Vidyo Healthcare Summit: Panel – Hitting the High Notes of Patient Engagement & Adoption

so let’s get straight to our next session it’s aptly titled hitting the

high notes of patient engagement and adoption is anybody planning to sing we

are in Nashville so we’ve got a great panel of telehealth leaders from MUSC

from Tallahassee Memorial Health and from the Mayo Clinic and I’m very happy to welcome Kate McCarthy senior analyst

with Forrester Research to lead the panel so take it away Kate I wish I can

still get a high E cuz that would just be funny I think to get this started

but aptly titled hitting the high notes of patient engagement and adoption really exciting panel for you and I want

to just open it with a few ideas for you all to think about looking around the

room I think most of you all have been in the industry at least as long as I have and you remember that moment in

1996 when we started seeing more volume and outpatient services than we had in

inpatient care how many people remember that yeah and it was a huge culture

shift for our hospitals right we built everything around bricks and mortar with inpatient buildings and our Suites that

made it easy to get to and from the floors where we might put patients when they were recovering from surgery well

now we can send people home same day from you know bilateral total joint replacements I never thought I would see

that day but that day is here and now we’re starting to talk about the future

of health care shifting not just to outpatient and we’ve seen huge Rises and

usage of retail and urgent care and so new sites of care that further disrupt

our bricks and mortar culture we expect that in the next five to ten years

virtual care will do two outpatient care what outpatient care did two inpatient

care so most care will be delivered virtually

this is better told with my service dog on stage with me and she’s getting a day

off today but I’m a rare disease patient I’m high-risk I have Addison’s disease I

obviously travel for my work quite a bit and most of my care because of the

nature of my work and because of the nature of my disease is actually virtual already today I use an Apple watch I’ve

got all sorts of cool gadgets when I’m home I have a smart home that connects to a healthcare ecosystem as well so I’m

living proof that you can actually take patients and engage them and give them

better care with digital and for folks you know looking at the future of

healthcare and wondering how we’re going to improve on cost and quality outcomes

and not just solve for patient engagement it’s one of the gateways to doing that Digital is a three hundred

billion dollar opportunity in our industry virtual care is about embracing

digital as a primary way to engage our customers whether it’s a patient whether

it’s a physician in a hospital we’re working with remotely it is where

healthcare is going and so I’m really excited to be here with you today I want to introduce our panelists we have Stu

spawn cyl from Mayo Lauren Faison from Tallahassee Memorial and Michael Hasker

from MUSC I want to give each of them a moment to introduce themselves and then

we’re gonna get started and I encourage questions as we get toward the end of

some of our initial questions this should be interactive and I want to hear from you all because there’s all of this

expertise on stage for you to take advantage Steve I am Steve spawn so

great to be here this morning I’m from Mayo Clinic I’ve been there for over 30 years now so a lot of fear a lot

of these transitions we are a large multi-specialty group practice and we

are in three states I’m based in mr. Minnesota we have facilities in Arizona and Florida as well it is a non

found a nonprofit foundation with a really strong message around that needs of the patient come first my role I’m a

director in media support services we support a variety of media platforms including video my personal background

is in graphic design and in workflow analysis kind of a kind of a strange mix but it’s been it’s been very fun

I have thinking about transitions I started out as a little kid helping manage the paper medical record and I’ve

been through the whole transition so being part of the design of our EHR and

getting involved in an epic implementation right now so my primary

role is coordinating our media platforms to support the clinical practice some of

the things we’ve worked on we’ve done the neonatology program Iran mentioned

earlier makes him cry makes me cry every time I think about that or see that video we’ve done virtual consults we’ve

worked with the video and SPRC Chris in this front row up here we’re doing a

tumor board case conferences using some video technology that connects

oncologists and pathologists and our organization with distant medical sites they’re looking for advice and referral

we are using the EC ICO product from Philips and our most exciting new

project that we’re exploring is inpatient digital engagement through the patient TV system in that in the

hospital room Lauren good morning my name is Lauren Faison and I am from the

big town of Tallahassee Florida and being that I have zero musical talent that’s into the only time I share a

stage with a Grammy winner so my kids are gonna be super excited when I call him tonight but in Florida we’re very

glad that it’s almost the end of hurricane season as well as for you college football fans college football

because my Seminoles have not had a good season but anyhow my disclaimer is I am NOT a clinician I am NOT a techie

