Encore! EP392: When Patient Journeys Don’t Fit in the EHR, With Emily Kagan Trenchard

[00:00:00] [SPEAKER_01]: Oncore EP392, When Patient Journeys Dont Fit in the EHR, Today I am speaking with Emily Kagan Trenchard.

[00:00:17] [SPEAKER_01]: American Health Care Entrepreneurs and Executives You Want to Know, Talking.

[00:00:23] [SPEAKER_01]: Relentless Seeking Value

[00:00:25] [SPEAKER_01]: I thought I would oncore this show after coming back from the 2020-23 nude conference held in the Microsoft Building in New York City, which I always enjoy.

[00:00:35] [SPEAKER_01]: Node and ODE stands for Network of Digital Evidence. Why is evidence so important? Here's the note, answer to this question.

[00:00:45] [SPEAKER_01]: It is so smart purchasing decisions can be made by consumers, health systems and payers, so devices and software that improve patient experience provide actionable insights and save time and money become part of care delivery, so trust is built between industry and healthcare.

[00:01:01] [SPEAKER_01]: No matter what direction you come at this from, evidence for care delivery endeavors is sorely needed. What's always interesting to me is kind of the context of this said evidence however.

[00:01:14] [SPEAKER_01]: The who said evidence is evaluated by and to what end. It was a really interesting juxtaposition wrangly to hit up the node conference which is attended mainly by digital health entrepreneurs and health system exact right on the heels of me going to multiple events with

[00:01:32] [SPEAKER_01]: The software is very much not an important part of the information that is not available.

[00:01:35] [SPEAKER_01]: What is the most important part of the information that is being triggered by the user.

[00:01:39] [SPEAKER_01]: The first thing I want to talk about is a very much not a nice to have from the employer slash purchase or point of view.

[00:01:46] [SPEAKER_01]: It's a must-have from their perspective because all of these care delivery, technological and organizational inefficiencies that Emily alluded to, it's all defined as expensive waste from the standpoint of the employers

[00:02:00] [SPEAKER_01]: other self-inchered entities. These self-inchered entities are the ones paying for

[00:02:05] [SPEAKER_01]: fragmented and unsupported patient journeys with their escalating commercial rates

[00:02:09] [SPEAKER_01]: after all. In some, I like how Joseph Wu, who is the current president of the AHA,

[00:02:15] [SPEAKER_01]: put it at the recent AHA scientific sessions in Philadelphia last month, which I was honored

[00:02:20] [SPEAKER_01]: to attend. Dr. Wu said during his presidential address, work hard, work smart, work together,

[00:02:26] [SPEAKER_01]: emphasis on all of the above, especially the work together. That's what the relentless

[00:02:30] [SPEAKER_01]: health value tribe is all about after all. So thanks so much for being a part of it.

[00:02:36] [SPEAKER_01]: My name is Stacey Rector, this podcast is sponsored by Eventria Health Group.

[00:02:41] [SPEAKER_01]: So a few things to remind everybody, first of all, don't forget, AHAs were purpose-built

[00:02:46] [SPEAKER_01]: originally for billing. This is no secret. People quite openly have called AHA systems

[00:02:52] [SPEAKER_01]: glorified cash registers. If I want to be generous, maybe I would restate this to say that

[00:02:58] [SPEAKER_01]: AHAs were designed to document patient interactions. This is what their core architecture

[00:03:03] [SPEAKER_01]: was built to achieve. But today there's a lot that goes on that isn't a traditional

[00:03:08] [SPEAKER_01]: patient's interaction. First of all, me even calling it. Frankly, a patient interaction

[00:03:14] [SPEAKER_01]: should give longtime listeners a clue where this is headed. I mean, say you're sitting

[00:03:19] [SPEAKER_01]: at home on your couch. I don't know. You're probably not considering yourself a patient.

[00:03:24] [SPEAKER_01]: You're considering yourself a person sitting on your couch. However, say you're sitting

[00:03:28] [SPEAKER_01]: on your couch and you haven't taken your COPD maintenance therapy. Potentially that is

[00:03:33] [SPEAKER_01]: something of clinical significance that maybe should get figured out and noted somewhere.

[00:03:38] [SPEAKER_01]: Potentially prior to the acute event going down or still talking about things that are

[00:03:43] [SPEAKER_01]: relevant to patient health but which don't naturally tuck into an EHR systems, native architecture.

[00:03:49] [SPEAKER_01]: There may be we have social workers and nutritionists and all kinds of people who are not

[00:03:54] [SPEAKER_01]: doctors or nurses or PA's in this mix. Most of the time these people don't even have access

[00:03:59] [SPEAKER_01]: to the EHR. In some, what is happening between codes getting written in patient health records?

