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HIStalk Interviews Kevin Coppins, CEO, Spirion

November 18, 2020 Interviews No Comments

Kevin Coppins, MBA is president and CEO of Spirion of St. Petersburg, FL.

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Tell me about yourself and the company.

Spirion is headquartered in sunny St. Petersburg, Florida. We serve the data privacy and data security markets. I joined Spirion just over a year ago. Before that, I spent the previous couple of decades working across a variety of tech companies, both in the cybersecurity space as well as in the networking space. I started way back when at Novell. 

With every role that I’ve held, I’ve had the opportunity to work with healthcare organizations across the US and around the world. Every company you talk to says they are different, their industry is different, or something is different. Healthcare is the only one that gets to carry that badge and actually mean it, because everybody else is much the same. Healthcare is definitely different.

How much information does the average health system have that they don’t know about or don’t realize is unprotected?

I typically start with a question. How much data do you have? Somebody tries to answer the question, and then they stop and say, we have no idea, because you don’t. Think about how fast data flows in and flows out, how it moves. It gets stored in the cloud, and then it gets replicated in the cloud, and you just don’t know. It’s a fair answer now, and people have gotten more comfortable saying that they don’t know. A few years ago, it was a little bit nerve-racking to acknowledge that you don’t know that.

The next question that you ask is, of the data that you don’t know how much you have, how much of that would be considered sensitive, and how do you define it? That depends on the industry, but healthcare will definitely go to HIPAA. Other industries will  go to GLBA or PCI. It depends on where they are regulated, because that’s where their brain thinks. You have to take a step back and say, that might be how regulation defines “sensitive,” but how would your patients define sensitive? How would your clients define sensitive? How would your board define sensitive? People take a step back and say, that’s interesting, we didn’t look at it that way.

First you have to define it. Then the challenge comes to, where does it live? Not just how much do I have, but where could it possibly be? That usually leads down another interesting conversation topic as well.

Is healthcare the worst of two worlds, where you have the legally defined protected health information, but you also have the business data of a health system that could be a multi-billion dollar enterprise?

Privacy is an overused term these days, but when you think about privacy, it’s fluid. How privacy is defined for you might be different than how it’s defined for me. It might be different how it’s defined for a provider versus an insurer. How that data is used or misused can also then help define what privacy means.

While regulations have tried to go ahead and put a fork in it, healthcare data back in February is different than it is today. I didn’t really care if the world knew what my body temperature was in February, but now, you could have a bias against me for having a temperature that’s not within the range that you’d expect. Or if you were to find out that somebody living in my townhouse complex was diagnosed with COVID, maybe then I’m not allowed to go to work the next day. A lot of information that’s associated — a combination of that PHI, but also proximity and demographics, et cetera — can be leveraged to help during a pandemic, but can also be leveraged after that to start doing some things that people might not be as comfortable with.

What is the biggest driver that might take a health system from going beyond being minimally compliant with HIPAA to having some enthusiasm about implementing tools and systems to protect data beyond what is legally mandated?

Every board across the US is waking up saying, how can I spend more money on something that doesn’t add direct value to what I do? [laughs] That’s the challenge of privacy security. CISOs deal with that challenge all the time. Vendors like us walk around and say, “If you don’t do it, you’ll be fined, flogged, and frozen and all these bad things will happen to you.”

Until organizations start making it personal, it doesn’t usually get traction. By personal, I mean recognizing that the data that you’re protecting isn’t some amorphous blob of sensitive data sitting in an Azure cloud store. It’s information about your neighbors. It’s information about your community. A lot of healthcare providers are community centric. Something happens to that data and it impacts the entire community, which includes your kids’ teachers and your own relatives.

A good example is that once your child who is under 10 years old has had their Social Security number compromised and used to get credit card, they begin their financial life in the hole. Then it starts becoming a little bit more real. There’s so many more ways than just identity theft in the ways normal people think about how privacy can be breached and how majorly impactful it can be when you start being impersonated by people online, et cetera, et cetera. Or you start getting discriminated against.

One example that I heard that is relevant today is that we’re supposedly getting closer to this vaccine. Let’s say the vaccine is rationed, and you have to meet a certain set of criteria in order to be to the front of the line for the vaccine. It would be pretty easy to figure out what that criteria are, mine for those criteria, and then sell identities that meet that criteria so people can go buy it and be first in line. Then when you go to get your vaccine, somebody says, “Nope, you’ve already gotten it.” Wait a minute, no I haven’t. That’s when it starts hitting home.

It’s really making it personal and shifting that gear to say, this isn’t just a nice thing to do it. It isn’t just a regulatory thing to do. It’s a critical thing to do. That’s when organizations start to shift.

Are hospitals thinking about security differently after the recent surge of ransomware attacks?

Yes, for sure. One of the first things they are asking themselves is, do I have a secure copy of my data, so that if I am ransomed and they want to shut me down, I can rebuild? The second piece is, how much data do I really need? How much of that is critical to my operations, and how much is non-critical? They are starting to think about data in a different way, because ransomware is either about shutting it down and saying, I’m not going to turn you back on until you give me something, or they will actually sell off your data. I’ve got all your sensitive data, and I’m going to release it if you don’t do something. The idea that data can actually hold you hostage is a new concept for boards to think about. That has started putting a different value on that data.

The unfortunate impact of that is people are paying a lot more attention for the wrong reasons, versus waking up and saying, we should do this because it’s the right thing. People who start solving for the privacy problem because it’s the right thing to do typically don’t have the ransomware and breach issues. They have solved it organically and culturally within the company versus as a by-product of something they think they are supposed to do because their regulator said so.

How does a health system reduce the risk that is associated with the data they discover?

The first thing is to reduce to the absolute optimal the number of copies that you need to have of that data, and then make sure that it can’t replicate itself. With cloud stores today, if you are looking at your laptop right now, it’s probably syncing to a OneDrive, Google Drive, or  Dropbox. When you save something, will save in the three other spots. Getting a handle on what sensitive data is, how that data can move, and how that data can be stored will be a big step in the right direction to solving the problem. We talk about reducing the threat surface of sensitive data, and you do that by understanding where it is and how much you have. You can only do that once you define what it means to your organization.

Healthcare is fairly new to the cloud and we’ve seem some inadvertent exposures because of incorrect cloud configuration. Is that situation commonly or easily detected?

A cartoon shows the son saying to his father, what are clouds made of, Daddy? And he says, mostly Linux servers, son. [laughs] It’s an abstracted version of storage, of a place to store stuff. The challenge is that people don’t recognize that where they are storing it is completely unsecured and it’s completely open.

Being able to say, wait a minute, this is sensitive data is step one. Step two is, how secure is it? Well, it’s sitting on a server that is wide open to the entire universe. OK, that’s a problem. How active is it? Nobody has actually accessed it since the Reagan administration, so we are OK. Actually no, there have been 10,000 hits on it from foreign countries in the last 15 minutes, so it’s a problem. 

It’s not just a matter of knowing that it’s sensitive data, it’s knowing the level of access to the sensitive data and the level of activity around it. You combine those three things together to create a pretty good heat map that would say, I need to shut this down or I have a challenge or issue here. If I can reduce the threat surface and I have fewer locations where sensitive data lives, it gets a heck of a lot easier to manage it.

We had less impact than I expected from GDPR, which could have changed how we think about storing, securing, and using data, especially consumer data. Will we see further effects from GDPR or other legislation?

You see it in California already for sure with CCPA and CPRA. You have the New York Shield Act and 32 other states that are actively debating privacy legislation. With the election behind us now, there’s definitely privacy legislation that’s at a Congressional level as well. So you absolutely will, it will continue to shift. Even CCPA has changed three times since it went into effect last year. It will continue to shift and morph because privacy is fluid.

The wrong lens to look through is, how big have the fines been for GDPR? Well, there’s been some massive ones. How many have been collected on how many have made it through the courts? We’re waiting to go ahead and see.

You have to take a step back and say, what’s the right level of stuff to do from a privacy standpoint? If you show that you are trying to proactively get ahead of the problem, then more often than not, you’re going to be in pretty good stead with the regulators. It’s not trying to keep up with the regulations, but more trying to keep up with the culture, and that usually takes a rethinking of how you move and store data. That wake-up call doesn’t typically come until there’s a breach or something bad that could happen to you that you saw happen to the healthcare organization across town.

Are health systems funding and completing projects related to security, privacy, and data protection?

They are absolutely taking it more seriously. We’ve seen an uptick, even during these crazy times, over the last six months in healthcare because they recognize that it’s a journey that they have to start. They don’t a panacea button that it solves all their issues, but they start saying that they have to get the right processes in place and the right underpinning tools in place to start getting ahead of this problem.

Most healthcare organizations didn’t pop up overnight. They have been around for 50, 100, or 150 years. If you think about the technological age, every healthcare organization that I’ve walked into has equipment and systems that go back to the time the first building was built, that date all the way to the time the most recent building was built. They have a little bit of everything, and across that little bit of everything lies a lot of complexity. For a while, the answer was, we’re just going to throw our hands up because this is too hard to get our heads wrapped around. Now it has shifted into, we have to start somewhere, so let’s put a stake in the ground and let’s start pulling the thread through it.

It’s a hard problem, especially in healthcare. Healthcare is different. A lot of it is because there’s a lot of legacy systems with a lot of legacy information that’s really, really important, but that weren’t designed to protect data the way it’s expected to be protected today.

How do you see that situation changing over the next 3-5 years?

The concept of data and sensitive data is at the core of both security and privacy. The next thing that goes around that is, what is the definition of sensitive as it pertains to privacy? Then also, what is the definition of identity as it pertains to security? I think that recognition is starting to happen, where people say, it’s not a matter of if I’m going to be breached, it’s a matter of when. The perimeter is not going to hold, so when they get in, what are they going to be able to do, and what are they going to be able to find? That gets back to the data part of the question.

People are starting to move in the right direction. They are starting to say, I need to get a handle on my sensitive data footprint so I know what the threat surface is. Then when I am compromised, I know what has happened or is happening and I can minimize the risk. I think you’ll continue to see over the next 3-5 years more and more efforts with a data-centric look at the overall infrastructure and security. That will spawn privacy. You cannot have privacy without security, but you can have security without privacy. We are already seeing that in how people are talking and thinking about how they are leveraging systems. It’s getting more and more prevalent.

Do you have any final thoughts?

When it comes to security and privacy and all the drama and all the noise that you hear about it and read about it, just boil it down to this — am I doing everything I can today to protect what matters most to the constituents I serve? And what matters most to them is their individuality. Recognizing that you hold the digital versions of those physical selves and treating those digital versions as you would treat the physical one is just as important, so make it personal.

HIStalk Interviews William Febbo, CEO, OptimizeRx

November 11, 2020 Interviews No Comments

William J. “Will” Febbo is CEO of OptimizeRx of Rochester, MI.

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Tell me about yourself and the company.

I’ve been the CEO and director of OptimizeRx for the last five years. I have 20 years experience in health technology. More specifically, I always find myself drawn to the challenge of connecting the life science industry with healthcare providers like doctors, both clinically and commercially. I focus on technology, data, and compliance as the key drivers.

OptimizeRx is a digital health platform that focuses on bringing adherence and affordability solutions to healthcare providers, patients, and the life science industry. We are publicly listed on the Nasdaq.

What are the ethical considerations involved with presenting sponsored product information to physicians within their EHR workflows?

We are highly focused on that. Our goal is to help drive positive patient outcomes by supporting patient affordability and overall adherence to doctor-recommended treatment plans. The doctor is driving the bus here, and anything we do is going to be triggered by activity the doctor is doing.

The market is fragmented. Doctors use electronic health records from many companies and spend hours a day on them. The last things we would want to do is add more clicks and distraction that would slow down their day and or bring content that’s just not relevant to that point-of-care experience.

We have a strong filter. Our partners have a strong filter. When you are trying to help patients and doctors with affordability and adherence, it’s really about connecting at the right time with the right people. There are certainly rules that apply. Compliance is a big piece for me when you’re trying to help in this arena. We understand that incredibly well, as do our EHRs who manage all the data. We have several filters layered in there, plus laws, and we respect them all greatly. We are helping the doctor prescribe what they want, then helping the patient afford that based on the insurance they have.

The other piece of the equation is that once people have their medication, how do you help them stay on it? We’re a big believer in SMS text as a way to stay connected to the patient once they have double opted in on that. We see compelling results when they make that choice. They are always given the flexibility to not engage or to stop being engaged.

How do you decide the best opportunities to pursue now that you have created the network and are engaging participants in it?

We have a team that has a lot of depth in terms of the life science industry, as well as the technology around networks. We focus on is the patient journey, the care journey, that we’ve all experienced personally. It sounds like industry talk, but you feel something, you go to the doctor in various settings, you’re then in the system through diagnosis and prescription, and then you pick up medication or have it delivered. We focus on the pain points for our clients, the doctors, and the patients along that journey. If we don’t meet those three criteria, we just don’t do it. 

This is not a pure advertising model. This is a model where the life science industry can bring messages — mostly clinical in nature, mostly unbranded — and give the doctor some information at a time when they’re thinking about a particular disease or therapeutic area. Then as the patient is leaving that setting, we want to be able to stay with them and help them understand and afford the medication treatment and to have the support be there. It’s through a mobile device and chatbot, which sounds like it isn’t real, but it’s better than being alone and often that additional support is what keeps people on the therapy the doctor has selected.

How do you connect your innovation lab to the folks who assess market need?

The innovation lab is really exciting. We partner with our channel partners, which can be an EHR, someone at point of dispense and retail pharmacy, or someone who does digital appointment scheduling. We focus in on those pain points. 

What has been exciting over the last few years for all of us — not just OptimizeRx, but other people in this space — is that we have both sides of the equation, the clients who can finance it and the users, providers and patients who are engaged and open to using these new methods of connectivity.

When I came in about five years ago, this company had one solution, which was focused on basically digitizing the co-pay and getting that to the doctor so they could enable it for a prescription after selection and help the patient. When we looked at all that, and we looked at our partners, we saw that there were just so many other solutions that we could bring that could address a pain point for the client, the physician, the patient, or all three. We focus on those at the innovation lab. 

We have in the recent past rolled out a hub-enrollment forms, which is in-workflow digitized, which is a pain point for physicians, anyone in the administrative side within a physician’s office, and the patient. It simplifies the paperwork process and the signatures required to process hub enrollment for a specialty medication.

We’ve also rolled out something called TelaRep. This came out of the disruption that the life science industry saw with their sales reps. Physicians can, within the workflow of the EHR, reach out to a sales representative with a question. They can do that by text or email, saying give me a call or they can do it actually through a telehealth type of video type interaction. We are really proud of that one because it, first of all, we had the technology, so we went to the innovative lab partners and said, look what we can do. Pharma had a real challenge with reps being at home, but doctors still have questions. If you look at the number of questions doctors had that went through the MyViva program and others, it’s exponentially higher. It showed that reps answer a lot of questions for doctors, around dosage, mostly. 

Those are two examples of solutions that came out of the innovation lab, where we’re close to the partners. We could talk to the clients and we could launch them all within six months, which we are very proud of.

What motivates EHR vendors to give you access to their workflows?

They are focused on their members. Helping doctors deliver care. Having the right tools to do that, to effectively try to spend less time on the EHR and more time with the patient. When we bring solutions like TelaRep and hub enrollment, it’s clear that that’s a tool for the doctor. That’s a pain point.

The other things that doctors have highlighted to the EHR partners is financial burden and any way you can bring those costs down. Patient education is another one. Prior authorization is another pain point that companies like CoverMyMeds address. We focus in on those pain points, and our partners know those pain points even more than we do because they hear from their members, the physicians. It’s a good filter test to not bring things that wouldn’t work for the doctor.

How has the pandemic changed the use of your product?

The life science industry has billions of dollars set aside for co-pay programs. We saw an increase in demand and awareness for that given the disruption in the economy for people. We also focus on specialty medications more than the gen meds, and while gen med certainly dropped because office visits dropped, you can’t go off specialty medications. You really have to stay on them. 

We saw our partners who didn’t have telehealth solutions immediately adopt it any way they could just so that they could keep a sidecar to the EHR, keep that connectivity going. We were impressed with how that was handled by everybody, because that’s a behavioral shift. Adoption rates were relatively low around telehealth and they went immediately high because they had to. The good news for everybody — patients, doctors, industry, and our EHR partners – since it is an efficiency all around. It should save time and money and keep care going through times of disruption.

Are you receiving inquiries about how your platform could help with distribution of a potential coronavirus vaccine?

When this pandemic hit in February for all of us here in the States, we as a team obviously immediately went to no travel and stay at home, like everybody. But we said, let’s make our technology available for doctors and patients for CDC alerts. Let’s just do that. Let’s not charge anything, let’s just do it for free. That’s our way of helping in a small way and it felt really good.

We immediately put those CDC alerts into the workflow for our partners. Doctors were able to see them. We allowed patients to set up an SMS text program for free, which is still active. I view the short term in a similar format. We have an opportunity to help our clients get to those targeted populations of patients that are going to be needing to take the vaccine first.

