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Todd Johnson, the CEO for HealthLoop joins us to discuss how Millennials are changing the primary care practice. Plus we delve into the world of successfully implementing digital health initiatives. This Week in Health IT.


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

 Welcome to this Week in Health It where we discuss the news, information and emerging thought with leaders from across the healthcare industry. This is episode number 41. Today we discuss how those pesky millennials are changing healthcare. Moment to highlight. Uh,

Work with a trusted partner that's been moving health systems to the cloud since 2010. Visit health to schedule your free consultation. My name is Bill Russell, recovering Healthcare, c i o, writer and advisor with previously mentioned health lyrics. Uh, before I get to our guests, uh, we want to thank our listeners who have given us such great feedback.

Uh, the show's popularity, uh, in the first year has exceeded all of our expectations. Uh, if you have a topic or a, uh, c i o guest that you would like to see on the, the show, uh, please drop me a line. Uh, some people have asked me, you know, how can they get their c i o on the, on the show? Uh, you can, uh, send me an email at this week in

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Colleagues as we continue to bring great guests, like, uh, like today's, uh, I, I like having new guests on the show. Today's guest is a digital entrepreneur and someone whose perspective on the space I greatly respect. Todd Johnson is the c e o of Health Loop. Good morning Todd. Welcome to the show. Morning Bill.

Thanks for having me. Yeah. So we were, we were talking a little before the show started that you guys have been in this space almost since its infancy. I mean, uh, your, your company started in 2009. In dog years is almost like a century in digital healthcare. So, you know, tell us a little bit about your journey as a company.

Yeah. So I joined Health Loop at the end of 2012, um, early 2013. And it's interesting, I had no intention of, uh, jumping back into another early stage company. Um, but I met the founder of Health Loop Jordan Slain, who had sort of . Recognized a very obvious hole in our healthcare delivery system, which is we do a really wonderful job of treating patients when they're in the clinic, when they're in the hospital.

But the standard of care when a patient is discharged is no care. And, um, what could we do, right if we wanted to make sure every patient got the best outcome possible? And you can imagine continuous follow up and compassion from a doctor reaching out to a patient every day to make sure. Um, That patient is getting the care they need.

And, and the fact is we just can't do that at scale. Right? We don't have enough doctors and nurses on planet Earth to do that. And so the auto, the idea of automation and finding ways to reach patients to deliver the right information at the right time really had a strong appeal for me. Um, so I found myself moving my family across the country, um, and jumping into Silicon Valley, um, which is a crazy experience, particularly over the last few years.

I mean, digital health has been such a rock and roll area with so much innovation. Success and failure. And I think that it is been, um, really fun to watch this industry sort of mature from early ideas to really beginning to see things hit the market at, um, truly, you know, large scale. Uh, we've known each other, uh, a number of years.

I think, uh, Darren Dorchen from, uh, Cedars Technology.

However, we were talking recently, I think it was an, uh, Avio event and we found out that we actually went to the same high school in, uh, in Pennsylvania. And it's amazing that we went a good four or five years being colleagues in, in work and not really knowing that we had graduated from the same small town high school back in, uh, in Pennsylvania.

So you were, uh, you were a part of the Freedom High School School. Uh, it's a small world and yeah, it, it is, it is amazing. So you were part of the Freedom High School marching band. Give people an idea because I, I try to describe this to people and they just don't get it, but when Freedom and Liberty, which are the two high schools in Bethlehem, uh, it's a very patriotic place, come together and play their, their, their big football game.

The two bands come out on the field. Describe that for people. I, I've tried to describe. Struggle to get their arms around it. It is pretty amazing. You know, it's, it is an amazing thing and I still keep in touch with my band director from 20 years ago and, uh, you know, in eastern Pennsylvania, wrestling is king, football is king, but band is really viewed

When I was a junior and a senior in Freedom, I was, you know, the band president, the orchestra president. I played Tuba. I was the biggest band nerd at the school, . And you know, the Freedom Liberty game, um, was so much fun. And I'll tell you just a brief story. It is pretty funny. We actually would do a reconnaissance because at the halftime show for that game, each band would try and up each other.

