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Where will the emerging consumer have the most impact on Healthcare? Andrew Rosenberg, the CIO of Michigan Medicine stops by for a two-part conversation on Experience. Last week we discussed the Internal consumer of Health IT services and now, the external consumer of healthcare services. Hope you enjoy.  


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 Welcome to this Week in Health, it influence where we discuss the influence of technology on health with people who are making it happen. My name is Bill Russell, recovering healthcare, C I o, and creator of this week in Health it a set of podcasts and videos dedicated to developing the next generation of health IT leaders.

This podcast is brought to you by Health Lyrics, have a struggling healthcare project. You need to go. Well, let's talk. Visit health to schedule your free consultation. Now we rejoin a conversation, which we started last week with Dr. Andrew Rosenberg, c i o of Michigan Medicine. The topic is experience.

Last week we took a look at the . Uh, internal customer of health, IT and their experience. This week we're gonna take a look at the external customer of healthcare and their experience. Now we resume this conversation already in progress. Hope you enjoy. All right, so that's in the internal customer and we've spent a, spent a lot of time there.

I just wanna make sure we're okay for time. Are we okay for time? Good. Okay, great. So, And I guess you have to start with the basic question, which is, um, you know, we're seeing the word consumer more and more with regard to health services. Uh, do you think that's accurate today or do, do you think we have, uh, well first of all, do you think it's accurate?

And then second, do you think it's good for healthcare to have consumers? I've heard physicians say, don't have consumers. Challenging very things, you know, might to to.

You know, it, it's to some extent having that, that tight relationship, uh, enables you to say the hard things when you need to say the hard things and whatnot. Yeah. So do you think it's accurate and do you think it's good for healthcare? You know, the, the, the current consumer discussion is, I think you were alluding to it also, um, similar to the discussion of client, do you call a patient to patient or a client?

That, um, I heard a lot through medical school in the late eighties and early nineties, and so I would argue this, I would argue the intent behind consumerism in that discussion is incredibly important, and I would say most of us are spending time thinking about that. At the same time, I think we're probably overplaying its importance, and I'm sure that there are other people who would love to disagree.

The reason is that there are parts of healthcare that are elastic and parts that are completely inelastic. You have a broken bone, you're just a very different consumer than when you have a broken down car. The more appropriate analogy may be a broken down car that your daughter is in on the highway at night in the rain.

Right. You know, and so your behaviors are gonna be incredibly different about consumerism based on the underlying situation. And so I think we, we hear a lot about consumerism for the more. Elastic part of healthcare, the, the primary care when you're not really that sick or the, um, uh, the lifestyle care, and I don't wanna diminish when I say lifestyle, but aesthetics or things like that.

And then there are other parts that why they may not originally, um, come across as, uh, inelastic. Uh, um, physical therapy, a voice therapy, when it really impacts your job. When you are a teacher, a pilot, a professor, and you can't get your words out. Going to the speech pathologist is incredibly important.

And so I don't think that the latest mobile app that allows the consumer to pick and choose and disrupt healthcare. Is going to happen as quickly as some people may think. I, I, I saw one vendor discuss the fact that millennials today have no loyalty for their doctors or their health systems, and I suspect part of that is accurate.

So it could be just an age difference. But when people do become sick or develop a chronic disease or develop one of those inelastic items that I've talked about, I don't think consumerism, I don't think people with really bad abdominal pain that might be appendicitis or might be the onset of ulcerative colitis will tend to look for the least expensive five star.

Clinic two miles from their home where they can drive through. You know, we can just take this analogy so far, and yet at the same time when we talk about patient experience, family engagement, I, I think there's some really good things there that in the past, certainly during my training, we never thought about who cares what the food is.

You're in the hospital. So there elements of this that are very good for the overall experience, but I think we overplay it. So let's, let's go back and forth a little bit on this. 'cause it's, uh, I mean, the points you bring up are really, uh, are really good and really, really fascinating to me. When I think about, uh, the consumer, it's, it's access method, cost, structure, and experience.

And you're right. So if I have something, um, am I gonna go to the, you know, where am I gonna go? Now what has traditionally happened is the healthcare system has. Primary care physician, you start there and then we will sort of branch out from there. And the first thing we're sort of seeing go away is that primary care physician is the entryway into the health system.