[00:04:05] [SPEAKER_01]: Where's all that information going? My guest today, Emily Kagan, Trentard, makes a super

[00:04:10] [SPEAKER_01]: point about all of this that I haven't heard made so succinctly or so eloquently. She talks

[00:04:16] [SPEAKER_01]: about identifying the core functionalities, the centers of gravity that are needed to bring together

[00:04:22] [SPEAKER_01]: providers and patients and everybody else in the mix. She talks about the four platforms

[00:04:26] [SPEAKER_01]: that she feels are very necessary to underpin or be the chassis to best support helping

[00:04:33] [SPEAKER_01]: providers and others help patients and people in and out of the clinic. She calls each platform

[00:04:38] [SPEAKER_01]: a tent pole. These four platforms are number one, the EHR. Number two, a CRM, a customer relationship

[00:04:46] [SPEAKER_01]: manager and by the way, when Emily says CRM, she's talking about more than software. It's more

[00:04:53] [SPEAKER_01]: like a philosophy or a whole approach around relationship building with patients slash people,

[00:04:59] [SPEAKER_01]: slash customers. Then we have Emily's number three which is a cloud platform for data and analytics

[00:05:04] [SPEAKER_01]: and number four, a data exchange. One last takeaway for me at least, Emily has talked about

[00:05:10] [SPEAKER_01]: two basic facts that inform her thinking. Number one, providers and patients alike are increasingly

[00:05:16] [SPEAKER_01]: not tolerant of friction and number two, what is easiest is the most likely to happen. Something

[00:05:23] [SPEAKER_01]: that we don't get into in this show, but certainly bears considering is the larger context here.

[00:05:29] [SPEAKER_01]: Yeah, we got Amazon. We got Google not only what they're doing alone but also what they are

[00:05:35] [SPEAKER_01]: investing in, they have platforms that are purpose built to remove friction and to be really,

[00:05:41] [SPEAKER_01]: really easy. One click easy. So let's talk about the whiffam here for health systems to get a move on.

[00:05:46] [SPEAKER_01]: When Merrill Goosner was on the show a few weeks ago, this is episode 388. He says that when

[00:05:52] [SPEAKER_01]: patients and employers and taxpayers start crying uncle on both healthcare prices as well as just

[00:05:58] [SPEAKER_01]: add friction-filled experiences and also when at the same time, technology and new competitors move

[00:06:04] [SPEAKER_01]: in on the supply side. He says what's going to happen then is older incumbents, like hospitals,

[00:06:10] [SPEAKER_01]: could find themselves getting their lunches eaten. Especially as we contemplate the stuff that

[00:06:15] [SPEAKER_01]: Mike Thompson was talking about in episode 389 about how there is increasingly data out there

[00:06:22] [SPEAKER_01]: which identifies hospitals who are very inefficiently run. Also I would be remiss not to mention that

[00:06:30] [SPEAKER_01]: non-purpose built, dare I say bad technology causes bad clinician burnout, which causes bad

[00:06:37] [SPEAKER_01]: turnover, which is really expensive. Dr. Ashad Rahim talks about this in episode 323. Emily Kagan

[00:06:44] [SPEAKER_01]: Trentard is SVP and chief of consumer digital solutions over at Northwell Health, Northwell in

[00:06:50] [SPEAKER_01]: case you haven't heard of this health system is very large 21 hospitals 850 outpatient clinics

[00:06:56] [SPEAKER_01]: 300,000 patients a year. Yeah it's big. My name is Stacey Richter, this podcast is sponsored by

[00:07:02] [SPEAKER_01]: of Entria Health Group. Emily Kagan Trentard, welcome to Rely Letless Health Value. Thanks so much for

[00:07:07] [SPEAKER_01]: having me. So just kicking off here with a question that we probably could talk about for three days

[00:07:12] [SPEAKER_01]: but how does the work that you are doing in consumer digital and really thinking about consumer

[00:07:19] [SPEAKER_01]: experience? How does it sort of all start? Like how do we slot your work in digital consumer

[00:07:25] [SPEAKER_01]: solutions into the larger health system technology stack or infrastructure, just the traditional way

[00:07:32] [SPEAKER_00]: that many conceive of it all. What it really does is take the consumer experience in a digital world

[00:07:39] [SPEAKER_00]: and puts it on part with a clinical experience when we are considering our technology and

[00:07:45] [SPEAKER_00]: just as we put a degree of diligence and investment into our clinical technology stacks

[00:07:51] [SPEAKER_00]: we need to do the same for what we provide to our patients and that that's not exclusively

[00:07:56] [SPEAKER_00]: something for marketing or revsight goal or access or just a promote patient monitoring program it

[00:08:02] [SPEAKER_00]: is unto itself its own key constituency who deserves the care and diligence of the design.

