CIO of Michigan Medicine, Andrew Rosenberg, joins host Bill Russell to discuss hybrid work, virtual care, innovation, 21st Century Cures.
According to Rosenberg, he believes that Zoom-formatted meetings are suitable for one-on-one work situations. Therefore, he expects remote work to persist with individual calls as it mimics the in-person experience well. However, when it comes to groups of people in a meeting, the benefit significantly diminishes. In the next two years, he predicts more people will be in the office instead of working remotely.
There are two reasons that Rosenberg expressed that in-person work will become popular again. The first is human biology; that is, the biological drive humans have to interact in groups.
"I think the advantages of the flexibility that remote work offers, which are very real, will diminish over time a bit. The biology of people wanting to congregate will change the equilibrium," he said.
The human need to stay connected to others will be a main driving force for this adjustment. Additionally, Rosenberg's second driving factor is peer pressure in the office.
"I think it's going to be a little bit difficult to fight the pressure that one will feel when a group of peers or your boss is meeting in person with people, and you're not there," he explained.
Within two years, Rosenberg predicted organizations will still be taking advantage of a flexible working environment; however, people will feel a cultural shift back to interacting and meeting in the office. The intention behind flexibility remains providing a working environment with a work-life balance.
For Rosenberg, he does his best to promote remote work while also decreasing obligations to stay at home. He does not want to keep employees from whichever they choose. For Michigan Medicine, one of the top focus areas is how to support flexible, hybrid, and remote working environments.
"How can you bring people together and still let them have that flexibility? I also don't want to artificially create more remote everything and now allow people to come together. I think we'll find that balance, but I do think it's going to take us a bit," he said.
Rosenberg is looking forward to moving workflow infrastructure to cloud solutions. This also considers application modernization, cybersecurity, business continuity, and general principles of cloud engagement. This will be a ten-year project that is one of the most notable he has personally taken on.
Another interest of Michigan Medicine revolves around remote patient monitoring with TeleCritical Care. The task is to take lessons from virtual care, shifting the paradigm from just home care to improve capacity in tertiary hospitals, increase patient engagement, and shift home care.
According to Rosenberg, the classic teaching is for a business strategy to be formed first and then supplement with technology. However, there are times where business strategies cannot be defined, or governance keeps them from being defined. This is where the use of technology can help constrain, shape, and direct the strategy. An example of this is in EHR implementations. After constructing workflows, the EHR was built to support it.
There is an appetite for approaching healthcare with new digital tools in the transition from an analog way of business. According to Rosenberg, the goal is to consistently shift from the inefficient to a more patient-centric, humane, and less expensive pursuit of healthcare.
"Healthcare is really complicated, very heterogeneous. And one thing that you think of that might be healthcare is very different for someone else. I am much less worried that our directions are being dictated by new technologies or somehow technologies are leading the way," he said.
Rosenberg believes that through technology, significant shifts in healthcare will take place.
Even with the innovation spurred by the pandemic, healthcare must still follow the money, according to Rosenberg. While virtual care satisfies patients, the locus of care still needs to be where payers pay them to provide care, he explained.
"I think we're going to see more virtual care, but I don't think we're necessarily going to see the kind of expansion of virtual care that we saw at the peak of the pandemic," he said.
Historically, telehealth has been successful in areas with capitation reimbursements and specific areas of care like mental health.
"One of the things that will emerge out of our discussions around COVID will be this enormous amount of recognition for the burden of mental health and the successful ability to provide those services remotely or virtually in some ways," he said.
Rosenberg explained a key driver for continued remote solutions is the challenge of getting specialty care in remote areas. Additionally, many patients love the accessibility of seeing a physician without a commute to the health system. Especially in capitation or bundled payment methods, these are natural areas that will expand, with the COVID-19 pandemic as the catalyst.
According to Rosenberg, the push from the ONC and CMS to encourage providers, payers, and third parties for 21st Century Cures will benefit everyone. He believes that it is less about information blocking and more about interoperability and availability of information. Remote care will be a catalyst for data, especially with open APIs and web services, for innovation to occur.
There is one concern to interoperability, according to Rosenberg. It is crucial to progress carefully and responsibly before opening large data portals. This is because the typical person does not understand the depth of their medical data.
"They seek a trusted professional to help them with their cherished, really important, healthcare data," he said.
For this reason, Rosenberg is trends conservative in the process, but he fully supports the intention of interoperability.
Price transparency makes a difference when it comes to elastic services. For these types of services, patients will most often go to the provider charging the lowest amount, he explained. In comparison, transparency will be outweighed by the convenience of proximity for time-sensitive medical needs.
"When I have a broken arm, or I have a gash in my child's head, I'm going to go to the nearest place. And if they're going to charge me double, I'm just going to pay it," he explained.
There has been a significant movement to storage on-premise instead of moving every service onto the cloud. Overall, according to Rosenberg, the cloud is driven by business continuity, data centers, applications, and cybersecurity.
Recently, organizations have spent millions of dollars replacing infrastructure to run EHR, which will change in the next five to eight years. According to Rosenberg, he thinks of it as circular and attempts to incise it with new things. He considered the overall application and infrastructure strategies.