Category: Coronavirus conversations

We need to figure out how to make the shift from face-to-face medicine to virtual medicine

Posted on by sanjith p

Coronavirus conversations

Coronavirus conversations

Dr. Ram Raju, SVP and Community Health Investment Officer at Northwell Health

"We need to figure out how to make the shift from face-to-face medicine to virtual medicine"

paddy Hosted by Paddy Padmanabhan
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In this episode, Dr. Ram Raju discusses how the global COVID-19 pandemic has impacted Northwell Health and how in future healthcare delivery systems will change in response to the crisis.

Northwell Health is one of the largest health systems in New York and has been a telemedicine leader for several years. Dr. Raju believes that healthcare systems will need to evolve and change their workflow as more and more people will be seeking care through virtual technologies. Primary care will leverage technology to shift face-to-face medicine to virtual medicine, while specialty care will stay in the hospitals.

Dr. Raju also believes that storing data in the EHRs and EMRs is going to be very different in the future with more data in video clips than text notes.

Dr. Ram Raju, SVP and Community Health Investment Officer at Northwell Health in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “We need to figure out how to make the shift from face-to-face medicine to virtual medicine”

PP: Welcome back to my podcast. This is Paddy and it is my great privilege to introduce my special guest today, Dr. Ram Raju of Northwell Medicine in New York. Dr. Raju, thank you so much for setting aside some time and welcome to the show. New York has been at the center of the COVID-19 pandemic. Can you share a little bit about what the experience has been at Northwell and how it is impacted Northwell and share a little bit about your COVID-19 response efforts?

RR: This is something which none of us ever prepared for, even dreamt about. Northwell, as well as the other healthcare delivery systems in New York City, has really raised up to the challenge and especially the providers and the frontline workers have done a fantastic job of managing the flow of the patients, testing them, treating them, and able to stay with the patients and putting themselves at great risk. The health system has done a remarkable job of trying to save as many people as they could. So, this has been a story of the greatest success. We should be in this country, which really had such a devastating epidemic with a tremendous amount of sacrifice on the part of the people to get this done. Now we see a diminution of the number of patients who are coming to our EDs with the virus syndromes, as well as to the number of people who are in the ICU and the number of people who are on the ventilator. All of them are showing a very, very good downward trend. So, it looks like we are probably behind the apex of the curve, but this also has to do a lot with what the government has done and also the discipline of the New Yorkers in practicing very, very strict social distancing, which has helped us a lot.

PP: Thank you for providing us with that background. I hope for the sake of New Yorkers and for everyone else across the country and the world, that we put this behind us as soon as possible. The healthcare impact and the immediate need of having to identify and treat those that are infected with COVID-19 is one part, there is obviously a significant financial impact to the broader economy as a whole because of the shelter at home and the health systems in particular as a result of the pandemic. I know that the federal government has done its best to help through CARES Act to set aside some money at 100 billion to help hospitals deal with additional costs. Is that making a difference? What is the outlook for hospitals and health systems in financial terms in this coming year?

RR: Healthcare systems in the country have always been on a very thin margin and they do not have much in savings to fall back on. That is true for most of the healthcare delivery systems of the country and New York City is no exception. This has produced a tremendous amount of financial burden on healthcare delivery systems. And the health of the federal government is definitely very much appreciated and very much welcome. And it is also extremely important to keep the healthcare delivery system going in New York City. But the long-term economic issues will be devastating because we have not seen what the long term outlook looks like even after the pandemic is well past us. We will take a long point of time, the economy to gear up to the level it has been there before the pandemic, as well as the confidence of the people able to go back to those restaurants in New York City, those tourist spots, those games, and all those things will take a long time for the New Yorkers and all across the country to get back to the way things were. People have started talking about the new normal after this pandemic. We are going to see a different way of people reacting to it which is unpredictable. I think a large portion of the economic recovery depends on individual behavior. How much confidence they will have in going back to doing things they have done before this without batting an eyelash.

PP: That’s very well-said. Healthcare went overnight to a virtual care model. I imagine like with other health systems across the country, Northwell too accelerated significantly in terms of its journey towards telehealth mode of delivering care. Could you talk a little bit about what some of those big changes in virtualizing your care delivery?

RR: Northwell has been a leader in telemedicine for the last five or six years. And we have used the telemedicine capabilities across our system very effectively in teleradiology, telepsychiatry was a major component of it. And also, our transitional care workers use telemedicine to a great extent to follow up on the patients at high risk and also be used extensively on our readmissions task force and making sure that the people are really taking care of. Having said that, it accelerated tremendously after our experience with the coronavirus. There was a little bit reluctance on the part of the patients adhere to this telemedicine concept. But this pandemic opened eyes and it made it more normal for the patient perspective to be able to get on a telemedicine call and able to chat with the patient. So, in the new normal there will be less reluctance. There is a huge cultural change that has happened. And people will be getting more and more care and consultations through virtual technology to a great extent. So, we need to get it out, get this up. That simply means that most of the healthcare delivery systems in this country have got to really change the workflow issues. There may not be as many patients ever coming to the clinics. And there may be a good number of people probably be seeking care and getting advice through virtual technology. So that simply has got different kinds of processes we need to evolve. We need more people who are having the telemedicine concept. That means we need more hardware, more software, and more situation room kind of things where we are able to guide the patient through the system effortlessly and with minimal delay. But at the same time, on the flip side, the real estate value of having these large clinics, there are large waiting rooms and all those things need to be rethought because there may not be as many people coming through who occupy those waiting rooms in the large clinics which some of the hospitals have built, very recently, to accommodate more flow. We need to really figure out how do we make the shift from face-to-face medicine to a virtual medicine and all the implications with come that. We need to gear up certain areas of our support system to accommodate high demand on the virtual and our doctor’s visit. And we may have to shut down some other areas of the healthcare delivery system which will not be needed as much in the new normal after the coronavirus.

PP: What does that mean for the healthcare sectors? Are you anticipating that there will be more M&A and consolidation? And to a point, inevitably some hospitals just closing. And what does it mean for healthcare consumers in general, especially for vulnerable populations or rural populations?

RR: What will happen is that the places which cannot be done virtually like an operation, or delivering a baby, or some of those things who need to be done in a hospital and are basically a face to face functions. Apart from that the organizations which has a huge reach of telemedicine capacity will probably eat up into the market of the people with the telemedicine were able to attach to the doctors. In other words, if I have an opportunity to attach myself to a hospital A where I was getting my face-to-face care, now I can attach myself with the same ease to another hospital. Hospital B which is like a large teaching hospital. I would prefer to go to hospital B because now the distance does not matter. The geography does not matter anymore. In the past, the geography, the distance mattered where I needed to go to the nearest place. I don’t want to travel like in all 50 miles to go and see a doctor. But now that has changed. So, there will be a tremendous re-shifting of the healthcare delivery system in this country. You will see the hospitals, which are basically doing mostly straightforward medical patients, will probably have a very tough time keeping their doors open. But a hospital might have done, as some specialists like in orthopedic surgery are a neurosurgeon, a spine surgery that cannot be done through telemedicine, though naturally, they will be more in demand. So, we will probably shift from primary care to virtual technology and specialty care will probably sit in the hospitals. And the hospitals need to figure out how can they shed their primary capacity real estate and acquire more real estate on the specialty.

PP: Talking about even the primary care shift in the telemedicine, there are sections of the population, vulnerable, low income, rural, and many others that are still not necessarily placed to receive care for telemedicine modality as a large urban environment that I’m kind of pointing out. There are two extremes here. But do you think that vulnerable populations may not benefit as much from telemedicine as maybe other parts of the population?

RR: You are absolutely correct. That is the point I was making in my last webcast. The problem is this is a group of people or I call them socially vulnerable populations, which has been my main focus for the last 19 years and trying to figure out how can we create health equity, social equity, and social justice for the population so that they can have a level playing field. And that has been a major concern. So there are people who do not have either the literacy level, the knowledge level to able to get this technology and the able to utilize the technology or the inability to access to a computer or a fast internet, which will make those virtual care easier. And then the language issues which come along. I am worried that it will create more health care disparities for this socially vulnerable population. This is the population we call social determinants of health. The population which lives in the food deserts, live in their transportation desert, population who are living in a publicly unsafe. These are people who live in a public housing with a large lead poisoning effect, all those stuffs which they suffer. Now, the fact of the matter, they tell you this healthcare is also shifting to a technology which they are either not capable of utilizing and or they don’t have the technology to get it done will probably be left behind. That has been my major, major concern. But the problem with that is it is apathy. I believe that there will be a further division of the healthcare delivery system in this country from their ability to pay issue will be hospitals which purely cater to the people who are socially disadvantaged, like public hospital systems in the country. And then there are hospitals which are basically catered to the people was got good insurance. So, the two-tiered healthcare delivery system will get further divided. There will be a bigger division and a bigger gulf between their haves and have nots in this country. We will have no further damage; I think the vulnerable population. So I’m very worried about that because the problem with that is the hospitals, which are really trying to stay at the cutting edge of this will probably invest more time and energy on the telemedicine, teleradiology, and telepsychiatry they’re using virtual care will probably think in better investing than opening up the face-to-face encounter, which will probably be widely utilized mostly by socially disadvantaged people. Another name for them is people who are poor, and they can’t afford, and they have no insurance and they are very underinsured people. So, this is a problem which will happen. There will be another shift of the values in this and the question comes in, how do you protect them and that is a bigger question to ask.

PP: There is a lot of food for thought there Dr. Raju. Talking about the technology itself. So, in my podcast, I mostly talk about digital technologies and digital transformation itself for health systems. Now we have obviously seen telehealth kind of take-off and all the visit visitor numbers are going through the roof because of COVID-19. What do you see that health systems across the country are now going to be compelled to accelerate their digital transformation and accelerate their investments in technology to transform the way they deliver care, not just in virtual visits, but a whole range of other things, remote patient monitoring, and AI-led diagnosis and treatment, what is your view on that?

RR: Absolutely, we have learned finally to break the barrier, the cultural barrier of some people believing that they are getting a business done through virtual technologies, somehow inferior to a face-to-face encounter, that is broken. So that means that flood gates are going to open. People are not reluctant anymore to seek care and they’re happy with the care they get through a virtual technology. This is completely going to change the way and most of the hospitals are going to raise towards creating the digital platforms and digital technology in acquiring or contracting that out to take care of the patients. It has really changed the way we do that. And also the way they function, one of the things the hospital systems are seeing like any business system in the country that a good portion of the hospital employees can do not need to be in the hospital or in the corporate headquarters to provide care. They can stay at home and work remotely. And that has created other issues, there will be about one third of the hospitals, a large workforce, maybe working remotely. So that also creates another, both on the employee’s side, how do we manage them when they work remotely, and also from the patient perspective, how can we use digital technology to reach more patients in a much more effective way. All those things are going to make the hospital go in the next few years absolutely a race towards the technology, a race towards the digital platforms all the things that they need to do. Whether it is caregiving or remotely monitoring all those things are going to change your answer. So, there’ll be less of a footprint of the hospital and the footprint will be more by the digital technology, which extends its influence over a larger footprint than they ever imagined in the past.

PP: At the same time, we also must talk about the existing technologies and how we leverage those technologies to integrate them into the future state. So, I’m talking about EHR systems. There’s been a lot of talk about 35 billion, 40 billion in taxpayer money over 10 years. And of course, that is the single biggest digital transformation that has happened in healthcare over the last 10 years, just the digitization of patient records and clearing electronic workflows and so on. Now, some of the deficiencies are the shortcomings of electronic health record systems have been coming up. One of the biggest ones has been interoperability. We saw the final interoperability ruling go through earlier this year. Hopefully, the data flow among and within EHR systems for delivering care and having the access to the data at the point of care is going to get better. What are your thoughts on the final ruling and what improvements in care do you think that is going to result in as a result of the implementation of the final rule?

RR: Even before we talk about the final ruling, we need to think about what is in the EHR or EMR might look like in the future. Yeah, we are moving into the virtual care on telemedicine. The handwritten notes or the typewritten notes are gone. We will be storing the patient’s information and their visits through videos into their EMRs because no one is going to go back and write anything or type anything into it. It’s basically their EMR in the future will be, all of them are basically the video clips of meeting of the patient talking to them. So, the EHR will probably have less typing or less information. And then the video clips, that is what will probably happen over time. That means the interoperability, which has worked so hard to create and connect the various aspects of it will probably take a different turn. And, how do we store the video chats, which are coming from various places, eventually people will need to open the video chat into their smartphone, which has got different technology? People are going to use not just the computer; they want to use smartphone technology to talk to a doctor on their phone like they do FaceTime today. So, the question will be, how will you then we need to have a special way, because those conversations are not necessarily encrypted at the level. We have the documentation and the present time. The final rule is not going to be the final, final rule. It is going to be something very different in the future. So how do we do this, who gets information, who gets to see it? How do you play it back if you need to find that out? The components of the EMR will probably be going to change tremendously. How we store the data in the EMR is going to be very different in the future than it is today. So, we are still trying to make some amendments to strengthening the various rules and trying to get information organized and synchronized across away by all these rulings. Some of them will become moot point eventually because you will not be storing any more documentation in this story, mostly clips.

PP: That is such an interesting perspective. I’ve never heard anyone say that patient medical information in the future is going to be stored more as a video than as text. That is a fundamental paradigm shift in how we look at patient medical information. If that is the case, it needs interoperability and it needs for even being able to access the data in the form it is going to be available in places where it changes dramatically. That is so interesting. What do you see as a path for a return to normalcy and health care operations for the rest of the year?

RR: First of all, there will be new normal. We need to get used to that. There is no real way of doing things. Things are going to change tremendously and it’s going to be different. So, the new normalcy going to be in the future is not going to be in a year. We may open the shops; we may open the hospitals. We may be trying to go back to the way things were which will never be the way things were. Having said that, we are trying to get back to how the life was before it completely closed the economy and the communities and societies in our country. So, as we reopen it, we believe that it will go back to the way it was, but it will not be, it will be completely different. And you will learn as you go along. You will change your habits to great extent. We will probably do things very differently than we’ve done before. So, the economy has got to change with that idea. It’s like, I do not know that we’ll be sitting in a movie theater next to each other and feel comfortable watching the movie or watching the show. I am not sure it will be a stay in our sitting packed up in there in the Yankee Stadium and watch the game. So, all those things are going to change. So, the new normal will be very different. It is going to be, a lot more will be on the virtual level. Maybe there are more people watching those games and more movies on the on the streaming services as opposed to doing that. In fact, starting in a couple of one, one particular group has actually started releasing movies, not in the movie theaters, but streaming directly to the patient. They can actually go and buy the movie ticket and get it streamed into their home. That is a big thing. What will happen to the restaurants? Do we have to wait outside waiting for the restaurants? The normal, as you know, will be very different. This is very difficult to predict because we don’t know what it looks like, how much of tolerance and how much of confidence we will have is something which we do not know what I love. We’ll get better quickly and come back normal on it. Maybe it’ll be a change in life for a long time.