[00:08:10] [SPEAKER_01]: Yes, one thing that you have said is that it is very exciting to form a platform around

[00:08:15] [SPEAKER_01]: something that is not revsight goal. So you're ever actually starting from a platform that was built

[00:08:20] [SPEAKER_01]: around revsight goal. How do you think about starting a new? Yeah, great question and I

[00:08:27] [SPEAKER_00]: know no shade to my colleagues in revsight goal. Well, I love dearly but as we know the EMR's

[00:08:34] [SPEAKER_00]: and EHR's are usually the center of or have historically been the center of people's

[00:08:38] [SPEAKER_00]: universe and those really were born out of federal mandates that had incentives tied to reimbursement.

[00:08:44] [SPEAKER_00]: Right, so you're incentive dictated the architectural structure of these applications and so you

[00:08:50] [SPEAKER_00]: ended up also with wonky things like all of access being driven out of revsight goal when maybe

[00:08:54] [SPEAKER_00]: that's not the smartest place to put your access strategy. So when we're trying to think about this

[00:08:59] [SPEAKER_00]: from the ground up it's not to say you don't need revsight goal systems you do it's not to say

[00:09:03] [SPEAKER_00]: you don't need an EHR you do but the question then becomes where else do you have centers of gravity

[00:09:10] [SPEAKER_00]: that you should respect in the architecture? And so for us what that means is not defaulting

[00:09:16] [SPEAKER_00]: to the historic center of gravity of an EHR, not defaulting to a historic center of gravity

[00:09:22] [SPEAKER_00]: in your registration and your billing systems. But saying no there is a constellation of need here

[00:09:28] [SPEAKER_00]: and we actually have to give it its proper due in our tech stack. And so that involves taking

[00:09:33] [SPEAKER_00]: an approach with CRM, right customer relationship management applications and making it another

[00:09:38] [SPEAKER_00]: center of gravity so that the tools by which we manage our relationships take their right full

[00:09:43] [SPEAKER_00]: place alongside the tools with which we manage our clinical concerns and our financial concerns.

[00:09:48] [SPEAKER_01]: Interesting that you are not considering this that the EHR is the center of the universe because

[00:09:54] [SPEAKER_01]: obviously historically we've gone through a couple of phases, right? Like we started out maybe

[00:09:59] [SPEAKER_01]: pre-meaning for use where it was maybe not as digitized nearly as it is today so this might

[00:10:06] [SPEAKER_01]: not be necessarily a fair comparison but there was things all over the place. Then you have to

[00:10:11] [SPEAKER_01]: have the EHRs and everybody starts to think what good looks like is integrating with the EHR

[00:10:17] [SPEAKER_01]: that happened. Effectively what you're saying is you know what the EHR is over there and it was

[00:10:24] [SPEAKER_01]: used case with a very specific infrastructure which is created at its core for that particular

[00:10:30] [SPEAKER_01]: use case. Let's not try to use something which was completely built to do something else

[00:10:39] [SPEAKER_01]: and try to retool it to do something that it was not purpose built for. Yeah and to be fair if we're

[00:10:47] [SPEAKER_00]: going to torture my constellation metaphor a bit more it certainly has a gravitational pull

[00:10:52] [SPEAKER_00]: that affects all of the other things. It is the biggest baddest thing in our tech stack absolutely

[00:10:57] [SPEAKER_00]: and I don't want to misconstrue my point in that way but exactly as you said it was purpose built

[00:11:03] [SPEAKER_00]: for our patients we interact with way more than just patients what about our caregivers what about

[00:11:10] [SPEAKER_00]: parents, children and other members of the community who are part of the care team there's not

[00:11:14] [SPEAKER_00]: an inherent way to encode the meaningful relationships and integrate them into care plans in ways

[00:11:22] [SPEAKER_00]: that can be speak the sophistication with which we're hoping to operate in our in the world at

[00:11:26] [SPEAKER_00]: large right so you need different tools for that and I think that that's actually a reflection of

[00:11:32] [SPEAKER_00]: a move especially on behalf of health systems away from again this the hospital being the center

[00:11:37] [SPEAKER_00]: of the universe and really taking into consideration the role that ambulatory is playing right more

[00:11:42] [SPEAKER_00]: and more procedures are moving out of the inpatient setting they're going into this outpatient there's

[00:11:47] [SPEAKER_00]: so much more virtual care so suddenly again that has shifted where the attention is and so you're

[00:11:53] [SPEAKER_00]: also now thinking about all of these ambulatory interactions the beats in between those ambulatory

[00:11:58] [SPEAKER_00]: interactions the moments that occur at home the sort of touch points of customer support or

[00:12:04] [SPEAKER_00]: payment or shopping or anything else you might want to call or that truly are going to influence

[00:12:11] [SPEAKER_00]: with if not equal force the nature of what ends up happening in an encounter that you encode

[00:12:17] [SPEAKER_01]: in the in the clinical record so when you were saying that the EHR was built around the patient I'm

