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