I am somewhere in between my job is to be a customer advocate at our Hospital and that is those customers being my

colleagues are employed and you know tracted physicians our bottom line but

most importantly of course our patients that is my role I’m in the business side of our operation we are a one hospital

system if you will we are nonprofit community hospital we get zero tax dollars or incentives so we what it

comes in the door we have to live on and we are doing very well at that we serve an 18 County region in South Georgia and

North Florida and we have a lot of challenges in doing that we’re the only level two trauma center in the entire

area of that 18 counties we stay on red we have a lot of full beds very crowded

ers we both a free-standing er to try to take some that load off the hospital ER and all we did was increase our capacity

and we are seeing more patients than ever so telehealth was a natural evolution for us I will tell you I have a

different background than probably my colleagues on the stage that I come from the nonprofit world so I grew up in

nonprofit administration where we know how to move mountains on a nickel so five years ago when I made the

transition to health care administration the sticker shop was amazing when I saw the amount of money that is spent in the

day-to-day operations of our little Hospital and the amount of in efficiencies it became an opportunity

all I saw was tons of opportunity and I remember the second day on the job I was shown to a room where there was three

big carts that the Department of Health and Florida had given for to help connect our trauma systems these big

telemedicine carts and they said figure it out right before I started I was googling what telemedicine was six

months later I was standing on the floor of our Senate at the legislature legislative session doing a live demo of

how telemedicine works and all the advantages and efficiencies before a Senate President when I got beyond not

getting sick to my stomach in front of him you know you you it’s hard not to get passionate about this technology and even in our small system I have major

budget envy of many of the presenters already this morning and probably my colleagues I spend about $40,000 a year

on our telemedicine program and most of it goes to video but that’s great because it’s all from my software fees

and it keeps us working so we love video but we really had to figure out how to do it very efficiently because in

Florida we do not have good telemedicine legislation we do not have parody laws there’s very little reimbursement it’s

very challenging so what we have really used implemented tell us medicine for is looking at cost avoidance and looking at

transitional care and how do we even within our system make us more efficient they’re literally enabled physicians to

be two places at once when I tell them that gets their attention and so my job is I am the telemedicine Department of

tmh my IT department has learned to accept me they don’t love me yet but

they will we actually had an empty club room that wasn’t being used and I wrote telemedicine command center on it on

paper and I convinced that if I you know have that idea if you build it they will come and they eventually have let me

have a little desk in there and I sort of float in and out but we were so challenged and in technology and in

healthcare is challenging it’s the security nightmares the HIPAA all of those implications are very scary for

our IT departments so I understand why those guys are very stressed and gals I get it so we actually developed a third

party and because we knew if we didn’t we’d still be talking about telemedicine six years from now and all the reasons

we shouldn’t do it and how dangerous it is we had it up and running in a week and now we have it across about six

different specialties and we’re doing a lot of direct to patient as part of our transitional care again we’re not able

to build for most of it but it’s keeping people out of the hospital so that $40,000 investment is saving upwards of

a million dollars a year in cost avoidance which for us is a big deal most importantly it’s improved our

patient satisfaction their engagement I love this topic because there’s no

better way to engage people than to look them in the face when you’re talking to them no matter where they are they’re two and a half hours away and they can’t

get there because they can’t beg borrow and steal to pay somebody gas money to drive them to you why would we do that once I click of a button we can see them

so I’m excited to share with you some of the things that we are doing and appreciate the opportunity to be here thank you Michael good morning everybody

my name is Michael Oscar and I represent the technology side of telehealth for

the Medical University of South Carolina I started in 2007 I was a former Network

