Todd Johnson, the CEO for HealthLoop joins us to discuss how Millennials are changing the primary care practice.  Plus we delve into the world of successfully implementing digital health initiatives.  This Week in Health IT.

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Bill Russell:                   00:08                Welcome to this week in health it where we discuss the news information and emerging thought leaders from across the healthcare industry. This is episode number 41. Today we’ll discuss how those Pesky millennials are changing healthcare. Plus we take a moment to highlight empathy within healthcare. Uh, this podcast is brought to you by health lyrics, how systems are moving into the cloud. Again, agility, efficiency and new capabilities, uh, work with a trusted partner that’s been moving health systems to the class, has 2010. Is it health lyrics that to schedule your free consultation. My name is Bill Russell, recovering healthcare cio, writer and advisor with previous previously mentioned health lyrics. Uh, before I get to our guests, we want to thank our listeners who have given us such great feedback of the show’s popularity in the first year, has exceeded all of our expectations. If you have a topic or a cio guests that you would like to see on the show, please drop me a line.

Bill Russell:                   01:01                Uh, some people have asked me, you know, how can they get their cio on the, on the show? You can send me an [email protected] That’s the best way to get ahold of us and be sure to share the show with your colleagues as we continue to bring great guests like, uh, like today’s, uh, I like having new guests on the show. Today’s guest is a digital entrepreneur and someone who’s perspective on the space. I greatly respect. Todd Johnson is the CEO of health loop. Good Morning Todd. Welcome to the show bill. Thanks for having me. Yeah, so we were, we were talking a little before the show started that you guys have been in this space almost since its infancy. I mean your, your company started in 2009, which in dog years, it’s almost like a century in digital healthcare. So, you know, tell us a little bit about your journey as a company.

Todd Johnson:              01:51                Yeah. So I joined health at the end of 2012, early 2013. And it’s interesting, I had no intention of jumping back into another early stage company. Um, but I met the founder of healthloop Jordan Shlain, who had sort of recognize the very hobbyists hole in our healthcare delivery system, which is we do a really wonderful job of treating patients when they’re in the clinic, when they’re in the hospital, but the standard of care when a patient is discharged as no care and what could we do right? If we wanted to make sure every patient get the best outcome possible and you can imagine continuous followup and compassionate from a doctor reaching out to patients everyday to make sure that patient is getting the care they need. And the fact is we just can’t do that at scale, right? We don’t have enough doctors and nurses on planet earth to do that.

Todd Johnson:              02:46                And so the audit, the idea of automation and finding ways to reach patients to deliver the right information at the right time really had a strong appeal for me. Um, so I found myself moving my family across the country in jumping into silicon, um, which is a crazy experience, particularly over the last few years. I mean, digital health has been such a rock and roll area with so much innovation, um, success in failure and I think that it’s been really fun to watch this industry sort of mature from early ideas to really be getting to see things hit the market at a truly large scale.

Bill Russell:                   03:21                Uh, we’ve known each other a number of years. I think Darren Dorgan from cedars was the first one who mentioned that should take a look at your technology and we started talking back when I was a cio at St Joe’s, however we were talking recently, I think it was an audio event and we found out that we actually went to the same high school in Pennsylvania and it’s amazing that we went a good four or five years being colleagues in, in work and not really knowing that we had graduated from the same small town high school back in Pennsylvania. So you were a, you are a part of the freedom pipe.

Todd Johnson:              03:59                Uh, it’s a small world.

Bill Russell:                   04:01                Yeah, it is. It is. Amazing. So you were part of the freedom high school marching band. Give people an idea because I tried to describe this to people and they just don’t get it, but when freedom and liberty, which are the two high schools in Bethlehem, a very patriotic place come together and play there, there their big football game, the two bands come out on the field. Describe that for people. I, I’ve tried to describe it and people a struggle to get their arms around it is, it is pretty amazing.

