1 00:00:00,160 --> 00:00:03,680 Would you like to exchange best practices and ideas to improve care, 2 00:00:03,830 --> 00:00:05,600 enhance operational efficiency, 3 00:00:05,660 --> 00:00:08,000 and address financial challenges with your peers? 4 00:00:08,480 --> 00:00:12,320 Becker's Healthcare is facilitating these conversations at their eighth annual 5 00:00:12,620 --> 00:00:15,400 health, IT Digital health and RCM meeting. 6 00:00:15,820 --> 00:00:19,120 You can check your eligibility for complimentary attendance at the Lincoln, 7 00:00:19,480 --> 00:00:22,120 the description. We are excited to welcome you in October. 8 00:00:23,220 --> 00:00:25,590 This is Laura Deda with the Becker's Healthcare Podcast. 9 00:00:26,210 --> 00:00:28,390 I'm thrilled today to be joined by Dr. Ethan Booker, 10 00:00:28,440 --> 00:00:32,030 chief Medical Officer of Telehealth and Medical director of MedStar Telehealth 11 00:00:32,030 --> 00:00:34,070 Innovation Center at MedStar Health. Dr. 12 00:00:34,070 --> 00:00:35,990 Booker is a pleasure to have you on the podcast today. 13 00:00:36,970 --> 00:00:38,160 Thank you, Laura. Thanks for having me. 14 00:00:38,700 --> 00:00:40,440 Now, I know we have a lot to talk about, 15 00:00:40,440 --> 00:00:44,560 and I'm excited to get into the meat of our discussion because I know Telehealth 16 00:00:44,560 --> 00:00:48,480 and virtual care is something that is on the top of so many minds in healthcare 17 00:00:48,480 --> 00:00:51,400 today, and really making sure doing it right is a top priority. 18 00:00:51,500 --> 00:00:53,840 But before we dive into that larger discussion, 19 00:00:53,840 --> 00:00:57,000 could you tell us a little bit more about yourself and your background? Sure. 20 00:00:57,880 --> 00:00:58,713 I think it's, 21 00:00:58,750 --> 00:01:02,960 it's useful to kind of set me within the context of my health system, I think. 22 00:01:03,260 --> 00:01:04,560 So as you mentioned, 23 00:01:04,620 --> 00:01:07,200 I'm the Chief Medical Officer for Telehealth at MedStar Health, 24 00:01:07,200 --> 00:01:09,440 which is kind of an interesting role, not a, 25 00:01:09,440 --> 00:01:11,640 not a role we needed a few years ago, 26 00:01:11,640 --> 00:01:15,400 and one that I've grown into as our health system's capabilities in telehealth, 27 00:01:15,820 --> 00:01:18,440 uh, have come along. So, um, 28 00:01:18,510 --> 00:01:22,000 MedStar Health is the largest healthcare provider in the Maryland and Washington 29 00:01:22,340 --> 00:01:26,840 DC region. Um, spread out over more than 300 locations in 10 hospitals, 30 00:01:27,500 --> 00:01:29,680 uh, urgent care clinics, ambulatory care centers, 31 00:01:29,780 --> 00:01:34,440 really all of the features of a regional, uh, health system, 32 00:01:34,630 --> 00:01:39,520 including a focus on, on the academics that we produce and research, 33 00:01:39,710 --> 00:01:42,840 education and training. Uh, and our, uh, 34 00:01:42,840 --> 00:01:45,240 when you sort of flagship academic hospital, MedStar, 35 00:01:45,240 --> 00:01:46,880 Georgetown University Hospital, 36 00:01:48,540 --> 00:01:51,000 the journey that I have had myself as I'm, 37 00:01:51,020 --> 00:01:55,600 I'm an emergency physician and I've been working clinically at MedStar MedStar 38 00:01:55,600 --> 00:02:00,200 Washington Hospital Center in DC for, uh, this will make 18 years, 39 00:02:00,940 --> 00:02:01,773 uh, now, 40 00:02:01,980 --> 00:02:06,920 and have had the opportunity to work in a variety of areas around innovation and 41 00:02:06,920 --> 00:02:11,400 improvement, um, air medical transport, uh, that kind of thing. 42 00:02:11,900 --> 00:02:16,840 And starting in 2015 began to have the opportunity to use telehealth to 43 00:02:16,840 --> 00:02:20,040 improve operations in our emergency departments. Uh, 44 00:02:20,180 --> 00:02:24,560 and so in 2017 when the MedStar Institute for Innovation, 45 00:02:24,690 --> 00:02:29,160 where I sit now, uh, chartered the MedStar Telehealth Innovation Center, 46 00:02:29,620 --> 00:02:33,200 uh, I came on board in partnership with Bill Sheehan, my boss, 47 00:02:33,340 --> 00:02:38,120 the Chief Innovation Officer, uh, now of MedStar Health. Uh, 48 00:02:38,120 --> 00:02:41,400 and we began to build the capabilities, uh, of, 49 00:02:41,540 --> 00:02:45,800 of telehealth that really prepared us for, uh, the moment, uh, 50 00:02:45,800 --> 00:02:50,720 in March of 2020 when much of what we built, uh, came to fruition. 