[MUSIC] Hello, I'm here today. This is Dr. Bruce Darrow with Dr. Wen Dombrowski, and we're going to be talking today about the use of health information technology, looking at it from the patient's point of view. And some of the promises and challenges in using health information technology for patient care today. Welcome. >> Thank you, thank you for having me. >> First of all, can you tell me a little bit, and our viewers a little bit, about how you got involved? I know you are physician and trained as a physician, but your path has gone in a different direction. Can you tell me a little bit about that? >> Yeah, sure. So as you mentioned, my training is in internal medicine and geriatrics, and my clinical expertise has been in the care of medically complex and socially complex patients. And what that really means is the elderly people with disabilities, HIV, and patients with multiple chronic disease. And what I realized early on in my training is that the care of these patients is really sub-optimal. There's always insurance headaches, and their ability to get care often falls through the cracks. And the information about them, whether it's their medical records or information for their day-to-day decision-making is not easily available to me as a clinician nor to the patients and their family caregivers. So one of the ways that I got more involved into the health IT of things is when I was, actually my training years, I started getting involved in the implementation and improvement of EMR systems. Since then, I've evolved to other types of software systems that help physicians and other clinicians, as well as patients and their families, make better decisions and get more streamlined care. >> And you've been at this without revealing either of our ages. You've been at this long enough that when you were implementing the first electronic medical record at your hospital, the iPhone didn't exist yet. >> That's correct. So when I was implementing systems, the iPhone did not exist yet. So the concept of mobile applications and mobile user interface was really not the primary consideration. It was really about the desktop and computer on wheels user experience. And one little tidbit of history that most people don't know is that even before then, so it's like 20 years ago, I worked on building access databases for diabetes registries in Inner-city clinics. And that was actually my initial, initial entry point into healthcare informatics. In that role, I worked with very low income populations who had a lot of social determinants of health and social service challenges as well as lots of medical comorbidities. And I helped them build their internal databases to really take a data-based and population-based approach to providing care to a large group but at a very individualized and customized level. >> So you've been at this long enough to look at the patient's side of medical care as a physician and as a patient advocate for many years as you seen technology develop. We're using technology more and more in various aspect of our daily life, health care seems to have lagged behind. Thinking from the patients you talked to and the perspective you bring, how are we failing our patients? What do they want that we've not delivered? >> Yeah, that's a great question. So I've worked with a number of patients. As a clinician, I have my patients. And then also, there's a number of patients that are out there publicly talking about their patient experiences as well as my friends and family, personally speaking. What I've noticed in the last five years is that people in general have more access to things like iPhones, smartphones, applications, websites, and all these resources in the rest of our life. And the common examples would be online banking, online shopping, Amazon, and those type of services. And what's really exciting about that is that, that cannot only help my shopping life. I can help my health and my clinical care, but it's unfortunate that we hardly seen those type of technologies be well-implemented on a broad scale within healthcare. One of the things that I'm noticing is that a lot of the EMR technologies that have been implemented in healthcare systems, let's say 5, 10 years ago, were actually based on software that was developed 20 years ago. And much of the software was really revolving around how do you optimize coding for billing and revenue purposes. And the design of the software was not created to make care easier for doctors, and it was not designed to make care easier for patients. It was really designed for data capture, for documentation improvement, and for billing and coding. And I always say a system will do what it's designed to do. And these systems are not designed for improving the experience of clinicians or patients in their care. And so what is disappointing is that while the rest of the world is moving forward with more consumer-centric applications and how to be engaging, and interesting, and fun, and easy to use, healthcare is still literally stuck in the 1990s in terms of their design philosophy. This is not just about whether a software application is available on a mobile device. It's actually the entire users experience. What's the content in it, what the logic behind the software, and whether it's EMR or analytic software. And we are seeing their new companies that are certainly developed more for thinking applications, but it's very hard to integrate for thinking applications with the old existing EMRs. >> People talk to me and to you about how healthcare technology