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HIStalk Interviews Russ Richmond, MD, CEO, Laudio

February 9, 2024 Interviews No Comments

Russ Richmond, MD is co-founder and CEO of Laudio of Boston, MA.

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Tell me about yourself and the company.

I’m a lifelong entrepreneur. I’m also a physician, and through that and other activities, I’ve walked the halls of over 100 hospitals and I understand how they run. I have focused my life on building solutions software for hospitals.

I’m the founder and CEO of Laudio, which is an AI-enhanced platform for the frontline leaders or frontline managers in health systems. We support these frontline leaders with workflow that saves them time and drives improved employee retention and engagement, operational efficiency, and improved patient experience.

How much health system employee burnout and turnover can be tied to manager-level behavior rather than organization-wide policies like compensation?

Our best guess is that 60% to 70% of the employee’s engagement, which is the proximal metric for turnover, is influenced or driven by their direct reporting relationship with their manager. Health systems assume that it is always compensation related. I’m not saying that compensation isn’t a very important thing, but we know that frontline workers attach much more to their managers than they do to the overall organization. We know that by improving the bond between a frontline worker and their manager, we can greatly influence their propensity to stay engaged and employed at that organization.

People often say that they love the company, but can’t stand the boss.

People don’t quit jobs, they quit managers. Managers have a tremendous amount of influence on the mental wellbeing of their employees, and anyone who has had a bad boss knows that well.

But what we have learned inside health systems is that they have a special issue, which is that the frontline managers have very large spans of control. It’s not uncommon to see team sizes of 50, 70, or 100 direct reports into a manager. That really stretches the bandwidth of that manager to do traditional management.

The biggest lever is to increase the frequency of timely, relevant connections between the managers and their teams in a way that feels personalized, in a way that makes a big team feel smaller. That in and of itself can drive a tremendous improvement in engagement and retention. If a manager takes the time to have a one-on-one interaction with their team member every month, the likelihood of that team member quitting falls by over 40%. It’s just that the managers sometimes don’t have time to do that.

Beyond that, it’s the intuitive things, and a few counterintuitive things, that make a difference. First, managers showing that they care about the wellbeing of their employee when they do interact with them. How is their schedule? Have they worked too many shifts in a row? Are they forming relationships on the unit and inside their teams? Celebrating or recognizing good work done? These are the types of actions that managers can take that can make a real difference. 

Then somewhat counterintuitively, even when managers interact with team members on accountability-related issues — like corrective action with a worker who is always coming in late — that actually drives an increase in retention. Because all of a sudden, the frontline worker knows that someone is paying attention to them, that someone cares about whether they are there on time.

It can be a wide array of interactions, but the key is that they have to happen, happen regularly, and happen in a way that’s not a bulk email, not pro forma, but in a caring, personalized way.

What is the disconnect between what executives expect and what managers do?

Many executives don’t appreciate the challenge these frontline managers are up against. Huge spans of control, extending to the number of systems that they need to interact with and operate, the administrative burden that they face, and just getting their regular work done in terms of documentation, getting data into the right place, and setting the schedule. Because they are disconnected from that everyday reality, it’s harder for them to support and coach these frontline leaders. It’s harder for them to connect their agenda, which may be system-wide performance improvement, with the everyday actions of the frontline leader.

Laudio solves for that. It connects the overall system wide agenda — say, improving retention of full -time employees, reducing contract labor, or improving HCAHPS scores — with specific daily actions that frontline managers can take that and that fit into their workflow in an efficient way. That’s where we have focused our efforts on solving that problem.

How does a health system define its goals and then package up individual tasks that frontline managers should be doing?

We have live API integrations into the systems around these managers. That includes the HR information systems, like Oracle or Workday. That includes the time and attendance systems, like UKG. That even includes Epic, where we get patient geolocation information. The data aggregation is handled through our platform. 

Once we have the data in one place, it’s just a matter of working with the senior leaders in the health system around their priorities. Some of them have priorities, especially in today’s day and age, around reducing turnover or reducing incremental overtime. In that case, we are pushing those types of actions through Laudio. Some of them have priorities in saving their frontline leaders time, because they can see that they are overburdened. In that case, we are working with the frontline leaders on automating their work and creating more operational efficiency. Some of them have priorities in patient experience or quality, and in those cases, we are emphasizing those workflows.

Because we are a platform that surrounds the frontline leader, it’s just a matter of, from an organizational level, determining what to emphasize first and foremost. Then once we are seeing good results there, we can move on to the next area.

I’m still thinking about a hospital manager having 100 direct reports covering a 24-hour schedule. Is healthcare unusual in that regard?

Yes, it is unusual. I have not seen another industry like it. Normal executive span of control is between six to maybe 12 people. Even when you get to 20 people, which is a low span of control inside an acute care facility, you are way beyond that. 

I think it comes from the guild-based practice of medicine, where practitioners were meant to be individual contributors in an era that wasn’t as team-based and wasn’t as technically challenged. We live with it today, and it has become a more or less a permanent part of the economics of health systems. They have a hard time affording span-breakers and hiring more managers, because most health systems are working to reduce their labor expenses. It becomes what can we do for our managers to give them more capacity to take on these larger team sizes and to still drive the results that we need in the system.

I would assume that a lot of those folks were promoted into management because of their own job performance among peers rather than having managerial aspirations or talents.

That’s correct. Managers in health systems are almost never hired horizontally from other organizations outside of healthcare, and very rarely are they hired horizontally inside a facility or organization. What you see almost all the time is individual frontline workers getting promoted into being a frontline manager when their manager leaves, which we call a battlefield promotion.

In the context of a battlefield promotion, it’s difficult to ensure that that new manager has acquired all of the management best practices, skills, and training that will be needed to be good at that job. It’s a very different job than the one they had been doing. This is where we believe that software can at least be part of the solution, and that we can hardwire a lot of the management best practices through our system and also introduce best practices as they are discovered so that they can become immediately diffused to the managers versus waiting for them to go to get a master’s in healthcare administration or to take some type of a training program that that health system may offer.

Software has a tremendous advantage in supporting especially new managers, but all managers, to quickly acquire some of the skills they need to do a great job.

Do managers get adequate employee feedback from hallway conversations, or is a formal feedback mechanism required?

It is very difficult for a manager in a hospital to get accurate feedback, because they are managing a unit that is working 24×7 while working 40 or 50 hours of the week. They are not regularly interfacing with the entire employee base. When they are, it’s often in the context of putting out a fire. I put that in quotes, such as handling on a patient issue, a physician complaint, or a near-term operational priority like a staffing gap. 

Employee voice tools effectively gather feedback regularly and efficiently. They help managers understand their unit better by highlighting only the key issues that require action. This saves time and enables quick responses to important matters. It’s a great use of technology.

What are early warning indicators for burnout that an overburdened manager can detect so they can at least take action to retain an employee?

Health systems are collecting a lot of employee-specific data continuously all the time. The problem is sorting the signal from the noise, figuring out what is relevant, and then in the context of a busy unit, finding the right way to connect on it. 

Our software helps prioritize and identify the individuals who need the manager’s attention most, using AI and risk models. Then we connect the manager to the evidence-based best next action with that frontline employee. That can vary dramatically, depending on the core issue. It could be helping them iron out their schedule if they have an unusual working pattern where they are always on weekends or something undesirable. It could include helping them think about their promotional pathway and clinical ladder to give them a longer-term view in the system. It could be reviewing complimentary feedback from their patients and recognizing them for a job well done. It really depends on the situation and the individual worker. 

Where Laudio has a real advantage is that since we are collecting all this information, we are understanding what the managers are doing with it and the actions that we are taking. We have created an evidence-based dataset of which actions can support the workers the most. We publish a new use of evidence every week in a part of our website called Laudio Insights, where in a non-commercial way, we are trying to promote the practice of what we call evidence-based leadership. Everyone can benefit from what we are learning around what makes the most difference for managers and how they can use this evidence to practice differently.

What are your company priorities over the next few years?

Continuing to focus on helping create management actions that will drive new levels of impact in health systems. We can handle the data aggregation and analysis that is done automatically in our machine. We are starting to turn our frontline managers into super-powered frontline managers and make them more efficient.

In the future, we want to continue to pull new and different data sources into our system to help them to achieve new horizons of impact. This could include things like the supplies that are used inside each unit. It could include all of the sensors that are in patient rooms around handwashing or whether the patients are being rotated on their beds. We see a future where more and more of this data and information is integrated into a single source of recommendation for the manager so that they can make the impact happen without having the analysis, risk modeling, and data aggregation get in the way.

HIStalk Interviews Larry Kaiser, Chief Marketing Officer, Optimum Healthcare IT

February 8, 2024 Interviews No Comments

Larry Kaiser is chief marketing officer of Optimum Healthcare IT and its sister company Clearsense.

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Tell me about yourself and your work.

I have been in healthcare IT for just over 20 years now. I started with Keane, which was acquired by NTT Data in 2010. They sold two EHRs. I started as the RFP manager and then moved up to running the marketing department. In 2016, I shifted to Optimum Healthcare IT, where I launched the marketing function from the ground up, built that, and helped grow the organization to about $160 million in revenue. I left Optimum to go to our sister company Clearsense for a couple of years. Now I am back at Optimum as we look at the next level of growth in the organization that is not centered on core EHR services. That includes ServiceNow services, Workday staffing and implementation, and cloud migration and cloud services.

How would you describe a marketing organization to someone who doesn’t know much about it?

Marketing is something different every single day. That’s what makes marketing interesting. That’s what makes it exciting. 

In the case of Optimum, where I was building an organization, I could look back on my experience at Keane and NTT Data over 10 and a half years. I saw how things were done from a corporate perspective and from a divisional perspective, how different people did different things, and learned from that. When you’re building a marketing department from the ground up, you have lots of examples of what worked and what didn’t work. You need to start very basic.

When I joined Optimum, it had a logo and a website that was built on the 2012 version of Drupal and had never been updated. This was in 2016. The first thing we had to do was to look at our public-facing presence and determine what we wanted to be. That started all sorts of internal conversations with many subject matter experts on how we should portray ourselves, the services that we offer, and start molding those together in a fashion that had never been done.

We worked on the website and the website content, getting it to a modern platform. Then we focused on pieces of collateral and slowly worked our way through that. Then we worked on thought leadership and exploring different types of white papers and case studies to allow us to show that we know what we’re talking about and to promote the successes that we had as an organization. From there, it goes off into many different areas, such as partnerships with industry organizations such as CHIME and HIMSS.

It’s really just understanding and taking an inventory. The marketing plan I put in place focused on several things across the board, looking through all of those, understanding from an organizational perspective and having all of those conversations, and then taking all that knowledge and executing it. Every day, I was doing something different. Having never been on the services side versus the product side, every day was an education for me, and I would learn something every single day. That allowed me to work through this process methodically to strengthen the brand position, promote that thought leadership, fuel that demand and lead generation, and ultimately educate the employees on what we would be doing  to grow the organization.

Have shortened attention spans changed the way that you create content?

Analytics plays a big role in that. If you talk to any marketers, whether it’s healthcare or any space, it’s all about the analytics. If I’m producing articles for a blog that will be mentioned on LinkedIn, X, or HIStalk, I have the necessary coding within those URLs to understand how many times it’s being clicked and who is looking at it. That helps drive the kind of content that we create. If we create infographics and find that traffic to those pages, clicks, and downloads are high, we will shift our attention to that.

White papers have traditionally been that lone piece of gated content that an organization will put up on their website. The challenge with that is when people fill out a form to download it, they will put Mickey Mouse for a name or a fake email address, because probably nine times out of 10, the form doesn’t check the email address and just opens the PDF for any entry. Emails sent by your marketing automation bounces back, but that person has already obtained that piece of content. It’s a challenge, in this day and age of cybersecurity threats and people’s phones and emails being hacked.

Social platforms are doing different things. LinkedIn offers newsletter capability. At Optimum, we have found that over the last couple of years, fewer people are filling out a short form that asks for name, organization name, and email address to subscribe to our thought leadership in their inbox. People don’t want to give their personal information.

This week, we launched Optimum Pulse, our new newsletter. That goes out to our 55,000 followers, and we’re up to 4,200 subscribers. Our strategy on our website now is that instead of asking you for your personal information to subscribe, we will put a link out for people to subscribe to our content on LinkedIn. Each week, we will publish a newsletter with a little preview and a link to our website. That link will be appropriately tagged for tracking. That will give us insight into what pieces of content are working.

From a white paper perspective, we haven’t published one in several years, for similar reasons. We didn’t have the bandwidth, because we’ve been so busy. They really weren’t being downloaded too much. We shifted to more case studies, blog articles, and when we had the bandwidth to do it, more video. We did lots of spotlights on some of our Optimum CareerPath students, and that has resonated in the market. Our target market of CIOs for the Optimum CareerPath program likes to view those videos of the people who have gone through and have had success.

It’s a challenge and it’s a constant struggle. It’s a constant monitoring of all those analytics to figure out what content your audience is reading.

How do you differentiate between brand awareness versus lead generation?

First and foremost, I don’t think brand recognition ever really goes away. That’s always going on. I’m of the belief that your public-facing website should be touched at least once every 18 months to update the look and the feel of that website to keep it fresh. That’s something that we’re doing at Optimum right now.

From a lead generation perspective, or demand generation perspective, for our basic core EHR services, our brand is recognized so much that we don’t really have to do demand generation in that space. People come to us, and that’s fantastic. But in the new areas of growth — ServiceNow services, Workday implementation and staffing, and cloud migration services – we are having to start from the ground up and focus on demand generation programs and developing those, because we’re not known for those things right now. That has been ongoing for the last several months.

For our ServiceNow practice, we hired a specific firm that specializes in ServiceNow demand generation. They are helping us develop the necessary content to start doing that demand generation.We will learn from that and probably do a little duplication of what they’re doing for the other practices as well. It’s definitely a shift as the organization grows into new areas and needs to focus on demand generation for them.

I’ve noticed on LinkedIn some health tech folks whose title involves “growth marketing.” How is that different from marketing in general?

That’s a toughie right there. A growth marketing individual is someone who is 100% focused on doing the B2B strategic, data-driven approach to building a pipeline in conjunction with your sales team. I’ve seen that same title a lot out there as well.

At Optimum and Clearsense, we have not necessarily had that individual. The marketing department is working with sales to generate the pipeline, qualify the leads, and make sure that everybody is doing what they need to do to move that opportunity through the buying cycle of the pipeline. Every organization will have a different cycle it goes through. I think it’s an extension, similar to saying that you’re a social media marketer or an influencer. It’s a small piece of the overall picture. It’s probably more like an inside sales rep, ultimately.

How do companies plan their involvement with health tech conferences?

I’ve been doing HIMSS for 20 years. For 16 or 17 of those years, we had one conference in healthcare IT, and that was HIMSS. If you didn’t go to HIMSS, you really weren’t relevant in the space. 

Because of COVID and how some things were handled, CHIME and HIMSS were no longer associated, and they went off and did the ViVE conference. The second year was much better than the first year. Clearsense went into that conference in 2021 in a rented booth from them and we really didn’t know what to expect. As a young organization promoting our SaaS product, we didn’t know who was coming. It was a little bit smaller, but year over year, it grew. Having CHIME associated with it brought our target market to that.

HIMSS was really struggling. I think that had a lot to do with how they handled the 2020 show. It wasn’t until last year when, all of a sudden, HIMSS appeared to be relevant again. At Clearsense, we had no idea what to expect at HIMSS last year. We were very pleasantly surprised. Our booth traffic was just as robust as it was at ViVE, to the point that we had a wait list to get demos of our product.

Clearsense is a product company. We are heavily invested in ViVE from various sponsorships. We built our own booth because financially it made more sense to build it and store it than to rent a booth every year. HIMSS is less of an investment, but I could see that investment growing in the future if the trend of growth and recovery for HIMSS continues.

As to HLTH, I have never personally attended. We explored the possibility of exhibiting at HLTH this year. I sought the opinions of many people. The folks at HLTH and I are friendly. They shared the breakdown of attendees. It’s more tailored to provider and payer now, where the angel investors aren’t as prevalent. But then when I have conversations with people, they tell me the exact opposite from their attendance. We chose not to invest in HLTH.

We are a main sponsor of ViVE, but we don’t have a booth. We have a pretty hefty investment in ViVE. Several years ago, we were no longer a HIMSS sponsor, but with these new areas of growth, it’s an area that I think we need to start investing in again because all the players are at HIMSS, such as AWS, ServiceNow, and Workday.

For both of our organizations, ViVE is number one, HIMSS is number two, and HLTH is a distant third, just based on the attendance.

Have you received any early indication of how the HIMSS conference will change now that Informa Markets is running it?

It’s too early to tell. The running joke in the industry is that maybe the aisles will have carpeting again this year.

Most of the HIMSS people that I was friendly with have moved over to the new company. In the questions I’ve been asking and the conversations that I’ve been having, we won’t see major change in HIMSS until 2025. What that change is, I don’t know. They haven’t really said what it will look like. Apparently HIMSS is still dictating the education at the show and Informa is doing the show itself. We’re all sitting back and waiting to see how it’s going to change.

HIMSS24 is too close to the acquisition to make changes for this year. It will be interesting to see what it becomes and whether they can return it to its glory of many years ago. I’m not going to say that it’s not relevant now, but they are playing second fiddle to ViVe now, unfortunately.

Companies reduced their spending to weather the investment and economic downturn. How will they restore the marketing function as conditions improve and companies have to reestablish their competitive position?

2023 was a tough year in general for healthcare IT companies, whether you sell services or products. Historically, marketing is usually the first to go and the last to get rehired. Organizations that had a strong financial footing may have done some some RIFs, some layoffs, but they didn’t eliminate the department across the board. I have seen some organizations cut their entire marketing department, which Is interesting to me because you still need to maintain your brand. You still need to maintain the marketing activities that you were doing in order to grow pipeline. Marketing and sales go hand in hand.

This year and going into 2025, I think you will see a slow reinvestment in marketing. A number of articles from well-known publications have said that from their research and conversations, providers are opening their purses up again. When providers start buying again, an organization has to have marketing to successfully engage with them. Probably by the middle of this year, I think you’ll see an uptick in healthcare IT marketing expenditure to bring teams back in. It will happen methodically. An organization that cut everybody will probably bring in a leader first and have that person assess where they were before, where they are now, what needs to be addressed, and what roles need to be brought in. Then you’ll see a trickle down effect of them slowly ramping up their marketing departments again.

I’m very much plugged into the healthcare IT marketing organizations. I can open up my my browser to X and I have a chat with about 15 other healthcare IT marketing folks from various organizations. We have a chat every day, and just this morning, someone said their entire team was let go. We are seeing that a little bit, but by mid-year, you will see a real push to reestablish those teams.

HIStalk Interviews Aasim Saeed, MD, CEO, Amenities Health

February 7, 2024 Interviews 1 Comment

Aasim Saeed, MD, MPA is founder and CEO of Amenities Health of Dallas, TX.

