Newsday - Building the EHR for Nurses and a Home-Spital in the Future This Week in Health IT
April 26, 2021

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April 26, 2021: It’s Newsday with Dr. Justin Collier, Chief Healthcare Advisor for Worldwide Technology. What’s the difference between working for a consulting organization versus being at a health system for a decade? In a new study nurses give EHR usability an ‘F’. They want more time at the bedside with patients. That’s why they went into healthcare. What mistakes do health systems make that lead to nurses feeling frustrated? Surgery techniques are changing and improving all the time. Home care is on the rise. What will the Home-spital of 2030 be like? AI and machine learning are fast becoming part of the virtual care team. You can learn about conditions you have or things that are impacting your wellness in an automated way that still feels warm and human. It’s the end of April. Vaccines are out there. Is your life getting closer to what it was pre-pandemic? Or are we still a little ways out? Plus 3M launches new social determinants of health platform. 

Key Points:

  • EHR usability can be a source of frustration for physicians but less is known about perceived usability among nurses [00:06:30] 
  • Nurses are rockstars. They deliver care, juggle the complexities of managing family and care team expectations and quarterback the patient experience while subsequently spending the lion’s share of the time in the EHR. [00:11:00] 
  • GPU acceleration for virtual desktops [00:14:15] 
  • You can’t have EHR lag. It’s death to the experience of anyone that is using the system. [00:20:07] 
  • The fourth industrial revolution will ensure that humans live longer and healthier lives [00:23:35] 
  • Hospitals of the future will become more like NASCAR pit stops rather than inescapable black holes [00:23:40] 
  • Worldwide Technology – Join the ATC Ecosystem


Newsday – Building the EHR for Nurses and a Home-spital in the Future

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Newsday – Building the EHR for Nurses and a Home-Spital in the Future

Episode 395: Transcript – April 26, 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.

[00:00:00] Bill Russell: [00:00:00] Welcome to This Week in Health IT. It’s Newsday. 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] Special thanks to Sirius Healthcare, Health Lyrics and Worldwide Technology who are Newsday show sponsors for investing in our mission to develop the next generation of health IT leaders. We set a goal for our show. And one of those goals for [00:00:30] this year is to grow our YouTube followers. We have about 600 plus followers today on our YouTube channel. Why you might ask? Because not only do we produce this show in video format but we also produce four short video clips from each show that we do. If you subscribe, you’ll be notified when they go live. We produced those clips just for you the busy health IT professionals. So go ahead and check that out. We also launched Today in Health IT. A weekday daily show that is on todayinhealth [00:01:00] We look at one story each day and try to keep it to about 10 minutes or less. So it’s really digestible. This is a great way for you to stay current. It’s a great way for your team to stay current. In fact, if I were a CIO today, I would have all my staff listening to Today in Health IT so we could discuss it. You know, agree with the content, disagree with the content it is still a great way to get the conversation started. So check that out as well. 

[00:01:24]Common question I get is how do we determine who comes on This Week in Health IT? To be honest, it started organically. It [00:01:30] was just me inviting my peer network. And after he show I’d asked them, is there anyone else I should talk to? And then the group, obviously the network group larger and larger, and it helped us to expand our community of thought leaders and practitioners who could just share their wisdom and expertise with the community.

[00:01:45] But another way is that we receive emails from you saying, Hey, cover this topic, have this person on the show. And we really appreciate those submissions as well. You can go ahead and shoot an email to [email protected] It will go to the entire team. [00:02:00] We’ll take a look at it, reach out to these people and see if there’s a good fit to, to bring their knowledge and wisdom to the community as well.  

[00:02:07] Welcome to this week in health IT Newsday. Today Dr. Justin Collier joins us as we explore the news. My name is Bill Russell, former healthcare CIO for a 16 hospital system and creator of This week in health IT. A channel dedicated to keeping health it staff current and engaged special.

[00:02:24] Thanks to Worldwide Technology our Newsday show sponsor for today for investing in our mission to develop the next [00:02:30] generation of health leaders. If you want to be a part of our mission and become a show sponsor as well, send an email to [email protected] Quick note, if you want to participate in the conversation, please follow me on LinkedIn Bill J Russell. I do one post a day and cover one new story. In addition, I do a daily podcast on that one story that you can find on Today in Health It which is on Apple podcasts, Google, Spotify, Stitcher really everywhere that you listen to podcasts, you can check it out on [00:03:00] Dr. Justin Collier’s in the house. Justin welcome to the show. 

[00:03:04] Dr. Justin Collier: [00:03:04] Thanks for having me. Yeah My pleasure to be here. 