This is not going to be a rollout for everyone to take it. The CDC will segment the market, find those in need, and go to there first. We think we have a great position to help our clients through that network and we stand ready to do it. Some of those conversations are starting. Obviously we all were thrilled to see the news from Pfizer this week. I think we’ll see others, but there’s still a lot of logistics between today and when they would need to communicate to the HCPs.

This week’s earnings call had a lot of enthusiasm and momentum that struck me as being more genuine that I sometimes hear. You’ve made a couple of key acquisitions, are using your innovation lab, and your product is doing well. Where do you want to take the company in the next several years?

We are small enough to be incredibly sincere. As you get bigger, it does get a little harder, but culture is big and we’re all in it to help outcomes and build a business.

We cited a McKinsey study that found that nearly 70% of US consumers use an online channel to manage health and wellness. Over 50% of US healthcare providers are digital omnivores who use three or more connected device professionally. I think of the network that we have already created and how we are expanding into retail and devices connected to medical professionals and patients. 

I see us as becoming a preferred digital communication platform for life sciences, principally patients and doctors, while being focused on affordability, adherence, and a little bit of care management. We are very fired up to get this kind of behavioral shift, which a lot of marketing dollars can’t even buy. Something has to push the shift.

I’ve been in the industry for 20 years and pharma is incredibly innovative clinically, but cautious commercially. We are at a stage where a lot of the digital solutions combine data-driven insights, compliance, and transparency, and those are matching nicely with the devices we all carry and use and our expectations for them. We do our banking. We do our shopping. Why wouldn’t we manage our health there? It makes for an exciting next three to five years as we try to reach more physicians, reach more patients, and help our clients drive outcomes.

HIStalk Interviews Carm Huntress, CEO, RxRevu

November 9, 2020 Interviews No Comments

Carm Huntress is CEO of RxRevu of Denver, CO.

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Tell me about yourself and the company.

I started RxRevu about eight years ago. I have about 20 years of early-stage startup experience. RxRevu is my first endeavor into the healthcare or digital healthcare space. 

The company has been focused mainly on drug cost transparency to providers for most of its history. It’s an exciting space and a lot is happening, both with our customers and even at a regulatory level.

What outcomes can result when a patient arrives at the pharmacy where their prescription was sent electronically and they’re told it will cost $200 instead of the $15 they expected?

When you look at the data, it’s pretty interesting. About one-third to two-thirds of prescription abandonment, depending on the studies that you look at, is due to cost. That’s only getting worse now with consumer-driven healthcare.

When you think about adherence, when you think about getting the patients on the medications and keeping them on the medications that are so important in terms of driving positive outcomes, cost is the biggest thing. A lot of the work we do is focused on preventing that sticker shock at the pharmacy, which leads to abandonment and the patient not taking their medication.

It’s harder to be a savvy consumer with electronic prescribing since you have to choose the pharmacy upfront without knowing the prescription’s cost, then extra work is required to send it to a different pharmacy that perhaps has a better deal. How does your system improve that situation?

We identify that as a major issue today. If the prescription is already gone to the pharmacy, the consumer really doesn’t have much choice. What we realized is there’s this point of shared decision-making at the point of care between the provider and the patient before the script is sent to the pharmacy. That’s a really important point as they are making that decision.

RxRevu works directly with the payers, pharmacy benefit managers, and insurance companies to bring real-time cost transparency to that point of prescription, that point of shared decision-making between the provider and the patient. As the provider is prescribing, we’ll show the cost of that drug at the preferred pharmacy of the patient. We will show lower-cost therapeutic alternatives.

We will also show drugs that have less administrative overhead, both for the provider and the patient, in terms of time to therapy, such as a drug that requires prior authorization that will take time, but there’s a preferred therapy from the patient’s insurance company or PBM that does not require a prior auth. The provider can simply select that and route the prescription to the patient’s pharmacy.

The last thing we do is show alternative pharmacies. Maybe it’s mail order, or there’s a better opportunity for the patient to save money just by going to a different pharmacy in their network. We will show that as well. 

Our goal is to bring that individual patient cost transparency around their drugs to the provider at the point of care, so both the provider and the patient can make the most informed prescription decision.

Does it benefit the prescriber as well since they can not only prescribe the most cost-effective therapy, but also avoid the extra work of issuing a second prescription or sending the original one to a different pharmacy at the patient’s request?

We are, so far, one of the rare tool that providers really like. Out of all the surveying we do, we get very high marks on, “This is really valuable information that I’ve been looking for.” There’s been a lot of distrust, when this information was static and not real time, and now we can provide it real time on a patient individual basis. The number one reason coming back from providers is that while it takes maybe a few more seconds to look at the cost information and make a better-informed decision, reducing the headache of pharmacy callbacks and patient friction in getting them on therapy and keep them on therapy is a huge benefit to providers.

That saved time means a lot for them and their clinical staff. Statistics show that it costs about $15,000 per year for a doctor or their clinical staff to manage prescription administration, such as prior auths, pharmacy callbacks, and those types of things. It’s a pretty costly administrative thing. We are trying to cut that off by getting this information front of the doctor upfront so that all these issues that we’ve talked about have been sorted out prior to the patient getting to the pharmacy to pick up the script.

What were the integration challenges involved with collecting real-time information from insurance companies and pharmacies and then inserting it into the EHR workflow so that it is actionable?

It’s a challenging two-sided market, and very hard to set up. On one side, you have to set up the direct connectivity between us and the PBMs, the pharmacy benefit managers, to bring real-time cost transparency into our network. There’s many of those that we have to connect to. We’ve connected so far to about 150 million insured Americans and our network continues to grow. Our hope is that eventually we’ll have complete coverage in the US, and there’s some good things coming, from a regulatory standpoint, that will help us achieve that.

On the flip side, once you aggregate all that data, you have normalize it and standardize it so you can provide it to the electronic health records. Today we are partnered with Epic, Cerner, and Athenahealth, which arguably are the biggest ambulatory providers in the US. It’s integrated directly into the electronic health record and the prescribing workflows. That’s a big challenge in terms of making sure that the integration is done well and is part of the workflow.

We have focused heavily on the prescriber experience and making sure that it’s really in line with what they are doing today. If the doctor has to go out to a portal or another service, they don’t use it. They won’t take the time. We wanted to ensure that this is part of their workflow, so that as they are ordering the prescription, they can see this cost transparency information.

It’s occasionally cheaper for the patient to pay cash instead of using insurance, especially if they have a discount coupon. Can you detect those situations where they will pay less by not using their insurance?

We look at all sorts of discount cards, things like GoodRx. What we found in our research is those discount cards are only beneficial about 5% of the time compared to a patient’s co-pay. There are certain situations where the drug is not covered, or other situations where a discount card may be beneficial, but the truth is that while insurance is getting more expensive and co-pays are going up, it’s most beneficial to get on whatever their insurance is. Where there are cost-saving opportunities, there’s usually a therapeutic alternative or lower-cost preferred drug in the same class that would be significant in terms of savings to the patient. They’re just unaware of that, and so is the provider, and that is the information we are providing. That can lead to significant savings to the patient.

Who pays for your service?

Whoever the risk-bearing entity is that covers the pharmaceutical costs. In this case, most of the PBMs and payers we work with cover the cost. We offer this free to providers across our entire footprint. A provider using Epic, Cerner, or Athenahealth doesn’t  get charged for this and it’s part of their workflow. We want to save money for the patient and the insurance company.

How does a physician or group connect?

A small practice might be running Athenahealth, which is a cloud-based EHR, so we are automatically turned on. The providers don’t have to do anything,. We are enterprise deployed across the entire Athena footprint.

In the case of where the health system is running an on-prem instance of the EHR, which has happened a lot more in Epic, we have to come in and do about 10 hours of work to install our network into the electronic health record. It’s not too much overhead and is pretty easy to do compared to the value you get from turning us on.

What role do you see for the federal government in prescription pricing and transparency?

There is now a 2021 Part D mandate to require cost transparency for payers and PBMs that support that market. That has been huge in growing our network as more PBMs provide this as a service. We think those mandates will expand and potentially lead to provider mandates, where they will be required to have this information available to them in the EHR over the next few years.

Our hope is that this will drive a bigger discussion about cost transparency across all services, so that just like any other shopping experience that we have in our life where we know the price upfront, we can get that for prescriptions, but all services. We are one of the leading indicators of the value of this because our payer and PBM partners are seeing significant ROI in terms of cost savings to both them and their members, as well as reduction in administrative overhead in terms of prior auth and other administrative things they face with prescription drugs.

Why did so many large health systems invest in your Series A funding round?

I think there’s a couple of reasons. The first is their identification of the administrative burden and time that their providers spend managing prescriptions and the benefit they saw in having cost transparency at the point of care.

Secondly, this is helping them move into value. If you think about the push in healthcare towards value-based arrangements –ACO, fully capitated, or shared savings — prescriptions are a critical part of that success. If they have to take prescription drug risk, this type of service, in terms of having cost transparency, is critical.

Also, because cost and adherence are so tied, they want to make sure they get the patient on a drug they can afford, because that is the biggest thing that drives outcomes and prevent things like readmissions.

That was a lot of the driving force behind health system interest in working with us and having this type of technology embedded in their health systems as they move to risk and to better manage their labor costs.

Where do you see the prescription transparency movement as well as your company moving in the next few years?

We will see a pretty broad expansion of cost transparency services across all payers. I think it’s obvious that we can’t really measure value unless we know what things cost. We have proved, at least in the prescription drug space, that having this information leads to better-informed decision-making by providers and saves significant money to the payers and PBMs. The cost transparency movement is here, it’s here to stay, and it is only going to expand.

We are focused on helping providers make the most clinically effective decision that is both cost-effective and convenient for the patient. We are going to help providers, as well as patients, get that most cost-effective drug. We will support health systems as they move into value more aggressively and take on risk to optimize costs, especially around prescription drugs. Our fundamental belief is that the whole prescription drug value chain should be based on value and the outcomes that these drugs deliver to the patients who take them.

HIStalk Interviews Cary Breese, CEO, NowRx

October 28, 2020 Interviews 3 Comments

Cary Breese is co-founder and CEO NowRx of Mountain View, CA.

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Tell me about yourself and the company.

I’ve done a few startups in my life, insurance and database. I’ve always had an automation focus, using technology to automate things in legacy industries.

I started NowRx in 2016 with an idea of making the pharmacy experience better. The real question that always intrigued us when we thought of the idea was, how do you make it profitable? That’s where the technology comes into play. We believe that if you can focus and optimize all the operations, software, robotics, and logistics, you can create a profitable model that’s a full replacement for a Walgreens and CVS experience. That has been the goal, and we think we have created it. We have since expanded from the Bay Area into Orange County, south of LA, and Phoenix, Arizona.

How do you think chain drugstores have failed to meet consumer needs?

The dirty little secret in the retail pharmacy world — and I think there’s enough evidence there – is that they want consumers to continue to come into their stores. That has been their model for decades. That creates a disincentive with where consumers are moving. They are looking for more and more convenience. I can get a car to come pick me up in two minutes and take me wherever I want. I can get my groceries delivered. I can get my lunch delivered. But the retail pharmacies don’t like that model. They want to have you come into a store for an in-store pickup.

They keep the pharmacy operation itself in the back of the store. They fill 15,000 square feet of space with all other products under the sun, and that’s where the majority of their profits come from. There’s a misaligned incentive. It has been exacerbated even more during COVID, where customers and patients are realizing there’s got to be a better way than going to stand in line for essentially a commodity product at a crowded store and risk exposure to COVID.

We work with some hospitals as well. Since we’re delivering prescriptions all day long anyway, we deliver right to patients on the day of the discharge.They get all their outpatient medication delivered to their room before they go home. We can reduce readmissions and hospitalizations. We think we’ve moved the needle on medication adherence and better patient outcomes through better prescription management. People are less inclined to not take their medications because they didn’t go to the pharmacy, they were too busy, they didn’t have time. Maybe they lack access to transportation. Maybe they just forgot. We resolve all of those issues right out of the gate. Plus we have some patient analytics that we’re layering on top of that as well to do pharmacy-based interventions to target chronically ill patients and try to make a more convenient and more reliable refill and just medication-adherence procedures.

Walgreens and CVS deliver through third-party services, and mail order pharmacies, including Amazon’s PillPack, deliver to the patient’s door. Why is it an improvement to have a physical, licensed pharmacy doing its own delivery?

Mail delivery pharmacy has been around for decades. We’re not too interested in that space. We think that works well for certain patients. Chronic meds are not urgent, and the 90-day fill can be a convenience.

But if you notice, mail delivery has been around for 20 years, as in Express Scripts and Caremark, but it hasn’t made a huge dent in retail pharmacy. Retail pharmacy is still the preferred model for many customers, particularly for medications that don’t necessarily fit a mail order delivery, like antibiotics that you need today, pain medications, or when your doctor changes the medication dosage and you need to get it refilled. All of those needs exist today and are a big pain point for customers. We believe that the right model is neither retail, which requires a patient to come into a store, or mail delivery. We see there’s a optimal model in between those two that picks the best of both worlds.

We use DEA-licensed pharmacy facilities. We call them micro fulfillment facilities. They are like the operation of the pharmacy inside Walgreens or CVS, but just the pharmacy part in the back. We take that out and put in a warehouse. We put it local to customers in their communities, within 10 or 15 miles of any patient that we serve. We do all the same things that a full-service pharmacy would do. We have pharmacist consultations over the phone, text, or video chat. We have technicians. We have our own inventory in those micro fulfillment centers. Everything is delivered right to the patient same day.

For a patient, they get the same-day service they would get from a regular pharmacy. We can do all the chronic meds and refills that a normal mail order pharmacy would do as well. We can do all of that and bring it right to your house, free of charge. You just pay your normal co-pay.

Inside the pharmacy, we take the best out of the mail-order pharmacies — the technology, the automation, the robotics, and all of that streamlined software. We built our own pharmacy management systems. We’ve been awarded the White Coat Award by Surescripts as one of the most accurate pharmacy management systems in the industry. Through that automation and our logistics, we believe that we can build a better solution for patients, taking the best of the other two models that are available.

How is chain drug store technology inadequate and how have you improved it?

I’d like to say that there’s more to fixing retail pharmacy than just adding delivery. That’s one of the problems we see, which is adding a third-party delivery service. You mentioned using Instacart or some other third-party delivery company. It doesn’t really fix the bottlenecks that are inside retail pharmacy, which we think are the key.

You have someone counting out pills, typically manually in a CVS or Walgreens. You also typically have a fairly antiquated software system that gets errors from insurance companies. Patients usually have to stand on line. There’s someone behind the counter on the phone waiting for 20 minutes to talk to the insurance company about how to resolve the claim. You can manage all of that with software.

Our software also connects with physician offices electronically. We have two-way communication. We get electronic prescriptions in, but we can also coordinate refill orders going back out. We also coordinate with the insurance companies. Then we have our own logistics.

Fixing those bottlenecks can make this a much more efficient process. The mail order pharmacies are  super high volume. They have far less labor costs per prescription because they’ve been able to automate. You don’t see that kind of automation in a CVS or Walgreens, so they don’t have enough money to spend on good customer service. They’re spending it all on all those manual processes and bottlenecks. That’s how we think we can fix the industry.

I assume that you would like NowRx to be valued as a technology company, but even with a closed-door pharmacy in individual communities, you still have to get a state license and hire pharmacists. How can you scale given the limitation of opening up individual, almost neighborhood-level pharmacies?

The key is the “almost.” It’s almost neighborhood-level, but it’s actually quite a much smaller footprint than a CVS or Walgreens that are, let’s face it, just about every two or three miles. I think Walgreens claims to be within five miles of every man, woman, and child in the US. 

We have far, far lower footprints than that. We have about one-twentieth of the required footprint compared to a CVS or Walgreens. We cover a much bigger territory per one of our micro fulfillment centers. A 15-mile radius is about 10 or 12 times the radius of a typical CVS, which only draws about a mile and a half or two mile radius. Each of our locations is a third the size. We don’t need 15,000 square feet of retail space, we need about 5,000 square feet. We don’t pay as much per square foot. We pay about a third the cost per square foot because we’re in commercial space, not retail.

Add that all up — about one-twentieth the number of locations and each one is one-third the size and one-third the price – and you’re getting pretty close to 1% of the fixed overhead that the big guys play. That’s additional savings for us that drops rates to the bottom line.

I assume that the chains stuff their stores between the front door and the prescription counter with all those products because the margin on them is high. Can you make enough money from just selling prescriptions?

They do have more margin on those products. A typical CVS makes about 60% of their profit from the front of the store, but they’re paying a big cost for that. The fixed overhead is very costly in the retail setting to have all of that product. That’s why they want people in the store. That’s why their whole model is there. They have that retail space. It’s an upsell model. They want the impulse buys. They put the pharmacy in back to try to attract customers.

We sell a list of about 250 non-prescription related items. It’s much easier for me to warehouse that product. I don’t need fancy retail shelving. I can just stack it in my warehouse. We get the customer the same convenience they would have by having additional add-on items like vitamins, probiotics, cough remedies, or pain remedies, whatever they would need to add on to their pharmacies. We don’t add so many products like back-to-school supplies or beauty aids, or I even saw tennis balls at my local CVS. We don’t go down that path. But vitamins, pain relievers, cough remedies, and things like that, we do offer today. It is a higher profit margin business, and it’s very easy for us to keep in the warehouse and add into a bag that’s heading out for delivery.

