Ed Ricks, Eli Tarlow, Fred Holston, Bill Russell, This Week in Health IT
July 22, 2020

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July 22, 2020: Digital initiatives in healthcare are being accomplished at a staggering pace. What is the patient room going to look like next? What is the future of hospitals? We had a compelling discussion with a CIO, CEO and CTO from Sirius Healthcare. Please meet Eli Tarlow, Ed Ricks and Fred Holston. They talk about the why, the what and most importantly the how. The cat really is out of the bag. We are never going back. Digital has changed things for good.

Key Points:

  • The landscape of the patient room [00:05:55]
  • Sharpening the digital tool belt [00:09:25]
  • See how organizations revamp workflows on the fly [00:10:15] ]
  • Transitioning from brick and mortar to more technology enabled outcomes [00:11:10]
  • Popup tents, temporary ICU, recovery rooms [00:11:55]
  • The shift to community care and more outpatient care [00:15:40]
  • Rethinking the whole paradigm of what goes on in the hospital and in workflows
  • Patients new expectations of healthcare [00:27:15]
  • We can do things today that we hadn’t even thought about before [00:41:40]

Patient Room Next

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Patient Room Next

Episode 282: Transcript – July 22, 2020

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: Welcome to This Week in Health IT where we amplify great thinking to propel healthcare forward. My name is Bill Russell, healthcare, CIO, coach, and creator of This Week In Health IT, a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. This episode, every episode, since we started the COVID-19 series has been sponsored by sirius Healthcare  Now we’re exiting the series and Sirius has stepped up to be a weekly sponsor through the end of the year. And [00:00:30] we want to give a special thanks to Sirius for supporting the show’s efforts, during the crisis and beyond. Don’t forget, we’ve gone to three shows a week. Now, Tuesday, we cover the news Wednesday and Friday.

We do a shows with industry influencers like today. I want to thank everyone for your support of the show. We’ve eclipsed a hundred thousand downloads for the first six months of this year, which as you recall is what we had for the entire 2019 year. You continue to make this the fastest growing podcast in the health it space.

Thanks for sharing with your [00:01:00] peers, to make it easier for you to share it with your peers. We’re launching a thing called clip notes, which is essentially a summary of each podcast that comes into your inbox. Think of it this way. What we’re going to do is we’re going to send you a, a single email for every episode that we do.

And it’s going to have a one paragraph summary of what we cover. It’s going to have bullets points with key topics and timestamps. So you can, determine where to go within the podcast to listen to what you want to listen to. And we are also going to have a couple of clips, one to [00:01:30] four clips from the show that the shorter segments, three.

Three to five minute clips of the show that might cover a specific topic. you’re going to have that within 24 hours of the show being released. And, you know, the thing that excites me the most about it is I had conversations with CEOs. during the, during the pandemic, during the peak of the pandemic.

And, they were talking about how they, they didn’t have enough time to consume all the content and they wanted a way to skim the content. And that’s why we came up with clip notes. what our hope is is that you’re gonna be able to [00:02:00] get this in your inbox, review it, and then forwarded on to key members of your staff or key people you work with, so that they can have the benefit of some of the conversations that we’re doing right here.

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You’re going to receive a link that comes right back to you and your [00:02:30] email. You click on that link and you can sign up that way. So we’re trying to make this easy and hope to get as many of you signed up for that as possible, so that we can continue to share the content from the show. As always special, thanks to our channel sponsors, VMware, StarBridge Advisors, Galen Healthcare, Health Lyrics, Sirius Healthcare and Pro Talent Advisors whose investment in the show has given us the ability to hire additional staff and to provide these great services.

So, I did this show a little while [00:03:00] ago. I recorded this probably almost eight weeks ago now and, didn’t get a chance to air it. We had so many shows recorded and so much in the pipeline that I didn’t get a chance to, to, to release it, but I wanted to get it out there for you and for the community.

I had a discussion with 3  partners of the show, around what is going to be next within the hospital. What is the patient room next  going to look like? And we had a good conversation, recorded it here for [00:03:30] you. Hope you enjoy. The patient room next is what we’re calling this conversation.

Our panel for today is  Fred Holston, Ed Ricks and Eli Tarlow from Sirius Healthcare. Gentlemen. Welcome to the show.

Ed Ricks: Thank you bill. Thank you.

Bill Russell: Alright, so, you know, I’ve been reading a lot and I’m sure you guys have been reading a lot on the impact of COVID-19 on healthcare. but some of it is has really accelerated the move to digital at an amazing speed.

Jack G. Lewis who’s [00:04:00] the CEO of USC shared that they did 300 total telehealth visits in 2018. And 5,000 over the last two and a half weeks. but before we jump into this, why don’t each me give maybe 30 seconds on your healthcare background? that way we’ll sort of set up the conversation. Eli we’ll, we’ll just start with you.

