October 11, 2021: It’s Newsday with Dr. Justin Collier, Chief Healthcare Advisor for World Wide Technology. A lawsuit is alleging that a cyber incident at Springhill Medical Center led to an infant’s death. A Mercer report confirms that the healthcare workforce is burned-out and traumatized following COVID. Graphite Health launched with its first three organizing members SSM Health, Presbyterian Healthcare and Intermountain. And the ONC reported an increase in patient portal usage. How do we bring clinicians up to speed quicker with technology? How can we make the onboarding process faster and more efficient for traveling nurses? And telehealth use is still surging but patient satisfaction has declined.
00:00:00 – Introduction
00:06:30 – In the next 5 years 900,000 nurses are projected to permanently leave their profession
00:10:36 – The clinicians focus on the patient and on patient interaction is what really fuels their engines
00:19:00 – If I were a CIO today, I’d be planning on a significant amount of turnover
00:21:48 – One of the key drivers of joy is knowing that your work has meaning
00:26:04 – Patient portal usage is up. Why is that?
00:34:30 – Once the world is healthier, I think it’s going to be convenience and ease that will drive continued telehealth encounters
Newsday – Health IT Staff Shortage, Telehealth Long-Term, and the Future Patient Portal
Episode 451: Transcript – Oct 11, 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: Today on This Week in Health IT.
[00:00:01] Dr. Justin Collier: The ideal technology is not necessarily in your face. It’s the innovation that melts into the background that’s invisible behind the scenes that just makes things better.
[00:00:11] Bill Russell: It’s Newsday. My name is Bill Russell. I’m a former 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.
[00:00:27] Special thanks to Sirius Healthcare, Health Lyrics and World [00:00:30] Wide Technology who are our Newsday show sponsors for investing in our mission to develop the next generation of health IT leaders.
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[00:01:11] It’s Newsday. And today we’re joined by Justin Collier with WWT, World Wide Technology. Justin, welcome back to the show.
[00:01:19] Dr. Justin Collier: Good morning. Great to be here.
[00:01:20] Bill Russell: Welcome back from vacation as well. You took a little time off. Congratulations. It’s not always easy to get away in these times is it?
[00:01:27] Dr. Justin Collier: No, that’s true. That’s true. [00:01:30] And of course we intentionally chose things that would be more outdoors just be more on the safe side. Plus, it’s a really nice time to be outside.
[00:01:37] Bill Russell: So you’re supporting your, what does that, is that a pink shirt?
[00:01:41] Dr. Justin Collier: It is. Yeah. So October, as we know is breast cancer awareness month. So our company like to support breast cancer awareness month,
[00:01:52] Bill Russell: Wow. Well, that’s fantastic. It’s also cybersecurity awareness month as I’ve been told. It’s hard to actually keep up with all [00:02:00] what month it is or, or what day it is, because there’s so many of them, but cybersecurity interesting topic. We actually don’t have any stories, which, I mean, we could have done stories, but we’ve been doing so many. There’s the brute force Azure story we could’ve done. But there’s also the the story that you were just sharing with me out of out of Alabama. You want to touch on that a little bit?
[00:02:25] Dr. Justin Collier: Sure. So big headlines two weeks ago. Really tragic [00:02:30]situation. Hospital was breached how to ransomware event. And unfortunately they have directly tied those clinical systems being unavailable to the the death of an infant. I think everybody realizes and recognizes that when the clinical systems are down, when hospital systems are down, that there is risk and certainly danger and problems that happen with patient care. But to have it this directly tied to an actual patient death and nothing more tragic [00:03:00] than the death of a newborn.
[00:03:02] Bill Russell: I’m actually doing the cybersecurity ransomware webinar in about three or four hours. But I did meet with them prior to the event and got to listen through it and really kind of interesting when that event hits. One of the things they tell you is shut down the systems as much as possible so that you actually, not as much as possible shut down the systems period so that they don’t get that that spread horizontally across your network.
[00:03:28] And that includes a lot of clinical [00:03:30] systems that only the clinical systems that absolutely have to stay on and then they go into local mode. Communication breaks down so Sarah, your badge system, whatever that all breaks down. Your phone system and a lot of cases is digital now and that goes down and we heard the story from John Gaede’s Skylakes Medical Center, who was who’s breached, and he said they were essentially, they were communicating on their mobile phones. But you know, a coordinated attack of some kind that took down the mobile phones and I mean, a lot of things went back to just [00:04:00] manual. I mean, runners going from place to place, overhead pages. It’s really hard and the other thing is you plan for a, let’s say an hour outage or a four hour outage or an eight hour outage, but none of us really have phenomenal procedures for a 30 day outage of systems and a lot of these devices are talking back to the EHR, communicating information back and when those [00:04:30] systems are offline for a week, two weeks, three weeks, four weeks, it almost becomes another Go Live to bring it all back online. It’s really kind of an arduous process and he talks about it’s been months for them to get all that information back in the EHR from those 30 to 40 days that they were down. The EHR was down for, I think, 20 some odd days.