Telehealth has a last-mile problem where the online visit still requires a trip to the drugstore or lab. Can that be improved?

I couldn’t agree with you more. We’ve always been big believers in telehealth. The stat I like to use is that 70% of physician appointments result in or involve a prescription medication. You are exactly right — it’s kind of ridiculous to expect a patient to have an online meeting with their physician and then be expected to get out of their pajamas and go down to CVS. We think we’re a critical component to the telehealth movement, which will is going more and more mainstream now because of COVID. We are really excited about that.

In fact, we have some additional technology offerings that are going to dovetail right in with the telehealth platform, including feedback to physicians in a portal that gives them real-time updates on the prescriptions and if they have been delivered. Did they hit the insurance plan, or does it hit a prior authorization? Do we need to do an alternate prescription? We coordinate with that physician. Then you start to have a powerful combination of collaboration between the physician, patient, and pharmacy to drive better care.

I think of all these third-party delivery services driving around to individual houses bringing groceries, takeout food, and prescriptions. An individual business, like a restaurant, might work with several of those services. There seems to be a lot of inefficiency in making multiple trips to the same front doors. Could there be a point where someone creates a Post Office-like network that does white-label delivery from any company that wants to hire them as a courier?

It’s theoretically possible, but pharmacy is so complex. There are regulatory concerns. There are patient privacy concerns.

We always felt like from the very beginning – and we’ve been even more strong in our beliefs as we’ve moved along the last few years — that the best way for this industry to provide this kind of customer experience where you’re fully remote and everything is delivered is to own the delivery stack yourself. You have your own employees of the pharmacy that are the drivers. We can background check them. We can drug test them. We check their driving. They’re branded NowRx. They wear the NowRx shirts. They are in branded cars.

The patients get a level of comfort seeing the drivers pull up. Many of these patients that are on recurring medications see the same driver month-in and month-out. They’re on the same routes. There’s no privacy issues as far as coordinating refills and who owns the patient file that you would run into with a third-party delivery service. We handle narcotics, so we deliver all kinds of medications, including Schedule II narcotics. That’s very difficult to do if you’re a third-party delivery company and trying to make that work. We’ve always come down on the side of, let’s make the best customer experience that we possibly can, make it as seamless as possible, and make it as a complete of a service as we can. To do that, you’ve got to own your own drivers.

Chain drugstores have tried multiple concepts to get more sales per square foot out of their physical footprint, sometimes launching their own services and sometimes contracting them out, such as with urgent care and lab access centers. How will that play out over the next few years?

Our original hypothesis about this space is right. The big chains are going to keep doubling down and try to make a retail model work. They have too much invested in all that retail space.

You look at the recent announcement about a month ago. Walgreens acquired a company called VillageMD, which adds clinic services inside the retail stores. Exactly what you’re saying. That confirms my hypothesis that they are going to continue to double down. They are adding reasons to bring customers into a store, and customers are looking for fewer reasons to go into the store, so there’s a misalignment there. 

In four or five years, you’re going to continue to see displacement of customers out of the retail, traditional brick-and-mortar model into these other modes. At some point, there is going to be a significant disruption. You touched on Amazon earlier — they might be a trigger point if they try to make a move. Right now, they’re doing mail order, but at some point, they’re going to try to move to a two-day delivery for pharmacy or maybe even a one-day delivery. That will put so much heat on the retail pharmacies that they will have to have a real heart-to-heart meeting with themselves to figure out how they can change their model to survive. 

Frankly, I don’t think the existing retail model will survive more than four or five years. I think consumers are going to pull away from the retail model. They want free, same-day and even same-hour delivery, and that’s where we’re going to end up.

HIStalk Interviews Paul Ricci, CEO, SOC Telemed

October 26, 2020 Interviews No Comments

Paul Ricci is interim chairman and CEO of SOC Telemed of Reston, VA.

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Tell me about yourself and the company.

I’ve been the chairman and CEO of SOC for about six months. Before that, I was the chairman and CEO of Nuance for about two decades. What brought me to SOC was the opportunity to accelerate the participation of the company in the exciting area of telemedicine and virtual care.

Telehealth usage skyrocketed, then tapered back off. What is driving its adoption?

COVID was an accelerant to a trend that was already underway, which was to take advantage of the efficiencies that virtual care and telemedicine offer for ensuring that we are matching patients with the best available healthcare that they can receive, independent of geographic proximity. We are focused on that in the acute setting, but it applies more broadly than that in the ambulatory, post-acute, and home settings as well.

What are the technology implications?

We serve the acute telemedicine market, so the consultations are taking place under high-acuity situations, such as a stroke victim in the emergency room or an emergency psychiatric visit. These tend to be high-acuity events. There needs to be a telemedicine specialist available with high predictability and with the requisite skills necessary to manage the consultation and provide quality care. In the case of a stroke victim in neurology, you would need to have a stroke neurologist specialist available.

The technology that is required to do that efficiently must rapidly access an appropriate specialist who is licensed in the state, privileged at the particular hospital, and with the requisite skills. That specialist has to be made available within a few minutes, with a high degree of confidence. The software and operational requirements to do that are quite demanding. It’s not really about the video link. The video link is the enabling transport mechanism for information. But it’s really about the software that fractionalizes and makes physicians available efficiently under these high-stress conditions.

Is it easier to address licensure issues since you serve specific clients in their specific locations?

You do have to address the problem of the appropriate licenses and privileging before the service goes live. But that is a significant challenge, and doing it 50 states compounds that problem. Building this kind of business at national scale is a complex operational task. That’s part of the value that we deliver to the hospitals we serve.

We’re starting to see telehealth services differentiate themselves, some offering clinical expertise and others just a platform, while some focus on remote monitoring or ongoing behavioral services versus low-urgency, episodic encounters. Are health systems offering new services through your services or are they augmenting what they were already doing?

There will be a heterogeneity of outcomes to the question you’re asking. Some hospitals will want significant coverage from a telemedicine solution, perhaps in entirely covering particular shifts or times. Other hospitals will want simply peak load support augmentation in addition to the existing resources they have, which might be their own resources or a third-party physician network. That mixture will evolve over time for a variety of reasons having to do with unpredicted scarcity, retirements, and peak demands that might occur because of prevailing illnesses. 

For us, we have built our business to be fluid with respect to that. Our software platform is agnostic to the source of the physicians, whether it’s our telespecialists, the hospital’s telespecialists, or the telespecialists they have contracted from someone else. Our platform is agnostic to that and meant to optimize under those heterogeneous circumstances.

How does the telepsychiatry service work with health system emergency departments?

Emergency rooms and hospital systems become backed up with patients who require psychiatric attention. There are strict protocols about how that has to be managed, and the capabilities and expertise necessary may not be available in the emergency room and may not be available through local staffing support. The backlogs within some facilities can become quite long, more than 24 hours, for example. Using telespecialists, we can help that facility significantly reduce their backlog, which is beneficial to the patient and beneficial to the facility as well.

What expectations have investors built into the high valuation of telehealth companies?

The market is anticipating that telemedicine is going to play a more significant role and that virtual care generally is going to play a more significant role in the delivery of healthcare services. As we look ahead five, 10, or 20 years, I think that is directionally correct. These companies, including ours, are being evaluated as having a significant growth opportunities within that growing market opportunity for the virtual provisioning of healthcare services, which has a number of benefits. It eliminates geographical inefficiencies and geographical restrictions. It allows optimizing the provisioning of very expensive scarce resources. It enables more data and analytics behind the delivery of the service, which over time will help to optimize service.

Can you describe the benefit of going public via a special purpose acquisition company or SPAC as SOC Telemed is doing versus the traditional IPO?

A SPAC is the merger of an operating organization, in this case SOC, into an investment company, in this case Healthcare Merger Corporation. By merging, the operating company SOC effectively ultimately goes public. That final event occurs, in our case, in a few days.

The advantages of doing that were twofold. One, the Healthcare Merger Corporation came with leadership with deep skills in the healthcare field. In particular, the CEO of Healthcare Merger Corporation, Steve Shulman, has a long history in the healthcare industry and is going to become the chairman of SOC.

It also brought a second benefit, which was that in a relatively short period of time — we announced the merger in July and will be consummating the transaction at the end of October — it allows access to capital, and SOC needed access to capital to prosecute the growth opportunities that are available for it in the market. Management expertise and capital for growth are really the advantages.

What lessons did you learn in your long career with Nuance?

There were lots of lessons over 18 years of Nuance. But the ones that in the end mattered the most were that if you have a big vision, stay focused on that vision and the mission of what that vision entails, assemble a great team, and pursue it with urgency and speed, you can get a great deal done. That’s really the story of Nuance.

We didn’t know when we started all the various avenues that would become available to us, but we worked incredibly hard. We took nothing for granted. We had a team that worked with a great deal of solidarity. We had an expansive vision about the ways in which speech and natural language could change the ways people engaged with information systems. All of that came together. We had a little luck along the way, of course, and in doing it, we affected some significant changes and built a great company with terrific associates.

Where do you see the SOC Telemed moving in the next few years?

SOC will be the leading provider of acute telemedicine services. The prediction that as much as 20 or 30% of acute healthcare can be done through virtual care and telemedicine is probably reasonable. Therefore, it’s an expansive opportunity.

The company will continue to build deep expertise in its existing specialties of neurology, psychiatry, and critical care, but it will grow and it expand into other specialties as well. It will increase the technological content of its solution, perhaps through the incorporation of more predictive analytics, incorporation of some AI capabilities, more sophisticated workflow, and integration into other aspects of clinical technology systems. All of that will continue to evolve over the next five years. SOC Telemed will be a leader and a visionary in doing that for acute settings.

Do you have any final thoughts?

The virtualization of healthcare is going to represent a significant opportunity for making healthcare more efficient and improving the quality of outcomes. SOC is proud to be a part of that because it will be a significant move toward the increased digitalization of healthcare.

HIStalk Interviews Darren Sommer, DO, CEO, Innovator Health

October 21, 2020 Interviews No Comments

Darren Sommer, DO, MBA, MPH is founder and CEO of Innovator Health of Jonesboro, AR. He is also an assistant professor in the Department of Clinical Medicine at NYIT at Arkansas State University, a lieutenant colonel in the US Army Reserves, and served two combat tours in Afghanistan in Operation Enduring Freedom as brigade surgeon for the US Army’s 82nd Airborne Division, 2nd Brigade Combat Team, where he earned the Bronze Star, Combat Medic Badge, and Combat Action Badge.

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Tell me about yourself and the company.

I’m an internal medicine physician. My origins in the telemedicine space came after deploying to Afghanistan in 2007. I had trained at a suburban hospital in the Tampa Bay area, but was then exposed to some unique pathologies being in a third-world country. The Army had a very good communications infrastructure that allowed me to connect with people around the world.

I used that as the foundation for thinking about how we can use telemedicine to serve and support our rural communities here in the United States. It was a glaring gap for me that the main telemedicine systems that are in existence today, and definitely those at that time, were created for another purpose and then repurposed for healthcare. It was difficult enough to have a conversation in the room with a patient about a diagnosis of cancer, HIV, or Mom’s dementia. It was almost impossible to do that with the existing technology. 

We set out to create a platform that would allow us to be at the patient’s bedside, in life-sized form, in 3D, and with direct eye contact, so that the patients felt like we were there with them. That was the origin of Innovator Health.

Now that we’ve quickly broadened experience with telehealth, how can doctors approach video visits in a way that is more acceptable to patients?

It’s funny, because if you ask 10 doctors how they define telemedicine, you’ll probably get 11 different answers. Most physicians look at telemedicine as just a two-way video conversation. Many of the health systems during COVID used basic Zoom-like technologies to connect with patients. When I talk about telemedicine, I talk about patients in a hospital environment, using medical instruments for diagnosis and treatment, access to the electronic health records, and sophisticated care delivery for telemedicine services. It’s different than how the rest of the market is looking at it.

Does clinician personality type play a role in their success in virtually connecting with their patients?

Good bedside manner is important, regardless of where you are in relation to the patient. I can be physically present in the room with a patient, not look them in the eye, not answer their questions, look at my watch, not allow them to feel at ease, all while being physically present. That’s not going to be a good experience for the patient.

On the contrary, I can be on the screen, be attentive, focus on their questions and answers, interact with their families, provide them the help they need, and have a great interaction. I’ve had many patients provide exceptional comments on the satisfaction that they’ve received from the care we’ve delivered through the telemedicine system in ways that I’ve rarely seen colleagues get in person. So I think it’s much more about how you interact with the patient as opposed to where you’re interacting from.

How do rural areas address the issues of having few doctors and limited connectivity?

My interest in the rural community is because it’s the area that has the greatest need. Look at the evolution of healthcare over the last 40 or 50 years. If I had graduated from residency in 1970 and moved to rural community, I most likely would have been able to do almost anything in that community — minor surgeries, delivering babies, primary care, and a host of things. Over the last 40 or 50 years, as we’ve evolved clinically as a profession, we’ve gone from just a few specialties to almost 100 specialties, and the ability to provide a broad range of services has become more limited. Hospitals don’t have the range of services they did 20 or 30 years ago. That means people in rural communities have to actually physically leave the local community and drive to an urban area to receive care from a specialist.

Many of these services could be provided virtually. Even take surgery as an example. You could have a preoperative visit, where the surgeon talks you to them about your case. You could make a trip into the city, let them examine you, figure out exactly what’s going on, have a follow-up visit before your surgery, have your surgery in the city, and then do post-op visits back in the local community. I look at it as a spectrum of capabilities that exist in combination.

These rural community hospitals are extraordinarily important. They are typically the largest employers. They bring in a lot of revenue. From an economic perspective, most businesses are not going to invest in putting plants or businesses in rural communities if there’s not access to healthcare for their employees.

We have about 1,500 of them across the United States. They make up about 25% of all the hospitals in the US. Without them, our healthcare would be in a worse shape than it is today. Having access to these hospitals is important. I feel like it’s our mission see what we can do to bring high-quality healthcare.

From a strategy perspective, as it relates to the low bandwidth, we understood early on that bandwidth is going to be limited regardless of where you are. There are always limits in bandwidth. It’s less of an issue in big cities and big hospitals, but if we’re going to make a difference in communities, we had to make sure that the communications interactions are going to be good. 

We focused on creating a low-bandwidth system, and the team at Metova was excellent in helping us create that. That has served us well, because as we have conversations with health systems, some outside of the geographic United States, one of their main issues in being unable to provide telemedicine services for COVID patients is limited bandwidth. That’s as much a part of what we do as the interpersonal parts.

The patient’s experience is also driven by factors that are outside the provider’s control, such as the device form factor, bandwidth, their location, and falling back on audio-only visits because of technical limitations. How can those be managed?

Anybody who is looking at setting up a telemedicine program that will serve rural communities or people in their home has to take that into account. They have to recognize that you may go into a 75-year-old widow’s home in a rural community that doesn’t have fiber broadband connection and that may have only one cell phone provider in their community. Recognize that if you really want to make a difference for that patient in that community, you’re going to have to take those things into account. Hopefully the vendor partner that they work with will help them to work through those types of ideas and thoughts. 

One of the things I noticed very early on in this industry was that there are a lot of telemedicine systems out in rural hospitals that aren’t being used. It was like a treadmill. Someone says, I want to get in shape, so I’m going to buy a treadmill. They take it home, set it up, put on their athletic clothes, and they start walking or jogging. They got hot, sweaty, and tired and they realize it was a lot more work than they thought. They fold the treadmill up, and then a year from now, it’s a clothing rack. Many hospitals have dusty telemedicine systems sitting around that have not been used since they were rolled into the room. A lot of it has to do with not being aware of some of the challenges that exist, which include bandwidth for providing these services to patients.

Why have telemedicine visit volumes dropped after lockdowns ended?

A lot of the telemedicine that was being done during the lockdowns was really just Zoom calls. They were not full-fledged telemedicine exams. I think a lot of it has to do with the fact that physicians still want to be able to not only see their patients, but be able to take vital signs, do exams, and listen to heart and lung sounds. That really wasn’t in play a whole lot during COVID. The other part of it is that there is still some lack of clarity as to the volume of visits that are being done today. I’ve seen varying numbers. 

People are still trying to learn and figure out how best to do it. They’ve made some headway in using telemedicine, but there’s still a lot of resistance. If we talked about telemedicine last year at this time, only about 25% of physicians in the United States were doing any form of telemedicine, and less than 1% of all visits in the US healthcare system done last year were done by telemedicine. So there is still a strong lack of real knowledge and understanding about how to put a program together, and what we are really saying when we say we’re doing a telemedicine visit, going back to whether it involves full diagnostic capabilities or just two people talking about their health issues.

What is your reaction to investor enthusiasm about telemedicine-related vendors?

