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July 31, 2023: Robbie Hughes, CEO and Founder of Lumeon joins Bill for the news. How can the healthcare industry overcome the challenge of operationalizing digital solutions at scale? What are the key issues with the current approach to digital front doors in healthcare? What are the limitations of electronic health records (EHRs) in driving operational efficiency and reliability in healthcare? What are the barriers to creating a reliability culture in the healthcare industry? How can healthcare organizations create a cohesive strategy that integrates technology, marketing, and communication to effectively position themselves within the larger community? What role does cost, quality, and experience play in healthcare marketing, and how can organizations effectively communicate these aspects to consumers? What steps can be taken to measure and understand healthcare costs in order to provide consumers with predictable pricing and transparency?

Key Points:

  • Digital front doors
  • EHR limitations
  • Reliability culture
  • Brand identity
  • Cost, quality, experience

News articles:

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This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Today on This Week Health.

Specialty visit with the right position for the right thing at the right time and the right context, the right patient on the right pair.

No way, not a hope. And unfortunately that's where the rubber hits the road. That's the hard stuff.

Welcome to Newsday A this week Health Newsroom Show. My name is Bill Russell. I'm a former C I O for a 16 hospital system and creator of this week health, A set of channels dedicated to keeping health IT staff current and engaged. For five years we've been making podcasts that amplify great thinking to propel healthcare forward.

Special thanks to our Newsday show partners and we have a lot of 'em this year, which I am really excited about. Cedar Sinai Accelerator. Clearsense, CrowdStrike,. Digital scientists, Optimum Healthcare IT, Pure Storage, SureTest, Tausight,, Lumeon and VMware. We appreciate them investing in our mission to develop the next generation of health leaders.

Now onto the show.

all right. It is news day and I'm excited. We're going to be talking with Robby Hughes, founder and CEO of Lumion. Robby, welcome back to the show. This is your second time on the show, right? It

is Bill. Thank you very much having me back after the first time.

Yeah. Looking forward to it. So, we talked about Lumion the last time, but just for those who didn't catch that episode just give us a brief of what Lumion does.

So we're a clinical automation tool. We call it care orchestration, but what we're helping our clients do is deliver fundamentally better care with less.

And we do that through the automation of clinical processes, allowing you to define an operating model and then scale it across your health system.

Wow. That actually is an elevator speech. They say the elevator speech you get from like the ground floor to the top floor. That's the amount of time.

I can't tell you the number of times I've asked people for an elevator speech and like five minutes later, I'm like, Hey, thank you. I think it's appropriate because today we're gonna talk about marketing you've probably spent a lot of time talking about marketing and how to position your company within health care.

Today we're gonna talk about health cares. ability to position some things with the larger community. And so we're gonna start with you picked out this article. This is how marketing digital health has blurred according to Arden's chief consumer officer. And this is a Becker's story from July 13th.

You have the chief consumer officer of Nashville Tennessee based Arden health services. Reed Smith is talking about this. This new role, which is a lot like a chief digital officer, except it also has the old marketing function as part of it. And he's making the case here that essentially it's all coming together.

It's the ability to do digital, but the ability to communicate to the community what it is the health system does. It's all sort of coming together now, and it really can't be separated into multiple departments, like the I. T. Department brings the technology and the marketing team brings the marketing and the, and the various parts of the organization.

it really has to be a cohesive strategy, a cohesive message. Yeah. What, what did you get out of this story as you read it?

So I think this is dead on. For me, healthcare is really peculiar in the brand that I, as a patient go, go to see when I go and see my physician is the brand of the physician, not necessarily the brand of the group.

And given that my physician can practice at multiple different places, that's confusing to me. What is. The brand, what is the identity of a healthcare system? And to me, this industry has evolved from a place where it's these series of little independent contractors or practices that have been consolidated, but the hard decisions of how to create that uniformity, that standard, that strong opinion around what care should be that hasn't really taken place.