Systems Manager for MU I see when two very bright physicians came to me with

ideas on how to impact their patient communities one of those physicians was

dr. James Miguel agate who is now the director medical director for telehealth for the

South Carolina telehealth Alliance and MUSC and the other physician was dr. Donna Johnson who started a maternal

fetal medicine program in MUSC and through their programs Donna

three years later documented a lower infant mortality rate because of her

program in telemedicine that kind of started my passion I made a career shift

into telehealth services and in 2013

MUSC formalized the Center for telehealth with an effort to deploy

telehealth across all the integrated clinical service lines again we we’re in

a very rural state in South Carolina a very poor state getting access giving

access to patients is my passion we are fortunate in that we have a large very

well developed private health care network called the Palmetto state providers network which was built with a

grant from the FDA and rural connectivity funding and through that

network were able to connect rural providers and get the access to the patients most in need now for members of

the audience how many of you have telehealth programs up and running today

awesome hands down how many of you are thinking about investing sometime in the

next 12 months oh I want to see some

hands now all right we’ll work on you Steve talk to me a little bit about

stepping back a minute some of the barriers to patient engagement you all have had at the Mayo Clinic well I think

one of the one of the most interesting things looking at where we’ve been you touched on it with the you know that

flipped from from inpatient outpatient we’ve always been outpatient with 90% of our businesses is outpatient practice

but we have been very destination focused we and we specialized we have

we have really excelled at brick-and-mortar I work in a 1920s

vintage clinical building that housed 400 physicians the building was literally built around the practice

patient flow medical record flow even even the arrangement of the specialties

inside of the building was was built on how the record needs to traverse the building so we’re fantastic at that it

all has to be rebuilt and the I think the the other really interesting thing there is that the patients understand

the experience very very well brick-and-mortar and they don’t so some we don’t understand it they don’t

understand it trying to rebuild a connection using enough of the features

of the traditional model and enough of the new team you know hit the right balance that it’s compelling but it

feels familiar yeah sure Michael how about you all you

know what are the big challenges you’ve seen in patient engagement as you’ve started to make these transitions so the

challenges from our perspective are access again as a rural state affording

everybody access to health care is a right to me

so getting relationships with those primary care Doc’s in the rural communities and getting them connected

providing the equipment and the technological services that they don’t have you know the IT support that they

need and then access to the specialists in the urban centers in South Carolina

we have three large cities Greenville Columbia and Charleston and that is

where I’d say 80% of the healthcare specialists exist in our state and we

know that as an academic Medical Center when you train medical students and they graduate you know but they’re not

itching to go to small town South Carolina and practice they want to

practice in urban centers and they want to get the experience that urban centers offers them I think telehealth is a way to you know

give them that experience but have them provide for patients in rural settings yep

pressure and Lauren what would you add I think we suffer many of the same challenges it’s hard to recruit to

places like Tallahassee even as a bigger city but even to give people those access points I always described it and

again I’ve been in this for five years so I’m still in my infancy but we do a great job when people come through our

doors of fixing them and helping them but how we bring them into the system and what we do as they transition out of

the system to their post-acute facility or home or wherever there’s huge opportunities to do it better when the

chips are down and you need something an emergency we’re going to do it right but how we engage you in managing your own

health proactively through wellness activities which just kind of so falls under my purview as well as what we do

with you once you leave our Hospital do we make sure you get your medications do we make sure that you get those

follow-up visits or do we just get you out and you know good luck you’re on your own and so we’ve really used

technologies a means to kind of do those virtual handoffs both with the patients and with their you know pre and post

care providers and really giving them a way to engage I think means house patients don’t know the questions to ask

or if they don’t have resources they don’t know how to get those things and so we’ve been using the technology a lot

particularly in that transitional care piece to reach out the people wants their home how are you feeling did you get your medication let’s do a virtual a

