Category: Uncategorized

To succeed with digital health is to become really good at technology integration

Episode #59

Podcast with Marc Probst, Former CIO of Intermountain Healthcare and CIO of ELLKAY

"To succeed with digital health is to become really good at technology integration"

paddy Hosted by Paddy Padmanabhan

Sponsored by

Share

Share on facebook
Share on twitter
Share on linkedin
Share on email

In this episode, Marc Probst, who served as CIO of Intermountain Healthcare for 17 years, speaks about digital health technologies, telehealth, virtual visits, and how these will determine the future of healthcare.

According to Marc, the top technology trends that will define the future of healthcare are interoperability and digital health technologies. He says that technology in healthcare should meet the needs of the population that we serve; they should communicate with each other and responsibly share data. Marc describes digital health as facilitating what we do today using digital mechanisms like telehealth and moving towards full interaction with technology, where technology will provide knowledge, capability, and expertise.

COVID-19 has accelerated healthcare industry’s adoption of digital capabilities such as telehealth. Marc suggests that the health systems need to ‘become really good at integration’ for a seamless digital health experience.

Podcast with Marc Probst, Former CIO of Intermountain Healthcare and CIO of ELLKAY in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “To succeed with digital health is to become really good at technology integration”

PP: Hello again, and welcome back to my podcast. This is Paddy, and it is my great privilege and honor to introduce my special guest today, Marc Probst, former CIO of Intermountain Healthcare and currently, CIO of ELLKAY. Marc, thank you so much for setting aside the time, and welcome to the show.

MP: Paddy, thank you very much. Appreciate the opportunity.

PP: You’re most welcome, Marc. So, let’s get started with this. You were CIO of Intermountain for a very long time and you’ve experienced your own share of technology changes. What do you think are the top two or three technology trends that are now going to determine the future of healthcare?

MP: Well, one of those may sound kind of self-serving, but I think interoperability is going to be a key requirement as we move forward for any of these things to succeed, because the second thing I would add would be digital health. And we will go into that, you will know what I mean by that in a second. But none of that really meets the needs of the populations that we serve, if our systems can’t talk together and share data in a responsible way. So, I think interoperability will continue to be really important. I’ve got a lot of history with that and why I think interoperability, I think digital health. I was just talking to a group at ELLKAY about that. They asked what I thought about digital health. And my answer was, there’s kind of two phases to digital health, from my perspective. One is just facilitating what we do today, using digital mechanisms like telehealth or even some of the handheld, iPhone-based kind of services and apps and that kind of digital health. And, of course, telehealth, our ability to communicate with physicians and other care providers through the digital means. So, it facilitates what we’re doing today. And I believe what we’re moving to is a digital health that is full interaction with the technology versus with human beings, where the technology will provide a lot of knowledge and capability and expertise to us as the consumers of healthcare. So those would be the two that come top of mind to me Paddy.

PP: We will unpack some of that in the course of this conversation. And, of course, you mentioned interoperability and you mentioned digital health. Those are kind of related to one another, one kind of drives the other, I guess. Also, I think alluded to the data and insights and we will come to that. Intermountain has done a lot of work in these areas. I do want to explore some of your thoughts on that. But before that, you’ve recently retired from Intermountain and have taken a role at a health IT firm. And I realize it’s early days yet, but I’d love to hear your first impressions on the view from the other side of where you’ve been all these years.

MP: Well, because of the organization I’m working with, my view is one of great excitement and opportunity. I love ELLKAY, I love the people there. I was a customer of theirs. And so, it’s something I’m very excited about and I think has a lot of potential. I spent 23 years actually in professional services serving the healthcare industry. So, I was a partner with ELLKAY and a partner with Ernst and Young. So, I wasn’t completely naive to what we affectionately called the dark side, when I was a CIO of our industry. I don’t mean that from dark is in mean, but, you know, we always are constantly looking for improvements.

But I am really excited about the potential of the organization I’m working with and just the kind of people that are there and leveraging. I felt I was valuable for twenty-three years. I kind of proved it to myself just how little value I was actually providing when I was a CIO. And now I think I have a richer skill set that hopefully, I can be of more value to the industry.

PP: Well, I wish you all the best in your new role. I want to talk a little bit about your experience at Intermountain since you were with Intermountain until very recently. Let’s talk about what you mentioned at the outset of this conversation, which was, digital health and interoperability. Let’s talk about digital health. Intermountain, to my knowledge, is one of the early adopters of telehealth. And you’ve had great success, especially with rural populations. And it’s well published. And there has been widely published articles about some of your work in that space. What do you see today as the general level of preparedness for this coming era of digital health and virtual care among your peer health systems? Can you also in that way, comment on the gap between what the top tier health systems may be doing and what the next tier is doing?

MP: Yeah, a lot of use of technology has to do with the sophistication of the health systems itself. And I don’t mean the sophistication of the technologies, but the actual care providers in the health systems itself. And Intermountain is remarkably sophisticated and courageous in taking technology and trying new things and what to do with it. So, we started really early on with telehealth. In fact, I remember our first foray into it was a good 15 years ago and the technology was incredibly young. But we decided to put it in an urgent care center and see how many people we could get the call in. And I think you could count on two hands how successful we were with that? The industry wasn’t ready, our people weren’t ready. But the thinking was there. And so, we kept a very close eye on the capability. And as it became more sophisticated, we started down the road of telehealth. We also had the advantage, like you just said, Paddy, of having a lot of rural healthcare facilities where we couldn’t afford to have all the specialists out there. So, if we wanted to provide care in those rural settings and not force the patients to come into one of the urban centers, we needed to get involved in telehealth and we did. So, we really started on the kind of B2B telehealth services and then ventured into the more retail kind of urgent care services. I think Intermountain is ahead not because, again, of our technical prowess, but because we developed a lot of playbooks and capabilities and people and getting them used to it. I don’t think the gap is massive between an Intermountain Healthcare and a much smaller facility that’s just getting started. Being a pioneer doesn’t mean you’re always going to stay ahead. It means you took some arrows and maybe you’re ahead for a while. But you also created a path that lots of other people could follow. I believe the gap isn’t that small and that it will get filled very, very quickly.

PP: Now, of course, COVID-19 has accelerated the shift towards digital and especially virtual care/ telehealth models. In this context, what do you think are or should be the top priority areas for health system CIOs, in that, not just dealing with the current situation, but also positioning the organization for what might be coming as their future state?

MP: Yeah. So, there’s always two sides to a coin. COVID had a silver lining in that. It got us really quickly involved in leveraging these digital capabilities, whether that was increasing our communications through texts or through other tools with our constituents or bringing in telehealth or just televideo to do meetings and the kind of things we’re doing right now. So, it means there was that bright side that a lot of technology got brought in very quickly and a lot of people got more sophisticated using it. But there’s the other side of that coin, the difficult side of that coin is the way we did it because we are forced to do it so quickly. In some instances, hours, but certainly in days, doctors moved home, administrators moved home, teams moved home. We would deploy just about any kind of technology to facilitate doing that. So now we find ourselves in an environment where a lot of disintegrated tools are out there that need to either be brought together or brought to a more singular platform to really make it efficient and effective for both, us as an organization providing the service, and for the patients or members or families that we serve. I think one of the big challenges right now that CIOs will be going through, I know they are doing it. So it’s you know, this is a novel that is to get this kind of quagmire, this cobbled-together solutions to something that is much more seamless, much more easy to maintain, secure, share data across. So, I think that is going to be one of the challenges that we have as we move more rapidly to this digital age. I feel kind of strongly about I don’t know how broadly this is shared, but you wrote the book so you can tell me is we’re creating non-native applications to facilitate communication or data sharing with the people that we serve. And what I mean by that is, if I want to text a doctor, I end up going into an application, signing into it outside of my phone, and then I can text within this very secure environment. And I believe more and more the challenge we’re going to have as technologists is not having these separate applications, but using tools that are native to the heart, the solutions that we have in our hands. So texting will be just like texting anyone else or looking up data like, I can ask Siri about my medical record versus having to log in into a separate application to do it. That creates challenges, but that’s when it’s really going to make this digital interaction much better for those that we serve.

PP: Yeah. You’ve covered several themes that we actually discussed in detail in the book, and you covered the fragmentation of the technology landscape and the need to integrate them in order to create a seamless experience for the patient. You talked about non-native application and that’s an interesting one, because when you say non-native, I’m hearing non-native to let’s say the electronic health record system and lot of health systems are kind of growing beyond their EHRs and are looking to best in class tools for certain kinds of functionalities. And I get the sense that they are doing that because the EHR system cannot be everything to everyone, which they also acknowledge. And so, it’s kind of forcing a certain best in class approach, which requires the EHR platform or the system of record whatever it is to be wrapped by best in class tools and solutions. And of course, the fragmentation and the use of best in class on top of the system of record creates interoperability issue, which is unfinished business. We have come a long way in the last few years. But it’s still unfinished business and we’ve still got a way to go. So, what will be the big takeaway from this is it that health system CIOs should avoid fragmentation of technology as much as possible or get better at integrating it, so they get a bit more seamless experience. What is your recommendation?

MP: No, I think they’re going to have to get better at integrating it. I mean, it would be naive to think that even the EHR vendors want to do, like you said, all the things that need to be done. And so, we can either depend on them to integrate solutions which will limit our options, or we can get really good at integrating and really good at creating the right kind of environments that allow us to plug and play solutions that we know. I mean, they’re going to change annually, maybe more often just because that’s how quickly the landscape is changing for us. So, I think the only way we succeed is become really good at integration.

PP: And what are the risks with that? If I can just stay on that point for another minute or so, you’ve got these best in class solutions or ostensibly the best in class solutions, but they are in many cases, small companies. They’re VC funded. They don’t make profits. They are very often new and not necessarily road-tested technologies. There are risks involved. And I’m sure you’ve taken your share of the risks as a CIO. What is your advice for not just the CIO, but also for tech firms that are trying to build a business in this kind of an environment?

MP: That’s probably a long conversation, but to boil it down, we’re going to make mistakes. I mean, we’re going to have like you said, we’re going to have to take some risks and place some bets. You know, you can do your homework so that they’re less risky, but there’s still risk out there. And I really think, again, these solutions are going to change rapidly. So, I need to be able to as a CIO, as a technologist or a technology team, I need to architect my overarching solutions in a way where I can plug and play these pieces in and out. And, that maybe I put certain requirements in place that the interfaces have to be FHIR based or some other kind of standards put in place that I’m going to do it, but that I don’t build these really difficult to build and unravel integration services, but that I have things that are much simpler to do so that I can change. I can take a chance with a certain AI-based solution. And if that company goes under or which would be the worst case, that if there’s something better that comes up that’s going to provide more value, that I can go ahead and make that change. And I really think that’s a skill set that we haven’t been tremendously strong on. We used to buy integration engines. And that was going to solve a lot of the problems and it didn’t. But we’re going to have to be good at this whole process of how to integrate things and be willing to change. I mean, we’re not going to sit on solutions like we do EHRs, a twenty-five-year-old solution, a solution would be a year or two.

PP: Yeah. It’s interesting you mentioned that, my firm is actually living through this with one of our clients where there is exactly this decision point just come to them with the firm that they’ve committed themselves to and it’s been going well for two or three years. And all of a sudden that firm is in difficulty. You know, there are financial difficulty. There is turnover among key staff. And then all of a sudden deadline have been missed and product is not coming out as quickly. So, I’m sure you’ve seen this movie before. And so, your advice is timely and makes a lot of practical sense. But that’s a nice Segue to my next question is kind of related to this. One of the reasons why you do choose to go out and acquire this best in class tools and platforms is in order to create a competitive differentiator for yourself with your population, the patient populations, give them better experiences, improve the quality of care in the process, improve productivity and all of that. Now, in the emerging landscape for health systems, the competitive landscape. How important do you think this is in order to compete against the CVS and Aetnas of the world on one hand, or maybe some tech firm that comes from left field and has got an entirely new way of doing things? Is this now becoming table stakes for health systems that you have to go out and work with best in class leading-edge technology solutions?

MP: Yeah. So, I’m a real believer that you have to be able to select good partners and work with those partners, whether those be technology partners or business partners in other ways. A strength that a CIO really needs to have is the ability to build those partnerships and maintain them and have them thrive. There’s no way, it’s just so complex. Everything that’s going on and it requires very fresh talent. And having been a CIO, it’s not easy to constantly refresh the talent on your team. You kind of have a team and you work with them and they’re excellent and they do great things. But to think that I can continually keep the most up-to-date skill set within my team is, again, kind of naive. So, you have to have the right kind of partnerships to help you solve those problems. And if you do that, then I think you can solve a multitude of problems. And you are going to have good partners, just like we were talking about, you are going to take risks on one that aren’t going to be that good a partner. That’s the skill that a CIO has to happen. That’s what we need to be able to do as CIOs.

PP: Just curious about one follow up thought on that. Do you think as a consequence, CIOs are going to become more technical in their personal abilities? Or do you think it’s going to be more to do with managing partnerships and having them all play well together?

MP: So, I think you’re going to see a bit of bifurcation. Those skills all need to exist, whether building those partnerships and technical skills. I do see a track for a very technical CIO. And the reason that’s going to happen is because the business itself is becoming so much more tech savvy. So where 20 years ago we had to convince people that a mouse was an OK thing and that this was a keyboard, this was a CRT. Because we were the only ones. We were the only nerds out there that were paying much attention to it. Today people are very sophisticated around technology. And what many organizations are going to need is someone that can get deeper into the technical aspects of it. And they’re going to have CIOs to do that. I don’t think you can get away from the skill set of being a good people person, a big builder of those relationships. So, it’s going to vary. It’s going to vary by the situation and what else exists in the leadership team of an organization that both skill sets are going to be very important.

PP: So I’m going to talk about digital health and digital transformation, Marc, switching topics here. So, one thing that I pay a lot of attention to as part of my work and part of my firm’s work as to how are health systems organizing themselves to drive digital transformation. What does the org model look like? Who owns the digital transformation function? And I see that there is no straightforward answer to this. By default, it seems like, it is the CIO in a lot of organizations. But with a lot of the leading health systems, you have these dedicated roles for Chief Digital Officers, many of whom have come from outside the industry as well. So, what is your sense today of where ownership for digital health and digital transformation lies today? And what, if anything, should change for accelerating transformation?

MP: It’s owned by the CEO; it is what it’s owned by. And again, pretty naive to think that’s not where we’re going right. That we can just continue to operate the way we’ve operated for the last 40 years. So, the CEO owns digital transformation and how we’re going to deliver services going forward. We all play different roles. So, at Intermountain Healthcare, we had a CIO and we had a Chief Digital Officer. And Chief Digital Officer was much more of a marketing type person. And that’s actually the background that he came to Intermountain with. But it served us really well because we were focused on digital and how are we going to change the way we did things and how are we going to change our perception within the community that we are more of a digital service? The technology work around that. That was mine, that was my team. That’s what we did. But CEO owned the problem and the CEO drove it. And that’s why Intermountain has been and will be very successful in this space. There are going to be places where it’s the CIO that’s going to be a much slower transition for that organization. They may even ultimately fail, not because the CIO is bad, but because it’s coming from the wrong place. Technology, it’s a tool. It can facilitate that shift. But the actual shift is people making that shift. And that takes the leadership of an organization and operations and ultimately CEO.

PP: Yeah, one thing I like to say is digital transformation is technology-enabled, or IT-enabled, it’s not necessarily IT led. The difference may sound insignificant to some, but what I see in the market is that CIOs don’t necessarily have to do it all. In some cases, I have seen a great collaboration, just like you described at Intermountain, which really makes the difference. And of course, you’re right about the fact that it has to come from the very top, the CEO and indeed the board, for that matter. We are coming up to the close of our time here, Mark, I just wanted to touch on one of the things in the immediate context of COVID. We have seen the results come out. The financial performance of health systems for the first six months has not been great. And in an environment of declining operating income, how do you see it impacting the pace of digital transformation, but also the level of technology investments? And what is your advice for tech firms in this context now that your part of a tech firm as well who are likely seeing reduced IT budgets and longer sales cycles as a consequence?

MP: Yeah, so the broad thing that comes to my mind is a race to the bottom makes everyone a loser. So, there’s no possible way that healthcare is going to cost cut itself to being successful or thriving. And so, it’s where investment gets made. And like just about every other industry, it’s come through investment in technology and using that technology to create efficiencies and better solutions for those we serve. So, I believe there’s a lot of wise people in leadership positions in healthcare, that those investments are going to continue to get made. That doesn’t mean we won’t see cost-cutting because there will be and there has to be. But there also has to be this investment in technical solutions, particularly digital solutions, digital health solutions that will allow the industry to thrive and will allow a much more ubiquitous set of solutions. You know, again, right now, it’s regional. I mean, healthcare is so regional and it’s so different. I mean, the level of care and the outcomes can vary by zip code. That’s because of the way we’re currently formed. But moving forward, technology is going to level the playing field not just across our country, but around the world. And that’s when we know we’re going to be successful. So, if I were, which I am involved in a technology company in healthcare, I’m very bullish on the future. However, to thrive, we have to show that value. And we can’t just be talking about it. We have to show the value that we can provide. And I think there’s a very white field out there just ready to be harvested.

PP: Oh, that is so well said Marc. That’s a perfect note on which we can end this podcast. Thank you so much for coming on the show. And I really appreciate your comments and your insights. I wish you all the very best to you.

MP: Thank you very much, Paddy. Appreciate the time. And congratulations on your book and 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

Marc Probst is the Chief Information Officer of ELLKAY. Before joining ELLKAY, he served as the Chief Information Officer and Vice President at Intermountain Healthcare for 17 years. 

Marc has been involved with Information Technology and Healthcare services for over 35 years. Prior to Intermountain, Marc was a Partner with two large professional service organizations. Marc has significant interest in the use of information technology to increase patient care quality and lower the costs of care. He is experienced in information technology planning, integration, design, development, deployment, and operation. 

Marc was appointed to and served 7 years on the Federal Healthcare Information Technology Policy Committee assisting in developing HIT Policy for the U.S. Government.

He has also been a Board Member of numerous Healthcare Information Technology organizations and served as the Board Chair for the College of Healthcare Information Management Executives. Marc currently serves on several HIT company boards and is a board member of Nemours Children’s Hospitals. In early 2020, the College of Healthcare Information Management Executives (CHIME) and the Healthcare Information and Management Systems Society (HIMSS) jointly recognized him as CIO of the Year.

Prior to living in Utah, Marc and his family have lived in Reston, Virginia and Tampa Florida. Marc is married with 5 children which span in age from 35 to 17 years old. Marc is a graduate of the University of Utah in Finance and earned an MBA from George Washington University.

About the host

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

Telemedicine will become a fundamental aspect of care delivery because of its effectiveness

Episode #58

Puneet Maheshwari, CEO
DocASAP Inc.

"Telemedicine will become a fundamental aspect of care delivery because of its effectiveness"

paddy Hosted by Paddy Padmanabhan

Sponsored by

Share

Share on facebook
Share on twitter
Share on linkedin
Share on email

In this episode, Puneet Maheshwari, CEO of DocASAP discusses their platform and their recent survey on consumer experience and attitudes to telehealth/ telemedicine.

Puneet believes that frictionless patient access is critical for reducing costs and improving health outcomes. COVID-19 has been a very high impact phenomenon for the healthcare industry. Their recent survey on telehealth consumer experience reveals that the telemedicine adoption rate increased by 92%. However, we cannot think of telemedicine in a silo; we need to blend it into the overall care delivery continuum, which is a foundational piece that must be solved by healthcare providers in the future.

According to Puneet, the reason telemedicine is here to stay and become a fundamental aspect of care delivery is because of its efficiency and effectiveness. The biggest takeaway from their recent research is that telemedicine is opening the door to the digital practice of medicine and a digital-first care delivery model.

Puneet Maheshwari, CEO DocASAP Inc. in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Telemedicine will become a fundamental aspect of care delivery because of its effectiveness”

PP: Hello again, everyone, and welcome back to my podcast. This is Paddy, and it is my great privilege and honor to introduce my special guest today, Puneet Maheshwari, Founder and CEO of DocASAP. Thank you for setting aside your time to join us on his podcast. Welcome to the show.

PM: Thanks for having me.

PP: Wonderful. So, let’s kick this off Puneet. Why don’t you tell us a little bit about your company and the product platform that you’ve developed over the years.

PM: Sure. DocASAP is an access engagement platform. We are pretty unique in the sense that we were both with the payers and the providers. From the very beginning, the mission of the company has been fairly straightforward, which is to streamline and reduce the friction when it comes to helping the patient find the right provider in the right setting at the right time. And while it sounds cliched over the course of the last several years that we have been doing this, we have come to realize that frictionless patient access is critical for reducing costs and improving health outcomes. What we’ve also realized is that payers and providers both lack meaningful solutions for effectively engaging and navigating patients to optimal care providers. What this results in is decreased quality of care with suboptimal outcomes and increased population risks, increased costs with consumers ending up at suboptimal care providers, and purely from the sense of and the side of the patient, fragmented access, which is uncoordinated, leading to frustrations and suboptimal outcomes overall for all parties involved. With that in mind, we evolved the DocASAP platform to have key three core capabilities. One is what we call navigation and matching. We have only one in the industry who will really go deep to fully understand the clinical and operational intake protocols of the providers. We translate those protocols then into decision trees that can be laid or end to end organization’s delivery model and use those decision trees then to help the consumer navigate to the right provider. Over the course of the last five months, particularly while we supported this before, setting or getting the consumer the right setting has become even more important. And that has been one area where we have doubled down over the course of the last five months. The second part of our platform is around accurate scheduling and the operative word there is accurate. We connect real time to the underlying practice management system and then also take into account all the considerations that the providers put in terms of managing their time and how they want to fill their appointment slots. With that information in real time access to that inventory, we then enable consumers to book their appointments instantaneously across all pathways that they use and trust. And the third part of our platform is what we call actionable engagement. And again, the operative word here is actionable, which is pre, peri, and post of an encounter. How do I enable the consumer to be prepared for that appointment, how do I remind them for that appointment, how do I make it easy for them to reschedule or cancel? And then post appointment how do I engage them for follow up care, which may be pertinent for the last encounter that they just had? And the key really is taking this platform and then touching the consumer across the care journey from when they’re searching for a provider, helping them select the right one, helping them schedule for a timely appointment across all different kinds of care settings that may be pertinent helping them prepare for that appointment and then engaging them for all the follow up care that may be needed from thereon. Where we’ve taken significantly farther is how we deploy this platform, because what they’ve come to realize further is that consumers use diverse and heterogeneous parts for finding care. On one side we power all sorts of digital channels, such as providers owned web and mobile properties or their digital front doors. We work with some of the largest health plans in the country to power their member engagement and doctor finder applications. We power search and social sites like Google, my business pages or embed our capabilities across other social sites. But then we also realized that there are other established pathways that the consumers take which are not digital, such as we enable access centers to have this capability so that they can help the consumer to help them get to the right provider within their health system. The power of similar capabilities for community providers or ambulatory providers so that they can refer patients into a specialty care, radiology lab, et cetera. And then we accentuate our capabilities in acute discharge settings. So, the discharge teams of hospitals or emergency departments can streamline, follow up care for the patients out there getting discharged from the acute settings.

PP: You’re in an interesting space. And by the way my firm, which is a digital transformation advisor firm that works with a lot of health systems and health plans, we are on the other side of the equation. We actually look at patient journeys and we look at all the different digital engagement opportunities or touchpoints and what kind of tools and platforms that are there that can enable that. And clearly the doctor finder is now getting more important than ever because consumers or patients are getting access to care and doing a lot of the things related to that access online and as. So, it’s kind of a mode. We are seeing this gaining importance. Let me ask you a couple quick questions about the landscape you’re in and then we can switch to other topics. When I look at the technology provider landscape for a situation such as yours, firstly, you’ve got the core systems of record, if you will, the big electronic health record platforms and have some of the functionalities that you just talked about. And then you have at least on the health provider side. And then you have the competitive landscape where there’s multiple tools out there that could be competing with your core platform. This is a find a doctor kind of capability. So, when you put yourself in that mix. Do you see your platform as something that complements what EHR systems do on the one hand? Is it a replacement, maybe a better tool compared to what they have native to their platforms? And what else is it that makes you a little bit different and unique? If you could just point out one thing that makes you different and unique.

PM: Let me touch both of those points because those are separate entities in terms of how to think about the overall problems. So, when we think about EHR or electronic practice management systems, what we’re realizing, working with several of our large enterprise healthcare delivery, clients that, EHR systems are built with providers in mind. So, they are more inward facing. And the solutions that have been developed are also developed with an inside out mindset, which tends to have platforms and solutions that do not really work and direct to consumer settings. You really need to apply an outside in mindset when you’re looking at how to engage the consumer and how to really engage the disengaged consumer, if you will. And that has been one big differentiation, that we have been able to bring to our provider clients. Another thing to think about is the space overall. While EHR organizations and practice management organizations by definition are health records or tools for managing practices, they are not really digital tools for enabling access and engagement for the consumers. So, it’s a completely different category in that sense. And some EHR service providers are looking to play in that category. But in most cases, they are still focused on their core business, which is around robust health record systems and robust practice management systems. Now, coming to the competitive landscape that we play in, particularly in the context of that digital front door, I would say that there are two core differentiations that we bring to bear compared to anybody else in the industry. One, we are not a point tool, we are a much broader platform that takes into account the overall patient journey and not just finding the doctor and help the consumer in that journey across all pathways that they use and trust. So, the holistic nature of the platform is one thing which has been a big differentiator for us as we have worked with large health organizations. The second piece, which is highly differentiated for us, is the ecosystem that we have been able to bring together as we solve this complex problem of helping the consumer get to the right provider, right setting the right time. And what I mean by ecosystem in this context is how do you really bring the payer and the providers come together and do and achieve the results in a collaborative way and deliver the coordination that is needed for the patient or the member? Whichever way you look at it, for better outcomes and reduce cost structures. And so, on that side, on one way we work with the large provider groups. But then we also work with large payers and then connect them together through our platforms such that at the end of it, consumers get what they need to get from an access and engagement standpoint. And that ecosystem is a very unique thing that we have been able to bring to bear, both for our provider clients as well as our payer clients.

PP: Very interesting. And that is actually a perfect segue to the next topic that I wanted to explore with you. Your firm recently did a fairly significant survey of consumer attitudes and consumer preferences as it relates to online engagement with their providers. And in the wake of COVID-19, we know that many things have been forced upon us. And I think your report goes into aspects of this new normal that consumers have adapted to very well and some that they have not particularly adapted well to. You want to touch upon some of the highlights of this. What was the driving force for doing this survey and what did you hope to accomplish? Tell us a little bit about some of the key findings from the survey.

PM: Yes. COVID-19 has been a very high impact phenomena for the healthcare industry and Paddy you are seeing this from your vantage point. And we are definitely seeing it from ours. I would say we are seeing close to five years’ worth of innovation acceleration happening in three to five months. And that is creating a significant disruption, if you will, at a pace that has otherwise not been experienced by the healthcare industry. And that brings me to the survey that we did and why we did that. As we were seeing that disruption happening. It was important for us to start understanding the underlying themes that were driving that disruption. And where should we then expect the new normal to fall was equally important for us to understand. The underlying themes essentially fell in three broad categories. One was around contactless access, and that theme was there before the pandemic and which got dramatically accelerated during the pandemic. I think we were already on that journey. But as I said, we saw that five years’ worth of acceleration in three months. The second piece that we wanted to understand was how this is really affecting consumer behavior and provider behavior overall. And the third piece was around looking at what are the foundational pieces that would need to be put in place to help our customers be the payers or the providers aligned better to those major trends that will be coming out of this pandemic. So that was the fundamental premise for doing the survey in the first place. So, we did survey around thousands U.S. adults those who had used healthcare provider in the last 12 months. And the learnings are pretty interesting. So, one no surprise there was this massive utilization of telemedicine beyond what it was. And the adoption was kind of increasing 92 percent of our respondents who have had a telehealth appointment said that they were satisfied, and their overall telehealth appointment experience was positive. When asked to describe their telehealth appointment experience, the top three descriptors were easy, efficient, and convenient, if you will. And those are fundamental themes, again, that we have to understand to say ‘Ok where the pick is going to be. Eventually, consumers, stations, members are looking for convenience, efficiency, and ease. And as a healthcare solution provider helping the healthcare providers overall. We need to think through what will help the consumers get that ease, efficiency, and convenience. But what was also very evident was the anxiety where in-person visits, at least in the short term. We heard loud and clear that respondents were not comfortable going back to see a health care provider in person until at least the fall. And there was a proportionate number that said they are not comfortable going back to a doctor’s office until early 2021. It’s pretty amazing when you start comparing the results and see that the respondents felt safe for going to a grocery store or a hospital or a doctor’s office and in a doctor’s office or somewhere around 26 percent compared to a grocery store, which was 42 percent. And those things are pretty eye-opening as you start thinking about how we going to go back to normal and how will we convince these consumers around the safety of the care that can be delivered within in-person premise. And as we started kind of taking that and talking to our customers, we started realizing that telemedicine is here to stay. And if you look at, you know, secondary searches done by firms like McKinsey, you’re seeing a massive shift of care delivery dollars going through telemedicine. But there’s also a realization that you cannot think of telemedicine in a silo. It’s not just about, you know, on-demand acute care. It’s about how do we blend telemedicine into the overall care delivery continuum. And how do we then make sure that the consumer, based on their specific needs, is navigated to the right care settings? So, if it’s a first appointment, which requires an in-person visit and you’re helping them get that in-person visit. But if it’s a follow-up, which can be done remotely through a video visit or a phone call. The consumer’s navigator to that. And enabling that streamlined, flow of care delivery across those different care settings is one foundational piece that has to be solved by the care providers as we move forward. I would say the biggest takeaway, which shouldn’t be any surprise to anybody, was that telemedicine is opening the digital front door to the digital practice now. So, the world is moving to digital-first when it comes to health care. And you would see a massive acceleration towards that mindset both from the consumers as well as the providers as we get out of the pandemic and start thinking about what the new normal is going to look like.