Eli Tarlow: Thank you, Bill. And thanks for having us on this podcast. so I’ve been with Sirius for about two months now, before I joined, I was most recently a CIO. [00:04:30] at Brookdale hospital in Brooklyn, New York for a couple of years before that, I was CIO for a couple of other hospitals, notably Bellevue hospital and metropolitan hospital in the city.

And I held other healthcare IT leadership roles in both public and nonpublic, healthcare since 2001.

Bill Russell: Fantastic. So you’ll represent the, the CIO’s perspective on this show, which is great, Ed, do you want to introduce yourself?

Ed Ricks: Yeah, thanks bill. Appreciate it. So prior to joining the series, I’ve been with Sirius [00:05:00] for just about two years now, but before that, about 20 years, primarily as a health system, CIO, around the Midwest and the Northeast and Southeast, but the last nine years and the town called Buford, South Carolina, where I spent probably the last three and a half years as the COO there and sort of still had IT but led operations of all the ancillary departments and service departments and our population health initiatives.

Bill Russell: Great. So we’re going to have you take to the CEO perspective and, and Fred, give us a little [00:05:30] bit of your background.

Fred Holston: Sure. Fred Holston I’m Director of Healthcare here at Sirius been with Sirius for just a hair over five, five years. Came from Intermountain healthcare is their chief technology officer. I also left as the creator and executive director of the innovation lab, which we call the transformation lab there didn’t know.

Bill Russell: Fantastic. so there’s your CTO, his practice perspective.

So CIO, COO and CTO. What we’re going to talk about is the changing landscape of the patient room and [00:06:00] really the hospital just in general. you know, the number of digital initiatives as we touched on earlier, and the pace at which we just accomplished, it is pretty staggering. Jonathan managed the CIO for Christus wrote in modern healthcare just today tha A t you know, the cat is really out of the bag and we were likely never going back to that digital, we we’ve experienced digital and our consumers have experienced digital and it will change things, for good is what he believes.

and, you know, I guess my first question is [00:06:30] why is that a good thing? And, you know, let’s start with Ed, let’s start with the CEO’s perspective. Why is that a good thing that digital is going to take hold for the, for the business of healthcare or for the operations of healthcare. you know, moving forward.

Ed Ricks: If you could remove the clinical benefit, what’s it. It’s going to be huge in that probably above anything else. We’re going to create some of the efficiencies that other industries have been working with for 15 years, you know, [00:07:00] the way they’ve used digital and sort of input it in their business from buildings to, operations, to people in the way they actually manage what’s going on.

So to me, that’s going to be one of the biggest gains, certainly because there’s so much technology available that we’ve underutilized from an operational perspective for years, it will be integrated into our day to day lives. Probably.

Bill Russell: Yeah, it is, it will be interesting to see, and we’ll go into more detail of, of where that sort of integrates and what that looks like, in the hospital.

You know, [00:07:30] Eli from a CIO perspective, digital is taken hold. Why is that a good thing?

Eli Tarlow: Well, first of all, why digital hasn’t taken hold historically in healthcare. And, you know, we can spend hours talking about why the healthcare industry lags behind. Others, as it relates to technology, you know, for one reason, healthcare, we have to be more risk adverse or risk balanced.

It is human life. it’s more it’s science as well as art. but with every crisis that comes opportunity. And with [00:08:00] most recently with the coronavirus, a lot of the things that we’re seeing in the last two weeks are things that we know. We haven’t been able to progress on whether it was. For funding reasons, legal reasons, et cetera that have now really propelled and, and, has gone for the last couple of weeks.

I’m personally excited about a lot of the things you’ll be able to accomplish. And I, I’m really excited about the fact that that will be sticking as you pointed out.

Bill Russell: Yeah, it will be interesting. you know, Fred, from, from your [00:08:30] perspective, you know, we’ve talked about patient room now in future, and the, technology foundation for that, you know, why is it a good thing that the digital technologies will be coming in, you know, was there, or were there challenges with the existing technology?

Were there things we were unable to do that now we’re going to be able to do.

Fred Holston: Well, I think so a part of it was that we wanted digital technology or technologies. I wanted [00:09:00] to start the study around digital, to influence healthcare, whether that’s decision, support, protocols, support, whether that’s the HR, regardless of what it is, but we kept layering those on without figuring out the workflows.

And the workflows now have gotten, we used to call it, we needed a tool belt for a nurse, cause there were so many things I needed to carry around or do so many computers. So the type on, so there’s two pieces. Yeah. The digital side one ends that we’re going to hopefully create better workflows and that the computer does more, but [00:09:30] actually gets out of the way.