So I think the idea that creating. Bringing these roles together, that's definitely the right thing to do. My question would be how far are they willing to go? Like, are we thinking about the medical processes? Are we thinking about the clinical operations? Are we thinking about just how care is executed?

It's got to be more than a brand promise. It's got to be brand delivery. And that's where we need to be really. Well,

Your first point's really interesting when I think about why I go to certain health systems. I don't go to see the health system. I go to see my primary care doc. It's the doc who takes care of me.

And I know, and who knows my history and that kind of stuff. And my parents have this great story of their primary care doc literally left one health system went to the other. And they kept going to that primary care doc. So essentially the patient moved to a different system And they didn't really recognize that move until they had to go to the hospital and they said, oh, No, i'm not with that hospital system anymore.

I'm with this one. So you're going to be going to this hospital And to them it just didn't matter. They were just like yeah, well, she's directing my care and she's saying this is the new health system that you're going to that brand, or I should say brand that relationship is stronger than the brand.

Well, and I think there's a really good question as to whether or not that should be the case, because ultimately physicians don't practice on their own. In the case of the PCP, it's probably closer than most, but if you're thinking about any kind of surgical procedure, if you're thinking about care management, population health, this is a team's work.

And that team doesn't, you don't have that relationship with the team necessarily. There's care coordinators, navigators. I mean, there's endless terms that we're using here to describe that overlay. But essentially what they're trying to do is bring consistency and predictability to your care journey across the fragments.

And that's really an articulation of the brand. The way they do that, the way they put it together. I mean, the way they price it. Ultimately, if you think about what this marketing piece should be, it's that you should be getting predictable care for predictable price at a predictable quality.

I mean, those are the core tenants of what we're trying to get as consumers and the point of this role in terms of. Articulating why ardent or anyone else has got to be foundationally based on those things, so you can't do that as a veneer. You've got to do that when you're thinking about the whole piece together, and I think that's incredibly challenging, but, from a consumer's point of view, at a PCP level, you don't really see it,

brands, right?

If we break it down, we think, And I'm going to do this in different ways. One is Mayo Clinic, that's a brand. We hear it and we think something of that brand. I would say oddly, interestingly enough, I think in its market, hospital for special surgery, which is orthopedics in New York City.

one of the largest orthopedic hospitals in the world, arguably. I'm not sure the entire numbers, but they have a brand around orthopedic surgery that is really top notch. You probably. have something similar in the cancer space. If I thought about it as well, there's certain cancer brands that you know, City of Hope N.

D. Anderson and others that have a good brand. I don't. Some of them are good brands regionally. Some of them are good brands nationally. But if you were not in that role, that the role that we're talking about with this ardent person it's really a difficult role because what did you said?

Cost, quality and experience. Were those the three things you said?

Predictable carrot, a predictable price and a predictable quality.

So those three things, most hospitals can't give you a predictable cost. Because I've made this argument several times on my show and nobody's ever pushed back on it, which is we don't know our costs.

Very few health systems know their costs, so they can't give you a predictable price. We can't tell you what your price is going to be ahead of time because we don't know it. So that one's. almost off the table. Now, operationally, we should be able to get their predictable experience predictable outcomes.

Those are the things we should be able to market, though. We should be able to market, hey, our fill in the blank, whatever it happens to be our cardiac program. And I think we see this in some cities. You drive in you see the billboard, number one cardiac care the thing that's Interesting to me is it always says u.

s news and world report. It doesn't like You know, it doesn't say You know number one based on outcomes. It just says yeah. Hey, this

is Yeah, I this I find this intensely frustrating because consumers Particularly in the U. S. have been trained to correlate a couple of things. So one is more expensive care is by definition, better care.

Like if you ask an American consumer, what's better, the cheap guy or the expensive guy, they're going to say, you don't want to compromise on cost. You want to go with the better person. That link is there. The other thing is around service and getting what you're paying for. So if I go and see a doctor and I say, this is what's wrong with me, I want these things and they don't give it to me.