PP: Yeah, everything that you said makes a lot of sense, especially in the immediate wake of the pandemic. I want to unpack that a little bit. So, what I do like about your earlier comments is the B2C focus that’s never been part of how healthcare operates in the past, at least. And now, in fact, my latest book, which of healthcare digital transmission, the subtext to the title as how consumerism, technology and pandemic are accelerating the future. We already covered two of them. Consumerism and pandemic and of course, we are in this podcast is all about technology and how it is driving transformation in healthcare. The consumerism aspect of it is the unfinished business. It’s still in early stages. We found the same thing that you talked about, which is that yours were the transformation effort has now been compressed into a matter of months and is putting an enormous amount of strain on organizations while dramatically altering the ways in which healthcare is access to consume. At the same time, the more recent data that’s based on our research, it tells us that we swung a little too far to one extreme in terms of virtual care models, telehealth, telemedicine, real time, virtual consult things like that. In the immediate wake of the pandemic because there was no option. But now it’s all pulling back a little bit. And, you know, there’s some kind of a variety of reasons, some kind of care cannot be done remotely, whether you want to or not, whether the technology is available or not. And then, of course, there’s a question of all of the revenue dollars. And in healthcare, you know, everything you need to follow the money right. Now, where the reimbursement is coming from, what are the puts and takes in terms of lost revenue versus what you can gain from telehealth visits and so on? So my question is, do you feel like you’ve reached some kind of an equilibrium? And if not, how long do you think if you were to look out a little bit, how long do you think, before we get to a point where we say, you know what, this is going to be a 60-40 split for all primary care visits between telehealth and in-person visits. Something like that. Can you share your thoughts on that?

PM: I don’t think we have gotten to an equilibrium right now. I think we are still in the middle of the pandemic. The surges are still happening, and members are still kind of going back and forth in terms of our level of comfort around whether it’s behind us or not. So, till the time that’s going on, I don’t think there’s going to be a very meaningful equilibrium that is reached. Having said that, there is an equilibrium eventually. And when I think about that, I think in two big parameters, if you will, one parameter is the disruption that is happening. And if you look at the new normal, I see the disruptions happening both on the business model side as well as on the technology side. And, you know, it’s easy to manage one disruption when it’s happening. And this is a bit of a perfect storm of sorts where we are having these still disruptions happening at the same time, which means that there will be winners and losers and organizations will have to really embrace these disruptions and navigate through them with the nimbleness and ingenuity. The second piece is around, you know, what are these disruptions really driving? And in my mind, the reason why telemedicine is here to stay and become a fundamental aspect of care delivery, if not the preferred health care delivery, is the efficiency and effectiveness aspect of delivering care to that pathway. And you touch the effectiveness part of it by highlighting how certain aspects of the care cannot be delivered in a virtual setting. But I think that’s a moving target in my mind. I think what we have come to realize is that more and more care can be done in a remote setting that doesn’t always mean that it has to be over a video call or a phone call. It couldn’t be through remote monitoring. It could be through shipping diskettes to individuals so that they don’t have to come to a lab and get exposed to other kinds of infections. It could be about augmented reality in future. I think the theme has to be consistent and till the time theme is consistent. The technology will catch up to that and one way or the other. And the theme really is that when you deliver care in a virtual setting or in a setting which is at home for the consumers, more efficient for the consumer and the provider. It’s more cost-effective. It’s less risky. And those three points are critical as you think about delivering ambulatory care of the future. So, in my mind, the world is moving to digital-first care delivery. The pandemic was a very strong impetus to push us in that direction. And you’re right, we probably swung a little too far on that side. But what it has also done is it has opened the eyes of the consumer and the providers, I would say, on the benefits that come out of it around efficiency, around cost, around the overall risks. And what that means is now the technology is going to be following that trend and we’ll be solving things that we haven’t seen solved till now. And you and I will both be very surprised end of 2021 on the amount of care that can be delivered in a home setting.

PP: Yeah, I think I agree with you there. What are you seeing in terms of the demand environment coming down to the real situation on the ground, if you will, for one of your own products and services? But in general, for digital health capabilities and the kind of tools and platforms that health systems in particular have to invest in order to prepare for this new normal or next normal and really position themselves for the inevitable digital future that you just talked about.

PM: Yeah. So, again, I would put it in, you know, two horizons. One is the immediate horizon. Another is the more midterm horizon. The immediate horizon is about helping our customers in my mind. Many of our customers are really struggling financially, given what the pandemic threw at them. Ambulatory visits dropped almost 50 percent for several of the providers across the country. And when the pie shrinks, you can only a vendor. You have to be a partner. And that is the approach that we are taking. What we are also realizing is the opportunity that this crisis is creating for our customers and for ourselves, which means that we have to double down in the investments that we are making for that midterm to long term growth that we can expect in the digital capabilities that are going to be used in the market. So, till the time we keep that set of horizon and mind, I would say at this point in time, yes, we are seeing a lot of demand in terms of providers realizing that they are behind the curve on some of these capabilities. But we also understand that they themselves are struggling financially. So, we are approaching it a very partner-oriented mindset. And then we also realize that nobody really knows where technology is going to be in two years, three years from now. And the companies that are going to be successful or companies who make their investments listen to their customers, keep their ears to the ground and execute. So those are the two ways we’re looking at the market and we believe that we are pretty strongly position with partners and customers that we have. We have been able to associate ourselves over the course of the last several years, and it’s going to be a very exciting ride as we move forward. I wish we didn’t need a pandemic for all of this to happen. We all would have been happier without it, I’m sure. But if there is a silver lining to any of this is the fact that we all are becoming more open to change and change is the name of the game if we want to move the needle on cost and quality in the U.S. Healthcare.

PP: Right. Never waste a crisis, as a wise man said. Well Puneet, it’s been a fantastic conversation. I’m afraid we’re going to have to leave it there. We’re coming up to the end of a time. But I wish you and your company and all the very best. You guys are in the right place at the right time. It looks like and I look forward following your company and the progress that you make. Thank you again for coming on the show.

PM: Thank you so much for having me, Paddy. It has been a pleasure.

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

puneet-maheswari-profile

Puneet is the CEO of DocASAP. He is a technologist with more than 17 years of experience working in various Silicon Valley technology startups and in the business technology office of McKinsey & Company.

Puneet earned his Master of Business Administration in Finance and Entrepreneurship from the Wharton School of Business, University of Pennsylvania.

About the host

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

Voice technology will enhance care delivery from within the EHR

Episode #57

Diana Nole, EVP and General Manager, Nuance Healthcare and Yaa Kumah-Crystal, MD, Assistant Professor of Biomedical Informatics, Vanderbilt University Medical Center

"Voice technology will enhance care delivery from within the EHR"

paddy Hosted by Paddy Padmanabhan

Sponsored by

In this episode, Diana Nole and Dr. Yaa Kumah-Crystal discuss the progress, future state, and challenges of voice-enabled technology in healthcare. They also talk about its usability and application in a post-COVID-19 world.

According to Diana, in a post-COVID world, we will see more acceptance of voice-enabled technology not just for clinical documentation but as a virtual assistant to command and control things within the physician workflow ecosystem. The pandemic accelerated the willingness and acceptance to look at things differently, such as telehealth; voice technology will be the next. It will be helpful in offering suggestions and recommendations to enhance care delivery from within the EHR system.

Dr. Kumah-Crystal states that the new era of voice mechanics and how we interact with the voice technology is instrumental in making queries and commands in the EHRs to retrieve information. A new dynamic of patient engagement will emerge from voice as a medium and as a method by which a provider engages with EHR in the presence of patient. Take a listen.

Diana Nole, EVP and General Manager, Nuance Healthcare and Yaa Kumah-Crystal, MD, Assistant Professor of Biomedical Informatics, Vanderbilt University Medical Center in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Voice technology will enhance care delivery from within the EHR”

PP: Hello again, and welcome back to my podcast. This is Paddy, and it is my great privilege and honor to introduce my special guests today, Diana Nole, EVP and General Manager of Nuance Healthcare. And Diana is familiar to our audience. She is coming back and joining us. She’s been on this podcast before. We’ll talk a little bit about that. And Dr. Yaa Kumah-Crystal, Assistant Professor of Biomedical Informatics at Vanderbilt University in Nashville. Welcome to the show. Let me kick this off. Diana, I think this may be a question for you to start with. I’ve always considered voice to be one of those highly promising, emerging technologies that is going to transform the way we live and work. In healthcare, we have struggled with how technology has taken away some productivity, even though it’s delivered a lot of other benefits. Voice has the ability, and voice enablement to voice recognition is potentially one of those technologies that could ease the burden on physicians. That’s been the thesis for the rapid growth of voice enablement in healthcare. So maybe you could start by sharing with our listeners a brief overview of the progress that we have made as an industry with voice enablement and healthcare. Where is voice finding its application today, especially in a post-COVID-19 scenario?

DN: Well, voice has definitely been on a journey. It’s not new to the industry. As I had mentioned, I’ve known Nuance now for 15 years. I’ve recently joined them on June 1st. But voice, dictation, the aspect of taking the ability of this technology to do clinical documentation has been around for a while. More recently, I think with the capabilities of all of our data processing, etc., we’ve definitely advanced where it’s much easier to get adopted. You don’t have to train the system as much as getting much more accurate. And so, the ability to get broader sets of users to use it has definitely kind of come up. What you see now in the post-COVID world is even more acceptance of things where you can use the voice enablement, not for just clinical documentation, but a bit more with like being a virtual assistant and being able to command and control things within the ecosystem that the physician is working in. For example, the announcement on UpToDate was to be able to search through voice and be able to say, hey, dragon, pull up what’s on UpToDate on this particular topic? And I think in the post-COVID world, just a simplistic thing that we’ll probably hear more from here on the show is just the contactless ability to drive and control commands. And we’re getting actually interested in not just the physician, but medical devices and use of that. And so, we also think that there’s gonna be more people wanting to use voice to kind of use in this post-COVID world.

PP: Yeah, that’s interesting. Contactless experience has kind of become a big buzzword and a theme as people start going back into the clinics and hospital environments. We will unpack that a little bit more. Now, when we had you as a guest on this podcast, you were at that time with Wolters Kluwer leading their healthcare business. And now you’ve recently done a partnership with Wolters Kluwer to help clinicians and researchers using the capability for voice-enabled content search. Can you talk to us a little bit about what that means?

DN: Yeah. So, what you can actually do is, you can say, hey, Dragon, search UpToDate for particular treatment options. And this actually then helps the clinician retrieve information in UpToDate. A big thing with physicians is not having to go between systems, but just having it seamlessly. And, then you can retrieve information in UpToDate, a leader in clinical decision support. You can get medication, dosage, disease stage, drug interactions, all that stuff is readily available in UpToDate. And then, you can also with the dragon engine, be able to do commands in terms of what you want to actually have the EHR do. So hopefully being able to get information more easily accessible, efficiency, productivity, just a better user experience. So that’s what we’ve done with UpToDate. And we think that there may be some other things that we can do together on that, so I’m very excited, although I’ve left. It’s really nice to continue to work together in that partnership.

PP: Yeah, yeah. Sounds really exciting. Dr. Kumah-Crystal, you have been using this new technology at Vanderbilt University. Can you tell us a little bit about how you’ve been using it? Are you using it as patient experience, context? Are you using it for research? Can you tell us a little bit about where you’re using this?

YK: Yes. So, I’ve been a voice enthusiast for a long time. I’ve been using dictation to keep my notes. What I’m so excited about is this new era of voice mechanics and how we can interact with the voice technology outside of just the dictation, which is extremely useful, but also to make queries and commands in the EHR to retrieve information. I just think it’s a really exciting new way to interact with technology, because so often when we need to find out something, we’re forced to drill down through different tabs and scroll through sheets and whatever. It’s hard to fight the technology just to give us the information we need. But just to be able to say a command, to make a request and have the information retrieved for you, just takes away some of the burden and irritation of the technology that has kind of integrated itself in our regular workflow. In medicine, it’s a culture of asking questions and making requests. As an attending, I am usually surrounded by fellows and residents and nurses, and we have our morning rounds and we talk about the patient and someone will ask like, hey, what was her last sodium? Or Hey, put that last journal article for so-and-so. And to be able to use that same method, that same medium to ask information for that electronic health record, makes it a more nuanced part of our care team as well, where you can interact with at the same level you’d interact with rest your colleagues.

PP: Yeah. So, what is the big play here? Is it productivity, is it advanced intelligence? What is the play here?

YK: I would say easing the friction of getting to where you want to get to. The whole point of the EHR is that we input information so that at some point we can get it out more efficiently. Unfortunately, because of limitations with time and money and whatever it takes to make it more functional, it’s not that easy to get information out. It’s always several keystrokes away, several tabs away, several lots of things away. But to be able to make a command verbally and instantiate that thing you want, just relieves some of that frustration you have, or you feel like you’re always having to go through a journey justifying the thing you need. I was trying to explain this to my nine-year-old son. He was like, oh, it’s kind of like being a wizard. You just say a spell and it happens like, well, that’s a very nine-year-old way to think about it. But I think I like that metaphor. You just kind of act on the things and they come into being. And I think that’s this part of the value of being able to articulate the things you need.

PP: Yeah and again usability has become a hot topic in healthcare. And in some of the work that we do, usability as a term is finding its way into all kinds of contexts, usability for patients when they come online to access care. And now we talk about usability for caregivers in order to get to the information they need so they can quickly get to answer those pointers for taking care of their patients’ needs. What about the other side of the table? What about patients? How do they get to see the benefit of a voice recognition technology? Is there something that providers are doing to enable voice recognition when a patient walks into the clinic, for instance? You know, Diana talked about this contactless experience. Is that something that the patient can take advantage of as well? Or is it mostly confined today to the caregiver side of the business?

YK: I was so excited to answer this question. In terms of how the patient benefits, there are different kind of ways and manners which the patient benefits. From the provider facing side of things, if a provider can easily call out orders to say like, oh, place a consult for social work or refill the metformin, and maintain their contact with the patient while just asking for those things to be fulfilled, as if they had a scribe in the room or something like that. That itself just helps the patient and the provider feel more connected like they’re in the same place together. And the pride is not distracted by having to pull away and go to their computer screen to answer these things. Also, I think there should be a study of this, but just the benefit of the patient hearing the provider place these orders or make these requests, for patients have better understanding of what is going on in their clinical encounter to know what things the provider thinks is important, to know what things the provider wants to call out. And maybe that would even make it more engaging to the patient. Make them want to ask more questions as about why would we want to try metformin or why did you ask about this specific thing? I think there’s a new dynamic, an element of patient engagement that will absolutely stem from being able to have voice as a medium and as a method the provider engages with EHR while the patient is there. But on the patient-facing side, there’s actually a lot of great work going into having patient-facing voice assistance so the patients themselves can interact with the EHR. And I think that’s just a wonderful opportunity to have people who might not be as comfortable with technology and navigating computers, just be able to talk to their machines and get the information back out. So, I think that’s really, really exciting and can really decrease barriers for people with disability issues because everybody knows how to talk. So at a very early age on people know how to engage with computers and with media using their words and to be able to fully leverage it, I think can take us just a whole another plane of usability and productivity and engage with it. 

PP: Yeah, that’s that is so well said. The importance of having a natural language interface that not only increases your productivity, but also provides some degree of comfort and ease during the course of the doctor-patient interaction is definitely something that I see a lot of other firms paying attention to as well. Now, you mentioned scribing as one of the core tasks of this voice-enabled interface. Now Diana, I want to ask you this question. There is obviously a huge amount of opportunity headroom lift, if you will, for just being able to use voice to do things like scribing, which can actually release a significant amount of time for physicians, but also improve the doctor-patient interaction so that physicians and their patients can have eye to eye contact, and all of the others that has been talked about a lot. What’s next? Tell us a little bit about what you see as the roadmap for the future. Where do you think we can hope to see, let’s say, advanced analytical tools being used in the context of voice recognition to improve our ability to do more advanced tasks, risk assessments, or just being able to predict things from a person’s voice? I’ve read that you can actually read biomarkers in the tone of the voice. Can you talk a little bit about some of the future state that is emerging from voice?

DN: There’s some interesting things. The last note that you had there made me think of something that we recently talked about from Nuance, and that is actually being able to recognize maybe the age. And I’m not quite sure exactly how I would apply that in healthcare, but I think you’re right on in terms of the things that it will allow us to do. What we’re really excited about is, moving from sort of voice and sort of an interaction with one person and the machine to being in this ambient environment. And that is really where we’re focused on. That brings great interaction between the physician and the patient, because now it’s really in an ambient environment. Your diarizing the conversation between the patient and the doctor. And I think that builds a lot of transparency, but also a lot of clinical and other types of accuracy of what’s being captured. And then if we can get that into a very good structured format. Then, the hospital itself can run a lot of analytics on that. You can continue to do sort of the voice commands. But what I see in the future is also the machine helping to catch things that might be within the EHR, or other items that would offer up suggestions, recommendations either in the visit or post a visit to continue to enhance and make sure that nothing falls through the cracks for the patient. And I think when you think about the ambient environment and then what we talked about with patient interactions and producing this capability for other care providers, such as nurses, et cetera, it will definitely unlock and bring back a little bit of what we’ve talked about in the past of bringing back that trust between the physician, the doctor, and their patient. So, I think the whole ambient environment will unlock yet another capability of being able to do analytics, recommendations, those types of things. And that’s what we’re heavily working on right now.

PP: Yeah, ambient computing has, become another hot topic because of all of the possibilities – to be able to remotely monitor or observe what is going on with a patient and being able to pick up things through voice, and other natural language interfaces, especially now in the COVID context. So, does your technology kind of seamlessly integrate with the EHR systems and other decision support tools? One of the big challenges in healthcare is this. All these technology tools, it’s a challenge to make them all work together in a seamless fashion. It’s getting better, no doubt. But still a lot of unfinished business. Do you want to talk a little bit about that?

DN: Well, with our rich history in healthcare, that’s something we rely heavily on, and we definitely have to have those connections. We had long-standing relationships with the EHRs. We can’t do without them, as you said. So, we do have that interaction with them, the virtual assistant. We work with them on how we actually get that information back out and then get it back in. You may have seen recently we did announce, for example, connections with Cerner on that. So, we’re very excited about that. We cannot make it work without it. And that’s why it’s so important for us to be sort of agnostic. We do the same thing in terms of telehealth platforms. So, we work with various telehealth platforms, so we can provide the opportunity to use it for the doctor when they’re in the office or on telehealth. It eases their not having to use a different tool. And then you really just have to work with all these different systems. And that’s something I think collectively as an industry, we are getting better and better at.

PP: Looking into the future, today, when you look at text-based interfaces – you go on your iPhone and you start typing out a text message – it finishes the sentence for you because it’s been observing what you write or what people like us to write on a normal course of the day. It’s been analyzing billions and billions of these messages. It helps you to complete the sentence. Do you think the voice is going to get there? You know, you start to see something, and the voice-enabled interface is going to complete the sentence for you?

YK: I think it’s going to depend on what your end goal is. I think there might be some folks who would find that really beneficial. And again, going through the concept of accessibility, that might be a feature for some people. For others, I think most people really look forward to technology helping to facilitate and optimize what they’re already doing. And one of the joys of being a doctor that is often kind of pulled away from us is engaging with the patient, having a conversation, learning about their story, and able to give them advice. But because you’re often having to pull away to turn back your computer, to type it, you don’t have the opportunity to do that. So, having something like an ambient scribe that can match all the words you say to create your note for you. So, you don’t have to do that will give you the opportunity to be present in that way and complete your sentences yourself. But yes, it would make sense for some folks, for whatever reason, to have a tool that can produce those numerations for them. And I absolutely love that feature in a phone and email; auto-suggests, and complete sentences for you. I also wonder if it’s saying what it thinks I would have said or it’s suggesting what I should say, and if the results of my email are really just the computer’s mind. Regardless, it sounds good and it’s all spelled correctly. So, I can just hit send and save myself an extra five minutes.

PP: I’m not so good with the auto finish. More often than not, I’m sending the wrong message out and manually correcting you.

YK: That’s an interesting point that you bring up. And with regards to the technology kind of just working and not having to worry about all the setup and integrating all that stuff. One of the biggest limitations in the past about voice technology was that because of the word error rate, you almost spent just as much time having to go back to fix the things that it thought it heard as you were trying to dictate. That was a huge barrier to adoption. But with machine learning techniques, even without training, a novice can pick it up and just get started. And I think that’s one of the big factors in making this a more mainstream thing that anyone can and would adopt, because if all you have to do is talk. And that’s something I had to do anyway. Then what’s the Problem?

PP: You did bring up something that I was going to bring up in the closing minutes of our conversation, which is what are some of the challenges with the technology? Obviously, the error rate is one of them and the error rate could be linked to a lot of different things. Accents, for instance. We live in a very diverse professional environment. Healthcare as much as any other industry is very diverse. Do you see this as technology, therefore, that needs to evolve a little bit more? I do agree with you, you know, from all accounts, it’s come a long, long way in the last few years. Diana, where do you see these multilingual capabilities headed?

DN: Yeah, I definitely think that there are going to be some, you know, what’s the level of accuracy that we can, that really delivers the right results. As was mentioned before. So, I think that will continue to get better. And so if you definitely think about the future, where I talked about, you know, being able to scour things and offer recommendations, I do still think that that’s a vision that can be achieved. But it will take a while because, as you know, we all get started, those recommendations from where we’ve shopped, et cetera, and not all of them are quite accurate. I think the other thing that people have helped me to remind myself is that when you think about this type of interaction and patient and patient interactions, we do have to remember that many of our patients still don’t have access to the technology. So, I do think we also want to continue to keep in mind the evolution that our patients are going through. But I am very, very optimistic. I think the COVID-19 has actually accelerated everyone’s willingness to look at things and do things differently. Telehealth is a great example. Voice will be the next. I’m very optimistic that there will actually be some really wonderful, positive things coming out of a very challenging circumstance.

PP: Fantastic. And I guess on that note, we’re going to have to leave it there. Dr. Kumah-Crystal and Diana, it’s been such a pleasure speaking with you. And I look forward to following all the progress with voice. I got to tell you, I am personally very, very interested in where the technology can take us at a personal and professional level. And I look forward to following all the work. Thank you once again for being on the show.

DN: Thank you.

YK: Thanks 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 guests

diana-nole-profile-pic-aug2020

Diana Nole joined Nuance in June 2020 as the Executive Vice President and General Manager of Nuance’s Healthcare division, which is focused on improving the overall physician-patient experience through cutting-edge AI technology applications. She is responsible for all business operations, growth and innovation strategy, product development, and partner and customer relationships.

Over the course of her career, Diana has held numerous executive and leadership roles, serving as the CEO of Wolter Kluwers’ Healthcare division and president of Carestream’s Digital Medical Solutions business. She was instrumental in bringing Wolters Kluwer's healthcare product offerings together into a suite of solutions incorporating advanced technologies to drive further innovation. Under Ms. Nole's leadership, Wolters Kluwer formed a centralized applied data science team that accelerated the successful introduction of next-generation AI-based solutions for data interoperability, clinical surveillance, and competency test preparation for nursing education.

Ms. Nole is a board director and Chair of the audit committee for the privately held life sciences company, ClinicalInk, and was recently named the first female Chair of the board of trustees of St. John Fisher College, home to the Wegman's Schools of Pharmacy and Nursing. Diana has dual degrees in Computer Science and Math from the State University of New York at Potsdam and earned her MBA from the University of Rochester’s Simon School.

Yaa Kumah-Crystal, MD, MPH, MS, is an Assistant Professor of Biomedical Informatics and Pediatric Endocrinology at Vanderbilt University Medical Center (VUMC). Dr. Kumah-Crystal’s research focuses on studying communication and documentation in healthcare and developing strategies to improve workflow and patient care delivery. Dr. Kumah-Crystal works in the Innovations Portfolio at Vanderbilt HealthIT on the development of Voice Assistant Technology to enhance the usability of the Electronic Health Record (EHR) through natural language communication. She is the project lead for the Vanderbilt EHR Voice Assistant (VEVA) initiative to incorporate voice user interfaces into the EHR provider workflow.

Within VUMC HealthIT, Dr. Kumah-Crystal functions as a Clinical Director. In this role, she works across clinical systems, to perform internal reviews on and provide advice about EHR change and integration projects, with the goals of optimizing products and processes. Dr. Kumah-Crystal remains clinically active and supervises Pediatric Endocrine Fellows and sees her own clinic patients. Her research and related publications define the use of technology to improve care and communication for providers and patients.

About the host

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

The equilibrium between in-person and video visits will be determined by specialty-specific care

Episode #56

Michael Bouton, MD, Chief Medical Information Officer, New York City Health and Hospitals

"The equilibrium between in-person and video visits will be determined by specialty-specific care"

paddy Hosted by Paddy Padmanabhan

Sponsored by

Share

Share on facebook
Share on twitter
Share on linkedin
Share on email

In this episode, Dr. Michael Bouton, Chief Medical Information Officer of New York City Health and Hospitals describes the significant changes that NYC H + H had to implement in their organization to deploy and integrate new technologies in response to the pandemic. NYC H + H installed hundreds of vital sign monitors linked to EMRs in the first few weeks of the pandemic and integrated them into the EHR system to enable caregivers with actionable, real-time information to address patient needs.

Dr. Bouton also discusses the challenges and opportunities of telehealth and other virtual care models that are transforming the quality of care delivery and interaction with patients and providers. He states that while no one wants to eliminate in-person visits altogether, video visits can increase low-intensity care quality. He believes the equilibrium between in-person and telehealth/ video visits will be determined by specialty-specific care in a post-pandemic era.

Michael Bouton, MD, Chief Medical Information Officer, New York City Health and Hospitals in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “The equilibrium between in-person and video visits will be determined by specialty-specific care”

PP: Hello again, and welcome back to our podcast. This is Paddy and it is my great privilege and honor to welcome Michael Bouton, Chief Medical Information Officer at the New York City Health + Hospitals, New York City H+H, as it’s called. Michael, thank you for setting aside the time. And welcome to the show.

MB: Thank you very much, Paddy.

PP: Would you tell us a little bit about your organization and your role within the organization?

MB: New York City Health and Hospitals or H + H for short is the nation’s largest public health system. We have 11 acute care facilities, a long-term care facility, a couple of SNFs. We also have over 60 clinics in all five boroughs across the city. And I am the enterprise Chief Medical Information Officer and also a practicing emergency medicine doc at Harlem Hospital, which is one of our hospitals in the system.

PP: Thank you for that background. So, Mike, New York has been one of the hardest hit by the pandemic, and we’ve all seen the numbers and everything. Tell us a little bit about some of the changes that your organization has gone through in responding to the pandemic over the last few months.

MB: The pandemic did a bunch of things, one of which is that it accelerated plans, it accelerated some of our digital transformations. It brought us to a place where I thought we might be two years from now, but we were there in three or four months during the pandemic. A couple of good examples are, in our ICUs and our ED’s, we have vital sign monitors that are linked to Epic, so vital sign monitors can be on patients and it transmits to a central station. The nurse at the central station can monitor the patient and then that information automatically kicks into our electronic medical records. So, it’s a great time saver for the nursing staff and it also allows them to monitor up to 36 patients sitting at a station. And in our EDs and ICUs, we’ve had that since we went live with our new electronic medical records in the past few years. However, on our medical floors, our surgical floors, a lot of other units in our inpatient side of our hospital, we did not have that ability. One thing that became clear very early on, in the pandemic, was that the COVID patients were going to require continuous pulse oximetry. We were sending everybody home that had a pulse ox, 95 percent or greater, which I think is appropriate clinical practice. That means if you were getting admitted to our hospital, basically you are hypoxic, and the patient would sometimes deteriorate quickly. So, they really required continuous pulse oximetry. We did a whole bunch of things, telemetry devices cannot do just the rhythm strip, but they can also do pulse ox. And then we went out and bought hundreds upon hundreds of vital sign machines that could do this continuous pulse oximetry. Our medical floors were transformed in the matter of about six weeks from places where our nursing staff would go bed to bed, taking vitals to not having to do that and that was part of our long term plan. That’s something that I had wanted to do for the past year. But from funding, time, and effort, and where we were going to prioritize that shot up very high on our list. Another example is our telehealth, our ambulatory video visits. That’s one thing that we had started with, in a non-integrated fashion, meaning we would basically send a link to a patient, and they could click on it and come in and it was very sparingly used. That whole process has gotten accelerated. For us, the tide of the pandemic was in April. We were doing almost all of our visits either via telephone or the video. That was the transformation we never fully expected to go almost all of our visits. We didn’t expect in-person part of our ambulatory side to go away entirely and it did. It dropped to almost nothing for a couple months.

PP: I want to spend a minute more on the vital signs, the telemetry, the Pulse ox problem that you had to work quickly. I imagine that if you had to go out and buy hundreds of machines integrate them, reorganize your processes, train everybody, and so on. That must have been a gigantic lift for an organization as big as yours. How do you manage it?

MB: It was a gigantic lift. We developed a dedicated team and prioritized it. What we had been working on previously was integrating some of our procedural areas. So, our GI suites were all fully integrated. We took the teams that were doing that, and we focused them on our medical floor. We took anybody who was able to do this integration work and we made this our enterprise’s number one priority. We went from acute care center to acute care center, outfitting the site CMIO, CMO, CNO, like the site leadership. So, from one of our 11 acute care would tell us which unit they wanted integrated first and we would come in about a day. We would get that whole unit integrated. We would do it off the floor without exposing the IT staff to the COVID patients on the floor. The devices would be brought up. We would stay there and troubleshoot, and move on to the next facility the next day. Now, training the staff was difficult because training in the best of times takes time, and doing so in the middle of a pandemic when everybody is already stressed. Everybody already feels like they have too much work because they did. We had a lot of COVID patients, and it was stressful. So, trying to train people in that environment was hard. The thing that we had going in our favor was that this really was a time saver for the staff. So, people that saw the benefit invested the time upfront. But getting them to pay attention for that first couple of minutes, that was challenging. And frankly, that is why we’re continuing the training at this point. No one knows if New York’s going to get a second wave, but we certainly are preparing as if we are going to. Not every single bed in our hospital is capable of continuous monitoring at this point. But we continue to expand our number of beds that can do this. And really, I think what’s more important than adding those devices is that training these and getting our nursing staff and our PCAs, which are our patient care, associate with them. Getting them able to do this is what we are working on right now. It’s really where the rubber meets the road.

PP: I heard someone say that, 80 percent of these kinds of programs, even if they’re technology programs, is really about the people. 15 percent is about process and the remaining 5 percent is tech. And the tech is the easy part. Everything else that surrounds it and putting it in place and making it work seamlessly, that’s where the lift is. And that’s kind of what’s coming through from your comments as well. Let’s talk about telehealth. In the wake of the pandemic, telehealth was forced upon us. Prior to the pandemic we had all been making progress. Every healthcare institution in the country was adopting telehealth to some degree and some were a little further ahead than the others, but there was some progress. At a broad level in the first few weeks of the pandemic practically every institution that had telehealth capability kind of blew through the previous years’ total numbers within the first couple of weeks in terms of just the total visits that they had to manage, the telehealth platforms. Now that was all very emergency driven because of the pandemic. But three months, four months in what are some of the challenges that we are now having to address, having had to put in and accelerate telehealth adoption. What are some of the challenges that you’ve had to address and can you talk about one or two learnings?