PP: My travel has come down to zero in the last couple of months and I have been a heavy traveler for decades and decades, and I just cannot imagine this. Someone told me this is like a 9/11 moment for healthcare care and more reason why travelers are not going to be the same again. Getting on a plane, sitting next to another anyway, just like you’re talking about Yankee Stadium or a Broadway show, life has got to change as well, among many, many other things. It’s going to be an interesting era, for sure.

RR: Yes, absolutely. That simply means it depends on the fact is how quickly the Broadway or the airlines trying to reorganize themselves and reconfigure the seats? It is going to be something we have to see. Maybe we will have less number of people traveling or more people willing to pay more money or people will be traveling more by car than by plane. So, there is going to be a big shift in transportation would not be in this country really quickly.

PP: Dr. Raju, it’s been such a pleasure speaking with you. Thank you so much for setting aside time and I look forward to staying in touch.

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

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

About our guest

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Ram Raju, MD, combines his executive leadership experience in healthcare with a deep commitment to achieving social equity to improve the health of communities in need. As the Senior Vice President and Community Health Investment Officer, he evaluates the needs of Northwell’s most-vulnerable communities and provides solutions for them by collaborating with community-based organizations. He is responsible for promoting, sustaining, and advancing an environment that supports equity and diversity, and helping the health system eliminate health disparities.

Prior to Northwell, Dr. Raju served as president and CEO of NYC Health + Hospitals from January 2014-November 2016. NYC Health + Hospitals has 42,000 employees, 11 acute-care hospitals, five nursing homes, six diagnostic and treatment centers, more than 70 community-based health centers, a large home care agency and one of the region’s largest providers of government-sponsored health insurance, MetroPlus Health Plan.

Dr. Raju also served as CEO for the Cook County Health and Hospitals System in Chicago, the nation’s third-largest public health system, where he improved cash flow by more than $100 million and changed the system’s financial health during his tenure from 2011-2014. His medical career began at Lutheran Medical Center in Brooklyn and he later served as Chief Operating Officer and Medical Director at NYC Health + Hospitals’ Coney Island Hospital. In 2006, Dr. Raju became the HHC Chief Medical Officer, Corporate Chief Operating Officer and Executive Vice President. Under his leadership, HHC continued to improve quality, patient safety, and health care data transparency.

Dr. Raju served as Vice-Chair of the Greater New York Hospital Association and currently sits on the boards of numerous cities, state, and national health care organizations, including the American Hospital Association, the New York Academy of Medicine and the Asian Health Care Leaders Association. Among his numerous awards and accolades, Dr. Raju was selected to Modern Healthcare’s “100 Most-Influential People in Healthcare.” Modern Healthcare also named him one of the “Top 25 Minority Executives in Healthcare” and one of the “50 Most-Influential Physician Executives in Healthcare.” In 2013, he was named a Business Leader of Color by Chicago United.

Dr. Raju earned a medical diploma and Master of Surgery from Madras Medical College in India. He underwent further training in England, where he was elected as a Fellow of the Royal College of Surgeons. He later received an MBA from the University of Tennessee and CPE from the American College of Physician Executives.

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

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The desire with the final interoperability rule is to liberate data flow in the industry

Posted on by sanjith p

Coronavirus conversations

Coronavirus conversations

Russ Branzell, CEO, CHIME

"The desire with the final interoperability rule is to liberate data flow in the industry"

paddy Hosted by Paddy Padmanabhan
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In this episode, Russ Branzell, CEO of CHIME discusses their role in the healthcare industry and how COVID-19 will impact health systems. Russ also shares his thoughts about the final interoperability rule and FCC telehealth investment program.

CHIME supports its members in their transformation and growth journey by assisting them in their professional development and be the best leaders in the healthcare industry. Russ states that we may see mergers and acquisitions accelerate in the industry due to the current pandemic. He also believes that the technology impact due to the COVID-19 crisis, whether intended or unintended, will accelerate digital activities in health systems.

This is also a video podcast.

Russ Branzell, CEO of CHIME in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “The desire with the final interoperability rule is to liberate data flow in the industry”

PP: Welcome back to my podcast and it is my great privilege to introduce my very special guest and friend, Russ Branzell, CEO of CHIME. Thank you so much for taking the time to be with us today. Please tell us a little bit about what CHIME is and what CHIME does?

RB: CHIME or the College of Healthcare Information Management Executives, is a professional association for healthcare IT executives, could be CIOs, which has been our history. We also have CMIO’s in the organization, CNIO’s, Chief Innovation now, and a bunch of other titles. As the industry continues to grow and mature positions, our role is simple that is to support our members, both our CHIME members and our CHIME Foundation, which are our vendor partners in their transformation, in their growth to support the industry. We are not a trade show organization, we don’t run Expos. Our whole role is to pour into these folks, support them in Washington, support them in the professional development, help them be the best leaders. Maybe what has been pointed out even most recently, a little bit of a broken system around. So, CHIME has seen some significant growth recently over the last few years. We are now in 57 countries around the world. We have eleven independent operating groups or chapters in other countries. And the domestic growth here in the United States has not only grown significantly in the CIO ranks and other CHIME members, but we’ve also launched three other professional associations for Chief Technology, Chief Application and Chief Information Security Officers and those have seen substantial growth. All of these roles are heading a pretty high peak of maturity in their organizations and as we can see recently, both for negative reasons but also positive outcomes, has never been more important than it is right now with what we’re fighting. 

PP: I am proud to say that my firm Damo Consulting is also a foundation partner with CHIME, and we have benefited greatly from the partnership. And I want to thank you and your team for all the wonderful work that you continue to do. 

RB: Thank you. It is an honor to have you in the organization, but most importantly, serving alongside of us as we try to take on tough stuff. 

PP: How the pandemic has impacted CHIME and what changes you had to make in the recent past. 

RB: We did not get to have our face to face meeting this spring that is held prior to the HIMSS annual conference, which for all our members that normally attend that. That is always a good time for us. It is a time for us to refresh relationships, build new networks. And that was difficult for us. Now, the converse of that side has been what I would construe as a significant positive. And that is the emerging technologies that are already out there that have gone from probably infancy to at least early adulthood in a matter of light-years. Whether it is what we are on now, Zoom or any of these other technologies that are out there. We havespent more quality time with people. One, we are constrained to home, so we are making a different effort and a different focus than traveling around the globe. We were able to spend some quality time with people, hear what is going on, find out new ways to support them. And that has driven us not that our technology and our strategy wasn’t already taking us there, but we were already heading in a digital path. And the digital path that we are on really was to support the entire globe from a digital platform perspective. Like many of our members, regardlessit is foundation firms or CHIME members and things that were planned for maybe months, even years have gotten done in weeks and days. We have now completely changed to a digital environment that will also complement in-person meetings in the future when things normalize out. That is probably the biggest change. But as you probably expect, the biggest impact has been there’s so much coming out of Washington right now and states, but mostly Washington, that we’re spending in an extremely large amount of time ciphering through all the different information, getting member alerts out. The perfect example is today when the alert that went out yesterday from the government, immediately they changed the timing within 24 hours of sending out. They immediately changed the timing again. 

PP: We’ll come back to Washington, D.C. on the work that CHIME doing on behalf of all the members. From your point of view as a CEO of CHIME you get to see a broad cross-section of health systems across the country and you probably have visibility from a first-hand perspective as to what is really going on. And we are beginning to see some early signs of some distress that health systems are going through. Financially speaking, we saw HCA announce their results earlier this week and they indicated that their results were not favorable, primarily because of all the non-elective procedures that have kind of dropped in volumes. But that’s just one data point. I am curious to know what you are seeing and hearing as it relates to how the pandemic is going to impact health systems in the near-term. What should we expect? 

RB: Everyone’s taken a big hit on this, whether it’s the U.S. or actually globally in different forms of economic models in hospitals or health systems around the globe. The U.S. model, which very much is revenue-based, is probably taken at the most significant hits on this. I’ve talked to people, not every state wants to say a significant number of them,and the themes are the same. Significant decreases in outpatient and acute procedures and or admissions. And that just has a significant effect on the bottom line, which means they are going to have to make hard decisions or are making hard decisions right now. And I think it is going to come in. This is going to come in two significant waves. One; short term weathering what they’re doing to just make sure they can still meet the mission requirements and then the long-term impact of that as well. Well, a lot of that will be told by time and how big of an impact, some organizations are going to be well, if they’ve got deep cash on hands and they can weather this out. They’ve built digital strategies that probably help them somewhat through this, maybe a little more proactively than others. But there’s definitely some that this will be a substantial, substantial long-term multi-year hit to recover from. And they’ll have to figure out how and what they do to invest, to recover from that. 

PP: The government announced a stimulus package and a second one is going through and there was a significant amount of the money set aside for hospitals. I believe it was a hundred billion in the first round. Is that making a significant impact or is it just a drop in the bucket in the grand scheme of things? 

RB: Anything that comes in at this point is going to help. I mean, especially whether it is the PPP program for smaller organizations or significant cash flow increase or infusion from this government, stimulus funds are going to help. Can’t infer that they won’t, but it is significantly less. I was spending time with some of the leadership of some of the other large associations that you can imagine what their advocacy work has been doing in Washington, D.C. And one of the numbers that one of the CEOs threw out was to make the kind of impact to normalize this out. We are probably talking north of a trillion dollars. So, if 100 billion was infused, that means we are probably missing this by about 90 percent. And again, I have talked to some CIOs representing their organizations that said whether it’s going to hurt. I have heard some say that they’re worried about what this looks like long term. I know there was a second-round that’s trying to be worked on right now for some organizations, but definitely it’s the right direction. But when you tell every health system in the country, turn off your elective procedures, turn off the things that generally drive the engine, even if you don’t have COVID patients in, which was probably the right thing to do initially. It does have a dramatic negative effect. 

PP: You mentioned, digital transformation and at CHIME you have undergone a bit of a digital transformation yourself in response to the crisis. My organization has been a virtual company forever. And we really didn’t feel any impact. We just transitioned very smoothly from our normal way of working to the current way of working with the only exception being that I don’t travel anymore. I have not traveled for a while. I remember my last travel date was the 6th of March. And in hindsight, maybe I should not have traveled on the 6th of March, but that’s a whole separate story. John Kravitz, CHIME CHAIR, and CIO of Geisinger was on my podcast and he talked about digital transformation. And it was interesting what he said to me was that his priorities in the near-term have definitely been influenced by the response effort to the pandemic. But that doesn’t mean they’re slowing down on digital transformation because that is what is going to position the organization for the future. What are you hearing with regards to the balancing of the near-term emergency-related response and what is important and essential for the longer-term survival and sustenance of the organization? What are you seeing across the board? 

RB: I think there definitely is a percentage of organizations you could probably divide this into thirds. And that’s, again, way overgeneralizing. There is probably a third of organizations that are very similar to John’s and obviously I am very close to John, I have spent a lot of time with them being my boss. But I know the organization well. Also, that are really these organizations that have been focused on digital transformation. And again, I do not want to say unfortunate because it is fortunate for us. Organizations like that can flex and move because they live a world of digital transformation already. And this is really forced what we were projecting three to five years based on a normal adoption curve to get to some of the places, the differences we did in three to five weeks. Some organizations like Johns were able to do that a little more seamlessly, maybe a better way to put that is a little less difficult. Some organizations were able to do it and it was painful. And there’s still some organizations are really struggling with that. I think John is a great example of this is a symbiotic relationship. Their digital strategy is its strategy moving forward. And even today so it fits part and parcel to their reaction to this from a COVID as well. So, it’s not different. It’s just now an adaptation to an existing strategy. Some organizations, this is really shined a light on what they were thinking of doing. Now they have done it in three to five weeks. Now they are going to put some really good wrappers around this, figure out how to really thrive in this environment over the next few years. But it is relatively new for those that were not even on their radar. They’re going to struggle for a little while, but maybe we’ll get help from people like you and others out there that can help them in this journey. But there’s definitely some out there, especially some of our smaller areas that don’t have the infrastructure, the support, telemedicine and the other things that this will be a bit of a journey for them and they may return to back a little bit more of an old school mentality. 

PP: Are we going to see some hospitals not make it to put it in a somewhat Darwinistic way that it’s going to be the survival of the digital fittest? And some are just not going to make it and we are going to have to be prepared for that. 

RB: Yeah, in order for it to normal numbers that have come out from the AHA in years past. There are hospitals that no matter what, even if this didn’t occur. There are hospitals that are going to merge with others may be closed. There were some reported even last year, there were just closing because of their financial model, their local area was decreasing in population. There’s just that normal process that goes on in any large ecosystem like healthcare. I think this may accelerate it for some as they struggle, or financial issues may happen. It may accelerate for the short term, maybe for the long term. But I think for at least the short term, you may see mergers and acquisitions accelerate, especially with those with the cash ability to help others out. And it is a good fit, but right out of the gate, we are just going to see hospitals close. I hope communities do not allow that to occur because they are such a vital asset. But in some places, maybe when there is there may be outside of COVID, maybe over bedded and too much competition, you may see some. And that may not be a bad thing. It may be a horrible thing. It just depends on the situation in each community. 

PP: Well, one thing is for sure, it seems like we are going to see some structural changes in the entire healthcare ecosystem. In terms of the technology, people have gone overnight to adopting telehealth as a default mode of operation.And that, among other things, puts a lot of pressure on the vendors, the technology vendors to make sure that the technology holds. What are you hearing when it comes to this? You mentioned Zoom. Zoom went from 10 million subscribers or 200 million. And we all know that Zoom has had some issues as well. What you’re hearing about how the telehealth technologies are holding up?

RB: I have been able to talk to some senior leaders, specifically CEOs of some of the telemedicine companies. And it is interesting to hear their numbers when they talk about their entire 2019 volume increase was 20 percent. And they were thrilled with that because they beat their budget estimates. In the first week of this, it went up 700 percent and then the next week it went up a thousand percent. And they said at some point we just stopped counting because a straight-up curve is not a curve. It is just a line. And most of them said they are handling it well. The biggest issue that they are seeing is the lack of technology support from the back-endpoint technology support. I would use the word maturity on the back-end support, home broadband issues. No one was expecting. I will pick on John. No one’s expecting eighteen hundred physicians in rural Pennsylvania live everywhere all of a sudden over a weekend to have to go home and have high-quality digital internet access at home to be able to do telemedicine, that there’s just going to be some latency issues to getting that all up to the speed it should be. It does point out also that the rural issues that we have, it is not a rural hospital as many issues because most of them have some level of access. It is connecting to all the individuals that may want to seek that care. And there are some major issues that are there. But again, the telehealth providers seem to be doing well, talking to some of the others that I was really surprised by. The demand that has been placed on the hardware providers, laptops, tablets, iPads, services, whatever you want to use brand names, throw it out there. And the fact that one a lot of this comes from overseas and a lot of those pipelines are drying up or are shut off temporarily. The other is there was only so much stock on hand. And when suddenly overnight you need a thousand of these or 5000 of that, well, one organization doing that might not be too bad. One hundred. Well, that could be probably more problematic, 5000 or even tens of thousands or ordering this much equipment all at the same time. Talking to one of the CEOs in New York who said their standard orders a thousand to 5000 orders devices at a time. And they are just generally ordering about every three to five days. And what I heard from several of the hardware vendors that they have to decide who to send equipment to. That there are constraints in the supply chain. And, those were all times I spent with people this week. That is the first time I heard that. It just weirdly the cycle of talking to people. I heard that three times this week that there is a definite supply issue with the type of hardware needed. And CIOs are what they’re doing is taking a company credit card and they’re running down to Best Buy and buying up wherever they can or going down to Wal-Mart or Cosco or wherever and buying what they can, because there actually may be some significant supply-demand issues for this short term. 

