April 2, 2021

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April 2, 2021: Patients relied heavily on virtual tools to connect with providers throughout the pandemic. A single click to a doctor is the holy grail. So is having access and control over your data. Our guest today is Sean Bina, VP of Access and Patient Experience for Epic. What role does MyChart play in this virtual care world? How is Epic working with the innovation community to optimise patient experience? What is their role in the vaccination effort? How has Epic been working with clients to streamline vaccine scheduling? What about interoperability? How can healthcare information be connected across health systems, retail pharmacies and statewide registries? Sean and Bill also dive deep into remote monitoring, telehealth, 21st Century Cures, MyChart Care Companion, Epic Health Research Network and the Vaccine Credential Initiative.

Key Points:

  • The hurdles for becoming a MyChart user are much fewer and easier to get over than ever before [00:07:40] 
  • In a study around remote monitoring  of their hypertensive patients, Oschner saw a 40% increase in the number of patients that were meeting their goals. That’s a huge reduction in readmissions. [00:13:20] 
  • As the FHIR standard continues to develop and grow it’s becoming even easier for Epic to make connections to third parties and other vendors [00:17:35] 
  • Epic is helping to establish privacy standards to make sure the goal of 21st Century Cures is achieved [00:24:35] 
  • Epic
  • MyChart
  • MyChart Bedside 
  • Epic Health Research Network

Maximizing EHR Potential, MyChart, and Interoperability with Epic VP of Patient Experience

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Maximizing EHR Potential, MyChart, and Interoperability with Epic VP of Patient Experience

Episode 385: Transcript – Apr 2, 2021

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

E 385 Maximizing EHR Potential, MyChart, and Interoperability with Epic VP of Patient Experience

[00:00:00] Bill Russell: [00:00:00] Thanks for joining us on This Week in Health IT influence. My name is Bill Russell, former healthcare CIO for 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff current and engaged. 

[00:00:17]Today we have a great show for you. We have Sean Bina who is the Vice President of Access and Patient experience for Epic. And we talk all things. MyChart, we talk telehealth. We talk all the things that Epic is sort of looking at right now around the [00:00:30] patient experience. Great show. I hope you’ll enjoy it.

[00:00:32] Special thanks to our influence show sponsors Sirius Healthcare and Health Lyrics for choosing to invest in our mission to develop the next generation of health IT leaders. If you want to be a part of our mission, you can become a show sponsor as well. The first step is to send an email to [email protected]

[00:00:48] Just a quick note, before we get to our show, we launched a new podcast Today in Health IT. We look at one story every weekday morning and we break it down from a health IT perspective. You can subscribe wherever you listen to [00:01:00] podcasts. Apple, Google, Spotify, Stitcher, Overcast. You name it, we’re out there. You can also go to todayinhealthit.com. And now onto today’s show.  

[00:01:11]All right. Today we are joined by Sean Bina the VP of Access and Patient Xxperience at Epic. Good morning Sean and welcome to the show. 

[00:01:19] Sean Bina: [00:01:19] Hi Bill. 

[00:01:20] Bill Russell: [00:01:20] You know I had to laugh because I looked at your LinkedIn page, and it said Epic’s spokes model. Is that an offical title or a self [00:01:30] selected title? 

[00:01:32] Sean Bina: [00:01:32] I, Let’s just say Judy, didn’t give me that title.

[00:01:37] Bill Russell: [00:01:37] Does she know you’re using that title? 

[00:01:38] Sean Bina: [00:01:38] I doubt it. 

[00:01:40] Bill Russell: [00:01:40] Well if she is I think it’s, I think it’s fun. I think it speaks to your culture at at Epic. So I think it’s phenomenal. I’m looking forward to this conversation. There’s a lot of stuff going on with regard to access and patient experience and you know with the pandemic and it just the change in behaviors, telehealth [00:02:00] growth the use of chart, vaccination scheduling.

[00:02:02] I mean there’s so many areas where we can go, but let’s start with, you know, tell us a little bit about your role at Epic to sort of level set the conversation. 

[00:02:11] Sean Bina: [00:02:11] Sure.So I started off 24 years ago at Epic. So I’ve worked half my life at Epic, and it’s been a great experience. It’s been a wonderful ride as we’ve grown as a company.

[00:02:23] And particularly I’ve been focused throughout most of that time on the patient experience and how we can [00:02:30] expand the use of MyChart and provide patient with patients with more digital tools that they can take advantage of. So now I spend my time working with customers. I work with both with prospective customers and our current customers on how they can deploy MyChart effectively.

[00:02:48] Bill Russell: [00:02:48] Well, yeah, so, and that’s and we might as well just start right there. So, you know, patients have really relied on virtual virtual tools to connect with their providers throughout the pandemic. And I’m [00:03:00] sorry for my listeners I just changed my microphone to my. Actual microphone. So it might sound a little different.

[00:03:05] I was on the road last week and I was using my Mac book microphone. So now I’m back back in the studio. So patient, patients have relied on virtual tools to connect with providers through the pandemic. Talk a little bit about how that’s affected the use of MyChart. 

