Latest / Becker’s Healthcare - Clinical Leadership Podcast / Taking Digital Transformation to the Next Level - Q&A With Dr. Aaron Neinstein

Transcript

Taking Digital Transformation to the Next Level - Q&A With Dr. Aaron Neinstein · Becker’s Healthcare - Clinical Leadership Podcast

• 0:04
  This is the Becker's Healthcare Podcast,
• 0:06
  created by the team of Becker's Healthcare,
• 0:08
  a multimedia company devoted to the people who power us healthcare.
• 0:11
  Four new 15 minute episodes are released daily containing industry news analysis
• 0:15
  and thought leadership from power powerful healthcare.
• 0:17
  Decision makers support our show by leaving at a five star rating and review on
• 0:21
  Apple podcasts or other platforms you use.
• 0:23
  It's a chance to tell us what you like about the show and act on your feedback.
• 0:26
  Thanks for listening. Now, here's the episode.
• 0:32
  This is Laura Dedo with the Becker's Healthcare Podcast.
• 0:35
  I'm thrilled today to be joined by Erin Einstein,
• 0:37
  chief Medical Officer at notable and former Vice President of Digital Health at
• 0:41
  U C S F Health. Erin, it's a pleasure to have you on the podcast today.
• 0:46
  Great to be with you, Laura. Thank you.
• 0:48
  Now, I know we have a lot to talk about.
• 0:50
  There's so much happening in the digital health space and,
• 0:52
  and things are really moving quickly.
• 0:54
  So I'm looking forward to our conversation. But before we dive into the,
• 0:57
  the broader discussion,
• 0:58
  can you tell me a little bit more about yourself and your background?
• 1:02
  Yeah, of course. So, um, I, I like to joke that I am,
• 1:07
  what an American,
• 1:08
  what happens when an American Studies major goes to medical school. Uh,
• 1:12
  that's a, uh, a, a ripoff of Bob Walker, who's, who's made a similar joke for,
• 1:16
  for many years. But, uh, uh, I've been, uh,
• 1:20
  a clinical informaticist and a practicing endocrinologist for, for many years.
• 1:25
  Uh, was vice president of Digital health at U C S F Health most recently.
• 1:29
  And as of, uh, this month, uh,
• 1:31
  have made the move to be Chief Medical Officer at Notable. Um,
• 1:36
  and so, you know, across my career, I've just really been,
• 1:41
  uh, deeply moved by interdisciplinary learning,
• 1:45
  by trying to connect dots across business, technology, healthcare, uh, science,
• 1:50
  sociology. And so, um, you know,
• 1:53
  the field of informatics became very interesting to me because as a practicing
• 1:57
  physician, you get to, uh, have a positive impact one patient at a time.
• 2:03
  Um, when you work in informatics, you can really move, uh,
• 2:06
  you can really have impacts at a much broader, uh,
• 2:09
  scale a across many more people. And so I found that, uh, really exciting, uh,
• 2:14
  as I started my career. So, um, over the years, um,
• 2:19
  helped lead our ehr, uh,
• 2:21
  implementation and optimization at U C S F, uh,
• 2:26
  was co-founder of a,
• 2:27
  a nonprofit organization called Tidepool that builds software
• 2:32
  for people with diabetes. Um, and over the past 10 years,
• 2:35
  really helped build our digital health programs at U C S F,
• 2:40
  um, in precision digital marketing, uh, patient communications,
• 2:44
  patient access and scheduling, uh, referrals, intake,
• 2:50
  uh, deploying AI capabilities at U C S F
• 2:55
  building programs in, in telehealth and virtual care, uh,
• 2:58
  and really helping drive digital transformation at U C S F.