51 00:02:50,740 --> 00:02:54,480 And I think we'll probably spend some time talking about the journey from, 52 00:02:54,750 --> 00:02:57,400 from that date onward and, and where we're at now. 53 00:02:58,400 --> 00:03:01,810 Absolutely. I think that's such a great point because for so many, 54 00:03:01,920 --> 00:03:06,370 that inflection point of the pandemic beginning really put them down, uh, 55 00:03:06,610 --> 00:03:09,490 a very fast paced journey towards virtual care and telehealth, 56 00:03:09,830 --> 00:03:12,450 and one that they weren't necessarily prepared for at the beginning, 57 00:03:12,550 --> 00:03:16,090 but you know, now are really able to lean into and become, uh, 58 00:03:16,090 --> 00:03:20,370 advanced within that technology in that space. So based on your experience, 59 00:03:20,370 --> 00:03:21,770 and especially the last two years, 60 00:03:21,920 --> 00:03:25,250 what are you seeing as some of the big opportunities as well as headwinds that 61 00:03:25,250 --> 00:03:26,083 you have your eye on? 62 00:03:27,550 --> 00:03:31,520 Yeah, I think there continues to be, um, you know, a lot of excitement, uh, 63 00:03:31,520 --> 00:03:35,800 about the opportunities that are in front of us in telehealth and, 64 00:03:35,860 --> 00:03:39,160 and using those tools really to expand the envelope of, 65 00:03:39,160 --> 00:03:42,280 of the way that we care for folks. You know, we're really excited that, 66 00:03:42,700 --> 00:03:45,600 you know, just recently in, in March of 2023, 67 00:03:46,180 --> 00:03:49,280 we surpassed 2 million telehealth encounters over the, 68 00:03:49,430 --> 00:03:53,080 that three year increment that I, that I mentioned starting in March of 2020. 69 00:03:54,260 --> 00:03:57,760 And as an, an academic health center, we're, um, 70 00:03:58,110 --> 00:04:02,520 excited about the opportunities to develop better learning in that space, 71 00:04:02,520 --> 00:04:04,280 including research that, 72 00:04:04,280 --> 00:04:08,360 that I co-lead with partners in the MedStar Health Research Institute, 73 00:04:08,900 --> 00:04:11,200 as well as partners at Stanford and Intermountain in the, 74 00:04:11,200 --> 00:04:15,200 the Connected Care Access Research Equity and Safety Consortium, the, 75 00:04:15,200 --> 00:04:18,760 the Connected Care and Safety Consortium for short, um, that, 76 00:04:18,760 --> 00:04:22,520 that is supported by grant work from A H R Q that we're just really excited 77 00:04:22,520 --> 00:04:27,320 about the opportunities to focus on safety and quality in the 78 00:04:27,480 --> 00:04:30,680 delivery of telehealth. I think those are some of the opportunities that we're, 79 00:04:30,680 --> 00:04:35,080 that we're really excited about. Lets kind of demonstrate, um, the, 80 00:04:35,220 --> 00:04:39,640 the success that one can have and really changing the care model for, 81 00:04:39,820 --> 00:04:43,960 for the way we, we care for patients. And I think that's really, you know, 82 00:04:43,960 --> 00:04:48,560 the big opportunities here are, are about creating continuity with patients, 83 00:04:48,860 --> 00:04:51,440 really creating an experience that that is, 84 00:04:52,380 --> 00:04:56,960 is or can be ubiquitous without being invasive, uh, 85 00:04:56,980 --> 00:05:00,920 to really change the, the model of care delivery and think, uh, 86 00:05:00,920 --> 00:05:05,440 really about the care delivery as opposed to the location per se. Um, 87 00:05:05,700 --> 00:05:08,080 so those are the, some of the opportunities kind of in a, 88 00:05:08,100 --> 00:05:11,520 in a global sense that we're excited about. Um, 89 00:05:12,120 --> 00:05:16,080 I think that the headwinds, as you mentioned, um, are kind of, 90 00:05:16,310 --> 00:05:20,080 they're kind of twofold in some ways, um, or at least how i, 91 00:05:20,200 --> 00:05:23,720 I am experiencing them myself in, in, in our organization. 92 00:05:24,420 --> 00:05:28,240 The major one that's external is really the evolving telehealth policy 93 00:05:28,590 --> 00:05:30,040 landscape. Um, 94 00:05:30,180 --> 00:05:34,640 and that is a really complicated one because it's not just sort of one set of 95 00:05:34,640 --> 00:05:39,280 rules. It is the rules that are determined at the federal level, 96 00:05:40,060 --> 00:05:43,800 um, by acts of Congress, by the regulatory environment, uh, of the, 97 00:05:43,900 --> 00:05:47,800 the many agencies that are involved, whether that's hhs, um, 98 00:05:48,060 --> 00:05:49,120 and Medicare rules, 99 00:05:49,340 --> 00:05:53,680 or how it is that they guide states and Medicaid implementation, uh, 100 00:05:53,680 --> 00:05:58,680 as well as other regulatory agencies like DEA regarding controlled 101 00:05:58,680 --> 00:06:02,680 substances, and then each of the states individually, uh, 102 00:06:03,500 --> 00:06:08,200 having their own, uh, rules and regulations and reimbursement landscapes, 103 00:06:08,200 --> 00:06:12,480 which really does create a significant headwind for how it is that we move 104 00:06:12,480 --> 00:06:16,840 forward. Now, the thing that's really very positive is that, 105 00:06:17,380 --> 00:06:20,480 um, the federal legislation, uh, 106 00:06:20,480 --> 00:06:23,280 that came out towards the end of the calendar year last year, 107 00:06:23,950 --> 00:06:28,400 ongoing guidance from those regulatory agencies is very positive 108 00:06:29,060 --> 00:06:33,280 as a whole, um, as is the state environment as a whole. 