MB: Sure. This is also relevant to what you were saying for the vital sign monitors. This is not my key project, telehealth is not my key project. It’s a clinical transformation. So, this is not just rolling up the technology and say, hey, you can do a video visit with a patient now. It’s all of the little workflow things that you didn’t. A couple of things that I’ve seen be successful with others that we are implementing now, they sound small, but I think they’re really important to the user experience. When I say user, I mean the patient and the provider experience. It’s virtual ruling. I remember when I started working at New York City Health and Hospitals, a decade ago, sometimes I would have to go out to the waiting room to call my next patient. We realized very early on that was entirely inefficient and we took that responsibility away from the doctor so we could work at the top of our license. But when we rolled out the video visits, we basically did the exact same thing. We had the doctor initiating the call with the patient, makes more sense in my opinion. It’s having really anybody else, if you have a medical assistant or registration staff, you can have them initiate the call with the patient. And if they’re having trouble, or if the patients having trouble getting on, it should be the MA that calls the patient, not necessarily the doctor. This isn’t different than if I was the one going up, had to call my patient from the waiting room and they weren’t there having to wait three times and go back a couple of days to go back. It would be a waste of my time. But if you can have somebody else do that and you can have your provider seeing another patient or finishing charting on somebody else, it is just a better use of resources. The thing is, we have those resources because the in-person volume went down. So, we had excess capacity of those ancillary staff. It’s really about leveraging mode. And another ancillary staff is that it’s really critical for New York City Health and Hospitals, those are important to a lot of organizations, is interpreters. How do you get an interpreter on the video visit? It’s something like 30 percent of our patient population is not English speaking primarily. So, that was absolutely needed. So, leveraging our in-house interpreters. It’s not just the video interpreters that we can call online, but there were problems integrating with those and we’re working diligently at that. But about using the resources you already have on site to help you with the technology. And that’s where we found the most success in this medium-term period.

PP: Now, related question. And this question probably is relevant in the context of the vital signs monitors as well. Ultimately, you have to integrate the data that is coming of your backend systems or of the devices that you put in front of patients or caregivers as the case maybe that’s kind of your world, I imagine, in many ways, CMIO. So, help us understand the data integration challenges. We know that there are several and they’ve been around since before the pandemic. What new challenges did it create for you and what new opportunities did it create as you really transformed the way you deliver care and interact with patients? Can you unpack that a little bit?

MB: Sure. The challenges when you’re talking about the data flowing in through the monitors: if the nurse is going to bed to bed and they write down the vital signs, come back over to the system and they type it. There might be a manual input of data, meaning that they might actually just type it in incorrectly. But otherwise that data is pretty accurate. If all they are being asked to do is verify that the information coming from the monitor is correct, they just being human like everybody. They might just say, yep, that looks right. And they’ll know the pulse ox might be reading zero because, 70 something percent, it’s not attached, if the patient got up to go to the bathroom. So, you do have various data entering the system, which is problematic. I got to tell you; I did not see as much of that as I thought. I think our nursing staff, there was a heightened level of awareness for our sick patients and they are the ones that were getting these continuous vital sign monitors. So, while certainly it’s something to watch out for, didn’t turn out to be a major problem for us. The opportunity, which is the other side of this, is that we put in a machine learning algorithm that took a whole host of factors. So, a patient’s age, patient’s diagnosis, their vital signs that were coming directly from these machines, their lab values. It actually was able to predict if the patient was going to deteriorate, meaning get intubated, be transferred to the ICU, or die in the next 24 hours. And using this as we use other early warning system to bring more critical attention to the bedside. And that was a major win for us, our staff liked that. In the face of an increased patient volume, we needed that more than ever.

PP: So, this is a great example from a clinical standpoint. So integrating the data to trying to do in real time, you’re running a machine learning algorithm on it that can provide you with some predictive values that help you target the patients most at risk for deterioration, and intervene in a timely manner and save lives. Great example. What about the telehealth side of it? How did you integrate the data? There is an administrative side of it. For instance, you mentioned that you used to send out a link. People would get on and do a video call. How would you link it back to your billing system as an example? Make sure that you capture encounters and the billing put it appropriately. And then doing it all in a HIPAA compliant way so that privacy and everything is taken care of. You talk a little bit about the access side of it.

MB: I think we’re speaking specifically about video visit here. But a related issue would be the incorporation of digital and digital vital signs, digital information coming from the patient that’s not a video visit. So, I’ll hit on that in a second. But in relation to the video, we had patients log in through their portal, primarily. I mean there are a couple of different ways that we did this. During the pandemic, I know somebody who likes to roll out an enterprise solution, get it adopted widely, and have really a single way of doing business. That wasn’t really a possibility during the pandemic. We had to use a bunch of different forms of technology to meet our various use cases. Speaking specifically about ambulatory scheduled visits, we use our patient portal, a large percentage of our patients had already an app on their phone. And if they didn’t have that app on your phone, we required that to put it on to have a video visit with us. Now, people that weren’t able to do that, we provided another means of coming in. But that was our standard way of doing business. And then from a billing perspective, what we realized, and what is not fully my area of expertise, but we did telephone visits and we did video visits. My understanding is that video visits were reimbursing about three times the rate of telephone. So, there was an economic push to move towards video. I think there is a clinical advantage of a video visit. The question is, how much advantage is that? I clearly want to be able to see my patients, then just eyeballing your patient, it has a lot of value. You get a sense of their respiratory rate. But we have both clinical and financial push to move towards video visits.

PP: What about other structures, your in-patient, virtual care, tele-ICU, and stuff like that. Maybe you could touch on that.

MB: We were a little bit further ahead with that for the pandemic, we had more experience. I think its easier to scale something that you’ve already had worked with, than rolling out something entirely new. And that’s true with every project I’ve ever done. This was really no different. So, yeah, we did a tele-ICU. We made it easier for folks to log into the electronic medical record from home and actually see the views of their patients that would be most beneficial to them and specifically in this case, to the intensivist, and then gave the ability for a video interaction. Now, I think video interactions are very helpful with ICU and we clearly did that. But interestingly, the video component in the ICU, specifically when I talk to my intensivists, it was valuable, but not nearly as valuable as I thought because so much of that data was already in the system. And ICU patients have such rich amount of data in the system, you have your event settings, your vital signs, your lab, your nursing. You have so much available in the system already that you don’t need to look at the event if that data is already in your electronic medical records.

PP: Interesting. So, back to telehealth and I want to touch on one more thing that is remote monitoring. Again, this is part of your world. You are taking care of your patients who are out there with chronic conditions, who are not necessarily coming into the hospital. You’re tracking them through devices and wearables and so on. Can you tell us a little bit about how any of that changed? And where do you see that heading in the wake of the pandemic?

MB: Yes, this is such a rich area to move into. I think there’s a huge amount of benefit here. I think most of your listeners will be enthusiastic for some of these specific projects that we worked on. If you have an implantable defibrillator, and you’re at home, you have an AICD, you don’t necessarily want to bring those patients into your hospital to get that device interrogated. Sure, if you’re sick and you need to come in during the pandemic, we want to take care. But if we could do that remotely and if we could get that information from your device without you having to physically come in, that’s a clear cut win. So, we’ve got a lot of projects like that. Now, the other very clear use cases for this are the tracking of your diabetic patients, tracking your hypertension patients. And to me, I think we never want to get rid of the in-person experience altogether. I think there’s a real value in doctor-patient relationship. Face-to-face interaction between hands on the patient, even if it’s not the most clinically beneficial, it has a therapeutic advantage. We’re not looking to get rid of that. But if I’m seeing one of my diabetic patients four times a year and now all of a sudden, I can look at their glucometer on a weekly basis and see how they’re doing and have machine learning algorithm seeing in the background, notifying me when things start to not look so great, that’s a clear cut win. And we’re there. This is not something that, we need more technology for. We are now at the point where we can do that. It’s about developing those workflows. And then what are you going to add to flag a patient like great. This patient is at high risk. But then what do you do? Is a phone call enough? Do you need to schedule for a diabetic, you need to schedule them with a nutritionist? Can you do look at their labs? And I think you it’s going to need to come in and get more lab work. We’re yet to see a whole lot of really rigorous studies on when X happens. This is the intervention that you should do that is clinically proven. And I think that’s really fertile ground for research.

PP: Yeah. Well the hypothesis here is already being validated through marketplace activity. We just saw the emergence of two big companies in this space, Livongo and Teladoc. One is primarily on the virtual consult space. And the other one is in the remote monitoring space and creating a gigantic entity, which kind of is a validation for the opportunity in this area. At the same time, I want to kind of explore the contrarian view a little bit as well. The recent data seems to indicate that telehealth visits have dropped off a little, maybe because they swung too much to one side in the wake of the pandemic. And to your point earlier, nothing replaces in-person care and for certain kinds of needs. I’d call it as an example, it’s hard to manage a condition entirely, remotely. So, we are seeing some of the swing back. But there are other issues related to access for rural or indigent population that may not have the broadband access, that don’t have devices, smartphones and things where you can jump on into a video console. Where do you think we are headed in terms of an equilibrium? Maybe from the point of view of your world at NYC H + H where do you see the equilibrium and what could be the roadblocks you have to overcome in order to really realize the full potential of telehealth and remote care models?

MB: I think it will be specialty-specific, meaning how much is in-person and how much is remote. If I’m going in to see my orthopedist because my knee hurts, there could be a lot of manipulation of my knee. And I think they are going to really need to feel and look at it. I think you’d be able to maybe lessen that on a video then, not none, but less. If you’re going to be seeing your primary care doctor to manage your hypertension and you’re coming in every four months because you’re having trouble with that. Well some of those visits can be done remotely and it can be done remotely without losing a whole lot. I think that the annual in-person physical is also going to be generational to certain extent. When I have the ability now to do video visits, and I can instead of taking a half a day off of work, I can hop out for 20 minutes on a call and then go right back to work. That’s what I personally would want to do as a patient for the foreseeable future. But if I need to go in and get bloodwork done anyway, well, I’d rather just do the visit in person. I’d like to see my doctor. So, it’s a question of the opportunity cost and what the patient is giving up. For example, if you have to come in any way to your ENT to get a scope done and you have an ENT who is going to be doing a scope on me. No, of course, I’d rather come in and get my blood work done and see my provider, all at the same time. But for those remote visits that are amenable to a remote interaction that don’t require physical contact, I think a lot of those are going to go away.

And when they’re settled out Paddy, I have no idea. If we switched to 90 percent video during the pandemic, let’s just say we were 100 percent in-person before. My guess here is we’re going to see maybe 20-25 percent of our visits on a video basis when the world goes back to normal. But after we get a vaccine and people feel pretty safe going back to their normal life, we’re going to see a tremendous increase in our video visits as compared to our baseline of six months ago. I don’t yet see it being the dominant trend. I think what we will see is more opportunities for low-intensity care interactions, which are – “Hey, what happened with your blood glucose? I saw it hit 400 today. What happened?” I could see that the social worker reaching out, but not replacing the doctors. I think it would increase the quality of care.

PP: I think whatever the next normal, it is going to look like what I kind of agree with you. I think we are going to see the needle shift towards virtual care models for many types of care. But then it’s especially dependent. I would imagine that more of ambulatory care and more chronic care is going to be amenable to virtual care models than procedures and things like that. But even for certain kinds of care, to your point, to see an orthopedist talk for oncology as examples. I want to leave you with one more question, which is, as they say – ‘never waste a crisis’. COVID-19 is definitely a crisis, but it’s also an opportunity. Where do you see the biggest opportunity in your world as a CMIO of New York City H + H, where you see the biggest opportunity arising from this crisis?

MB: So we are pretty large system, implementation of our new electronic medical records spanned a few years and we finished in March. So, we put in our long-term care facility in March, right before the pandemic started. It was great timing. What we used this crisis for was to act as a system, meaning we had system level data that we just didn’t have before. When we compared the capacity to bed capacity at one hospital towards another. We were really comparing apples to apples. This allowed us to transfer patients from the hardest hit hospitals to the less hard-hit hospitals and really have a fair basis in comparison for why we were doing so. This improved patient care. I think the strength is to save lives, because if you got a hospital that was way over capacity, we could get them out somewhere else. And the other receiving hospital had all of their data from our other hospital, which is a huge benefit to our system and eased the transfer process. But what I’m saying about acting as a system, the literature of the COVID pandemic changed at a dizzying pace. So, was hydroxychloroquine good or was it bad? There was a time where people thought it could actually do something positively. And I think that’s changed. But there are things that have been proven very effective. So, like dexamethasone, we have a randomized trial showing that it works. So, we have in our order sets, as soon as those trials came out, we added in dexamethasone.

MB: And, there’s a million different examples just like this. But when we made those changes, we weren’t making those changes at one of our hospitals. We made those changes at every single hospital. The reason it was so easy to do for us is that we only have one order set for this. So it drove us towards an enterprise standard and enterprise way of doing business. When we put into vital sign monitors, we didn’t all eleven of our hospitals weren’t buying their own vital sign monitors. We were buying them for them. So, we already had a clear path to integration. So, on the others, these examples and so many more. But we got to act like a system really came together. We were able to achieve more. I think that would best take way for our organization. That standardization allowed us to do more and deliver a better product to our patients and to our hospitals better.

PP: Fantastic. I think that is a fantastic take away. I’m afraid we have to leave it there, but such a pleasure having you on and look forward to following all your work on NYC H + H and all the very best to you and your team. Thank you for being with 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

Michael-Bouton-profile-pic

Michael Bouton, MD, MBA is a practicing emergency medicine attending and the Enterprise Chief Medical Information Office for New York City Health and Hospitals.

Dr. Bouton is focused on the development of health systems that provide access to quality care and that are financially sustainable. He was the first director of a homeless health clinic in Harlem, developed a respite housing program for homeless emergency department patients in Boston. He was also the director of pediatric ED at Harlem Hospital before getting involved in informatics.

About the host

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

COVID-19 has given us an opportunity to reset and create a better healthcare system

Episode #55

Podcast with Sara Vaezy, Chief Digital Strategy and Business Development Officer, Providence Health

"COVID-19 has given us an opportunity to reset and create a better healthcare system"

paddy Hosted by Paddy Padmanabhan

Sponsored by

Share

Share on facebook
Share on twitter
Share on linkedin
Share on email

In this episode, Sara Vaezy, Chief Digital Strategy and Business Development Officer of Providence Health talks about their recently published series of reports – COVID-19 Digital Insight Series – that describes new digital requirements and opportunities brought by the acceleration of virtual care models due to COVID-19. Sara also speaks about the current state of telehealth adoption level and possible reasons for its drop after the industry witnessed a surge in telehealth visits in wake of the pandemic.  

According to Sara, COVID-19 acted as a catalyst for digital transformation in healthcare. She categorizes the transformation happening in the healthcare industry in two possible ways. One, where the industry needed to control and tackle the challenges created by the pandemic and the industry mobilized its IT, digital, and technology services overnight. Second, is considering the pandemic as an opportunity to evolve the healthcare industry and finding new paradigms and ways of caring for people and business models.

She adds that the healthcare industry needs to design better experiences for increasing adoption of telehealth technology. The industry also needs core IT enablers to make it a success and provide better healthcare experiences to both patients and providers. Take a listen.

Sara Vaezy, Chief Digital Strategy and Business Development Officer, Providence Health in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “COVID-19 has given us an opportunity to reset and create a better healthcare system”


PP: Hello again and welcome back to my podcast. This is Paddy and it is my great privilege and honor to welcome back Sara Vaezy, Chief Digital Strategy & Business Development Officer of Providence Health. Sara is very well known and a thought leader in the space and she has just published a series of highly interesting reports on the current state of the healthcare market, especially from a digital transformation standpoint. Sara, welcome back to the show.

Let’s start from the top! Seattle was ground zero for COVID-19 in the U.S. and one of your hospitals treated the first patient. And you had come on this podcast right about the time in the early days of the pandemic to talk about the response effort. I urge our listeners to go back and listen to that episode. Now, you have published a series of papers called – COVID-19 Digital Insight Series and you have titled the series – Journey Toward to the Next Normal. Tell us how the series came about and how you went about putting this together.

SV: Back in February and early March, when we had the first wave of COVID-19 outbreaks in the regions where we serve our patients in the western United States. We had to mobilize our assets across the organization very quickly. That was the topic of our conversation last time, Paddy. As we continued throughout this process, we realized that not only from a build standpoint, we have a significant product development organization that can build technology to address these needs. Everybody had mobilized across the country. Healthcare IT, digital, and technical services needed to address and tackle the challenges that we were all collectively facing within COVID-19. Healthcare systems’ challenges are on full display now. How we are struggling with the business model for healthcare and the strange incentives that it puts in place and creates for providers and for health systems, for instance, in a fee-for-service environment. All these things came on full display, and we saw an opportunity for us to reset and use what is out there and create a better system. So that was sort of the goal that we had. How do we process all that is happening? What are the key trends? What are the things that will be accelerated because of this unique catalyst of COVID, like telehealth, for instance?? What are the potentially new opportunities? What we’ve realized is it’s mostly going to be about acceleration of new paradigms and new ways of caring for people and business models that actually prioritize health and well-being. This was about taking all the stuff that was happening and trying to think about how does this actually contribute to a reimagined system that works better for our patients and our providers.

PP: You have not only looked at what was happening within the Providence system, but also looked across your peer group health systems. You interviewed several people who are in your peer group. Is that correct?

SV: Yes, so it was not just focused on Providence. We did not even stick with just our peer group. We interviewed over 100 individuals that spanned different segments of the industry. We talked with other providers and with payers. We talked with folks in private equity and venture. We spent quite a bit of time with policy makers and folks who had deep expertise on the regulatory environment. We spoke with clinicians. So, we really took a broad approach to this and interviewed folks from as many segments as we possibly could of the industry to get a holistic view.

PP: I read several of the reports, and it’s outstanding stuff, it was very informative and I learnt a lot of new things about what was really going on in the market and the changes. Your first report of the series starts by calling this – The end of the beginning – is kind of an ominous Churchillian reference from the World War II. This quote goes back to the very early years of World War II. We knew that in hindsight that the war was then extended for a few more years. So, I hope your comment doesn’t imply that we’re going to have another four or five years of COVID-19 upon us. The report goes on to talk about COVID-19 and the response effort. But then interestingly, it talks about the first order and the second order impacts. It’s a really interesting framework. Can you help us unpack the structure of the report? How did you go about setting it up this way?

SV: We made that Churchill reference, as you’ve articulated, of course, in hindsight changed our view of how we look at that statement. I would say that probably the same applies in this situation. When we finally published that initial piece, we thought we were at the end of the response phase or the mobilization phase. I think that depending on which region folks are in, there are some still in that mobilization phase. So, there is a bit of hindsight for us in terms of not being 100 percent accurate. Hopefully, to your point, we don’t have another four to five years of this. Knowing that because the situation is evolving so rapidly that it’s likely that some of what we’ve proposed in this is incorrect. So as your listeners engage with the reports and have thoughts, we would love to hear from them and engage in that conversation around how things are evolving post what we’ve already articulated and perhaps proving us wrong or bringing into light new information that would be informative. So, the way we thought about the report was, when COVID started, it was a catalyst. It wasn’t necessarily the reason why things happened, but it was a catalyst for sort of two paths of activity. The first was all COVID related. How do we rapidly adjust to this very acute situation? That was the mobilization phase, so the acute phase dissipates, but its not going away permanently. So, we must continue to manage and mitigate and monitor the situation. So that’s one stream around mobilization and mitigation. The other stream is, in the interest of responding to a very acute situation, what we are now dealing with is that our business has been fundamentally disrupted within providers. Most of the providers had to shut down facilities, brick and mortar facilities, at least for some time because of the unknowns and the risk of exposure. It disrupted our business fundamentally. And then we had to travel down the path of recovering from that. So, it’s not COVID specifically. It was catalyzed by COVID but any other kind of major catalytic event that would have caused us to shut down our clinics would have had a similar sort of consequence. That actually makes way for this sort of next possibility where we have an opportunity to take a good, hard look at how to evolve from where we are. We have to immediately get back to recovery and understand how we can, in the near term, get back to business. But then in the long term, this fee-for-service model, for instance, isn’t necessarily working for us. How can we evolve pass that and use this as an opportunity to do so? It’s really not a COVID-related path of work. It’s more about continuing to serve while evolving. It’s that sort of classic refrain of changing the wheels on a moving car or something like that. And then both kinds of paths result in a bunch of different ultimate consequences. Mental health, behavioral health, for instance is a hugely impacted area. The second-order impacts and outcomes in this report were not intended to be lower priority, but just that they are impacted by these two streams and everything that’s happened across the industry. So that’s how we thought about it in terms of the most fundamental drivers of change. And then other impacts and outcomes that were a result of that.

PP: So, there is an underlying theme of an industry in transition, transformation and everything that you have taken for granted about the fundamentals of the business now up for discussion. The report talks about business model transformation, new norm for patient safety, such as contactless experiences that you were alluding to in the context of COVID-19, and about industry consolidation and what is common. Obviously, financial distress is the reality for many health systems. Then you’ve got the whole supply chain and you’ve got a lot of other things going on. The underlying theme that permeates through all the reports is that of an industry in transition, and how do we get business back to some level of immediate normalcy. But really, It is about how do we prepare for what is inevitably going to be a very different normal, which is what you’re referring to as the next normal. Can you share a couple of big insights that came out of this work that you do?

SV: I’ll give you one that’s very relevant in the context of a lot of change happening, and that’s around telehealth. So, we’ve been talking as an industry about telehealth for twenty-five years, possibly more. But the industry and we haven’t really paid for it. We haven’t had the underlying enablers to make it a success. For instance, we have not had the legislative or regulatory framework underneath to ensure that telehealth was viable from licensure, from a reimbursement standpoint. There are just a lot of the underlying enablers that haven’t been there. Another aspect of it is that we haven’t had a lot of adoption. Most folks had not experienced telehealth as patients and our providers weren’t really using it. Providence itself did not have telehealth as a common modality available to our physician enterprise to serve our patients in our ambulatory network prior to COVID. And what we saw was that now millions and millions of individuals have experienced it for the first time. One insight that we got was that folks are online now, which means that they are more susceptible to not being our patients anymore. There has been this general trend toward patients not being quite loyal to one system or one provider. And with the sort of proliferation of all of these potential telehealth solutions out there, coupled with the fact that folks are now actually utilizing them. They are much more open to being grabbed by a really great experience that’s provided by the 98point6 or an Amazon care. This whole opening it up is like our biggest strength and our biggest weakness at the same time. We now can do telehealth at scale. And unfortunately, if we don’t move quickly enough, it could work to our detriment. So that’s one piece of it. In addition to that, the notion of scale, we built a system that was able to scale, but a lot of the providers really struggled with scale. What we learned was that the industry, from a telehealth standpoint, had been very feature oriented. Because of which the investments did not happen across the board to scale up these technologies. And scale became the most important thing in delivering high-quality telehealth experience that didn’t require hours of waiting. As a result of that there was a lot of the big providers of technology came into telehealth as providers of telehealth, for instance Zoom became a very prominent player as it relates to telehealth. Microsoft increasingly looks at these kinds of things. We think that over time, the actual video conferencing will likely be largely commodities. It’s going to be more about the value-added services and things that you can layer on top of that experience to make it really worthwhile for the consumer.

PP: I actually just published an article in CIO magazine where I explore telehealth in detail. It focuses on the limits of telehealth because ultimately, as administrator Seema Verma said on one of her blogs recently, telehealth is not going to replace the gold standard in-person care in totality. There are several aspects of healthcare that are going to turn towards a virtual care model. But there are limits to that. Those limits are determined by what types of care you are talking about, what kind of populations you’re talking about, and a variety of other things. I have also seen data that suggest that even though telehealth visits, virtual consults in particular and real-time video consults and video visits, dramatically went up in the wake of the pandemic, those volumes have dropped off a little in the last month or so. And there are several reasons for that. There are also obviously the uncertainties around the waivers that are going to stay in place and whether the reimbursements are going to continue and so on. Do you think we are still a long way away from reaching some kind of a natural limit for telehealth penetration in healthcare, or do you think that we’ve kind of tapped?

SV: From a Providence standpoint, we have seen a similar trend where there was a peak and then decline. And now we’ve stabilized. What we are seeing is a result of a couple different things. One is that the experiences for telehealth still aren’t great. As practices started to fill back up and could open with physical visits, it’s difficult to maintain and sustain the peak progress and momentum when the experience is challenged from a telehealth standpoint. It is incumbent upon us to make that experience better, to drive adoption. This is not about all telehealth. I think there is always going to be a mix. And where we have a long way to go is to identify the mix and the kinds of use cases, that work for telehealth because we are still sort of new to this. As an industry, we still don’t know exactly what are the great use cases that we have demonstrated value in. But we have some indications and the more that we can kind of hone the experience and get more data around those use cases, for instance, certain types of chronic disease management can be done really well remotely. Certain maternity care can be done well remotely. Now that we have some folks that have adopted the technology and have experience with it. I think we can start to gather data around how to make those experiences more efficacious and more value added for customers. That’s where we have the biggest runway or ramp up that we still need to engage in. The technology and the experience still need to improve as well. But how we utilize it for which use cases that are most appropriate, is the biggest kind of body of work that we still need to do.

PP: I think that is great insight because there’s so much that is broken or suboptimal in the telehealth experience today that even by just streamlining it can make it a little bit more seamless. Can you tell us what do you plan to do with this body of research ? Firstly, of course, you’ve done yeoman service in sharing with us, which I think is fantastic. What do you plan to do with the reports themselves or the insights that you gained from them?

SV: These are not one and done kinds of things. What we were hoping to do is get the industry kind of talking and start identifying opportunities either for individual systems or individual sectors, also opportunities for partnerships and just collaboration around common themes. That was the big objective, to get the conversation going and make room for collaboration around specific areas. Paddy, you had talked about public-private partnerships that have emerged as a result of this on LinkedIn. I absolutely think that is very interesting and important area where we could accelerate those private public partnerships and make them effective. The second is we are going to use this as a basis for our own strategy. And we are taking a long, hard look at our digital strategy and identifying where we need to pivot, where we need to sort of double down, for instance, as it relates to business model evolution. How can we really support the movement of our organization, to managing risk with specific populations like those folks who are on Medicare advantage? And a unique, interesting wrinkle is that they are older patients. So how can you really make digital work for them? So, we are going to use it in that way. And then finally, we were not intending these to be just one report. We are going to continue to monitor all these trends and update them. And when we are wrong, we are going to write about it. And when there’s new information, we’re going to synthesize it and continue to drive the conversation so that as an industry our learning can accelerate, and we can work to solve these really big problems more efficiently.

PP: Fantastic. That is so well summarized once again for our listeners. For those who could not catch it earlier on in the conversation, the series of papers is titled – COVID-19 Digital Insight Series and it can be pulled off the Providence Health web site.

SV: Yes, you can go to our Providence Digital Innovation Group, Resource Center, which is providence-digitalinsights.org and you can download them all there.

PP: If there’s anyone out there who wants to really understand, get a finger on the pulse of what is going on in digital transformation, especially in this post-COVID-19 era. There’s no better place to start. Sara, thank you so much for coming back on the show again. 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

saraveazy-profile-pic

Sara is the Chief Digital Strategy and Business Development Officer at Providence. She leads the development of the digital strategy and roadmap, digital partnerships with health systems and technology companies, commercialization and digital business development, technology evaluation and pilots, and thought leadership at PSJH.

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

About the host

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

Data if done right, has the power to galvanize communities, inform leaders, and empower people.

Episode #54

Podcast with Steve Miff, PhD, President and CEO of Parkland Center for Clinical Innovation

"Data if done right, has the power to galvanize communities, inform leaders, and empower people."

paddy Hosted by Paddy Padmanabhan

Sponsored by

Share

Share on facebook
Share on twitter
Share on linkedin
Share on email

In this episode, Dr. Steve Miff, President and CEO of Parkland Center for Clinical Innovation (PCCI) discusses how they build connected communities of care with a focus on cutting edge uses of data science, social determinants of health, and clinical expertise across clinical and healthcare community settings. Steve also speaks about his recent book – Building Connected Communities of Care – based on the experience at PCCI.

At PCCI, the belief is that data if done right has the power to galvanize the communities, inform leaders, and empower people. According to Steve, healthcare is a complex, multi-year journey and having a connected community of care during a pandemic, such as COVID, is essential. To control the pandemic, we need better targeting of COVID hotspots, effective and efficient communication between healthcare providers and community-based organizations, and connected services through referral directories.

Steve stresses that while technology is a critical enabler for connected communities of care, there is a need to invest in robust backend data management infrastructure. Take a listen.

Steve Miff, PhD, President and CEO of Parkland Center for Clinical Innovation in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Data if done right, has the power to galvanize communities, inform leaders, and empower people.”


PP: Hello again, everyone and welcome back to my podcast. This is Paddy and it is my great privilege and honor to welcome back, Steve Miff, President and CEO of the Parkland Center for Clinical Innovation or PCCI, as it is called. Steve, thank you so much for setting aside the time and welcome back to the show. For the benefit of our listeners can you tell us who PCCI is?

SM: I have a huge passion for innovation and to use next-generation analytics and technology to help serve the most vulnerable and those underserved residents across our communities. PCCI has been the perfect place to make this a reality since it is a mission-driven organization with some interesting expertise in what I consider to be very practical application of both advanced data science and social determinants of health. At PCCI our focus is to try to innovate. We are called pioneers in new ways to health. We started the department of health and hospital system and spun out as an independent nonprofit organization in 2012 to not only serve the needs of Parkland but to also pursue additional transformative initiatives that could have a broader impact. At PCCI, we believe data if done right, has the power to galvanize communities, inform leaders, and empower people. We also believe that clinical data only paints a partial picture of an individual and his or her specific needs. Our business model focuses on cutting edge uses of data science, social determinants of health, and clinical expertise across both clinical and community settings.

PP: We covered some of your work in our previous podcast. Since then, you have written a book along with one of your colleagues. The name of the book is – Building Connected Communities of Care. Would you care to tell us what is a connected community of care?

SM: A connected community of care, I consider to be a local ecosystem that is comprised of health systems, payers, community-based organizations, philanthropic organizations, and municipality officials. They are all connected by digital technology and centered around the need of an individual to address his or her social determinants of health. I consider the aim of a connected community of care is to improve the health, the safety, as well as the well-being of the community’s most vulnerable residents and do this in a coordinated, cost-effective, and ultimately sustainable manner.

PP: I was fortunate to obtain a copy of your book and I read through it. It is very interesting and is a great playbook for several healthcare executives in different roles. In your book you explain in detail how to build this community of care. This ecosystem that you refer to of different participants in an individual’s care, especially those who are underserved and are vulnerable populations. This is obviously particularly relevant in the current context of the pandemic. You’re based in Dallas, Texas, and it has seen a surge. But how have the core themes in your book helped in responding to the pandemic? I know the book came out a little bit before the pandemic but felt like a lot of those themes were still probably very applicable in the context of the pandemic. Can you share a little bit of that?

