Screening questions may seem benign, but may come with some unintended consequences. During a medical appointment last year, I asked…
Robbie Hughes, MEng is founder and CEO of Lumeon of Boston, MA.
Tell me about yourself and the company.
I’m an aerospace engineer by background. I got excited about healthcare when I was given a problem coming out college, which looked to me like the normal sort of problem you would see in any industry. Fifteen-plus years later, I’m still doing it, because this is healthcare and things are a bit different.
Our product is the Lumeon Care Orchestration platform. We are a companion app for EHRs that automates clinical and patient workflows. The end result is a massive improvement in care team productivity that transforms the patient experience and improves the wellbeing of the care team more broadly. It’s a tricky thing to do, but we are lucky in that it works extremely well.
You said the last time we spoke that your product helps standardize decision-making rather than standardizing care. Can you give some perspective or examples?
There is a common misconception in the way people think about care processes, that a journey of care starts on the left hand side of a sheet or a screen and ends up on the right. That’s just not the reality we live in. Every patient is different, every disease progression, every care process is different. Things unfortunately don’t happen the way we expect them to.
But if you were to present yourself in front of a physician or a care team member more broadly, they would work you up following a relatively common set of protocols and methods. The output of that workup would essentially be a personalized care plan for you, based on what they see right there in front of them. Standard decisions are being made inherent to how care is delivered, but the way that we implement care from a technical perspective is to assume that care is linear and standardized.
The question becomes, how do you embrace that personal aspect of care that is delivered by care teams, but try to bring the operational efficiency that comes through standardization as you might see in other industries? This personalized yet standardized thing is a bit of a Rubik’s Cube that people struggle to conceptualize and to use in reality. But it actually boils down to one very simple thing, which is that the decisions of around what care should be delivered should always be consistent and should always be repeatable.
For a given presentation, you should always get the same output. That should result in some specific personal action, some specific personal activity for that patient. That inherently means that for every decision, you’re going to get a personalized output, and every patient’s care journey will be the product of a bunch of personalized actions — not standardized actions, but personalized actions based on standardized decisions. The trick to all of this, the trick to delivering great care, is how do you repeatedly and reliably deliver that personalization in a scalable form to create predictable — not standardized, but predictable — processes. Lumeon has worked at how to do that very well, one of the biggest misconceptions that sits at the heart of why scaling healthcare can be difficult. That’s the core of what our business does.
We’ve laid out EHRs so that other clinicians and even the patient themselves have to reverse engineer a bunch of chart elements to try to follow the thought process behind the actions. Are patients themselves usually aware of what their doctor is thinking and could technology help them understand?
That is the $84 billion question, isn’t it? I would reframe that a little bit. Why do we do what we do today? It’s worth saying I’m not a physician, I’m an engineer, so everything looks like a problem to be solved to me [laughs]. The way I think about this particular problem is that if you look at the way a care team practices today, there are these interactions I have with the patient, there are interactions I have with the EHR, and a lot of this stuff is based around this notion that I, as a care team member, don’t, necessarily trust what’s documented in front of me. I’m going to ask the patient or about their history. I’m going to order another MRI. I’m going to do all these things because I as a responsible clinician need to understand that what I’m doing is the right thing for that patient, and that’s a perfectly rational place for them to be. And in a world where people are paid on activity on a fee-for-service basis, that makes economic sense as well.
But in a perfect world, they would be able to look in the EHR and see a complete record with everything there. As a result, they wouldn’t need to reorder things and redo things, because they look at the documentation and say, OK, this is complete, I trust it, life is good, I will do the right thing by the patient.
So back to your question, the way the patient perceives this is maybe inconsistent delivery, repeating things that they’ve already done, potentially gaps in care where mistakes are made or things aren’t followed up, et cetera. From a care team perspective, what they experience is the repetition of things that should have been done already, but they don’t have necessarily 100% confidence have been done to their satisfaction or done well.
The more we fragment care through increased specialization and more handoffs, the more this problem permeates. In a perfect world, all the documentation would be there. This is actually one reason that what Lumeon does is hard. If you’re trying to introduce automation into clinical care processes, there’s this pyramid of need, and at the bottom of it is complete and accurate data. If the complete and accurate data doesn’t exist in the EHR today, then how on earth can you hope to safely implement automation on top?
You get to the same situation that the care team has, which is that most of it is there, but not enough for them to be able to run it completely, so they ask the patient or they go to secondary sources of data. It’s similar to what we do. We create a composite record, we ask the patient, we ask the EHR, and we ask other secondary data sources and other authoritative records systems that we can speak to. We create this composite synthetic record that says, the EHR says this, the patient says that, the Surescripts or DrFirst or whoever else says these three things, and therefore we believe that the complete picture of the patient is this. And by the way, there’s a conflict between those two things, so we had better give that to someone to reconcile.