109 00:06:34,340 --> 00:06:34,820 Um, 110 00:06:34,820 --> 00:06:39,440 but the complexity of the interaction between the two kind of creates this 111 00:06:39,440 --> 00:06:44,040 circumstance of, of some uncertainty, um, about, 112 00:06:44,340 --> 00:06:48,160 you know, for any individual provider thinking, well, 113 00:06:48,620 --> 00:06:51,560 for the things that I do, what does that mean for me? 114 00:06:51,900 --> 00:06:55,160 And what does that mean for me in the way that I approach my patients 115 00:06:55,680 --> 00:06:59,360 cohesively? Right? Because it's not as if, particularly around telehealth, 116 00:06:59,360 --> 00:07:01,600 you're dealing only with one state jurisdiction, 117 00:07:01,780 --> 00:07:06,360 or you're da dealing only with one payer. You really have to approach, 118 00:07:06,700 --> 00:07:10,200 you know, a kind of all jurisdiction, all payer model, you know, 119 00:07:10,200 --> 00:07:14,120 in a place like, like, uh, MedStar Health spread out over dc, Maryland, 120 00:07:14,220 --> 00:07:15,053 and Virginia. 121 00:07:15,470 --> 00:07:19,200 That can create the kind of complexity that creates the second headwind, 122 00:07:19,200 --> 00:07:22,840 which is one that's internal. And this is true for all health systems, 123 00:07:23,070 --> 00:07:27,480 that complexity and uncertainty creates a, 124 00:07:27,640 --> 00:07:30,680 a sense of a conservative approach. Um, 125 00:07:31,220 --> 00:07:33,840 and so the challenge or headwind that, 126 00:07:33,840 --> 00:07:38,760 that is created by those external features comes in the internal environment 127 00:07:38,900 --> 00:07:40,640 by trying to help us, you know, 128 00:07:40,640 --> 00:07:45,600 we try to be clear with our organization what's permissible, 129 00:07:45,740 --> 00:07:50,600 what's reimbursable, uh, what's kind of safe and high quality, 130 00:07:50,780 --> 00:07:53,480 what's equitable, uh, that kind of guidance. 131 00:07:53,940 --> 00:07:56,280 And we really have to be consistent in that messaging, 132 00:07:56,280 --> 00:07:59,960 both understanding it from those external, um, parties, 133 00:08:00,700 --> 00:08:05,040 but also being able to communicate it effectively to our own people so that we 134 00:08:05,040 --> 00:08:09,600 can remove that uncertainty and that bit of hesitancy, um, 135 00:08:10,230 --> 00:08:12,640 that that can prevent us from leading as, 136 00:08:12,780 --> 00:08:17,520 as much into these opportunities as we'd really love to. Um, so I, 137 00:08:17,600 --> 00:08:21,320 I think those are the two things that kind of contribute both that regulatory 138 00:08:21,510 --> 00:08:26,480 framework that then creates the uncertainty internally that in 139 00:08:26,480 --> 00:08:27,840 some circumstances, not all, 140 00:08:27,860 --> 00:08:31,480 but some circumstances just kind of creates a hesitancy, uh, 141 00:08:31,480 --> 00:08:34,560 that is the job of our innovation institute, uh, 142 00:08:34,560 --> 00:08:37,200 to often innovate around and overcome. 143 00:08:38,580 --> 00:08:42,410 Absolutely. I, I think that's such a, a great point. And, you know, definitely, 144 00:08:42,670 --> 00:08:46,370 um, with video, that uncertainty, whether it's the regulatory, 145 00:08:46,470 --> 00:08:49,490 the telehealth or, or anything else, um, that that's happening, 146 00:08:49,490 --> 00:08:52,010 I know change is happening so quickly, and so it, 147 00:08:52,010 --> 00:08:54,330 it's great to have that kind of outline of, you know, 148 00:08:54,390 --> 00:08:56,440 how do you approach that with your team and, 149 00:08:56,440 --> 00:09:00,080 and really keep moving forward even though you know that, you know, 150 00:09:00,080 --> 00:09:02,440 there are certain things that aren't set in stone. So I, 151 00:09:02,440 --> 00:09:05,400 I really appreciate you doing that. Has the team been pretty responsive? 