[00:04:53] Dr. Justin Collier: Yeah. And some people think that that’s an overestimate of how long you have to really prepare for. But you know, the Scripps’ outage was [00:05:00] from May 1st to May 25th. I mean, it was almost a full month and that’s a world renowned health system.
[00:05:06] Bill Russell: Little over 3 billion. So they’re there at scale. They have budget. You could look at Sky Lakes and say it’s a 200 bed hospita l . They don’t have the resources and whatnot. So maybe, maybe that was the reason it took them 40 days to come back. But at the end of the day, he talks about, we had to rebuild everything. We had to rebuild active directory. We had to rebuild their routing tables. They had to rebuild everything from scratch. [00:05:30] And if you could imagine just wiping out your data center today right now, and then going all right, start over. And by the way most of your digital systems are locked.
[00:05:40] So if your documentation is digital and online, you can’t have access to it. Now, go ahead and rebuild.
[00:05:46] Dr. Justin Collier: Yeah, business continuity disaster recovery. It’s not just for natural disasters. It’s not just for fiber seeking backcodes. We’ve got to consider that anytime we’re talking about cybersecurity and everybody says it [00:06:00] but you really have to believe it’s not a matter of if, it’s a matter of when you’re going to have a cybersecurity event in your organization.
[00:06:07] Bill Russell: Yeah. I want to talk to you about the labor market. There’s been a couple of things that have come out. McKinsey has the great attrition graphic. I’m going to share some information with you from that. And then Mercer came out with a report. Healthcare, labor shortage will continue to grow. And that’s I, I pulled the story from healthcare innovation. I give you a couple of the findings [00:06:30] from the press release. I think the most interesting is the nursing shortage. So in the next five years 900,000 nurses are projected to permanently leave the profession. Employers will need to hire 1.1 million nurses by 2026. If current nursing trends do not change 29 states will not be able to keep up with demand and will be short approximately 100,000 nurses in the next five years. Just a whole bunch of other stats around primary care physician [00:07:00] shortage.
[00:07:00] I think the other one that was interesting was the comments around the labor shortage for according to the report about 9.7 million individuals currently work in critical, albeit lower wage healthcare occupations. In other words, medical assistance, home health aides and nursing assistants. The need for these workers will grow over the next five years to around 10.7 million. And the report goes on to talk about how there’s going to be significant shortfall in that group as well. I assume you’re reading [00:07:30] the same things. You’re hearing the same things. How acute is this problem today? Or is this one of those in 2026, we’re going to have a major problem?
[00:07:37] Dr. Justin Collier: I think it’s a major problem today and I think it’s been growing over quite a long time, it’s just been growing slowly up until this point. It’s just increasing in momentum. So it’s been a growing problem for probably a decade. And it’s impacting physician medical specialties as well and has been for awhile. Certain specialties aren’t having people enter them [00:08:00] and all around, just not educating as fast as we need to, to keep up with demand. And having enough interest amongst those who are entering the labor force and moving into those kinds of careers.
[00:08:13] Bill Russell: We could talk a lot about why people are leaving, but that’s not really the direction I want to go on This Week in health IT. The direction I want to go is what’s the role IT, what role are we going to play in developing solutions, right? So technology is phenomenal at increasing efficiency [00:08:30] but generally speaking, what we’ve heard from the industry so far is we have not provided more efficiency to the industry. Now we’ve provided more insight into the data and into disease states and we’re digitizing pathology and other things. All great things that are going to lead to cures and wonderful things, but the efficiency aspect of technology. Every other industry, it’s like we have really made people much more efficient. What areas [00:09:00] can we or have we really seen success in driving efficiency in healthcare?
[00:09:08] Dr. Justin Collier: I’m going to actually flip that just a little bit. I don’t know that driving efficiency in and of itself is the answer here. If that makes some sense. It’s, it’s more the experience of the workflow. The performance of the workflow. Taking away the rough edges, the friction points, the things that aggravate. I mean, yeah make me efficient. [00:09:30] Everybody loves the efficiency experts right. They come in and tell you’re doing your job wrong.
[00:09:36] Bill Russell: We dislike them cause they come in and they essentially say, Hey, you can do this with 50, less people. And we’re sitting in going okay, just put it on a piece of paper, how we do that and we’ll embrace you.
[00:09:47] Dr. Justin Collier: Exactly. And in many cases, either because of the shortage or just because of the way that staffing ratios are set up, there already are too few people for an ideal working environment from an [00:10:00] experience standpoint. And so that has to be looked at as well. But really finding ways to help people work in the way that is most comfortable for them, I think is important. Letting people be more mobile. That’s a key trend that we’re seeing and seeing a lot of improvement as well.
[00:10:21] Nurses and others being able to do more work from a smartphone like device. Do more work from tablets. Do more work in other ways. The rise of voice [00:10:30] assistance I think is an interesting one as well. That ambient AI technology is in a great place.
