Dr. Nick van Terheyden on Involving Clinicians in Innovation

This Week in Health IT Nick van Terheyden
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Continuing our series of discussion from CHIME/HIMSS 2019 we hear from Dr. Nick van Terheyden where we discuss innovation, rediscovering foundations for health and the walking gallery.

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Bill Russell:                   00:11                Welcome to this week in health it where we discussed the news information and emerging thought with leaders from across the healthcare industry. This is Bill Russell, recovering healthcare CIO and creator of this week in health it a set of podcasts and videos dedicated to training the next generation of health it leaders. This podcast is brought to you by health lyrics, helping you build agile, efficient and effective health it let’s talk visit health to schedule your free consultation. We were recording a series of discussions with industry influencers at the Chime Himss 2019 conference. Here’s another of these great conversations. Hope you enjoy.

Bill Russell:                   00:46                Okay, here we are from chime. Uh, nick, do you wanna introduce yourself?

Nick van Terhey:           00:49                Hi, my name is Dr. Nick. I’m the incrementalist and I’m an emergency room physician and I focus at the intersection between technology, healthcare, and business.

Bill Russell:                   00:59                So when we first met, you’re very active on social media. When we first met you were with Dell. So you’re now on your own.

Nick van Terhey:           01:07                Uh, yes. So I’m running my own company. Sounds rather grand, but this is it. You see all of it. Um, uh, offering strategic advice, trying to find those small improvements, um, revolution through evolution. Um, don’t let perfection stand in the way of progress.

Bill Russell:                   01:23                Oh, absolutely. You can’t innovate if you’re looking for perfection or you know, big bang kind of stuff.

Nick van Terhey:           01:28                And it’s the lowest risk approach because if you make a mistake and you’re trying to make for that big league, that’s a really costly mistake. Whereas if you go for those small steps and all the exponential companies all started with these incremental improvements, Uber, airbnb.

Bill Russell:                   01:45                Yeah. So you, uh, did you consult with providers, payers, Pharma, startups? I mean, where, where do you

Nick van Terhey:           01:53                all of the above. Okay. I, I’m very fortunate in the 30 plus years that I’ve spent at this intersection point that I’d been involved in companies, uh, that come from the small, the large, from multiple backgrounds. And as I put it, I have multiple arrows in my quiver to shoot at All of these opportunities.

Bill Russell:                   02:14                Yeah. Physician background, technology background and uh, and the innovation side can always use that perspective because you have all these people coming in from Silicon Valley saying, um, you know, we think we can change health care and they can really, I mean, what’d I just say? I just read two and a half billion was invested in healthcare in January.

Nick van Terhey:           02:35                I’m not surprised by that, but I would strongly advocate the involvement of clinicians in anything involved in if you’ve got health anywhere in your company name or activities, if you don’t have clinicians involved, I think you’re missing the mark or you’re going to potentially miss the mark. That’s an expensive mistake to make.

Bill Russell:                   02:55                So I’m going to, I’m going to ask you to maybe a dangerous question here, but could traditional clinicians lead you down a wrong path though?

Nick van Terhey:           03:04                I think that’s a fair comment. Um, you know, if you get stuck in, uh, the history of medicine and the way that we practice medicine and electronic health records are a great example of that. I mean, what did we do? We essentially digitize the paper system, right? That wasn’t the smartest thing in the world to do. Right. But yeah, and then see if you think about the physicians, that’s what they would have said. Well this is how we do it. We should go and you know, so there has to be some innovative thinking and you have to push people in that direction. Some folks and others like me, I see 25 years ahead. I was doing population management at school, um, as my sixth form science prize. Wow.

Bill Russell:                   03:45                So let’s talk about this conference. So Hims is, uh, is interesting. What, what are you, how do you do this conference? What are you looking for at this conference?

