitman-Walker Health

"A lot of point solutions are emerging, but if they’re not integrated into the EMRs, they’re likely to fail."

paddy Hosted by Paddy Padmanabhan

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In this episode, Harry Fox discusses his role at Whitman-Walker Health (WWH) and how as a community-based health center they are serving a diverse patient population with technology disparity and making healthcare inclusive for everyone.

WWH is a federally qualified health center. A significant part of their patient population is the low-income group and LGBTQ community. Harry shares that half of their patient population is below 100% of the federal poverty level, and around 40% are below 50% of the federal poverty level. This automatically creates an issue of digital divide among them where they struggle with technology. Technology providers are addressing these disparities, and several standalone point solutions are emerging. However, the two major issues – interoperability and integration – still exist in the healthcare space. Take a listen.

Our Podcast Partners:    

Q: Can you talk about Whitman-Walker, your role there, and about your prior experiences?

Harry: Whitman-Walker is a federally qualified health center. It was started back in 1979 to serve the needs of the gay and lesbian community of Washington. Since then, it has evolved with all kinds of services for the growing demand in Washington. About 10 years ago, it became a federally qualified health center. Today, it offers medical, dental, mental health, specialty care, specific youth service, and pharmacy services in multiple locations. Whitman Walker has a division that does clinical research in HIV and hepatitis. It’s got a policy and advocacy arm, and an education arm.

I joined the board back in 2014 when I was still the CIO of CareFirst. Today, I sit on two boards – Whitman Walker Health, which is the federally qualified health center where all the clinical services are, and also chair the board of Whitman Walker Health System, which houses the Whitman Walker Foundation and the Whitman Walker Institute for Research Policy and Education. It has been a fascinating ride. I’ve been in healthcare forever but began around 1999 in what was then called e-commerce, which we now call digital health. I started in the space with PricewaterhouseCoopers, then through Coventry Health Care as their vice president of eCommerce, and then at Kaiser Permanente as the regional CIO. Lastly, at CareFirst, and then, in more recent years, as an independent consultant. All of my work has its anchor in core digital health. I had the opportunity at the beginning at Kaiser Permanente to implement the mid-Atlantic region’s first telemedicine for primary care in certain specialties like dermatology, and then at CareFirst, worked extensively with third party telemedicine vendors to implement that service for our members.

Q: How has the pandemic impacted care for Whitman Walker’s patient population?

Harry: It’s been dramatic. When Washington DC issued their stay-at-home order, we shut down for two days. Over those two days plus a weekend, we pivoted completely to virtual services.

Whitman Walker uses eClinicalWorks as their EMR. In a three-day period, they had to bring up the module, test it, develop patient education documents, and develop staff training documents. They implemented DocuSign, because all the forms that you would fill out in the office, now had to be done virtually. Luckily, CMS around that same time made some changes in both repayments. So, if we couldn’t do telemedicine, we could do an audio encounter with a patient who might not have been able to do video services and we can still get reimbursed for it. CMS also lifted some of their licensure restrictions. Earlier, patients came to us in one of our locations in Washington, DC. Now that we serve the tri state area, we have patients in Maryland and Virginia and then a small population of patients from across the country, who come for our specialty LGBT care. Before the pandemic, if you weren’t licensed in a state, you couldn’t virtually see someone in the state. That’s been lifted now, at least temporarily. So, we pivoted over a very short time and opened on Monday morning. Everything went virtual, except for a small number of patients who were still coming in for more serious issues – COVID related and breathing kind of issues.

All the rest went virtual and it’s continuing to evolve. We had started out with everything on the eClinicalWorks. We found that for patients with behavioral health, some in individual and some in group sessions, eClinicalWorks couldn’t handle groups. It handled patient to doctor. So, we pivoted to zoom for behavioral health. Also, the bandwidth demand was better in Zoom with lower bandwidth could still get high quality video. ECW had a little bit higher requirement for that. So, we now operate with eClinicalWorks for all of our medical and dental patients and then we use zoom for behavioral health and substance abuse treatment for individuals and groups.

Q. Were there any unique needs for the LGBTQ populations that you had to take care of while standing up these capabilities?