[00:12:21] [SPEAKER_01]: understanding what you mean is that the EHR people aren't patients all the time so effectively

[00:12:26] [SPEAKER_01]: I think what you're you're saying is that the EHR was built around the moments in time when a person

[00:12:31] [SPEAKER_01]: is a patient and they are in a clinical setting and they are talking to a clinician that is the

[00:12:36] [SPEAKER_01]: moment in time that the EHR was constructed to wrap around maybe and as many have said it was mainly

[00:12:45] [SPEAKER_01]: built to capture codes which then are used for billing so while that is important if you start

[00:12:51] [SPEAKER_01]: thinking about the entity on the show we have talked many times about having a defragmented patient

[00:12:56] [SPEAKER_01]: journey if you are by the technology's very nature fragmenting the patient journey or at least the

[00:13:02] [SPEAKER_01]: digital one into it's only sort of picking up the moments of time when the patient is interacting

[00:13:08] [SPEAKER_01]: with the clinician then there's a lot that is left over absolutely and I would even say that

[00:13:15] [SPEAKER_00]: it's not just the patient anymore every single one of us has been talking about social determinants

[00:13:20] [SPEAKER_00]: of health social determinants of health don't happen in isolation no one of us is an island again

[00:13:25] [SPEAKER_00]: pandemic if it taught us anything it taught us that how can we stop thinking about our patients

[00:13:31] [SPEAKER_00]: as these teeny tiny discrete entities who don't have connections to other patients to other people

[00:13:37] [SPEAKER_00]: in larger communities if we truly want to do population health as we all aspire to do we have to be

[00:13:43] [SPEAKER_00]: to understand the network of relationships and a population that is necessarily going to require

[00:13:49] [SPEAKER_00]: us to understand relationships with people who are not patients and that is also something

[00:13:55] [SPEAKER_00]: that the EHRs are not well suited to be the driver of that is a really actionable insight

[00:14:00] [SPEAKER_01]: you just laid out there that I would love to emphasize that if EHRs just clip a few moments in time

[00:14:06] [SPEAKER_01]: out where one patient happens to be in a clinic with one clinician like their some little

[00:14:11] [SPEAKER_01]: Christine silos of transactional moments what we inadvertently do is chop up the patient journey

[00:14:17] [SPEAKER_01]: into a sprinkling of documented moments inside a gigantic black box moving on then if we're thinking

[00:14:25] [SPEAKER_01]: about then this other tent pole I think you called it so you've got the EHR and what goes on

[00:14:31] [SPEAKER_01]: in clinic as one of the tent poles and then the CRM the customer relationship management tool

[00:14:38] [SPEAKER_01]: as that second tent pole how do those things interact like is there some sort of API are they

[00:14:44] [SPEAKER_01]: integrated in a big way you know how are you thinking about that both short term because we are

[00:14:50] [SPEAKER_01]: where we are right now but then also from a vision perspective like what does this look like five years

[00:14:54] [SPEAKER_00]: from now? Yeah absolutely so I think integrations up the Wazoo absolutely these two utilities need to play

[00:15:00] [SPEAKER_00]: very very seamlessly with one another and in fact many of these platforms are are suggesting that

[00:15:06] [SPEAKER_00]: they have complementary features that you could actually take your pick you could do a caring

[00:15:10] [SPEAKER_00]: journey navigation in either one of these types of tools you could do types of sort of social

[00:15:15] [SPEAKER_00]: management and trigger off text messages from either one of these utilities so there's going to be

[00:15:19] [SPEAKER_00]: some choices some architectural design choices that we need to make along the way and as you said

[00:15:23] [SPEAKER_00]: it'll be an evolution those probably gonna be somethings we do today and one that maybe are better

[00:15:27] [SPEAKER_00]: suited in another later on down the road but for us what where we're largely starting are sort of

[00:15:33] [SPEAKER_00]: implementation strategy in the wild is in the context of the human being who's going to be

[00:15:38] [SPEAKER_00]: touching these systems right again always go back to what does it mean for that person and their

[00:15:42] [SPEAKER_00]: day-to-day flow when they've got a patient stepping into the office or stepping up to register

[00:15:46] [SPEAKER_00]: what are the first most important tasks that they need to do are they clinical tasks or are

[00:15:51] [SPEAKER_00]: they more relationship and orientation and transactional in nature if it's more of a relationship management

[00:15:56] [SPEAKER_00]: task you're probably gonna start off in your CRM now you absolutely are gonna need a little bit

[00:16:01] [SPEAKER_00]: clinical context where are their elements from the medical record that we can surface up as appropriate

[00:16:08] [SPEAKER_00]: in that context or have someone capture and write back so follow in the narrative here patient