Nick van Terhey:           03:55                So I just want to say that’s the understatement of the year, but otherwise, um, I mean it is, it’s the biggest aggregation of healthcare, technology, innovation, all of these folks coming together. What are you,

Bill Russell:                   04:06                45,000 people,

Nick van Terhey:           04:08                right? How do you plan? How do you involve yourself? So I always come with a plan, but pretty much almost as soon as I arrive, I throw that plan out the window. There’s elements of this that are random. Um, and I think you have to accept that let’s the sort of small areas of focus that you’re interested in, individuals that you interested in and meeting. Um, it’s a great opportunity. It can be challenging` to do and then find those opportunities where you can learn from others and engage with others.

Bill Russell:                   04:39                So will you, uh, are there trends that you’re going to be keeping an eye on that you’re going to be looking at those technologies?

Nick van Terhey:           04:44                So I think we see an awful lot of the trends around artificial intelligence. You just have to look at the numbers of sessions to know that cyber security is a top pick, a artificial intelligence, population analytics. So all of that gives you a sense in my mind of, of if you think about the innovation cycle, they’ve all sort of moved over the peak of disillusionment and we’re sort of moving. We hope, I try and pick some of the things that are further out. Um, you know, where is technology going to take us? What are the opportunities? One of the foundational things that I think is really going to hit us very hard is around sleep and sleep innovation. When I went to medical school, I was doing 136 hour week, the zoning 150 something in the week. So that’s a lot of hours, huge sleep deprivation. It was clear that that was a major issue. We failed to focus on that sufficiently. And it’s not just a pillar of health, it’s the foundation of health. How do we fulfill that obligation to our patients? Because one night bad night of sleep is worse than missing your exercise for a week or eating five big macs every day.

Bill Russell:                   05:55                And we heard this morning and the Chime session, we heard about, um, isolation and lonely loneliness and its impact. Essentially the impact of loneliness is the equivalent of creating a chronic stress state in the body. And, uh, you know, lack of sleep. Is that also that other thing.

Nick van Terhey:           06:13                So, uh, you know, and that’s a great point. If you think about loneliness, that’s one of the tortures that are used in warfare. It’s an awful concept. But you know, given that that’s an effective torture methodology, we have to find means of communicating and connecting. And the thing about technology, one of the things that you’ll see in Japan is they’ve led the way with some of these robots and innovation. And whilst That’s technology. It turns out that that’s actually companionship. It’s no different to having a pet. Not everybody can have a pet. We could all have some kind of robot that interacts with us. It makes us feel good, simple solutions.

Bill Russell:                   06:49                You know, and it’s, it’s interesting cause sometimes you see those videos of the robot and whatever and you almost sort of chuckle at it. But then, you know, my father in law comes to live with us. He’s 87 years old and he’s interacting with, uh, with the echo. Like it’s his, his companion. And it almost is like, hey, what’s going on in the news? What’s going on in sports? Hey, can you play music, country music? I mean it’s, he’s interacting with it all day and that’s not even a back and forth. Right. But

Nick van Terhey:           07:16                it’s, it’s, I think the important part of that is that you imbibe an element of personality in those artificial agents, whether it’s just a speech element in the case of the echo and Amazon Alexa, um, and you give them a sense of you. And one of the things that happens in these interactions is, I know something about you, I’ve got some of the history and I apply that to our conversation. If you do that with technology, it starts to be more engaging. It’s, it’s more humanlike you can’t replace humans, but you can augment them.

Bill Russell:                   07:47                Well, let’s talk about providers. So you know, one of the things about providers is they could potentially get pigeonholed in terms of you’re going to be, our a place to go for episodic care and those kinds of things. But they have this opportunity to be the trusted partner in their communities. If they can figure out how to break down the walls, right? And, and engage the community, engage people in their homes and those kinds of things. Are there, are there different technologies you’re looking at that they’re a provider system is going to be able to make those transitions because we’re seeing the other players try to, I mean you’re seeing the, you know, the JPM, Amazon, Berkshire, you’re seeing, uh, you know, just cvs, Aetna, you’re seeing other players saying that’s where we’re going to go, are provider’s going to be able to get there.

