David Butler, M.D. Principal at Calyx Partners stops in to share his thoughts on Epic UGM 2019. Cosmos, Patient-Centered Advancements and even far off concepts like Voice command and control of the Epic UI. Hope you enjoy.
Bill Russell: 00:09 Welcome to this week in health, it influence where we discuss the influence of technology on health with the people who are making it happen. My name is Bill Russell. Recovering healthcare CIO and creator of this week in health it a set of podcasts and videos dedicated to developing the next generation of health it leaders. This podcast is sponsored by health lyrics. If you’re looking for a, an executive coach, give us a call, visit healthlyrics.com to schedule your free consultation two new services just to make you aware of this week, health insights for health it individuals looking to propel your career forward. And this week hell staff meeting for managers who are looking to introduce their team to new thinking from industry leaders to get the conversation started on the right foot. If you want to get to either of those, hit the website this week, health.com/subscribe or click on the subscribe button on the top right hand corner.
Bill Russell: 00:55 That’ll take you to the page and get signed up. Uh, today we’re having another one of the, uh, short episodes around the epic UGM. Uh, you, uh, the user group meeting, I keep calling it a conference. It’s a user group meeting, uh, from 2019. This is, uh, Dr. David Butler, who is a principal and chief digital officer for calyx partners, which is a, uh, you know, physician focused epic consulting firm. Uh, he’s been working with epic for the better part of, uh, almost 20 years and uh, just really appreciate all the things he was doing on Twitter and I thought I’m going to reach out, get him on the show and get his feedback. So here, uh, here’s the, uh, session with him already a in progress. Well, today we’re, uh, we’re joined by another attendee of the, uh, epic UGM 2019 Conference, uh, Dr. David Butler, principal and chief digital officer for Calyx partners. Uh, welcome David. How’s it going?
David Butler MD: 01:52 Going well, thanks. Thanks for having me on bill.
Bill Russell: 01:54 So you’re still, you’re still on your way back from the, uh, from the conference, it sounds like.
David Butler MD: 02:00 Um, on the way back from the conference, I’ve left all my bell bottoms and a 79 gear there. Yep. Got popped in my cassette tape and I’m heading to the airport. Yeah, that’s me.
Bill Russell: 02:11 Well, for, for listeners who don’t know, Calyx you do a lot of consulting around the EHR, but you, your background is as a CMIO, uh, for a lot of different companies. Um, and you’ve, you’ve done work at a Cleveland Clinic, a New York health and hospitals, Guthrie, UCI Health, and anything else I’m missing? There’s going to be a short bio cause we only have 20 minutes together. So,
David Butler MD: 02:33 yeah, no, no, no problem. I think the biggest thing is I, I’ve been, I’ve been an epic, um, user position, large for large, uh, healthcare clients of the largest been started out, uh, three years ago, vice president over their epic optimization program. And from there I left to start consulting with other epic clients that needed, uh, assistance. So, yeah. Yeah.
Bill Russell: 02:54 Well that’s awesome. So, uh, so you, you, you were in attendance, so, uh, you know, what, what jumped out at you? What were some of the key themes that you’re, you’re walking away from the conference with?
David Butler MD: 03:06 Um, do you know the campaigns I think are, they’re pretty s uh, I’ve been coming to Epic side\, usually you’re meeting for 17 years now. And so, um, I think Judy and Carl and then the leadership, there’s, there’s still standard spot on as far as, uh, the way they build a software around the patient. And, uh, this was their 40 year anniversary. And, uh, they had just had a chance to say, you know, they highlight it over the 40 years what they’ve done to build the software around the patient. And I’m going to save invested in r and d research and development. And for a lot of epic clients, if you’re an epic client and you know what that means and you know, all the time that they spend and all of that, if you’re not, sometimes it’s a bit cryptic as far as understanding what is and how does that all work.
David Butler MD: 03:47 It’s like kind of like Mac, you know, Kopell the Mac kind of. So that’s what I think about it. So, yeah, they also, you know, every year also they, um, once again she emphasized, uh, and everyone, a lot of the, a lot of this was about using what you bought. You know, it’s like we’ll, we’ll purchase these large big investments and, and I, a lot of clients may not be aware of the functionality that they purchased and to do that. And also they talked about some resources that Epic continues to invest in as far as getting, having the client speak to one another, put together papers, documents on how they do certain things or there from sepsis, heart failure to population management and put those papers, use them and two, and they’re available internally on something called the epic uses web that’s available to all clients. So they were just, a lot of them was reiterating some things that clients should be using or that are available to them that they may not be aware of. And these are kind of, it comes with the kind of comes with the car.
