The State of Digital Health

An insider’s look at key considerations and approaches to digital innovation healthcare providers face today.

An interview with Melinda WagnerMBA, MS, BSN, RN, FACHE
with our guest interviewer, Anthony Sloan

 

Today I have the distinct pleasure of interviewing Melinda Wagner, Senior Client-Partner and Healthcare Strategy Lead at Technossus in Irvine, CA. Melinda has enjoyed a diverse journey in healthcare. She began at the bedside as a nurse working in labor & delivery, critical care, cardiac rehab, and post-anesthesia. With a passion for preventive medicine, she moved to the ambulatory setting and ultimately became the Chief Operating Officer for a large physician-owned healthcare organization.

 

Eager to be a part of the technology and data-enabled transformation in healthcare delivery, Melinda joined Cerner Corporation in July 2012 where she led the startup of the behavioral health product division for 3+ years. Melinda then served as a Client Partner for several complex health systems including Boston Children’s Hospital, Emory Healthcare, and Moffit Cancer Center.

 

Melinda has an MBA from the University of Missouri – Kansas City and is also a Fellow of the American College of Healthcare Executives (FACHE). Over the years Melinda has developed great insights on all things digital health and digital transformation, so let’s jump right in and hear her thoughts.

 

AnthonySo let’s talk about digital strategies. What are you seeing and hearing in the world of digital transformation specifically around healthcare these days?

 

Melinda – It’s funny, WSJ asked CIOs what buzzwords they are tired of hearing, and not surprising ‘digital’ and ‘digital transformation’ were both on the list. While the words may feel like nails on a chalkboard to many of us, this ‘transformation’ is just now getting really interesting. It’s become pretty clear; Healthcare is a digital business.   We started this journey with the first EMRs 50 years ago. While still far from nirvana, 95% of hospitals and 90% of providers have digitized their patient’s health and billing information into an EHR according to the CDC.

According to HIMSS Analytics, over 83% of healthcare organizations are already using some form of a cloud platform. Some 40% have ERP systems, and nearly as many have CRM systems. The real magic is starting to happen in how we are using the data in tools outside the EHR.

 

The digits around digitization.

 

Consider some of the stats around the “digitalization” of healthcare and you quickly realize just how much healthcare really has changed (despite being a laggard).

  • – By 2026, the digital health market demand will reach 640 billion U.S. dollars according to Global Market Insights, Inc. – (someone is buying into this transition!)
  • – Medical app downloads grew 50 percent year over year to over 3.2 billion downloads across mobile healthcare apps according to Data.ai’s State of Mobile 2021 Report
  • – In 2022, 38 percent of care was delivered virtually according to mHealth Intelligence.
  • – According to the National Center for Health Research, more than 30% of people now use some type of wearable device to monitor their health.
  • – The global healthcare chatbots market is projected to reach  $314.3 million by 2023. Source: MarketandMarkets.com
  • – The global artificial intelligence in healthcare market size is expected to expand at a compound annual growth rate (CAGR) of 38.4% from 2022 to 2030. Source: BioSPace.com
  • – The global virtual and augmented reality in the healthcare market is expected to reach $5.1 billion by 2025. Source: Grand View Research. If you’re a healthcare company planning your digital marketing strategy, you should highly consider investing in this technology.

And we haven’t even begun to talk about the impact on research and bio life sciences. The pandemic certainly accelerated the transition but most importantly, we now have demonstrated successes in how individual systems are using this power to improve how they deliver care and how they do business.

 

AnthonyWhat are the most important lessons you see at Technossus as clients are trying to accelerate their digital strategies?

 

MelindaIt’s all about extending care affordably.  Healthcare is about people, and so we must address the diversity of people in how we conceive, design, and deploy technology in the healthcare setting. The newest addition to the buzzwords is ‘equitable by design,’ but I think it is so much more important than a buzzword. I hope it does get overused until it becomes rote in how we think.

 

Digital health can make health systems more efficient and sustainable, and enable them to deliver appropriate quality, affordable, and yes, equitable care. We have to be committed to understanding the digital experience through a DEI lens and investing in the training needed for our technical teams to achieve success for all our consumers.  Measure twice (or as many times as possible) before coding… Another lesson that seems doomed to be repeated is the need to have incredibly strong governance and change management in place before you start. This is an enterprise journey even if on the surface a specific objective only impacts one service line.

 

Digital strategies fail when there is a lack of system-wide alignment on priorities/objectives, lack of project planning/management, and poorly defined or ignored success metrics. It’s not new information, yet we still see it happening more often than not.

 

On setting priorities…and expectations.