• 3:02
  So moving more towards, uh, a product mindset, uh,
• 3:05
  incorporating and building a human-centered design practice, uh, agile, uh,
• 3:10
  methodology, uh, use of embedded analytics, uh,
• 3:14
  and really trying to help U C S F become a more digital organization, um,
• 3:19
  fortunate to still have a clinical practice in endocrinology where,
• 3:22
  where I focus on diabetes care, uh, and really love doing that, um,
• 3:27
  and have also been really fortunate to be engaged, uh,
• 3:30
  in federal health IT policy. So, uh,
• 3:33
  I serve on the federal high tech,
• 3:35
  the health Information Technology advisory committee, uh,
• 3:39
  and really passionate about advancing federal policy related
• 3:44
  to, uh, patient data access, interoperability, APIs, uh, and,
• 3:49
  and advancing virtual care capabilities across the country. Um,
• 3:54
  and then, you know, as I mentioned,
• 3:56
  recently took this role as Chief medical Officer at notable, uh, and,
• 4:00
  and very excited about, uh, having the opportunity to,
• 4:03
  to really continue my passion for removing inefficiencies from the
• 4:08
  system. Um, you know,
• 4:11
  thinking about all of the administrative burden that gets in the way of,
• 4:15
  of providing great care to patients, uh,
• 4:18
  and how can we use technology and,
• 4:20
  and modern capabilities to remove those administrative burdens and make
• 4:25
  the patient experience, uh, much better, uh, than it has been, uh,
• 4:30
  over the past years.
• 4:33
  That's amazing to hear.
• 4:34
  And what a great journey for your career in terms of starting off as a clinician
• 4:37
  and obviously making a huge impact on the patients that you're serving,
• 4:41
  but then broadening that out, um, as an informaticist and, and doing a ton to,
• 4:45
  uh, make the healthcare system more efficient and, and,
• 4:47
  and better from the technology side and touching so many more lives. And then,
• 4:51
  you know, I, I know in the past few years, as you were talking about,
• 4:54
  digital transformation has been such a huge undertaking, uh,
• 4:57
  for so many health systems as well as U C F S health. And,
• 5:02
  and from your perspective, when you're looking at, um, you know,
• 5:05
  some of the opportunities and headwinds, what do you have your eye on right now?
• 5:08
  What do you really see as being spaces that, um,
• 5:11
  have a lot of open opportunity, but also, um, you know,
• 5:16
  things that are,
• 5:18
  could be potential roadblocks or challenges for digital transformation in the
• 5:21
  healthcare space?
• 5:24
  Yeah, I think there, there's sort of the, the macro, um,
• 5:29
  trends that have been, you know, going on for the last 10,
• 5:31
  15 years in healthcare, and then the,
• 5:34
  the things that have really accelerated in the past year or two. Uh,
• 5:37
  when we think about the headwinds,
• 5:39
  I I think the broader trend is that unlike other
• 5:44
  industries where technology has really transformed the
• 5:49
  consumer experience, uh, has driven, uh, a lot of efficiency,
• 5:53
  has maybe lowered costs, those things haven't happened yet in healthcare.
• 5:57
  And as an industry, we largely, you know,
• 6:01
  we've moved from paper to, uh, digital records,
• 6:06
  but we haven't really been,
• 6:07
  we haven't really leveraged technology to make the consumer experience better,
• 6:12
  to lower cost, to improve access, um, um, and,
• 6:17
  and to, to really tackle some of the big challenges that we, uh,
• 6:21
  face in the healthcare system. And,
• 6:24
  and we're seeing those challenges get worse these past few years,
• 6:27
  really exacerbated by the pandemic. So, you know,
• 6:30
  burnout among our providers and our nurses and people leaving the workforce,
• 6:36
  uh, rising cost of, of labor, uh,
• 6:39
  for hospitals and health systems and facing labor shortages,
• 6:42
  unable to hire enough staff to, uh,
• 6:47
  to staff hospitals, with nurses, to staff clinics, with, uh, clinic staff.
• 6:52
  Um, worsening frustrations among patients with,
• 6:55
  with challenges in access to care, long wait times for care, uh,
• 7:01
  friction and a subpar, uh, experience. And at the end of the day, you know, the,
• 7:05
  these headwinds on health systems, the impact these have on,
• 7:09
  on all of us as, as people and patients and parents, um,
• 7:14
  you know, it's getting harder for people to afford care.
• 7:17
  It's getting harder for people to access care.
