[MUSIC] Hello, welcome to today's round table forum. My name is Nicholas Genes and with us is the Senior Director of E Health and IT Sudipto Srivastava, Senior Director of IT governance, Matthew Grob, and Dr. Bruce Darrow. Today's topic will be the patient perceptions of health IT. Although we're all physicians or in IT ourselves, we are patients, we work with patients and we wanted to share some of our perceptions and experiences. Let's begin with Sudipto. >> Well thanks Nick, it's very exciting to be here particularly on a topic that really gets us enthused in getting to work on a daily basis. As I was thinking about this talk and some patients stories, what really resonated with me, was a chat that I was having with a friend of mine who has a son with type one diabetes. And what she was struggling with was, there are the industry is so sometimes stuck in modalities of HIPAA and privacy and so on, and they forget things that relate to the patient or the consumer at the base level. And she was telling me about this company called Night Scout. And what they do is, this is a bunch of patient parent hackers who got together. They tried to get into the industry to say how I can get data from my glucometer that my son or kid uses over to myself. And they just hacked into these devices and they tried using it. You go to their website, they even have a hashtag called, I can't wait any more, or something, for the industry to evolve. Because they're saying we need to take action right now. So, there's a huge demand out there in the industry for e-health, digital health tools and I'd love to talk more about that as we go on. >> Thanks, my story is really about a patient but I'm not the patient, my mother's the patient. And through our own EHR portal through Epic, MyChart. My mother is elderly homebound and has dementia and she needs help managing her healthcare. And I'm able to do it remotely either on a desktop or simply on my iPhone. And it has come in incredibly handy because she'll let me know actually, that she's running out of her medication. I can just go right into MyChart and ask for a renewal from her doctor. I can converse with her doctor about things that are going on at home and provide information that she's probably not providing to her physicians. She's under the care of her primary, she's under the care of her cardiologist, and a neurologist, and to provide them with that information I can monitor. She also has a-fib so she has a coumadin levels checked regularly and I can see that. I'm alerted to the appointments that she's making so that I can make sure that not only that she's going to be at the appointment, but I or another another family member or caregiver can be there with her. So it's really provided me the phenomenal tool. And in e-health and digital medicine, we tend to start thinking about all these very high tech solutions and what can we do with wearables, and what can we do with all this incredible new technology. And it's something really relatively simple that's been around for awhile that's proven to be a tremendous use. >> Nice, Bruce? >> What I find is that fortunately most patients are very happy with the medical expertise, knowledge, and care that they get from their doctors and their caregivers. And quite honestly, if they're not, they go find other doctors that they do like. So when I talk to patients, their frustrations are very rarely my doctor didn't know how to treat me, my doctor didn't diagnose me properly. It's about the surrounding things. I had to go and fill out the same piece of paper in this office, that I filled out a week ago in that office. I wanted to pay my bill, but I got three different bills from three different components of my care, at three different times, and I didn't understand it. I want this to be as easy as everything else in my life. In my life, if my kid's school is canceled because of a snow day. If the package that I ordered was delivered, if I want to change my reservation to go have dinner or buy tickets to a movie, I can do that really easily. Technology allows me to do those things. I believe my doctor is a good doctor, but the technology fails in the operation of my getting my healthcare. >> Can you think of an example or in your capacity, both as a physician and within IT, where access to records or access to a patient portal led to a difference in patient outcome? >> Yeah, the good news here is that we're continuously improving. The state of the industry, while it's not nearly where I or most people would like it to be, is definitely better than it was three years ago, five years ago, eight years ago. Things that were on paper are no longer on paper in many cases. Things that were completely disassociated are now becoming more associated. So, I can give you an example of something where the patient was actually the agent of change. A patient of mine, and I'm a cardiologist, so a patient of mine needed to have a heart operation and wanted to go get a second opinion at another hospital somewhere else in the country. So the patient came to me and said, so I need you to print out all my records so I can take them with me. And I said, no you don't. We use the EMR they use the same EMR so they talk to one another with your permission, you can go and they'll just pull my records. You don't have to carry them with you. So the patient came back a couple weeks later, and he said, so I got to that other hospital and the first thing the doctor said to me is, so please give me all your records, I need all your records. And the patient said to him, no you don't. You just go here and he went up to the computer and he showed him how to pull my records to his computer. And sometimes, doctors are very well trained to be doctors, but they are not, as a cross section, they are not always the most tech savvy people on the planet. So sometimes the patients will push them a little farther. >> Yeah, so in this case, the patient did the instructions, the doctor