pharmacy visit show me your medications what are you doing what are the blue pills or the pink pills were the white pills when are you taking them getting

way of people a comfortable safe way for them to engage with all types of our providers in our facility and they just

didn’t have a means to do that before yeah absolutely for you all in the audience how many of

you recognize culture change is one of the biggest challenges in making this transition show hands yeah I think

that’s pretty common it is not just culture change for our bricks and mortar

culture as we talked about but as Steve pointed out a culture change for our patients and we’re shifting what they

can expect from us as we start to engage with technology one of the things I’ve

worked with a couple of providers on myself over the years is is you get people to engage with you not

just on their health but on their wellness and on the social behaviors that influence disease outcomes and I

think is you were just talking about both of you especially in your rural communities

this is serving as an access point to people who would have social limitations to getting to your care settings for you

at Mayo familiar to my background at MGH as the big AMC it also gives folks in

rural communities access to your amazing talent and it gives patients some

removal of Geographic barriers so they can get to that next level of care if

they need it so the nice thing about our panel today is that diverse set of

experiences you all are bringing to the table and I’m sure as you’ve executed there have been a number of challenges

that you faced in implementations so Michael I’m gonna start with you

would you mind telling us a little bit about what challenges you’ve had either technologically or otherwise as you’ve

implemented your very successful program I think one of the major challenges that

we face and MUSC is has created a very extensive training program around that

is to understand we call it diversity and inclusion to understand the cultural religious ethnic

and socio-economic differences amongst the people in our state this is very

important in how you communicate a health care health care plan to people and how they they understand what you’re

communicating and our staff goes through extensive training to deal with

different cultures different religions different ethnic groups and and how to communicate with those groups in their

care great I think I was thinking about culture I was thinking about the my

professional culture within the walls of our our system has been challenging because everybody is so busy everybody’s

running around I don’t have time to deal with your project I’m dealing taking care of patients and really forcing the message of

telehealth and telemedicine solutions should be a tool in everybody’s tool

belt no matter what your specialty no matter what the services you’re providing it’s not Lauren’s project over

here which is high to fight that battle it’s not this whole another system of

healthcare it’s doing what you do every way but instead of going into an exam room you’re going to a computer to see

that patient everything else can stay the same I’m not you know this is not a whole new system of you providing your care and I think say having to say it

over and over I’m known as the telemedicine cheerleader which is a little offensive but I because I have to

do I mean sometimes you say it to him 10 times they go well where’s this technology then and I’m like I’ve been telling you about it for three years but it has to wait to the right time it has

to fit in need immediately and so I constantly keep going around showing them this is what it can do now think

about your biggest challenges is this a right fit because it’s not always the right fit but for many instances it is

if there’s budget constraints well what are we spending the money on is there a way to solve that problem virtually for

our rehab unit across the street literally if you have a good arm you can hit our hospital with a baseball league or shut you transferring people back and

forth across the street for follow-up appointments you know orthopedic follow-up appointments after surgery was

costing us 110 dollars to drive them across the street not to mention you’re getting somebody out of bed you’re putting them on a van you’re driving

them up putting the orthopedic office in the seventh floor which is always a good idea or somebody’s had a hip replacement and so we said well why are we doing

this so I had to go talk to her with a PETA group which is not employed by us but there are big partner and I had to show them how this works well now

they’re doing all those visits virtually and they’re the patient’s getting better care because now the nurse who takes care of me all day as part of that

surgical follow-up I see the surgeon I mean these some of our elderly patients are great the ladies will say oh I need

to put lipstick on before I see you know and because there is on the screen and and they love it because now I’m still

in my bed the people who are taking community care of me all day can help me articulate my challenges and what’s going on with my care you can hold the

webcam up they can see my knee they can look at my sutures and so for the patient engagement pieces that’s easy

it’s an easy sell for the patients it’s getting the providers and the nurse who doesn’t want to see herself on the screen you know getting her comfortable