SM: I think we’ve been fortunate that we’ve been on this journey in Dallas for the last six plus years. We realized that having a connected community of care during a pandemic is more important than ever. I think there are three key themes that we’ve been leveraging here locally, as we’ve been trying to connect individuals to better manage the pandemic.

One is targeting. The first thing that we’ve done is to be able to bring social determinants of health data that we’ve had through the connected communities of care with the clinical data and other demographic information and mobility information, and build a corporate vulnerability index. That has been instrumental to give us a very direct and tangible way, to understand where individuals across the community are. They are most vulnerable for not only contracting the disease but also displaying symptoms that require more advanced interventions. So, being able to use that to work with community-based organizations, local government leaders, and several large health systems across the Dallas metroplex to quickly assemble not only the data, but use that to identify and hotspot neighborhood specific locations where the virus is having a disproportionate impact on the residents. To be able to really inform where testing should be done, both physical locations as well as mobile testing and do it in a way that not only meets those needs, but is also very accessible by those that might lack transportation or have difficulty getting to the more traditional points of access. I think that is the first component, the targeting piece.

Number two, is the communication and the value of the connected communities of care communication network to link the healthcare providers and CBOs that cannot be underestimated as it represents a highly effective and efficient mechanism to disseminate information, particularly information that requires both clinical information and a specific element about at-risk population. And we’ve seen first-hand that communication delivered to community residents through familiar entities, whether it’s a food pantry at a homeless shelter or a place of worship, are much more effective than community wide public information campaigns, broadcast, radio or television. They all play a role, but similar to targeting and understanding where resources are needed, targeted messaging aims at specific community residents. In this case, they have been tested positive for COVID-19 or are living in close proximity to other individuals previously diagnosed, much more effective when their communication is done via those known entities in the community. Having already an established relationship via connected community has proven to be very beneficial.

And the third one, is truly connecting services. One of the first things that we’ve always considered to be really important as part of a connected community that technology piece is to have that up to date referral directory of who’s offering services, where and what type of services, who’s eligible to receive those services. As the pandemic started, we realized that those referral directories need to be updated on a daily basis for them to have the right information, because not only the supply of food or other services was becoming challenging, but also the volunteers that the community based organizations were previously heavily relying on. So, the hours and the availability of resources changed. Having an establish connected community and ecosystem to be able to update those referral directories real time became a very important component of managing this on an ongoing basis.

PP: It sounds to me like for all these years, you have basically been preparing for the pandemic in many ways and you were ready when the pandemic hit. You had the information on your communities, where to reach them, who they are. You had the partnerships with the community-based organizations who could reach out to them. And you have the technology infrastructure that could quickly identify at-risk individuals and populations. Now, were you able to enhance the value of this platform or this service, this community that you’ve built by additional partnerships like maybe public health agencies for maybe launching contact tracing as an example? Were you able to turn on those kinds of things as a consequence of the pandemic? Did you have to make any changes to the platform?

SM: Fortunately, we built a platform that is robust enough to be able to manage these very specific, not only personal information but health information. I think it’s a very critical component because we’re able to quickly create data sharing partnerships with the local health department, and that something was an important piece before, but became a critical component during the pandemic. The ability to integrate and merge PHI data with other factors is something that was very important. I think about the technology aspect itself, there are several things that are important.

One, is the ability to integrate and bring healthcare data with other social determinants of health data that requires a level of security that needs to be HIPAA compliant, multifactor security, etc. It requires how you deploy it rapidly and for it to be cloud based, accessible anywhere, we get an internet. That is something really important and also minimize the onboarding process. And that’s something that our partners at PIECES Technologies who are managing this on an ongoing basis. Also deployed a web-based opportunity for community-based organizations to be able to do the right licensing, download this quickly and become part of the connected ecosystem. Those are just a couple of the key elements that have proven to be very important as the epidemic has played out.

PP: In your book, you basically lay out the different phases of setting up a connected community of care as a six-step process. And it includes several things: a legal framework, governance, and so on. Obviously, one of the tracks is the technology track, which is something that PCCI is heavily investing in. I read the chapter, basically the technology track, there are two components to it, data component and the underlying infrastructure component to it. So, in the data and the analytics, you spend a long-time kind of building up the platform. Did you develop any new algorithms or capabilities specifically in response to the pandemic?

SM: A couple of points, one, our patent application for our SDOH case management technology has been approved. And I believe this is the first patent for this type of a system in the space. It’s kind of nice that they came together right when we released the book. I think that is another important development in this journey, as you mentioned, that we started a while back. The key things that have been relevant during COVID-19 are not only the front-end technology itself but its integration with electronic medical systems such as Epic. The technology now is on the app orchard. So that level of integration is important on how you connect to the providers?

I think that the second one, I mentioned briefly was the ability to and download this for quick onboarding, particularly on the community side.

And the third factor that was mentioned is the ability to have this multi-level of consent because ultimately consent needs to reside in the hands of the individuals that we are trying to help. But giving those individuals multiple ways to opt in anywhere from just sharing basic demographic information all the way to be able to share sensitive information, whether it’s around the safety and domestic abuse or around two very specific comorbid conditions. That is something critically important. We have seen a measurable impact in our ability to actually use this technology during this time.

PP: Congratulations on the patent and this is a great news. All the very best with that. Let’s talk a little bit about the community partners themselves. You’ve gone out and built this fantastic platform, you’ve got the governance, players, data, consent rights and all of the good stuff that you’ve put in place. What kind of enablement do your partners need to participate effectively in this connected care ecosystem? Can you give us a couple of examples of some of the typical challenges that you’ve had to overcome? I hear, for instance, about the digital divide where you might have the technology, but your communities may not be technologically ready to accept it, either because of bandwidth issues or lack of access to devices. Tell us a little bit about a couple of the challenges that you have had to overcome to build the community of care.

SM: You are so right in that, so it’s sort of as we structured the book. Technology was one of six chapters. And while it’s a critical enabler by itself, it cannot solve for everything. So, of all the other components probably one of the most important one is the governance upfront to be able to establish some of those specific areas of how data is being shared. Also, to establish how consent of some of the other things that we’ve talked about. Then some of the other factors, one being the community workflow is so important. So, we can help those community-based organizations figure out how do they weave this in within the processes that already have. And they’re working on a meeting to comply with. To be able to demonstrate the effectiveness and the value that they bring to those that fund their operations.

There are actually a couple of different things that are really important. One is the building of the capacity. Just because we are able to provide a community-based organization with technology, doesn’t mean necessarily that they can use it to its full effectiveness. So, I think building their own capacity, not only how to use the technology, to weave that in within their workflows, but constantly provide ongoing training is important. This is because often times they have quite a bit of turnover as they rely on volunteers. Those pieces become very important in this journey.

Number two, I think is important is to really help them. Again, this kind of goes into the capacity building to define and measure and use that. The backend reporting pieces of the technology so they can measure their outcomes. And in this case, most of them is the social outcome measures that become really important, things such as time to help somebody to obtain stable housing, to return to shelters, reduce rates, meet requirements, maintain housing assignments in transitional care units, etc., or documentation of a food insecure clients visit to a food pantry partner and adequate food provided to obtain that food. So those things are concurrently important on how useful technology can be to do some of their social outcome measures and how they can actually report on the impact they’re having.

And then one of the other things is, it’s not just funding the technology itself, but that backend digital data environment. You need to be able to enable them to provide you with the information in whichever way they can. Oftentimes we talk about, APIs, FHIR APIs and all the new things to integrate. In this case to be able to just ingest a spreadsheet here, you have to have that flexibility to be able to meet them where they are.

PP: You don’t have to make technology more complicated than it has to be. And yeah, we all like talking about FHIR APIs and so on, but spreadsheet can do a lot of good on its own, nothing wrong with using a spreadsheet. So, Steve you wrote this book and it was published just before the pandemic hit if you had the opportunity to release this book today, what would have changed in the book?

SM: I don’t think much would have changed. The message to me remains the same, that this is a complex, multi-year journey. And if you wait for a pandemic to start, you are probably late. So, you need to start now with a focus on how I manage beyond the pandemic. As we look at our own journey, there is the need to really start with a readiness assessment, to build a plan before you even jump both feet in and to build a connected community of care. You cannot stand up a fully functional and deploy the connected community overnight. Given all the other urgent priorities during a pandemic or natural disaster, you need to start doing this now for the next need. Each market is different and there are likely elements that can be leveraged. There are many things that I would say define a market maturity, things such as access to the social economic data, the willingness, and ability of organizations to collaborate, what and how the local incentives are structured. What is the maturity of the committee-based organizations and how aggregated or distributed they are throughout the community? So first, you need to sort of answer a few critical questions around, are you ready? Meaning that the entity that’s taking this on for the community, how ready is that community? And who do we need to work with first? What should be the measurement framework and what’s the sustainability plan? Because it’s not just getting it started, but then how do you sustain it over time? So not only sort of thinking about that front end component, but the other thing that it forced us to sort of just take a step back and think about is building and deploying it, what are the top three things that you need to consider? I mentioned that this being multi factorial, multi-dimensional, its people, its processes, its technology. And one of the new entities into this equation with COVID-19 been the public health department, needs to be an integral part of it.

Number two is engagement, which is complex. You have new diverse organizations that evolve. Many are small and many are volunteer based. The current challenge is how do you do this virtually and you do need to rely on the broad technology more than you have in the past. And how do you actually manage through staff shortages? As I mentioned, a lot of the community-based organizations’ motto is to rely on volunteers. How do you manage and enable them to manage through that? And finally, the technology and data are essential, it is an enabler. And you need to be able to integrate and manage PHI, not just social determinants of health. So that is why that upfront governance for the data decisions, data use, data sharing workflows is so critically important.

PP: I have to tell you, the book has so much for so many different types of executives within the healthcare ecosystem, regardless of which part of the spectrum you’re on, a private sector public sector, on the technology side, or on the administrative side, or even on the clinical side. There is something in the book for everyone. With your permission, I’m going to borrow some of those ideas in your book for my own work, because there’s just so much there that you’ve put into it. I strongly recommend anyone listening to this podcast to pick up a copy. You mentioned something about whether the pandemic has changed your views on what might have gone into the book. As you know, I’m coming out with my second book, co-authored with Ed Marx, on healthcare digital transformation. We did see a big change as far as the pace of acceleration of digital transformation, especially the adoption rate of telehealth and virtual care models and the shift towards those models accelerated in the immediate wake of the pandemic. Our book was going to come out in Q2, and we had the opportunity to put in some of our observations on what we saw happening in the immediate wake of the pandemic. Steve, thank you so much for coming on this podcast one more time. And for those listening, Steve’s book – Building Connected Communities of Care, is absolutely a real hands on playbook for anyone in this space trying to drive change by using technology. Thank you again, Steve. Look forward to speaking with you soon.

SM: Paddy, thank you so much for having me and thank you to all your audience for the opportunity.

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

Dr. Steve Miff is the President and CEO of Parkland Center for Clinical Innovation (PCCI), a leading, non-profit, artificial intelligence and cognitive computing organization affiliated with Parkland Health & Hospital System, one of the country’s largest and most progressive safety-net hospitals. Spurred by his passion to use next generation analytics and technology to help serve the most vulnerable and underserved residents, Steve and his team focus on leveraging technology, data science, and clinical expertise to obtain unique social-determinants-of-health data and incorporate those holistic, personal insights into point-of-care interventions. Steve was the recipient of The Community Council of Dallas’ 2017 Social Innovator of the Year award and a finalist for the 2019 Dallas Business Journal most-admired healthcare CEO. Under his leadership, PCCI was named one of the 2019 Dallas Best Tech Startups by the Tech Tribune.

Steve earned his PhD and MS degrees in biomedical engineering and a BA in economics from Northwestern University. He has been an adjunct professor of biomedical engineering for more than five years and has authored more than 100 thought leadership, white papers, and peer-reviewed publications.

Before joining the nonprofit world, Steve served as the General Manager at Sg2, a national advanced analytics and consulting business serving over 1,200 leading healthcare systems, and as the Senior Vice President of clinical strategy, population health, and performance management at VHA (Vizient Inc.). He has also performed in various roles at the Rehabilitation Institute of Chicago, the National Institute of Standards and Technology, and St. Agnes Hospital System.

Steve has served on the Senior Board of Examiners for the Baldrige National Quality Program and on the Executive Quest for Quality Prize Board Committee for the American Hospital Association. He currently serves on multiple other boards, including DFWHCF, NurseGrid and the SMU Big Data Advisory Board.

Steve is a first generation American and he lives in Dallas with his wife of 23 years and their precocious seven-year-old daughter. He is a data and technology geek, an avid sports enthusiast, world traveler, and a self-taught sous-chef and mixologist.

About the host

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

Emerging healthcare technologies will enable higher level of care delivery with fewer resources

Episode #53

Podcast with Jeff Short, Vice President and Chief of Staff, Montefiore Health System

"Emerging healthcare technologies will enable higher level of care delivery with fewer resources"

paddy Hosted by Paddy Padmanabhan

Share

Share on facebook
Share on twitter
Share on linkedin
Share on email

In this episode, Jeff Short, Vice President and Chief of Staff at Montefiore Health System describes how Montefiore prepared for one of the biggest surges of COVID-19 cases in the country, and how they used emerging healthcare technologies to manage capacity and deal with the crisis.  

By end of April this year, 80 percent of all patient visits in Montefiore were being managed through telemedicine. Telehealth visits volumes have fallen back a bit since then. Jeff believes that face-to-face visits in certain specialties will always remain essential, however, with the ease of working with patients digitally, we will continue to see an increase in telehealth visits. Jeff defines digital health as the use of technologies such as digital front doors and telemedicine to improve patient engagement and access to care delivery. He further states that once we get efficient at delivering digital care and leveraging emerging healthcare technologies like chatbots and AI, we will be able to treat more patients at a higher level of care with fewer resources.

Montefiore Health System is one of the leading medical centers with 11 hospitals and over 300 ambulatory locations. They mainly serve the populations in the Bronx and Westchester counties.

Jeff Short, Vice President and Chief of Staff, Montefiore Health System in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Emerging healthcare technologies will enable higher level of care delivery with fewer resources”

PP: Hello again, everyone and welcome back to my podcast. This is Paddy, and it is my great privilege and honor to introduce my special guest today Jeff Short, President and Chief of Staff of Montefiore Health System in New York. Jeff, thank you so much for setting aside the time and welcome to the show.

JS: Thank you, Paddy. I really appreciate the opportunity to be here. I want to congratulate, as you recently completed your fiftieth podcast. So, congratulations! That’s really a great milestone and I’m also looking forward to reading your new book, Healthcare Digital Transformation. It’s where we are, so I can’t wait!

PP: Thank you. I greatly appreciate that. So, Jeff tell us a bit about Montefiore and the patient populations you serve.

JS: As you mentioned, we’re in New York. Montefiore Health System and Einstein College of Medicine form one of the nation’s leading academic medical centers. We have 11 hospitals, approximately 3000 beds, and over 300 ambulatory locations. We serve mainly the populations in the Bronx and Westchester counties. We are major employers in both geographies, we serve a diverse population both ethnically and socially. And it’s been an incredible experience working with Montefiore and seeing all the good that we do in the communities that we serve.

PP: If I’m not mistaken, you also serve possibly one of the most ethnically and linguistically diverse populations in the country, if not the most diverse population. Is that correct?

JS: Yeah, depending on how you measure it. But definitely one of the most diverse populations in the country.

PP: New York has been one of the hardest hits by the pandemic, and Montefiore was featured in this fascinating TV program on CBS. Those who haven’t seen it, I strongly recommend it. It’s called ‘Bravery and Hope’, which took viewers like me to the frontlines of the COVID-19 crisis and was an eye-opener to see what really happened in the frontlines of a crisis like this. So, Jeff I know that Montefiore stood up telehealth operation practically overnight. Can you tell us a little bit about that experience?

JS: CBS did an incredible job of capturing what it was like during the surge of the pandemic. In the days prior, we spent a lot of time preparing. One of the things our network performance group did was to regularly update predictive models based on what was going on in Italy and around the world and in New York. When we looked at the numbers, we realized it was not going to be a linear increase. It was going to be an exponential increase. I remember one day looking at those projections and realizing that we could be out of capacity in a few days and out of our surgeapacity a few days after that. It really hit home how we needed to change. We knew we were going to have a wave of patients coming, we didn’t have steep, but it looked pretty daunting. Our facilities team did a great job by extending capacity. We put new rooms in our ORs, cafeterias, auditoriums. We redeployed a lot of our clinical staff. But the real question was, how are we going to leverage our intensivists to treat all those patients. We knew we’re going to need that level of care. One of the people featured in that video, Dr. Michelle Gong, who is our Chief of Critical Care, worked with our team and with IT and bioengineering. In a span of a few days, the team stood up a 24/7 ICU command center. My team put together a new server to feed healthcare information and healthcare records to a central location – Bioengineering linked, real-time, vital signs, ultrasound results, electrocardiograms. To all the physicians in our ICU command center, we gave iPads out to each unit. This way they could do bidirectional communications by the command center. So, when we were done, essentially what happened was a clinician anywhere in the facility could connect with one of our critical care pulmonology specialists in the command center for assistance with the patient. In a span of mere days, we went from nothing to a fully functional ICU command center, that really helped us deal with the surge capacity.

PP: That is an incredible story. What about the patients? What about those who wanted to either come in because they felt they had symptoms or others that were in your care, like the chronic population and so on, because you obviously locked down the entire facility for a period of time like everyone else did in order to deal with the COVID-19 cases. Did you already have or were you able to turn on a telehealth/ virtual concept kind of capability to help your patients?

JS: Yes, absolutely. In the early days, no one wanted to go see the doctor for elective care. Nationally, over 70 percent of in-person visits were canceled and we saw the same experience here. Lucky for us, the CMS approved 80 new services within a few weeks of the pandemic hitting the US, which was really fantastic. But what we needed to do is create a new solution. So in about a week, March 11th was our first patient, we started to get things in place to create the ability to deliver contactless care to our patients. By March 26, our team built the infrastructure to enable us an Epic to schedule document and bill for a telemedicine visit. We identified our partners to help us build a platform and an app. By April 1, we had launched what we call Montefiore First, which is an app platform that is in Android and the Apple store. And by June, it was among top 100 medical download on the Apple store. So, by the end of April, 80 percent of our visits were in telemedicine. Right now, it is shifting back a bit. But in the last 12 weeks, we have had 250000 telemedicine visits. In February, we had zero. We went from zero to doing most of our visits in telemedicine quite quickly. And, we’re really not alone, across the industry, we have seen 50 times to 150 times increase in telemedicine.

PP: I want to go back to one comment you made very briefly, that is you’re seeing telehealth visits kind of fall back a little bit. We know that the acceleration of telehealth and specifically virtual consults and everything took off in the immediate wake of the pandemic. But I am hearing from across the board that those volumes are now kind of going down a little bit, either because patients are coming back into the hospital or because there is not that much need. What is driving that? Why do you think telehealth is going down? Was it because pent up demand for in-person visits is now coming back? Or are people not happy with Telehealth as an alternative? What do you think is the reason?

JS: I think it is in part of patients that needed to be seen face-to-face. We’re putting off care. So, they’re definitely rushing back in. I think for certain clinicians and certain patients, there’s a comfort level with face-to-face. But I do really think that things have changed permanently, and the change is here to stay. Before the pandemic, a survey done by McKinsey stated, 11 percent of patients were interested in telemedicine, post-pandemic 76 percent, the same survey updated. We’re interested in using it going forward. We will always have face-to-face care and certain specialties will remain that way. But as we get better and more comfortable working digitally or remotely with patients, those numbers will continue to increase. Also, as adopters become more comfortable, as technology providers create more in-home devices that are linked through your smartphone and operate effectively, we’ll be able to do a lot more remotely. But I do believe it’s here to stay.

PP: You mentioned digital, digital health is all the rage now. We talked about telehealth, digital front doors, and just virtual care in general, which is enabled by technology. How are you defining digital at Montefiore and what has been your digital transformation journey so far? Can you share some of that?

JS: Digital health can encompass a lot of things. For me, in this context, it’s basically using technology to enhance the quality of access or the delivery of care. But to be more specific, the general areas that we’re looking at our digital front doors using technology are to improve patient engagement, to enable contactless interaction to increase access, the use of telemedicine, which we just spoke about. It has profound opportunities to reduce the cycle times of care. With remote monitoring, there’s so much we can do that you don’t need to come back in just to monitor condition if we can check in with you remotely through technology. In tele-consult, the ICU example creates incredible ability to keep patients in a regional hospital, a local hospital and deliver top level of care remotely. Artificial intelligence: Dr. Parsa Mirhaji in our team has made incredible strides in using artificial intelligence to predict things like respiratory failure. What we see is that opportunity to use AI in many more ways and build those into systems. We stood up a chatbot to answer COVID-19 questions. We see a lot of new startups using that technology in front of visits to help the patient and the clinician get to the root of the problem and also improve their interaction. We see huge opportunities to leverage AI. And then the same deal with inpatient. So, hospitals around the country are looking at doing central stations, whether there is AI and other technology to better run their hospitals. And we see this as a huge opportunity. We’ve made a ton of progress in a short amount of time, especially on telemedicine, digital front doors, and also some of the remote monitoring on the inpatient side. We really have a long way to go. But it’s very exciting.

PP: You’ve covered most of the high value, high impact initiatives. And the focus areas you talked about remote monitoring, digital front door, which is growing as digital engagement touchpoints become more and more amenable to digital engagement, online tools and so on and so forth. And, of course, telemedicine and virtual care. How do the patients perceive it? One of the things that I hear from all the health systems and the Chief Digital Officers and everyone that I talk to is that it’s extremely challenging to create the kind of seamless experience that we are used to, like e-commerce Amazon or your personal banking site. It is very difficult to create that kind of experience in healthcare. It seems to me that there’s a lot of standalone best in class type tools. Then there’s a dominant EHR system in the background that does a lot of things, stitching it all together and creating those experience journeys which feel seamless and can delight patients just from an experience standpoint that seems extremely challenging. Is that consistent with your understanding of the challenge as well? What are you seeing in terms of how patients are reacting and responding to your digital front door initiatives, for instance?

JS: Telemedicine has struggled for years to really get adoption. COVID-19 has changed the landscape through which now clinicians and patients were encouraged or forced or compelled to give it a try. Obviously, the ultimate goal is to have that seamless experience. But it’s something we’ve been working on in healthcare and made a lot of improvements over the last few years. I think it is somewhat like when I traveled a lot and the first time I encountered an airline kiosk, when I arrived at the airport, I was really unhappy with the change, not being able to deal with the person, but probably the second time I never really wanted to interact with an agent again unless I had a major, complex problem that I needed to deal with. As long as we continue to seek out clinician and patient feedback and very closely monitor where the pain points are and where our opportunities are to improve and build those in very quickly adapting to the patient experience, but also meeting the patient where they are. So, whether you want to do an asynchronous visit, a synchronous video visit, or you want to see a physician face-to-face, it’s really seamless. And if you want to speak to someone on the phone or go at 2:00 in the morning, do something on your cell phone or your laptop, no matter what we’re meeting the patients where they are and like you said, giving them a seamless experience. It’s just going to be like any other customer experience. It is really going to be listening very closely and getting good data on how patients feel. And again, just iterating to make things more seamless and more effective.

PP: You mentioned a couple of examples of digital initiatives that you’ve launched, chatbot, for instance. Have you done any research into what your patient populations value or what your own caregiver’s value and need? When you look at the digital engagement opportunities, can you talk about one or two of those that you think have high impact possibilities in the short term?

JS: Sure. We’ve done a number of surveys, interviews. We have active working groups that get together every week and walk through their experiences and their problems. We’re adding on to our application ways to get customer and clinician feedback at the moment to better understand their experience. When we look back at our priorities, telemedicine has drastically changed the way we deliver ambulatory care and that is just a key opportunity. We are able to actually bring care into the patient’s homes at scale effectively and efficiently. The digital front door, the ability to gain access from wherever you are to a clinician in a smart way is top of the list. I believe that on the inpatient side, telemonitoring, tele-ICU is a better way to deliver care. And we experienced that during the pandemic and the surge.

PP: You also mentioned contactless experience, which I think is a new beast that we have discovered as a result of the pandemic. But what about your patient population? You are in New York, part of your operations is in the Bronx area, which is kind of a low-income area in the least in some parts. Does your patient population have certain preferences? Do you think you need to tailor your strategy, keeping in mind what are the limitations that maybe with your patient populations, or do you think that is not a factor at this time?

JS: It’s an absolute factor. I mean, the access to and comfort level with cell phones or computers is definitely something we’re looking at. And where there may be disparities in how we can actually address that. Also, access to data that seems to have been an area where patients are concerned about data charges. We’re figuring out other ways we can improve access. Living in a city this could be a great infrastructure type project to provide broadband access to patients for healthcare and could be an absolutely incredible opportunity. We realized little things that people not wanting to download apps. Are there ways we can get them broadband access, even just comfort level using a mobile phone for this purpose? And we’re kind of combining all these things to really create different options and then monitor which options are most successful. And then doubling down in those areas. We’re expecting it’s going to be different by different groups, different age groups, different specialties. And we’re just going to keep listening and looking for opportunities to improve.

PP: The digital divide that you talked about. This an interesting point, because clearly not all sections of the population have the same access to bandwidth or the affordability aspect of it as well. In Chicago where I live, there’s a public-private kind of collaboration that is emerging where there’s going to be a program to make sure that the coverage of the entire population in terms of their access to broadband is going to be uniform. So that there’s no digital divide, there’s no sort of disparity. Are you seeing anything like that emerging in New York? During the pandemic itself, there was a lot of public-private collaboration. Can you talk a little bit about that? I think it’s an interesting trend that is emerging. What your experience has been collaborating with local authorities.

JS: Absolutely, it was really one of the incredible things to see. From the start, the governor’s office essentially stated that we are one healthcare system, they really lined up everything essentially around the same goal, which was the surge that we were going to see, that did a pretty good job of predicting how things were going to play out in the early months. That spirit of collaboration really ran through a lot of things that we worked on. We worked with local vendors, we worked with other hospitals, it was really incredible to share the knowledge and ideas. And we were on the phone with colleagues understanding and sharing best practices, sharing how we’re working together. So, that spirit of collaboration continues. It was always there somewhat in academic medicine, but it’s kind of expanded more to people caring for their communities and can be defined in a number of different ways. We’ve got a couple of discussions going on with companies really trying to bridge that digital divide, because there’s so much evidence out there that does exist. And it is an equalizer that if we can bridge that gap, we can do a lot of good and create a lot of value, not just in healthcare, but also in education, etc. I’m hoping that’s an area where we can really collaborate and do public-private partnerships in order to create a lot of value.

PP: Everything in healthcare is linked to reimbursements in some way. And you did make reference to the fact that the CMS has brought telehealth visits on par with in-person visits. There are still some gaps in the reimbursement model. The broader question is, all these investments that you talked about, the digital front, the tele-ICUs and all of that have to be paid for in some way, shape, or form. So, you have to demonstrate some kind of ROI. How does a health system approach this typically, especially if you are predominantly in a fee-for-service kind of a model?

JS: It’s one of those things we’ve always struggled with as an industry and some of those unintended consequences of how incentives are structured. I guess where we start with is really what’s right and best for the patient. And then we figure out what options we have. The nice thing about our size and our scale is we have a couple of ways economically to get to create value for the business model. So sometimes because it’s the right or efficient way to use resources, it may take a haircut on revenue. But try and take a step back and look at the whole picture. What kind of value we can curate for our patients? Where are these gaps and maybe how the incentives are structured? And then what can we do to kind of either countermeasure to deal with those gaps, work on waivers, try to be creative in trying to deal with those gaps. But it’s something we’re constantly working on, constantly looking for new ideas and new innovations to address those gaps. I think ultimately around the reimbursement for digital health needs to be about equity and payment. I think once we get much better and efficient and effective at delivering digital care, we’re going to find ways to leverage technology like chat technology and AI and be able to treat more patients at a higher level of care with fewer resources. I think at some point what we want is our payment models to recognize that and balance that. So, yeah, and that’s why that’s one equity, I think is really what we want to get to and try and get away from the gaps that we have that cause some of the barriers to innovation and to delivering care.

PP: There’s a saying that never waste a crisis and we are going through an unprecedented crisis because of the pandemic. Are you seeing COVID-19 as an opportunity or as a long-term threat for your system?

JS: I think it’s both. It’s a tremendous threat. I mean, we had a tremendous loss of life. We had employees, colleagues who passed away from this awful disease. Our industry has taken a real hit. The local economy and national economy have taken a tremendous hit. But all those things are done. So within that, there’s an incredible opportunity to do better. To accelerate change, to challenge the status quo. I mean, look at all the things that we have been able to really make progress in the industry. We’ve made so many improvements and we’ve had so much innovation last few months. We have to take advantage of this crisis. We’ve paid the price; might as well take advantage of the opportunity to really accelerate the innovation in healthcare and really bring it forward. So, the answer is it’s both, unfortunately.

PP: Jeff, it’s been such a pleasure speaking with you. Thank you so much for sharing your thoughts and look forward to following all your progress and all the best with your digital transformation program.

JS: It’s been great speaking with you and I look forward to catching up soon.

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

Jeffrey-Short_pic-profile

Jeffrey B. Short is Vice President, Chief of Staff of Montefiore Health System and the leader of Montefiore’s Faculty Practice Group. Montefiore is one of the leading academic health systems in the country with 11 hospitals, 300 ambulatory locations, 35,000 employees and 6 million unique patient encounters. Montefiore’s Faculty Practice Group is one of the largest in the country with over 1500 physicians.

Jeff received his BS in Accounting from the University of Scranton, and his MBA from the NYU Stern School of Business. He came to Montefiore from NYU Langone Medical Center, where he served as the Department Head for Strategy and Business Development. Earlier, Jeff worked as a management consultant for 13 years with both Deloitte and PricewaterhouseCoopers. At PwC, Jeff was a Director and regional leader in the strategy and enterprise growth practice, working with clients such as the Cleveland Clinic and John Hopkins Medicine. He also spent 3 years in Europe leading business development and healthcare engagements with clients in the Middle East and Europe.

About the host

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

The nation needs an automated, real-time, effective syndromic surveillance system to detect COVID-19.

Episode #52

Podcast with Mike Alkire, President of Premier Inc. and Dr. Jonathan Slotkin, Vice Chair of Neurosurgery and Associate Chief Medical Informatics Officer of Geisinger

"The nation needs an automated, real-time, effective syndromic surveillance system to detect COVID-19."

paddy Hosted by Paddy Padmanabhan

In this episode, Mike Alkire, President of Premier Inc. and Dr. Jonathan Slotkin, Vice Chair of Neurosurgery and Associate Chief Medical Informatics Officer of Geisinger discuss how technology and data is helping public health officials to keep a balance in opening the economy versus managing the spread of COVID-19 virus.