PP: Yeah, but not a great time. If your assets are end of life, you could be having some issues in refreshing or replacing them. You mentioned your advocacy work and all the other work that CHIME members, by the way, a big shout out to the CHIME team that keeps us informed about what’s going on in Washington. Big shout out to the webinars that CHIME and everybody else is doing. I just want you to know that we greatly appreciate it as members of CHIME. Couple of big announcements have come out in the recent past. Now, I know that every day there are some incremental announcements, but the two big ones I want to talk about – the final interoperability ruling and the FCC telehealth 200-million-dollar investment program. Can you help unpack what that means for your members? 

RB: Now, whether I’m agreeing or not agreeing with it, I’ll give you kind of the perspective that we’ve heard of what ONC’s intent is, especially with the final interoperability rule, is I think they reached to a point where they had a desire to I’ll use their words exactly in putting a little, quote, signs up in the air, “liberate data flow in the industry”. And I think that was their intent was we’ve made this huge investment in EMRs, which, by the way, thank God we’ve EMRs in the last five to seven years or none of what we’ve done, the last two months could have ever occurred. No matter how painful or maybe not running as well as they could for physicians and nurses, thank God we put these things in or we would be in a lot bigger hurt, but we really made this huge investment. Now, how do we liberate the data? The intent of the interoperability rule from their perspective and in many cases, we agree with some of their philosophies in this. There are some areas that we have concerns through APIs information-sharing requirements, ADT requirements. They want to accelerate the process. I will use another word ‘mandate the process’ to make these standard API, standard flows, and standard requirements occur at a fast pace, fast adoption pace. Now, what we still are trying to figure out from this week it sounds like they are jumbling a little bit the finalization of the enforcement dates based on different requirements. But when you consider that there are some pretty fast requirements while we’re fighting the COVID, we’ve expressed pretty strong that the longer we can give our organizations time to adapt to this, probably the biggest area of concern that we have those still how do you balance open accessibility, which, by the way, this battle I’m about described has been going on for years and decades this isn’t new. How do you balance security and privacy with outright open accessibility and flow, and everybody in between have been expressing their concerns or opinions that one area is right, one area is wrong? I think CHIME tries to play in the middle as much both. The reality is everybody is right. And that is the hard part when you think about this. We should have strong security and privacy. We should have an open flow. I think as we work through this, what we are going to see is there’s going to be some areas that maybe needs more tweaking like most government rules, and there’ll be some areas that flow fairly easily. And well, we do know there are some areas that do amazing work, whether they are doing it with a foundation or vendor partner, or they are doing it through an HIE, ADT flows seamlessly through their areas. How can we scale that up and do that now nationwide? Going to be a challenge to do that in a year that really will be maybe your hospital with your HIE, perfect, beautiful. You can handle that in Chicago. Well, in rural Nebraska, maybe not going to be easy. We will have to see. But again, the basic philosophy now, the part that probably everybody’s worried the most about is ending up in an orange jumpsuit, picking up garbage on the side of the highway because I was an information blocker because that really is still a fundamental issue that most people have a hard time getting their head around is how am I going to ensure that I’m not labeled and or accused or even worse than that indicted for being an information blocker. And I think that is the number one area is still that there is significant work to be done on the one enforcement and or the penalties or the thoughts around what really that is occurring. 

PP: What about the FCC, there is this talk about the telecom investment funding, good news right? 

RB: I think that’s good news. But in any of our minds, I am sure your mind. I amon my mind. When you start talking about hundreds of millions of dollars, you think while this is going on. This will revolutionize things. Well, it would be if it came to me. Butit is still a relatively small amount. I think the hope from this was one, it will fund some of the stuff they’ve been forced to already do, but it will also hopefully open up some opportunity to extend this into some environments where it hasn’t may be seen the maturity that it has rural environments, rural hospitals. This is not new technology. I mean, we had telemedicine to rural clinics. And when I was in Colorado all the way back in the early 2000s, which does not sound that long ago to you consider it was almost 20 years ago that we connected every ED in rural Colorado to telemedicine. It is just it hasn’t taken off to the degree that now this has caused it to. The money will help, but it does not go anywhere near as far as it needs to really get us the maturity we need. 

PP: Well, my understanding of that is that the 200 million is really seed money because they have put a cap of a million dollars for every single application. You get a million dollars if you have an interesting idea. And from the initial awards that have been announced, it seems to me that the focus seems to be to really enhance the reach of medicine towards serving underprivileged, low-income populations, which in all fairness is a good focus for a program like this. But is really seed money. A million dollars is not a lot of money unless you are a tiny startup. But I think it’s important to at least give some kind of an initial boost or support so that if the program succeeds, then organizations can go out and find ways to invest more money in it and monetize it and so on. There may be another round, maybe a follow-on funding. 

RB: You bring up a great point, though, and it’s easy to say small and rural and you immediately think the open fields of Kansas when the reality in some cases it could be the outskirts of Chicago or underserved older area in Detroit. It just does not have the infrastructure they need or the broadband they need to be able to take advantage of this. In some cases, they need it more than some others that are out there. So, yeah, yeah, it is a universal issue. 

PP: Yeah, well we are kind up to the close of our time here Russ. What does a new normal look like for healthcare whenever this is?

RB: I think there are two thoughts that we need to consider right now. One is this concept that we aregoing to jump from, as I have been using the wave theory on this in expressing it. That wave one isgoing to be this COVID thing it comes up. There is a tail. And then we recover and wave two means it is somewhere in the middle, which is pure recovery. We are back to “normal”, I think is incorrect. I think there is at least one, maybe two more curves involved in here in the middle. There probably is a long-term curve of returning to send my normal hospital operations ED functioning the way they should, surgery suites offering we should inpatient rooms. But there is this probably this crazy phase in between where you keep COVID operations and response things up while you start trying to turn on elective surgeries. Andwe have talked to someone that has started during elective surgeries this week and a whole bunch will be turning them on early next week ahead of even some of the recommendations. So,we will see how that works out. And I think what we are going to see is there is that, but there’s the impact, whether unintended or intended, of this technology, digital activity that goes on. And I have been keeping notes and all my little binders here. I should be digital, I am sure. But I am not I amwriting this all down because I love flipping through all these pages at one time. It is interesting hearing the stories right now, whether it’s big corporations that said, we send forty-eight thousand people home that used to work in offices, we’ll only bring back eighteen thousand of them to offices. We are already canceling leases. I was like, okay, that is hard to process. Hospitals, since they think who really needs to be on the grounds, and does it create a better environment by not having these things there? So, I think there is that portion of it is where will people work? Then the other portion of this is how will people work in the future, which is really the fundamental question is how will digital stuff really fancy technical term digital stuff fundamentally change the DNA and how we work as a society moving forward? And what is the long-term impact of that? Because there is a behavioral mental part of this that we must consider, which I always call the fourth or unintended or unwatched wave, which is this is going to fundamentally change people. And people do not always handle change well, we are going to have to do a lot of human care during this period to help people through this. Jobs will disappear. New jobs will be created. How do we help people? There will be changes in the way we interact with each other. So, it does have an advantage, but it is different. 

PP: That’s true. You know, the point you made about normalcy, I think the COVID-19 outbreak. What I am reading, and hearing is that it is going to be a sawtooth curve, it is going to go down and come back up, go down, come back up. Maybe, you know, the lower and lower amplitude as we go forward and the recovery and the return to normalcy will also reflect and mirror that sawtooth curve in some ways. And we can only hope that the amplitudes get smaller and smaller till it comes to a straight line. We do not know when that is going to be. But Russ, as always, a real pleasure speaking with you. Stay safe and we will talk soon. 

RB: Thank you very much, blessings to all. 

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

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

About our guest

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Russell P. Branzell is the CEO and President of the College of Healthcare Information Management Executives (CHIME) and its affiliate associations, the Association for Executives in Healthcare Information Security (AEHIS), the Association for Executives in Healthcare Information Technology (AEHIT) and the Association for Executives in Healthcare Information Applications (AEHIA). In addition to his position at CHIME, he serves on the faculty at Columbia University, where he teaches executive classes in health information technology. He also is a member of the Baldrige Foundation Board and a former member of the Board of Overseers of the Malcolm Baldrige National Quality Award, a position that was appointed by the Secretary of Commerce.

Mr. Branzell joined CHIME as President and CEO in April 2013 after being an active member for 15 years. He served on the CHIME Board of Trustees from 2004-2008, as chair of the CHIME Education Committee from 2004-2008 and as chair of the CHIME Education Foundation. He is currently a faculty member of the CHIME Healthcare CIO Boot Camp.

Prior to taking his position at CHIME, he was the CEO at the Colorado Health Medical Group; Vice President of Information Services and CIO for Poudre Valley Health System; President/CEO of Innovation Enterprises (PVHS’ for-profit IS entity); and Regional Deputy CIO and Executive Director of Information Services for Sisters of Mercy Health System in St. Louis, MO. He served on active duty in the United States Air Force and retired from the Air Force Reserves in 2008. While on active duty, he held numerous healthcare administration positions, including CIO for the Air Mobility Command Surgeon General’s Office.

A native of San Antonio, Mr. Branzell earned an undergraduate degree in business administration, specializing in human resource management and labor relations from the University of Texas. In addition, he earned a master’s degree in Aerospace Science from Embry-Riddle University with an emphasis in management.

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

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We are teaching cloud to speak the healthcare industry language

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Coronavirus conversations

Coronavirus conversations

Amit Zavery, VP & Head of Platform and Aashima Gupta, Head of Healthcare Strategy & Solutions at Google Cloud

"We are teaching cloud to speak the healthcare industry language"

paddy Hosted by Paddy Padmanabhan
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In this episode, Amit Zavery, VP & Head of Platform and Aashima Gupta, Head of Healthcare Strategy & Solutions discuss how Google Cloud is helping healthcare organizations with digital transformation and operational efficiencies. They also discuss the new Cloud Healthcare API and how it will accelerate the healthcare industry.

In the context of healthcare, Google Cloud is providing API connectivity by applying AI/machine learning algorithms and making it accessible for the industry. The company’s new Cloud Healthcare API solution is built to ingest complex data from different industry-standard sources and provide a unified access to it for a meaningful usage. Google Cloud offers the whole lifecycle governance, policy management, security, tracking, delivery, and ease of use over time so that more value and real-time capabilities can be built around it.

To help the healthcare industry during the current COVID-19 pandemic, Google Cloud is taking targeted solutions to the market like helping researchers with cloud credits, helping with Kaggle competitions, and enabling healthcare-focused chatbots with their Cloud AI platform. They are also enabling the healthcare organizations with digital triage that can treat patients remotely and can reduce in-person visits through telemedicine.

This is also a video podcast.

Amit Zavery, VP & Head of Platform and Aashima Gupta, Head of Healthcare Strategy & Solutions, Google Cloud in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “We are teaching cloud to speak the healthcare industry language”

 

PP: Welcome back to my podcast. Today’s special guest are Amit Zavery and Aashima Gupta from Google. We are going to be talking about the exciting announcement that they made recently about their Cloud Healthcare API and a lot of other things. So, Amit and Aashima it is great to have you on the show. Tell us about how Google Cloud is helping healthcare organizations with digital transformation and operating efficiencies.

AZ: Broadly at Google Cloud, we work very closely with many industries, and healthcare is one of the top ones where we have been providing them a lot of technology to run their different systems today, which they operate. That could include being able to run their applications on top of our infrastructure, be able to connect those applications together using a lot of the technology we provide for backend connectivity, to be able to build to modernize those applications and really get the benefits of the latest technologies like Kubernetes and Istio, to be able to get benefits around expanding that portfolio in an easy manner as well and be able to manage it very quickly and easily as well, and then be able to expose that information and systems to all the different users they might have in their industry. That is where we provide a lot of connectivity, also a lot of algorithms and AI capabilities for them to improve the efficiency of the systems they run today. In healthcare, we have been doing a lot more of that nowadays where a lot of modernization happening, as well as they wanting to be able to expose their systems and make it more efficient using APIs as well. We do a lot of work to improve the lifecycle of managing the APIs and exposing that as well.

AG: Google cloud is now becoming much more industry-focused and healthcare is one of the industries in the overall Google cloud portfolio. From the industry standpoint, our mission for healthcare is very similar and a reflection on Google’s overall mission, which is to connect that information and make it accessible and useful. We have adopted that for healthcare, but for our customers and the enterprises, and help them connect that information and make it accessible and useful. So, when I say connect, that is where the API is coming. When we say useful, that’s where AI/machine learning comes in because the data needs to be connected and make more useful. And of course, doing it in a secure and HIPAA compliant way from the industry standpoint. So that is how our products and solutions are purpose-built for the industry in all three different areas. The product – Cloud Healthcare API, it is the cornerstone for us in terms of data, platform, and connectivity that Amit just talked about.

PP: Great background and the healthcare cloud API has been in the works for a while and you recently made the announcement and launched it. So, what Cloud Healthcare API is, what need are you are trying to address in the market and who is your target audience?

AG: So, from the healthcare perspective, providers in the industry are looking for a meaningful way to look into the data. That is a very simple problem, but very profound one because data is buried in different silos. So, when you are looking to the EHR data or you looking to it, talk about images, MRI, CT scans, their DICOM, then PACS systems and you’re looking to genomic information. That is a completely different data siloed to different formats. Our hope for the Cloud Healthcare API is ingestion of different industry-standard data sources providing a managed service so that data can get hosted onto the cloud as a managed service. We are teaching cloud to speak the healthcare industry language. So, we speak HL7 and FHIR, clinical core components which represent 80% of use cases from the healthcare standpoint. Similarly, so to put it in perspective, let’s say if you want to run a query today to say female age 45 to 55 who have BRCA1 and BRCA2 gene and who haven’t gotten their mammogram and their healthcare insurance allows that if you want to now connect that you need to connect to your EHR system, your claim systems, your imaging all that different point data silos. Cloud Healthcare API allows the ease of ingestion, we are taking the complexity of ingesting different formats, giving a unified access in the cloud. And once the data is in the cloud, it just means to an end, the end to create meaningful applications, apply AI/ machine learning, and create an ecosystem around that.

