HIStalk Interviews Jeff Kao, GM, NCR Healthcare

Jeffrey Kao is general manager of NCR Healthcare.

Tell me about yourself and about NCR Healthcare.

I’ve been in the healthcare IT world for quite a while. My career started in 1989. I was an executive inside with GE, went to IDX, and then transferred back to GE with the GE acquisition of IDX. My last assignment was with Hill-Rom, also in the healthcare information and nurse call communication.

NCR is best known as National Cash Register, but in the past 25-30 years, we’ve been best known as a self-service company. We want to empower our customers and patients and everybody associated with helping service the industry, whether it be in ATM, travel, or gaming. 

With all the transactions and all the need inside of healthcare, we’re becoming a bigger and bigger participant inside of healthcare. We’re eager to participate in the category and really empower the patients associated with servicing themselves in a very complex network that’s in need of revamping and modernization.

Most high-volume businesses like airlines, banks, and big box stores have an impressive array of customer-facing self-service technologies. How do hospitals and medical practices stack up and where do you think they’re going to go with it?

We are leading the technology frontier in many categories, but falling behind in others. Healthcare informatics is one of the particular cases. If you think about a high-volume transaction basis in any industry, I can’t think of any other where you can’t schedule an appointment online with physicians to speak of. You can do that in terms of servicing your car at Jiffy Lube today.

We’re still an industry that’s very antiquated and backward in terms of how we communicate with our customer or patients. Very little secure messaging occurs over the network. I can’t think of any other industry in which e-mail, SMS, and text messaging hasn’t transformed in terms of our transactions dealing with anybody. We are an industry dominated in terms of forms, informatics, and payers and all kinds of bureaucracies in which we are still dealing primarily with paper, imaging systems, and document management systems. 

By the nearest estimate — without even prescription drugs and so forth – with provider and hospital dealings every single day, there’s two billion transactions happening in a given year, but very few of them are automated and happen on a consistent basis in which we empower the consumer where the patients actually having to deal with the category of self-service. It’s all still very intensive. That’s why I think we’re prime in terms of automating the space with our expertise in other industries that we can bring some of these practices into healthcare.

You worked at IDX and GE. Do you think traditional vendors are focused on customer self-service or is it going to take a company like NCR to add that on?

It requires a complement of companies working together. In IDX, we were obviously big in terms of the provider space, automated provider workflows. But if you think about it, we really started with the healthcare informatics first. We started with the big customers first. We really didn’t take a perspective associated with what the consumer actually needs.

For example, I’ve relocated to Duluth, Georgia. Like in any relocation, our employees were looking for primary care providers, looking to embed ourselves, ingrain ourselves, and get the kids registered for schools. It was hard finding a primary care provider. It was hard to navigate through the system, We waited in line for six hours to basically get shot records updated for our kids. I think those are the kinds of things that have a predominant role for self-service.

It’s amazing. We moved our headquarters from Dayton, Ohio to Duluth, Georgia. We brought over about a thousand covered lives associated with our entity. Over and over again, the experience associated with providers is they offer little or no tools in terms of registering ourselves, in terms of understanding who our payers are, in terms of being able to register for appointments.

We provide a preventive care benefit to all of our employees, meaning physicals and so forth, are 100% paid for by employees. Yet overall, if you look at our employee experience, not a single provider has ever contacted us to go in and get a physical. With all the electronic medical record adoption, with all of the investments in healthcare IT, something as simple as contacting one of our employees, one of the kids, or one of our spouses to come in for an annual physical doesn’t occur on a regular basis. 

This is a primary role for us in, terms of providing self-service. At eight o’clock at night when I’m clearing my e-mail messages, a reminder that says, “Hey, you’re 40 years old, you really need to come in for a check-up. By the way, click on this link. Go in there and register yourself, provide the necessary demographic information, update your present patient history, and come on in, because I think the care of you and your family is important.”

I think something as simple as that doesn’t exist in our industry or any of the patient populations today. This is what we really need to transform, especially with the advent of healthcare reform and changes. Empowering the consumer to handle the most mundane transactions that we have to do every single day. That’s why we’re so excited about this category.

In most industries, there would be two reasons to use customer-facing technology. One would be for general efficiency, the other would be to give customers what they want. What do you see that healthcare customers want to be able to use that they typically can’t?

