At first glance, it may be difficult to understand that AWS, a subsidiary of Amazon — the tech giant that employees more than 1.5 million people across the globe — could be playing a key role in making care more personal. But it’s precisely what the organization seeks to do, according to Kim Majerus, VP of Academic Medical Centers and Education, and State and Local Government for Amazon Web Services.
“We want to change the interaction” and help create “a meaningful relationship between the patient and provider,” she said during a fireside chat with Anthony Guerra, Founder and Editor-in-Chief of healthsystemCIO, at the recent ViVE22 event in Miami Beach, Fla. AWS, a provider of on-demand cloud computing platforms and APIs, has partnering with both health systems and vendors to help solve “the biggest problems in healthcare,” many of which stem from inequities and barriers to care.
However, even if care becomes more accessible, there are still obstacles in facilitating better interactions between providers and patients. “We hear a lot of organizations and clinicians say they want to have a more meaningful relationship with patients, but it’s extremely difficult to do that if you have information in disparate buckets.”
During the conversation, Majerus talked about the critical role cloud technologies can play in providing a holistic view of patient information; why she believes technology itself is “not a panacea for curing and solving the biggest challenges”; how Covid has changed the industry; and why healthcare should be ‘personal’ to everyone.
We hear a lot of organizations and clinicians say they need to have a more meaningful relationship with patients, but it’s extremely difficult to do that if you have information in disparate buckets. What we try to do is to work with those organizations to understand that if you pull those together in a data lake format, it allows a holistic view.
Technology is not a panacea for curing and solving all of the biggest challenges. It does, however, allow people to understand that they can get care and they can be proactive in their care.
When you start to move into more cloud-based environment, those same tools you’re using for finance and operations in a payer-type of environment can also change the dynamics of how you look at a patient from a medical perspective.
It’s about having a meaningful relationship between the patient and provider. To me, that’s the biggest opportunity that we have. How do we make sure we’re keeping our clinicians healthy, happy, and engaged with their patients, while they’re literally sifting through piles of data to figure out the right questions to ask.
If you start with what you’re trying to accomplish and work backwards from there, the technology will help support that. And the data will show whether you’re making those meaningful impacts throughout the journey.
Guerra: Hi Kim, looking forward to chatting with you. Can you tell us a little bit about your role?
Majerus: Sure. I wear many hats at AWS and all I’m very proud of all of them. I represent academic medical centers as well as the education, research, and government entities within the U.S.
Guerra: There’s been a lot of talk at ViVE about health equity. What does health equity-enabling technology mean to you?
Majerus: If you take a look at our communities, we’re not all hubbed together. We have an opportunity to reach those who aren’t getting the right care, and more importantly, giving access to those individuals. So, I think it’s extremely important that we recognize that our communities are in different places. Ensuring that we provide that forward care is, in my mind, what will lead us to a more equitable environment for healthcare.
Changing the dynamics of patient care
Guerra: Are there particular technologies that you think get us there?
Majerus: I think all technologies could get us there. We have to start with the foundation and the basics of, where’s the data? The legacy environments we see with providers as well as government institutions is very siloed, which means it’s not accessible. Therefore, it’s extremely difficult to understand what the information is telling us.
My team is focused on how we can help institutions leverage data to improve the care for our patients. And it’s not just about providing a doctor’s visit or a consultation. It’s about changing the dynamics. We hear a lot of organizations and clinicians say they need to have a more meaningful relationship with patients, but it’s extremely difficult to do that if you have information in disparate buckets. What we try to do is to work with those organizations to understand that if you pull those together in a data lake format, it allows a holistic view of why the patient is coming in, or maybe even the questions they should be asking the patient, because it is truly about moving to a more patient centric approach.
Guerra: At its core, what you’re talking about is an interoperability issue — being able to move data across silos and get it where it needs to be.
Majerus: That’s one piece of it. And while it is important that the data is organized and coordinated, you have to be able to access it to understand what questions you need to be asking. During Covid, whether it was state or local government and even global entities, the amount of data they were able to compile and embrace really provided us a better understanding of where the variants were, where the hotspots were, where care was happening, and where the care needed to be.
Telehealth & the care process – “It literally changed overnight”
Guerra: Speaking of Covid, it was ironic that we thought technology would help us with equity by bringing the healthcare enterprise out into the community. One of the challenges was that the places where we wanted to bring healthcare didn’t have the technology needed in that final mile. And so, it was a mixed bag. What do you think Covid showed us about health equity and technology?