AZ: Once you have the data in the system, how do we now make it useable? And how do you make sure that the right kind of privileges, right kind of security, right kind of policies are applied to that data as well as who gets access to what and when did they get access, the governance around that, all the stuff is really the heavy lifting we provide. So as part of the technology we have around the API management capabilities in Google Cloud with the product with Apigee and a few of the things we build around it. We can now allow operators to put a lot of policies into those access to the data as required. And we are able to track it all the way, end to end, so that you have ability to introspect and find out what happened and when and eventually make it available to people who need to have it in an easy way. Once you have that privileges, you should be able to access things through an API and be able to now use that information to create much more meaningful applications with it. So, if you want to build a mobile application, you want to build another kind of data sharing application or few other things. Those are all doable once we kind of provide these policies on top of it and it does not go rogue then, because we are able to now manage it. And then you have systems in place with the IT groups and the business practitioners, analysts who can now run this thing and operate it in a much smarter way. So that is what the technologies we build around. What Aashima was talking about is to really provide the whole lifecycle, governance, policy management, security, tracking, and delivery and ease of use over time so there is much more value and real-time capabilities you can build on it.

PP: What I understand, this is a generally available API, but I think was a term that you used, which means it is free. And I think you do not have to necessarily use a Google cloud platform for managing your data and you can use the API on whatever environment you have got your data in. Can you clarify that for the benefit of our listeners?

AG: So, the data is coming to Google Cloud. When you leverage industry-standard, API is like USCDI data set of FHIR APIs that Amit is talking about. There is an interoperability both at the semantic level so and the data interoperability. Meaning if you speak the common language no matter where your data resides, those APIs will still work. So, it is not a Google proprietary dataset, we’re talking FHIR, we’re talking HL7, we’re talking DICOM. And these common APIs are common language regardless of where your data is stored. So the trick is, understanding and ingesting the data, creating a unified or unified layer and then exposing through the FHIR APIs and those APIs are the same, whether you’re connecting with on-premise, whether you are connecting with a cloud hasn’t let you speak the same language from the north bound API. We have this terminology we call north bound versus south bound. What we are saying here is the open standards allow for that data portability and it’s very important because we don’t want now to be logged into one infrastructure. It is a managed service, we’re giving the tools out. What we’re doing on top of that is better connectivity when you use Google cloud, we have inbuilt and BigQuery machine learning that we are applying, it comes gateway to that machine learning, building models and creating insights on top of that.

AZ: The key thing is that applications you build could be running anywhere. I think with these APIs and with API management capabilities we built, you can build an application, leverage the things we have through this API. But the application is independent of where you want to run that application.

PP: And that is where your Apigee API Gateway and API management platform also comes into the picture. So, you are abstracting the API and the data layer underneath from the actual application there. Are you planning to implement, or have you already implemented the full set of the CMS FHIR data standards? What is the roadmap for that?

AG: So, if you look into the USCDI, which is the core dataset we have implemented that. We have a full listing. If you look go into the documentation, what are the FHIR resources we are supporting. This FHIR has a very robust community of developers, innovators working on it. Our hope is, as and when the new FHIR resources are introduced, we can support them in our product, but a lot of representation of clinical data as FHIR is a continuous journey right now.

PP: You made a reference to the final interoperability ruling as well and it’s been pushed out for six months and so. Does that in any way impact your product or market roadmap? Is there any implication at all for the healthcare API?

AG: I believe the changes we are seeing with COVID-19 and pandemic. It is underscoring the need for interoperability. So, think of that if your labs were available as a FHIR resource, then I could connect with LabCorp or any other information. Of course, with the patient consent and the right security and privacy. But today I believe we are all seeing the response as a nation from the COVID-19 and connecting information from the patient perspective would have been a lot better if interoperability rules were in place of anything. We will see rapid exploration for these going forward.

PP: That’s what I’m seeing as well, there are several clients that we work with are already down the path of getting ready for the compliance dates. You mentioned one of your clients in the Google blog, which is Mayo Clinic and John Halamka, who is quoted in the blog, has also been on my podcast. Can you share a little bit about what is going on there specifically as it relates to the API itself and have you deployed it there, what are some of the use cases? Are you in a position to share some insights from that experience for the benefit of others who are looking to adopt the API?

AG: With Mayo Clinic, we formed our partnership last September and one of the premises of the partnership is cloud to be the cornerstone for the digital transformation for Mayo Clinic. We are very honored and really inspiring to work with Mayo Clinic. They are the leading physician expertise. Now, when you combine that with Google’s AI and machine learning capabilities, our data analytics capabilities, our API management capabilities. So, they are really looking into unifying the data and just ingesting from different data sources and creating that digital platform and cloud healthcare API is the engine and where all the different data sources and the data will be collected. When we say cloud is a cornerstone of the foundation, it is a means to an end to create more meaningful applications. And one thing I would like to underscore here, as the data is coming into the cloud and we are looking into building an app ecosystem or creating meaningful applications the healthcare industry needs more examples of implementations like theirs, the work that we talked about was the crux of it. If we can do it in a governed way, secure way, this is not going to take off. So, it is very important to get that implementation rigor in the engine. That is what Apigee provides that secure gateway to connect to that information, the right analytics, the right reporting. Which API is a public, which are private, and which are for your partner and in building that robust operating model for API as a lifecycle is critical.

PP: So, Amit we have work together on client engagements where Apigee has been the API management platform of choice, and many of the things that Aashima is referring to are being adopted. All the throttling and the air traffic control and all that stuff. What is your sense of the general adoption level of an API and microservices architecture as a strategy in healthcare enterprises? How do you rate or compare healthcare with other sectors that you are working with?

AZ: I think we have a lot of customers who use API management and Apigee product in the healthcare sector. It has gone up a lot over the last couple of years than it used to be before. If you look at the adoption of API management, I will say the highest industry penetration no doubt is telecommunication, financial services, retail media. And healthcare is becoming one of those top five now. There a lot of interest, especially now where you want to have efficiency, you want to have things which are connected well and a business process, which is little more digitized. So digital transformation is starting to become a big requirement by a lot of healthcare customers. It is also opening the ability to collaborate and share things between different pieces of the ecosystem and is becoming top of mind for many healthcare customers I speak to nowadays. And the number of projects we are seeing now with the Apigee in healthcare is gone up considerably. This was slow-moving earlier on, but now I think has gotten faster. I would say retail, financial services are a little faster at digitizing a lot of the processes and integrating the systems because they have multi-channel kind of access required for banks. For example, you want physical access as well as digital access, like retailers that physical stores have e-commerce and the multi-channel kind of mobile-based applications. I am having a similar mindset now in healthcare. So, it is been late to the journey but exhilarated very much over the last couple of years.

PP: Is there a typical profile of healthcare enterprises that you find are faster adopters of API and microservices?

AZ: In healthcare specifically, I have seen with the providers who have provided healthcare services. They want to connect those things together, so you have one single way of accessing patient records and sharing that with the different providers. And on the backend to the insurance companies to digitizing those processes where it was very difficult for them to have a single view of a patient or single view of a claim or single view of the physicians, those kinds of things. So those are the typical early and the fastest growing area in the healthcare side for us. Digitizing any complex process, basically.

PP: When you talk about digital transformation, people are mostly thinking about digital front doors, the experience that UX/UI, telehealth now, of course, is front and center where everybody don’t usually think about API and microservices strategy as a digital transformation enabler. And once you start seeing the productivity benefits for development and speed of innovation and so on and so forth, that is when these things start becoming a little clearer. So, it is kind of behind the scenes in some way.

AZ: You are hundred percent right; I think that this is not about improving your user experience only. And you will do want to have that always because your customers want to have a good experience dealing with you. But now I think the efficiency, the cost savings, the business continuity, all the kind of stuff is becoming top of mind. And those all come from the backend. Is it really connecting systems and making them easy to interoperate? And there is a lot of as you know, more about health care than ever will. But there are a lot of systems out there some are legacy, some are homegrown, some are packaged, some are modern. All the things still need to interoperate. And there is the need for making that happen in a seamless manner using technologies like Apigee, Google Cloud also provides a lot of other things in that space to modernize and integrate. And I think that really makes a big difference for digital transformation.

AG: That is why clients are adopting this platform thinking for their lot of assets. When you look at a typical hospital system. They have wealth of information. If you think of it, patients, medications, what treatments work for all. Ever since 2009 where 94 percent of hospitals have an EHR. Now that information is there and if you want to build an application and connected experience. So, it is not just UX layer, it is connecting the right data and making sure it’s coming up when you either seeing the patient. Am I able to pull the data at the right time and create the right intervention or i I am a payer? By the way with the new rules from CMS ONC we should see a lot of acceleration from the payer side as well.

AZ: This has been you talking to the banking system and connecting the ecosystem, especially because you have now a lot of third-party people involved in the whole end-to-end flow. And I think that is really where having a well thought out technology set which has that in mind from the beginning. It is an important part, and that’s really where the line of the differentiation comes in when we talk about Apigee. We talk about Google cloud. We talk about some of the connectivity in the technologies. Is it really that built in mindset? I think that really makes a big difference.

AG: And that’s hard work, doing it yourself takes years and years to build a product like Apigee and then creating all the vessels, the analytics, the governance, lifecycle.

PP: Apigee is remarkable story, and now, more than ever, you should be seeing an accelerated interest for the platform. Are you seeing providers or healthcare in general investing in unifying the data infrastructure? Are you also seeing a shift towards the cloud? I hear a lot of things about the cloud economics and that it is more expensive than you think it is. But in the net analysis it ends up costing us more. So, we must do the tradeoff. What do you see as it relates to the cloud story and particularly the whole data infrastructure that supports this digital transformation?

AZ: I think in our view from the beginning and I think what we have been thinking about is that to make sure we have flexibility with one size fits all. There is a lot of different use cases we have seen with healthcare customers who have different needs, but also different profiles from the risk perspective or profiles from the infrastructure perspective. They might not all be willing to move all of it to cloud or they might want to keep everything in-house but modernize pieces of it. So, we want to give them flexibility and the way we architected lot of things in the Google cloud is to provide the ability to run things in hybrid. It is been our strategy from the beginning and make sure multi-cloud in a way. So, hybrid is a big thing for many of the healthcare customers specifically because we have a lot of their data in-house and the system’s already been operational and moving everything centrally might not make sense instantly. It makes sense to move to the cloud because you might want to get better insights or reduced tools which are not available on prem or whatever may be the case. We will have this flexible way of architecting and then you can do it specifically to a project, what and how you want to operate that. That is how we have been building a lot of these things. I think that it has really resonated very well with the healthcare customers because we are not saying that, you move everything to Google Cloud and that’s the only way to work with us kind of a mindset at all. We do operate a lot of things. We have technology like Anthos which runs multi-cloud. We just announced today the GA availability of Anthos running on AWS, for example. And soon Azure, it runs on-prem. Same thing with Apigee, runs on-prem, runs on hybrid, runs on Google Cloud. We just acquired a company called AppSheet where you can build an app without taking a single line of code, runs on top of any set of APIs eyes or on top of the G-suite, for example. A lot of those things we are doing aggressively to make it very easy for customers to adopt without having to do lot of work themselves.

AG: That is where the customer empathy is coming from. Again, from the industry not everything is cloud native or cloud ready. It is a multi-year journey that they take with us. It is a transformation truly. And from healthcare, there is that pattern that we do see that where there is a need to connect multiple different data modalities. As I gave you an example, when one piece of critical data element is in EHR, the other is in a different claim system, third is in an imaging system. Those innovative use cases require a layer where all of this comes together. So, then they are looking into creating this kind of secondary data layer of packet where data is ingested in the cloud and a unified layer is created on top of it.

PP: As it relates to cloud, is it fair to say healthcare is going to be a multi multi-cloud hybrid approach for the time being?

AZ: Yeah, I would think so. That is typically the kind of profiles you have seen with the healthcare customers. They will be looking at it that way. I think we have a lot of value we provide them. If they are running on Google Cloud directly, but of course, we still provide them a lot of the advantages and benefits of a technology if they want to run it in multi-cloud or hybrid. And we understand nobody is going to completely stop everything and move everything to one place. We must work in the way the customers want to work.

PP: We are now in the middle of the COVID-19 crisis. We are all sheltered at home. I know that Google and other technology firms have been doing things to help public health in terms of coming up with products. One thing that is been in the news is the contact tracing app that you’re working on together with Apple. Love to hear if you have anything to share with regards to that. And of course, anything else that you are doing to help clients right through the COVID-19 situation from a healthcare standpoint.

AG: From the COVID perspective and the blog that you just mentioned. We have lists of very targeted solution that we’re taking to market both helping researchers so they range from offering the very basic level, the cloud credit for leading researchers, then helping with a Kaggle competition, which is another unit in Google cloud, really bringing in the innovators and leading AI researchers to look into the data and help with the forecasting. The third thing that we have done is the solution for healthcare focused Chatbot, we have a solution which is cloud AI. It Is a conversational engine. So, the problem statement here is what we heard from our customers, especially healthcare lot of triage calls, they are looking into help and creating this digital triage so that patients will not have to come to the facility. We took the CDC questionnaire. So, any way we can alleviate the burden, the burden like reducing the in-person visit by a telemedicine or alleviate the burden on the call center by doing this conversational AI and the digital triage. Those are the offerings that we have today in the market and being actively working with a lot of our customers. These are unprecedented times and there is a lot of burden on a lot of folks. And then we also launched National Response Portal, which is our partnership with HCA and SADA. If you are looking to this cloud, there is looker, the dashboard, and creating this analytics and forecasting models on capacity and the critical care capacity in utilization reports from different facilities who can share the data. So those are few listed in the blog. We are taking Contact tracing very responsibly. There is a blog and more information on how API will be released. And we will be starting with the public health agencies first.

PP: We are coming up to the end of the time here. I really appreciate your sharing your thoughts on the API economy all the best for that product. Google is obviously very serious about healthcare and that is becoming increasingly clear to anyone to whom it is not clear. Where do you see yourself a couple of years from now if you want to share any thoughts on that? Look a little bit ahead after we come out of the COVID-19 crisis into a new normal, whatever the new normal maybe.

AZ: We will continue doing what we have been talking about for some time. The clarity which we have been providing to our customers has been straightforward in terms of how our innovation can help the health care industry. And that is really the long-term goal to the growth plan here.

AG: It will be accelerated, like what we thought we will have X months. It is like very compressed timeframe, but it is accelerating. There is a positive side like there is a digital acceleration at the unprecedented speed, especially healthcare industry will change in the most profound ways and it is about helping our customers through that journey.

PP: It is a wonderful time to be in healthcare and I feel personally very grateful. Because you can make a difference. Any final comments before we close out of the podcast?

AZ: Thank you for having us. I think there is a lot more opportunity for us to continue discussing this. And I think with the COVID situation healthcare industry is probably going to get transformed even faster. So, we are here to kind of collaborate and partner and work and see how we can help.