Nick van Terhey:           08:31                So I think what’s old is new again in my mind. So when I was practicing medicine, we would do home visits. We were imbedded in the community. Why did we stop? Well, it was a cost issue. It was a challenge from a, um, a coordination standpoint. And you see some of the companies like care more who are inserting not just the physician, but all of the other, uh, groups into the community. I think it’s essential component. The way that technology helps is not by replacing but augmenting. So instead of you’ve got a limited set of resources. So we triage the same as I did an emergency medicine. You triage the patients coming through and deal with the ones that you have to deal with urgently. Same with this insertion into the community. Find the ones that are desperately in need. Focus on those. You reduce their costs, improve their health care, do all of the good things and then you can focus on the others. You’ve got more resources left as a result of that. So I think it’s the combination. People are terrified of this technology, but technology isn’t going to replace us. It allows us to do more and to process more information and deliver the best possible care all of the time.

Bill Russell:                   09:37                So last question, culture, right? So I worked for a fairly large health system, uh, for about eight years. The, the, the culture of healthcare sorta just keeps going in a direction. How do you, it’s not that there aren’t innovative people within healthcare. There’s a ton, there’s a ton of innovative people, but how do you gather those people and create a movement within maybe a very traditional trajectory of a health system?

Nick van Terhey:           10:05                So I, I, I sometimes use this analogy and I’m, I’m always a little bit concerned when I do because it has some negative connotations, but it’s a bit like plutonium. Plutonium is kind of interesting dispersed, but when you bring it together, you create something incredible and impressive. And I think it’s the same with all these resources. I, you know, nobody goes into work with the intent to delivering poor care and not caring about patients. It’s just not the way that we were brought up. You know, the individuals aren’t built that way. So you have to facilitate the bringing together of those resources in an environment that encourages it. I’ll pick just one simple example. Instead of this punitive approach to medical errors take page out of the airlines, and I know they’re imperfect, but for the most part it’s a no fault activity. We just saw a case just recently of a nurse being prosecuted, uh, for a mistake that was made posts in Ehr implementation and an error is did she come intending to do that? I don’t believe that for one second. We have to find ways of supporting so that people feel confident to contribute and to enable them. That for me is, is really, you’ve got all these resources, we just have to tap into it and they’re desperate to deliver the best that they possibly can.

Bill Russell:                   11:22                Yeah, absolutely. Nick, thanks. But I do have to get a shot of your, the back of your jacket. Is there a story behind the back of your jacket?

Nick van Terhey:           11:29                Yes. So this is the walking gallery. I’m very passionate about it. Um, uh, Regina, um, created this, it was initially, as you know, a, a painting on a wall, in fact, and every jacket tells a story about an individual’s journey and struggle. In fact, it’s ironic that you picked this and I’ll allow you to focus in. So the story is me. So the hourglass and the sun and the moon represents time. Uh, the people in front of it or all my colleagues that I worked with as a junior doctor, that’s me, I think at the front. And then the lady on the top is a friend of mine who committed suicide. Um, as part of that whole process, couldn’t cope with 136 hours and other things that went on. Um, you know, we all have a story to tell. We’ve all got a passion. Um, you know, I was enduring sleep deprivation. Uh, that was good for me in, in the days that I was experiencing it. Um, the concept of this is to have people have that conversation. I was just at breakfast in a hotel and the uh, receptionist there asked me about it. I got an opportunity to share the story. That’s the purpose. I just, my hat’s off to Regina and the walking gallery at such a fantastic experience. Thank you for your time. Really appreciate it.

Nick van Terhey:           12:47                Really enjoyed it. Thanks very much.

Bill Russell:                   12:50                I hope you enjoyed this conversation. This shows a production of this week in health it for more great content. You can check out our website or the youtube channel at Thanks for listening. That’s all for now.


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