[00:03:23] Sean Bina: [00:03:23] Yeah. So first of all, it’s been really exciting to see. We had groups that did thousands of video visits in [00:03:30] 2019, that do thousands of video visits a day in 2020. And so the use of virtual care has really expanded. My personal experience I’ve actually, this year has represented a lot of health care for me back in February of last year I tore my Achilles and so I had to go through full surgery, all kinds of physical therapy in the middle of, in the middle of COVID.

[00:03:55] And then my daughter also had some pretty significant healthcare issues. And what [00:04:00] I found as a patient was that certain things work great from a virtual care perspective and certain things aren’t so great. So some examples of things that were great are things like followup visits with a clinician where you already have a relationship. And you’re really just having a discussion about what’s been going on. The amount of time that, you know, I’ve saved in terms of my daughter and I both being able to be connected in virtually into a visit instead of having to drive in and park and you know get into the [00:04:30] hospital, find the right room and wait.

[00:04:32] And instead, just being able to get on a virtual call with my daughter’s position has been phenomenal. But for something like physical therapy, I did both in-person and virtual physical therapy and the in-person physical therapy was certainly a better experience in terms of being able to take real measurements.

[00:04:48] Hands-on my physical therapist being able to see how I was recovering from my surgery. And so I think there’s really room for both of these things going forward. And what we’re [00:05:00] seeing is that while virtual visits have dipped from their peak. We’re still continuing to see that, you know, potentially I think in the future we’ll see about a third of all visits being done virtually.

[00:05:12] Bill Russell: [00:05:12] Yeah, no, definitely a third, a third is- a little higher than what I’m hearing. I’m hearing it’s about 25%. But a third would be phenomenal. 25 to 30% or 33% would be exceptional. I think it will just have to follow the funding and see how that sort of transpires, [00:05:30] let’s focus in on MyChart a little bit.

[00:05:32] So. You know, I know, I know people who I’ve interviewed and clients who use MyChart like straight out of the box. Here’s your MyChart and use it. And I know people who’ve taken the components, broken it down and built it into their own experience. Talk about how you’re working on the MyChart experience, that the usage of it and the sign up and just to simplify that process for users. And how has that been [00:06:00] impacted by the pandemic? 

[00:06:01] Sean Bina: [00:06:01] Yeah. So a few things. Yeah we definitely have customers, the vast majority of our customers going to use MyChart on the out of the box. Now when I talk about that, they still do a branding, they use their own colors, they use their own setup. Many of them have their own app that you can download from the app store.

[00:06:21] And it’s really a small minority of our customers at this point that kind of self-developed their, MyChart. And then just consume components of MyCharts through data tiles [00:06:30] and the mobile library. But with that said, in terms of our focus on signups is we’ve seen a huge spike in terms of the number of patients that are actively using MyChart and on an ongoing basis.

[00:06:44] Well MyChart isn’t required to having a video visit. It certainly makes that experience better because you can do all of the pre-visit work. So when you traditionally went into the office, you’d have to, you know, pay your copay, review your insurance information, sign off on forms, and then potentially, you [00:07:00] know, fill in, you know, in the old days, you’d fill in a paper sheet with all of the information about your upcoming visits.

[00:07:05] Now that can all be done in MyChart so that when the physician and the patient connect, all of that tenant pre-visit work has been done in a MyChart experience. Now in terms of the other part of your question in terms of signup, we’ve continued to make that much easier than ever before. So for a patient that goes to a health care organization really it’s just a matter of either before or after their [00:07:30] visit, they get an email or a text.

[00:07:32] And from that they can just enter their date of birth and then create a password, username and password and get signed up for MyChart. So the hurdles for becoming a MyChart user are much fewer and easier to get over than ever before. 

[00:07:48] Bill Russell: [00:07:48] What was that driven by the vaccine scheduling challenge of, I mean, these people weren’t necessarily patients but you still needed to get them in line. Is that one of the things that drove that? 

[00:07:59] Sean Bina: [00:07:59] Yeah. [00:08:00] Well we’ve been working on this whole process of getting patients signed up easier over the last few years. So all of the groundwork had been laid for this, but then you’re right like we had healthcare organizations that would have 30,000 vaccines that they needed to give in a week.

[00:08:17] And then the patients that were going to be eligible for that, some of them were already active MyChart patients but some of them might’ve been, they might’ve received a file from a school system that we want to get all these teachers vaccinated, or we [00:08:30] want to get all these patients have vaccinated that are in nursing home.

[00:08:34] So we had to have a new ability to kind of upload those patients into the system and then send them what we call a scheduling ticket so that they could go in and schedule for the first time and then create a MyChart account. 

[00:08:47] Bill Russell: [00:08:47] Wow. So talk about that process a little bit. Are a lot of systems using the vaccine scheduling through Epic and through MyChart? And then will that [00:09:00] become sort of their proof of vaccination that they can use MyChart for that. 

[00:09:06] Sean Bina: [00:09:06] Yeah. Yeah. Good question. So the fun thing  here is like that example, I mentioned where they had 30,000 slots that they needed to fill. They did the vast majority of that online. So they were actually able to fill all 30,000 slots in 24 hours.

[00:09:21] Patients are obviously anxious to get in and get their vaccine. And 75% of those were filled through MyChart. So when we look [00:09:30] at the kind of how vaccines are being administered, there’s kind of like this multi-step process. First, you obviously have to identify which patients are going to be eligible.