had the tool, but didn't know how to use it, and it was the patient. >> And it's interesting, because I had, just coming back to my mother, this very similar experience. She had been getting her care at another academic medical center in town, who also use the same EMR that we do. And when I finally convinced her to switch her care to Mount Sinai, and we went in for her first visit with her new primary care physician, the physician again did not know that this capability was even there, and I showed her how to do it. And not only was the physician impressed, and said I'm going to do this for all my patients, but my mother was impressed. And it helped allay any fears that she had about switching providers and getting used to a new environment. And made her feel more confident that she was going to get good quality care, and that they really knew her because she didn't have to bring any records, they were right there for her. >> And this is a good team that's developing, just around the access to the information itself. Because the example that I give about my friend who had a child with diabetes. It empowered her to know even through this hacked up system on a watch to know what the diabetes levels of her kids were at any particular time. Of course you had to have a phone or something to send them alerts, to take the medication or eat an apple or something. But it really, the same example that Bruce talked about, the patient feeling empowered, your mom feeling great. This mom just felt that this was such a life changing thing for life. It was simple technology applied in a very basic manner. >> Yeah, and I work in the emergency department. My patients often expect this kind of interactivity and connectivity. And they're sometimes alarmed when I say, I gotta pick up the phone and call your other hospital and get this data. But still, that's often the reality. And yeah, as you mentioned, things are improving. Every year we're adding more functions, more features. You mentioned some frustrations that the patients have experienced. What are some things that you think will we quickly solved, or at least in the coming years, for the patient experience? >> So I think that the basic sharing of information will be improved. And I think the ability to share it not only from clinician to clinician or doctor's office to hospital, but directly to the patient, so that the patient can be at the conduit. You as a doctor may not be able to get to my records, but I can get to my records as the patient, and I can bring them to your attention. I think the more we push information as people in healthcare and health technology to our patients, the better we'll be serving them. And I think this is a journey for a lot of clinicians. There is a system called OpenNotes, or a movement called OpenNotes, for example. Which is the idea that if I'm a doctor and you come to see me in the office, when I write my documentation, I saw Nick Genes in the office and this what I found, and this is what I advised. That information is visible to you. It doesn't just sit in an envelope on a rack in my office, but it's visible to you. >> And it's been more than 10 million patients are involved in this initiative across the country, Mount Sinai is involved in this initiative. And it's something where the first time you go to a doctor and you say okay, all of your notes are going to be visible to patients. There's a lot of reluctance, like well, that's really for my purposes. So I know what's going on, or so that I can tell the other doctor what's going on. I'm not hiding anything from the patients, but I'm not writing it for them. They're going to look at it and they're going to wonder, I'm using these medical terms. I'm talking very dispassionately about something that could be life or death or very serious. I'm not really writing it with them in mind, I'm afraid or reluctant to show it to them. But the experience across 10 million patients is that both patients and providers actually do very well with this. >> That's right. I think maybe a lot of doctors anticipate that they're going to have to answer a lot of questions. They're going to make a few remarks in the chart about possibilities, low-risk probabilities, that they don't want to alarm the patient. But in your experience, has that been the case? >> No, it hasn't been the case, but the other thing is that every doctor feels like he or she is their own unit of operation, and they have their own scope. And when you put them in a setting where the technology brings in information, they feel like there's somehow on the hook for anything that has ever been written about a patient by any doctor. So, if I write a note and I bring in information from the past medical history and the patient says to me, I'm not nearsighted, I'm farsighted. >> I don't know about your eye condition. I don't know which is right and I'm not in a position where I can really comment on that, but I'm now on the hook as the provider. And it's one of these things that nags at doctors when they are thrust into, it's like being in a Chinese restaurant, where suddenly you're eating communally instead of on your own plate. >> That's a good one. >> And that's a great one to build up on as well. Is we look at things from a patient perspective, we've started to think in terms of modalities, and you compare yourself to other industries and say, well similar things happen in media and entertainment, and so on. Where it didn't matter how the consumer saw the movie or the video, they could watch it on a phone, they could see it at home on a big screen TV, they could watch it with friends. And I think a similar movement is taking place within healthcare as well. Where we're starting to think in terms of modality. You want to text your doctor, sure. You want to speak to them within your comfort settings at home or within your living room, let's go ahead do that. If you want to have an appointment with the physician, let's make it easier