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Tell me about yourself and the company.

I’m a Texas native and I live in Dallas. I have a medicine and public policy degree background, but I never practiced clinically after medical school. Instead, I went the route of management consulting at McKinsey, where I was almost exclusively focused on US healthcare and US healthcare systems specifically. I wanted to make an impact on the healthcare provider side. That remains my passion today. I was at McKinsey for a few years and then started getting into technology and jumped out from my first startup, which was an early stage fintech company that was acquired by H&R Block.

For the last four years, prior to launching Amenities about two years ago, I led innovation at a large healthcare system here in Dallas, Baylor Scott & White Health. It was an interesting time to be there from 2017 to 2021, when I left. Obviously COVID happened, but we also made massive investments in digital health, and I think we were pretty much leaders in the field from a health system side. That has a loaded connotation onto itself, but I did a lot of cool things, part of which sparked the ideas and opportunities that I wanted to explore at Amenities.

At Amenities, we help large healthcare systems build a much better patient experience. Specifically, we think that the digital consumer is dramatically lacking in US healthcare, and that health systems have a huge opportunity to shift the market experience and then hopefully get rewarded for doing so by moving patient volume.

We call our platform a digital front door and patient loyalty platform. That last part is important, because our bet is that if you not only improve patient experience, but do so in a new business model that rewards you with loyalty, that could be game changing. That’s the idea behind Amazon Prime, where you went from occasionally shopping online to basically shopping online exclusively. I have hardly set foot in a Walmart again because two-day shipping and free returns solved all my concerns.

Part of what we are trying to do is help health systems figure out how to be more compelling and exciting to their patients. That’s why we’re called Amenities, literally.

Healthcare consumers have a high lifetime value. Why don’t providers compete on customer experience?

I don’t think there’s a single answer, if I’m being blunt, and I’m definitely not the smartest person in the room to have a perfect answer for you. They don’t compete on it because nothing changes your decision-making as a patient. If you’re in an ambulance, you’re not typically choosing where you’re going. If your doctor says go to Baylor, THR, or Medical City, you follow those instructions. You only find out what it costs afterwards. You are picking based on a vague idea – what’s a good doctor or good health system? There is an abundance of reasons that patients aren’t able to discriminate health systems.

If you’re being fair and say, why aren’t health systems more motivated? It is because to date, if they have done something, it hasn’t resulted in more volume. They might have experimented with doing something for the patient, but it didn’t move enough volume in a specialty that mattered financially. There is a massive missing ingredient, which is a business model that rewards them in a metric they care about. I think that is membership, loyalty, and lifetime value of a patient, instead of just saying that we offer this concierge primary care practice, we signed up 100 patients, and that’s it. It doesn’t result in downstream loyalty.

Patients want to know what it’s going to cost. I spent four years at Baylor trying to figure out how to do meaningful price transparency. Frankly, it’s not really a solvable problem right now, based on the infrastructure we have and the multitude of players. 

There have been both handicaps for health systems, as well as that they haven’t had a financial business model that gets them excited enough about doing game-changing things. It’s sometimes unfair, but I think accurate, to say that this industry is known for conservatism. They don’t take big risks. They don’t swing for the fences. They don’t do this. We are trying to show them an opportunity not to do things for incremental cost reduction or try to find a use case for AI for AI’s sake, but rather let’s swing for the fences and change how healthcare is delivered here. Incentives around a membership could be a big activator.

Do health systems that launch innovation and digital teams have specific ideas of what they want to accomplish and establish metrics to track results?

You will find, unfortunately, some variation of the Triple or Quadruple Aim as the mission, just reworded to sound fancier, like reduce cost, improve quality, provider satisfaction, patient experience. At Baylor, when I was there but I think it’s changed now, we had value-based care. We had operational excellence. There was cost reduction. We had consumer digital, which was  patient experience. 

Again, they might call it something different, but we haven’t seen much that’s materially different than that in different innovation teams. That’s because we haven’t accomplished those goals. That’s not a knock on health systems. Those are the things that we are all trying to achieve.

The question is, how is it going to scale? Where health system innovation teams struggle is that everything feels like an experiment, with death by pilot or a dozen little pet projects. We very much started out that way. You have to get to the core of the health system and what’s it trying to do. You can’t experiment for experiment’s sake.

Unfortunately, we’re seeing a lot of that. We get asked a lot, what’s your AI strategy? What are you talking about? That’s such a weird thing in healthcare. It’s like, what’s your cloud? I mean, I understand why people care in the IT arena, but that’s not a business case. If McKinsey taught me anything, it was to start with a tangible outcome that is undeniably important to the overall business, and let your strategy, especially your technology strategy, stem from that. 

The time that we had the most clarity at Baylor, and the digital health office that I ran, was during COVID. It was like, oh my God, patients can’t access virtual appointments and we’re not serving our patients. There was immediacy. But even immediately after that, our strategy became specific, to double the number of Texans served. That was so helpful for the innovation team to focus. We stopped doing things that just came to us, and we said, is this going to move the needle?  

That’s a level of focus that I left with for Amenities, to say that we’re not an app for app’s sake. Building a prettier app is not going to fix healthcare. If the app helps a patient register in under 30 seconds, find a doctor, and book an appointment, now we’ve done something. If AI can help, great, but 90% of those problems do not require AI. We have refused to create the operational systems, the scheduling systems, or whatever it is. We fix those things. We don’t try to do big, shiny things. We’re trying to help the health system attract new patients, make it incredibly simple for them to become a patient, find a doctor, and book an appointment. 

The fun really starts when we think, what would keep them loyal that doesn’t exist in the market today? When we think about loyalty, you have to be better than One Medical. You have to be better than than what’s out there in virtual health like Teladoc or whatever they can find on the street. There are creative opportunities to do new services that patients don’t know to ask for, but that they really love, based on our research.

What is the current and future state of the digital front door and patient portals?

For me, it’s absolutely clear. If your digital front door doesn’t add new patients simply and immediately, what is the point? That’s where patient portals are good. It’s good to have a patient portal, but they are completely lacking in imagination of what a comprehensive consumer experience should look like. 

Starbucks doesn’t say, I would just like an app to review my history of orders. It is a transaction tool. Starbucks would never in a million years go to the Coffee.com app with Joe’s and Pete’s and everybody else all using the same app, that’s no big deal. Like it or not, health systems are competing. The fact that they defer their most valuable digital asset to another company is just beyond me. It is an acquisition tool. That’s what it is. That’s what it should be. The fact that it’s not viewed that way is a gross oversight, full stop. Are people getting into your system and are you adding new users?  If not, then it’s lacking in what it could be, and how it could be financially ROI-backed in all of your investment.

At Baylor Scott & White, during COVID for 2020 through 2022, we added half a million net new patients through the app. That number for most other health systems, nine out of 10 of them, is zero. That’s crazy. That’s like health systems just now realizing that they need a website. That’s the equivalent of the app. In five or 10 years, we’ll look back and be like, that was crazy. Why would we limit use of the app to current patients or current customers? 

I don’t know how that happened or why, but it’s a lack of imagination to say, this is a digital commerce acquisition and loyalty play. Once we earn a place on their phone, what are we doing to keep them using that? Why do they love that? Why are they coming back to us over and over again? That’s how every other business thinks. I don’t know why healthcare doesn’t think that way.

A simple healthcare problem is that someone can’t get in the app unless they are already a patient. We found that nine out of 10 people threw their hands up and said, “I guess I can’t get into the app.” Why can’t they register? Oh, we don’t want to create duplicate accounts. OK, great, then we need to ID verify them. How do you do that? There are only really crappy systems where you have to take a picture of your ID and wait for HIM to review it. We said no, we want to automate all of that, and that’s what we do. In 30 seconds, we can full ID verify someone better than literally Experian can, with no data entry required. 

We don’t create any duplicate accounts. If they don’t have an account already, we register them into Epic in MyChart. We don’t have to make these sacrifices. The tech can do this. You just have to build an experience. Start with the experience that you are trying to create and then get it there. We got the idea from fintech and built that experience. The other one is airlines, which are the king of loyalty programs. No airline would ever say, here’s our loyalty program app, and you have to download this other Sabre app to actually book flights. That’s where health systems are. They haven’t forced these things to be the same. They haven’t said, “This is our brand and this is how we interact with everyone.”

Lack of transparency on pricing from a patient standpoint is a massive problem. I spent four years trying to figure out how to create meaningful price transparency for consumers at Baylor Scott & White, and two things went wrong. One is after like four years, we could tell them if their co-pay was going be $20 or $25. No one cares about that. That’s not the thing that they are worried about. They are worried about bankruptcy. They are worried about a surprise bill. Somebody’s out of network. The doctor who is wearing your scrubs, who has your ID badge, who is located inside your building, somehow doesn’t work for you. That’s the surprise.

We tested this and came up with a feature called no surprise billing guarantee. It was the number one feature wherever we tested. It’s an example of a feature that consumers aren’t asking for, but when you test it and you put it in front of them, it goes off the charts. The No Surprises Act exists, but patients aren’t understanding that, so let’s build a product around no surprise billing guarantee. That’s one of the primary things that Amenities does.

Health systems struggle to show their true pricing everywhere within a system. Baylor would direct you towards ambulatory surgery centers and not the main hospitals, because we all know that the pricing is cheaper for the same procedure at an ASC, but health systems aren’t really incentivized to do that. There was always this internal struggle. But I believe that health systems should embrace that and say, get on the patient side. Get on the consumer side. Because once you become a consumer advocate like that, that’s how you think big, not playing these games of, is that good for our hospitals, and what will that hospital president think? My push is to be on the consumer side completely.

Customers like to feel that the business knows them. Health systems people can look in the EHR for your medical history, but do they use technology as customer relationship management way to accommodate preferences or non-medical lifestyle information?

I was there when we brought in Dynamics and evaluated Salesforce as a CRM. CRMs are fine and definitely a tool, like cloud, that any modern company and architecture should be built on. It always comes down to, have we started with a use case? I see so many health systems, including ours, saying that we can’t do anything until we have a modern CRM that connects the website to the contact center and to our data. That’s just not true. That will take like four years, and if you don’t start with the use case, you won’t have the funding by the end of it. Everybody would be like, why did we just spend $50 million to do this thing and nothing has changed on our website? 

You have to start with the basics. Can we register a new user? OK, great, and then to your point about preferences, what are all the different communications channels that they get, and how are we letting them set those preferences so that they are not getting a bunch of phone calls when they only want texts or other things? There’s a lot of little, immediate things. What often happens in healthcare is that once you start talking about CRM and big legacy platforms, it becomes a five-year journey, and you don’t know if you’ll make it with the same team by the end of it.

Amenities is keen to say, you can try to build what we built, but Baylor Scott & White spent north of $25 million trying to build the MyBSWHealth app. It was wildly successful, even at that number, but that’s insane. Why is every health system doing this? Part of why we left to do this is that we built this at scale. We can be live in a matter of weeks, if not months, whereas we’ve never seen a health system spend less than $5 million a year and take two to five years to build something custom. Why would you do that? It’s not a good idea. We have to do something with the health system industry experts, like what we’re trying to do, which is custom build. Not take a generalized platform like CRM in every other industry and then try to spend two years plugging it in to get value out of it.

I’m not saying that’s not going to be required for the long run. It’s just that any large infrastructure investments are going to take two to four years just to get implemented, let alone the payoff period. Why not do something immediately that differentiates your health system from the consumer experience tangibly in a matter of months? That’s what we’re trying to offer and say, it’s really not about the technology. What is top of mind for those patients? We’re finding that it’s cost. It’s the worry of financial ruin. It’s a lack of transparency on any sort of quality metrics. 

Patients ask us in our research for things like no surprise billing guarantee, satisfaction guarantee, transparent cash pay pricing, or things like best surgeons. I don’t know a health system that’s willing to show their own data on who’s the best surgeons, but I can tell you that patients would love it. Those are the types of things where we have to get out of a conservative mindset and start offering consumer-centric things that make us uncomfortable and take a bet that it is going to pay off. Because if we are really on the consumer’s side, they will pick us over any other system. 

I don’t think that’s a crazy bet, because what would you want as a patient? If you or your parents need a CABG surgery and you have no information on any doctor about how good they are or their mortality rate, what’s it like? You’re just out there in the blue hoping that’s a good doctor over there. I hope they treat me nice. I wonder if I can get in the patient portal to track the progress? Doing little things to be on their side could be massive and saying, that’s really differentiated.

People want to self-schedule appointments with a provider who accepts their insurance, is conveniently located, has a good background, has time slots available, and accepts new patients. How well have health systems met that expectation?

It’s paramount. We gave a hype factor around AI, big data, and intelligence. I want to know, how many doctors do you have? Which ones are accepting new patients? What’s the earliest I can get an appointment? So few health systems in the country can answer this question. 

Until you’ve done that, you haven’t earned the latitude to go build AI tools. If you couldn’t build a online scheduling platform correctly that is meaningfully used, if you aren’t doing 25% to 50% of your volume in online scheduling, what are you doing? What are you doing on the other stuff? Because that is such low-hanging fruit. It saves you money in contact center. It delights patients who don’t want to call for any of these things. It’s a massive opportunity to shift volume in the market share. There’s so many reasons to do it. 

The only reason we don’t is that we’re not eating our own dog food. I don’t know many health system executives that are having to go through their own online portal and their own online scheduling, because as healthcare administrators, we all have access to calling the office to get us in, or we know Dr. So and So and we text them to get us in. We get to cheat. If we had to use our tools to try to book an appointment, nine out of 10 of us would be pulling our hair out because it’s so, so bad. You wouldn’t accept that from a barber. You wouldn’t accept that from a restaurant where you are reserving a table. Yet we say, “Sorry, but Dr. So and So doesn’t agree to open schedules. They think it’s unsafe or want to screen all patients first.” Well, too bad. Are we going to be consumer centric or not?

The fact that that’s all locked up in the EHR is a problem. We’re one of the only platforms that we’ve ever seen that can aggregate 50 to hundreds of providers and show you all their schedules sorted by next available. But it’s really all of that for that last step, sorted by next available, because we fundamentally believe that patients are going to pick their doctor based on who is available the earliest. Baylor has had that up on their website for three or four years. We’re starting to see one or two other health systems do it, but that basic capability is so far lacking and something that Amenities can do in a matter of weeks and months for health systems.

Just start there. That’s not an AI problem. Just get the logistics out and make all of primary care available for online scheduling. No questions asked, no exceptions. It’s the first thing we tell every health system. We’re going to make an amazing digital experience. Great, do you have online scheduling? No, not yet, but we’re talking to our docs about it. Our first question is, would you download the Pizza Hut app if you couldn’t order a pizza in it? No one’s going to use that thing you’re building, no one’s thinking about adoption and usage, and what will promote this and why is it differentiated?

We’ve started to talk to various health systems about memberships. One thing that we hear repeatedly is, we would like to do a virtual concierge program. That’s been done. That was done four years ago. You have to be better than One Medical, because One Medical is being advertised now inside of the Amazon app. Everyone has access to it for $9 a month.  Are you going to be better than that and differentiated? Because if not, why even start? Would you use that? I feel like sometimes that we don’t want to ask this type of questions, and we need to, because that’s how we build something better.

What are the company’s goals over the next five years?

We would love to see a massive shift in the whole industry, ideally with us, Mission driven. We want to see the industry eliminate all of this friction. A lot of our products – provider scheduling, registration, and the digital front door – will help get the friction out of healthcare. Well within those five years, I hope we can start to demonstrate how market-making and how transformative memberships could be.

You’re seeing a ton of back and forth about too much MyChart message usage. “Well, I guess we have to to charge patients.” Let’s piss them off, because we’ve already pissed off the doctors. That is such an uncreative solution. Taking MyChart messaging away from patients is like now saying, “I’m sorry, it’s going to be 10 cents per text message” like when cell phones first came out. That’s literally where we are. The reality is that people want to use this.

This is a massive opportunity to create a new business model. I don’t know about you, but if I want to talk to my doctor exclusively, I would happily consider $9, $10, or $20 a month to say that I have unlimited messaging for them. They can actually create new services and capabilities. Now I would want more than that, but that’s the opportunity. That’s what I want to see us doing in the next five years, that we can point to a couple of core examples in the industry where they try something new and different, wrapped in a membership. We are seeing that mindset shift, where people are starting to say, that’s interesting. That could actually be transformative and move a ton of market share.Why don’t I try that first before my competitor does?

How do we massively change the dynamic? You have to go through health systems. Direct-to-consumer healthcare is nice, but health systems deliver the majority of care in this country. Two, you have to align incentives. We are not incentivized to compete on experience, but what if we were? Could that be a motivation to do a lot of new and different things?

HIStalk Interviews Jonathan Rosenberg, CTO, Five9

February 6, 2024 Interviews No Comments

Jonathan Rosenberg, PhD is chief technology officer and head of AI at Five9 of San Ramon, CA.

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Tell me about yourself and the company.

My job is to direct our overall technology strategy, run our AI engineering teams, and figure out how to apply AI technologies to the evolution of contact center technology, which is a super interesting and exciting space. I’ve been in the IP communications industry for approaching 30 years. I was previously the chief technology officer for Webex and for Skype before that.

How has technology changed the way that inbound telephone calls are managed?

It’s having a huge impact, and that impact is going to get even bigger over time. Probably the biggest thing is that we have been able to dramatically improve self-service, not having to wait on hold to speak to a live agent for tasks that users would prefer to self-service anyway. 

There’s tons of examples in the healthcare space, things like appointment scheduling and rescheduling, looking up and getting information on prior authorizations, answering questions about hospital visits, benefits coordination, cost estimates, and insurance verification checks. The list goes on and on. All of these things are relatively easy to support with self service. We can get the call to the right person and understand what the caller wants, collect information, and direct them to the right place. We’ve all experienced way too much transferring. You get to the wrong person, then you transfer somewhere else and you have to repeat everything all over again.

But it isn’t just inbound, there’s outbound as well, communication from healthcare providers and payers to their patients and customers.

Are technologists surprised that many people still prefer making a phone call?

The death of voice in the contact center, which has been predicted for 20 years, is absolutely, positively false. We are seeing an increased amount of usage of communication of the technology. It’s not that people aren’t doing other things. They are, but it’s the total amount of interaction that’s happening between customers and the brands and companies they work with. That has increased as these additional tools, like chat, SMS, and website have gone up.

But at the end of the day, there’s a lot of stuff where people still want to call and talk. It’s faster. It’s interactive. You feel greater levels of trust, especially when you talk to a live person. And in many cases, you want to speak to a real person. We don’t think that everything will go to self-service. That is best done with voice, especially in high-emotion, high-stress situations like we see in healthcare. A voice of empathy — nothing beats that.

What is the role of AI-powered virtual agents?