 

The saying Rome wasn’t built in a day definitely applies to achieving your digital strategy. Trying to do all things at once will not only be demoralizing to your teams but extremely expensive. Digital strategies cannot be accomplished at the expense of things like cybersecurity, infrastructure management, etc. – these ‘keep the lights on’ kinds of things that actually become more critical as you add on more apps and devices. Start with the masked elephant in the room.

 

Healthcare is a target for would-be attackers so it is not if, but when your organization will get hit. Investing in the continuous modernization and security of your digital infrastructure is simply a cost of doing business. Plan for the less fun aspect of modernization first and make it a priority before security emergencies force you to do so midstream. 

 

Find sensible decision-making strategies from trusted sources. Digital strategies also don’t always mean rip and replace or buying the absolute latest and greatest. Certainly, leave room for truly innovative opportunities that can achieve your defined need. Don’t be afraid of proof of concepts (as long as you follow through on the winners and fail fast on the losers).   As an example, at Technossus we like to refer to the “6 R’s” when thinking about whether to replace, rebuild/modify, buy, or sustain a digital platform. It looks something like this:

 

1. Retain (or Revisit) – “Keep & Reap” –– Keep the application in its current form, at least for now. This doesn’t preclude you from revisiting it in the future.
2. Retire – “Stop & Lop” -– Get rid of the application completely.
3. Rehost – “Lift & Shift” –– Move the application to the cloud (IaaS) and continue to run it in more or less the same form as it currently runs.
4. Replatform – “Lift, Tinker, & Shift” –– Move the application to the cloud and perform a few changes for cloud optimizations.
5. Refactor – “Cut & Gut” – Rewrite the application, taking advantage of cloud-native architectures.
6. Repurchase – “Drop & Shop”– Replace the application with an alternative, cloud-native application and migrate the data.

 

AnthonyHow do you recommend healthcare systems prioritize their objectives?

 

Melinda – The question is really what drives the greatest value (another notably irritating buzzword). It starts with getting into the weeds of asking and holding leaders accountable for their answers on what defines measurable and sustainable value and for whom? The backlog blackhole?

I hear all the time from IT leaders that they have hundreds of projects on their backlog…there’s no value to a backlog that can’t be done. In fact, it is demoralizing and creates riffs between those putting in projects and those who can’t even begin to get them all done.   I also know leaders who tie everything on their list to “regulatory and/or patient safety” because they believe nothing else will get done. There is, and always will be a finite number of resources to dedicate to IT and to the digital journey.

 

Trust your data

 

Instead of thinking about what this department needs or that provider wants, ask the tough questions about what delivers concrete impact to your defined metrics of success – and then be vigilant. Don’t be afraid to be bold and go in a different direction than your peers when the data support tells you something different.

 

AnthonyWhat trends do you think are most exciting right now?

 

Melinda – I think of the digital opportunities in several buckets.  People want and deserve more control. Consumer support is one and I am really excited about the ability to put information and tools in the hands of the consumer to help them take accountability for their own health.   In bending the cost curve, personal accountability has been one of the hardest things to impact and while we are still in its infancy, the opportunity to guide consumers on a personalized journey to be the best health advocate for themselves they can be is exciting.  Use AI & ML to save you money, it’s what they’re good at.  In the enterprise support bucket, I think the tools to use AI and ML to improve the cost of doing business from supply chain management to revenue cycle have tremendous value.

 

Personalized care will improve clinician support. In the clinician support area, I am very excited about the pursuit of different care delivery models beyond telehealth into things like ambient support. I am especially excited about the opportunities to help clinicians focus on personalized care. It is truly mind-blowing to me that the physical exam I receive today is essentially the exact same one I received 20 years ago and for the most part the same as my mother received 40 years ago.

 

Digital care sees a change in what we evaluate and for who, especially for mental health. In patient diagnostic/monitoring, therapeutics, and research, I am really excited about the focus on mental health. For literally centuries it was relegated to the shadows. I am sorry it has taken a series of national crises to elevate it but I do believe it will get the needed attention now.  I am hopeful, albeit concerned, that the healthcare regulations and payers keep up with the changes needed to capitalize on the opportunities for advancement.  For example, during COVID part of the reason we could shift so quickly was some requirements were relaxed. It begs the question if they can be relaxed in a crisis, are they necessary at all?  I am by no means suggesting full anarchy, but we can’t stifle progress because of rules that no longer serve the patient or the industry.

 

Closing Thoughts:

 

I want to thank Melinda for her generous time and willingness to share her thoughts and candid insights about these important topics. These are challenging and exciting times for the global healthcare industry. Technology, medicine, research, business, and health provider services seem to be colliding in complex new ways. Let’s hope more good-faith discussions like these will inspire others to make the changes necessary to improve the processes that will impact the communities they serve to the greatest degree possible.