[00:09:38] You can’t just open the flood gates and say anybody that wants to come in can go in and schedule online and book an appointment because there’s a limited supply at this point in time. So first it was identifying an eligibility. Then the second thing was sharing these, what we call scheduling tickets out to patients, which then gave them the ability to schedule their first vaccine.

[00:09:59] And then once they had [00:10:00] that to schedule their second vaccine in the prescribed timelines from there. And then the third thing that you mentioned is that we need to be able to track and maintain a COVID status for every patient. So we have been building out essentially a COVID passport.

[00:10:16] Where I can see all of a patient’s latest COVID information, or as a patient, I can see all my latest COVID information, my last negative test. Any self-assessments that I’ve been doing, when my next appointment is going to be, whether I’ve had [00:10:30] vaccines administered. And then obviously the goal of that is to get to the point where once a patient’s had two vaccines administered that they can then kind of hold this up as a passport to groups to say, you know, I’m fully vaccinated at this point.

[00:10:47] Bill Russell: [00:10:47] What’s the key metrics that you track for MyChart usage? Is it log-ins? Is it, is it logins? 

[00:10:55] Sean Bina: [00:10:55] Well, so we track, first of all, we tracked just overall activation. So there’s [00:11:00] over 200 million patients that have been active on MyChart. And then more specifically we track how patients are using it. So are they active in a given year? And so like we have 120 million patients that are active users of MyChart right now in the last year. And then and then we break that down from there. So the thing that we’re actually really interested in tracking is for patients that are getting regular health care.

[00:11:25] Are they active MyChart users? So we say, we look at a metric [00:11:30] that says for patients that have been in to their health care organization three or more times in the year, are they active MyChart users? So we’ll oftentimes see that even though a group may only have 50% total adoption across their total, all of their patients, bill at be at like 75 or 80% adoption for patients that have been seen three or more times in a year, 

[00:11:54] Bill Russell: [00:11:54] Interesting. So it’s interesting to me because we’ve moved beyond logins. We’re [00:12:00] looking at really engaging the community in their health. And so there’s a lot of different ways to do that. And one of the ways is just get more touch points. And one of those is remote patient monitoring. And I know that, you know, you’ve done some work with Cleveland clinic and connecting up you know, Apple Health, Google Fit and those kinds of devices does that drive more activity in MyChart?

[00:12:21] Sean Bina: [00:12:21] I think, you know, interestingly the things that really drive activity in MyChart, if we look at organizations, is, are they opening up scheduling? [00:12:30] Are they providing things like patient estimates and the ability for patients to pay their bills online or set up payment plans or request financial assistance.

[00:12:39] Those it’s still those kinds of core operational things that drive adoption. Now there are of course huge benefits as we start to be able to connect up. So home, remote monitoring or home monitoring devices at Ochsner they’re kind of famous for their Obar where what they’ve done is they’ve they allow [00:13:00] physicians to prescribe, various remote monitoring devices, and then they send patients out to their Obar where patients get signed up connected to the devices. They help them kind of walk through the steps of either connecting to Apple Health or Google Fit or doing direct connections to devices. So if the data will then upload and then they’ve seen that for example, they did a study around their hypertensive patients and a 40% increase in terms of the number of hypertensive patients that we’re meeting their goals, that we’re [00:13:30] doing this sort of remote monitoring. So huge reduction in readmissions. 

[00:13:34] Bill Russell: [00:13:34] You know that’s so fascinating. It just takes me back when we were developing our portal back in 20 gosh, 12 or 13, people were like, we had to get the patient record just right. To be viewed just right. And so we finally, you know, after almost six months of work, we went out, we finally went out to the patients and said, what do you want most in your portal?

[00:13:53] And they said, scheduling and bill pay. And I’m like, yeah, Why did we spend so much time getting the [00:14:00] record just right. When all we had to do is ask the patients, what do you, what was it you use it for? And so if you were to stack rank, I mean, you sit there and you go, scheduling makes perfect sense. Right?

[00:14:11] I want scheduling to be easier interacting with the health system. And this is one of those tools that does that. And then you have I know you have bill pay. Are there other things that sort of rank up there, high that get usage of a portal like MyChart? 

[00:14:26] Sean Bina: [00:14:26] Yeah, I we oftentimes talk about this as [00:14:30] Maslow’s hierarchy of patient needs and you know, it kind of just like Maslow said that you need food, warmth and shelter before you can write write poetry.

[00:14:41] I was actually in Finland. They told me that you need food, water, shelter and wireless. In order to write computer code. And so I thought that was kind of funny. But as a patient, you need the basics in place. The scheduling, the billing, the ability to communicate with your physicians is really important.

[00:14:57] So we see, you know, [00:15:00] messaging back and forth. There’s a real key. And then obviously, obviously access to clinical information. I’m very excited as a patient that test results and notes are going to be automatically released to release to me in the coming, coming months as a 20th Century Cure goes through so that I’ll have even more access to my record than or before.