with hitting the two buttons to make the connection it’s really you have to engage everybody for both ends but the patient

to me is the easiest cell we have a unique challenge I think that we’ve

opened up some new space I mentioned that we’re looking at this really kind of an experiment to see how we can use

the patient entertainment system to introduce more digital interactions

two-way interactions we’ve been partnering with video on this we have a

mobile application and a portal presence that that we’re really quite proud of but it’s still only about half of our

patients use the portal or use the mobile app and that’s a self-selected

audience so you know we are a self-selected audience everybody in this room has addressed that a lot of this we

love what we’re doing our patients that sign up for the portal really want it and I know in looking at the portal

literature parents of chronically ill children are the number one users of

portal other chronically you know chronically ill adults are the second ones but we’re at destination Center we

have we have kind of a short-term interaction so yeah the engagement is a

little bit different but we’re looking at that at the hospital setting it’s literally a captive audience so we are

looking at the interactions with everyone not just the people who are self selecting in and what we found is

that there’s a huge age divide we have a patient audience that’s about I mean the

patient I think in Rochester’s around 73 our Arizona and Florida facility it’s

even higher we’re seeing a dividing line at about 40 we deployed a new streaming

TV system that that will allow us all of these interactive features in our

Wisconsin facility in a birthing unit with 20-something mothers who love the

new system they just it’s very it looks like Netflix and they’re they totally get it we also deployed in art st. Mary’s

Hospital in Rochester with a very high age audience we ran a cardiac intense cardiac unit and basically they almost

verbatim response from from our patience is where the hell my channels

you broke my TV and and so we clearly have missed something there and and

we’ve got to figure out how to simplify and how to really think about it from

the patient’s perspective and we talked a little bit earlier in that earlier presentations and when you start with

people we were patient fall because we need to understand the patient needs the provider needs move on to what those

processes are and then to play the technology we got like everyone else we

get really excited about our new toy and it just doesn’t resonate with everyone and unfortunately it doesn’t resonate

with the people who need it the most and and that can be a real challenge I think the really interesting thing about what

you all just said though is I mean in fairness I’ve been sitting in this seat for a long time and usually when I throw

out that question I get something back about you know my physicians aren’t over the epic install they don’t want to use

new new technology we can’t get it to interface all sorts of technical

challenges and no one said that like you’re working on making a better UI so you get better engagement but no no one

saying it’s it for every one of these Pratt every one of these engagements we’re looking at 10 percent of the

brausen is technical and 90% of it is the cultural is the workflow and of many

programs are they see is a technology project and it’s really not and that’s I always resonate the same message technology is easy but if you don’t plan

how to embed it within your workflow you will fail then people say oh it didn’t work telemedicine didn’t work it was a

waste of money it’s not that and it can’t be owned by IT it has to be owned from your c-suite people to you your

physician champions to the nurses to me the nurses are the one they’re the key to success and getting you gotta the

physicians willing to see them but a lot of them don’t want to be bothered with you know it’s two buttons to click they don’t want to be bothered with that sort

of thing so if you can have the nurses that shove it in their face and then they’ll actually use it that’s where the

the real planning has to go and we started our first use of telemedicine was behavior health like a lot of folks

it was easy it was a quick win so we had the billing lady the check in person one of the physicians the nurse

everybody sat in a room and we did a diagram a flowchart of what had to change to accommodate a virtual visit

versus a face-to-face and so you had to think about it not just from the high-end piece but every little piece

when the patient calls us is I have a telemedicine visit and the lady who answers the phone is no idea what they’re talking about that’s a fail

point so you have to take it from like you were saying the patient’s perspective and the end user perspective and think it through all the little

steps that was a painful three or four hour meeting but then we got it done and everybody knew exactly what to do and they could refer to it and we did some

role-playing we tried it and I find a lot of times once they just try it get your hand just please try it nobody much

try it once and then they’re sold in they’re hooked and they realize that the technology is very simple but it sounds very scary yeah and so once they try it

their music I read a very interesting article last week I’ve subscribed to Flipboard for those of you that don’t

know what it is it’s just a it’s a search engine for magazines and articles on the that the subjects that you like

and the the title of the article caught my attention it said the death of telemedicine so naturally I was curious