Special thanks to our guest interviewer, Anthony Sloan, for helping us foster another great discussion on innovations in digital health. Antony Sloan is with Anthracite Consulting, Switch4Good, and California State University focusing on the ethics of AI and related technologies.

Until next time,

Team Technossus

Industry leaders weigh in on technology’s role in consumerization, health equity, labor shortages, COVID recovery, and more.

May 5, 2022

 

By Melinda Wagner MBA, MS, BSN, RN, FACHE
Moderator, Sr. Client Partner – Healthcare, Technossus

 

I had the pleasure of moderating an exceptional panel of leaders from diverse backgrounds in healthcare, discussing four critical topics impacting today’s ecosystem. I was humbled by the investment each of these leaders makes in driving change into their organizations and those they consult with and by offering incredible depth in what they are willing to share.

 

Our first topic was ‘Consumerization’ of healthcare, loosely defined as individuals asserting more control over directing their health and wellness. I asked the panel what they saw as the most important factors to address health equity by design and ensure consumerization doesn’t leave behind the most vulnerable in our communities?

 

Mr. Mike Seagraves, who leads the digital transformation consulting practice for Phillips, emphasized that health equity in the consumerization of healthcare is not about technical transformation. Advancing health equity is about asking the right questions and deconstructing institutionalized cultures and the ways of thinking that created the bias in the first place.

 

Mr. Ian Slade, who is a registered nurse and founder of IT Consulting Group and HPMA, further added that true health equity is not “the final coat of paint on the systems we’ve built”, but rather requires a reboot at the foundational level. Technology is part of the solution, but health equity is an organizational transformation in every way.

 

Dr. William Feaster, Vice President, Chief Health Information Officer at Childrens’ of Orange County, shared that, in his experience, access to care, education, information, funding, etc. is the most important aspect of health equity. While certainly not 100%, the mobile phone presents the best opportunity today to reach people where they are, not just for a single transaction, but for a complete digitally-enabled experience.

 

Dr. Robert Lubitz, CMO at 30e Scientific and a Principal at Progressive Healthcare Inc. added that training and tools are needed that help clinicians create culturally competent strategies to care for their patients. Coupled with the low health literacy of much of the population, cultural incompetency creates tremendous communication gaps that negatively impact the provider-patient relationship and patient outcomes.

 

From the payer perspective, Mr. Doug Albro Vice President, Information Systems at Good Samaritan Health, reflected that health equity is not just about physical health care but includes things like mental health, food resources, housing, etc. The overall complexity of navigating the

 

ecosystem and especially the handoffs between sectors is a challenge even for those in the industry. Further, many people have developed distrust in healthcare systems because of past experiences where the system failed to treat them as a person. Engaging people and ultimately driving down the cost of care must include re-establishing the human relationships that have been distorted for transactional procedures.

 

Pivoting the discussion from equity to lessons learned in the digitization of information into the EHR, I asked the panelist what were the most important lessons learned from the EHR era that can now be applied to the consumer’s digital journey? I hope that we can do better for the consumers than we did for the clinicians if we apply what we have learned. Ms. Geri Pavia, who is a Sr. Client Partner at Technossus, offered three specific pieces of advice that she gives her clients:

 

• More is not necessarily better so don’t overwhelm the consumer with data. They need specific information, at the right time that is personalized to them.
• Evaluate where you have data integrity or reconciliation issues and resolve them before you digitize the experience. Even internally across the departments there can be disparities that will at best confuse the patient.
• The EHR has long been seen as an obstacle to the patient-provider relationship so train the clinicians and providers on how to talk with patients, so they use the digital tools as an effective relationship builder. Simple things like teaching them when and how to message the provider or where to find their appointments can become a very quick, WOW moment for the patient.

 

Dr. Feaster pointed out that during the EHR era we built the complexity of the healthcare system right into the EHR spending millions to hard code ourselves into painfully hard-to-use workflows. The lesson is to build for consumers in the same experiential way they do everything else in their lives, i.e. at their fingertips. Think about the patient’s experience first and talk to them.

 

Mr. Seagraves added that while we learned a lot about implementing EHRs, it often never got applied. Leadership has to create growth-minded cultures that value simultaneously “being and becoming’ so that what is developed today also creates the capability for what is needed next. He again said it starts with asking the right questions and not being binary in our thinking.

 

We talked about the impact to consumerization on misaligned incentives among the players in healthcare. Dr. Lubitz reflected that at the start of his practice the data needed on a patient fit on a 3X5 card which evolved into early SOAP notes and eventually the EHR. The promise of EHRs was the ability to support the provider in clinical decision making with the right data but sadly other agendas came into play, and it became about clinically driven billing instead.