Todd Johnson:              04:28                It is an amazing thing. And I still keep in touch with my band director from 20 years ago. Uh, you know, in eastern Pennsylvania a wrestling is king. Football is king, but band is really beautiful sport. Junior and a senior in freedom. I was, you know, the band president, the orchestra president. I played Tuba. I was the biggest band nerd at the school. And you know, the Freedom Liberty game was so much fun. And I’ll tell you, just a free store is pretty funny. We actually would do a reconnaissance because at the halftime show for that game, each band would try and help each other, but we always did a show on the field together. You didn’t have 450 kids out on the field and it was really a spectacle and one year that we did some reconnaissance on liberty high school and saw that they were going to do this thing, the secret where they are going to elevate one of their drummers onto a stand and sort of rotate them around and drown. And so when we got that reconnaissance the day before the big game, we not only did admit to that, but then we’ve got all of our sousaphones, which is the big tube, is to line up around them and do this kind of dance where we almost hit each other in the head and we want to upset them and they never let healthy competition for band nerds

Bill Russell:                   05:53                in reconnaissance. Yeah. The battle of the bands. That was a, that was a big deal. They, they would do all sorts of crazy things during the halftime show. And uh, it was, it was a lot of fun. All right, well let’s, let’s get to the show. You know, one of the things we’d like to do with our guests is start with a pretty open ended question just to get us started. Uh, what are, what are some of the things you’re working on today that you’re excited about?

Todd Johnson:              06:16                Yeah. Specifically when we spike in the patient engagement in realm of digital health, and I think that can mean a lot of things to a lot of different people. Um, for us it’s about continuously engaging patients throughout an acute episode of care, deliver the right information at the right time, but Azure, how they’re doing. And I think three things that really are exciting. It’s a, we’re seeing this go to scale. I mean in some communities around the country, hundreds of thousands of, uh, uh, at home, sort of automated patient visits a month, which is really quite rewarding. Um, and now that we have enough data, there are real validated outcomes. So not only do we know that this is intuitively a good thing, how can you help guide patients to get outcomes, but that it really does impact patient experience. Insignificant ways patients have less failure, fewer mortalities and the data is crystal clear, so I began to think of these technologies really is almost medical interventions that can help to improve quality and I think there’s sort of two other things that are happening at an industry level that are really beginning to spur growth.

Todd Johnson:              07:27                One is the federal government and commercial payers are recognizing that these students do in fact impact costs and outcomes that are now beginning to pay provider organizations when they use these technologies, which I think is the right answer. Then secondly, as the capabilities mature, that beginning to spread out. So you know from Ross when we started, it was really a one to one between the doctor and their patients and now that has expanded to include the hospital, the doctor, the Cardiac Rehab Center of post acute care providers. Is it physical therapist all connected together in all connected to the patient and we’re starting to see this sort of network effect in communities where more and more providers are connected to their patients and can collaborate for better outcomes.

Bill Russell:                   08:13                Yeah, it is exciting and I think we’re going to touch on that a, in both stories in our, in the new section. So I’m looking forward to, uh, to delving in here. In fact, we’ll just go in and so on our show we do two segments. We do in the news and soundbites in the news. We both pick a new story discussed and then the sound bites come up with five questions to ask you about. Uh, primarily we’re going to talk about your entrepreneurial journey and what really differentiates your product set. And it’s something that really impressed me when we had our first conversation. So I’ll kick us off with our first story. Our first story comes from the Washington Post for millennials are regular visit to the doctor’s office is not a primary concern is the headline. And uh, I’ll just read the first section here because I think it gives a pretty good understanding of where they’re coming from.

Bill Russell:                   09:01                So Calvin ground, it doesn’t have a primary care doctor, uh, since his graduation last year from the University of San Diego, Brown has held a series of jobs that have taken him to several California cities as a young person in a nomadic state. Brown said he prefers finding a walk in clinic on the rare occasion when he’s sick. The whole going to the doctor phenomenon is something that’s fading away from our generations, that Brown, who now lives in Daly city outside of San Francisco. It means getting in the car and go into a waiting room in his view, urgent care which cost them about $40. A visit is more convenient, like speed dating services are rendered in a quick manner. Manner. Brown’s views appear to be shared by millennials. The 83 million Americans born between 1981 and 1996 who constitute the nation’s biggest generation. Their preferences for convenience, fast servers, connectivity and price transparency are upending the time honored model of office based primary care.