Harry: As a federally qualified health center, we serve the entire community, and a portion of our patients are in the LGBT community. Because it’s a federally qualified health center, it’s often lower income. So, we have issues of technology disparity where people may have a cell phone but may not have an email. We find our younger clients usually have a phone but often don’t have a PC or a tablet. Our older patients may or may not have a phone, or another device, but often struggle with the technology. I have a 92-year-old mother that I do tech support all the time and I know how hard it can be when you’re trying to get someone to hold the camera a certain way and point the camera here. A lot of people have these challenges. About half of our patient population is below one 100 percent of the federal poverty level and thirty nine percent are below 50 percent of the federal poverty level. We have folks at the other end of the spectrum, too. When you have this tremendous diversity of background, it makes rolling out telehealth ubiquitously difficult. We have patients, living at the lower end of the poverty level, who may not want us to see where they live. They may have access to technology, but they’re uncomfortable having their homes seen. There are these very interesting, unique situations that are not LGBT specific, but are more issues of equity and what people have in terms of education and access to high-speed internet and technology.

Q. What are you seeing in terms of efforts by the technology community to address these technology disparities and making healthcare more inclusive for everyone?

Harry: It’s an interesting question. We got two small grants and we’ve been able to purchase three Wi-Fi only phones. That’s helpful up to a point because the individuals in the community may or may not even have access to Wi-Fi. There is no Wi-Fi in some areas of Washington, D.C. So, it’s useful if someone doesn’t have a phone, but they still have to access Wi-Fi for a virtual visit. There is a lot of point solutions I see emerging, but if they’re not integrated into the electronic medical record, they’re likely to fail. Every time you’ve got a standalone point solution, it is more work. When we’re using Zoom, we have to schedule the patient in the EMR and then schedule zoom separately. We’re using the eClinicalWorks for a virtual visit only and then we’re using them for the digital part as well. It’s all set up within the system. We create the scheduled event, we say that it’s digital. Automatically, the patient gets an email with the link and then later a text with a link. So, there’s some really fast emerging useful technologies in this space. The issue all along has been interoperability and integration.

Q. If you just expand the Zoom versus the eClinicalWorks situation you went through, how you kind of roll it out across a broader ecosystem?

Harry: The larger, well-funded delivery systems have the luxury of having enough cash and can choose best-in-class solutions and integrate themselves or work with the vendor to integrate them. If you’re a CIO of a small clinic, you don’t have that luxury. In Washington, in Whitman Walker’s case, eClinicalWorks is funded by the DC Primary Care Association for all seven FQHC’s in the District of Columbia. So, it’s not a technology choice Whitman Walker made. They wouldn’t have been able to afford that kind of platform without the DC Primary Care Association. So, your ability to pick best-in-class really depends on who you are and what kind of assets you have to invest in technology. The bigger systems just have the luxury of doing a lot better job of picking best-in-class solutions. Although I will say that there’s a thorn there too, because if you let best in class run wild, you have a situation soon enough where vendors get acquired. What was best-in-class this year is not best-in-class next year. And so, you’re pulling things in and out of connectivity around your electronic medical record, which is kind of the heartbeat of it all. So, you’ve got to choose very carefully when you think about going best-in-class. Make sure it’s not going to get acquired by a bigger player because they’re so small right now, because that can also cause a lot of rework and a lot of spending down the road.

Q. Tell us a little bit about how your experience with CareFirst as a CIO of a health plan. How is that different from your similar role at a leading provider was is Kaiser. What are the big points of difference between payers and providers at a broader level when it comes to approaching digital patient engagement today?

Harry: Kaiser has two arms of its company. It has the insurance company, and it has the whole care delivery operations. And because of their scale, Kaiser has the luxury of truly picking best-in-class. And they have been an early investor in EHRs. They really put the Epic chart on the map, and they’ve been a big investor in digital solutions for their patients. When you get to the payer side, it’s a very different world because there’s a lot of intent to help on the clinical side. But it’s really around the edges as far as I see it, because at the heart, you’re an insurance company. So, when you look at the member portals of an insurance company, they are your claims, your explanation of benefits, your annual deductibles, and co-pays. They may have other services like telemedicine, but they are really rolling out telemedicine in support of the clinical community outside their four walls. It’s a different perspective. My observation is that the payers often have more money to invest in technology. The very large clinical delivery systems have money, but the smaller hospitals can really struggle to stay abreast of the technology. Implementing a hospital EMR, like Epic or Cerner, is millions and millions of dollars and a multi-year process. They often make or break projects for the organization. So, it takes a lot to bring up these massive EMR solutions.

Q. How does all the regulatory environments affect the pace of acceleration or pace of adoption of digital health and telehealth?