That's a frustrating experience for the consumer. That's not the experience I want. I want to be given what I'm paying for. So. The, unfortunately, the fallacy with with this industry is that neither of those things are necessarily true. We know empirically that more expensive care is genuine, generally worse care because it's tolerating less specialization, less measurement, and generally much more variation on the consumer is always right side.

Doctors, evidence, science, industry, we've got a whole industry around this idea that they should be the experts in guiding us, not the other way around, so why would we think that? I don't know, but the points around, the Mayo Clinic, HSS. These are people who've expressed strong opinions around what they're trying to do.

They have built a recipe and then they measure to that recipe. If you go to a Mayo Clinic doctor, they're going to be practicing in a particular way, doing certain things. That operating model, those strong opinions are very deliberately set up and they measure like the point around. We don't know what our costs are.

All of this comes back to the first thing measure. There's no reason why we shouldn't know what our costs are, but I don't know. I'm very passionate about this. I think it's hugely important and the positioning of great care if done well is very valuable. The challenge is I don't think there's a common definition of what great is.

And from a marketing perspective, that's the first thing they've got to sort out.

Well, it's interesting when we talk digital and we talk marketing, they talk about this digital relationship we're establishing with the consumer and they're coming to our digital front door, if you will.

And Sarah Vazie and Doug Grafsky with Providence wrote this article. A digital front door is so yesterday and they make the point they do the analysis and they look at digital front doors and they have some of these points. Most health system services still cannot be booked or managed online.

Consumers still cannot shop for care. It can't preview what the service will cost. Outbound communications are not well coordinated. Clunky EMR patient portals are still largely a default entry point into the health systems. Health systems experiences aren't integrated with core ecosystem partner.

experiences and health system digital experiences still aren't omni channel. And when you think about it, I'm like if I went to JP Morgan and said, Hey, we're gonna write a banking app and you're not gonna be able to shop for services. You're not gonna be able to do this. You're not gonna be able to book things online.

I mean, they would be losing clients left and right. Is there sort of a panacea going on? Oh, we had this many logins last month. It seems to be the metric. Are we just looking at the wrong things to, to measure the effectiveness of our digital relationship with the consumer?

I think this comes back to the same point.

To me, we are really good as an industry at putting in a digital veneer over the top of things and saying, right, another system, more technology, fantastic. What we forget is that the more stacks, the more layers of technology we put in, the more glue we have to bind them together. And unfortunately that glue is usually humans.

And there's certain things that these digital front doors will do nicely. So booking a 20 minute PCP visit for an open presentation, fine. That's easy. That's just a simple slot scheduling. Specialty visit with the right position for the right thing at the right time and the right context, the right patient on the right pair.

No way, not a hope. And unfortunately that's where the rubber hits the road. That's the hard stuff. It's funny. I, I did some work with a client last year and they were outlining their access problem saying, we want to make it easy for patients to book online.

Great. Okay. I get that. What they actually meant was they want to make it easy for new patients to book online because they're trying to open the funnel and get more revenue in. And I understand why that's important. What they're not doing is looking at follow ups and what they're not doing is looking at recall and all of the things that happen off the backend.

So, it's not a one off sliver. You can't just drop something in the top, but like increasing your funnel from a marketing perspective is not going to make you more successful. It's about looking after what you've got and. And again, working stuff through the funnel in a consistent way, again, over the lifetime of that customer, those are equally important.

And, bringing in more people at the front to then burn them later, because you've provided a terrible follow up experience. It's not really the problem we're interested in solving. Sarah also makes the point around identity, and again, I'm sure you've spoken to tons of people about identity in healthcare and the problem that creates and the identity, the need for an identity system and the lack of willingness to do that and all of those problems.

But I mean, even identity across internal systems within a health system, the fact that's still a problem today, in decades after things like Active Directory and LDAP have been frankly standard in every other industry, I think that's. Great shame. But again, these are hard problems.