Bill Russell:                   09:59                And this is backed up by a by a Kaiser Foundation study that was done that essentially says the millennials at about a 40 some odd percent clip, do not have primary care physicians and are seeking alternative methods for getting their care when they need it. And not as much the other generations, but still a pretty high percentage from where I sit. It’s like 25 percent for some of the older generations that are relying pretty heavily on urgent care in other venues. So, you know, let’s just start with this. I mean, what do you, what do you think this means for health care? Let’s start with this. We’ll go back and forth on that. So if this trend continues, what will this mean for healthcare?

Todd Johnson:              10:44                Yeah, well I think, you know, looking in the rear view mirror, it’s sort of obvious to see how we got here. Right? I think medicine has optimized around how do you sell as many tests, visits and procedures, as you know, with acid fruit. That’s the sort of the game, right? And I think what that means from a patient’s perspective is we’ve had less and less time with our doctors. It’s all too frequently the experience that you end up sitting in the waiting room for an hour and a half and then you get seven minutes and then you’re out the door. And so I think if we think back to the olden days of medicine with a deep relationship with your physician that really understood you, your family and your concerns, that sort of disappeared. Right? And what that leaves us with is, um, people that are seeking something that is more convenient,

Todd Johnson:              11:32                right? We, I mean the last 15, 20 years, it’s just been explosive in terms of how technologies reduce friction to get to services and make everything faster, easier to have an medicine will definitely continue to have to address that. And um, for those urgent care centers have done that well, I think it’s meant that they’re stealing market share from traditional primary care physicians and provided that they can give a high quality convenient accessible solutions will continue. But when, and I think that the trend that’s pretty obvious where this all goes into an urgent care center is kind of an expensive place to go get medicine or, or, or, uh, uh, and we’re going to see it increasingly go to virtual or telemedicine is that front edge, you know, clinic says that next point of triage and you’ll march up. And so I think we’re gonna continue to see the erosion of the traditional clinic as the first point of care.

Bill Russell:                   12:33                Yeah. I don’t know about you, but I mean, my, my family, we had a family doctor. We had Dr Pauling or was our family doctor in eastern Pennsylvania and we went there and actually all of us, it was our primary care doctor, my mom and dad, my brother and sister, we all went to that same doctor. In fact, his office was on the first floor of his house and he lived on the second and third floor of this, of this home. And I just remembered, I mean that was, he was the one who coordinated our care. He ordered the tests and he was a, he was a family friend. He actually came to, you know, weddings and he came to, uh, those kinds of, you know, that’s, that’s such a, a throwback to an era that is a little different than what we have. So you know, the value of primary care is really not disputed and really not disputed in this article.

Bill Russell:                   13:25                They are a trusted advisor, you know, they are the person that we go to to sort out treatment options. Some people fear it in dot article. Some people fear that this trend is going to lead to worse outcomes. And there’s a couple of anecdotal stories in there. However, the, I think the message from millennials is pretty clear, which is this wait time thing is not something they’re used to nor do they like. They don’t like sitting in a room with a bunch of sick people. They don’t like the lack of transparency in terms of the cost. And they want to know this is going to be $40, this is going to be $100. It’s going to be a thousand dollars. Just tell me what it’s going to be ahead of time. So they want that transparency. And an urgent care visit sort of has it, you know, it’s, you go in and they say, you know, it’s going to be 40 bucks, it’s going to be 80 bucks, whatever it’s going to be.

Bill Russell:                   14:11                There’s also this backlog that the 28 days for the first time you see a primary care physician before they accept you as a patient, you know, that’s something that people are looking at going, well, wait a minute. I mean 30 days to wait to even get in there. And then there’s obviously the whole convenience aspect, which is, you know, when I’m sick, I might be sick on Saturday, I might be sick at 8:00 at night. And um, you know, it’s, it’s one of those things that, this is what we’re hearing from the millennial generation and now you have a, the aetna cvs deal, you have a walmart getting into it pretty heavily. You have, uh, other that are starting to rise a, it would really be really not be good for healthcare organizations to ignore this trend. So you mentioned some of the things that they’re going to be doing. What are you talking about? A telemedicine, what are some things we can do for shorter wait times? What are the things we can do for more transparency of costs, a more convenient hours? Is it all digital or is it a combination of things?

