February 18, 2022: This once in a century pandemic has been hard and grueling but it has also been fascinating, inspiring and exciting as we think about our future in healthcare. Phoebe Yang, General Manager, Amazon Web Services, Healthcare is leading the high growth cloud service business that sits at the inflection of technology and healthcare. What are the problems that technology is best positioned to solve? Clinicians now have AI, ML, Big Data, Architecture and Automation tools at their fingertips within minutes. What does this mean for workflow? What does it mean for patients? When it comes to health equities, does technology alleviate or exacerbate the problem? How can we use technology to help solve the labor shortage in healthcare?
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00:00:00 - Intro
00:31:15 - Amazon Transcribe Medical and Amazon Comprehend Medical
00:18:00 - AWS is enabling the innovators at Houston Methodist with clinical voice technology. Why, in the operating room, does any clinician, surgeon or staff member ever have to touch a screen or keyboard?
00:06:40 - How can healthcare become more consumer centric?
00:30:10 - We are at a transformational and revolutionary moment in the provision of healthcare
Today on This Week Health.
I do see progress and I think a silver lining, if there is one in the pandemic is that it has given us all the ability to really focus and be intentional about these questions of access, because it's always been true that what happens to one of us impacts all of us.
Thanks for joining us on this week health Keynote. My name is Bill Russell. I'm a former CIO for a 16 hospital system and 📍 creator of This Week in Health IT. A channel dedicated to keeping health it staff current and engaged. Special thanks to our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in developing the next generation of health IT 📍 leaders.
All right. Today we are joined by Phoebe Yang, General Manager for the nonprofit healthcare space at Amazon Web Services. Phoebe, welcome to the show.
Thank you, Bill. It's great to be here. I'm an avid follower of your show. So I appreciate the opportunity to join you.
Well, I appreciate that. Our backgrounds actually overlapped a little bit at at St. Joe's. You were on the board and I was the CIO there early, early on in my tenure. I'm not going to ask you to comment on anything that I did while I was at St Joe's. But give us a little of your background in healthcare.
Yeah, thanks for asking. We know my start in healthcare actually began when I was in the media and entertainment industry long time ago. And it was a time when digital forces were beginning to disrupt traditional revenue, streams and incumbent player. It sounds kind of sounds familiar. Consumers were demanding better access, more affordability, higher convenience.
And I was being asked to help turn around a underperforming health business in a particular media company that wanted to become publicly traded. And in that process I that really interested in the digital aspects of what we were doing and began doing the. At that point in time, it was early on in the media space of digital disruption.
And I began to do a lot of deals with organizations that were up and coming that were not the big deals that everybody in the C-suite wanted to do, but they were the smaller deals with some of the technology companies that are very familiar to all of today. And so I began to see sort of the emergence of new business models and how digital fortress could in fact propel consumer delight as well as new models for revenue streams for incumbent companies that led me then to the FCC in an administration that was really focused on broadband issues and really helping to lead how we should be thinking about broadband proliferation in the same way that in the past we thought about highways and railroads and electricity and telephony. And then from there I went to lead corporate development at a publicly traded research and SAS analytics company. And then from there became Chief Strategy Officer and Chief Architect for population health at another big health system Ascension.
And so in all of those contexts, really seeing how healthcare has been transforming pretty dramatically over the couple of decades. And having had the privilege then of serving on three health system boards I've been really inspired and driven by the mission of health care to increase access, affordability and convenience for everyone.
And then that ultimately led me to Amazon. To lead the high growth cloud competing business in service to healthcare customers and sitting at the inflection of technology and healthcare during a time, a once in a century pandemic that's been really those inspiring, fascinating, hard but also exciting as we think about our future.
Yeah. So AWS is the infrastructure and data compute storage, AI tools, those kinds of things. It's the infrastructure arm of Amazon. And I remember back in the day at St. Joe's, we were trying to move to the cloud. Back in 2012 and we couldn't get BA with any of the providers. And so we had to build out our own cloud. Fast forward like I think it was only like a year or two after that all the providers started coming back to healthcare and saying, okay we believe that our technologies can assist. When you look at the healthcare landscape, what are the problems that you believe technology is best positioned to solve today?
