I think you're referring to this: https://www.wired.com/2015/03/how-technology-led-a-hospital-to-give-a-patient-38-times-his-dosage/ It's a fascinating example of the swiss cheese effect, and should be required…
HIStalk Interviews Guillaume Castel, CEO, PerfectServe
Guillaume Castel, MBA is CEO of PerfectServe of Knoxville, TN.
Tell me about yourself and the company.
I worked 14 years in technology, first with IBM and then Cisco Systems. I was fortunate to rise through the ranks. I come from a family of healthcare providers and executives and I am married to a physician-epidemiologist, so I felt I had no choice but to go into healthcare. I joined The Advisory Board Company in Washington, DC in 2014. It was probably the most consequential experience I have had in my career, an amazing 4-5 years before we sold the company to Optum.
Then I went to work for a health system in the DC area. I put what I thought I knew into practice and learned what it means to deliver care every day. I joined the advisory board of PerfectServe about two years ago at the request of our private equity sponsors, and then about a year and a couple of months ago, I became the CEO of the company.
PerfectServe offers unified healthcare communications solutions to help physicians, nurses, and care team members provide patient care. We serve 145,000 physicians, 240,000 nurses, and 600,000 users. I mention those metrics because we track them each month to remind of us the importance of the work that we do and the number of lives that we are privileged to touch each day.
How has the company absorbed its recent acquisitions of Lightning Bolt, CareWire and Telmediq?
PerfectServe acquired three companies in essentially 12 months. Telmediq was complementary to PerfectServe. CareWire was in the slightly different space of patient engagement, which was visionary at the time. Lightning Bolt has become a critical part of our company in delivering scheduling capabilities for physicians, and increasingly, beyond physicians.
We spent a great deal of time thoughtfully integrating the various capabilities and thinking about how we could make the sum of the parts bigger than what they were. What we have now is a cross continuum way of enabling communications at scale for the largest health systems in the United States. We embed optimized and sophisticated dynamic schedules to make sure that we get the right communication to the right person at the right time, which is critical. Then, in this era of ongoing crisis for health systems in the United States and beyond related to COVID, it has become critical to help patients who are inside the four walls of the hospital communicate with their families and for hospitals to communicate with patients who have gone back home.
How has technology changed the ways that hospitals and practices are serving patients compared to a year ago?
We have gone through an acceleration of a three-year roadmap into a three-month timeframe. Care providers suddenly had to manage patient flows safely at volumes that they could not have anticipated. They also had to provide as much care as possible without requiring the patients to come into physical spaces such as a physician office, an ambulatory setting, or an inpatient setting.
The news was most prominent around the advent of telehealth, but telehealth is not new. It has been important in care delivery for years. But we have learned that we can and should provide good care remotely.
PerfectServe has committed to helping our clients through the crisis with bi-directional texting capabilities with their patients and families from home or anywhere they wish to be. We built a video capability, which took off in March, April, and since then because it does not require scheduling – it is completely ad hoc. It is secure and does not require infrastructure for hospitals to deploy it. These are the required ingredients for any solution to become relevant.
Some of our most innovative and forward-leaning clients expected to do 1,000 telehealth visits in 2020, but have already done 300 times that number. Our essentially app-less offering was the most convenient way, in a moment of urgency, for physicians to get in touch with their patients at home or elsewhere.
Do you see a second wave where organizations that quickly implemented consumer tools such as Zoom or Skype will look for video solutions that are more specific to healthcare?
People did what they could during the urgency. Health systems and physician groups are essentially doing pervasive preparedness for what another wave of COVID or another virus outbreak could mean to them. They are thinking about not just what’s required, but what the perfect design would be to stay connected to their patients in a moment of crisis. That goes far beyond having access to video capability.
It needs to be integrated in the way that you would want your physicians, nurses, and care team providers to communicate with the patient. It needs to be safe. It needs to be the right person at the right time. It needs to be secure. It needs to be connected with your EMR. It needs to be connected with the way you would want to manage clinical communications within your hospital.
Horizontal technology providers just aren’t going to get there. They don’t understand the workflows. We are seeing a lot of work and money being spent on how to deal with the next wave or the next crisis. That pushes us and assures that health systems and their patients will be better prepared for the next time.
I saw on your website that 85% of patient records contain their cell phone number, which allows providers to text them with health management questions and appointment reminders with minimal work and infinite scale. I also saw an interesting statistic about how patient portal use can be increased dramatically by texting patients a link to the log-in or to materials that exist within the portal.
It’s fascinating to me what we’ve had to do over the last six months. What you are touching on is critical. We build products at PerfectServe by spending a lot of time with our clients, making sure that we are educated, vetting the solution, and testing it. What we heard about engaging with patients remotely in their use of portals is that it can’t require a three-month deployment. It needs to be lightweight, secure, and app-less. This concept of asking a patient or a patient family member to download yet another application was a non-starter and will continue to be.