How does a pa, how do you create a way for a patient to identify themselves clearly and easily, and then link that back to a record, and then that gives you rights authorization that gives you purpose and intent and context around the record. No one said this was gonna be easy. We're not talking booking cinema tickets here.

And you can take slivers off the problem, but the more slivers you take, the more you need to join up, the more glue you need, the more I would say you need you create a need for orchestration of joining these things up. Again, that's my pitch, but these are big problems and they can't be taken lightly, unfortunately.

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Every now and then I sit and I watch a panel discussion at one of the conferences, and it's the it's really smart people up there talking about all the problems that health care has in the digital front door. Doesn't have this and this and when we finish, I'll be sitting next to somebody and I'm that cynic and I'm sitting there and they go, wow, it's amazing what these people have been able to do.

I'm like, they haven't yet told us what they've been able to do. All they've told us is what is wrong with the industry. Which we can all sort of map out. We had back when I was CIO, this is back in 2013 or 14. We had journey maps. We had journey maps from one end to the other. And that wasn't the challenge.

The challenge wasn't mapping the journey and seeing the problems. The problem was when we finally mapped it out. It wasn't a digital solution that we needed. It was an operational solution. We need it. And that is such hard work that is sitting down with doctors and saying, okay, how are we going to be able to do specialist visits?

online and they just look at you like it can't be done and you go, it's got to be done. Like, we're smart people. Let's step back and figure out how to make our health system more accessible and how to make it, just better for everybody that's doing it. As I look at the digital front door, first of all, most times it's just the standard, whatever the EHR provider gives you, boom, here it is and away we go.

But the operational, what you can see based on what's being offered in that digital front door is the operational efficiency. I, if you and I sat down with 50 portals. And start breaking it down, we'd be able to identify it's like, yeah, they haven't fixed their intake process. Yes, they haven't done this.

Yes. I mean, because you just look at the ones that are effective and the ones that aren't, and you're like, they haven't done the operational work.

The challenge you're describing there is the reason why innovation fails to scale in healthcare. Fundamentally, which is that there is so much operational variation.

There's a lot of good clinical intent, but actually executing it and operationalizing it at scale is so mixed that in order to execute any kind of change of value, you've got to Document where you are, get harmonization and agreement and alignment around what you're trying to do, and then execute that change and then put rails around it to put the digital piece through to make it work.

And you can do that in pockets really easily. I'm, there's, I'm sure you've done a million pilots of different things and little pockets where you can get 10 people to agree on, right, we're going to do this. But doing that across, I don't know, 4, 000 beds, 20 hospitals and getting them all to adopt a common operating model, digital or not, frankly.

That's just a different scale of thing. And, our point of view on this is trying to get people to move from a place where they don't really know how they work today to a new place, which is better, but still unknown, that's never going to work. You just can't do that. You end up with a car crash, but what you can do is you can create this sort of journey where you can say.

Well, this is what you say you're doing today. This is what you're actually doing today. How much of this do you think you want to adopt or change or whatever? And you can look at this in a stepwise fashion, but you can use the digital to put rails around it and make sure that you're at least eliminating variation and using automation to take out things that could be at risk of creating divergence.

And again, it creates the measurement platforms. You can have debate about, does this work or not? These are the things that need to happen. And it Payment models, transparent pricing, managed service integration, et cetera. These are things that are going to be forcing functions. But the, as the article says, healthcare is hard.

It's not impossible, but it is hard. And it requires, I think, a lot more effort than people necessarily expect when they go into this.

I want to do one more story, but as you're talking about that, I think people would be surprised how much clinical variation there is. within health care.

Like they say, I'm going to this hospital. I'm like, that doesn't necessarily mean you're going to get great care. I'm like, which doctor you see? Because of the way insurance works, because of the way you know, we end up with these blocks of doctors, the insurance, you can't write like these five doctors off for bad outcomes.