[00:10:36] Not going to necessarily name, drop any companies that are working on that but have done a lot of work in that space so that you’ve got that ambient data collection happening as the clinical encounter is going on. Let’s the clinicians focus more on the patient and on that patient interaction, I mean, that’s, the thing that really fuels our engines, right? Is that interaction with the patient. [00:11:00] That time to provide the care of healthcare. And letting technology in the background actually help us get our work done while we’re doing the parts that mean the most to us and me the most of the patient.
[00:11:14] I think that brings up a key and critical point is that the ideal technology is not necessarily in your face. It’s the innovation that melts into the background that’s invisible behind the scenes that just makes things better that we need to really focus on if we want to improve that [00:11:30]experience.
[00:11:30] Bill Russell: I want to touch on a couple of those things, cause I, I agree with you by the way. I remember having a physician who was highly inefficient with our EMR. And so we had the ability to collect all that information. And now it’s pretty common, but we had Meditech and back in the day, it was not that common, but we collected all the log files. We could tell what physicians were struggling and we would send people out to be at the elbow. And I remember the physician champion, who came back to me, said if I practice [00:12:00] medicine with the way he had customized the EMR, I would have quit a long time ago. And then he created all sorts, of he customized that environment. He spent probably a week with that physician listening to him, creating different ways to interact with the EHR and highly customized to it. And that physician was incredibly grateful because he gave him back a significant amount of time. So that workflow should not be underestimated.
[00:12:25] And I’ve also talked to nurses who feel like they’re the [00:12:30] forgotten clinician in the process of the EMR optimization and if we look at these numbers and look at the the nurse shortage that is happening to us today And the nurse shortage that we expect coming down the pike. We really can’t ignore that important group. And one of the ways we make them more efficient is through those automated systems, through those customized workflows. And as you say, taking the friction out, taking the rough edges [00:13:00] around the workflows and that’s a fair amount of hard work. It’s not just, Hey, go out and buy this, pop it in and everything’s going to be good. Because we’re talking about good EMRs here. We’re talking about there’s only a handful left. We’re talking about decent EMRs. It’s really about what we do with them. So where do people start with those projects? How do you identify areas where clinicians specifically would benefit from better workflow, better processes?
[00:13:28] Dr. Justin Collier: I think you have to start by [00:13:30] talking to them. We can’t in healthcare IT assume that we know the answers or assume that other stakeholders know the answers. You’ve got to actually talk to them. Do the journey mapping walk through a day in the life with them. They’ll tell you where the friction points are. They’ll tell you the things that frustrate them, keep them up at night, so to speak. In some cases quite literally keeps them up at night. It keeps them from getting pajama time. They’ll tell you what those challenges are [00:14:00] and then once you have identified what those challenges are, spend time with them doing what we call innovations sprints. Something that we do with our partners, our customers, really looking through here are the technologies that could be employed to solve those friction points, which ones make sense to you and really having that sort of focus group mentality to walk through what’s going to make the most sense? What’s going to make the most [00:14:30] impact? Interestingly sometimes it’s not the things that you would expect on the IT side to be the things that they gravitate toward. Or there may be other perceived barriers that prevent certain technologies from being the right answer ff that makes some sense.
[00:14:45] Bill Russell: That does make sense. I do remember having some of those conversations and the nurses going if you just put a printer over there instead of over there and I’m like, well, I mean,
[00:14:54] Dr. Justin Collier: Sometimes it’s a low-tech fix. Exactly. Yeah.
[00:14:57] Bill Russell: It’s pretty straight forward. It’s not only [00:15:00] in. And by the way, I don’t want people to get the impression I think that technology can solve this problem. It’s not strictly a technology problem. I think we can help with this problem. From a technology standpoint, I think the thing I would be thinking about is how do I bring clinicians up to speed quicker? Right? The onboarding process. The onboarding processes is in a lot of health systems is bad. I mean, they request access to systems. It takes a couple of weeks to get their credentials, to get everything sorta [00:15:30]online. Now I know some health systems are sort of looking at me like, what are you talking about? For us that’s a 24 hour process. But others it’s it’s a two to three week process before the clinician is actually functioning. And I would look at that process. The other process I would look at is. If there is a shortage like they’re talking about, we’ve experienced that during COVID. And some of the stories we’ve read is we bring in people like the national guard or we hire 20 nurses and we put them in the in different areas in the hospital. And I’d be [00:16:00] looking at how do we bring them up to speed very quickly on our systems?
[00:16:03] These are traveling nurses and traveling clinicians of some kind. I think there’s an assumption, there was an assumption in one of the stories that everybody’s on Epic. They went to one of the hospitals, that wasn’t on Epic. And like five of the traveling nurses walked out and said, I’m not learning a new EMR.
[00:16:20] There’s not enough time to do that. And so the staffing agencies have to be aware of what’s going on, but on our side how can we bring them up to speed [00:16:30] quicker? If you bring in traveling nurses and help from afar what are some of the practices we can look at to bring those people up quicker?