 

Mr. Slade pointed out that in other countries, they collect a fraction of the data and still deliver the same, or even, better care. Mr. Albro more bluntly acknowledged absolutely the incentives are misaligned. We could solve our situation if providers, payers, and regulators would align around the patient and use other industry learnings to leapfrog into the modern consumer experience. Why shouldn’t the patient expect to be able to pay for their healthcare in the time it takes to Venmo a friend?

 

Our next topic involved moving quickly but safely on the digital journey. Digital health startups received $57.2 billion worldwide in 2021, according to a report from CB Insights, a New York firm that tracks private companies and how much money they raise. It was a 79% increase from the previous year. I asked the panel how they navigated the market with so many digital technologies hitting the market?

 

Dr. Lubitz and Dr. Feaster both commented on the challenge of not overwhelming the users and the need to invest in things that simplify and elevate any given process/task. The focus has to be on relevance and value to the user, such as deploying robots to unburden the nurse from menial tasks. Mr. Slade commented on the number of organizations that don’t even know what all the systems are that they have today so starting with understanding your foundation and moving slow to go fast is critical.

 

The healthcare industry’s number one problem is the labor shortage. How can we use technology to evolve traditional roles to mitigate the impacts of what is crisis levels in some areas? Dr. Feaster and Mr. Slade both pointed out that while technology can certainly play a role in extending a given clinician’s capacity and ability to work at top of license/role, in nursing, regulations on patient ratios will impede the progress unless they are addressed concurrently.

 

Mr. Seagraves added Robotic Process Automation (RPA) can be a huge satisfier in retaining staff while also optimizing revenue. He further shared that it is not just about clinicians, administrators can also benefit from better use of the data for example via digital twins in making decisions. Dr. Lubitz talked about the use of predictive analytics to anticipate resourcing needs for such things as flu season peaks so the capacity can be flexed with the need.

 

From the payer perspective Mr. Albro shared that while much of their work is remote and they can therefore use professionals such as nurses literally from anywhere around the world, they still must consider the need to simplify the work and optimize the efficiency of their associates. Both Dr. Feaster and Mr. Albro described the convoluted flow of getting a bill to a payer and then actually getting it paid.

 

The answers must come from the HC industry, not from the additional government regulation. Mr. Albro commented the consumer’s level of dissatisfaction with the system is higher now than ever in his career opening the risk that someone will come in and create a completely different system if we miss this opportunity to simplify and win back the patient’s trust.

 

Our final topic was having peaked in the pandemic, and what’s next in the recovery of the industry. One of the most striking impacts of the Pandemic has been how it has both contributed to and illuminated the mental health crisis. Dr. Lubitz added that people have also put off preventive and chronic care management, so we have to find ways to get consumers back into a ‘rhythm of care’.

 

Dr. Feaster pointed out that well people are not a burden on the system so the opportunities for digital technologies to help patients plug into the system in new ways to prevent disease will drive down the demand and cost. Everyone wins. Ms. Pavia and Mr. Slade relayed how mental health impacts of COVID isolation and PTSD won’t be known for years to come especially on the children/young adults. Mr. Slade has personally been working on the use of the Metaverse technology in mental health. It is also applicable in other areas such as primary care, pain management, and pediatrics.

 

As I brought the discussion to a close what struck me most was that despite very diverse backgrounds, the panelists were quite cohesive on what needs to be done to improve the healthcare ecosystems and our patients’ experience.

 

Dr. Feaster pointed out that through COVID, the healthcare industry and governmental agencies demonstrated the ability to rally around a common enemy and pivot our operations and people to respond with exceptional effectiveness. We literally shifted millions of people to work from home, converted entire units to care for the overwhelming volume of COVID patients, relaxed regulations for the good of the patient, transitioned research to practice at lightning speed, solved a global supply chain crisis, innovated, and implemented remote care and video visits and delivered a vaccine in the shortest period in history.

 

For all that we accomplished, there is so much more to do. In my mind, what is yet to be seen is if through continued consumerization and use of digital technology will we once again get mired in the complexities of the traditional healthcare ecosystem or actually transform our industry into a consumer-centric digital health business? Will we consider the lessons of the EHR era or codify our convoluted processes into a consumer’s nightmare?

 

Ultimately will we ensure healthcare is truly accessible for all patients in a way they can simply orchestrate what they need when they need it? I fear if we as an industry don’t continue the collaboration and laser focus, we have shown ourselves capable of, some yet to be identified entity will solve it for us with a completely new system and today’s players could be tomorrow’s Blockbuster story.

 

Thank you, to all our panelists, for such a thought-provoking discussion. And many thanks to all the attendees and organizers of another successful event.

 

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