Majerus: That’s a great point. I don’t want to discount the biggest challenges that we have in healthcare, and I think the pandemic really accentuated the problems we probably already knew about. It forces us to move quicker. Telehealth changed the entire care process — how you see patients and how you’re paid for that literally changed overnight. You couldn’t bring in patients who didn’t feel well.
The move to a telehealth environment really accelerated the opportunity to care for and protect patients, and more importantly, enable providers to serve them where they are. That’s always a challenge, especially because Covid wasn’t limited to one area; it was global. It hit urban and rural areas. Without technology, it would’ve been much more difficult.
Don’t get me wrong — technology is not a panacea for curing and solving all of the biggest challenges. It does, however, allow people to understand that they can get care and they can be proactive in their care. The policy, people, and processes needed to change. And I think we all came together very differently through the pandemic to address it.
Guerra: Right. A lot our readers are CIOs in health systems who are fighting for budgetary dollars. Ideally, you want to have a good governance process where you’re able to line up your spending with the organization’s objectives. Where do you think health equity fits into that discussion? And is there a way CIOs can frame up certain technologies that helps them bubble to the top of the governance process?
Majerus: The important part to note on that particular piece is that it shouldn’t be a give and take, like ‘if I do this project, I can’t do this bigger modernization.’ We have to look at it holistically, just as a doctor looks at a patient. Having competing projects is a challenge and will continue to be a challenge. But when you start to move into more cloud-based environment, those same tools you’re using for finance and operations in a payer-type of environment can also change the dynamics of how you look at a patient from a medical perspective. So, although there will be competing projects, I think having a holistic strategy really helps change the conversation for those who support the mission of care.
Guerra: We’re hearing a lot about the cloud-based environment and its advantages. Obviously, AWS is playing in that space. One of the biggest benefits is the flexibility it gives you to spin up environments and be more innovative in providing services to different departments that want to do different things. Do you see a connection between that flexibility and the potential to further health equity?
Majerus: Absolutely. It’s important to be able to access the data in a non-siloed environment, which is what we see today. When you start to take a look at the data and the information a provider could look at, you see that they could be more predictive. When you look at the challenges that one demographic has from a location perspective, you see that you can really change the impact of their care by being proactive and sending a mobile health team to that area.
We saw that with the vaccine distribution; some people wanted to go to a clinic or a care center, but some communities are better served by their local EMS, for example. If you look at and understand the data they have on their patients and the community to which they serve, you can bring healthcare to them. Whereas in the past, if you wanted to do to the doctor, you had to a facility to receive that care.
Tacking health inequity
Guerra: AWS has a $40 million commitment to health equity. Can you talk about that initiative?
Majerus: Yes. It’s an exciting time at AWS to be able to support innovation in this space. We’ve committed $40 million over the next three years to advance health equity globally, and those funds will be applied toward AWS computing credits as well as the technical expertise of our teams to help companies who are focused in this space. We’ll work with selected institutions to help further their needs. But that’s just one piece.
We’ve also launched the AWS Diagnostic Development Initiative, which provides support to 87 different organizations in 17 countries. We work with not-for-profits, research institutions, startups, and large companies to leverage technology to help them further the mission of care.
We also announced recently that we’re working with Medtronic to provide 50 GI systems throughout underserved communities to screen for colon cancer. This is an opportunity to solve of one of our biggest challenges as it pertains to healthcare. Through our partnership with Medtronic, we’re excited to see the work that’s done and, more importantly, the lives that are impacted.
Incorporating social determinants
Guerra: One thing that comes up in conversations with CIOs is integrating social determinants of health into the clinical workflow. In many cases it’s aspirational, because there’s so much work being done internally to move data from here to there within their own health systems. It seems only a small number of organizations are actively getting that data. Looking at the concept of social determinants, what does that mean to you? How can they be incorporated into the clinician workflow?
Majerus: We’re partnering with UC Davis to work backwards in their community in terms of the care and the challenges it has. When I think about social determinants, whether it’s access to food, diet, or even what care they believe is needed, we try to focus on what problems we’re trying to solve. What’s the environment in which they’re operating? That’s all in the data. And it’s extremely difficult for a clinician to be able to have a full scope of what an individual is dealing with without asking. We want to change the interaction.
It’s about having a meaningful relationship between the patient and provider. To me, that’s the biggest opportunity that we have. How do we make sure we’re keeping our clinicians healthy, happy, and engaged with their patients, while they’re literally sifting through piles of data to figure out the right questions to ask that patient? It goes back to the idea of patient-centric care. How are we providing clinicians with the information they need to make that a meaningful conversation?