But the other is, is that in many of our healthcare patient rooms, we can’t do the surveillance or monitoring of patients. Like we really would like to hook them up to a heart monitor. That’s one thing. Then later that’s one thing, a pump. That’s one thing. But when they’re just in the patient room, who’s watching them.

The nurse can’t be there all the time. The family may or may not be there all the time, the digital influence on what we’re going to be able to watch going forward and what we’re going to be able to learn about people and how we change their care minute to minute. [00:10:00] And then as they go home with what we’re going to be able to watch, I think will be a huge impact in the future.

Bill Russell: Yeah, I agree. So the, you know, the COVID-19  pandemic that we’re currently dealing with. We’ve seen, organizations revamp those workflows on the fly. Right. And so we’ve, we’ve put some things in place and we revamped some of the workflows and obviously some of that stuff will have to be thought about when we’re not in a moment of crisis.

So let’s, let’s [00:10:30] assume let’s, let’s fast forward a little bit. cause we could talk about now, but right now people are still sort of battling through crisis mode and, and you know, it’s amazing that we stood these things up there. They’re filling gaps, but if we were to step back and start to think about.

I’m setting this up in a, in a way that is, you know, is purpose-built planned thought through, in order to get the, you know, the best outcomes for the health system. you know Ed, we’ll start with [00:11:00] you, you know, what, what kind of outcomes are we looking for? What kind of workflows and what kind of outcomes would we be looking for? From really transitioning from brick and mortar to more technology enabled workflows and processes.

Ed Ricks: Yeah. I mean, I think the word that always comes to mind for me, bill is flexibility. Right? So you, I mentioned sort of, Necessity is the mother of invention. And so people are accelerating what they’re doing today, which is incredible. When I’m talking to [00:11:30] friends in the industry, what they’ve done on the last two or three weeks, it probably is more than they’ve done from a change perspective in the last two or three years. Really when you think about your clinical workflow and everything to the organization, so building flexibility, using a thinking more virtually beyond the bricks and mortar, cause we’re sort of stuck with the bricks and mortar that we have, you know, for our own perspective. And I know we’ll get into some of the concepts in a little bit, but today we have what we have, right? So you’re seeing the popup tents. You’re seeing people [00:12:00] converting recovery rooms to temporary ICU and things like that really quickly.

And the plans were probably already, always in place for that. But now it’s gone into action and you learn from that, which is the other good thing really from this. Is everything that people are going to learn. Well, they can improve on. So, you know, most of them organizations over the last 15 years or so adapted some sort of maybe lean technology for performance improvement.

And this is really accelerating that even the, so this is like make a change is a better, good. If it’s not better, make a different change and keep going on. [00:12:30] And that is the stuff that sort of really excites me and energizes me in what people are doing.

Bill Russell: Yeah, absolutely. Eli and Fred, I’d like to really hear both of you sort of weigh in on, you know, what does it look like? So we want to build the agility in, and we’ve seen some of this play out, right? So the health, it really, it has been, kind of the, you know, the support best supporting actor in this whole thing of ramping things up with a certain amount of agility. So we had some systems in place to, to make the transition [00:13:00] for rooms and those kinds of things. Is that going to be the design criteria, moving forward, agility, being able to respond, in, in a crisis and being able to, build new workflows and those kinds of things. And, and, you know, Eli, I guess we’ll start with you. you know, how are we thinking about the technology at this point?

Eli Tarlow: Thanks bill. So how to answer that in two ways, the first is that as Ed mentioned, it’s about having flexibility or, or make things so that they’re module modular. Cause we don’t know what [00:13:30] the next crisis will be and we need that kind of flexibility or the ability to just change, purpose. But the second thing I want to really focus in on is that coronavirus and repurposing of space has really, amplified something that we’ve all been we’ve known for a while is that hospitals are really, really becoming more care centers for the highest level of acuity, you know, previously over decades.

People went to hospitals for many things that are now being taken care of and ambulatory care [00:14:00] settings is moving to home health. It’s moving to tele-health, it’s moving outside longterm care post, et cetera. And hospitals at brick and mortar buildings are becoming more and more where patients have no other places to go.

Now if this latest epidemic, that’s exactly what we’re seeing. People are making choices. They’re saying, okay, I’m going to go to the hospital if God forbid I not, not. If I have a virus, I’ll go to my, you know, my primary care physician. I’ll go to a, pop up. I hate to use that term, but you know, I, I’m a clinic, a [00:14:30] CVS just if I think I have the symptoms and I’ll only go to that to the brick and mortar hospital if it’s, if it’s lifesaving and I think that’s really.

A, what the hospitals are going to become and BA, and how we designed it from a technology standpoint that has to really become our true North. If it isn’t there already, we have to start to think about the patient rooms, not just how can I turn a med surge bed into an EIQ, but how can I continue to turn the hospital into the higher level, of care, place.