Harry: United States unlike a lot of countries has healthcare at the local level, rules at the state and often county level. With the pandemic, public health has been in a mess of a rollout because everything is at the local level. In Maryland, for example, we have state rules following CMS rules. Then we have county versions that are different. So, by county in Maryland, when you get your inoculation, it will vary because the rules are different. I say that as a backdrop because reimbursement and regulatory landscape is a little bit like this. When you think of the fact that providers during COVID almost universally are getting reimbursed for telemedicine, whether it’s a private payer or Medicare or Medicaid. Before COVID, they didn’t get reimbursed for a phone call. They are temporarily getting reimbursed for a phone call. If that goes away, it will hurt the lower income portion of the patient population. Same thing with provider credentialing. Whitman Walker Health, for example, wants to serve their communities in Maryland and Virginia with telemedicine services. If the rule switches back to what it was before COVID, that’s going to be a barrier for us. So, the more that CMS, HHS and the states can break down these healthcare islands and barriers through rule making or credentialing. I think it’s going to be critical. When CareFirst was looking to do telemedicine, we were looking to hire a third-party company to be our telemedicine provider. One of the big challenges was finding a company that had providers credentialed in every state and not all the companies did. So being able to learn the lessons of what worked and what didn’t work during this pandemic and be able to carry some of those temporary regulations and make them permanent, I think would be really valuable as we go forward.

Q. Can you talk a little bit about the startup ecosystem in the context of Whitman Walker? What are they getting right today and what are they missing?

Harry: Whitman Walker for the most part is using more established vendors. First, looking at emerging technology in the digital space, the biggest challenge I see is multiple vendors telling how incredible their new thing is. Most don’t understand the complexity of medicine. They don’t understand the complexity of health insurance. So, when you look at the life cycle of a claim insurance you look at the workflow in the clinical delivery side. These are incredibly complex today. Any vendor that wants to make it, must bring in enough clinical expertise that they understand and they’re not naive about how complex the health care world is.

Secondly, I would say going back to what I said earlier, they must be integrated with the major players. So, for example, Whitman Walker is implementing a texting solution called Well. And if you look on the Well website, they integrate with all the major EMR. So, we’re looking to do bidirectional text messaging with our patients. We’ve got to be wary of HIPAA rules, about privacy as we do that. And so, going with a major player, is important, but also going with a major player that fully integrates that into EMR is absolutely critical of the box. So, we’re not creating an island somewhere of information separate from the EMR. So those are two key areas I think are critical success factors.

Q. Big tech companies like Amazon, Microsoft, Google all have their sights set on healthcare. Companies like Microsoft have been in the enterprise workplace collaboration software space for a long. What can we expect from them going forward?

Harry: It’s a great question. On the truly clinical side, I personally don’t think a lot. Microsoft touted its own health record years ago, which is now shut down heavily. I think they’ve all struggled with solutions that rely on deep domain knowledge of healthcare. But if you take a broader view, AWS has done well. It’s not HIPAA certified, but it’s something like that. It’s an area that’s more secure to meet HIPAA regulations. Microsoft and Google have similar parts of their domain. That’s a big area because there’s a lot of fear in the clinical space of what do you put in the cloud. If I put it in the cloud, what happens if it’s breached and what are my liabilities from the perspective? I would say to payers and hospitals and clinics, delivery systems, to look closely at what these three companies call their HIPAA space in the cloud because they take no liability. They offer you increased protection, maybe from their regular everyday part of the AWS or cloud environment, but they’ll indemnify you for very little. But nonetheless, it’s where the world’s going. We are going to see more and more movement to the cloud, but I would also tell the healthcare domain spaces to move very carefully and thoughtfully because there is significant risk at the same time.

About our guest

Harry Fox is currently a Principal at Oak Advisor’s Group, a strategic advisory firm focusing on the intersection of information technology and healthcare.

Harry has broad experience with information systems and over thirty years working in IT leadership roles. He has a strong background and a focus on cybersecurity, healthcare systems, and strategic architecture. He has extensive experience in eCommerce, large scale systems development, data warehousing and business analytics. He has experience developing strategies for cloud, blockchain and big data.

