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2018 Year in Review: The Clinicians

This Week in Health IT 2018 Year in Review: The Clinicians

Bill Russell:                   00:09                Welcome to this week in health it where we discussed the news information and emerging thought with leaders from across the healthcare industry. This is episode number 53. Last week I said 51. I was wrong. This is why I need an admin. This is the second of the special year end in review or year in review episodes. Last week was the innovators. This week is the clinicians. Next week will be the CIOs. And then finally we’re going to end out the year with a, uh, with a top 10 episode, a Little Casey Casen going on here of, you know, what are the best, uh, videos and snippets from this week in health it this year. So hope you guys are enjoying it. I’m enjoying just a look. Going back and listening to some of these great leaders just sharing their experience and their, their wisdom. Uh, this podcast is brought to you by health lyrics. Be a market leader.

Bill Russell:                   01:03                We help you to clarify your health it plan, eliminate confusion, align your work experience breakthroughs, visit healthlyrics.com to schedule your free consultation. My name is Bill Russell, recovering healthcare. Cio, writer and advisor with the previously mentioned health lyrics. And, uh, here we go. All right, so, uh, without further ado, um, I do want to give you, keep giving you a little bit of background on the, uh, on the show this year and uh, just what an experience it has been. So this is the 53rd episode. Most of the shows have been done right here in beautiful southern California, but, uh, you know, but from time to time you’ll hear the different glitches, different background and that kind of stuff. Uh, it was a busy travel year for me. We’ve done episodes literally all over the country. We, uh, I’ve done an episode, an episode in Philadelphia too in Bethlehem, Pennsylvania.

Bill Russell:                   01:55                One in Chicago, a two in Chicago. Um, we did, uh, uh, down in uh, oh, up in San Francisco. We did. Um, Gosh, I know we’ve done a couple of others in other cities. in the Midwest. We did a two in St Louis, now that I think about it, in fact, that was probably the most difficult episodes to do. I was in a Drury Inn in St Charles, Missouri. That was a time where I was actually helping to Rehab my daughter’s first home and, uh, this hotel did not have the best Internet connection. So, uh, the two episodes there and, uh, it was a little spotty, but, uh, we, but we got through it and I believe I did one in Texas as well. I’m a Oh and definitely did one in Arizona last year at the, uh, uh, at the Scottsdale Institute a conference. I did an episode from the back porch of, um, of the, uh, wonderful hotel that we were at.

Bill Russell:                   02:58                So, yeah, we’ve been, been around the country doing this thing. It’s a, it really has been a joy. We continue to do it for the next generation of health it leaders. And if you agree that the content is valuable, uh, I, my, I’m going to probably make this just a part of the intro for the, for the coming year, but please share it with somebody. Please find somebody that you think would benefit from hearing, uh, from great leaders, uh, about, you know, what’s going on in healthcare and how to think about it, um, and, uh, and, and share the episode with them and we look forward to producing us new episodes in the coming year. All right, so without any further ado, we’re gonna. We’re gonna. Kick this off. We have a, the clinicians episodes. So we’ve had a lot of clinicians on the, uh, on the show this year specifically.

Bill Russell:                   03:49                We’re going to highlight a handful of them. Dr David Bensema. Um, I think has been on the most of anybody. I think he’s on three times and I really appreciate him. The first time he was on and it was a, we had a start of a relationship. We really struck a really connected on a lot of different levels. I had them on the show and then through a scheduling snafu mostly on my part did I mention I really need an admin. Um, he was booked like three weeks later or four weeks later. Uh, so we somehow got through that and, uh, he was kind enough later on in the year when I had somebody a drop because there’s schedule couldn’t accommodate it. He came back on, I love his insights because he was a cio, cmio and a practicing physician. So we got into some deep things with him, which is phenomenal.