[00:03:07] Bill Russell: [00:03:07] This is your first time on the show. So yeah I’m looking forward to the conversation, but since this is your first time on the show can you give the community a little bit of your background where you come from, what your area of expertise is?

[00:03:20] Dr. Justin Collier: [00:03:20] Yeah, sure. So I am a dual boarded physician. Physical medicine and rehabilitation was my primary specialty in clinical informatics as my sub-specialty. [00:03:30] Been with Worldwide Technology now for the past three years, as one of their Chief Healthcare Advisers. I have the blessing to work with two other fantastic physicians and an absolutely rock star nurse doing a lot of fun, transformative things for all parts of the healthcare ecosystem which is pretty great.

[00:03:49] And then before that, I spent a decade at HCA and seven and a half of those years as a division CIO for them. 

[00:03:57] Bill Russell: [00:03:57] What’s the biggest  difference [00:04:00] being with a consulting type organization versus being at HCA for a decade. Cause I’ve done both. I’m curious your thoughts and I’ll give you some of my thoughts.

[00:04:14] Dr. Justin Collier: [00:04:14] Yeah. So the fantastic thing to me about the job I have now well, there’s a bunch you know, of course, fantastic culture. Both organizations are well-known for their culture. But you know, with Worldwide just [00:04:30] being on the top 100 best places to work for the 10th year in a row which I think may be a record? It was pretty fantastic to, to move to Worldwide.

[00:04:41] But I get to help more than one health system at the same time instead of just helping one to get better. So that’s been a really great thing and I get to see the work that we do across all the other sectors we serve and bring those innovations into healthcare faster. So that’s been, been really rewarding.

[00:04:59] Bill Russell: [00:04:59] Yeah, [00:05:00] that’s the thing I, you know, that’s the thing I really like. The thing that like about being in a health system is you get to go really deep and solve very specific problems. The thing I like about being a consultant is a handful of things. One is you do get to work with a lot of different health systems. You get smarter every day cause you’re visiting several health systems. Potentially several a week or whatnot. And so you’re seeing some really neat things happen in it. You almost act as the cross pollinator I’ll say for the industry, because you’re [00:05:30] going from place to place saying, hey, I’ve seen that before.

[00:05:33] Here’s a good idea. So I there’s part of me. I understand the draw to each but I really do. I enjoy the consulting side of it. It just feels like you get to work with more people and see more things. That’s my, my take on it. I don’t know. I’m not asking you to comment on it. I’m just curious. 

[00:05:53] Dr. Justin Collier: [00:05:53] No I would agree.

[00:05:54] Bill Russell: [00:05:54] Well let’s hit the news. So we’ve got some interesting stories. I’m going to start with one that is right [00:06:00] in your wheelhouse. And that is a study was done this past week. I posted on it today and we’ll get to some of the comments on LinkedIn. Nurses give EHR usability an F in a new study.

[00:06:13] And the researchers found that among 1300, roughly 1300 nurses who responded to the survey about usability and burnout, the mean nurse rated. EHR usability score a 57.6 which researchers gave a grade of an AF. Let me tell [00:06:30] you a little bit about the study. EHR usability has been found to be a source of frustration for physicians but less is known about perceived usability among nurses. The study team, comprising researchers from Yale school of Medicine, Mayo, University of Virginia school of nursing, American nurses association, and Stanford school of medicine sought to change that. And, you know, as they went out, they found that there was a fair amount of frustration with the build. You know, I posted this this [00:07:00] morning. Does that surprise you at all?

[00:07:01] That you get that kind of grade from a study of nurses on EHR usability? 

[00:07:08] Dr. Justin Collier: [00:07:08] Sadly, I would say no. It doesn’t surprise me. I think it’s been known throughout the industry for quite a while. I think probably any user of any EHR probably would rate the usability as an F in almost all cases. It’s unfortunately just kind of the nature of the beast, if you will.

[00:07:28] But it’s good to see [00:07:30] it studied. You know, I would, I would definitely like to see a similar study done for the allied health professions. You know, physical therapy, occupational therapy, speech therapy and others.

[00:07:40]Bill Russell: [00:07:40] What do you think can be done, I mean, part of this is just the nature of software, right? So this is still written on a code base that is fairly old. It’s very specialized towards healthcare, a lot of clicks still in it. And one of the challenges is it’s being compared [00:08:00] to the other things that people use. Right? And so the other things we use keep getting more and more sophisticated, easier and easier to use. You know, we can pick up our phone and say, give me directions to fill in the blank and it gives you directions.

[00:08:13] And so the rest of our world, the rest of the technology that we’re using is getting easier and easier. And so with every day that the EHR just feels a little clunkier, even if it was state-of-the-art the day it was installed. It’s maybe not keeping up to the, to the [00:08:30] standardsof usability that’s going on. So you sort of have that perception issue, but what are some mistakes, do you think that health systems make that, that lead to the nurses being frustrated with the EHR? 