Bill Russell: 04:50 Yup. And, and, uh, you know, so some of the patient centered things that, uh, that I’m picking up on are, uh, you know, epics happy together, unified patient centered view of my chart. Uh, you had, uh, my chart estimates you had a care everywhere. Patient initiated a sharing of the, uh, uh, record. Um, yeah, I’m just throwing out some of the things where there’s some other things that they did that you, you, you heard they were like, yeah, they’re, they’re really making movement around this, uh, around patient-centered, around helping also some more patient centered.
David Butler MD: 05:24 Yeah. You know, uh, I think, I think you, you, you totally rattle off the big ones. And those are a lot of stuff. Sometimes I call epicisms, some of those words and, and so non-epic clients might not know what that mean, or even patients that may be listened. So yeah, putting it, putting the care into the patient’s hand is what it’s about. And that’s where it’s gonna it’s been about. And so where if you have three different records, like for example, I moved over four states, me and my family, uh, for various jobs, I have about five different MyChart accounts. Now one there. Now I can one click, I can now see one patient portal and all my data. And if I go to a doctor somewhere and that doctor does not have epic, it can be a medical care. It can be an urgent care.
David Butler MD: 06:04 I can always share everywhere. I can give them a code, they will log into a website and not a patient portal. They can log into a website, put in that code because I’ve given them access to my kit, my notes or whatever they need if they need that. So I think that it would, is, it has been the biggest, um, one of the bigger deals innovations that I’ve seen in over like 10 years dealing with epic as far as, um, on the patient side and, um, without much build or effort on the client side. So,
Bill Russell: 06:35 yeah, I mean that’s, that, that’s pretty exciting stuff to be able to literally, I could leave California and go to, uh, you know, go to Florida, you go to a, an epic shop or actually go to anywhere, quite frankly, anywhere, doesn’t have to be an epic shop and give them access, uh, patient initiated care everywhere. It just means, you know, that it aggregates that data and makes it available wherever I’m receiving care, which is pretty exciting stuff. Um,
David Butler MD: 07:01 yes, via a website, that’s what’s crazy, right? The, via a web portal, not, you don’t have to log in. Citrix and all this other crazy stuff that we’re so used to in healthcare, you know, how they, you know, so, yeah.
Bill Russell: 07:11 Yeah. You know, how that goes, uh, you know, for, for those, those people not able to attend, I mean, what’s the, what’s the one or two things that you’d say, Hey, you should really look into this, that, you know, uh, I don’t know. Maybe Cosmos or I, I don’t, I don’t know. I don’t know what they talked about, but actually I have a good idea for, they don’t, I’ve read a lot of articles written.
David Butler MD: 07:28 No, no, no, no, it’s fine.
Bill Russell: 07:30 So what are those one or two things?
David Butler MD: 07:35 I think the, I think the one, the one thing that was really impressive was cosmos and Cosmos is this, you can just imagine a clients and say, you know, one of the research, all this data that’s embarrassed, epic, uh, all over epic is about it. Guess what? 60 to 70% of Bennett patients, some data lives in epic at some point and time or something like that. I don’t know the quite statistics, but if you can imagine driving through those databases, trying to find a researcher or like cases, sometimes you’re going to and sample of two of your within one organization. But if you can now scour cosmos to say, okay, for all patients that I treated for sarcoid with this medicine first line, this was where it ended up. Or for this type of medicine that they gave it. Really good example, Phil Lindemann, who’s over the analytics was really sharp.
David Butler MD: 08:24 He gave an example like this, how you could look at Cosmos and ask a question to say, does this medicine in 10 year timeline, would it, what is the chance of it leading to say dementia versus this medicine versus medicine. So those are really difficult type things to do today. And research type studies, a longitudinal study. So that was really powerful. And I think that’s pretty much, I feel like Judy’s Moonshot, which is a great one to have. And uh, so yeah, so to cosmos is used, but also I think we’re real clients that are not even there. That’s all future stuff. I think the biggest thing that I see over and over and that even, you know, is that clients have bought a Lexus but they keep taking it to Jiffy Lube. You know, and I think epic is trying to say stop taking the Jiffy Lube relaxes.