I read the article and and what what the article was about is it is our job to

remove the TEL a–from telemedicine and to integrate it into daily healthcare

and and the article was spot on in my opinion if we’re successful if we make

it easy if we really change outcomes if we give everybody access we will

effectively kill the word telemedicine and I see that as our goal I haven’t

done that and one of my favorite meetings in the last couple of years I I’m not actually part of our connected

care team but we do we provide support to it but 75 people they have a monthly

meeting and their medical director at a relatively recent meeting stood up and and and said you know we need to think

about what success looks like success is when you all have worked yourself out of

a job this is this is just the way we do business there isn’t a thing called connected care there is just the way we

see patients that’s great I want to challenge you all to kind of focus

some of the thoughts you just had and thinking about members of the audience and the fact that they’re trying to

figure out how to be successful or they might be talking about buying into a platform what are a couple of pieces of

that are tactical or a strategic advice you would give members of the audience

we’ve talked about a few already many would say over and over again think

about the user experience first what are you trying to achieve what province are our physicians in tell me what problem

you’re trying to solve first and then work through that progression of a written you know implement the

technology when you know what you want it to do not the other way around and I’d say that the number one problem that

we’ve run into is people come back from a show with oh god if we had that tool the world would be different and they

try to shoehorn it in and work for us it was really I had to I find a couple

physician champions cuz I as an administrator I can have all the great ideas in the world but until basing it then people really listened so once I

found a couple physicians and we just did it as a pilot and we had some real stories to tell and we could start to

quantify and qualify those stories and then you start to build the case for why everybody should be looking at this it

really made a big difference I mean I think initially you know my CEO was kinda okay you can go play you know

figure this out you know and he wasn’t really paying attention to it now suddenly he’s out there in front of our board talking about why this is such a

valid you know an important piece of what we’re doing and the ROI is so large and how it’s improving patient

compliance it really for me you I kept hitting my head against the wall until I found a couple physicians to really be

the champions and they really began using it and it wasn’t a theory it was now in practice that was huge for us and

a lot of and I talk with a lot of people who are just starting you know telemedicine and it said don’t focus on the technology you’re gonna get calls

from 20 different vendors we can we get them all the time I’m like save your breath let me tell you what I’m doing I

don’t need this you know and that there’s Cadillac versions with drop-down menus and all these different interfaces all we wanted was a simple way to see

patients virtually that was secure are my doctors were not ready to try it change and in and thinks it’s not embedded in our EMR

that scares my IT people to death so where it’s over here it’s separate but we just wanted to secure way to see

people wherever they were that was a you know it was affordable for them so we could send them a link on their cell

phone and the truck driver who’s at the truck stop who just left the hospital from a heart attack now I’m looking at him in its truck I knew when he had to

stop and I’m talking to him about his care that’s the kind of stories we had to tell would be head began showing it

but to not focus on that all the bells and whistles and don’t get caught up and then latest toy but what’s the

functionality you want to achieve and you can do that in a very efficient way it doesn’t have to be a you know multi-million dollar investment but you

can to start very small and very efficiently and not wait till you can do everything to start doing something

exactly so from my perspective I’m not a clinician I’m not a physician I work

with many physicians but the the the aha moment for me is when I learned to put

myself in the patient’s shoes and to understand the pains that they go through to get the health care they got

so PTSD patient for example who’s afraid to leave their own home how do you get

patient compliance with PTSD well we give them an iPad and we start their

visits on their terms and then when they get well enough we bring them into the institution for face-to-face visits so

that would be my biggest message put put yourself in the patient shoes a rural patient for example has a primary care