But then we always did a show on the field together and. 450 kids out on the field and it was really a spectacle. And one year, um, the, we did some reconnaissance on Liberty High School and saw that they were gonna do this thing, the secret where they were gonna elevate one of their drummers onto a stand and sort of rotate 'em around and drum.

And so when we got that reconnaissance the day before the big game, we not only. Mimicked that, but then we got all of our sousaphones, which are the big two, is to line up around them and do this kind of dance where we almost hit each other in the head and, um, we won up them and they never let healthy competition for band nerds.

Yeah. And, and reconnaissance. Yeah. The battle of the bands. That was a, that was a big deal. They would, they would do all sorts of, uh, The halftime show and, uh, it was, it was a lot of fun. Alright, well let's, let's get to the show. Um, you know, one of the things we like to do with our guests is start with a pretty open-ended question.

Uh, just to get us started. Uh, what are, what are some of the things you're working on today that you're, you're excited about? Yeah, I mean, specifically we, we spike in the patient engagement realm of digital health, and I think that can mean a lot of things to a lot of different people. For us, it's about continuously engaging patients throughout an acute episode of care, deliver the right information at the right time, but measure how they're doing.

And I think three things that really are exciting is a, we're seeing this go to scale. I mean, in some communities around the country, um, hundreds of thousands of, uh, At home, sort of automated patient visits a month, which is really quite rewarding. Um, and now that we have enough data, there are real validated outcomes.

So not only do we know that this is intuitively a good thing, like how can you help guide patients to get outcomes, but that it really does, um, impact, uh, patient experience in significant ways. Patients have less failure, fewer mortalities, and the data is crystal clear. So I begin to think of these technologies really as almost medical interventions that can help to improve quality.

And I, I think there's sort of two other things that are happening at an industry level that are really beginning to spur growth. One is, The federal government and commercial payers are recognizing that these things do in fact impact costs and outcomes and are now beginning to pay provider organizations when they use these technologies, which I think is the right answer.

And secondly, as, um, the capabilities mature, they're beginning to spread out. So, you know, for us, when we started it, It was really a one-to-one between the doctor and their patients. And now that has expanded to include the hospital, the doctor, the cardiac rehab center, post-acute care providers, phy, physical therapists, all connected together and all connected to the patient.

And we're starting to see this sort of network effect in communities where more and more providers are connected to their patients and can collaborate for better outcomes. Yeah, no touch on stories in our, in the section. So I'm, I'm looking forward to, uh, to delving in here. In fact, we'll, we'll just go into, so on our show, we do two segments.

We do in the news and soundbites, uh, in the news a. Come up with, uh, five questions to ask you, uh, about, uh, primarily we're gonna talk about your entrepreneurial journey and, and what really differentiates your product set. And it's something that really impressed me when we had our first conversation. So I'll kick us off with our first story.

Our first story comes from the Washington Post for millennials, our regular visit to the doctor's office. Concern. And, uh, I'll just read the first section here 'cause I think it gives a pretty good understanding of where they're coming from. So, Calvin Brown doesn't have a primary care doctor. Uh, since his graduation last year from the University of San Diego, brown has held a series of jobs that have taken him to several California cities as a young person in a pneumatic state, brown said he prefers finding a walk-in clinic on the rare occasion when he's sick.

The whole going to the doctor phenomenon is something that's fading away from our generations at Brown, who now lives in daily City. Outside San Francisco, it means getting in a car and going to a waiting room, and his view Urgent Care, which costs him about $40 a visit is more convenient, like speed dating services are rendered in a quick manner.

Brown's views appear to be shared by millennials. The 83 million Americans born between 1981 and 1996, who constitute the nation's biggest generation, their preferences for convenience, fast service connectivity, and price transparency are upending the time honored model of office-based primary care. And this is backed up by, uh, by a Kaiser Foundation study that was done that essentially says the millennials at about a 40 some odd percent clip do not have primary care physicians and are seeking alternate methods for getting their care when they need it.

And, uh, not as much the, the other generations, but still a pretty high percentage from where I. Some of the older generations that are, uh, relying pretty heavily on, uh, urgent care and other venues. So, you know, let's just start with this. I mean, what do you, what, what do you think this means for healthcare?