Premier recently launched a syndromic surveillance tool for COVID-19 which they are piloting at Geisinger to improve the quality of medical interventions and prevent the spread of the virus. Mike believes that there is a need for syndromic surveillance system, contact tracing, and performing tests with higher accuracy rates.

According to Jonathan, siloed information and disparity in EHRs across health systems limits the scope of innovation and in case of COVID-19 it is affecting patients directly. He further states that, as part of a public-private partnership, Geisinger is performing contact tracing and have followed up on 1,600 COVID-19 positive patients, benefiting patients, providers, and communities.

Mike Alkire, President, Premier Inc. and Dr. Jonathan Slotkin, Vice Chair of Neurosurgery and Associate Chief Medical Informatics Officer, Geisinger in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “The nation needs an automated, real-time, effective syndromic surveillance system to detect COVID-19.”

PP: Hello again everyone, and welcome back to my podcast. This is Paddy and it is my great privilege and honor to introduce my special guests today, Mike Alkire, President of Premier and Dr. Jonathan Slotkin, Associate Chief Medical Informatics Officer and Vice Chair of Neurosurgery at Geisinger. Dr. Slotkin also has a dual role with Contigo Health as the Chief Medical Officer. Gentlemen, welcome to the show. Tell us a little bit about the COVID-19 surveillance tool that Premier has just launched, and you’ve started piloting it at Geisinger.

MA: Paddy, over the last year or so, we have been building out technology to help with the PAMA guidelines, which are guidelines that CMS is implementing to get after high-cost images. The focus has been on building up these pipes to Epic and Cerner and these electronic medical records to ensure that patients were appropriately utilizing these high technology images. So when COVID hit, we sort of pivoted the technology. And because we already had the pipes built into all the EMRs, we found out that if you looked at the symptoms of patients, there are a number of characteristics around the symptoms that you could see that there is a high probability these patients were COVID patients. And we thought that it was incredibly meaningful because we could do it in real-time. So, at the point when the physician is meeting with that patient, we can identify somebody that has those critical symptoms. Given that data, we can dive down into the zip code level. We can use that data or get that data to organizations that are interested to understand where surges are occurring or where there is a high prevalence of the disease. Also, there’s obviously a lot of interest on behalf of the federal government and the states to understand where surges are happening. The whole idea is to provide this real-time data mechanism to inform these public health officials around “do I open the economy” or “do I keep it shut” or “open in some degree, but I see a surge, am I putting the appropriate resources in those communities?” We think it’s very, very critical and it’s part of a three-legged stool. We think, to manage the virus you need this syndromic surveillance. We obviously think you need this contact tracing. And we need to do a better job of rolling out testing with higher accuracy rates.

JS: Paddy, the problem we all wanted to solve for is that existing syndromic surveillance in 2020 is dramatically lacking. I think it will surprise many of your listeners when they hear what those systems actually consist of. So existing state and federal syndrome surveillance consists largely of reactive, non-real time reporting of disease diagnoses. And by the way, that are picked up mostly by emergency departments. These tools run on 20-year-old technology and are not automated. And in some areas, clinicians and public health officials actually need to print data from EHRs, manually fill in, and fax reporting forms to public health officials. Some of these forms take up to 30 minutes to fill out. And in some instances, the lag between a patient receiving a positive test result and the reporting of that data can be as long as seven days. And Paddy, you’ve spent a lot of your career on this problem. We’ve troves of important data like positive COVID results, signs, symptoms, but sitting in siloed EHRs across different hospital systems in care settings across the country. So, the nation desperately needs an automated, real-time, effective national surveillance system, and that was the major impetus for this work. The team set out to build exactly that and the goals were to build an application that can be used by a health system, states, and federal government, just like Mike said, to perform several really important tasks like to know when and where COVID is surging before the numbers tell us that, to better determine which patients are more likely to become profoundly ill, and to provide healthcare systems with risk and severity adjusted information to predict findings. So the tool uses natural language processing and machine learning to scan free-text notes and orders for hundreds of phrases like trouble breathing, or loss of taste, and other free text and discrete data for signs, symptoms, and other indicators of infection. By using this approach, the system is able to rapidly identify patients who are presenting with signs and symptoms of COVID-19.

PP: This is very interesting and of course very timely as well given everything that we are going through today. The tool is essentially an NLP algorithm that mines clinical notes and information in the form of text, and unstructured data essentially sitting inside electronic health records systems. And this is the route that many COVID-19 apps are taking in the context of dealing with the pandemic and having early warning surveillance systems. Jon, can you talk a little bit about how you use this information as a decision support tool not just to flag patients at risk of infection, but in terms of closing the loop? What do you do with that information? What happens next? How do you adjust your care management or treatment and how do you integrate it with your reporting requirements?

JS: We and other health systems are very eager to start using this application. In addition to Geisinger, Atrium, Community Health Network, Advent and I think over 30 other systems are coming online with the application shortly. There are some really valuable ways that health systems can use the information from this application, even above and beyond this important work of syndromic surveillance. I think that systems can identify flare-ups based on health systems’ zip codes. We think often it will be one to four, even more days, before lab test results come back in some instances. In some patients that don’t even get tested or wouldn’t have been tested, usually a week or more before hospitalization based on symptom progression. With this kind of foresight, systems can do things like plan decrease and elective procedures well in advance of being just reactive to public numbers, forecast equipment that an ICU needs based on incidents and even the severity of disease that the tool picks up in the outpatient setting. The tool can also identify patients in the ambulatory setting that are high risk for admission or maybe are more appropriate for a home care environment with home pulse oximetry or other programs. It is important to call out two really powerful features that are coming to the app in the next several weeks. One is that the system will present a pre-test probability based on symptoms to help providers interpret negative diagnostic test results, which we know can be inaccurate, sometimes significantly inaccurate, and both true negatives and false negatives, for that matter. This is where you get to the action at the point of care which Premier always thinks about. The team has also embedded the NIH COVID treatment guidelines right into the CDS tool. I think it’s important to point out that Stanson tool has over 300 hospital system customers. So, this affects and is live and can be live at over two to three hundred thousand providers systems. In this way, with treatment guidelines at the point of care, you can support providers with real-time interventions and to translate evidence into practice, which I think is a core mission for Premier.

PP: One of the things that I read about when I saw the news release on the tool is that it works across different EHR systems. And we all know that interoperability has been a challenge for a long time, it’s getting better, we have got the CMS final ruling that’s going to affect 2021. We are going to see more seamless data flow, but it is still a significant challenge. Can you talk about how do you look across Epic and Cerner as an example or other systems out there? How is this different from other COVID-19 tools that are out there?

JS: Paddy, siloed information and disparity in EHRs across different health systems, not only limits innovation, but in a situation like COVID-19, it’s affecting patients immediately right now. Thankfully, in the last few years we have all seen significant progress in these areas. But this tool, ADAM, which is Advanced Detection Analysis and Management, works well with Epic, Cerner, and I think it’s going to be live over the next couple of weeks or month or two in MEDITECH. As Mike mentioned, the rapidity of getting those solutions live across multiple EHR vendors comes from the fact that the backbone of this solution is Stanson’s PAMA tool that is live at 300 hospitals. So what this then brings is, from growing machine learning standpoint, you’re going to get the combined experience and data of all of these hospital systems across three and now soon to be 40 EHR vendors that will allow powerful improvement of the systems’ machine learning algorithm, not just from one system, but from all of them. This data is never going to be sold to pharma companies and device companies, but there is power in the aggregation of this data. Mike can elaborate, the advanced discussions with several states and parts of the federal government. But important to be clear here, and we know at Geisinger that this data that Stanson and Premier have will never be shared with any outside parties like a state or federal agency without the provider systems written permission, which I think many providers systems, given the mission that we’re trying to accomplish here, would be open to.

MA: The only thing I’d add here is that Premier has taken a pretty significant focus from an advocacy standpoint for interoperability. For all the reasons that Jonathan said, we obviously want the ability to track a patient throughout the progression of the disease, no matter where they’re actually getting care provided. We spent a lot of time working with various datasets to integrate those and work with these EMR vendors, and other vendors to ensure that they have got open data sources. To Jonathan’s point, I do want to sort of make sure to tie this all together from a COVID standpoint. So the reason it’s so meaningful for the states and the feds to sort of step up here and really look at that three-legged stool of controlling the virus is that there is such a high false negative testing depending on when you test versus when you actually get the disease. There were a couple of few articles three weeks ago, one from the Annals of Internal Medicine, the other from the New England Journal of Medicine. They talked about significantly high false negatives. That’s really an issue if you think about somebody’s on their way saying – you don’t have the disease and in fact, you have the disease. Those articles actually presented the fact that the further away you are from being tested when you actually acquire the disease, obviously your false negatives go down. So, you’re waiting, often times, two or three days to get decent results. And what we’re saying is we have the ability to do that real time looking at the symptoms.

PP: I want to dig a little bit deeper into this Stanson tool that you mentioned and how that creates synergies for not just the business, but at the level of the tool itself.

MA: The whole thesis for Stanson, for our investment from a capital standpoint really was, we’re a performance improvement company. We’re all about helping healthcare systems drive improvements from a cost reduction standpoint and a quality and safety improvement standpoint. What we had been doing over the years is obviously taking our best areas or amounts of data in the clinical settings and safety and operations, which is labor and supply chain, integrating those data sets and creating insights into performance improvement for the healthcare delivery systems. And that was great because those insights drove a ton of value. But what Stanson allows us to do is to really create an impression of those improvements. So, Stanson actually writes into the Epic and the Cerner and the Athena EMRs, the appropriate protocols that should be followed that are maximizing high quality, great safety, and low cost. That was the whole initial thesis. We wanted to hardwire those improvements to the point of care into the workflow at the EMR.

PP: It’s all about having the decision support tool at the point of care and being able to act on that. That is kind of the holy grail or the mantra for any kind of decision support tool. You pointedly mentioned that you are very careful about data privacy. I read a study recently, I think it was done by the University of Illinois in Urbana Champagne that looked at some 50 different COVID-19 apps and they were very concerned about the lack of clarity on what is really going to happen to the data. How are you explicitly providing assurances to your patient community that data privacy is going to be maintained, how do you ensure that? How do you execute that? When there are so different people getting access to it?

MA: Premier is an organization that’s been in clinical data analytics, labor data analytics, health information, patient health information for years. So, we have been at it for probably more than twenty-five years. We’ve got a very rigorous and consistent process to ensure that data rights are appropriately being followed. And our ability to deidentify data, we’ve been doing it for years. So, if there is an institution out there that has the ability to do it and has been doing it and that has processes and technologies to do it, it’s us.

JS: Paddy, I think for all of us it’s a fascinating time to think about balancing public health needs and privacy in our own minds and also even what each of us is willing to tolerate in our own personal lives during a worldwide pandemic. As Mike said, the Premier team feels that if it doesn’t have the trust of its partners and their patients, we don’t have anything; and Geisinger certainly feels that way. A lot of the apps that you mentioned are often going to be consumer-facing apps. It’s important to call out for anybody that kind of just dips into the surface of this, that this is not a patient consumer-facing application. This is a robust clinical decision support tool that’s been live for years and has been repurposed and sits with health systems’ EHRs. So what that means, is it sits with extensive BA’s and other agreements that all of Stanton’s existing work is covered by. It’s the type of software and activity covered by HIPAA and has privacy literally protected by law. It’s important to point out that existing syndromic surveillance in our states and country, as I mentioned, involves printing documents, filling some aspects out by hand often, manually keying certain forms, and sometimes even faxing results. That is absolutely a system which is not only not modern but is also insecure from a privacy standpoint. We think that this kind of automated, fully digitized, secured solution to disease surveillance, it leads with privacy and is a significant improvement over the existing model.

PP: What triggers the tool itself since this is more like a surveillance tool. What is the event that triggers this tool?

JS: So, for the informatics wonks there are three, and it started with one and then Stanson came and Geisinger helped and others have worked with Epic and other EHR vendors for the rapid expansion. And I should call out Epic and Cerner. But Geisinger is an Epic shop, so that’s the one I can speak to, has been a tremendous partner here. Understanding that during a national emergency, we need to always move smartly, and we need to move quickly. So, three triggers really fire the tools, ability to take a look and give actionable insights. One is the ordering of an imaging test and of course, in COVID that’s critical and is the backbone of what Stanson’s functionality always was. The other is the order of a COVID test, which is another great place to fire functionality that takes a look at natural language processing on free text and also does analysis on discrete data at the time. And the third is that when COVID test is resulted and the charts opened to analyze the COVID test. That’s a moment when there’s a dip-in and a look-in and Epic’s helped with this, done extensive analysis on the overhang time associated with this. And these are times significantly less than half a second in the hundreds of millisecond time frame.

PP: You mentioned false negatives a couple of times. Have you had a problem with false positives?

JS: Not really. False negatives are the big enemy right now, in terms of what have we seen, how do you validate a tool like this? Early testing that the team has done has found that when we look at symptoms using the methods that we’ve talked about and compare to a later positive PCR viral test, to answer your false positive question, probably about four percent. And so that’s really good but the team’s making it better. I think one really important way to make it better and also to validate it is something that’s ongoing with our health system now, and that’s retrospective cohort evaluation. So, we, and everybody, have months of medical records on patients who later go on to test positive and negative. And folks that do well clinically or unfortunately in some cases do not do well clinically. What we are doing is looking back at a cohort of patients who went on to test positive where they know how they did clinically, and also, a group went on to test negative. So not only does that allow validation but have a very big history in the machine learning and AI area. In fact, we can not only validate the tool there, but also do data driven research to tune and improve the algorithms to significantly increase the sensitivity and specificity of the tool with a known data set and tuning.

PP:: A related question on that, obviously, is evidence. And you are kind of going there at times. Are you building the evidence for this tool as you go along?

JS: Well, some of those initial looks that I mentioned have already occurred and led to that data I mentioned. The other studies that I mentioned, like the retrospective validation and the tuning is happening as we speak, from quality improvement and research perspective, because I do think it is quality improvement work. But as far as the machine learning algorithms tuning is concerned, that’s an ongoing iterative process that’s consistent.

PP: One of the things that has really impressed me is the level of public-private collaboration that COVID-19 has brought about. I have seen many examples at the state-city level. One of my guests on this podcast talked about what they’re doing in the city of Austin for instance. And I see many great examples of how public and private sector are coming together to really address this. Can you talk a little bit about how this tool is being used for public health in general? Let’s say in Geisinger you’re in Pennsylvania, you talked about how this is contributing to public health efforts and especially contact tracing and all that, which is not really a big thing.

JS: There’s a ton of important opportunity in this area. We know that contact tracing, etc., usually falls under local and state health departments, but they’re all spread thin. I think we all saw the study that Ars Technica wrote up that we would actually need three hundred thousand contact tracers to do this job right. Geisinger quickly realized that it’s already expert in managing testing, communicating results, and treating those who test positive. So, Geisinger is performing contact tracing as a public-private partnership and now has twenty-four employees spending significant parts of their workweek on contact tracing. As of a few weeks ago, the team had made over twenty-seven hundred phone calls to follow up on sixteen hundred positive patients. This directly benefits patients, providers, and communities. And how do you take the Stanson tool and actively connect that to states; Mike, I’m sure can elaborate on.

MA: I think at the end of the day, these health officials that we’re having conversations with are trying to really have these decisions from a public health standpoint, be informed by data and science. The idea is if you have what we suggested, which is that three-legged stool of testing and more advanced testing and getting more refined testing and better testing, plus contact tracing, which we always think is going to be something that is going to be debatable. Jonathan made a great comment early on about the debate of positive societal impact versus liberties being sort of tightened. But we do know there are a number of countries that are using iPhones and those kinds of things to track as to where folks have been that have the virus and to be able to alert people that they may have been exposed to the virus. That’s a very meaningful discussion that we need to have and the debate that we need to have in the U.S. around the importance of that. And then finally we have been talking about this syndromic surveillance and the reason it’s so critical is that if you’re the governor of a state, early on, governors of huge states decided to shut the entire state down when maybe there was only a surge in eight, nine percent of all of the counties that represented, 60 or 70 percent of the population. But those other counties were very limitedly impacted. So, all we’re saying is that there is technology and there is data that at the zip code level can provide a great deal of information around how to balance public health versus open the economy, that’s number one. Number two, we have heard a lot of conversation about how this is disproportionately affecting the cultures of color, people of color in the urban settings. Our technology has the ability to identify those issues. And for public health officials to sort of think through what’s the best way to provide capabilities and services to those parts of the population. So, we think there’s a couple of incredibly important use cases that public health officials should leverage for.

PP: Well, John and Mike, it’s been such a pleasure speaking to you. Thank you so much for sharing your thoughts on this. I think this is a very important initiative. And I hope to get you, folks, back again on this podcast maybe a few months down the road when you have more learnings to share from the tool as work on the field and again all the very best.

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

Mike J. Alkire is the President of Premier. As President, Alkire leads the continued integration of Premier’s clinical, financial, supply chain and operational performance improvement offerings helping member hospitals and health systems provide higher quality care at a better cost. He oversees Premier’s quality, safety, labor and supply chain technology apps and data-driven collaboratives allowing alliance members to make decisions based on a combination of healthcare information. These performance improvement offerings access Premier’s comparative database, one of the nation’s largest outcomes databases. Alkire also led Premier’s efforts to address public health and safety issues from the nationwide drug shortage problem, testifying before the U.S. House of Representatives regarding Premier research on shortages and gray market price gouging. This work contributed to the president and Congress taking action to investigate and correct the problem, resulting in two pieces of bipartisan legislation.

Jonathan R. Slotkin is the Vice Chair of Neurosurgery and Associate Chief Medical Informatics Officer at Geisinger. Dr. Slotkin is board certified in neurosurgery by the American Board of Neurological Surgery. His clinical interests include care for back and neck pain, as well as sports-related spine injuries, and he has particular interests in consumerism and the digital transformation of healthcare. His research interests include post spinal cord injury regeneration. Dr. Slotkin has expertise in spine outcomes, caring for degenerative and congenital spine conditions, spinal tumors and spine/spinal cord injury. He earned his medical degree from the University of Maryland, and completed his residency at Harvard University, Brigham and Women's Hospital. He completed his fellowship in spine surgery at New England Baptist Hospital. Dr. Slotkin is director of Spinal Surgery for Geisinger and also serves as associate chief medical informatics officer.

About the host

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

For a frictionless digital consumer experience, healthcare providers and payers must work together.

Episode #51

Podcast with Bill Krause, Vice President of Experience Solutions, Change Healthcare

"For a frictionless digital consumer experience, healthcare providers and payers must work together."

paddy Hosted by Paddy Padmanabhan

Share

Share on facebook
Share on twitter
Share on linkedin
Share on email

In this episode, Bill Krause, Vice President of Experience Solutions at Change Healthcare, talks about removing friction points in healthcare – finding, accessing, and paying for care – throughout the consumer experience journey.

According to Bill, COVID-19 created a big explosion of interest around the role digital can play in the healthcare system. He states that there are several barriers that consumer experiences while accessing care through digital means. To accelerate digital patient experience, healthcare providers must understand the role of payers in a patient’s journey and work together to provide a frictionless digital consumer experience.

Recently, Change Healthcare collaborated with Adobe and Microsoft to launch a connected consumer health suite that enables healthcare providers to create a more streamlined digital health experience throughout the patient journey. Change Healthcare is one of the largest independent healthcare technology companies in the U.S. Take a listen.

Bill Krause, Vice President of Experience Solutions, Change Healthcare in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “For a frictionless digital consumer experience, healthcare providers and payers must work together.”

PP: Hello everyone, welcome back to my podcast. This is Paddy, and it is my privilege and honor to introduce my special guest today, Bill Krause, Vice President and General Manager of the Connected Consumer Experience Practice at Change Healthcare. Bill, thank you for setting aside the time, and welcome to the show. Do you want to spend a couple of minutes talking about Change Healthcare, what does the company do, and what are your focus areas today?

BK: Change Healthcare is one of the largest independent healthcare technology companies in the U.S. We provide a variety of data and analytics-driven solutions and services that focus on clinical, financial, and patient engagement outcomes. We really occupy a unique space in healthcare with our focus on connecting the broad ecosystem. For example, we have deep and broad networks across financial and clinical areas that improve decision making, simplify billing, help with payer and provider processes, payment processing, and generally, help enable better consumer experiences.

PP: On this podcast, we focus mostly on digital transformation. What that means to healthcare enterprises, as well as to the technology provider community that serves the needs of healthcare enterprises. Change Healthcare recently announced a new platform that you have just launched. Can you tell us a little bit about what is the platform called? What kind of marketplace needs you are looking to address with the platform?

BK: Recently, we announced the availability of our connected consumer health suite. The solutions Digital Patient Experience Manager, Shop Book and Pay, Virtual Front Desk, and other capabilities, they really help providers to create more consumer-style digital healthcare experiences. We like to say we are helping providers with this platform power, the connected digital journey for consumers, from internet search through to the exam room. And our focus is around removing as many of the friction points that are typical with today’s healthcare experience across finding care, accessing, and paying for care.

PP: Let us talk a little bit about these suites of solutions that you have launched. In the Shop Book and Pay, you mentioned digital experiences and consumer empowerment and so on. When I look at the digital health solutions landscape, I see that you already have the big electronic health record vendors such as Epic, for instance, and their MyChart platform. And then you have a whole marketplace, called the digital health innovation, an ecosystem of startups that have identified an opportunity relating to any one single touchpoint in the online consumer experience. So, it looks like what you’ve done is taken many of those features, many of those needs, looked for the touchpoints, and kind of aggregated them all into a one-stop platform. Is that a fair way to state that? How exactly would you describe that?

BK: What I would say is our insight and what’s behind the solutions we announced is that what we see as the need is to remove, as I mentioned, like many places where consumers hit barriers in accessing care and using great digital to do that. So really, the analogy is we think about our examples, such as Rocket Mortgage or Carvana, Amazon Go, and others that have taken technology, and to your point, there are existing technologies out there serving different points in the healthcare consumer journey; but the unique insight was bringing these together dramatically, simplifying the process that a consumer goes through really to access the services or products that they need, and to do that in a way that works within the context of healthcare.

PP: So, give me an example of how this would work if I am a healthcare consumer. First of all, would I even be accessing your platform directly, or is your platform kind of sitting underneath maybe a health systems front end portal? How does this work as a consumer, what would the experience look like for me?

BK: There are a number of ways and a number of on-ramps for a consumer to enter this digital journey that we make available for providers. We have partnered with Adobe here and Adobe is a leader in digital experience. As a result of that, we have a variety of capabilities that can really customize the experience to fit the brand and styling and many of the other factors that our provider customers need to really reinforce their strategies. It’s never really been more important now in light of COVID-19 and the dramatic shift towards digital. But most consumers today are really struggling to understand what their financial responsibility is going to be, and their struggles with healthcare. They are struggling to connect together with the steps they need to take. So, a consumer would start the journey, perhaps on the web site of their local provider and they will be able to search for care, understand what care is available to them based on any number of services that are increasingly more shoppable if you will. And by that, we mean where consumers are more actively involved in the decision making around those services. So, they’ll enter through the provider’s web site. They’ll enter into the Shop Book and Pay experience, which is branded for the provider. They’ll locate the provider and the services that they need within their local area. They’ll be able to understand their out of pocket responsibilities, schedule care, and complete the pre-service journey in as simple a way as possible.

PP: And you mentioned Adobe as one of your partners. You also partnered with Microsoft in building the platform. Am I correct?

BK: That’s exactly right. This is bringing together the best of three very complementary companies that are leaders in their respective domain. Bringing together Microsoft’s leadership with cloud hosting and regulated industries and significant capabilities around making it scalable and serviceable across the market. So, one of our objectives here is to make these solutions available for the largest providers, but down to the smallest independent practices as well. And Microsoft has a great role to play in making that scalable. As I mentioned, the role of Adobe and really leading many consumer industries and powering the digital experiences that we all know and love and then change healthcare. And one of the important insights here is in order to make great progress in consumer experience and consumer digital transformation, you have to get access to the workflows and data and other backend systems that are necessary to bridge those silos, if you will. And that’s a great capability that Change Healthcare brings to this partnership on behalf of the customers we serve.

PP: So, staying on the consumer experience for a moment, I imagine that you have your first few clients or deployments already live or in the process of really going life. Can you maybe describe what the architecture looks like? You know, let’s say you’re working with a healthcare provider who is on one of the major electronic health record platforms, Epic or Cerner or one of them. How does your platform fit in that architectural construct? And also, are all the capabilities that you talked about, are they all built native in your platform or do you also have components that are maybe a white-labeled with other startups? How is this whole thing architected? If I look at it from an enterprise standpoint as a healthcare executive.

BK: Certainly. So, it’s architected in a cloud-native structure and with an architecture that allows us to on behalf of our provider customers, to integrate into their systems of record. If you think about just from an overall philosophy and approach standpoint, we view the provider has a number of systems of record that house data needed to support these consumer journeys, be it their electronic medical record or their revenue cycle system. Change Healthcare equips many providers across the industry with some of those systems like revenue cycle management. But those systems of record then interact with the systems of engagement. And that’s really where the Connected Consumer Health Suite plays the role it’s delivering to those providers – a scalable, cloud-hosted architecture that integrates with their data sources and powers for them those digital experiences that they need to support for finding and accessing care.

PP: One last question on the topic. Who pays?

BK: There’s a very simple model to this, which are the customers the providers pay for. And I also want to address another question you asked around third parties as well. But I’ll come back to that. But yeah, it’s a simple subscription model based on consumption that providers pay for and the benefit to them is multifold from operational efficiencies to really and most importantly, attracting and retaining their consumers. And that is really where the value that they receive out of this solution. But back to the other question. We have architected our platform in such a way as to incorporate third parties into the journey. We recognize that healthcare journeys can take many different avenues and providers need the flexibility to be able to accommodate those third parties we’re working with. For example, M.D. Safe, which is a great innovative early-stage company that helps to create a single billing experience for consumers prior to when they need care. So, it just dramatically simplifies what a consumer sees and understands their responsibility to be able to satisfy that responsibility. So, we’ve incorporated that capability into our Shop, Book, and Pay. And we’ve built our architecture and that’s, again, back to the role that Microsoft plays here as well with us and in a very flexible manner. So, it can be extensible over time-based on our customer’s needs.

PP: And it seems to me like the platform you built is one of the early examples that I see in the market of a comprehensive digital consumer experience platform. I see a lot of standalone solutions and one of the big challenges that my clients and all the others that I talk to face is about creating this seamless consumer experience. For the most part, the standalone solutions, they are kind of glued together in a somewhat brittle way and building the seamless consumer experience that we are used to from the Amazons of the world or in our personal banking experiences. Is that a fair statement and how do you think a platform like yours changes that?

PP: That is a fair statement and that’s very much been front and center of our strategy. And really the reason why we’ve partnered with Adobe to utilize the Adobe Experience cloud within this architecture. And our view on this is, again, our customers cannot be locked into perhaps more brittle, single service solutions that don’t allow them to really create and expand on the experiences their customers need. So, if I get underneath the covers of that statement, we’ve made a lot of investment to enable our providers. The use of a content management system that really is world-class and allows for a lot of flexibility. Again, back to customizing, to branding, to be able to create different experiences, to be able to deliver those experiences across any variety of endpoints that consumers will pursue and really bring all of that capability that’s instrumental in a digital experience platform approach, but also campaign management, the analytics to instrument all of the endpoints and engagements so that we can match across the channel and understand consumer behavior and how better to serve it. Again, tying back to the earlier point here, about how to remove frictions. If we don’t have those analytical insights on how consumers are interacting with those digital experiences, then it’s not possible to really effectively remove the friction points and optimize the experience over time.

PP: Yeah, interesting. So, switching to more general topics, what are you seeing in the market in the wake of COVID-19 in terms of acceleration of virtual care models, digital experience related investments in your client communities? Can you talk a little bit about what you’re seeing in the market in general?

BK: Certainly. And I would that there are the near-term imperatives that the market has been responding to, and then there are the medium and longer-term realities that our customers are now positioning themselves to address and all. And what I mean by that is the near-term imperatives, things like enabling virtual care so that patients could be served from that standpoint. I think we’ve all talked about that uptake in the industry, but also things like touchless check-in and minimizing any contact with staff where possible and moving things like forms, paper forms to electronic and delivery, etc. So, there’s been a lot of effort to really identify those gaps in the workflows and really plug those gaps as quickly as possible among our provider base. So that’s the near-term that we see. And I think that’s really true across all different types of providers. And then there’s the medium term, and by medium term I might mean 12 months. You know, for some people, medium is six months or so. But at the end of the day, that medium-term is around reimagining those, the pathways that consumers have got access to care and, how to deliver those digitally. And that ties back to a recognition that any barriers that the health systems or providers can see with regard to enabling easier access to care for their consumers. Those barriers now take a higher priority in terms of where their investment dollars, talent, and resources are going. So, we’re getting a lot of inquiries around consumer experience, strategy, and how to rethink the digital front door. The digital front door concept has expanded beyond perhaps the patient portal to other channels and modalities. So, I think it really created a big explosion of interest around the role digital can play in the healthcare system.

PP: One of the big things that people don’t talk about is that along with this shift to virtual care which has been brought on by a lot of restrictions on people coming into a clinic or a hospital for care. There is a big concern around how to take care of the population in their homes and the chronic care of patients, for instance. And we see that remote care and remote monitoring technologies are also having some sort of a renaissance if you will, or if not a renaissance, maybe accelerating. Is that also happening in what you see, along with improving access to care through virtual modalities?

BK: The short answer is yes. And there are few drivers of that. So, the recognition that increasing scope of care can be delivered in the home setting from the standpoint of now more consumers are being accustomed to that, just given the realities of COVID. But there’s been a growing body of evidence related to shifting care to the home and the value that delivers in terms of benefits to consumer’s quality of life, health outcomes, as well as benefits to the system from an efficiency standpoint. So those drivers as well, I think just continue to encourage that trend. So short answer is yes. We’re seeing that and it goes back to that reevaluation of the predominant models that our provider organizations are really funding and developing. And I think that will continue to play an increasingly large component of how consumers receive care and then how those providers are going to need to retool their system to support that.

PP: What do you see as the one or two big challenges that providers are facing today as they make this transition, as they get ready to accelerate? Because the acceleration of the transformation is kind of inevitable. You either accelerate or you get left behind. What are the one or two big challenges you’re seeing providers struggling with as they try to make this transition?