• 7:20
  We're seeing widening health disparities. And so I think the,
• 7:24
  the real opportunity now over the coming years
• 7:29
  is to actually leverage technology to do the things
• 7:34
  that we've seen technology do in other industries. Um,
• 7:38
  so a few examples of what I mean by that. So, you know,
• 7:42
  areas where I've been focused, um, improving the front door for patients. So,
• 7:47
  you know, if you have a refer, you get a new diagnosis of, you know,
• 7:52
  diabetes or, uh, inflammatory bowel disease or cancer,
• 7:56
  and you get a referral to see a specialist, there are a million hurdles,
• 8:01
  uh, standing in your way between, you know,
• 8:05
  wanting to see a specialist and getting through to that appointment and getting
• 8:08
  the care that you need. And so, how do we use technology to, uh,
• 8:14
  automate, streamline, reduce friction, reduce inefficiencies from that process,
• 8:19
  all the way from referrals to the, to authorize authorizations,
• 8:23
  to scheduling, um, to everybody's, uh, you know,
• 8:27
  people still dread the clipboard, uh, for,
• 8:30
  for intake and registration with the health system, but it,
• 8:34
  it should be much easier to get from,
• 8:36
  I want to see a new doctor for this new condition I have, um,
• 8:40
  to actually seeing your doctor.
• 8:42
  And so how do we use technology to eliminate all of the friction, uh,
• 8:46
  that's in the way there. And, and some of that is, uh,
• 8:51
  friction in the, in the patient experience,
• 8:53
  and a lot of it is really what's under the surface.
• 8:56
  The operations in health systems, you know,
• 8:59
  still faxing documents around, uh, lots of inefficiencies in,
• 9:04
  uh, workflows that require a lot of clinic staff to, you know,
• 9:08
  type information in or, or make, uh,
• 9:11
  phone call outreach and a lot of opportunities for, uh,
• 9:15
  technology and automation there. Um, there's similarly,
• 9:20
  you know, once people are engaged with a, with a physician,
• 9:24
  lots of opportunities for ongoing, uh,
• 9:27
  engagement through the patient's care experience. Um, you know, again,
• 9:31
  thinking about someone with diabetes or Crohn's disease or cancer, you know,
• 9:35
  you see your doctor, uh, they give you, uh,
• 9:40
  some recommendations for follow up items, you know, pick up a new prescription,
• 9:44
  go to the lab, um, and that's kind of scribbled on a piece of paper,
• 9:48
  or it's in the electronic health record, but it's kind of manual.
• 9:52
  And so how do we help support people in getting those things done,
• 9:56
  in scheduling those next steps in,
• 9:59
  checking in with them to make sure they were able to get the medication from the
• 10:03
  pharmacy and in, uh,
• 10:05
  checking in with them a week later to see if they have any side effects from
• 10:08
  that new medication. Again, you know,
• 10:11
  the information is probably in a computer now,
• 10:14
  but it's essentially on a piece of paper in a computer,
• 10:17
  because our systems are not supporting patients in,
• 10:22
  uh, in educating them in, in supporting them,
• 10:25
  in taking those next steps in their care. Um,
• 10:29
  and then I think the last piece is, you know, if you look broadly, uh,
• 10:34
  across digital and healthcare, you know,
• 10:37
  people are appropriately concerned that technology, uh,
• 10:40
  could worsen disparities. We obviously have huge challenges with,
• 10:45
  with health disparities, uh, in this country. The way I look at it is, I,
• 10:50
  I think technology actually has the opportunity to reduce disparities because
• 10:55
  by giving everyone the exact same experience that isn't tailored to
• 11:00
  people's individual needs, um,
• 11:03
  which is the way things kind of are today, um,
• 11:08
  I think that's part of what may worsen disparities,
• 11:11
  but we can use technology to actually understand people's individual needs.
• 11:16
  You know, what language do you speak? What's your education, uh, level,
• 11:21
  um, what's your family situation? At what hours of the day, uh,
• 11:25
  is best to communicate with you, is that morning or evening?
• 11:29
  And really understand p people's personal preferences and, and needs, uh,
• 11:34
  and tailor our outreach and our,
• 11:36
  our engagement with them to their individual needs. I think that has, uh,
• 11:41
  a significant opportunity to personalize and, and create more,
• 11:47
  uh, equity, uh, and, and reduce disparities.
• 11:52
  So, uh, i, I think there's, you know, lots of,
• 11:55
  clearly lots of headwinds, um, that we're facing as an industry.