AG: Likewise, Paddy. Thank you for having us.

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

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

About our guest


Amit Zavery is a result-oriented transformational leader with deep technical knowledge and proven business acumen. He is the Vice President and Head of Platform for Google Cloud. At Google he is responsible for defining product strategy, running engineering and building the business application platform. Previously he was an Executive Vice President and General Manager of Oracle Cloud Platform and Middleware products generating more than $6 billion of Oracle’s revenue annually. He led Oracle’s product vision, design, development, and go-to-market strategy for cloud platform, middleware, and analytics portfolio and oversaw a global team of more than 4,500 engineers.

Amit has a proven track record of designing and delivering market leading products and building organizations by recruiting and retaining world-class talent.He was instrumental in building Oracle’s Fusion Middleware product portfolio that scaled from zero to $5B in annual revenue in less than 10 years. He led Oracle’s transformation into a cloud platform provider by starting and building Oracle Public Cloud and operating multiple cloud native services that were adopted by thousands of customers.

Amit is a regular keynote speaker at industry events and considered a thought leader in enterprise software by customers, press, and analysts. He also has extensive experience in identifying, acquiring and integrating numerous private and public companies. He has a BS in Electrical and Computer Engineering from The University of Texas at Austin and MS in Information Networking from Carnegie Mellon University.


Aashima, is the Head of Healthcare Strategy and Solutions for Google Cloud. In this role, she sets the strategic direction for the transformative Healthcare solutions and leads industry engagement with healthcare key executives in helping transform their business strategies that define new models for care, revenue generation and improved care experiences.

Prior to this, Aashima led Digital Health Incubations at Kaiser Permanente and brought several frameshifting opportunities to life. She was responsible for driving innovation through the convergence of various digital technologies.

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

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We connect the dots with our solutions for better healthcare outcomes

Posted on by sanjith p

Coronavirus conversations

Coronavirus conversations

Karen Kobelski, VP and General Manager of Clinical Surveillance, Wolters Kluwer Health

"We connect the dots with our solutions for better healthcare outcomes"

paddy Hosted by Paddy Padmanabhan
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In this episode, Karen Kobelski, VP and General Manager of Clinical Surveillance of Wolters Kluwer Health, discusses their new offerings that are helping clinicians respond to the Covid-19 pandemic. She also discusses how health systems are adopting the new interoperability rule and how it will result in better healthcare outcomes.

At Wolters Kluwer Health, the mission is to bring the latest evidence-based medicine to the benefit of clinicians, learning communities, and patients. Their infection surveillance system and pharmacy surveillance system are helping hospitals and health systems respond and cope with the current Covid-19 crisis. Karen believes that with the new interoperability rule in place, patients can be treated in a lot of different ways if they have access to their health records. She further states that telehealth will stay with us for a long time, and traditional visits to hospitals will be replaced by virtual treatments, just like everyone is working virtually today. Take a listen.

Karen Kobelski, VP and General Manager of Clinical Surveillance, Wolters Kluwer Health in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “We connect the dots with our solutions for better healthcare outcomes”


PP: Hello everyone, we are continuing our series of Coronavirus conversations. It’s my privilege and honor to introduce my special guest today, Karen Krobelski, General Manager of Clinical Surveillance and Compliance for Wolters Kluwer Health. Karen, welcome to the show. Can you telling us about the Wolters Kluwer’s offering for healthcare and how you help clinicians and educators at a high level?

KK: Wolters Kluwer’s mission is to bring the latest evidence-based medicine into the workflow of clinicians, students, and the learning community. So from the beginning of their journey in medicine, whether they’re studying nursing or studying to be a doctor, we’re providing the textbooks and the clinical education and we take them all the way through their journey and continue to provide the latest evidence-based medicine; and then provide electronic workflow solutions to actually make their lives easier, their jobs easier, more efficient, to bring that evidence-based medicine to the benefit of both the clinicians and the patients in the healthcare system. That’s really the mission of Wolters Kluwer Health and that’s the mission behind our solutions.

PP: You recently released some new offerings to help clinicians respond and cope with the COVID-19 pandemic. What those offerings are and how you’re helping clinicians in the current context?

KK: There are a few different areas that we’ve been able to jump right in and help with the existing solutions that we already have in hospitals. I’ll give you a specific example. One of our solutions is an infection prevention solution that does infection surveillance for hospitals. We recognize that, right now, the best thing that we could do with the COVID-19 situation is to create a dashboard for hospitals where we could put in one place, a snapshot of the status of every patient in the hospital that has been tested or not tested for COVID-19, whether they are in the ICU or not. Some of the demographic information like, how long they had been there and their prognosis, some of the other complications, etc. So, you have a one-stop-shop for the COVID-19 status in your hospital or your health system. We can aggregate it up to the health system level. So that has really simplified the data collection process. You can imagine how complicated it would be to try to aggregate all that information on a real-time basis. We do that for them. Another thing that we do is we help them automate the process of submitting that information to the National Health System Network. As you know, the CDC is trying to collect that information on a daily basis so they can track the progress of this pandemic. We’re able to aggregate all that data for them and provide that to them so they can serve that up very easily to the CDC. So, in that way, we’re helping to streamline that workflow, make it easier, and provide that information at their fingertips to make sure that they know they can do that without having to go through the complicated process of trying to build those reports, aggregate that data and distribute it on an ongoing basis. Another thing that we’ve done, we also have surveillance in the pharmacy. So, you can imagine patients have been prescribed things like Hydroxychloroquine, [they’ve been prescribed Azithromycin another some of these emerging medications that they’re trying to treat patients with. Those can have some adverse effects. So we’ve written alerts into our pharmacy surveillance system to help bring to the attention of pharmacies someone who might have been prescribed Azithromycin, [but might also have been prescribed something that’s contraindicated]for Azithromycin or someone who might have a condition such as heart arrhythmia or something that would be contraindicated with Hydroxychloroquine. So, we’re really trying to bring to the surface someone’s attention that patients who would need an intervention might be overlooked in the hubbub and the constant presses of the workflow that’s going on right now. So, that’s another solution that we’ve introduced very rapidly and pushed out to our hospital customers who use our solutions.

PP: So, your solution reads the clinical notes in an electronic health record system and surfaces insights that could be indicative of an infection or some other indicator. Is that a fair assessment?

KK: That’s a fair assessment. We are basically bringing in real-time, as the patient’s status changes, vital signs, lab results, medication orders, and we’ve written a series of algorithms. When certain conditions are met to alert a physician or clinician to a patient that needs intervention, you can imagine it’s very hard to sometimes tie all those things together. So we do that for you proactively and push that to the attention of the clinician so they might get a text on their handheld device or they might go to a dashboard and say, hey, show me all the patients that have triggered this alert so that I can do something about that.

PP: So, in terms of the benefits to the clinician, obviously there is a benefit to having all of this information aggregated and presented in a consolidated way, so it saves them a lot of effort. Does it also have an impact in terms of earlier detection of a condition that could potentially become complicated or even fatal? Is there a timesaving involved here that could mean a difference between life and death? Is there an aspect

KK: Yes, we actually have one solution that we have with customers right now that’s focused on early detection of sepsis. A little different from COVID, but COVID and sepsis does go hand in hand. But for sepsis detection, every hour counts. You usually have about eleven hours between the onset of sepsis and death. So, if you can detect that a patient is decompensating earlier and bring that to the attention of the clinician so they could start treatment faster, you’re going to have a better outcome. They may not end up in the ICU and may have a shorter length of stay, it is an overall better outcome for that patient if we can detect it earlier. And so, we can detect when the signs and symptoms start to indicate that someone has sepsis, we can bring that alert to the forefront. We’re working right now on trying to do the same thing for patients who are in the hospital with COVID, who might start to show signs that they’re going into respiratory distress. So, we’ve been testing out some alerts. We’re not quite ready to release them, but alerts that are detecting those patients who are starting to decompensate in terms of their respiratory rates and things like that, that we can push an alert to somebody who may not realize that 15 minutes ago they were fine. But suddenly their oxygen levels are dropping, the respiration is faster, and they need intervention earlier. So, what we’re really trying to do is to bring to the attention of the clinician, a patient who they may have overlooked just because they’re dealing with so many patients and so much going on and haven’t really connected the dots. We connect the dots with our solution.

PP: CEO of Wolters Kluwer Health Diana Nole was recently on my podcast. We spoke just before the national shelter at home guidance went into effect. I think this was in early March and we kind of knew what was coming. She mentioned that Wolters Kluwer already instituted some travel restrictions in anticipation of what was coming. How has the demand environment changed for your company? How you’re adapting to the change in the environment, either in terms of changing up your product portfolio? You talked about some of the new offerings and how are your traditional offerings are doing?

KK: I think, as you said, WK, to some degree, saw it coming and we really started preparing to be able to work from home immediately. In fact, the entire worldwide organization has been working from home for about four weeks now. This is the end of our fourth week working remotely. And it’s good that we’ve made that digital transformation as an organization because it was pretty seamless to be able to be in the office one day and then be working from home and just keep going. You can imagine that this is not the time for someone to try to roll out a new workflow solution or change necessarily to assess the software. So, our focus has really shifted from new sales to helping our existing customers with new features, new solutions, new reporting, new alerting, new code sets to help them manage the current pandemic and navigate through this as fast as possible. To help them kind of get to a new normal it’s important to focus on our existing customers, bring them the resources that we have. And not only our customers, but we also have actually kind of mobilized across the entire health division to put a lot of resources out there into the public. On our web site we’ve taken some of the things that are usually available only under a subscription and we’ve made them publicly accessible, such as our UpToDate content for how to treat COVID, the information related to drugs that are used to treat COVID through our lexicon product. We put that all out there for the public to consume. And we’re continuing to try to innovate every day, to try to find other things that we can put out there to sort of help the world deal with this current crisis. Our focus has shifted from selling new units to new customers to really helping our existing customers benefit from what they have and point them to the right direction and also pushing out new things, new reporting, new learning, and new code sets that they can use to help navigate themselves through this difficult time.

PP: You mentioned that you had gone through your own digital transformation and you were able to seamlessly transition into a remote mode of operation, if you will. I listened to a podcast, with your Global CEO, Nancy McKinstry on one of the other podcasts. I think it was HBR Ideacast, what she talked about is transformation that you’ve gone through as an enterprise. And it seemed like a pretty dramatic change for the organization. But it also sounds to me now like it’s placed you in a very good position to seamlessly transition from what you were a month ago to what you are today, which is virtual cooperation. So it’s really interesting that some organizations either saw it come in or they just grew up in a certain way of working virtually and the other ones that are probably seamlessly transitioning into this, whereas others are, probably struggling a little bit. But I guess the question that I would lead into from that is what do you see as all the trends and future as it relates to virtually delivering care? How does the virtual model translate into the healthcare environment? What do you see as the long-term trends taking hold today as we go through this crisis?

KK: Yeah, I’ve had more telehealth visits with my doctor through in the last couple of weeks that I’ve had ever. And I just think telehealth is here to stay. I know that a lot of the requirements that were in place for telehealth visits have been waived. But, potentially, I think those could be waived in the future. But I also think that we’re going to see all these new modalities in terms of delivering health insights to patients. When you take that and you couple that with this new interoperability rule that’s passed, where the patient record can really be seamlessly exchanged from one vendor to another, and so that you can kind of take your record with you as you go. You’re going to start to see that patients can be treated in a lot of different ways and they will have their full health record with them. I can only give you an example of what’s happened over the course of this past couple of weeks that I think is going to be the future. My mother’s Apple Watch indicated that she was in Fib and I took her to the hospital and she got a pacemaker put in during this whole thing right in the middle of the COVID crisis. But in the future, if Apple has access to or if the provider can actually get the history from that Apple watch of all the incidents of my mother’s heart rate, etc, and marry that with the rest of the patient record, you’re going to have a much better and more efficient and better treatment,. You’re not going to need to traditionally go into these hospitals to see somebody or into a doctor’s office to see somebody, the treatment will really be virtual, just like we’re working virtually today.

PP: You mentioned interoperability on the final rule of from the ONC and the CMS. What kind of changes are you making to your products and what kind of changes you’re seeing health systems, your clients making as they prepare for the upcoming deadline? Are those deadlines even going to be enforced? Assuming that they are, despite the current situation, what is Wolters Kluwer doing and what do you see your clients doing in preparation for that?

KK: Yeah, I do think they’re considering whether or not to stick with the initial six-month deadline that they have. Most people knew that it was coming and hopefully had been sort of preparing for it. I’m not exactly sure that’s the case though. What I would say is that one of the products that we sell is what we call data normalization solutions and reference data management solutions. And this allows hospitals, payers, and healthcare vendors to take all that unstructured data and convert it to the standards that are mandated by the interoperability rule. And so, while we’ve seen hospitals and health systems really be consumed with the COVID crisis, we’ve actually seen a spike in demand from our payer and our vendor customers because they realize they do have to react to this interoperability rule. And so, we’ve been seeing a lot of payers come to us trying to organize how can they embrace these data normalizations solutions and the reference data management solutions so that they can comply with the interoperability rule. And similarly, for vendors, they’re going to need to be able to create a patient record that complies with those standards from a lot of unstructured medical data that they have on the records. So, they have to quickly mobilize to do this. I think what you’re going to see is that providers themselves are going to rely on the vendors to do that for them. So, whether it’s their electronic health record or vendors like us who will do that and help take their unstructured medical data and turn it into a structured format that’s required by interoperability. It’s going to be done through your vendor as opposed to necessarily by the providers themselves, so the demand is really actually still coming to us because of the interoperability rule from payers and from healthcare vendors. And then those providers themselves will actually look to the vendors to be the way that they solve the problem or meet the requirement.

PP: Do you think providers should be doing anything more than relying on their vendors to ensure compliance with interoperability rules. Are there systems that may be homegrown or something else that they need to be preparing for? Is there any burden on them?

KK: I think that the burden came really through meaningful use. Because of meaningful use, they all deployed electronic health records that became the repository of that information. And so, what they really are going to rely on those health record companies to be the place where this transformation happens to the standards. Now, a lot of health record companies have maybe not been as fast to act on this, but I think they realize that this is a mandate that they have to comply with now. There are very few, I think at this point in time, providers across the country, health systems who don’t already have an electronic health record. So that was the first stage of this. And now it’s just taking the electronic health record and making sure that they can now seamlessly exchange the information electronically between vendors and between providers, etc. I think it’s less about the provider having to do something themselves and more about relying on their vendors to be the source of that solution for them.

PP: Just like every other large global organization or every other company, every other business, employees are now working from home. And it’s created a set of circumstances for them in terms of how they manage their life and their work and so on in what is virtually confinement and also, they have to keep themselves safe. They also need to make sure that they don’t feel sick and don’t fall prey to the pandemic. How has Wolters Kluwer been helping your employees cope with both aspects, having to work from home and having to deal with this whole new paradigm, but also keep themselves safe?