[00:16:38] Dr. Justin Collier: Well, and sometimes it’s not quicker. It’s better. If that makes sense. Sometimes we force things to be fast that maybe shouldn’t necessarily be fast. What we really want is to do a better job of it. To do a quality job of it and spending time on training is one of those things it’s been proven to improve worker satisfaction [00:17:00] with any system in any industry, but it’s definitely been proven in healthcare.
[00:17:05] Bill Russell: The hard thing is you’re bringing these people in and they’re only going to be there for, hopefully they’re only gonna be there for a month let’s say. HOw do you make them efficient? I mean, I realize there needs to be training. There absolutely needs to be training.
[00:17:18] But how do you make them more effective or is it more of a logistics thing where you say, okay, these people are going to operate in this capacity because they’re not going to have full access to the EMR?
[00:17:29] Dr. Justin Collier: [00:17:30] I don’t know that I have a great answer for that, honestly. You’ve got to do the right thing for the employee and for the patients that they’re going to take care of. You’ve got to have adequate training. That’s going to make them competent number one. But you have to go beyond just competent. If they’re going to be comfortable.
[00:17:48] Bill Russell: Well, let me hit on an IT shortage that’s happening as well. And that is this McKinsey article talks about the great attrition.
[00:17:56] And they say, or the great attraction because they have great marketing people. [00:18:00]A record number of employees are quitting their jobs as the pandemic has irrevokably changed what workers expect. Organizations that learn why and act thoughtfully will have an edge in attracting and retaining talent.
[00:18:11] I actually talked to a CIO this week. Because of the vaccine mandate they’re looking at potentially losing 10%. And as we went through the conversation, I said, okay, that’s worst case scenario, what’s best case scenario. And he thinks it’s going to be 5%. Well, I think back at St Joe’s I had 700 staff members.
[00:18:27] If I lost 5% that’s a dent. [00:18:30] If I lost 10%, that’s a significant dent in our IT capacity and capability. They gave some stats here. 40% of employees say they are likely to leave in the next three to six months. 64% of employees are considering leaving, say they would do so without another job in hand, that’s a startling statistic to me.
[00:18:50] 38% of employers believe attrition is due to compensation but 54% of employees leave because they don’t feel valued by their managers, while [00:19:00] 51% of employees leave because they don’t feel a sense of belonging at work. These are some interesting numbers and I, if I were a CIO today, I think I’d be planning on a significant amount of turnover. It doesn’t matter how good your culture is. I think I’d be planning for it. And then I’d be working on the culture as much as I possibly could.
[00:19:21] Dr. Justin Collier: It’s every workplace. And I think that latter point that you made in terms of a sense of belonging at work, how do you feel a sense of [00:19:30] belonging when every meeting is just like what we’re doing right now, interacting over video. It’s not the way that deep relationships are built and trust is built. It lacks the depth of human interaction that we were used to pre pandemic. And so I think those remote workforce scenarios, that’s just the nature of the beast that you’re going to see more turnover. Particularly people that didn’t have a long work history with the companies before the pandemic hit. One’s that have come [00:20:00] in since the pandemic. How incorporated are they into the culture? It’s tough on that employee. And it’s tough on those coworkers that they’re interacting with to build adequate relationships that make teams work well.
[00:20:12] Bill Russell: It’s interesting because the conversations I’m having with certain people, they’re saying from the employee side, they want it to continue as long as possible and they, they like it. They’re okay with this meeting thing because when they walk out that door, they’re with their family and that’s really who they want to [00:20:30] spend time with and have community with. And they just want it to be a job and get the work done. Not all of us but there’s a portion that are saying, Hey, I really like the autonomy and flexibility that this gives me. As well as productivity.
[00:20:44] One of the things we’ve heard is that people’s home environment is more conducive to those times where you need to have heavy thought and really work through problems and those kinds of things. But I hear managers saying, man, we really miss getting together.[00:21:00] There’s a value to getting together. There’s a comradery that gets built. There’s a a sense of mission of solving problems together. In health IT, one of the biggest challenges is there’s a sense of connection with the people. If you’re remote, I mean, at the end of the day, it can be this health system over here, or it can be this health system over there.
[00:21:23] It almost doesn’t matter anymore. You’re like not connected to the mission of the organization that you’re serving. [00:21:30] And so I’m hearing managers step back and say, okay, we can’t do this. It’s gotta be hybrid at a minimum. And they would prefer it to be more on-site than remote if possible, just to get back some of that connection with the team.
[00:21:48] Dr. Justin Collier: Yeah, I think that’s important. And you highlight something that’s absolutely crucial. One of the key drivers of joy in work is knowing that your work has meaning. Connecting to that mission, understanding the impact of what it is that you do. Reminds [00:22:00] me of the Patrick Lensioni book.
[00:22:02] Five Signs of a Miserable Job. Not having that connection to the meaning and the value that your work provides who your customers are. What service you’re providing to them. It makes you miserable. So I think, I think that is very important.
[00:22:17] Bill Russell: Yep. I I want to hit on a couple of things here.