Bill Russell:                   04:37                I’m trying to think who else we were gonna highlight. Dr Daniel Kraft also on the innovators episode is also on this episode. We have a Lee milligan cmio out of Asante in the great northwest. Uh, he was again, another phenomenal, a interview with me. I learned a ton from him. Uh, John Halamka, as I mentioned in the last episode, John Somehow has made it onto all four he. He eeked with a, a top 10. He’s a clinician, he’s an innovator and he’s a cio. So he, uh, he got in there and uh, cannot forget, uh, a rod hochman. Dr. Rod Hochman is also on this show and we talk about the competitive landscape with him. And that was a, that was a phenomenal time as well. And, uh, finally to round out this Dr Anthony Chang came on and he has so many credentials behind his name.

Bill Russell:                   05:37                He is a chief intelligence innovation type guy for the Sharon Disney Lund medical institute. He’s also heading up a Ai Med with conferences around the world and he came on and talked about artificial intelligence. So that’s, uh, that’s the, uh, the game. Oh, you know who else I forgotten Amy Maneker is on this episode as well. Amy was introduced to me. She’s one of those starbridge advisors, a starbridge advisors advisors. A, you get the picture. Uh, she had just recently joined them and uh, she was on the show as well and we had a phenomenal conversation and we talked a lot about informatics. We talked a lot about EHR programs. So this is a great episode, just really good content from these, uh, uh, clinical leaders. And I look forward to just diving in. So the first clip here is with a Dr David Benson. He’s going to talk about health it and, uh, what health it from a physician perspective, what he wishes every cio and healthcare organization would hear, uh, from their physician partners. So here’s our first clip.

Bill Russell:                   06:50                Let’s assume right now you’re, you’re able to this on this podcast. Every it person in the country is going to be tuning in. What’s the one thing you would tell all these, it people that they need to hear from a practicing physician that they may or may not really appreciate or understand.

Dr David Bensem:         07:11                When I asked for customization or personalization, please understand that it’s driven by my customized, unique patients. Every patient is special. Every patient comes a little bit different. I don’t get the opportunity to have a standard patient interaction. Every patient comes with their own needs and expectations. I’m trying as a clinician to adapt to that and to provide the most personalized care that I can, the most focused care that I can to that patient, that sometimes causes me, ask it to do things that it really can’t, hear me with empathy and explained to me in a way that I can understand how you can get close through personalization, how I can learn other workflows in the Ehr, but don’t tell me no. No is the wrong answer. It’s, have you thought about this? Have you done this? Because I need as a physician to tell you every one of the patients I deal with is special.

Bill Russell:                   08:20                Yeah. And I, I think there’s such wisdom and to what Dr Bensema was saying here, which is, um, empathy, right? Put yourself in their shoes and understand, you know, how the technology is impacting the, uh, the clinicians. I think that is a, you know, and it’s fantastic words to live by for anybody in the it space. Anybody in the digital space as well. Our next clip is Dr Anthony Chang who I talked about a little earlier, a Ai Med artificial intelligence expert, went to Stanford, uh, literally had so many degrees, a one, two, three, three or four advanced degrees, um, went back to Stanford to get his degree in artificial intelligence, also a practicing pediatrician and he has his mba as well. So a great insights from him on the promise of artificial intelligence. And I, I pulled this clip because I, I, I just think it’s a, uh, it’s coming and it’s, it’s great to hear a physician’s perspective on, on the promise of artificial intelligence. So here’s our next clip.

Bill Russell:                   09:31                Let’s start at the beginning. What’s the promise of Ai? Why, why are you so excited about it? Why are you looking at it?

Anthony Chang:            09:40                When I think, after four years of education, I realized that it’s kind of like wearing a different Lens and looking at the world, you see so many little places where data science or computer programming can really make an impact. And if you think about our world in general, so many facets of our life is, are already being replaced by automation. How we order books and how we get referred books is all algorithm driven. It’s not perfect, but it’s pretty good. Um, how we, uh, have now autonomous driving vehicles now at least in the picture. And I think 10 years ago, if you were to ask people, do you think there will be autonomous driving vehicles and everyone will be thinking this is like 20, 30, 40 years down the road, but it’s not uncommon to see one in, in Silicon Valley now. And I think there’s so many aspects. And then it was February 14th, 2011 for Valentine’s Day. So it’s a special day for cardiologists that the human contestants were beaten soundly by the super computer, Watson from IBM. And that was the night that I downloaded the application for the data science and AI program at Stanford. I realized that, um, this time ai ishere and it’s going to probably going to be here for a long time.