I think there are always three things. One is that you’ve got to deliver a service that your customers or your patients want. We all carry computers, we all carry tablets, we all carry smart phones and mobile devices. We want to interact for all the services that we do. Today it’s really naïve to think that any service industry would neglect self-service, whether it be online banking, checking in at an airport, and so forth. I think for the most part, everybody is going to demand technology.

If you think about retail health, take a look at Walgreens. Every Walgreens store offers prescriptions, but they’re going to get into the primary care space and taking care of providers. They’re going to offer online scheduling, they’re going to offer electronic forms, they’re going to offer online check-in. The employee clinics are doing it today at Cisco and so forth. I think consumers are going to drive that demand, first and foremost.

I think the second thing is, with 34 million people coming into the healthcare system, unless we continue with the practice that we have today, we’re going to drive up a huge amount of administrative costs if we don’t adapt a different practice associated with enabling the consumer to self-service themselves to cut the administrative burden. 

Thirdly, I think it’s the central part of the Obama administration in terms of cutting medical errors. What better way to prevent all of the redundant entering and keying in and scanning and documentation and printing and so forth, other than making sure that the person in charge of his own personal information enters it correctly into the system, is adequately documented, adequately categorized, adequately feeding into all the ancillary systems? I think this is where self-service has a primary role in terms of cutting administrative costs, enabling the consumers, and also making sure that it’s more accurate and more up to date, and giving the power back to the patient and providers in terms of time to care for each other.

You mentioned Walgreens. They have a financial interest in interacting in more creative ways with their customers than the average hospital or physician. Do you think that the lack of incentives is the reason that physicians and hospitals have not looked more at engagement-type technologies like Walgreens has?

I think that’s a great question. Engagement technologies …  any time you talk about physicians and hospitals, it’s a little bit different.

I think for the most part that physicians haven’t engaged because there hasn’t been a solution out there that services the way they need to purchase and support the technology. There are 850,000 physicians in the United States. That’s a big number. But primarily, these physicians are still in relatively small, aggregated groups. The last number I’ve seen, they’re still in five doc or less groups. For them to buy their technology the same as a hospital is very challenging. They don’t have a CIO, they don’t have IT space. For the most part, they have found their way onto the Web through some kind of hosting service, but to be able to manage technology the way the big IDNs do is very challenging.

This is where companies like NCR and others need to find a way to support them in their mission for self-service that doesn’t require them to buy millions of dollars of hardware and capital, but rather understands the way they want to practice medicine, the way they want to service their customers, and offer it in a holistic hosted way that doesn’t require them to support all this technology, but supports it for them. In fact, we need to be just more than a technology provider. We need to be a total solution provider.

I think that’s what’s going to enable a 20-doc group to offer a service to their patient population that allows them to self-service, that allows them to smart schedule, that when somebody logs in their system, they’re registering for their five-year old kid or a seven-year-old kid that knows that the patient’s going to prefer a time slot between two-thirty to five o’clock because that’s when they’re out of school. For a person that’s a working professional, they prefer to go in the morning or late at night so they can go before work or after work. For a retired person that has a little bit more schedule flexibility, maybe between the hours of ten and two. For the middle summer when the flu season’s not impacting the patient volume, to draw somebody in for a physical, or two weeks before school starts, to linearize that volume because everybody’s trying to get their physicals to participate in school sports or get their shot records updated so they can participate.

I think the systems are there. The logic is there. Those patterns exist inside the healthcare system, but we don’t provide the providers assistance to systematically manage the way their patients want to be treated. We know there are bottlenecks inside the healthcare system. The week before school starts, the pediatric offices are full because everybody’s trying to get their shot records and physicals done. There’s a way of linearizing that volume. In middle of summer, nobody has the flu — it’s the perfect time to run people through physicals and preventive care. But right now, it’s a lousy time. We’re in the height of the flu season. There are patterns associated with what we can do to help the physician practice associated with participating in self-service that will benefit the patient as well as enable provider their business practices.

When you talk to a hospital about self-service, they probably most often picture the kiosk, which I know you offer. If you look down the road and where kiosks are and where they might ultimately move to, where do you see that developing?