Right now, the entry away into the health system, right, wrong or indifferent, a lot of times is the ed and we don't want it to be the ed. So then we stand up these urgent care clinics around the community, and so then that is sort of a, I don't know, it's, it's another form of ed, if you will, but we end up going in there because the, the model that you've given me as a, as a, as a consumer, Of health.

I, I don't like, I mean it, I, I don't, what, what model is that? The primary care. So I have to call my primary care doc and they go, well, it's your first visit. You know, we, we only do first visits every Tuesdays of, you know, third Tuesday of the, of the month. So we'll see you in, you know, two months for your first visit.

And I'm like, well, I, I got, I got a broken arm, you know, can I. You, you get the idea. I mean, the primary care. Um, my daughter needed a primary care in Missouri. She called and they were like, and literally first visit two months out and she's like, What the heck am I supposed to do for two months? Right. This, this is the silliest thing going and so she went to the urgent care clinic for That's, that's a great example.

Let's just take that for one second, bill. That's a great example where consumerism really has a place because it is starting to appropriately modify hundreds of years of tradition in healthcare and that to. Is a superb example where better data and the apps that deliver those data would allow your daughter or someone like that to see a very good, um, physician or provider in a fraction of that time.

So, for example, the whole point of, um, self-scheduling. Is a real sea change for a lot of providers. In fact, we're still struggling with it ourselves because we would, I would say we have, I'm gonna make this up about a third of our faculty who are really strongly proponents, but two thirds aren't. And the reasons are complex.

Part of it is because we have a very strong academic faculty at the University of Michigan, right? And so some of these people, they're very dedicated, but they're in the lab or they're teaching or they're doing something else. Part of it is tradition. Uh, part of it among specialists is, um, you know, the complexity of what they do, but the consumerism part that you started with is a good pressure to modify some of those age old things.

You should not have to wait, wait two months to see a primary care provider. Uh, one of my best friends, uh, did have a hurt arm in Baltimore and he called me up and he said, I can't believe that all the eds in Baltimore don't have wait times. Available by app, so I could go to the ED with the, the least wait time.

And he said, it's because you're all competing with each other and you don't wanna share the data. And I said, actually, I don't think it's even that by the way. Uh, I think Eds would love to decompress their wait time. I think it's, we've just not sat down to really talk about how we could share those data, because technically we could.

I don't, I don't see it as a competitive. Process. I think it's, it's really a priority issue, but that, that would be a very positive step that consumerism takes. So I do think those are good examples. Yeah, it's, um, it's interesting. So the, uh, so let's just take the ed, um, you know, 'cause the, the head of Walmart's care delivery essentially.

I was speaking at a large conference and she said, I, I want you all to take that down. You don't want my people going to your ED anyway, so stop telling 'em it's five minutes at this ed. You wanna, you want 'em going somewhere else, so stop encouraging them to go there. We don't want 'em to go there either.

Um, and it's, it's kind of crazy 'cause we, I, one of the health systems I did some work with, they had an ED and across the hall they had an urgent care clinic. As you know, the cost structures, even though it was across the hall, are completely different. I had a conversation with a C I O who said we had an ED and we had a person sort of standing at the door who said, you know, asked them what their thing was and said if you'd like, you can do a telehealth visit in that room right over there with a physician.

And you know, the cost would go way down and the wait time would be a lot less. Uh, and I think it was, I forget the percentage, but it wasn't, it wasn't an insignificant percentage that said, yeah, all right. If I could talk to a doctor quicker, I'll go sit and do the telehealth visit right over there as opposed to going to the ed.

Um, There's, there's so many, there's so many things that are just, uh, from a, from a consumer standpoint, let's take it from a consumer standpoint. You just look at it and you go, I don't understand. I don't understand why that urgent care one door over from the ED costs that much less. I don't understand why I can do telehealth.

Uh, if I go to the ed, I can do telehealth there, but I can't do it from my home. There, there seems to be so many things that the consumer's looking at it going, they say the millennials look at it, and the millennials do. The millennials look at it and just go, I, I don't understand healthcare at all. If this is the, this is the way it is.

I, I just don't get it. And as you say, it's a hundred years of. Of practice and it's a hundred years of, of education and, and those kind of things. And cultures change very slowly, and especially cultures with this much backend infrastructure and this many backend workflows and processes and regulations and security and compliance, they don't change overnight.

So it is, it is a slow process, but on the flip side, there's an awful lot of new entrants coming in saying, that's fine. You, you guys move as slow as you want. We're gonna just start picking off clients one by one, uh, from around the edges. And, and as my friend John Manis said in last week's show, um, You know, they're not looking to take the low margin, uh, high risk business.