Yes. Yeah Bill it's so interesting because I think in the last two years in particular we've just seen a heightened interest in and technology's potential to support really every corner of the healthcare industry. From remote patient care to planning for surges from pre-empting, overwhelming bed capacity at hospitals to research and vaccine development.
And I would say if you think about it, there are areas that I think have really taken off.
And three of those that, that we spent a lot of time on are access to care, meeting consumer demand and really unlocking siloed data. With respect to access,
one of the biggest challenges I've found when I was helping to build and scale a population health business for Ascension was this question of access to care.
And the pandemic only heightened and worsened in some ways the challenges of a lot of people. But especially those underprivileged individuals and families and communities to get in-person provider care and particularly when that care is most needed. So what we saw, which was really super interesting, but also very inspiring was a lot of health systems really stepping up, I think to support telehealth. They broadened and diversified the points and modalities that patients could access clinicians and get the care that they needed. And the goal now is really to leverage what we've learned to advance and not retract those modalities so that all patients and providers who really saw really a better experience can reduce the burdens and and also the burnout factor and to have better experiences.
At the same time and we've been talking , I think when I first joined the St Joe's board, one of the interesting things to that board when I joined was that I had this sort of media and consumer background. And so for a long time, we in healthcare have been saying, well, how do we become more consumer centric?
I was just last week talking to a friend, who's a Chief Clinical Officer of a national health system. And really one of the most common questions I still get is how can we become more consumer centric? And it's an axiom people now say, well I can get what I want when I want it, how I want it.
And media, finance, restaurants, they all know me why can't, why can't healthcare also know me? And so we all say we want the ease, the immediacy, the location, agnostic care from getting or finding a caregiver to booking an appointment to getting treatment. And in all of those areas we've really built the expectation that we're going to have more personal relationships with patients.
And at the same time, I think it would be too glib for us to suggest that healthcare is completely like booking a restaurant reservation. As well as either there's a wide range of types and acuities of care and what drives, how, where, and whom we engage really is dependent on the specific aspect of care that's needed.
And so that's where technology can really help. We can help distinguish and target the right type of care, the right location, provide that in the modality that that a particular patient or a provider either even needs to provide it and, and we can do that at different stages. And technology can really help assess and triage and prioritize and personalized care in a way that enables and enhances how care can be provided.
So what's interesting is there was a big marquee health system out there whose name we would all know and appreciate. Sort of a household name out there. And the CIO was recently sharing that he is increasingly seeing clinicians who were surgeons or specialists in particular medical areas becoming increasingly well versed in AIML and really understanding not just sort of the usages, but actually how you know wobbles get built and how the technology works. And at the same time, we're seeing technologists becoming more and more sophisticated in diagnostics and training around medical treatments. And so it, it's a really interesting time in the industries to kind of see some of these capabilities really coming together.
You've given me so many directions I can go from here, but here's what I'd like to do. I'd like to move up that stack because AWS does so many things, but I want to start with access then I want to start to talk about some of those tools that are available to us to personalize care, to reduce the burden on the clinician, to solve some of the interoperability problems. I mean, there's so many things that AWS does, but let's start with access because that's part of your background as well. It's interesting that during the pandemic access became so important. More so than, at really any, any time in my history on this planet. We were trying to figure out how we're going to reach these people in their homes. How are we going to reach them where they are? Because coming in contact with people was dangerous. Early on in the pandemic. We didn't know what we didn't know. And so those organizations that had adopted the cloud early. We're able to scale very rapidly. They were able to stand up systems.
They were able to stand up telehealth and whatnot. But one of the things you also noted, and I'm not sure what the question is here, but one of the things you also noted is it also really, there was a huge spotlight shown on the fact that some people aren't on broadband. Some people aren't connected to our digital economy and you would think, oh, that's rural America.
But we saw this play out in New York city. We saw it play out in Philadelphia. I mean, people couldn't go to where they normally go to, to get on a computer. And Education was being done that way. Healthcare was being done that way. It wasn't just, Hey shopping and that kind of stuff. We're talking about essential items people were having were struggling to get access to.
That was part of some of the work you were doing back in the day. I mean, are we making progress in that area? Do you see progress being made so that we could get more people engaged in the digital ecosystem?