Let's start with this. We'll go back and forth on that. So if, if this trend continues, what will this mean for healthcare? Yeah. Well I think, you know, looking in the rear view mirror, it's, it's sort of obvious to see how we got here, right? I think . Medicine has optimized around how do you sell as many tests, visits and procedures as you know, with massive throughput.

That's the sort of the game, right? Yeah. And I, I think what that means from a patient's perspective is we've had less and less time with our doctors. Um, it's all too frequently the experience that. You end up sitting in the waiting room for an hour and a half and then you get seven minutes and then you're out the door.

And so I think if we think back to the olden days of medicine with a deep relationship with your physician that really understood you, your family and your concerns, that that sort of disappeared. Right. And what that leaves us with is, um, people that are seeking something that is more convenient, right?

We live, obviously, I mean the. 15, 20 years has just been explosive in terms of how technologies, um, reduce friction to get to services and make everything faster, easier, and on demand. And medicine will definitely continue to, um, have to address that and. For those urgent care centers that have done that well, I think it's meant, um, that they're stealing market share from traditional primary care physicians and provided that they can, um, uh, give a high quality, convenient, accessible solution, they'll continue to win.

And I think that the trend that's pretty obvious where this all goes is, you know, an urgent care center is kind of an expensive place to go get medicine, right. Um, Uh, and we're gonna see it increasingly go to virtual, um, or telemedicine as that front edge, you know, clinics as that next point of triage and you'll march up.

And so I think we're gonna continue to see the erosion of the traditional clinic as the first point of care. Yeah, I don't, I don't know about you, but I mean, my, my family, we had a family doctor. We had, Dr. Poller was our family doctor in Easton, Pennsylvania. And we went there and actually all of us, it was our primary care doctor, my mom and dad, my, uh, brother and sister.

We all went to that same doctor. In fact, his office was on, uh, the first floor of his house and he on the second and third floor of this, of this. And I just remembered, I mean, that, that was, he was the one who coordinated our care. He ordered the tests and he was a, you know, he was a family friend. He actually came to, you know, uh, weddings and he came to, uh, those kinds of things.

Uh, you know, that's, that's such a, a, a, a throwback to an era that is, is a little different than what we have. So, you know, the val, the value of primary care is really not disputed and really not disputed in this article. They are a trusted advisor. You know, they are the person that we go to, to, to sort out treatment options.

Some people fear, and in this article some people fear that, uh, this trend is gonna lead to worse outcomes. And there's a couple of anecdotal stories in there. However, the, I, I think the message from millennials is pretty clear, which is, You know, this wait time thing is not something they're, they're used to, nor do they, like, they don't like sitting in a room with a bunch of sick people.

They don't like the lack of transparency in terms of the cost. Uh, they want to know this is gonna be $40, this is gonna be a hundred dollars, this is gonna be a thousand dollars. Just tell me what it's gonna be ahead of time. So they, they want that transparency. And an urgent care visit sort of has it, you know, it's, you go in and they say, you know, it's gonna be 40 bucks, it's gonna be 80, whatever.

There's also this backlog that the 28 days for the first time you see a primary care physician before they accept you as a patient. You know, that's something that people are looking at going, well wait a minute, I mean 30 days to, to wait to, to even get, um, in there. And then there's obviously the whole convenience aspect, which is, you know, when I'm sick, I might be sick on Saturday, I might be sick at eight o'clock at night.

And, um, You know, it's, it's one of those things that, this is what we're hearing from the millennial generation, and now you have, uh, the Aetna c v s deal. You have, uh, Walmart getting into it pretty heavily. You have, uh, other competitors that are starting to rise. Uh, it, it would really be, it would really not be good for healthcare organizations to ignore this trend.

So you mentioned some of the things that they're gonna be doing. What are, uh, Telemedicine, what are some things we can do for shorter wait times? What are the things we can do for more transparency of costs, uh, more convenient hours? Is is it all digital or is it a combination of things? Well, I think it's gotta be a combination.

And I think that the way that health systems should try to think about this, which might be a little bit different or different, um, perspective is to me it's a classic market segmentation problem percentage. Primary care is extraordinarily transactional, right? Things like strep throat, um, you know, U T I and sinus headaches and all those things.