Bill Russell:                   11:03                Yeah. It’s, uh, it’s, you know, artificial intelligence is right around the corner in that episode we also talked about it’s going to be applied in a lot of places before it really permeates the clinical environment. But, uh, you know, we’re, we’re getting our, we’re getting our feet wet, we’re seeing it with RPA and we’re seeing some real advancements there and we’re seeing it applied to supply chain. We’re seeing it applied to a revenue cycle. Uh, AI and security. We’re seeing it applied. Artificial intelligence will be the talk of the town. That’s, that is not going away anytime soon. Okay. Our next clip we’re going to go. We’re going to go right back to. Let’s see. Dr Bensema. Well, we’ll go right back to him and uh, and uh, I posed this question to him, how would the physicians changed the Ehr if it were possible? So let’s just, uh, let’s just take a listen to it at some of his thoughts on how physicians would change the hr if it was possible.

Bill Russell:                   11:58                If you had the power of what changes would you make to the Ehr to make life easier for physicians?

Dr David Bensem:         12:05                Oh, this is one of my favorite subjects. In fact, I was talking with Dr Brett Oliver, who replaced me, a Cmio, my, you know, I had the dual role and Brett became the cmio is I left while Trisha Julian became the cio. Brett’s a voice Yada here. Bread is a phenomenal voice, but first and foremost be things that are immediately achievable is voice recognition for order entry and notes so that we can get so many of our colleagues who struggled with the keyboard off of it and speed the order process. Um, another area would be to enable, um, I’m going to say this, a better exchange which actually requires that we tell the EHR providers that you have to have the standard format and the process interoperability is only going to happen with a deadline. And with some mandates, the EHR manufacturers and systems that like to protect their data are not going to come to the table until there’s those two pressures, time pressure.

Dr David Bensem:         13:11                And I’m a mandated structure that that’s critical for exchanging patient data. So in a meaningful way so that the physicians can use it within their workflow as opposed to looking at horrible line after line after line of, um, some of the formats that we’ve seen. And then third, and this one’s kind of conjecture it, it’s a little aspirational. I’m not quite ready yet, but get the analytics, get the artificial intelligence thoughtfully built in with input from physicians, you know, this time around, let’s not build it and then put it in front of physicians and say, use it. Let’s get the physicians to help us build it. Get the artificial intelligence in place and create the ability to say you cannot be as good as a physician as you want to be without your Ehr. Because for precision medicine, for all the things we want to move through population health, you can’t do that without an ehr. I can’t carry that data in my head. You and I can memorize a lot of things. We’re talking to a very smart audience. They can memorize a lot of things. They can carry a lot information, can’t carry all of it. So we need the help of the augmented intelligence of the artificial intelligence, we need that, but we needed in a way that we can say, you can’t be as good a physician as you want to be without it.

Bill Russell:                   14:39                Again, great insight. Um, you know, where the put yourself in their shoes is more than just, I’m just talking about putting yourself in their shoes or just talking about empathy, but, you know, walk around with them, see, see the, the need for getting that information into their workflow. I think we all know that it’s, it’s another thing to watch it and then to round. And I know some of the more successful cios are a part of the rounding process and they spend a lot of time with clinicians to understand and um, they also understand the burden that the clinicians are under and they’ve prioritized the things that would really alleviate that burden to. So again, great insights from Dr Bensema and uh, always appreciate him coming on the show. I, you know, our next clip I’m going to, I’m going to head over to a Le Milligan, a cmio for Asante and uh, you know, we open up the show every week with a softball question and just, you know, just a, you know, what are you working on, what are you excited about? And the reason we do that as a, just to give them a platform to talk about different things and say, and it has amazed me how diverse the answers are. Sometimes people talk about work, sometimes they don’t talk about work. Sometimes people talk about their family, uh, you know, it’s in just different things that are going on. A lee just jumped right in and started talking about removing friction from healthcare and uh, he so articulate and so smart. So I really appreciated his insights. Uh, take a listen. So one of the things we like to do is just ask her guests, you know, what they’re excited about, what they’re working on today. And, and really I’m just gonna turn the floor over to you and talk about what, you know, whatever your, whatever has your, your interest right now.