[00:15:22] And then I think as a patient, I also am starting to expect that not only will I see my test results but I can also do things [00:15:30] like access my images. So I can directly access the images in the past. Because all of that becomes really important as a patient when I need to share my record inter-operate with somewhere else.

[00:15:41] And so we’ve built a set of tools and into MyChart. Kind of multifactorial way to do this. You can download record, you can pick up your record and share it with somebody else. You can., we obviously support underlying interoperability so I can do a direct message and send a [00:16:00] CCD to another provider.

[00:16:01] So and then one thing that’s really cool is MyChart also provides this concept that we call happy together. And what it’ll do is it’ll pull information from multiple organizations very much so through Epic to Epic today but then we’ve also started linking up non-Epic vendors like Cerner to be able to pull in information so that as a patient, I can go to one MyChart and see all my test results, all my visits, my [00:16:30] allergies meds, and current health issues across all the sites of care that I go to.

[00:16:37] Bill Russell: [00:16:37] That’s really powerful. 

[00:16:39] Sean Bina: [00:16:39] Yeah. And this, my personal example was when I tore my Achilles, I did not tear it here in Madison, Wisconsin. I was actually running a race in Arizona. I went to Mayo, Scottsdale to get my care there initially came back. I usually get my care through group health but I needed to surgery at the university of Wisconsin.

[00:16:58] So I had to coordinate care across three [00:17:00] organizations and I can go into my MyChart and see all of that information in one place. 

[00:17:07] Bill Russell: [00:17:07] Right? Well, you’re talking Mayo, which is an Epic client. You’re talking Wisconsin, which is an Epic client and I’m not, well, what was the other one you referred to 

[00:17:15] Sean Bina: [00:17:15] Group Health is also an Epic client. Yep. 

[00:17:17] Bill Russell: [00:17:17] Yeah, so, I mean, so that’s the, I mean, that’s been, your claim to fame is sharing across Epic clients is is extremely effective and and, works really [00:17:30] well. How does it, how does it work with with with a Cerner client? 

[00:17:35] Sean Bina: [00:17:35] Sure. We’re using the FHIR standard and as the FHIR standard continues to develop and grow it’s becoming even easier to be able to make these connections to third parties or to, to other vendors. And so that’s definitely the kind of the core pathway that we’ve gone for that. 

[00:17:56] Bill Russell: [00:17:56] All right. Well, we’re, I’m probably going to come back to interoperability [00:18:00] and really round innovation a little bit later, but I want to get back to something you were talking about earlier, which is the care journeys and how they’ve changed as a result of telehealth.

[00:18:11] So how are you delivering telehealth today through the Epic platform? Are there multiple ways or is there a preferred way that people are experiencing telehealth through MyChart? 

[00:18:23] Sean Bina: [00:18:23] Yeah. So Epic has our own telehealth or video app that you, that [00:18:30] organizations can use. I think we’re at about a hundred organizations that are already using that today.

[00:18:35] And then we’ve worked with, you know, kind of everyone else under the sun so Voximity and Teams and Zoom et cetera. So you can use whatever video platform of your choice. And then that really creates an integrated experiment experience for the patient. Most of those vendors have done the kind of deeper level integration that we need.

[00:19:00] [00:19:00] So you don’t have to view, sign ins to multiple platforms, but rather once you’re in MyChart, it just takes you directly into that video clip. And as I mentioned earlier, we also have support for physicians bolts within the Epic video clients and then some of the other vendors also offer this. To be able to email a patient and then have them link into the video client without going through MyChart.

[00:19:27] Bill Russell: [00:19:27] Yeah. So that’s the direction I was going to go. So [00:19:30] how close have you gotten to, you know, single click talking to a doctor? I mean, cause that’s like the Holy grail, I guess. 

[00:19:37] Sean Bina: [00:19:37] Yeah, it, that, that exists today. So a physician can just email a patient, a link and they can connect into the video client. And now we saw actually I think it’s next week we will be supporting an Epic other vendors, already support this, a multifarious video visit as well.

[00:19:55] Which is really key for like, when we talk about situations where an interpreter [00:20:00] needs to be involved or multiple family members need to be connected and, or you need to have multiple physicians connecting with an individual patient to be able to have that kind of collaboration. 

[00:20:09] Bill Russell: [00:20:09] Wow. So this is really going to change it. It has the potential to really change how healthcare is delivered, bringing family members in from afar, bringing  as you say, interpreter services in as well bringing consults into, I mean, you could have a pretty robust platform. How [00:20:30] are health systems rethinking those care pathways and those care journeys with telehealth integrated. Cause it’s not just going to be, when we think of, when we think telehealth today, we think follow-up visits and we think you know, that initial visit of, hey, I’m not feeling well, but this has the potential to be really integrated across the board. Are we seeing a lot of that work?

[00:20:52] Sean Bina: [00:20:52] So yeah. You know, you’re exactly right. Group started with kind of the kind of initial onboarding visit and [00:21:00] then doing follow ups through this particularly, you know, it’s a great use for post-surgery. You know, I can very quickly have a nurse or a physician look at how I’m recovering. Look at my wounds, go through my follow up instructions and education without me going into the office.