Telemedicine was first listed in the medical literature in 1974, if I remember correctly. It has been around a lot longer than people think. Companies like Teladoc and Doctor On Demand have been able to commoditize a service that has always been available to most people. Ten years ago, if you had a family doctor and weren’t feeling well on a Friday night, you had the ability to call the office. The on-call doctor would talk to you, ask you about your symptoms, and call you in a prescription for an antibiotic. If you didn’t have a doctor, you didn’t have access to that service. 

Having a Teladoc or Doctor On Demand allows everybody to have that capability, so that when they need something, they can make that phone call. They found a way to turn that into a business, but that’s a very small percentage of all the healthcare service that we are providing today. Acute care is about 20 to 25% of the total visits being provided in the US healthcare system, and there’s only so much you can do when you’re just having a conversation with a patient about their healthcare. You can’t get vital signs. You can use the camera to look at a rash or at the back of somebody’s throat, but there’s a lot of variability in lighting, motion, and distance. 

If we’re being honest, most visits, even through those types of companies, are probably being done without the use of video. The vast majority of those are done just by having a conversation with the patient, understanding what their complaints are, and then talking about how to manage it.

Are you concerned as a physician that primary care, especially in young adults, has turned into episodic, as-needed encounters via video or urgent care centers?

The market will have to correct itself on that. People will overuse this capability, bad outcomes and customer dissatisfaction will result, and people will steer away from it or demand a better service or outcome. That will drive the change. That’s probably natural and inherent in all types of businesses and economies.

For me personally, I’ve always tried to focus on the clinical standard of care. If we can provide that through telemedicine technology, then we will, and if we can’t, then we won’t. We’re not going to do anything that won’t deliver the same level of care and service virtually that we would expect in person. Having that as a standard has served us well.

For quite a long time, we were the only physician-led telemedicine company in the country. Most all of these other companies are led by some type of executive that’s not healthcare oriented. In many companies, if you go and you look at their “about us” page, even in the telemedicine space, you’ll scroll down quite a way until you find an actual physician on their leadership team. That has a big part of the problem that we’re seeing

I was struck by a statement you made to an interviewer in which you said, “”In the Airborne, they drop you in behind enemy lines and you find a way to succeed or you expect to die.” How does the Army select or train soldiers who can succeed in that paradigm, and how has that influenced how you practice medicine and business?

The Airborne has evolved since its founding right before World War II. It created a legacy for itself about who and what they did that has extended through generations. Not everybody who’s in has the same mindset, and sometimes somebody is assigned to a unit who may not want to be there. But for the most part, the esprit de corps that exists within the 82nd Airborne Division is of the mindset that they understand that that’s their mission. Either you go in behind enemy lines and you succeed , or you face death. Having that experience and having the opportunity to work with warriors that have that same mindset changes the way that you focus and look at managing problems.

Now in my life, failure is not really an option. I focus on what the mission at hand is, and then any way that I need to go about it to succeed. Starting a company six years ago … you hear the stories of how hard it is and how challenging it is. I don’t think there’s any way to help anybody understand what that really means, because it’s a personal journey, but it is one of the hardest things I’ve ever had to do in my life. If it wasn’t for that experience and  training in that mindset, I might have given up. I’m very thankful for having the tenacity to tackle this without any thoughts of giving up.

Where do you want the company to be in the next 3-5 years?

We are not focused on gratuitous growth. We are completely privately funded. We have very deep relationships with our clients. We help them. Most of our growth has come internally from existing clients, doing a good job and then growing the company.

I still think the market is very immature. Although COVID has pushed us towards an acceptance of telemedicine, I see a lot of people still doing it incorrectly. We are in a phase right now where people are going to get the opportunity to try to do some telemedicine and they’re going to fail. They’re going to look to companies like Innovator Health to say, we hadn’t done telemedicine before COVID. We tried it during and after COVID. It hasn’t gone really well. We see the success that you’re having with a lot of these other health systems. Can you help us? We will be right where we want to be during that time to help them.

I’m quite comfortable being the biggest company that nobody’s ever heard of. Our focus is on making sure that health systems have the ability to reach out and connect with communities. We don’t want it to be about us. We want it to be about the relationship between the patient and the provider.

Do you have any final thoughts?

I appreciate the opportunity to share what we’re doing. People really don’t understand the capacity of what we have the ability to do until they actually see it. If someone says, this is interesting but I don’t think it’s right for us, then I would say they should definitely reach out and let’s talk.

From a “if I knew then what I know now” perspective about telemedicine, I always encourage people to try to do something. People talk about doing a telemedicine program, they try to set something up, then they try to do too much at once and they don’t wind up doing anything. Start a small project, learn and grow from that. You’ll see that in time, small projects will turn into something large and successful, as long as you take the leap of going out there and trying to get something done.

HIStalk Interviews Feyi Olopade Ayodele, CEO, CancerIQ

October 19, 2020 Interviews No Comments

Feyi Olopade Ayodele, MBA is co-founder and CEO of CancerIQ of Chicago, IL.

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Tell me about yourself and the company.

I started CancerIQ when making the transition from the world of finance into healthcare. I joined healthcare with an amazing co-founder, my mother, Dr. Funmi Olopade. She’s not only a great mom, but she’s a MacArthur Genius Award winner for her work in understanding the relationship between cancer and genes.

I was motivated to start the company after working with her at the University of Chicago and realized that her vision was for genetics to be part of routine care, but that was really only possible in some of the academic centers that have those resources. I’m all about democratizing access to what we believe is the most cutting-edge version of care. That’s why I left the University of Chicago to start CancerIQ.

To what extent can cancer be predicted using genetic profiles?

To a great extent. In fact, the first cancer gene that was identified was the BRCA gene. Despite us having known for 30 years that the BRCA gene causes breast and ovarian cancer, there has been unfortunately limited adoption of genetic testing. About 10% of patients who should be tested, even for the BRCA gene, have been tested. What’s also exciting is that they can not only understand your risks, but there are also well-defined clinical protocols that have been validated to help you reduce your risk, or eliminate that risk altogether.

Many oncology treatments aren’t pursued because of insurance or other financial issues. Does insurance cover the cost of genetic screening?

Absolutely. The insurance companies have done the math. It’s expensive to treat a patient, only to have them come back with a secondary cancer that you could have known about earlier. It’s also very expensive to treat somebody who has a predisposition and is going to get a more aggressive cancer, or get it earlier than standard cancer screening age, so payers have been willing to cover this testing.

What has held providers back is knowledge, workflow, and time. We’re solving those with CancerIQ.

What is involved in doing the screening and what kinds of providers can offer it?

Risk assessment starts off with the cheapest genetic test available, and that’s your family history. While it costs nothing to evaluate your cancer history, if you’re like me and have 31 first cousins, it could take a provider a whole lot of time. That’s one of the initial barriers that holds people back from this process. It’s time-consuming to see who meets the criteria for genetic testing, but it’s also time-consuming to fill out all the insurance paperwork to get coverage for it. 

In terms of the types of providers who can perform the screening, genetic testing was initially incurred in specialty care. Genetic counselors were given this responsibility, but unfortunately, millions of patients need this service and we have only 700 cancer genetic counselors. A number of professional societies encourage doing this kind of genetic evaluation, ranging from oncologists to OB-GYNs, who have been on the forefront of doing this in preventative care.

Can the screening be performed in a telehealth visit?

Absolutely, and that’s where we have seen the biggest traction, during COVID, when people are anxious about going in for their cancer screenings, CancerIQ is a mechanism by which providers can evaluate their patients remotely and give them peace of mind on whether or not they can afford to delay their cancer screening or determine if they must be prioritized to be screened earlier rather than later.

What would the trigger be that would suggest that an individual is a candidate for screening?

Pretty much every patient should get a CancerIQ at some point in time. What we see as the future of healthcare is being proactive and preventative. If we could know everyone’s risk by the age of 21 in the future, it could help with better, more personalized, or precision health recommendations so that people can get ahead of cancer.

Is there psychology involved in telling that 21-year-old that they are genetically predisposed to get cancer decades down the road?

I would say that 21 is probably a little early because there aren’t too many established guidelines that would change the way you’re managed at the age of 21. But that depends on your risk. If you are at an elevated risk and many people who have these predispositions will get cancer under the age of 30, then you should start some of these screenings under the age of 30. I don’t want to opine on when you should start, but what is exciting about the future of healthcare is that you could get a genetic evaluation at a certain age, and through CancerIQ, your provider can monitor and manage you over time.

An individual’s genetic makeup doesn’t change over time, but new research findings about the health implications of DNA are ongoing. How do you collect those new findings and reapply them to existing genetic profiles?

You hit the nail on the head. While your genetic data will not change, the interpretation of that data and the recommendations on how to address that predisposition will change all the time. In fact, they change almost quarterly. That’s why CancerIQ has a great, purpose-built use case alongside the EHR. At the end of the day, we are a content engine that can help interpret that information, not only for the provider, but to make sure that patient is getting the most up-to-date care.

What elements of patient engagement are involved in regularly reapplying that new knowledge to someone’s profile and then communicating any new concerns?

That’s where CancerIQ has differentiated ourselves as a solution that will manage a longitudinal relationship with the patient. We not only have provider features that provide clinical decision support, but we also have cutting edge patient engagement features that allow them to receive reminders and updates through the CancerIQ platform. Eventually we will make it so the patient can carry their CancerIQ from one place to another.

What are the typical steps in a patient journey in interacting with your system?

I’ll use the BRCA case because that’s probably the easiest for people to picture. When you check in to a provider visit from the comfort of your own home, you provide your family history. It’s a lot easier for you to recall the cancer in your family than for your provider to interview you to find it out, so we take that burden off the provider. If you are at elevated risk, we will generate some patient education for you and your provider will have a discussion about the need for genetic testing. That’s where your provider will be able to use the test platform to order testing from a number of our embedded genetic testing partners, where CancerIQ will ultimately facilitate the ordering of that test.

As I mentioned before, providers are being held back by filling out the insurance documentation paperwork. Patients who go through the CancerIQ experience are going to be working with providers who have a streamlined, easy way of making sure it’s covered by their insurance. They have peace of mind that they won’t really need to pay much out of pocket. When they get their test results back, they’ll get a personalized action plan based on their genetic testing results.

Some of those action plans could be things like getting a breast MRI in addition to a mammogram. In the COVID context, it could be that you were at the top of a priority list for someone who needs the breast cancer screening because of your level of risk and ultimately that early detection strategy isn’t something that happens once. As a patient, you’ll get a reminder every year that you need to get that breast MRI. Should the guidelines change, where they say, “Maybe we need to do one of those really cool blood detection cancer tests in the future,” CancerIQ will communicate that to the patient so that they ultimately have not only the most clinically valid options, but the best options for detecting cancer early or preventing it altogether.

Consumer DNA test results often surprise people whose blood relatives don’t necessarily match what they have believed, with unknown siblings or different parents than they were raised with. How useful is the self-reported family history compared to actually testing someone’s DNA?

The future of healthcare is going to be genome-first. Family history is what we had in place and is the earliest form of risk assessment. We of course continue to support that. But part of the real value in CancerIQ, and where we see the healthcare ecosystem heading, is that we will be able to do genetic testing on people, and we may reach to that first. But as we reach to doing the testing first, what will become more important is the interpretation of the testing, the clinical decision support, and a lot of the intelligence layers that CancerIQ offers. If you don’t know your family history, CancerIQ can still interpret that genetic data to get you the right preventative health care plan.

Most investors are older white men who, consciously or subconsciously, tend to fund startups that are led by founders who are like a younger version of themselves. How do you pitch the company for funding knowing that’s the case?

I always pitch my company in the way I know it will resonate with an investor. I started my career in finance and used to be an investor. To get over the hurdle of them looking for a younger version of themselves, I’ve always shown them data on the value of our company and the traction that we’ve made. We have demonstrated that we are extremely valuable to some of the best health systems in the country. We are data-driven in showing how we can increase their downstream revenue, detect cancer early, and even improve their cancer screening rates. I’ve always had to lead with data to overcome some of those biases. Once they see the incredible performance and traction of CancerIQ, it typically gets me to the next meeting.

What do you see happening with the company over the next 3-5 years?

I see the market growing, primarily driven by the science. We understand the correlation between cancer and our genes, but we’re also starting to learn a lot more about cardiac diseases and other chronic conditions. I see the company in the next 3-5 years meeting that need and expanding from CancerIQ to CardiacIQ and ultimately being able to support full genome-based care.

I also see this moving from something that is done only in specialty care to becoming part of a primary care visit. Decision support technologies and things that can offer artificial intelligence will be a huge part of what we do in the future.

Do you have any final thoughts?

CancerIQ is partnering with a number of the available HIT solutions. We started off point-to-point integrations to make sure that our data gets into the EHR. But we are excited, given that we are managing content and data information that changes, by FHIR interfaces and allowing the provider to feel like they are not leaving the EHR, but are still getting the benefits of CancerIQ in their workflow.

HIStalk Interviews Harjinder Sandhu, CEO, Saykara

October 12, 2020 Interviews No Comments

Harjinder Sandhu, PhD is founder and CEO of Saykara of Seattle, WA.

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Tell me about yourself and the company.

I’ve been working on artificial intelligence in healthcare for about 20 years, starting before it was cool to call it artificial intelligence. I transitioned from a role as a professor of computer science into entrepreneurship. A friend and I co-founded a company doing speech recognition and natural language processing in healthcare. We sold that company to Nuance Communications and I spent several years as the VP and chief technologist in Nuance’s healthcare division.

I founded Saykara a few years ago with the idea that doctors should be able to focus on seeing patients and that we can build AI systems that can capture what they say and automatically enter the pertinent data into the chart. That’s what Kara, our virtual assistant, does.

Healthcare encounters involve a complex, two-way conversation with minimal guidelines, structure, and length. What technology advances allow turning that conversation into encounter documentation whose accuracy is high enough to avoid manual cleanup afterward?

Two things. One is that we started out using a “human in the loop” model, which means that behind the AI is a person who will make sure that the system gets it right. Doctors get a good experience from Day One because the AI picks up a lot, but then humans not only help correct it, but also teach it.

The second thing we do is on the AI side. AI is advancing at a very rapid rate and our goal is to get to a solution that is purely autonomous, without any human in the loop. We are doing that by teaching our system how to recognize specific clinical pathways that are the subject of what the doctors are actually doing with their patients and start interpreting along those pathways. That helps a lot in terms of figuring out what the system should key in on at any given encounter.

How is that use of behind-the-scenes humans to correct and teach the system different from just hiring scribes?

In the short term, it may look very similar to the end user, where they get a clinical note or an order put into the EHR. In the longer term, as the system gets better and better, we can provide that same service at a much lower cost, but also go well beyond what a scribe would be able to do. Our system is learning to predict what’s happening in an encounter, to put specific nudges in front of physicians, and then along the way, we capture everything in the form of discrete data. We are able to populate and construct data in a way that is virtually impossible for people to do without a lot of effort and cost.

What does a typical patient encounter look like to a provider using your system?

There is no “one size fits all” for all providers. Different providers use the system very differently. But a typical experience would be that during the encounter, the physician turns on Kara on their IPhone app. They walk in, turn the app on to start listening, and then they just interact with their patient.

A lot of providers like doing what we call reflective summarization to make sure that the system captures the right things. They will speak, either during the encounter or afterward, to tell Kara, here are the key points that came up in this conversation or the things I did in the physical exam or in the assessment plan. They let the system key in on all of those things and make sure those are the core of what gets documented.

How does EHR integration work to get the information into the chart?

That varies a lot by EHR. Some EHRs are not geared towards capturing anything more than a blob of text as if it were from a clinical note. Others have granular APIs that allow you to take specific parts of what is being communicated and populate it, uploading diagnoses or other information that needs to go into registries. We find that the integration experience varies a lot, but we capture on our side as much detailed data as we can, then push into the EHR as much as the EHR is able to consume in the form of APIs.

What do users cite as the biggest benefit?

The biggest thing that our physicians say is that it eliminates pajama time. That’s the biggest thing that users want. Physicians are spending hours in the evenings trying to close their charts. We eliminate that almost across the board for all of our users.

Physicians like the idea that whatever they’ve done in that encounter, they can rely on the system to create very accurate rendition. Because we have humans behind the scenes helping the system and making sure it got it right, physicians get accustomed to the fact that the system creates very accurate information. They can mentally offload what they are doing and then move on to that next patient.

How long does it take from the first time a physician turns on the system until they feel that it is benefitting them?

Most of the time, it’s on the first day. A provider either types during the encounter, which draws their attention away from the patient, or they spend their evening time trying to close that chart. Their first note on the first day they start using the system will be highly accurate. Providers literally tell us, “This changed my life on Day One.” Largely because, all of a sudden, they found that they weren’t sitting there typing during that encounter or that evening they went home and they didn’t have those charts to do.

The value is very, very fast. And of course, behind the scenes, the AI is learning and getting better and more autonomous over time. That part takes time, but the immediate value for that physician is on Day One.

Having spent time at Nuance, how would you compare Kara to their ambient intelligence product?

Ultimately, we are trying to solve the same problem. The proof is what is happening behind the scenes and how intelligent the systems are getting behind the scenes, because Nuance also uses human scribes behind the scenes. We started four years ago at Saykara trying to solve the hard NLP problems to get the systems to be fully autonomous. We are on the cusp of releasing models that are going to be fully autonomous for specific pathways. The real distinctions are coming in the next little while.