If you can create that trust in the data through this super record or composite record, and you can then use that to provide a basic level of cleansing and then ideally automation on top of it because that you’re missing things or things need to be sourced, et cetera, then you are automatically eliminating a huge amount of the stuff that plagues the care team from a busy work point of view. But you’re also joining things up incredibly efficiently for the care for the patient, because what they’re experiencing is direct, precisely choreographed outreach and engagement that is specific and individualized to them.
The psychology is interesting that providers don’t trust each other’s data and instead ask the patient or repeat the test.
It’s very unfortunate, isn’t it? The way that our chief clinical transformation officer would put this is, if we have to go hunting and pecking inside the EHR for something and can’t find it within 10 seconds, we just order another one. Because once you end up in this situation where you have a giant system of record with a huge amount of stuff in it, if it isn’t immediately available and reliable it, you automatically create this need for hunting and pecking.
Once you get into that situation, then immediately you are demotivating the care team. They have better things to do, so it’s easier to place an order, because obviously we have massively optimized for order creation instead of looking through retrospective or historical data to see if something exists. From a Lumeon perspective, or more broadly, from a care orchestration perspective, a lot of the value is bringing that relevant data to bear in the form of specific and automated action so that we can identify even before the encounter is open that we’re missing a couple of things and so we need to do something about it.
In fact, we are missing so many things perhaps that maybe this encounter isn’t worth having face-to-face. Maybe it needs to be diverted to a phone call or something else. That sort of intelligence, I use the word choreography, can be a massive driver of efficiency because it is eliminating that waste work that shouldn’t exist.
How has the business model evolved of an ecosystem between EHR vendors and companies like yours that can add value if given access to EHR data?
It is becoming increasingly clear. From a regulatory perspective, that the roles and responsibility of the EHR are very clear. It is a documentation system, a quality system, and a billing system. There is an entire industry based around the creation, maintenance, and support of that and the regulation around it. That is a treadmill that exists and will continue to exist for a long time. There is a further regulatory point around giving others access to the data that sits within that. Again, that’s only going to get stronger as payment models become more exotic and the need for data and the application of data becomes more acute. Now from an ambition perspective beyond that, it comes down to a cultural question, which is, what is the culture of the company and what are they trying to solve for?
A huge amount of the work that we do as a company is effectively services led. We are sitting with our clients. We are listening to what they do. We are listening to their challenges. We are applying our best practices and our tooling to address their specific challenges, which may be actually unique to them, but against a standard set of models that we have developed over time that we know to be good practices. What that creates is an organization that is obviously strong in product, but also strong in services, change consulting, data and insights, and integration. There’s a bunch of core capabilities that we need to have there and muscles that we are working, which are inherently different to other companies where, for example, maybe they sell something online, it’s very light, you click and you install. The muscles they are working are different.
Just as the comparison between those two companies is different, so the comparison between EHR company and a EHR partner company is going to be. Every company in its DNA has a purpose and has a trajectory that is set based on the things that they do that differentiate them. When a company tries to be everything to everybody, then they will end up losing some of that discipline and some of that excellence. That doesn’t mean that they won’t create a solution that is good enough for some use cases, but it would be exceptional if that company ended up creating the best-of-breed solution in all of those use cases. I don’t believe that you’ll ever see companies that dominate everything everywhere. My belief is that we will find that focus and discipline of execution creates companies that are differentiated through that focus and that discipline. That’s true for the EHR as it is for any other company.
The market has changed due to COVID, hospital financial problems, and hospital consolidation. How do you get a prospect’s attention when they are experienced change management fatigue or have a full plate?
The reason people buy Lumeon is because they have a urgent need to effectively do more with less. They will have strong opinions around how they want to deliver care. They’ll have a strong desire to grow, and they need to work out a way to do that in a way that they haven’t done before, which is to change their care delivery model so that it is supported through technology.
Our experience is that right now we are at a fascinating time in the market, where people are effectively creating rolling budgets. If you can walk in and partner with a health system and say to them, we are going to both improve the quality of care you deliver, drive more revenue, and make your care team happier, and do that on an ROI that pays back on a same quarter or same year basis, everyone is open to that conversation today. That’s a testament to how open people are today to change. They’ve seen what happened in COVID and what was possible. There is an urgency that I’ve never seen in the market to drive that kind of change. It’s incredibly exciting.
What are the company’s goals over the next three or four years?
From a product perspective, we are continuing to develop our knowledge library, our repository of best practice recipes of how to effectively do what I’ve described, do more with less, but in very specific areas. From a personal perspective, that’s the thing that I’m the most excited about. Its truly a knowledge and a knowledge library of how you go into particular use case areas — surgery, inpatient case management, ambulatory care, whatever it might be — what are the specific recipes that work, how do they get done, and what are the outcomes? That is my passion and that’s what we do exceptionally well.
We have started on this journey. We have more to do, but in the space of three years, we will have the most unbelievable content and evidence behind it. That’s the thing that I’m focused on, because it ultimately comes back from, we’ve done this because we’ve delivered these results for our customers.