David Butler MD: 09:07 Not Lexus. You know, you know the analogy meaning you already paid for this, you bought it, here it is. Here it is. And Stop Innovating and start imitating because a lot of your colleagues over here have already done it, built it. And in the system and it’s working in there, putting points on the board, but you may not be aware of that. So they were bringing more awareness to things like the CEO handbook where the CEO’s can flip through financial handbooks, what other companies that seeing how they decrease ar days or costs or control, things like that. So I think that’s just been a consistent message that I heard and I think clients just need to ask the question, hey, you know, if I was a client, if they’re hearing this, it’s just like Asher BFF is a weird term that epic uses best friend forever. Okay. So just say, Hey, can I talk to my BFF? Or you know, can I get on the next call with my BFF? And then they can go from there. That’s what I think about it. So
Bill Russell: 09:57 yeah, it’s such, I think the analogy you’re you’re searching for is they, they bought a 50 room house and they’re only using three of the rooms and it’s
David Butler MD: 10:05 exactly, yes.
Bill Russell: 10:07 Epic saying, Hey, you know what? You don’t have to live in the kitchen and that one bedroom, you actually purchase a 50 room house. Why don’t you go explore the rest of it? And, uh, I think the other thing which you drive home, which is really true, is epic does a good job of building community. I mean, 10,000 people there a lot of great presentations from organizations sharing what they’ve learned, how they’ve moved the, uh, physician experience forward, how they’re addressing usability and, uh, and they’re building runbooks and playbooks and those kinds of things. Um, plus a few developed things. There’s ways to share it through their, uh, their network. And I’m talking as someone who was not an epic client, uh, and just looking in and saying, hey, this is the, they’ve built a very good community of people that share. And that’s, that’s a, that’s a strong message.
David Butler MD: 10:55 It is. It is. And I think I’ve been part of that community so long. I forget how a normal, how abnormal that is. I’ll say that. I mean, just, you know, in this space
Bill Russell: 11:05 it can be. So, um, I was, I was looking at something and you know, one of the, Gosh, you know, golly kind of things was they talked about or demonstrated voice recognition, uh, doing more command and control kind of stuff, uh, within the plan. I know that’s futures, but sometimes I like to talk about futures cause people are like, really, we’re gonna, we’re gonna get a day where the physicians controlling epic with their voice. Uh, give us a little idea. I send that,
David Butler MD: 11:36 that was the one that was one where I roll my eyes just a second. But I also knew how close epic is to that, just from previous demos at Himss where they demoed this like a year ago at the epic voice assistant, you know, and then work as a nuance kind of working with nuance to do a lot of that. Right. So, and we’ve been here in Amazon and other companies, send them the conversation capturing, uh, if you will. Um, one second. I want to, can you hear that? My alarm going off? Sorry about that.
David Butler MD: 12:09 Okay. So, um, yeah, so that was really cool. They did a demonstration basically of a conversation type that a patient and a doctor would have and how it would not only you can say, hey, every quarter Amoxicilin hey epic, can you go ahead and sign this patient up for something? I think at some point people are calling this digit ceuticals for example, because every can you order the calm app for this person or ever, you know, things like that. And you could see it kind of load up order in would actually put the order in. Right. That is like a, that’s a place where we’ve been, uh, that’s the holy grail, although that’s pretty cool stuff. Right. And, um, and it will delete it, will relieve the doctor of having it back to the patient and all those things that we, we, we get railed on a press any, uh, you know, uh, surveys and things like that.
David Butler MD: 12:52 If they say, oh, Dr. Butler was awesome, then he said, but the computer gets in the way, well, a computer save your life a little bit. But I had to kind of look through it, you know? Sorry. You know, and so, uh, they, they showed the voice assistant and how they’re advancing that a lot of one on one demo they show was a very future demo. So I think a lot of folks may have felt like, not a lot of folks who, a couple of them say, oh, that was, that wasn’t real. That was vaporware. And that’d be, they’d get on stage after that and explain like, that was futures. That’s where we’re going. But this is live now, like epic voice assistant that’s live today. So, and I think about a lot of clients are using it so,
Bill Russell: 13:27 well, you’re, you’re on the road heading back. So I’ve, I’ve, you know, two questions, which we’ll get more into the pragmatic, uh, the first being, you know, talk to me, talk to us about the conversation around physician burnout and what, what you heard at the conference, how epic’s addressing that.