Harry was the Executive Vice President, Chief Information Officer and Shared Services Executive at CareFirst Blue Cross Blue Shield from 2011 to mid-2018. CareFirst is a $9.0 billion not-for-profit health care company offering a comprehensive portfolio of health insurance products and administrative services to 3.2 million individuals and groups in Maryland, the District of Columbia, and Northern Virginia. Harry was the most senior out executive at CareFirst and was the Executive Sponsor for ProPride, CareFirst’s LGBTQ Associate Resource Group.

Harry has also held senior-level positions at Kaiser Permanente, Coventry Health Care (now Aetna), and PricewaterhouseCoopers. He currently serves on multiple boards. He is on two private equity-backed healthtech company boards, Medliminal and Trusty.care. Harry also serves on the boards of two not-for-profit organizations, Whitman-Walker Health System, where he is the Board Chair, and Whitman-Walker Health a Federally Qualified Health Center (FQHC), serving greater Washington’s diverse urban community.

Harry is a graduate of the Wharton School, where he received an M.B.A. in finance.

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.

Roughly, 30% of total healthcare spend for provider organizations falls into the shoppable category.

Season 3: Episode #72

Podcast with Bill Krause, VP and GM, Experience and Consumer Engagement, Change Healthcare

"Roughly, 30% of total healthcare spend for provider organizations falls into the shoppable category."

paddy Hosted by Paddy Padmanabhan

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In this episode, Bill Krause, VP and GM, Experience and Consumer Engagement at Change Healthcare discusses how the CMS’s price transparency rule will affect consumer’s shoppable behavior, the providers, the traditional payers, and the new emerging payers – the employers.

A better functioning healthcare marketplace requires transparency in access to information provided to consumers during their healthcare decision-making time. With COVID accelerating digital health, organizations supporting digital transformation can now drive the digital first approach and provide a seamless digital experience to consumers. Consumers’ journey to care begins with the awareness of their need, understanding the options of where they should go, and knowing their financial responsibility. This is the core of any digital transformation agenda. Access to information regarding price will drive consumer shoppable behavior beyond just going to a provider’s digital front door.

Bill states that, because of the new emerging payer in the marketplace, i.e., the employers, roughly 30 percent of total healthcare spend for providers fall into shoppable tests and procedures. He further projects that this is poised to grow in the future. Take a listen.

Our Podcast Partners:    

Q: Change Healthcare will be now a part of Optum from what we see in the news. Is that right?

Bill Krause: We expect the transaction to close in the second half of 2021, subject to regulatory approvals and other customary closing conditions. Until that time, we will continue to operate in the market as separate entities. That means, for now, it is business as usual from both the Change Healthcare and Optum sides.

Q: Since we spoke on this podcast, you have continued to focus on payment, transparency, and solutions for healthcare consumers. What is driving that focus from a marketplace standpoint, and what is the emerging need you are trying to serve?

Bill: Several factors are going into this, and the government has also provided a fair amount of commentary around their rationale for putting forward the regulatory changes. From a customer standpoint, the provider and payer experience underneath it needs more information to be available at decision making time to inform consumers on their healthcare journey.  There is tremendous friction today with consumers in understanding their financial responsibility at points in time when they can manage and make decisions to address whatever those needs are. This friction in understanding has a ripple effect for provider organizations because it’s challenging for the revenue cycle departments to function at a high performance given the challenges. From a more macro standpoint, better-functioning markets require transparent access. This plays into the government’s objectives to create a more functioning health care marketplace.

Q: The CMS had announced the hospital price transparency rule in May 2019. The deadline for compliance is already up. Can you tell us more about that?

Bill: The CMS price transparency rule became effective on . The rule requires providers to post on their websites all prices in a machine-readable format and prices for a select group of shoppable services in a consumer-friendly format. That has changed the dynamic as it relates to making information available. The rule went much further than previous iterations of transparency rules requiring publishing providers’ chargemasters. Now, providers must put forward the negotiated rates for services that they have established with all the payer organizations that work with the providers.

Q: As a consumer, I should see some degree of price transparency, which allows me to exercise some choice. With digital transformation, I should see all this information online, make choices, and make payments before taking the service. How does this fit into the notion of a seamless digital patient experience?

Bill: It fits in a very critical way through a lot of the research that we have done with consumers around their top needs and friction points in healthcare. Among the very top is understanding consumer benefits and their financial responsibilities. When provider organizations are laying out their strategic priorities to transform digitally, financial management and financial information are among the top areas providers are looking to address first. For a consumer, the beginning of that care journey begins with awareness of what they need and then considering in more detail where they should go, their care options, and financial responsibility.

