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The national surveillance system must have real-time syndromic surveillance, contact tracing, and testing with higher accuracy rates.

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 national surveillance system must have real-time syndromic surveillance, contact tracing, and testing with higher accuracy rates."

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 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.

Will be uploaded soon!

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.

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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

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.

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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

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

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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.

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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

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.

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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

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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

About our guest

saraveazy-profile

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

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

About the host

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

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Digital front door is just the start for digital transformation

Episode #38

Podcast with Diana Nole, Chief Executive Officer, Wolters Kluwer Health

"Digital front door is just the start for digital transformation"

paddy Hosted by Paddy Padmanabhan

In this episode, Diana Nole discusses Wolters Kluwer’s healthcare business and how they are building expert solutions for insights and evidence that are more deeply embedded into clinical workflows. She also discusses how digital transformation is much more than digital front doors.

Wolters Kluwer Health has invested significantly in digitizing their products and offerings over the past few years. They now use advanced technologies such as AI and NLP to enhance their heavily curated content to provide quick and easy-to-find answers for evidence-based clinical decisions. They are also enhancing the delivery of their content with emerging technologies such as voice-recognition. Additionally, they are also improving the user interface by delivering smaller nuggets of curated information customized for individual patients and caregivers. Diana and her team are using voice-enablement to enable clinicians to learn in a setting that’s more interactive and stay updated on the latest practices and clinical knowledge.

Diana believes in evidence-based data to enhance user experience with the latest available technology. Their focus now is on getting patients to engage more, especially those that need stay on very good pathways for their own health.

Wolters Kluwer Health, Chief Executive Officer, Diana Nole in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Digital front door is just the start for digital transformation”


PP: Can you tell us a little bit about your healthcare business for the benefit of our audiences?

DN: We like to think of ourselves as a very helpful business. Our focus is around making sure every patient has the opportunity to benefit from the best evidence and data. We really focus on what prevents that and what causes variation. We start with education. We have a suite of education tools that continually evolves. As you think about how students get educated today, it’s very different than in the past. But then when they go into practice, as soon as they walk out of the door, they need to keep learning and be updated on what’s the latest practice techniques. As they continue their research and education, we stay with them throughout that. Again, really focusing on what causes breakdowns in clinical care, really caused by variation. So that’s a little bit about who we are and our suite of solutions really tailors towards that.

PP: Would you care to share your thoughts on the final ruling on the interoperability question made recently by the HHS?

DN: I think all of us are trying to digest it as I understand it. I think it’s over like twelve hundred pages. So, we will learn a lot. But I think at the core of this, we really are a supporter of needing to have good strong interoperability without sacrificing any issues relative to privacy or security. So we believe for the long term, if you really want to have the benefits of a digital system and digital ecosystem and be able to support things like AI and its ability to really alter and augment the intelligence that our clinicians need, you have to be able to do this. And we still struggle with that in many cases. And so, the aspect of standards and procedures and interoperability is very important. So, I look forward to, as does my team, really understanding how this may help advance that. I think it’s early days, but certainly we are positive that a ruling has come out and helps to put guidelines for all of us that are kind of working within the system of how to operate best.

PP: Did anything leap out at you when you saw the initial press release, anything at all?

PP: Yeah, I think that the interesting thing is, there’s always been this aspect of who owns the data and whether they have to pay for the data; so they clearly are saying patients should be able to get access to their data without any issues and without having to pay any fees. I think for us working within the ecosystem, it helps to understand how this will actually work as we interface and integrate it into, like the EHR systems. For us the most important thing on our clinical practice side is really how can we do this and how can we do this as quickly and efficiently as possible. So, I think there have been some things written in the document that kind of talks about from a contractual arrangement, things you can and can’t do that would sort of define you being information blocking or not. So, we think that will maybe actually help us in our arrangements with our EHRs. We were very critical and important to us.

PP: What is the current state of maturity of digital transformation as it’s defined broadly in the healthcare ecosystem, in your perspective?

DN: It’s a big question. And obviously you’ll get lots of opinions. But from my perspective, I think we’re beyond sort of the foundation building. I mean, things really are in digital format. We did talk just briefly now about the interoperability issue. We still are plagued by the fact that we can’t probably get data in and out of the system for all the various use cases that could potentially use it. So, I think we’re beyond the foundation building. I do think you’re seeing some nice basic enhancements to experiences on the patient side. You know, there’s pretty basic things, but you can see what your lab results are. You sort of have a place where all of your data is. If you’re in a certain system, you have the ability to do electronic check-ins. We see telemedicine kind of coming up and we’re starting to see some ability to see sort of AI and its application where we have large data sets of labeled things.

I came from the world of radiology. I think there’s a lot of thought that now that we have all of this labeled data, we could apply AI and AI could augment a radiologist role and understanding where there are issues. So, we’re still I would say sort of early on. I think that is really where I think the hope is. If you go back to our focus around variations in care, you still have a lot of handoffs that aren’t managed well within the digital ecosystem. Once the doctor sees the patient and they kind of decide on a treatment path, is it all carried out even out to the patient? I mean, a customer told me, you know, a simple thing is now we can tell whether a patient has actually picked up their medication or not. It’s a simple thing, but obviously goes into a lot of parameters around, OK. They didn’t pick it up. Should we reach out? Can we have a discussion with them? Can we understand what happened? Is it a cost issue? Is it an access issue? What is it?

I think we’re also in that stage where we’re starting to better appreciate what the true connection of digital health could mean for us. And I think that’s still you know, that’s the vision that we’re all kind of working toward. So still in the basics. But, you know, moving through and got a lot of good foundations laid.

PP: In another podcast, the CEO of Wolters Kluwer, Nancy McKinstry, talked about the massive digital transformation that you folks have gone through as a company. Can you share a little bit about what that feels like for your business and share some learnings from that?

DN: Yeah. So, in health, we’ve gone through a similar transformation in our content-oriented business. It’s very heavily curated, just like the rest of our businesses within Wolters Kluwer. And so, the first step was taking everything from what used to be in a printed format and getting in a digital, and 90 percent of all of our solutions now are in digital. We still do have books. People do like hard books and hard journals.

But now, just like we talked about the transformation, the EHR kind of gets everything into digital. We have gotten everything into digital. But now what we’re really focused on is something we referred to as expert solutions and expert solutions or more deeply embedded into the workflow, take into context the use cases of how they’re used. I’ll use as an example UpToDate. We have now gone to something referred to as UpToDate Pathways, and that is more than augmented or guided decision-making tool for specific things that have evidence that’s very strong but wide areas of variation. So, we are really starting to see the move from just taking something that was in print and moving into digital and now moving it into expert solutions. And that’s really where our focus is, where I think we’ll unlock a lot more value and being able to serve exactly the content that our customers need. Having them have to rely on the questions to ask to serve up the content is not the long-term goal. We want to be able to take the patient information from the EHR and provide what we think is most relevant and help them kind of walk through, especially for complex situations. The best way that they could consider a treatment for their patients. So, we also are in a transformation. It’s very exciting, though, because I think that’s really where you see significant impact on patient outcomes if you can do that.

PP: I imagine you use a lot of natural language processing because you’re a content-heavy business in order to curate the content and to get to answers faster than you would through conventional or traditional news. Are you also changing the way you deliver this content?

DN: So, in terms of digitizing it and delivering it in different ways, we’ve been thinking about what’s the interface. We are working on voice because we think voice will be one element of how you might want to get the content and then serving it up. I think what you’ll find is instead of lengthy textual things, you’ll see something either in a curated order or much smaller. We also have, just recently, even in our more patient oriented space, videos that interact with the patient to help them get prepared or help educate them on things that they’re experiencing. We definitely have found in that world we need to have smaller nuggets and to be able to kind of customize it more for the patient and allow them a little bit more flexibility. So, I think you’re right in the fact that the way we serve up the content will be very different, and different types of content, whether it’s video, whether you do it by voice; those things will continue. It’s all about the user experience now and how can you best use the most available technology? So, you hit on a great point there.

PP: Based on what we are seeing, the focus of digital transformation is on digital front doors and the consumer interface.  Do you think that is too narrow and limiting a definition? What are your thoughts on what else health systems should be looking at as we transform the entire system really?

DN: I think the digital front door is just the start. If you use that analogy, there’s so much more in the house that you want to be able to use. I think that we obviously had to have that window and you have to have that be some kind of an enhanced experience. So, people want to open that door. But if you think about it, the type of information I mentioned before, you can now get your lab results. But the lab results, most of us as consumers of that information, we don’t really quite understand what it would be. So if you think about moving more into how are you going to actually manage your health and how do you really get the patients to engage, especially those that really do need to engage and stay on very good pathways for their own health. That’s why we saw so much value and made the investment in the acquisition we did a few years ago. Emmi was really beyond just patient engagement, but it was shared decision making as well as really helping patients as they move into their home healthcare in a transitional environment. So that’s more of how do you stay connected with them? Get things like, register your sugar levels, how is your pain level doing and then how do you really get to understand how that patient wants to interact? And do you see the ability to see when a patient is going into rising risk such that you will outbound and outreach to them to help keep them in their home healthcare environment, which is probably the best situation for them? So, I see it much more oriented towards true engagement with the patient on a much more sophisticated level. But it’s easy to interface with not just the portal, if you will.

PP: You’re kind of at the intersection of education and healthcare. Education itself is going through a dramatic transformation in its own way. What are you seeing there that’s comparable to the kind of transformation the health systems are going through? And how are you enabling that transformation?

DN: Yeah. And it’s really interesting because I called on an academic and I think the professor said people don’t really come to the lectures anymore. And so, it’s sort of indicative of what a student wants, and a student wants to kind of mimic what they’re going to be asked to do outside in the real world. So, we definitely see virtual simulation for things like nursing labs. The interface with the EHRs so they practice within sort of a version of that. But more importantly, what we’ve also done is we’ve integrated technology around adaptive testing where the student can self-test themselves. You can’t game the system. It’s based on AI so it constantly kind of thinks about how you answer something and then serves up additional things. But it really understands if you are getting to the core of clinical judgment. Can you actually understand in these various scenarios how you would react? And we believe and there’s evidence that shows that they’re much more ready. They have higher scores on their high-risk test exams and they really then get out into the world and are ready to go and practice right off the bat.

So, I think that that’s one aspect at the initial education and then the subsequent things, we do a lot of education. We obviously have the ability to do continuing medical education within UpToDate. And then we also have the aspects of our product called Audio Digest, where you can actually continue to learn along the way in a setting that’s more indicative again. Listen in the car, listen while you’re working out, how do you just continue to kind of have those? So, the way people stay updated on the latest practices and how they get their clinical knowledge and judgment at the beginning has definitely changed. It’s much more exciting, I think, as well. Students react much better about getting in and really kind of looking at real life situations.

PP: There is also a component of the infrastructure that is required to support digital front doors and patient engagement and so on. What is your sense of where health systems are, especially as it relates to your solutions? Are the infrastructural components that you expect health systems to have in place and are they ready for what you are providing to them?

DN: Yeah, that’s a really big broad question because I would probably say we all think that there’s still things to invest in. The EHR kind of is the big road, right? The big pipes around the hospital system. But what you’re tending to see, which is typical of where we’re at in the stages, is you see digital solutions popping up. And it’s unclear to us sometimes that as a vendor exactly who will own that. Some of our systems have put in place, like a Digital Health Officer, but we still find that projects and initiatives seem to be owned and influenced in a particular area. And so, will the Chief Nursing Officer still be overly responsible for things that deal with patient experience, patient education, patient interface. I don’t know that we see the need for additional infrastructure to be built. I do think people are still very worried about the aspects of security and privacy and all of those. So, I think that will continue to be an evolving state of affairs.

In terms of the infrastructure, I think most of that is in place. I do also think that you’ll see these naturally have different types of solutions. But ultimately our customers are recognizing that the way a patient is cared for is kind of shifting from various pieces of the solution, like a doctor, a nurse, and a pharmacist to actually seeing the whole ecosystem of the care team. And that’s where we’re trying to work on our own solutions, of how to make sure that we start wherever possible, can populate our solutions with each other’s data. So, as an example, if you’re in UpToDate as a doctor, we do populate drug information and access that we will put Emmi videos in there so you can see what the patient might be prescribed as far as patient engagement. We’re just trying to make the user interface is consistent. So, we are trying to make our own sort of clinical decision support suite look like a suite, act like a suite, have information accessible to it so it can support the movement to the care team approach.

PP: You may have a Chief Digital Officer who is making decisions on certain types of solutions, but then there are other solutions for which functional leaders like the CNIO, for instance, are making the decision. Are you seeing this all converging in some way to some kind of an org model which is becoming a defacto standard like a digital transformation office, for example? Are you seeing that happening? Or do you anticipate that it will continue to be the way it is, which is that decision making will remain fragmented based on the type of solution that people are buying?

DN: We definitely are seeing decisions become more solution, holistic enterprise wide. I think the org models specifically are continuing to evolve. So even when organizations have put in place a Digital Health Officer, they themselves are still getting the lay of the land in terms of how to bring in the right influential clinical people to get to a decision. But we definitely have seen more and more decisions being made sort of enterprise wide, and consolidation sort of more structure around how the decisions are made, which ultimately I think is going to be a very good outcome while not sacrificing any particulars that may need to happen at a particular site. So, I think they’re being very thoughtful about it.

PP: We’re in the middle of the Coronavirus. How is your business coping with the impact and how are you helping your customers cope with the impact?

DN: Yeah. I really do truly hope that we’re more in the middle than it’s still at the beginning. Obviously, we have our own employees that we want to make sure that we have good care around them. And so, we always continue to make sure they’re in a safe environment and have flexibility for them in terms of working from home. In terms of our customers, we’ve made readily available whatever information we have on the situation. We’ve just posted it out there. We’ve posted access for patients. If you as a consumer want to understand what’s real and what’s the facts. We’ve made that available so that we try to put that out there to kind of depict fact versus, you know, maybe not facts.

In terms of our customers obviously, our customers are bearing the biggest burden of all of this right now. And so, we’ve been very flexible. I’ll give you some examples. From a sales call perspective, a support call perspective, if we had planned onsite visits, we’ve automatically called them and said, would you prefer us to just do it virtually. About 50 percent are doing virtual kind of conversations with us right now. And then we have a lot of relationships with societies and many of the societies have had to cancel their conferences. And so, we’re working with them on how we can get there. Very valuable information was going to be presented at those conferences, how can we still get it out? So, we’re kind of working with them on flexibility of trying to still sort of in a virtual environment, get to the objectives that they had for those things. So those are some of the things that we are doing in this current state.

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

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

About our guest

Diana Nole is the CEO of Wolters Kluwer Health, a leading global provider of trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers, students, and the next generation of healthcare providers with advanced clinical decision support, learning and research, and clinical intelligence.

Wolters Kluwer Health solutions support more than 2.5 million clinicians in 187 countries and educate over 1 million medical and nursing students under Diana’s direction. Research and development investments leverage the latest technologies including artificial intelligence to deliver innovative solutions that improve the quality and cost of healthcare, specifically focused on: user experience, decision support, disease detection, advanced workflows, and analytics. Her approach as CEO for Wolters Kluwer is to focus on the customer, drive a sense of urgency, and execute on plans.

Prior to joining Wolters Kluwer Health, Diana served as President of Carestream’s Medical Digital division, a global leader in medical imaging systems. Under Diana’s leadership, the breakthrough wireless x-ray detector, DRX-1, and mobile x-ray solution, DRX-Revolution were introduced and gained market leadership positions. During her tenure, Carestream’s healthcare IT solutions also received “Best in KLAS” designations and the company was chosen as vendor of choice by large, prestigious global healthcare providers across the globe. A nice recognition and acknowledgement by customers that these solutions had a true and meaningful impact. She has held a number of executive positions and is a passionate leader behind many healthcare technology innovations. Her view of the rapid evolution of technology is not one of a challenge but, rather, a chance to unlock new opportunities.

Diana holds an MBA from the William E. Simon Business School and a B.A. degree with Magna Cum Laude honors in Computer Science and Mathematics from the State University of New York. In addition, Diana is currently a Board Trustee of St. John Fisher College, recently appointed their first female Vice Chair, a Board Director of ESL Federal Credit Union, and a Board Director and Chair of the Audit committee of the life sciences company, Clinical Ink.

About the host

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

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Digital isn’t just about new care models but enhancing traditional care models through digital means

Episode #37

Podcast with Angela Yochem, EVP, Chief Digital and Technology Officer, Novant Health

"Digital isn’t just about new care models but enhancing traditional care models through digital means"

paddy Hosted by Paddy Padmanabhan

In this episode, Angela Yochem discusses how Novant Health, a $5.5 billion nonprofit integrated healthcare provider network based in North Carolina, focuses on improving care quality for consumers through advanced technologies. She also discusses her current role and responsibilities at the organization and how digital health is much more than digital front doors.

At Novant Health, digital care is not just about new models of care delivery using digital tools. It is also about enhancing traditional models of care delivery through digital means. Angela, along with her team, provide advanced digital capabilities to improve the quality of care for patients and community members and ensures increased access to care through digital means.

Angela believes that healthcare organizations must adopt contemporary methods and technologies to improve patient engagement and care delivery. However, this opportunity is closing rapidly due to the emergence of unconventional entrants in the healthcare ecosystem. In the podcast, she discusses how she and her team have developed approaches to identify and rapidly onboard innovative digital health solutions for high-impact areas such as stroke care. She advices health systems leaders to bring in people from outside of healthcare for diverse perspectives to solve the most complex problems.

Novant Health, Chief Digital and Technology Officer, Angela Yochem in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Digital care is about care delivery and enhancing traditional care models through digital means”


PP: Can you tell us a little bit about Novant Health and your role and perhaps also touch upon your unique org structure?

AY: Certainly. Novant Health is a $5.5 billion nonprofit integrated healthcare provider network. We have 15 major hospitals. We have between 650-700 clinics and physicians centers and about 30000 team members. As you can imagine, we’re focused on meeting our consumers’ needs by shaping new services and experiences that resonate with our consumers and the communities that we serve. Technology advances drive a lot of those expectations that our consumers have and certainly change the way we think about engaging with our patients. And, of course, our team members and the border communities. My position was added in late 2017. It was meant to provide a way to increase access to care through digital means and also to define how we can improve the quality of care by leveraging advanced technologies. And, of course, our unprecedented access to data that we enjoy in the healthcare space.