BK: You know, there’s a few things. One is the organizational capacity to support that transformation. Increasingly, providers are understanding their roadmaps that they want to pursue from a digital transformation standpoint. But the IT departments and teams are just taxed with a number of priorities on a number of fronts. So just that overall transformation burden and fatigue, that’s a reality that the industry faces. I think also, if we play this out a little bit, there’s a dichotomy around how or what maybe good looks like and really a recognition on what is the path forward. So, everybody recognizes the growth of telemedicine is needed and some of the other more tactical areas have to be addressed in the short term. But our industry has a record of adopting many different solutions. And in fact, you know, it’s not healthcare. It’s many consumer industries. But at the end of the day, I’ll come back to those models that were really breakout and drove substantial benefits, were the ones that brought together the journey and really streamlined the consumer journey. So, that’s a different paradigm. So, I think there’s an opportunity and there’s a challenge around that. And the challenge is really what does that look like? And when you start to get underneath that, you realize that a number of the steps in the consumer journey fall on the payer side. So, we can’t forget the payer’s role in this, whether it’s understanding from a consumer standpoint what doctors are in my network, and what are my insurance benefits for particular service, or any number of steps where the consumer is left with a fragmented journey. So, for provider organizations to address this holistically, they have to think about the role of the payer in this and how they can work together.

PP: Interesting. It’s been a real pleasure speaking with you. And I wish you all the best with the launch of your new platform. It sounds very, very interesting, and I will be following what is going on with the progress as you kind of make public statements about it. I look forward to having you back on the podcast, maybe a few months down the road, and maybe you can tell us more about your learnings from the launch of the platform.

BK: Thank you, Paddy. And I really appreciate you having me here today.

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

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

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

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

About the host

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

Post-COVID, virtual care will be about stability, quality of service, and agility.

Episode #50

Podcast with Aaron Miri
Chief Information Officer
The University of Texas at Austin, Dell Medical School, and UT Health Austin

"Post-COVID, virtual care will be about stability, quality of service, and agility."

paddy Hosted by Paddy Padmanabhan

Share

Share on facebook
Share on twitter
Share on linkedin
Share on email

In this landmark 50th episode of our podcast, Aaron Miri discusses contact tracing and UT Health’s contribution to prevent the spread of COVID-19 through their public-private partnership with city of Austin, TX.

Austin Public Health has partnered with Dell Medical School and UT Health Austin to prevent the spread of COVID-19 by doing contact tracing on behalf of the city of Austin. Besides contact tracing, the University is also using emerging forms of healthcare delivery such as symptom checking, COVID-19 drive-through testing stations, home monitoring, and nurse triage to control the spread of the current pandemic. Currently, the medical school has over 200 contact tracers working remotely and have successfully performed one-third of the contact tracing in the city of Austin.

Due to the current COVID situation, healthcare consumers are adopting virtual care technologies that are changing the way healthcare is being delivered today. To ensure smooth delivery of care post-COVID, Aaron discusses how virtual care should be a flawless experience for clinicians and patients.

On data interoperability, Aaron suggests three major areas of focus: Identifying and capturing data for public health; the need for the entire continuum of care to be on some sort of a digital system. According to Aaron, healthcare organizations need full data transparency, governance, and internal communication working together to advance interoperability. Take a listen.

Aaron Miri, Chief Information Officer, The University of Texas at Austin, Dell Medical School, and UT Health Austin in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Post-COVID, virtual care will be about stability, quality of service, and agility.”

PP: Hello again, everyone, and welcome back to my podcast! This is a special episode, our fiftieth episode of The Big Unlock podcast. It is a real privilege and honor for me to have as my special guest today, Aaron Miri, CIO of the University of Texas at Austin, Dell Medical Center. I am really thrilled to have him join us. Aaron, thank you so much for setting aside the time and welcome to the show.

AM: Thank you very much. Congrats on your fiftieth episode!

PP: Thank you very much. For the benefit of our listeners please tell us a little bit about UT Health Austin and the Dell Medical School and the focus areas for your institution.

AM: UT Health Austin is one of the top global universities in the world. About five or six years ago we decided that we really needed our own medical school, our own teaching institute, our own clinical enterprise, and really help Austin and Travis County in the state of Texas out by bringing out some of the world’s best physicians through Austin. Our goal here has been, number one, first and foremost, putting out the best medical students possible, prepare them to enter residency. Number two, having a clinical practice really grounded around value-based care in the principles of community and community impact. And three, what UT Health Austin is known best for, which is research. How do we do some game-changing research in genomics and sequencing and really take it to the next level? So, it is that every aspect of an academic health care delivery network that you could possibly imagine and then some. And then now, you throw in COVID into the whole situation and it grows even more so.

PP: I know you are a thought leader and you’ve written and spoken extensively about advanced technologies and digital transformation in healthcare. And you are a practitioner of all the same principles in your institution. I want to start by asking you about the acceleration of digital transformation in light of COVID-19. We are seeing that healthcare is going virtual – telehealth and all other forms of virtual care, digital front doors and so on. What are you seeing in your conversations with your peers across the healthcare industry as the high priority initiatives for digital consumer engagement in a post-COVID-19 scenario?

AM: A couple of things. Number one, if you look at it from the CIO’s perspective, it is ensuring smooth delivery of service. So, all the way from the clinician experience, the patient experience, and the entire continuity of care virtually should be flawless. So that there are no hiccups in terms of workflow, orders, medical record, what not. Telehealth experience has been one that we continuously refine, even though now our practice is that majority of it is telehealth, although we’re slowly up ticking the in-person again. So, to the degree of it has been about stability, quality of service, execution, agility. There are new workflows.

I mentioned earlier that we are big believers in value-based care. That’s a team-based approach. So, how do you use a virtual lobby to be able to do a pre-staging of a virtual care team, where you have a social worker, a musculoskeletal worker, and a pain management worker altogether visiting. And then, they are able to meet with the patient as a team. Those kinds of virtual workflows we have been innovating because we are not going to stop our principles, which is, we believe, cohort and value-based care. So that’s from a CIO perspective, making sure that your health systems are able to make that leap and suddenly go from in persons up in the dozens to over the virtual telemedicine into the hundreds, if not thousands of sessions daily. So, you have that component.

From a policy perspective, what we’re seeing is this question mark from the CMS. We even saw last week with Seema Verma stating publicly that it’s her intent or her desire to want to leave a lot of the statutes in place that reimburse at even parity level. So I think as that decision comes out, it’s going to obviously affect the landscape, because if they’re not paying and reimbursing at a level that’s sustainable, our health systems will have to make some tough decisions. Most of my peers I’m speaking with are trying to keep the lights on, making sure that they are able to shake and bake to whatever the requests are coming in and ensuring that their staff, be at their remote or in person, are feeling secure and safe and what not. And so, we’re able to deliver medicine remotely without an issue.

PP: In terms of virtual care, in a post-COVID-19 context, some of the things that I’m seeing through our work in my firm is the emergence of newer forms of healthcare delivery. And a couple that come to mind immediately are contact tracing as an example, and COVID-19 apps in general. Of course, it’s kind of hard to unpack what a COVID-19 app means when there are so many technology providers out there saying they have a COVID-19 app. But then contact tracing is something that is a little more tangible. Could you unpack these things a little bit?What should one be thinking when somebody comes up and says,I have got a COVID-19 app that I can help or a contact tracing app that can help you? How are you going about it?

AM: Let’s talk in generalities now, talking specifically about what we’re doing here with UTH Austin. So in generalities, when I mentioned a COVID-19 app, I applaud the vendor community for trying to pivot, especially a lot of startups out there and say how can we apply our platform, our tech, our algorithms towards something related to COVID-19. The majority of the market seems to be leaning towards temperature indicators, whether your home monitoring for temperature checking, whether you are able to baseline an individual based on questionnaires to say, are you potentially symptomatic. Because you were out on Memorial Day weekend on a lake without a mask around 10000 people and probably at a high-risk to catch COVID-19. A lot of what you are seeing on the market are symptom checkers, home monitoring type platforms, algorithms. I have seen RTLS vendors make a pivot towards trying to say, hey, our Wi-Fi, our TLS system can now track your patients that are positive – where they are and ensure that they are maintaining quarantine procedures, that sort of thing.

What we did here at UT Health Austin is a couple of things. Number one, Austin Public Health asked us to partner with them formally and via that delegation of the public health authority, we were able to do contact tracing on behalf of the city of Austin. So, we stood up an app that does that. We have over 200 or so contact tracers all working remotely, calling into a central call center, and accessing this app that we partnered with a startup based out of Seattle to deploy quickly and robustly. These contact tracers are able to enter any information, such as, where was Aaron? Did Aaron go to the barber? Who was at the barber? Let’s call them. Are they symptomatic, that whole lineage of contact tracing?

Believe it or not, Paddy, contact tracing has been done for quite some time with numerous disease states. COVID is not new but this is the first major disease state I’ve seen a public drive towards. How can we digitize contact tracing? And it’s difficult because the CDC is constantly evolving their data sheets based on what they learn. Obviously, more that we learn from the disease, the more types of data they want, and specificity collected. So, we are constantly having to evolve the product that we put on the market here to help. But I just read some stat last week that we’ve successfully done one third of all the contact tracing for the city of Austin. If you think about the 11th largest city in the country, that’s pretty darn impressive. We did this here at UT Austin on behalf of the city of Austin. So, to the degree that there’s a number of components that go into this, but overall, I’d say from our position here, what we’re doing is number one symptom checking. Number two, we have our drive through COVID-19 testing stations. Number three, we’re doing contact tracing, as I mentioned. Number four, we are doing home monitoring. We’re also doing nurse triage, because a contact could quickly say, hey, I have symptoms, I can’t breathe. We need to triage them so we can escalate into that triage and then immediately either enrolling in-home monitoring if it’s manageable or ask them to be present at the emergency department as soon as possible. So, we’ve been phenomenal at getting in front of this and really wrapping our arms around it and taking it very seriously in partnership with the city because UT Austin has those kinds of resources to bring to practice.

PP: You make a very important point in your comments, which is this emerging public-private partnership, public health agencies partnering either at a state, local, or federal level with the private sector. And we’ve seen some efforts to do that at a national level like Google and Apple have gotten together to develop this API, which they’re making available to the federal health agencies at the national level. Then we’ve seen state-level or city level initiatives where public-private partnerships are getting a handle on this whole contact tracing and controlling the spread of infections. What are the one or two things that are truly important for this kind of a public-private partnership to work effectively to ensure that there is public safety, ensure that there is accuracy in all of the testing and tracing and everything that goes on and that at the end of the day, the desired outcomes are met? What are the one or two things that came out of your experience?

AM: I would say these are the top three things for anybody navigating these hurdles. Number one, full transparency, i.e., partnership at a fundamental level of what are you doing, how are you doing. What are our shared objectives? What are our shared populations that we’re going to focus on? Case in point, UT Austin is really focused on indigent care for the city of Austin, which has been fascinating to learn about. So, making sure that there is transparency, there’s constant communication between myself and my counterpart with the city of Austin, the CIO for the city of Austin, who’s excellent. Our data teams are constantly talking to make sure that the data is being shared appropriately, securely, and that there, again, is full transparency on dashboards that we’re building. And so, the data that we’re putting out and that they ultimately published for the public has validity. That there is data provenance behind it. A lineage that anybody can say – how do you know how many tests you’ve given? So those kinds of things are very important because that’s what takes transparency.

Number two is governance. Making sure that just because somebody wants something doesn’t mean that your two teams and two organizations go out and just do it right. It’s got to have a benefit objective and particularly when you’re dealing with public health, you have to have a hyper-focus on ensuring that these are the objectives laid out by the mayor, by the governor or whatever else as appropriate.

Last but not the least, is internal communication. What has happened with COVID is you have a number of practitioners that are logged in from home using Zoom or whatever. So, we are communicating and having standups routinely with them to understand what the shifting landscapes are, what’s going on here in Austin, and the experience of COVID positive patients walking through the emergency department. Are there new protocols, are there new surveillance problems to stand up based on comorbidity? Is there different demographic that we need to be able to focus on a little differently? We had a discussion this morning on how to if we needed to start monitoring neonates, what would we do? How would we handle that issue? We’re trying to get in front of potential questions that come up.

So those are the kinds of things you need to be doing. There really is that hand-in-hand approach and that there is no one institution blazing down a trail inadvertently because of a lack of communication.

PP: What has been your experience with regards to false positives and false negatives in your application and your program with the city of Austin?

AM: I think the false positives, and what not really stemmed from the types of testing that are available, whether it’s serological, whether it’s swab, whether it’s saliva, and all of those components, I think that the general public is learning more about the accuracy of those various COVID-19 tests. Subsequently, if we get the data back from the lab saying – Aaron is COVID positive, but it was a saliva swab. Looking at the level of validity around that, it has downstream effects. So, as the general public learns more, we’re learning just as fast along with them because we can now have more experience. The world has more experience with COVID-19, and so the CDC modifies their approach on a lot of things as to what’s going to happen there, which affects our day to day planning. But that is really where the rub is then, and it’s not around contact tracing or issues with that. I’m actually impressed with the general public’s willingness to partner. I would say the consensus of folks out there, if you call them and say, hey, Aaron, you may have been exposed when you went to the grocery store over the weekend. Do you recall who you’ve been around the past 48 hours? We haven’t had people like, who would spat out and say, you’re invading my privacy. Generally speaking, people want to help, and people want a partner, and people want to do the right thing. So that’s been really positive.

PP: You mentioned the public’s cooperation in these programs, which is extremely critical for you to get a handle on the spread of the infections. In general, when you talk about virtual care models, going back to the earlier comment that you gave us about digital transformation initiatives, virtualization of care, telehealth models. What are you seeing as the public’s acceptance of those kinds of care delivery modalities, if you will? Are they comfortable with it? Are they happy with it or are they just tolerating it in the short term because there’s no other option? What are you seeing with your population?

AM: What’s important is to understand the population you are trying to serve. So, let me give you a few examples here. One of the populations we take care of, beyond obviously the commercial population, is indigent care, disconnected is another terminology I have heard, using an epidemiology sense. People that maybe do not have access to a smartphone or a stable home or resources to care, they may be live in a food desert. All those social determinants of health type issues. So, we have really had to spend a lot of time to understand that population of the kinds of modalities they do want to engage with. Specific to Austin what we have noticed a few things. Number one, most of the indigent population, English is a second language for them. So how do we put apps in front of them that they feel more comfortable engaging with? In our case, it is predominately Hispanic speaking individuals.

So, we put out a Spanish version of the apps. There is an iOS app, also in Spanish, there is an Android app, also in Spanish. And a responsive web form that’s also in Spanish. This is where they can upload their own contacts, they can do their own home monitoring, they can engage the app. The app lets us know who they’ve talked to, all these kinds of dynamics, which are very important when looking at contact tracing. And then, of course, consent. We spend a lot of time getting consent from people. And that’s explicit consent. So you understand that you were sharing with me, your family members at home and who was around you, and you’re consenting to tell me that you’re giving me permission to go ask those questions on your behalf. I never want people to feel like even though this is a public health crisis, they don’t know what’s going on. And those components of, again, transparency and putting applications of tech in front of people they understand and seeking first to understand have been the acceptance criteria over the general public. And we see most people, because we’re taking the time upfront to do these things, are natural to them. We’re not forcing them to jump through hoops or we’re not forcing them to have to not understand, but yet still share information. People want to help. We have not seen that pushback. So those are important components to understand.

Something I found interesting about the population, a data fact for people out there building apps, is that a lot of the indigent care actually do have a smart device of some sort. They’re just disconnected from the app store. They don’t have a way to download an iOS app or an Android app. Or they don’t have a data plan. They just simply go free Wi-Fi to free Wi-Fi as they walk around the city. So, it is interesting, the other types of connected behavior that we’re seeing, and I think there’s an entire ecosystem at some point that needs to get in front of this. Perhaps this is what you could do now with Elon Musk’s Starlink. He’s putting up with the ubiquitous coverage of Wi-Fi. Those kinds of industries are going to crop up to help connect the disconnected.

PP: We’re doing some work with some health system in New York City. Of course, the population is very similar to what you’re describing, indigent population, but a diverse, ethnically and linguistically. You mentioned the need for multilingual apps, and then you also mentioned that everybody has a smartphone, but they don’t necessarily have access to the app store because they live in either bandwidth deserts or they just cannot afford it or for whatever reason. And so, a related concern that seems to be arising is the notion of inequalities in access to healthcare by virtue of these inequalities in access to bandwidth as an example. Hopefully, all of that will be addressed through initiatives like the one you just talked about, where you’re giving people access to bandwidth so that they can go and download their apps. The apps that they need or being prescribed to them by their physician and so on.

AM: That’s right. And I would also say one more thing is that we have phenomenal teams of clinicians, family medicine docs that are helping us to do all of this. So, they encountered somebody, say, in a food desert. They’ll also set them up with a connection back to local and state resources that help identify may be meals on wheels. Other programs out there that maybe they didn’t have access to or even know about. So, you can use your COVID-19 programs to help populations of people beyond COVID. In our case, we’re giving them resources and access to state resources that they didn’t know existed and say, look, you don’t need to sit there in hunger, or you don’t have electricity. There are ways we can help you navigate these things. It just takes a focus on public health and it takes your team caring, and I’m very proud of the UT Austin team.

PP: Everyone I’ve talked to have come a long way in the last few months. In March, we really didn’t know what hit us and we had to scramble to get things in place. So, that we’re going to take care of the infected population and at the same time make sure that our regular population doesn’t deteriorate in their conditions and so on. I’m going to come to that in a minute. But it also seems to me like over the three or four months, a tremendous amount of knowledge sharing has happened and people are learning from each other’s experiences and really come a long way in terms of understanding how to address a situation like this in future. We’re a long way away from the current crisis itself. We don’t have a vaccine yet and so many other things, but it seems like we’re much more informed today. What has been the kind of collaboration among your peer groups, across your peers, CIOs in other health systems who are doing similar things? Do you have a forum platform where you share ideas, best practices?

AM: There’s been a couple of things. Number one, across all of the UT system – these include all the CIOs of UT South-Western, M.D. Anderson, myself, others – we are all constantly collaborating on what our institutions are doing across the state to take care of Texans and things that we’re learning, whether it’s data, whether it’s processes, whether it’s how do you set up thermal imaging cameras the whole nine yards across. Across CHIME there are numerous discussion boards and information sharing forums where CIOs are talking, there’s a group of about 40 of us that converse via email asking general questions, asking how do you return to work? Thermal camera discussion, like I mentioned, data, data provenance issues, all sorts of things.

At a federal level, I also am a congressionally appointed member of the HITECH. There has been some phenomenal data and idea-sharing exchanges between the CMS, which would just cross all of HHS, and with the payer side and the provider side to understand what is happening boots on the ground and they make modifications. I recall very vividly there was a couple of emergency discussions with HITECH in March and April in which I was very vocal. In couple of Modern Healthcare articles where I stated pretty emphatically that CMS and others needed to help us, they needed to help us immediately. Our cellular lines are getting overrun, there were all kinds of issues. If you recall that timeframe, people thought what was happening in New York was about to happen across the country. And to the credit of HHS, they mobilized.

Whether it’s helping to make sure that data was more quickly, readily available, and normalized, whether it was making sure that CMS was relaxing telemedicine rules as fast as possible. I’m not saying that the HITECH meeting made that all happen. I am saying the right people were listening and they committed to changing it. So, I give a lot of credit to the administration for listening and for making changes that really benefited boots on the ground. So those are the kinds of things that are happening. It is not happening in isolation where you’re sitting at a hospital and you don’t know who to talk to. The whole healthcare community has rallied together to really get behind this. And I haven’t found one person unwilling to help or dive in or lend a hand if you need it.

PP: Yeah, in a way, the pandemic has accelerated the future. And that’s kind of what Ed Marx, my co-author for our upcoming book on Healthcare Digital Transformation pointed out, which is that consumerism and technology are already changing the way healthcare is being delivered and being accessed and experienced. The pandemic has accelerated all of that and by an order of magnitude is what it seems like. Would you agree with that?

AM: I would agree with that. I would also say that consumerization has always been here. The problem with healthcare is that it’s an industry that has always been focused on reimbursement first. And that’s from the early days when Medicare and Medicaid first came out in the mid-60s. That has just become the focus of how do you submit claims for payer reimbursement? And so, because we thought that telemedicine was never reimbursed at a parody level or whatever, that there was never going to be mass adoption, and yet the consumers actually want it. I will give you a specific example. We do net promoter score – scoring for all of our patient encounters on top of age caps and all other things you have to do. We want to know in real-time -How was your experience? Would you recommend a friend? Then, tell us something, in free text form, about your experience that we should know. You usually get the whole, “Aw! Traffic is abysmal on Austin or parking was hard in a garage.”

OK! I’m (Austin) a city. I can’t change the traffic situation. Austin, Texas. I wish I could write for beyond healthcare purposes. However, our NPS was always in the 80s, which is really good looking at the net promoter score. However, since we’ve gone to telemedicine, our net promoter score is now in the 90s. People don’t have to put up with those headaches of traffic and parking anymore. So, consumerization has always been a desire. The problem is the healthcare industry just wasn’t going fast enough for what the general public wants. And so, my hope is now this COVID, as bad as it is, has highlighted the fact that you can be thought blazing with health care and people will adapt to it. They’re not stuck in the 1980s. They want to engage with you via a face time, communication or whatever. They want that. I want that right. I don’t want to drive unless I absolutely have to.

PP: Another topic, the whole notion of data interoperability and how we are set up today versus how we need to be set up for the future. You mentioned CMS finalizing interoperability ruling back in March. And so, we’re going to hopefully see an improvement in data interoperability and all the information blocking practices. But having said all that, the way data is structured today within our primary repository, a system of record, which is the electronic health record. The pandemic has exposed some serious limitations, and this is what I hear everywhere I go. What are your thoughts on that? What should we be doing now from data interoperability and just data management standpoint, knowing that we have what we have, which is a current electronic health record landscape, but our needs are now evolving very, very quickly?

AM: So, without getting overly technical and starting to talk about standards and other formatting and data issues, I will talk about the generalities. Number one, we are still learning about COVID, particularly in public health. We’re still learning what data elements we need to track. This is why the recent issues cropped up about race and ethnicity. And gaps of care, because not everybody mandates those fields to be filled out or we are not capturing it accurately. So, I would say, number one is we need to get a general baseline field for public health criteria. What are the standards that need to be tracked every single time? Is it race and ethnicity and of course, age and comorbidities? What is it? We had the same issue with Zika a few years ago with pregnancy. We weren’t able to track people who were pregnant because pregnancy status at that time was not mandatory. Now it is a required field. So, there are these things we need to learn. I would say, number one, a general baseline of definitions and data capture for public health that everybody must adhere to, rights that standards formation and you could put it through the USCDI process that was developed into 21st Century Cures Act that we did in the HITECH so that we can adopt those criteria.
Number two, I would say that we need to make sure that we do not forget other types of care across the care continuum. Right now, rehab, nursing homes, SNFs, they all need to be on some sort of digital system. They are not, obviously, with the American Recovery and Reinvestment Act of money was allocated towards digitizing the inpatient and acute care market. Not a bad thing. That is where people are the sickest. I totally get it. But we have to go back and make sure those care locations are just as digital and just as regulated as the inpatient facilities are. So, we have a continuum of discrete data.

And number three, a better partnership between public health and private sector. Again, I’m blessed here to be with Austin and UT Austin, which have a great relationship. I do not think the same exists in every locale, in every city. So how do you reboot and have those types of didactic discussions so that in the event of a pandemic, in the case of COVID 19, there’ll be future COVIDs. How do we make sure that those tenants we spoke about earlier are in place of transparency and governance and communication? You’ve got to have all those components working together. It’s not just standards, but that’s how we’re going to advance interoperability. I do think that 21st Century Cures Act, that is the law, as you just mentioned, was finalized, I believe it was beginning in March, should help. But we still have a long way to go because just because I put the tool in front of you doesn’t mean it’s going to be used appropriately.

PP: Well Aaron, we’re coming up to the end of our time here. I had just one last question related to the innovation ecosystem and their role in driving healthcare forward, especially from a digital transformation standpoint. And I know that as part of CHIME, you are also launching a series of webinars related to digital health innovation. What are you trying to address there? What are you seeing in the marketplace and what are you trying to address with this new series? What’s the expectation?

AM: I am a big believer in partnering especially with startups and young companies, on how do you and in a very agile manner, deal with a problem that you’re facing, whether it’s COVID related or not. There are companies out there that are hungry to want to innovate with you, and not that the large companies are bad. We have great partnerships with major companies here, too, at UT Austin. But it’s sometimes a lot easier to partner with a startup and solve a problem. And so, this innovative series that CHIME has started is around that. How do CIOs partner with a startup, a young startup to solve a specific problem? And the session that we have coming up is specific around contact tracing and home monitoring and the whole issue of COVID I just spoke about. When we were faced with this in March, the request comes to you as a CIO. Hey, what do you do for home monitoring on patients? What do we get? How do we build it? Do we build it in Redcap? Do we build an app ourselves? Hey, we need to do contact tracing. We don’t want to do it in Excel. Do we want to build an access database and do some crazy requests? You get like stop. Right. I can do the same old thing over and over again and not really advance the problem. Or I can partner with someone and really knock us out of the world and really benefit the society as a whole, which is the route we went. That’s what this series is about, its about thinking different, stepping outside your comfort zone and feeling OK to break a few rules, because it’s at the end of the day, you have a much more robust delivery of care and care processes. Also, your physicians are a lot happier and your patients, too.

PP: We never really got to talk about remote monitoring, and that’s a whole different maybe another podcast sometime in the next few weeks. Thank you so much for joining us and I look forward to participating in these webinars that you’re doing with CHIME. That is going to be very interesting for those who are listening. I would strongly recommend it. It’s got Aaron moderating them, so it’s got to be an interesting discussion. Well, Aaron, thank you again for joining us and I look forward to being in touch.

AM: I appreciate very much. Thanks, Paddy.

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

Aaron-Miri-profile

Aaron Miri is the Chief Information Officer for The University of Texas at Austin, Dell Medical School and UT Health Austin. He brings more than a decade of healthcare experience driving growth and innovation, leading both provider and commercial healthcare enterprises, and providing thought leadership and close collaboration with state and federal representatives. As the CIO, Aaron is passionate about humanizing technology by collaborating with clinicians, technology partners, and business champions to truly transform healthcare delivery for consumers, patients, and providers.

In 2018, Aaron was congressionally appointed to the Health and Human Services, federal Health IT Advisory Committee (HITAC), established under the 21st Century Cures Act. Previously, Aaron was federally appointed by HHS Secretary Sylvia Burwell to serve on the HHS Health IT Policy Committee established under the American Recovery and Reinvestment Act of 2009. He is the prior Chair of

the HIMSS National Public Policy Committee and serves as an expert adviser to the United States Senate Committee on Health, Education, Labor, and Pensions (HELP) and to other congressional panels engaged in numerous Health IT policy topics. Aaron also serves as an advisor to the National Academy of Medicine on the topics of healthcare privacy, secure, and data.

Aaron is a well-known international thought leader and he brings a deep understanding of how to leverage digital health and the latest technology to accelerate healthcare delivery across the continuum of care. Prior to joining U.T., he served as the Chief Information Officer for Imprivata, the Healthcare IT security leader, where he helped to build and transform a global commercial enterprise focused on healthcare cyber security. Prior to Imprivata, Aaron was the Chief Information Officer for Walnut Hill Medical Center, lauded by Forbes Magazine as the hospital that Steve Jobs would have built. He has successfully led organizations that achieved the HIMSS Nicholas E. Davies Award, HIMSS Level 6 and HIMSS Level 7 EMRAM status, HITRUST CSF designation, and led the first provider organization to receive the SECURETexas Health Information Privacy and Security certification awarded through the Texas Health Services Authority (THSA). Aaron is also a proud member of the CHIME CIO Boot Camp Faculty and routinely mentors’ early careerists through CHIME, HIMSS and other national associations.

Aaron received his MBA, with honors, from the University of Dallas, and his Bachelor of Science in Management Information Systems from the University of Texas at Arlington. Aaron is a Certified Healthcare Chief Information Officer (CHCIO) through the College of Healthcare Information Management Executives (CHIME), a distinguished Fellow with the Health Information Management Systems Society (HIMSS), and he is a Project Management Professional (PMP) with the Project Management Institute (PMI). Aaron is a nationally recognized 2020 “CIOs to Know” by Beckers Hospital Review and was honored with the 2016 Computerworld Premier 100 Technology Leaders award, 2017 Texas Health IT Leadership Award, and the 2019 Constellation Research Business Transformation 150 award. He serves as a board member in the not-for-profit Cartwheel Health, serves as a CIO board advisor for Dell Inc., and as an advisor for numerous healthcare startups and leading venture capital corporations.

About the host

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

If telehealth is our first peak of digital medicine in COVID, the second will be digital monitoring.

Episode #49

Podcast with Ashish Atreja, MD, MPH
Chief Innovation Officer, Medicine
Mount Sinai Health System

"If telehealth is our first peak of digital medicine in COVID, the second will be digital monitoring."

paddy Hosted by Paddy Padmanabhan

Share

Share on facebook
Share on twitter
Share on linkedin
Share on email

In this episode, Dr. Ashish Atreja, Chief Innovation Officer, Medicine at Mount Sinai Health System discusses how virtual care technologies – remote monitoring, video visits, telehealth, and digital medicine – will bring value to health systems by decreasing cost, increasing efficiency, and improving healthcare outcomes.

Dr. Atreja’s role at Mount Sinai Health System is to enable digital health for value-based and patient-centric healthcare. He states that COVID-19 has been the most significant technology transformation agent in the healthcare industry. According to Dr. Atreja, the next technology after telehealth that will rise out of the current pandemic is digital monitoring.

Dr. Atreja is also the founder of non-profit Network of Digital Medicine (NODE.Health), that promotes evidence-based digital medicine by bringing together a network of societies, foundations, and health system associations to enable digital transformation in healthcare.

Ashish Atreja, MD, MPH, Chief Innovation Officer, Medicine, Mount Sinai Health System in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “If telehealth is our first peak of digital medicine in COVID, the second will be digital monitoring.”

PP: Hello again, everyone, and welcome back to my podcast. This is a Paddy, and it is my great privilege and honor to introduce my special guest today, Dr. Ashish Atreja, Chief Innovation Officer of Mount Sinai Health System in New York. Ashish, can you share a little bit about your role at Mount Sinai and what you are working on today?

AA: Currently, I’m the Chief Innovation Officer in Medicine at Mount Sinai Health System. My goal is to really enable digital health together for value-based healthcare and healthcare efficiency. My foundation was laid in Cleveland Clinic where I did my Residency and Informatics Fellowship. I led on to implement an electronic health record for the hospital. And that got me to innovation bandwagon where I got a chance to go to the first web-based paging application way back in 2006. Really good to see the value in being licensed out and implemented across the clinic health system. And then Sinai hired me for a role where we can combine the best of digital health with the electronic health record to make it a wholesome, patient-centered experience for healthcare. So, it has been just a fascinating journey, learning from everyone in the community, from startups to my partners in NODE.Health and trying to make a difference.