David Butler MD: 13:43 Yeah. So physician burnout. Yeah. I have, um, I’m a big proponent of this one. This is one where, um, I feel like, you know, you know, all the multifaceted things that go into physician burnout from feelings of loss of control. Uh, you know, a, just a computer to more tasks or going to the doctor that you’d go to the nurse. So they did address this briefly, just, uh, some things that can help with physician burnout in what epic can do versus what I think the clients need to be doing to be quite honest. And I see epic is continue to improve their user interface to make things easier for the doctor. They are also continuing to make, um, the things that the physicians and clients are asking for, uh, available and also turned on meaning that way you’d, they’re not depending on, let’s say epic does something and then the client takes, uh, the upward upgrade.
David Butler MD: 14:31 But if the client decides, don’t turn that on because we think we don’t feel like training our doctors or our doctors may not like it. Well, we’ve already vetted that pretty good up here, you know, at epic. And so they want those things turned on. And I think a lot of doctors like that, that concept and I think a lot of companies do too. And that’ll also help them to manage their software. All the extra support that they have available, uh, a lot easier. So those are some things. And also just like a note bloat, you know, no bloat a big deal, you know, when you don’t, when you’re looking for something in the chart, they showed the tools that were being used, the tools that weren’t being used and they showed the, some reports that you can ask epic for epic tracks every click inside of its thing, they called it signal.
David Butler MD: 15:12 How do you use your signal data to focus on those physicians that may need help that say there’s after hours called Pajama time and it says, Hey, this doctor that has pajamas that has two hours Pajama time each night. These are your areas where you want to focus and here’s some little quick elearning type things that they may want to benefit from. And that’s pretty focused type of as some pretty focused, uh, help I would say. And these are just out of the box. Epic is free. So things like that. So that was pretty cool.
Bill Russell: 15:42 So, outside of that, what are, what are your, you know, what were people talking about on the floor? What are some challenges that health systems are having that they’re either, either challenges or things they’re excited about, uh, that you heard as you sort of walked around in your bell bottoms and whatnot?
David Butler MD: 15:59 Yeah. You know, um, I, I think overall the, the actual, the, the, the quality of the presentations, you know, was just God knows how many, like three or 400, I can’t even know. I don’t know how many presentations there were, but I think, um, a lot of population health stuff, you know, also a lot of new clients came on, you know, that were trans, they were switching from all Cerner, allscripts or whatever. So they always have that kind of floating through the, so all the new plans welcomed in them. And so they were in the audience. So they were just different generations of epic clients and the audience and, and having an epic to figure out, you know, or having them figure out what is relevant to them right now and their maturity in this thing. Right. So I felt like that, that there was a positive vibe as far as that everybody could find what they needed, where they were.
David Butler MD: 16:47 Uh, they were getting ready to install if they were post live. Uh, there was things that were being presented that they could sit in on and network Meet a CMIO from this hospital to get that number, uh, set up a Webex later on with them and see how do they do this or that. So I think just in general that just pushing together all the Epic clients and making it so that they have a, a venue of forum where it’s, it’s open, it’s free, it’s fun. I mean, you know, it’s fun and flowing. And so I think that was just the vibe that I got, you know, but that’s kind of every year, it was no one topic that was really hot. I didn’t think that was on the floor because I mean, of course API is apple orchards. That’s always hot. Right? You know, that’s going to be the thing. But I find that there is in 90% of clients don’t care about that right now because there’s trying to just get their doctors to get CHF, heart failure and some of those quality measures with the tools they have. So that’s what I, my take on it.
Bill Russell: 17:43 It’s interesting. I refer to it as a conference every now and then and it’s not really a conference. It is a user group and they are very different, uh, very different animals. I mean, a user group meeting is really around getting the most out of the tools that you have and connecting your users, uh, in a way that they can collaborate and, and talk and, and that’s what epic does a really good job of. And that’s why it feels a little different than a, a conference, although it looked like it was a lot of fun. Did you go on the, uh, on the America round and other there?