My teams, of course, helped the organization explore many ways that the digital capabilities that we provide can improve the health and the lives of our community members. I’m fortunate that I work for someone I would describe as a digital CEO, Carl Armato. This notion of a digital CEO I think is something that’s so important to so many industries today. Digital CEOs understand that advanced technology functions are essential to providing differentiated services and products regardless of industry and that the executive team for any company must have expertise in the tech field represented at the decision-making table so that they can identify those opportunities when they emerge. In my organization, we moved all of the roles, all of those related roles report to me. And that, of course, helps us reduce fragmentation and avoid conflicting investments or duplicative investments and technology and analytics space across the board. So my senior staff includes a Chief Information Officer, the Chief Technology Officer, our Chief Medical Informatics Officer, our CISO for cybersecurity, our Chief Data Officer and the Chief Digital Health and Engagement Officer, as well as an executive responsible for learning and research across the Digital Partner Services Group, which I believe is a strong, cohesive team of highly talented people from a variety of industries in a variety of backgrounds and credentials area. It’s been incredibly rewarding.

PP: There’s a fairly impressive set up there and we’ll talk about some of the initiatives that you mentioned. Novant Health is based in North Carolina. Is that right?

AY: It is. We’re headquartered in North Carolina. We operate primarily in three states and we have a footprint across five. And I guess what you’d call a super-regional.

PP: Angela, you came from outside the healthcare industry. What struck you the most when you came into healthcare and into this role? What is your assessment of the current state of maturity of digital transformation and digital health in the sector?

AY: Those are two very interesting questions. What struck me when I came here and in fact, one of the reasons I joined Novant Health is that the significance and the importance of the work being done in Novant Health, I mean, literally life and death work, right? Drives a tremendous appetite for adoption of the latest and greatest capabilities that would allow us to provide higher quality care, greater access to care, get better outcomes for our patients and communities. So, it’s that appetite and that ambition for improvement across the board and a passion that I think our team members bring, our clinicians bring at Novant Health that struck me that is so different than what I’ve seen in other industries. I had an opportunity to work with very, very smart, driven, amazing people across the other industries. But the life or death aspect of what it is that we do here just elevated that intensity and I’m the type of person that appreciates that intensity. So that’s one difference that I saw that I really appreciate it.

The other thing I’ll say in response to the second half of your question is that healthcare organizations have an opportunity to adopt more contemporary methods and technologies and architectures and philosophies related to engagement and the delivery of solutions sets to consumers and team members. And I’ll add that the window of opportunity for adopting more contemporary capabilities is closing rapidly. And I would say that based on the number of unconventional entrants that we’re seeing in the healthcare ecosystem.

PP: Defining digital health in terms of just digital front doors, is that too limiting? Should we be thinking about modernizing technology to your comment about bringing in contemporary technology and therefore expanding the scope of digital transformation? How are you defining digital transformation in your role?

AY: This is a fantastic point that you raise. Thinking about digital front doors and only that as being the scope of digital engagement is of course very, very narrow. At Novant Health, we define digital care in both the ways in which we use digital channels to offer care, which is what you’ve just described, but also in the ways in which we enhance our traditional models of care delivery through digital means. You see a lot of investment across the investor community in point solutions that are allowing us to provide as we adopt them. Unprecedented access to care using devices such as our on-demand TytoCare visits or, the ICU capability, tele-behavioral health, kiosks, and remote locations, community centers, and schools. All of these sorts of things are highly visible and they’re absolutely a real thing and a real focus area for us as well as for everybody else.

But to your point, we also focus very relentlessly on capabilities that increase the quality of care. I’ll give you a couple of examples. Earlier in 2019, we launched across all of our hospitals a stroke care solution. I’m sure that your listeners know what happens when a patient exhibiting stroke symptoms shows up in emergency department. But just for those who don’t, I will describe it very briefly. A stroke patient shows up, an emergency department whisks them back, puts them in a CT scanner. They get into a CT scanner, CT scanner runs. And then once the scan is complete, the images examined by the radiologist on call, who in turn might pass it along and see something that may need some care, some attention, will then pass along to the physician on call who then engages the neurosurgeon on call and somebody at some point ready for the operating room. And if there’s some sort of operable occlusion, the patient is treated in that operating room. My understanding is that the national average is somewhere in the mid-50s of minutes. So, between the time when the patient shows up to the time when the operation is being conducted, and if you think about a stroke patient losing a couple of million brain cells a minute, give or take, that’s a lot of minutes. It’s a lot of brain cells lost. So, we have partnered with a third party called Viz.aI who receives the CT scan data while the scan is still being conducted. So as soon as the patient goes into the CT scanner, in any of our hospitals, we stream the data into the Viz.aI environment and they apply AI-based algorithms to the streaming data as it comes through and they can identify an operable occlusion if it exists well before the scan is complete. And so, their solution actually sends the scan to the neurosurgeon on call and makes a notification to the OR so that we have treated patients in as few as 14 minutes from the time they show up to go and see department exhibiting stroke symptoms. Big deal. Our average amount of time with this AI solution in place is about somewhere between 22 and 25 minutes. Well below the national average.

Now coming back to an important point, between the time when we learned of the existence of this type of solution and the time we had it in all of our hospitals, its four months. So, it’s not just about adopting solutions that are truly life changing, life saving for our patients. Increasing the quality of care in this example in the stroke protocol. It’s also about preparing the environment so that you can adopt rapidly these sorts of solutions without the traditional sort of year-long analysis phase that might go on otherwise.

PP: Can you share any early learning, any data points that could benefit our listeners and all those who are implementing these kinds of tools for improving patient engagement?

AY: Absolutely. One of the things that was so interesting when we launched this digital health and engagement division, which is led by a practicing family physician and a strong team of people from a variety of backgrounds, is that the appetite in our patient community is so strong for helping us as we develop these solutions. Our strategy for everything we do at Novant Health starts with the patient. We want to know how we can eliminate their pain points, what do they need, how can we change to meet those needs, and so on. So, when we announced the creation of this division, we ended up having 7500 patients sign up to be members of this group we call ‘community voice’. So, this is a group of patients, community members, and caregivers who’ve agreed to be our focus group and sometimes a pilot group for new digital capability.

So, the learning that I would pass along to others is the appetite exists. And you can have a very, very large sample set of participants as you run experiments with new ways of engaging your patients digitally. I think you have to figure out how you’re going to manage that community, which we’ve done and obviously which can be done. It’s been a wonderful success. And the most recent example I’ll give you is our exclusive partnership with a company called TytoCare.

So, it’s just soft launched in North Carolina and it’s for On-Demand remote medical exam. We’ve had On-Demand video visits forever. TytoCare is a device that’s about the size of the palm of your hand and it has a variety of peripherals that plug into it. And these devices, when used by patients or caregivers, allow them to connect with a Novant Health provider who can virtually examine the heartbeat, the lungs, look at the breathing, look at the skin, look in the ears, look down the throat, look in the eyes, look at the nose, check the abdomen and so on, from wherever they are. And all of these examinations are not only being guided by remote provider but in the case where a patient might want to do the self-exam without a provider live, then the device itself will guide the patient through the process, analyzing the signals coming in from the advanced sensors and the device in real-time and using those signals to tell the patient how to adjust the device.

For example, if your patient is trying to capture a picture of his or her own eardrum, then the device will guide the patient until the image of the eardrums is collected and then it’s automatically, immediately saved in the electronic health record for that patient. So, a really interesting advancement in providing access to care. For anybody who’s ever had a child who suffers from multiple ear infections, if you can imagine, 10:30 at night your child exhibiting ear infection symptoms, wouldn’t it be great not to have to worry about taking off work the next day and trying to get the child an appointment and instead allowing an exam to happen right then, having the ear infection diagnosed right then and having the prescription called in right then and the child gets to start taking the treatment immediately before even going to bed that night. So, this is the sort of thing that the team is working on and doing some fairly groundbreaking work in our region.

PP: You’ve had great success in having your patients engage with the digital tools that you’re putting out and have thousands of patients sign up and be a part of it, willing to participate. Now you’ve got a self-triaging kind of a tool through the TytoCare device. So, it seems like that is a recurring theme that you’re getting patients engaged in their own care instead of having to push it out to them. And you’re getting a fair amount of success in the virtualizing care through advanced technologies. Am I getting it right? Would you agree with that assessment?

AY: I do agree with that assessment, but it’s a journey that goes on constantly. So, this is not a space in which we can rest on laurels. This is not a space that remains stagnant by any stretch. We have to continue to adjust to emerging patient expectations, the needs of our communities as they evolve. And those are the sorts of things that I think keep us on our toes. And that’s why we built these constructs that allow us to continually look for these opportunities and run experiments with some of the technologies so that we understand what the impacts would be and how to prioritize the work.

PP: Can you talk a little bit about what your goals are for the Institute of Innovation and AI and how you are harnessing data to drive these improved experiences? Talk a little bit about the institute itself and the goals, if you could.

AY: Sure. So, we launched the institute this past year. I co-founded it with Dr. Eric Eskioglu, who is our Chief Medical Officer. He happens to be a practicing neurosurgeon and before he was in medicine, before going to medical school, he was actually an aerospace engineer. So, he’s a rocket scientist. So really great partner to have as we think about things related to innovation and artificial intelligence and other advanced technologies that really need never be explained to him. He’s always there as a tremendous partner with me, as a digital leader. So, when we launched the institute, the goal was to identify these technologies that may not even be commercially available? How do we use them to accelerate solutions that allow us to provide the highest quality, highly personalized care.

The constructs allow us to work with our very engaged physician community, as well as other team members from across the system and partner very easily with a variety of third-party types. We partner with members of the startup community. We partner with universities and other research organizations, other healthcare organizations. A variety of unconventional partnerships tend to be crafted as part of the work that we do inside of the institute. And ultimately, this allows us to run rapid experiments with new solutions that understand impact based on real data that we can collect, not just, suppositions, better engage the broader community inside of Novant Health to get involved in making these game-changing advances for our patients and in our practices and also to best manage investment so that we’re not a naturally fragmented in the sorts of experiments that we run across the board. It’s been a great success in the sense that we’re able to do the work rapidly and with a feeling of having the right experts in the room at the right time.

PP: Can you give us the State of the Union on data interoperability and how are you really harnessing all the emerging datasets that we’ve talked about? We tend to talk a lot about EHR data, but there’s so many other emerging data sets. How are you actually harnessing the data for all the insights that you can potentially generate or some of your programs? Can you talk about that?

AY: Let’s break this down a little bit. So when we think about the broader state that we manage, what are our assets? What do we bring to the solutions that we define for the toughest problems that we’re facing in healthcare? Data is one of those assets. We have patient clinical data. We have consumer data. We have behavioral and trend data. We have our business’ master data. We have a variety of data from many, many sources. We have to have a place where the data can reside and we can apply functional capability to it.

Functional capability is expressed through a variety of solution sets. Some are homegrown, others are provided by various third parties. As we’ve discussed already, we have digital assets that provide care and other access related capabilities to our patients and our communities. We have capabilities that support the running of our business and other foundational elements. Many of these capabilities can and should be provided by a traditional healthcare vendor like an EHR vendor. It is about about data. It’s best for us to focus on creating an architecture that can allow for interoperability between solution sets and various third parties in a highly secure fashion. That’s how we get the most out of the unprecedented access to data that we have. This is what’s going to allow for rapid adoption of potentially differentiating services for our patients. This is what leads to that extreme personalization in all engagements with patients improving the quality of their care through faster diagnosis, breadth of treatment options and of course all the other advanced tech that we can apply to it.

With such extraordinary availability of data and the things that we know we can do within the existing constraints, and within our existing agreements that we have that patients for the usage of the data. We are watching with great interest this debate and the deliberations that are ongoing. And while I don’t have direct visibility into how those considerations are playing out, my hope is that the eventual ruling will benefit our patients. And meanwhile, the things that I can control are the architectural choices that I just mentioned. As long as I stand ready to be as interoperable as possible and as secure as possible across the board, then whatever the decision is, we will be best positioned to serve the patients and communities.

PP: Digital programs, in general, are in early stages of maturity and there’s a long way to go to your point earlier that it is a journey that is by no stretch it’s all done kind of thing. So how do you actually keep track? How do you measure progress? How do you keep score of whether a program is working or not?

Well, so we look at outcomes fairly consistently across the board. So, we measure the quality of our care through a variety of mechanisms. We measure the access to care, the ability that patients have to access care at Novant Health. We in the digital channel space have all of the usual measures that other industries have been using for engagement, for digital engagement, and we certainly track that because we are a business and we’re a rather large business. We track how we can continue to provide advanced capabilities to our patients and community still within an acceptable cost structure.

So, all of those sorts of things are measured as you’d expect them to be. I think that is the most important thing that is specific to digital capability to be able to measure and track progress. The nature of how we’ve defined progress outside of these broad buckets that I just mentioned would be different from case to case. But measurement is one of the most important things we can do post-launch. You’re not done when you’re launching a product or a solution. You are never done. The incorporation of the measures and the results that you’re getting should always feed into the next decision cycle and in our case that has a relatively short window of time.

So we continue to iterate on all of the services and products that we deliver to our communities as well as to our team members inside of Novant Health. As we think about how we are acting as stewards of the resource that our companies have that are so important to us ultimately to the health of our communities.

PP: Any final thoughts that you’d like to share with our listeners as it relates to how they could be looking at their digital programs or anything from your own experience as a best practice?

AY: One of the things that has been such an accelerator for us here is the creation of the chief data officer role and corresponding organization, which include the Cognitive Computing Group, which includes Enterprise Information Management Organization. These sort of constructs and the corresponding investment that allowed us to accelerate some of those foundational capabilities t are absolutely required in advance of being able to do any of the more exciting things we’ve talked about that are more functional in nature.

So, getting those foundations right is important. That doesn’t mean you have to take a couple of years to do it. It has been done in other industries. My advice to other healthcare systems is unless you are in need of additional health care expertise, don’t be afraid to pull people in from outside of healthcare because it’s a gift to allow them to participate in such a wonderful industry. And it will be a benefit to the industry to have diverse perspectives involved in solving some of our most complex problems.

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

Angela Yochem is EVP, Chief Digital and Technology Officer for Novant Health, a super-regional healthcare system with one of the largest medical groups in the US. She and her teams deliver the world-class consumer capabilities, differentiating technologies, and advanced clinical solutions that allow the high-growth system to provide remarkable patient care.

Angela has served as EVP/CIO at Rent-A-Center, Global CIO at BDP International, Global CTO at AstraZeneca, and divisional CIO at Dell. She’s held tech exec roles at Bank of America and SunTrust and held senior technology roles at UPS and IBM. In these roles, she built B2B digital product lines, grew digital retail channels (B2C), created technical services lines of business, and transformed global technology capabilities.

Angela has been a Director for the Federal Home Loan Bank of Pittsburgh, BDP Transport, BDP Global Services Asia and Europe, and Rocana, with experience on Audit, Enterprise Risk, Operational Risk, and Governance/Policy committees. She remains an EIR for Vonzos Partners, a Mentor for SKTA Innopartners, and an Advisor for Dioko Ventures. Angela serves on the board of Freedom School Partners, a non-profit committed to promoting literacy in the Charlotte area, and on the executive team of the Go Red for Women organization, part of the American Heart Association. She is a Trustee of the Charlotte Regional Business Initiative and is an advisory board member for the American Hospital Association Innovation Council and the University of Tennessee Electrical Engineering and Computer Science department.

Angela has a Bachelor of Music from DePauw University and a Master of Science in Computer Science from the University of Tennessee, holds three US Patents and is an author with Addison-Wesley and Prentice-Hall.

About the host

Paddy Padmanabhan is a widely published and quoted thought leader on digital transformation in healthcare. He is the author of  The Big Unlock: Harnessing Data and Growing Digital Health Businesses in a Value-Based Care Era, and the CEO of Damo Consulting Inc, a digital transformation and growth advisory firm based in Chicago.

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Every patient has a right to control where their health data goes

Episode #36

Podcast with Paul Black, CEO, Allscripts

"Every patient has a right to control where their health data goes"

paddy Hosted by Paddy Padmanabhan

In this episode, Paul Black discusses the next wave of opportunities for Allscripts and how digital transformation is shaping the healthcare sector. Paul also discusses emerging technologies and how Allscripts has embraced cloud adoption for many of its solutions. He believes that emerging technologies such as AI, Blockchain, and voice recognition are improving patient experience, driving better healthcare outcomes, and substantially enhancing the physician’s life.

In the context of the ongoing debate about patient data access and the proposed ruling by the HHS, Paul states that Allscripts strongly supports legislation or regulations that address information blocking in healthcare. He suggests that health systems, looking to harness innovation, must bring together outside help with industry experience and their own organizational knowledge from a clinician standpoint to accelerate transformation.

Allscripts CEO Paul Black in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Every patient has a right to control where their health data goes”

PP: In terms of technology for the healthcare industry, what do you see as the next wave of opportunities for Allscripts?
PB: Allscripts has done a lot of work over the last 25-30 years to get the entire platform, especially in the United States, to be completely digital. It is a very exciting place for Allscripts to be in especially from patient safety standpoint, from our capability to have efficiencies and just to ensure better patient care and better patient access to that care. Also, the digitization of patient records enhances the ability for health systems to deliver care protocols in rural areas just as they deliver care protocols in a large academic medical center in a large populated urban area. This is transformational, and in a transformed environment you are actually going to practice medicine differently for the rest of your life. So, from here, going forward, we’ll never go back to paper. We’ll never go back to the way we used to do it. The entire platform has been not only digitized but transformed. So, again, we look at that and we see a lot of opportunities for that going forward.