[00:08:43] Dr. Justin Collier: [00:08:43] So I think the systems that do the best job. I’ll frame it that way. So maybe best practices rather than, rather than pitfalls. Obviously the other side of the coin is not doing those things well. But I think the systems that do best [00:09:00] are the ones that have nurses on the informatics team. Nurses who have been at the bedside and understand the workflows personally. That makes a huge difference. And then the second step is engaging all of the stakeholders during the build process. So that they are part of that decision-making. Certainly that helps quite a bit in terms of adoption as well as potentially improving the usability. Third thing that [00:09:30] really makes a difference too, is not stopping with installation or implementation or the build. It’s going back and doing continuous cycles of optimization. So continuing to improve that.

[00:09:43] And then the fourth thing is not actually in the EHR at all. It’s making sure that you have the right surrounding technologies that can improve the workflow overall for the nurse and doing as much as you can of that work to [00:10:00] automate manual work, manual processes improve the overall workflow, leveraging all the best technologies you can. Hopefully that makes some sense. 

[00:10:11] Bill Russell: [00:10:11] Yeah. No, that makes perfect sense. I want to give you some of the, some of the quotes that are going on and I posted it this morning. So this is all of ’em. How old is this? Four hours. Four hours old. It’s already gotten 2000 views and quite a few comments. Dan Howard chief information officer [00:10:30] notes not surprised by the usability score.

[00:10:33] I may be a bit biased as a former RN, but most of my work around EHR automation and automated optimization has had nursing as stakeholders. That’s what you were just discussion discussing, but physician workflows and user experience has always taken center. Stage physicians typically are the most vocal about their complaints and have senior leaderships ear on what they need out of the EHR [00:11:00] compared to nursing. Nurses are rockstars. They deliver care, juggle the complexities of managing family and care team expectations, quarterback the patient experience while subsequently spending the lion’s share of the time in the EHR. The great news is that the promise of AI, ambient clinical listening and enhanced digital capabilities is beginning to move the needle on end user experience for many of our clinical applications. And I guess that tees up the question of, are you seeing some of [00:11:30] those technologies and what technologies are you seeing that’s augmenting the experience within the EHR? 

[00:11:37] Dr. Justin Collier: [00:11:37] So a lot of it has to do with performance of the systems.

[00:11:42] So making sure that you’ve got good hardware that’s going to perform well, that you’ve got the right network and the right wifi support. So that those are not barriers. You certainly don’t want to lag the system, even if it’s for a specially, if it’s not particularly usable, you don’t want to add friction to the [00:12:00] system.

[00:12:01] Things like roaming sessions can be nice so that when the nurse has to change computers she can pick back up or he can pick back up wherever they were last in the system. You know, and again technologies, I think like AI ambient listening, things coming in that regard, speech recognition, things like that I think are significant.

[00:12:29] And then [00:12:30] I think automating other manual processes that are part of the nurses day in and day out are really important as well. So what are the tasks that can be managed for them that allow them to have more time at the bedside with the patient which is why they went into healthcare. Yeah.

[00:12:49] Bill Russell: [00:12:49] Yeah. You know, we spent a lot of time on this. I mean it was interesting. We had a badging process, a badge in badge out and it would move the virtual machine with them. And I [00:13:00] think at one point they had to actually the dash and badged out but it would drop them at a home screen. And one of the things they kept telling us is look when I leave  that room and I go to that room. I want to be in the same place. And so we did that to make it easier for them, so that they badge out of one machine badge into the new machine and they’re landing exactly where they left off. 

[00:13:24] Dr. Justin Collier: [00:13:24] Roaming sessions are powerful. 

[00:13:26] Bill Russell: [00:13:26] Yeah. And so there’s, there’s an awful lot of things and part of me is [00:13:30] like you just, there has to be a constant dialogue I think going on around the build. Is this working for us? Are we doing the right things? What things would benefit you. I think it was one of those things. And actually to your point Joe Webb, who I’m not familiar with but it looks like a technologist really at heart.

[00:13:52] And he talks about the latency that you were talking about. It frustrates everyone, including patients, performance tuning, and high [00:14:00] availability in the backend data systems should be considered with all implementations 

[00:14:04] Dr. Justin Collier: [00:14:04] Yeah, I would say one really cool thing that’s come out recently or relatively recently that a lot of people haven’t necessarily adopted in the healthcare industry that we’re seeing really accelerate a lot of things in other industries is GPU acceleration for virtual desktops. That actually can significantly enhance the performance. I mean it’s something that, you know, PC gamers have known for a long [00:14:30] time. You know, if you get some GPU support, you get better performance and imagine how long it’s taken us to figure that out that you could accelerate your virtual desktops that way. But it can be a really powerful improvement. 