So. [00:15:00] I think A, we have to look at those rooms, the wards, the units, those services, and how do we, how do we kind of align the technology strategies for that, but, and keeping it somewhat flexible cause we won’t get there overnight, but B is, that’s really what those buildings are going to become. So how do we make sure that whatever our investments are that, they make sense in the decade from now.

Bill Russell: And Fred, I’m just going to ask you to build on that, but Eli, I’m not sure we can say that anymore. We can’t build it overnight. Cause we just did. We built [00:15:30] a ton of stuff overnight. It’s unbelievable.Fred do you want to build on, on what Eli’s talking about?

Fred Holston: Yeah, I mean, I think we were headed there anyway, I think is the shift to community care, more outpatient care as Eli was talking about shifts, and really that hospital becomes this. It ebbs and flows between, well, if I’ve got room, I’ll keep people for observation. If I don’t have room people for observation may go home and be centered up, you know, as they go home. And so that room was always [00:16:00] needing to change for the future so that we could have them flow it. What’s really needing to change in situations like this is how do you help? Clinical equipment is one issue. Staffing is another well, they’ve always been staff on the floor for those rooms, but they’re not always necessarily fully trained on the protocols for certain critical or ICU situations. So how did, how can you now have the room rise to help them with those protocols step by step, [00:16:30] the distance specialists, those kinds of things.

And so it’s always been on that path, but I think now we have a reason to. expedite that path.

You know, one

Bill Russell: of the things that, I’m struck as I hear you guys talking is just how, how integrated the  technology tool is going to be and the physical design and plant and how we sort of play in these things.

And you guys have probably been through building projects. I’ve been through building products. It’s amazing to me, how much of an afterthought IT was. In those [00:17:00] building projects way back in the day. I mean, it was essentially, yeah, we set aside this much money. Just make sure that the room can do what it needs to do was sort of the conversation.

But it sounds like what you’re saying is, yes, we’re going to have to think about the workflows. It’s almost like we’re completely. changing how we think about how we provide care, what the what’s, the proper setting, getting them to the right setting, providing, you know, higher level of acuity care.

In certain instances, maybe even maybe a certain [00:17:30] higher level of acuity care out of the home with remote monitoring and those kinds of things. Are we going to be rethinking the whole paradigm of what goes on in the hospital and in the workflows across the board? Is that what I hear you guys saying?

Eli Tarlow:  If I can jump in bill a federal smile, Fred and I spent a big part of last week, actually. We were asked by a hospital, in the Tristate area, in Connecticut actually. And they were there, they’re building, new brick and mortar, property. And they asked us actually, before they stick a shovel in the [00:18:00] ground to help them design their technology stack for that building. And a lot of what we’re talking about today.

So they haven’t even begun. You know, construction on it and they’re really yeah. Asking us to help them think about these things. So that’s a forward thinking organization. I wish all were the same, but we’re starting to see that more and more where, our clients, where hospitals are starting to say, hold on a second, how do wee? We have an opportunity, whether it’s a new building it’s weather or it’s repurposing something [00:18:30] different types of opportunities, come to us and stopping to say, hold on a second, before we do anything, how do we prepare this to be something that, it makes sense for a long time.

Bill Russell: So Ed what kind of business questions are we asking? Are we, are we rethinking some of our, some of our normal business practices?

Ed Ricks: You have to, then I think it does start the technology though, and it’s sort of their thought leadership to be in advance of the building. So Fred nailed it in the future. I think that acute care hospitals would be for extremely [00:19:00] acute patients and that’s it.

That’s all we’re going to do are procedural things. You know, everyone else was going to be treated some other step down way or at home or whatever, whatever it could be. And the technology brings the clinical process together that, so I think the business questions are, can we make. Any place flexible enough to be a very high level of acuity may not always use it that way.

Right. But you gotta plan ahead. And I think if you’re not planning ahead in you’re sort of short shifting yourself later. So to me, it’s looking at that. It is, how [00:19:30] do we use technology not to be in the way, but to be invisible to the clinicians, you know, as also a CIO for 20 years. I know I was, I’m very big part of the problem of sort of screwing up to the clinicians.

Life and work flow all for the right reasons, you know, and we can say whatever drove us, if it was to be meaningful use, if it was to be compliant with some regulation, whatever, whatever it was, we were still glorifying EHR as billing systems and letting the clinicians pay the price for that. And I think that the effort now is let’s look ahead. How [00:20:00] can we get the most advantage out of those clinicians who are fewer and fewer, by the way. And I think the workforce in the future is going to be an issue. And we may talk about that later. Well, how can we get the most out of their skillset without invading or, you know, being in the way, being a barrier to what they do and, you know, making the technology more invisible from thinking of it in advance, not as an add on which is what we’ve historically done.