PP: So, Paul, you mentioned transformation. Everybody talks about digital transformation. Do you have a definition for it at Allscripts? What do you see as big themes playing out in the name of digital transformation today?
PB: There are three or four things. We have, in many cases, tried to anticipate where the industry is currently so that we can have platforms that are relevant to people that are doing business in a transformed and digitized area. So specifically, around interoperability and population health, our definition around digital transformation has to do with the ability to take a vast amount of data from multiple different electronic medical record organizations and companies to give a unified and community view, a single view, of that patient’s information. We’ve been doing that for quite a while now. And I think that’s an important construct that you have to have which is foundational.
Infrastructure has to be in place because no one is ever going to get to one record. You are always going to talk to the state, you are always going to talk to insurance companies. People have different electronic medical records or other information systems that have clinical information in them that are relevant to that individual person who has a condition that you’re trying to help them recover from. So that’s one.
The other one that I think is important, is the consumer. We all have talked about the concept of a patient being a consumer. Unfortunately, the status they have as a human being is defined as one who has become sick, met an accident, or some episodic condition that they have been battling for many, many years. But the consumer, is somebody who proactively looks for and shops, compares and writes, and, you know, is really actually very actively is engaged in the buying process. And specifically then for us in healthcare, the consumer is somebody we have to really be aware of and what their patterns are, what their likes and dislikes are, how they like to be treated, how they like to access the health system and what kind of requirements they have when they are on their smartphone or their iPad. What are the services they are looking for that weekend, that night, that evening; where they can quickly go in and get certain mobile care.

PP: What is your take on the debate that’s going on today with regards to providing access, specifically the HHS proposed ruling around providing access and where do you think we are today? Is this something that you see being resolved in the near term or do you see that being an ongoing concern?
PB: The regulations that are out there and being proposed are going to be distributed very quickly, I think. We actually have been very heavily engaged in this process going back to the 21st Century Cures Act. I think it is about going back to a very foundational and important pillar inside the EHR community. We have a very important voice in Washington, D.C., and on multiple different topics I’ve had a chance to testify in two separate congressional hearings on the topic.
We met two months ago with HHS Secretary Alex Azar and Joe Grogan. Joe is the White House Director of Domestic Policy. We had discussions in this specific area and the specific arena, and there are a lot of things that we really like about it. There are just a few things that we asked for some further clarification around intellectual property protections, market-based pricing models for information exchange, and the appropriate scope of certification requirements. They’ve been very good about listening and have been very considerate of the feedback. We’ve had a very constructive dialog with them on those topics.

PP: I heard you say that there have to be some guardrails around how the access is provided in order to protect patient data. Did I hear you right?
PB: Yes, you did. The guardrails are already in place that we are adhering to. Anybody in this industry has been extraordinarily cautious about and respectful of the laws that are out there for all the good reasons. Specifically, on this one, going back to the regulatory environment, we have never advocated against legislation or regulations that address information blocking in healthcare. We strongly support that and have been part of this open infrastructure ecosystem since 2007. It’s interesting that same year the iPhone came out too.
We believe that people should have access to the data and that system should be much more open at an API level, which the legislation also requires more than just the HL7. FHIR also been very important in that area. But we also believe, importantly, that every patient has a right to control where their health data goes when it moves or doesn’t move, and who sees it. And so, we actually grant consent at the patient level with our consumer platforms. We have been advocating for that, and that was one big piece of this legislation that we were extraordinarily supportive of. We’ve always been encouraging of the legislation to give the patient full control of their patient medical record.

PP: Where do you see are the big use cases for AI, machine learning, advanced analytics in your work and in some of your clients?
PB: There’s been a fair amount of work that’s been going on for a long time. Over the last two or three years, AI is getting a lot of attention for things like Watson and some of the other big players that are out there using artificial intelligence for cancer, or radiology. They are using it for the substitution of a human to be able to look at certain data patterns and to come up with a different answer or a better answer and a more efficient answer. So, I think those are a couple of examples of the way the people are looking at it today. I think that there will also be, from an efficiency standpoint, a lot of artificial intelligence utilized for that.
The other piece of data that comes in is when you’ve automated the shop for healthcare. Not only do you get clinical information in real-time, but you also get consumption information in real-time, such as how efficient organizations are about moving patients through the system. Will that be the ED wait time? Or components like that all the way through how many resources were consumed in order to do a certain specific surgery and how much time it took in the overall costing of that? I think it’s going to be a lot of fun to track. What we like a lot are the capabilities once the data is stored, structured and now we have to study it, but also to use the data crawlers and some other capabilities that exist out there to give us new insights about populations that we can go then put specific programs around.
When you think about it, you’re financially responsible for a large community of people. That’s one element at the big data level that I would look at. By big data, I mean you’re looking at multiple hundreds of thousands if not many people at once and you’re looking for specific conditions and specific precursors of that disease warning signals or flares or other weird events, that if you follow closely, you might be able to prevent the further deterioration of that patient. Whether that be COPD or cancer or some other areas that are out there.
So, I think those are all capabilities that exist today that I think are exciting and those are capabilities that many different organizations are getting much, much better at utilization.

PP: Do you think we are seeing more benefits from non-medical use cases of AI than in the actual practice of medicine?
PB: I probably would not agree with that. There are equivalent use cases for the financial information around HCC coding, around appropriate billing, around the financial side of healthcare. Anytime you look at large rooms of human beings that are staring at screens and are punching away on their keypads – I think there’s great opportunity for that. But I wouldn’t necessarily say that overreaches what the clinical benefits are in the clinical usage of those systems are today. But I do think there is a substantially large amount of that.
Things like blockchain are probably, at least currently, best suited inside of financial elements in insurance companies and other things inside of healthcare that makes it a great tool. But there’s also the clinical side of blockchain, another great example of that use case would be Medrec. Medical reconciliation of all the different medications that people are on would be a perfectly well-suited application for a blockchain. And it’s a big, big opportunity.
It is also a big problem if you do not properly understand every single medication that a person is on. And unfortunately, many times, the number of medications that people are on, they don’t really remember everyone that they’re on either. Therefore, as a pharmacist, you are engaging with a bunch of different systems at once – the consumer side, the hospital dispense, the local pharmacy dispense, the mail order, and making sure that all of those medication administration records tightly fit together and they all have a ledger approach with which blockchain can lead a very simplistic way to be able to make that happen, which is pretty exciting.

PP: Can you comment on where we are with voice recognition and specifically may be what you’re doing at Allscripts to incorporate voice into your solutions?
PB: Voice recognition has been out there for the last 25-30 years, especially in radiology departments. It has been great. And, probably on a scale of 1 to 10, 10 being finished, that’s probably somewhere at a 9. So, there is the ability for voice recognition to replace a keyboard, substantially enhance the physician’s life.
There is a lot of experimentation going around taking that technology and extrapolating that and using it into a very busy primary care clinic and having the caregivers being able to talk to a device that’s in that room and not have their hands on a keyboard. We call that the keyboard-less visits. And we have clients that are working on that today at scale and they’re getting a lot of value out of that. They’re clinicians like that, because anything that takes them away from having to hunt and peck on a computer keyboard, they’re all in, especially when you’re trying to see 40 to 60 patients a day. It really can help compress the amount of time that they’re spending, doing documentation. Chart reviews and other things like that in advance are still needed. But that’s another very important use case. I think that will only continue to enhance the experience that clinicians have and the usage of will continue to be accelerated outside of radiology into almost all areas of the practice of medicine.
That’s certainly the work that’s going on between Microsoft, Apple, and Amazon on this topic and will highly accelerate the efficient and clever uses of the technology that has been out there since the 80s and perfected, about 20 years ago for radiologists. Voice recognition needs to be moved into mainstream clinical care.

PP: Do you see keyboard-less technologies, such as identity and access management for patients through facial recognition, picking up as well from an emerging tech standpoint?
PB: Yeah, there’s a lot of different ways for people to log in, which is another problem. But the two-factor authentication is needed from a security standpoint. And that requirement will be out there, especially for medications, the narcotics, and other controlled substances that are out there. And so, the ability to navigate and identify a person through a palm, a fingertip, a retinal eye scan are capabilities that exist today. It will continue to get better and easier for caregivers to get through who you are. That will form a very important part of the process of being logged into a system.

PP: We’re seeing a lot of cloud data sharing agreements. Where do you see us today in terms of cloud adoption in healthcare? And where do you see the big opportunities?
PB: We have a number of our applications that are a native cloud today. We have other applications that are moving to the cloud. There’s no question that this technology is being rapidly embraced by and adopted throughout healthcare. I do think that they are a bit of a late adopter, but that doesn’t mean the acceleration of that adoption can’t be substantial as compared to somebody that might be in the cloud in other industries 10 years ago.
So, number one is that it is not only coming, but it’s here. And as recently as three years ago, we do business in other countries, a national policy minister for health stated you could not have patient data in a cloud infrastructure. Today, it’s encouraged and considered an extraordinarily important move. For people like us that have applications whether it’s an EMR or other solutions that are out there, that opens up a lot of opportunity. So, from our perspective, the benefit of having something in the cloud is somewhat obvious. The ability to ubiquitously access this data from any device, to have a different, and more robust layer of security, especially when you think about the investments that these organizations – Amazon, Google, Microsoft – make every year in the digital infrastructures and the cybersecurity surveillance capabilities, they dwarf the investment that a large integrated delivery system could ever make. I think that will be one of the more compelling reasons why people move to the cloud.
The third reason would be that the total cost of ownership, not having to do upgrades, not having to buy hardware, not having to have your own local backup data centers, all of that goes away with the transition to the cloud. And therefore, the total cost of ownership for an institution as they look at being able to have a different utility that provides those services to them. While it may not be the total parity today, there’s no question in my mind that over the next decade that service will be performed and that the competition between those organizations, like any other technology, will eventually drive that cost down to a point where the cloud will not only be affordable but extraordinarily attractive.

PP: How are you harnessing digital health innovation in your own product portfolio? And what is your recommendation for health systems that are struggling to do it in a way that doesn’t break the bank?
PB: Well, there are three or four things, I guess I would say. Number one is the fact that when we talk about being open and connected, that we build open, connected communities at health. The word “open” is really important, it’s not just a buzzword. In our ability to not only have that as a culture inside the company but how we build our solutions and the access that we grant third parties to relatively deep level APIs, is an important construct that distinguishes us from other people that have been in this industry as well. Part of that open framework for us creates an incentive for startups to utilize our platform and to partner with us to build their business case, their business model, and to take their innovation into a welcoming environment where they can prove out and test cases, but also get access to clients that are already connected to a network and potentially gets to scale much more quickly. So, we encourage that. We fund some of the people that we work with. We see a lot of different companies. We have over 279 different companies that have written applications that sit on top of our solutions. We have clients that have written their own and sit on top of that environment, that ecosystem that we’re trying to create to support entrepreneurs and support innovation. It has been something that I actually inherited when I first got here. In 2013 we gave out that are in the user’s group a million dollars for the top four applications that have been developed and that sat on top of our ecosystem. So that’s something we’ve got. It’s not a lip service, we actually embrace it and we support it. We have people that are dedicated to helping those folks become successful.
Clients, many of them are building a capability inside their organization, especially large ones, where they have a JV fund, where they’re actually looking for and then putting money into third parties, entrepreneurs who are building applications and have already declared startup status. There are a number of large organizations all over the country that have this business line of helping fund venture capital-backed organizations that are building and innovating new platforms inside of healthcare. There’s a lot of that activity and I like that, and I encourage that, and again, to the extent that those applications that are funded by JVs and supported by large integrated delivery networks are also part of the Allscripts ecosystem. We just think that’s a wonderful, wonderful way to bring innovation to healthcare in a much-accelerated manner.

PP: What is your recommendation to health systems that are looking to harness all this innovation? How should they go about accelerating the adoption of innovation? What are some of the best practices that you’ve seen?
PB: I think organizations like University Hospitals in Cleveland, Northwell, Ascension – all have these funds that are set up and they act. They brought in somebody from the outside typically who had background experience in investing in joint ventures that combine them with the organizational knowledge of what kind of solutions actually would work in that kind of experience from a clinician standpoint is a pretty powerful combination. I’ve got people that know what problems I’m trying to deal with today. I got people that know how to look for, search out and procure dollars and to find the companies that are building things. The combination of those two with them, the ability to immediately inject that solution into a relatively large ecosystem, their own caregivers make it a very powerful combination.

PP: Paul, any closing thoughts? Anything exciting planned for HIMSS that is around the corner?
PB: We love HIMSS. We like to have a lot of people there. A great place to meet a lot of clients, suppliers. We actually do a fair amount of recruiting there. We talk to analysts, both people that follow the industry. We talk to a lot of people that write about the industry, folks like yourself. So, it’s a very efficient way to spend three or four days. We will highlight some new capabilities that we have down there, which is always kind of fun. Talk about the innovation that Allscripts brings to the table and also a fair amount of putting exclamation points around some of your clients’ experience and some of our clients’ success.

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

About our guest

Paul Black is the Chief Executive Officer and a Director of Allscripts. As the CEO, Paul guides the company’s vision to fulfill its global commitment to build open, connected communities of health.

Prior to joining Allscripts in 2012, Paul spent more than 13 years with Cerner Corporation in various executive positions, retiring as Cerner’s Chief Operating Officer in 2007. Paul’s career started with IBM Corporation where he spent 12 years in a variety of leadership positions in sales, product marketing and professional services.

Paul has served on multiple publicly traded, private company and nonprofit boards of directors for companies in healthcare information technology, patient monitoring, healthcare services, healthcare delivery, healthcare device, and consumer internet marketing.

In Kansas City, Paul spent 16 years as Chairman and as an Executive Officer of Truman Medical Centers, an academic safety net health system. He currently is on the board(s) of The Advancement Board University of Kansas Health System and the Harry S. Truman Presidential Library. Paul holds a Bachelor of Science degree from Iowa State University and an MBA from the University of Iowa.

About the host

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

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We give hospitals the ability to quickly and securely send patient records to outside clinicians

Episode #35

Podcast with Dr. Peter Tippett, Founder and CEO, careMESH

"We give hospitals the ability to quickly and securely send patient records to outside clinicians"

paddy Hosted by Paddy Padmanabhan

In this episode, Dr. Peter Tippett, one of the first person to develop a commercial antivirus software, discusses how careMESH is providing easy and secure communication and collaboration between clinicians locally to share digital patient records. Peter also discusses the issues related to information security in healthcare.

Healthcare, like in other industries, requires digital communication in everything, be it care coordination, patient safety, reducing readmissions, unnecessary ER visits, or analytics. To address this marketplace requirement, careMESH makes a set of national secure service that helps health systems to easily communicate about patients and share patient records from their own EHR to any outside physicians/ clinicians, reducing the time consumed by traditional communication ways within health systems.

According to Peter, health systems have started investing in and adopting digital transformation to provide ‘virtual health’ through their own EHRs, EMRs to provide care coordination, social determinants, and enabling home health workers for patients. These health systems are the powerhouse, incubating the innovative startups and providing them the focus they require to make the change happen in healthcare.

Welcome to The Big Unlock podcast where we discuss data analytics and emerging technologies in healthcare. Here are some of the most innovative thinkers in healthcare information technology talk about the digital transformation of healthcare and how they are driving change in their organizations.

Paddy Padmanabhan: Hello again everyone. Welcome back to my podcast. This is Paddy and it is my great privilege and honor to introduce my special guest today, Dr. Peter Tippett, Founder and CEO of careMESH. Peter, thank you for joining us and welcome to the show.

Peter Tippett: Thank you so much. It’s a great privilege.

Paddy Padmanabhan: Thank you. So, Peter, you have a very interesting background. And among other things, you are also the first person to have developed a commercial antivirus software. So, tell us how all that came about.

Peter Tippett: Well, I was one of those tech engineering nuts even when I was a teenager. I was a ham radio operator and a commercial radio engineer and a pilot. I was one of those couple of kids that were allowed in high school to touch the 55-board teletype locked in the closet. And in college, I stumbled into more things. I used a very similar computer in a lab doing really early cholesterol and Hyperlipidemia work. And I used it to automate their analysis and results. And then for my college seasons, I wound up as an apprentice and an assistant for two different Nobel Prize winners. The first guy sequenced the first protein and the second guy, Bruce Merrifield, synthesized the first protein. And I was there, you know, and used computers in his lab to automate that whole process. And along the way was the first guy to synthesize an active immunoglobulin. And of course, all of that got me a scholarship for an M.D. Phd at Case Western Reserve. And then when I was at Case, I was President of the Cleveland Computer Club. I started a software company in my attic trying to do other sorts of things. And when the virus problem came along, I created the first commercial antivirus. It was called Vaccine, but eventually changed its name. We wound up in a booth a few booths down from Steve Jobs at the West Coast Computer Fair. We grew that company, which was called Certus, for a couple of years before McAfee and the other guys came along and we sold it to Symantec and renamed it Norton Antivirus and then grew it in two more years past 300 million bucks. It was the big heydays that everybody likes to hear about.

Paddy Padmanabhan: Yeah. Well, Norton Antivirus. Now, that’s a household name almost.

Peter Tippett: Well, that’s a lot to do with those guys now of course.

Paddy Padmanabhan: Well fascinating story. I do want to spend a few minutes, given your background with software security and antivirus software and so on. I do want to spend a few minutes on this podcast talking about the current state of cybersecurity. You know, healthcare has been the target of cybercriminals for several years now. And my understanding is that it is the favorite industry for cyber-attacks. I read somewhere that the annual cost of healthcare data breaches in the region of four billion dollars and there’s no sign that is abating anytime soon. And four out of five data breaches are attributed to healthcare data breaches, and providers, in particular, are being singled out for these attacks. So, can you kind of break it down for us and tell us what the big issues are today as it relates to information security in healthcare?

Peter Tippett: Yeah, absolutely. Obviously, security is a huge subject. Maybe I can talk you into doing a whole podcast on it down the line. But, you know, security is hard, but it’s really not as hard as we all give it credit for. I’m kind of a scientist in this world and I spent a lot of energy over the last 20-30 years trying to get a sense of how the risk economics really work. And my biggest take home over the years is that we’ve really typically get talked into putting what my mom says is putting the emphasis on the wrong syllable. We have spent a huge amount of money and user equity on things that have very low marginal value and we ignore and allow the simple, inexpensive things that are relatively easy. For example, you mentioned ransomware. The basic solution to that is backup. Nothing fancy. Right. And oddly, using some of these newer information sharing services like my company’s new careMESH offering that gets some of your data accessible in other ways, all by itself is a mitigation for things like ransomware. If you look at the breach science and look at how that works out in risk dollars, there’s really just two things that reduce the overall costs and risk and likelihood of a breach by vast of the majority than all other things combined. The first one is a strong identity, despite what everybody says, making passwords stronger or more complex doesn’t do a squat. But adding a second factor like the code that comes to your phone or a token or whatever, that reduces risk by many, many orders of magnitude. So, turn those things on. That’s really simple. And it is really, hugely strong. The other thing is around network management. Running your own data server and data centers and firewalls and all that stuff is hard and expensive and we’re all error prone. But any one of the cloud providers has a hundredfold more security and ops people than any IT health organizations does. And you know, they have the experience, use the cloud and embrace it. Those are the key issues.