[00:14:43] Bill Russell: [00:14:43] Well  that makes perfect sense. I mean, a virtual desktop is essentially just delivering screen captures for the most part. That virtual sessions running in a data center, you know, miles away. And really all you’re [00:15:00] delivering across the line is the pixels that go up on the screen.

[00:15:04] And so yeah, GPU that, that’s interesting. I hadn’t really thought about that one. That’s a good idea. I’m trying to think if there’s any others in here Drex DeFord. Of course Drex weight in . And let’s see what Drex has to  say. I was talking to CMIO last week. He admitted that their EHR strategy was to, was to suck less, his words.

[00:15:24] Once I cleaned up my coffee off the desk, that I just spit on the desk I [00:15:30] asked him for more, in his words. They can’t help it. None of the EHRs are great. And the current models make clinicians do a lot of clicking and typing than working late to do more clicking and typing and cutting and pasting, which is loosely translated the EHR sucks. Can’t make it better. The goal, according to this CMIO is to make it suck less. I’m not sure that’s, you know, what’s interesting to me because I mean, you do this, I do this, I sit down with CMIOs. I sit down with [00:16:00] CIOs. The tools within the EHR have gotten so much better that you can really identify the people that have figured out the EHR. They’ve customized it. They put in the bill that they want to have, and they’re very efficient at it. And you can look at the other doctors and sort of compare them across their use of the EHR and those kinds of statistics that are built into a lot of the EHR is back when we were doing it in 20 .. 2013, 2014. We actually had to [00:16:30] build a a data repository, bring all the log files and do some some big data data analysis. And we were able to create the same thing. But today in Epic, that’s available and within some of the other, Cerner and other larger players, she can get that data. I would assume that that data is very helpful.

[00:16:51] How would you feel as a physician if I showed up and say, it said, hey, we’re here to help you with the EHR. Notice you’ve been having some challenges you [00:17:00] know, let’s talk through those. I’d assume you’d respond pretty good to me? 

[00:17:03] Dr. Justin Collier: [00:17:03] Yeah. And I think it’s the right strategy. And I want to say it was Jamie that a few years ago had published a study that showed time and training.

[00:17:13] The amount of time physicians spend during that training process, actually getting trained on the EHR as well as the amount of time physicians spend with doing customization upfront and periodically on an ongoing basis. Those [00:17:30] are two real keys to improving efficiency of use of the EHR and the comfort of using those EHR.

[00:17:40] So I think, I think training upfront but to your point, when you see somebody that’s struggling, that’s spending way more time, especially after hours reaching out to those folks and saying, Hey, there are ways that we can help you, let us help you get better. Let us help you with the customization.

[00:17:58] Let us help you with [00:18:00] additional training, tips, tricks, things like that. And especially if you can do it in a peer-to-peer way, that makes a tremendous difference as well. You know, pair them up with sort of an EHR mentor of sorts who is you know, a similar specialty, if you can who’s performing it, you know, at the opposite end of the spectrum.

[00:18:23] Bill Russell: [00:18:23] You know what, to be honest with you, I was surprised that this story got this much traction on my LinkedIn posts only because [00:18:30] at our health system, the chief nursing information officer was a pretty prominent person. They’d pretty. No, I mean, she was at the table, she was at the executive table.

[00:18:39] She was very much a part of the build. The nurses were pretty much center stage and she constantly reminded us that the nurses are going to spend more time in the EHR than anyone else. And so the build, we spent a lot of time with the nurses to get the build, right. And so I was kind of surprised to see this, and I assume your experiences [00:19:00] there, there are other health systems that have gotten this right. Because they, they really do include their nurses early and often and they’re a part of governance going forward and they’ve made sure that the system really serves the nurses. I I thought that was the norm is I guess why I was a little surprised.  Are you surprised  by this at all?

[00:19:19] Dr. Justin Collier: [00:19:19] So I would, I would say even if you’re doing all the things right, that you can as the health system that doesn’t necessarily fix the underlying platform that you’re [00:19:30] operating on. If that makes some sense. And I think it’s really that underlying platform that’s getting the F. It’s not necessarily the support. Cause I would, I would say a majority of organizations are doing a good job in terms of trying their best to engage the nurses and to serve them. Call to the EHR vendors though. 

[00:19:47] Bill Russell: [00:19:47] Yeah, well the EHR vendors and it could also be to the the infrastructure that’s behind it. I know we had some performance issues early on in my tenure. We had to rearchitect [00:20:00] the platform that our EHR ran on it. It was fairly expensive to do, but gosh, was it worth it.