It has two sides. People understand less about what we call agent assist. In agent assist, AI is involved, but it isn’t replacing the human agent, it is augmenting them. It provides lots of benefits to the agent that help them do a better job and provide a greater experience for the customer. That includes things like coaching the agent to make sure that they perform their checklist of required tasks to the patient or to the customer. Helping provide information at the agent’s fingertips so they don’t have to put the customer on hold and go look something up — the information can just be put right in front of them.

Another really good thing that we have seen is that our agent assist application provides a live, real-time transcript to the agent. If they didn’t quite hear what someone said, they can just glance back at the live transcript.

That is one half of agent assist. The other half is self-service use cases, where a customer or patient calls in and they are talking or chatting with a bot to provide these self-service kinds of use cases that I’ve described. Both of these are powerful in the contact center.

Are health systems assembling all of their interactions with patients – mailings, outbound calls, fundraising, billing – so that anyone who interacts with them has the full story?

One of the hardest problems to solve in the industry is breaking down these silos. It is becoming more important than ever for companies that are providing customer service to do that. 

One of the interesting drivers that will accelerate the collection of all this information together is this emergence of generative AI and large language models. These things are incredibly powerful and highly beneficial to a lot of the use cases that we are talking about. They need contextual data to work. They need to know about the caller and the customer to provide the experience they want.

The more of this information that you can collect and feed to that generative AI model, the better job it can do to provide superhuman experiences, something that you couldn’t even hope to get from a human alone. We are excited about that, and we think it will drive a lot of the collection of all this data together.

Healthcare is powered by fax machines, photocopies, and clipboard forms, yet consumers interact everywhere else with chatbots, smart search, and voice processing. Will healthcare embrace these technologies?

I hope so. Customers in general are seeing advances in technology and how they receive service in other industries, and that sets levels of expectation.

For the benefit of healthcare, a lot of the rest of the world is becoming more sensitized to the type of issues that have traditionally prevented or made it difficult for healthcare to do this, related to sensitivity of data and the protection of personal information. With all of this, especially with this genre of AI technology, those questions are top of mind now for buyers of these products and services. They were top of mind for healthcare before, and now they are top of mind for everybody else. That will drive increased attention to solving those problems so that we can deliver solutions that are broadly adaptable in the healthcare industry. That’s the optimist in me that thinks this way and hopes to see this technology penetrate quickly across healthcare.

Health systems have grown by acquisition into regional or even national organizations that have a large scale and an increased technology capability, but that may create more bureaucracy. How will this affect their use of technology?

In some sense, centralization helps a lot of these things. It consolidates the buying power and the deployment of these technologies. You can deliver it out to your regional hospitals and practices so that everyone gets it quickly. Instead of every single doctor’s office or hospital having to do this on their own, you get to do it just once. That could be helpful in accelerating adoption of this technology.

How does a software company incorporate AI into their product when it changes every day?

At Five9, we have adopted a strategy that we call engine-agnostic. That means that we have built our software platform so that we can consume third-party AI engines, as we call them. These engines are the raw ingredient that do the processing.

For example, the thing that takes an audio file and spits out a transcript. Or the thing that takes a sentence of text and delivers the intent. What was the thing that the customer said? Or you send it a paragraph and it produces the medication name, the doctor name, and the dosage off the information paragraph.

These are like raw engines. We have designed our system to allow those to be pluggable, so that we can adapt and evolve as these technologies improve. They are improving at a lightning, breathtaking pace, and that has definitely made it challenging. In fact, we have already switched our underlying LLM engines a few times for different use cases. We have only been able to do that because of this engine-agnostic strategy.

How will the market respond to companies that add the simplest AI wrapper to their product with few actual benefits, just to be able to use the marketing buzzword?

Especially in the contact center, tons of little startups said, “We can finally build the chatbot that the world has wanted.” Then they throw a UI wrapper in front of ChatGPT and call it a day. 

That’s not what the market wants. The market, especially in the contact center space, wants a platform that spans all of the interaction modes – voice, chat, email, SMS, and social channels. They want powerful reporting and analytics. They also want to make sure that humans and AI are integrated together so that calls and chats can bounce between them, and all of that just works. 

That’s hard. You realize that the value proposition is delivering all of that, and then plugging in the AI to make it better. The platform plays are the likely winners in the in the contact center technology space, and we are one of them.

AI allows companies to create closed models of their internal documentation and processes to help a frontline person who is in the middle of a call or chat session. Is that creating new possibilities?

This is another thing that has taken a generational leap forward. Prior to large language models and generative AI, we would have to train a custom model on the different intents, as we call it, different use cases and things that would be discussed in the conversation that need to be detected that would then trigger information to be shown to the agent. That all had to be done looking at their existing conversations to go collect all that data to train and fine tune the model. 

Generative AI has changed dramatically the way that we can think about that. We used to need to enumerate every single use case, what might be said and asked, and then handcraft the model to detect it and handcraft the response that should be shown to the agent. Now with gen AI, we can just ingest all of this knowledge, processes, and documentation the same way a human agent would go read those materials. Then we can give written direction to the agent assist functionality on what we want to do. It can start to provide this knowledge and guidance.

We are seeing great initial results with this, and this is what we are building towards. It will be transformational in this space in the coming years. It is incredibly powerful and amazing technology.

What does the company’s strategy look like over the next three or four years?

With generative AI, three to four years is like really far away [laughs]. But it’s that thing, generative AI. It’s going to be incredibly amazing in delivering superhuman experiences to customers and delivering the kind of customer experience that the contact center market has always dreamed of delivering to customers, but that in many cases, fell short of expectations. Now we have the tool to deliver the kind of experiences that we have really wanted to.

I talk about the end of call hold. I can’t wait for the day when you can call the contact center, you want to speak to someone live, and they never need to put you on hold ever again. Because anything that they need, anything that they have to say, anything that they need to do, is instantly at their fingertips. That will be a great day, and we are working towards that day in the next two to four years.

HIStalk Interviews Jonathan Davis, CEO, Trualta

February 5, 2024 Interviews No Comments

Jonathan Davis is founder and CEO of Trualta of Ottawa, ON.

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Tell me about yourself and the company.

I started Trualta about six years ago. I was investing in healthcare education companies that provided training, continuing education, and certification for healthcare professionals. It dawned on me that there were so many great best practices for caring for loved ones, especially aging loved ones, that families didn’t have access to. For example, why did an aide in a nursing home know how to manage a particular symptom of cognitive decline, but a family member didn’t?

That inspired me to think about how we could adapt professional-level training to the families who need it most. That was the start of Trualta. We built a caregiver education platform with articles, videos, and modules to help families build skills and establish confidence to provide care at home.

Right away, we started working to demonstrate that trained, confident family members can provide better care at home. By proving those outcomes, we could partner with governments, payers, and providers to offer Trualta for free to caregivers. We always believed that the caregiver shouldn’t pay for support. We know caregivers are often already facing unexpected costs.

Since then, the business has grown to offer not just caregiver training and support, but also community and coaching.

People don’t always know in advance that the caregiver role is about to be placed on them. What is the most common training and support they need?

That’s very true. Many caregivers don’t even self-identify as caregivers. The training and support that is most effective is a mix of topics related to the caregiver’s own wellness and how to manage this often unexpected, challenging care situation. We personalize our content to the caregiver’s unique care situation and the conditions they manage at home for their loved one. At the end of the day, all caregiving journeys are different. We anchor on the training outcome. We want our caregivers to feel more confident and less alone, which we know leads to better care for the patient, the loved one they are caring for.

What is the blend of people, technology, and support that makes it possible to successfully send patients home for care?

On the technology side, we’re all about finding the right support for the right caregiver at the right time. Maybe it is post-surgery. Let’s say Mom or Dad got a hip replacement. We know that individual care situation and can target the caregiver with specific content. For example, a common reason for readmission might be a UTI or a bed sore.

Where the technology and the tech-enabled community and coaching come in is that we start to understand how the caregiver is feeling. They’re a bit lonely and isolated, providing care 24/7 for their partner who is recovering at home. We know that they would benefit from a support group, so we direct them to one. It is a virtual, tech-enabled support group, but it is facilitated. To us, that’s a healthy mix of technology and people. If the care situation escalates and we see a high risk of caregiver burnout, we can route that person to a one-on-one coach.

A national challenge is the large number of baby boomers who will eventually need care, but with fewer people to care for them. How will that play out?

This is such a tough problem on both the demand and supply sides. On the demand side, we have this aging population. Folks are also living longer, with a higher likelihood of certain chronic conditions or cognitive decline. We know that older adults prefer to age in place. Then we have government policy promoting home and community-based settings instead of the institutional setting.

Demand is way up, but there’s an acute workforce shortage, so supply is also down. That market dynamic is putting so much on the family members. It’s more important than ever that our healthcare stakeholders support families and people who care for loved ones at home with skills, community, support services, and coaching.

How do you work with partner organizations?

We are thought partners with the organizations we work with. Most of the payers and providers that approach us know that they could be doing more for caregivers, and intuitively understand it will lead to better outcomes for members and caregivers. But they don’t really know where to start. They don’t have a caregiver strategy. Often, they don’t really know who the caregiver is or have contact information for them.

We build that strategy with them. We provide the learning and support platform, and then make sure it’s integrated into the workflow and existing systems.

Do you roll it out broadly, or is it case by case?

Generally, our partners have specific populations in mind where we focus, but access to the program is usually available across the organization, because supporting caregivers is becoming an enterprise-wide priority.

We’ve always focused on high-need populations. We’ve helped a lot of folks in really challenging care situations, like parents of kids with intellectual and developmental disabilities, or caregivers for individuals with dementia, cognitive decline, or a recent stroke. These are areas of focus where a social worker, nurse, or discharge team might be more deeply ingrained with Trualta than in other service lines.

What are the company’s priorities over the next three or four years?

Our vision for Trualta is that caregiver support is as ubiquitous as patient education. At every point of care, any discharge, especially with our aging population and shift to value-based care, it is so important that families are supported.

Our vision is, let’s take caregiver support from being a “nice to have”, where a few teams are doing it with some populations, and make it a critical part of every point-of-care experience. If a caregiver is present, we need to identify them, engage them, and support them to ultimately improve outcomes for their loved ones. We need to make sure that they are not overwhelmed and burning out.

An HIT Moment With … Steve Shihadeh

January 31, 2024 Interviews 1 Comment

An HIT Moment With … is a quick interview with someone we find interesting. Steve Shihadeh is founder of Get-to-Market Health of Malvern, PA.

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Startups have been forced to adjust their strategies, execution, or expectations as investment activity dropped substantially. How will that change the industry over the next few years and how should companies prepare for a turnaround?

At the end of 2022, and throughout 2023, startups and most mid-sized companies shifted their #1 priority to conserving cash. Forecasts of possible recession and rising interest rates put a damper on spending of all types, and especially the more expensive industry events. Companies lowered expectations, cut staff, and tried to do more with less, or at least hold their own. In my opinion, industry momentum, risk taking, and progress on using tech to improve healthcare were all off course for the last 18 months.

2024 has a much different feel already, with several significant funding announcements and a renewed focus on growth. Digital health investors who showed lots of patience over the last year and a half are pushing for the returns they were promised when their funds launched. As a result, I expect attendance, new product announcements, and customer interest at the big national shows to be on the upswing.

The HIMSS conference has a new owner and competition from ViVE and HLTH, with an emphasis on hosted buyer programs by all three. How would you advise companies to plan their participation in these conferences for maximum return on investment?

HIMSS23 in some ways seemed a little dated. It was big as ever, but when compared to the feel of ViVE and HLTH, it needed a reboot. I guess HIMSS understood that, and I am really curious how the show will change this year under new leadership.

To get maximum returns on your tradeshow investment, I think my assessment last year mostly holds true. The top three of the top 10:

  1. Pick the most important show for any booth investments.
  2. Have a presence, even if just one key person, at as many shows that you can.
  3. Send only your best, most committed people.

What has changed in health tech marketing since the pandemic eased?

The pandemic pushed people to hone great digital marketing skills and tools. That is table stakes today, and now we have the full return to strategic in-person events like trade shows and targeted regional and bespoke events. 

The vast improvements in marketing in our space continues to impress me. When I first started Get-to-Market Health in 2017, we presented to a CEO about how we would recommend he revamp marketing. He said something to the effect of, “I am going to just hire a grad assistant type instead.”

That was then. Now, to keep pace, most digital health companies have a strong marketing VP who is directly aligned with the sales VP. Awareness, public relations, lead generation, lead conversion, pipeline development, and deal closure are very much a team effort. Digital tools, social marketing, and micro-targeted outreach are mandatory today, and it is great to see companies taking full advantage of new ways to educate customers.

How will the increased healthcare involvement of big tech firms such as Microsoft, Oracle, and Google affect the ways that healthcare-only vendors run their business? 

I was able to see firsthand the impact of a big tech firm committing to healthcare when I was with Microsoft about a decade ago. The company made large-scale market development investments, engaged in key policy discussions that smaller companies just can’t do, and along with Amazon, laid the foundation for the cloud business in healthcare as we know it today.

I am bullish that the big tech firms that stay committed to the space — “stay committed” being the key point — can really drive change and make a difference. I would advise our clients and friends in the space to carefully evaluate who has the staying power before they go all in with one of the bigger players.

What is your advice for health tech startups given the business and industry conditions that you expect over the next two years?

Assuming the general economy stays strong, I see a great run for the companies in our space who have most of these attributes:

  • Differentiated products or services.
  • Demonstrable ROI that holds up to CFO scrutiny.
  • Company culture that your employees enjoy and your clients can feel.
  • Sales and marketing teams that work together.
  • A thoughtful plan of how to work with or around the big vendors.

Healthcare delivery in the US is complicated. but when it works, is the envy of the world. Technology improvements need to be made in all facets to drive down costs — the US is not the envy of the world on this point — and continually improve care. Every hospital in our country can benefit from all that tech has to offer, which is why I remain so positive on the runway in front of health tech companies.

HIStalk Interviews Mark Burgess, President of North America, Agfa HealthCare

January 17, 2024 Interviews 1 Comment

Mark Burgess is president of North America of Agfa HealthCare of Carlstadt, NJ.

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Tell me about yourself and the company.

I’ve spent the majority of my career in electronic health records. I have worked with a startup and have done tours with Cerner, Allscripts, and NextGen Healthcare, with roles that included strategy, product and solutions management, and business unit leadership. I have enjoyed seeing the progression from the introduction of the EHR into interoperability, and now I’m on the imaging record side.

Agfa HealthCare is a global imaging software business that has been in the market for 25-plus years. We were an early mover in PACS. probably one of the first to bring that to market. The company started the transition into enterprise imaging, which is more of what we do today. We’ve gone from a single system to the enterprise system. That has contributed to the evolution of the image to the image health record.

We have 1,200 employees across the globe. We work with some world -class organizations. We have a talent base that is second to none because we’ve been doing it for so long. We provide diagnostic imaging software solutions to thousands of client sites who read millions of image studies each year.

What are the similarities and differences between the EHR application business and the imaging business?

Imaging software is a medical device that is governed by specific regulatory requirements, agencies, and rules. That’s not true of the EHR side.

With imaging, there’s a lot of work and thought that is put into the design of the technology and the way that the technology needs to show up, because you’re using it as an instrument to diagnose. You can obviously use the EHR to get to a diagnosis, but it’s even more intense with imaging, where you are putting it into the hands of a radiologist who forms a diagnosis with it. There are more regulatory components involved with managing a medical device and maintaining it from version to version. 

The EHR side is more governed by achieving regulatory guidelines or regulatory thresholds. The EHR side has to deal with things that surround the EHR, which we don’t see as much of on the imaging side, although that is changing with things like AI. As the imaging side starts to mature and reach deeper across the enterprise, it is getting more involved with those things, including the EHR itself.

What is the demand for accessing and exchanging the actual images versus the reports that are created to describe them, and how does that align with EHR interoperability?

You want all of that to show up in the EHR. You don’t want to have two systems. You are seeing the convergence of that in the industry. We work with all the major EHRs. The radiologists who use our system produce reports and studies that show up in the EHR for the for the physician and the clinical team to see, or in the patient portal for the patient to see, depending on how the organization makes that available.

The image health record and the clinical record are becoming fused. That fits the direction that we are going in healthcare with regards to IT and how patient records are being managed, which is more of the whole-patient care model.

The enterprise imaging decision is relatively new. It reminds me of the days before people started buying enterprise EHRs instead of those that were specialty based. The EHR  grew up in front of everybody, and then the goal was to create a single patient record across an organization. Organizations want to know how they can get a single imaging record across their organization. We’re spending a lot of time ensuring that organizations know how to go about making this decision.

How has the work of radiologists and radiology staff evolved as imaging volume and expectations have increased?

Diagnostic confidence is above all else. Performance and workflow are fast followers, meaning that radiologists prioritize a high-performing system with intelligent and integrated workflows that presents information when and where they expect it. We’re still in a world where performance is key. Radiologists are still focused on safe productivity where they make no mistakes. They want high-performing systems, so by definition, that includes workflow that gives them what they need, when they need it. That means point-of-care capabilities and the ability to pull a prior or to do a report.

Third is coordinated care and integrated care, the ability to see relevant clinical data when they are reading images as well as having access to care team members to share and collaborate.

Finally, we need little to no barrier to system access, bringing the data and information to the radiologist and not the other way around. Streaming data is the future.

Is it hard to develop a company strategy for incorporating AI when it changes every day?

The idea of formulating an AI strategy is accelerating among the radiology base, especially radiologists in the US. An extraordinary number of algorithms have been FDA cleared. Radiologists are starting look at where they can put those to work. It’s a partnership between their ability to operate at the top of their license in a high-performing way, but leveraging the goodness of those AI algorithms. Clients are 100% prioritizing AI and seeking the initial phase of production use, moving from the proof-of-concept stage to focusing on production clinical use.

We want our clients to have choice, so we are staying nimble. It reminds me of the early EHR days, when we started looking at patient portals, scheduling systems, and other applications that were hanging off the EHR. You wanted your clients to have choice and you started to build an ecosystem.  We are focused on the AI side with building an ecosystem, and that ecosystem will be able to go to the point of care or the point of need.

We make sure that as we bring more AI partners into our ecosystem, we hold them to a standard so that what we put in front of our clients has been pressure tested. But it’s fast and furious. The FDA has cleared more than 500 algorithms, with the vast majority of them targeted to radiologists. We have a team that’s in charge of that. But the most important thing for us is to stay aligned with our clients on where they want to put time and energy relative to AI. We are doing our best to curate those opportunities for them.

Do radiologists question how algorithms were developed or do they evaluate them on their level of transparency?

They are curious and have asked many questions about it. I don’t know that we are seeing as much of that healthy skepticism as before, now that we are starting to see some of these organizations gain track records of success. That is lending more clarity and confidence to the radiologist. They are starting to look at, how do I get a better experience with an AI algorithm? How can I improve it in another part of the body?

While we work with a lot of scientists who are always interested in how something was built, what it was based on, and how it was tested, we are seeing more curiosity around how it can be applied to a particular workflow or to a particular part of the body than we saw two years ago.