[00:21:16] And so those were initially the primary use cases, but now, you know, there’s. There are certain specialties where this is going to be the predominant way that people are seeing patients, particularly like in areas like behavioral health where, [00:21:30] you know doing a video chat is very natural way to get that type of care. And we’ll continue to see that kind of a focus focal point. 

[00:21:41] Bill Russell: [00:21:41] Yeah. The it’s interesting to me, as I as I think through this, I mean there could be an awful lot of different areas where this gets integrated talk about. So one of the things I heard was that the percentage of [00:22:00] failed connections, for whatever reason, you know, people don’t recognize that you need a cell connection or a wifi connection to do a good video call or whatever. Are you guys tracking like the failed visits and helping organizations to identify the challenges around that? 

[00:22:17] Sean Bina: [00:22:17] Yes, absolutely. So that’s kind of one of the things that we’ve machined into the softwares. A, the ability for patients to test out their video prior to the visit. B we see a lot of groups that are [00:22:30] using a virtual rooming process now where a nurse is connecting with the patient first. Making sure that they’re all set up and connected. So a physician doesn’t come into an empty room and then wait and then C. We, we do reporting and analytics that kind of whether the patient was able to connect how many failed connections there were. And we’re excited because with the Epic video client in part, because it’s so deeply integrated in with the experience, we’ve seen a big reduction in the number of failed [00:23:00] connections.

[00:23:01] Bill Russell: [00:23:01] Yeah, so much of the, I think what I’d like to do is start talking about some of the interoperability initiatives and things you guys have going on. Because you connect up to so many different aspects of healthcare. One of the things you guys recently did was participating in the vaccine credential initiative. Can you describe that work a little bit and what you guys are doing? 

[00:23:23] Sean Bina: [00:23:23] Yeah so the vaccine credential initiative is really about patients being able to share proof of their vaccination. [00:23:30] And the focus of the initiative is really kind of giving patients control, which I’m a big advocate of. And then also making sure that we’re maintaining the patient’s privacy.

[00:23:41] And so VCI as they’re called, they’re finalizing the specifications and we’ll be delivering them to the EHR vendors so that we can basically create the smart health card, which we’ll have a QR code, which would be readable by other systems [00:24:00] so that you could instantly as a patient and communicate your vaccination status. So I think it’s a really admirable initiative. It’s fun to see all the different vendors coming together and participating in it. And you know, I think we will start to see results from that in the coming weeks. 

[00:24:18] Bill Russell: [00:24:18] Yeah. So that that’s one initiative. Talk a little bit about 21st Century Cures and where you see, see that, those efforts sort of taking, I know there was some initial pushback, mostly from a [00:24:30] patient privacy perspective is why Epic was pushing back and saying, hey, the controls aren’t really in this yet. Are you guys participating in helping to establish some of  those privacy standards and helping to make sure that you know, that the goal of 21st Century Cures is really achieved?

[00:24:51] Sean Bina: [00:24:51] We’ve participated in that process, you know, for the last couple of years, in terms of helping them find and think through the implications of [00:25:00] some of the things that were happening. The main thing that we were concerned about was that patients’ data would be used in Seoul without patients knowing about it.

[00:25:10] And so again, we want to give patients control over their data, and we want them to understand what is happening when other apps are accessing their data in the same way that we would, we expect that other systems would kind of demand from Epic. How are you using this using patient data as we’re requesting it?

[00:25:29] So [00:25:30] that was really our focus was just simply Simply on making it so that it’s transparent to the patient what’s happening with their data. We all, we of course are big advocates of sharing as much information with the patients as possible but then also building in the right tools so that in certain physician patient interactions there may be, there may be certain circumstances where the time is not right for a physician to share a particular piece of data because it could lead to [00:26:00] something that would be life-threatening for the patient. So we had to build controls into the system to really, to support that. So the fun thing here is the default behaviors that we’re sharing with patients. But then we have built in a series of controls to, for physicians to be able to step in and say, not for this. 

[00:26:22] Bill Russell: [00:26:22] Yeah. And it’s interesting. I mean, we all understand 21st Century Cures. I mean, just the name says it all right. We want to [00:26:30] advance Cures and we want to advance the health of the community.

[00:26:33] And, but part of that is by enabling all these innovators to be able to access portions of the record on my behalf and hopefully with my permission. I mean, this is part of what you were saying. I mean it’s, I want to grant permission to my record to be used by this third party to help me with my health.

[00:26:52] And that could be something like my fitness pal or something to that effect that I, what I’m just, I’m just conjecturing. I don’t know if my fitness pals [00:27:00] heading in this direction, but I’m just saying, you know, something to that effect where I get more engaged in my health on a day to day basis, they pick up one or two things from the health record that helps them.

[00:27:09] To help me to stay engaged with my health. But along with that came and we talked to a lot of different guests about this team, some challenges like, okay, how do I know that the vendor on the other side is a, you know is an honorable actor on my behalf and not just collecting information. And am I going to know if they’re using the information in other [00:27:30] ways, other than the stuff that I’ve told them that I can utilize it.

[00:27:34] And and some of those things weren’t really defined out of the shoot with with the 21st Century Cures. And that’s the work that we are still trying to get right today to make sure that I know how my record is going to be used on my behalf. 