[00:20:07] Because you can’t have lag. It’s death to the experience of anyone that is using the system. 

[00:20:16] Dr. Justin Collier: [00:20:16] We do a lot of that work for our partners. We really do consider our customers to be partners. You know our mission is the same as theirs, you know, it’s improved the health and wellness in the US. Very excited about [00:20:30] that. 

[00:20:30]Bill Russell: [00:20:30] Interesting. So you ready to go onto the next story? 

[00:20:33] Dr. Justin Collier: [00:20:33] Yeah we can. Or we can stay here. I think I’ll throw out one closing thought on that article. The biggest challenge for EHR in EHR usability is that the regulations around documentation were written in the paper era and haven’t been updated. I think that’s probably one of the biggest underlying problems. 

[00:20:57] Bill Russell: [00:20:57] Yeah and that really, that came to the, that came to the floor during [00:21:00] COVID. I mean, people were like, Yeah, we have to move faster. We’re just not going to give you this info. I mean, they never was saying, give us this and this, and they’re like, you don’t need it.

[00:21:08] We’re not giving it to you. This is what we need to do because they had to move so quickly. And I think it’s sort of shown a light on the fact of, you know, what information do you really need in order to be effective in terms of monitoring the progress of really care and care outcomes, as well as building the right infrastructure to [00:21:30] respond to public health needs and those kinds of things. 

[00:21:32]We’ll get back to our show in just a minute. This episode of Newsday is brought to you by Worldwide Technology and Intel. WWT’s advanced technology center is like no other testing and research facility with more than a half billion dollars of equipment, including solutions from key partners like Intel corporation and it’s virtual as well. So you can access it seven by 24. To learn more and get insights into all that it offers. Go to [00:22:00] 

[00:22:03]So we will go into the next story. And this is, this is what we’ve been following for a while. There’s just a lot of movement in this area. And what I’d like to do is tap into your expertise of what this means to physicians, what it means on the technology side.

[00:22:18] And it’s a medium article. It was done by Melanie Walker, a senior advisor to the President of the World bank and the title of the article is healthcare in [00:22:30] 2030, goodbye hospital, hello, home-spital. And I assume home-spital just means we’re going to be moving out of the moving out of the large facility, a hospital facility.

[00:22:44] Let me just give you a little excerpts, give you some background on this. When I look forward to the future, I see a very different trajectory who needs a hospital when you can prevent and treat conditions from the comfort of your own home. The global burden of disease is largely vascular with heart attacks and [00:23:00] strokes, the biggest cause of death around the world, and therefore preventable with better understanding of risk factors.

[00:23:06] Rates of traumatic injury are falling and will continue to decline. As we introduce driverless cars and robot workers who are risky tasks. And well, 80 is the new 60 and all the regenerative options on the horizon. She goes on to say by 2030, the very nature of disease will be further disrupted by technology so disrupted in fact [00:23:30] that we might have a whole lot fewer diseases to manage. The fourth industrial revolution will ensure that humans live longer and healthier lives so that the hospitals of the future will become more like NASCAR pit stops than inescapable black holes. You will go to the hospital to be patched up and put back on the track.

[00:23:49] Some hospital practices might even go away completely and need for hospitalization will eventually disappear. You know, I share this article. It’s interesting [00:24:00] to me, this is probably the rosiest picture I’ve ever read of healthcare. It’s 2030. I mean, it’s really rosy. And I wish healthcare would move this fast.

[00:24:09] And I wish the move towards, you know, disease prevention, specifically obesity and diabetes and other things. You know, I wish I could see an end in sight to that that technology is going to be bring around but does the nature of the hospital change as a result of the pandemic? I mean, [00:24:30] people receive care in the home. We had some chronic conditions being monitored in the home. We had CMS start to reimburse some chronic care in the home. Do we think that that’s the first step that we are going to see more home-based care? 

[00:24:47] Dr. Justin Collier: [00:24:47] I think it’s absolutely already been happening happening or possibly in pockets, especially for the payer provider health systems whose incentives are aligned a little bit differently [00:25:00] than the typical fee for service model. If that makes some sense. The hospital at home movement was already under underway. That was already progressing. I think COVID and the pandemic accelerated a lot of things that will continue even, you know, and not necessarily a post COVID world. Cause it looks like that may never happen but in a a future world I’ll phrase it that way.

[00:25:28] I think, I think it’s just going to continue to [00:25:30] accelerate. Things that the pandemic did thrust to the fore or things like virtual visits and doing more in the home to create capacity at the hospital for things that had to be managed more acutely. If that makes some sense I would say even, even some of the COVID care ultimately was delivered as a hospital at home type service for good reason.