That's a great question because it goes back to the core, why we're all in this. Right. And I do see progress and I think a silver lining, if there is one in the pandemic is that it has given us all the ability to really focus and be intentional about these questions of access, because it's always been true that what happens to one of us impacts all of us.
And yesterday was the day that we commemorate the life of Dr. Martin Luther king Jr. And a lot of what he said around justice and equity really applies in the context of healthcare as well. And so as we've seen the pandemic sort of force us to make hard decisions, invest in what matters and in fact come together where maybe sometimes we thought we were competing against one another or you may be tripping over each other. We've really come together to focus on real solutions and we still have a long ways to go. But the fact that we came together is really, I think a great thing about humanity and the human spirit and the resilience that we have, but it also enables us to say, okay, we've come this far. Now how farther, can we go together and advance what we've been able to achieve in these areas of access and equity. But we do, it's going to take that kind of focus going forward because we still have huge gaps in care. We have challenges around affordability. And we are still, I would say in the early stages of really understanding the dynamics of some of the social determinents that really drive healthcare outcomes. We've known that they do, but really understanding them at scale, we're still, I think we're still early stages in that.
📍 📍 We'll get back to our show in just a minute. I'd love to have you join us for our next webinar titled Owning Cloud in your Organization: Understanding, Implementing and Designing Your Hybrid Cloud Strategy. We're going to have experts from Sirius Healthcare, Cone Health, St. Luke's University Health Network and they're going to walk us through the lessons they've learned in moving to the cloud and adopting a hybrid cloud strategy. But specifically, we're going to talk a lot about moving your EHR into Azure, which both of these health systems have done. Join us Thursday, February 24th. You can register now at go.thisweekhealth.com/cloud_webinar or by clicking on the registration link in the description below. Now back to our show. 📍
📍 Another thing that came up through the pandemic was the burden on clinicians. And this is something that AWS has weighed into with various tools with voice, with personalization tools, with trying to make the systems easier to access and reducing the friction of the whole transaction. Talk a little bit about the provider experience. And what technology has been able to do and what we hope to do.
Yeah, this is this issue of sort of provider experiences is so heavy on all of our minds. In speaking with a friend not long ago, who is also happens to be the CEO of a health system in the Midwest she was just sharing how COVID is a big risk to the business, but it's not COVID itself.
It's one, if not the biggest risk to the business is really provider burnout and attrition that is exacerbated by COVID. But you know, as a broader trend that we're seeing and certainly the sacrifices that healthcare providers are making day in and day out for us. They always have, but the last two years have been just immeasurable is really both inspiring, but also challenging and heartbreaking on many levels and so I just really wanna acknowledge and thank everyone who is involved in providing care at the front lines and at the back lines of care to really enable all of us to live healthy and well lives. But in the context of that teacher question Bill, it wouldn't be really hyperbolic to say that the need to streamline clinical workflows and plan staffing times and predict and reduce burnout are just table stakes for all of us.
And we need to come together to figure these things out so that clinicians can focus on patient care or top of license and really do what they were trained to do and are passionate about doing. You know cloud-based solutions can really help them that things like automated speech recognition can give clinicians quick access to information they need.
And at the same time, reduce the burden of data entry. We've seen customers deploy voice technologies to help with time-consuming labor intensive and other really inefficient tasks and functions. And at the same time is possible even not just to reduce burnout, but to, to delight providers by using technology and innovation to, to really enable what they do even better.
I mean, one example I'll give you is our friends at the Medical College of Wisconsin Health network. It seems simple, but it's actually quite transformational and what they did, they built an app. It really focused on providers at the beginning of the pandemic to do self screening for COVID and symptoms.
And they could do this daily. They had a clearance passport that they use to get in. And the out this is before any of those modalities or tools were available, they received the alerts in the case of potential risk to have exposure to them, or others have infect action on, they could schedule fast track testing, and they got real time access to information and guidance on what they should do.
And that app was intuitive and convenient and created a user experience that enable providers to really see you know huge surgeon's sort of satisfaction and engagement at the time when they were most needed by their communities and the patients. Similarly Hawaii Pacific health began to deploy over 600 Alex as in their hospitals and use multiple Alexa skills that help to streamline provider and nurse to patient communication.