152 00:09:06,380 --> 00:09:10,750 Yeah, I mean, I think it's, it's a question of, of consistency, um, 153 00:09:11,010 --> 00:09:12,270 and also kind of, you know, 154 00:09:12,970 --> 00:09:17,750 the ability to get in with the team themselves and do the work. Um, 155 00:09:18,050 --> 00:09:19,550 as I mentioned, I, I've, 156 00:09:20,020 --> 00:09:23,870 I've been an emergency physician in my health system for, uh, 157 00:09:23,890 --> 00:09:28,670 for getting close to 18 years now, and I work clinically every week, 158 00:09:28,810 --> 00:09:32,950 and so experience, uh, what it is to deliver care. Uh, 159 00:09:32,970 --> 00:09:34,590 and so I think I have the, 160 00:09:34,730 --> 00:09:37,790 the great fortune of being able to engage with service line leaders and 161 00:09:37,790 --> 00:09:41,870 frontline clinicians and, and kind of say like, listen, I know this is hard. Um, 162 00:09:42,570 --> 00:09:46,630 uh, but this is, this is an opportunity for us to do, um, 163 00:09:46,990 --> 00:09:50,230 a better job of, of providing access to our patients, to, 164 00:09:50,290 --> 00:09:54,590 to connect to our patients, um, to be, uh, 165 00:09:54,590 --> 00:09:57,950 innovative and flexible about our workforce, um, 166 00:09:58,000 --> 00:10:02,710 addressing not only the demands, uh, of a really changing environment for, 167 00:10:03,210 --> 00:10:07,030 for hiring and, and retaining workforce, but making sure that that, 168 00:10:07,030 --> 00:10:11,070 that they're sort of operating efficiently and effectively and, 169 00:10:11,530 --> 00:10:14,950 and doing sort of well in the work that they're doing. 170 00:10:15,450 --> 00:10:18,350 And I think those are the things that, you know, approach that way. 171 00:10:19,220 --> 00:10:22,190 This is a way to, to improve the access to your patients. 172 00:10:22,420 --> 00:10:26,430 This is a way to improve the efficiency of our practices. Um, 173 00:10:26,460 --> 00:10:30,910 this is high quality care consistently, I do have, 174 00:10:31,060 --> 00:10:33,110 have positive results from folks, 175 00:10:33,130 --> 00:10:37,150 and we've had just terrific partnership within our system on, on, 176 00:10:37,290 --> 00:10:40,600 and not just kind of pivoting, you know, 177 00:10:40,600 --> 00:10:45,280 things we used to do in person to now we can do through a different 178 00:10:45,320 --> 00:10:49,320 modality, but really rethinking the model of how we're delivering care. 179 00:10:50,370 --> 00:10:52,680 Absolutely. I, I think that makes a lot of sense, 180 00:10:52,680 --> 00:10:54,960 and definitely it's inspiring to hear that, you know, 181 00:10:54,960 --> 00:10:59,280 you're able to really keep your eye on that goal of better patient care. Now, 182 00:10:59,590 --> 00:11:00,560 from your vantage point, 183 00:11:00,560 --> 00:11:03,280 and especially what you're doing with the telehealth Innovation Center, 184 00:11:03,900 --> 00:11:07,160 how would you really see that adding value to the organization overall? 185 00:11:07,160 --> 00:11:10,400 Where do you see big opportunities for growth and how are you measuring that? 186 00:11:11,770 --> 00:11:15,180 Sure. I, I mean, I think they come along the same lines that I just described. 187 00:11:15,200 --> 00:11:19,100 And so I'll, I'll give you an example of, of, again, 188 00:11:19,120 --> 00:11:22,540 not just replacing one thing with another, but really pivoting the model. 189 00:11:23,400 --> 00:11:28,100 So we are working with our clinical service lines on a model called 190 00:11:28,100 --> 00:11:29,700 Connected Care. Um, 191 00:11:29,760 --> 00:11:33,980 the implementation of this most in its most mature firm is in primary care. 192 00:11:34,040 --> 00:11:38,940 So in our connected primary care model, we have, um, 193 00:11:39,180 --> 00:11:44,180 a workforce and workflow transformation in which we've added 194 00:11:44,240 --> 00:11:45,500 new workforce, uh, 195 00:11:45,500 --> 00:11:50,020 including nurse practitioners and medical assistants who work a hundred percent 196 00:11:50,020 --> 00:11:51,460 remotely, uh, 197 00:11:51,560 --> 00:11:55,880 and focus on a handful of activities that we know are gonna be high impact. 