That is a, that's a, a situation where patients need a quick, convenient fix, right? But as soon as you learn that you've got a significant disease, I. You need a relationship with a clinician that can help you learn how to manage that disease and empower you. And so I think health systems need to segment their own markets and provide services at different levels that meet patients, um, where they need to be met and move them into the right, um, sites of care to help to address the, the issues that they're facing.

And I actually think this is going to continue. Not primary care, but we're starting to see the emergence of, you know, um, in orthopedics like these, it's almost the Panera bread of joint replacement, right? Where you can commoditize and build products that are really good at outstanding service and convenience for, um, particular segments of the market.

And that's how they need to be thinking about where do we deploy the right capabilities and technologies to meet these different segments of the market. Yeah, I, I read a post recently where somebody said, you know, healthcare isn't one business. Healthcare is a hundred, uh, disparate businesses being run under one, uh, umbrella.

And that's, that's really true. And we need to look at the different ways we can, uh, we can really customize these services. Okay. So, uh, so that's our first story. I'm gonna kick it to you to, uh, to set up our next story. Great. I think there were two candidates. Do you wanna go with the patient experience story or do we want to go with the health economics story?

Your call? Well, let's, let's go with the, uh, let's go with the c m s story and then I will get back to, uh, some of the other stuff in the, uh, in the back and forth on the, uh, on. Great. So, uh, I'm probably one of the few people that gets excited when there's new announcements from the federal government about, uh, payment models and regulation on, um, on July 12th.

And I think Med City News or Healthcare Informatics both broke the story right away. But you can find these stories all over the internet. C m s did something that I think is important. Uh, I think the Trump administration wanted to make a statement about how they're going to help be more transformative, um, uh, to the healthcare industry.

And, um, to some degree they just took a bunch of older ideas and repackaged them with new names. Um, but they sort of declared two things. Um, one is that the traditional ways we've looked at documentation and billing for consultative services were.

some fixes there, which has been met with a lot of, um, uh, actual resistance, which I think everybody has been surprised at from the medical associations and physicians. But the second, and, and more important from my perspective thing that the administration is doing is to recognize that. Healthcare has really poor communication architecture.

We've designed the system to be responsive and reactive. And as new technology has hit the market broadly in the commercial space, you know, it's been slower to adopt in healthcare. And you know, the really simple way to look at this is if you talk to many doctors that are in Epic or Cerner and have portal.

A little grumpy about having to answer patient's questions because they're not paid for it, right? They see this as, now I have to spend even more time doing stuff that, that I'm not getting paid for. And so c m s announced, um, in an effort to modernize, uh, the way that we communicate in healthcare and to help support those new methods, um, really a.

A couple of, of, um, new incentives for doctors, and one is to say that we're gonna pay doctors for what they're calling a virtual check-in. And that is if a patient is at home right, checking in with their doctor and the doctor has to, or the doctor's team, uh, has an opportunity to intervene and provide guidance and counseling to patients, that there's a payment associated with that.

And the second one that I think is even more interesting is they're really putting the foot on the gas. For, um, physician organizations that deploy remote patient monitoring technologies, right? How do we use technology to continuously surveil our patients? Um, make sure that they're on track and give us early warning signs when they aren't.

And, and this stuff starts to become material, I think, um, in our analysis, um, physicians that, um, engage with the, their patients using these capabilities, um, can earn 150 to $200, um, for every new patient that they get on board. So we're starting to see real economics to support the use of advanced technology to interact with patients in more convenient ways.

Yeah. And now, so. I guess my question to you is gonna be, is this gonna be the tipping point? 'cause it's, it's kind of, you know, when I was sitting in the c i o chair, we, uh, the telehealth uptake was not that, at least the, uh, I mean the telehealth within the health system was pretty, the telestroke and whatnot was, was taking off pretty significantly.

But the telehealth between a physician and the patient, Was a very slow uptake and remote patient monitoring was very hard to get funded. Yeah. And so do you think this will be the tipping point that starts to really drive these, uh, use cases up? So I'll start by saying I'm an optimist and that colors everything that I, that I do.