What is the company’s vision of a enterprise imaging solution?

As I mentioned,  this organization was an early mover on the PACS side. As organizations started digitizing images, they also started standing up multiple PACS. Health systems are coming together and finding that they have three, four, or five of these different systems, and they don’t really don’t talk to one another. It’s not very efficient.

We want to be that single imaging platform. We want to be able to serve not only the needs of the core radiologist user, but start to expand out into all of the different service lines that have imaging needs and imaging demands. We absolutely want it to be treated as a platform. We want to be able to put more capabilities into the hands of these different medical professionals to enhance what they do with medical imaging, and that’s starting to get into the reaches of analytics, research and teaching and how that incorporates into the medical record.

We want to be all things from an imaging software standpoint on this single platform, much like the way the EHR has developed. And then of course the fusion of those two things, so that medical professionals can look at an image with clinical data, or look at clinical data with an image. We don’t want limitations to that.

One of the final frontiers of imaging is digital pathology. What trends are you seeing?

This is one of the most complex parts of the hospital that is moving to becoming digitized. We are certainly seeing more and more of our clients that are moving in this direction. We have been tracking this with some of the largest organizations in the in the world, and certainly in the US, there’s a great appetite to start moving pathology into a digital state. They are hungry for more efficiency, the ability to do more with the slide samples and unlocking more of what they can do with that. Whether it’s data insights, driving better outcomes, or better synthesizing that data into the medical record, they are hungry to unlock more opportunity with what they are doing today.

I see it as maximizing the use of the data to increase efficiency and improving turnaround times, enhance clinical collaboration with the care team, increase access to care, and streamline workflow. Like radiology, pathology is seeing an accelerated
demand for services and a shrinking base of pathologists. Maximizing pathology resources through digital modernization enables the pathologist to better force multiply their expertise to accelerate and advance specialty care like oncology, decrease surgical time that includes reading samples during the procedure, plus comprehensive clinical collaboration through networking with specialists and subspecialists.

How much imaging volume has shifted to non-hospital locations, and how has that affected interoperability requirements?

As patients, we demand more. We want a better experience. We want more options. We don’t want to be tied down to going to one one place at a certain time. The idea of imaging becoming more pervasive in the community is popular and well documented.

The demand for medical imaging continues to go up year over year. In the US, we are hovering around a billion imaging studies annually. The aging population contributes to that. As you capture images, store them, and move them around, you want to make it convenient for the patient. You don’t want patients carrying images on a CD. I had scoliosis as a child and  my parents carried around a jacket of x -rays to different doctors. Those days are gone. It’s like the fax machine in the medical practice, where you just want to be done with that and build the network.

We think about it as an image health network. We want to connect all the different places that are using our platform, and other platforms to some degree, so that these images can be moved in an intelligent, safe, and a effective way. Physicians should not be seeing a patient without having access to the image that will help get the best outcome for them. The image health network is the key to that.

What will be important to the company’s strategy over the next few years?

In addition to our ongoing client success activities such as continuous engagement and collaboration, meeting the accelerated demand to replace PACS with enterprise imaging, and continuing to innovate and expand the utility of our platform and eco-system, we want to make a dent in addressing burnout. Burnout among radiologists is higher than in most specialties. That drives our work around curating high-performing workflows, leveraging AI, and building the next-generation imaging health network.

We are in a high-growth situation. We want to cover the market properly, continuing to serve those who have an interest in what we do and how we do it. There’s a lot of activity in this market, with a lot of interest in moving to an enterprise imaging solution. First and foremost, we want to be able to accommodate everybody who has an interest.

We are on this journey to cloud, which is essential for us. We recently struck up a partnership with Amazon Web Services and we are pretty excited about working with them. We are starting to move clients into our own AWS private cloud model. The level of interest in that is growing exponentially faster than even the upper reaches of the model we created a couple of years ago. We are excited about what that means from a modernization standpoint, getting organizations away from legacy worries about storage and compute power. We can neutralize that through our cloud offerings.

As we continue to build the ecosystem, we will continue to curate the ability to give our clients the most options that we can give them. AI will have a part. It’s all about continuing to serve across the enterprise, helping all the medical specialties that are in need of medical imaging, where it lives inside our platform that sits on top of this image health network and is connected to the EHR.

HIStalk Interviews G. Cameron Deemer, CEO, DrFirst

January 15, 2024 Interviews No Comments

G. Cameron “Cam” Deemer is CEO of DrFirst of Rockville, MD.

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Tell me about yourself and the company.

I was a latecomer to healthcare IT. I started my career in the ministry and didn’t get into this side of the industry until the early 1990s. I started working with PCS Health Systems in Scottsdale, Arizona. I did about a decade with PBMs, worked with NDC Health for a couple of years building what became Surescripts later, and then joined DrFirst in 2004.

When I joined DrFirst, I would have called it an e -prescribing company, which would have been easy to understand. But since then, we’ve developed a much broader vision. Today, the company is about making sure that patients have their best outcomes through their medication therapy. We do that through offering technology platforms that help providers work with patients around things like electronic prescribing, medication reconciliation, and population health. Our fastest-growing platform addresses patient adherence to therapy.

How has the original vision of e-prescribing expanded?

I had a front-row seat in the early days of e -prescribing. We did some seminal piloting of e -prescribing when I was with PCS. It has gone from essentially a record of what would have been written on a piece of paper to being a more fully informed decision support system.

As an example, we connect to all of the state PDMPs, the controlled substance registries, so that a doctor can consider that information at the same time they are writing the script. They have a much better idea of whether someone is drug seeking or legitimately coming onto therapy. Similarly, a real -time benefit check allows them to understand exactly how much the patient is going to pay. Then, bringing other information in from outside, such as formulary status and electronic prior authorization. Essentially e -prescribing has become an ecosystem as opposed to just a replacement for the prescription pad like it was originally started.

How does seeing cost and insurance coverage at the time of prescribing improve patient outcomes as well as patient satisfaction?

We view it as two parts. There’s what happens in the doctor’s office when they are  prescribing therapy, and then what happens after the patient is released back into the wild to act on the prescription.

In the physician’s office, we think that real -time benefit improves compliance with therapy, because it finally gives the physician a real idea about the impact of what they are prescribing. How much is this drug going to cost versus that drug? Or is therapy going to be delayed because you have to go through a prior authorization if you choose this therapy versus that therapy? It is giving the physician real insight. They already know what they want to write, so now they get insight into what the outcome will be from the patient’s perspective.

The reason that we started working downstream from there, on what happens to the patient after they walk out of the office, is that we often found that the providers maybe didn’t have time, or maybe they weren’t focused enough on the extra information, and weren’t necessarily helping the patient make a decision that would be ideal for the patient to then go fulfill the therapy. 

We try to hit the patient immediately after they leave the doctor’s office with more information. What prescriptions were written? Where are they going to get them filled? We have a call to action to pick up the prescriptions. We provide financial assistance information if the physician has chosen a drug that is extraordinarily expensive for the patient. We give the patient the tools to make up for what may have been missed when they were in the provider office, or to reinforce the decision the provider made.

Have coupon-type programs, such as manufacturer assistance programs or GoodRx, made displaying patient prices more complicated?

Systems have come a long way in being able to present all that at once. From a provider perspective, they wouldn’t be perceived as a set of different decisions. At least for our system, it’s all combined into one decision point, so the physician can consider them all at once. From a patient perspective, it would only really be one thing, because their therapy has already been decided at that point. Now they just have the one decision to either pick it up or don’t pick it up. The financial incentives can help them with the “pick it up” decision if they are available.

Has the prior authorization process, which everyone seems to agree is burdensome, improved?

Boy, I agree that it needs to be fixed, so I’m on that page. Prior authorization is widely recognized as a coping mechanism, a way to stem the flow of products that the payers feel are expensive. They don’t necessarily want to cover the therapy unless they are pushed to do so.

I’m not sure how much incentive exists to truly fix it. Truly fixing would look like the barriers make sense and they are readily overcome. What’s going on in the industry right now to fix it is that when the physician is confronted with a screen they have to fill out for the prior authorization, can we just grab that information out of the EHR, fill in the form, and let the physician have very little work to do to send that PA?

The whole thing is counterintuitive. They are intended as a barrier. Making it easy makes the barrier less effective. It’s an interesting problem that I’m not sure we are really solving yet.

If the prior authorization is a prescribing speed bump that payers hope will discourage the prescription, what interest would payers have in solving the problem? Why couldn’t they look at a prescriber’s history, even with AI if needed, and bypass the front-end work unless that provider is an outlier in deviating from accepted norms?

That would be a fascinating way to handle it. I’ve actually not thought about that before, but with machine learning and AI, you should be able to analyze, give the doctors some kind of performance score, and put a lower set of barriers in front of those who are good actors. There would be a lot of discussion about what equals a good actor from a provider perspective. I imagine there’s a wide range of thought on that.

An interesting development is Lilly’s program, where they are to some degree working around these kinds of restrictions with some of their new drugs for weight control and diabetes management. They appear to be sidestepping the process and maintaining pricing control rather than throwing rebates at formulary status. 

Rather than being told that your drug will go off formulary unless you can bring this price way down from a PBM perspective and that you will be faced with a prior authorization hurdle that will be a giant pain to get people on, they are essentially setting up a parallel system. Patients can have relatively simple access to the drug and they can help manage the cost for the patient without causing the kind of disruption to everybody that a massive rebate program causes. Good or bad, I think it’s a really interesting approach that was creative on Lilly’s part.

It’s also interesting that they are working with third-party companies for telehealth prescriptions and pharmacy fulfillment. Will other drug companies follow suit?

I want to reinforce that what they have effectively done with those third parties is sidestepped the plan design. Patients are being asked to go outside of the health plan that they are paying for, and instead participate in this other parallel program that’s been set up for these drugs.

That will make it a little more difficult for other drugs. Not many drugs have the demand profile of the weight loss drugs. If your expensive drug is less in demand, there’s probably less incentive for the patient to step out of their plan design. I’m paying for this insurance, I should use it, that kind of psychology, so I wouldn’t think that everybody will be in a position to follow suit. But it’s a creative model when the drugs fit the profile that would make this work. It’s brand new, so we don’t know yet.

Lilly is also potentially keeping some of the revenue that would have otherwise gone to PBMs or pharmacies while gaining control over pricing. Is there a DrFirst technology implication for manufacturers that sell drugs directly with patient discounts?

One of the things we are excited about is our ability to engage patients, let’s say five minutes after they leave the doctor’s office. Because of our position in workflow on the prescriber side, we actually know when the electronic prescription has been sent. At that point, we can reach out and engage a patient. We are four and a half million patients a week touching about one out of every four new prescriptions. Our scale has  gotten fairly large because of the number of EHRs that we work with.

As a result of that, we are in a position to work with somebody like Lilly to be an entry point for patients into their program who might not know about their program. In the event that the physician bypasses whatever opportunities Lilly has provided for them, we have an opportunity to talk to both the provider and the patient because we sit squarely in that workflow. So yes, I hope we can be a part of that. I really enjoy these creative solutions to persistent problems around cost in healthcare.

What is the state of medication history and its delivery directly into the clinician’s EHR workflow?

I would say not greatly improved. There may be broader access to records now, a more complete patient record. But not much has happened to clean up the dirtiness of the data, this kind of shady underbelly of the whole data space. We spend a lot of time on data optimization because we find that the data feeds still are not semantically usable by the people who receive them.

As an example, somebody who creates a record might be using Latin abbreviations, and somebody who is receiving it might use English abbreviations. No matter what abbreviations they use, they can still write the sigs [abbreviations for instructions] differently and you can make millions of different combinations out of any given sig, depending on how the one system prepared it and how the other system wants to receive it. A big part of our business remains matching those data feeds up. How do you massage the incoming feed to make sure that all the fields are discrete and all the data elements are ready to be imported into the receiving system so that somebody doesn’t have to manually retype it?

That kind of data optimization is still missing from the industry and still needs to be handled independently before a system can receive the records. The bottom line is that I would say that there’s availability of a lot of records now, more than there’s ever been, but they are still just as dirty as they were years ago and still need that cleanup.

What role do you see for AI in your business and the industry in general?

We’ve been all over AI for data optimization for at least six years now, and it makes a huge difference. Machine learning and AI provides a much more elegant and complete solution than, say, a table of substitutions. You can only anticipate so many errors that a person might make, and the ability of the AI to sort that out automatically is huge. We end up with much higher rates of cleanliness of the data than are available through traditional methods.

We call that augmented intelligence, meaning that we do the cleanup, but then we provide the clinician with both the original and the cleaned up version. If they’re good with it, they can just say, “That’s good.” Otherwise, they can tweak it if it’s incorrect in some way. We put most of our focus on trying to find practical problems in the workflow and provide an efficient solution so that providers can get more work done and get away from that burned out feeling of having to retype everything.

What are the company’s near-term priorities?

One of our major business lines is providing e-prescribing platforms for EHRs. We serve over 300 EHRs in that way. A major change is coming in 2027, when Surescripts is going to implement the 2023 version of the SCRIPT standard. We expect other changes to come along with that. That will make everybody stop and do major development in their systems again. A big part of what we’re going to do over the next few years is work on helping people with that conversion. Some will decide that this is the last straw and that it’s not worth maintaining their own e-prescribing channel any more and we’ll be able to do integrations with additional companies. It will be a major focus to make sure that the industry is ready for this big change in coming in 2027 around prescribing standards.

Another major focus for the company is to continue to drive our adherence programs. We believe that we will eventually get to one out of every two new scripts, and when we have that level of aggregation, we will be meaningfully able to address things like access to specialty scripts. The industry is moving towards specialty drugs at this point, and those have all kinds of access challenges. We’re going to be spending a lot of time cleaning up those processes for the industry and making sure that patients can get on therapy quicker and stay on therapy for specialty.

The last thing is perhaps a little controversial, but we believe that it’s time to take a hard look at what happens after a script leaves the doctor’s office before it gets to the pharmacy. We’ve been working since the 2000s under a 50-year-old technology, the switching network that we use to move scripts between doctors and pharmacists. It’s a lowest common denominator solution that lets everybody have a level playing field, but doesn’t give anybody an opportunity to innovate and try new models.

We’re going to be breaking out of that mold over the next few years. We are standing up a capability to provide real innovation in this space with a broader set of data exchange between providers and pharmacies to enable better business flows on both sides of the equation. Just think about when you write a script, knowing that the drug is in stock at the pharmacy you are writing it to. Or if you’re on the pharmacy side trying to do some primary care type functions, think about what it would mean to get a patient record at the same time the script comes to you. That kind of innovation isn’t available today. We’re going to make that a part of how the industry works going forward.

I got into this industry in 1992 and have been talking to pharmacists this whole time. They are always trying to find that a breakthrough to be able to work at the top of their license, but never getting there. We’re developing our pharmacy channel to get closer to pharmacy. That takes a while. It’s a big area, and you need to build some trust. But I’m hoping that we can finally help them practically get there where they’ve really struggled before. Since we have theses massive EHRs behind us on one side and pharmacy customers on the other side, we believe that we can finally bring them together so that we get this real collaboration around the patient that has eluded the industry for a long time.

HIStalk Interviews Dan Schubert, CEO, Revuud

December 18, 2023 Interviews No Comments

Dan Schubert is co-founder and CEO of Revuud of Charlotte, NC.

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Tell me about yourself and the company.

Software technology has been pretty much my entire career for the last 25 years. I was a founder of a very early software-as-a-service platform in the commercial real estate industry back in the 2000 timeframe. I grew that and sold it to a large private equity firm in 2021. I started Revuud with my partner Eric Utzinger three years ago. We coined the idea in 2020 and officialized the business in 2021. The original premise for Revuud is to disrupt the staffing industry related to healthcare IT.

How do health systems engage with IT contractors?

Hospital CIOs and other hospital managers generally contract with full staffing firms, who then recruit talent or contractors who work directly for the staffing firm. The staffing firm places them with the hospital for employment. You call your recruiter, you say I need a certain kind of people for a project, and they go off and try to find people who meet the job description. They submit resumes to the health system, the health system reviews them and decides who to interview, and then they make a decision on hiring someone.

Revuud is replacing a lot of that process. You join the Revuud marketplace as a health system. Your users can search, or even better, they can create the job opportunity itself in the platform and it goes out to the entire talent database that has joined Revuud. Contractors create a profile in Revuud so they can be found for these health system job opportunities. 

There’s no need for the health system to call a staffing firm. They can simply log into Revuud, create a job opportunity, and see the results that match that  job opportunity instantly. Or they can search the talent database themselves, find the talent that they’re looking for, and then message them to set up an interview. They engage them through the platform, contract with them through the platform, and then Revuud pays the talent and we invoice the health system on a per-payroll period basis.

The workers are 1099 contractors to Revuud?

Correct. They are all 1099 contractors. We are a  gig economy platform, so it’s all about 1099 contract work.

Are most of those contractors supplementing a full-time job or are they doing gig work exclusively?

I’m not exactly sure of the percentage breakdown, but I would think that 60% to 80% are full-time contractors. The rest are full-time employed people who do contracting on the side.

How does your system make it easier for the health system to manage those contractors?

Instead of having to go through staffing agencies, we are cutting that middleman out. They log into the Revuud marketplace themselves, instantly find and recruit, and 1099 them through our platform. Revuud pays the contractor and we invoice the health system. The health system does not have to hire these people, either as a full-time employee or on a contract basis.

Do most of the contractors work remotely?

Yes. The vast majority are remote, although we do handle 1099 contractors on the platform who come on site as well.

In healthcare IT, you can only have contractors in place in the larger health systems all the time. Some of our clients have anywhere from 10 to 50 contractors on staff at any given time in their departments. Health system CIOs manage north of 100 applications at any given time. It’s normal to have contract IT workers as part of your staff.

Are health systems searching for a specific skill that makes it easy to explain what they need?

It can be that simple, but we have some pretty sophisticated AI-driven matching technology that we have developed, so that when a client’s hiring manager creates a job opportunity, it instantly matches it to qualified talents who meet the job opportunity’s requirements. They don’t even have to search because based on the job description, it instantly matches them with qualified candidates. A strength of our application is that matching, which also removes the non-qualified applicants that you would get through normal processes.

People who contract full time must always be looking for their next gig since they aren’t paid to sit on the bench. Does the platform make it easier to stay booked?

Yes. It has given contractors a platform or a marketplace, just like Uber drivers, so that they have a lot more opportunities for work. It’s the one place they can go that is specialized in their industry where they can find gig contracts to work on.

The other difference is that staffing firms no longer employ a lot of contractors on a bench. They don’t pay them when they aren’t working on contract engagements. That’s a thing of the past. Hospital systems and staffing firms, particularly staffing firms, don’t want to pay for bench time any more. It’s too costly, especially with platforms like Revuud that streamline the process and remove the human being third party from of the equation. 