Q: Change Healthcare recently launched a solution to meet this need. Can you talk a little bit about that?

Bill: We had previously rolled out Shop Book and Pay™, which is the solution to create digital storefronts for provider organizations. You can brand and put forward into the public square shoppable tests and procedures. Last year, we decided to enhance the solution further by meeting regulatory requirements for price transparency. Many hospitals have adopted the solution to comply with transparency, host, create and host the machine-readable files, and meet other requirements around both tests and procedures in a consumer-friendly, self-service searchable format. So that’s part of our connected consumer health and patient engagement portfolio. It is an area that, as a company, we have been making a lot of investments and innovation.

Q: How are hospital administrators responding to the Shop Book and Pay™ solution? As consumers, are we going to see the level of transparency that is intended through this ruling?

Bill: As of December, the estimates were that about 60 percent of providers were still not compliant with the rule. The smaller providers are more likely to be compliant, probably because they cannot afford the three hundred dollars per facility per day penalty. For large hospital organizations, achieving that transparency is on the agenda, but they have not yet gotten into compliance with the rule. Across the US, there is varied adoption of the rule while many are still working towards it. The work itself requires a fair amount of detailed analysis of their contracts with payers and efforts to bring that data into a format to comply with the rule.

Q: What impact does it have on the business of the health systems?

Bill: According to the initial assessment, there has been tremendous interest from all parties in accessing this information to incorporate it into decision making, beyond just informing consumers. Many providers are just beginning to integrate ways to communicate the availability of the tool in a language that a consumer can understand. When you compared this to the situation prior to the CMS rule on transparency, there have been select examples in different markets throughout the country where transparency information was made available through a few contracting cycles.

Right now, among the top issues are the providers and payers thinking through what this means for pricing strategy for shoppable tests and procedures, which then will come back to consumers. It, however, will be driven more from provider and payer strategies than it might be from direct consumer shopping in the immediate term.

Q: Consumers who are covered by employer-based health insurance do not care who pays and how much. What would be driving this interest in increased transparency among consumers? Are there specific types of procedures that are now transparent to consumers, and is it making an impact in the way they make their choices? Is there a certain type of demography among consumers taking advantage of this more than the others?

Bill: The government has specified the everyday services and tests to be included in the consumer-friendly requirements of the rule. Things like physical therapy visits, office visits, and simple lab tests are the highest volume areas and have the largest everyday care needs across the broader population. In the case where a patient has purchased care prior to a service, the demography is typically a female in her early forties managing a household, and thus taking care of healthcare needs of the household and demonstrating a real tendency towards shoppable behavior. This demography is going to pursue shopping more frequently. The other thing is, there are many organizations that are growing quite rapidly in the arena of care navigation and support. When you think about the consumer holistically, the influences, and their healthcare experience, they will have other resources such as navigation services that an employer or organization may license for the consumer to use. There are other ways that steering and price shopping can show up and drive consumer behavior beyond just a consumer going to the front door.

Q: How did the pandemic impact consumer attitudes for healthcare services in general and price shopping? Has it accelerated the price shopping behavior?

Bill: It is accelerated the movement to digital healthcare journeys. There is a dramatic shift toward telemedicine behavior. The general behavior of interacting with a digital-first channel of care is the primary driver. This also supports the digital transformation initiatives of companies putting information transparency directly in front of the consumer. With the most recent rollout of price transparency, it is really in the first innings. It has not yet shown up from a shopping standpoint so much as just the general shift in the use of the digital-first approach to care, which is a precursor to shopping for care services and using transparency and further.

Q: We see more employers contracting directly with providers, taking control of healthcare costs, and funding something themselves. What do you make of this trend, and what kind of impact does it have on consumer behavior and price transparency and choice? Is there a correlation between this trend and what you see as the demand for your offerings in particular?

Bill: I see a correlation between those trends. Employers are taking an active role and driving our health care industry to be a more value-based care system. [9.9s] Direct contracting is an example of things that provider organizations, associations, and others representing the self-insured employer segment are helping to facilitate. There have been many examples of centers of excellence, strategies of large employers contracting with health systems for certain services, and more. Direct contracting strategy for price transparency and a focus on shoppable testing procedures is probably poised to grow even faster. For example, according to data shared by a payer customer, there’s a vested interest on both the provider and the employer organization to find new ways to direct contract to include shoppable tests and procedures. Previously, this interest might have been focused more on certain surgeries, service lines, and centers of excellence.