[00:27:51] Sean Bina: [00:27:51] Yeah. That’s really, the focus for us is just making it so that patients understand what’s happening. And [00:28:00] then also the secondary thing is, you know, we’re really excited about the ability. To connect more apps into the patient experience. So we didn’t really see MyChart is a platform on top of which groups connect wide variety of the apps. So some good examples as we’ve had groups build in wayfinding applications or, or for inpatients the ability to do dietary or ordering.

[00:28:24] So being able to order from a menu based system and then and get connected and, [00:28:30] or the ability to add a provider finder. So we see. Lots of we’ve seen, this has gone on for many years, the ability for us to connect in other apps, into MyCharts to create a better experience. 

[00:28:43] Bill Russell: [00:28:43] Is that primarily through Apple orchard. And does that change a little bit under 21st Century Cures? 

[00:28:49] Sean Bina: [00:28:49] It is. Historically we just did direct connections with apps but then we have really transitioned that into Apple orchard so that everyone [00:29:00] is kind of. Playing by the same set of rules and guidelines and so that our customers can easily go in and see what apps are already out there and available as they’re trying to make these decisions. 

[00:29:13] Bill Russell: [00:29:13] You know, it’s I’m going to go back to this idea of, we have some, really some organizations that have really forward thinking, they work with you directly, but they also, they have some initiatives and they step back and they go, all right, I’m going to break Epic into [00:29:30] our, MyChart into its components.

[00:29:31] I’m going to use those components, but then I’m going to augment it with a handful of other things. You talked like wayfinding, Hey, well, that’s already, you can do that within MyChart. You don’t need to do that outside, but  there’s some things that they might 

[00:29:44] Sean Bina: [00:29:44] Sorry, just to correct you there. We don’t, you know, like I’m not going to Epic. Doesn’t send robots into your hospital and identify, you know where you should park your car and whether there’s a spill they need to get around. You know, there’s third parties that do that. So we would [00:30:00] connect into them. That’s certainly not something that kind of falls within our domain.

[00:30:05] And then you’re exactly right. Some of the especially some of the larger organizations that were, that have a a history of doing a lot of self-development and spend, you know, tens of thousands of hours creating their app. And creating their own presence. They want to continue down that path and we love that and continue to work with them on that because, you know, like we may not, at least right now develop [00:30:30] the kind of payer functionality, for example, that’s a Kaiser would want to offer to some of their patients.

[00:30:37] Bill Russell: [00:30:37] Oh, that’s interesting. Yeah. And that’s a great example. You know the, the payer functionality and what not. And they can use, and the good, the good thing about that is they’re not starting from scratch. They have this base that they can work from, and then they can really focus in on the things that differentiate their organization.

[00:30:55] Sean Bina: [00:30:55] Exactly. I think that is the real key is that you’re not in a situation where you’re rewriting a [00:31:00] lab results control, where we’ve spent, you know, thousands of hours working with organizations, interviewing patients to create a great view for patients regarding their lab results. But then if you do need to create something, you have the opportunity to kind of build on top of MyChart or request services from MyChart the other example, by the way that we see very commonly as some of the self-development shops need to support multiple [00:31:30] EHRs. So they live in a world where they have Cerner Athena, Epic Allscripts, and they need to create a single patient portal. At least for a period of time while they’re making transitions. And that’s a great example of where people do pull information from multiple portals all together into a self-developed one.

[00:31:53] Bill Russell: [00:31:53] Interesting. You know, I joke sometimes with this show is the education of Bill Russell. What am I not asking that I should what’s an area [00:32:00] that I should be delving into. 

[00:32:02] Sean Bina: [00:32:02] Well one thing, two things that you brought up that I wanted to go back to. So one you talked about remote monitoring and telehealth and where that’s going.

[00:32:12] And I talked about kind of some of the basics but we really see we really see a lot going into a remote monitoring or home-based hospital in the homestyle workflows. So moving from doing basic things, like setting up [00:32:30] this video visit to not only being able to pull in data from home-based devices, but then also allowing patients to do everything from infusions at home.

[00:32:41] Being able to communicate with a nurse who’s managing a kind of a virtual patient floor being able to allow patients to order supplies from the home. So we think that we think that the hospital in the home will be a huge use of that. 

[00:32:59] Bill Russell: [00:32:59] Yeah. And that’s, [00:33:00] and that’s going to be a significant push post COVID I think. Well, it’s a significant push during COVID and I’m not sure we’re going to see that change.

[00:33:10] So it’s going to be that, that will be an interesting an interesting play to see how all that information flows back into the medical record. Now, the problem we’ve always had is doctors are like, You know, no mass, I mean I can’t take any more data. So what are we doing around that? 

[00:33:29] Sean Bina: [00:33:29] Yeah [00:33:30] which is totally fair. Like we oftentimes say the great thing about the EHR is that all of the data is there but that’s also the hard thing of EHR. And that’s been, that’s actually increased as we have more and more interoperability. So now you have a med list from the patient. You have med lists from two or three organizations they’ve been into in the past.

[00:33:50] And then how does a position really reconcile and manage? All of those meds in a clean and fast way. So that’s kind of like that’s one of [00:34:00] our focal points is how do we reduce the noise for physicians, bubble up the most relevant stuff at any given point in time and then make it so that lots of things can be dealt with directly with the patient.