Lee Milligan:                 16:23                Okay. Um, there’s a lot of things on the plate and a lot that hold my interest, but I would say in general, the theme of minimizing friction is top of the list and that that could be patient friction, um, you know, near and dear to my heart is provider friction. Um, and one of the ways that we’re looking at doing that is really improving voice recognition. So, right, you know, we’ve used voice recognition up until now, but it really, we haven’t really gone further than to kind of a superficial utilization of it. I would love to get to the space where eventually we’re using voice recognition to do all of our navigation throughout the electronic health record. We could just simply say, pull up chart review, pull out all the cts of the head and the last three years and list them for me. And then you can see them beautifully. I think we’re on the cusp of getting there, but not quite. But that’s really what gets me motivated right now is that voice recognition and NLP world that we’re heading into.

Bill Russell:                   17:17                So we’ve been doing, we’ve been doing charting and notes for awhile within nuance. I think we were doing that, uh, probably five or six years ago, maybe seven years ago, but, uh, but now when we get to navigation, I mean it really becomes more of a star trek kind of thing where you’re just, you know, hey, computer, tell me what the vitals are for this patient. Hey computer, you know, that kind of stuff. And yeah, that.

Lee Milligan:                 17:38                Yeah. And I think that’s a good point. And I think that’s where we get over that hump of us working for the computer versus the computer working for us. The first couple years we are on an EHR. Really, we felt we were all data entry monkeys putting stuff into the computer and it wasn’t really doing much for us. What you just described in my mind is really the computer flipping that and now working for us.

Bill Russell:                   18:00                Isn’t that a great quote? US or the computer working for us instead of us working for the computer. That is such a great quote. And that is, uh, that’s, that’s the promise of a, that’s the promise of technology in healthcare. And, uh, removing the friction he talked to an awful lot about removing it from the clinician side and you can imagine that you just close your eyes and Imagine Star Trek and uh, you know, when they talk to the computer and they say, Hey, computer, you know, give me the coordinates of coordinates beem down and do this, do that. Uh, clearly there’s still people doing work, uh, across the starship enterprise. But, uh, the interaction with computers changes everything, especially when we simplify that process. Uh, okay, where am I going to go next? Let’s go to a, let’s give a John Halamka. Let’s go there.

Bill Russell:                   18:50                So John shared so many great anecdotes and stories. This one is about Amazon, Amazon machine learning at work in healthcare. And, and you know, John is so pragmatic, which is what I love about him, that he just says, what’s the problem? Here’s, here’s the different ways we can solve the problem. And then he solves the problem. He’s not looking to prove that cloud is better than on prem or would he? He’s very practical and this is another case of that. So take a listen to this, uh, this case study of how Amazon machine learning is being used, uh, in, in, uh, at Beth Israel deaconess.

John Halamka:              19:32                I know this is gonna sound like the Gartner hype curve, right? But I thought the theme of, of HIMSS in 2018 was machine learning, right? And you had to be careful. What is machine learning? It’s not, you know, Watson is going to replace doctors. I mean, that’s not what we’re talking about. We’re talking about boring, prosaic stuff. And let me give you an example of what I went live with yesterday. Now I hope you’ve never had to have surgery, but if you’ve ever had surgery, you know, the doctor can’t put a knife in you without a consent. Have you? I mean, you were a cio, you know what a nightmare it is to track down thousands of pieces of paper coming from doctor’s offices all over humanity with a handwritten wet signature on consent. And so fine, you digitize this or that and you have econsent.