Paddy Padmanabhan: Yes. You know, just coincidentally this morning, I was on a Twitter chat with a group of cybersecurity professionals and a couple of things came out of that discussion. And these are very commonsensical type of things. The two big issues that the participants in the chat pointed out were, one, it’s a cultural issue, less of a technology issue, more of a culture issue. And really educating everyone in the organization at every level to be watchful of phishing attacks or to your point, turn on two-factor authentication. It’s a cultural thing. And so, you’ve got to have the right kind of culture to protect yourself against cyber-attacks. The second thing they talked about was in the context of healthcare the business associates are a big point of vulnerability. So, care to comment on those two observations?

Peter Tippett: Yeah. I mean, you know, the power is clearly in the hands of the attacker if you’ve got a million people and you can succeed at one percent opening a phishing email. That one percent is in trouble. So, a big attack surface is how we talk about that. But two-factor authentication works even against phishing attacks. The bad guy gets your password. So, what? Still doesn’t work. So really, really, you have to do both. Don’t spend all your energy worrying about one thing. You need seatbelts and airbags and then speed signs and all the others, and they all work together to really reduce things.

Paddy Padmanabhan: Yeah, OK. I kind of agree with you. We should do a separate podcast down the road just talking about cybersecurity issues. But for today, let’s switch gears here and talk about your company. Tell us about careMESH briefly, the company and the solution you’ve developed and what does a marketplace need you’re trying to address?

Peter Tippett: Yeah. Thanks so much. I’m a doctor. I spent most of my time doing emergency medicine and paying for all these startups by working at night in the ER, but I’ve long been frustrated that doctors can’t simply send a patient record to some other doctor or to some other clinic. It’s like we’re in the years before the internet ever came along. A huge hospital system client of ours reinforced that for me again lately. They worked at this giant referral academic center. They take care of 20-30 percent of their patients come from more than 25 miles away. You know, when they send those patients back home, half of those doctors get a two-page fax. And the other half get two pages sent to them in the US mail. I’m not kidding. The likelihood of getting a digital record outside of that 25 or 30-mile range is nearly zero. And this is not right This isn’t how the world should work. It drives the doctors nuts on both ends. It drives the patients crazy. Even the average hospital is not at that pinnacle of referrals to the world where two-thirds of their community doctors are using a different EHR than the hospital. Less than 20 percent of those outside doctors routinely get digital-only useful patient data. And almost none of them can communicate back and forth with a big hospital or the doctors or whatever. So careMESH came along to change all of that. We decided to make a set of global national, you know, secure services that don’t require complex IT infrastructure. So, hospitals can easily discharge patients or send referrals right from their own EHR to any physician or practice in the country and not make that other end, have to do anything or buy anything or even know who the heck careMESH is. Like when you send a FedEx, they came along with the idea, which was, give it to us and we’ll get it wherever it needs to go, even if it’s on some weird island somewhere that’s our problem. So, hospitals should be able to simply look up a patient in their own EHR enhanced by our national careMESH provider directory and push the send button or the complete button. So, hospitals can also automate the setting of detailed admission and discharge summaries, not just ADTs and PIDs without requiring the recipient to submit patient panels or log into portals or pull lists of patients or other things like that. So, careMESH is a solution like none other available in the healthcare industry, giving hospitals the ability to quickly and securely send patient records to any outside clinician. Of course, we want to completely embrace the new cloud, compute models and strong identity and modern high-end security and privacy and all that and make those problems go away as well as further participating hospitals. And any big platform can do a lot more than just sending records from hospitals or getting two-way communication going or keeping things digital. Because hospitals need to be able to efficiently share data outside their walls. Care coordination, patient safety, reducing readmissions, unnecessary ER visits, analytics, you know almost everything requires digital communication. So, we want to be complementary to the stuff that already works like HIEs and EMRs. But they just don’t work well enough.

Paddy Padmanabhan: So, it seems like there’s two aspects to what you’re trying to do. One is having a robust provider data management system, process platform where you can go to it as a single source of truth. And it really is the truth as it relates to providing data and then using the same platform or related functionality as a draw on the platform, you’re using it for care coordination, doctor-patient communication and so on and so forth. Am I right? Are these two broad components of your platform?

Peter Tippett: Yeah. We think of it as finding the doctor in the first place or the clinic. I want to send a message to Dr. Smith in Salt Lake City; the patient just knows Dr. Smith right. And figuring out which Dr. Smith and making that part easy from within your own EHR for whoever the clerical or clinical person is. That’s the directory problem. And then once you find the person making it so that just doing whatever you normally do. You know, a doctor’s order to discharge and a clerical person following up with the pieces need to happen to get the record out there or the doctor going into the messenger or the basket or whatever it is in their EHR and finding somebody that’s outside their building and saying, you know, asking them a quick question or something. That’s the directory problem. Then once you find the person, you want all the natural things to happen so that when you hit the complete button or the send button, they actually receive the message and it works. And it’s digital and it helps them at the other end as well. So that’s the delivery problem. Of course, it’s not as easy as all that you’ve got to HIPAA get going and compliance and interoperability and make it easy on the other end and make the reimbursements all happen. Big compliance and incentive payments from PI and all that stuff work. But yeah those are the main two components.

Paddy Padmanabhan: Yeah. Let’s talk about the competitive landscape that you operate in. Provider data management has long been an issue in healthcare. If I recall it right, it’s like a three billion-dollar problem or something like that. There are lots of companies trying to address it and using different technology. You know, there’s one aligned group of companies using blockchain, for instance, to create a single version of truth among other things. And everyone every doctor that I’ve talked to would love to have this single source of truth where they don’t have to keep on credentialing them again and again. They go to this one place where, you know, everybody has it all in one place, and it’s all a single source of truth. But it is a competitive landscape and lots of people are trying to solve this problem as well. At the same time, it comes to the other aspects of your platform, the care coordination, the messaging for the EHR vendors, Epic, Cerner, big tech firms. How do you see yourselves in this competitive landscape and what do you think makes you a little bit different?

Peter Tippett: Yeah. The technology like blockchain versus not seems to me to be pretty relevant. The most important thing is, as you said, figuring out how to solve, I call this “the surround problems.” I wrote one of the chapters in Ed Marx’s book on innovation – ‘Voices of innovation.’ And I know you’re working a little bit with him. What a great project you guys are working on. And it seems to me that things that actually get the job done when there’s a huge legacy installed base of things is not trying to fight the installed base, but trying to complement it to work within the system that’s already there and figure out how to extend it relatively easily. The trend of making programs to decide you’re going to blow up whatever is there and start over again is kind of crazy. So, if you can make a directory, you know, ours is FHIR enabled and it’ll work through a browser or a phone or any of that. But that doesn’t help the hospital. You need to make it so that it just becomes the natural directory that’s used by all the services that already use the directory in the hospital like your Epic in basket or the discharge floors or whatever. It doesn’t make that disappear so that no workflow changes happen. And then you’ve got the other issue. But when you get to the competitive things, I think of this as healthcare is wildly local and always has been. And the technology that follows it has been local as well. So, it’s been really easy to hire a big contractor and spend a million bucks hooking your hospital at the other hospital. After you spend a year planning and you’re doing in a year fixing, it works. But now you’ve got two points connected. Well, you know, if you do the math, there’s five thousand plus hospitals and two or three hundred thousand clinics. That would be two hundred three hundred thousand factorial connections and BAAs and all that. That’s by the way, more than our grains of sand on earth. So, this is stupid. This isn’t something that could possibly scale. So, what we need is analogous to what we got when we built the internet. We need a way that everybody can use the same network for all of the basics to not to find the other guy, but also to get something to them without file size limits or anything like that. We need something that works with the EMR vendors and the HIEs and extends their functionality naturally. And we need something that enables all the care coordination platform. I don’t want to build a care coordination platform. I just want to make the ones that are out there actually work for somebody who isn’t involved or some other end that didn’t buy the other end. Making everybody buy both ends of a fax machine or a telephone is nuts. That’s not how those industries evolved and ours can’t get there either.

Paddy Padmanabhan: So how do you build a business case? I understood what you said that you’re working with the existing technology stack solutions that are out there and making them better. So how do you actually build a business case? What do people look for when trying to justify investment in your platform?

Peter Tippett: Yeah. I was on the PITAC, the President’s Information Technology Advisory Committee. I know it’s going on 20 years ago with Baylor and that whole gang. And we said if health, you know, this is a triple aim, in my words, slightly. If health care could only use information technology in rough parity with, the banking or other industries would get three things right. We’d get wildly healthier people and better long lives and all that. We’d get wildly lower costs to our study in the PITAC showed about 70 or 80 billion dollars a year. But the Institute of Medicine came along and did the big study and came to 700 billion dollars a year of savings for the country. And we get an entirely new kind of science. But other than that, it’s, you know, it’s probably not worth doing. So, we’re all married to this, right. And we now have computers everywhere. But there is pain. Everybody hates them. That’s largely because we haven’t had this sharing in the internet part that makes that work. So meaningful use came along we checked our 25, 15 or 20 or 10 or 16 boxes and got our checks. And now it’s switched to PI, promoting interoperability. And the PI penalties are real. Two of the six criteria are called referral loops or HIE measures or, you know, getting your care coordination going. They explicitly require getting of facts for a large proportion of referrals and discharge and transitions of care out of your own organization, 40 of the 50 points you need for PI and that’s 2 percent or 3 percent of your hospital payments from Medicare. So that, you know, for a medium or a bigger hospital, that’s 5, 10, 15 million bucks a penalty. So, there’s real meat now behind some of those and those the screws are tightening a little bit on that arena. And so, there’s some value there. We see the biggest value for getting this working, you know, the two thirds or three quarters or whatever it is of doctors and clinics that don’t work for you in a hospital. We really need to coordinate with these guys. In the past, we’ve ignored the people on the other side. But now that we’ve fixed the inside and it’s possible to do all the basics in the hospital, now it’s time to sort of extend. I hear this all the time from the CIOs. We’ve spent the last five years making this work at all. Now if we can only get the outside provider’s data and get them engaged and make it so that their job is easier and maybe make it so that they get some PI benefit or efficiency benefit, we’re still spending a huge amount of our time on the telephone and waiting around for the other doctor to talk to the other doctor or hiring a massive care coordinators to call and to show up at eight o’clock every morning and dial for dollars. And this is all nuts. This is 20 years ago. The internet fixed that for other industries. And it’s easy enough to find the efficiency value of tightening up your referral network and getting above 50, 60 percent referral leakage. And, you know 2, 3, 5 percent improvements in referral leakage add up to many millions of dollars of new revenues for a hospital.

Paddy Padmanabhan: Yeah, it’s very interesting. You mentioned banking and you mentioned how other industries are much further ahead. And John Glaser, who is the former CIO of Partners Healthcare, who is on my board of advisors, he wrote an article about this in the Harvard Business Review, where he pointed to this exact same contrast between banking and healthcare. And he makes the argument that you don’t have to do the whole hog, do everything the banking has done. But even if you do it selectively and move the needle, their significant gains to be had. And one of my other guests on the podcast, Daniel Barchi, who is the CIO of NewYork-Presbyterian, he made a very telling comment, he said we have really low thresholds today for digital engagement in healthcare. If somebody uses an online platform just to schedule an appointment that counts as digital engagement and that counts towards digital-enablement patients, and it can qualify you PO points for all kinds of incentives or conversely, penalties as the case may be. Healthcare I think is very unique in that regard because it is a system of incentives and penalties that are driving in many ways digital adoption. Is that a fair statement?

Peter Tippett: Yeah, I think so. You know, I think that the regulators have the right end game in mind. And I think that the knobs are roughly aligned and reasonably aligned. But nobody no business aligns themselves around regulatory incentives unless it’s also valuable to the business. I’ve had I can’t tell you how many CIO discussions I’ve had where they said, why aren’t you worried about this three-million-dollar penalty? And the answer is, if I spend so much of my energy worrying about that I wouldn’t do my business. We have to solve our real problems inside the business. And if we can make it align with getting two or three or million dollars or 10 or whatever it is, the feds fine, right? But it can’t be the principal driver. And so, the argument in banking is they’ve got a simpler data set than we do in healthcare, and that’s true. But tearing things down to the simple issue, you know, meds, problems, allergies, and demographics get that actually working, make it actually digital and get it sharing in both directions and make it work easily, whether at the other end is using a browser or there’s hundreds of EMR as it might be when your brother in law invented and there are twelve other users in the country that you still have to make it work with whatever the other guy is using and getting down to the basics and making the communication work at a really basic level is the key. And you know, once the basics are working, it’s easy enough to extend those a little bit.

Paddy Padmanabhan: Yeah. So, we are at the close here Peter. I would just love to hear your thoughts on what you’re seeing, your customers and health systems, in general, investing in as it relates to digital transformation. What are the top two or three things that you think that you see them focused on?

Peter Tippett: Yeah, I think that as a community, the health systems and IT activities in hospitals and bigger health systems has gotten the inside job pretty well under control. They are feeling like they’ve got, you know, actual functional EMRs, EHRs that actually do the basics and people are being productive with them on the inside. And so, I think there is a view towards the outside. We call it different names of call care coordination, we call social determinants, we call it enabling, you know, the home health workers, all those. We get lots of different names for all this stuff. In the end, it’s very virtual health. It’s getting, you know, getting the communication working. In the case of B2B, getting it working among providers means that you don’t have to force the patient to carry the record or come get it or be the middleman. And everybody wants the patient to have the data and be able to deal with it. But none of us make it. It doesn’t make a lot of sense to force the patient to be the connectivity link. So, I think that we’re getting towards this place in our world where we are enabling the communications. These platforms like carequality and the national sharing platform they’re getting some traction. The vendor platforms by Epic and others, they’re getting good traction. They enable good pieces of what needs to happen. But they don’t enable two-way communication. They don’t enable messaging. They don’t often enable giant things like x rays, sharing or other pieces. They often don’t enable a little guy very well on the Oddball platform. And so, you know, providing the glue that sort of fills in the gaps between the stuff that does work seems to me to be the place to be. And I think the venture community and the venture incubators and hospitals and health systems and those kinds of groups, they’re really a powerhouse. They’re the ones that can get the little startup guys and the new innovation guys. They can keep them on track. They can give them the focus they need because all kinds of people have good ideas. But all of us inside, you know, we largely are scientists in this world and businesspeople and the venture world in an incubator, they’re supposed to be experienced. And the good ones do help focus on actually making the change happen.

Paddy Padmanabhan: That’s said. In fact, in my recent podcast, I had a couple of senior executives from Epic and kind pretty much said the same thing that you just said, at least in terms of their product, focus on their platform, focus in terms of facilitating the seamless exchange of information, if you will. Well, Peter it has been such a pleasure speaking. There’s a lot that we can talk about and hope to carry on with the conversation and have you back on our podcast sometime soon. In the meantime, I wish your company, careMESH, and your team all the very best and look forward to staying in touch.

Peter Tippett: Great. Thanks so much.

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

About our guest

Dr. Peter Tippett is Founder and CEO of careMESH, former Chief Medical Officer of Verizon, and a leader in Health IT transformation, information security and regulatory compliance. Among other start-ups, Tippett created the first commercial anti-virus product, which became Norton, and founded TruSecure and CyberTrust. He was a member of the President’s Information Technology Advisory Committee (PITAC) under G.W. Bush and served with both the Clinton Health Matters and NIH Precision Medicine initiatives.

Tippett is a physician, board-certified in internal medicine, and was Research Assistant to R.B. Merrifield (Nobel Prize, 1984) and Stanford Moore (Nobel Prize, 1972) at Rockefeller University. He received a PhD in Biochemistry and an M.D., from Case Western Reserve University, and a B.S in Biology from Kalamazoo College.

Throughout his career, Tippett has been recognized with numerous awards and recognitions — including E&Y Entrepreneur of the Year, the U.S. Chamber of Commerce “Leadership in Health Care Award,” and was named one of the 25 most influential CTOs by InfoWorld.

About the host

Paddy Padmanabhan is a widely published and quoted thought leader on digital transformation in healthcare. He is the author of  The Big Unlock: Harnessing Data and Growing Digital Health Businesses in a Value-Based Care Era, and the CEO of Damo Consulting Inc, a digital transformation and growth advisory firm based in Chicago.

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We essentially see ourselves as stewards helping clients manage their data

Episode #34

Podcast with Seth Hain, VP of R&D and Sean Bina, VP of Access and Patient Engagement, Epic

“We essentially see ourselves as stewards helping clients manage their data”

paddy Hosted by Paddy Padmanabhan

In this episode, Seth Hain, Vice President of R&D and Sean Bina, Vice President of Access and Patient Engagement at Epic discuss the next wave of opportunities for Epic and how the company has evolved by focusing on patient experience and advanced analytics.

At Epic, the focus has always been on providing patients with access and tools to view and have control over their data. Epic works with over 300 health systems today to help them manage their data. Over 160 million consumers have or are using its MyChart patient portal which has been around for nearly two decades. The company uses advanced analytics such as AI/ machine learning and monitors how they are performing on different populations before embedding it into workflows, be it clinical-facing or patient-facing.

Epic has lately started focusing on providing transparency around healthcare costs and has been working on creating accurate estimates for patients so that they have price transparency at the point of care.

Welcome to The Big Unlock podcast where we discuss data analytics and emerging technologies in healthcare. Here are some of the most innovative thinkers in healthcare information technology talk about the digital transformation of healthcare and how they are driving change in their organizations.

Paddy Padmanabhan: Hello again, everyone and welcome back to my podcast. This is Paddy and it is my great privilege and honor today to introduce my special guests. We have two of them today, Sean Bina, who is a Vice President for Patient Experience with Epic and Seth Hain, who is VP of R&D for Epic. Seth and Sean, thank you so much for joining us and welcome to the show.

Sean Bina: Thanks for having us.

Seth Hain: Thank you.

Paddy Padmanabhan: You are most welcome. So why don’t we get started? Maybe you can give us a little bit about your background and your current roles at Epic for the benefit of our audience.

Sean Bina: Yeah, so I’ll start. So, this is Sean and I started at Epic 23 years ago doing implementations of our systems. And then over the years, I’ve worked with a variety of our different products and now focus my time on the patient experience. And that’s really my goal, to help patients get connected into their health and wellness in a way that they’ve never been able to before.