should be easy, it should be a pleasure to use. It should be something that they would rather do than speaking to a person or waiting on a phone. What's your experience? >> Yeah, so my experience is that in most healthcare organizations, it's not easy for patients to access to the healthcare services in a digital manner. And part of the reason of that is many hospital systems right now are focused on EMR implementation and meaningful use. And that has really siphoned off the attention to other ways of using technology to improve patient care, both for the experience of clinicians as well as experience of patients and their caregivers. One of the issues is literally just attention span, time, and budget. If entire hospital leadership teams are focused on meaningful use, then they're not able to focus on other things. But even when there is attention and appetite to look at new emerging technologies, it is a very confusing landscape for most hospital leaders and other healthcare leaders to understand and decide where are the best and most relevant technologies that would actually impact care. And how do you use these technologies that are available in other industries in a way that makes sense in healthcare? And once you select a type of technology or a category of software or hardware to pursue, one of the challenges that I am frequently seeing in my role working with the innovation groups across various health systems is that it's very hard to integrate these new technologies into both the old technologies stock as well as the old processes. So I really believe that technology in and of itself isn't necessarily what's going to solve everything, but it is an abler to creating new workflows and new culture. But a lot of work in implementing the technology needs to focus on actually doing the culture change on a social level and doing the workflow redesign on a process engineering level. >> As you've mentioned, you've had the ability to look across different healthcare systems at what they're doing. Both of us have worked as physicians with patients with addiction problems, and if I can put it in those terms, the first place you have to start is admitting that you have a problem. Do you think that we in healthcare, and as healthcare leaders, have we admitted that we have a problem, that we're not giving patients what they need and what they're asking for? Or are we still in denial? >> So I think there are some forward thinking healthcare leaders that realize that technology is out there and that patients expect and demand a more seamless consumer experience. But those are far and few, and what I'm actually seeing more often is that most healthcare leaders that I'm meeting, they believe that they are doing very well. Because they've always been the dominant one in their market in whether it's a hospital or whatever type of organization they are. And based on resting on their old laurels, they're not necessarily realizing that they're actually falling very far behind the curve very quickly. And one of the things I'm noticing with healthcare leaders is that there's a generation of healthcare leaders that is not tech savvy, and they're intimidated by technology. Let's just take health systems, for example. So there are some health systems where the majority of the is still using pencil and paper and barely using blackberries. While the rest of the world has migrated to iPhones, Android phones, and virtual reality, even in some organizations. And so it's very hard to explain to a C-Suite what, why, and how patients like to interact through a mobile application or a website or other types of technology medium when they themselves are not users and consumers of technology. And so in this situation, I would really advise all leaders at whatever stage of leadership they're in, to really study the market trends of technology. But also, to really immerse themselves into the customer experience, the patient experience just in terms of what is the workflow of a patient to get through the healthcare system and really brainstorm how technology beyond an EMR able to improve that experience. And sometime, that could be an information tool, sometimes that can be a motivational tool or encouragement tool. It could be a communication and coordination tool. I mean, there's so many forms of technology now, and as including devices that do monitoring, tracking, sensing, or learning. There's just so many type of technology out there right now that are very inexpensive and starting to be deployed in across many other industries that healthcare can learn from and really move health IT beyond just an EMR play. >> So, and I like the fact that you mentioned several different examples of how you can use technology, technology to improve scheduling, technology to use monitoring communication to be able to share information back and forth. I'm going to now move a little bit forward and be a little more optimistic, and I'm going to give you magical powers. And say if you imagine over the next one year, or three years, five years, how the best patient experience would look like. What would you use technology to do? What would you be giving patients with technology? >> That's a great question. So in terms of magical powers, what's technically possible is different than what most organizations politically and financially will allow. So just to cover the latter portion first, there are lots of technologies available, lots of innovative companies that are creating new and exciting products that organizations at the leadership level really need to