[00:22:19] I want to do a telehealth update with you. I want to ask you about some CPT codes and stuff that that’s driving that before we get there. Pretty interesting announcement last week, it was just last week.[00:22:30] Leading health systems launched Graphite Health. A new member led nonprofit company to accelerate digital transformation of healthcare, three health systems, SSM Healthcare, Presbyterian Healthcare services, Intermountain Healthcare.
[00:22:42] These are some of the members that were a part of Civica RX, which was about generic drugs being manufactured for hospitals. That’s actually a pretty large group of health systems. So I expect this group to grow. It’s an interesting business model, they’re coming together at the problem they’re trying to solve [00:23:00] is standardizing the way that data and applications are built.
[00:23:06] They’re trying to build an interoperable data platform. That’s not only going to work on, it’s going to work on the major EHR platforms and it’s going to give innovators the opportunity to write applications in sort of an app store kind of model. You write it once and it works on any of the underlying systems that happen to be connected to graphite health. And I love the name because it takes out the friction [00:23:30] of, and we’ve all been there, right? You bring in this really new thing, and then they’ve got to integrate with the EMR and they have to integrate with this and they have to share data with this and each one of these projects almost feels like you’re just repeating the same steps over and over again with every vendor you bring in. And they’re looking to alleviate that problem. I think the first thing I want to ask you is, the business model TruVeta is a similar model, a lot of health systems coming together. Is this gonna be how we innovate going forward? Is this going to be how we scale [00:24:00] innovation in healthcare?
[00:24:00] Dr. Justin Collier: I think collaboration’s always been the right way to scale innovation in healthcare. So I do think that that makes a lot of sense and I think it gives them better negotiating power with those entities that are not necessarily as ready and willing to allow interoperability or if they’re slowing things down for various reasons. If you are a one hospital system or a two hospital system, you don’t have a lot of negotiating power when you’re trying to make the EMR let [00:24:30]you do something.
[00:24:30] But if you’re a coalition of larger entities or a large coalition of small entities, you’ve got a lot more negotiating power there. You have to be taken seriously by the Epics, by the Cerners, by the Meditechs of the world. I think that’s the direction that this is going.
[00:24:47] So from that standpoint, it makes all the sense in the world. They’re going to be able to get a lot more done working together. Plus you’ve got just more smart people working on the same problems and exchanging [00:25:00] ideas, finding solutions.
[00:25:01] Bill Russell: All right. We’re going to hit on a bunch of stories real quick. Anything else you want to add on that story?
[00:25:05] Dr. Justin Collier: No I think it’s, I think it’s great.
[00:25:07] Bill Russell: I think it’s great as well. I think we’ll see where this goes. ONC. So ONC more patients are downloading their medical record and using portals. I found this interesting. The agency analysis suggest increases in interoperability and patient provider communication, along with frequent use of mobile health apps. Now people might say, Hey why? Isn’t this really due to COVID? [00:25:30] And in this it says ONC notes these data points are from the health information national trend survey, which was fielded from January through April of 2020.
[00:25:40] In other words, this is statistics include patient portal use before the pandemic. And before the final rule, implementing key patient access provisions of the 21st Century Cures. So many patients have clearly delayed the hunger for their health information. The 4 and 10 individuals who access the patient portal [00:26:00] in 2020 represent a 13 percentage point increase from 2014.
[00:26:04] I want to say the portal is dead. Long live the portal. Because we see digital front door is now the new terminology and we see people really heading down that path. What do you think portal usage uptick is due to and what is the future of the patient portal?
[00:26:24] I didn’t give you any of these questions ahead of time. So these are on the fly. This is Justin Collier right on the [00:26:30] fly coming off vacation answering these questions.
[00:26:32] Dr. Justin Collier: Yeah. So I’ll answer your last question first. So what do I think the future looks like in terms of patient portal? I do think digital front door is catching on and for good reason.
[00:26:42] And that’s, if you provide a platform that does more than just serve up maybe lab results. That provides the ability to have meaningful interaction with your patient. It’s great for the patients. And it’s great for the health system. That’s how you can drive patient engagement. [00:27:00] That’s how you could drive patient satisfaction, patient interaction. But you have to have not just a massive library of point apps if that makes sense. Niche solutions that you can have your patients to death if they’re not a single platform that brings it all together. But the more features and functionality you can provide in that digital front door, the more access you can give patients to what they want or what they need to do to interact with the health [00:27:30] system the more powerful that’s going to be. You know, it’s the same kind of omni-channel strategy that we see every other industry has had and has been building on over the past two years throughout the pandemic. Any other big brand that we interact with, we’ve got one place to go. You can do it on the web. You can do it on your phone. You can do it from, whichever device, but it’s one app where you can do everything that you need to do to interact with that brand. Your bank doesn’t have a bunch of different apps, [00:28:00] right? Your bank has one app. Your airline back when we used to travel a lot you didn’t have to go a bunch of different apps to do everything you needed to do to interact with Southwest or Delta or any of the others.