They're just gonna take the high margin, low risk, uh, business until we're left with a shell of what we used to have that probably, and, you know, at Michigan or Cedars or Mayo. But it may happen at some of the other health systems. Right. And, and, uh, I guess what I'm saying is that the consumerism ideas are great.

John and I, as you know, talk a lot about this. Yep. I, I happen to think that. Again, you, you have to ask what is it that you're talking about? Um, I don't think the analogies of, um, low end steel production ultimately, you know, being taken away, lead to the high end, really high margin steel production, like in some other industries.

Some of those examples that are then applied to healthcare are a bit. Difficult. I, I think that there are aspects where consumerism has made enormous differences. When I was training, we had wards with 10 to 12 patients in. Uh, when I was done with training, we still had rooms with at least two patients in them.

Now, it'd be hard to find a hospital that's being built without private rooms, whether they're for, uh, infection control, but as much they're being built for the patient engagement. In patient experience. Even even that conversation's getting old fashioned. When you think about the ability, what, what we really wanna do is move patients back to be taking care

At home and with increasing sensors, technology, audio, visual, uh, automation, robotics, drones, and all of these kinds of tools, we're gonna start being able to do things at home that we could never do for a while because we need the monitoring, the rapid response, the, uh, precision of, um, different tools that could only be available in hospitals that are now being used at home.

This is all part of . Consumerism, but I only say this because as we shift some of these cases to ai, mobile devices, urgent care centers, uh, other types of providers, what I think it does is it also frees up time and effort to do the more complex things that we don't do or that we don't do as well. Uh, we, we know that virtual care is really just care.

The ability to provide telemental health, um, store and forward images for more complex dermatology, radiology, pathology, all of those things are not virtual care. Those are just care. And I think as we move those items, some of which are perhaps more influenced by consumerism, but others which are, um, influenced by the funding models.

What we're really gonna have is not our lunch taken away from us, as some people will say, I think what it's gonna do, it's gonna free up new opportunities that right now we're just not even doing because we're spending our time on some of this other work. But that's gonna be one of those endless debates that people will love to have.

I, I love, I love having these conversations with you. I, 'cause I think it is the conversations that are gonna move this forward. I think it's the, I think it's the interactions. It's, it's the discussions around. Um, just what can we actually do? What can we accomplish? Because there's nobody, there's nobody on either side of this debate that's sitting there going, yeah, you know, we don't want, we know we don't want healthcare to change.

Almost everyone's sitting there going, we know it's gonna change. Yeah. But my point that I've made to you before, which I, I still very strongly feel, is there's just so much that . Non-healthcare examples can then be applied to healthcare. And that's not a Luddite and that's not a defensive posture. And I think we are having those kinds of conversations.

You know, millennials are used to having this, this, this, that all at the touch their button. So they're gonna want it for healthcare. Some of it's true, but you see these examples already starting.

Probably slowed down more by the funding models than anything else. Not a desire to do it, but a lot of it, I argue, is just not that transferable to healthcare, and that's where we need to be a little careful that the fear of missing out, the desire to not look like a Luddite, the need to always show the cutting edge healthcare.

Is different. And by the way, it's not dissimilar in some of the other work I do around academic. Um, it support the, the idea of the flipped classroom, the idea that you can see a video and then go to classroom to do your homework is a interesting idea. And in some areas an education that is happening and happening more and more.

But that doesn't mean that all education now gets flipped. It's just part of, and where it makes sense to do it and what kind of education you're talking about. Very high level graduate education requires a very different type than, uh, technical . Training. And so we have to be careful with when we talk about consumerism and there's an app for it.

When I say, you know, how are you gonna do it? How are you gonna pay for it? How are you gonna secure it? I, I would also add, and what problem are you really solving with it? Right. That. Is really amenable to that technology or that, um, patient, um, expectation and it gets more complicated. So bottom line for me is I see examples of consumerism everywhere.

I would argue like I did virtual care, virtual health, telehealth, consumerism is really just how we do healthcare. And while I think we can get examples from other industries, you know, We were at a conference, you and I, where we heard a chief innovation officer talk about the experience of a huge entertainment company and applied to a very well known health system that's, that's good.

But where some of that service offerings of a huge entertainment company I think are great. And that's why I go to that entertainment park. , only parts of those really can be applied to a Demen A, a patient with advanced dementia who also has three very significant chronic diseases and whose family is very conflicted over the care.

