Dr. David K. Butler came to healthcare as a digital native, unwilling to accept the paper-based status quo. In about a decade he went from using Microsoft Word to make medical notes legible to being named Epic Systems Physician of the Year for his contributions to the field of EMR implementation and optimization.
Butler is VP of EHR Optimization and Transformation at Sutter Health. In this podcast interview, I asked him to share his opinions and expertise. You’ll hear interesting perspectives on workflow, video games, and more.
(0:13) You went into medicine to be a practicing physician. How did you get interested in EMRs?
(2:58) EMR implementation has supporters but also detractors. What do you say to people who complain that EMRs have ruined the practice of medicine?
(6:36) In a decade you went from your first insight on electronic record keeping to being name Epic Physician of the year. How did it happen? What does it mean?
(9:32) How do video games fit into your view of how an EMR should operate?
(12:50) You work near Silicon Valley. What are you seeing from startup companies there? How do you advise them?
(16:18) What changes do providers need to make in EMR utilization as they shift from fee-for-service to value based payments?
Neil Smiley is CEO and Founder of Loopback Analytics, which supplies tools to providers to manage bundled payments. I asked him to comment on the growth of bundled payments and the role of analytics.
Why are hospitals hesitant to adopt bundled payment options? What strategies can long-term care providers take to encourage bundled payment adoption on a large scale?
In most cases, a hospital’s financial responsibility ends upon patient discharge. Bundled payments significantly lengthen the care episode, making hospitals responsible for the costs of downstream care partners. The shift to value-based reimbursement from our current environment of fee-for-service represents a sea-change for the industry. Decades of business practices, clinical relationships, payment structures and core competencies are being reevaluated in light of this new payment model. Such evaluation and reflection takes time, and we are starting to see leading organizations embrace this challenge as an opportunity to develop differentiating capabilities.
Long-term care providers can help accelerate this process through proactive engagement with their hospital colleagues. Hospitals will need better data from their post-acute care partners to have confidence that they can consistently deliver efficient care and strong clinical outcomes. The long-term care providers that can demonstrate these capabilities pave the way for hospitals to better understand, trust and rely on the broader care delivery pathway they must manage with bundled payments.
What are the main benefits patients will reap from bundled payments?
Bundled payments have the potential to significantly improve patient outcomes through better care coordination across providers and care settings.
Under a fee-for-service payment model, there is little financial incentive to help ensure a patient makes a successful transition to skilled nursing after an acute care stay, or ensuring that patient successfully transitions home after leaving a skilled nursing facility.
Under bundled payments, there is now an aligned incentive with providers across care settings to ensure transitions are clinically successful and financially efficient. Patients are likely to get more help in navigating multiple silos of care, when participating providers are financially responsible for the cost of poor outcomes.
What factors are holding back scalability of bundled payments options?
Broader scalability of bundled payment options will be paced by the availability of accurate and timely data from network participants and workable frameworks for sharing risks and rewards among bundled payment partners.
At the national level, CMS has relayed its intention to aggressively advance pay-for-value reimbursement models, with bundles being a prominent example. Ready or not, the expectation is that bundles will quickly expand to include additional conditions and broader mandated participation.
At a health system level, first movers that have invested in the tools, competencies and partnerships needed to succeed in bundle configurations will be courting more bundle opportunities to take advantage of their lead in the market.
What is the role of analytics in bundled payment? Can you provide an example?
Advanced analytics are absolutely essential to success in bundled payments.
Bundled payments require that different providers across the care continuum come together to consistently deliver a clinically successful and financially efficient episode of care. Without deep knowledge of potential partners’ strengths and weaknesses, a bundled payment manager stands a poor chance in creating a winning network.
CMS provides data to healthcare systems, ranging from high-level quality ratings to detailed, individual claims records. With effective application of data analytics, these sources of information, combined with data from network partners can be used to create the most effective care delivery network possible.
How will analytics advance over the next 5 years? 10 years? How do you measure progress?
Looking towards the future, we expect a pronounced shift from retrospective, historical analytics to prospective, predictive analytics. The former allows healthcare systems to accurately assess their current and historical states, and is an essential component for improving operations. The latter allows healthcare systems to avoid costs and adverse clinical events before they even occur. The availability of real-time health data will continue to grow with the proliferation of digital monitoring devices. Machine learning and predictive algorithms are already establishing themselves in matching patients with appropriate resources based on a diverse set of data markers. We foresee significant expansion on this front in the coming years.
With so many analytics solutions vendors out there how do you distinguish yourself?
Loopback Analytics puts analytics into action. Loopback has an integrated technology platform that allows our clients to move from investigatory analytics to data-driven interventions, through a platform that provides a closed loop feedback system to ensure executed actions achieve the expected impact.
It is only through such an integrated solution that healthcare organizations can be assured that the problem is understood, the appropriate actions executed and impact quantified.