Todd Johnson:              15:17                I think it’s got to be a combination and I think that the way that health systems to try to think about this, which might be a little bit different or different perspective is to me it’s a classic market segment. Rotation problems

Todd Johnson:              15:34                to to the primary care is extraordinarily transactional, right? Things like strep throat, you know, uti and sinus headaches and all those things. That is a. that’s a situation where patients need a quick can be fixed, right? But as soon as you learned that you’ve got a significant disease, right? You need to have a relationship with a clinician that can help you learn how to manage that disease that empower you. And so I think health systems need to segment their own markets and provide services at different levels that meet patients where they need to be met and move them into the right sites of care to help to address the issues that they’re facing. And I actually think this is going to continue you. Not Primary Care, but we’re starting to see the emergence of, you know, I’m in orthopedics like these, it’s almost a Panera bread of joint replacement, right? Where you can commoditize and built products that are really good at outstanding service and convenience for a particular segments of the market. And that’s how they need to be thinking about where do we deploy the right capabilities and technologies to meet these different segments of the market.

Bill Russell:                   16:47                Yeah. I wrote a post recently where somebody said, you know, healthcare is one business, health care is 100 a disparate businesses being run under one umbrella. And that’s really true. And we need to look at the different ways we can, uh, we can really customize the services. Okay. So, uh, so that’s our first story. I’m going to kick it to you to, uh, to set up our next door.

Todd Johnson:              17:10                Great. I think there were two candidates. Do you want to go with the patient experience story or do you want to go with the health economics story, your call?

Bill Russell:                   17:19                Well, let’s, uh, let’s go with the, uh, let’s go with the cms story and then I will get back to some of the other stuff in the, uh, in the back and forth on the, uh, on the soundbite section.

Todd Johnson:              17:31                Great. So I’m probably one of the few people that gets excited when there’s new announcements from the federal government about a payment models and regulation on, um, on July twelfth. And I think Med city news or healthcare informatics both broke the story right away, but you can find these stories all over the Internet. And cms did something that I think is important. Uh, I think the trump administration wanted to make a statement about how they’re going to help be more transformative, uh, to the healthcare industry. And to some degree, they just took a bunch of older ideas and repackage them with new names, but they sort of declared two things. One is that the traditional ways we’ve looked at documentation and billing for consultation surfaces were outdated and um,

Bill Russell:                   18:20                let to,

Todd Johnson:              18:24                to some fixes there which has been met with a lot of, uh, actual resistance, which I think everybody’s been surprised that from the medical associations in positions. But the second and more important from my perspective thing that the administration is doing is to recognize that healthcare has really poor communication architecture. We’ve designed the system to be responsive and reactive and as new technology has hit the market broadly in the commercial space, know it’s been slower to adopt in healthcare. And you know, the really simple way to look at this is if you talked to many doctors that are in epic or Cerner and have a portal and a little grumpy about having to answer a patient’s questions because they’re not paid for it, right? They see this as now I have to spend even more time doing stuff that, that I’m not getting paid for. And so cms announced, um, in an effort to modernize the way that we communicate in healthcare and to help support those new methods. I’m really a,

Todd Johnson:              19:26                a couple of, of, um, new incentives for doctors and one is to say that we’re going to pay doctors for what they’re calling it virtual check in. And that is if a patient is at home or checking in with their doctor and the doctor has to, or the doctor’s team has an opportunity to intervene and provide guidance and counseling to patients that there’s a payment associated with that. And the second one that I think is even more interesting is they’re really putting the foot on the gas for, um, physician organizations that deploy remote patient monitoring technologies, right? How do we use technology to continuously surveil our patients and make sure that they’re on track and give us early warning signs when they aren’t. And, and this stuff starts to become material. I think, um, in our analysis physicians that I’m engaged with their patients using these capabilities can earn 150 to $200 for every patient that they get on boards. And we’re starting to see real economics to support the use of advanced technology to interact with patients and more convenient ways.

Bill Russell:                   20:35                Yeah. And now, so I guess my question to you, is gonna be, is this going to be the tipping point because it’s kind of know when I was sitting in the Cio’s chair, we, the telehealth uptake was not that, at least the, I mean the telehealth within the health system was pretty. The telestroke and whatnot was, it was taking off pretty significantly, but the telehealth between a physician and the patient was a very slow uptake and remote patient monitoring was very hard to get funded. And so do you think this will be the tipping point that starts to really drive these use cases up?