And at the same time, they were able to really transform for the patients, the in room experience, because they no longer had to sort of rely on outdated nurse call buttons, which can be annoying for everyone. And they were able to replace those buttons with natural conversations with Alexa.
And at the same time, the nurses could be freed up because they were no longer being called to administer in room amenities and entertainment options and answer questions that Alexa in fact could do. And so those were some things that really delighted both patients, but also providers in the context of what you know they were doing.
So yeah, one of my favorite examples out there is what we've been doing to enable the innovators that Houston Methodist with clinical voice technology, where they had the vision that why in the operating room, does any clinician, a surgeon or staff member ever have to touch a screen or a keyboard?
Why can't we focus on the patient, on the surgical procedure, on the prep, the things that we're trained to do, and that we do. And so they ended up working with us and a partner Pairveda, creating a digital voice assistant for engaging before, during and after surgeries with the patient record so that you never had to touch a keyboard or a screen. You can initiate queries of data from the patient's electronic record.
You can allow clinicians to start and stop verbal timers like start the tourniquet right arm. And and you can allow staff to complete verbal safety checklists for the surgeries. And so in the context of that both nurses, residents, surgeons, staff have a wonderful experience that is, it seems futuristic, but in fact, it exists now and today. That was such a huge satisfier that the clinicians wanted it outside the surgical environment and began to move to Houston Methodist and this began to move it into the exam rooms where you can use any device, a tablet, a phone, a PC to capture the dialogue between patients and clinicians in a secure, compliant and consented manner. But at the same time, doctors and patients can talk to each other and could look each other in the eye and not through a screen or at a keyboard. And then at the end, the doctor and the patient automatically gets a summary of the interaction and that da gets indexed and placed to a patient record that's later searchable. And so it creates a great satisfier from both a clinician and a patient standpoint, and it eliminates that sort of click heavy EMR engagement that so many, so many clinicians have just been burnt out with. And say, this is not why I came to practice medicine. I came in fact to practice medicine, to engage with my patients and care for them. And so it's been a, it's been a real positive thing at Houston Methodist. And we anticipate it will be in many other places as well.
Yeah. I interviewed Michelle Stansber y. And if people want more information on that specific solution that you were just talking about, they can listen to that episode. On our website. Michelle goes into a lot of detail in how they've deployed that. And she's really excited about it. I I also talked to Cedars has deployed the Echo devices in each one of their patient rooms as well.
That was a pretty common theme. And you're right. If we can get rid of that nurse call button and get more, I don't know, personal in terms of how we do that. I think that that's going to be all in all a much better experience across the board. It's interesting cause people are wondering why am I not asking questions about Amazon care and those kinds of things. It's because AWS is really the infrastructure arm. You provide the infrastructure and those AI tools and whatnot on the backend that people can program to. They can hit those APIs. They can, they can do all sorts of amazing things on that back end processing that.
But essentially Amazon functions as, and we've all read the articles and it's an amazing culture. But it really functions as a lot of entrepreneurs and a lot of startups within a larger umbrella. And so it's exciting to talk about Amazon because you have so many different areas that you are working in healthcare, but if people are wondering why I'm not asking you specific questions about that is because AWS has so many things that you are specifically doing in healthcare but not necessarily, I mean, you, you supply the tools to the others, but not necessarily integrated and interacting with the others. There are entrepreneurs that are building on top of your environment the same time way health systems can build out those capabilities on top of your environment.
That's exactly right. They're customers of ours. Just as important to us as our customers in healthcare that I've given examples on. And if they choose to work with other customers, they choose and you know one of our customers, say a health system decides to work with another part of Amazon. We're delighted to see that, but it's like two customers working together and we're running our businesses with different leadership and I, I have the privilege. I think I have the best job in healthcare at Amazon because I get to enable those healthcare heroes on the front lines with the best in class technology for the benefit of patients and the communities they serve.
What are consumers? Early on, you talked about the consumer experience, the patient experience, but really the consumer experience, we're starting to reach outside the four walls. Nobody does that better than Amazon. Reaching outside the four walls of the building and really engaging people where they live and giving them experiences that delight them.