Is it easy for health systems to onboard a contractor that they book through your platform?

Once that engagement is being worked on, the contractor logs into Revuud every day, or every other day, to record their time and their notes on what they worked on on that date. That gets submitted to their manager’s dashboard and reviewed for approval. There is specific time entry functionality within our application, and then the health system approves or declines that time. It’s a complete accounting package for both the contractor to manage all of their hours that they work for the different health systems through Revuud and also for the the health systems themselves, their bookkeeping on who worked on what, what they worked on on this day, how many hours they worked, and things like that. 

For the contractor, they typically have an LLC that they’ve set up. They don’t have to submit invoices to Revuud. We have detailed accounting functionality within the application for the contractors. We call the statement of work between the hospital and the contractor an engagement. That is executed through the platform electronically and approved by the talent and health system electronically. 

How do the parties arrive at a contract pay rate?

Talent contractors create their Revuud profile like they would on LinkedIn and indicate their rate and type of qualification. When the health system searches or creates a job opportunity that matches, they see the rate that the contractor is willing to accept for that work. That’s part of the hiring managers’ evaluation of who they want to hire. 

It’s a transparent environment, which is a key strength of the application. The talent indicates what they want to make on a per-hour basis and the health system can post what they want to pay for a particular job opportunity. When they match up and the talent contractor applies to the opportunity or is found during a search, they can then negotiate, decide what the agreed-upon rate is for the engagement, and then execute the contract for that particular project through the application.

It’s a transparent environment. The hospital system knows what the talent makes and what the Revuud platform makes.

Is it challenging to market the company’s services to both health systems and contractors?

It absolutely is. It’s a dual-sided marketplace. We are selling to both parties. We have resources that market to talent and attract them to the platform as well as our sales team going out and attracting health systems to go to the platform. We have functionality where talent can invite other talent resources to join the platform. Health systems can invite other health systems to join the platform.

Once the marketplace takes hold, it starts to take care of itself, where it grows organically as everyone in the platform is inviting others and making those connections happen. The more health systems that we have in the platform, the better it is to help us build the talent side of the database because more job opportunities are created. We are creating that public marketplace that allows health systems to join, talent to join, and to do gig work contracts together on their own terms.

What will be important to the company over the next three or four years?

The continued use of more technology features through the application to make the whole process much more efficient for both the talent and the health system. We’re talking about assisting our clients with the interviewing process, being the system of record for onboarding requirements, and offering health systems better analytics about their contractor pool, contractor spend, and the types of contractors they use. 

We will see a lot of advancements as has happened in other industries as Uber has done. We’re cutting out the middleman where they’re not necessary. Our intent is to make the entire process more efficient and less expensive for health systems, but at the same time, allowing talent to make more money on a per-hour basis with whatever opportunity that they want to work on. Talent on our platform are making more money than they usually do on an hourly basis, yet the health system is saving significant money, usually 20% to 30% over what they usually pay for contractor labor.  

It’s a decades-old process that we are changing and disrupting. It always takes some time. But we already have quite a few health systems that have come on board, including one of the top five health systems in the nation, that want to be those industry leaders and use technology to make things much more efficient and more organized, and at the end of the day, that also saves dollars. We’re here to take this industry that has been around for decades into the technology revolution.

HIStalk Interviews Sagnik Bhattacharya, CEO, Rhapsody

December 13, 2023 Interviews No Comments

Sagnik Bhattacharya, MS is CEO of Rhapsody of Boston, MA.

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Tell me about yourself and the company.

My background IS in computer science, and I started off as a software developer. I moved into product leadership roles and general management. Through the course of my career, I’ve been fascinated by healthcare and user workflows and have spent hundreds of hours shadowing clinicians, understanding how our healthcare policies and incentives work, how technology works, and how we can bring it all together. That has motivated me throughout my career. I spent a number of years on the EHR side of things. 

That journey has led me to my current role as the CEO of Rhapsody. Rhapsody is a technology platform that enables interoperability across healthcare systems, with the goal being digital health adoption. There are so many digital health solutions, and if they aren’t integrated into workflows, they won’t work. We help enable that. We serve both providers and health systems, which is about half our business, and a lot of the digital health companies — hardware, software, AI, or what have you – that have a need to integrate their solutions with clinical data.

We are a global company. We serve customers in 22 countries and growing with our technology.

How have the interoperability needs of hospitals and health systems changed as they run their businesses differently?

First and foremost, interoperability has become a broader term than eight or 10 years ago when it started as point-of-care interoperability.  When a patient is going from physician to physician or to the emergency room, how does their record follow them? Now it’s much broader. You have systems that interact with the patient virtually and physically, so how do they all talk to each other?

With respect to the changing climate, there’s consolidation happening on the provider side. On the other hand, there is also a lot of proliferation of digital health solutions that is happening at around the same time.

When any kind of M&A happens, part of the thesis is that you’re going to get economies of scale, because you will have consolidation of your IT vendors and your IT stack. In healthcare, though, that that sometimes takes a little bit of time. Almost paradoxically, in the early part post-M&A, you actually have more systems to manage, to make talk to each other, and to interoperate, than you originally thought about. It takes three or four years post-M&A before system consolidation and EHR consolidation really starts to take effect, when there’s a lot more energy and effort that goes into integration and interoperability of systems.

How is the healthcare technology market shifting?

So many healthcare technology companies out there, big and small, are trying to essentially make their solutions be available to providers. They are doing some very cool, innovative things.

A universal challenge is, how do you make yourself accessible available to the end users in their workflows? That challenge is growing, unfortunately, because on the IT teams that we work with on the hospital and health system side, they are working on tight margins. Their budgets are being cut. In fact, many of the CIOs that I’ve spoken with recently said that they are spending more time with their CFOs than they ever have. 

There’s this tension right now between digital health adoption, innovation, AI adoption, at the same time, having tighter and tighter IT budgets. How we make those two things happen at the same time is a bigger challenge now than it has ever been.

ONC said in the early days of interoperability discussions that it would create innovation and new business models. Did that play out as expected?

It’s a bit of a mixed bag. The market has stabilized a lot more, where you have to be focused on the value and ROI that you are  driving for your customers, whether it’s your provider, the patient, or whoever your stakeholder is. Interoperability is just part of it. I don’t think interoperability is a goal in and of itself. Better patient care, digital health adoption because you are going to get better patient engagement and so forth, is driving a lot of the conversation.

Then the interoperability part, along with some of the other cases. Can you integrate with my core systems? Are you secure? Do you match my security standards? Those are things that are really more about, can you do that? You have to convince people that you know how to do that. But those are not necessarily decision-making criteria that people are using to say, are you going to deliver value to me?

In the interoperability space, as happens with any kind of hype cycle, there’s always a lot of buzz. Some of that was driven by regulatory interoperability needs.

The way I see it, and the way we see it, is that interoperability is more about enabling others to do the work that they are trying to do. Interoperability is not a goal onto itself.

How well do the major EHR vendors support workflow integration? And related to that, will companies that offer AI solutions need to overcome that issue?

Let me break it up into maybe two parts in terms of integration with the EHRs. The first part is data integration. Can you seamlessly exchange the data that you need to, at the time that you need to? Most of the EHRs are doing a fairly good job of that. It’s more about making sure that you’re picking the right tool for the job, whether it’s EHR vendor APIs, FHIR, HL7, or whatever it is. With the data integration aspect of it, as long as you know what you’re doing, you can do that with every EHR.

The second part is workflow integration. Let’s say that you are an AI company that has insights about the patient —  a risk score, insights that from care gaps, and so forth. You can push that into the EHR. There are ways to do it. But then there is the second part around the workflow change management. How do you enable physicians, nurses, or whoever the right actor is to act on that information, to really take action? That’s where the rest of the challenge lies. Some of it is on the EHR side, but a lot of that is on the workflow change management side.

Physicians already have too much on their plate to react to, in terms of information overload. Having more information available to them to act on is a barrier, quite frankly.  The work to be done, and the innovation that needs to happen, is thinking about clever ways to do that in workflow integration without causing additional burden for the end users. EHR vendors, digital health providers, and AI companies that are providing these solutions need to work together on this, coming up with ways to reduce end user burdens while enabling them to act on that information.

Early discussions around APIs involved issues around user cost and data security. Have those challenges been resolved?

On the security side, there is a security part and a privacy part. On the technical security side, a lot of advancements are being made. I would say that all the technical concerns are solvable and people have become very aware of those things.

On the privacy side, there are still open questions around whether patients know where their data is going and how we can make sure that we have the right guardrails in place for the appropriate use of the patient data with the right level of transparency and accountability. There are still some open questions around that.

On the business models around APIs, we are seeing that evolve over time. I think there are probably three ways to do it. You can have a transaction-based model, where the more times you use the API, the more you pay. There is a data-based model, where you essentially monetize the data that is flowing through the pipes. There’s also a software-based model, where it’s not about how much you use an API or how much data you’re consuming, but you license the software or the appliance and that’s what you pay for.

There is still a little bit of tension in terms of the right model from a business perspective. My personal belief is that over time, it will gravitate towards the third model, where you are essentially licensing the software or using the software to either call APIs or exchange data. It can’t be as much of a system where the amount of usage or amount of data flowing across is tied to the business, because that creates disincentive for greater interoperability.

What are the opportunities and challenges of TEFCA?

A lot that is still TBD, and time will tell. I have served on the board of Carequality for a number of years, so I am relatively familiar with what’s going on. A lot of the insider talk around that is probably not as relevant or on the radar of most clinical end users. In the near term, TEFCA will probably be a bit of a non -factor for most providers. It will mostly replicate a lot of the work that national non-profit efforts like Carequality and CommonWell have done. 

The potential for TEFCA over the next three to four years would be to enable some additional use cases, such as for payment and operation, which will allow not just provider-to-provider and patient access, but also allow data to seamlessly flow between payers and providers and other non -treatment stakeholders for the patient. That’s when TEFCA could start to have a bigger impact. But it will take a few years to get there. The second part of that is a little bit more of a risk.

Part of TEFCA is the QHINs that are being formed and will keep forming over the next year or two. For some of the larger QHINs where this is not their primary business, they will do fine. But there will be a business model question that will come up for the smaller QHINs because you ultimately need a sustainable business model. It’s a hyper-competitive QHIN model where 80% of the market might be rendered by the EHR vendors. There probably won’t be enough business for the rest of the QHINs to justify a full business model based on that alone. The value-added services that you are trying to build on top of that will be key.

When the HITECH Act came about back in 2010 and 2011, health information exchanges were a big thing, A lot of those health information exchanges are operational today and successful because they had a business model that went beyond just the initial push that they got from the government. I think something similar is will play out here. The QHINs that are successful in the longer term will have solid business models that go beyond just the basics.

What lessons did you learn from your many years at Epic?

I lived in Madison, Wisconsin for 16 years, and lesson number one is to always support the Green Bay Packers on Sundays. That is in my bones and will be a forever thing.

Epic was a wonderful learning ground with the sheer wealth of knowledge that you assimilate on the healthcare side. It’s just amazing. I wouldn’t have been able to get that anywhere else. Judy is a remarkable person and a remarkable leader. She has an orthogonal way of thinking that I really have appreciated.

My time there influenced how I think about leadership, which is to hire really smart people and give them responsibility and autonomy early on and watch them thrive. Culture is key and putting the customer first always, even when it’s difficult or inconvenient, and keeping your promises. A lot of those cultural aspects have been really ingrained not just through me, but a lot of the Epic alumni that are out there in the industry.

Over time, the other thing that comes from my Epic upbringing and also from my time in healthcare and healthcare technology is the importance of focus and thinking long term. Those are really important, because in the typical hype cycle, there is some buzz going on every two or three years. It is so important to stick to it and focus on doing what you believe in so that you eventually get to the goal. To Judy’s credit, she has done that exceptionally well.

What will be important to the company’s strategy over the next three or four years?

First and foremost, it’s focus. We are going to single-mindedly focus on how to build a technology platform to make interoperability easier across the board for healthcare. Not just in the US, but globally. We often end up talking about US-related interoperability challenges, but this is a global problem, and we aim to be focused on solving that. That is what we will focus on. This is not a side business for us. We are not trying to build EHRs or CRM systems or what have you. We will just be focused on this.

Our approach will be technology first. How do we use technology to make sure that we are making things better and better over time? A good analogy from years past would be Cisco. It was a networking company and still is, and then over time, they kept improving technology and then they added more and more things to help their customers around that core. That’s how I see our trajectory.

On the software and product side of it, we want to build generalizable software and make it flexible so that our customers don’t have to buy point solutions for different things. Customers shouldn’t need to buy different things for APIs, FHIR, and something else. We want to be more. We can create generalizable software that can fit all needs.

Last but certainly not the least is to just stay focused on the customer. We take a lot of pride in our customer satisfaction and our KLAS scores and so on. That is something that we will forever hang on to.

Interoperability is a broader problem than it seems. A given hospital might have 200 systems that need to talk to each other, if not more. Sometimes these systems are within the hospital’s four walls and sometimes they are outside. A huge amount of effort goes into making all of that happen. The work of Carequality, CommonWell, and TEFCA is probably just 2% of interoperability and data exchange. I would encourage everyone to think about interoperability more broadly and how to make sure that all parts of the healthcare system have the data that they need to deliver the value that they are supposed to deliver.

HIStalk Interviews Nicolas Vanden Abeele, CEO, Ascom

December 11, 2023 Interviews No Comments

Nicolas Vanden Abeele, MA is CEO of Ascom of Baar, Switzerland.

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Tell me about yourself and the company.

I have been the CEO of Ascom for the past two years. Ascom is a Switzerland-based, mid -cap multinational in healthcare technology. All we do is what we call critical communication and collaboration in the healthcare domain, in hospitals and long term care homes and also in enterprise. We are multi-national, in 20-plus countries in the world. The Americas is an important market for us, and definitely Europe and Asia. We span pretty much the three regions around the globe.

We have strong purpose, which is to bring data to lives, with an S. It is all about the lives and the well -being of our patients. By doing so, we want to bring better outcomes. It’s all about, bringing data to life and providing better outcomes. That’s a strong purpose.

It’s about making sure that care delivery is done with the best quality and is as efficient as possible. We improve patient outcomes and patient lives and we enable the caregiver — doctors, nurses, and others in hospitals – to do it as well and as easily as possible.

How will remote patient monitoring develop, both as a technology and as an alternative to in-hospital care?

We enable remote monitoring, which can be in a hospital or care setting or also outside of that, such as monitoring patients at home. We collect patient vitals via medical device integration. We run a number of algorithms within our software platforms to generate outputs, which is data or information that we give to the right caregiver — nurse, doctor, or other  caretaker in a hospital — to take the appropriate actions.

That monitoring can be done in an any hospital setting or care area, such as an emergency department, ICU, operating room, a general ward, or a rehab center. It can also be done at home as an extension of the monitoring in a hospital to a setting outside of that hospital environment to allow a patient to go home earlier. There’s a lot of discussion about earlier discharge, because it’s sometimes better for a patient to be back at home in a more normal setting. It’s also better in terms of recovery, and having these monitoring solutions allows us to also provide the necessary care, even while at home and still under recovery.

We are a key player in what we call critical communication and collaboration. We have mobility solutions, nurse call, and patient assistance solutions. Our software platform aggregates these data and orchestrates a number of actions, outcomes or outputs as information that is sent to the right caregiver, who can take the right action at the right time, even earlier than they would have in a normal situation. It’s all about providing a secure environment to give that right information for the right actions to be taken in time.

Our ambition is to become the the enabling platform to which everything and everyone connects, including sensors, medical devices, and mobility devices. Our ambition and vision is to become that enabling platform in any hospital or care setting.

How have nurse call systems evolved, both from the patient’s point of view as well as the routing of messages?

We have our nurse call and patient system, and then we have our software platform that is the orchestration behind that. Our Ascom Healthcare Platform orchestrates by using the right patient data to trigger the right outcomes. These right outcomes are alarms, alerts, and basic data sent to the right caregiver. If that caregiver is not available because they are treating another patient, the information is sent to other caregivers to make sure that that the appropriate care is given within the appropriate time.

We are speaking about lives of patients. We are speaking about patient safety and patient quality. Our systems are robust and ensure that the caregiver is informed in time of any event or issue. It could be replacing an insulin pump, but it could also be a more serious issue.

These systems operate in a medical environment, so they must apply filtering to extract the right information from all of the noise and information that is circulating. They capture the right data points and trigger the right actions to the right caregiver with an escalation procedure, so that if that caregiver is not available, it’s then immediately sent to the next one available to make sure that within a short timeframe, the right action is taken to serve the patient.

We need to ensure that level of quality, and to avoid being viewed as a system that is interruptive, integrating the technology well into the workflow of the people who receive those messages.  We have quite a number of workflows for medical device integration, alarm management, smart alarm filtering, and clinical monitoring in a hospital setting. It’s also in all of the different care areas — emergency department, operating room, ICU, general ward, rehab center, then also to outpatient rehab centers, dialysis centers, and even the patient at home.

On that latter, there’s a lot of discussion going on about the hospital at home. It is definitely something that is increasing and will increase further going forward. Hospitals are under certain financial pressures. It’s better for the patient. It’s also clinically proven that for certain recovery, it’s better to be in a more relaxed home environment. That’s where the monitoring solution provides the care in monitoring of the patient at home.

How is technology being used to help with care coordination in going beyond simple messaging to exchanging of media and content, where one clinician shares what they are seeing with another clinician who is located elsewhere?

We want to ensure that information is made available to the caregiver at the right time in order for them to able to deliver care more easily and efficiently. We have a shortage of thousands of nurses in the US, and that is expected to increase in the near future. You need to deliver different types of workflow solutions to make sure that you can provide it as efficiently as possible.

Secondly, the aging of the population will put additional demands, and I would say additional strains, on the healthcare sector. Over the next 20 to 30 years, we will need to rethink the way that care is being delivered and to leverage all potential digital tools to make care delivery as efficient and as easy as possible. For example, a nurse today walks an average of 12 or 13 kilometers each day doing their job, going to patient rooms. With the systems and the tools that we provide, we can reduce that to seven or eight kilometers. That is still a lot since they still have to move from one room or one department to another, but it’s a significant reduction in distance walked, time, and the quality of the job that a nurse can provide.

We have deployed, in a number of our customer hospitals in the US, a virtual nurse solution. We complement the nurse who is rounding with assistance from specialist nurses in certain care areas or certain care domains.

These are examples of making care delivery better for the patient, but also easier and better for the caregiver given the nurse shortages and increased demand on the healthcare system. This is of growing importance given the demographics and trend. We’re on a good path to position our footprint in many the hospital networks in the US.

Is that virtual nurse back-up different from health systems that have created 24×7 virtual nurse centers?

We do remote monitoring and clinical surveillance, which can be within a hospital setting or remote when the patient is at home. But the one I was referring to in terms of virtual nurse is a novel concept, something that we see as necessary in many hospital settings in the US to complement the level of expertise. It’s an additional pair of eyes or hand for the nurse to call in specialist advice. We see a good traction and demand in the market for that.