commit to exploring and adopting technologies that will improve care. At the end of the day, improving care is not just about helping patients feel better and the caregivers feel better. But it will also help the staff moral and help with overall organizational operations and revenue. So really looking at technology in a better picture and understanding the larger ROI beyond just the financial bottomline. So in terms of magical powers, so some of the technologies that I'm looking at right now that I think are definitely very exciting in the upcoming years, they can't be implemented until some basic infrastructure technology is set in place. So let me just first talk about the foundational stepping stone layers. A key issue is data interoperability. I think most healthcare organizations are struggling with having multiple different EMRs, different patient registration systems, different patient apps, different research registry databases, and different patient trackers. And there's just so many different data sources that are not all talking to each other. And the forward-thinking healthcare institutions are really proactively investing a lot of time and money into improving interoperability to make sure that the different data sources can be combined and be used for other purposes. And what I mean other purposes, on a very basic level, that could be something like a data warehouse that can match up all of each patient's data into one record and then be able to run basic analytics off of it. The most basic level would just be reporting but also dashboards, having real-time operational business intelligence dashboard to guide clinical and operational managers in running a more seamless business. That to me is not new technology, this is something that other industries have used for over a decade. But most healthcare organizations are still struggling with not even a big data problem but a small data problem. And once that foundation is laid in terms of interoperability, figuring out how to integrate and match up and map different data streams, that really opens up the possibilities in terms of data science. Using more advanced mathematical and statistical techniques to analyze data beyond just pure reporting. And some of that can be predicting who was most likely to be readmitted or predicting who's most likely to have a bad outcome or good outcome from various interventions. And using that information, that can guide both clinicians as well as administrators in trying to understand what services to offer to both their larger community as well as to specific individuals. One of the lessons that I'd like to point out from marketing, and I know a lot of health cares. A lot of health care leaders, and specially clinicians, are very adverse to the concept of marketing. But I think a great lesson to learn from that is that markers have three years. They've been analyzing our web data, our buying data, all of our habits. And then they deliver us very specific recommendations of what you might like to buy, where you might like to buy it. An example that I frequently talk about in the conferences is when I'm on Facebook, Facebook always knows that I have a certain friend and I that we always share Legos. And we love Legos, and whenever it's that friend's birthday, I always get a reminder to buy a Lego kit or if the new Lego movie is out, or the new Lego song is out and that to me is using my data. It's analyzing my data but targeting a very specific, offering a resource or intervention to me at the right time and place in a way that's relevant and I can immediately click on it and access that if I want to. Whereas in healthcare, someone could be looking for something. How do I treat my cancer? How do you I improve my pain? And they could be literally searching for hours and hours and still not find that needle in a haystack whereas new types of technology on the data science side and also with applying artificial intelligence techniques. My vision is that with the data that we're collecting on patients, when I say we, it could be healthcare. Broadly speaking and also the data that patients are collecting, I really hope that with the data that's being collected, there'll be new artificial intelligence and other systems that will really proactively recommend what's the best treatment, the best health improvement activity or just little reminders of how to feel better. This is how we're going to get better health on a day-to-day basis. In addition to specific patient recommendations, there's also ways for this new data and artificial intelligence systems to help with coordinating scheduling, the convenience of getting to appointment, or maybe even avoiding appointments. If we have data to know that a patient is not sick enough to need to go to a hospital or need to go to a doctor's appointment, maybe they just need to do a video visit or maybe just have a little email message exchange to get some information about the patients. So I'm really hoping that we can move care from the current paradigm of the patient has to make all this effort to get to a hospital, has to wait around for hours and hours for maybe nothing to happen. And they go home, and they're clueless. They're not sure what happened with the results. And really moving that to a more patient-controlled paradigm where patients are given the resources to provide self care, to know what to do when they're not feeling well, or to know when to escalate the call for help, and to be able to provide more care at home for themselves and their loved ones. [MUSIC]