Bill Russell: All right. So we’ve talked about the, why we’ve even talked about [00:20:30] th what that we’re going to do. We’re going to remap these, we’re going to remap our care settings. We’re going to raise acuity and do those things, but start to talk about the how, and Fred, I think we’re going to start with you on the, how, which is, you know, how we do this, what does it look like?

You know, the same, is it the same way we put in a foundation? For the  physical building, we’re going to put in a, a technology foundation to support this and a business process foundation and a staffing foundation. I mean, what [00:21:00] does it look like to do this?

Fred Holston: Yeah. So we’re, we’re viewing it as in the foundation side of, of your comment. What are all the sensors we could be putting in the room to make the room. work for us and collect data. I mean, part of this knowing what’s going on, collecting the data, everything from touch, and we’re looking at touchless. How do you do touchless vitals? How do you do. Touchless proof of life. How do you do touchless movement?

How do you, and then how do [00:21:30] you model the data that you’re getting to say and actions happening? If you look at one of our goals, when we look at patient room next, we really want the actions of what nurses and doctors are doing to create documentation, to get out of it, pecking on the computer, do what you do, do it well.

And while you’re doing it, create the documentation. And by the way, when you’re not there physically around the patient, We’ll look at what’s going on and be able to, alert you ahead of something going wrong ahead of a code blue or ahead of a fall or ahead [00:22:00] of whatever it happens to be those all start with putting the right types of sensors.

There’s thousands of sensors out there. You can imagine column IOT, call them whatever you want, but there is a subset of those that are really good at what they do. And we can put those in. Make them part of the infrastructure, take the data from that build models. And as we get smarter over time, we’ll build more models.

We’ll load those models and we’ll get smarter over time. We’ll load those models and continue this evolution. And then for [00:22:30] staff, hopefully we will be changing their workflows in such a way that they become more efficient. They’re doing the things that number one, they like to do most nurses get into it.

Because I’d like to take care of people. It’s not just a job. I like to hear people. My brother’s a physician, he got into it because he likes to take care of and help people, let him get back to doing that and doing it well. But the other piece, I think that’ll change is the satisfaction of our patients, whether that’s family members that we’re trying to deal with or satisfaction and mental, [00:23:00] not mental health necessarily, but the mental attitude of people in the hospital, are they satisfied? Are they distracted? And do they feel like they’re being taken care of? Can we provide digital companions that allow them to feel like they’re being taken care of? And then when they transition out of the health, traditional brick and mortar back home, can those companions go and continue that cares. We move them from one, look, one. Here environment to another. So there are a lot of things that’ll, that’ll come along and it starts with kind of this fundamental foundation of, [00:23:30] but to get the right sensors in there and start this process of getting data and modeling that.

Bill Russell: Wow, that is interesting to me in that first of all, you mentioned a lot of technologies that are already out there. I think we’re talking about the next iteration of this. And some people might think, Oh, that’s, that’s way off what you’re talking about, but we’ve already had nuance and others on the show talking about ambient clinical listening, IOT.

We’ve seen things from a lot of different vendors. Some of them are really sophisticated, the amount of [00:24:00] data and the things that they can actually monitor that are going on in the room. as, as you said, you know, that that technical jargon for it would be IOT, but there are thousands of IOT devices.

So is this another one of those cases where there’s a ton of technologies and we really have to figure out a way. To, again, we don’t want the technology to lead the business problem, right? This is how we get in trouble and we get in trouble. How we’ve gotten in trouble over the years. We really want to step back and understand the business and then start to put those [00:24:30] things in.

Now, are we seeing business models start to move in this direction? I mean, Intermountain was one as, the EIC view or actually they have the digital hospital, right. It’s mercy in st. Louis that has the ICU, and others. Do we think that that’s going to be, you know, one of the more prevalent business models that we’re going to see, start to, people are gonna rethink the hospital and, and start to provide those digital services for their community.

Fred Holston: I [00:25:00] just think there’s, there’s no doubt. there’s, there’s zero doubt in my mind, they’re going to be rethinking that. you know, one of the things that, that occurred in all the healthcare legislation for the past in number of years, patients feel empowered and patients want to work a certain way with their health system.

And that is now driving. How they, how we, I I’m a patient. How do I want it care? And it’s driving that, and it’s not just a cool digital app. That’s out your phone, it’s the entire [00:25:30] process. So I think this entire rethinking of what it is provide, but the good news about that is it isn’t just, Oh, we have to do this because that’s customer service of our patients and satisfaction.

They want, it really can be a game changer of how we can lower our costs. Improve patient outcomes and actually make our physicians and nurses more happy in what they do. And at the end of the day, collect more data that will help us in the longterm research of, you know, how we solve bigger, bigger medical and healthcare [00:26:00] problems.