PP: Can you tell us what NOAD.Health is about?

AA: One of the major gaps we see in our ecosystem is there is so much going on in digital health. But who puts it together in terms of saying, these are the best solutions that we have to look for? But really taking a scientific approach to that. So, we created this concept of evidence-based digital medicine or EMDM where we can trust really what is working, what is not working. We create a framework for people to evaluate the technologies because then we feel comfortable in advising and bringing them to the health systems. NODE.Health is a nonprofit network of societies, foundations, and health system associations. It is followed by a consortium of health system leaders and the goal is to first promote evidence for digital health and then enable transformation. We do that through our validation network we have. We also do that through annual conference we have as an education way for people to learn from the case studies and learn from each other.

PP: In my work with health systems today, we see that digital transformation is accelerating and largely as a result of competitive pressures. It seems to me that the focus is primarily today on telehealth and digital consumer engagement. Obviously, because of the high revenue dollars attached to improving access to care. Is that a fair observation? Can you talk of some of Sinai’s digital investments in the near-term and from the longer term as a consequence of the pandemic?

AA: With the COVID phase, COVID has been the biggest transformation agent for us, I would say the progress we saw which would take a few years happened in months. But I think the COVID phase is actually parallel. The transformation technology that has been happening, the access was a big issue and initially, we got it to rise because of the bots. The bots happened to screen patients because we did not have much triage capacity with our personal thing. But then because we had to convert rapidly our in-person visits to video visits, telehealth really become mainstream. I think consumer engagement telehealth became mainstream because of we could not see in person. Post-COVID or the tail of the COVID will take us to a world that is going to persist. If telehealth is our first peak of digital medicine in COVID, I feel the second peak is going to be digital monitoring. Nearly every patient can be monitored through a software or a hardware that will dovetail into a population health approach. That is where I see the biggest gain as well happening from the technologies.

PP: How are the consumers responding to the shift towards telehealth? Are you seeing not just the volumes showing an uptick because that is to be expected, but also the kind of satisfaction levels? Are they happy with the experience, are they going to stay with it when things come back to normal?

AA: My wife is practicing cardiology and she was saying all my patients are coming back as a re-open for the physical thing. And we are going to see a variable pattern. I call it a blended approach. You are going to see some patients who have tasted telemedicine and may not require that heavy physical examination or heavy touch, maybe completely ok with preferring telemedicine. Some people would be equivalent. And some people would still like to come in. I think where it becomes really tougher is now the practice, patients who tasted telemedicine will demand a mixed approach. Some patients will lean towards telemedicine continuation and some will actually go to physical. So, you have to actually take all of those aspects into account. So, it creates an additional layer of complexity than telemedicine only.

PP: In this whole new world, there’s a lot of startup activities that are trying to address opportunities with digital engagement touchpoints in this new virtual care environment. How do you see them holding up from your standpoint? Do you see them pivoting their businesses? Are they staying the course? Are they doing something different? You have a unique perspective by virtue of being the Chief Information Officer. Can you share your observations on that?

AA: I think there are many startups who are suffering if they are in a unique niche area and they are in a research skill or something. And your entire business model was dependent on that. You certainly are in a no man’s zone and don’t know where to go. I have seen many startups evolve and rapidly kind of support virtual care. I can give examples for the Mount Sinai spinout Rx.Health, which I continue to guide. And they have a platform approach to prescribe digital medicine directly from EHR and unify the entire ecosystem. They rapidly extended a partnership and got a whole virtual care tool kit with national societies to support health systems. I think startups, which already have the ecosystem and the infrastructure and the platform, like in case of Rx.Health, it was just adding additional tools to it, will rapidly able to do that and evolve themselves. And that is like one million lives within three months. And startups who are very early are startups who have a unique niche area were struggling. So, we are seeing both patterns, but irrespective we are seeing a pattern where consumer engagement and more than AI engagement really has become pivotal. And patients are able to see what a health system, what a good patient engagement looks like.

PP: In the wake of COVID-19, startups, by definition, they’re meant to be opportunistic. They’re nothing if not opportunistic. One thing that we are seeing is that there’s a lot of emerging opportunity in addressing the immediate needs of the COVID-19 pandemic. And it is a lot of apps, a lot of new solutions, and a lot of existing platforms. They have now either built or launched “COVID-19 applications.” I read a study recently, I think it was done by the University of Illinois in Urbana Champagne, which looked at some 50 different apps, and they raised a lot of questions about the evidence of the effectiveness of some of these tools. They also raise questions about things like the privacy of the consumer data that they are going to access. What do you make of all those that you, as the Chief Information Officer, especially in the NODE.Health? How do you really adjust to all of this? I mean, make recommendations about what tools are going to work and what will not?

AA: I think in terms of COVID, it’s tougher because we don’t have a legacy or a history. We don’t have the time to evaluate. So here you will have to really just see what is happening in real-time and just make some conclusions out of that, which can sometimes be wrong. So, I can take the example of contact tracing apps, which I have been engaged with a lot. And it is just a no-man land right now. This is not like South Korea or China or in some cases India, where you have a government-mandated app that everybody is using. This is free for all and there are so many apps in the market. Most of them are not talking to each other. So, what is the value in terms of public health? There can be value in personal health by guiding. But what is the valid public health space is uncertain. I think what you also have to take into account that you do not have the luxury of evaluating everything. When it comes from a health system perspective my recommendation will be, we look at patterns, look at problem first approach later than what’s out there as a shiny object syndrome. COVID has also accentuated the problem of shiny object syndrome. I think we have to say where your health system is really struggling with. Is it getting new patients into telehealth? Is it as you are reopening getting patients back into surgeries or appointments? Is it your ACO population that is really getting hospitalized a lot? Is it post-discharge care where you are struggling? Or all of that? And then which are other solutions which actually fit into that our platform solutions, which can serve all of them. My recommendation would be to not go with one isolated partner like a point and get solutions. But look at COVID solution as a strategy to evolve post-COVID. So, take the solution that you would really like to evolve and play with post-COVID because it is so much time in security as has been integration and of diligence and other staff. You want to leverage it for the long term, not just for the next six-nine months or so.

PP: Yeah, you mentioned contact tracing. That was the other thing that I was going to talk about. My firm’s been following this, and I’ve been following this. Google and Apple came together and launched the API but then ran into a few challenges because, you know, the public health agencies wanted location data, and they don’t want to share that. So, you know, there is questions about reapplication that wouldn’t be built on top of the API and how effective they’re going to be. Having said all that, despite all of the challenges, it seems to me like some of these new technologies, contact tracing, for instance, have a lot of potential in the future, regardless of whether it is to deal with COVID-19 as a concept, as a theme. Seems like there’s a lot of potential for that. And from my experience, it looks like some health systems are doing their own contact tracing within their own populations in a very limited way. Do think that’s the way to go right now, look at your own population, focus on that, and try to make it work, and then we’ll see about what happens in the broader scheme of things?

AA: I think its elementary. In fact, I’m working closely with MITRE, which is a nonprofit which works with federal agencies a lot, and the presentation was completely focused on we need to have a complementary approach for health systems and public health agencies. And I’m talking with the New Jersey Public Health in New York City as well. And if we just limit the stuff to contact tracing to public health agencies, they don’t have their own patients. So, they’re going to be just putting something out there, but that adoption can be very, very variable. I’ll take the example of Mount Sinai Health System, we launched an initiative called STOP COVID NYC. We were able to reach out to close to one million New Yorkers. Within a few weeks, and we were able to actually digitally monitor 55000 people. I think there’s a value in having five million patients in your network, which you can reach out to and get to engage with them and protect fifty-five thousand employees. So, there’s a lot at stake for health systems and for self-assured employers as well. I do think at least in the U.S. there is more federal approach and data sharing issues and privacy concern, we cannot wait for nine months to actually have a mainstream contact tracing app universally if at all that happens. We have to still look at and within weeks or within days, protect our population and patients.

PP: I think New York is a great example of public-private collaboration, especially in the wake of the COVID-19 crisis and New York is also one of the most heavily impacted areas in the country. Back to the patient experience, consumer experience when it comes to digital engagement. There is no dearth of digital health tools that can solve some problems in the entire patient care continuum, especially in the context of digital engagement. At the same time, I hear all my clients and everyone, they’re saying that they are struggling with creating the seamless experience that people look for and something that you might be used to in an Amazon type of experience or your personal banking experience, for instance. That kind of experience seems to be very, very challenging in healthcare. Why is that? Is that because apps do not talk to one another? Is it because we are not designing them properly? What are your thoughts on that?

AA: I think there are two potential reasons. One is the EHR. The APIs is now opening up. So if that’s your system of record and that’s where your physicians are living, the patients are completely living in a patient-centered world, you have to have an open API to share the data to actually enable that seamless thing. If you can’t have open API, even if it is said they have open APIs and it’s not easy to do that, then you can’t create a customized experience because your record is completely in a proprietary system and you are not able to unlock that. That has been the number one major stumbling block. With FHIR and other standards, I work in FHIR at the scaling committee for ONC FAST Committee, and I think they have in progress. But still daggered what is possible to what is actually a really feasible what people are doing. It like a O gap. The other part is there are differences in operations, whether it’s underserved or not, digital disparities, and also disease-specific differences. Getting a primary care doctor visit is very different than having a surgery done on new for orthopedics, for example, or getting a heart attack or being in a stroke or being in a nursing home. So, the context, the people around you are very different, the length of the time is very different. So, there is enough variability on the patient level, on the system level, on the electronic records level, to be able to orchestrate that in a meaningful fashion and make it universal requires time and effort and investment. And look at the investment Amazon has to make it a seamless thing, people undercount. They just see the expenses here. Hey, let me get it without investing 100 dollars per year and do it, while I am a five-billion-dollar health system. So, I think there is something to be said about investment, but also something to invest in investment, getting things together to make it unified in unison and rather more fragmented.

PP: We’ve had the final interoperability ruling come out in March. And leaving aside the information blocking aspects of it, when we talk about creating these seamless patient experiences, you think that’s going to make a difference? Do you see improvements coming about in the experience directly as a consequence of the ruling?

AA: Yeah, I think that we are going to see a lot more applications, patient-centric applications, leveraging that. And I think we have been waiting for that for a long time. But I think that would become much more mainstream now. There’ll be definitely value. I think the data exchange between EHR’s to EHR’s will still be less. But I think at least the patients will have it, hopefully, and then they can be a whole ecosystem that has to be developed around it.

PP: We’re now in the midst of COVID-19 or somewhere in the journey. But clearly, there is a shift to virtual care and virtual care models of have accelerated, telehealth is mainstream, digital front doors are all the rage, and remote monitoring is gathering steam. We did not talk much about the remote monitoring piece. Do you want to spend a couple of minutes talking about how that is going to change the healthcare experience in the future?

AA: Yeah, I think remote monitoring is probably going to become the dominant way to manage patients. And continuously manage patients. Whether its chronic disease and the reason I am saying that till date the remote mountain has been suffering from two things. One is hardware only play and the patients may not have an easy way to set it up and link to the Wi-Fi. But with 4G devices, which can actually implement hardware, we do not have anything to test or connect makes it very easy. The second was reimbursement for that. So that’s why there’s limited mostly to ACO or post discharge. Now with reimbursement coming from RPM and CCM codes. I think we’re going to see a lot more mainstream implementation of that. I think any chronic disease patient as cardiovascular to others will require digital monitoring. And we are doing it a lot for even many devices which do not have devices by doing software, only digital monitoring. And that is even much more affordable than the hardware on the disk monitoring where you can access patient symptoms and other things to track them and schedules and logic for them. So, I think this combination whether its value-based healthcare, whether it is the readmission reductions, whether it is payer, and then you can automatically set up triage rules or alerting rules to convert those people who are digitally being monitored and can load them into virtual visit or in-person meeting as needed, as we saw with COVID-19. I think we are going to see a lot more push on that and becoming things to scale and getting a lot of value for health systems to decrease the cost, increase efficiency, and improve outcomes.

PP: I think the reimbursement environment is definitely improving, as you mentioned. We saw that for telehealth they made some significant changes and those changes may possibly stay on for the longer term. And we see the same kind of positive momentum on the remote monitoring side as well. So, all that is good news for virtual care models. Well, Ashish it’s been such a pleasure speaking with you. And thank you so much for taking the time to join us and look forward to following all of your work at Sinai and Node.Health and of course, Rx.Health. Thank you again.

AA: It’s been a pleasure, Paddy. Thank you for having me.

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

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

About our guest

Dr. Atreja is a healthcare executive with board certification in internal medicine, gastroenterology, and clinical informatics. As the Chief Innovation Officer, Medicine, he leads the Sinai AppLab (http://www.applab.nyc) that is one of the first collaborative hub within academic medical center to build and test disruptive mhealth technologies.

As an intrapreneur, Dr. Atreja has won innovation awards at Cleveland Clinic and Mount Sinai, successfully licensed technologies from academic centers and advises startups, accelerators and Fortune 500 companies in digital medicine. He was first gastroenterologist to get board certified in informatics and one of the first to develop virtual pager and messaging application. Dr. Atreja serves as Scientific Founder for Mount Sinai Spinoff, Rx.Health that brings first enterprise-wide app curation, prescription and engagement platform to risk sharing hospitals and payers in an affordable and scalable manner. Recently, Dr. Atreja established non-profit Network of Digital Medicine (NODE.Health) to connect innovation centers worldwide and share best practices for digital medicine innovation and implementation between industry, payers and health systems. Dr. Atreja is a member of many professional organizations, has published 70 academic papers, presented more than 200 abstracts and has been a keynote speaker globally on topics related to digital medicine evidence and health system transformation. Dr. Atreja was nominated among the Top 40 HealthCare Transformers in the US.

About the host

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

We believe that a business model of payer-provider partnership is best for patients and communities

Episode #48

Podcast with Ceci Connolly, President and CEO, Alliance of Community Health Plans

"We believe that a business model of payer-provider partnership is best for patients and communities"

paddy Hosted by Paddy Padmanabhan

Share

Share on facebook
Share on twitter
Share on linkedin
Share on email

In this episode, Ceci Connolly, President and CEO of Alliance of Community Health Plans discusses the findings of their recent survey on how COVID-19 has shifted consumer behavior towards healthcare and tripled the use of telehealth and other virtual care technologies.

Ceci shows concern about the existing health inequities and hopes that we close the fundamental gap of the digital divide affecting certain sections of the society. She believes that in a post-COVID-19 era, healthcare payers and providers will focus more on virtual care for better patient experience. Ceci further hopes to see virtual care at the core of value-based model in the future.

ACHP is a non-profit organization that brings together innovative health plans and provider groups delivering affordable, community-based, high-quality coverage and care.

Ceci Connolly, President and CEO, Alliance of Community Health Plans in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “We believe that a business model of payer-provider partnership is best for patients and communities”

PP: Welcome back to my podcast and it is my great privilege and honor to introduce my special guest today, Ceci Connolly, President and CEO of the Alliance of Community Health Plans. Ceci, welcome to the show. Would you tell us about the ACHP and your work?

CC: The Alliance of Community Health Plans is a group small but selective group of health plans that are nonprofit, community-based, and aligns with providers. They’re either part of an integrated system or they have these very close partnerships in their communities with physicians and hospitals. We believe that the model of the health plans and the providers being really aligned around the patient and the community makes for a very successful approach in healthcare today. Our work really grows out of that belief and that view that a business model of payer-provider partnership is best for patients and communities. We see better health outcomes, often at a lower cost. Here in Washington, D.C., where we are based, we advocate for that at the federal level, in Congress and in the administration. We also do a lot of work with our clinical innovation department around best practices, shared learning, and research. And we also have a market competitiveness team that looks at that model and really tries to document the great success stories, does a lot of benchmarking, comparative analysis, et cetera. So that is a bit about ACHP and our wonderful members.

PP: What is the size of the members and how many such health plans are there in the country that are closely affiliated with the community health systems?

CC: We have 25 member companies. They range in size from a couple that have enrollment of 100000 covered lives all the way up to Kaiser Permanente with the 11 or 12 million covered lives. We and our members are present in 35 states plus the District of Columbia, representing now about 22 million covered lives.

PP: Your organization recently published an interesting survey on how COVID-19 has shifted consumer attitudes towards healthcare. Would you care to discuss one or two findings? Was there anything that surprised you?

CC: This was a national survey of adults 18 and over across the entire country, a good demographic mix, if you will, to really represent the nation. And we were most interested in the way in which the COVID-19 pandemic has altered patients’ views about going to a doctor’s office or hospital, how they are interested in receiving healthcare services now and in the future. And in many respects, the data validated what we have been hearing anecdotally, but it’s always so powerful to get the data. A very sizable 72 percent of the respondents said that the pandemic had dramatically changed their use of healthcare services over the past few months. What we saw consistently was that through the early months of the crisis and for at least the next three to six months, high levels of anxiety about going to a doctor’s office, a hospital, an urgent care clinic, any of those in-person sites for elective procedures, diagnostic procedures, tests, et cetera. We heard from those individuals who said they had chronic conditions and senior citizens in our survey had even higher levels of reluctance to return to in-person facilities for probably at least the next six months. As you can imagine, that has very important implications for the health sector and potentially large implications for individual’s health. The good news flip side of that is that we saw a remarkable tripling of use of telehealth or virtual care in that time period. And even more impressive was that the satisfaction rate, customer satisfaction with telehealth was just terrific. Of those that had a telehealth experience, whether it was phone or internet in that short time period. Eighty-nine percent said they were satisfied or highly satisfied with the experience. And the individuals in the survey that reported using a smartphone app to manage an existing medical condition might think in terms of diabetes, sleep problems, heart conditions, 97 percent of those individuals describe that as valuable or very valuable.

PP: This is really very interesting data. My firm does a lot of advisory work in this space. So we work with a lot of health systems and help them with their digital health and digital transformation roadmaps. And obviously over the last three months in the wake of the pandemic, telehealth and virtual care models have become front and center in their overall business strategies. The numbers that came out of your survey are just validation for what we’re seeing on the ground. Interestingly, I also saw another survey that was published recently. I think it was by FAIR Health were the increase in total health claims is on the order of 4000 percent over the last one year. And, there are regional differences and some regions are higher and the others are not as high. But you mentioned anxiety. Some of the claims also reflect the fact that there’s a lot of anxiety among patients and were unable to take care of themselves using conventional access to healthcare. So, we are clearly in the middle of a very interesting transition is what it looks like. And I hear that 80 to 90 percent of outpatient care could potentially shift to some kind of a virtual care model. Some of your survey results seem to be indicating that we are headed in the direction. So what are your views on this shift specifically as it relates to access to care for the population served by your member health plans?

CC: I am happy to report that several our members were really in the vanguard of this movement. If you think about UPMC and Pittsburgh or Select Health, which is part of intermountain in Utah or of course, Kaiser Permanente, they have been very early adopters of the technology options and really helped spark ACHP to lobby successfully over a year ago for inclusion of telehealth in Medicare Advantage. And so, we are so pleased to see much of the rest of the world now seeing what we have long seen in terms of the convenience, the lower cost that is available. And I think that the COVID-19 crisis really drew sharp relief as we saw people that otherwise could not get access to medical services, finally could have it with a click of a button on a device. That said, we have also seen that inequities in our society play out in this area as well as so many others today. So, the number of individuals that do not have broadband, that do not have smart devices. Right now, CMS has put in place waivers for audio only services. But there are concerns about whether or not that will hold, especially if it would be factored into what’s known as risk adjustment calculations in the future. So, there are some unknown questions there. We certainly hope that Congress will finally move forward with broadband legislation is one step in terms of closing the digital divide. But there are other things that need to occur, certainly. We are worried that some providers will hurry back to the in-person visits, in part because they have bricks and mortar businesses that rely on the fee for service payments, not just of the visit, but often a lot of additional tests and checks and things that can be run in person, whether critically necessary and appropriate or not. So as much as we see public attitudes moving very quickly and being very pleased with these alternatives, we are not certain yet about the providers. And we know from our own health plans that they really needed to approach this as a partnership with clinicians every step of the way in terms of what areas of care are best suited to virtual versus the ones that are better in person. One of it shouldn’t be a surprise, but many seem surprised that behavioral health or mental health care is specially affective done virtually. These are populations that maybe are not as comfortable out in society at any time, let alone when there is the threat of a corona virus infection. They may have transportation issues or other chronic conditions that make in-person visits challenging. And many of our health plans report that patients sticking to scheduled appointments virtually is higher than the rates that they were seeing pre pandemic in person.

PP: You mentioned the policy environment as a business for telehealth. But there are other aspects of costs that are stranded that come into play when things go back to normal from the patient or the consumer standpoint. There’s also the question of you mentioned it as a digital divide, and especially if we’re underserved populations with broadband connectivity issues and so on. That is the affordability aspect, the transparency to the costs of care or costs of other enablers for cares such as devices. Where do you see all that today and how do you really support your member populations in sort of wading through this thicket of these new tools, technologies, modalities and get the care that they need, but also not find themselves at the receiving end of unexpected costs?

CC: We always try to start with evidence and the wisdom of clinicians when it comes to appropriateness of care. What care being delivered, when, how, where, etc., clinicians talking to their patients. So that is always the starting point for these conversations. As far as the Alliance of Community Health Plans is concerned, we very quickly want to layer on the value discussion. There’s been talk and effort in this country for an awfully long time about moving from our volume based fee-for-service system to a value-based system that rewards outcomes as opposed to just number of procedures, and I would certainly put virtual care into the value-based model approach. And again, clinicians and patients are going to guide much of this. But if a clinician has a diabetic patient, they should be able to think through how much of that can be remote monitoring, emailing, the occasional video check-in. And then when does the patient really need to come in for certain lab work or tests or procedures? So that’s just one tiny little example. But it’s probably going to be a mix. And ideally, you want that clinical team, not just an M.D., but an entire team, to be paid a certain amount of money to care for that diabetic. And they work out sort of the best formula in a value-based arrangement. We have seen that so many of the delivery systems, physician group practices, hospitals, et cetera, that we’re so heavily reliant on volume-driven revenue and fee-for-service that they encountered very severe cash shortages very quickly in the crisis. If you were to talk to clinical teams, physician groups that were in more of the value-based arrangements, they continued to receive those steady payments throughout the crisis. And it meant that they were able to focus on patient care during a crisis as opposed to their revenue stream.

PP: What about price transparency? Do you have any specific thoughts on that, especially as it relates to all the new modalities of care in a predominantly virtual care environment, digital health tools and devices and the like?

CC: We are bullish on price transparency and we have several members that have been far out in front with consumer tools for very personalized price and quality information. I’m thinking about priority health in Michigan and health partners in Minnesota, Presbyterian in New Mexico and many others where a consumer is not only looking up a potential price of a service, but it’s there out of pocket cost and it factors in their own deductible where they are in that deductible. It tells them different locations where they could go and get the service so they can think about travel time and convenience, where if there is a virtual option and many of these tools also marry in quality data so that they can shop for value. And in fact, we are seeing that happening in all the plans that I mentioned. And its terrific news because the patients want to go to those higher value sites and offerings and options, and both the plan and the individual member end up saving dollars. So when you then come over to a policy discussion, what we have put forward for the policy community is a framework for transparency tools that would be along these lines of geared toward the individual consumer where they are with respect to their own coverage options. Where they are located, giving that quality data, et cetera. So, we have put out a framework for certifying an independent certification of those tools. What we are doing over the next several months is inviting many other stakeholders to help us refine this and move it forward in the hopes that we could really offer an innovative, flexible, independent certification as a way to help consumers make their own choices.

PP: The certification presumably will really help consumers kind of navigating their way through all the multiple options that have been offered to them. I want to go back to the point that you made about the digital divide and these are the underserved sections of our population. One topic that keeps coming up in these conversations is social determinants of health. Is your association doing any work in this regard? Could you share any highlights, any of the research that you’ve done or any of the successes that you’ve had in using social determinants of health to better serve your member populations.

CC: It all ties to what our own member companies are doing in their communities. And that is where we learn and identify best practices that we can then share much more broadly. ACHP members have long understood the connection between unmet social needs and disparity in health outcomes. The evidence is very clear. A couple of the areas that our members have really got an out in front. One is around food insecurity and a number had programs dubbed food pharmacy or food as medicine, because the data is overwhelming in terms of your health and nutrition. And it is actually one of the areas in the social needs space where you can have a significant impact in a very short period of time. And I think now with unemployment of 40 million or, so Americans and we are seeing the tragic long lines at the various food pantries that this is so important. So UCare are a member in Wisconsin, which has a significant Somali population and has long also had very culturally appropriate meals, or Geisinger in central Pennsylvania, which not only has the food offering and get your healthy food. But they pair that with things such as cooking classes for individuals to make certain that it’s fun and enjoyable and they know what to do with these vegetables and things that they might be getting. Several of our members are also partnering in their communities around the homeless population. UPMC is a real leader in that and being able to partner with other social service agencies where UPMC comes in and helps to coordinate and manage care for those individuals. So that is another good example. Just since the pandemic specific source out in the Pacific Northwest has turned its entire 20-20 grant-making program to funding healthcare services for the vulnerable populations most impacted by COVID-19, which of course we see across the United States communities of color in particular, that have really in the victims of this awful pandemic. So those are a few of the different very successful approaches that we see in one of our members. And then often we can help to carry it across to others, share it with the policy community, etc.

PP: I am much familiar with the Geisinger example that you talked about, the fresh food pharmacy initiative and how just making fresh food available for populations that are at risk is the ones that have multiple comorbidities and so on. And the evidence is clearly documented. One of my earlier guests on this podcast was the CEO of the Corporate Center of Clinical Relation in Dallas has done something similar with regards to prenatal care and young mothers. Nutrition fresh food has been clearly demonstrated as a factor in improving the health of those populations. What are your members doing today in terms of planning for a post-pandemic era? What kind of long-term shifts are they planning for, especially as it relates to digital health and social care models?

CC: Well, I can tell you they are very committed to the virtual care option for patients, and they are now working to ensure that the areas are good, safe and secure and private guardrails included in all of those communications and that it’s going to sync up nicely with a person’s electronic medical records, that everything is kind of tied together in a coherent fashion for the patient and the clinical team and other technology investments that they may need to expand those services. Working an awful lot with the provider community, especially perhaps some of the specialty areas that might not have had much exposure or experience prior to the outbreak and are really quite hungry for the education and the training and the best practices to continue that. We’re working on the policy level to think through those issues, around reimbursement over the long term and the regulatory environment, hopefully in a value-based setting. We do not believe that it advances health in this country or affordability. If at the end of this crisis we simply have a whole bunch more fee-for-service codes, that will not get us for word in our health care progression. So, we’re very focused on that. Some of the other things are companies are thinking about is their own workforce and more flexibility for their workforces. Of course, they are giving a lot of thought during what will clearly be an economic slowdown, if not recession, for an extended period of time. Growth in Medicaid, growth in the individual market, as well as some number of uninsured. Our plans are focused a great deal on being able to serve those individuals who find themselves in a different coverage situation than maybe they were just a couple of months ago.

PP: Ceci it’s been such a pleasure speaking with you. Thank you so much for joining us. I look forward to following all the great work that the ACHP is doing.

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

Ceci Connolly is President and CEO of the Alliance of Community Health Plans (ACHP), the trade association for nonprofit, community health plans. A prominent voice in healthcare for more than a decade, Connolly has served as a national correspondent for the Washington Post and a leader at international consulting firms, including PwC and McKinsey.

She is coauthor of LANDMARK: The Inside Story of America’s Health Law and What it Means for Us All and has been published in numerous publications, including the New England Journal of Medicine. Connolly was included on Business Insider’s inaugural list of “DC Health Care Power Players” and was also the first non-physician to receive the prestigious Mayo Clinic Plummer Society award for promoting deeper understanding of science and medicine.

About the host

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

In future, 80% of healthcare needs will be addressed by digital health tools.

Episode #47

Podcast with Tom White, Founder and CEO, Phynd Technologies

"In future, 80% of healthcare needs will be addressed by digital health tools."

paddy Hosted by Paddy Padmanabhan

In this episode, Tom White, Founder and CEO of Phynd Technologies discusses why digital front door technologies and interoperability are the key to the healthcare delivery ecosystem. He also talks about the company’s evolution and the marketplace needs they address.

Digital front door technologies are being adopted extensively by healthcare systems and are practical and useful for the industry, especially in the current pandemic situation. Tom believes that 80% of healthcare should be driven through digital means and 20% through phone calls, unlike the current situation.

Phynd Technologies’ platform focuses on the provider data, defined as people, places, and services, and simplifies provider data management for healthcare systems.

Tom White, Founder and CEO, Phynd Technologies in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “In future, 80% of healthcare needs will be addressed by digital health tools.”

PP: Hello, everyone, and welcome back to my podcast. It is my great privilege and honor to introduce my special guest today, Tom White, Founder and CEO of Phynd Technologies. Tom, thank you so much for setting aside time. And welcome to the show.

PP: Tom, could you start by telling us briefly about the company and its evolution and what the marketplace needs you’re trying to address.

TW: Phynd technologies is a little over seven years old. The core thesis that we started with is still the same concept in that we believe that health care systems need a central hub of provider information that can flow into their clinical, marketing, and claims systems that keep everything in sync from a data perspective. But then also enables output into areas that can drive consumer experience and better operations through better provider data. The marketplace need that we focus on was that EHR is fantastic in managing the patient journey, but not designed as much to focus on the providers themselves and providers really defined as people, places, and services. It’s a broad term that means that basically some products, the health care system can offer to the consumer population. So, it literally is the doctors. It’s the locations even nowadays a COVID testing site would be a place to the services that the healthcare system can offer, whether it’s telemedicine, e-visit, virtual visit, those types of things. Historically hospitals manage data on people, places, and services in different places in EHR. From the clinical perspective, marketing typically has its own that drives its patient engagement strategies. Claims have their own system, their own database. What we’ve done is we’ve merged everything into one profile. So, following the Epic model of one patient, one record, we really focus on one provider, one profile, and that profile can be people, places, and services.

PP: You’re right now in the middle of a very exciting time and a transition for healthcare. COVID-19 has accelerated telehealth adoption and virtual care models. So, I imagine that the need for having the ability to go online, triage your own symptoms, find a provider, and schedule an appointment. All of that is coming together in a way that potentially is beneficial for a company like yours. Many health systems are also having financial challenges because of the unexpected costs of COVID-19. How has the market environment changed for you from pre-COVID-19 to now and what does it mean for Phynd in the marketplace now?