John Halamka:              20:20                It’s just still a nightmare. What do we do? We ask Amazon to monitor our fax machines now. What’s that all about? We trained Amazon machine learning services to recognize consent forms. And so what happens, this is literally the application. Amazon is a listener on our facts traffic and when it sees a consent form, it knows how to identify the patient on the consent form and then writes a fire Api, a check box into the EHR that says consent received. Thats all it does. So wow. Suddenly no armies of humans searching stacks of paper and Amazon just does it for us with 99 point nine percent sensitivity and positive predictive value.

Bill Russell:                   21:14                First of all, John is so articulate, I just love him, but sometimes his solutions are so simple that you sit there and you just want to smack yourself on the side of the head and say, why didn’t I think of that? Uh, and uh, it’s a great, a great little solution, uh, using NLP, identifying the consent forms and putting a little check box and using fire. Um, you know, it’s that kind of stuff that may not win you awards or are those kinds of things, but gosh, you start stacking those things up, they make a huge difference in terms of a overall efficiency and productivity of the physician. So, you know, Kudos to John, really appreciate him sharing that. Let’s, uh, let’s see. Let’s go to Dr Bensema and I give him a lot of, a lot of time on here mostly because he was on three times a year and had a lot of great things to say. Um, in, uh, in this clip we take a look at the future of the cmio role. Uh, uh, David had written an article and I wanted him to share some of his insights. So take a listen to this,

Dr David Bensem:         22:19                try to take a look into the future regarding cmio roles because of my kind of unusual perspective on things. And so I started thinking through this and what I realized is we are in a world of specialists and we tend to become focused on our specialty. And I wanted to direct cmios. In particular though, I think it’s valuable to all leaders to become a generalist in your knowledge and a specialist in your focus on the population or the team or the group that you are serving, and so my push for Cmios, um, was really more about them becoming more diverse in their knowledge base to read about finance and read about nursing, to read about I’m a business operations to make sure that they understood the needs of their customers because the whole healthcare system is the customer or the Cio and the cmio, but know their needs and then be able to anticipate where the puck is going so they can be more useful.

Dr David Bensem:         23:28                The other thing that I see for Cmios is the need to take what is already a physician advantage. The integrative mindset. We listened to disparate information coming from the patient. We have the chart, we have labs, we take all that disparate information, we integrate it into a differential, and then we test our hypothesis and make rapid course corrections to arrive at the correct diagnoses and treatment plan. Well, that’s integrative thinking. If we can apply that to the rest of the healthcare system and to our interactions with the healthcare system, we will be more useful and then finally a really develop your skills and strategy and ensure that you are in a position to influence strategy and have a deep knowledge of what the system strategy is. So whenever folks are coming with the bright and shineys, you can point them back to the system strategy, you know, is this really helping us move forward? Is, is this in the same vector direction as our strategy or am I pulling energy in another vector direction? Because if I’m starting to pull in multiple directions, you know, and I know the cart doesn’t move very fast forward and in fact usually gets tipped over.

Bill Russell:                   24:43                Wow. What great insights from Dr Bensema. Yeah, I mean this is just a continuing trend. You’re starting to see a clinicians, uh, go into the technology area. You have clinician builders working in the EHR, clinicians going into analytics, clinicians going into the business in the c suite and a recurring theme on the show and, uh, exciting theme. So in fact, it continue on with that, with that theme. Uh, uh, amy Maneker and I sat down, amy Maneker a cmio for Starbridge advisors, uh, discuss the key roles and talent in clinical informatics teams. And one of the first thing she drives home is the need to recruit a qualified physicians and good physicians and clinicians to be a part of your clinical informatics team. So take a listen at this. You built out a clinical informatics teams. What are some of the key roles that you had to fill in and where’d you find that talent?

Amy Maneker:              25:38                So I’m going to talk about the physicians. There were some other key roles. It’s you need to draft physician informaticists and I would offer that the vast majority of the time you have to train them or find training for them. So often you have to find them from within your organization because of the mind for medics team was they were part time informatics and the majority time clinical. So you have to draft them and you don’t want it. And I actually, I think the answer is you want to recruit them because you actually don’t want to draft that. You want volunteers. You don’t want people who are drafted, quite frankly, I used the wrong term. So you really get the message out there that it’s an opportunity and it’s not the technology. You get people to understand that it’s really a quality of process improvement tool and then train them in informatics and I think you’d be amazed about how many great docs really do want to improve quality and process and I think that’s the guy walks into my office and this would happen to me, hey, I know sql code.