Could that virtual nurse concept extend across care settings, such as a nurse in a skilled nursing facility who has backup from a specialized hospital nurse?

Yes. Long -term care home settings use similar workflows as in a hospital, and we offer those. Obviously it’s sometimes less complex than in a more critical hospital environment. But the virtual nurse concept, the monitoring concept, can be within the care home setting. That allows more privacy and less disturbance of the residents since the nurse doesn’t have to go in every half an hour to have a look.  They can leave the resident in their room or apartment in the care home setting.

We can do a number of things there as well. For example, our SmartSense solution has sensors that can perform movement detection in the room. That could prevent falls if the patient is moving a lot, for example. But we can also look at patterns. If the patient normally has a good night and sleeps seven, eight, or 10 hours and all of a sudden that pattern is disturbed and they wake up four or five times a night, that’s unusual. Even with the best nurses, you might don’t notice. The system can help monitor these things and then preventively say that something seems to be happening here. If the patient normally is up at 7 or 8 a.m. and a couple of days they wake up at 9 or 10 or spend 20 minutes in the bathroom, it triggers an alarm automatically.

We can parameterize certain habits of patients to provide better care. We also do monitoring of patients in long-term care homes, elderly patients. For Alzheimer’s patients, you also need to monitor movement and give them access rights for certain areas of that care home. You can block doors or block access to certain departments so the patient doesn’t get lost and to make sure that you have a secure environment where they can move around. We offer quite a number of very interesting workflows across the different domains of long -term care homes or hospitals.

What are the company’s priorities over the next three or four years?

We are a global company. We want to become that enabling platform in a care setting and hospital, a platform to which everything and everyone connects, and to provide these workflow solutions to deliver better patient outcomes and also better outcomes for the caregivers. We are an innovative company, so we are continuously innovating and enhancing our solutions to provide more value and a better return on investment for our customers.That’s what we do every day, and that’s what we want to continue doing in the future.

We are a company with a strong purpose, bringing data to life and delivering better outcomes. That’s all we do. We are an innovative company with with significant growth ambitions, and we are on a very nice growth track in a very interesting industry.

HIStalk Interviews Jeff Smith, CEO, Bamboo Health

November 6, 2023 Interviews No Comments

Jeff Smith, MBA, MIB is CEO of Bamboo Health of Louisville, KY.

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Tell me about yourself and the company.

I have successfully led multiple startups to market-leading companies that have served payers, pharmacists, and providers. I have found that with a relentless focus on the customer and their needs, you can exceed expectations. While at Lumeris, I led the value-based care enablement business. We worked with health systems and independent physicians to transform their financial and clinical model towards value-based care. That required strategies and tactics that were data-driven, team alignment, and clinical innovation to get to better outcomes in the communities we serve coast to coast. At CVS Health, I led enterprise strategy acquisition, physician connectivity, and population health. I was responsible for working with leaders across the business to develop innovative strategies and translate those into technology-enabled services at the point of care decision-making with the physician office and the pharmacy. That was focused on a scaled, innovative approach across the US for a Fortune 50 business.

Bamboo Health works across the healthcare ecosystem. We have the ability to share what we call critical information through our Smart Signals network. We do that by connecting with more than a billion patient encounters across the United States annually through 2,500 hospitals, 8,000 post-acute facilities, 25,000 pharmacies, 32 health plans, and 50 state governments. It’s a broad reach of the ecosystem, enabling admit-discharge-transfer alerts, bed capacity and availability, insights around where patients can receive care, and valuable prescription drug information down to the point of care as well as at the pharmacy. We do that across more than a million acute and ambulatory providers as well. It’s a broad reach on which we will build our strategy to help individuals across the country.

What has changed since the early days of the pandemic when it quickly became obvious, particularly from a public health standpoint, that our lack of real-time capacity and patient information hampered decision-making?

That’s part of the reason that I joined Bamboo Health. I saw that they had these hundreds of millions of critical moments that were occurring every year at the physician level, point of care, at the hospital admit or discharge, or in the pharmacy. Bamboo’s network has the capacity to be real time. It presents an opportunity for us to branch out from being just a technology company into a technology-enabled services company to connect those individuals, when those critical moments are occurring, to the care they need.

How will drug chains and other retailers fit into a system that has been based around health systems and physician practices?

The value-based care movement is creating companies, or is challenging companies to rethink their strategies as well, as what the end-to-end delivery of care looks like for these individuals. The CVS organization has created  strong vertical integration of everything from insurance all the way to pharmaceutical dispensing and engagement at the filling of those prescriptions. That will present an opportunity and a challenge for many of the existing players to rethink the overall value chain and how they can participate and drive value going forward. 

What’s most critical here is that we keep the patient and what’s best for them in mind and determine how everybody can contribute to the end result of what value-based care is trying to achieve, which is a better experience, a better financial outcome, and overall quality for that patient.

With all these new players requiring clinicians even as more of them quit their professions, how will we shift the design of the system to address clinician scarcity?

The solution is ensuring that people are operating at top of license and that we are efficiently connecting individuals to the care that they need at the right location for the right value for the patient in the system. That will be central to the Bamboo strategy and is seminal for us going forward to be successful as a country and fighting these high cost trends and quality challenges we have.

How will AI contribute?

It will be about information assist versus artificial intelligence actually taking the action. We have started to see here at Bamboo, and I’ve experienced this in other companies, a leapfrog moment for the healthcare delivery system in the United States. The ability to leverage vast amounts of information and be able to create an information assist environment — whether it be for physicians, pharmacists, or even the patient — presents an incredible opportunity for us all to drive greater quality of information that will be presented to all of those different stakeholders, along with an opportunity to create greater efficiency among the system itself and get to the highest value outcomes more quickly.

How do you set a company direction that involves AI when it changes significantly literally every day?

That’s why information assist is the correct framing for the healthcare community versus artificial intelligence that actually takes the action. As we see the future unfolding over the next several years at Bamboo Health, we have these millions of critical health moments occurring. We need to take all of the information that we have through our network and have those manifest themselves in the best next action for the patient. We can turn these seminal moments into an information assist moment for the healthcare providers to help them take that next best action.

We are focused on whole-person care at Bamboo Health. That means prioritizing the entire patient, including behavioral health, in the hundreds of millions of critical moments that occur each year. For example, an elderly woman is brought to the ED by her family after she has ingested a large number of pills. The ED physician will have certain suspicions around what she’s suffering from, such as depression, lack of sleep, or other life pressures. These individuals with severe to moderate mental health or maybe drug addiction issues show up into these points of care, and unfortunately, hospitals don’t have the infrastructure to help them.

The doctor at that moment could create direct access for that patient through what I would call the Bamboo Bridge or maybe some type of easy button, where they would be able to connect that patient to a caregiver in that moment who can serve up information to help them assess that patient. Then imagine that a Bamboo Health care navigator springs into action based on that easy button from the physician, where they can directly assess the patient with the information that we have and that’s provided to us. They can help determine the level of care that is required and then schedule, for example, this woman into a mental health care moment as a follow-up.

We have now been able to efficiently capture a critical moment and connect that physician so they can make a decision based on the information that we either serve up to them or to a Bamboo care navigator who will be more informed because of the information assist that occurs. Now that patient gets connected to the right next step, right next moment of care, and then the physician can feel like the next best action has occurred and that patient is better teed up for their next step with care that’s going to occur. We are getting to a state where we are able to help that patient navigate the system and providing the level of care at each step that is more complete, more informed, and helps that caregiver in the limited time that they have be able to make better decisions on the next best step for that patient.

Many people, especially younger ones, prefer episodic interventions over having an ongoing relationship with a primary care provider who quarterbacks their health needs. Could that next best action concept serve as a technology substitute for an ongoing provider relationship?

Our healthcare system needs to meet the patient where they are. What I’ve seen is that at least around value-based care, you need a quarterback of that care that the patient is attributed to. What’s critical here is that we think about some of these patients in behavioral health, where there’s not enough infrastructure around that primary care provider who has this patient attributed to them. This is something that I think the government is recognizing, that there hasn’t been sufficient reimbursement for physicians who are treating those with depression. They have made some changes to the reimbursement model and ensuring that there are enough dollars to those who are providing care for some of these complex patients that have comorbidities.

To your question, the technology should be part of that infrastructure and providing that information assist for these patients, so that not only are we identifying and engaging, but also helping nudge the patient towards the right actions as they move through their life and through the care delivery system going forward. I see it as complementary, and it likely will be different based on the type of patient and individual that we’re treating.

A healthy individual will have different needs than somebody with behavioral health and the complexities associated with that. The top 5% of patients drive about 50% of healthcare costs. Those patients in that 5%, as we see based on primary and secondary data, have behavioral health issues. These individuals will require more infrastructure and more care, particularly given the comorbidities they have. A patient that has substance use abuse may also have chronic kidney disease. Of those that have chronic kidney disease, one study found that almost 50% have symptoms of depression and anxiety. They also likely have heightened hypertension and diabetes. How are we creating an infrastructure and a care around that patient to engage them based on the different points that they engage in the healthcare community?

Part of our mission at Bamboo is that we want to work with these individuals who have these needs and then take advantage of all these seminal moments, working with our care partners — physicians, pharmacists, the care teams — to best engage that patient along each step of the way. I hope that if we can do that, that technology can nudge them into that next best action. Where I’m particularly excited about is that given the opportunity to engage some of these patients earlier in their disease or as we start to see certain habits emerge, we can more rapidly connect them upstream to these care providers to get them the care that they need. That will help the patient and the families that are trying to get them to a better state down the road.

As a company with private equity backing and an acquisitive history, what are the challenges for younger companies that might be running out of financial runway and opportunities for companies like Bamboo? 

Bamboo is very strong in terms of the current state of the company and our future growth prospects. I feel confident with the involvement of our backers Clearlake Capital and Insight Partners, with $100 billion of capital. Healthcare providers are looking for a turnkey solution to their problems. Bamboo is well positioned, given our customer base and the solution we already have in place, to find partners to supplement what we’re able to do today to create a better turnkey solution for our customers and the patients that we look to serve and exceed their expectations every day.

I came here because of the personal calling that I saw observing the healthcare system and where it is today. We have an opportunity to reduce the suffering that people are experiencing today, like many of us who have had family members and close friends who have struggled with behavioral health. We can make a real difference with the platform we have.

HIStalk Interviews B.J. Schaknowski, CEO, Symplr

November 1, 2023 Interviews No Comments

B.J. Schaknowski, MBA is CEO of Symplr of Houston, TX.

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Tell me about yourself and the company.

I have been the CEO of Symplr for three years. Over that time, we have tripled the size of the company. We acquired seven companies in that time, but we have seen strong organic growth because we have developed a competency around delivering value for our healthcare system customers. We are in 97 out of 100 US acute care facilities. We are earning the right to add more value as we deliver for these systems and deliver important outcomes during a time where they have financial problems and workforce shortages. Symplr turned into an important partner over that time, and we are just getting started.

How has the company integrated those acquisitions?

It’s a lot of work. It starts with a thesis and a strategy. We say no to infinitely more potential acquisitions than we ever do. For most of them, it’s not for lack of what would be otherwise a creative financial engineering, but it’s that they don’t fit our strategy. We have built a concept of non-clinical or administrative healthcare operations that are divided into four portfolio areas – provider data management; workforce management; contract and supplier management; and compliance, quality, and safety. If a potential acquisition doesn’t round out or add scale to one of those pillars, we say no.

We have a concept of a connected enterprise. We believe that interoperability and a common UI will make a healthcare worker’s day simpler, with better outcomes, less time in front of computer screens, and more time in front of patients. Acquisitions have to fit into one of those portfolio areas.

Once we identify one and get the deal done, it becomes, how do we take the best of that acquisition, incorporate it into the Symplr culture, lexicon, and core processes, or if we have better, more mature processes here at Symplr, how do we apply those to that asset to get the right level of scalable and sustainable competency for our customers going forward? It takes a lot of time. It takes a lot of hard work. Our team puts in long days and long weeks, but our systems are telling us that it’s working.

Financing and competitive challenges may force young companies to be acquired or die. How would you characterize the likely winners and losers?

There are certainly fewer processes in general. There is still access to capital, even for the smaller companies that weren’t running at much of a margin. It is wildly expensive right now, as you might imagine. Some of those companies that might have otherwise tried to stick it out for a few more years, or sell to somebody like me or another strategic, may be looking at taking on new private equity investment or new partners. They will give up more of their companies because they are not at a point where they can realize the full value.

But the good companies, the companies that have run well — which are the ones that we are interested in, that for a sustained period of time, have had good customer referenceabiliy and have thought about both profitability and growth — those are still attractive assets. It’s less about the financial profile for us. It’s more about the value that they bring to a customer. If we have a complementary or tangential solution, we call it one plus one equals three. Those are still the most interesting assets for us. They usually come from companies that have managed their overall operational portfolio and financial portfolio well.

How aggressively are health systems reducing their technology vendor count, and how has that influenced acquisitive, investor-backed companies versus a one-product startup?

It is the dominant theme relative to technology in healthcare today. COVID shone the spotlight on all the inefficiencies. Fifty or 60% of healthcare systems are using 50 to 100 applications. Think about the credentials, data security, and privacy issues on that. Think about the inability to get your data and send it to your healthcare administrator to be able to make intelligent decisions about how to run the system. At the same time, you’re trying to drop a nurse into three or four facilities, and he or she may literally feel like it’s Day 1 on another system facility that he or she walks into.

It is the driving force behind a lot of technology decisions. It is the driving force behind the evolution and escalation of the CIO as a real driving force of healthcare system — productivity, efficiency, financial outcomes, patient safety, and workforce engagement. Technology consolidation is applied to a highly fragmented patchwork quilt of systems that it took to run a healthcare system. You will see that phase in to more centralized decision-making over the next five years, how it relates to the availability of healthcare technology assets.

Companies that look like Symplr are trying to accomplish the same thing that we have. They may not have the same philosophy around integration or UX/UI, but I see a narrowing of the aperture relative to the willingness to consider a lot of small vendors versus partners who can be there at scale and deliver for you in a variety of areas. As the commercial challenges potentially mount for those companies — and there will be good ones, there are always great ideas, true innovation, and real outcomes —  but they will become a little bit more scarce. The larger, the more sustainable, more successful ones that can offer more breadth and depth will continue to become more attractive. It will be interesting to see where that leaves some of the little guys.

OpenAI just killed the valuation and prospects of a few startups by enhancing ChatGPT to read PDF documents, which made those other products instantly obsolete. In digital health, how do companies stay out of Epic’s way while hoping not to be killed off by Epic as an incumbent vendor building a good-enough competing product?

You have to be really careful about where you pick your lanes. With Symplr and some of the other larger operational software companies, there will always be a little bit of coop-etition. But you need to understand where any of the large players are headed and then understand how you can be complementary.

We have our own AI ML strategy, which is a funny thing since AI is not new. The consumability of AI relative to ChatGPT and some of the other formats that have been released recently has been the game-changer. But as you think about their ability to meaningfully come in to do the non-value added workflows, that is super interesting. OCR is 20-plus years old and isn’t new or novel. We would never create a business around that. It’s understanding your swim lanes and having technological innovation and process differentiation that allows you to collaborate and live alongside, hopefully at incremental value, and very rarely overlap.

Health systems are reporting poor financials even though they have near-monopoly markets, charge high prices, and should theoretically be improving efficiency at scale via acquisition. What technology business opportunities does that create?

At the end of the day, if you are a services business and you don’t have enough people to fulfill demand, you are going to have financial troubles. We have a 45% nursing shortage and another 25% saying they will retire in the next five or 10 years. That’s problematic. When you can’t actually get the patient throughput to fulfill the demand you have, even if you are somewhat monopolistic in a market, that’s bad math that doesn’t take an MIT PhD to figure out.

The real question is, how do you leverage technology? This is what Symplr does. Everyone else is oriented around the patient, while we are oriented around the healthcare worker. We’re trying to make them more productive. That means more efficiency, more productivity, and less time in front of a computer screen, yet better outcomes and more time in front of the patient. Seeing more patients, having better patient safety,  having better patient quality visits and engagement when they are actually in the system through leveraging technology. That’s where we see the differentiation. 

There is still extraordinary waste inside healthcare systems, particularly those that have been run in a highly fragmented or decentralized way. We see in our contract and supplier and spend management portfolio the opportunity for hundreds of millions, if not billions, of dollars of improved savings just by leveraging better technology, which obviously that system can then redeploy return to shareholders or whatever it looks to do. Getting back to the fundamentals of what a healthcare worker is supposed to do and how to manage the bottom line through technology are the two obvious areas.

How are health systems addressing clinician labor challenges?

It’s putting the same level of emphasis around healthcare worker processes and workflow that they have had around patient throughput and patient workflows for all these years. 

If you look at the amount of time that a nursing leader, for example, had previously spent in front of a screen scheduling nurses or doing patient safety audits, all of these things could be done in a simpler way, where they are served to served to him or her. Cut that time by two-thirds to 75% and then you get 45 minutes back in an hour to spend on patient care or mentoring younger nurses, which is from what we’ve seen is the key to improving healthcare. It’s all about time. Healthcare is all about giving them more time and then giving them the optimal workflows to get through the day, to see the right patients and give them the right outcomes. 

That’s where more progressive systems are focused. How do we empower rather than constrain our nurses, our physicians, and our respiratory therapists? And down the line, to be in the moment more and less in front of that computer screen being forced  to follow a set of antiquated workflows or processes.

What are the biggest changes you expect to see in digital health over the next handful of years?

It’s not a sexy answer, but a return to basics and doing it at system-wide level. Where you used to have 47 different facilities inside of one system running as 47 different organizations, as you begin to see them consolidate into a standard way, a best practice way, a gold standard way, you’ll see that beginning to improve not only patient outcomes, but healthcare worker outcomes. That’s what this is about. The focus on the healthcare worker — their engagement, minimizing burnout, making sure that they have the right tools to do their job successfully and effectively, and making sure they aren’t wasting their time on red tape administrative workflows. It’s a return to some of those things, leveraging technology, be it workflow technology or a little bit of AI/ML, to augment and make them more productive. If we get back to the basics and leverage technology to do so, you’ll see a step function improvement in the outcomes that healthcare systems deliver, and that will be to the benefit of every constituent in the healthcare ecosystem.

HIStalk Interviews Ben Hilmes, President, Healthcare IT Leaders

October 2, 2023 Interviews No Comments

Ben Hilmes, MHA is president of Healthcare IT Leaders of Alpharetta, GA.

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Tell me about yourself and the company.