Todd Johnson:              21:10                So I’ll start by saying I’m an optimist and that colors everything that I, that I do and I, and I think, um, I think that this will be highly rewarding to organizations that find the right capabilities, um, that

Todd Johnson:              21:27                at the meet the regulatory statutes to get paid, you know, from a health perspective that if you look over the last six years, you know, the, the first cohort of people that invested a purchased these types of, of technologies did it from a place of I want to provide the most outstanding service to patients in my community to differentiate myself and impress my patients. That came from a place of real goodness, right? Because there was no economic benefit to better outcomes at lower costs in their fee for service model. And those are the, those are the good guys and Gals, the ones that are really in it for making the investments for the right reasons. Um, the second major wave of adoption here has been well aligned to the value

Todd Johnson:              22:17                that has significant economic reward for higher quality outcomes and lower costs. And in my opinion, the best and most meaningful models are the bundled payment models, acs or just a little bit weak on the edge of bundles, go right into the heart of, of cost reduction and provide really strong words to doctors that manage their patients well. And so in our analysis, we found a lot of research and publishing on this, you know, a physician in a higher acuity state can save 700 to a thousand dollars per case, right? By deploying these technologies. So there’s real teeth. But in order to feel that reward, it takes real economic analysis, right? I mean, you’re looking at, you know, utilization of healthcare services have or 90 days for every single patient. And that’s not easy to measure and track. And I think now that we look at these new models, it’s just sort of the easy button, right? It says to providers, not only is it easy to get paid for this, that payments will not only cover the cost of the technology, but give you a reasonable margin around it. It’s the right thing to do. It drives higher quality. And so I do think it’s going to act as a lubricant in the marketplace to see adoption really, really come to scale.

Bill Russell:                   23:28                Yeah, I agree with you. Or are the bundled payments for orthopedics? Are those still progressing at the same pace they were under the Obama administration? Or has that slowed down?

Todd Johnson:              23:39                So I’m both. So after trump, the trump administration in as secretary price, who was the secretary of Health and human services, the one that had to resign because of this private jet issue immediately re repealed the program, which I think is an incredible disservice to taxpayers into patients because this was a model that we know delivers superior clinical outcomes and has a significant reduction in costs. The good news is they came back and implemented what is called a BPCI advanced and launched that on Jan one of our

Bill Russell:                   24:19                right

Todd Johnson:              24:20                January this year and actually just went live last week and it just announced a couple of days ago, uh, the participation rates in the new voluntary bundle payment model. And it eclipses what we’ve seen in the past. So I think doctors now I’ve seen enough data that tells them that they can make a lot more money, right. By taking risks around their cases and so they’re, they’re engaged. I do think it’s important to segment those and surgical domains. It is crystal clear in medical domains. It’s proven to be less easy to demonstrate a better economics every single time.

Bill Russell:                   24:58                So this is still a knees and hips essentially, or is it beyond that?

Todd Johnson:              25:03                Yeah. Now there’s a, I’m going to say 38 conditions. It’s a mix of med search. There’s a lot of spine, emt gis in there, and then a lot of the traditional exacerbations of chronic disease, heart failure, cbpb, imodium, etc. So it’s a pretty strong mix. I waS just looking at the data yesterday. You do see these spikes along to nationally therapeutics and spine and cardiovascular surgery, so those tend to be the ones where physicians know that they can be heavily rewarded by participating in this.

Bill Russell:                   25:35                Great. All right, well I’m going to. I’m going to transition to soundbites. I’m also going to apologize to our listeners. I’m actually recording from a hotel room, which a has its pluses and minuses. Every now and then one of your words will drop out and I know people would be like, yeah, what, what did he say? Well, you know, I’m understanding it only one word or dropping out, so I think we’re going to be fine. So, uh, we’re in transition to soundbites. During the section I typically toss out a about five questions. Try to stay to one to three minute answers. If you go longer, I’m not going to stop you. It’s a guideline, not a rule. And if you want you can throw questions back at me. I cannot guarantee any answers because I haven’t prepared any answers. So this is my turn to ask you some questions. So when we first met you, the thing that struck me was you talked about empathy in design, empathy, in the design of digital tools and how that could really extend the empathy of the, of the creator of empathy of the organization to those patients. Can you gIve our listeners a little background on that? On that concept?