[00:25:56]That was a better and safer model. And if you [00:26:00] really think through it, it’s impossible to get a hospital acquired condition if you’re being cared for in your home. So there’s a lot of reasons to think that that may be a better model for a lot of conditions. 

[00:26:15] Bill Russell: [00:26:15] Talk to me about the nature of surgery.

[00:26:17] I mean you’re a physician, so you’re going to have a better view of this than me, but I live in Florida so I’m around a lot of people that are getting surgeries. And it’s interesting to me. I, you know, orthopedics a [00:26:30] gentlemen got a I think it was a hip replacement and he was playing golf three weeks later.

[00:26:36] Now, when my mom got her hip replacement a while ago it was a significant rehab process for a long period of time. My father and I were talking about the stints he has put in is his heart. And he’s had two open heart surgeries but since a certain timeframe they avoid that like the plague at this point. [00:27:00] They will, you know, crack open the chest as a very, as a last resort. And he’s telling me of all these surgeries and strands are having where, you know, hey, they’re going in through here, they’re going in through here. And they, they can do so much in the heart and so much inside. And it’s all about the recovery time.

[00:27:16] It’s all about really reducing the the recovery time. Obviously, if break, open the chest. I think my dad’s recovery was significant coming back from that. It’s the nature of surgery gonna continue in this direction where we’re really doing surgery [00:27:30] from the, from the inside out almost. 

[00:27:33] Dr. Justin Collier: [00:27:33] Yeah, absolutely. I think, I think the technology is definitely headed that way. And I think one of the other things too you know, kind of ties it into our other, our other discussion. One of the other things that’s accelerating is not just the technology, but the prevention. That makes, that makes sense. It certainly seems to me that the more you can prevent or stave [00:28:00] off the need for these interventions on the front end the better it is for all concerned.

[00:28:06] So seeing a lot of trend in that direction as well, but definitely the surgery techniques are changing and improving all the time. And the components that are used, if it’s something like a hip or knee replacement, those are improving all the time. The devices are improving all the time. I’m seeing a lot of neat things happen too with other implantable things.

[00:28:26] Things like pacemakers that now are being made to do [00:28:30] more than just the pacemaking. If that makes sense. So adding more features when you have to have an intervention to prevent having to have multiple surgeries. 

[00:28:45] Bill Russell: [00:28:45] Well let’s talk about you know, one of the stories here is 3m launches new social determinants of health platform and social determinants of health platforms are interesting to me in that.

[00:28:58] You know, all right. So [00:29:00] surgeries are going to become less and less of a big deal, or at least recovery from surgeries are going to become less and less of a big deal as we get smarter and do these kinds of things. But when you start talking about prevention and wellness and I’m seeing more and more health systems start to talk about this really under the banner of health, equities, and bringing health to the communities that they serve.

[00:29:25] You know again, diabetes and and [00:29:30] obesity and those kinds of things. What are you seeing in that area where technology is helping to start to identify and help people to live healthier lives? 

[00:29:44] Dr. Justin Collier: [00:29:44] So I think one of the big things that we see having a big impact are those health systems that are very forward and future leaning when it comes to having digital engagement with their patients.

[00:29:56] Providing a truly holistic digital strategy [00:30:00] has really made a difference in terms of being able to deliver education. Health literacy is one of those big social determinants truly understanding what it is that you are facing from a health standpoint, how to be well how to avoid complications.

[00:30:20] Just it just having that information accessibility and the ability to understand and consume that information I think is a huge [00:30:30] intervention with tremendous power. Access to care is another one that technology is really driving. So moving more toward that virtual. Care model really helps with people who have transportation challenges.

[00:30:45] You know, it can definitely keep them from having missed appointments. That could be very, very important. A lot of the move toward remote patient monitoring makes a huge difference, too, particularly for a lot of those chronic conditions that you mentioned being able [00:31:00] to better understand how the patient is living and how their disease is impacting their health and wellness on a daily basis not just those few measurements of data that you might get if they saw the physician two or three times in a year. You know, think about how much better you can make medication dosing decisions, for example, by truly understanding how patients do and not just understanding how they’re doing in that episode episodic way, where they’re just visiting you [00:31:30] very infrequently . You know in many cases patients are really nervous when they go see the doctor. And so the data that you get may not even be that great. Or they live really well. They, you know, live right for the two or three weeks leading up to a physician visit cause they want to impress the doctor at how great they’re doing.

[00:31:49] But that doesn’t necessarily reflect how they’re really doing on an ongoing basis. So that better understanding that better ability to manage and then to also be proactive, [00:32:00] you know, leveraging things like AI to really understand and be able to get predictive of who’s having challenges who’s heading the wrong direction and being able to intervene much earlier makes a tremendous difference as well.