As we start to think about that in healthcare. What kind of experiences might we give them that they would walk away and go, yeah, that was a delightful experience. Are we starting to see some of those things or enable some of those things or do we still have some ways to go because of the nature of the data and the nature of interoperability?
The patients and consumers, I think our defining and driving sort of the advances that, that we all hope to see. Right. And so they, they in fact are helping us as an industry, when I say us, I mean, healthcare as an industry, think about what it is that's most important for them. And I think we've heard loud and clear during the pandemic that location agnostic care is really critical.
And also being able to distinguish between the kinds of care that really require Coming into the four walls of the clinic or a hospital in those that actually can be done perhaps even better through virtual health modalities. And so in that context, as we begin to move in those directions, I think we've really advanced quite a lot in those areas. At the same time, you know what we're seeing and one of my favorite things that happened during the pandemic, as we started to see health systems really say, you know what? We have all of this data and we've got to start to understand the data so that we can begin to predict the kinds of interventions that we really need to be having.
And with which populations and when and how. And so, for example, Dr. Kurt Newman, the CEO, at Children's National Hospital and his really innovative team began using Amazon web services to predict potential drugs for COVID treatment and using those machine learning models to train their team on how to intervene.
And at the same time, really capture data coming in from all kinds of public drug response, datasets. Similarly my good friend, Omar Watith at Rush University Medical Center used Amazon Health Lake for really pulling together data to drive COVID response and to address health inequities.
I don't know if you've heard a little bit about that. I'm happy to share that quickly they took in sort of disparate data from multiple data sources and far format to really gain critical insight to the care of patients. And then they use natural language processing to extract information from doctors clinical notes to enrich patient records and then examine the various barriers to access. And then they created a mobile app to really examine care gaps across the west side of Chicago. And so in the context, they became very sophisticated around understanding the communities that we're serving, but they also became a real sort of thought leader in Chicago, but also nationally about how you pull together data from not only your data sources, but other data sources to really enhance your ability to serve the patients.
That's fantastic. I mean, that's when I think about what the patient wants and when I think about those experiences, it's I want my health system to start to anticipate. I trade some of my privacy to companies, well, to Amazon, for example, so that they can make suggestions.
And a lot of times those suggestions are spot on and it's based on my previous purchase history and those kinds of things. The health system has a bunch of transactions that I've done with the health system, but as they start to gather more information, I'd like to see them get more proactive in maintaining the health of the community. Proactive in helping me to stay healthy.
Tat's the thing I'm hopeful for the next five years is that we can start to bring the data together. I can start to engage my health system or other players in keeping me and my family healthy on an ongoing basis. If we can get to that proactive level, I think that's the dream of applying all these tools isn't it?
Exactly exactly. I mean, understanding those relationships, identifying the trends and then making the predictions from normalized Instructure data. That's the key. You gotta have comprehensive, normalized and structured data to really be able to do that. I mean, some of our old friends you're in your old stomping grounds, the Children's Hospital of Orange County in Southern California created a big data analytics ecosystem that ingests and normalizes information from their EHR. And then that enables their data sciences team to build models and to help predict clinical outcomes based on medical, really important, demographic equally as not more important than other data that they've got and then be able to take those analyses and inflect the clinical decisions.
Not 6, 8, 10, 12, 18 months later, but in real time. And so in that context they were able to really improve the area under the curve, the AUC for 30 day hospital readmissions, pretty significantly material improvement. So in those contexts we're all learning from one another.
And it's a great time to, I think, be in healthcare and really start to see some of this drive towards understanding. But also being able to support and flex our consumers and their needs.
I think this was a little before your time at St. Joe's. But when I first came in, we did a survey of the clinical community and we left a lot of open-ended questions where they could give us comments and they were pretty brutal, but my favorite was 1984 just called and they want their technology back. And that was indicative in 2012, that was indicative of where we were looking. We were 20 years behind in healthcare. The pandemic seems to have accelerated our progress, our adoption of new technologies, our adoption of of listening to the consumer and respond to the consumer.