I’ve been in the industry for 25 years, going back to grad school. I have an MHA and am a fellow with the American College of Healthcare Executives, so I’ve been active in all of those industry channels. I spent 22 years with Cerner in a variety of roles, and when I left, I was running our US not-for-profit client organization that was about a $2.5 billion business as well as the outsourcing function called ITWorks. I then transitioned to Adventist Health as a chief integration officer, where I had responsibility for IT, informatics, analytics, and enterprise PMO. In April 2023, I joined Bob Bailey and Healthcare IT Leaders as president of the company. It has been an exciting five months.

I’m also doing a podcast called “Leader to Leader.” We will have a guest every month who is relevant in the industry, names that people know. Our first topic was revenue cycle outsourcing, a good conversation with Doug Hire, former COO of OptumInsight. We also talk about leadership. I think this industry is starving for really, really good leaders. Any insights I can pull out of these incredible people about their leadership journey and share those with the audience, we’re doing that.

What services are clients seeking?

Our services fall into three categories. EMR, with the main players like Oracle Health, Epic, Meditech, and Athenahealth. A second grouping is workforce management, human capital management, and ERP, with players such as Workday, UKG, and Oracle ERP. The third area is helping clients on their cloud journey, which can be as simple as how to do rationalization and get them out of the data center all the way to helping them migrate even the most complex of things, including EMRs, to the cloud.

Vendors and suppliers are getting out of the services business. We’ve seen a massive migration away from services from the primary vendors. Secondly, health system cost pressures are challenging them to think differently about how they get things done. Doing those things with a large system integrator sometimes doesn’t achieve the price point that they are looking for. We have found ourselves in a unique and exciting spot for a lot of those clients that need work done across those portfolio of technologies, being able to go direct to them or even working with some of our great partners like Deloitte, Accenture, PwC, KPMG in partnership to get their overall price points to something that is acceptable and sustainable by these clients to get work done in a challenging market.

Why are EHR vendors moving away from running a separate services organization?

It’s pretty simple. It’s margin. If you think about the Cerner transition, Cerner was at its core a software company. Oracle is even more of a software company, from a focus standpoint, than Cerner. When they acquired Cerner, they started getting out of some of these services businesses that were low margin. Cerner was doing that a little bit toward the end, getting rid of revenue cycle, starting to jettison low-margin CommunityWorks, their community hospital deployments. They were pushing those out to a couple of partners to do those end to end.

We have seen that trend almost in all of the software suppliers. The services business creates risk. It’s hard work. It creates a lot of noise and then doesn’t generate the kind of margins that these organizations demand and expect for either their shareholders or their overall business performance.

If the vendor can’t generate adequate margins on services, how can a third-party company?

The poor health systems that end up with one or two points of margin feel like they’ve had a great success. Software suppliers are well above that 70% or 80% margin. Services business run somewhere in that 30% to 40% margin range. We do a really good job of managing our overall overhead and spend. We don’t have a tremendous cost pressures from R&D with all of the development activities that a software company needs. We find a nice margin spot somewhere in the middle. That works for us and our shareholders while enabling us to create price points for our customers and clients that work for them.

Big healthcare organizations outsource big functions such as IT and revenue cycle management, but not infrequently bring them back in house not long after. Will we see the same buyer’s remorse with health systems who scale back data centers to move to the cloud and then find the eventual cost to be excessive or unpredictable?

I’ve been involved in outsourcing IT, revenue cycle, and hosting. Every one of those tends to be really, really strong out of the gate. But at some point, there is pressure to achieve margins. The overall service model changes over time. You see the vendors start tweaking that service model, whether it’s leveraging more offshore or leveraging less-expensive, less-experienced resources. We see it time and time again, trying to leverage technology to drive more efficiency or trying to do more with less. Every time I have seen that, there was a degradation in overall client experience. 

I suspect that you will see a similar trend as people move to the cloud. There may be enough incremental benefit in the movement to the cloud to offset that, so maybe it’s a little different business model. I think it’s too early to tell, but it’s interesting that when you are in a lot of those conversations, while it’s not the exact same thing, it sounds a lot the same. At the core, you are outsourcing this function to a different organization. It will be interesting to see if it follows the same trends.

How will Oracle’s ownership change the former Cerner business?

We can plainly see the number of clients that are transitioning away from Oracle Health to Epic or some other supplier. That trend continues to grow. It was eye-opening at Oracle CloudWorld to see  what Oracle is doing with Cerner. Some decisions are positive, while others make me scratch my head. But at the end of the day, Oracle is an incredibly formidable company that will eventually get it right. We need them to get it right. This industry needs a balance in that space. Having a strong player in Oracle Health is healthy for the industry.

I spent 22 years at Cerner, starting when we had 1,700 associates. We grew to 30,000 and had a lot of fun getting there all under the leadership of Neal Patterson and the vision that he had. It was almost emotional listening to Larry Ellison’s speech at CloudWorld, because if you listened closely and had the legacy information that I have, he is still talking about the same vision that Neal had around healthcare and the role that these systems can play in transforming this industry, whether it’s the national network, robotics, or analytics and insights. It was the race to get healthcare digitized. When we did, then it was going to be the fun stuff, and Larry is excited about that.

I would not count them out, as they continue to invest heavily. I heard it – he was very clear about healthcare being their number one focus. For a company the size of Oracle to boldly say that, coming from their chairman’s mouth directly, was a pretty big statement. But the clients are saying, let’s get on with it. We need to get there faster. We have real challenges today. You are seeing a lot of clients say, we can’t wait any longer and we are making the move. 

That creates a ton of opportunity for businesses like ours. As clients transition to Epic, we can play a meaningful role in helping them deploy that new solution. Secondly, there’s a large balloon effect. When you transition hundreds of resources over to a new project, such as Epic or some other system they have selected to deploy, you have to maintain all the legacy systems during that time. Our firm steps in incredibly nicely in that space with our managed service capabilities to provide all of that legacy support, all of that bridge strategy for these IT organizations as they go through the transition. Lastly, as they move to the new systems, we are rapidly stepping into the managed services space, being able to take on the application support for these organizations as they continue their journey on their new platform.

Where will innovation come from, or what areas will be ripe for a technology solution?

If you go through the major buckets of labor in healthcare, nursing is probably the best example. It’s a big spend and there’s a big gap. When I was at Adventist Health, we were spending 3X of our budget on contract labor, mostly in nursing. That’s not a sustainable model. So, how do I think about leveraging technology to create efficiencies? We were evaluating virtual options, such as patient care centers, to offset some of the work that nurses were doing in clinics. All the pre-work that could be done virtually.

Backing up, we were evaluating, on both the ambulatory and acute sides, going end to end looking at overall jobs to be done and breaking them down into two categories — things that have to be done in the physical environment and things that could be done in a virtual environment. As you start to think about those things that could be done virtually, you can start to think about virtual call centers, leveraging offshore capabilities, et cetera, to fill some of those voids. It was interesting on the acute side how many functions fall into the “we could do that virtually” category, and the same model could emerge. You’re going to see a lot of virtual nursing come to play, leveraging different technologies to provide those capabilities in a different way than physically being present.

The other place that is ripe for technology innovation is revenue cycle. You can’t just throw more people at it because we don’t have more people, people are expensive, and it doesn’t seem to be making any difference. Cost-to-collect for health systems is starting to get really out of hand. When I was at Adventist, we were looking at north of 5.5% cost to collect, which is unsustainable. We were at how we could leverage technology, offshoring, or some other business model to help us deliver a more efficient and higher-performing service.

Healthcare systems spend a lot of money on technology on the back end, but what patients see often remains clipboards and scanned documents. Are the technology changes in revenue cycle more consumer facing or more process oriented on the back end?

Revenue cycle is pretty broad. A lot of people think about it only on the back end. But a lot of the innovations are coming to play on the front end, engaging the consumer differently to create stickiness and increase and improve the overall patient experience. The challenge is that there are a lot of siloed solutions and data sets that don’t, at this point, create the intended outcome, which is to improve the overall experience, improve efficiencies, improve data capture, improve overall quality and outcomes.

For example, uniformity in how you communicate with your patient population or member population. You have four or five different technologies that do some sort of that, whether it’s a bot, a text, some kind of chat function, or a portal. How do you make those all seamless? We were faced with that challenge through our consumer strategy development when I was at Adventist Health. Working with these is almost like going back to the EMR of the early 1990 before you got to the single platform thought, the enterprise thought, You had silos of data, and the challenge was interop and getting these systems to communicate together. I think you’re facing the same challenges on the consumer side, and the front end of the rev cycle is front and center on that.

On the back end, there needs to be more innovation and stronger alignment with the payers. Providers and payers are going to have to come together and find unique ways to solve the real problems. Right now, providers have their agenda and payers have their agenda. I have been in tons of these dialogues with payers trying to think about new ways to address some of the challenges in the revenue cycle. In terms of innovation, I haven’t seen anything that’s leapfrog groundbreaking, but the business model tends to get in the way, which is unfortunate. But I still hold that promise that big orgs are going to come together. Clear minds are going to come to the table, and they are going to put the real focus, which is the patient, at the center of their objectives and start to find ways to bend the cost curve, create more efficiency, reduce the overall spend on revenue cycle, get claims adjudicated faster, all those functions. There’s an intersection between the payer and the provider that needs to be resolved

What are the key elements of the company’s strategy over the next few years?

We will continue to lean heavily in on our core focus around our staffing functions, across our three pillars of EMR, workforce management, and cloud. We will lean heavily into the managed service space. It’s about improving our overall revenue line to balance the staffing revenue with a recurring revenue. I believe we have the tools, the right people, and the capabilities to not only deliver a better managed service to our clients, but at a better price and with better outcomes. That’s exciting for us.

I could sit here and echo all the other pundits out there that talk about AI and all of the fun things around that, which is exciting, exciting stuff. But we don’t fully understand how it’s going to play out. So when I look out two to three years, we’re going to learn a lot about those things. It’s a little bit beyond that to really understand the true application of those things and how they can improve the overall healthcare experience, the delivery, the industry itself. But it will be exciting to see

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HIStalk Interviews Charlie Harp, CEO, Clinical Architecture

August 30, 2023 Interviews 7 Comments

Charlie Harp is CEO of Clinical Architecture of Carmel, IN.

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Tell me about yourself and the company.

I’m a developer by training. I’ve been building systems in healthcare for about 35 years. Back in 2007, after working for a bunch of different companies, I started Clinical Architecture to focus on the plumbing of healthcare, such as semantic normalization, data quality, and gaining insights by looking at patient data.

The industry has more technical pipes available to exchange data, but have we equally advanced terminology and semantic issues?

In the last few years, people have become a little bit more sophisticated in how they share data. USCDI has driven some folks, through the Cures Act, to at least try to share more data. The guidelines we have are still a little fuzzy in terms of being more guidelines than rules. We have made some progress, but we are still dealing with people that might have access to the data through something like data exchange. I think TEFCA  is going to continue this, but I still think there’s a lot of hesitancy to accept that data when you get it.

The last time we talked, you said that providers don’t trust each other’s data, and that one provider doesn’t have much incentive to clean up their own data that they have already used for someone else’s benefit. Has that situation improved?

A little bit. We started doing a data quality survey last February. People generally did not think very much of their own data quality. Most of them — depending upon the domain, whether it’s drugs or labs — had some level of confidence, but they didn’t have high confidence in the quality of that data. The only thing they had less confidence in was the quality of other people’s data, which I thought was interesting.

The problem we have in healthcare today is that we gather information as a byproduct of the process of providing care. Providers rely heavily on their notes to go from one patient encounter to another. They fill in the structured data because they have to.

We have this illusion on the analytics side of healthcare that the structured data is of high quality. When we go to share the data, most of these systems — whether it’s Epic, Cerner, Meditech, or whatever — are still using dictionaries that were developed for that EMR, with code systems that are specific to the EMR. They still have to be normalized on the outbound.

The challenge with people sharing data out, especially if it’s a regulatory requirement, is that it’s a “letter of the law” as opposed to “the spirit of the law” type of engagement. The data is leaving, and people tend not to care as much about the data that’s leaving as they do about the data that’s coming in. The problem with the data coming in is that, to the people who sent it, it was data leaving, so it wasn’t as important to them.

Do those clinicians who don’t trust their own data at least have confidence in the subset that they need to treat patients, or do they create their own notes or records?

It’s a combination of the time famine that providers have. They don’t have a lot of time. A handful are aware and plugged into what’s happening with health informatics and interoperability, but a lot of them in the trenches are just focused on how to provide the best care while complying with the things they are being asked to do by their organization. A lot of them, at least the ones that I talk to, tend to still rely heavily on their unstructured notes to go from encounter to encounter.

A few years ago, we looked at the structured data and did inferencing to find patients who were undocumented diabetics, patients who had no mention of it in the structured medical record. We looked for other indicators, like the fact that they had a hemoglobin A1C that was out of whack, or they were taking something like insulin or metformin. In six months, we found 3,600 undocumented diabetics. When the folks we were working with presented that finding to providers, the feedback was pretty universal — I know those patients are diabetic, that’s why I gave them metformin.

The problem is that there’s a disconnect between the provider, who is legitimately just trying to take care of people, and the unintended consequence of not having the structured data in the system. That means that your quality measures are out of whack, your patient management software is not scheduling foot exams. There’s still a disconnect between why you put in the structured data in the first place and all the downstream systems that consume that. Analytics, machine learning, and AI, all these things that we want to embrace and leverage in healthcare, depend on the structured data being there and being correct. We are pretty far off from that, unfortunately.

Does AI offer opportunities to structure that data using free text notes or audio recordings of encounters?

We have done a lot with NLP and also evaluated what’s going on with large language models. The problem in healthcare is that when it comes to data, it always falls back to trust.

If I could wave my magic wand and fix healthcare, I think what I would change is the way that we collect the data, so that we are collecting structured data without turning the provider into a terminologist to make that work. The problem we have is that providers don’t want to go to a list and pick something. They want to be able to articulate something in a way that is natural and organic for them, and then get it back in a way that’s natural or organic. We’ve had two worlds, one where you create a note and the other where you put things into a list.

I think the real answer is finding a way where the provider gets what they want. They say something in a way that’s granular and organic. We capture in a way that preserves the granularity of that information in high resolution, and can leverage that from an analytics perspective. When the provider wants to see the data, we can deliver it in a way that’s organic to them instead of them looking at a list and reconciling things. We’re a little bit off from that.

The problem with what we are doing now is that we are trying to find an easy way out. We’re saying, let’s just take the note and use NLP, a large language model, or something else to read the note and turn the note into something structured. You can do that, and we have had some success when it comes to high-certainty type data like pulling ejection fraction out of a procedure note or looking across a complete patient record and coming back with a sense of the patient’s diabetes because I found all these references that I can correlate to that. But you still run into the problem of, how can I trust that?

When you look at all the things that are happening in the industry now with AI, large language models, and NLP, there’s a lot of talk about transparency. In the past, when people have tried to do things in healthcare with these types of approaches using NLP or AI, it hasn’t been successful. The machine works great 60% of the time, and then 40% of the time it does something horrifically wrong. That comes back to this idea of trust. If you are taking care of somebody and their life is in your hands and the machine just happens to pick that day to follow the wrong probabilistic pathway, that’s challenging in healthcare.

Thinking back to providers not trusting their own data, is that a vague impression or is it measurable? What could they measure to assess or improve data quality?

When I’m working with clients, I sometimes ask them this question, so I’ll ask you. When it comes to healthcare data for an individual patient, who is responsible for the quality, accuracy, and integrity of that one patient’s data, regardless of where it is?

Some would say the patient, although that’s not a reasonable expectation for all types of data.

The problem is that patients aren’t really trusted to do that. You can fill out a form, hand it to somebody, and they’ll type it in, but rarely is a patient trusted to own and articulate, “Here’s my health situation.” It usually has to be vetted by some kind of clinical person.

That’s fine, but it goes back to this root problem that nobody is responsible. There is no data steward for an individual patient’s health record. When you talk about how you trust the data, the fact that I can take one patient and look across multiple venues of care and see different information. They don’t really trust each other and where their data is coming from. They don’t know whether that ICD-10 code was added for billing purposes or added for clinical purposes.

The problem we have in healthcare is that we don’t have a mechanism that allows us to objectively and quantitatively look at the data and say that the quality is good or bad. We are working with other organizations to do this taxonomy for healthcare data quality, because I think that we should be able to look at patient data in an abstract way and say, is the quality of this data good? Is there duplicate stuff? Is there old stuff? Is there stuff that’s clinically impossible? Are there things in the medical record that contradict themselves?

How can we automate the evaluation of that semantic interoperability so that you don’t need a sweatshop full of clinical people looking at 5 million patient records? How do you build something that can objectively, with some type of deterministic AI, evaluate an individual patient and any data that comes in for them to say, yes, this all makes sense. It looks real, and I just noticed that there’s no mention of this patient’s diabetes, whether you’re looking at unstructured notes and pulling it out.

At the very least, you should pull the data, check it against the integrity of the rest of the medical record, and say, yes, the fact that the note says they are diabetic resonates with the fact that they’ve got a funky fasting blood sugar and they’re taking these three medications that are indicated for diabetes. Let’s go ahead and suggest that they add diabetes to their official structured medical record so that we can take advantage of that. All these things that only look at the structured medical record and retain the evidence of where that came from. Those are some things that we could do to improve the level of trust and the reliability of the data.

My big fear is that we start to roll out some of these more sophisticated things that could be beneficial, but because the data quality is bad, we fumble the results early on and these things fail, and because we applied them before the data quality was ready, people don’t have confidence. You only have one opportunity to be credible. You come in with this new technology and say, “This is going to save lives. This is going to do great things.” But because the data that we are feeding it is bad, it is very possible and probable that the results of what it comes up with will be likewise bad. We will flip the bozo bit, as they used to say, on that thing. Then later, when we fix the data quality, we say, “No, we tried that and it didn’t work.” But maybe it would work if we fed good quality data.

What is the oversight structure and mechanism of reviewing the longitudinal patient record from multiple providers and identifying missing or conflicting data? Then, going back to the data source and either asking them to fix their problem or perhaps excluding their data as being unreliable?

The first place is the pipes. Look at what’s happening with TEFCA and QHINs. Let’s say the QHINs turn on their pipes and people start streaming data from Point A to Point B for every patient. The first thing we need to do is, somewhere in that pipe, we need to have something that looks at the message. Is the message right? Does the data look fundamentally correct? Not clinically correct, but is a valid code in the value set? Let’s say it’s an RXNorm code. Does the name match what RxNorm says that code stands for? So the first thing you do is evaluate someone in the network to determine whether they are a good data provider.

If they’re not a good data provider, you can’t really remediate data quality in flight. You have to go back to the source and say, you’re not a good data provider. This is what our taxonomy is focused on. By identifying the nature of the quality failure, you can go back and say, you’re putting the decimal place in the wrong spot on your lab results. You are not using a valid RXNorm code set. Your maps are bad. Whatever the feedback is.

The first thing we need to do is to make sure that the people that are sharing data from their systems are good members of society who care about the data they are sending out and are making sure that the quality is good. QHINs are going to be in a great position to evaluate the data in flight at a basic level and say, OK, the data that you are sending looks clean, looks good, and has good intrinsic quality. That’s the first step, because that’s where you stop bad data from getting out.