[00:32:14] Bill Russell: [00:32:14] Well let’s you and I brainstorm in the last couple of minutes we have here, let’s brainstorm on what we need to do you, you brought up a lot of interesting points, prevention, engagement,  well actually, let me just give you the case. A lot of people put on 10 to 15 pounds during COVID. [00:32:30] A lot, a lot less exercise, a lot less travel, you name it.

[00:32:35] We just, you know we were less outside of the home during, during COVID. Now I just interviewed Sarah Richardson who lost 15 pounds during COVID. But I don’t think that’s the norm. I think the norm is in the other direction. Back in the day, we were talking to physicians about bringing some of this data from these monitors and it can be simple monitors, like a scale that it has an [00:33:00] IP address and communicates up and bringing that into the EHR could be tip data, that kind of stuff.

[00:33:07] Generally speaking physicians look down their nose at that concept. They’re like, look, I don’t need 55 more readings to look at. But with that being said, when we talk about engagement and getting in front of these things in a preventative way, if you were to see my weight going up 15 pounds over a 12 month timeframe [00:33:30] isn’t that an opportunity for a health system or a care provider to intervene?

[00:33:37] Dr. Justin Collier: [00:33:37] A hundred percent. And there’s another side to that too, that a lot of people don’t necessarily think through and that’s presenting the data back to the patient themselves to truly engage them in their health and wellness. If I can show you, Hey, when you do these things, it impacts your blood pressure in this way, or it impacts your condition, whatever it may be in this way, that’s not to your benefit.

[00:34:00] [00:34:00] When you do these other things that are what we’re really recommending, you can actually see the improvement. I think that helps tremendously. Just being aware of what’s going on with your health in a more data-driven way has a huge impact in terms of those behavioral choices. And those are even more impactful. A lot of studies have shown that those behavioral choices we make every day are vastly more impactful than [00:34:30] the traditional healthcare that you can get. If that makes, if that makes sense to you, it certainly does to be. 

[00:34:37] Bill Russell: [00:34:37] Yeah. So so my question is, does this the primary care models shift?

[00:34:43] And let me, let me say how I’m thinking about this. Obviously primary care physician is great. But it’s almost like I want my primary care physician to be a telehealth provider I want, and it could be with my local buy local health system. But I want [00:35:00] somebody that this week I can get on the, you know, have an appointment with, you know, they’re doing 10 minute appointments and they’re just going, zoom, zoom, zoom, zoom.

[00:35:09] And they’re seeing a lot. Their panel can be larger but they’re interacting with me more. I heard. Jonathan Bush, who is a part of Firefly health. And they said the average, because they have a model similar to this. And they said the average interaction that their patients had with a physician last year was 62.

[00:35:29] And I [00:35:30] thought, yeah, that’s good. That means I’m engageed. We always said we want them to be more engaged. So there’s so part of me wants to, instead of having to set up that visit, which by the way, I have to get a new primary care doctor and it’s like two and a half months. So I can get in to see the primary care doctor because they have to do a complete panel and all these other things, whatever they’re going to do.

[00:35:52] And so for two and a half months, I’m just going to wait until I can see that primary care doctor. That’s a, that’s a broken model to me. [00:36:00] Seeing the the telehealth doctor makes sense over that two and a two and a half month timeframe. The other thing is you talked about AI and machine learning but they almost become a part of that team of the virtual care provider who’s triaging all my stuff, the primary care physician, and then AI is taking all that data, right? So the internet of things, the internet of health things, and it’s bringing all that stuff [00:36:30] in. So I might have Livango devices. I might have a scale. I might have an Apple watch. But it’s bringing all that data.

[00:36:37] And the machine is crunching that data and providing insights to either my virtual care doctor or my primary care doctor that they can communicate back to me how, I mean, first of all, does that make sense? And second of all, if it makes sense, how hard is it to transition a health system to that kind of model of care?

[00:37:01] [00:37:00] Dr. Justin Collier: [00:37:01] So a couple of things I’ll share is. I don’t think it’s an either or model. I think it’s an end model for sure. It’s all of those things working in concert. I think we’re seeing a trend where the types of interactions also include asynchronous communication as well. Right. And other ways AI can be leveraged including conversational AI or what most people know is chat bots.

[00:37:28] Those texts [00:37:30] conversations that in some cases can be automated to make it easier for the humans to pay attention to what only humans can do. So I think that’s another method of engagement. Get answers about medications, get answers about side effects, get answers about the conditions that you have or the things that are impacting your wellness very easily in an automated way but it still feels more warm and human. Because it’s a [00:38:00] text message. Like we all text back and forth with all of our friends, loved ones, family, coworkers, all the time. So it still has that human interaction feel to it. That’s another component you know, email and other, other messaging communications.