In terms of the hospital segment, the kiosk is an equally important participant, but that’s not the only technology. It has to be a hybrid of three technologies — the portal, the kiosk, and the mobile environment. Here’s why.
Think about our complex setting. I have a friend with breast cancer. If you think about what needs to go through the transaction, many of the forms and the preparation and so forth really need to happen in the comforts of our own homes, associated with basically entering the form, maybe the prep associated with the visit, preparation in terms of somebody to take you there and take you home from the hospital in an ambulatory visit. If you think about it, the visit really happens in terms of the preparation in terms of self-service, making sure of the insurance and demographics and so forth, because it’s a traumatic time already.

Once you update all the things that you can do online, what needs to happen associated with the kiosk is you need to know what happened on the Web so that the same experience continues when you go on the site. When you think about an oncology visit for a typical patient, the first visit may be checking in, just making sure that the hospital or the IDN knows that you are there, followed by a management of your visit for the whole day. It may be a visit to the lab to make sure they draw blood and do a white blood count. After that, you may have to wait for the results.

Depending on the result, then your workflow gets changed. It may be going to imaging, or it may be going to chemotherapy. After that, observation, and finally released to make sure that you are properly cared for and arrive home safely with somebody driving you home.

If you think about that experience as a holistic portal, the in-presence visit management experience requires not just one technology worth thinking about in terms of kiosks, but really managing expectation on the portal, managing forms and so forth so that you can streamline your visit, using the kiosk to basically take you from place to place making sure that your visit happens in a consistent, coherent way and you don’t bypass any of the procedures because the handoffs are very complex in healthcare. And then, finally the discharge and the scheduling of the next visit. 

Along the way, smart alerts can remind you where you need to be and what you need to do, because most of us walk around with a cell phone. I think that’s what our customer service, our self-service experience, inside the hospitals and physician offices, need to be. Many procedures are now outpatient, but the visits in a complex IDN setting are many-modal, many departments, highly complex. All these systems need to be tied together in terms of giving you a holistic view and holistic experience.

What you get in one setting, in one department, you need to carry forward to the next one. It makes no sense for you to do four stops and update your patient records, your demographics, your insurance, and your insurance cards, and everything else four times. That’s the waste inside of our systems and leads to a less than satisfactory and costly experience in terms of what the IDN or hospital or physician actually knows what’s going on with you.

When you look at the Meaningful Use emphasis on use of technology by providers, do you think that will create opportunities to push technology out to patients?

I definitely think so. If you can think about Meaningful Use, a major portion of it is updating the patient associated with the right information. I think EMRs and the traditional hospital information systems offer the foundation in making sure that all the information is electronically stored and compiled in a meaningful way.

But what Meaningful Use sometimes overlooks is that all the information is stored on a server somewhere. How do you intend to interact with your patients to provide the information meaningful to your patients? It does you no good to have the demographic information as well as the results on the computer. Moreover, you have to advise the patients. I think all the Meaningful Use criteria I have seen require a portal or some kind of informatics that gets back to the patient.

I think this is where we have an important role to play. Centered on our self-service strategy at NCR, it is really not how the information is stored or what information or technology the hospital or the physician has, but how do we enable the interaction between the information to the patient so we can empower the patient to have the right information? Allow them to enter the information. Have them manage their own visit. Have them manage their own care in a meaningful way with the technology that’s already embedded in the system.

I think that’s a little bit of a twist in terms of what we’re doing, but we intend to be a very strong participant in making all this electronic medical record and all this electronic data exchange meaningful to the patient.

Any final thoughts?

The moment is ripe in terms of a change in the way that medicine is practiced. I know many people talked about it in the past, but I consider self-service this way. It’s like making soup. We have 34 million people coming into the system, probably driving on the order half a billion additional transactions into the system, with probably declining reimbursement rates. The pressure associated with it is we’ve got to get better, more accurate, faster, and cheaper with how we care for this volume.

If you look at the industry over and over again, whatever segment we’ve looked into, people have gravitated to a self-service model to enable the consumer or the patient to do more, to have more accurate information. Over and over again, what industries have done is gone to the Web, gone to kiosks, and gone to mobile devices.

I think the moment is right for us, over the course of the next three years, to experience something that’s revolutionary in US healthcare associated with Meaningful Use, with adoption of self-service technology, whether it be portal, mobile, or in-presence with a kiosk. I don’t think there’s going to be one winner inside of these three technologies, but it’s going to be a combination of these technologies all working in a coherent way, reaching all the technology on one single platform that allows a unique patient experience. I think this is why it’s so exciting being inside self-service, inside healthcare IT right now. I think the moment is right for that tip.