KK: Yeah, as I said before, WK acted very quickly to halt travel and to make sure that people could seamlessly transition from being in the office to working from home. So, everybody’s been working from home really for the last four weeks or last month. We’ve been able to make sure that people can comply with social distancing. The company has really gone out of its way to communicate and to provide resources and guidance to people working from home, we have been able to provide free online exercise program, a whole library of resources so people can work out at home. So, you get that physical exercise out of the way since they can’t go to gyms anymore. They’ve provided increased medical coverage to cover the testing and covering the treatment if anybody does have to be treated for COVID or tested for COVID. They’ve made telehealth resources available, so people do not have to go to the doctors. They can actually be treated through telehealth. And we’ve also really stepped up our communication. So from Nancy McKinstry, our CEO, sending regular video messages to everybody worldwide, even down, from Diana’s level at the division level and myself, our business unit level really trying to on a regular basis, just be out there and be in touch with every employee. In fact, I do something every day to my teams across the country where I just send them a note just to check in, send them something just to say, we are here for you. I’m here for you. Let me know what you need. At Wolters Kluwer we have thousands of employees worldwide and there are a few people who still do have to go into the office. One of the things we do is we see lawsuits in service of process. So those have to be served physically. So, for those employees, we’ve actually increased their compensation during this time so that they don’t have to take public transportation. They can go in privately to the office and then they can get childcare provided for them. So, you know, those are exceptions. Most of the workforce is able to work virtually. But for those who are, they are able to, get some extra compensation to help them during this time. So really, I think the WK has gone out of its way to make a variety of resources and provide a variety of support to its employees to help us navigate our way through this unusual time.

PP: That’s wonderful to hear. Karen, thank you so much for joining us. And it’s been a pleasure speaking with you. Stay safe and all the best to you, your team, and the whole Wolters Kluwer family.

KK: Thank you very much. You, too.

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

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

About our guest

Karen Kobelski is the Vice President and General Manager of Clinical Surveillance, Compliance & Data Solutions at Wolters Kluwer. She brings more than 25 years of experience to her position, which expands her previous leadership role over the Safety & Surveillance group to also include the Health Language portfolio of data normalization solutions.

In her role, Karen is responsible for market-leading solutions that provide clinical surveillance, risk detection and data normalization, which improve the quality of patient care, regulatory compliance, and operational performance of organizations in the industry. She is also responsible for guiding the strategic direction of these businesses, a core component of which is delivering expert solutions into the healthcare market by leveraging the company’s deep clinical domain expertise with leading edge technologies.

Karen joined Wolters Kluwer in 2003 as Vice President, Operations Process Management for CT Corporation. Since then, she has served a variety of roles including General Manager of BizFilings and Vice President of Small Business Solutions for Corporate Legal Services. Within the Health Division, she was Vice President of Client Services for Pharmacy OneSource and most recently served as Vice President and General Manager of Safety & Surveillance. A Six Sigma Black Belt, Karen holds an MBA from Harvard Business School and a bachelor’s degree from Georgetown University.

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

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Covid-19 is the 9/11 moment for healthcare

Posted on by sanjith p

Coronavirus conversations

Coronavirus conversations

Will O’Connor, M.D., Chief Medical Information Officer, TigerConnect

"Covid-19 is the 9/11 moment for healthcare"

paddy Hosted by Paddy Padmanabhan
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In this episode, Will O’ Connor, Chief Medical Information Officer of TigerConnect discusses their company structure, the marketplace they are servicing, and challenges healthcare enterprises are facing in response to the Covid-19 pandemic. TigerConnect is a clinical collaboration and communication platform and serves around 6000 customers across the world.

Due to the ongoing crisis, healthcare providers are witnessing a massive uptick in telehealth and virtual care. Dr. O’Connor states that in the last 2-3 weeks there has been 10 to 15 years of advancement in telehealth both in terms of policy and in practice. The company saw a growth in their messaging platform from 5 million to 6 million in just ten days.

Dr. O’Connor hopes that after Covid-19, care delivery will undergo a permanent sea change. The notion of delivering quality of care to patients who can be managed remotely will stay with us for a long time. Take a listen.

Will O’Connor, M.D., Chief Medical Information Officer, TigerConnect in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast –“Covid-19 is the 9/11 moment for healthcare”



PP: Hello, everyone, and welcome back to my podcast. Today’s special guest is Will O’Connor, Chief Medical Information Officer of TigerConnect. Will, tell us a little bit about who TigerConnect is and what marketplace need you are serving?

WC: We are one of the several providers in the clinical collaboration and communication space. And mostly we work with providers, some big and some small. We have about 6000 customers all over the world now, mostly in the United States. At the core, we provide a communications solution that removes barriers, removes friction, and is designed to let health care practitioners and other people involved in health care, including patients, communicate easier, faster, better, more accurately.

PP: You are privately held, are you VC funded or mostly privately closely held. What’s the structure of your company?

WC: We’re privately held and it’s a pretty small investment group.

PP: What has been your company’s observations on healthcare enterprises, specifically health systems, big challenges in responding to this pandemic? They went overnight from running the business as usual to something they were completely unprepared for. What did you guys see first when you started seeing health systems confront this problem?

WC: To some degree, we saw this coming a little back. Singapore is a very large customer of ours. And as you know, they were impacted by Covid-19 several weeks before the United States and really had their surge before that. And since our customer, we were able to see their message volumes and a big spike in the volumes. We knew how serious this was, based on how they were communicating. It really gave us some good hints at what we needed to do here to help prepare our overall messages. To go to 4 million messages to 5 million messages, it took us about one hundred and sixty days and that happened late last year. We went from 5 million messages to 6 million messages growth in just 10 days. So, we saw this tremendous growth starting in Singapore and now that has translated across the United States as well. A lot of our big customers like Geisinger, St. Luke’s, Temple, New Mexico, RJW Barnabas have really seen the numbers of messages they are sending go up and up. I think what you’re seeing is just more open communication and constant communication related to Covid-19 and a lot of these places are trying to use our system to coordinate. One of our CIOs just told me yesterday that we’re in every single workflow that they have, and she could not imagine what they would be doing without us. So, we’ve seen communication really regarded now as something premium and really needed. This was not always the case. CIOs have definitely had to flex and to be ready for that. I think it was a wakeup call for lots of people including CIOs. I think this is sort of become our 9/11 moment for healthcare. What we’re seeing in the last two to three weeks is 10 to 15 years of advancement in telehealth both in policy and in practice. Folks are now able to get reimbursed for this. And we’re seeing a massive uptick. I think Geisinger has seen a 500 percent increase in telehealth visits. Another big issue CIOs are having that have been moving a lot of people to become remote workers, like Geisinger. They saw more than a doubling number of remote workers that they, almost overnight, had to figure out how to support and move all those people out of the hospital and move them home. So that was another big thing for them.

PP: John Kravitz, who is the CIO of Geisinger, was a guest on this podcast. Through these podcast series, I am essentially taking a look at how technology is enabling the response to the pandemic in the short term and also looking at how this is going to play out in the new normal, whatever that new normal may be. Everyone that I’ve talked to, they are saying any virtual care models has seen a dramatic spike in volume. Whether it is telehealth, synchronous video consults, e-visits, symptom triaging tools, all of the above. I talked to Providence Health as well, and they have seen the same kind of spike. So, most of the messaging that you’re talking about is it between caregivers, or caregivers to patients, or is a combination of the two?

WC: It’s a combination of the two. But I think the preponderance of the communication increase has been on the clinical side with clinician to clinician trying to coordinate care for patients and coordinate it quickly. We’ve seen an uptick on the patient side as well. And there’s a lot of use cases that we’ve seen really come into play overnight that we would not even have even imagined just a month ago or so. Certainly, we’ve seen an uptick in virtual care and that’s where we’ve seen an increase in the patient communication volumes. Even though HIPAA has been partially waived, you are still responsible for a breach. So, we’ve seen a premium placed on being able to communicate with a patient in a HIPAA compliant way that you can still report on. But keeping that patient at home and keeping them out of that physical location so that you can save the care givers for the patients. This has done a couple of things; it has certainly helped organizations address the surge that they’re seeing. They still have all the normal patients that need care. Excluding the amount of flu patients, which has dropped off the chart and has essentially been replaced by Covid-19 patients. But you’re still seeing all heart failure patients, diabetics, hypertensives, many of whom can be managed remotely. So, I think there is a permanent sea change that we will see. It saves time, money, and you can deliver a great quality of care. But being able to address the surge in patients has been a big use case that we’ve seen that has really spiked the volumes. I think the other big one we’ve seen right away is using the application to keep onsite workers safe and being able to connect staff and then being able to connect patients and staff and do so in a virtual way where now the practitioner doesn’t necessarily have to enter the patient room. They can have a secure conversation, voice, video or text with the patient from a location. They could be in the hallway or in their office 50 miles away giving care to that patient. And it’s become exceptionally important. Every doctor takes an oath when we graduated medical school and then becomes a doctor. At the beginning of that oath is first do no harm. That includes us too, and our families. The lack of personal protective equipment that is out there and some of the problems that we’ve had, being able to keep practitioners, nurses, physicians, respiratory therapist safe and giving them the ability to interact with a patient but be outside their room in a sterile area, where the patient is not and keep that patient in isolation. I can’t think of anything more important that we’re doing. Henry Ford in Detroit came out today, seven hundred and thirty-four workers have already been infected with Covid-19. And we’re just getting started. So, I can’t think of a more critical issue for a CIO than enabling their practitioners the ability to provide telehealth and real-time virtual care.

PP: I imagine that the communication tool that you’re referring to is a simple app of some kind, and you use that to have secure communication between caregivers as well as between caregivers and their patients. How does any communication tool like this integrate with a backend system like an electronic health service system? I imagine there is more value than just communication. There’s value in analyzing the nature of the communication to see whether there is some additional insight that you can get. You mentioned in Singapore, I have friends in Singapore and they’ve done some interesting things, including the contact tracer, which is a phenomenal tool that has really helped them keep a lid on their infections because several thousand people have downloaded them. Is there a utility to this messaging platform that is more than just a communication tool is something that can provide you with a indicator of something that is going to happen or provide additional insight? Let’s say, a pattern in one hospital that you could then abstract and maybe make available to another hospital. Is there any aspect of that you are working on?

WC: It is an application., we developed natively on both iOS as well as Android. But the beauty of it is you don’t need the app. If you’re communicating with someone who is using TigerConnect and you don’t have the app, it simply sends you an SMS with a secure link. You click on that link and you immediately open into a browser window where you have a very similar experience as if you have the app itself. It reduces the amount of friction we’ve seen as an industry. I would say a relative lack of success with patient portals that are relatively heavy and hard to use requires the end-user to have some sort of internet connection and a phone. Reducing that amount of friction has helped tremendously. But most of the end-users we have who use it every day will have the application that they download in their phone. As far as patterns, we do have a full reporting suite that comes along with the application and that can be used for reporting on things like the amount of telehealth someone is providing, links to conversations. But within hospitals we can really help them both inside the hospital and then out in the community as we can see the amount of communication going on. We, of course, can’t see the messages. Those are all secure, but we can see the numbers of them. And then folks that have our service and report on those and see different things like this department’s not really using the application or they’re not connecting or sending as many messages as we would expect to this other department. It allows them to dig into those data and perhaps they are maybe a department within the hospital that’s not connected the right way. Maybe their end users aren’t fully deployed on it for different things like that. So, we can spot some patterns and help people get more utility out of it. And then out in the community as well, we can check referral patterns. The applications can see if there are messages going within their network or there’s a lot of messages going outside that network and they’re losing patients and losing referrals elsewhere. We can see that as well. So, there’s a lot of data that you can tease out of the application that becomes helpful as far as spotting patterns as well as spotting different utilization jumps or lack thereof within current clients that we have.

PP: The referral tracking is a very interesting use case. You can very clearly see where it’s going, and act as required. So, your product is a communication platform. You don’t really see the actual content of the communication. So, you are like cloud providers. You’re hosting the data, but you don’t really see what the data and so you maintain privacy of the patient. So, I imagine the hospital has the data. They can see the communication, where does it go. Are they storing it or is it transient data? What is happening to all this communication?

WC: It’s HIPAA compliant. We’re also high trust certified. We’ve got the highest level of security available. It’s encrypted on the device itself within an app container and in transit as well. We cannot as a company see any of the messages at all going back and forth. A healthcare system typically takes two options. First, they may just store the metadata and keep the metadata and let the conversations fade into the ether. We have the patterns on the ephemeral text message. And I would say about half of our clients choose to keep the messages somewhere between 15 and 30 days. And then they’re gone forever. There is no way to retrieve them after that. The other half of our clients choose to either do integration with an EMR and actually store the conversations within the context of the electronic medical record or the more preferred method for them is to store those conversations and archive them. We provide an archiving service as well for them. If they like they can archive them themselves, or they can archive them with us as well. We can keep them for up to 50 years.

PP: So, they’re probably not digging deep into the text right now, except maybe to look at recent messages to understand the here and now and what to do about it. But maybe in the future some insight that comes out of analyzing these vast amounts of text data, especially if they’re going to be combined in some way with clinical notes in the electronic health record system. So, it’s kind of TBD, as I understand.

WC: There’s a lot that goes back and forth and it’s hard to know even if you’re talking to a patient. Beginning of that conversation, may be very friendly, very colloquial, not something you would want to store in the medical records. There’s a lot of picking and choosing what you’re storing. Then within the data itself there may be some useful things in there. But we’ve really shied away from that in order to maintain the highest level of privacy we can. What we’ve done to leverage the network for medical information, best practices, a couple of weeks ago we launched a physician only network which was by invitation. It was open to physicians within our client base as well as physicians outside of our client base and establishing a network where we could connect verified physicians to comment on and share information on the best and the latest treatments available for Covid-19. And we’ve seen a very large usage of that network so far. As far as I know its one-of-its-kind. We’ve been sort of comparing it to some of the Facebook physician groups that are out there where you have hundreds of thousands of folks involved and you see lots of political content that’s not sourced. Information is coming at us so quickly nowadays, as healthcare practitioners, we felt we wanted a place where folks could go to the field to share the best and the latest around what has come out. So, we’re taking time to curate some high-quality content and then sharing it amongst those physicians. In a way, we are mining our network in different way. We’re still leaving all the messages that go back and forth private, but we’re allowing folks now to go on there and do something a little bit different than we have before but share high-quality content across the United States. And we’re really seeing some nice up to date and quality content being shared because this is still such a new disease for us. Information that’s a week old is often dated. So, we wanted to provide a place where they could keep up to date.

PP: We’re coming up to the close of our time here. How do you see all this changing the way healthcare is delivered in the future? And what does a new normal look like to whenever that may come about?