[00:38:17] It doesn’t always have to be a video visit but incorporating all of those things together and a more holistic model and. An interesting sort of side note [00:38:30] too, is we’re also seeing an expansion of the direct primary care or more dedicated models health management that are out there just different from the traditional system.

[00:38:43] Some of them yeah. Incorporate all of these things. Very tightly and really are focused on that, that wellness wellness picture, you know, Chen, Chen med as an example. That a lot of people have been exposed to in terms of the way that they approach the Medicare [00:39:00] population very directly with a very preventive mindset.

[00:39:04] But incorporating a lot of these same types of things that we’ve been talking about. So I do think a lot is changing, but I think the answer is not to throw out the baby with the bath water it’s to so to speak. It’s. It’s really to incorporate all the new tools and make them part and parcel of the overall experience.

[00:39:24] There will always be things that require human interaction and to [00:39:30] some degree that’s much better in terms of just your general sense of wellbeing as well. It’s hard to feel cared for example, if you’re on a video meeting like we’re having today versus when. There’s actually that true contact in person. So it’s, it’s not either, or it’s and. 

[00:39:53] Bill Russell: [00:39:53] Yep. Although Justin, I feel, I feel cared for just it’s your calming voice I think that, you know, [00:40:00] it’s the physician in you that, that has, you know, gives them, gives me me calm and whatnot. So I do feel cared for through this Zoom call. Just for the record.

[00:40:08] Dr. Justin Collier: [00:40:08] I appreciate that. 

[00:40:09] Bill Russell: [00:40:09] Hey, just out of curiosity, we’re end of April here vaccines out there and whatnot. Are you seeing your life get closer to what it was prior to the pandemic? Or you still see that a little ways out? 

[00:40:25] Dr. Justin Collier: [00:40:25] I am hopeful that it will be this year. And [00:40:30] certainly sooner would be better from my perspective I think, I think there is and better for all concerned. I think there’s a serious loneliness and disconnected sort of pandemic that’s also sort of coincided with the COVID pandemic. I see it getting potentially better soon. Still being cautious, still doing the recommended things. But I do see it probably returning to more [00:41:00] in-person interactions in the relatively near term. 

[00:41:04] Bill Russell: [00:41:04] Yeah. I’ve officially been on two flights in the last year. Not that I’m complaining. I traveled way too much prior to this and it’s been great to see the family.

[00:41:15] And actually one of those trips was to see my entire family. So that’s been good. Are you finding that the requests to get on a plane are increasing or. Some of my, most of my healthcare clients are still saying [00:41:30] hey, no contractors onsite where they still have not opened up. So there’s no reason for me to get on a plane. Are you seeing the same thing? 

[00:41:37] Dr. Justin Collier: [00:41:37] I haven’t been on a plane yet. So I will say that but I do think we’re starting to see. a shift where in person meetings are preferred. And it kind of makes intuitive sense. You know, when all you had for months and months and months were video meetings and in some cases, nonstop video meetings all day, [00:42:00] every day that’s not going to be your favorite way to interact.

[00:42:05] So if I had to put on my futurist predictive hat, I think we’re going to see the pendulum swing in the opposite direction for awhile, and then it will probably settle to a happy medium. I do think that in, you know, in the longer term it’s going to be less travel overall than what we had preplanned Dimmick more virtual interactions.

[00:42:29] And [00:42:30] frankly that allows a lot more efficiency as well. You know, it’s certainly faster to see multiple different teams over video like this than it is to only see a one a day with the old model. But I think as soon as things are truly, you know, sort of safe and quote unquote reopened, I think we’re going to see that pendulum swing much in the opposite direction.

[00:42:59] Very [00:43:00] very in-person focused and probably more than it was before for at least a time. 

[00:43:08] Bill Russell: [00:43:08] Yeah. Yeah cause we miss each other. We will, we actually want to be in the same room. I do miss a lot of my colleagues and we just did the CHIME spring forum and I, you know, I got to see him, I got to chat with him, got to do video face-to-face with them, but yeah, it is just not the same thing.

[00:43:26] Justin. Hey, thanks., thanks for coming on the show. I really [00:43:30] appreciate it. Thanks for sharing your wisdom with the community. It’s always appreciated. 

[00:43:34] Dr. Justin Collier: [00:43:34] I don’t know how much it was wisdom but certainly happy, happy to share some thoughts, 

[00:43:39] Bill Russell: [00:43:39] Wisdom of years. You know, after after doing things for a couple of years, seeing a lot of different health systems yeah, it is wisdom. So I appreciate it.

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