Otherwise, doctors are oblivious to what happens behind the scenes. They just see a note that comes back to them.

We are training our system to do a lot more than clinical notes, such as clinical guidelines, coding, providing nudges, and predicting what is about to happen in that encounter. We are starting to put some of that in front of physicians, and you’ll start seeing those differences.

Since the clinician isn’t aware of how much of the final result was delivered by the AI or the scribe, is it the company rather than the user that will get the benefit of moving toward better-trained AI?

It’s a bit of both, actually. Certainly we benefit as the system becomes more autonomous, but there’s a huge benefit for the providers. I look forward to a point where they can see what the system is doing in real time, and we are starting to put some of those things in front of the physician. They can see guidelines and what information they need to capture during this particular encounter to cover it. Physicians are asking about those kinds of things.

The system is learning to interpret these encounters. We can teach it to figure out for the subjective part when the patient says “shoulder pain” to consider what questions the physician would typically ask a patient about shoulder pain, or the kinds of responses that a patient might give.The system is gearing up to be able to communicate directly to the patient to collective the subjective information before the encounter begins, which will offload work from the physician. Ultimately, that subjective information is really the patient’s voice, and it’s coming from them anyway.

Sometimes companies that offer a physician-targeted product struggle with creating a marketing and sales organization that can reach out to an endless number of practices to make sales. Who is your target customer and how will you reach them?

We get users across all tiers of the healthcare ecosystem, from large health systems all the way down to small group practices. I would say the sweet spot for us today is really large specialty groups. That’s where we find rapid uptake and a great deal of success. Within the large health systems, we find specific physician groups reaching out, particularly in primary care, for example, where burnout is a big issue. And then of course the small group practices.

From a marketing perspective, we’ve focused our efforts on reaching out with a message of, “We solve the problem of burnout.” A lot of the sales effort ends up being directed at the large specialty groups, but we get a lot of the health systems and the small groups coming along just because they feel that message and they want solutions for their physicians.

I appreciate your transparency in describing how humans are involved in your offering since some companies, especially those who yearn for a tech company valuation, market a proprietary black box that performs magic. Are companies trying too hard to get AI to do everything instead of accepting that it could be brought to market faster and less expensively by just shooting for 90% and letting humans lend a helping hand?

It depends on the area that AI is being applied in. When it comes to conversational AI, by which I mean listening and interpreting conversation, that’s an extraordinarily difficult AI challenge. We are making pretty substantial strides in that right now, but there are areas where you can apply AI where the AI systems can actually do a pretty good job without needing any kind of human power. But certainly in this space today, we are just at the infancy of NLP.

NLP has been around for a long time. I’ve been working on it for 20 years. But I would say just in the last year, we’ve seen so many gains just within our own system and across what’s happening in the industry outside of healthcare, even in NLP. But where I can see over the next couple of years, a lot of these solutions, our solutions, are going to be completely autonomous. But right now, that’s the right fit for this space today. For other industries, other applications of AI, it may or may not be. You  have to pick and choose the strategy used for what you’re trying to do.

Where does the technology and the company go over the next 3-5 years?

I often use the analogy of driverless vehicles. Ten years ago, people thought autonomous vehicles were a distant future, and nobody gave it much thought. Suddenly we wake up one day and there are autonomous vehicles on the road. They have drivers behind the wheels, but the vehicles are starting to drive themselves. Now you can go a pretty long distance without actually touching the wheel.

I look at AI in healthcare in that same kind of way, where we have the human in the loop. The AI is learning from what those humans behind the scenes are doing, but what is more interesting is that it is learning from what the doctors themselves are doing. If you put a camera on a doctor’s shoulder, connect it to a really intelligent system, and tell it to watch what the doctor is doing — how they’re interacting with the patient, what kinds of questions they are asking, what they do in their physical exam — and connect this to the EHR whose data the physician is using to make their decisions, you are building, over the long term, an intelligent system that can actually understand medicine. 

The scribing part of what we’re doing is just the cusp, the tip of the iceberg. The more important and more interesting trend is that, over the next 3-5 years, these systems will actually start understanding the process of providing care to patient. We will be able to supplement and assist doctors in ways that we haven’t really thought about today. That’s the part that I get excited about.

Do you have any final thoughts?

We are extremely early in the AI revolution in healthcare. Really, it hasn’t been a revolution. We are augmenting processes in healthcare, making them more efficient, and making physicians happy. Not just us, but other companies in this space. But what we’ve seen with AI technology in other industries is that it reaches an inflection point, where the AI begins evolving much faster and starts being able to do more in a short span of time than people would have imagined possible. I think we are almost at that inflection point in a lot of processes within healthcare. We will see, over the next couple of years, incredible disruption to the business of healthcare, and in a good way.

A core part of that is natural language processing.  So much of healthcare, so much of medicine, is communicated by voice. When you can do a really great job of interpreting and understanding what’s being communicated, what never actually makes it into the medical record or doesn’t make it into the medical record in a systematic, discrete way, you’re able to understand how to communicate with doctors on their own terms. Not in the way that you as a interface designer want doctors to interface with your system, but the way the doctors would naturally interact with other doctors or with a patient. You can interact with them in those terms. You can interact with patients on their own terms as well. That revolution is going to create a new platform and new capabilities that we can only start dreaming of today.

HIStalk Interviews Brent Lang, CEO, Vocera

September 30, 2020 Interviews No Comments

Brent Lang, MBA is chairman and CEO of Vocera of San Jose, CA.

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Tell me about yourself and the company.

I’ve been with Vocera for 19 years. I was brought in by the founders, initially as the VP of marketing back when it was just a few guys in a dark lab trying to figure out if they could make our product work. My wife used to tease me that I was the VP of business, as opposed to the VP of marketing, since I was trying to figure out our go-to-market strategy, our pricing strategy, and our target customer.

The company was not originally created as a healthcare-focused company. The founder’s vision was to enable wearable communication across multiple markets. One of my first jobs as a VP of marketing was to go out and interview a bunch of potential customers about the idea of wearable, hands-free communication. We started talking to some hospitals and nurses were so excited. I remember one hospital nurse saying to me, “You’re going to change the way nursing is practiced around the world.” At that time, I had no idea what she was talking about because I had not come from a healthcare background. I was more of a technologist, having made my way through Silicon Valley tech companies with an interest in technology and business strategy.

I fell in love with the impact that technology could have on hospitals and healthcare workflows. I was an industrial engineer back in school and never really thought about too much how I would use that until I started thinking about the role that communication can have on improving workflow and operations within a healthcare setting. I tell people all the time, just learn what you can, because you never know what knowledge you’re going to pick up along the way that will be relevant to you at some point in your future career, even though it may not seem particularly relevant at that particular moment in time.

Cell phones, apps, and phone-based texting were not around when the company was started. How have they changed the appeal or the marketing of healthcare-specific communications?

People forget that we created the company before Siri, Alexa, and the IPhone. Vocera revolutionized the idea of communication using voice as a user interface and thinking about mobility. We built the original Vocera badge because there weren’t any other appropriate devices. The closest ting might have been a Palm III, Palm V, or later, the Treo. Hands-free is critical in a hospital, so we built the device mainly because there was nothing else that would work. We have learned over the years just how essential the hands-free capability is.

We have embraced a range of different devices. Our strategy is very much about being device of choice, and our software platform supports iPhones, Android devices, tablets, and desktop interfaces. But we find that the closer a clinician is to direct frontline care, the more important it is to have that hands-free capability, and it’s even more relevant during COVID. But what has been important for us was to figure out ways to bring in those other modes of communication that you mentioned — text messaging, alerting, alarming, and other forms of media — into the platform and into the devices that we support.

The new Smart Badge recognizes a “wake word” to make everything hands-free. How important is that to clinicians?

We introduced the wake word earlier this year. You can say “OK, Vocera” to wake up the Smart Badge and allow you to issue a voice command, such as, “call the nurse for room 101” or “call a respiratory therapist.” You don’t have to have any interaction with a button on the badge at all. In this era where people are wearing personal protective equipment, or PPE, a lot of people are excited about the wake word functionality, because they are able to wear their Smart Badge underneath their gowns and maintain an entirely hands-free environment.

Could you integrate your system with inexpensive consumer voice assistants that could be placed in patient rooms, which would allow patients and nurses a simple, hands-free way to communicate, either along with or instead of a call system?

This is actually an area that we are really excited about. We are building a Vocera skill for Alexa that will allow you to put an Alexa device, like an Amazon Echo, in the patient’s room and enable the patient to issue voice commands. Those messages are then routed to the appropriate caregiver. We can leverage our software platform and routing intelligence so that we know who to notify if the patient asks for a blanket, but if the patient says that they are in pain, it can go directly to their nurse to take immediate action. 

It’s really combining, as you said, the consumer devices that are becoming so available and the prevalence of using voice as a user interface and speech recognition as a user interface, combined with the intelligence and routing capabilities of our software, and then the connectivity that we have out to the employees of the hospital. We’ve shipped over a million Vocera badges out into the marketplace. There are hundreds of thousands of people using them every day. That gives you an instant connection to nurses, transport techs, housekeepers, and food services. A patient can get immediate access to all those people, rather than it just being a hardwired connection back to the nurse station, where someone then has to figure out how to deal with that patient’s request. We are seeing a convergence of technologies that people have become used to and comfortable with in their personal lives and in their homes, merging with hospital-specific workflows and hospital-specific solutions that leverage the sophistication that we can build within software.

How has COVID affected the use of your products and the trajectory of the company?

The pandemic has raised the awareness for our company, our solutions, and the value proposition of what we offer, in particular, the hands-free capability. Every time a care team member removes or replaces their PPE, there’s a risk of contamination. Minimizing the number of times PPE is removed reduces the risk of infection and helps preserve these valuable resources. Whether that’s in a triage tent, an ICU room, or an isolation room, the hands-free capability of our solution has been really valuable, because it can be worn underneath the personal protective equipment.

We have seen the product being used in temporary tents being set up to triage patients. We’ve seen the Vocera badge being used connected to the bedrail, to allow patients to reach care team members and for nurses to do virtual rounding, where they can call a patient’s room instead of going in and out for a quick conversation, which keeps them safer and reduces the amount of PPE used. It allows them to reach out to family members. It has been exciting to see the role that that communication can play.

For our employees, our connection to our mission has never been stronger. Our mission is to improve the lives of caregivers, patients, and family members. While the pandemic has been tragic in many regards, it has been inspiring for the employees. Our level of employee engagement is higher than it has ever been because we have been part of the solution. It has been inspiring for employees to feel like they are doing something that is having a direct impact on patients, caregivers, and family members.

What sales and marketing changes have you made given travel limitations and the cancellation of HIMSS20?

We were one of the first companies to drop out of HIMSS when we saw the pandemic rising. Maybe it was the benefit of being out here on the West Coast and seeing what was happening in Washington. But we very quickly started transforming the company to being virtually oriented in our sales, services, and marketing efforts.

Just to give you an example, within 30 days of this all coming about, about 90% of our professional services had been transitioned to remote work using Zoom or other virtual technologies. Our sales team quickly embraced reaching out and working with customers on a virtual basis. Our marketing team did a really good job of creating new use cases and case studies talking about COVID-specific workflows and how the product could be utilized in these environments. We used it as an opportunity to support our customers. We issued several thousand free, temporary license keys for our software to customers who needed to increase their capacity to respond to COVID surge situations.

I’ve been incredibly proud of the response by the company and by the employees to support our customers and do the right thing during these really challenging times.

How do you position your offerings in rounding, patient experience, pre-arrival, and patient monitoring software within the framework of enterprise communications?

Our vision is around enabling the real-time health system across the care continuum. That is more than just voice communication. It is more than just communication broadly. It is all about eliminating the friction points in a patient’s journey and making sure that the right data is delivered to the right person, on the right device, at the right time, with the right level of urgency.

Take as an example our recent acquisition of Ease, which is a patient and family communication application. It enables caregivers to give updates to family members when a loved one is in the hospital for surgery, COVID, or other situations that prevent family members from visiting them. This speaks to our desire to expand to enable this real-time health system.

The company has its roots in the Star Trek communicator kind of mindset, but our software platform is much broader than that now. We have had to evolve as the industry’s has evolved. In the old days, a lot of actions in a hospital were triggered by a nurse walking into a patient’s room and noticing a change in their condition. The workflow started by the nurse needing to reach out to get the appropriate help. More and more today, patient monitors, physiologic monitors, smart beds, and the electronic health record are becoming expert systems. They can, in many cases, notice a change in the patient status quicker than the nurse who is walking into the room. The event that needs to be triggered from that, and the people who need to be activated as a result of that change in patient status, can be coming from lots of different sources beyond just the initial human interaction with the patient.

As a company, we focus on evolving what we do to be able to incorporate all this data coming from these expert systems, route it through our workflow engine, and more importantly, prioritize it and triage it so that we aren’t creating cognitive overload or cognitive burden on the clinician, so that they’re receiving just the most critical information. and know the most important activity to act on next.

You are at a blurred line between what you’ve traditionally done and new technologies that are gaining in popularity, such as chatbots, artificial intelligence-powered population health management, asynchronous text-based provider chatting, and patient-reported outcomes, all of which are usually offered by a standalone startup company. Do you see Vocera getting more involved in either these specific technologies or with those companies that offer them?

You’re absolutely right. Hospitals tell us all the time that they are looking to consolidate the number of vendors that they are working with. They are looking to build platforms that are unified and fully integrated.

We try to create as much of an open platform as we can. We want to be interoperable with data from a range of different systems. Whether it’s a piece of technology that we develop ourselves, creating an interoperability relationship or some sort of partnership, or a potential acquisition — those are all ways of building up a platform that is easy to use and is delivering the right information to the caregiver.

I love to see the innovation that is occurring in the space, because the more information and the more data that gets generated, the more of an opportunity there is for us to analyze that data, route that information, and provide better patient context. When a call or message comes in, it’s not just an interruption, it’s actually patient context-aware events that provide the caregiver with situational awareness that allows them to decide what the next action is.

Our strategy is to say that we are going to do a lot of this ourselves, but we’re also going to create open APIs and open standards that allow us to bring data in from other organizations. One of my favorite examples is sepsis alert technologies, those sophisticated algorithms that can  predict when a particular patient might be headed towards sepsis. The challenge with those is that often that the algorithm can identify the patient who is at risk, but it may not do a good job of notifying somebody who can take action. In that case, we do a simple integration with them, they send us that alert, and we route that to the appropriate caregiver. They can take action much more quickly than if we were just waiting for the clinician to go log into the electronic health record or some other expert system that has identified that the patient is at risk.

Do you have any final thoughts?

Technology vendors have an important role to play in transforming healthcare, whether it’s providing improved safety for clinicians and for patients, reducing the cognitive burden, our doing a better job of protecting our frontline caregivers. Technology must be part of the answer to bridge the gap between where we are and where we need to go. Vocera is really excited to have an opportunity to participate in that.

HIStalk Interviews Blake Margraff, CEO, CareSignal

September 28, 2020 Interviews 1 Comment

Blake Margraff is CEO of CareSignal of St. Louis, MO.

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Tell me about yourself and the company.

I co-founded the company CareSignal, which was previously called Epharmix, and I serve as CEO. CareSignal is a simple enough concept. We create device-less remote patient monitoring solutions to help support risk-bearing providers, payers, and the patients or members they serve, with a primary focus on chronic condition long-term management and support.

What led you five years ago — as a 22-year-old coming out of pre-med — to form a company in an industry that is notoriously hard for newcomers to crack?

There’s a pragmatic answer and a philosophical answer. The pragmatic answer is that I saw an opportunity to do one of my favorite things, which is to orthogonally combine technology – which, to your point, a lot of people have thought would work by itself and hasn’t — with evidence. The basis of our company is evidence first, sales second.

Philosophically, though, if I could spend my time doing anything, I want to be able to look back in one month, one year, 10 years, 50 years, and be proud of the impact it had and the scale of that impact. I think healthcare, and specifically health technology, is the best one-two punch out there.

Some wellness technology companies offer solutions that, if they work at all, won’t deliver ROI for years, when the cost savings of improving chronic conditions will finally pay off for some other employer or insurer. How do you approach a prospect who questions return on investment?

These are two really important concepts. The credibility of the argument, fundamentally, always involves return on investment. That credibility comes in the form of defensible impact clinically and then financially, but also the time horizon of that impact. Getting a person to stop smoking is a good thing, but financially it might not actually be a good thing for one, five, or 10 years. 

To the people who have abused the concept of evidence-based or clinically validated outcomes — and you can bleep this in the written version — but frankly, f*** them. They are treading on one of the most elegant and powerful parts of medicine, which is the concept that you can advance the standard of care by thoughtfully conducting high-impact research and iterating on innovation in the process.

In terms of CareSignal, we announced recently that we now take risk on any contract we sign. We are confident that we can engage through all the patients, drive clinical outcomes, and return financial benefit to our partners with the time horizon of less than a year, and generally within six months. That touches on all the points that you mentioned. It’s not enough just to do it — you have to do it in a way that is financially compelling to your partner.