David Butler MD: 18:15 Yeah, yeah. You know, we all grew up in a small town. We had something called the regional fair out in Texas, you know, regional fair every summer we were there, you know, and uh, yeah, I, when I did the merry go round, I, I’d say that I think I went in both that too, just to, I’m growing into my own now. I got on the mirror, go around, I said it, they came out that don’t tell him about
Bill Russell: 18:35 the last thing. And you know, Twitter has a couple people talking about this. So Judy made some comments about, uh, the onc, CMS, uh, type, uh, you know, the interoperability and the um, uh, the, uh, 21st century cures act and whatnot. Uh, you know, I mean, what’s the general, what’s the, what’s the general feeling around that? Is that, is there, I mean, is there a lot of conversation around it or is it like you’re saying, which is, you know, a lot of health systems are, you know, just trying to just get the basic blocking and tackling down. And this is something for the heavyweights to really, uh, weigh in on,
David Butler MD: 19:10 I think. I think in general what the clients are seeing, the folks that are here that came to the conference, that’s not on their radar. I’m at the onc and all the, you know, the alphabet soup, the government will do whatever. Right. That’s cool that, but I think more importantly what, what the gist is is that epic was just epic gave the message to say, look, if you’re going to, if we’re going to start giving out, if we’re going to start sending out all this patient data, right to everybody, any app that wants it, it feels like, and I feel the same way as that though, these app companies that have, where there’s free, where share, where Eagle, where, what is their accountability to that patient data. And it’s as simple as that. And now epic is like, look, they, they’re only skin in the game is to say before you, you know, put a spicket in here and just fill out all this patient data.
David Butler MD: 20:00 Does the patient really understand what that means? And I, and I, for one, I don’t want any app taking my data that I don’t feel that I don’t really know all the fine prints, you know. And especially if I know that, um, when I go to another place, I got something like share everywhere or whatever and they can know what’s going on with me and provide the care. And so, I dunno, I think that’s as simple as I heard it. And of course it gets very difficult in this fire and all the other things like that, that some of the companies are really want to be innovative and they are very innovative in that space. And I can see the benefits of it truly. But I think for this conference and for the right now in healthcare in 2019 right now where, what I heard this past week, epic saying, okay, the onc is going to come out, they’re going to ask us to start doing a lot more things cause you know, the big dogs on the block. So, you know, but um, that was the kind of conversation about it. And, uh, but I think it was more like this thing, like this is from our perspective, what it means to us and what it should mean to you as far as how your data is shared. Who is it shared with, how is it used? Things like that, you know? And then, yeah. So.
Bill Russell: 21:05 Absolutely. Well, David, thanks. Uh, thanks for taking the time to pull over to the side of the road to have this conversation.
David Butler MD: 21:13 Yeah, no, no thanks. Thanks for asking me for my opinion. You know, always a willing to help. So open made sense. That’s, I know, once again, that’s Dave butler, my opinion.
Bill Russell: 21:23 Is there any way that, uh, people can follow you or get ahold of you or,
David Butler MD: 21:28 yeah. Oh, definitely. Yeah, definitely. I’m on Twitter at David Butler, MD on Twitter. I’m on Linkedin. Look me up. Follow me. I definitely always posting something weird or goofy that deals with medical informatics, it health care, you know, I try to keep it weird to keep it fun and not troll too bad, but there you go. Yeah.
Bill Russell: 21:46 Alright. Sounds good. I want to thank David for joining us and hope he has a a safe travels back. He actually pulled over to a Starbucks on the side of the road to have that conversation. I really appreciate him doing that. Uh, please come back every Friday for more great interviews with influencers. And don’t forget every Tuesday we take a look at the news, which is impacting health it this shows the production of this week in health it. For more great content. You can check out the website this week health.com or the youtube channel this week health.com, and just go ahead and click on one of the links up top. Thanks for listening. That’s all for now.
Bill Russell: 22:26 [inaudible].
David Butler, M.D. Principal at Calyx Partners stops in to share his thoughts on Epic UGM 2019. Cosmos, Patient-Centered Advancements and even far off concepts like Voice command and control of the Epic UI. Hope you enjoy.