for you to schedule the appointment. And I think those are the ways that we can start meeting the patient, or the future consumer in ways that they're getting used to within the larger ecosystem. >> And it's interesting because I think one of the themes that we're talking about is the access for patients. And I think we tend to lose sight of the fact that we really need to consider what our patients want and what they're comfortable with. And we need to have the voice of the patient representative in everything that we do. Funny story, a few years ago, I was working with the community health center which provides healthcare services to Medicaid patients and uninsured, so typically low income patients. And in that environment, there is a fair amount of fraud and abuse. So, they try and do positive patient identification when the patient presents. And a lot of community health centers were going with biometrics. And at the time, fingerprint sensors were fairly common, retinal scanners were much less common and therefore more expensive. And I was working with a community health center in the South Bronx and they were implementing retinal scanners. And I asked the CEO, why are you going with a much more expensive and not quite yet proven technology? And she looked at me and she said, Matt, our patients are in the South Bronx. How many of them do you think are willingly going to give us their fingerprints? So it was really a matter of being culturally competent in terms of understanding the patient population and being able to serve them in a way that they were comfortable with. >> Yeah, I can see that. Wow, I guess I hadn't considered that myself and that's really different. Other thoughts, frustrations that you might have encountered. You mentioned before, Sudipto, the diabetes the glucometer and being able to hack that. It seems like such an extreme example for parents to have to dig into their own devices or their children's devices, to get them to function the way they want. Is that a failure of the industry, how [CROSSTALK]? >> Well, I think it's part of the evolution and the journey of how healthcare has gotten to where it has gotten so far. Of course, we are in the business of saving lives, so everything is measured against that. Saving lives, making sure your information is protected appropriately. Making sure that no data gets to any, so there's a lot of regulations that have built on top of regulations with that. When you twist this around and look in from consumer's perspective, they have to fill out these forms again. They have to go to ten different centers and ask for the data in paper format because the industry feels a need to protect that data somehow. And that is frustrating. So even from this parent's perspective, her response was, who cares, I decide for my child. I'm willing to forego a little bit of privacy there because I- >> Or take on some risk. >> And take on some risk, but I get so much more in return. I can take care of things. I think that's where we get stuck as an industry often. And that's where we need to do a better job especially, leading health systems like ours, to start breaking the barriers, the OpenNotes concept. Sharing a lot more information, giving the patients that choice. And once we reach a tipping point, they'll yank it out of us, or they'll leave and go somewhere else. >> One of the things that being able to push the information to the patient does is it helps account for one of the key weaknesses of health information technology, which is the fact that it's distributed across software solutions. And it's historical. If you think about the things that a doctor would do in his or her office in 1970, examining a patient, talking with them, writing down information on a note. Writing something on a prescription paper, ordering a blood test, sending a bill to an insurance, scheduling your follow up appointment. There was no reason to think that if you were going to computerize any one of those processes, that it would necessarily be part of the overall way of providing technology. So they got picked off one by one. The company would come and would say I'll take care of your billing. I'll take care of your scheduling. I'll handle your electronic prescribing. I'll write your notes for you. I'll handle the results of your lab tests. And today even a vast majority of healthcare institutions have different software applications. So bringing the information together to provide a seamless experience, is technically very challenging. And so if each one of those is pushing information towards patients, they become the lingua franca that can assimilate it all. >> [CROSSTALK] define the experience if we- [CROSSTALK]. >> Yeah, or esperanto, if you prefer. >> And, Bruce I think brings up a very good point. We are conditioned by the world around us to expect that technology is always going to work when we need it. I just this past weekend saw the new Jason Bourne film. >> You're dating this, by the way. >> Yeah, [LAUGH], I could have seen it on Netflix if that's still around when this is being viewed. >> And the amount of technology that's required for the plot to work is really quite amazing. And if you're in a film, especially, the technology only fails when it's critical to the plot point. Otherwise, it always works. And that's just not the case. >> And works in seconds, and you don't have to check the password. >> It works in seconds, there's no delay, exactly. The batteries never run out, unless it's a plot point. You've always remembered your charger, you always have cell signal, and that's not real life. >> It's actually hard to watch movies from the 1980s and 1990s, why don't you just take out your cell phone and call someone for help. >> [LAUGH] >> [CROSSTALK] That's for sure. >> Well, that's all the time we have for this forum. Thank you to our distinguished participants Sudipto Srivastava, Matthew Grob, Dr. Bruce Darrow, I'm Nicholas Genes thank you for viewing. [MUSIC]