• 12:01
  Um, but, uh, lots of opportunities facing us to, um,
• 12:06
  to improve th those outcomes that we really care about.
• 12:10
  That's such a great point, Erin,
• 12:12
  in thinking through all the different ways that technology could make a
• 12:16
  difference for the healthcare system operationally as well as patient outcomes
• 12:20
  and personalizing medicine in more,
• 12:23
  more ways that could close some of those health disparity gaps. And, you know,
• 12:26
  from your perspective,
• 12:27
  you've been in the field for a long time and really seeing how technology is
• 12:31
  integrating in healthcare and some of the unique challenges, um,
• 12:34
  with that as well. So, you know,
• 12:36
  what does growth look like in order to meet these,
• 12:39
  this reality that you're talking about in terms of integrating technology that
• 12:42
  they have in so many other industries to, um, improve the patient experience,
• 12:47
  to cut costs, to become more efficient?
• 12:49
  How do you grow as an organization and really add value with the technology
• 12:54
  that's available?
• 12:58
  So I, I think sometimes it's, it's counterintuitive because of what,
• 13:03
  uh, what gets the headlines. So I think
• 13:07
  there are a lot of exciting ideas for how,
• 13:12
  um, healthcare can change dramatically, you know,
• 13:16
  where there can be disruption, where we can completely, uh,
• 13:19
  change care models or disrupt, uh, the way things work today.
• 13:24
  And, and I think those are very exciting and very important, uh, at,
• 13:29
  at the same time,
• 13:31
  you take a very pragmatic look at where there's friction
• 13:36
  today, where there's challenges. I think there's so many opportunities,
• 13:41
  uh, to identify process efficiencies,
• 13:44
  remove friction from within care delivery systems. Today, I,
• 13:49
  I was, uh, talking to someone last week, uh,
• 13:52
  who's at a hospital and is a, uh, revenue cycle, uh,
• 13:58
  leader,
• 13:59
  and she was recounting her challenge.
• 14:03
  So she had a team who helped patients with cancer get, uh,
• 14:08
  authorization to get their chemotherapy infusions. Uh,
• 14:12
  and with labor challenges over the last year, she's lost many,
• 14:17
  uh,
• 14:17
  people on that team and no longer has an enough staff to,
• 14:22
  um, help patients get authorizations for chemotherapy infusions when they,
• 14:27
  when they show up, when they wanna show up for those. Um,
• 14:30
  I was talking to someone else who, who works in patient access, uh,
• 14:35
  at another health system,
• 14:36
  and they said their doctors have empty space in their schedules cuz they don't
• 14:39
  have enough access center staff to help create appointments and help do the
• 14:44
  scheduling, uh, for, uh, for their doctors. And so I think,
• 14:49
  you know, again, as we were talking about these headwinds, there,
• 14:53
  there are some just very pragmatic basic
• 14:58
  challenges that our healthcare delivery systems are facing.
• 15:04
  And these are opportunities to use technology, uh, and automation to help.
• 15:09
  Um, these are things that, uh, helping, you know,
• 15:15
  fill out authorization, uh,
• 15:18
  forms and send them to the payers or helping patients self-schedule,
• 15:23
  uh, and, and managing the intake and scheduling electronically. Uh,
• 15:28
  these are things that technology can achieve.
• 15:32
  And so I think there, uh,
• 15:34
  is a lot of low hanging fruit out there where we can reduce inefficiencies,
• 15:39
  support the health systems that are struggling with, uh,
• 15:43
  not enough staff and not enough people to manage these workflows. Uh,
• 15:47
  and at the same time by, you know,
• 15:51
  we don't have to design something very fancy to make the experience better for
• 15:55
  patients. Um,
• 15:57
  it's removing all of these inefficiencies and blockers that are in the system
• 16:01
  and all of this extra work that health systems are,
• 16:05
  are trying to do with not enough staff. Uh, and I think, you know,
• 16:09
  that may not draw the headlines, uh,
• 16:11
  but I think by solving those challenges kind of in the,
• 16:16
  in the bowels of every health system, uh, we can really, uh, you know,
• 16:21
  move the needle on on those outcomes again, you know, patient access to care,
• 16:26
  reducing disparities, lowering costs. Um,
• 16:29
  so those are the things I'm really excited about. And I was,
• 16:31
  I was happy to see the New York Times actually did,
• 16:33
  I can't remember exactly what the, uh, headline was last week, but um,
• 16:39
  they, uh, they, they did a piece basically headlining, you know,
• 16:44
  AI is not, uh, necessarily going to, uh,
• 16:48
  do all of the, the fancy things yet in healthcare, but, uh,
• 16:52
  it's gonna start making your life easier. And I think that's the right headline.