[00:16:13] [SPEAKER_01]: walks into clinical setting you said their first interaction might be in a CRM so they're filling

[00:16:18] [SPEAKER_01]: out a form on a tablet and that information might be pre-populated from the CRM information

[00:16:24] [SPEAKER_01]: that our party has or it might be information that goes back to the CRM and the EHR is feeding

[00:16:29] [SPEAKER_00]: certain things or it could go back directly to the EHR it might have been the EHR that triggered

[00:16:33] [SPEAKER_00]: off forms if their clinical forms absolutely so again the the hard part in all of this is not

[00:16:38] [SPEAKER_00]: can you trigger a form to a patient and collect the data and the hard part is not can we have one

[00:16:43] [SPEAKER_00]: form and have it ingest data that it puts to two different spots the question is where does a human

[00:16:48] [SPEAKER_00]: being work where do they do their job when they open their computer what button are they clicking

[00:16:51] [SPEAKER_00]: first and that's what we're trying to design around and so people who primarily need to encode

[00:16:56] [SPEAKER_00]: information about how did you get here are you going to be able to get to an next appointment

[00:17:00] [SPEAKER_00]: did you call to reschedule because you don't have a ride can I send a car to go pick you up

[00:17:04] [SPEAKER_00]: I see that you're coming in for this procedure but your kid has an appointment the next day should

[00:17:07] [SPEAKER_00]: I move that appointment for you those are the types of interactions that a CRM is going to best

[00:17:12] [SPEAKER_00]: capture if you go on now on the clinical side of things as a clinician of course you're going to start

[00:17:17] [SPEAKER_00]: in your EHR but that doesn't mean you don't want some of the information that might be in

[00:17:21] [SPEAKER_00]: that social history and that context that is more rich and dynamic than what you're necessarily

[00:17:25] [SPEAKER_00]: going to capture in an HMP and so that is where you are going to have elements from the CRM world

[00:17:31] [SPEAKER_00]: typed in so what is HMP's a history and prognosis form it's like a standard clinical intake form

[00:17:36] [SPEAKER_00]: where you capture somebody's general life state not just a specific reason that brought them into

[00:17:41] [SPEAKER_01]: the doctor that day okay so I have two questions and one's going to be from the clinical side

[00:17:45] [SPEAKER_01]: and then one is going to be from the you mentioned care navigation side which is something that is

[00:17:51] [SPEAKER_01]: a problem to say the least so actually let's start there and then I'm going to ask you something

[00:17:57] [SPEAKER_01]: that I've heard clinician say so from a population health standpoint we have patients who are

[00:18:04] [SPEAKER_01]: falling into one care gap just situation analysis falling into one care gap after another and

[00:18:08] [SPEAKER_01]: as I've said on the show it's really hard to keep mopping care gaps off the floor when the

[00:18:12] [SPEAKER_01]: faucet is still running that is creating more and more care gaps because we don't have these

[00:18:17] [SPEAKER_01]: fragmented patient journeys and also it makes busy bees job clinician job really difficult

[00:18:22] [SPEAKER_01]: when somehow or another in a seven minute meeting not only are they dealing with a primary complaint

[00:18:27] [SPEAKER_01]: but somehow or another they also have all these alerts popping up that says that this patient is missing

[00:18:32] [SPEAKER_01]: 15. Exactly care so if we're thinking about solving for that specific use case right

[00:18:39] [SPEAKER_01]: like first of all you gave some examples where a patient was already interacting with the system

[00:18:44] [SPEAKER_01]: like they called to make an appointment and then they canceled and then I'm assuming that either

[00:18:49] [SPEAKER_01]: within that digital interaction or whoever's on the phone with them is saying why are you canceling

[00:18:54] [SPEAKER_01]: can I help you reschedule? But does this system have ways that aren't patient initiated or

[00:19:00] [SPEAKER_01]: patient triggered like for example the patient gets any mail that says something right like how are we

[00:19:07] [SPEAKER_01]: keeping the patient on their non-fragmented patient journey in a really proactive way so that it doesn't

[00:19:14] [SPEAKER_00]: turn into a game of whack-a-mo. That's a great question and that's exactly why we want to have programs

[00:19:21] [SPEAKER_00]: that we can build out not just from an HR, from a clinical context but also from a CRM so this

[00:19:26] [SPEAKER_00]: sort of notion of proactive outreach, the sort of outbounding of a message to a patient which they

[00:19:31] [SPEAKER_00]: then can choose to maybe self-serve right maybe they can book that appointment for them self or

[00:19:35] [SPEAKER_00]: rebook that appointment maybe they can use that tool to give an update on how their pain is or

[00:19:40] [SPEAKER_00]: something of that sort that is absolutely the intention in bringing these tools into the mix

[00:19:44] [SPEAKER_00]: because we shouldn't have our humans chase if we don't need to have them chase and every single