[00:34:13] So a good example is let’s say that I have a home glucometer that’s connected up to Epic and I’m using a care plan through MyChart. Well if I have low blood sugar hypoglycemic, we could actually automatically trigger alerts to the patient that say here’s [00:34:30] education about what to do when you’re hypoglycemic.

[00:34:33] Here are the tasks that we want you to do over the next coming days. And then we want to do a video visit with you in a week regarding this to make sure that you’re on track. So pushing many of these things right back to the patient versus having the physician have to take a look at that data before providing that next care.

[00:34:55] Bill Russell: [00:34:55] You know it’s interesting as you’re talking about these things, I wonder if there’s an opportunity [00:35:00] for an Airbnb of healthcare hospitals right? So Epic is managing a thousand beds in this community and oh, by the way, only 500 of them are in hospitals, but 500 of them are in people’s homes. 

[00:35:13] Sean Bina: [00:35:13] Yeah, I have not thought of that, but that is a cool concept. And I could definitely see that type of thing happening. 

[00:35:19] Bill Russell: [00:35:19] Yeah. That would be interesting. You said two things. Whatelse did I miss? 

[00:35:25] Sean Bina: [00:35:25] You kind of alluded to that. I think is super essential to what we’re doing is [00:35:30] the whole issue with the digital divide. And so, you know there’s kind of two different elements to the digital divide. There’s getting people access. So how do we provide internet to our rural communities? How do we make sure that people in the inner city have access to being able to, you know you know, just simply get online and get connected. And then the second thing is really where our work is, which is creating a super usable [00:36:00] platform.

[00:36:01] There’s a lot that goes into this. So we have to make sure that our software is accessible. So that if I have issues with my eyesight hearing, et cetera, that I can get connected in and that I can use, for example, an appropriate screen reader to use the software, we have to make sure our software is responsive across platforms.

[00:36:24] So it has to work whether I’m an Android iOS user, whether I’m using a [00:36:30] mobile browser, whether I’m using it on my computer, we need to provide multi-lingual support. So, you know for patients that their native language is Spanish or French or whatever their language is, we need to surprise, be able to make it a comfortable, easy experience for them.

[00:36:47] And then there’s a lot that we have to do technically like, Supporting something like Android sounds relatively simple, but we have to continue to support Android versions that go all the way back to 2014. [00:37:00] So we still have thousands of patients that are using Android five. Is there a coral S and we don’t want to cut them off of MyChart just because they can’t afford a new phone.

[00:37:11] And then the last thing I’ll say there is we’ve really been focused. As a company overall on social determinants. And that means that helping patients AE identify patients that are having issues with depression, by doing things like PHQ nines, and promise cat [00:37:30] B, being able to help patients get into their appointments.

[00:37:32] So working with like Lyft and Uber, to be able to overcome some of those barriers. 

[00:37:38] Bill Russell: [00:37:38] You know, it’s you’re giving me chills as you talk about development. And I think people think this is pretty easy, but you know, just try to develop a simple ADA compliant website and you’ll realize how hard this is because now you’re not only talking about an ADA compliant website, you’re talking about apps on phones and you’re talking about multiple sides of [00:38:00] the phones.

[00:38:00] Now the Apple’s ecosystem, the only thing you have to deal with is apples constantly tweaks to make it better. And so you’re constantly just catching up to them as they tweak their system. But Android as you, I remember the amount of libraries we had to maintain for Android apps was ridiculous and it doesn’t function the same way across all those different you know all those different platforms. It is very challenging to maintain essentially multiple builds [00:38:30] across all those platforms. 

[00:38:32] Sean Bina: [00:38:32] Well and then of course there’s the multiple builds across those, all those things. But then we also have multiple versions. So, you know, we come out with a new version every single quarter, winter, spring, summer, and fall, which has new updates.

[00:38:46] And so as you know, as the government adds requirements, we need to make sure that. All of the prior versions that customers are using, or at least the vast majority of them that the customers are going to be [00:39:00] upgrading to support that new requirement. So that’s the kind of dark side of the development process.

[00:39:07] Bill Russell: [00:39:07] Yeah. And our listeners would be familiar with the dark side of the process. Social determinents is interesting. Is Epic going to be a platform for social determinants data? Is that a direction? 

[00:39:20] Sean Bina: [00:39:20] Yeah. Yeah. So we already both clinically and then from the patient side track and manage social determinants information. And [00:39:30] then increasingly we’re trying to make the resources to help patients directly available from from Epic. So being able to allow a physician to actually we like, we have physicians now that write prescriptions to community food pantries. For patients at Hurley medical center, they actually have their clinic kind of over the top of a farmer’s market and they will give the patient a food prescription to go downstairs [00:40:00] and get  healthy food.

[00:40:02]Bill Russell: [00:40:02] The thing that’s interesting to me is just the the amount of information that’s going into the medical record is so vast and necessary right to provide the best care for me. 

