As healthcare and technology become more complex, “it’s going to require a lot of hand-holding.”
Much has been made — and rightfully so — of the enormous strides healthcare IT has taken in the past year to improve the consumer experience and help individuals feel more connected with their health. There’s a lot to be learned from industries that offer the “seamless experience” users have come to expect.
With healthcare, however, the stakes are higher, and there are considerations that don’t arise in travel or hospitality, one of which is the digital divide, according to Patrick Woodard, MD, CMIO and VP of Clinical Systems at Renown Health. He believes health systems have an obligation to “recognize that the ones for whom we are often architecting solutions may not be the ones who benefit most from them.”
During a recent interview, Dr. Woodard talked about what IT and clinical leaders must do to ensure they’re not “standing in the way,’ while also ensuring they’re thinking “like a business.” He also discussed Renown’s experience in distributing the Covid-19 vaccine, how they were able to remain focused on strategic objectives, and how he has benefited from previous experiences.
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- The pandemic helped accelerate digital health adoption significantly, but as the industry moves forward, it’s important not to do too much, too quickly. “We have a whole bunch of people connected us to digitally who had never been before.”
- Delivering seamless care across the continuum means making sure all physicians have the right access — not just those who are employed by the health system.
- One of the key lessons healthcare can take from other industries? Creating a seamless consumer experience, which not only builds loyalty, but also helps people stay “more connected to their health.”
- With the digital divide getting wider, it’s critical to bake connectivity into things like remote patient monitoring, and ensure “we’re answering all the questions before they get asked.”
- Making data available is just one part of the equation. The other is “helping people realize what to do with it.”
Q&A with Patrick Woodard, MD, Part 2 [Click here to read Part 1]
Gamble: One of the priorities you mentioned is the digital front door. We’ve talked about how digital adoption has accelerated with Covid, but what does that mean in terms of creating a digital front door, and how do you see that hopefully evolving?
Woodard: I think there are some elements that had to take place immediately, namely the move to virtual visits, and the ability to schedule without necessarily calling a contact center and to message your physician. We were fortunate in that this year was focused on really enhancing some of what we had available through our portal, and really creating an ability for people to be able to access our health system digitally.
Because it was already planned, we were able to keep our focus on that, which become even more necessary during the pandemic. As we look forward, I believe we actually have to be careful that we don’t do too much, too quickly. We have a whole bunch of people connected us to digitally who had never been before — how do we make sure that experience is seamless?
And it’s not just patients; we have a large community of independent physicians working here and in the community who either see patients at our hospitals or in clinics. They work with a much broader set of resources than we do. We’re fortunate in that we have a reasonably sized IT team. We have coding and billing support. We have a great finance team. We have great leadership.
As an independent clinician, I don’t necessarily have all those resources, but I still want to be able to deliver high-quality care. And so, as a health system, we need to think about how we help the independent physicians who help support our overall mission of caring for the community and providing high-quality care, while also recognizing that they may not want to be employed. They may want to stay independent but will need to be able to access data.
Thinking about it from an independent physician’s perspective, how can I be supported in helping my patients receive population health management or care management, or simply access to labs and data that may exist at a Renown facility? It’s making sure we’re creating an open garden; we don’t want to create a walled garden where nobody can get in and there’s a gatekeeper. We want to make sure that for the right type of access and the right type of care that’s being delivered across the community, we’re making sure that’s seamless.
Gamble: Very interesting. You’ve spoken before about the need for vendors to have mobile-forward strategies and really drive that forward. Do you think that will start to change?