[00:28:13] Yet all those platforms are a platform that has a bunch of different features. And of course Amazon’s a great example of that, too. Right? You can get to Prime music you can get to Prime video. You can shop, you can order your groceries. Like all of those things, all from a one-stop shop [00:28:30] and healthcare is just catching up to that trend.
[00:28:32] But it’s the right trend and right and it’s the right value to deliver to your patients, right? Give them their education, give them their place to jump to a telehealth visit, give them their place to store their information, to provide information at the health system, to get information from the health system, to schedule an appointment, to do all the things they need to do to interact with the health system.
[00:28:54] Bill Russell: Yeah, you hit the nail on the head. I mean, one of the things I say more patients are using the portals to communicate with providers roughly 6 [00:29:00] in 10 did so in 2020. And that is the magic bullet. And more than half user clinical notes written by the provider. In 2019, about 10% requested a correction of inaccurate portal information.
[00:29:13] When we were developing our digital front door back at St. Joseph was interesting because we were spending so much time on getting the medical record presentation just right. And we had a list of like 10 features we were working on. And that’s when we were spending all of our time.
[00:29:28] And I don’t remember who suggested it, but [00:29:30] we ended up going out and doing a survey of our patients and saying, what do you want most out of the digital front door? And it was that communication. It was, I want to schedule an appointment. I want to communicate with my doctor. I want to I want to interact with the health system.
[00:29:43] And I think storing and viewing the medical record was like, Number eight and the aspect of storing and viewing the medical record they wanted to have was to be able to give it to somebody else like, so they have their medical record from us. They’re tired of being [00:30:00] asked by somebody else or filling out a form to request that medical record to come over.
[00:30:03] They wanted to just from their phone and be able to go, would you like my medical record? Swipe. Here you go. And give it to that next provider. And that really changed how we were thinking about it. Not that we didn’t spend a lot of time making sure that that presentation of the clinical data was right but we did direct a lot more resources to the communication and the scheduling and all those things that they really wanted to do through those, through that application, be called a [00:30:30]portal or whatever we cal it.
[00:30:31] Dr. Justin Collier: And that, that desire to exchange information or to be the driver, to get the information to the right provider at the same time, it could be within the same health system in a lot of cases, unfortunately.
[00:30:42] We experienced that last year when my mom was going through her terminal cancer journey. If we went to the hospital we had access to things, but we had to bring things from the physician and vice versa. Even though the physician was part of and an employee of that health system, it was absolutely miserable. [00:31:00] So being able to just have that information flow less friction and with more ease, I think that’s a huge desire for patients. So I think that’s fantastic, but you know, to your point on communication with physicians that’s not even new news, right? It’s you know five 10 years ago, Kaiser had already had more interactions happening asynchronously and not in person.
[00:31:25] Phone message, email other avenues with their primary [00:31:30] care than they had in-person visits. And that’s a longstanding trend. But it’s because they made it a big. And patients gravitated. It was easier for the patients in some cases easier for the physicians to do things synchronously you get an email, you answer the email, but at the same time, you don’t want to overload the physicians with their in-basket.
[00:31:52] Bill Russell: Well the reason they made it available is because their business model is different. They’re not fee for service. They’re the carrier and they’re the [00:32:00] provider.
[00:32:01] Dr. Justin Collier: They’re aligned.
[00:32:03] Bill Russell: Yeah they’re aligned. And it’s interesting. Cause we’re going to go into telehealth here and take a look at just get a little update on telehealth and where it’s at. There’s a handful of stories. CMS is boosting telehealth and remote patient monitoring with new CPT codes. Maryland Ensure Care first launches virtual first primary care business. Telehealth use is surging but patient satisfaction with the service has declined. A new study finds that’s JD Power and [00:32:30]associates survey, and then telehealth experience growing pains along with expansion.
[00:32:35] Dr. Justin Collier: Let’s touch on the patient satisfaction real quick. So I have a theory. I have a theory on this one. I think it’s because the novelty is gone. I think that’s a big piece of it. I think that early in the pandemic, when it was a new thing and it was easy and convenient and that new experience, I think some of the newness of it probably was driving some of the higher satisfaction before and now it’s, [00:33:00] if you’re having a televideo visit with your physician, it’s, it’s no different than your zoom meeting with your colleagues at work or your customers. It’s just another Zoom meeting so to speak.
[00:33:10] Bill Russell: Yeah. From my parents’ perspective, it is they’re afraid that they’re not going to catch everything. Right. So I guess their hope is that when they’re sitting in front of the clinician, they will see something. And my mom has a story where they actually did see something and say something’s not right. And she wonders if they would have seen that through telehealth.
[00:33:29] [00:33:30] We can’t ignore, there’s different views of where we are at in the pandemic and getting together and all those things. There’s a whole host of people that are essentially saying you know what I’m ready to get back in front of my physician. I’m ready to get back out into the world.
[00:33:47] I’m vaccinated. I’m protected is the thought process. So I want to get back out there and so there’s almost a dissatisfaction if you don’t let me come in and see you which my mom actually expressed to me this week. She’s just like the [00:34:00] doctor wouldn’t let us come in and see her. We have to do it via telehealth.