Bill Russell: Yeah. And that’s one of the things I want to back to the how in a minute, but that’s one of the things I wanted to touch on with you guys. And I’m sorry, I’m throwing you curve balls. I’m just throwing a question out there to all three of you and letting you jump on each each other. So I apologize, but I don’t, I’d almost rather have that, you know, whoever feels, whoever can jump in, feel free to jump in.

I want to talk about the customer experience. Because, you know, we’ve seen these, you know, we’ve had people come in and say, you know, why aren’t you more like these customer service [00:26:30] organizations who have, you know, thought through this and put in digital tools and all the other stuff. And to be honest, we responded with things like, I don’t know, a patient portal and we responded with things and people were just like, Yeah, that’s, that’s really what we were doing in 2000, but this is 2020.

So, you know, how do we get to the tools that really think through how we want to receive care really from the patient perspective, right. I need a, I need a ride to somewhere. I [00:27:00] need someone to bring me my drugs. I need someone to monitor me for falls, not only in the hospital room, but in my home. I need somebody to check my temp.

I mean, literally we could set up. Pretty interesting things out of the home, if that’s what people require of us as a health system. So talk about the patient experience. What, what do you think is going to change as a result of this, the COVID-19 situation we’re going through right now that patients are going to go, Hey, you know what? This is, this is my new [00:27:30] expectation from healthcare. And again, I’ll throw it out to all three of you. Whoever wants to go, just raise your hand.

Eli Tarlow: you just talked about, Bill was traditional. I, you know, it organizations or, or manufacturers of EHR, et, etc.

The way they attacked the patient experience was by building on their existing tool set. So you mentioned the. [00:28:00] Patient portal, right? So a manufacturer or an EHR, company that has a EHR can now open it up and say, okay, I want to, you know, cut out this, this section of data, make it patient facing. And now voila, you have patient experience, right?

What we’re seeing more and more now are things that are coming totally from left field. So things that are. Being manufactured or created by companies that have not been in the healthcare arena. And it’s not, this is nothing new. This has been going on for a while now and [00:28:30] they’re modeling it after other industries.

it could be anything even loyalty program. It doesn’t have to even be, patient experience doesn’t necessarily have to be, you know, a way to see their vitals. It could be like, you know, Modeling after the gaming industry on loyalty, it could be modeling, you know, you mentioned now there’s sending cars, you know, taking Uber or whatever, to send cars, to lower patient cancellations and improve access.

So I think the Genesis of patient experience was okay, what can we do with the tools we have? [00:29:00] And it’s completely turned around where it’s saying what’s available out there and how can we benefit from that? Fred and I. and, and actually the three of us, we heard about a manufacturer that’s using Alexa, which ties into, COVID-19, which is.

Moving towards using it an Alexa to, detect abnormalities in, breathing patterns. You know, one of the early symptoms of COVID-19 was, was shallow breathing and imagine an elderly in a house who is having difficulty breathing and ambient listening [00:29:30] can now detect that against algorithms and other signatures of that person and set off alerts.

That’s not building on an EHR. So I think a lot and that’s obviously patient experience. So I think what we’re seeing now is that ideas are coming from everywhere and it is a little bit of a tsunami. No, they’re going to be challenged with saying, okay, what makes sense? What can we adopt? What  why do we have to push off?

What are we going to wait to see others, how they do with it? And that’s going to be the challenge. I think it’s going to be to just going from so little to so much.

Fred Holston: Yeah, I think [00:30:00] another one of the problems that we’re seeing as part of this is the evolution of how it’s happening. I walked into one of our was one of our customers not too long ago.

And when I walked into the lobby, there are four banners and one banner said, Hey, if you want to figure out where you’re going inside of our hospital, download our wayfinding app. And there’s one app. And then it said, Hey, if you want to, your patient, whatever, download our portal app. Oh. And if you want to, be part of this, education thing, download this thing.

And there was one other one, but, but the [00:30:30] point being our evolution is w w we’re we’re evolving by looking at, Oh, we think people want this. We think people want this. And we’re, we’re buying a solution, which is what we’ve done for the last. 25 30 plus years, we buy a solution that solves a very specific problem.

And then we’re looking at our patients, our doctors, and our nurses to try to figure out how to use all those too many applications where the shift is really going to curve. If you talked about the experience component of this is we’re going to have to create this. One [00:31:00] organization experience. We call a digital front door it’s overused, but this idea that you can create a relationship with somebody long before they become your patient, you can use them for goodness, you know, and trying to keep them healthy and all those other things. But then when the day comes that they need something, whether that’s my minor or major, they have a relationship that relationship leads them where they need to go. It helps along that way. and then ultimately it’s sending them back home, but keeps that [00:31:30] ongoing relationship.