Seth Hain: My name is Seth and I started a little after Sean. I’ve been here for about 15 years and when I came to Epic, my focus was on architecture and the kind of systems infrastructure behind the scenes. And then I combined that with my prior experiences around mathematics and focused on and continued to today the research and development around analytics and machine learning and in particular embedding that type of intelligence into workflows, be it clinical facing or patient-facing, for example. And the tools that are used throughout the system for analytics and machine learning.

Paddy Padmanabhan: And between the two of you, I would argue that you are looking after the top two focus areas for health systems today – patient experience and advanced analytics. So, I’m looking forward to this conversation. I want to start with this, now we have near-total penetration of electronic health record systems in the country today. Of course, it’s been a great run for Epic as leaders in the market. So, what are you seeing as the next wave of growth opportunities for Epic?

Sean Bina: So, we see a few different areas where we’re continuing to do a lot of work. One is we just continue to work with our customers to expand the adoption of Epic and then to add new additional modules. One of the things that we’ve learned over time is that every specialist needs a system that’s really designed specifically for them, whether they are core things that all physicians and clinicians use around ordering and reviewing results and doing some basic documentation. But then there’s a lot of subspecialty support that’s needed for doing things like managing images, for registry support and for doing the kind of specific documentation within a given subject area. So, we continue to go deeper and deeper into those areas to create a great experience for physicians. The one thing I would add is when we look at the industry in general, we do see our customers are really focused on three core areas. One being patient experience, two being analytics, but then three is really bringing the joy back to practice for physicians.

Seth Hain: I would also add that the space around healthcare continues to change and evolve. And I think there’s a lot of opportunities as we start to look at and see more collaboration between, say, payers and providers in the space. There is an opportunity there to help facilitate faster exchange that benefit both the provider and their workflow, but also the patient and the care they’re receiving in a timely manner. And that expands as you start to think about a broader definition of health. Thinking about things like dental, long term care, even where people get care, be it a telehealth encounter through, you know, they pay from the app directly on their phone, or they’re in a retail clinic and they just need to swing by for a flu shot and making sure that’s a continuous experience from a health perspective.

Sean Bina: The other thing that we continue to work on is we continue to move internationally. So, you know, outside the U.S., we work with an increasing number of countries on our software and there’s kind of a wonderful cross-pollination that we get as a result of that. So, for example, we’ve been working a lot with Finland and they’re very focused on social determinants of care, really, really focused on reducing the need to get into the hospital or readmissions into the hospital. And so, a lot of the work that we’re doing with them around their social care system then ends up benefiting our U.S. customers.

Paddy Padmanabhan: Right. Right. And we’ll unpack some of these, especially around the emerging tech stuff in the context of digital transformation, which is what we mostly focus on as a part of this podcast. So, let me ask you a simple question. What is your understanding of the term digital used by everyone? And almost everyone has a definition for it. And how do you define digital? What is your understanding of the term and how is it impacting all your choices or investments in health systems, specifically from your point of view with your clients?

Sean Bina: Yeah. If you don’t mind, we take a quick trip back down memory lane. You know, when I started back around 20 plus years ago, the world was very different in terms of what was available from a digital perspective. You know, there weren’t integrated ambulatory inpatients solutions. You couldn’t do an end to end revenue cycle system that covered all your hospital and clinics. And so, people were using best of breed systems and trying to cobble systems together to manage all of that. And until around 2003, there wasn’t even such a thing as a patient portal. So, one of the things that when I think about what it means to be digital today, it’s obviously changed over the years. But I think it’s important to remember how far we’ve come that we now do have fully integrated systems that cover all the kind of food, warmth, and shelter that is needed by healthcare organizations. So that now we’re getting to the point where we can do a little bit more of the poetry.

Seth Hain: I think that depending on who you ask or the definition of digital transformation, you tend to hear a pretty different perspective. Some people immediately come at it from the patient experience perspective and the possibility of having access to health care through your phone at any point in time. Others and I tend to take a foundational view of systems perspective on some of these topics. You know, start to also bring in things like cloud computing behind the scenes and the running of machine learning algorithms on data that is flowing into the system from a combination of devices. Then being able to be back into wherever the provider might be so that they can be sure that in the ICU, be that walking down the hallway so that they have a better-informed picture of what patients they might want to spend some time with at that exact moment in time. So, I think that gets to more of the transformation point in building on what Sean was saying.

Sean Bina: Yes one other key element of digital is the interoperability piece. So, if you go back to the year 2005, 2006, 2007, interoperability was a fax machine. We’re now passing five million records a day around the country and it’s starting to be around the world for patients. And so we’re really starting to see where physicians have gone from thinking of records from the standpoint that I have my record at this site versus there are other records at other sites to wanting to have combined digital views of all of a patient’s information pulled seamlessly together.

Paddy Padmanabhan: Yeah, I think we certainly have seen a significant amount of progress on interoperability. But I just wanted to make one observation. You know, when you look at the past decade or so, well, the single biggest thing that happened in terms of digital transformation was really the digitization of medical records. I remember working with paper records with my physician 10 years ago, and it so happened that he was fighting tooth and nail about going digital. But if you really look at it, I don’t think any of the sectors has seen the kind of transformation that healthcare, in particular, has seen, just by virtue of digitization of medical records. So now it looks like we’re, you know, phase one of the mission has been accomplished. Now they have the strong foundation of digital records. And so, everyone seems to be talking about what do we do next with it? Advanced analytics, building better experiences, looking at data from multiple sources and so on. So, in that context, the whole competitive landscape is also changing. So I want to probe a little bit on how you see Epic evolving in the context of this emerging landscape of technology players and the evolving needs for health systems, as they compete with a whole different marketplace with a lot of nontraditional competitors in all kinds of other things going on. Do you want to comment on that? How are you evolving and what are the changes you’re seeing your clients go through and how are you evolving in step with that?

Seth Hain: You’re getting back to that kind of world of transforming from a paper chart to a kind of maybe a desktop PC where somebody would go to get information, I think is an interesting analogy to kind of transformation we’re seeing right now where in many cases it’s not about the chart, right? It’s about a continuous health experience that folks are receiving. Be that a patient or a provider. So, we see somebody like Rush down in Chicago who builds automated workflow to understand as patients come into the E.D., their likelihood to leave based on machine learning algorithm using inputs from a variety of different sources, not just the medical record, and then use that to help drive workflows where they can walk around, touch base with the patient, let them know where they’re at from in my perspective, to see a nurse or a clinician. And they saw a drop of about 50 percent in folks leaving without having been seen from the emergency department. So, you start to see a different type of transformational workflow emerge that isn’t based around a single machine but is more driven by a backend kind of ubiquitousness of data accessibility from a cloud perspective. And then differing devices be those iPads being used for rounding or watches used to alert physicians in the ICU of patients that might be at risk of deterioration from based on a machine learning model. So, it really starts to transform how clinical practice is being given some of the financial aspects as well, are also are being looked at.

Sean Bina: Yeah, I would just add from the patient perspective, I think they don’t think in the same way as they used to that I have a record at a particular healthcare organization. Increasingly, they’re thinking about their health and wellness and how that includes what’s going on their Fitbit, and on their Peloton and on the medications that they’re taking. And so, they’re looking at a much broader ecosystem of inputs. And I think the expectation is growing that what healthcare organizations are going to be able to do is take all of those inputs, pull them all together, and then provide recommendations based on a much broader set of data than that’s ever been data available in the past.

Paddy Padmanabhan: Yeah. And my firm did some research back in the summer of 2019. On the current state of digital transformation in healthcare, and what we found was that over half of the health systems that we polled in the study were looking at the electronic health record platforms systems as a starting point for the digital transformation. One of the reasons was that integration aspects in pulling data adding it all from within the workflow of an EHR system is easier to do. And when you talk about digital transformation, people are talking about integrating data from multiple sources. But it’s still a lot of integration work that is involved here. I want to switch at this point to talk about the data itself. You know, your obvious strength for Epic is in the data that you have access to, all the patient records that are being processed through your system, across all these health systems across the country. Now, that is a huge advantage to Epic as you try to build out your models and as you try to build out your experiences and just get a better understanding of your patient populations. Can you share a couple of examples of how you’re actually using the access to the data to improve experiences as well as outcomes for patients? Do you want to talk about one or two examples? Maybe you mention a couple of clients where you’re doing some work in this regard?

Seth Hain: Yes, sure. So, I can address a couple of those points. One of the things to be clear here about is that organizations work with us and we essentially see ourselves as kind of stewards helping them manage the data that they have on-site. And we work with them to kind of build out workflows that have the opportunity to be fully informed by the data in their system and the context around the patient and the provider. We often think of this internally as a concept we call relevance, where we want to make sure that full picture is brought to bear. I mean, some of the easiest examples to think about in this context are around the acute space where we rapidly see folks deploying machine learning models around things like sepsis, deterioration, and fall risk being three of the most common ones. We see folks start with often implementing them as a bundle. And at this point, we have over 300 organizations either running directly in their system or in the midst of implementing machine learning models in those types of contexts. And it’s exciting to see the impact that it has. And, you know, it ranges from something like a 17.7% decrease at the North Oak, which is a community hospital down in Louisiana in mortality reduction for sepsis patients to, you know, also a decrease in alerts that providers are saying you use machine learning models to better identify patients. It also helps save folks time. So, UC Health, who spoke to Amy about this, saw a 19 percent reduction in the number of alerts they were seeing in these types of contexts as well. So, it both benefits from a provider time saving perspective while improving care.

Sean Bina: We also do models on the operational side of the house. So, doing things like identifying the patients that are most likely to “no show.” So, in the past, you obviously could run kind of massive report and you could do a lot of analysis and trying to find this information. But now we can’t just have the system waiting. What are the most important variables and identify which patients are the most likely no shows and then do things automatically based on that information? So, whether it’s doing a reminder phone call or texting the patient or whether it’s overbooking the patient because they’re unlikely to show up at a particular day in time. We can automate some of those processes. For me, that’s part of the excitement as you mentioned, as we’ve got completed the underlying digital transformation; we can now do these things. One of my favorite examples is what we call a FastPass at Epic, what it does is it automatically monitors the waitlist, identify the patients that are at the highest risk and need to get in the soonest, and then will automatically text or email them when new appointments become available. John Hopkins, they saw about a twenty-seven-day improvement from when patients were scheduled with a specialist until when they got in based on using this FastPass. So at one time improves the convenience and access for patients, but then at the same time, it also helps the healthcare organization because you’re filling times that would have otherwise gone unfilled or where you would have had to have a lot of staff managing the situation.

Seth Hain: And to your point, Paddy, I think, about platform, that equally important to data in regards to machine learning and these types of scenarios is the workflow in understanding what data is present and ready to be used at the point in time that somebody can make an intervention that will really matter and how to get that information into the people’s hands. They can do something with it. And so, as we build out more machine learning models here in the data science team at Epic, that’s actually where we start. It’s not with the data that’s available or those sorts of things, but it’s about the impact that we want to have in the workflow and how we see that fitting in and then work back towards the true kind of machine learning training processes and the stuff that the data scientists really do day to today.

Paddy Padmanabhan: Yeah, there was this one question that I have on this. When I talk to CIOs and digital transformation leaders, one thing that I hear often is that it’s very important to identify the right kind of use cases if you will, or AI II and machine learning applications. And often I’ve heard that the bigger opportunities today, maybe in more in non-clinical use cases, administrative functions, and revenue cycle management as an example or even for the patient experience related applications. Is that the sense you get in based on all of the work that you’re doing that we’re further ahead? Or maybe there’s a bigger opportunity in the short term with non-clinical versus clinical use cases? What would you have to say on that?

Seth Hain: I would hesitate to say that that is exactly what we see. I think it’s different depending on the area. Certainly, in the operational areas, we see real opportunities for automation, and we see folks using machine learning embedded into the workflow to save folks time and energy in regards to moving through those operational workflows. On the acute side, we see a variety of impactful outcomes like the ones I just referenced, be it around deterioration, be it around sepsis, be it around palliative care. There is a lot of opportunity that folks see there and documented outcomes such as on the North Oaks, one that I shared a moment ago. There is also real opportunity in the population health space. I think it is harder there to truly measure the outcomes when you’re looking out two to three years in regard to the impact that folks have and directly tying it to the clinical management and care management that takes place. That’s not to say that it doesn’t help. You know, we have documented evidence and dug in as we build machine learning models around, say, sorting outreach for diabetic patients just based on an A1 C value compared to a predictive model of their two-year risk of Type 2 diabetes complications. We can really see a difference in the math when we dig into that. It’s harder and takes longer to produce those studies, though, about outcomes longer term.

Paddy Padmanabhan: Yeah, yeah. But let’s switch to the patient experience. Patient access, patient experience, these are hot topics for health systems today, high focus areas. And there’s also a teaming ecosystem of a digital health startup funded by billions and billions in venture capital money that are addressing specifically the patient experience and patient access aspects of the healthcare value chain. Now, you know, when I look at health systems, I ask myself – what would we be looking beyond an electronic health record system for? As I mentioned earlier that half of the health systems that we polled in our study were already using electronic health records systems for most of their digital functionalities. But there is also a growing trend of using startups. So, I guess this is a question for Sean. Where do you see Epic fitting in this overall milieu of digital startups that are coming up with maybe new ways of defining experiences and new solutions? Where do you see Epic fitting in this overall context?

Sean Bina: Yes. So, first of all, a little bit of context. MyChart has been around for a long time now. It goes all the way back to 2003 when we first went live with it. And kind of the patient side has always been a focus for us at Epic in terms of providing patients with access and tools to be able to see and view their records. That’s always been a core thing that we want to make as seamless as possible. And we now have almost I think we’re over one hundred and sixty million MyChart accounts. So, we’re closing into the point where about one in two people in the country having and are using a MyChart account today. And we’re starting to see much greater adoption than in the past. So, I think in the past, you know, we would see our customers have around a quarter to a third of their patients be active MyChart users. But the trend is way up. And so, for example, one of the most interesting things I’ve heard recently is that at M.D. Anderson, if a patient is seen three times, then there’s a 90 percent chance that they’re using MyChart for M.D. Anderson. Now, of course, those are patients that are sick, and they have a whole set of issues. But what it shows is that patients really will adopt the technology when it comes to using it, when they do have health issues. And so, I think one of the questions for us is not will patients use MyChart if they’re sick and they have chronic diseases and they’re in for surgeries and all of that. We know that for patients that are connected to health systems, that they will become active adopters of MyChart. But for people that are generally well or have particular health concerns are just trying to manage their health issues, but are not constantly going in to see the doctor, how do we reach out and get connected to those patients? And so, our focus is really kind of turning to help patients do a lot more self-management and do a lot more wellness within the system than we’ve ever done in the past. Some of that is providing people with targeted education based on the information that’s flowing into Epic. So, when you talk about this whole ecosystem of startups, a lot of startups feed information in which we can then consume and take advantage of in Epic. So, whether it’s your blood pressure monitor, your heart rate monitor, whether it’s your Fitbit, whether it’s your Apple Watch, all of those things then become data feeders that then get, consumed through MyChart up into the EHR and then we can provide monitoring and management of that data based on configuration within Epic.

Paddy Padmanabhan: Yeah. And you know, one of my recent guests on the podcast mention that right now we have a fairly low threshold for option of digital tools by patients. If people start using the tool, that itself is a significant change. And it’s really heartening to hear that you’ve got 160 million patients who are now beginning to actively use MyChart in some way. I am one of them, by the way, and I can’t remember the last time I actually called into my physician’s office for scheduling an appointment or just for non-emergency type questions. I do that all through MyChart today.

Sean Bina: Yes. I’m the same way and I use MyChart all the time for managing my daughter’s care and then managing my care. And so, you know, I love to access digital tools and I would much prefer to always do something online than have to make a telephone call. And I think many, many patients are in that same boat. There is a cultural change that still needs to happen at many health care organizations to give patients more control. So, one of the things that I’m continually advocating is that we don’t need to wait to give patients their test results until after a physician has reviewed them. We should be providing open notes to patients as much as possible. And so, we have those capabilities within MyChart today. And so, it’s just a matter of transforming the healthcare system. And some of this will almost certainly be mandated by the government in the next year or two is that really to provide that full context for patients when they go into their shared medical record.

Paddy Padmanabhan: Yeah and that would be a huge leap, actually, especially the comment you made about the notes and all that. So, let’s talk about emerging tech stuff again. You know, we talk mostly about digital transformation and now we are on the cusp of some big breakthroughs with some of the emerging technologies that can potentially play a big role in the way health care is delivered in the future. So, we just touch on a few of them. And let’s start with this one, cloud computing. What are your thoughts on the role of cloud going forward in digital health?

Seth Hain: I think there’s a number of things that cloud computing provides, but at the end of the day, I think it is really about faster delivery of technology to folks to be able to put it into practice. So, a couple of years ago we released our cloud-based machine learning platform, which is essentially provided as a service and allows organizations to embed directly into their workflows, machine learning algorithms that run in real-time on the latest data in the chart. And when we built that out, we build it out in a manner that used. Forgive me, I’ll dive into a little bit of techno-jargon here, but used containers, which is a kind of new approach for deploying software out on the cloud and is agnostic, so that runs on Microsoft Azure today can run on other platforms as well in the future. And that enables organizations to also both getting access to new things we’re developing here in Verona, but also to embed their own software more efficiently. So, we’ve seen organizations like Ochsner who now have deployed nine different machine learning models directly onto that platform and embedded them back into their workflows. So, they see this as a tool to allow them to more rapidly evolve both their clinical and financial operational workflows. And they share those types of results and approaches our UGM conference, XGM, and in other forums so that folks can learn how to do that and move more quickly with it. So, I really see cloud as an approach for faster delivery and that then enables that type of faster execution on new clinical programs and the like.

Paddy Padmanabhan: Yeah, I had a quick follow up question on that. So you mentioned Microsoft Azure, so they are the big tech firms that have their own plans for the healthcare market, in some ways they may well be competing with you, and in other ways, you could be partnering with them. So how do you approach this today at Epic? Where are you partnering with? What do you think you’re going to be competing and what do you see as it relates specifically to the big tech? I’m talking Microsoft, Google, Amazon in particular.