Woodard: I think it has to. Healthcare is several years behind other industries in terms of technology adoption. I think it’s out of necessity. Healthcare itself is a conservative industry, and for good reason. You don’t want to do anything that could potentially harm patient safety just because it’s new and shiny. If I try to log in to a hotel website and I can’t book a room, nobody’s going to die. I just don’t get a hotel room. If that happens in healthcare, that could be potentially devastating. The stakes are higher in healthcare, and so there’s a little bit of conservatism in terms of adopting new tools. The fact is that when people interact with a company, they don’t think of it as the food industry or the hospitality industry or the transportation industry. They think, ‘this is somebody I want to interact with.’ Consumers are smart; they are carrying their experiences from other industries that work very seamlessly. There is an expectation that, as I move into something as important as health, why shouldn’t I be able to have the same experience there? I think we’re obligated to learn from industries like the airlines who have managed to take something that is incredibly complex, and turn it into something really seamless.
A few years ago, I was traveling, and I was able to follow my bag from my phone while I was sitting on the plane. Why shouldn’t I be able to do the same thing with my loved one who’s going through surgery? Those types of experiences create customer loyalty, which is important as a business, and help offer a better experience that helps people get more connected with their health.
This is where health literacy is really important. The more I’m able to connect with my health and recognize that it’s something I can play an active role in, then, by definition, I’m going to have more ownership of it. Out of necessity, we have to move toward a more mobile and more connected health system across the country. There are a lot of really great opportunities to learn from other industries; we should be comparing ourselves to the best of the best — not just the best in healthcare.
Gamble: I agree. Let’s talk about your career background. How have some of your previous experiences — especially your time as a physician — helped shape you as a leader?
Woodard: What a great question. As a physician, one of the things you’re obligated to remember is who is sitting across the room from you and what their experience looks like. I’ll never forget a patient I had when I was in residency in Washington DC. She was a young grandmother, probably in her late 50s. I remember asking her to take another blood pressure medication, because her blood pressure was too high. She asked me about the cost — it was about $15 or $20 — and she asked me almost tearfully which other medication she should stop taking. With the money she was getting from disability, she made something like $680 a month. Her rent was $600 a month and her utilities cost about $40 a month. And although she got food stamps, she needed to feed herself and sometimes her grandchildren.
To hear that question — which of those medications would I recommend she not take — was very difficult. As a physician, I hope I haven’t prescribed anything that wasn’t necessary, but we took a look at her drugs and we were able to reduce the costs of some of them. But the broader implication here is that as we think about where people are coming to us from, we have to recognize that they may not have access to broadband internet, or to any internet at all. Their cell service may be on a monthly or prepaid plan where minutes matter, and so if we’re asking them to put an app on their phone and send us data for remote monitoring purposes, that’s going to cost them extra money that they may not have.
So I think there’s a broad obligation on the part of the health system to recognize that the ones for whom we are architecting the solutions may not be the ones who will benefit most from them. When we think about consumers, we have to think about it from the lowest common denominator in terms of how we can make it as easy as possible for people to be connected to their health, to be connected to their physician with whom they have a personal relationship, and to make sure that we’re standing out of the way as much as possible.
Gamble: The big question is, how we can take steps in that direction?
Woodard: I agree. If you start by thinking where you want to go, that’s the best place to start. I don’t think the answer is for a bunch of physicians’ offices to go and buy broadband for all their patients and make sure they all have an iPhone, or the latest model that can accept Apple watch data. There is a role for that in terms of innovation and making sure we provide new and innovative technologies to make sure we’re keeping people healthy. But if we want to do remote patient monitoring and we want to create a system for remote patient-monitoring, we want to bake in connectivity so that we’re answering all the questions before they get asked.
One of the challenges is that as healthcare and technology become increasingly complex, there’s going to be fewer people who are able to see that level of complexity. Even today, we don’t know what an AI tool may be thinking within the little black box or there’s an input and then there’s an output and something happened in the middle. We’re already, in many cases, at a place where neural network is completely unfathomable to the creator.
As we bring this level of complexity into healthcare, we need to make sure we’re relying on the experts, and that best practices are widely available and can be adopted by anyone, whether that’s a $15 billion system or a million dollar a year private practice. That level of expertise and support must be available to everybody. From a vendor perspective, how can we share our expertise with our community and our clients? As a provider, how can I find these resources without having to spend half of my life now learning about something that is increasingly complex?