What portion of patients show a willingness to interact honestly with automated messages about a concerning condition, but would not have taken the initiative to reach out directly to their provider?

You are hitting on selection bias, and maybe touching on the transtheoretical model of behavior change as well. It is true that some healthcare innovations can only help people who want to be helped. That’s always true to an extent, but I fundamentally reject that as a barrier to bending the cost curve, or even engaging the vast majority of patients who need to be engaged and supported.

The argument that I provide is a simple one. When providers, meaning physicians primarily, want to effect change, they leverage this power of the prescription. There is still an element of healthcare that is relationship driven, stemming from the strong relationships that many providers still have with their patient populations. The best technology sits at that intersection of clinical and relationship.

Does the political concept of campaigning only to the undecideds make sense in population health management in focusing resources on patients who are most likely to benefit from health messaging?

I don’t have deep background, so I’m almost wary of speaking to that and I would just be pontificating on it. I will say that looking at chronic conditions, there’s kind of an ironic behavior trend that we see across our patient population and partners. Patients who are doing just fine wind up disengaging faster than patients who are experiencing adverse outcomes or adverse symptomatology. The heart failure patient who hasn’t had pedal edema or nocturnal dyspnea for months, maybe even years, is going to be much less inclined to stay engaged and to provide clinically helpful, actionable patient-reported outcomes. Whereas the one who’s struggling is going to do so more.

A well-designed system will support people who are doing just fine for the long term, but will then allow the benefit to be had by the people who decompensate or get worse, whenever that happens, and that could happen a month or a year down the road.

Does the interaction between care managers and patients in your system populate other systems, such as EHRs?

Absolutely. CareSignal can operate as a standalone system. That’s important because a lot of groups need to operationalize and prove any new partnership or investment. We integrate with Redox and have a whole lot of respect for Niko, Luke, and the team. They can integrate with any EHRs that they touch.

Providers might react to a patient’s response to automated messages by either assuming that they are fine or that they need to come in for an office visit. What other kinds of communication do you see?

Our system is white-labeled, so from the perspective of our partners and patients, it is always their system. It’s essentially a warm line that is always ready. For patients who are in that rising risk bucket with barely-controlled chronic conditions that could go south at any moment, having a direct line to the care management team that you already know is powerful.

How is your system being used differently in the pandemic?

It’s just being used more. I’m grateful for the new opportunity from a business perspective, but the whole team and I have been pretty humbled to see that it’s doing what we always thought it could do in virtual health. Telehealth is table stakes and is increasingly quite present and quite high quality, but providers especially are emphasizing the need to defend relationships and grow revenue, and sometimes the reverse depending on their financial position. It’s the long-term engagement, ideally long-term, clinically actionable engagement, that seems to speak to them as we all go through this frustrating process.

What advice would you offer to people like you who didn’t come up through the health IT ranks or who may be disappointed by its bureaucracy and long purchasing cycles?

There’s a great mental model of Chesterton’s Fence. A couple of guys come across a fence in a field. One says, “Let’s tear this down. This is stupid. This is pointless.” The other guy says, “That’s fine. You can do that, but at least first tell me why it was built.”

That’s how I approach a lot of the conversations. It can seem like there’s too little of one type of thing and there is too much of another thing that seems unnecessary. You have to understand why it was put there in the first place if you’re going to effect sustainable change that will benefit all of the stakeholders. I guess that has  brought me to the conclusion that everybody in this space deserves a huge amount of respect, if only for their patience and often their iterative investment in a pretty weird industry over the past decades.

What is good and bad about how investors may take a company in a different direction that it originally planned?

Founders have to remember that investment is a means to an end. Folks who want to raise money so that they can raise money … most investors will not invest in that type of founder or business. More positively, I can cite investors such HealthX, UnityPoint, OSF, and others that are deep in healthcare, as well as many more that are immediately adjacent to health IT. They are run by operators and industry incumbents. It’s too complex of an industry for me to think that I can come in and figure everything out. The best investors not only provide good direction, but help you learn faster.

You started your entrepreneurial journey at a young age. What do you hope to accomplish?

Impact. Help as many people as possible live better lives and live longer lives. It comes back to the beginning. That’s what keeps me so motivated, even in a sometimes slow-moving industry, to keep pushing.

HIStalk Interviews Scott Weingarten, MD, Chief Clinical and Innovation Officer, Premier

September 23, 2020 Interviews 1 Comment

Scott Weingarten, MD, MPH is chief clinical and innovation officer, Premier; professor of medicine and consultant to the CEO, Cedars-Sinai; and health sciences clinical professor at the David Geffen School of Medicine at UCLA.

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Tell me about yourself and your work.

I’m an internist by background. I have been associated with Cedars-Sinai for many years. I have a passion for improving the quality of patient care. I have been focused on clinical decision support and information technology as a means to an end, with that end being better patient care. I started a company out of Cedars called Stanson Health. It was acquired by Premier about two years ago, and I’m now chief clinical and innovation officer at Premier.

How is Premier, along with its companies Contigo Health and Stanson Health, addressing clinical variation and waste?

Premier has rich data and analytics assets that can identify opportunities to improve outcomes of care, mortality, morbidity, and cost of care. The question then becomes, after you’ve found an opportunity, how do you realize that opportunity and demonstrate improvement?

One of the most effective, scalable, and sustainable strategies is providing context-specific information to healthcare providers that are integrated into the workflow, offering suggestions to the doctor or other healthcare provider to inform care that, in some cases, will change care for the better to be more consistent with the evidence. That’s a way to close the loop in not only identifying opportunities for improvement, but implementing those improvements and being able to measure their impact or being able to measure the actual improvement.

After the acquisition of Stanson by Premier, Contigo was formed. Contigo, as a company that is part of Premier, works with employers who have a vested interest in improving the quality and reducing the cost of care for their employees.

Is information sharing among peer health systems, as is done through Premier and vendor-sponsored programs such as Epic Health Research Network, having a significant impact on patient care?

Yes. Data is critically important to understanding the gaps between current care and optimal care. In addition to data, it’s what you do about the opportunity you recognize. How do you bring about those improvements and be able to demonstrate to your satisfaction and everyone’s satisfaction that care has improved, and significantly improved?

So sharing of data is critically important, but perhaps equally or more important is being able to change care. When I say change care, it’s the interactions among doctors, nurses, pharmacists, and the patient that lead to better care with lower mortality, morbidity, and cost.

Sharing of data is the beginning. It’s necessary, but far from sufficient. Sharing of data alone will not bring about improvement.

Is it a positive development that COVID has created an urgent demand for data in the form of anecdotal findings, observational studies, and pre-print research results that would have been delayed for years otherwise to meet formal research standards?

With a caveat. The Institute of Medicine – now the National Academy of Medicine – shared years ago that there was a 17-year delay between the discovery of important data that could save lives  and the time when that knowledge is translated into practice. That’s bad. Seventeen years is far too long, and efforts were made to shorten that gap significantly to save lives and improve care. I applaud that effort to disseminate valid scientific evidence as quickly as possible.

Pre-print publications, as we’ve seen with COVID-19, can be very helpful.  But it’s also important that the information be rigorously reviewed for scientific validity, because invalid information that is disseminated and translated into practice can be potentially dangerous. We want to shorten the gap for scientifically valid, scientifically credible information, that gap between when the discovery is made and when all patients benefit from that information. But we want to remain responsible that the information that’s disseminated proves to be scientifically valid.

Clinical decision support and evidenced-based medicine are sometimes seen by physicians as intrusive, where they trust their personal experience and practices more than the results of someone’s study. Are we seeing any new capabilities or use cases that would lead to their wider acceptance?

I believe so. The key is providing physicians, nurses, pharmacists, other healthcare providers with information that is integrated in the workflow that they find helpful, that will help them take better care of patients rather than being annoying. One of the best ways to do that is to suppress the information when it just validates what the physician or healthcare provider was going to do anyway. Only provide that information when it’s incremental to what the healthcare provider is already doing or informing them when whatever they are doing is in conflict with the evidence.

There may be many good reasons that it’s in conflict. Maybe they offered the patient a treatment where the evidence has shown that the treatment can be effective, but the patient, for whatever reason — sometimes a very good reason — refuses to take the treatment. But you always want to make sure that the care is informed by the latest scientific evidence.

Another development to improve the precision and value of the information is to examine the free text information in the electronic health record. Not only discrete data elements — such as demographic information, medications, or laboratory values — but the notes that the provider has written in the electronic health record. To be able to read, interpret, and contextualize the notes to further guide the clinical decision support that can be potentially be most effective for an individual patient. It’s really a type of precision medicine, where to the best of your ability, you get to know the patient based on what is recorded in the electronic health record and tailor the guidance for that specific patient when the evidence suggests there is a testing strategy or treatment that would be best for the patient.

Have EHRs gotten better at surfacing information that tells the key story of the patient and the clinicians who have treated them so that a quick glance at the electronic chart provides the most situationally relevant information?

Electronic health record vendors have worked very hard at solving this problem. They’ve certainly heard from healthcare providers that this is an important issue that needs to be solved, and that it contributes to burnout. But I have heard that in the United States, notes of healthcare providers are much longer than those of our colleagues in other countries in Europe and so on. If that’s true, then we may be inadvertently contributing to this issue.

The question is, how can we — in addition to the electronic health record vendor — help solve this problem? Can we have shorter notes, where the high-value information, the clinically important information, is still available to other healthcare providers, and potentially the patient if OpenNotes or other strategies are used to enable patients to retrieve the information in the notes? How do we, together with the electronic health records vendors, make the notes more concise, easy to read, and easy to interpret in a short period of time?

What is the status of large health systems, such as Cedars-Sinai, getting involved with health IT accelerators, health IT investment, and acquiring commercial businesses?

I think you’ll see some health systems, not all health systems, having a greater interest in accelerators, venture capital funds, and even creating companies or spin-outs for a variety of reasons. Out of Cedars-Sinai, my colleagues and I created two companies, the order set company Zynx and my current company Stanson. We were able to commercialize the IP, which was largely related to clinical decision support, and sell both of those companies. 

You will see this trend continue with some health systems, in particular, with academic medical centers. They are in the business of creating a new knowledge and discovery and disseminating that information to improve patient care, not only at their own organization, but across the country and potentially globally.

In addition to publishing the results in peer-reviewed journals, a way to increase the impact to a greater extent is to commercialize or productize that IP so that it can be used across the country and around the world. Many health systems will say that is consistent with their mission, including academic medical centers.

The second thing you will see is that patient care revenue is increasing very slowly. In many cases, wages are increasing faster than patient care revenue, so some health systems are looking to diversify their sources of revenue. You hear about health systems thinking about creating startups, creating accelerators, and having venture funds.

What technology and data needs have been exposed by COVID that will accelerate future development and adoption?

The American Recovery and Reinvestment Act was a very large subsidy of electronic health record purchases, installments, and implementations in physician offices and hospitals. However, with that investment, there was a very small investment in comparison in public health infrastructure. We’re finding that public health information technology infrastructure has lagged significantly behind, and we are reading almost daily of the consequences of not having state-of-the-art information technology for our public health professionals across the country during a pandemic.

COVID-19 will change healthcare and the way it is practiced for the foreseeable future in many ways. We’re going to see investments made to upgrade to 2020 standards the public health information technology infrastructure to benefit from the information in the electronic health records, so that we are ahead of the curve and ready for the next pandemic, for bio-terrorism surveillance, and for understanding the next carbon monoxide poisoning or diarrheal disease outbreak.

What personal characteristics and practices allow you to be involved in so many things simultaneously?

I have a certain intellectual curiosity that causes me to do a number of different things. Some might question how well I do any of those things. But the underlying theme is that I have a passion for improving care. My mission is to make a contribution to improving patient care. I’ve set out to fulfill that mission through a variety of things — direct patient care, academics and teaching, implementing quality improvement and value improvement strategies across a health system, and creating businesses that hopefully will enable health systems across the country and beyond to improve care. That’s the underlying theme of all of my attempts to make a difference.

Do you have any final thoughts?

As someone who has been in clinical decision support for over two decades, I’m now quite bullish on the field. I feel like the advances in technology, electronic health records, natural language processing, machine learning and AI, and speech recognition will enable transformation and significant improvements in the field of clinical decision support. I’m quite hopeful and optimistic that we’re going to see greater improvements in patient care from clinical decision support in the future than we have in the past.

HIStalk Interviews Bill Grana, CEO, HCTec

September 21, 2020 Interviews No Comments

Bill Grana, JD, MBA is CEO of HCTec of Brentwood, TN.

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Tell me about yourself and the company.

I am a technology entrepreneur, going on nearly 30 years. I have been involved in starting, investing in, and leading high-growth tech product and tech services companies, many of which have been related to healthcare or HIT. I’ve been with HCTec for three years.

We are an IT services business that is focused exclusively on the hospital system sector and other specialty providers. The tagline of a German multi-national chemical company used to be, “We don’t make the products you use. We make the products you use better.” In HCTec’s case, we don’t make the technology that is used by hospital systems. We make the technology work better through our team of talented IT professionals with specialized IT skills.

How has your business changed with the pandemic?

Like many other businesses, we transitioned to full remote work in early March. I’m very pleasantly surprised and proud of my team for how well that they executed that change. We haven’t missed a beat in terms of service delivery with our clients, more specifically with our two primary business lines of consulting and managed services.

We’ve seen the consulting business negatively impacted. As hospitals experienced stress, particularly financial stress, one of the first things to be cut was contingent labor. A number of our contract consultants were released. But we are seeing that pick back up. On the managed services side — where we provide both an IT help desk solution as well as application support for current generation and legacy systems, primarily focused on the enterprise EMR — that business has stayed robust. We have seen huge volume increases on the help desk side tied to the transition to remote work, but particularly telehealth. So it’s been a tale of two different worlds in terms of how COVID has impacted our business.

Is remote work for go-lives and support here to stay, or will onsite work bounce back once travel limitations ease?

Much of that is going to be here to stay. There is no reason to revert back to what it was pre-COVID, assuming that from a service delivery and outcome perspective, it can be equally effective. From a cost perspective, it’s certainly better for hospitals to do it that way. In many cases, it’s better for the consultants who are providing the work to be able to do it remotely, whether it be from an office setting or from their own homes, rather than having to get on a plane at the beginning and end of each week.

How are health systems prioritizing their IT projects differently?

The projects that were put on hold in March and April are beginning to be resurrected. The contingent labor that is necessary to execute those projects is coming back as well. I think that the demand will return to pre-COVID levels. We will see more openness to remote work by consultants. Many of our hospital clients have moved the entirety of their IT organizations to remote work. That will give them a greater comfort level that their vendors and partners can do the same thing.

The COVID experience has opened the eyes of health system IT departments and leaders to the importance of having partners that can be nimble and react quickly in unforeseen circumstances like this. We have demonstrated that in a number of ways.

I hate to use the word “outsourcing,” because it is considered a dirty word in many circles. But I think we will see health systems take a hard look in the mirror, not just with IT functions, but more broadly, in asking the question, what are truly our core competencies? For many hospitals, that is provider support and high-quality patient care. Everything else, in many cases, can be performed as effectively or more effectively at a lower cost by a partner or some sort of alternative labor arrangement beyond just hiring full-time staff.

We’ve seen Optum announce a couple of deals over the last 12 months where they are taking over all non-clinical operations. I think that trend will continue. Maybe not necessarily a full partnering, but more of a best-of-breed approach, where companies like HCTec will step in and provide services that are important, but that aren’t necessarily core competencies of hospital systems.

We’ve seen those deals ebb and flow, however, where hospitals outsource core functions but then bring them back in-house within a few years. What are the success factors in making outsourcing more than just a short-term experiment?

There has to be a clear cost justification, where the partner can provide the same service at the same or lower cost. The same principle applies to quality, where there must be service level agreements and metrics that the vendors are held to, with penalties or other consequences to the extent that they fall short.

These things go in cycles, but I believe that the COVID experience will encourage hospitals to look at partnering with firms in non-core functions in a much bigger way than we have seen.

How do you explain strong investor interest in the health IT sector even as its health system prospects are struggling, at least temporarily?

Some categories have been really hot. A lot of money has been invested in telehealth following the boost it received as the result of COVID. Artificial intelligence and analytics solutions represent huge opportunities in the long term. Outside of the IT segment, a lot of investment has gone into services side and into different specialty ambulatory practices as well.

I don’t know that any of those things will last into the future and provide an opportunity for growth. Sectors get overheated. It’s hard to fathom the valuations that go along with some recently announced deals. I guess my small brain is not smart enough to get wrapped around that.

But overall, I think the health IT segment is a very attractive long-term investment sector. As we think about what healthcare looks like in the future, it involves a greater adoption, prevalence, and reliance on technology to support clinical service delivery and hospital operations. We will certainly not see less of that in the future. You could probably say this to a degree about any market sector, but I healthcare is particularly ripe for technology that can benefit its performance.

Telehealth boomed early in COVID, but now it seems to be cooling off everywhere except on Wall Street. How will it play out in the next two to three years?