[00:34:04] Whereas during the pandemic, almost everyone was saying, Hey, I’m satisfied with this because they understood and recognized the safety aspect. And I realize we’re still in the pandemic. I will say early on in the pandemic, we didn’t know what we didn’t know. And people there was a high level of satisfaction because we could still get care and we were doing it in a safe way. Whereas there’s just different views today than there was early on in the pandemic.
[00:34:29] Dr. Justin Collier: [00:34:30] Yeah. And in the longterm once the world is healthier, I think it’s going to be convenience and ease that will drive continued telehealth encounters. It will be an option. Some people will gravitate toward it and then it also will depend on what they need to be seen for.
[00:34:49] Bill Russell: A couple of things from the survey telehealth adoption spikes across all generations in 2021. Convenience speed and safety drive utilization. That’s what you were just touching on. Patient satisfaction [00:35:00] declines as pain points emerge. Overall satisfaction with both direct to consumer and payer sponsored telehealth services decline in 2021 for 2020.
[00:35:10] The most frequently cited barriers encountered by patients are limited services, lack of awareness of costs, confusing technology requirements and lack of information about providers. All right. So those are the four things that were cited. Not really, I mean, if I thought about it, not really a lot of [00:35:30] IT related things. I guess 24% are weel no a lack of awareness of costs. Not sure what we can do from a technology standpoint except for have the costs easily seen.
[00:35:41] Dr. Justin Collier: Transparency. That’s pretty easy to fix. So this is the trend that we’re seeing across the country, across the world with our customer base, is the need to mature what was slapped in very quickly, in some cases with virtual duct tape and bailing wire to have a telehealth [00:36:00] solution. But it really wasn’t a full telehealth solution even then, it was a televideo solution. So the limitation and services that you cited as one of the number one examples, that’s a grey area while we’re seeing things mature and we’re seeing the addition of remote patient monitoring and certainly that oNC CPT code change. Making things more permanent in terms of remote patient monitoring in terms of what can be delivered virtually. I think that’s great. [00:36:30] And I think that’s going to drive some of those improvement in terms of improvements the number and variety of different services that can be provided.
[00:36:37] Yeah, when it’s just video interaction, then that limits things quite a bit. And it really limits things. When you’re dealing with patients who have chronic conditions, where you need more data points. You need to know what their vital signs are. You need to know those other things once you can virtualize that it makes that care much more efficient, much more effective and lets you do more [00:37:00] things, but there’s also gotta be better technologies, better experiences. Perhaps it’s incorporating it in the digital front door that we talked about earlier. It’s making it easier to access, easier to use making it something that’s as easy as the click of a button, not a confusing technology where you have to download something and then you have to verify and validate something and you have to connect this way and do that.
[00:37:24] It’s the maturation process that it’s all going through that’s going to solve at least some [00:37:30] of those drivers and dissatisfaction that you mentioned.
[00:37:33] Yeah, it’s
[00:37:33] Bill Russell: interesting. They rank one of the major providers of telehealth, Teladoc was ranked the highest in customer satisfaction among direct to consumer brands with a score of 874 and B live ranked second and My Telemedicine 859 ranks third. United healthcare ranks highest months payers with Humana and Kaiser tied for second. It’s interesting. I don’t think I’ve used my provider telehealth [00:38:00] but I have used my payers telehealth. It’s included in my plan. The initial visit is free because quite frankly it saves them money.
[00:38:07] They get to direct my care and make sure I don’t over utilize or go to the wrong place and that kind of stuff. So I guess there’s a benefit in that. And both my wife and I I have started visits in that direction. And in every case we never ended up at the provider. Like it was taken care of without ever going [00:38:30] to the the local provider network.
[00:38:32] And I think that’s one of the things that healthcare providers need to be aware of is that there is, and that’s the point of entry I believe that everyone’s trying to get to, which is we want to be your first call. CVS wants to be your first call. Your payer wants to be your first call. Amazon Care eventually wants to be your first call.
[00:38:57] EmployerTtranscarent is a new model [00:39:00] that that Glen Tullman is bringing out. They want to be your first call for an employer plan. Everybody wants to be your first call because if you direct the care, you can either, you control the experience, you can drive costs out of the equation.
[00:39:17] And I think that’s where people are starting to find the dissatisfaction with healthcare is and transparency and cost. And they’re saying, all right, if somebody else can help me navigate this to [00:39:30] drive out my costs. And a lot of times I hear people say, well you’re not paying for it anyway. Well, I, I sort of am. I’m an employer. I have people on my insurance plan and yeah, I don’t want to just use that because eventually what that’s going to be is higher premiums for me next year. And so that’s why we’re investing all sorts of things around wellness programs. You know programs for stretching. Programs for things that keep you from injuring yourself [00:40:00] and whatnot.
[00:40:00] Those are valuable to employers and we’re, we’re trying to drive cost out. And it’s that first phone call? I guess the question I have is can providers step into that gap? And are they going to step into that gap of being that first phone call to help direct care?