Amy Maneker:              26:38                I’m like, congratulations. Was less likely to be a good fit for the team than the person who said, hey, I have all these ideas how we could be doing better care and then introduce them. Hey, here’s the tool how to do it. Because it really is a tool to improve quality and value of healthcare. And then it’s creating a team and really teaching everyone informatics and the verbiage and then also teaching them the. They have to understand whatever your Emr is better because they need to be able to have know the language to be able to speak to the analyst, then they become, they can speak medicalese and they can resonate with the other clinicians, you know, docs, nurses, whoever, and they can speak to the analyst team and then they can, they can make things happen.

Bill Russell:                   27:24                Great insights from amy looking forward to having her on the show in the future, haven’t set the, the, uh, the slate of candidates for 2019 yet, but looking forward to having some of these. I’m just talented people back on the show. Uh, speaking of talented people, the, the, uh, the next clips from, from, uh, you know, probably one of the highest ranking people we’ve had on the show. Dr. Rod Hochman, CEO, president and CEO of Providence Saint Joseph Health. And I love his insights into this, this challenge that’s facing healthcare, which is, you know, the, the competitive landscape continues to shift and you have new partnerships, new models, uh, that continue to pop up. And. Rod is one of those people that believes that you can, uh, that traditional healthcare is going to be able to compete in this environment and he is investing in digital.

Bill Russell:                   28:14                He’s investing in new business models and take a listen to this and how, how the traditional providers remain competitive in this changing landscape. Uh, health care leaders article, um, you, you said we’re deconstructing the traditional health system. We have built a, we have been built around large hospitals. That’s an old version of a successful health system or soon will be our new plan, makes us more digital, more ambulatory and there’s less emphasis on the hospital as the core, and this goes back to something we talked about earlier where, you know, you have health systems that have really pushed out into the community. They’ve deconstructed, uh, their, their buildings and really put, you know, labor and delivery and they put these really facilities all over the city. Um, but I don’t, this isn’t the end of deconstruction is it? I mean, digital technologies, the consumer revolution, new paradigms for delivery of care. Um, and we’re, we’re going to see much more deconstruction moving forward. How do you see that playing out

Dr Rod Hochman:          29:18                Well, I think the only way for us to compete in the market that we’re in. I think it would beat against a natural national… Well if every ambulatory search that we have have as part of a hospital? …somewhere You’re not going to be competitive. What we’ve said is that we’ve got to bring all of those units down so that the ambulatory division … then allows us to function more as a business…. Then an add on to any cheap care facility. In the same way I say a cheap care facilities need to tighten up how they work they better get streamlined better smarter faster as well. but they need to concentrate on cheap care in those facilities the medical group needs to be able to function as a medical group plus …. That’s a different type of delivery of care that has probably a digital arm to it. But it also has much more … they’re really taking apart those and the other thing for Providence St Joseph is also the kind of service thats come through. We’re taking a page out of what Optim did. We’ve got to optimize providence St Joseph. So we …given our scale have to become become a services company to other medical groups to other hospitals, and the worst thing is, you know were supplying EMRs to other hospitals that we don’t own,… I think we’re going to have to figure out ways to produce revenue from things other than direct patient care.

Bill Russell:                   30:56                Yeah. I Love Rods perspective. Uh, you know, essentially you’re gonna, you’re gonna break the traditional health system down into its component parts and you’re going to rebuild it for a different model, for a digital model or for whatever model. Uh, there is in the future and it might be your re re designing it for 2018. You might need to redesign it again for 2021 and 2023. That’s the pace of digital. And, uh, you know, it probably sets up our next video pretty well. The pace of digital is one that moves very rapidly and will require some new, some new skillsets for us as healthcare organizations. And lee milligan talks about really applying lean and agile. Lean is a new, but agile is, is something that we’re starting to see pop up a lot of health systems and uh, you know, it’s, it’s iterative, it’s a short sprints, a defined deliverables.