198 00:11:56,540 --> 00:12:01,320 Um, those activities include same day and next day telehealth, uh, 199 00:12:01,320 --> 00:12:04,800 appointments with established patients, because as I pointed out, 200 00:12:04,860 --> 00:12:07,280 access is a critical issue. Uh, 201 00:12:07,340 --> 00:12:11,520 and so we've been able to improve access to our primary care footprint, 202 00:12:12,140 --> 00:12:17,080 um, as measured by third next available appointment. Uh, in those, um, 203 00:12:17,800 --> 00:12:19,080 practices in which we've implemented, 204 00:12:19,130 --> 00:12:23,200 we're about two thirds of the way through scaling through this implementation, 205 00:12:23,740 --> 00:12:23,980 uh, 206 00:12:23,980 --> 00:12:28,880 at which point all 360 of our employee and primary care providers 207 00:12:28,880 --> 00:12:31,880 will be supported in this model. Now, 208 00:12:31,880 --> 00:12:36,400 what was important about the change was not just inserting telehealth 209 00:12:36,740 --> 00:12:38,280 to, to drive this change, 210 00:12:38,460 --> 00:12:43,000 but we protect nearly 50% of the time of those nurse practitioners 211 00:12:43,420 --> 00:12:47,440 to do the kind of asynchronous work, um, that's really important for access, 212 00:12:47,580 --> 00:12:49,400 but also, um, 213 00:12:49,820 --> 00:12:54,360 was sometimes preventing our primary care physicians from focusing on the 214 00:12:54,360 --> 00:12:56,880 face-to-face encounters that they really wanted to be doing. 215 00:12:57,540 --> 00:13:01,560 So those activities include things like prescription refills, 216 00:13:02,340 --> 00:13:05,160 uh, portal message management, lab follow up, 217 00:13:05,380 --> 00:13:08,040 and also opportunities to be the, 218 00:13:09,060 --> 00:13:13,720 the supervising clinician for remote patient monitoring for folks with chronic 219 00:13:13,750 --> 00:13:18,360 illnesses that are appropriate for that, for that, um, type of service. 220 00:13:19,300 --> 00:13:20,133 So, um, 221 00:13:20,820 --> 00:13:25,160 the prescription refill in particular is worth pointing out as a, as a way of, 222 00:13:25,580 --> 00:13:29,960 of leveraging a remote workforce and asynchronous type of work. 223 00:13:30,300 --> 00:13:31,640 And we've also, um, 224 00:13:32,400 --> 00:13:37,000 inserted some automations into that process to make it as efficient as possible. 225 00:13:37,580 --> 00:13:38,413 And the, 226 00:13:38,500 --> 00:13:42,960 the 12 nurse practitioners who are currently in support of our primary care 227 00:13:42,960 --> 00:13:47,400 footprint have supported more than 270,000 228 00:13:47,400 --> 00:13:51,760 prescription refills that would've previously been done by primary care 229 00:13:51,760 --> 00:13:54,440 physicians, either after hours or, 230 00:13:54,540 --> 00:13:58,320 or squeezed in between the appointments where they were seeing patients. 231 00:13:59,260 --> 00:14:00,840 So in addition to the, 232 00:14:00,900 --> 00:14:05,760 the nearly 20,000 telehealth visits that we've done, um, 233 00:14:05,770 --> 00:14:09,120 which were access to our established patients, 234 00:14:09,140 --> 00:14:12,880 we were able to take the load of those prescription refills off of, 235 00:14:13,300 --> 00:14:15,560 of the primary care physicians. 236 00:14:15,980 --> 00:14:18,920 And we've measured the impact of that through a couple of different ways. 237 00:14:19,060 --> 00:14:23,080 One of them is about our cycle time to refill these prescriptions, 238 00:14:23,080 --> 00:14:24,640 which has improved significantly, 239 00:14:25,100 --> 00:14:29,760 but another one is actually after hours EHR time by the 240 00:14:29,760 --> 00:14:30,920 supported physicians. 241 00:14:31,500 --> 00:14:34,240 So we've been able to demonstrate in some of the practices that have really 242 00:14:34,240 --> 00:14:38,520 leaned into this somewhere in the neighborhood of 30% reduction and after hours 243 00:14:38,980 --> 00:14:40,520 EHR time for providers. 244 00:14:41,020 --> 00:14:45,840 So that's that 6:00 PM to 8:00 PM or 9:00 PM time that most primary 245 00:14:45,910 --> 00:14:49,000 care doctors will tell you was, um, 246 00:14:49,490 --> 00:14:53,320 every day something that they were doing, uh, and what really was, 247 00:14:53,660 --> 00:14:57,400 was not the most fun thing they could do in their practice. And so by, 248 00:14:57,700 --> 00:15:01,400 by taking that and being thoughtful about how we manage it, uh, 249 00:15:01,400 --> 00:15:04,680 we've been able to allow those primary care physicians to actually have some 250 00:15:04,680 --> 00:15:09,480 increased capacity in their day to see new patients or more 251 00:15:09,590 --> 00:15:13,200 complex patients. And so in addition to generating the, 252 00:15:13,300 --> 00:15:16,880 the novel revenue of those telehealth visits for the nurse practitioners, 253 00:15:17,660 --> 00:15:22,160 the productivity of the supported physicians has also gone up. 254 00:15:22,630 --> 00:15:25,840 This is a model that is entirely additive. 