And I, and I think, um, I think that this will be highly rewarding. To organizations that find the right capabilities, um, that, uh, that. The regulatory statutes to get paid. You know, from a health perspective, if you look over the last six years, um, you know, the, the first cohort of people that invested, purchased these types of, of technologies.

I. Did it from a place of I want to provide the most outstanding service to patients in my community to differentiate myself and impress my patients. It came from a place of real goodness, right? Because there was no economic benefit to better outcomes at lower costs and their fee for service model. And those are the, those are the good guys in gals, the ones that are really in it for, in making the investments for the right reasons.

Um, the second major wave of adoption here has been well aligned to the value.

That have significant economic reward for higher quality outcomes at lower costs. And in my opinion, the best and most, um, uh, meaningful models are the bundled payment models. ACOs are just a little bit weak on the edge. Um, bundles go right into the heart of, of cost reduction and provide really strong rewards to doctors that manage their patients well.

And so in our analysis, we've done a lot of research and publishing on this. A physician in a higher acuity state can, can save 700 to a thousand dollars per case, right? By deploying these technologies. So there's real teeth, but in order to feel that reward, it takes real economic analysis, right? I mean, you're looking at, you know, utilization of healthcare services over 90 days for every single patient, and that's not easy to measure.

And. Now that we look at these new models, it's just sort of the easy button, right? It says to providers, not only is it easy to get paid for this, the payments will not only cover the cost of the technology, but give you a reasonable margin around it. It's the right thing to do. It drives higher quality.

And so I do think it's gonna act as a lubricant, um, in the marketplace to see adoption really, really come to scale. I, I agree with you. Are, are the bundled payments for, uh, orthopedics, are those still progressing at the same pace they were under the Obama administration, or is that slowed down? So, um, both, so after Trump, um, uh, the Trump administration came in, uh, Um, secretary Price, who is the, uh, secretary of Health and Human Services, the one that had to resign because of his private jet issue, um, immediately re repealed the program, which I think was an incredible disservice to taxpayers and to patients because this was a model that, um, we know delivers, um, superior clinical outcomes and has a significant reduction in costs.

The good news is they came back and implemented what is called um, B P C I and launched that on. January this year and actually just went live last week and they just announced, um, a couple days ago, uh, the participation rates in the new voluntary, um, bundle payment model. And it eclipses what we've seen in the past.

So I think doctors now have seen enough data that, um, tells them that they can make a lot more money right. By, um, taking risk around their cases. And so they're, they're engaged. And I, I do think it's important to segment those in surgical domains. It is crystal clear. In medical domains, it's proven to be less, um, easy to, um, demonstrate, uh, better economics every single time.

So this, this is still, uh, uh, knees and hips, essentially, or is it, uh, beyond that at this point? Yeah. Now there's, um, I wanna say 38 conditions. Um, it's a mix of med-surg. There's a lot of spine, um, E M T GIS in there, and then a lot of the traditional, um, exacerbations of chronic disease, heart failure, C O P D, pneumonia, et cetera.

So you, it's, it's a pretty strong mix. I was just looking at the data yesterday. You do see these spikes a. nationally, orthopedics and spine and cardiovascular surgery. So those tend to be the ones where physicians know that they can be, um, heavily rewarded by participating in doing it well. Great. All right.

Well, I'm gonna, I'm gonna transition to soundbites. I'm also gonna apologize. To our listeners, I'm actually recording from a hotel room, which, uh, has its pluses and minuses. Every now and then one of your words will drop out, and I know people are gonna be like, ah, what, what did he say? Well, uh, uh, you know, I, I'm understanding it.

Only one word or, or here or there is dropping out. So I think we're gonna be fine. Um, so, uh, we're gonna transition to soundbites during this section. I typically toss out, uh, about five questions. Try to state a one to three minute answers. If you go longer, I'm not gonna stop you. It's a, it's a guideline, not a rule.

And if you want, you can throw questions back at me. I cannot guarantee any answers because, I haven't prepared any answers. So this is my, my turn to ask you some questions. So when we first met you, the thing that struck me was you talked about empathy in design, empathy in the design of digital tools and how that could, uh, really extend the empathy of the, of the creator and empathy of the organization to those patients.