Bill Russell:                   31:50                It’s not a big design build kind of concept, but just iterative success is building upon each other. And uh, this is a skill we’re going to see. We’re hearing this over and over again, especially as healthcare becomes digital and they start to build out digital capabilities. So here, take a lesson to a to Lee Milligan talking about a lean and agile in a analytics programs. How do you, so how do you scale this? So you have a clinical data analyst and you have a, a, a, a new training, a principal trainer for analytics. Uh, that sounds like two people to me. Um, so it would seem to me that they would either be extremely busy, um, or that they figured out a way to scale the work that they’re doing it across the organization. Is there, is there a trick or is there something about scaling that you guys have figured out?

Lee Milligan:                 32:42                Well, we also added a few bi developers, traditional bi developers to that mix, one of which we have dedicated to registries, which might sound a little odd. Uh, but with, uh, with the work that’s happening now around our aco model and our, our basically our ambulatory contracts that we have, having somebody dedicated to registries is key because most of this stuff feeds off of registries. So getting those right people in the right positions was important that the single biggest improvement in our ability to deliver has been our work around lean and agile. So about two years ago we started going down that road. Um, my manager, Michael Olsen has, uh, has really been at the tip of the spear on this and we’ve completely revamped our approach based on agile and lean methodology with three week sprints.

Bill Russell:                   33:34                Wow. That’s, uh, well I, I love, I love it when we close out a show by introducing a topic that we could do a whole show on. So, uh, we’ll, we’ll, we’ll definitely have to have your back and talk more about that because that sounds like a, a, you know, a lot of people talk about a lean and a lot of people talk about agile and um, I think there are at least agile for from where I sit is one of the least understood terms within it organizations and it gets, it gets kind of convoluted. So yeah, this was the precursor for me having lee back on the show where we really talked a lot about data and analytics and so you want to check out that other episode as well. It’s just a, they’ve done such great things at Asante with such, with such a small staff.

Bill Russell:                   34:17                It really is kind of impressive. Uh, you know, hey, we’re getting ready to close out the episode. So let me, uh, we have one more clip. It’s actually probably the longest clip. It’s about five minutes where I talked to, um, when I talked to Dr Daniel Kraft, uh, the, uh, physician scientists chair of singularity university and exponential medicine. I talked to him and, and, and this was really the start of these, uh, case study episodes. And what I threw to him was we have five. He and I have $5, billion dollars to redesign a new health system from scratch in southern California. What does it look like? Does it look different given the technologies that he’s tracking and the technologies that are coming into play and the changing business landscape. So, um, you know, it’s, it’s, it’s pretty lengthy as you would imagine. I mean, we’re redesigning a $5,000,000,000 health system in southern California and, uh, I really, fascinating insights.

Bill Russell:                   35:11                Uh, take a listen to this. So I’d like to do two hypotheticals with you. Um, and, and the first we’re going to design a health system from really from scratch that we’re going to launch in 2020, say in the southern California market and just say, hey, it’s Greenfield, we’re starting over. Um, and then the second senario I want to talk to you about, I’m going to make you the exponential consultant to, uh, uh, Dr Atul Gawande on this new role at Jpm, Amazon, Berkshire, and just take a few minutes to understand how exponentials might be used in care and wellness of him one point 2 million employees that he’s going to be overseeing. So, uh, let’s start with this one. So we’re designing something from scratch. It’s going to have to integrate with what’s already in our market. It’s going to have to leverage the, the various things that are already present. But let’s assume we just got $5,000,000,000. You and I are going to start a new health system. Uh, it’s in southern California and let’s just dream a little bit on, you know, where do we start to invest that money to provide really proactive care versus reactive care, continuous care versus a sort of intermittent sporadic care. And uh, where, where would you start? What would it look completely different? Like we’re, we should be thinking about buildings and acute care facilities or, or how, where would we start? Do you think?