TW: Yes, we’ve seen an acceleration in interest from prospects across the country because of the digital front door ecosystem, whether it’s symptom checkers, smart waitlist, appointment reminders, self-scheduling, providers search all these different things. That ecosystem is certainly right now very, very practical and useful. And it’s really being adopted across the industry. What all those systems need is a provider data solution and the central hub idea back to the original question of provider information that people, places, and services that can feed all these different types of systems. Because there’s lots of vendors out there and hospitals, it’s competitive. So, there’s a lot of startups and hospitals are looking at buying different types of solutions. But what they need at the bottom of that is that foundational level is this provider data management platform, the central hub that can keep those. And so, we’re seeing a lot of interest in what we do because it really is that basis for the digital front door. We call it the digital house; we are the foundation for that house. The front door is the web site and the consumer experience. But that notion is going to change and shift as patient engagement tools get adopted. It is maybe the web site for the narrow network that the health systems partnered with. It could be a pop-up microsite on COVID testing tents that are in the city. It could be a payer health care system, the partnership web site really exposed, some value-based care entities, whether it’s ACO, CIM. And so, the notion of a digital front door, we think is going to be expanded to include windows, another door, a front door, back door windows and all those kinds of fun things. The house framework itself is the provider data that’s going to see those different types of systems. And then you have got apps, you’ve got mobile applications, everything’s going to end up being kind of done on your phone anyways.

PP: That’s a very interesting way of looking at the digital front door concept. And I agree with you that there is no single universal definition of digital front doors. That means different things based on the context, based on the entity and so on. And of course, you are obviously approaching it from the point of view of provider data, patient data as the other side of the coin, which is also something that health systems are focusing very heavily on in order to get a unified view of the patients. So, all of this is converging in a way that I think is going to make for some very interesting times for all the companies that are active in this space. And that actually leads me to my next question to you. Where do you see yourself in the context of the entire ecosystem of solution providers that are operating this whole space that for want of a better term, we call the digital front doors? You’ve got the EHR companies – Epic, Cerner, and so on. You have got big tech firms who are trying to have some kind of role play in this. And then, of course, your compatriots in the digital health ecosystem. Where do you see yourself and how do you see yourself kind of maximizing your opportunity in the coming quarters?

TW: So we see ourselves side by side with the EHR, we sit next to Epic or Cerner in that we integrate by directionally where we are the partner with both of them. We have unique applications on provider enrollment with those systems. As the clinical area is engaging with patients, they need provider profiles to actually run the claims and do care coordination, and then that we act as the backbone again the central hub. And so, the provider profile flows from Phynd into the EHR when the patient encounters start. If they’re in the EHR that data is being essentially managed inside Phynd and it’s bidirectional with EHR. So, what’s in Phynd is also in the EHR. If the providers not in the EHR, which happens about 20% times, then we embed ourselves in the EHR workflow so that the registration scheduling folks which are thousands of people in the hospital, can onboard a provider via the EHR that really using the Phynd platform to pull that data and create that provided profile inside the EHR. And then once they’ve created that provider profile in the EHR, its in Phynd. We call it IPASS. It’s integrated. It’s an integrated platform as a service. So again, one to one relationship, then the Phynd application is used across the enterprise. And one of our clients, we have 12000 end users. And these are all staff inside the hospital systems that are changing data on the providers real-time inside Phynd. And then that’s updating Epic as an example or Cerner. But then it’s also going downstream to the marketing team to give them the updates. So, marketing knows what the latest information is and the providers that they’re publishing now on their web site are web sites. And then it pushes down into the claims so when the claim is processed, that the hospital system actually gets paid faster because they have better data in the system on the provider itself.

PP: Are you, therefore, looking to become the single source of truth, if you will, for provider data?

TW: We are the single source of truth is a touchy word. I guess it’s a political word in that, credentialing they manage the privileging in the onboarding of privileged doctors into the hospital. So, they are the source of truth for that process. Whereas from a clinical side, the EHR typically is the source of truths for certain parts of the record of the provider. And then if you look at marketing, marketing is going to have to go to be they’re going to have their own, you know, their own information, whether it’s a bio video, clinical taxonomy, those things, that is a source of truth for marketing. So, we don’t want anybody to think that we’re replacing what they do from a process perspective. But what we do is we integrate all that data into one profile. So, there’s one profile on you, for example, that would have all your clinical information that’s relevant for Epic, all your credentialing information that’s relevant to the credentialing system that the hospital uses. All the marketing data and all the claims data. So, everything’s managed inside one profile. And then what you can do with that because you’ve got it to download one location versus 20 different silos, which is what the way it works now is that you can then point that profile to different things to optimize the operations at the healthcare system. You can make Epic actually work better. You can make marketing have a better search for the providers and scheduling experience for the consumer. And then on the claim side, you can get claims very faster.

PP: Who is your primary target audience within our health system? You mentioned so many different stakeholders. Is it the Chief Marketing Officer, Chief Patient Experience, Chief Medical Officer, who is it?

TW: The CIO is always involved. Some of your past guests on the podcast are clients of ours. Its CIOs, CMIOs, certainly marketing. The marketing officer is heavily involved as well. But in a lot of ways it’s a technology purchase. It’s a data platform that transforms the healthcare enterprise and it can make marketing a lot better. But what is interesting, in the market there is been a lot of vendors for a while that have made marketing-focused solutions. And we think that those were good transitional technologies. But as the pandemic happened and as healthcare systems have focused in on the notion that fewer vendors doing more platform focused concepts like what we do. We think that it makes sense for healthcare systems to really look at things like Phynd and say how can we optimize and operationalize provider data across clinical marketing claims, these different areas versus having these independent systems. So, we end up selling to everybody in a typical environment, we will have a CIO in a room, even CEO, CMIO, Chief Marketing Officer, certainly Chief Digital Officer as well. We have a lot of those clients because we speak their language. We kind of talk to all of them at the same time.

PP: What is your kind of sales cycles look like? I imagine that you have to get multiple stakeholders on board before somebody signs your purchase order, right?

TW: So, it’s certainly enterprise software sales. So, it’s our sales team is a very experienced professional, a consultative team that focuses on the issues and the problems that our clients have. So, the sales cycle could be four months, it could be twelve months to 18 months. It just depends on where the client is. So, I think that it’s just a matter of time that this notion of this digital house, the digital front door certainly has accelerated some conversations we’ve had. The Epic relationship and the EHR relationships are accelerating right now because it’s interesting a lot of our clients when the pandemic happened, they said, we need to bring back retired doctors, nurses and all these folks that we’re not in the day to day health care workplace. They said, how can we find folks that are either retired, maybe taking a sabbatical, those kinds of things. We have all that data. So, it just depends on the event or the opportunity to really say, hey, we really need provider the data front and center in our core IT strategy. Where we are standing up right now is a microsite where one of the biggest clients showed all there COVID testing tents because those testing sites move based on where the hotspots are in their geography. And right now, there’s no way to go for a consumer to go to the web site and say, show me where they are today or where they were yesterday. With Phynd, you can in real-time say, we want to show these 20 or 30 different tent sites and we want to show the hours of operation. And they can change the hours of operation to their web site at a moment’s notice so they can really expand the offering to consumers, just like what you’re used to when you get at Nordstrom’s or any other kind of retail operation that a consumer-focused. We’re helping our clients do that right now. So back to your question. It’s the cycles based on the need in the event of our clients. But we think this universal need for it is just a matter where they all kind of get there and the thought process.

PP: Tom, the digital health ecosystem has been receiving billions in VC money over the last several years. By all indications, it is a thriving ecosystem. A lot of innovative products that are coming out, such as yours. And firstly, I’d love to get your thoughts, on how you’re funded, are you VC funded. Are you in a position to share any of those details just to get a sense of what your profile is, what Phynd’s profile is? And then generally, what do you see as the opportunities and challenges for digital health startups in light of the COVID-19?

TW: We’re VC funded. We have a traditional kind of tier-one VCs. But then we also have some health systems as investors. So Memorial Care based out of Long Beach, California. So, it’s the system that runs from LA down to San Diego. They have an innovation fund. They’re a significant investor in Phynd. The University of North Carolina health care system, they have a venture fund. They’re an investor in Phynd. And so is Orlando Health as well. When we did or our funding, we said let’s blend together both top-notch VS operational experience with top-notch healthcare strategic experience and on the board level. And so every board meeting is really interesting because we get both the VC and put around risk finance, operations and then the healthcare side really driving into things like what we’re experiencing right now in what’s happening to them because we get we kind of get access into what their CEOs and their boards are talking about, triaging their own business over the last couple of months because it’s blocking revenue, because of, elective surgeries and all the things you heard about and talked about. We’re really happy with our mix of investors. Since the pandemic is still a tremendous amount of investment in the patient engagement area. And there’s a lot of great solutions that are out there. And I do think that there needs to be a coming together of them. There’s just going to be too many choices for healthcare systems to have to kind of weed through to buy things. And so, I think that there’s got to be some level setting eventually, whether it’s consolidation, M&A activity, or partnerships as well. But there’s going to be some consolidation. There are just too many vendors kind of chasing some of the same ideas. I think right now and, you know, we help our clients, really. We’re agnostic when it comes to other vendors. And so, we’ll integrate with any of them. But they’re certainly asking us a lot of the questions that you get asked a lot, too, as well. As you know, there are five people that do this one thing. How do we just differentiate?

PP: That’s kind of what we do as a business. We really help our client’s sort through their technology choices when it comes to implementing the digital roadmap. We start by helping them figure out whatever the roadmap even needs to look like for them. And then we go to the technology layer and then the actual partner selection process. But you’re right, that is certainly one of the questions that we get asked a lot, because, there’s so much so little public information about many of the startups. And there’s not a lot of evidence either, especially if you’re a young startup, you don’t have a whole lot of clients and you may have a great product. What are the risks and rewards involved here? How do we manage to all of those become very interesting questions in the context of digital health? These are questions that were never asked. They’re talking to one of the big tech firms. But there’s a whole different set of questions there. Let’s just coming up to the close of our time here. Tom, I just want to get your thoughts on what the emerging healthcare experience looks like for regular consumers like you and me. And what are some of the emerging technologies that you think are going to play a big role in that experience of the future?

TW: I think that’s the future is bright for consumers. When our clients are doing and what my local healthcare system is doing, they have an app that I can message my doctor, my PCP right now. I can do evisits. Those are all great starting points. I do think that they need to get deeper into digital, into the digital diagnosis, that there’s that mystery in science about healthcare, where you think you either have a common cold or you’re really sick. It’s like people tend to be hypochondriacs. I feel really sick when they may not be. And so, this notion that the industry should do a better job of saying, no, no, you can do a digital diagnosis and you’ve got to come call whatever it may be. So kind of really taking some of the mystery out of the diagnosing certain issues. I do think that the digital front door in the technologies will hopefully expand the learning and the use of consumers across the board. There are just too many phone calls, right? I mean, I don’t know your experiences, but I still have to call into my providers sometimes not my PCP, but other providers to schedule, whether it is colonoscopy or whatever, radiologists and. Yeah, and those things need you to know, it needs to flip. I’d say that 80 percent of health care is driven on phone calls and 20 percent digital and needs to be 80 percent digital, 20 percent phone calls.

PP: That’s so well. So, I think that is the headroom for growth. So, if you were half empty or half full, you would look at it differently. But that whole picture there that you just painted. I see that as the opportunity landscape, just inverting that mix going from 80 percent phone calls to 20 percent phone calls. That is the Holy Grail, I imagine. And I hope that we see it in the foreseeable future. And I’m kind of confident companies like yours are going to play an important role in that I guess.

TW: Yeah, I agree with you. I’m a glass half full person in general and I’m just being a startup person. It just kind of comes with the territory. The other point I want to make is that interoperability integration is key. We talked about a tremendous amount of patient engagement vendors that are coming to market in that that you have to be integrated into the IT topography, the landscape. So, the data has to be bidirectional, it has to create this feedback loop. So, if you’re doing digital diagnosis, what are people asking about? What are the conditions? What are the hotspots as far as illnesses? And so, this notion that the digital data feedback loop needs to be there. And so, I just think that’s important for when health systems are looking at vendors that they ensure that it’s bidirectional into their core clinical systems because of the ideas are that of patient care. And so, you just need that data feedback loop.

PP: I generally tend to like startups and especially digital health startups that have a very focused offering and they go deep into it and they do it really, really well, as opposed to a company that might want to do the multiple things and not do any of them really well. I am a half-full kind of guy, I’m an entrepreneur like it comes with the territory. I feel like the digital engagement touchpoint in a typical consumer journey today are not only many, but they’re also expanding. A year ago, you might have thought often, or twelve touchpoints that you would consider high priority focus areas or opportunity areas. Today I can name 25 or 30 such touchpoints. And who knows, a year from now there may be 60 high value, high impact digital touchpoints. And in an ideal situation, you would have a handful of companies that do exceedingly well in one of those touchpoints. And that is what would open up the opportunity landscape for buyers, namely the health systems, in order to really transform the experience of healthcare today. I think part of the challenge also is to your point. A lot of people are pursuing the rainbow, some think that triaging is the cool thing or COVID-19 is a cool thing. But you’ve got to really take a step back and commit yourself to the longer come and pick the sport for you and go deep into it more likely than not to come out successful. But it is a long, hard journey.

TW: Yeah, it’s a journey for sure. And it’s definitely a movement. So, I think that the industry is moving in the right direction, but it’s going to be a long-term process. And it’s going to be great for consumers. So, I’m excited about it. As a consumer of health care on the telephone.

PP: Tom, such a pleasure speaking with you. I look forward to staying in touch and following the progress of finding all the best to you and your team.

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

Thomas-White

Tom is responsible for day-to-day management decisions and for implementing the company's long and short-term plans.

Prior to Phynd, Tom co-founded healthcare IT company Vocada (now part of Nuance Communications; NASDAQ: NUAN) and Newscast, Inc. He also serves as a mentor to the start-up accelerator Health Wildcatters.

About the host

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

Connect

Share on facebook
Share on twitter
Share on linkedin
Share on email

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

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

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

Dr.ram-raju-profile-pic

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.

About the host

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

Connect

Share on facebook
Share on twitter
Share on linkedin
Share on email

This pandemic is really showing how efficient and useful a video visit can be and it is here to stay

Coronavirus conversations

Coronavirus conversations

Seth Hain, Senior VP of R&D and Dr. Sam Butler, Leader of Clinical Informatics at Epic

"This pandemic is really showing how efficient and useful a video visit can be and it is here to stay"

paddy Hosted by Paddy Padmanabhan

In this episode, Seth Hain and Dr. Sam Butler discuss how emerging technologies like video visits will become an integral part of healthcare in the future and how the current COVID-19 pandemic is proving its effectiveness. They also discuss how health systems are advancing their virtual care technologies in response to the COVID-19 crisis.

Epic observed 2.5 million video visits in April. Seth states that the changes we are seeing in the industry due to telehealth is not only convenient to patients but also preventing exposure of providers and clinicians on the front line. He further states that the effectiveness of technologies, like contact tracing, will be driven by broader adoption and will need to be augmented to fully account for the whole population.

Sam believes that in future physician’s schedule would be 50% face-to-face and 50% non-face-to-face visits through video, telephone, and an asynchronous electronic visit back and forth. He further states that video visits are here to stay and hopes that these visits will be associated with appropriate reimbursements models.

Seth Hain, Senior VP of R&D and Dr. Sam Butler, Leader of Clinical Informatics at Epic in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “This pandemic is really showing how efficient and useful a video visit can be and it is here to stay”

PP: Welcome back to my podcast, this is Paddy and it is my great privilege and honor to introduce my special guest today, Seth Hain and Sam Butler from Epic. We are seeing some very interesting times in healthcare and technologies currently. Telehealth obviously has gone through the roof in the last couple of months and by now that is old news. We also saw one of the leading telemedicine platform companies announced their results and as expected their numbers are off the charts. Are we going to see telehealth visits pull back to lower numbers in a steady state maybe later in the year or we are seeing kind of a permanent shift of certain types of care to telehealth model by default in the future?

SB: I think that we are going to see video visits as an integral part of healthcare from now on. And it took this pandemic to really show how efficient and useful a video visit can be. In my practice, I did pulmonary and critical care before joining Epic and I can remember many times seeing patients in my office, elderly men in a wheelchair with oxygen. For every visit, this patient had to visit IN every three months, a family member would have to get off work, go get grandpa, put him in a car, get their oxygen set up, get him into the clinic, get him into my exam room, which typically needed some furniture rearrangement to fit the oxygen in the wheelchair. All for me to visit with him for 10 minutes. The physical exam was limited in any emphysema patient. There is not much to hear when you listen to their lungs. And I used to think back then, what a waste for the whole system. The family member usually had to take off work to bring the father in. And many times, I could have done that visit as a video visit. But what stood in the way years ago and up until recently was that it was very difficult to get reimbursement for a video visit. In fact, Medicare had this rule that the patient had to go into another healthcare system and sit in an office and then do video between that office and the doctor or you could not get reimbursed. Now, with this pandemic the emergency rules changed, we are allowed to see patients with video visits and bill standard office visits and E&M codes for those visits. We saw 2.5 million visits in April alone and many customers went, we know one customer that went from, thirty-six hundred visits a year to thirty-six hundred visits a day. Video visits are here to stay.

PP: Sam, so you share your specific experience as a pulmonologist, and some use cases have been, for want of a better word, better candidates for tele-visits than others into the recent past. Are we going to see an expansion of the types of use cases for which telehealth is now going to be considered seriously while they were not before, right?

SB: Yeah, it used to be that it was encouraged for you not to do a new evaluation via video visit. And I think from a specialist standpoint, I would have wanted to see that patient with emphysema at least once to get acquainted with him. But the subsequent visits many of them could have been done through video visits. I think other types of complaints and other types of specialties will lend themselves to video visits, things like dermatology and also urging care where you can use questionnaires before the patient comes in. You can say this patient is a perfect visit for a video visit. They are either possibly contagious and you don’t want them to come in the clinic or it’ll be very difficult for them to get into the clinic because of the nature of their illness. For all those things you could do a video visit first. So, I think that the idea that a video visit can’t be used for the initial visit is also in the past.

SH:In addition to the obvious increases that folks are seeing and familiarity that patients and providers are getting with using telehealth platforms, say through MyChart and the changes in billing. We’re also seeing an increase in the number of home monitoring devices that are available. So this is sort of coming on the back of a series of changes in technology that make it more viable as well for that individual to stay in the comfort of their own home and understand things like their pulse ox as part of a visit. Provide that to their provider. Both provides convenience for the patient and in some cases helping not expose the providers and clinicians and folks on the front line as well. So, there’s a variety of positives that we’re seeing start to emerge on top of this.

SB: Now what about the technology to make this happen? I think as we get more home, in-home technology like oximetry and spirometry and even a stethoscope that could be placed on the patient’s chest and to be then listened to or recorded and listened to by a provider, all those are possible. In fact, I recently attended a conference where the discussion was, how do we get more lung function data directly into the EHR and one of the attendees at this workshop was a patient. And he had undergone a lung transplant a few years ago. Every day he does some spirometry, which is he measures his lung function. He does it in a handheld device. And it immediately goes up through his handheld device right into the EHR. And he did that. He said, let me pause during this introduction and blew into the device. And he said, I just sent it to my transplant specialist. So, they will have a very early warning system if he starts to have a problem with his lung.

PP: All these use cases point to a fascinating future in terms of technology-enabled remote care models. In the immediate present, though, with COVID-19 upon us and we’re kind of somewhere in the middle of this crisis. What are you seeing health systems doing in terms of advancing or modifying their clinical care protocols with the virtual care technology, not just telehealth consoles, but other things digital screening you mentioned a couple of uses for remote monitoring?

SB: Many of our customers have enabled and spread quickly pre-visit questionnaires for patients with COVID. So, if you use MyChart, the patient’s portal and say that you’d like to come in and you have a concern about a fever, cough, or shortness of breath. We can direct the patient to ask to a questionnaire. That questionnaire can be easily changed, as recently the CDC added additional symptoms to the presenting symptoms of COVID so we can ask about changes in taste, etc. Those questionnaires then can be answered prior to the visit that can direct when the patient does arrive. The healthcare providers know does this patient need to go directly to an isolation room. Is it best he even stays in the car and somebody comes out and tests them in the car? All those different steps can be done using questionnaires of the patient takes before they arrive and even, they can be used in a handheld device. Eighty-one percent of patients in the United States have a smartphone. But those that don’t can use their computer with an internet browser or even use family members’ or friends’ as long as they have proxy access to their record. And that is the first step.

SH:I think that the underlying platform that organizations are using with the Epic EHR at their core allows them in the context of something like COVID to deploy these tools quite quickly. For example, Cleveland Clinic kind of went from an idea around how to use MyChart care companion to have it deployed in 10 days. And now they are using that in sharing that content across the community, seeing other sites with 15 organizations, using it in another 70 implementing it. And it’s been that kind of core platform that allows those organizations to innovate in that way and then to spread what they learn to other organizations to help all care for their patients more effectively. I think the other interesting piece here is that these tools both help at the point of care in regards to those patients who haven’t been able to fill out their questionnaires at home and provide asynchronous visits, but they also help with public health where we have deeper information and a better understanding of symptoms across the population, for example.

SB: The first part was questionnaires and the second one was the Care Companion. Care Companion is a tool that we use, typically we thought it’d be great for monitoring patients with diabetes and heart failure at home over a protracted period of time. But it is being used for now with COVID to monitor patients with confirmed or presumed COVID infection, monitoring them while they stay at home and doing early detection of symptoms that would indicate they need to come to the hospital. And Cleveland Clinic developed that from zero to in place in 10 days. And then that have spread that to other customers as well. The actual content of the protocol. So, patients can be monitored at home, given daily tasks to monitor their temperature, their oximetry, their symptoms. They have tests to read and become more educated in as they start to feel better, what should they do to keep their family safe for their friends and as they go back out in the community? So, there are educational tasks and then the questionnaires and data that they’re entering are automatically monitored. And if a problem develops like declining oxygen saturation, even before it becomes abnormal, they can be sent to a case manager who can then contact the patient and do one of those video visits we talked about to check with them at home. So, it’s all working together.

PP: I actually really like the idea of co-developing a new solution for an immediate need or even for future needs as an example of Cleveland Clinic and then making it available to the broader community of your clients. One of the things that have been in the news as a collaborative effort among technology companies and between technology companies and health systems is contact tracing. What are your thoughts on this technology as an effective tool for checking the spread of the virus and is Epic doing something in this regard? Are you working on a contact tracing tool?

SH:I alluded a piece of this a moment ago in regard to MyChart functionality and I think broadly looking at contact tracing and possible technology implementations for supplementing it in the community. The effectiveness is really driven by broad adoption. And I think that in the context of some of the technologies that are being discussed today, there are reasonable considerations that might limit that adoption in certain contexts. Both privacy as an example for some of the technologies that track and understand what individuals have come in contact with others as well as limitations in regard to the use of those technologies in certain communities and certain populations. And because of that, we see this as one piece of the puzzle in understanding and tracking the spread of disease across the community and helping understand who may need to self-isolate, for example. But it needs to be augmented with other capabilities, both technology as well as kind of good old-fashioned folks reaching out to others to make sure that they’re taking care of themselves and their loved ones and isolating where appropriate. So, we certainly see it as part of the puzzle, but it needs to be augmented to fully account for the whole population.

SB: I think we are improving some of the functionality of MyChart to allow that. If the patient gives it permission to have like a home screen that says like, I’ve been recently tested, and I am negative. So that can be and allow patients to enter a negative test from an outside source that didn’t come from the health care system.

PP: I think there’s a lot of questions on the privacy aspects of it, but also the effectiveness of the technology. And as Seth spoke about adoption rate in a country like Singapore, where adoption rates are much higher than as a percentage of the population than elsewhere in the world. Still only in less than a million people have downloaded their contact tracing and in a population of four or five million people. So, it’s still not that high. And so, there are limitations even in a closed, tightly monitored economy like Singapore. Interestingly, the emerging job of the zero is contact tracing. So, it’s going to need a lot of people to actually follow through and track down people who potentially may have been infected, as indicated by one of these contractors.

SH:I think in addition to the contact tracing technology is kind of directly around understanding folks coming in contact with one another using smartphones and other devices to allow folks and enable them to track and understand their symptoms COVID flu-like symptoms, for example, and using that to understand it as population level, how things may be spiking or declining as we’re going through this period of social isolation right now. I think that can provide real value in understanding how and when we can start to open things back up.

PP: That’s a great segment. Hospitals are now turning to AI tools to a risk profile patient and predict deterioration, specifically COVID-19. I know Epic has launched a tool to help with this. Do you want to talk about that a little bit?

SH:We’re seeing pretty broad adoption at this point of using our deterioration index model, which aims to predict twelve hours in advance of, say, a code event or need to transfer to an ICU for a patient on the med surge floors. We are seeing that tool used in the context of patients that have tested positive for COVID-19. As this pandemic started to hit we rapidly released a series of capabilities for healthcare organizations to evaluate and understand that model in the context of COVID-19 positive patients, as well as guidance on workflows to use it in that context and it’s been an interesting set of conversations where they have quickly evaluated how the model performs and deeply understood the impact and value of it in workflow and have been implementing it across. We have over 50 organizations using the model at this point.

PP: We focus a lot of the conversation on this podcast also around digital transformation. Now, COVID-19 has happened, as you look across your customer base and when you look across the landscape in general, are you seeing digital transformation slow down, accelerate or remain pretty much the same in light of everything else that is going on with the COVID-19 response?

SH:One of the keys that we have seen is that by having a solid base of both a kind of critical infrastructure and a foundation across the health system, as well as things like MyChart in patients hands, healthcare organizations have been able to rapidly innovate in a variety of spaces, both on the technology front as well as in regards to their operations. So, we’ve talked about some of the technology pieces such as Cleveland clinics, rapid deployment of MyChart Care Companion, the use of the Deterioration index model for COVID the rapid rollouts of telehealth where organizations have changed their practice. But in addition to that, they’ve also updated their operations and continue to roll out in new ways. And we’ve found that particularly interesting to see how they work.

SB: In fact, one of our customers decided to continue their go live as planned before COVID. They were a pediatric hospital and clinic organization, so they were not as affected by the surge or the preparation for such a surge. So, they decided to go ahead and partly they wanted to be up live and ready to go in the fall if influenza, RSV and COVID comes back. And we supported them virtually. So typically, there is a command center set up that go live with many tens, perhaps hundred on how large it is. People in the command center and physicians like myself go onsite to support physicians. And that was all done virtually remotely this time in a virtual command center that we hosted here at Epic with everybody sitting in separate rooms in a single building. And it was wonderful. We were able to give instant support to physicians who were sitting in front of a computer out in California. And our picture would appear, and we could see their screen and answer questions. In fact, it was better than running around the hospital from one floor to another. So, it is changing. And I think implementation meetings, everything is we are doing so much more over webcasts and video ourselves.

PP: That’s amazing. Coming up to the end of our time here. What does a new normal look like once they’re done with all of this?

SB: I think from a physician’s standpoint, I think the new normal will be as Kaiser gave us a preview of that for a couple of years now, 50 percent of their primary care doctors’ visits have been non-face-to-face and that included a smaller amount of video visits. They did a lot more e-visits. But I think the future physician schedule will be 50 percent face-to-face visits and 50 percent non-face-to-face through video, telephone, and an asynchronous electronic visit back and forth. I think that’s going to be the norm and it’ll be associated with appropriate reimbursement so we can continue to do that.

SH:In addition to that, patient and provider approach to new technologies with telehealth, we will see organizations building out and continuing to enhance their foundational platforms to be able to adopt in the workflow. The implications of large datasets using things like the deterioration index model that I described earlier on a new set of patients to help provide better care and get them home quicker to their loved ones. So, I think it is understanding that in the context of, say, rapid changes in the types of patients and the types of illnesses that folks are addressing. These platforms allow them to help rapidly and quickly care for those patients efficiently for seven sets.

PP: Fantastic talking to you folks. And thank you so much for sharing all of your insights. And I hope to talk to folks again sometime in the near future.

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

Seth Hain, Senior Vice President of R&D at Epic, focuses on ambulatory clinical care and the integration of analytics and machine learning into healthcare. During his 15 years at Epic, Seth has also led the system and performance team, with an emphasis in database performance and architecture. A native of Seward, Nebraska, he received a B.S. in Mathematics from the University of Nebraska and an M.S. in Mathematics from the University of Wisconsin. Seth currently resides in Madison, Wisconsin with his wife and two children.

SamButler-profilepic

With eight years of senior-level experience in multi-specialty medical group management, along with fourteen years of clinical practice experience, Dr. Sam Butler brings a wealth of knowledge to his role as leader of Epic’s Clinical Informatics Team, and helps to guide the direction of Epic’s applications. He is heavily involved in the creation and enhancement of features and development of Epic and works extensively to improve physician wellbeing. Sam has a B.S. in Interdisciplinary Science and received his M.D. from the University of Florida.

About the host

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

Connect

Share on facebook
Share on twitter
Share on linkedin
Share on email

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

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

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 BranzellCEO 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

PPWelcome 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?

RBCHIME 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. 

PPI 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. 

RBThank 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. 

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

RBWe 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. 

PPWe’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? 

RBEveryone’s taken a big hit on thiswhether 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 peoplenot 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. 

PPThe 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? 

RBAnything 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. 

PPYou 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? 

RBI 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. 

PPAre 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. 

RBYeah, 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. 

PPWell, 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?

RBhave 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. 

PPYeah, 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? 

RBNow, 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. 

PPWhat about the FCCthere is this talk about the telecom investment funding, good news right? 

RBI 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. 

PPWell, 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

RBYou 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. 

PPYeah, 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?

RBI 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. 

PPThat’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. 

RBThank 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

Russ-Branzell-CEO-CHIME-profile-pic


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.

About the host

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

Connect

Share on facebook
Share on twitter
Share on linkedin
Share on email

We are teaching cloud to speak the healthcare industry language

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

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.

About the host

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

Connect

Share on facebook
Share on twitter
Share on linkedin
Share on email

We connect the dots with our solutions for better healthcare outcomes

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

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.

About the host

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

Connect

Share on facebook
Share on twitter
Share on linkedin
Share on email

Covid-19 is the 9/11 moment for healthcare

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

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.

About the host

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

Connect

Share on facebook
Share on twitter
Share on linkedin
Share on email

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

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

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



PPWe 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? 

SVWe 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. 

PPI 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. 

PPWith 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 wellYou’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

SVAbsolutely. 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. Iresponse 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. 

PPIt’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 hospitalsUnited 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. 

SVThis 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? 

SVI’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 standpointGrace 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 yearsWe 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. 

PPI’ve talked to other health systems as well. And self-triaging bot serves two purposes. One is, it prevents an overwhelming of thehealthcare system when people start calling in such large numbers. And secondlyit 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 quicklyhave 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, virtualWe 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. 

PPI 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 1015 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. 

PPI’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. 

PPOne 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. Solike 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 teamOur 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. 

PPI 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?

SVAbsolutely. 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. 

PPThat 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.

SVThank 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. 

PPThank 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.