Can you give our listeners a little background on that, on that concept? I'll share a story of how I learned the value here. Um, you know, empathy in design is, is a simple concept. You know, put yourself in the shoes of the user, right? And try to experience their day, their life, their concerns through their eyes, and, um, uh, try to meet them with a solution that's gonna be, um, really assistive helpful and productive for them.

And, you know, moving to Silicon Valley is a bizarre experience, right? It's a crazy world here. I was out on a fundraising circuit for our Series A financings. This is years ago. And I had the opportunity to pitch to Greylock Ventures, which is a big venture capital group here in the valley. And one of their partners is a guy named Josh Elman.

And Josh was the, um, principal product designer, um, at Twitter, Facebook, and LinkedIn. In the sort of the moment when those companies went like this, Um, I mean, clearly he's a special guy. Um, I, he probably doesn't remember our conversation. Uh, I did a demonstration for him of Health Loop, and at that moment in time, health Loop was really about how do we identify the patients that need help?

And it was a really clinical mindset. It would be like, bill, what's your weight today? Bill? Did you take your meds today? Do you have any chest pain today? All about getting information from me, right as a doctor. And he stood back and he said, Todd, the problem with your software is it has no soul. I said, okay, what does that mean?

And he says, when we designed, um, uh, LinkedIn, or we designed Facebook every single time, A user interacted with a screen. We tried to make sure that there was a tone and a voice and a familiarity, and we treat our product as if it's a thoughtful, compassionate person. So we kind of, I reflected on that and said, you know, HealthLoop isn't a software.

HealthLoop is like the best nurse you've ever had. And she's compassionate and she's thoughtful and she knows that you're in pain and she knows that you're scared and she knows that you have questions. And we really flipped in our mind what it meant to be a user of this technology and started to invest in a content team of physicians and nurses, and we call them em, pathologists.

Right to script these experiences that acknowledge what a patient is going through and put it through a tone and a voice that could be helpful to them. And then I think on the professional side, there's a, there's a sort of, another view on this is from the providers experience. I think all too often, nurses and PAs and doctors feel like they're on a treadmill.

One patient to the next one patient to. . And, um, one of the things that we believe, and I think many people believe, is that clinician burnout is, is maybe one of the biggest risks to our healthcare delivery system. What we experienced with Health Loop was that patients were really impressed with this experience.

Like, wow, my doctors checking in on me every day. I've never seen anything like that. And so we capture from patients their sentiment, right? Gratitude. Serve it back to doctors, nurses, medical assistants. We call it patient love. And it's this continuous feedback loop that really, um, reminds clinicians that what they're doing, their, what their work is, it matters.

Their patients adore them. They're grateful and it is a very, very powerful thing for physicians and their teams to see when they, uh, participate with health food. Yeah, I, you know, on the show I usually don't let people talk about their product all that much, but I think your approach is so, uh, strong and I think it's a message that needs to get out there.

So, which leads me to my next question, which is, let's assume I'm a C I O who's chosen to create my own portal or my own experience for patients. What process would you coach me to take to ensure that my design has a, has a deep understanding of, of the person and empathy towards the. Yeah, I guess I'll start by saying I think we've really missed in this domain, right?

The version one of portals has really taken what electronic medical records are really good at, which is storage and retention of data for patients, and expressed that data to um, patients like, what are my lab results? What are my test results? But really I think what patients are worried about is when will I get better?

What does this new diagnosis mean for my life? Right? Am I going to live? What are the side effects? And so the patient's concerns aren't what is their test result? It is what's gonna happen to me. And so I think the first thing that I would recommend to CIOs is, Think about the window through which patients are meeting you, and again, segmentation matters.

If I'm a healthy millennial that just needs to take care of a transactional issue, then boy, that should be fast, convenient, easy, quick, delightful. But if I'm a cancer patient, it needs to be very, very different. So segment your market and and bring the solutions. And the other thing, you know, we're seeing this trend of.

Health systems now wanting to build their own portal, right? Build their own front door, the digital on-ramp to the health system. And um, I was in a round table with the c e O of a. Large health system in the southeast a couple weeks ago. He says, we are going to build the best tools, um, and give patients exactly what we need by owning the patient, right?