Sean Bina: Its really customer driven. So, you know, its what customers are coming to us and asking us for and then us doing an evaluation on our side in terms of what models are going to work the best, who’s the best groups to partner with?

Paddy Padmanabhan: Right. OK, good. So, let’s move on to the next one on my list – voice recognition. Boy, I have to tell you, I’m pretty excited about what I see in terms of its potential. I just saw a news item that said that we now have the ability to identify biomarkers based on voice. And I thought that the future of health is here. But anyway, I don’t want to get too far ahead of myself. What do you guys think?

Sean Bina: Oh, we’re super excited about voice too. So, you know, people have been using voice obviously for years in terms of using systems like drag and then model to capture notes. And we have a lot of physicians that are highly efficient doing that. But we certainly want to kind of add a few additional layers onto them. And so, the first thing that we did was we started creating a voice assistant. We now have a voice assistant that runs on our mobile platform where I can say, hey Epic, and then have it answer certain sorts of questions for me. And then we are doing the work to move that into hyperspace. So on the workstation, you’ll be able to have a microphone where it will work in the ambient fashion and you’ll be able to use voice commands to drive workflow, to find out information about a patient, and to really work hands-free. I think a lot of our focus is, you know, where does this technology make sense? Whether it’s, you know, in the room for an inpatient where the patient is the driver, whether it’s in the OR, where people are scrubbed in or whether it’s in the clinic where the physician is focused on the patient instead of being focused on the workstation. And how can they quickly get the information that’s most relevant and then get things cued up in a simple and easy fashion? And we feel like the voice assistant is going to be a great way to do that. And then a little bit farther, but not that much farther down the path is the conversational capture with diarization and natural language understanding to basically be able to start to construct a note out of the natural conversation that is happening during a visit. We’re already seeing kind of experimental groups are doing this in areas like orthopedics where you have pretty structured common visits that are happening over and over again and then using machine learning to eventually get to the point where instead of having a human being as your virtual scribe, the system is really the virtual scribe creating that note.

Paddy Padmanabhan: Yeah, ambient clinical computing environment I think that’s kind of becoming a term in vogue today. I saw one of my earlier guests on his podcast mention that in 10 years’ time we’re going to completely keyboard-less and we’re going to have a voice-enabled or ambient computing environment where you don’t need a keyboard anymore. That’s where physicians are looking forward to that because that is going to significantly reduce their burden. But, how close or how far away are we? Is voice recognition mature enough today? What are the error rates within control, what’s your quick comment on that?

Sean Bina: Kind of we’re learning a lot right now is what I would say. So, we know that voice recognition works when I have a microphone in my hand and that they are at 95, 96, 97 percent accuracy using the new cloud computing platforms. So, for example, when Dragon moved to the cloud, the accuracy increased, and it can handle more accents and different styles of speaking better than ever before. So, we know that the accuracy is really good in kind of that clinical scenario. We’re kind of in the first layer of watching how the voice commands are being used and that hit rates and success for that. And we’ll learn a lot as more and more customers go-live. And then, you know, we’re kind of doing close monitoring on these first areas where people are piloting ambient voice assistance in specialty areas like orthopedics. So my sense is that in areas where you have a fairly structured dialog, you’ll have fairly fast adoption over the next year to two years in areas where a kind of a more classic internal medicine visit, where a patient might have nine different problems and you have a 45-minute visit where you’re covering all different types of things with the patient and doing a lot of education. But that’ll take a little bit longer.

Paddy Padmanabhan: Yeah. Yeah. Well, I’m still trying to get my car to listen to me and play the exact song that I want to hear. And so, I am, I guess, a little further away on this. So, the last one on my list for emerging tech and we’ve covered a fair bit of this with Seth as far as, you know, artificial intelligence. But I do want to touch on one thing as it relates to that topic. I hear a lot from people who are practitioners in the field and the customers as well that there are some concerns, they have about black-box algorithms, algorithmic bias, even some ethical considerations around the use of AI in certain contexts. So, Seth, do you have any thoughts on how we address these and where we are in really gaining or enabling customers and users to gain more confidence in these tools?

Seth Hain: Two things really, I think come to mind. The first one is really understanding how they’re being put into practice, where machine learning is really embedded into this system to kind of augment the information available to a user. I have a quote here from a user group meeting presentations from Denver Health, where they were talking about implementing a deterioration index model and a nurse shared with the folks, then put it in the plot practice that the deterioration index doesn’t change the way I nurse my patients, but it gets me into the right rooms faster. Right. So, understanding how those are embedded into the workflows I mentioned previously, I think can certainly go a long way to addressing it. The second piece that comes to mind is really about the process that an organization goes through as they implement I and put models into practice. First, understanding how it is performed on similar populations. What went into building the models? We published briefs on every model we create that organizations can review prior to putting it into their system. The second is the ability to run that model silently and understand how it performs at the organization in the context that is likely to be used in prior to putting it into practice. The third is obviously putting it into the workflow and making sure that users understand the context in which is being included and having it embedded directly there in an explainable fashion.

Sean Bina: And actually, this is true not only for AI/ machine learning, this is true for all decision support. You can’t turn on the decision support alert without first running it silently seeing when it’s going to be triggered. How often it is going to be triggered and whether it’s being triggered in the right circumstances? And then you have to measure over time how a decision support alert is being used for it to be effective.

Seth Hain: And I think that last point is key here. It is often not talked about in the context of machine learning, where after you have machine learning models live and in practice, it’s important to continue to monitor them and understand how they’re performing on different populations and then taking steps to adjust that where appropriate. It might mean adjusting the model. It might mean adjusting the workflow. But understanding its performance on a variety of different individuals, and in a variety of different circumstances over time is key and we provide that type of monitoring capability directly within the platform for augmentation.

Paddy Padmanabhan: Yeah, I think that makes a lot of sense. We’re coming up to the close for our podcast here. Is there anything that you’d like to share with our listeners about any new product features or new functionalities that you planning to launch this quarter or the next quarter?

Sean Bina: One thing that has been available for a while that I would just quickly highlight because we didn’t talk about it. We didn’t talk very much about the financial side of the house. But transparency around how much healthcare costs is absolutely essential. We have to make it so that as patients are coming in for their visits, they have a good sense of what this visit or procedure is going to cost them, what’s going to be out-of-pocket, what’s going to be covered by their insurance, and provide them with an understanding of the mechanics of that. In many cases, a patient might even be charged differently going to the same healthcare organization, depending on whether they’re going to the clinic or the hospital for the same disease. So, we have to make sure that patients know about that as they’re making these decisions about when and where to go in and who they’re going to be seen by. And so, we’ve been really focused on being able to create estimates for patients that are highly accurate based on historical data and can be provided at the point of care by the doctor. So, the doctor can say this is what an upper GI is going to cost. He or she can say what the medications are going to cost and whether there are less expensive alternatives. And then also providing that same information as a patient is going in to schedule their visits and procedures. So, to me, that’s a really big deal and it’s something that could really transform a patient’s experience by not being surprised by what the costs of things are in the end.

Paddy Padmanabhan: Yeah. And I agree completely with you. It is a big deal. I think the price transparency, cost transparency is something that is unfinished business as far as healthcare is concerned. Well, Seth and Sean, it’s been such a pleasure speaking with both of you. I greatly appreciate your joining us on this podcast. And I look forward to catching up with you again soon. Thank you again.

Sean Bina: Thank you.

Seth Hain: Take care.

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

Rubik Cubes make a perfect gift for any occasion. Learn more about this entertaining puzzle visiting ruwix.com.

About our guests

Seth Hain, Vice President of R&D at Epic, focuses on integrating analytics and machine learning into healthcare. This includes the development of business intelligence tools, data warehousing software, and a platform for embedding machine learning across Epic applications. During his 13 years at Epic, Seth has also led the Systems and Performance group, with an emphasis in database performance and architecture.

A native of Seward, Nebraska, he received a BS in Mathematics from the University of Nebraska and an MS in Mathematics from the University of Wisconsin. Seth currently resides in Madison, Wisconsin with his wife and two children.

Sean Bina is the Vice President of Access and Patient Engagement at Epic. His focus is on improving health and wellness by helping people to become more connected, knowledgeable, and in control of their care. He currently divides his time between strategic application planning and product management. During his 23 years at Epic, Sean has worked as an account manager, team leader, implementer, an RFP writer, and as a salesperson.

Sean graduated from Beloit College with a degree in Philosophy and Literary Studies. He lives with his wife, daughter, and dog in Madison, Wisconsin.

About the host

Paddy Padmanabhan is a widely published and quoted thought leader on digital transformation in healthcare. He is the author of  The Big Unlock: Harnessing Data and Growing Digital Health Businesses in a Value-Based Care Era, and the CEO of Damo Consulting Inc, a digital transformation and growth advisory firm based in Chicago.

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Digital medicine is just medicine

Episode #33

Podcast with Daniel Barchi, SVP and CEO, NewYork-Presbyterian

"Digital medicine is just medicine"

paddy Hosted by Paddy Padmanabhan

In this episode, Daniel Barchi discusses the current state of digital transformation in healthcare, their goal to bring cutting-edge technology, and focus on delivering outstanding patient care.

According to Daniel, a good technology is one that saves clinicians and caregivers time without getting in their way. He believes that healthcare technology is “80% people, 15% process, and 5% technology.” He further cautions that while using advanced technologies such as AI, health systems need to be thoughtful, careful, and respectful of the way technology interacts with patients.

The healthcare system as a whole has very low thresholds for measuring progress in adoption rates for digital health tools such as digital front doors. Digital health startups have a lot of brilliant ideas; however, they are years away from being integrated into core EHR systems. Daniel advices startups to get deeply embedded with their clinical partners to develop innovative solutions for healthcare.

Welcome to The Big Unlock podcast where we discuss data analytics and emerging technologies in healthcare. Here are some of the most innovative thinkers in healthcare information technology talk about the digital transformation of healthcare and how they are driving change in their organizations.

Paddy Padmanabhan: 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, Daniel Barchi, CIO of the NewYork-Presbyterian Hospital. Daniel, thank you for joining us and welcome to the show.

Daniel Barchi: Great. Thank you for having me Paddy.

Paddy Padmanabhan: You’re welcome. So, Daniel, I was at your presentation recently at the CHIME Falls Forum and your presentation was titled ‘Digital Medicine is just Medicine.’ We know that healthcare is in the early stages of a digital transformation. So maybe you could start by giving us an assessment of the current state of digital transformation in the healthcare sector.

Daniel Barchi: Sure. Well, thank you. First of all, I’d think I’d start by saying digital medicine is just medicine in the same way that really good technology is not about technology. It blends into the fabric of what we do in our everyday lives. So, at one point, I’m sure it was novel that somebody owned an automobile and today we don’t think about owning or using an automobile. I was reading the book ‘Thinking Machines’ recently about the birth and growth of artificial intelligence. And it pointed out the fact that the first supercomputers were huge, and they filled rooms and now they’re small and, on our wrists, and we just don’t think about technology. And in the same way, technology and healthcare is important. Quite frankly, if we’re eating up physician or nurse time dealing with technology, then technology is not doing what he or she needs. The technology that’s important for medicine called digital medicine is that which blends seamlessly into what we do daily in taking care of our patients. And so, it’s my goal and that of my team to certainly being on the cutting edge of what technology can offer. But it’s not an end to itself. It just blends into our larger focus on delivering outstanding patient care.

Paddy Padmanabhan: Right. And I recall you had mentioned something along the lines of technologies, 80 percent people’s, 15 percent process, and 5 percent technology. Did I get that right?

Daniel Barchi: That’s true. Although, you know, I’ve been using this quote for years and it was originally coined by my colleague, Marc Probst, CIO of Intermountain. And I use it all the time because it’s absolutely true. I’ll repeat it again. Healthcare technology is 80 percent people, 15 percent process, and only 5 percent technology. Day in and day out people who are leading technology transformation in healthcare are not focused on python programming, or XML, or interfaces, or FHIR. What we’re focused on is how does this work for the end-user? What do they need? Do they need the two of them? Or can we get down to one of them? Can we cut down the time that they spend digging around these systems by making it more ubiquitous? It’s all about the people on the process side, not the technology side.

Paddy Padmanabhan: Right. My firm’s research suggests that health systems are driving a lot of digital transformation initiatives. However, they seem to be a portfolio of standalone projects and for the most part, if I look at the health system landscape as a whole, most health systems are relying primarily on their electronic health record platforms for driving digital initiatives. Is this consistent with what you’re seeing in the market? And maybe you can talk a little bit about how you’re approaching it at NYP?

Daniel Barchi: You make a very good point. We always strive to adopt technology, which is going to be cutting edge and it’s going to help our physicians. At the same time, we want to make sure that it’s not getting in their way. And so, there’s a push-pull, the push being that we want to embrace small companies that are coming up with new ideas. And then pull being to make sure it’s part of the overall fabric of what we’re doing. And so, it’s a fine balance between being on the bleeding edge of what’s happening and being on the trailing edge of what’s happening. So, we like to think that we at Presbyterian were thinking about that balance from the physician and nurse’s point of view all of the time. We’re really focused on our core electronic medical record. And let’s be honest, that’s where our clinicians spend the bulk of their day. And we want everything to be accessible through the electronic medical record. We don’t want to say, sure, you do your core data and your core documentation and ordering in the electronic medical record. But when you want to use a cool decision support tool, log out and log into this other system, or when you want to use the latest PACS system, log out of the EMR and log into this other system. And so, you know, the great technology that comes in startups that are being innovative is generally years away from being well integrated into the core EMR. So, we need to think about where we can embrace the best of what’s cutting edge and coming from small companies, small startups, small standalone tools versus what we can incorporate in the larger EMR. And there’s probably a threshold, you know, something that is a 100 percent great idea, a standalone application versus 70 percent as good using the functionality of the EMR. Probably the 70 percent embedded in the EMR beats the 100 percent standalone because of the ease of working and for the idea that everything that’s done in the core system is interfaced with everybody else. So, it benefits not only the clinician who’s using that tool, be it the outside tool or the inside tool, but the inside tool is integrated into the seamless care of patients end to end.

Paddy Padmanabhan: Yeah, and this is very consistent with what I hear from other CIOs, as well as. This constant trade-off between what might be the absolute best in class on the one hand, but also what is more practical and optimal for the here and now. And you made a couple of very good points about the importance of not adding to the physician burden, which was kind of your underlying message about using the electronic medical record as the landing page or a landing point for physicians to use some of the advanced functionalities. Let’s talk about the front end a little bit. There is a lot of talk about digital front doors today and primarily relating to patient access. And a lot of health systems have launched some very intuitive apps, including NewYork-Presbyterian. And there are also nontraditional players like Walgreens getting into this space. What are your thoughts on how these digital front doors are reshaping the patient experience? And maybe you can share some thoughts from your own experience with the apps that you’ve launched, at NewYork-Presbyterian?

Daniel Barchi: Great. Thanks for bringing this up. Just to use an example, going back 20 years or more, we can think about a lot of this in the way that airlines did about booking and ticketing systems. In that 20 years ago, it was all about how the consumer, the traveler, gets in contact with the airline to start the process and make things happen. And today, it’s all about putting the perfect app in travelers’ hands and letting them make their reservations, do the special requests and drive the process. We can think about the healthcare industry being on the early phases of doing this, where certainly the clinical care is delivered by doctors and nurses in physician practices or in the hospital. But the coordination of it more and more is getting into the patient hands. And the only way you can allow them to do this if you give them access to the fundamental operating systems, primary through a portal. We’re going through the process of implementing a single common EMR across all 10 of our hospitals as well as Columbia doctors and Weill Cornell. Medicine is simply a huge endeavor, and as we think about this core EMR that we’re implementing, there will probably be about 45 to 50 thousand clinical and financial and operational users on a daily basis. But what we realized at one point is, you know, they’re probably going to be one hundred and fifty thousand patients that use this system every day through the portal. So, it’s great that we’re doing it for physician efficiency and for operations in the hospital. But it has to be a really good tool as a portal for the patients to use it and get the data themselves. And then I tie this back when I comment about standalone. Sure, it’s great if you’ve got a perfect fertility app or motherhood app or depression screening app, and it’s great that specialized standalone tool can go deep. But I think the best applications that face patients are the ones that go deep. But they’re also broad. They tie into the larger environment of care, including legacy records, including prescriptions and allergies and the ability to schedule follow up appointments.

Paddy Padmanabhan: Yeah, and can you talk to any metrics or how do you track the effectiveness of how these apps are truly reshaping the patient experience or impacting your own inflows if you will? What kind of metrics do you track for, telling whether it’s successful or not?

Daniel Barchi: Well, I will start by saying that I think that health care is generally still very new into this. Even core EMRs that have very good patient portals, it is the few and far between health systems that have really made great inroads in getting their patients to use them. And even when the functionality exists, getting the physicians and physician practices to use them and saying, you know, we probably don’t need Daniel at the front desk answering phones and making every single appointment for Dr. Jones, maybe we should open up Dr. Jones’s schedule. And I know that Dr. Jones is reluctant and that she really likes control over her schedule and understanding exactly what patients are getting scheduled when. But wouldn’t it be more efficient if we either had the front desk staff answering questions and doing follow up and not just making appointments and putting this capability in the hands of the end-user? So, I’d say that we as an industry are very, very new to this. And I think in many cases we’re testing the waters in terms of effectiveness. Most health systems, including us, are just measuring the percentage of our patients that are even signed up on the portal, never mind using it. It’s a very low threshold. So, what percentage of our active patients are using the portal today? The next step is going to get into, instead of process metrics like simply signing up but outcome metrics. So, we have more than nine million inbound phone calls to our health system annually. How do we reduce that over time by making a lot of what patients do online self-service? And we’re starting to adopt some artificial intelligence and putting it on the front end of our phone calls so that we can answer basic questions about scheduling or visiting hour time or directions, just very, very basic things to at least call off those basic things that can be best answered automatically for a patient. So that people who are answering calls are better suited to answer and more deeply the kind of question that our patients raised.

Paddy Padmanabhan: All right. I’ll come back to AI in a moment. But you mentioned health care outcomes in general. And of course, in the current era that we’re in. It’s all about data. It’s about harnessing data for insights. And it’s the number of data sources is increasing. The types of data is increasing. However, my understanding is that aggregating and analyzing the data in a healthcare context has been a challenge and remains a challenge despite some progress due to data quality, data silos, interoperability issues and so on. Can you share your experience at NewYork-Presbyterian on how you’ve approached this in your world?