Technology “is the easy part”
Guerra: Let’s talk a little more about the cloud. When you speak with healthcare organizations about the potential of moving to the cloud and how it can better manage workloads, what are some of the concerns they have? What’s holding people back from going to the cloud?
Majerus: Culture. The technology is genuinely the easy part of the efforts to support the mission. It’s understanding where the organization is in terms of skills and what applications they’re leveraging, and more importantly, how do you translate that and move it into an environment at the right time and in the right order? That’s where partnerships come in; whether it’s through AWS or our partner communities, or the many of the ISV technology companies that are actually already on this journey with them.
Guerra: So, the strategy is to discuss the migration plan with them — here are some things you may want to move and here’s the process you may want to use, and try to get them comfortable with that. Does that sound right?
Majerus: I think it’s important to note that healthcare providers are tasked with delivering care, but they’re also challenged with reduced payer costs or the payer receipts they’re getting for the same types of services. And so, we work backwards with what they’re trying to solve, and make sure their direction is in parallel with a technical and strategic plan that moves them through the process to serve their biggest needs.
They have to do both. They have to save money and they have to reinvest. That’s part of the opportunity with cloud — where do you save to invest instead of the legacy acquisitions of hardware that continually need to be refreshed? And so, we’re working with them to take two steps backwards. Let’s look at what you have and let’s move it and modernize it so that when you go to the cloud, it’s done in a cost-effective way. We’re incented to see institutions save money, because the more they save, the more they can apply toward patient care.
Keeping on top of security
Guerra: One of the benefits of the cloud is to take things off your plate, which gives you more resources to do interesting things. Let us do what we do. And security is certainly an element of that. What are your thoughts around the security angle?
Majerus: At AWS, security is literally day zero. That’s where we start from, and that’s what we built off of. We take HIPAA information and PHI very seriously. It’s not that one could do better than the other better. It’s where our foundation is in terms of where we are as an organization. We are focused on the trust of our customers; earning trust and customer obsession are part of our leadership principles. It’s how we operate every day; it’s that focus to say, it’s not all or nothing. It’s the right process and the right path, and getting the culture in the right place to support it.
Guerra: The CIOs we speak with always want to be comfortable that a larger company that deals in multiple verticals is committed to healthcare and understands it. What has AWS done to help people feel that level of comfort?
Majerus: The best part of this vertical is the fact that the opportunity to change and impact lives comes in different ways, whether it’s through my work with state and local governments who provide first line healthcare to those on Medicare or Medicaid, or corrections environments, or working with academic medical centers that are focused on solving the world’s toughest challenges in healthcare. The commitment we’ve made as an organization, whether it’s through the initiatives that we talked about or just our investment in the vertical overall, it’s not short-termed. When we look at an opportunity, it’s not about the impact today. It’s the impact that generations will experience.
I see it in the work we do today with some of the academic medical centers and the research projects. Whether it’s genomics or determinants of health based on food equity, it’s exciting to see the paths that many of these institutions are going down. It’s their commitment; we’re there to support them and provide them with a secure environment that’s flexible and agile. We saw many organizations that weren’t able to achieve what they needed to because of limitations within the infrastructure. But those who had moved to the cloud were able to scale up when Covid hit.
Now, we’re back to an environment in which we’re close to one another. We’ve seen the lifecycle of this come through. We’re starting to turn some of those systems back down to pre-pandemic areas; with a legacy environment, once you buy it, it’s yours. With the cloud environment, the agility and flexibility allow you to optimize costs.
“Healthcare is personal”
Guerra: I would describe you as being a true believer in the potential to improve healthcare. This isn’t just another vertical to you; this is meaningful.
Majerus: Absolutely. Healthcare should be personal for all of us, because we’re all going to go through our own challenges. I lost someone at a very early age and to see what healthcare was like in 1998 compared to how it is now is incredible. I’ve seen the impact of how technology, research and commitment could effectively change the trajectory of someone’s young life. And so for me, it is personal and it’s exciting to see some of the advancements we’re actually making.
Guerra: Any final thoughts? What’s your best piece of advice as folks go out and try to change healthcare?
Majerus: It’s a journey. The important part is to start with your mission, whether your mission is to help the underserved, to cure cancer, or to provide elderly care in a different, more meaningful way. If you start with what you’re trying to accomplish and work backwards from there, the technology will help support that. And the data will show whether you’re making those meaningful impacts throughout the journey. It is a journey. It’s not a flip the switch you’re done. It is a journey to make sure that you’re in the right space to accelerate.