And that’s, I think how we’ll create an experience. So we lead them along. That it’s kind of a one view of that world. And we feel like even though we’re multiple departments and specialties and people, and maybe even different organizations within the same organization, that it feels more like one.

And I feel like I’m being taken care of from a, from a clinical perspective, it becomes a branding issue. It becomes a satisfaction issue. It becomes a health issue, as well as that’s really the way. We need this to work going forward. And the room, [00:32:00] as we talk about that is one piece of that, right?

We’ve got the pieces that occur before you ever get there. And then we’ve got what occurs in the room, but those are all part of the same ultimate conversation. How do we take care of people in that continuum of care when it’s cheaper and most appropriate to take care of them and before it gets to most expensive and it becomes more difficult.

Bill Russell: Right. And go ahead, please.

Ed Ricks: I was just going to say, I think that part of this whole thing is what’s going to probably lead us there. It’s kind of funny. [00:32:30] So for the last 10 years, probably we’ve been talking about the shift to consumerism and the fact that you are not going to remain financially viable.

If you can’t figure out patient experience and you’re going to lose anything profitable and your system to the businesses to understand how to do that. Well, you know, and there’s a lot of them that are retail and, and really know how to connect to patients. And yet I still don’t think we’ve done a great job, you know, in healthcare in general.

But, you know what? We do really good in healthcare where we respond to crisis. And I think that’s the interesting thing right now. It’s like, here’s the real [00:33:00] expectation that patients have. So yes, they are consumers now and yes. They want all these things to improve the patient experience. And I know that we’ve got to get to that point, but they also want.

Good care. And they want to make sure that they feel comfortable. They’re going to, wherever they go, that they’re going to get taken care of. They’re going to save their lives. I mean, right now it’s a real crisis and you’ve seen that response. And I think that’s why you’re seeing such a monumental shift so quickly, like this drop the top 10.

So let’s bring in the mobile units, let’s find a unused dorm room, whatever, you know, whatever it might be [00:33:30] to get these temporary hospitals, because I think healthcare does that really well. We’ll recover from this and then go on. And if you’re already starting the building blocks in place for the shift to consumerism, and how do you fix that?

Not only patient experience, but Fred will mention, you know, clinician experience. That’s a big piece of this. I think that you’ll be better suited for the future regardless of the way reimbursement works, because that’s a big piece of it, but really because that’s what people have an expectation, the next for on everything.

Bill Russell: Yeah. And actually, you know, one of the [00:34:00] things I think is really fascinating to me is we were sort of as a health, as a industry, we were sort of plotting along, waiting for big tech or somebody to come in and completely upset us. I mean, literally we were not responding as quickly in any one area, especially around the, you know, a unified experience and we were sort of waiting for it to happen to us.

And it’s really interesting because I think this has caused us [00:34:30] to do just some of the things that we’ve we’ve really needed to do. And I keep coming back to tele-health just cause it’s the best example. Tele-health had a net promoter score of like 85 to 90%. There’s almost nothing else that healthcare does that gets a 90% net promoter score and we just implemented it across the board.

Okay. That’s great. That’s one example. That’s one piece of really being responsive to the consumer. But there’s now a whole host [00:35:00] of other things that we can do if we focus in and do these things. And what I think has changed the trajectory. It used to be, Hey, you know what? CVS is going to come along and eventually get in between us, our consumer in a way it goes.

But we, the healthcare systems just jumped over CVS. CVS was going to be convenient because it was down the street. We’re now going into the home. Right. So, so that’s fundamentally changing things, but, and I’m sorry. Aye, but I [00:35:30] digress. I’m going to keep, I’m going to go back to interviewing, talk to me about the clinician experience and Fred, you touched on this earlier, you know, why is it going to be fundamentally better?

We’ve been saying it’s going to be fundamentally better for a while but you know, it seems like we put technology and it doesn’t make their life better. Why is this fundamentally gonna be better?

Fred Holston: Well, let’s put it this way. I certainly hope it’s fundamentally better. The way we’ve done technology in the past is we’ve gone based on clinical workflows.

We’ve always looked at [00:36:00] how nurses actually work in there, wherever environment they are and how doctors actually want to work. And what do they need when at the most appropriate time. And as they’re moving. You know, not going in and saying, well, I got to review this chart. What can we tell them right here right now, as they come in to see bill, in order to have the best conversation or, or make the best, recommendation on bill right now.

And I think that’s where we have the opportunity to make it better. Look, there are lots of [00:36:30] systems. There’s EHR, there’s the there labs, there are many other systems that they interact with that have information. They potentially have to put information in, but we have, new and interesting opportunities to make it more like their workflow.