Gamble: Can you talk about some of the work you did as a medical informatics lead, and what you learned about the importance of data literacy?
Woodard: Sure. It’s similar to my current position. The chief medical information officer role has changed a lot over the course of time. The first part of that is medical informatics — that’s part and parcel to the job. It’s thinking about it from a workflow perspective and how we can lower the barrier for technical literacy and data literacy.
We need think about the implications of the downstream impact, and not just what may make the workflow easier. Actually one of the most critical elements of informatics is thinking, what report will this break if we change it? That’s the very first part of data literacy. The second part is helping people know what to do with it, because once you’ve made data available, it isn’t always obvious how to take that and change it.
When I founded a startup in a prior role, we were really focused on doing that as lean as possible. It was a small team. When you don’t have a lot of resources you have to be lean; you have to focus on what’s going to have the biggest impact and what things you can change, and bring that thought process into the way that we work. In informatics, it’s important to help people to understand even just simple things like Pareto charts. They’re simple when you learn them, but if you’ve never been exposed to the concept that you can make a bigger impact by making smaller changes, they can be difficult to understand. The idea is that biggest area of impact is not always be the one that’s right in front of you.
Using that data to help make the right decisions is an ongoing conversation. You can’t just have a discussion and folks start automatically using the data continuously. It’s something that, as data becomes increasingly complex, will require more hand-holding. That’s a good thing, because it means people are asking how it works and how they can use to impact the business or impact the way they care for patients. It’s one of those things that sometimes requires learning together.
Gamble: It seems like you really enjoy the CMIO role, and are happy with the different direction it has taken in recent years.
Woodard: As a friend of mine described it, a medical information officer or somebody who does medical informatics should solve problems, and then the chief medical information officer should solve the problem that the solutions might have created.
It’s a great way to think about it, because systems are complex. Health systems are complex. Technology systems are complex, and it’s very difficult to know every possible potential downstream impact that a decision could potentially make. It might be favorable or unfavorable, and you’re going to do your best to anticipate problems in advance. You might be successful, but there’s a pretty good chance you’re going to miss something. And so you need to be able to step back and look at it from a systems perspective and say, now that I know what the impact is, how can I adjust it and make sure everything stays working?
Gamble: That’s a great way of putting it. It’ll be interesting to see how that evolves as we get into the post-Covid world.
Woodard: Take vaccines, for example. There is such complexity in the delivery and distribution. I think it’s actually highlighted that level of complexity to a lay person who maybe visits her doctor once a year and doesn’t think about healthcare. It doesn’t solve the problem. But at least it allows people to think about it in terms, maybe this isn’t as easy as we thought; maybe it’s a little bit more complex than that.
It allows us to recognize a level of complexity that exists, without necessarily focusing on those things are not possible. They’re absolutely possible, we just need to be mindful and thoughtful about how to get there.
Gamble: Well, we’ve definitely covered a lot. We speak with a lot of CIOs and even CISOs, and I think getting the clinical perspective is so important, especially in light of what the industry has gone through, and so I really appreciate your time and your insights.
Woodard: Absolutely. It’s my pleasure to be here. I think it’s important really as we recognize that IT has to think more like a business and more about what our clinicians and our consumers need to make sure we have a focus from a clinical perspective. Ultimately, the number one goal of a health system or an IT vendor is to help provide high-quality care; that’s the product. If we’re thinking about a healthy person as the product who’s also the consumer, we need to think about it from their perspective and make sure we’re not staying too deep into the weeds of technology; but rather, thinking about what value it will bring, how it will impact our patients, and how it helps us deliver the product, which is a healthy person. If we do that, we’ll be a lot more successful than if we focus on the nuts and bolts of the actual implementation.