[00:19:50] [SPEAKER_00]: one of us knows that today in this day and age, we're less likely to pick up the phone and call

[00:19:55] [SPEAKER_00]: right we'd rather just maybe no show for that appointment or put it off another day. We also are

[00:20:00] [SPEAKER_00]: not very likely to pick up a phone call from an unrecognized phone number right so how can we use tools

[00:20:06] [SPEAKER_00]: in channels that not only proactively ascend an email or send a text message to someone but then

[00:20:13] [SPEAKER_00]: complement that with a smooth path for the patient to take that next action but doesn't require

[00:20:18] [SPEAKER_00]: them to get on the phone so there absolutely has to be this degree of outbounding and sometimes

[00:20:22] [SPEAKER_00]: that outbounding might need to be a little bit more social than it's directly clinical right it

[00:20:27] [SPEAKER_00]: might need to be a little bit more hey how you do in and not did you know that you haven't

[00:20:32] [SPEAKER_00]: taken your med and we saw it on the on the track or you haven't gotten this prescription filter

[00:20:35] [SPEAKER_00]: whatever it might be. So again that's when you get back to a relationship management so inside

[00:20:40] [SPEAKER_00]: of these tools not only can you have the ability to automate these things right an automation is a

[00:20:45] [SPEAKER_00]: huge component of what a CRM can bring to bear but it also can do relationship scoring right so

[00:20:50] [SPEAKER_00]: we can actually say who are our most disengaged patients who are the patients who might

[00:20:55] [SPEAKER_00]: have digital accessibility concerns right who might normally be an engaged patient but they actually

[00:20:59] [SPEAKER_00]: just had like a trip to the urgent care and it did not go well that's when maybe I'm not going

[00:21:04] [SPEAKER_00]: to send the text message but I'm going to ask that human to pick up the phone and give a call

[00:21:07] [SPEAKER_00]: and see what happened there and see how we can make it right but you won't be able to know

[00:21:11] [SPEAKER_00]: those things at scale unless you've got tools that help you understand not only when to outbound

[00:21:16] [SPEAKER_00]: but how to outbound and what's the most appropriate way to reach out to that person.

[00:21:20] [SPEAKER_01]: What I think about what you're saying that's really fascinating actually is that most of the time

[00:21:24] [SPEAKER_01]: I think that people are doing what you are saying in several discrete silos for example you have

[00:21:33] [SPEAKER_01]: the care navigation people who are doing something or other right then you have the CRM which is

[00:21:39] [SPEAKER_01]: used as a marketing tool primarily and it is when you say CRM people think of the technology

[00:21:45] [SPEAKER_01]: system that they're using right like if I go in a computer and I type in CRM I'm going to get

[00:21:50] [SPEAKER_01]: a whole lot of software vendors so it's interesting that you're thinking about CRM customer

[00:21:55] [SPEAKER_01]: relationship management as a whole entity in and of itself that folds together both all the

[00:22:01] [SPEAKER_01]: technology that you're using but also all of the care navigators right because they're part of this

[00:22:08] [SPEAKER_01]: and sometimes you want to reach out and sometimes an automated texture or email is going to do

[00:22:12] [SPEAKER_01]: the trick but really thinking about the term customer relationship management like what are those words

[00:22:17] [SPEAKER_00]: actually mean yeah it's really more of a philosophy and in fact we're putting together some

[00:22:22] [SPEAKER_00]: presentations to start to do a bit more of a roadshow around the organization and I've actually started

[00:22:26] [SPEAKER_00]: changing into consumer relationship management because one of the things we can't forget is that

[00:22:31] [SPEAKER_00]: relationship management is not just for our patients we need to manage relationships with our staff

[00:22:36] [SPEAKER_00]: we need to manage our relationships with our providers and relationships between providers

[00:22:40] [SPEAKER_00]: really want to make use of the networks we have of the type of cross-disciplinary care that we

[00:22:46] [SPEAKER_00]: always again aspire to but where do we have friction there where do we have clinicians who's practice

[00:22:52] [SPEAKER_00]: could be grown their networks built their sort of career strength and by support from other types of

[00:23:01] [SPEAKER_00]: who's a consumer of our digital offerings has a relationship with us and we need to know how well

[00:23:06] [SPEAKER_00]: we're doing at that relationship but if we're doing it right consumer relationship management should

[00:23:11] [SPEAKER_00]: make every single one of us feel like we've got superpowers right it should feel like our

[00:23:16] [SPEAKER_00]: technology is not just there to drain our headspace and heart space but to actually make room for more

[00:23:22] [SPEAKER_01]: right yeah and I think there's probably a lot of clinicians that are applauding right now because

[00:23:27] [SPEAKER_01]: as we all know a major cause of burnout and moral injury is getting stuck you know I've heard many