WC: I hope that this represents a sea change. As I said earlier, I think this is the 9/11 moment for healthcare. While this has been crushing in some respects for us, I think that a lot of good is going to come out of this. We’re going to see a lot of these changes be permanent. I think Medicare in the past has demonstrated, if they can find a way to save money, they’ll do it. And I think the changes that we’ve made to telehealth are going to end up saving them a lot of money and being a lot more efficient. That is one of the things I would like to see permanently change. And being able to have people receive care from within their homes rather than dragging them into an office for a checkup that could have been performed remotely. That is a change that hopefully will not go away, because I think we’re going to be in this for a while here. As far as we’re going to see some improvement. But the desire to keep patients away from your physical facility and away from your office is going to be something that’s with us for a long time. Hopefully sticking around permanently and one that’s really here to stay. I think the other one is going to be healthcare systems establishing a communication network. We’re in the CC&C that is Clinical, Collaboration and Communication space. I think most people would be surprised at how relatively undeveloped the entire space is. I would still say that most providers, especially big providers, do not have a good handle on the breadth of their network and can’t communicate to all their physicians or all of their practitioners in a meaningful and connected way. We see patchwork communication systems all over the place where they might be using six or seven different applications as well as a couple of different EMRs trying to communicate. And what we found is most people end up not using that at all and either going to an application like ours or simply resorting to a text message or I-message something not secure or not trackable and not reportable and really not good for healthcare or for the patients. I think you’ll see a big uptick after this is all over in these clinical communication and collaboration platforms. I hope that’s one that’s here to stay as well.

PP: We are suddenly seeing a lot of money coming in to support this. We saw the FCC announced A $200 million investment the other day, which is exclusively for telehealth. And then, a lot of the money that comes out of the fiscal relief package, 100 billion or so has been set aside for hospitals and providers. As providers get used to virtual care as more of the norm than the exception, a lot of this money is going to go towards strengthening these technologies and modifying the treatment protocols and care protocols and so on, so forth just to get on board with the notion of delivering care virtually as a matter of routine and only for the exceptions, you bring people into the hospital. So, it’s going to be interesting times for sure. First of all, congratulations, you guys seem to be in the right place at the right time, no matter what the circumstances may have been. And wish you and your team all the best. And thank you for joining us today on this podcast Will.

WC: Thanks Paddy for having me on and best of luck to you as well.

PP: Thank you very much!

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

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

About our guest

Additional experience includes EHR and HIE implementations, clinical communication and collaboration, clinician adoption, analytics, clinical decision support, provider operational analysis and clinical process redesign.

Will O’Connor, M.D. is TigerConnect’s Chief Medical Information Officer. He is an industry-known physician executive with more than 20 years of healthcare experience focused on operations, strategic planning, consulting, client delivery, and thought leadership across the healthcare industry.

As an orthopedic surgeon, Dr. O’Connor has significant provider experience as well as deep commercial experience having worked for multiple companies including McKesson, Allscripts/Eclipsys, and PriceWaterhouseCoopers. He specializes in assisting large health systems, academic medical centers, community hospitals and payers to leverage healthcare information technology and operational improvements to advance their clinical and financial outcomes.

Additional experience includes EHR and HIE implementations, clinical communication and collaboration, clinician adoption, analytics, clinical decision support, provider operational analysis and clinical process redesign.

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

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Virtual visits to our chatbots are 10-15 times more than pre-pandemic levels

Posted on by sanjith p

Coronavirus conversations

Coronavirus conversations

Sara Vaezy, Chief Digital Strategy Officer Providence Health

"Virtual visits to our chatbots are 10-15 times more than pre-pandemic levels"

paddy Hosted by Paddy Padmanabhan
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In this episode, Sara Vaezy, Chief Digital Strategy Officer of Providence Health, the first health system to confirm a Covid-19 infection in the U.S., discusses how the organization has come together in a coordinated way in response to the crisis. Providence was one of the first health systems to enable patients with a set of FAQs and assessment tools by reconfiguring their chatbot Grace, which was developed over two years ago. In addition, the digital innovation group has helped Providence Health significantly scale up virtual visit capacity by redeploying and training clinicians in their same-day care operations to provide telehealth consults.

Providence Health has also successfully launched creative efforts to crowdsource PPE such as the 100 million mask challenge to ensure adequate availability of PPEs to protect the caregivers at the frontlines. Take a listen.

Sara Vaezy, Chief Digital Strategy Officer, Providence Health in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Virtual visits to our chatbots are 10-15 times more than pre-pandemic levels”



PP: We are continuing with our series of conversations related to how technology is helping respond to the Coronavirus crisis. This week we have with us Sara Vaezy, Chief Digital Strategy Officer of Providence Health. So, Sara;Seattle has been ground zero for the Coronavirus epidemic in America. What’s life been like for the last few weeks? 

SV: We have been at the unfortunate leading edge of the pandemic for quite a while now. Providence Regional Medical Center in Everett, which is just outside of Seattle, had received the first coronavirus patient in the United States. We have been dealing with this for about a month now. We are coming together across every department, every function of the organization, under the leadership of Dr. Amy Compton Phillips, who is our Chief Clinical Officer. And in multiple times per day, emergency operations, command, huddles on various issues to tackle this. So, it’s been a busy month of doing whatever we can to help our patients, our caregivers, our broader communities, which include other community partners as well as other health systems. It’s been an extraordinarily busy time where a lot of the best has come out in folks in terms of the service that we provide. 

PP: I have been following some of the extraordinary steps that you’ve taken at Providence Health to respond to this crisis and some extraordinary humanitarian stories, as well as.The stories related to how a large health system can come together to respond in a very coordinated way. What has been the single biggest challenge in your view in responding to the pandemic, how has Providence Health addressed it so far? 

SV:I think one thing that holds for everything is that things are changing. They’re so fluid and we’re learning a lot along the way. It’s a quickly evolving situation and it’s different for every city, county, and state. Each has diverse needs and manifestations of the situation. So, just dealing with that has been an interesting challenge. There’s also just basic stuff like we’re all bracing ourselves for the volumes that we’re afraid will result from this pandemic. There is quite a bit of sort of consternation out there about this. It’s sort of two sides of the same coin. Our biggest concern is supporting our frontline caregivers while they deliver high-quality care to patients in a very difficult situation. If I were to summarize it into one sentence, that would be it. 

PP: With a constantly evolving situation and all indications seem to be that we haven’t crested yet as far as the pandemic itself is concerned, as far as the United States is concerned. Everybody’s talking about the shortage of testing kits, PPE for frontline healthcare workers. And as you pointed out, that is a top priority for a health system to keep your healthcare workers, especially on the frontlines, safe so that they can deliver care and take care of themselves as well. You’ve taken some very creative approaches to address some of the shortages in the near term. Can you talk about a couple of those just to help our listeners understand how you respond on the fly to these kinds of situations? 

SV: Absolutely. Thecredit goes to again our clinical teams who have been amazing. Our Chief Quality Officer, Jen Bayersdorfer, had an amazing idea for the hundred million mask challenge. In response to the shortage of PPE, she pulled together this effort and engaged the public around making PPE and masks to protect our caregivers. They found a template and high-quality supplies. Then our digital team supported them by putting it on a website and asking for volunteers in getting engagement. We were so overwhelmed with the enthusiasm and outpouring of support from volunteers. We didn’t even need as many volunteers as we got. Part of that was due to some local companies coming out and working with us and saying, we’ll make masks for you, we were a furniture company before this, but we think it’s important and we’ll make surgical masks for you by using this template and these materials. So that was incredible and was very creative in terms of making the most out of available resources. Volunteers providing their time and organizations just stepping up and supporting us. That was by far one of the more uplifting experiences that we’ve had throughout this whole thing. 

PP: It’s an amazing story and I’m sure we’re going to see many more like that emerge in the coming weeks. There’s a lot of creative repurposing of our existing assets and resources across the country to deal with this. Hotels have been converted into hospitals. United Center, one of our biggest arenas, has been converted into a logistics hub for dealing with all the supplies and the logistics required to support this. You started a go funding program to help impacted residents. Tell us a little bit about that. 

SV: This was a volunteer-run effort between many of us and the digital innovation team as well as population health, where we really wanted to focus on homeless, shelters and services, and homeless individuals who received services from those organizations.With a situation like this, those places had significant challenges with getting disinfectants, enough funding for buying food, and other supplies for the folks. Thanks to the broader community and all those who participated.From around 80 donors, we received over $22,000 that we distributed to 56 shelters across three states. And those shelters provide services to almost 500000 people. And we were able to do that in just a matter of three days from start to finish. It was in the interest of supporting our most vulnerable populations. And it was the brainchild of Dr. Rhonda Medow’s, who is our Chief Population Health Officer at Providence. 

PP: I want to switch tracks a little bit and talk about the technology side of it. How your virtual care models have kicked in, in response to this crisis, especially telehealth, and anything else that you may have either built or repurposed from what you already have in responding to this crisis? What kind of adoption rates in terms of numbers you see and how is it the technology itself held up? 

SV: I’ll focus primarily on what the digital innovation group has done. Before that, I want to mention that our IS colleagues have done a tremendous amount of work on a whole host of other technology-related things like standing up drive-through clinics, making iPads available to patients in the hospitals who are isolated, working closely with our physician enterprise to get thousands of providers who were providing care for established patients like chronic disease management care and things like that, getting them onboarded and ramped up on virtual visits. Our digital innovation group are absolutely at the forefront of everything happening from a technology standpoint and their efforts are running in parallel to everything else thatthe organization is doing.Froma patient-facing standpoint, we have stood up an assessment and FAQ chatbot, we call her Grace, and she does quick assessment by asking simple questions and triages patients to the appropriate next level of care, whether that just stay at home and rest or conducting a virtual visit with the provider. The second thing is really scaling up our virtual capacity for those same day use cases with folks who have concerns about Covid, whether they’ve been exposed, or they may have other risk factors. And that virtual visit capability has just seen tremendous ramping up over the course of the last few weeks. The third area is patient home monitoring. And for sub-acute patients who are either PUI patients under investigation or have tested positive but are not exhibiting the symptoms that would require them to be an inpatient in the hospital. We have sent them home and are monitoring their conditions remotely. And then we’ve done a lot of work around just a hub for consumer education and things like live locations for testing. So those are the primary activities that we’ve engaged in from a digital team standpoint. Grace is our chatbot, we call her Grace because we are a Catholic healthcare system. But Grace is a chatbot that we had made investments in for a couple of years. We could leverage those investmentsfortunately for Covid-19 specific use cases which means for patients essentially, we stood up a pathway that was with specific questions and workflow tied to Covid-19. So, things like have you traveled to a specific place that may have made you at higher risk for contracting the virus? And a whole host of other questions. We created the country’s first virtual assessment tool for quickly and safely assessing patients for Covid19. In the first few weeks, we helped over 70000 patients and had over a million messages exchanged between patients and the bot. It’s been a tremendous way to touch a lot of folks. In particular, keepthe worried one well, give them some peace of mind, and keep them in their homes, which we all know is very important, and then get folks who may need more sophisticated care. Care by talking with a provider live, get them triaged into virtual visits. 

PP: I’ve talked to other health systems as well. And a self-triaging bot serves two purposes. One is, it prevents an overwhelming of thehealthcare system when people start calling in such large numbers. And secondly, it triages into the right and the appropriate care. And I imagine that you have to put the clinical community through a new set of training or orientation to responding to what’s coming in through the triaging tool, and then appropriately responding to them. Have you had to invest quickly, have a lot of training, are our providers comfortable with this mode of operation? Overnight you went from seeing patients to not seeing them anymore. What has been the challenge?

SV:When folks get triaged into virtual visits, they get triaged into what we call express care virtually. Express care is a clinical service that we have, and which is part of our ambulatory care network. We have over 50 providers who are just servicing express care. These folks are very specifically focused on express care. And in this case, they’ve been trained on those same-day use cases, particularly, virtual. We have been working with them really closely. Through our product team, they provide training like how to pull up the dashboards on your computer and just making that experience frictionless, not just for the patient who is accessing the virtual visit, but also for the provider who is delivering that care. So, they have stood up an entire customer success essentially team to be able to get our providers onboarded and trained for those same day’s virtual visits through Express Care Virtual. 

PP: I want to share an anecdote with you, my daughter who lives in the city. She came down with a cold and a mild fever. The first thing that we told her to do was to schedule a virtual appointment. It took her a day to actually get to speak with a doctor even through a telehealth visit. So I imagine that even with a virtual model in place, even with the triaging in place, and the tools in place, there is still a feeling of maybe getting overwhelmed just because of the sheer volume of cases, all your routine cases which would have come in anyway. But then you layer on Covid-19 cases on top of that. How has the system responded in terms of Express care? Is it still same daycare, even though you switch to virtual or have the goalposts shifted a little bit? 

SV: There are significant challenges that the ambulatory care and the express care team rose to those challenges to findlarge number of providers to staff those visits. On the technology side of things, the volume that is coming through the platforms is 10–15 times greater than what we had seen prior to the pandemic. We saw more volume in three weeks than we had in the entire previous year. And that has been a very interesting challenge in terms of the model. So previously it was on-demand telehealth and now what we’re seeing is almost like on-demand virtual visit. And lately, now what we’re seeing is like virtual urgent care or like a queuing model. And patients do wait in a waiting room in order to be able to access those visits. Now that it’s not a one day wait time, but they do sit in a waiting room in order to be able to access it. So, it’s almost a new model of care as compared to what we had previously. 

PP: I’m hoping that, it’ll flatten out once we climb out of this crisis. And then hopefully when we go back to some level of normalcy, if you will, whatever, however, we may define normalcy going forward. 

SV:An interesting point, though there is a lot to be said for the adoption of technology potentially being accelerated through this process, given patients’ behavior is potentially different because they’ve now experienced a new form of care, a new modality of care that they otherwise wouldn’t have. And it’s unlikely that it will go back to completely the way it was and revert to the pre-pandemic days. This is alsobeen facilitated by a lot of regulatory and payment changes. And it’s also unlikely that it will willfully revert again just because we’re all getting used to engaging in a different way. And so the hope is actually that things like telehealth will be more ubiquitous in the future.We have this opportunity to meet patients and customers where they are with some of the enablers in place, too, like payment and like the regulatory environment has changed. 

PP: One of my previous guests said that with every crisis, a new opportunity arises. Maybe telehealth and virtual care models are what is going to be going forward. Switching to one more topic here, the dramatic jump in work from home employees. So, like every other business, every other enterprise across the land, you have seen remote workforce, double or triple. I know this is probably more or less function kind of responding to sit them all up remotely. What have been the challenges? Have there been more technological or cultural? 

SV:From a technological standpoint, Providence has a strategic alliance with Microsoft that is led by ourIS team. Our utilization of Microsoft Teams has just been through the roof. It has saved us in so many different ways. We’ve used it as a collaboration platform across the entire organization and it’s been tremendous. I’m sure that all of these collaboration platforms have been strained to the full extent that they possibly could be. But it has really served us well to have been up on Teams and be able to utilize all of its functionality from its video conferencing, but also to like collaboration spaces and SharePoint integration and things like that. So that’s been reallyhelpful for us. We also use things that are cultural in nature, like virtual social hours and happy hours and with the teams just to reconnect. And we’ve put some best practices in place, like actually having video when we are talking with each other and meetings so that we can ensure that folks are engaged and that we get to see each other’s faces. It’s not a requirement, but it is definitely something that we try to encourage. So, we maintain that closeness while we’re social distancing. 