About our guest

Bill Krause is the Vice President and General Manager, Experience and Consumer Engagement at Change Healthcare. Serving the healthcare industry for over 12 years, Bill Krause leads innovation and solution development for patient experience management at Change Healthcare. In this role, Mr. Krause is responsible for the development and execution of strategies that enable healthcare organizations to realize value through leading-edge consumer engagement capabilities

Previously, Mr. Krause provided insight and direction into new product and service strategies for McKesson and Change Healthcare. He also managed business development planning, partnerships and corporate development across a variety of healthcare service and technology lines of business for those companies.

 

Prior to McKesson, Mr. Krause worked at McKinsey & Company as a strategy consultant, serving a variety of clients in healthcare and other industries. He received his MBA from Harvard Business School and his undergraduate degree from University of Virginia. He also served as a lieutenant in the United States Navy.

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.

Solutions that meet patients, where they are and where they want to be, has tremendous legs in 2021 and going forward.

Season 3: Episode #71

Podcast with Colin Banas, MD, Chief Medical Officer, DrFirst

"Solutions that meet patients, where they are and where they want to be, has tremendous legs in 2021 and going forward."

paddy Hosted by Paddy Padmanabhan

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In this episode, Dr. Colin Banas discusses how they are uniting different stakeholders in the healthcare space through their concept – HealthiverseTM – and providing actionable solutions for a better healthcare experience and outcome to all.

According to Dr. Banas, the overall spend in the U.S. healthcare market in medication management and adherence space rose from 10 percent to 20 percent over the last few decades. In future, the opportunity lies in the solutions that meet patients’ needs wherever they are and where they want to be.

DrFirst serves hospitals and health systems, individual clinics, offer e-prescribing platforms, provide patient-focused price transparency solutions, and much more. Take a listen.

Our Podcast Partner:

PP: [00:01:02] Hello again, everyone. Welcome back to the podcast. This is Paddy, and it is my great privilege and honor to introduce my special guest today, Dr. Colin Banas, Chief Medical Officer of Dr. First Colin. Thank you so much for setting aside the time. And welcome to the show.

CB: [00:01:20] Thank you for having me. I’m honored to be here.

PP: [00:01:23] You’re most welcome. Thank you so much for that. So, let’s get started.

PP: [00:01:26] Tell us a little bit about Dr. First and the market need that the company is trying to address.

CB: [00:01:33] Yeah. So, Dr. First is a pioneering health technology company that’s been around for over two decades. In fact, we just hit our twenty first birthday on January 1st. And what started as an e-prescribing company, a medication management company, has morphed and evolved over these decades to include more and more solutions. And what we’re trying to do is unite all the different players in the health care space and break down the silos. So, we have this concept of the healthy verse. This is because there are so many different players in the health care universe that we’ve coined the term, the healthy verse. And we like to put the information in an actionable way in front of the key players at the moment of care so that we can provide better outcomes and better experiences for all of them.

PP: [00:02:27] So would you then call yourself a more of a data management and a data services company? Or are you offering solutions that use the data? Which side of the aisle would you see yourself more in?

CB: [00:02:45] Yeah, I love the word solutions and we are a solutions company, so putting actionable solutions in front of those key players is really where we sit.

PP: [00:02:54] You mentioned that the company’s origins are a prescription medication management that I imagine continues to be at the core of what you do.

PP: [00:03:04] So let’s talk a little bit about what are the biggest gaps that you see in this market today as you try to unite the data sources using the Healthworks concept that you talked about? And what really is the size of this opportunity? What are we talking about here?

CB: [00:03:20] Yeah, so I’ll start with the size question. I think it’s an interesting question, depending on how you define the medication management space and all of the various pieces and parts.

CB: [00:03:31] But what I’m reminded of is, if you look at the overall spend in health care in the United States a few decades ago, the medication management in its totality was probably 10 percent of the spend. And of course, the rest of it was 90. And over the course of these decades, it has inched up to the point where medication spend and all things related to it is closer to 20 percent now.

CB: [00:04:01] And so depending on how you want to visualize the pie of opportunity, it could be quite sizable. And when I think of medication management, I think of the lifecycle of the prescription from soup to nuts. The decision to initiate therapy and write the prescription all the way to getting it filled at the pharmacy to adjudicating the potential claim all the way to medication history services. So, when you’re seeing the patient back in the clinic or back in the ER or for an admissi