255 00:15:25,950 --> 00:15:30,480 It's not just moving fingers around from one to another. Um, 256 00:15:31,020 --> 00:15:33,760 and the impact of patients has really been significant. We, 257 00:15:33,760 --> 00:15:38,240 like a lot of health systems use press gainy to understand the experience of our 258 00:15:38,240 --> 00:15:39,400 patients, uh, 259 00:15:39,400 --> 00:15:43,200 and we've seen some really significant improvements in percentile rankings, 260 00:15:43,200 --> 00:15:46,120 particularly along the lines of access, uh, 261 00:15:46,120 --> 00:15:50,120 of our patient experience scores as we've scaled this model through our primary 262 00:15:50,190 --> 00:15:54,320 care footprint. Um, right now we're also using this model, 263 00:15:54,700 --> 00:15:56,120 not an exact replication, 264 00:15:56,180 --> 00:16:01,160 but really a framework of how we think about using these technologies, uh, 265 00:16:01,220 --> 00:16:03,000 in cardiology. Uh, 266 00:16:03,020 --> 00:16:07,120 and also we're thinking about the opportunities to use this not just as a sort 267 00:16:07,120 --> 00:16:08,440 of service line transformation, 268 00:16:09,060 --> 00:16:13,560 but to think cohesively about a disease condition or a patient population. 269 00:16:14,020 --> 00:16:18,520 So we're also applying this model to diabetes, um, as a, 270 00:16:18,580 --> 00:16:23,120 as an approach where we're looking at the opportunities to, uh, 271 00:16:23,180 --> 00:16:27,840 engage patients with a chatbot remote patient monitoring, uh, 272 00:16:27,990 --> 00:16:32,680 grouped sessions for diabetes education. And again, 273 00:16:32,680 --> 00:16:37,040 kind of leaning into the model of how it is we can optimize our resources, 274 00:16:37,730 --> 00:16:41,040 which we're a big health system. We have, we have, 275 00:16:41,420 --> 00:16:44,120 we are well resourced in many ways, but we, 276 00:16:44,150 --> 00:16:48,560 like other health systems are constrained and how do we become very efficient, 277 00:16:48,980 --> 00:16:52,760 uh, while also improving the quality of care we deliver? And that's a, 278 00:16:52,840 --> 00:16:56,800 a kind of way of thinking about how we use these tools, uh, 279 00:16:56,800 --> 00:17:00,120 to really to move forward and not just in a, um, 280 00:17:00,910 --> 00:17:05,640 incremental replacement, but really in a, a transformational way. 281 00:17:07,100 --> 00:17:10,460 I love that. I, I think it makes so much sense to, um, you know, 282 00:17:10,460 --> 00:17:13,100 think through how you can leverage that technology, um, 283 00:17:13,160 --> 00:17:17,300 to make things easier for the clinicians as well as patients and, and, uh, 284 00:17:17,480 --> 00:17:19,180 become more efficient as an organization. 285 00:17:19,180 --> 00:17:23,180 And I really appreciate the detailed way that you went through how you track and 286 00:17:23,180 --> 00:17:25,020 measure and think about, you know, 287 00:17:25,090 --> 00:17:28,740 what that return on investment for these changes and these technologies are. 288 00:17:29,120 --> 00:17:32,900 And speaking of that, I know that, um, you know, um, 289 00:17:33,390 --> 00:17:36,860 right now is a particularly challenging time for many industries, 290 00:17:36,880 --> 00:17:41,580 but healthcare in particular dealing with inflation and in short staffing from 291 00:17:41,580 --> 00:17:44,260 many organizations. And so from your perspective, 292 00:17:44,370 --> 00:17:47,740 what do you see as being an important investment or a risk that's still worth 293 00:17:47,740 --> 00:17:52,160 taking, taking, um, even as healthcare resources and dollars are precious? 294 00:17:53,500 --> 00:17:55,630 Yeah, it's a, it's a great question. I, 295 00:17:55,670 --> 00:17:59,670 I think what I laid out for you in our connected care models was focused on the 296 00:17:59,670 --> 00:18:03,390 ambulatory environment, you know, um, the, the clinic, the office, 297 00:18:03,530 --> 00:18:08,190 the patient's home. Um, but obviously we're a, we're a hospital system. Um, 298 00:18:08,650 --> 00:18:10,110 and so, um, 299 00:18:10,280 --> 00:18:14,590 there is a significant amount of opportunity in, um, 300 00:18:14,930 --> 00:18:19,470 in making smart investments in our inpatient footprint. Um, and, 301 00:18:20,010 --> 00:18:23,950 uh, we also have a, a very large, uh, nursing workforce, 302 00:18:23,960 --> 00:18:28,230 which is one of the areas that like other health systems, 303 00:18:28,810 --> 00:18:31,190 uh, is a risk. Um, and, 304 00:18:31,210 --> 00:18:35,990 and our ability to recruit and re and retain nursing staff, 305 00:18:36,610 --> 00:18:36,890 uh, 306 00:18:36,890 --> 00:18:40,790 is really an important part of where we see value for ourselves going forward. 