We put our best brains on it. We established the most practical things that folks can use in a moment of urgency, and that was essentially a link. We send a link to the phone number that was gathered at the point of registration the week before, the month before, or the year before. That has changed the way practitioners are embracing new technologies.
What are some practical uses of escalating messages that haven’t been responded to within facility-defined parameters?
Our approach to that issue is that we need to enable person-to-person communication, nurse-to-nurse communication, nurse-to-doctor communication, and care team member-to-care team member communication. We also need to track and document that whatever communication was sent has been received and read. The traceability, the ability to audit backward, is critically important to our clients, and we believe that that level of sophistication is now baseline. You don’t get that level of transparency with emails.
We believe that we are differentiated by our standard of delivering the right message to right person at the right time. We do that using algorithms that leverage what we think of as situational variables. The person’s role is the one that is most often mentioned, but it’s much more complicated than that. It also includes their department, the facility, the day, the time, and the call schedule. We establish deep, optimal communication that is based on those variables.
It’s essentially an optimized communication pathway that folks can standardize around. Our most sophisticated clients have established standards across their 10, 20, and sometimes 30 facilities to establish a standard around communications. We track and we give the sender the ability to see who has received the communication, who has opened the communication. It doesn’t need to be sent back that it has been read, but you can track it. We believe, and have always believed, that this is critically important. People are now accepting this is a benchmark and a standard.
Texting, as the preferred messaging mode of many or most people, is a channel by which messages can be scaled infinitely, covering health follow-ups, pre-visit questions, appointment reminders, and anything else that the provider organization feels is important. How do organizations decide how to use that capability optimally without seeming annoying or impersonal to their patients?
Our job is to give our clients options to communicate with their patients in the way they believe is most effective. I don’t believe that voice has completely gone away, so we need to continue to enable that. Texting is core, unquestionably, and video has become important. Six months ago, people communicated maybe 20% by videoconference and the rest of the time with just regular conference calls, but now 90% of my days are spent in front of a camera.
Our goal is to give our clients options for their patients, a multi-channel array of capabilities. The ability to do appointment reminders, surveys, and education pre- and post-visits or procedures is critical. We see it now. I’ve been spending a ton of time with potential partners around this concept of education for patients who are coming in for surgery or an oncology appointment. The more you know, the better prepared you will be and the less stressed you will be, which has proven to have an impact on the efficacy of the care you’re receiving.
We are using all those ways of communicating to funnel real quality to patients, pre and post, having an interaction with a care provider. That’s not going to go away. How people decide to digest it, how proactive health systems are in actually promoting it, is a matter of sophistication level. We are committed to helping any and all systems, regardless of where they are on that spectrum of sophistication. But I believe that the engagement with patients and consumers will grow through text.
People don’t talk as much about the importance, the crucial importance, of the call center. We see call centers as a core to that multi-channel communication strategy. They are a huge part of how clinical communications are relayed to and from the front lines and patients and family members. There are massive opportunities for health systems to engage more effectively.
People like texting because it can be real time if both parties are available and interested, but it can also be asynchronous if you don’t catch someone at the right moment. Does that same concept apply to video, where two people converse via video messages that aren’t necessarily answered in real time?
I think it’s all based on the use case, the degree of acuity, the stress expressed by the patient, and the urgency expressed by the health system. These are all variables that come into play. We think that having three or more ways of applying communication strategies to the situation is the right answer.
Texting seems most convenient for less-urgent situations, but when you’re back home after a round of chemotherapy, you want immediate video or voice feedback from a care professional who can tell you that how you feel is normal and you don’t need to drive an hour to come back to the facility to be checked out. We will continue to invest in having as many communication strategies as possible to allow every use case to be facilitated by our platform.
Do you have any final thoughts?
The journey is what we think of as unified communications. It crosses boundaries and it cannot be an afterthought. It needs to be core to the mission of the company that commits to delivering it. Similarly, workflow enhancements can be achieved by combining technology and innovation with experience and know-how, not just releasing tools and demanding that a clinician use them.
All 350 of us at PerfectServe wake up in the morning with a desire to solve bigger problems for our clients and their patients.We start with the end in mind. We are excited about the progress that we have made with our clients and the progress that they are making with their patients.
Great interview, insight and vision! As Executive Chairman at PerfectServe, it has been energizing to sit alongside Guillaume and the team during this dynamic time in our lives and industry. Guillaume leads with clarity and conviction, and never loses sight of what is right for patients and those providing care for them. In our increasingly complex and now highly virtual world, coordinating these multi-channel, multi-stakeholder communications has never been more important and nuanced.
Executive Chairman, PerfectServe
Founder + Chief Executive Officer, GetWellNetwork