[00:40:13] Sean Bina: [00:40:13] Well what I will say about that, that topic is we really do see the intersection of healthcare and social care coming together. And in fact internationally, some of our customers are using Epic, not [00:40:30] only for healthcare, but also for social care tracking. And what that means is that they, you know, all of their kind of core services that they’re providing for, for, people in general are getting linked in and connected to their health care. And so when we look at a patient, we have to look at who is in their network. So not only the patient needs to care for themselves, but do they get support [00:41:00] through the church?

[00:41:01] Do they get support from family members? Do they get support from other members of the community? And then how do we create this kind of community connectivity for our patients? 

[00:41:11] Bill Russell: [00:41:11] Yeah. And yeah we looked at that back in 2012, 2013, we were looking at cares, I guess they called care circles or those kinds of things.

[00:41:19] It’s the people that provide care because when we talked to our, at the, to the community, one of the things they said is, Hey, I’m caring for my parents in Wisconsin. [00:41:30] And I, and we were sort of sitting back on, okay, what can we do for those people who are caring for somebody. Halfway across the country. And that’s a very real need, very real challenge for a lot of people.

[00:41:42] Sean Bina: [00:41:42] Yeah. It’s been particularly hard with COVID. Right. So if my mom lives in Seattle and she ends up in the hospital that I, you know, I can’t go in, I can’t fly to Seattle and see her in person in the hospital. So I need a way to be able to track and manage her care. And [00:42:00] we haven’t really talked about this but MyChart isn’t just an ambulatory application.

[00:42:04] It really extends through our toolkit that we call MyChart bedside into the hospital where now proxies can do everything from being able to see what education and who’s on the care team and what the schedule looks like a floor for their family members on a day to being able to of course see things like test results or place orders or requests for their loved ones directly from home.

[00:42:30] [00:42:29] Bill Russell: [00:42:29] Proxies. Yes. I’m sorry you’re bringing back, bringing back a lot of memories. All right. Last, last question here. So, you know, Epic started the Epic health research network. Can you just describe what that is and we’ll end on this. 

[00:42:44] Sean Bina: [00:42:44] Yeah. So the Epic health research network is really, it’s an electronic journal that was launched to help customers and data scientists to share insights derived from EHR data.

[00:42:56] So the goal was to make it really fast [00:43:00] and easy for our data scientists internally and also for our customers to be able to publish new information with a particular focus originally around COVID 19. So just simply being able to look at the data, being able to track and report on things that patterns that we’re being able to see in the data like ventilator use, for example and then be able to publish that onto our website for review by [00:43:30] anybody out there in the public.

[00:43:32] Bill Russell: [00:43:32] Wow. Well I promised that would be the last question. So I’m going to have to have somebody from Epic in the data science area and whatnot dive a little deeper. Cause that sounds, that sounds again just extremely  powerful and something that a lot of health systems could really benefit from.

[00:43:49] Sean Bina: [00:43:49] Yeah. The the other kind of element there is, you know, you’ve probably heard about cosmos, which is we’ve been aggregating data. From [00:44:00] across our customers, we have over a hundred customers participating and we have about a hundred million patient records, unique patient records that have been identified that are in there that now people can go in and do research on that data at scale.

[00:44:16] Bill Russell: [00:44:16] Yeah. Yeah. That’s amazing. Sean you did not disappoint as Epics spokes model. I love, I love that. So you guys are back in the office, it looks like you’re back in the office in in [00:44:30] Wisconsin. How’s that going? 

[00:44:32] Sean Bina: [00:44:32] Well we, I love it because A, the food is great. You probably heard about at Epic. B, you know the offices, our offices are really safe. So we have great HVAC and then we all are working from private offices, the people that are coming into Epic. And so you’re really in like the safe, secure spot. And I just love being able to get out of my house and come in and focus a hundred [00:45:00] percent on work. 

[00:45:00] Bill Russell: [00:45:00] Yep. And we’ve had a lot of conversations on what does life look like after COVID-19, it’s going to be a hybrid of sorts.

[00:45:07] This is what we’re sort of picking up. And people are like, yeah, well, people aren’t gonna want to come back. I’m like, nah, I don’t think that’s the case. I think there’s a mix. I think there’s, you know, people who are looking forward to getting back in that collegial kind of, you know, back and forth and that kind of stuff. Even if they have to wear a mask, even if they have to, you know, whatever the protocols and precautions are, I think they’re just looking forward to going to lunch [00:45:30] with some friends. 

[00:45:30] Sean Bina: [00:45:30] Yeah. We have about 4,000 people that come into our campus every day throughout the COVID crisis. So a lot of people definitely feel that way already.

[00:45:41] Bill Russell: [00:45:41] Fantastic. Sean, again. Thanks. Thanks for your time. I really appreciate it. 

[00:45:45] Sean Bina: [00:45:45] Yeah no problem. Nice talking.

[00:45:47]Bill Russell: [00:45:47] What a great discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to [00:46:00] this show. It’s conference level value every week. They can subscribe on our website thisweekhealth.com or they can go wherever you listen to podcasts, Apple, Google, Overcast, which is what I use, Spotify, Stitcher. You name it. We’re out there. They can find us. Go ahead. Subscribe today. Send a note to someone and have them subscribe as well. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders. Those are VMware, Hill-Rom, StarBridge Advisers, Aruba and McAfee. [00:46:30] Thanks for listening. That’s all for now.

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