Daniel Kraft:                 36:31                If it’s a full on system, of course you want to go from soup to nuts from prevention, longevity through diagnostics therapy so youre gonna still need the acute care facility. But let’s start reimagining what would like when you might join that system. Using what’s here now, what’s coming? Um, so this is starting to bubble up, you know, the fact that I can now go on my iphone and get my, my epic record from Stanford, Mit, Stanford dot. See My digital exhaust from my smart phone that’s not, that’s not necessarily being utilized. So imagine a system where it’s been folks that joined this healthcare system. They get essentially a bit of the Hli or avail type element where they get their genome done. Um, and that information isn’t just a data file. It gets synthesized into your personal health record and the one that you’re, let’s say a primary care doctor sees so that when you’re coming in for your annual visit, we can look at that and help tune some of your prevention.

Daniel Kraft:                 37:23                Uh, maybe therapy was an interesting paper out this week from Tech Authority who was actually a resident with me at mass general. I’m looking at multiple genes for risk factors, let’s say a cardiovascular disease, so it won’t be any one gene at many diseases are multicultural, but imagine when I’m seeing you in my clinic, I can already get a look at that genetic risk score and use that to tune whether you rightly need to be on staten or what might be the optimal prevention regimen given some of those risk factors. Lifestyle. Um, and then obviously again, overused term, but patient engagement, the fact that hopefully everyone in your system can, can touch their healthcare, how and when it fits them, right? If you’re a millennial versus a baby boomer, you’re gonna interact differently with your technology and user interface. Then even if you have the same type one diabetes issue, um, so melding that, it’s not one size fits all.

Daniel Kraft:                 38:14                Precision a Ui as well. So then just riffing here a little bit, you know, when, when you have a patient with an issue, let’s say something common like hypertension, um, they may now be a, not just with the usual, once a day blood pressure device, it might be able to know to watch there’s one coming up which might squeeze your wrist or several servants doing noninvasive radar based hypertension so you can have especially realtime hypertension numbers and use that in a seamless way to tune often two or three different drug classes. So building in these sort of algorithms and feedback loops that continually to learn, um, and fit into both the prevention side and disease management. So that requires good user interface that requires some smart reimbursement elements. It requires you to have a bit of a digital Pharmacopeia, um, and our clinics like forward and others are trying to build what’s the next generation of that primary care visit look like?

Daniel Kraft:                 39:09                Um, that’s a little bit of, I think about in terms of building a system from scratch with on the exponential, not just building it with 2018 to mind. What kind of data elements or platforms or pikes might you need to preserve for what’s likely to be here in a couple years? Five G is rolling out in many cities, including southern California within the year. So what could you be doing to be thinking about five g and six g, m, where could you be building in a platform integrated telehealth where a asynchronous or synchronous care it could be used, get across the care paradigm. So those are a few things I’d be thinking about. And not just with lens of 2018 as well.

Bill Russell:                   39:46                Wow. What a great time to be in healthcare. So much opportunity, so many, uh, so much change going on. Um, I hope you enjoyed this episode. I really enjoyed making it and just reminding myself of some of the great insights from these industry leaders, these clinical leaders. Um, one last thing, one last bit of house cleaning before we close out the episode. The, uh, I’ve created a, a get feedback form. I’m gonna. Put it right there at the top of thisweekinhealthit.com website. Would love to get your feedback. I’d love to hear more about what we’re doing well, what we’re not doing well, but you’d like to see more of what you’d like to see less of. I’m already starting to get some feedback from, uh, from some people and we look to look forward to incorporating that into next year’s episodes. So, um, you know, I really appreciate, uh, all of our listeners. You can, uh, you can obviously find this episode on thisweekinhealthit.com, the videos at thisweekinhealthit.com/video. And, uh, you can follow me at, @thepatientscio, but probably more importantly, the show you can follow @thisweekinhit. And, uh, you know, that’s all for this week. So please come back every Friday from our news information and commentary from industry influencers.

 

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