And they just want to know what do they need to know when they need to know it at the time they need to know it so they can do their job the best and spend more time with the patient. Let’s look again, which you see the nuance solution, right? What part of what that’s for great documentation while spending more time directly with the patient.

That’s [00:37:00] a great, great use of technology in order to. To create a better patient, you know? Doctor physician relationship, in that mode, but there are other things that we can bring along. So that will be one machine vision, machine, audio, you know, content delivery, distraction, or eight are all pieces of this grand I think future that we have

Eli Tarlow: Bill I’ll add to what Fred said. There’s, you know, there’s the component of patient experience with the F where the provider has more time. a lot of that, like Fred mentioned [00:37:30] his ability to use technology to have more time when they’re in the room. telehealth and other forms of technology means that patients don’t necessarily have to interact with the provider unless it’s absolutely necessary, which gives the provider more time back in their day.

But, another thing that Fred alluded to earlier, which is from a clinician or provider satisfaction, Are all the things that we’re seeing technology such as sensors. You know, I remember when the Ebola patient was at Bellevue hospital. I know that everybody knows that story. And I was the [00:38:00] CIO there at the time.

One of the big challenges we had was entering the room. it was a Malone procedure to Don and doff the PPE. it was an airborne pathogens, so there was inherent risk to the provider. And now one of the things that Fred is I know is building on with a patient with next is the ability to care for the patient without even entering that, that perimeter, whether it’s the sensors.

All those types of touches technology that’s available. Physicians don’t have to enter that area, the perimeter where they can expose himself to unnecessary risk. So I mean that if there’s [00:38:30] no, I can’t think of a better, clinician satisfier than, their own health.

Bill Russell: Yeah, absolutely. add, should we give you the last word on this or who would like the last word on this?

Ed Ricks: Well, we all would deserve this because this has been his vision for a long time. And then I, and you know, and it’s a big part of why I actually joined this team just because of the way I think we think it we’re very pragmatic. We want to solve problems. We don’t want to sell parts. We don’t want to do that.

We’re looking to the [00:39:00] future, trying to tie it all together. I do think, you know, so my piece of this is I would say. Being pragmatic. We can solve a lot of clinical efficiencies. A lot of workflow efficiencies. Think about space differently. Think about digital differently in the way you tie things together.

I love this concept of the future, because that means maybe a Greenfield, you know, you building things away from a design process on up thinking about digital instead of the retrofit, but I’d love to hear Fred’s final thoughts.

Fred Holston: No, I think [00:39:30] I agree. And I think the other thing I also want to just make sure that.

We get across is that while we are a technology company, while we are looking at technology, I’m certainly a technologist by. History. we’re really taking two approaches to this and they’re, they’re being done at the same time. One is how do we curate the technology and find the right pieces that, you know, will give us the kind of data that we need in order to answer a lot of these questions in the future.

But the second piece is we’re asking our customers. What are the most important things [00:40:00] we could be doing? If we could check this box and take that off your plate or make this easier or solve this particular type of problem, do we impact costs? Do we impact satisfaction? Do we impact outcome of care? What are those clinical things that we could be doing?

And how do we marry those two? How do we take the data we’re getting from all the technology and the capability we’ll put in and marry that to what the real needs out there and try to check those in some kind of order that, and by the way, I don’t know what that order is. It’s different by [00:40:30] organization.

So we’ll have to figure that out. It’s different by doctors versus nurses versus patients, and even the administrative side of the organization. But we’re asking the questions as to what can we really, and should we be solving so that we do this in some kind of, again, pragmatic yeah. Useful way that people actually want to use.

And then how do we sell it and install it in such a way that they can use just what they need, because that’s what they need now. They’re not ready for all the other. Who was bank stuff that might, could be done, let that come as, as [00:41:00] it’s appropriate for it to come or for the next pandemic kind of situation that says I need that.

And it will be more prepared maybe to, to, move those things a little faster.

Bill Russell: Well, so this is an exciting future, I think, and I think there is a positive that comes out of this as we talked about. Earlier, just the a and the positive is a healthcare that is more designed around, the clinician and more designed around the patient and the patient experience.

[00:41:30] And hopefully some of the regulatory things that have kept us from doing that. Some of this stuff in the past will open up as well. And I think the thing I’ve heard from you guys, the exciting thing is. the technology has progressed in such a way that we can do things today that we haven’t even thought about before, which gives us the ability to create some of these, some of these new processes, supported by technology that gives people.

The, the joy of practicing, clinical work again, and, the efficiencies that we [00:42:00] need to give them the time that they really want to spend with each one of the patients. Gentlemen, thank you very much. I appreciate your time

Eli Tarlow: Thank you, Bill.

Fred Holston: Thanks Bill.

Bill Russell: That’s all for this week. Special. Thanks to our sponsors.

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