One of the things I love about cloud and these capabilities is you're talking about. AI machine learning, big data, architecture, automation. You're talking about some very sophisticated tools that literally, while we're on this call, I could just go out provision and start to utilize. Now I've gotta be careful about the data I'm moving out there and whatnot, but in the security architecture, but at the end of the day, I have access to tools within minutes that I couldn't before. So when you talk about these physicians starting to engage in this way they can, they can access resources across the country, start to interact with consumers, collect information, pull that data in very rapidly and with very sophisticated and powerful tools to really improve healthcare.
Exactly. I mean, it is, we are at a transformational moment, a revolutionary moment in the provision of healthcare. And what we're seeing is that clinicians are getting excited about what they can do that they'd never been able to do before. And the insight that they can gain in it to really better serve their patients, but the huge and growing, rapidly growing volume of data could on the one hand seem overwhelming on the other hand is a gold mine that is beginning to really be mined used, leverage, understood.
And those AIML tools are, are really critical to that. And Amazon understands that and is really trying to make tools available that will help to automate some of that machine learning capability. So I mentioned earlier Amazon Health, like that is essentially a lake that automatically normalizes and indexes instructors healthcare data in that FHIR format using machine learning and brings together a complete view of a patient's medical history and makes it easier to understand those relationships in the data.
But then at the same time, when you layer in tools like Amazon Transcribe medical and Amazon comprehend medical, those tools quickly enable you to accurately capture and structure the medical data, but then be able to marry it with unstructured data. Some of that demographic and socioeconomic data that comes in to a taxonomy structure that then you can begin to drive insights and analytics from. So it's a incredible time in and through the history of, of humankind to be able to have those sorts of tools. And we're still very early stage and unlocking the potential that they have.
Yeah. Final question, as I look forward to 2022, we still have a lot of challenges in front of us. It's been hard to do this to people over the last couple of years, because with the pandemic around, it's not like you can look into your crystal ball and say, Hey, this is what this is what I expect for 2022.
But as you look out on the landscape maybe instead of saying, Hey, this is my crystal ball, and this is what I think is going to happen. What do you hope for 2022 that we're going to be able to accomplish at the intersection of technology and healthcare?
My hope is that as we've seen ourselves come together, we have an opportunity to continue to come together in new ways, really to solve those inequities in health care, but sort of more broadly the things that drive health outcomes and we're able to then start to use all of the data, the medical, the clinical data, the administrative data, the demographic data, the zip code data, which as we all know drives so much predictably of the outcomes and do it in a way that is comprehensive, inclusive and unbiased so that we can really begin to inflict how we administer care, but also the new kinds of tools that we can develop that can drive further advances in medicine, but also in overall health of our communities. One of the things that Amazon has done recently is this question of health equities is a really important one.
And technology is a force for good, but you know, you have to make sure the technology is deployed in a way that in fact is promoting that good. And so it's really critical to ensure that your data inputs and your algorithms that come from those data inputs are in fact complete, comprehensive, inclusive, and viewed from a broader and appropriately contextualized lens.
And so one of the exciting things that Amazon is doing because of the commitment that we have to reduce inequities is set up a new global health equity program that will support organizations who want to develop technological capability in these areas. And so we've got $40 million that we're committing over the next three years to really support organizations that are looking to increase access for underserved communities, address social determinants of health and leverage data through the cloud in a way that that will really leap, frog their capabilities. So there's a lot going on. And if anybody's interested in that happy to provide more information, but I would encourage anyone who is to apply because the deadline, the next deadline is March 31st.
And we're really excited about some of the things that we're seeing coming in. But that's my, my ultimate hope is that we use what we have and what we've learned to really advance things is with the ships of progress for all
Fantastic. Phoebe. I want to thank you for your time. I love the picture that you paint. We really are on the edge of being able to do some really amazing things at the intersection of technology and healthcare to relieve the burden for clinicians to engage patients in their health and new ways and to alleviate the inequities that exist. There's a lot of work to do for sure, but the tools are there to to engage in and the smart people are there to engage as well. And I want to thank you for all the work that you're doing in healthcare
Well, thank you Bill. It's a privilege to get to be with you today, but also you have such a great audience who are all working so hard to advance what we're trying to do together and I love being part of it. So thank you.
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