• 16:56
  And, and Eric Topol wrote about this, uh, in his last book saying, you know,
• 17:00
  we don't need AI to cure cancer. We just need it to help restore,
• 17:05
  uh, the doctor patient relationship and, and remove administrative burden.
• 17:09
  And I, I think that's where we're gonna see the value, uh,
• 17:12
  over the next several years, uh, and, and really have impacts there.
• 17:19
  That makes so, so much sense. And, and definitely love that idea of, you know,
• 17:23
  really first and foremost focused on how healthcare can be easier with
• 17:27
  artificial intelligence and other technologies. And then, you know, seeing, uh,
• 17:31
  seeing where things go from there. Um,
• 17:33
  so I think that makes a lot of sense and I appreciate you spelling out, um,
• 17:37
  some of those different areas where disruptions, you know, may happen, but,
• 17:40
  but really it's kind of like the,
• 17:41
  the little areas in the little spaces where it can make a big difference, um,
• 17:45
  operationally as well as clinically.
• 17:48
  I know for a lot of hospitals and health systems, they're being presented with,
• 17:52
  um, on a daily basis, a lot of new technologies now a lot of AI driven,
• 17:57
  um, applications and, and functionalities and platforms and whatnot, um,
• 18:02
  to,
• 18:02
  to consider to help them in the future will also grappling with some financial
• 18:06
  challenges and realities that, you know, we haven't faced, um,
• 18:10
  prior to the pandemic. So from your perspective,
• 18:12
  what do you see as being really, um,
• 18:14
  important for healthcare organizations to continue to invest in right now?
• 18:19
  Um, especially thinking through, you know, a, a, um,
• 18:22
  limited resources on their end.
• 18:26
  Well, so this is the year of AI and large language models, right? So I,
• 18:31
  I would be remiss if I, if I didn't answer, uh, in, in that context,
• 18:36
  but I, but I'm gonna put a twist on it.
• 18:39
  I think there is an impulse when people get their hands on a new technology
• 18:45
  to come at things from the perspective of, wow,
• 18:47
  there's this exciting technology. What, what can I do with it?
• 18:53
  And I, I, I go back to what I was talking about a minute ago. I,
• 18:57
  I think we need to look at it through the, the reverse lens,
• 18:59
  which is we have some very real pain and problems in our health
• 19:04
  systems. You know, again, not enough nursing staff, not enough clinic staff,
• 19:09
  uh, trouble servicing patients' needs with scheduling appointments,
• 19:14
  uh, or, or getting access to care.
• 19:17
  I think we need to ask how these,
• 19:21
  how this new technology,
• 19:23
  how these new capabilities can help us solve those problems.
• 19:26
  We don't need to go looking for, you know, new things to do or,
• 19:32
  uh, or something new exciting. We, we have the problems that we need to solve,
• 19:37
  and this gives us a new set of capabilities and a new tool in the toolbox,
• 19:42
  uh, to go do that. So I, I think the,
• 19:46
  the investment really is how do you take this new set of capabilities,
• 19:51
  um,
• 19:51
  and use it to solve a problem that maybe felt intractable previously and
• 19:56
  felt like you couldn't make headway a against it, but,
• 20:00
  but maybe now we can.
• 20:03
  Got it. I, I, I really, um, enjoy and appreciate that it,
• 20:06
  it's just so important. Um, well, before we wrap up our conversation here,
• 20:10
  I'm just wondering,
• 20:11
  where do you see some of the best opportunities for growth and development in
• 20:14
  the future? I know we've talked a little bit about, um, some of this,
• 20:17
  but just especially from a,
• 20:18
  a tab digital health and IT executive for hospitals and health systems. Um,
• 20:23
  you know, what's really the next step? Where do we go from here?