PP: I know the Providence Innovation Group has a significant portfolio of investments in digital health startups that have developed a range of innovative solutions. How this crisis has impacted them one way or another. And what are some of the things you’re seeing and how are they responding to it? Can you talk about a couple of your portfolio companies as illustrative examples?

SV: Absolutely. I think across the board they’ve all risen to the challenge with various creative solutions for how they can help and that’s been really heartening.I’ll talk about a couple of our portfolio companies, Xealth, which is a digital prescription platform and an integration mechanism into the EMR and Twistle, which is a digital pathway company that we’ve partnered with both of them, both in an investment capacity from a portfolio company standpoint. Providence was the home for Xealth when it was incubated. And we’ve worked with them for over two years prior to making an investment. They are working together to provide that core platform for the home monitoring that we just talked about. So,Twistle is the pathway that patients use to input their data. And that alerts our providers when a patient needs additional care and Xealth has been the mechanism by which Twistle has integrated into Epic for us. So, they’ve been tremendous partners and Xealth has also done some other separate innovative things. For instance, Kroger grocery delivery and making that available for patients directly. They are all doing really interesting and kind of creative things and have done them very quickly. I thinkthis crisis has focused on all of us. And just the sense of urgency has made things go 10 times faster than they ever did in the past. For all of us. 

PP: That is the sense I’m getting from digital health leaders, from other health systems as well as some of these programs and put them on a sense of urgency that may not have existed prior. And the part of the technology to dramatically change the way you deliver care and also do it in an efficient, cost-effective way is becoming more and more evident. As you’re aware, my second book was about to come out about digital transformation that I was co-authoring with Ed Marks, the former CEO of Cleveland Clinic. We have put it on hold for now. We are going to write a new chapter on how the digital health landscape is transformed as a consequence of this crisis. And I hope to come back to you and maybe request introductions to some of these portfolio companies of yours to really understand how they changed their product roadmap or turn on a dime, if you will, to respond to this crisis. Thank you for sharing those examples. Anything else you’d like to share with us Sara before we close the podcast.

SV: Thank you for having me and thank you for continuing to spread the word. We just want all of us to rally together, to marshal our resources, and manage the situation as much as possible. So, folks should feel free to reach out and learn more about how they can leverage what we’ve already done. 

PP: Thank you, that is indeed part of the purpose of these series of what I’m calling the Coronavirus conversations. I want to be able to spread the word of how health systems across the land are responding to the crisis. And our hope is that someone, somewhere is picking up something useful from these conversations. 

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

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

About our guest

saraveazy-profile

Sara leads the development of the digital strategy and roadmap, digital partnerships with health systems and technology companies, new business commercialization and business development, technology evaluation and pilots, and digital thought leadership at PSJH.

Prior to PSJH, she worked for The Chartis Group, a healthcare management consulting firm, where she focused on enterprise strategic planning, payer-provider partnerships, and the development of population health companies.

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

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We’ve seen a 500% increase in telehealth visits

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Coronavirus conversations

Coronavirus conversations

John M. Kravitz, Chief Information Officer Geisinger Health System

"We’ve seen a 500% increase in telehealth visits"

paddy Hosted by Paddy Padmanabhan
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In this episode, John Kravitz, CIO of Geisinger Health, one of the largest health systems in the country, speaks about how the organization’s leaders have been “blown away” by how technology has stepped up to help address the covid-19 crisis. Geisinger’s IT organization has kept up with a 500% increase in telehealth visits and a doubling of remote workers to 13,000 employees and minimized disruptions to operations. John believes this crisis has created a new awareness of the opportunities with digital transformation. It’s a remarkable story. Take a listen.

John M. Kravitz, Chief Information Officer of Geisinger Health Systemin conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “We’ve seen a 500% increase in telehealth visits”

 
 

PP: We are starting a new series – coronavirus conversations – where we will feature healthcare leaders, especially those who are leading IT in large health systems and healthcare organizations on how they’re responding to the crisis. Today is March 20th and it’s my honor and privilege to introduce my first guest for these series, John Kravitz, CIO of Geisinger Health Plan and Health System. 

John can you tell us what is the situation at Geisinger? How many Covid-19 cases have come in and how are they being screened and tested? 

JK: At Geisinger Health System the number keeps changing by the hour. We’ve had several Covid-19 confirmed cases, some have come into our acute care system and others are being treated in ambulatory settings. The numbers have continued to increase in the state of Pennsylvania. My last count was 158 patients had tested positive for Covid-19. Most are in ambulatory, some very sick are in the acute setting, and some have expired. Unfortunately, happening all over the country. We, like others, have set up screening tents and treatment tents. Trying to keep those patients outside of our ED settings to avoid infection to other people. We’ve used a lot of technologies to support that, like iPads or FaceTime so that people can do work at their existing workstations. For example, registration people can get into communication with patients. Not everybody has to be in the tent and exposed to things. This minimizes for us the PPE because they are becoming in short supply, especially masks, even level 1 and level 3 masks, not include in the N-95 masks. We have 11 campuses and 13 hospitals in our system. We’ve set up these screening and treatment tents in every one of them with all the technology. They have got workstations on wheels, printers for lab labels, patient wristbands, everything you can imagine. It’s like a MASH unit and is well established. 

PP: Do you develop your own test too?

JK: Yes, we were one of the two in the state of Pennsylvania to do our own testing. We got validation from the state and were cleared to begin our testing process. The challenge is the test kits. There aren’t enough test kits for all the requests coming through. We’ve been using a triage process. We use a bot that helps us considerably on our website and direct patients to that. Communication goes out through our patient portal as well to let people know what the process is. They can access that bot there. But it goes to a nurse triage hotline where they go through several questions with the patients and then set up appointments to be screened. 

PP: ChatBots have been introduced to respond to the crisis. Anything else for launching a new tool or reconfiguring any existing tool or technology in order to respond to the crisis? 

JK: We have a particular tool at the bot that is called Syllable. We have some in concept testing but haven’t had more fully deployed yet. Our main concern in responding to this crisis is getting people to have access to work from home so that we can do social distancing, so the disease doesn’t spread across our employee platform. Anyone who is a non-clinician can work from home in our environment. Clinicians can as well, when they don’t have to have direct patient care. Part of our process has been establishing remote connectivity for home workers. We use VMware’s VDI when people are in contact centers and need to make phone calls. We provide the Meraki type device; it’s an IP address mobile device that allows them to work at home effectively. We do not allow printers at home because of PHI or credit card processing machines at home because of PCI. But we take measures and provide access so that our employees can be separated. For example, in a contact center or a call center where we make appointment calls for our patients, if we have 300 people in a contact center we will move 100 those people to the home setting provided they have proper internet connectivity and speed and everything else to support that. We’ve created our own speed test and can run that for any of our potential people moving at home which has worked effectively. This allows us to spread people out more than 6-foot distance easily between contact center agents because we’ve taken people out of that mix. So those are some of the things that we’ve done. At this point time, we have 13000 remote workers at home on our systems and working well.  

PP: So, when your work is going from a campus-based workforce to a remote workforce, what have been some of the challenges you faced both from clinician standpoint as well as from a technology standpoint? 

JK: We have a lot of radiologists that do work from home with high-speed connectivity at their homes with high-resolution monitors. We call them broadband monitors,standard in the industry. We have a number of those people and we are doubling the size of the folks working from home. This adds new challenges to make sure they have adequate bandwidth, adequate facilities, and proper security at the devices at home. With our employees working from home, we still are cautious of PHI and making sure that the data is protected. And folks using Zen desktop or VDI, the work goes on back in your data center or in the cloud, where you’re connecting to, adding a layer of protection. That information isn’t sitting on someone’s home equipment. It’s easy to install that connectivity and in most cases, in a matter of minutes, people are functioning as long as they have adequate bandwidth. 

PP: Are you seeing any increased threats from cyber-attacks in this current situation and are you being extra vigilant about any of that? 

JK: We do have surveillance systems that are in place. I have not received any through our Chief Information Security Officer about any new attack vectors that I’m aware of.Although I’ve been reading that there are increased attacks that are occurring. When there is a potential for vulnerability, the bad guys always want to look at new ways to attack and leverage their cause, unfortunately.We have not seen an uptick on that. We do have endpoint security, which is very strong to minimize or mitigate the spread of malware. I think it is the network surveillance that goes on all the time through MSSP. That’s a cloud-basedsolution and it’s worked well for us. Fortunately, we have not seen those increased attacksor are just not allowed to occur. So thankfully, that is the case for us so far. 

PP: Switching to the front–end technologies, the ones that you use for engaging with your patients. Telehealth is now front and center as you want to try and avoid in-person contact in the current situation unless it’s absolutely necessary. Have you seen an uptick in telehealth visits and how your platforms coping with that? 

JK: We’ve seen a tremendous increase, probably a 500% increase in telehealth visits. And our platforms and our physicians are all being trained as we speak now. It’s been happening all week, but they’ve been trained in proper technique. We have a thousand new providers that are going to be doing telehealth visits. Whether in the office or in their home settings, they will be able to do telehealth consultation visits. We pulled roughly a thousand iPads which can be used to do the telehealth visits. This is a crisis situation where good opportunities will come. I am hopeful of the relaxation of payments by commercial insurance as Medicare, Medicaid. In our state, Medicaid has paid for telehealth visits for a number of years in Pennsylvania as an in-person visit. But I would hope that the changing tipping pointfor people to really utilize telemedicineis seen in crisis, how it works. We can see it works effectively in day–to–day settings. It’s a new opportunity. Out of every crisis, a new opportunity arises. I believe telemedicine is a new opportunity for us and I am excited about it. We have patients in our ICU that may be nearing end of life because of this disease, we will utilize telemedicine. We will utilize links into our eICU so that they can talk to their loved ones. I hope there will not be any end of life and people do recover from this. 

PP: How is the technology itself holding up against this surge in usage? 

JK: Actually, very well, we’re using VDI in our cases where people may be using Zen desktop. It is really sending a minimal amount of data back and forth. When I looked at our internet pipes just yesterday to see the trends, we have not spiked up. We do have three major internet providers coming into our organization and we have the ability to burst and grow considerably higher if necessary. But honestly, I am surprised with 13,000 people at home, radiologists moving at home, and contact center agents, we have not spiked considerably. We may have gone up about 25 percent on our usage, but we still have a lot of capability. I expected more to be honest with you but seeing very pleasant results here and our systems have been doing very well.

PP:What about the IT organization itself John? These are new times, has there been any impact to your day–to–day operations in the data center? What kind of adjustments you had to maketo respond to the crisis and to support that with your capability? 

JK: As every other health system, we have tried to minimize disruption in operations. Our service deskbeen doing very well. When we have information, we can communicate. Communication is the key for us and getting proper communication out to people. For example, when we started this telemedicine expansion, we’ve set up on our ACD, our automated call distribution. We have a menu item that says if you are calling about telehealth problem there is a special small group of technology people supportthat will address those calls. Our data center has been working very smooth. I think part of the challenge is because we’re looking at new and creative ways to tackle this problem. We have six enterprise implementation systems going simultaneously, including CRM and billing systems and everything else. We’ve not really stopped them, but we have reprioritized our work for this period and we’re going on two weeks now and I don’t see it stopping anytime soon. We have people working, unfortunately, in some cases 16–17 hours nowadays. And we are not the only ones. At some point we’ve got to give our staff rest time and we want to do that. Butthe patient and our providers are top of mind for us. I am the CIO for the health plan and the health system and have been pulling resources from my health plan in augmenting for our health system, which is beneficial. 

PP: How do you think healthcare is going to get reshaped as a consequence of this crisis? Do you think that telehealth is going to become more and more mainstream?

JK: We’re all looking in digital. How do we do digital technology? How do we provide the best service for our customers? I think this is the opportunity and telehealth is one area. But, reach outs, capabilities make the process smoother to enable and get good care, whether it’s in the setting or in an ambulatory setting or an acute setting. Using technology to leverage that is going to be important. Leaders from all over our organizations are blown away by the level of support they’ve received from information technology and information services throughout this entire process. They never expect that we could respond like this and they are so thankful. I am sure every organization is hearing the same thing because we’re all hardworking, good people. As Winston Churchill said – never miss the opportunity.’Do not miss the opportunity for innovation. That’s what we’re doing now, and I think it’s going to only continue. It’s an upward trajectory for us. Unfortunately, lives are at stake, but we’re doing what they can with technology to support that. 

PP: John, I really appreciate you taking the time and I want to extend my deepest gratitude to healthcare workers all across the country for all that they’re doing in responding to this crisis. I think we’re going to be forever indebted to all of them. 

JK: Paddy, if I could put in one plug for my fellow CIOs. I happen to be the chairman of CHIME. And I know there is a lot of work going on behind the scenes for policy and in communication to CHIME members. I think that the team works extremely hard to support our CHIME members. A lot of these initiatives, telehealth, national patient identifier, things that we’re going to need for the future. CHIME is really working hard to help support us to push that forward. I just wanted to give acknowledgment to them because the team, while it’s very small, is very agile and they’ve done fantastic work. I’m really honored to be the chairman of the board for that group. And I think this will help us as well for my fellow colleagues and members of IT. 

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

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

About our guest

John brings more than 25 years of healthcare experience to Geisinger Health System. As the Senior Vice President and Chief Information Officer, John is responsible for IT Strategy, Digital Strategy, Cloud Migration Strategy, Governance and Operations and business growth through merger and acquisition or joint venture activities. John has the technical responsibility for the organization’s advanced analytics platforms, including two Big Data platforms to support innovation of the Integrated Delivery Network as well as the Population Health Platform. Responsible for the regional health information exchange, KeyHIE, which currently connects organizations throughout Pennsylvania & New Jersey.

He is responsible for all technology support for the enterprise. This is comprised of the Geisinger Health Clinical Enterprise, Geisinger Health Plan IT support of business operations as well as Geisinger Commonwealth School of Medicine.

John is Board Chairman of the College of Health Information Management Executives (CHIME). He is a member of Health Information Management System Society (HIMSS), has been a past CPHIMSS Board member (Central Pennsylvania HIMSS Chapter Board), and KINBER Board, which provides fiber optic connectivity throughout the Commonwealth of Pennsylvania.

John currently serves as the CHIME Board Chair and is very active in the CHIME Policy Steering Committee which advocates on behalf of its member organizations. His areas of focus in the past have been the Opioid Crisis, testifying to the House Energy and Commerce Committee on behalf of Geisinger’s work in reducing the impact of Opioid prescriptions by more than 66%. Other initiatives include interoperability, use of telemedicine services and 5G Broadband in rural communities.

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

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

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

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