[00:23:33] [SPEAKER_01]: times doctors don't dislike technology they just dislike bad technology correct and there's just so many

[00:23:37] [SPEAKER_01]: things that are it's like a bandaid for the workflow bandaid for the bandaid and you just wind up with

[00:23:42] [SPEAKER_01]: this quagmire of clicking around so it sounds like having the philosophy that you have and really

[00:23:48] [SPEAKER_01]: thinking about the users of the technology as constituents and people who need to have a voice and how

[00:23:55] [SPEAKER_01]: this whole thing gets constructed I'm sure it's gonna work out better and I would say that as

[00:23:59] [SPEAKER_00]: I think about taking the sort of CRM strategy forward in so far as on my right side is my

[00:24:05] [SPEAKER_00]: partner in marketing on my left side is the CMIO and is the head of clinical informatics because

[00:24:11] [SPEAKER_00]: they need to be right there alongside us making sure that again this relationship management is benefiting

[00:24:16] [SPEAKER_01]: the clinicians as much as it does the patient so I have heard from more than one clinician who says

[00:24:22] [SPEAKER_01]: in response to those H&P's those history and prognosis forms that you mentioned earlier

[00:24:28] [SPEAKER_01]: that now you've got these social determinant scores or whatnot that are part of those H&P's

[00:24:33] [SPEAKER_01]: that are now appearing in the EHR system and the clinicians response is why are you showing

[00:24:39] [SPEAKER_01]: me this information this is not actionable to me in any way this is just cluttering up my mind space

[00:24:44] [SPEAKER_01]: there's nothing I can do with it anyway it's just data more data why is it even here so I think

[00:24:51] [SPEAKER_00]: it's such an important concept to unpack because it has a lot of things underneath it so if we

[00:24:57] [SPEAKER_00]: have a clinician who doesn't know what they're supposed to do with social determinants of health

[00:25:02] [SPEAKER_00]: information that tells us a few things first of all where they the right person to receive

[00:25:06] [SPEAKER_00]: that information if they don't feel empowered to do it if they were empowered to do something

[00:25:09] [SPEAKER_00]: about it would we want them doing it anyway if what this person needs is a quote unquote prescription

[00:25:14] [SPEAKER_00]: to a farmer's market should that be the clinicians role or should that be somebody else who

[00:25:19] [SPEAKER_00]: doesn't have a medical degree and is paid at that hourly rate there's so much just centralization

[00:25:24] [SPEAKER_00]: around assuming that the doctor is the one who that all care pathways must be administered through

[00:25:30] [SPEAKER_00]: we're not making use of our NPs our ACPs other levels of clinical expertise how can we make

[00:25:37] [SPEAKER_00]: better use of our nurses how can we make better use of our health navigators if we can

[00:25:42] [SPEAKER_00]: some of that stuff down to be acted upon by other members of the care team and empower them

[00:25:49] [SPEAKER_00]: so many of those social determinants of health can actually be accounted for in different ways

[00:25:53] [SPEAKER_00]: before the patient of a arrives again back to the example I gave if it's a ride to get there the

[00:25:58] [SPEAKER_00]: doc doesn't need to be the one dialing up the Uber that can be somebody else in the office but perhaps

[00:26:02] [SPEAKER_00]: it's really important for the clinician to know that because that this patient has mobility issues

[00:26:07] [SPEAKER_00]: the ask for them to go to two different clinics in order to do the next testing and follow up

[00:26:12] [SPEAKER_00]: that's going to be hard on them and so maybe we should think about sending them someplace else

[00:26:15] [SPEAKER_00]: where it's a multidisciplinary practice or something of that sort so again clinical context

[00:26:20] [SPEAKER_00]: is this information relevant and do we have enough other people in the mix to act on it because

[00:26:25] [SPEAKER_00]: again we can't keep putting the burden only on our docs there are so many other members of the

[00:26:29] [SPEAKER_00]: care team that need to be activated just as there's so many other people around the patient who

[00:26:33] [SPEAKER_00]: could be empowered to support them in their care and again that's what we're hoping to do with these tools

[00:26:36] [SPEAKER_01]: yeah and I think you are bringing to bear actually a really important point that there's this idea

[00:26:41] [SPEAKER_01]: there's this notion of team base care and it can be done very very well and when it is done very

[00:26:46] [SPEAKER_01]: very well it supports and empowers physicians when it is not done well and is a euphemism sounds

[00:26:53] [SPEAKER_01]: good let's just call it team base care anything but then it diminishes a term that actually does

[00:26:59] [SPEAKER_01]: have a very important place in our evolving future to support clinicians and yeah yes that

[00:27:07] [SPEAKER_00]: absolutely and again that this it gets back down to relationships right how do we make sure

[00:27:11] [SPEAKER_00]: that we're allowing everybody the space to have the kinds of relationships they need