You know? Yeah. And as the patient population ages, Some of these items that we talk about, millennials do not transfer over to an aging population. So we have to be thoughtful what we mean by these terms, like consumerism. Yeah. Well, and the other thing is, I mean, you talk about, and you, you lay it out really well in terms of the complexity.

Um, we, we just say, you know, we're consumerism in healthcare and it sounds like it's just one big bucket. But we all know that healthcare is a hundred businesses. I mean, even within the four walls of a health system. That you are managing and running. It's the reason you have 600 applications. It's the reason you have so many specialists in so many different areas, so many care delivery.

Mechanisms. That's why you're looking at home-based care. You're looking at, uh, clinics, you're looking at, uh, I mean there it's a hundred different businesses. And so when we, one of the ways we get in trouble is we start talking about consumerism and healthcare. Like it's gonna be applied to all hundred businesses the same way across the board.

Right? And the reality is the people that are making progress and really doing well in this are stepping back and going, okay, let's identify the . You know, the, the three patient experiences we're going to tackle first, and then we're gonna add two more, and then we're gonna, and they're not saying we're gonna become a consumer business tomorrow overnight.

Uh, they're, they're really sort of wadding into it thoughtfully and saying what areas will. Um, and, and listening to their consumers. What, what, what areas will benefit the most and what are the consumers really looking for that we can offer? And what are the consumers looking for that potentially they don't even understand what they're asking for, because the complexity of healthcare is such that they, they may not want what they're even asking for.

I guess. Yeah. And you know, lemme give you two quick examples. Um, one that I really like is a few CIOs and I were at a small meeting and a. That it produced an app that was actually pretty cool. While the c t O of the company was talking, I literally downloaded the app, signed in, created a new user account, logged in, and actually started using it all within about 10 minutes.

It was a pretty sweet design and it essentially would use AI algorithms to take you down a series of questions and then put you in touch with an actual clinician. So, Bad. But when I asked what was the business model, they said, well, millennials are, um, are disloyal or not loyal. They wanna disrupt healthcare.

They don't feel that they need to have their own doctor, let alone their health systems. So we're going to try to disrupt healthcare classic, you know, phrase, uh, for, you know, $25 a visit. We know they're gonna pay it, something like that. And okay. But what I said was, you know, whether a millennial or an individual is not initially associated with a physician or a health system, their health plan, uh, where healthcare financing is going.

Or when they do get older, they do get a chronic disease, they do get ill. They probably will get hooked into some form of some integrated network. Somehow, and I don't think the platform as a standalone will disrupt healthcare, but the platform for those health systems to still do new types of care to engage with patients, that consumerism idea, I thought it was actually a really great platform that wasn't their business model.

So when we talk about consumerism, we again have to talk about what's the business model that either the vendor or we're looking for the, the other one was an example you gave a little bit earlier. Um,

like I said before, hospitals, clinics, providers, new technologies are, I would say, more focused on the patient experience than ever before. And where we can find this artful, and I think it's art, it's not science at this point, approach. To those examples that are standard or standard or amenable to being standardized.

You talked about, you know, maybe pick three use cases. Well, right now, those three use cases could be totally different for a variety of patients with the exact same condition based on their age, their financing, their education, uh, you know, Dozens of of reasons. The art to it will be where are those robust, those standard approaches, robust to the patient in their setting.

And I would argue that it's just the attention to the consumer, to the patient, to the family experience in and of itself. That probably is the starting point. And . You know, think about CIOs who've been doing this for more than 10 years. They never had these discussions ever, I would think, or very rarely.

Yeah. Um, now we're having these discussions frequently. That's a, that's a fundamental change. The question is, what are the models that are robust and then what are those that are very, very specific that an individual or a small unit will find helpful and others won't? That's part of the conversation. I.

How much of your, the last question, I promise, but how much of your time is spent on technology today and how much of your time is spent on these kinds of questions, these kinds of discussions, culture, people, um, workflow, those kinds of things? I think I'm combining them. I mean, that example I gave earlier about the storage, that to me is as much a question about

How do we partner? I'm talking about this massive amount of storage requirements to do types of basic science in this case, but over time, this is gonna be more and more going into operations. That's as much a question about how do we find truly new technologies as it is about one or two individual faculty's labs.