Todd Johnson:              26:44                Yeah. I’ll share a story of how I learned the value here. Um, you know, empathy in design is, it’s a simple concept, you know, put yourself in the shoes of the user, right? And try to experience their day, their life, their concerns through their eyes and I’m a try to meet them with a solution that’s going to be really assistive helpful and productive for them. And you know, moving to silicon valley is a bizarre experience, right? It’s a crazy world here. And I was out on the fundraising circuit for our series, a financing system years ago

Todd Johnson:              27:24                and I had the opportunity to pitch to greylock ventures, which is a big venture capital group here in the valley. And one of their partners is a guy named josh elman. And josh was the principle product designer. I’m at twitter, facebook, and linkedin in the sort of the moment when those companies went like this. I mean, clearly he’s a special guy. Um, he probably doesn’t remember our conversation. I did a demonstration for him of health book and at that moment in time health that was really about how do we identify the patients that need help and it was a really clinical mindset that would be like, bill, what’s your weight today, bill? Did you take your meds today? Do you have any chest pain today? All about getting information for me. Right?

Todd Johnson:              28:13                And he’s back and he said, todd, the problem with Your software is it has no salt. I said, okay, what does that mean? And he says, when we designed a linkedin or redesigned facebook, every single time a user interacted with a screen, we tried to make sure that there was a tone in a voice, in a familiarity, and we treat our product as if it’s a thoughtful, compassionate person. So we kind of. I reflected on that and said, you know, healthy business software health loop is like the best nurse you’ve ever had. And she’s compassionate and she’s thoughtful and she knows that you’re in pain and she knows that you’re scared and she knows that you have questions. and we really flipped in our mind what it meant to be a user of this technology. It started to invest in a content team of physicians and nurses and we call them empathy,

Todd Johnson:              29:14                right? To script these experiences that acknowledge what a patient is going through and put it through a tone and a voice that could be helpful to them. And then I think on the professional side there’s a. There’s a sort of another view on this is from the provider experience. I think all too often nurses and pas and doctors feel like they’re on a treadmill, one patient to the next one patient to the next. And I’m. What are the things that we believe I think many people believe is that clinician burnout is. This may be one of the biggest risks to our healthcare delivery system. What we experienced with health loop was that patients were really impressed with this experience. Like, wow, my doctors checking in on me every day. I’ve never seen anything like that. And so we capture from patients their sentiment, right gratitude and serve it back to doctors, nurses, medical assistants. We call it the patient love. And it’s this tenuous feedback loop that really reminds clinicians that what they’re doing or what their work is, it matters their patients, adore them, they’re grateful and it’s a very, very powerful thing for physicians and their teams to see when they, uh, participate with health. Yeah.

Bill Russell:                   30:34                I, you know, on the show, I usually don’t let people talk about their product all that much. But I think your approach is so strong and I think it’s a message that needs to get out there. So, which leads me to my next question, which is let’s assume I’m a cio who’s chosen to create my own portal or my own experience for patients. What process would you coach me to take to ensure that my design has a. Has a deep understanding of the person and empathy towards the person that’s going to be using it?

Todd Johnson:              31:02                Yeah. I guess I’ll start by saying I think we’ve really missed in this domain, right? The version one of portals is really taken what electronic medical records are really good at, which is storage and retention of data for patients. And it expressed that data to patients like what are my lab results, what are my test results? But really I think what patients are worried about is when will I get better? What does this diagnosis mean for my life? Right? Am I going to live? What are the side effects? And so the patient’s concerns aren’t what is their test result? It is what’s going to happen to me. And so I think the first thing that I would recommend to ceos is think about a window through which patients are meeting you. And again, segmentation matters. If I’m at healthy millennial that just needs to take care of a transactional issue, that boy, that should be fast, convenient, easy, quick, the light fall.