We’ve already seen the levels pull back from what they were as people become more comfortable returning to their physician’s office. But there are certain use cases for telehealth. Behavioral health is one example, where it can arguably be delivered even more effectively via telehealth, in a way that makes the patient more comfortable or more apt to seek help where there may be some behavioral health challenges.

But clearly, if you need a physical — at least given where we are with technology right now – you have to go to the doctor. Over the next five to 10 years, I think that could change with different and improved patient-facing technologies and monitoring devices, where much of your regular physical could be done from home or outside of a doctor’s office.

What technologies hold promise now that EHRs and stable infrastructure are universal?

It’s probably overused, but the digital front door, creating a single entry point for customers, or patients in this case, to provide an improved overall digital experience. It is disjointed with many health systems and across providers today. It’s hard to navigate, even for folks who are technology savvy and Millennials. Effort and emphasis will be placed on that.

You see the same thing in the financial services marketplace, even though it’s probably several years ahead of healthcare. I’m on the board of a financial technology business and I chuckled at our last board meeting, where they were talking about all these banking institutions that are focusing on the customer digital front door. The exact same thing is happening in hospitals.

We are in the nascent stages of bringing a mature experience to market. It’s about the customer, or again, in this case, patient experience. As systems compete for patients, it will be important to give them a strong digital experience.

Will small health systems lose to the bigger ones that just keep getting bigger, as happened in banks that bet big on expanding outside their regions and deploying technology such as ATMs and online banking that customers valued?

It is probably not necessarily the best thing for the marketplace, but I do think that that’s the case. COVID has accelerated that with the financial stress that has been placed on smaller institutions that don’t have the balance sheet to weather the storm. We’re already seeing consolidation happen that would not have without COVID. The same holds true for the ability to invest in these digital and patient-facing tools that drive the whole experience.

What will the company’s direction be in the near future?

The future is bright, despite the fact that we still have COVID hanging over us. It will dissipate, hopefully sooner than later. From a service portfolio and capability perspective, we are well equipped to meet current and future demand, and with some incremental changes, to realize some additional opportunities.

We’ve put a great team in place. I wouldn’t have wished COVID on us, but it has given us a little bit of breathing room to focus on operational improvement that is already making a difference in our current business of quality of service delivery to our clients, and will continue to make a difference in the future. Growth and improvement remain continuous and will be future themed.

Do you have any final thoughts?

The pandemic has put healthcare clinical workers in the spotlight in a well-deserved way that was not seen previously. We also need to recognize the people who are behind the technology that is used by hospitals, the improvement in healthcare delivery and the extra hours and work that they put in during this challenging time.

Technology doesn’t always work as it was designed, and in those cases, we need experienced people with specialized skills to provide support and continuous care and feeding to maintain the health of these hospital tech ecosystems. That is the essence of who we are and what we do at HCTec.

HIStalk Interviews J. Erin Hutchinson, Owner, Narrative Shift

September 9, 2020 Interviews No Comments

J. Erin Hutchinson, MA is owner of Narrative Shift of Herbster, WI.

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Tell me about yourself and the company.

I’m a Midwestern farm girl, so I don’t like to talk about myself, as most of us don’t. I’ve spent my career starting companies, starting with clothing stores and video store chains. I have 45 years’ of experience in the healthcare technology world. Ten years ago, after launching many small ventures, I started what is now Narrative Shift.

We help founder-led companies and startups in the healthcare and biotech space successfully launch their products and services. We help them craft compelling narrative to create curiosity and excitement among their target customers so that they are interested in having a conversation. All of us are bombarded with lots of shiny marketing stuff, but it’s hard to get your message out there so that people take action and have that initial sales conversation. We do full-service graphic design, marketing, and go-to-market strategy. It’s a startup advisor in a box, as I like to say.

You went from being a psychologist to leading teams at Epic, engineering companies, and consulting firms. How have you applied your psychology knowledge in those roles?

I worked for Epic back when it was fewer than 100 people. In my late 20s, I was working with physicians and surgeons who were new to technology, to the point that I had to teach them how to turn on a computer and use a mouse. A surgeon threw a keyboard at my head once, so that’s when I used my clinical psychology skill set to get people to change.

In helping new companies get launched and bringing more revenue to tech startups, I draw from that background of how we communicate and connect with other people. Companies tend to get myopic. They may have the best thing since sliced bread, but they lose track of being able to put themselves in their customer’s place. I help these companies craft their identity and craft their story so that it is communicated and connects with their target audience.

Tech people are not always the best at the human element, so my background has helped a lot. Plus I was a child and adolescent psychologist where humor is important, especially when you are working with young kids. I bring that to my work with my clients. Starting and growing a company is hard work and I like to bring a little bit of fun to that.

What is narrative therapy?

I was trained in, and my dissertation was in, using the narrative approach in working with children and adolescents. I could bore anyone to tears with all of the heavy post-modern theory aspect of narrative therapy, but in essence, it’s that we as humans create meaning and communicate with each other through through narrative, through stories. That is the core element of how we express our experience. The essence of successful design and marketing is that you have to communicate to your customer through a story.

Bringing the narrative therapy approach involves working with your clients to understand the narratives that shape their world view, and then working with them to re-author those in the way that they see themselves. Maybe they can re-author their narratives to psychologically shift their perspective.

Founders are usually interesting and have a lot of personality and humor, but they seem to be coached into dullness as their companies grow, to the point that all communication is filtered through conference rooms pull of people who suck the life out of it. Can large companies be interesting and fun?

To be 100% transparent — and sometimes I’m painfully so — one benefit of owning a company is that you can choose to be that way. I choose not to work with many large, established companies. They are either overly prescriptive about “this is how we must present ourselves” or they have armies of corporate marketing people who are maybe good at putting on events, but not so great in figuring out better ways of connecting with their customers.

We in healthcare are do a really bad job of using creative ways to get the interest of target customers and target markets. I set a rule with clients that if they want shiny, happy stock photos of people who look like doctors and nurses, then they need to find a different agency to work with. I generally shy away from those companies that grow and become the Borg.

Early-stage or founder-led companies, which more often maintain that entrepreneurial culture, are more open to being creative and asking for help to find their voice, establish their identity, and craft the narratives that will get prospects interested. I’m probably trying too hard to be politically correct in saying that big companies are boring. Those that grow successfully need to maintain that fine line, but cut through the noise by being a little bit irreverent and not being afraid to try something different in their marketing. It’s easier to do that if you have strong leaders who maintain that entrepreneurial spirit and don’t hire a bunch of marketing Borgs or large agencies without experience in healthcare or healthcare tech, which perpetuates this culture of stock photo websites and material and messaging that all looks the same.

How much do you help create strategy rather than just communicate it?

It’s a little bit of both. I love working with smaller companies and startups because I’ve been in the role of starting companies. I’ve been a part of many ground-floor new ventures. I’ve done the work. I didn’t just get a marketing or design degree. I’ve gone through the process of getting funding and I know what that takes.

With my background as a therapist, many clients ask for help because they hate their website or their sales pipeline isn’t growing. But most of the time, that ends up turning into a combination of helping to craft the strategy, especially from a go-to-market perspective, as well as the messaging and those narratives. I find it impossible to separate those two. Maybe it’s because I’m opinionated, honest, and open that I can’t hold back, so I give my advice and clients can take it or leave it. I can’t just churn out stuff that looks pretty and sounds good. If I can help someone with their strategy and to be more successful in growing their company, I’m going to do that.

Because of my background and being one of the few firms out there that specializes in the provider market, they don’t have to spoon feed me and educate me on their business and their customers. I know it. That also helps me to be more strategic and holistic in the work that I do with my clients. It also means they don’t have to go through the agonizing process of writing a lot of copy for me to clean up because I can already articulate what is needed to their customers.

Social media tech companies have embraced psychology in ways that aren’t entirely positive, getting people to keep coming back, pushing analytics-targeted ads, and entertaining them with short videos. Does that change the way that companies might get and keep the attention of prospects?

Because of the evolution of media and how people consume information, there’s no longer a standard recipe of what will work for a particular type of company or customer. I tell clients that some things aren’t worth wasting your time on. You aren’t going to get a hospital CEO to call you just because you have a great Twitter feed. Some clients I’ve worked with think a social media presence will magically result in more customers.

I wish that the diversification of media and expansion of the ways people get information make it easier to grow your company and to get the attention of your customers, but frankly, it has made it a lot harder. You have to spend more time understanding who they are, developing your buyer personas, and then figuring out where they are. What are they looking at? How do you get in front of them and get their attention? You need to have a multi-pronged approach. We no longer have four TV channels, three radio stations, and two newspapers.

It goes back to psychology understanding. What do you have to offer? What is your secret sauce? What makes you special? Whose attention are you trying to get? The psychology component gets infused into figuring out which tools to leverage and crafting campaigns and materials that are targeted at these types of potential customers. That was simpler before social media.

Some companies based their entire marketing strategy around the HIMSS conference, then reaped whatever benefit they received for a whole year. How will that change in the absence of in-person conferences for now and with provider customers whose priorities are dramatically different than they were six months ago?

I’ll be blunt. If there is one upside to the pandemic that we’re living in, it’s that it upended the HIMSS apple cart. My guidance to clients for at least the last five years is, don’t do it – don’t spend the majority of your marketing budget on this one event. Feedback from the last 10-15 companies that I’ve worked with, which has gotten louder over the last few years, is that they sunk a ton of money into HIMSS and got next to zero return, other than meeting a few new people. I’m hoping that this has forced companies to reevaluate and rethink their spending. I will be curious to see, by the end of this year or the middle of next year, if companies look back and realize that HIMSS didn’t really impact their bottom line that much, and they got good results using other methods.

Will that level the playing field so that small companies can use creativity rather than a big bank account and sprawling booth to chase business?

The benefit is that people have to think differently about getting their name out there and marketing themselves. The benefit of in-person conferences was getting face time in forcing your way in front of those most likely buyers. The companies that will succeed now will be creative and able to adapt. That’s harder for a large company that has entrenched corporate marketing departments and strategies, where it’s harder to adapt and be willing to diversify in trying different things and methods. Established, bigger companies put 75% of their marketing budget into HIMSS or other conferences. Now there’s the freedom to take that money and be more creative and use a variety of marketing campaigns.

Smaller players are relegated to the HIMSS “basement,” sometimes literally on the fringes of the big show floor. This is a time where it’s harder to get healthcare buyers to pay attention to you. They playing field is leveled if you are creative an willing to try different things. Your prospects aren’t getting the impression that since you don’t have a big booth, you’re not worth talking to.

I live in a very rural, isolated part of the country that relies on tourism. I’m involved in the local farming and arts communities. We have offered for 15 years a local artist studio tour, with hundreds of people visiting this tiny town of 100 people that I live in. We couldn’t do it this year because of the pandemic, so we pivoted to a virtual tour. We’ve had three times the traffic as we had last year, which had been our most-attended year. This has made made everybody think differently about how you can market and sell art and for artists to connect with potential buyers as well as just people who appreciate art. Corporate America and companies that sell into the provider market might be surprised by the amazing results they can see if they connect with people virtually.

What psychological observations do you have from working in 100-employee Epic now that it’s 10,000-employee Epic?

They have had to adapt some things as they have grown, but I’m not surprised that the company’s culture has remained consistent, since it is 100% driven by the founder. She has remained consistent in her perspective on how she wants the company to be portrayed, even in things like not wanting to get a bunch of “professional” marketers and designers.

Back in the day, I was one of the people producing the UGM multimedia presentations. It was all employees, and now they have people they pay to do that. But the company has always been proud of not devoting tons of time and resources to sales and slick marketing, and that has helped them continue that same kind of vibe. Going back to pure psychology, Judy established the narrative of what she wanted Epic to be early on and has not deviated much from that as the company has grown.

Some great case studies will be written in the next decade or so that Epic didn’t follow the rules of the road, but still scaled the company without growing up, maturing, and making everybody wear suits. People will look back and see that you can be true to yourself if you establish that really strong identity and strong narrative. You can grow and become the monolithic, 10,000-pound gorilla.

Do you have any final thoughts?

Everyone is struggling. 2020 has been a year that none of us could have expected. If you are struggling, like we all are, this is a great time to reevaluate and take a look at how you are communicating and defining the story you want to tell. Think about trying something different, because honestly, what’s it going to hurt? The rules have been broken by the fact that we are living in a completely new reality. Have fun with that a little bit.

HIStalk Interviews Guillaume Castel, CEO, PerfectServe

September 2, 2020 Interviews 1 Comment

Guillaume Castel, MBA is CEO of PerfectServe of Knoxville, TN.

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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.

HIStalk Interviews Jose Barreau, MD, CEO, Halo Health

August 24, 2020 Interviews No Comments

Jose Barreau, MD is chairman and CEO of Halo Health of Cincinnati, OH.

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Tell me about yourself and the company.

I’m a physician and oncologist. I practiced until 2015. I was involved in creating a cancer institute and what I called multidisciplinary care, where a patient can come in and see all of their oncology doctors — surgical, medical, and radiation – at the same time. That got me interested in communication and collaboration and how that is important to a health system.

Halo Health offers a clinical collaboration platform. It is a cloud-based application that goes across health systems and has every clinician on it — doctors, nurses, and medical staff. It allows them to message each other, call each other, and receive alerts. It supports real-time clinical communication on one application across the system. We focus on real-time, high-priority, urgent and emergent information and communications.

How would you describe the clinical collaboration platform market and how Halo Health differs from its competitors?

We are focused on role-based communications, which is different in healthcare than in other businesses. About 40 to 50% of healthcare communication with a role you know – such as “cardiologist on call” or “charge nurse on the 14th floor” – rather than a named individual. Our platform allows for accurate manual and schedule-based, role-based communication, which differentiates us from anyone else.

How has the care team definition changed with COVID-19 and the rise of telehealth?

We started off as a secure texting application. We realized pretty quickly that secure texting is OK, but it is poorly adopted. People only text the people they know are working at that moment, so the platform is adopted only in pockets. Identifying roles and communicating call message and alert roles opens up the other 50% of the health system in a single platform.

With COVID, we really needed to set up teams, identify contacts, and get people moved through the system quickly. For example, “COVID charge nurse” is a role that multiple people fill based on the time of day, and a role-based platform can support that.

How has the mix of message types changed between real-time voice and asynchronous text?

I learned two things in studying communication and collaboration. Doctors and nurses want to do things faster, but they also want to be interrupted less. A doctor or nurse is interrupted from a patient encounter every time their phone rings since they are usually in front of a patient. That’s a problem when just calling them or messaging them with routine information. You want to give them a chance to respond when they can, and asynchronous communication is effective for situations where you don’t need to answer right away, but instead can wait a few minutes to wrap up your conversation with the patient. Nurses and doctors want patients to feel like they are the most important thing in the world to them at that time.

Do clients expect their messaging systems to be integrated with other systems?

They do. The big question is, what do you integrate? We are trying to clearly define that to protect the platform. We don’t want all the information that’s out there. If you want something from the EHR, we want you to go to the EHR. We also want to keep integration real time, so we integrate with the nurse call system, the PBX, physiological monitoring, and those types of things.

We have to do discovery about what that organization thinks is important. Even the level of integration with the EHR depends on what the organization wants.

Do you have to protect clinicians from being barraged with messages that non-clinicians send just because it’s convenient for them to do so?

I battled a long time with that when I was practicing medicine and directing the cancer institute. Some physicians are comfortable with being contacted when needed, but others don’t want anyone contacting them. We do a lot with healthcare leadership, such as chief medical officers. I personally feel that physicians should be open to communication from everyone, but everyone should know what is appropriate to communicate at what time, and that’s our philosophy.

I don’t think doctors and nurses should be on separate platforms, although some people believe that. I think that’s a huge mistake. One communication platform for everyone is appropriate, as long as the platform can provide certain protections and users have been educated on what is real time and reminded that they are interrupting a doctor or a nurse.

I find it funny that people talk about interrupting doctors, but nurses get interrupted all the time and nobody is saying much about that. Nurses are barraged with alerts and all this type of stuff. It’s OK to interrupt nurses eight times when they’re with a patient, but it’s not OK to interrupt a doctor. I would argue that nurses often spend more time with patients and develop stronger relationships with them.

It needs to be looked at holistically across the organization in terms of each role, but each doctor, nurse, or other clinician should be easily accessible. That’s our philosophy.

Email is notorious for allowing people to add others to a conversation without turning any of the discussion into actual assignments. Are messaging workflow components available to assign actions and log them as either completed or reassigned?

Everything in a clinical collaboration platform like ours is auditable and traceable. It’s usually individual-to-individual or individual-to-role. Everyone has an ID, and there’s an individual behind that role. Everything that is sent, delivered, and read is tracked. If you send a message to five people on the code team, all of them have the responsibility to read the message and respond to the code. The sender can see who has read it and who hasn’t.

You can put controls in place for resending and escalating, but if the message was directed to you or the role you’re filling, you are responsible. That’s why the role-based platform component is important, and having accuracy on the other side so that someone receives the alert or message.

What capabilities of secure communications systems have changed with the availability of cloud-based systems?