[00:40:18] Dr. Justin Collier: I think they already are in many cases. And I think it’s, I think it’s absolutely crucial as we see things move toward a more value-based care system where it’s a move toward [00:40:30] true health insurance to work toward wellness as the focus and not just sick care fee for service. And even those fee for service systems that are slow to move into at risk models. If they can do a better job, drive cost out of the system, be more efficient. It’s going to help them negotiate their insurer rates, their payer rates with private insurance and move in a better direction from a business model standpoint. [00:41:00] But the other thing that’s going to drive it honestly, I truly believe and it’s been happening and it’s been accelerating is the consumer expectation that those technology tools will be available. And that it’s not just that you could be my first call it’s that you are the first call. That’s easiest for me that has the best experience that gets me what I need.
[00:41:24] That’s what’s really going to drive success in the space. So it’s not enough just to have an [00:41:30] option and it has to be a good option. Yeah. Convenience is king and experience is everything.
[00:41:38] Bill Russell: Yep. This will be the last thing I touch on. CMS boosting telehealth and RPM and CPT codes. Because at the end of the day, we can talk about adoption from a consumer standpoint but the incentives have to align, the culture has to align, clearly the technology has to be in place but quite frankly, policy has to align. And the biggest payer is CMS in the country. They pay all the [00:42:00] Medicare claims. And so they’re adding some CPT codes. And I think that is one of the things I’ve heard as I’ve talked to people is that they want. They want to see the government and both federal and state step up and recognize areas where telehealth has been beneficial to the community, driving better health driving down the cost of healthcare and start to support that.
[00:42:27] And I think when you see additional [00:42:30] CPT codes, especially for remote patient monitoring, I think you see that. They now have a wealth of information. They have the entire pandemic of claims data and codes to look at to say, okay this was beneficial. This was not. This was just an added expense.
[00:42:48] And there, there is a case to be made. Telehealth can be just an added expense if not in the right area. They’re starting to add those things and they’re also starting to identify fraud and go after the fraud that they said was the [00:43:00] reason we did not expand this earlier and they’re not wrong. There’s a fair amount of fraud they’re going after right now.
[00:43:06] Dr. Justin Collier: I think the other thing that they’re looking at is what was missing. What could have been, that would have made a difference that would have been an improvement as the pandemic has grinded on what we’ve seen is that some things you can take care of, great over televideo but televideo alone doesn’t give you great insight on everything. The other thing CMS is looking at is those health systems [00:43:30] that do provide remote patient monitoring for chronic disease or post acute care. Their outcomes are better because they have more data on how the patient’s doing.
[00:43:40] They can be predictive, they can catch things early, be preventative or at least be earlier in terms of treating things rather than waiting for somebody to crash sort of huge benefits and that’s another thing that’s being weighed in. To me, that’s the exciting part about seeing the permanence starting to happen as these CPT codes are being [00:44:00] changed, instituted. Seeing some of the things that have been a permissive environment transitioned to being a real and more permanent kind of a thing. And remote patient monitoring, I think is absolutely crucial. If you have let’s, let’s keep it simple. So if you have high blood pressure and you’re dependent on a couple of visits at your physician’s office to be all the data that’s collected about your high blood pressure.
[00:44:25] Or maybe you’re keeping track of it and writing it down [00:44:30] with a blood pressure cuff at home and bringing that in to the physician’s office. That’s one thing, but it’s a very analog very episodic monitoring of that condition versus moving to something thats remote patient monitoring of your blood pressure.
[00:44:46] You still have a blood pressure cuff at home, but that data’s being uploaded and it’s digitized and it’s going into the system where it can be analyzed where AI in the background can take a look at it [00:45:00] and see trends. Your clinician can see it graphically in the digital tools that they use to do their job.
[00:45:07] They can understand what’s going on with your condition over time. Anything that’s a real danger sign that AI can flag. Bring it to the awareness of the right clinician at the right time to say, Hey, this is not a good trend. Something’s going on with this patient that we need to address.
[00:45:24] And there’ve been health systems that have been moving in that direction. St. Louis, for example Mercy Health, Mercy Virtual. They’ve [00:45:30] been doing this for a long time where they’ve had their chronic disease patients being monitored continuously through remote patient monitoring, they’re able to catch a lot of things, prevent a lot of things.
[00:45:41] I ,see a lot of improvement in terms of reduced re-hospitalization reduced infections, reduced septic shock desks, things like that, by doing these things seeing the government start to recognize that it’s not a new trend, the places that have been doing it have better outcomes.
[00:45:58] Let’s make it [00:46:00] available for everybody so that the incentives are aligning around taking better care of those patients. It’s absolutely fantastic.
[00:46:06] Bill Russell: That’s a great note to end on. Dr. Collier. Thank you for taking the time out of your vacation to spend some time with us. Really appreciate it.
[00:46:15] Dr. Justin Collier: Absolutely. Pleasure.
[00:46:16] Bill Russell: 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 this [00:46:30]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. [00:47:00] Thanks for listening. That’s all for now.