• 20:27
  Yeah,
• 20:28
  I think the thing that I'm most excited about really
• 20:33
  is about moving from sort of a reactive model,
• 20:38
  uh, that, that doesn't really serve people's needs to, you know,
• 20:43
  again, now that we have moved from paper to digital records,
• 20:47
  how do we take what's there?
• 20:49
  We have all of this information in people's health records,
• 20:54
  how do we use it to better serve their needs? Um,
• 20:59
  and so I'll go back to the experience that I had in my, in,
• 21:02
  in my clinic last week, you know, seeing, uh,
• 21:05
  someone with diabetes where, you know, we, we had our conversation,
• 21:11
  um, and I wrote out next steps that said,
• 21:14
  go get labs done next week. Um, pick up this, uh,
• 21:19
  new prescription for, uh, for a new kind of insulin.
• 21:23
  Adjust your insulin, uh, up by two units. Um,
• 21:27
  go see the podiatrist in a couple of weeks, and here's the referral. Uh,
• 21:31
  come back and see my nurse practitioner in four weeks. Uh,
• 21:35
  and here's information. And you know,
• 21:37
  today I kind of type all this information into the computer,
• 21:41
  and while it's in the computer, nothing's happening with that information. I,
• 21:46
  I go home that night and I think to myself,
• 21:51
  you know,
• 21:51
  have I really given that person the tools to go accomplish
• 21:56
  those next steps? Um, how are,
• 21:59
  how are they gonna take those next steps of making sure, uh, that they,
• 22:04
  the referral gets processed and they get scheduled, that they, uh,
• 22:08
  know what lab tests need to be done and where to go and when to come get it
• 22:13
  done, uh, that they have the,
• 22:16
  the right ability to schedule with my nurse practitioner that the prescription I
• 22:20
  wrote and thought I was sending to a pharmacy is gonna be affordable for them,
• 22:25
  uh, that they're not gonna have side effects the next week,
• 22:28
  or that they're gonna have questions about how to take it.
• 22:30
  There's all of these loops that I created, uh,
• 22:35
  in, in suggesting follow up. And again, today, our, our system,
• 22:41
  um, basically puts all of that on the patient. Um, you know, in an ideal world,
• 22:46
  we'd have enough staff in our clinics to help patients do all of those things,
• 22:51
  but no health system has an enough staff to, uh,
• 22:56
  support the patient in every single one of those follow up steps. And,
• 23:00
  and patients may not have, uh, the tools, uh, to do it themselves.
• 23:05
  And so how can we use intelligence to understand that those are the next steps
• 23:10
  in their care that, uh, patients need to take, uh,
• 23:15
  and, and help them, you know, give them the tools,
• 23:19
  give them the education, provide the electronic nudges, um,
• 23:24
  remove the barriers behind the scenes from that referral being processed.
• 23:28
  So I think what I'm most excited about over the coming years really is moving
• 23:33
  from, you know, V1 of,
• 23:36
  of digital in healthcare where we just have, uh,
• 23:40
  free text notes to actually adding that layer of intelligence on top of
• 23:45
  the electronic health records, um,
• 23:48
  that allow us to really support patients and doctors and care teams, uh,
• 23:53
  again, as, as Eric Topol said, in restoring, you know,
• 23:56
  focusing on the doctor patient relationship, um, aligning, uh,
• 24:01
  interests between doctors and patients to support patients in getting the best
• 24:05
  care outcomes, uh, that they want to achieve and, and removing those barriers,
• 24:09
  uh, out of their way.
• 24:12
  I love that. Erin, thank you so much for joining us on the podcast today.
• 24:15
  This has been such a fun and interesting discussion,
• 24:17
  and I look forward to connecting with you again soon.
• 24:21
  Thank you so much, Laura. I really appreciate it.
• 24:27
  It's so important for leaders at the top of organizations to keep learning,
• 24:31
  stay sharp, grow their networks,
• 24:33
  help our audience better do this in a more simplified, personalized,
• 24:36
  and meaningful way. Becker's Healthcare has launched my B h c,
• 24:40
  it's your trusted Becker's healthcare experience and more with content,
• 24:43
  connections, events, and learning opportunities.
• 24:46
  Join the community free of charge@www.my dot becker's hospital
• 24:51
  review.com and we'll see you there.