307 00:18:41,770 --> 00:18:45,270 So, um, we think that the inpatient environment, 308 00:18:45,670 --> 00:18:49,550 starting at the patient and thinking about the patient's, um, 309 00:18:50,030 --> 00:18:54,870 autonomy and control of their environment through technology is an important 310 00:18:54,870 --> 00:18:56,350 place to be making an investment, 311 00:18:56,850 --> 00:19:00,710 but also one that we can effectively leverage to make ourselves more efficient. 312 00:19:01,330 --> 00:19:02,870 Uh, meaning, um, 313 00:19:03,100 --> 00:19:07,910 getting more technology at the bedside for the patient to 314 00:19:07,910 --> 00:19:11,070 feel connected, um, to their care team, 315 00:19:11,530 --> 00:19:15,070 to the services that we provide to their family members, um, 316 00:19:15,130 --> 00:19:18,110 as a way of staying connected to them while they're in the hospital, 317 00:19:18,110 --> 00:19:22,470 whether they happen to be, you know, just across town or across the country, 318 00:19:22,900 --> 00:19:25,910 that digital connection's really important at the bedside, 319 00:19:26,330 --> 00:19:30,910 but it also allows us to bring services to the patients such as our palliative 320 00:19:30,910 --> 00:19:34,750 care team, uh, which has a really robust capability, uh, 321 00:19:34,750 --> 00:19:39,430 and is really leaned into telehealth as a way to deliver those services. Um, 322 00:19:39,430 --> 00:19:43,870 our acute pain service, uh, is rounding on patients fairly routinely. 323 00:19:44,450 --> 00:19:44,770 Uh, 324 00:19:44,770 --> 00:19:49,470 and we're working on ways in which to deliver things like chaplain services and 325 00:19:49,470 --> 00:19:51,310 music therapy, uh, 326 00:19:51,370 --> 00:19:55,830 and case management to the bedside in a way that is efficient and effective, 327 00:19:56,510 --> 00:19:59,630 standardized and centralized throughout our system. 328 00:20:00,450 --> 00:20:04,830 So that introduction of technology at the patient bedside in the inpatient 329 00:20:04,830 --> 00:20:07,670 setting is a place where we think it's worth making an investment, 330 00:20:08,450 --> 00:20:11,150 but it has a set of risks as well. Um, 331 00:20:11,410 --> 00:20:16,190 the introduction of new technology to a workflow always comes with the risk of 332 00:20:16,510 --> 00:20:17,050 friction. 333 00:20:17,050 --> 00:20:21,510 And so kind of an additional part of the investment we've made is a group of, 334 00:20:21,810 --> 00:20:26,590 of of our associates that called Telehealth technology coordinators or TTCs, 335 00:20:27,210 --> 00:20:28,790 uh, that really grew out of a, 336 00:20:28,950 --> 00:20:32,590 a kind of redeployment and volunteer program that started during covid, 337 00:20:32,730 --> 00:20:36,070 but it's matured and formalized to be a group of people, 338 00:20:36,590 --> 00:20:38,830 non-clinical people, um, 339 00:20:39,050 --> 00:20:43,630 who can be quickly dispatched with appropriate technology to a patient's bed ti 340 00:20:43,780 --> 00:20:48,400 bedside to kind of proactively prevent that friction from 341 00:20:48,400 --> 00:20:50,520 occurring either from the patient side. 342 00:20:50,940 --> 00:20:53,480 And really importantly from the nursing side, 343 00:20:53,580 --> 00:20:57,920 we want our nurses to be focused on clinical care of patients and not doing 344 00:20:57,920 --> 00:21:01,040 these things that are, that are not clinical care, that are, 345 00:21:01,040 --> 00:21:04,880 that are not within where they should be spending their time and energy. And, 346 00:21:06,300 --> 00:21:11,080 and so the TTC gets to the bedside and facilitates that encounter to make sure 347 00:21:11,110 --> 00:21:15,040 it's, it's seamless for the patient, that it's comfortable for the patient, 348 00:21:15,660 --> 00:21:20,480 and that if you're a palliative care physician who needs to be engaged with the 349 00:21:20,480 --> 00:21:21,880 patient and the patient's family members, 350 00:21:22,340 --> 00:21:25,520 you have certainty that that connection's gonna happen. 351 00:21:26,060 --> 00:21:30,960 And you yourself don't have to do the troubleshooting as a clinician to 352 00:21:30,960 --> 00:21:33,960 make sure that it happens, but it's really all queued up for you. 353 00:21:34,660 --> 00:21:39,440 So we think there's great opportunity for an improved experience 354 00:21:40,020 --> 00:21:42,240 for patients and their families, uh, 355 00:21:42,240 --> 00:21:46,080 in the inpatient setting through greater control of their environment, 356 00:21:46,080 --> 00:21:49,320 some autonomy, more connection, more information, 357 00:21:49,470 --> 00:21:53,560 more ability to deliver education, a more seamless, um, 358 00:21:53,560 --> 00:21:57,960 transition back into the, their home in the ambulatory setting, uh, 359 00:21:57,960 --> 00:22:02,160 but also for us to be more efficient as a business to distribute 360 00:22:02,560 --> 00:22:06,640 services more effectively. But, and, 361 00:22:06,900 --> 00:22:09,000 and that may come at, you know, 362 00:22:09,000 --> 00:22:13,480 we wanna make sure it doesn't come at the cost of distracting 363 00:22:13,530 --> 00:22:16,200 clinicians from doing the work they should be focused on. 364 00:22:16,460 --> 00:22:20,840 And so we've made that investment for someone who's really proactively there to 365 00:22:20,840 --> 00:22:24,000 make sure it doesn't become an environmental full of friction. 