So they're a part of the block. So you have to be careful of clinical variation exists. I guess my question to you. And we'll close out this article with this question, which is a lot of people have addressed this variation that you talked about and how they addressed it is they moved to a new EHR and I won't use a specific name, but they're like, Oh, look at, because there is a lot of work there's a lot of application rationalization that goes on.

There's a lot of conversations that you have to have in order to implement a new EMR and it gives people the perception that. we've, sort of arrived once we've rolled out this EHR. But that's really the starting point, isn't it?

Yeah, I think an EHR is foundational. It's definitely not sufficient.

You need to have data. You need to have consistent documentation. You need to be able to do your billing. That's foundational stuff. But the fact of the matter is We don't have what I'd describe as sort of a reliability culture in this industry yet. The kinds of failure to execute that we see and tolerate, what I mean by that specifically, like a heart failure patient going home and not getting followed up.

I mean, patients coming in being optimized for surgery, but things being missed and then the surgery going to be canceled. These are avoidable issues that we know clinically what needs to be done. There's no debate about that. But there's a gap in execution. That kind of stuff is more than checklists.

It's process, it's teamwork, it's consistency. It's a reliability culture that if you had those issues in the airline industry, you wouldn't get in planes. You just wouldn't go anywhere near a plane if you thought that the stuff that you see, or sort of we as insiders maybe see in healthcare, was happening in that industry.

And I think, reasonable people would make the case health care is different, every patient's different, etc. That doesn't mean we don't have checks. It doesn't mean we don't have evidence based processes. It doesn't mean we don't have all of these operational constraints that we need to put in.

Because yes, every patient's different, but we need to know why they're different and how they're different. We can't just say they're different and then use that as an excuse to say we don't need controls, process, checks, etc. And, unfortunately, what the EHR does is it gives us sort of the illusion of that process, allowing us to document whatever we see, it allows us to document whatever we want to do, but it doesn't get us to that second order problem as which was, is that the right thing?

And is that intention being executed and then done by the right person at the right time in a timely way and that's a level of optimization, which is where the efficiencies come from. It's where the quality comes from. And it's where candidly, this kind of standard operating model piece comes from.

And the, I recall a piece of work I did a few years ago where it was simple diagnostics looking at glaucoma, and you'd think that even in the case of glaucoma, there'd be a diagnosis made, and then there'd be a recall protocol put in saying, right, we're going to, this patient's got a diagnosis, we've got to follow up within six weeks.

Couldn't even get alignment on that, let alone how that manifests and what you should do and should it be a letter or digital or whatever else. Late. There's so much variation on which... Which kind of, it's understandable given how the industry's evolved, but as, if we can't get to an explicit decision around what should be done, let's at least measure it.

Let's look at the outcomes it delivers and then let's agree as a group, what's better or not. Let's try to eliminate the variation around an unknown way of working. While we're in this kind of mystical world of he said and she said we're never going to make progress on any of the things we're talking about here in this idea around better care.

It's going to stay on billboards, I'm afraid, and not actually be evidence based.

We have some other great articles to go through, but we're actually at our time for this episode. But you're going to come on again. I think you and I are talking within the next couple of weeks. Yeah, that's right. We'll carry on.

That's great. I want to get back to this data and compute are the ultimate flywheel article, but it's dense and I don't want to kick it off at the end here because we'll be talking about it for 15 minutes. But that's probably where we're going to pick up the next time you and I get together is talk about this explosion of data and how GPT is.

changing how people think about this massive data that just sort of accumulated. But I'm curious, what the thoughts are going to be around healthcare, but we'll save that for our next conversation. Robbie, I want to thank you for your time. Always great to get your insights on

this. Thank you, Bill.

It's a pleasure to be here.

And that is the news. If I were a CIO today, I think what I would do is I'd have every team member listening to a show just like this one, and trying to have conversations with them after the show about what they've learned.

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