Daniel Barchi: You raise a very good point. Data is certainly an outstanding tool to be able to improve our operations financially, from an efficiency point of view and from a clinical point of view. I often think that when people say it’s hard to get data out of systems, be it financial systems or billing systems or clinical systems, whether in healthcare or anywhere else. It’s sort of a lazy second hand for acknowledging that this work is challenging, doesn’t mean it’s impossible, but nothing’s easy. If you were to say, you know, organizing all the photos that my family has taken from all of our vacations and celebrations over the past 10 years. Yeah, that’s difficult. That’s not impossible. You need to do the work. I feel in the same way, aggregating and analyzing data is difficult, but not impossible. And where members of our research teams at Columbia and NewYork-Presbyterian and Weill Cornell have wanted to, they’ve gotten access to the data and been able to drill down and make real conclusions about efficiency or about clinical outcomes. And I think that it’s never going to be easily done until we get to national standard for how we record data in more discrete fields. We are always going to have issues of unstructured data, physician notes and the quality of the data and the quality of the data that comes from clinical care is never going to meet the standard that researchers want. And it’s our job as technology people who work in healthcare to tie the two together. But I wrap up again by making the point that just because it is challenging work doesn’t mean that it is impossible to do. And we should spend more time actually drilling down into what conclusions do we want to draw, what data sets we need to get that information from, and how do we go about taking the eight steps that are necessary to do it than simply saying it’s hard to get the data out of the system.

Paddy Padmanabhan: So, can you share a little bit of detail on what your data and data integration, data aggregation, and data management infrastructure looks like at NewYork-Presbyterian?

Daniel Barchi: Sure, we are doing a lot of good work led by our analytics leaders and informatics departments at Columbia, Weill Cornell and NYP to do two things, not only look at the data that we have on hand, but we’re planning the future because we are three institutions to top 10 Ivy League medical schools and a top 10 health system all working in concert. We have many, many different sources of data and teams using that data. And yet we’ve done a really nice job of having the leaders of these data sets and our analytics teams create shared governance. And in that way, we’ve been able to tie this shared governance to our new integrated electronic medical record and we’re looking for outcomes together. So, the analytic leaders from Columbia, Weill Cornell and NewYork-Presbyterian meet now twice weekly to look at data requests, figure out how best they meet those needs, and then to share the data that they need. We’re also planning a longer-term how we integrate data into a data lake and do a shared database so that we aggregate not only clinical data from the EMR but all of the different research that’s going on into one pool. So, it’s not a going back to comment before about 80 percent people, 15 percent process and 5 percent technology. It’s not a technology challenge and aggregating data or deciding where to store it. It’s about who has access to it and how do we make that access necessary available to the researchers and the clinicians who need it at any moment.

Paddy Padmanabhan: Now, let’s come back to AI which you brought up a little while ago. Now we are seeing significant advances in AI and machine learning tools and it’s being applied in the healthcare context in a wide variety of ways, both on the clinical as well as on the administrative side of the business. However, the sense I get is that for a vast majority of health systems, analytics is mostly still about retrospective analytics and AI is still in its early stages. And those enterprises that are making progress with AI are challenged with, you know, what kind of use cases are the right ones? How do you ensure transparency in the machine learning models? Algorithmic buyers, you know, ethical issues and so on. What are your thoughts on the current state of AI and how are you deploying AI at NewYork-Presbyterian?

Daniel Barchi: Well, first of all, Paddy, I really appreciate you raising the issues of algorithmic bias and the quality of the data. The black box problem and ethical use of AI, because as we think about using advanced technology with patient data, we have to be very, very thoughtful, careful and respectful of the ways technology interacts with our patients. This is people’s health. These are people’s lives that are at stake. And so, we can’t be cavalier with it in any way. And so even at the most senior levels, led by our CEO and the two deans, we talk about those challenges and we are very careful about what we do. So that said, we do know that AI can help us do a better job of delivering care and being more thoughtful about how we’re using data. Although if you’ve seen me speak publicly, Paddy, you know, I tend to talk about the fact that we’re still in a gold rush phase of artificial intelligence in healthcare, where if you think back to the gold rush of 49. People who made the money were not the miners who were using the picks and shovels to dig gold out of the hillsides. It was the people selling them, the picks and shovels. People like Leland Stanford, who accumulated money and was able to underwrite Stanford University or Levi Strauss, who is selling clothing and blue jeans to those miners. And so, I feel like at this point with artificial intelligence, the gold is not the clinical side of it. Equate the physicians and nurses to the miners. The gold right now is on the back-office side of it. The people who are creating the environment, the finance people, the IT people, the HR people, people who are running these large systems. And so it’s much easier to apply artificial intelligence to a billing system to make predictions about which bills will or will not be approved by a payer, or to use AI to look at documentation by a physician and see if it’s going to pass muster or use artificial intelligence to do the basic robotic process. Automation work of reaching out to an insurance company and looking up information online and aggregating that data so that somebody else saves hours of time by doing all that finger keyboard work and can more thoughtfully think about it. So, at NewYork-Presbyterian we are using AI in clinical ways, which I’d be happy to describe in a minute. But a lot of our focus is the recognition that it’s much easier. We have much more constrained data sets, meaning discrete data in the field that you can use to feed AI systems on the finance and the IT sides of the house.

Paddy Padmanabhan: Yeah, I love the analogy of the gold miners and people selling picks and shovels because, you know, unglamorous as it might sound, the people selling the picks and shovels are actually making money more consistently than were the people who were going after the shiny objects. So, I just love that analogy. Daniel, thank you for sharing that. I have seen some of your presentations where you talk about the robotic machine that carries the food between floors and releases the people in the kitchens to focus more on the food preparation. Doesn’t sound like the sort of thing that you would expect a hospital to be focusing on from an artificial intelligence standpoint. But that, to my mind, illustrates where the gold actually lies in today’s content. Would you sort of agree with that?

Daniel Barchi: I would agree. If you think about the fact that healthcare is a very labor intense business because we rely on the clinical skills and compassion of our physicians and nurses. The question is how do we give them more time to do their work and how much of all of the other administrivia can we take off of their plates? So the example that you just gave of the autonomous robots that we run in one of our large academic medical centers from the kitchen in the basement, down the halls, they’re robots automatically call the elevator and take the food trays directly up to the right floors and deliver it to the right area. So, a person can deliver the last 20 feet of the patient’s room. That’s an example of technology doing the basic work so that the people who are actually delivering the compassionate care, in this case, our food service workers have more time to deliver each meal personally to our patients. Ask them how they’re feeling, get a sense of whether the meals are meeting their needs and focus on those individualized patient needs. So, I feel like more and more AI will blend into care. But for right now, the big opportunity is taking tasks off of physicians, nurses, finance people, IT people and other support services that otherwise get in the way of the way we talk about that care.

Paddy Padmanabhan: It’s a fascinating example to me. So, in the remaining few minutes that we have, I wanted to walk through a few other topics really quickly with you. We do something called a lightning round where I ask for the top of the mind thoughts on some emerging technologies. Let’s get right into it. Let’s start with this one – cloud computing.

Daniel Barchi: Cloud computing is important. 10-15 years ago, every health system was very proud to talk about its data center and the investments it was making. And now we think, you know, do we really even want to own data centers? How can we get out of the data center business? Our skill set and healthcare is delivering outstanding care and making people’s lives better, not in running large facilities with a track and other fire suppression systems. So, I would like to put more and more what we do into the hands of third-party companies that do it really well. When we have to store data in its own state, I would be happy to do that using a large cloud computing system. The challenge is most large academic medical centers, in fact, healthcare generally is a relatively thin margin business and not for profit side. So everything that we do has a cost component to it and it’s relatively cheap to own a data center and keep servers in there in every two to four years as is appropriate, replace a five thousand dollars ten thousand dollar server, which is a capital cost. It’s much more expensive to pay a third-party company, an AWS or a Microsoft to store and manage that data for me as an operating cost year over year. So one of the challenges that many of my colleagues and I across the nation are finding is that we make them move to more, more cloud but cloud tends to be expensive operationally, I think that there are advantages from the security and reliability and a backup point of view. But we do face the challenge of the cost.

Paddy Padmanabhan: Yeah, OK. Next one on the list – voice recognition and natural language processing.

Daniel Barchi: I think that 20 years from now we’re going to look back on the state of healthcare and quite frankly, the state of technology in the United States and think, can you believe that the interface between somebodies brain and the computer was their eyes and their fingers and that we made people type into things? I think it’s going to get replaced over time by certainly voice and then other ways for people to ubiquitously transfer their ideas and thoughts into our systems. And so, voice recognition is the easiest way to get quickly to the next step. We’re starting to make investments in small companies that are doing voice recognition. We’re exploring artificial intelligence and voice recognition, listening to the conversations between physicians and patients with the patient’s consent so that the doctor can focus on the patient and the computer listens and documents what the physician says in terms of the current situation of the patient and what orders he or she needs to be placing. And so, I think voice recognition is going to get very important very quickly.

Paddy Padmanabhan: One of my previous guests, David Quirke, CIO of Inova Health System, he said in another 15 years from now we’re going to be in keyboard less environments. Do you think that’s something that we’re heading towards?

Daniel Barchi: Absolutely. I think there’s going to be much more optical character-driven management of our technology and a lot more voice recognition. You start to see it, although the order in the industry for its interfaces tends to be about 5-7 years behind. You can see the auto industry trying to free people from being having to touch anything and do more voice recognition. I see that happening in healthcare as well.

Paddy Padmanabhan: OK. Automation and RPA. I think you made a reference to RPA. But what do you think of those two?

Daniel Barchi: RPA, especially on the back-office side, especially in our finance side, we employ hundreds of really talented people on our finance teams who do repetitive tasks. We would rather have those people drilling down deep into solving problems, but for our health system and for our patients on a billing point of view instead of doing repetitive tasks they do today. So, we employ many bots and we’re expanding our fleet of bots to make us more efficient on the back office robotic process automation side so we can get more customer focus. And I think that’ll increase not only here NewYork-Presbyterian, but it’s happening across healthcare and it’s happening in all industries as well.

Paddy Padmanabhan: That’s correct. That’s correct. Last one in the lightning round, 5G networks.

Daniel Barchi: I think right now 5G is really high on the hype cycle and really low on what it’s going to deliver. If you think about what we’re able to do, both on the consumer side and on the business, side using wireless today, it is quite incredible. And in many cases, we’re still operating in a 3G or early-stage 4G. I think that 5G is being touted as something that is remarkable, going to change what we do. But if you really drill into the examples that people give about being able to do robotic surgery from across the world. So that’s possible for 5G, but it’s possible in a wireless or even a wired environment today. In many cases, being able to do something wirelessly is good, but not a crucial must-have. And if you think about it, every one of our ORs is wired for everything that we need. And the ability just simply for something to be an air gap in the data transfer is no real advantage. And in many cases, we’re not limited by speed either. One of the consumer things touted by 5G companies is imagine being able to download a two-hour room movie right before you get onto a plane. It’s not how people watch movies anymore; they don’t download movies onto their devices. They stream them in many different ways, including, you know, 20000 feet on an airline. So, I think that 5G right now is a outstanding technology looking for the kind of problems it’s going to solve. And I’ll add one more thing. I don’t think we’re spending enough time talking about the downsides of 5G. So, at the higher frequencies of 5G, the blanketing of cities that we’re going to need with higher frequency, shorter range antennas are not something we’re spending enough time thinking about. So essential in every light pole in every city we’re going to have 5G antenna, 5G touted to solve some of our rural wireless problems when in fact 5G doesn’t have the range that some older systems have. And so, I think that’s misleading. And if you think about hospitals, they tend to be older buildings that might be 20, 60, even 100 years old with thick walls, with lead-lined areas for imaging. And 5G doesn’t have the penetration that some other systems do. And so, we’re going to have to have repeaters in just about every space or room. So, these are the challenges that I think we need to face and that we’re not talking enough about as everybody benefits of 5G.

Paddy Padmanabhan: Yeah early days yet. So, you mentioned something about startups and working with startups early on into the conversation. And I have to ask because we are now seeing a lot of venture capital money pouring into literally hundreds and hundreds of digital health startups, many of whom have very promising solutions and are making great progress. Others that are not, but from the point of view of the CIO of a large health system looking to harness innovation, how do you go about really managing the risks and how are you doing it at NewYork-Presbyterian? What’s the advice you have for digital health innovators who want to be a part of your journey?

Daniel Barchi: So, the way that we manage the risk is that we are clinically driven, not technology or financially driven. So, we go to our Chair of Medicine, Chair Surgery, other clinical leaders and ask them what do they need? And ultimately, they’re the ones who say, here’s a promising technology or this small startup fills a gap that we don’t otherwise have. So, we don’t find technology to search for problems to solve. We go to the clinician to ask him what problems they have and then try to find things that meet their needs. And then once we find them, we do a lot of due diligence before we enter something into our health system. We have a program management office that looks at things from a financial, from a risk, from a technology, from a patient privacy idea, even from an algorithmic biased point of view before we embrace technology. So that’s from our side of the house. If I was on the startup side, I would get deeply embedded with clinical partners who know today’s problems. Unfortunately, there’s a lot of money and a lot of brilliant ideas in small companies. They’re working in healthcare space, but if they don’t have clinical insights, then they can be creating the world’s greatest X, whatever X is, and not recognize that a physician would look at that and she would say, that’s not what I do. That’s not my problem. It’s great idea, but it’s not going to work in my practice. So, thinking about things purely from a clinical point of view, first, would physicians use it? Would it make clinical care better? And then everything else to follow is really important mindset for a small startup or venture capital or private equity company to have.

Paddy Padmanabhan: Yes, that’s very insightful. Thank you for that. Well, we are in 2020. And would you care to share what your top priorities are for the coming year?

Daniel Barchi: So just like over the past couple of years, my top priority is reliability and integration. So, it’s my responsibility and that of our team to create new technologies and solutions. But for our clinical end-users, the doctors and the nurses that deliver the care, they want to see things integrated in a holistic, easy to use package. And so, while we’re constantly advancing the care that we’re delivering with great technology, it has to be part of a seamless environment. So, undoing and this is not just unique to our health system, but all health systems across the country. Undoing 20 plus years of worst of the breed and tying it together in easy to use integrated packages is our challenge. And it’s incumbent upon IT leaders to think about end-users and how they seem to use technology in the environment that they’re in. And that’s all going be our focus for 2020.

Paddy Padmanabhan: Daniel, thank you so much for taking the time to share your thoughts with us. It’s been such a pleasure speaking with you and I wish you and your team all the very best for the coming year.

Daniel Barchi: Thanks for having me Paddy, I enjoyed it and I appreciate what you do with the podcast.
Paddy: 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

About our guest

Daniel Barchi is SVP and CIO of NewYork-Presbyterian, one of the largest healthcare providers in the U.S. and the university hospital of Columbia and Cornell. He leads 2,000 technology, pharmacy, informatics, artificial intelligence, and telemedicine specialists who deliver the tools, data, and medicine that physicians and nurses use to deliver acute care and manage population health.

Daniel previously led healthcare technology as CIO at Yale and earlier as CIO of the Carilion Health System. He was President of the Carilion Biomedical Institute and Director of Technology for MCI WorldCom. Daniel graduated from Annapolis, began his career as a U.S. Naval officer at sea, and was awarded the Navy Commendation Medal for leadership and the Southeast Asia Service Medal for Iraq operations in the Red Sea.

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About the host

Paddy Padmanabhan is a widely published and quoted thought leader on digital transformation in healthcare. He is the author of  The Big Unlock: Harnessing Data and Growing Digital Health Businesses in a Value-Based Care Era, and the CEO of Damo Consulting Inc, a digital transformation and growth advisory firm based in Chicago.

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AI predictions need a thoughtfully designed closed-loop to drive action

Episode #32

Podcast with Mudit Garg, CEO and Co-Founder, Qventus

"AI predictions need a thoughtfully designed closed-loop to drive action"

paddy Hosted by Paddy Padmanabhan

In this episode, Mudit Garg discusses the evolution of Qventus and how they are applying AI to help hospitals and health systems in managing their operations with real-time predictions for improved care delivery.

With a focus on patient flow automation, Qventus helps hospitals and health systems in reducing the length of stay and other operational metrics. Based on early insights that machine learning models and prediction scores can be confusing to users in the absence of an accountability engine, the company has developed an interdisciplinary approach, augmenting AI with behavioral science principles to drive sustained improvements in healthcare operations.

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Welcome to The Big Unlock podcast where we discuss data analytics and emerging technologies in healthcare. Here are some of the most innovative thinkers in healthcare information technology talk about the digital transformation of healthcare and how they are driving change in their organizations.

Paddy Padmanabhan: Hello again, everyone. This is Paddy and welcome back to my podcast. It’s my honor and privilege to have my special guest today, Mudit Garg, CEO and Founder of Qventus. Mudit, thank you so much for joining us and welcome to the show.

Mudit Garg: Thank you so much, Paddy. It’s an honor to be here. I appreciate the chance to be here. I’m looking forward to our conversation.

Paddy Padmanabhan: Wonderful. So, let’s get started. Tell us briefly about the company and its evolution and what is the marketplace need that Qventus is trying to address?