Todd Johnson:              31:58                But if I’m a cancer patient, that needs to be very, very different. So segment your market and bring the solutions. And the other thing, you know, we’re seeing this trend of health systems now wanting to build their own portal, right? Build their own front door, the digital on ramp to the health system. And um, I was in a round table with the ceo of a very large health system in the southeast a couple of weeks ago. He says we are going to build the best tools and get patients exactly what we like owning the patient. We’re going to give them everything we’re going to own the patient. And I think it’s so short sighted because patients, when they go through particularly higher acuity episodes of, you’re often not their only provider, right? They need to see, you know, this skilled nursing facility, this physical therapy group. And so I think health systems need to adopt a mentality that they are an important part of the patient’s experience, but they’re not the only part so they should make it frictionless for other providers across their community to collaborate around best outcomes.

Bill Russell:                   33:02                So I, you know, it a little insiGht into the show. I send these five questions over 24 hours before we actually do the show. But I’m going to, I’m going to hit you with A question that’s not on here only because I’m curious. So if we want, if we want our technology that, you know, to have a soul as, as you described it earlier, the ehr is the most predominant pervasive technology we have. What could we do to give it a soul so that it could, you know, to, to really see that the, the, the journey of the physIcian and the journey of the clinician who are really struggling at the hands of the ehr today. What do you think? There’s anything we can do there?

Todd Johnson:              33:44                Uh, yes. So I was, I was sort of daydreaming in response to some of your other questions around, you know, what can we do better to serve our healthcare professionals, you know, can you imagine this for a second? How long have we been in the world of high tech and meaningful use for probably about a 10 year, 12 year. You Imagine whatever

Todd Johnson:              34:08                our clinical tools would be like if that program was designed around a couple of very, very simple, um, drivers. One is step one, provider organization, all your orders in medical information that used to be digitized needs to be on demand and available digitally. We don’t care how you do it, but it needs to be digital. Second, I’m going to get a bonus payment depending on how your physicians, nurses and staff rate their experience with the emr, right? How it delighted as the doctor with the emr, how delighted is the nurse with the emr, because the, the satisfaction with emr is across the country by clinicians. They typically have a negative net promoter score, right? People are not thrilled with these tools. And what was the driver for? How you get rewarded with more money is that your clinicians love this. Um, and then the third rail to make sure that this serves our communities. Let’s just look at patient satisfaction and made sure that is also a boy. So just imagine the types of tools that a cio would be able to purchase or build that was the driving economic force behind the adoption. And that’s just not the case, rIght? So I think I’m just going back to some simple, simple ideas that the people that use these technologies, the more we can delight and impress them and help them be efficient, the better off. Yeah.

Bill Russell:                   35:38                Um, gosh, we can talk about this for awhile, but we’re running out of time here. So let me go to the third, third question that I sent over to you, which is, you know, with this, with this digital empathy, with the, with these tools that have empathy built in to talk to me about the level of engagement that you’ve seen with these kinds of tools and with their physician.

Todd Johnson:              35:58                Yeah. You know, we can continuously measuring engagement and I think, you know, there’s some cohort of individual that is just going to always be the good patient, which means whenever there’s

Todd Johnson:              36:11                reaches out to them and ask them to do it, they will do it no matter how poor the experiences, no matter how irrelevant it is. And that’s maybe 17 to 20 percent of people are just sort of intrinsically motivated to be responsive and courteous and, and quick to respond. So that leaves a huge spectrum of work to do. And um, I think the keys to engagement are simpler than we want them to be. Sometimes it’s, are we delivering something that’s pertinent and relevant to me right now? Right? Is this useful? And, you know, think about the ways that hospitals typically engage with patients, um, you know, in the post acute phase, except robot call, maybe it’s an age cap survey like this, I don’t care about any of that, right? But when humans are helping, reaching out to or technology is reaching out to patients to, uh, um, uh, uh, to provide relevant, pertinent, useful information for right time patients want that. Patients don’t want outcomes. Patients don’t want to spend more than they do on their healthcare costs. And so as long as they feel like it’s a useful partner, relevant and personalized interaction, they’re on board. It’s not that hard. You just have to meet them with what they needed, where they are. Yeah,

Bill Russell:                   37:34                absolutely. Alright, so this is a selfish question. Let’s talk about implementation from, from a digital entrepreneur standpoint, what are the characteristics or activities that organizations that have successful implementations, what, what did they have in common? Because I know you probably have good because we had this, to be honest with you, there was some digital entrepreneurs that came in that we implemented really well and there’s others that we didn’t. And I’m sure you have clients, some that have implemented extremely well and some that you’re still waiting for, you know, to move through contracting or something to that effect. So what are some of the characteristics that, that, uh, you, you have seen that lead to success?