We're gonna give them everything we need. We're gonna own the patient. And I think it's so shortsighted because, um, patients, when they go through particularly higher acuity episodes of care, You're often not their only provider, right? They need to see, you know, this skilled nursing facility and this physical therapy group.

And so I think health systems need to adopt a mentality that they are an important part of the patient's experience, but they're not the only part. So they should make it frictionless for other providers across their community to collaborate around best outcomes. So I, you know, a little. Insight into the, I I send these five questions over 24 hours before we actually do the, the show.

But I'm gonna, I'm gonna hit you with a question that's not on here. Uh, only because I, I'm curious, so if we want, if we want our technology to, you know, to have a soul as, as you described it earlier, the e h R is the most predominant, pervasive technology we have. What could we do to, to give it a so, You know, to, to really see that the, the, the journey of the physician and the journey of the clinician who are really struggling at the hands of the E H R today.

What, what could, do you think there's anything we could do there? Uh, yes. So I was, I was sort of daydreaming, um, in response to some of your other questions around, You know, what can we do better to serve our healthcare professionals? And, and, you know, can you imagine this for a second? How long have we been in the world of, uh, high tech and meaningful use?

We're probably about a 10 year, 12 year. Yeah. Can you imagine what our . Our clinical tools, um, would be like if that program was designed around a couple of very, very simple, um, drivers. One is step one, um, provider organization. All your um, orders and medical information needs to be digitized. It needs to be on demand and available digitally.

We don't care how you do it, but it needs to be digital. Second, um, you're gonna get a bonus payment. Depending on how your physicians, nurses, and staff rate their experience with the E M R. How delighted is the doctor with the E M R? How delighted is the nurse with the E M R? Because the, the, um, satisfaction with EMRs across the country by clinicians, they typically have a negative net promoter score, right?

People are not thrilled with these tools. And what if that was the driver for how you get rewarded with more money? Is that your clinicians love this? Um, and then the third rail to make sure that this serves our communities well is let's just look at patient satisfaction. And make sure that is also a avoidant lever in those.

So just imagine the types of tools that a C I O would be able to purchase or build if that was the driving economic force behind adoption. And, and that's just not been the case. Right. So I think, um, just going back to some simple, simple, um, ideas that the people that use these technologies, the more we can delight and impress them and help them be efficient, the better off we'll.

Yeah. Um, gosh, we can talk about this for a while, but we're running out of time here, so lemme go to the, the third, third question that I sent over to you, which is, you know, with this, with this digital empathy, with, with these tools that have empathy built in. Talk to me about the level of engagement that, that you've seen with, with these kinds of tools and with their physician.

Yeah. You know, we, you can continuously measure engagement and I. You know, there's some cohort of individual that is just going to always be the good patient, which means whenever their doctor reaches out to them and asks them to do it, they will do it. Um, no matter how poor the experience is, uh, no matter how irrelevant it is.

And that's, um, maybe 17 to 20% of people are just sort of intrinsically motivated to be responsive, um, and courteous and, and, um, uh, quick to respond. So that leaves a huge spectrum of work to do and, um, I think the keys to engagement are simpler than we want them to be. Sometimes it's, are we delivering something that's pertinent and relevant to me right now?

Right. Is this useful? You know, think about the ways that hospitals typically engage with patients. Um, you know, in the post-acute phase, it's a robocall, maybe it's an HCAP survey. Like there, it's, I don't care about any of that, right. Um, . But when humans are helping, reaching out to, or technology is reaching out to patients, to, uh, um, uh, uh, to provide relevant, pertinent, useful information at the right time.

Patients want that. Patients don't want bad outcomes. Patients don't want to spend more than they need to on their, uh, healthcare costs. And so as long as they feel like it's a useful, pertinent, relevant, and personalized, um, uh, interaction, they're on board. It's, it's not that hard. You just have to meet them with what they need and where they are.

Yeah. Absolutely. Alright, so this is a a selfish question. Let's talk about implementation from, from a digital entrepreneur standpoint. What are the characteristics or activities that organizations that have successful implementations, what, what do they have in common? 'cause I know you probably have.