Mudit Garg: Yeah, it’s a great question. So, we provide a solution for hospitals and health systems to manage their operations in real-time. And specifically, where we focus is patient flow automation. So, reducing the length of stay, excess days in the inpatient environment, improving the throughput in the ED environment, things like that. Our platform has both artificial intelligence and behavioral sciences built together. And what it does is it empowers frontline managers so that they can identify, predict bottlenecks before they happen. But not just stop there but orchestrate solutions, drive accountability long term. And we layer on top of that a set of operational experts to bring those new capabilities to life in the hospital environments with process design and management practices alongside. So, that’s the market need where it comes from, as you know, is this immense pressure on hospitals and health systems across the country right now to drive a lot more efficiency. And this has been true for some time. You asked about the evolution of the company. And for me, a lot of this came from probably 10 to 12 years ago, doing process and performance improvement in health systems. And I don’t know if you probably felt the same way, but I definitely thought working in the hospital the first time that it was remarkable. The quality of the people; world-class equipment, world-class therapies, world-class clinicians are available at most hospitals that we work with. But on the other hand, as a patient, we really struggled to provide them with world-class care. And it’s really despite immense diving catches and super-heroic efforts from these clinicians. So, it’s really an odd dichotomy that those two things exist simultaneously. So, the market needs really, as we dug into it and as I dug into it early on, was how do you create operational reliability? How do you make everything else around the clinical care, reliable, repeatable and mature, so that world-class operations can exist to truly unlock the potential of people? So that’s kind of where we started from. The evolution of that has been very interesting. I was, you know, maybe biased a little bit to look at data. That’s one of its key ingredients to create that operational reliability from the beginning. But it was very clear in the beginning when we started focusing on AI and ML that the prediction was very important. The prediction of the bottleneck was very important, but not enough to drive that. That was the first phase of the company. We went from looking at the data and seeing that people were excited about dashboards but didn’t log in when they got busy. People decide what machine learning, but just putting a machine learning score and board didn’t do anything, that didn’t drive any action and what really needed was action. So, we built a really robust platform then that can take different parts of a machine learning distribution of a prediction and activate different decisions and action, over mobile, over boards, over email, over text, many, many different mechanisms. And that was really valuable in fact getting the insight into action. But as is the case with everything we saw that in the immense scale that exists in an operational environment like a hospital, things slowly started reverting back to the mean. So, then we built an accountability engine. And what this does is remarkable. If you’re in the world of manufacturing, there is something monitoring every machine so you can do preventive maintenance in the machine before it breaks down. Similarly, if you’re in a health system environment, there’s tons and tons of processes going on all the time. What sequence and preventative maintenance can you do? And that’s really behavioral. Right. You could have if you’re seeing this unit do a phenomenal job of planning, how can you make sure as a leader you can praise them? If this unit the person has changed or somehow the quality of the process is dropping, how can you actually make sure that there is coaching involved at the right time? Our statistical monitors are monitoring all these process metrics continuously and then searching opportunities for praises and opportunities for coaching for leaders so they can scale themselves. So those are the different phases of a company going from just information and dashboards to machine learning and prediction to action, to then the accountability engine coming through. And that was a core of the platform that we built in our evolution. I’d say the last probably evolutionary phase is recent in the last year or so. Whereas we went deeper and deeper, the market, we saw that to truly bring these capabilities to life; we needed to create a set of predefined best practices of how to use these capabilities where there’s predefined artificial intelligence models of software, but also operational processes and management practices, and then put together a team of world-class experts on clinical operations, doctors, nurses, AI experts to help bring all this to life. So those have been the evolution in trying to address that market need through the course of the company.

Paddy Padmanabhan: Very interesting. There’s a lot to unpack from what you said. A couple of things that come to my mind right away that no matter how good a solution is unless you’re integrated into the clinical workflow of a hospital, it’s very hard to get users to adopt it and use it. And so, it seems like that was kind of one of the early insights you had, and you quickly went about addressing that. What I do like about the fact is this closing the loop, if you will, in terms of getting people to not just to use the platform, but holding themselves accountable in some ways through some kind of a feedback loop which tells them how they’re doing in order to avoid the reversal to the mean, which, as you know, is the bane of all management consulting. That’s right. Interesting. We’ll unpack some of that. Just tell us a little bit about from a growth perspective. I’m aware that you raised a significant amount of venture capital. Do you want to just quickly walk us through how much you’ve raised, who your major investors are?

Mudit Garg: Yeah, absolutely. I think from a growth standpoint, we’ve been fortunate in partnering with our health system partners to see growth in the work we do with them and concurrently, therefore, in the investment and that we can make in growing the company as well. We have raised to date about 45 million and we’ve been very, very blessed to have some very top tier investors from the valley and in the healthcare specifically as well. Some of the largest investors are Mayfield, Bessemer Ventures, Norwest Ventures. We also have YCombinator as a very early seed investor in the company and many other phenomenal seed investors in the company. And what’s been amazing is also some of the customers who work with us also felt compelled enough by the results they have seen to become strategic partners in investments as well.

Paddy Padmanabhan: But are you allowed to name any of your customers? You want to name one or two just for our listeners?

Mudit Garg: Yes. I mean, Dignity and New York-Presbyterian are two are the ones that have actually both been customers, but also investing in the company as well.

Paddy Padmanabhan: Dignity and New York-Presbyterian, is that what you said?

Mudit Garg: Yes.

Paddy Padmanabhan: OK. All right. Switching back to our topic at hand, which is your solution and your platform? How do you see yourself in the context of the ecosystem in which is the technology ecosystem in which you operate, namely electronic health record vendors, big tech firms that are building a lot of the capabilities that you’ve talked about in terms of advanced analytics, AI, machine learning-based decision making. And last but not least, other digital health startups who may be on to the same kind of ideas that you have. How do you place yourself in the context and in the milieu?

Mudit Garg: Yes. So, yes, you’re right. I mean, it’s a really exciting time to be in healthcare. That is just so much innovation and excitement across the ecosystem. I mean, to start with, EHRs are supercritical right there. We complement the investment health systems have made in the EHRs. Without that, we wouldn’t exist. If the data and the workflow itself wasn’t digitized, it’d be impossible to drive any kind of improvement. What our customers have found is that they’ve made substantial investment, in these areas of operational improvement over the years, both in terms of, you know, it could be in terms of process improvement, it could be a technology investment. If you look at the length of stay across the board, for example, that has really not budged much over the last 10-15 years, it’s been increasingly plateaued. So, when they look at looking to partner with us, what they’re looking for typically is the next step function improvement. And what really stands apart is, one, let’s take the inpatient, for example. In the inpatient environment we aren’t just helping you provide an understanding of [00:09:39] the workflow as isn, but our machine learning algorithms are, A) Identifying the problems, like this patient may need an MRI upfront several days in advance, then helping orchestrate the action and then helping manage throughout the ability. That’s super unique because one of the things that you do talk about the closed-loop part of it, just providing the AI/ machine learning is simply not good enough, in fact, and can sometimes be even more confusing to end users but closing that loop, providing the AI/ machine learning, helping create the action, and then helping create long term sustainability. That’s what is supercritical to our customers. And that’s where they see it most different. Of course, EHRs are pretty critical in view of the process improvement consulting teams that exist are pretty critical ingredient from a mindset standpoint, do all of that. But this infusion of AI and behavior science, not just AI, but the behavior science of, we think of like, how do I change behavior as a human? I need to have a cue, something prompting me to do something. I need to have the right thing to do. The easy thing to do. And I need to have some feedback on accountability. We have incorporated those vague principles in creating this organizational behavior change as well.

Paddy Padmanabhan: Yeah, fascinating. So, is it fair to say you mentioned length of stay a few times? So, is it fair to say that, that is one specific problem that you’re focused on and have been able to demonstrate results, and by extension, is that kind of the main use case for your platform?

Mudit Garg: So, our platform is fairly extensible. Patient flow ends up often being the first-place customers start because as one of the things for health systems among many, many things they can do. Length of stay and patient flow is something that no matter where in the spectrum of fee-for-service to the value-for-service organization you might be, It’s one of those rare problems where the incentive of the customer, the patient, the incentive of the hospital, of CMS or the payer are all aligned. No one wants the patients to have to stay an excess amount of time in the hospital. The patient doesn’t want that, payer doesn’t want that, the hospital doesn’t want that. So that is an area where we’ve seen a tremendous amount of pool as a result from the market. And increasingly as hospitals and health systems look at Medicare break even. How do we break even on a Medicare patient long term? Length of stay is such a massive part of that problem that we’ve seen a strong amount of pull there. But our platform extends beyond that to throughput in the E.D. and the operating room. We have worked in the outpatient access space. We are working on system operations similarly as well. But for most health systems inpatient as a state has been a place that they have had a strong interest and often a place to start with us. We have seen, as you asked the question, pretty significant improvements there as well. Statistically significant reductions in length of stay between 0.2 to 0.7 days, which is phenomenal. If you’re in a capacity constraints institution and being able to serve more patients and if you’re not in a capacity constraint, information in terms of being able to reduce the cost to serve patients.

Paddy Padmanabhan: So, it is a business case, fairly straightforward. Because it is a single number that you can track, which is length of stay. And if you reduce the length of stay by a factor of 0.2 or to 0.7, as you mentioned, the results kind of automatically speak for themselves and they are visible. Is it a fairly straightforward business case?

Mudit Garg: The business case is straightforward. The problem is complex. Yes, I think that would be a fair assessment. The business case, I mean length of stay is a top initiative for many, many health systems in the impetus to drive down unnecessary cost. And so therefore, that already exists. Any excess their patient spends is at least a thousand dollars of excess costsin the hospital. Along with the propensity to have a hospital-acquired condition or infection or other pieces and the lack of satisfaction that comes from it. So not even counting for those other downstream effects just a core excess cost is significant by itself.

Paddy Padmanabhan: Yeah. Who is your target audience for something like this? Who do you normally start conversations with? Is it a CIO, Chief Digital Officer, Chief Medical Officer?

Mudit Garg: That’s a good question. I mean, the operator is the Chief Operating Officer, the CNO, CMO. Those are ones who are already strategically often focusing on this problem, like the problem of length of stay, throughput flow. We help remove the cognitive boredom from the front-line teams that help to ease some burnout. So those are the folks that are often probably most directly eating and seeing the problem and looking to solve it. The CIO is a very critical stakeholder in the discussions right because we are complementing the EMR. They may have other tech investments. We want to make sure we have a good understanding of the data transfer and data lakes and all of those things. So, they are a critical component. And then the last piece of it, which is given the compelling financial return, the CFO are often important stakeholders as well. It can be between 10 to hundred billion dollars of annual financial benefit for assistance to the CFO and to be critical to that conversation as well.

Paddy Padmanabhan: So, if you look back at the past several years that you’ve built this business and built the platform and gone through their evolution. Can you talk to what have been the most significant challenges that you’ve faced in really validating your solution against a known problem?

Mudit Garg: So, most significant challenges in validating or are those two questions validating the solution and the challenges we face?

Paddy Padmanabhan: The length of stay problem is a well-known problem; it’s been a problem for long. So, when you went about trying to sell the idea of it. What were the most significant challenges you had to overcome in the process?

Mudit Garg: That makes sense. So, I mean, look, it is a big, big problem, right? Like when a patient, for example, is being taken care of in an inpatient environment, there are just so many things involved. There are physicians taking care of them, diagnostics taking care of them, there are procedures happening. They are going for imaging, a pharmacist helping them with medication reconciliation, so many things beingdone. It is a fairly complex problem. The first thing that we had done, and we needed to do was just to make sure we understood the complexity and size of the problem we’re going after. It is a hard problem. The next challenge is healthcare data, as you know, is often hard and messy because unlike advertising, where all the data is machine-generated, much of the healthcare data is not machine-generated. It’s human-generated, so by nature it’s messy. So, for us, one of the very core needs early on was to build a pretty significant platform capability to do real-time and automated data quality checks so we can pick up when things are off and not looking right. So, they don’t affect all the downstream applications significantly. So that was one of the big challenges, just the quality of the data, the availability of the data. How do you make sure, for example, building a machine learning model in an academic environment would control data where you can take out the outliers, where you have historical data and it has been cleaned. That is way different than running it in real-time. So, first that was a challenge to solve. The second piece is also just recognizing how much change people are going through already in healthcare on the front lines, how little time they have. And to some extent, how much fatigue or change fatigue may set in situations like that. And therefore, not just taking, hey, this is a cool prediction and putting it up on the board and expecting something to come out of it, but really very thoughtfully designing the closed loop that we were talking about. And I think that was an important challenge to recognize and to work towards because otherwise, it is easier in some ways to solve the mathematical problem that is to be solved. But forget the true problem of trying to drive change in the environment. Those I would say are probably two of the challenges along the path that we had to face, that shaped as I said in the beginning of the conversation our evolution from just predicting and prescribing actions, to actually building the accountability and getting the platform and then to actually creating these prescriptive, proven methodology combinations of tech and process that we now deployed to a team on the ground.

Paddy Padmanabhan: That’s fascinating. We hear a lot about the struggles of digital health startups, death by pilot, long sales cycles. So, on and so forth. Healthcare organizations want the innovation, they need to innovate. There is alignment around the problem to be solved to your point around something like the length of stay. But in reality, executing on an innovation program is incredibly hard. As you pointed out, should healthcare organizations be doing based on your experience so far to accelerate the adoption of digital innovation with all these constraints? You don’t have time, we have fifty other things, but we also want innovation, right?

Mudit Garg: Yeah. I mean, it is hard, right? It is really hard. I understand where it comes from because the business and the care, they are providing already is complex. There’s a lot of change in the market, so that takes a good amount of the bandwidth away from the day to day already. And so then in a way, it becomes harder. But I think what I’ve seen very effective organizations do is, one really thinks about what the no brainer moves are. We may not know what the latest CMS guidelines are going to be almost certain things. We may not know how the regulatory environment might shape. What are the no brainer things that we need to do as health systems no matter what? So for a lot of them, like reliability and cost comes to the top. Okay, so that’s that then. I think oftentimes in saying of what are the one or two or three partners we can pick and go deep with them? And that doesn’t mean you have to start with the big bang right away. It just means that, , you engage with them deeply. And I think that is supercritical. From an innovation standpoint, that it’s very hard to have a spray and pray kind of an approach where you have your hands in a lot of things or you’re just assessing the market, but actually doing it because I think for the organization to see some wins and to see some action, that’s supercritical. Honestly, even if it doesn’t result in wins, see that something was talked about, done and learnt from is critical. And the last thing I’m saying from an innovation standpoint that’s critical is that finding the operational alignment is important. The innovation cannot be devoid of what the people are feeling day to day. That operational alignment must exist. And I think in doing these three things, what we’ve found is like, for example, for us, we worked with early customers, went deep on their specific problems, created these best practices, AI models and all that stuff. So, when customers, then innovating, appreciated it. There are parts of what we do where they don’t need to reinvent the wheel and they are parts of innovation where we are learning with them and just sort of appreciating. We’re not trying to reinvent the wheel entirely. But, taking what’s already there and then actually finding unique ways of improving the innovation as well is something that I find to be effective. It is a hard space. So, the sales cycles for enterprise, in general, are hard, not just healthcare, they are long. But I think if we can do these things, then when you align with someone, you find the right partners and you make sure that it actually drives through, impacts the business and starts fueling an appetite for more and more innovation over time.

Paddy Padmanabhan: One of my guests on one of my earlier podcasts mentioned that she benefited greatly from having these sponsorship and support of some early believers and risk-takers in their client environment. And let’s face it, there is a lot of risk involved in innovation. Healthcare is a margin constrained environment. There’s not a lot of like to have. You also had that experience, you know, the early believers who make a huge difference who you co-innovate with and, you know, somehow make it happen? Has that been your experience as well?

Mudit Garg: Yeah. I mean, if you look back all the way back in the beginning, now we have a ton of outcomes and we have customers and stuff. So, it’s a little bit of a different risk profile today. If I go back three-four years ago, those same questions existed. And I think Mercy was a great example of an institution where we had operational champions, the head of their ED for example, the presence of a disintegration across the board. Folks who just jumped in, worked hard with us, understood it. But you have to have those early champions who are willing to connect the business pain to the problem to be solved, to the solution that’s coming through and help sort of get everyone excited and fired up on that. And that’s critical, especially even more so in the earlier days. Of course, as you go deeper in the market people evaluation and sort of reasons to buy change and become more and more business focused. But early on, that is absolutely critical.

Paddy Padmanabhan: Fascinating. So, guess we have coming up to the end of our time here. I have just one last question for you. You’re a classic Silicon Valley digital health startup. So, tell us what are the upsides and downsides of being in the valley?

Mudit Garg: Yeah, that’s a good question. Not surprisingly, everything sort of has this upside and downside. I mean, what I love about being in the valley is you have access to world-class talent; technical talent, and business talent. People who been at the vanguard of the AI and behavior science and innovative technology and most importantly, who have scaled businesses and transformation of industries and other industries before. And that is amazing and very, very critical to have that ecosystem around you and to have that quality of talent, it seems to be brought to bear for the problem you’re trying to solve. I mean, the flip side of that is, of course, it’s the value become extremely both costly and sometimes in that they hard to scale and just as so much of innovation comes out of here and I think over time now, a lot of the talent is actually going to other places in the country, which is phenomenal. And that’s allowing us to create much, much more of a remote enabled culture as well, where folks can still have the core of the same ethos that came out of here but actually scattered across the country and beyond. So that’s sort of the upside and downside of being here. The upside of this, that is like so the quality of talent and the experience of folks before the downside is dropped, perhaps the cost is sort of a distraction value that exists by being in the valley.

Paddy Padmanabhan: Well, not to mention the traffic on one-on-one.

Mudit Garg: Ya we’re gonna one-on-one is not a very friendly yes. Yes, you’re absolutely right.

Paddy Padmanabhan: Mudit, it’s been such a pleasure talking to you. And thank you so much for sharing your deep insights from all the work that you’ve done. And congratulations on the progress so far. All the very best to you and your team. And we’ll be watching.

Mudit Garg: Yeah. Thank you so much, Paddy. It’s always a great conversation with you. I am excited to continue the conversation. 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

About our guest

Mudit Garg is the CEO and Co-Founder of Qventus. Qventus is an AI and behavioral science-based system that integrates with EHRs and automates patient flow. In this role, Mudit works closely with leading health systems including Dignity, Emory, Fairview, Mercy, NewYork-Presbyterian, and Stanford. Together with Qventus, these organizations have been able to transform their operations, reducing length of stay by 0.3 to 0.8 days, eliminating thousands of excess days, decreasing ED LWBS by 50%, and more – ultimately resulting in higher margins, decreased staff burnout, and a better patient experience.

Prior to Qventus, Mudit co-founded multiple technology companies including Vdopia and Hive. He also spent time in McKinsey & Company’s healthcare practice helping large providers with organizational transformation and performance improvement. Mudit has been recognized for leadership as one of the Silicon Valley Business Journal 40 Under 40. He is a Stanford-StartX mentor. He earned his Master’s in Business Administration and Electrical Engineering from Stanford University and a Bachelors from the Indian Institute of Technology.

About the host

Paddy Padmanabhan is a widely published and quoted thought leader on digital transformation in healthcare. He is the author of  The Big Unlock: Harnessing Data and Growing Digital Health Businesses in a Value-Based Care Era, and the CEO of Damo Consulting Inc, a digital transformation and growth advisory firm based in Chicago.

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