We also need to do a better job of knowing where data’s coming from originally so that we can stop duplication. We worked with a partner who gave me a bunch of data to evaluate, data that was coming from a bunch of different sources. In a couple of million records, there were about 750,000 duplicates, the exact same lab result done at the exact same time. Because of the way the data was shared in some of these older formats, you had no idea that that was the same data. It just looked like this patient had 64 lab results on the same day at the same time.

That’s the other thing, if we want to trust data, we need to know where it originally came from, especially as we start sharing data across an entire network of participants.

The last thing is you need is a way where we are landing it or looking at the data in our own system, saying, does it look right for every condition that I have? Do I have a treatment for every drug that’s in their profile? Do I know why they are taking that drug? This goes back to what you are talking about when it comes to oversight. Within any repository of patient data, perhaps a large IDN doing analytics or population health on your patients, we need to have mechanisms that can identify issues in the patient. Data can alert a human operator. Let’s call them a data steward. The data steward can inform the systems that they are connected with on how to remediate the data.

There needs to be oversight. The trick is, how do we have enough automation in place so that instead of a human looking at 5 million patients, automation is looking at 5 million patients for things that are a concern, and streamlining the resolution of those things? Because it’s easy for a human to be presented with something and say, “Yeah, that looks right,” as opposed to humans poring over data looking for something. That’s why when we do semantic normalization, our software does like 85% of the work, where it tries to search for the right target and it suggests the target. A human can take two seconds to look at the target and say, “That’s right.” We need to get to the same place when it comes to patient data.

It’s one of those things where the idea of having people whose job it is to review issues that come up with patient data and resolve it at a patient level might seem a little daunting, but the problem is, that’s the only way we can fix it. You have to fix it at the atomic level to have the entire ecosystem be of high quality. There’s no way to do it at a macro level. You have to do it at an individual patient level.

What factors will be important to the company and the industry in the next few years?

For us to use artificial intelligence and some of these other things that we are coming up with in a meaningful way, we are going to have to move away from pre-coordinated terminologies as how we collect data for patients. We’re going to store patient information in a much more granular graph style, so that both software and people can make better use of it. Right now, everything we do with the terminologies and practices that we use today create these big pixels of information that limit our ability to do sophisticated reasoning over that data, whether it’s for research purposes or for decision support purposes. We’re going to have to dial up the resolution to get to where we want to be in terms of software providing meaningful assistance to people that are providing care.

HIStalk Interviews Sean Cassidy, CEO, Lucem Health

August 16, 2023 Interviews No Comments

Sean Cassidy is co-founder and CEO of Lucem Health of Raleigh, NC.

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Tell me about yourself and the company.

I’m an old enterprise software guy, going back to the early 1990s. I’ve been in digital health since about 2004. I’ve worked mostly on big platform type products sold to healthcare providers, such as data integration, data management, and analytics.

The idea for Lucem Health originated within Mayo Clinic a little over three years ago, Mayo Clinic, like a lot of academically oriented healthcare providers that were doing research in AI and machine learning, was struggling to figure out how to deploy AI at scale so that they could deliver real value and impact in the clinical workflow. They went looking for platforms that could be Swiss army knives, for lack of a better term, for the deployment of a broad set of clinical AI type solutions. They didn’t really find anything, so they made the decision to fund the start of a company which later became Lucem Health.

How do health system executives decide when to jump in or experiment with AI among the daily flurry of AI announcements or research results?

It’s important to have a perspective on what the potential value and impact of AI could be to your organization. But primarily, I would orient yourself — as health system leaders are doing these days – to the real problems that are vexing you; for which solutions exist in the market that are novel, unique, and different from what you have seen before; and that can be deployed against those problems and be force multipliers. When you are inquisitive about that, you will  find that there is AI at the center of a lot of those solutions.

However, it’s important to note, and this is our perspective, that AI is not a panacea. An algorithm is not a solution. It may deliver a strong and accurate predictive output, but if it can’t be delivered to stakeholders in the right context, right place, and right time, then it’s all for naught. It can’t deliver any meaningful value and it can’t solve for those problems that a healthcare provider may be facing.

Are health systems looking for a turnkey solution to address one specific problem or do they want tools and assistance that can help them develop their own expertise?

I actually think that they are looking for both. It depends on the context.

There is a certain class of provider, large providers that do a lot of research and development in a variety of areas, who are struggling with the bench-to-bedside problem. Their problem is not necessarily a technology-oriented problem, but it turns out that they need technology to solve for that.

But let’s take a provider organization that doesn’t have a data science team and is not doing research and development. They see, as they are exploring the market, that there is value in opportunity and solutions that may have AI at the center. They are telling us that they would prefer not to invest in point solutions or a fragmented set of underlying technology platforms, but would rather buy or deploy on a consistent and uniform infrastructure.

How hard is it for connect those external AI systems to their underlying data and work around issues with interoperability and terminology?

As your readers know, in healthcare, that’s a pervasive, it’s always an issue that there is heterogeneity in the operating environment, but the data can be represented in different ways and can be semantically different. AI solutions are no different from any other solution that is trying to leverage data that already exists, whether it comes from an EMR or some other modality. There is a curation process that has to occur in order to optimize the data so it can be served to the AI and provide the appropriate context to a broader AI solution so that it can be delivered effectively.

What are the steps involved in talking to a health system that has defined a problem and thinks AI can help solve it?

Leaving aside the business case for deploying it, what we find today is that providers are looking for a clinical and financial yield, an ROI, that is significant. Otherwise, it’s difficult to gin up yet another project to try to optimize data infrastructure that they have already invested in. But in terms of connecting into infrastructure, we deploy what I would define as narrow AI. These are not large language models or generative AI. These are very specific hammers for very specific nails. Their data requirements are not terribly broad. They are fairly narrow. There are, for example, plenty of ECG-based models that are powerful in terms of being able to detect cardiovascular disease. Generally speaking, virtually no optimization and curation is required on that signals data to be able to feed it into most of the models.

There are a number of really interesting models that are using EMR data. Fairly simple stuff, like demographic data plus usually one or two lab values that can identify risk of certain kinds of diseases. Again, there’s a little bit of work that has to be done to do some curation on that data, but because the dataset is relatively narrow, it’s straightforward.

If they have FHIR connectivity available in their  EMR, which they should have, we can get those EMR-based models up and running quickly without a lot of effort. FHIR as a standard is starting to take hold, and it’s incredibly useful. It’s a bigger lift if we have to go into their PACS and pull CT images. It’s a bigger lift if we have to go to Philips or GE to get enterprise class 12-lead ECGs, but it’s doable. We are finding that health system integration teams have sophisticated integration tools and are really good at being able to tap into the data that’s needed to make AI sing and dance in the real world.

A new survey found that health system executives believe that AI is ready to address some of their issues, yet few of them have developed an AI plan. Is that because they are looking at specific solutions rather than AI in general?

There is an impedance mismatch. I’ve seen those surveys too. When you poll forward-thinking CIOs, CMIOs, and clinical leaders, they are familiar with the opportunity for AI. Of course they to say that they believe that there’s value here, but when it comes down to brass tacks to actually investing in deploying these solutions, their mindset shifts away from the notion of AI as a technical capability to finding solutions that they can deploy. The tip of the spear for them is the solution and the value of the solution over the technology. We think a very high percentage of people feel that way.

How do you position an AI company in a constantly changing environment? 

We talk about that a lot. We have to be solution oriented and solution focused. When we package and position what we are taking to market, we are trying to confront real-world problems. The fact that AI is part of the equation is, to a large degree, incidental. We are in conversations with healthcare providers where AI barely comes up. We’re talking about how to identify undiagnosed diabetics, how to get people into the clinic for overdue screening colonoscopies, and how you deal with undiagnosed or undetected breast cancer from mammographies.

The other thing that we talk about a lot is that the solution matters. What we mean by solution is not just the ability to connect with data and to deliver a novel, powerful insight into a clinical workflow. How do you set up infrastructure? How are you capturing telemetry or instrumenting the process so that you can understand whether the thing is delivering the value and impact you expect? Do you have facilities in place to actually make improvements to that over time?

Every provider organization is different. They are different culturally. They are different in terms of the patients they see. They are different in terms of their affinity for technology and their ability to change or not change workflows. All of those things matter. A solution that can be highly optimal at XYZ health system may not be working very well at ABC. Why is that? How do we detect and understand that? How do we make the necessary adjustments to ensure that it does ultimately deliver value? Everything that I just said puts the solution at the front of the conversation and puts the technology in the background.

How are health systems involving physicians as they consider the potential of AI?

I have two thoughts on that. One is that we are trying to frame the conversation in such a way — and this is not a bromide, this is truth — that clinicians feel at the end of it that it’s going to help them practice better medicine. We think it is important that they are left with that impression, and that is their ultimate reality.

The other thing is that we believe that changing clinical workflows, trying to change how clinicians are using EMRs when they are already frustrated by their EMRs, is not the way to go. We are trying to bring solutions into clinical workflows that deliver impact that don’t require any modifications to workflows. They may make those workflows more efficient, but certainly won’t make them inefficient. They won’t pop up more alerts or fill their inboxes with more junk. We help them practice better medicine and practice it the way they have been doing it in the past without requiring radical change.

Your website says that you don’t make algorithms or applications. What technologies to bring to the table?

I want to be clear that our solutions have AI at the center, so we work with AI innovators. The best analogy that I can come up with is that we are car makers, not engine makers. We work with engine makers, and these engines are immensely powerful. They have a lot of horsepower. They can spin really fast. They can deliver a lot of impact. But if they are not dropped into a car, they can’t get very far down the road and actually do any good in the world. We have optimized our assembly line to make it easy for us to build a lot of different kinds of cars. We can build an ECG-based solution, an EMR-based solution, an image-based solution, and everything in between. That’s core to what we do, and it’s like breathing to us.

We use the phrase “AI solution ops” to distinguish from MLOps, which is a term that is fairly well established in the industry. What we do is relatively straightforward, and I’ve hinted at it already. So what is the car? The car is the ability to connect to a broad set of data sources, specifically to support the needs of AI. We are not a general purpose integration platform. That’s not what we are trying to build. To provide mechanisms to support the deployment of many kinds of AI, a broad set of capabilities to interpret the output of the AI in a way that’s human interpretable, human readable, and human understandable, and then to provide robust options, including an application framework for delivering AI insights to clinicians, clinical staff, or to supporting staff so they can benefit from those insights. Underneath the covers, all of that measurement of value and impact, continuous improvement stuff that I mentioned. All of that is the car for us. 

What are your goals for the company over the next few years?

Not surprisingly, like a lot of companies at our stage, we are focused on growth. We think that we have established a product-market fit. We think that we have established that what we are offering to the market is something that the market actually wants. We know who our buying personas are and we know what market segments we should be engaging with. We are focused on trying to get more and more customers to hear that story and to sign up with us and to deploy our solutions.

When we look three to four years out, our goal is to have a broad portfolio of powerful, impactful, practical, and responsible AI solutions that are confronting the hard clinical problems that are facing providers. Today we are talking about cancers, chronic diseases, and areas where there are existing solutions that have not necessarily delivered the goods that providers expected when they made original investments.

The other piece to the business is that we want to be working with a significant number of large provider organizations who are trying to do AI research and deliver AI impact to the front lines of care within their organizations and potentially even beyond, but are struggling with the bench-to-bedside problem. That’s where we intend to be.

HIStalk Interviews Patty Riskind, CEO, Orbita

August 14, 2023 Interviews No Comments

Patty Riskind, MBA is CEO of Orbita of Boston, MA.

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Tell me about yourself and the company.

I’ve worked in healthcare data analytics tech for over 30 years, predominantly in the patient engagement and employee engagement side of the industry. I founded a company that was the first electronic survey company in healthcare. At the same time SurveyMonkey was starting, I started a company called PatientImpact, which I ended up selling to Press Ganey, which is the largest patient satisfaction survey company in the US. From there I worked for Qualtrics, which is an experience management company, as the global head of healthcare. I created their healthcare division. 

From there, I joined Orbita. Orbita is a conversational AI company. We help use technology to automate workflows. We strive to be the human side, and use conversational AI and generative AI to make it easy for patients to navigate through the healthcare system and alleviate the administrative burden on employees and clinicians. So I moved from measurement of the patient experience now to actually trying to impact the patient experience by making it easier to do business in healthcare.

What components of the digital front door have provided the strongest return on investment, and how do you expect to see that change in the next few years?

The biggest return on investment using a digital front door is, in many cases, twofold. One, if someone goes to a website, they are looking for something. If you make it easy for them to find it, then you have improved that patient experience. Often what people are looking for is ways to schedule an appointment. If you can automate the process of identifying where to go, who to see, and then actually help them execute on that in terms of scheduling, then you are contributing to a better patient experience. You are also driving revenue. That’s an easy measurement  to understand the impact that a digital front door can have.

In addition, digital front doors can reduce call volume to call centers. Many health system and medical groups are still dependent on a patient making a phone call. If you can reduce the number of calls that are coming in, call center and front desk staff are less inundated with handling basic questions related to scheduling, where to park, or or how to prepare for the visit.

I see return on investment coming from both a cost reduction as well as revenue generation and reducing the administrative burden of staff. The cost of labor continues to be high in healthcare, and the number of the people that are needed to work in things like call centers as well as administrative roles is still a challenge for many health systems and medical groups.

Search engine companies are trying to figure out when users prefer traditional search versus AI chat. What are the use cases for provider website search and the tools that support it?

We have actually married search with a chat experience. The most common search of hospital and medical group websites are keyword searches. We have married the search capabilities with a conversation. If someone types in, “I’m looking for a foot doctor near me,” we can pick that up and then ask related questions. Are you referring to a podiatrist? When you say “near me,” what is your ZIP code or address? How old are you, so we know if this is specific to pediatric or a geriatric? What kind of physician are you looking for?

We know that about 43% of people who go to a website start with the search bar. We narrow that search by walking folks through the steps to help them find what they are looking for. There’s a real opportunity to take the chatbot out of the bottom right hand corner and instead place it anywhere on a website, including the search bar.

In the pre-cellphone days, consumers would do anything to avoid navigating a phone tree and would instead press random buttons hoping to be transferred to a human. Now they will expend equal energy to avoid talking to a human in favor of pressing phone buttons. How do health systems address those consumer preferences?

You are absolutely right. The Gen Z population doesn’t want to talk on the phone. I’m a Gen Xer and I don’t want to talk on the phone either. People are more comfortable interacting with a chatbot these days, especially with the rise of ChatGPT. There’s a greater understanding and a greater tolerance for interacting with an automated attendant.

But you always need an escape hatch. You always need the ability to escalate to a live person. You can start a digital conversation, but the bot should be smart enough to identify when someone needs to talk to a human being. Either they’re getting frustrated or they are asking questions that require a more hands-on human who can answer the questions or can help that individual.

We build in an escalation to a live agent as part of everything that we do. That’s our recommendation for customers. There’s still the need for human beings. Ideally we remove the mundane or the repetitive type questions that someone s in a call center might get, and instead they get the more complex questions or can talk to those patients who really need to talk to a human being.

One of the advantages we bring, in addition to a digital front door or a Q&A chatbot, is that we have a communications hub that allows a call center agent to have a  digital conversation. They can manage up to six conversations at the same time. A consumer might start with a chatbot type of experience and then escalate to a live agent. That live agent gets the transcript of what has been discussed up to that point, and then they can take it on. The content or the knowledge bases that we use to power our automated assistance can be used by the call center agent to answer questions. So when it comes to onboarding new staff and training them, we provide an elegant way to get folks up to speed fast so that they can start taking phone calls. They have the best of both worlds in being able to use technology to deflect those routine phone calls, but also allowing those agents to leverage the technology so that they can answer questions when they are engaging with a person.

To what extent are providers using, or planning to use, AI-powered technologies to triage calls?

They are planning on using it more, because call centers are inundated and there’s not enough staff. They can analyze the types of calls they are getting and deflect the routine questions. We’ve heard that 80% of the calls that come in involve where to park or how to schedule an appointment. It’s the same questions over and over. More providers are going to take advantage of automating the routine questions so that they can leverage the staff that they have in a more effective way.

How are customers using your CallDeflectAI product?

CallDeflectAI does exactly what we have been talking about. Patients or consumers can find information by going to the website and interacting with a chatbot versus having to talk to a human by making that phone call. CallDeflect AI uses generative AI to scrape everything that is on the customer’s website or in manuals. Whatever data that they can provide that will be relevant to what someone will call about or want to talk about. We can ingest that incredibly quickly. 

Within a couple of hours, we can stand up a Q&A type chatbot that our client places on their website. It then directs patients, or their call center or automated attendant can say, “Can I transfer you to our website or our digital assistant to answer whatever questions you may have?” It drives folks to find answers in a more convenient and helpful way versus staying on hold or taking up the time of an agent that could be spent differently. 

CallDeflectAI has been exciting for us because we have been using generative AI for some time, but this allows us to put it to work really, really quickly. When your call center is inundated, it provides an elegant way to deflect those phone calls.

As health systems expand into multiple states with dozens of hospitals and hundreds of locations, how do they use technology to help patients find the nearest location or first available appointment while enhancing the corporate brand?

You would think they would be taking advantage of it, but there’s relatively slow adoption, partly because healthcare doesn’t always move quickly in terms of adopting new tech. There is fear and concern as it relates to security, and especially with ChatGPT’s hallucinations, there’s a lot of paranoia.

We host on a private cloud. We only reference content that has been validated and authenticated. We are HIPAA and SOC 2 in terms of privacy and security. We can reassure that the content that is referenced is correct and that everything is hosted in a secure and private way.

They then can take advantage of their content that they trust and we can customize to reflect their local environment while maintaining the brand, both from look and feel as well as the content itself. We can reinforce the brand that that organization represents, but also allow for access to local doctors, the local urgent care, or the local resources in a specific community that relate to that individual location.

How has the digital health market changed and what is coming next?

We saw things slow down pretty significantly in 2022, in large part because providers had negative operating margins and the mantra was cut costs and don’t invest. But I’m seeing that loosen up. I’m seeing more curiosity about new tech, as well as more of an appetite to make specific investments. I think we are turning a corner and the market is going to continue to improve over the course of 2023 and into 2024.

It probably will take until 2025 before we start to see anything coming even close to the investment environment that we saw in 2021. We may never get to the go-go days of 2021, where companies that were not making any money got 20 times revenue type valuations. I am not sure we will see that for some time.

Orbita’s goal is to continue to leverage technology, but focus on the problems that we are solving for our customers. We will create solutions and use cases that help address the needs that our clients have, whether that relates to growing revenue or managing costs, leveraging ways to extend the capabilities of their workforce by leveraging automation and technology. We are focused on growing and listening to our customers to meet their needs. Hopefully the market will respond in kind.

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