Because we had this, I, to be honest with you, there were some digital entrepreneurs that came in that we implemented really well, and there's others that we didn't. Uh, and I'm sure you have clients, some that have implemented extremely well and some that you're still waiting for, you know, to move through contracting or something to that effect.

So what are some of the characteristics that, that, uh, you, you have seen that lead to success? Yeah, I mean, it's conviction, right?

System, have conviction around a thesis and really work to identify the right partner and treat them like a partner, um, and make the, make real investments to achieve those outcomes, right? Find ways to really, really go strong. I think it, it is almost that simple. And clearly when there's the right economic incentives and organizational objectives, that we can align those incentives together.

It works. You know, we've seen, and you've seen this, um, you know, the emergence of the, the pilot, right? There's so many damn pilots, and now we have innovation centers that just, you know, they're pilot. Um, uh, wood chipper factories. And on the one hand, it's great that you know, health systems get to take a test run for digital innovations and digital innova innovators get some test runs with hospitals, but more often than not, it results in failure and it results in failure.

'cause it gives everybody an doubt, right? A chance to. Take the exit ramp as opposed to just saying, look, we're committed to this one way or the other, we'll make this succeed. This is where we're going and we're going to go big. And, um, I think that's really the critical, like when a, when a health system has conviction and is committed to achieving real outcomes and is willing to expend the energy to get the change management inside, the sky's the limit, right?

You can do amazing things without that conviction. You can sputter. Yeah, and I actually, I think the conviction, I, I think that's a great answer by the way. I think the conviction starts with what problems are we trying to solve? I think too many health systems are trying to solve a hundred problems, and, uh, you can't solve a hundred or or more problems every year.

You almost have to say, these are the 15 to 20 problems we are going to solve this year, and we're gonna focus our energy, our resources, our investments on these 15 to 20 problems size the organization. Just find. The, uh, the focus of the organization is spread so wide. So there's a sort of a conviction that these 20 problems are the most relevant to our community, uh, that we serve right now.

So, last question. You know, what's the one thing health it can do to most dramatically improve patient care from your perspective? Yeah. I, I think it's, um, might be odd, but I say take risks. Um, actually take risks, you know, the healthcare IT community. I feel like I. Vendors have underserved their customers forever.

Right? Healthcare, it has not been sexy. We've seen waves of different E M R vendors come and go. Over the last 30 years, the technology lags 10 to 15 years behind what we expect in other areas. And I think that, um, providers should. And squeeze outside of their comfort zone. And, you know, don't choose I b m, uh, that IBM's a big player in the space.

Um, but make a bet with something new and innovative and, and be prepared and accept failure as a good outcome. Right? Failure is something that we can learn from. Um, but take some risks. Try something new and different. Um, don't be afraid, right. To try things that are new and different. Yeah. Obviously, referring to the old adage that no one gets fired by choosing I B M.

You're saying, uh, sometimes the solutions are outside of the, uh, traditional players that are in the space. And I think that's, that's really true. You know, walk the side aisles of the, uh, HIMSS conference, not necessarily . That's right. Uh, so Todd, hey. Thank you for coming on the show. And, uh, what's, is there a good way for people to follow you?

Or do you, do you have any time in your life to actually be active in social media? Sort of, I have a marketing team that does a lot of that stuff, so you can follow us on Twitter at HealthLoop. Um, but, you know, I love talking to, uh, you know, providers out in the market and interesting people. So I would just invite people to email me

I'm always eager to entertain a conversation. That's great. You know, last week we had actually somebody share their cell phone number, so I, I'm not gonna go that far with you. Um, but, but if people want to get ahold of you via cell phone, they can contact me as well. Awesome. Hey, you could follow, uh, you could follow me at the patient CIO on Twitter health lyrics website this week in health

The Twitter handle is this and all on channel from today, we'll, another seven out there.

Now on the, uh, on the channel, a great resource for, uh, IT staff out there, especially those that are looking to take risks. There's a lot of great, uh, great content from some of the people who are at the forefront of that. So please check back every Friday for more news information and commentary from industry influencers.

That's all for now.


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