Todd Johnson:              38:12                Yeah, I mean it’s conviction, right?

Todd Johnson:              38:18                System have conviction around a thesis and really work to identify the right partner and treat them like a partner in the make real investments to achieve those outcomes, right? Find ways to really go strong. I think it’s almost that simple. And clearly when there’s the right economic incentives and organizational objectives that we can align those incentives together. It works, you know, we’ve seen, if you’ve seen this, um, you know, the emergence of the pilot, right? There’s so many damn pilots and now we have innovation centers that just, you know, their pilot of wind shift for factories. And on the one hand it’s great that, you know, health systems get to take a test run for digital innovations in digital innovators, get some tests, rounds the hospitals. But more often than not it results in failure. And it results in failure because it gives everybody a chance to take the exit ramp as opposed to just saying, look, we’re committed to this one way or the other, we will make this succeed, this is where we’re going and we’re going to go big. And I think that’s really the critical. Like when a, when a health system has a conviction and is committed to achieving real outcomes and is willing to expend the energy to get the change management inside, the sky’s the limit. Right? You can do amazing things about that conviction. You can sputter

Bill Russell:                   39:49                yeah. And I actually, I think the conviction, I think that’s a great answer by the way. I think the conviction starts with what problems are we trying to solve. I think too many health systems are trying to solve 100 problems and uh, you can’t solve 100 or more problems every year. You almost have to say these are the 15 to 20 problems we are going to solve this year and we’re going to focus our energy, our resources, our investments on these 15 to 20 problems. Uh, it dEpends on the size of the organization, but I just find that the, uh, the focus of the organization is spread so wide, so there’s a sort of a conviction that these 20 problems are the most relevant to our community that we serve right now. So last question, what’s the one thing health I t can do to most dramatically improves patient care from your perspective?

Todd Johnson:              40:38                Yeah, I think it’s, um, I’m beyond that. I say take risks and actually take risks, you know, that healthcare it community. I feel like vendors have underserved their customers forever, right? Healthcare, it is not been sexy. We’ve seen waves of different emr vendors come and go over the last 30 years. The technology lags 10 to 15 years behind what we expect in other areas. And I think that I’m pro black fighters should know since squeeze outside of their comfort zone and you know, don’t choose ibm that ibm is a big player in this space. Um, but makeup that was something new and innovative and be prepared and accept failure as a good outcome. Right? Failure is something that we can learn from the, take some risks, try something new and different, don’t be afraid to try things that are new and different. Yeah.

Bill Russell:                   41:31                Obviously referring to the old adage that no one gets fired by choosing ibm. You’re saying sometimes the solutions are outside of the traditional players that are in this space. And I think that’s, that’s really true. You know, walk the side aisles of the himss conference. Not necessarily. That’s right. Uh, so todd, hey, thank you for comIng on the show and uh, which is, is there a good way for people to follow you or do you have any time in your life to actually be active in social media?

Todd Johnson:              42:02                Sort of a marketing team that does a lot of that stuff so you can follow us on twitter at all.

Bill Russell:                   42:07                Um,

Todd Johnson:              42:09                but you know, I love talking to providers out in the market and interesting people. So I would just invite people that email me directly at [inaudible] dot com. I’m always eager to entertain the conversation.

Bill Russell:                   42:21                That’s great. Last week we had actually somebody share their cell phone number, so I’m not going to go that far with you, but if people want to get a hold of you via cell phone, they can contact me as well. Awesome, and you can follow. You can follow [email protected]om website. The show’s twitter handle is this week in hit and you can catch all the videos on the youtube channel from today. We’ll probably put another seven out there. We’re getting up to around a little over 350 videos now on the, uh, on the channel. A great resource for it staff out there, especially those that are looking to take risks. There’s a lot of great, great content from some of the people who are at the forefront of that. So please check back every friday for more news, information and commentary from industry.

Speaker 3:                    43:11                Now.

 

 

 

 

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