[00:27:15] [SPEAKER_00]: which is not just what they bring to the table but what can they get back out of the relationship

[00:27:20] [SPEAKER_00]: where can we help our physicians feel more supported where do we help our patients feel more

[00:27:24] [SPEAKER_00]: supported so that they're not pinning all of their hopes for feeling healthy again on those

[00:27:29] [SPEAKER_00]: seven minutes they get with that dog because that's not going to be enough how can they see

[00:27:33] [SPEAKER_00]: other members of the care team as critical to their success as invested in their success to stay

[00:27:38] [SPEAKER_00]: healthy and then how can they also this is another thing we talk about a lot I'm I'm pretty

[00:27:42] [SPEAKER_00]: passionate in advocating for tools for caregivers we don't build enough tools for caregivers

[00:27:46] [SPEAKER_00]: how do we make sure that the things we build in the instructions we give don't just get given

[00:27:50] [SPEAKER_00]: to that person who might be feverish and coughing and maybe not in the best state to remember

[00:27:55] [SPEAKER_00]: every single bit of instruction that you just gave looking at and employ others who are in

[00:28:00] [SPEAKER_00]: their social network who can be there to support them and help make sure that they're on the

[00:28:03] [SPEAKER_00]: right track to to getting healthy again all of this is about relationships and it's about not

[00:28:07] [SPEAKER_00]: just identifying the relationships and writing it on a piece of paper but acting on it in ways

[00:28:12] [SPEAKER_00]: that are smart that are well informed that are meaningful and that ultimately are going to have

[00:28:18] [SPEAKER_01]: a clinical benefit so Emily is there anything I neglected to ask you that you think is important

[00:28:23] [SPEAKER_00]: so the only other thing that I talk about whenever I have the opportunity is to talk about the

[00:28:29] [SPEAKER_00]: importance of data in all of this and it's one of these like boring but deeply important topics

[00:28:34] [SPEAKER_00]: right because everybody says yeah yeah I'm going to click yes to the privacy policy in terms of service

[00:28:39] [SPEAKER_00]: yeah yeah yeah it's frustrating to figure out who who is buying and selling my data but at the end

[00:28:43] [SPEAKER_00]: of the day when we move into this world of digital health the medicine is being practiced not only

[00:28:48] [SPEAKER_00]: our physical bodies but on our digital bodies decisions about our care are made based on how we

[00:28:54] [SPEAKER_00]: are encoded in these systems and if you went today and printed out your medical record if you looked

[00:29:00] [SPEAKER_00]: at it would it have all the accurate information someone would need to care for you probably not

[00:29:06] [SPEAKER_00]: and those errors those omissions are what we're training our artificial intelligence is on

[00:29:12] [SPEAKER_00]: there what we're increasingly leaning on as we interconnect these systems to make decisions about

[00:29:17] [SPEAKER_00]: what's the next best action how do we empower patients to be active contributors to their medical

[00:29:23] [SPEAKER_00]: records in ways that go far beyond what our clinicians would otherwise consider how do we empower

[00:29:28] [SPEAKER_00]: patients to give information that they think is domain to what a clinician needs to know about

[00:29:33] [SPEAKER_00]: taking care of them and have that captured in our records and in our systems so that when we train

[00:29:38] [SPEAKER_00]: our artificial intelligence when we ask our clinicians to take a look at this patient and make

[00:29:43] [SPEAKER_00]: recommendations they're doing so not only based on what historically has been determined to be

[00:29:47] [SPEAKER_00]: what's important to the patient with the patient says is important to them really I think patient

[00:29:51] [SPEAKER_00]: empowerment in their own medical record and data management is one of the most critical things

[00:29:55] [SPEAKER_01]: we can be talking about. Yeah especially just given what's that stat that doctors cut off patients

[00:30:00] [SPEAKER_01]: after 18 seconds? 13 seconds there's a you know assuming that after 18 or 30 seconds that the patient

[00:30:06] [SPEAKER_01]: feels heard but probably more accurately is heard is is probably a stretch. Yeah Emily it has

[00:30:12] [SPEAKER_01]: been such a pleasure to have you on the podcast today. Oh thank you so much again I really enjoyed it.

[00:30:16] [SPEAKER_01]: So let's talk about going over to our website and typing your email address in the box to get

[00:30:21] [SPEAKER_01]: the weekly email about the show that has come out sometimes people don't do that because they

[00:30:27] [SPEAKER_01]: have subscribed on iTunes or Spotify and or were friends on LinkedIn what you get in that email is a

[00:30:35] [SPEAKER_01]: full and unredacted unedited version of the whole introduction of the show transcribed there's also

[00:30:41] [SPEAKER_01]: shown notes with timestamps just apprising you of the options that are available. Thanks so much for

[00:30:47] [SPEAKER_01]: listening.