We are 100% Amazon technology. We evaluated a lot of technologies in 2015 and felt Amazon gave us the most scalability, reliability, and security. We signed a business associate agreement with them and developed a good partnership.

The Amazon platform gives our product scalability. We can have a huge organization on the West Coast, a huge organization on the East Coast, and another in the Midwest, and all of them can add users and mobile transactions without affecting response times or delivery times. We can add organizations on the fly and constantly release products and features as software as a service. Health systems, physicians, and nurses should be on the latest, greatest technology in the most current version at all times and cloud technology allows us to do that.

How do you see the company’s future?

We have built all the channels, the alerting, the calling, and the messaging. We have a tremendous amount of data going through our system. A lot of it was never captured before, stuff on pagers or on personal phones. We’re focused on data analytics to create insights around communication patterns and communication workflows to define their impact on patient outcomes.

We want to get the right information to the right person, make it accurate, improve patient throughput, reduce staff burnout, and increase clinician satisfaction. The future is in creating those insights and continuously optimizing workflows to improve patient care. We add features and functionality solely to improve patient care. Then we need to have data to show the chief medical officer, the CFO, and people who are playing for the platform how it adds value to patient care in their health system and how it creates return on investment.

Do you have any final thoughts?

The lack of communication and collaboration is one of the biggest, if not the biggest, causes of patient harm right now. Solving this problem will save more lives than a new medication. It has been fragmented in the past. We should all get behind unifying it and shedding a spotlight on the importance of communication and collaboration to keep making progress.

HIStalk Interviews Jay Deady, CEO, Jvion

August 3, 2020 Interviews No Comments

Jay Deady is CEO of Jvion of Suwanee, GA.

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Tell me about yourself and the company.

I’ve been in health IT for 30 years, having started in 1989 with Cerner. I’ve had a series of opportunities and roles on both the clinical revenue cycle and analytics sides of the business. Mostly focused on providers, but with some exposure to payers along the way and keeping my career focused solely on health IT.

Jvion is an industry-leading prescriptive AI company. Our mission is to drive down preventable harm to patients, both clinical and cost-related harm, however we can. That has been company’s mission since Day One. The co-founders have done a great job bringing the company forward over the last eight or nine years. I was fortunate to have the opportunity to join a few months ago as CEO.

Are health systems interested in how AI and predictive analytics work under the covers, or are they just looking for solutions that can deliver the results they need?

They are definitely looking at some of the details. The reason is that over many years, certain terms in healthcare and healthcare IT tend to get somewhat abused and therefore misunderstood. It was “workflow” and “analytics” back in the day and now everybody seems to be an “AI” company. Health systems, ACOs, and payers want to understand how Jvion is different from some other company that claims to be in the space. They are clearly interested in the outcomes and benefits that current clients are achieving and they want to understand how our approach is different.

Do health systems, and particularly clinicians, struggle to trust AI that functions as a black box with hidden proprietary algorithms?

It’s a balancing act. We have proprietary technology and methods, and other companies might say the same. Under an NDA, we will go to a certain depth to explain how it is that we do what we do. Fortunately, we have a relatively large number of clients that have been using Jvion for a while, so those documented outcomes and references help in those conversations. Details about how we approach the data science and strong peer references help. We also use a model control study versus just a benchmarked pre- and post-analysis. We have a lot of rigor around documenting the outcomes we have helped clients achieve.

Will AI become another example where technology companies try to solve problems they don’t understand because they don’t know healthcare?

There is some of that. There’s another side as well. On one hand, you have AI companies that don’t understand how healthcare works. They don’t understand the triangle between a patient / member, a payer, and a provider and how you add value to each constituent by understanding their alignment. On the other hand, AI draws a lot of different correlations and can provide a lot of different solutions for a company that does healthcare, but understands that healthcare is complex and needs help with a lot of questions. It’s challenging, from a corporate perspective, to narrow the focus so that you can efficiently scale versus answering one question for one client and trying to multiply that.

How important is it when training a model to avoid amplifying existing biases and to resist the urge to overstretch the model’s capabilities?

One of Jvion’s differentiators is that we have 33 million lives with between 2,500 and 4,000 data points within our machine. We don’t take in a large volume of data for one particular client, which will be biased to their capture solely, and then run the analysis only against that. Our scale and our nine-plus years of experience allow us to leverage the underlying clusters across those 33 million to even out any regional or local biases that might come from a single data source or data from a single region.

What information from outside the EHR can help identify patients who could benefit from an intervention?

Beyond EHR data, the machine uses publicly available data from the federal government, such as community vulnerability and social determinants of health. There are various capabilities around lab data and claims data. EHR-specific data makes up less than one-third of the data that we have in the machine.

What do clients most commonly learn when they apply a broader set of analytics capabilities to data that extends beyond their Cerner and Epic systems?

There’s a lot of additional data that isn’t contained within the EHR. Cerner and Epic are clearly trying to go down the path of balancing, however they describe it, between analytics and AI. But there’s additional behavioral data — environmental data, lifestyle data, transportation data, and even weather. These have impact on the health of a population and on the health of an individual in a specific area, but they aren’t within the EHR. That is one way that we significantly differentiate our offering from the nuanced early capabilities of what Cerner and Epic are doing.

Is social determinants of health information useful other than recognizing that an individual has a problem that goes beyond the health system’s ability to fix it?

Our clients aren’t just hospitals. While source data for SDOH does in some cases come from health systems, we gather information from other sources.

We break our market down into three segments. We have health systems on the provider side. We have population health entities on the provider side, where on their own or in conjunction with maybe a payer joint venture. There are ACOs or other initiatives where some level of risk is being taken around the defined population, whether that is the hospital’s employee base if they are really large or expanded into a provider-sponsored health plan. We have more than hospitals as clients and sources of SDOH.

What opportunities have arisen from helping customers address COVID-19?

It certainly was an unexpected impact for the industry, the nation, and for Jvion. I started as a new CEO three days after Georgia locked down, and multiple months into my career at Jvion, I think I’ve met 18 of my colleagues in person. I just went on my first in-person client visit in Georgia two days ago, wearing masks and socially distancing. Otherwise, it has been a virtual engagement, and that has had a big impact on general business operations.

At the solution level, the hospital provider segment has been impacted the most. Their economics have been fairly devastated. They were a 2-3% margin business, generally not for profit. They lost 30-60% of their high-margin business for a period of time. Our average health system client will probably be off 20, 30, or 40% of the financial operating numbers they had expected for the calendar year, and that is massively impactful from the operations side. From the caregiver side, the daily onslaught of delivering care in this COVID world versus a multi-service line clinical care delivery system is very different.

We initiated a COVID map that we pushed out for free. We worked with Microsoft on it. It’s available online. We’ve had 4 to 5 million hits and uses of it, everybody from the Pentagon and the White House Task Force to the CDC and others. We mapped down to the actual block area to show the vulnerability of a particular community, which is more beneficial – particularly for health systems – than looking at government data that’s at a county level. We expose that for our clients as well as anybody that would care to use it. We’ve been happy with the massive use.

For our clients, we took a look at their current patient lists, applying both the COVID map and other data we created and something we do for our normal solutions. We don’t just create a list of folks who might be susceptible to a negative quality event coming up and predict that. We do that, but we also put that in rank order based on the ability to intervene with a suggested intervention that could make a positive trajectory change and improve the potential outcome based on what the current trajectory is. A number of our clients are using that to outreach to those in their capture who might be the most susceptible and vulnerable from a COVID perspective to make sure patients are getting assistance.

We created a triage select solution, which we refer to as a vector. It works both for COVID and for any type of potential respiratory-impacting areas or diseases, such as basic flu, where you may need to make triaging decisions around the right time and appropriateness to ventilate. How do you prioritize that as the patients are presenting? That helps our clients deal with the onslaught of folks coming in.

I’m really proud of the team here at Jvion and appreciative of the feedback that we got from our clients in critical, overwhelming times. We were able to take that input, understand their needs, and bring our resources, assets, and capabilities to assist.

Do you have any final thoughts?

The US health system environment has faced challenges in my 30-year career and in the past, but they were more financially market oriented, where hospitals had reduced access to the bond market during the financial crisis, for example. But I’ve never seen anything that was so impactful to the actual operations of the health system itself. We will move through this at Jvion. 

We are also looking at our prescriptive AI, which historically has been solely clinical in nature, to understand the challenges of our health system clients. In those parts of the country that are post-COVID or in a lesser COVID world, how do they start getting a return to care? One client’s research found that 68% of community patients are reluctant to seek care because of fear of going to a medical facility related to COVID.

That deferment of care is having a major impact on the providers and the services that they can provide to patients. They will have higher acuity and more severe illness and disease state based on the deferment of that care. If they’re a commercially insured patient or member, payers have an influx of money today based on all the deferment of care, but there’s a tsunami coming of that care having to be delivered, and it will be more expensive later than right now.

It’s an interesting alignment period, with patients getting the care they need sooner than later, providers needing those types of patients back into their health system, and payers wanting them to get the care now versus deferring it and it being more expensive later. We’re focused at Jvion on how we can help drive that alignment across those three constituents whose interests are aligned with a single incentive.

HIStalk Interviews Matt Wilson, SVP of Healthcare Strategy, Infor

June 29, 2020 Interviews No Comments

Matt Wilson is SVP of healthcare strategy for Infor of New York, NY.

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Tell me about yourself and the company.

I’m a healthcare IT lifer, with 27 years in the industry. It’s kind of a family business. My father was an HIT executive going back into the 1970s, so I have been in and around this business for my whole life. I am fascinated in the way it has evolved and I enjoy watching its trends. It’s a pleasure having the opportunity to participate.

Infor is a global cloud computing company with deep investments in industry-specific lines, executives, and products, such as Infor Healthcare.

How has adoption of cloud technology in healthcare changed?

Adoption of cloud technology gives us an opportunity to manifest a remote workforce, which we’ve seen through the pandemic, and we will see more of that. Cloud provides the ability to rapidly respond to customer needs with updates that don’t require the same kind of effort as on-site, on-premise solutions. We can engage our customers more consistently and more rapidly, which is an enormous benefit of cloud in addition to the reduced costs of maintenance.

Are you seeing a new urgency for agility in your customers since the pandemic started?

We are. Customers need us to be agile, especially in areas such as supply chain and real-time location services. Our objective has been not to get in our customers’ way, but simply to make ourselves available for what they need. We have found that our greatest opportunity to help has been engaging with something that takes a couple of weeks instead of the months and months that we’re used to with typical implementations.

How do you see the synergy between EHRs and enterprise resource planning systems?

Infor as a company, and I as an individual, are focused on how create a more balanced ecosystem. We have spent years and years, decades in fact, investing in EHRs. I was a beneficiary of that, as I helped build Cerner through the late 1990s and early 2000s. The lack of commensurate investment in ERP has created an imbalance.

We believe we can move the industry by modernizing the technology, driving a set of functionalities that contribute to the core mission of patient outcomes and a better system of health and wellness. You must have world-class systems and functionality across the core pillars of finance, supply chain, and human capital management. The way that we use interoperability and the way we orient ourselves to that core mission is critically important.

What is left to accomplish with ERP?

We need to bring together those investments to orient themselves to a single goal. We have tended to think about upgrades and technology as an ability just to upgrade the tech itself. The future holds orienting towards making one leverage off of the other, creating that ecosystem and integrating some of the billions of dollars we spend each year on management consulting on transformation. That transformation creates change. Tech should be used to sustain change. As you are moving forward with big transformation projects, how can you use your clinical solutions, your revenue solutions, and your business solutions to sustain the efficiencies, cost reductions, and tech advancement? That will be critical as we move forward, and we can play a big role in that.

As EHR and ERP vendors get bigger, does the opportunity still exist for smaller vendors to offer an ecosystem of wrap-around products?

Our Cloverleaf solution is the most widely implemented integration engine. True interoperability creates a wire that connects both traditional and nontraditional data sources and care venues, but should be used to facilitate small tech, where the gating factor for cool, innovative companies to have their products used by big health systems is the IT organization. They don’t have the time and resources to complete the interfaces, or there’s a lack of understanding around anything from security standards to interoperability.

Big platform companies like Infor and the large clinical software vendors should think about how we can facilitate the inclusion of that other cool technology that can help drive value. How can we more easily connect them into that ecosystem for the purpose of creating balance? That should be one of the central themes that we as big platform vendors should be thinking about. I think a lot about that in my role at Infor.

How do you assess the federal government’s interest in interoperability?

The Cures Act has laid down to the letter the requirement to interoperate. Vendors often give lip service to how they’re adhering to that, and some vendors continue to push back. We are seeing an absolute requirement to go do that. We’re looking to facilitate it.

What we need is an attitude change. While it can legitimately be an impediment to competitiveness, what we should be thinking about is how we’re working together to advance an industry right now that is not in the best of shape, an industry that is critical to us as a society. We need to take that signal, act on it, and find ways to include others. We are seeing those signals from life sciences, big lab testing companies, and payers that they need to be a part of that as well. They are developing standards that are oriented towards meeting those federal guidelines and making data liquidity a prime imperative in healthcare.

What was your reaction when you saw that the information that is needed for pandemic-related public health reporting was being sent by fax machines and emailed worksheets?

It’s just such an incredibly inefficient process. There is regulation to begin phasing out fax machines, but we need to move more quickly. That’s an area that we think will evolve quickly, even potentially with stimulus, in the area of supply chain and public health reporting. Those are necessary when something goes wrong, such as a once-in-a-generation pandemic.

The billions and billions that we’ve spent were sufficient in areas such as telehealth, but didn’t get us where we needed to be in terms of a fractured and disrupted supply chain and using antiquated technology to quickly report on outcomes. Interoperability becomes a central theme, and while we have had so many attempts with CHINs, RHIOs, and the rest of the alphabet soup, we still haven’t effectively created a true system-wide capability to normalize data and move that data around for those purposes that you’re describing. That’s critical as we move forward.

Are customers asking for new capabilities or guidance to help them stabilize their supply chains?

We asked clients what they need most. We responded quickly by developing supply chain dashboards for PPE. We are proud of how we were able to participate in a bit of a solution. We think that will be an ongoing need, the requirement to connect disparate supply chains and to develop functionality to find clinically equivalent alternatives when a particular supply, device, or PPE item becomes unavailable. We have to evolve with our use of AI, machine learning, and physically connecting suppliers. We will work closely with our customers as we go forward because it will be critical if we experience something like COVID-19 again.

What product opportunities do you see with AI?

For us, again as a platform company, we have so many opportunities to advance and help. It’s really listening to the market. What we are hearing from caregivers and business operations associates is that supply chain becomes a huge issue. We saw human capital management evolve and the role of chief human resources officer created around the country, and we expect to see more senior executive supply chain personnel taking roles in the strategy of the organization.

We also see a huge need around real-time location services in contact tracing, to be able to efficiently understand where a diagnosed patient has been, what equipment they have touched, and where that equipment is at the moment. Apple and big tech companies are working on that for consumer. We have solutions, but more importantly, we need to continue to evolve that inside of the hospital system. It’s critical when you have something like COVID-19 or Ebola that you know where things are, whether they are usable, and who is coming in contact with them.

The pandemic seems to be accelerating the health system acquisitions that create sprawling regional or even national enterprises. How do you respond as your customers get bigger and move into business areas that don’t involve traditional hospital operations?

You respond by listening, even though that is a bit of an obvious answer. We also try to educate ourselves to become healthcare experts. We spend a lot of time talking to outside interests, outside experts, and trying to understand where we should push, advance, and lead through thoughts and action.

We saw two things advance during the pandemic. We saw not only telehealth and the inevitability of pushing healthcare out more directly into the community, but we also saw an evolved need for inpatient facilities. We had been moving away from that over the last decade as we attempted to decentralize healthcare, but all of a sudden, we saw this need to ramp up quickly.

As a software vendor, the key is flexibility. Are we making core investments in the things that we do well today? Are we making core investments in technologies that allow us to be flexible, like contact tracing and interoperability, things that allow us to move where healthcare is and to bring our solutions and services where our customers need them, not where we think we’ve designed them to operate? That’s a critical piece.

Do you have any final thoughts?

We hope that investors and users will give us the opportunity to display how a traditional ERP company can become central to a mission. It’s not enough to upgrade technology, create a better user look and feel, and deliver greater functionality in its traditional sense. We can be accretive to the broader picture of healthcare by providing this healthcare operations platform that helps balance out that ecosystem, works together with clinical, and advances the overall mission of the organization. That’s what Infor is looking to do, and we invite others to speak with us and give us that chance.

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Reader Comments

  • AnInteropGuy: I would hope that we have better medicine and science than we did 67 years ago. Our understanding of virus mechanisms ar...
  • Angela C. Witt: Most of the suggestions you have to improve order management in the EHR are features available in current vendor product...
  • masterblaster: I was intrigued by your statement of "Because they so tightly control access to the vendor’s documentation, I have no ...
  • IANAL: In spite of AMA lobbying, regulatory changes in the early 2000s allowed pharmacists to give flu shots. Costs fell, acces...
  • Brian Too: My theory is that telehealth is a bigger benefit for the patient than it is for the clinician (though there are clinical...

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