So I use that. Need. We have faculty who are asking for that now. To stimulate a much more interesting strategic conversation. So I don't view it as technology or strategy or integration or things like that. I tend to find those really good examples. Oh, another one that, again, I'm just picking things that are happening this week.

I could, I could do this for hours. Audio visual. Audio visuals all over the place right now. And one of them to get back to one of your themes about consumerism are our bedside engagement tools, our, uh, family networks, whether it's Getwell Network or Epic Bedside, or any dozens of these. Um, that gets into a discussion about what do we mean by av?

We put TV screens up, we put flat screens for digital signage. We put whiteboards in the or. We have classrooms and we have conference rooms, we have monitor capture, we have lecture capture, we have evaluation tools, and all of those get wrapped up into av. So what do we even mean by that? Just getting our hands around what that means to run, to replace, let alone, to innovate in it has some very pragmatic side.

I have to keep the trains running. But then they also get into how those tools that I just mentioned play into some of the new areas like we've been talking about, consumerization, patient engagement, efficiency, real time analytics. I tend to look for use cases to wrap all these discussions and because they tend to be so integrated anyway, separating them out is, is, um, Is, uh, is a mistake.

If anything, the problem is trying to not over connect dots 'cause you also sometimes just have to execute and get some things done. It's uh, I had a conversation with the c I o. And he said, where did AV report in your organization? I'm like, construction. He's like, you're, you're kidding. I'm like, no, I kid you not.

It, it reported into construction. They had a little AV team and e every new piece of AV that went in anywhere was was them. I'm like, He goes, well, did that work for you? I'm like, oh, not at all. . It didn't work at all. I mean, every time I walked into a room, it didn't work. And, and this is exactly it. I, we could have a hundred CIOs and other IT professionals on the phone and we would have almost the identical experience because that's exactly what it is for US facilities.

We'll put in some, but now not even all of those parts. We'll do the networking. They'll do the conduit, they'll attach the flat screen, or another group will do that then, and this is where you see it play out. Who's gonna pay for the replacement? We're, we're dealing with that right now with one of our very advanced auditoriums that has probably a million dollars worth of advanced AV in it.

It's now 10 years old. No one knows who's gonna replace it. No one owns it. And I only bring that up because your question about how much is technology and how much is operations, well, that's a, that's a classic problem. Any c i o has to deal with. Yeah. But where do you now attach those kinds of examples to something new like, um, Waypoint Finding and Family Education in order to turn the hospital into a staging area for care at home.

Because what you really want is to not stay in the hospital for any length of time. You want people to efficiently get to where they need, get all the support they need so that they can be now taken care of at home. I can attach some of those AV discussions even into something that is as cutting edge as turning a hospital into a staging platform for co, for care at home.

That's interesting. That's fantastic. Well, thank you for your time. It's, uh, I, I really appreciate it. Um, is there a way for people to follow you? I mean, do you, do, I mean, you have a full-time job. What, what I'm finding more and is I. When would I have time to hang out on Twitter? Um, I know I, I wish I did, but I don't right now for really those reasons.

So, no, I am, I'm, I am not at all disrespectful of it, but I am occasionally on LinkedIn. Uh, my email a of course is always available to anyone. But, um, yeah. And, and, and you, you teach, do you teach as well? Now I'm faculty at the University of Michigan in the medical school as well. Yeah. So it's, it's not, it's not like you're not out there teaching.

It's just a matter of, you know, where you have to choose where you can engage. Otherwise you'd never get to see your family. So, and I can be guests on great, you know, great outlets like yours, so, and I appreciate it. That was a shameless plug for you, by the way. Well, I appreciate it. And, and, and we'll see you, uh, again this year at the Becker's conference, I assume.

Yeah. Yeah. Fantastic. That's a shameless plug for you. Right. No. We're, we're gonna be, I'm gonna try to be taking the con to all things visionary in it. I'm, I'm hoping to stimulate the debate of all the great things we wanna do, and then how are you gonna pay for it? How are you gonna secure it? How are you gonna do that?

As well as all the other things you have to do, right? And that's what we all face. But you're not taking the con because that's where you live. You live on both sides of that. Oh, I'm gonna be the Darth Vadar of, of CIOs. That should be a fun covering. I'm looking forward to that. And that's in Chicago in the fall, I believe.

So looking forward to it. Uh, this show is production of this week in Health It. For more great content, you can check out the website at this week in health or the YouTube channel at this week in health Thanks for listening. That's all for now.

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