366 00:22:24,700 --> 00:22:28,160 That's such a great point. Dr. Booker, thank you so much for, um, 367 00:22:28,160 --> 00:22:31,920 jumping in and talking through all of that. Now I know we're, um, 368 00:22:32,180 --> 00:22:35,240 ha have had a great conversation. And before we wrap up, I just wanted to know, 369 00:22:35,240 --> 00:22:38,760 is there anything else you see as great opportunities for growth in the future 370 00:22:38,860 --> 00:22:40,760 or anything else you wanted to leave us with? 371 00:22:42,040 --> 00:22:43,410 Yeah, I mean, I think that, you know, 372 00:22:43,490 --> 00:22:47,690 I started by talking about opportunities for continuity. You know, 373 00:22:47,690 --> 00:22:51,690 I mentioned this connected care environment I mentioned, um, 374 00:22:51,690 --> 00:22:54,330 talking about the inpatient environment and, 375 00:22:54,470 --> 00:22:58,210 and some more patient technology there that allows a more seamless 376 00:22:58,940 --> 00:23:03,730 transition back home, back to the ambulatory environment. And I, I, 377 00:23:03,850 --> 00:23:08,130 I think, you know, just sort of again, globally strategically, 378 00:23:08,630 --> 00:23:12,410 the opportunities to really create continuity, um, 379 00:23:12,750 --> 00:23:14,290 and what I would describe as, as a, 380 00:23:14,930 --> 00:23:19,730 a ubiquitous experience without being invasive is really 381 00:23:19,730 --> 00:23:23,730 where the opportunities are for growth. Um, and what I mean by that, 382 00:23:23,740 --> 00:23:28,490 ubiquitous but non-invasive experience would include things like remote patient 383 00:23:28,540 --> 00:23:29,373 monitoring, 384 00:23:29,780 --> 00:23:33,890 partnering with patients to understand their own consumer wearables. 385 00:23:35,150 --> 00:23:35,630 Um, 386 00:23:35,630 --> 00:23:40,490 really thinking about a cohesive approach to partnership with patients 387 00:23:40,500 --> 00:23:45,400 about the data they are collecting in many ways themselves, uh, 388 00:23:45,420 --> 00:23:50,200 and how we can create for them a climate of care, um, 389 00:23:50,510 --> 00:23:55,360 that is less dependent upon the locations where they happen to 390 00:23:55,380 --> 00:23:58,640 be for care. Um, meaning not just at home, 391 00:23:58,740 --> 00:24:03,640 but at work and in transition and as they go to visit family and friends 392 00:24:03,780 --> 00:24:08,360 and, and really being available to our patients in a way that is 393 00:24:08,780 --> 00:24:12,640 really continuous and comprehensive. Uh, 394 00:24:12,660 --> 00:24:16,440 and to do that in a way that also meets the needs, um, 395 00:24:16,550 --> 00:24:19,760 that they're likely gonna have proactively, uh, 396 00:24:19,760 --> 00:24:24,120 and rather rather than waiting reactively for an encounter to occur. 397 00:24:24,740 --> 00:24:28,280 Um, and I think there's gonna be lots of different pieces and parts, uh, 398 00:24:28,280 --> 00:24:32,920 to do that effectively. That means thoughtful change about our ehr, um, 399 00:24:32,920 --> 00:24:37,160 which is still encounter based. Uh, it means thoughtful, um, 400 00:24:37,270 --> 00:24:40,480 changes about data, data security, um, 401 00:24:40,780 --> 00:24:44,800 how we collaborate with patients on the data they're collecting themselves and 402 00:24:44,800 --> 00:24:49,160 how we visualize it, how we manage the noise of all of that. 403 00:24:49,820 --> 00:24:53,440 Um, so I think there are definitely challenges in there, 404 00:24:53,500 --> 00:24:55,920 but I see great opportunity, um, 405 00:24:56,340 --> 00:25:00,960 for application in that space of really thinking about ubiquity, um, 406 00:25:01,060 --> 00:25:02,000 and continuity. 407 00:25:03,250 --> 00:25:06,560 Absolutely. Dr. Booker, thank you so much for joining us on the podcast today. 408 00:25:06,560 --> 00:25:08,720 This has been such a fun and interesting conversation, 409 00:25:08,720 --> 00:25:10,480 and I look forward to connecting with you again soon. 410 00:25:11,530 --> 00:25:12,680 Great. My pleasure. 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