The US added 38,000 jobs in May, including 46,000 in healthcare. In other words, healthcare added more than 100 percent of the new jobs in the economy. That won’t happen every month, but it’s a pretty striking statistic.
Job destruction is happening today on a large scale. Manual laborers have been vulnerable for a long time, but professionals are now under threat as well. There’s little opportunity in previously safe jobs like bookkeeper and paralegal. I firmly believe that a big driver of Donald Trump’s popularity is the alienation felt by many workers –including skilled ones– whom the economy no longer really needs or won’t need soon. It’s easy to blame free trade pacts, Chinese, Mexicans, and our feckless political leadership, but technology is actually the root cause.
The two big exceptions to job loss are healthcare and education, sectors that have been very slow to match the innovation pace established by the rest of the economy. That’s kept costs high and rising. As a result, Americans are getting killed by healthcare and education expenses at a time that incomes are stagnant.
Healthcare is always 10-20 years behind the rest of the economy (I’ll let someone else speak for education) so we can expect continued robust healthcare hiring for some time.
If the jobless future described in The Second Machine Age really comes to pass, society will be in serious trouble. I really don’t like the author’s idea of addressing joblessness by paying everyone a guaranteed minimum income. Sure people need an income, but they also need purpose in life, which often comes from having something productive to do on the job.
I bought an Amazon Echo this week and have been enjoying using it in the kitchen. I can ask, “Alexa, what time is it in Germany?” and it will tell me. Or I can say, “Alexa, play music by the Beatles,” or ask, “Alexa, how many ounces in a cup?” and it will let me know. It’s remarkably easy –and not at all frustrating– to use. The whole family is enjoying it.
Naturally I started almost immediately to think of healthcare uses, so I wasn’t at all surprised to pick up the Boston Globe yesterday and see that my friends from Boston Children’s Hospital are a step or two ahead. Chief Innovation Officer John Brownstein, PhD and clinical innovation director Michael Docktor, MD have launched a KidsMD app for the platform and are testing out uses for Echo in the OR, ICU and bedroom.
Although the article lays out some of the potential for Echo, overall I find it too dismissive, highlighting a software glitch, voice recognition problem, and asserting that “another layer of technology might frustrate staff.” The article ends with a quote from a Children’s engineer whose own kids aren’t interested in speaking with Alexa. None of this reflects my family’s experience.
What the article misses is that Echo represents the latest example of physicians bringing cutting edge consumer technology into the hospital and running circles around the standard tools offered by the IT department. In the real world, physicians are early and enthusiastic adopters of tools like the iPad and iPhone, and through the bring your own device (BYOD) movement they have upended the traditional, clunky hospital IT environment.
Here are some thoughts about what could make Echo so useful for healthcare:
It’s the rare tool that can be used equally well by doctors and patients
It’s a handsfree device, which makes it easy to use when one’s hands are occupied, dirty, or injured
The voice recognition is really good, and works just fine in a noisy environment
It enables continuity of care because a patient could use the same device at home that was used at the hospital
It gets smarter all the time as new intelligence and apps are added to the cloud
It can entertain as well as inform
I can foresee apps that help patients remember their customized care instructions, “Alexa, how often am I supposed to change my dressing?” or “Alexa, am I supposed to take my medication with food?”
I also think it will be useful for hospitalized patients who are trying to remember questions they want answered the next time their doctor or nurse comes around. There is a built in ability to say, “Alexa, add butter to my shopping list.” So there’s no reason it couldn’t compile a list of doctor questions as well.
These are the veritable tip of the iceberg, and I look forward to seeing a thousand (or more) flowers bloom as the healthcare field embraces Echo. “Alexa, I love you.”
Uber and to a lesser degree Lyft have decimated the taxi industry with a disruptive model that lowers costs, improves service, and identifies the few bad apples among drivers and passengers. Now both companies are venturing into a niche market that’s in need of serious reform: medical transportation.
Some patients need help to get to their medical appointments and Medicaid and Medicare step in as needed to pay for transportation. However, too often a patient is transported in an expensive limo or even an ambulance when a regular car would have been fine. The government recognizes the problem and has taken some steps to clean up the business, but it’s tough going.
I’m not exactly sure how Uber and Lyft will tackle the intricacies of the business, but they are diving in:
Boston Children’s John Brownstein has helped form Circulation, which will use the Uber network to provide rides to medical visits to seniors and those with disabilities. Medicaid will provide coverage
These services will be valuable in their own right because they are likely to reduce costs and improve service. But the downstream value to the healthcare system is even greater: if patients can get to and from appointments more reliably it may well reduce overall medical costs and improve outcomes.
Finally, it’s helpful for patients to have their medical appointments bracketed by state-of-the-art service experiences, since it will encourage patients and maybe medical offices to strive for the same service levels in their medical care. Kind of like how Disney pulls up all customer service in the Orlando area.