provider and the primary care provider has very limited resources so how do we augment those resources to help the

provider which in turn helps the patient great I mean I think we’ve heard a couple of themes here so you know one

being think about what you really want the solution to do for you but also be

thinking about your customer and your customer is your physician or your patient and building a user experience

that’s engaging is important again you know we’re still not hearing about

clunky technology or anything like that which is really exciting one of the

things I I want to ask you all to do is start thinking a little bit more future

minded so imagine five years from now where

might we be with I’m gonna call it virtual care rather than telemedicine

because I think the things that we’ll be able to do will shift dramatically where

might we be with virtual care and how is that going to shift our ability to

engage our patients Steve Foster with I

think one of the most exciting things we’ve been working on at Mayo we have been a a destination Medical Center

tertiary specialty care for our entire existence so we rely on a vast referral

base and as you mentioned if you look at something even like total hip replacement you’re out you’re in and out

very very quickly so we don’t have that patient there very long and and it

really that the time a hospitalized patient is with us is not a great time to communicate they’re highly medicated

they’re in pain so would you really don’t get a good opportunity to engage with them we have

started building out a Mayo Clinic Care Network where we’re partnering with other organizations throughout the

country and the the best outcomes in that in that program are that we are

interacting with a local care provider about the care of their patient and

basically we’ve set up a sister a situation where there’s a three-way when the patient can stay at home they

virtually or or physically get the care they need there if they have a problem that’s too big for that group to take

care of they can consult with us and we are doing some of that virtually certainly we’re doing a lot of consults that way but when they need the the

kinds of services we offer we can get their referral in very quickly and we can get them back home where they can

get literally it’s seriously better post-discharge care and in their

hometown so that’s worked very well already and I can see the you know the virtual tools making those early

connections and the follow-up care much much easier the engagement much more immediate we’re

not quite there yet but that’s I’d say five five years out looking at how it will impact us make it it will make us

much more powerful as a as a highly specialized destination Center and they

having the patient stay at home for virtually the entire period of their care my dream is that by then the

Florida Legislature would have woken up the rate parity legislation in the state of Florida because I keep hearing the

challenges of reimbursement and yes people need to get paid for what they do so hopefully that barrier will go away

it’s not stopping telehealth from growing leaps and bounds in the state of Florida but it is create a challenge so

that we can really put the system back in towards health care system because right now it is so fragmented and so

siloed and we hand people referrals and prescriptions and we kick them to the next place and there’s no nice handoffs

and we’ve started doing that in some small aspect with other partners of doing this virtual nurse to nurse

handoffs so a child who has to go to Wolfson’s or Shands sees that nurse they

meet those that facility they have that comfort level and and so they know where they’re going but I think really

creating a system is gonna save us all a tremendous amount of money and that we quit we go back to the you know the

black bag the doctor going to where the patient is rather than always expecting patients to come to us I do a lot of

work with our post acute facilities and the amount of money even in my area that we spend hauling people around in a five

mile radius is astounding that’s money that could go to serve people who don’t have insurance that’s money that can go

to get people prevent preventative health care that they desperately need and so I think really just it’s gonna

take uniform embracement embracing this technology but I think just stop putting

people around and only worrying about our piece of the continuum and our piece of the puzzle but having ownership and

accountability to what each other does and we’re starting to see some of that we do do bundled pay with some of our

hip and knee guys that’s why they were so willing to play with this technology but in my area we’re still very fee-for-service and so there’s still

that mentality while I do my piece and I need to get paid for it I’m not worried about what happens over here over here we have to

collectively own that process and be accountable and this technology is essential in to making that happen I

hope it happens in five years maybe not I’ll be happy if we get a little further down the road but I think you know

having being able to get the care where you need it when you need it with a click of a button it’s just that’s essential so a little history before I

complete my vision in in 2008 South Carolina was one of the states that

chose not to extend Medicaid and I don’t know why they made that decision but the

decision was made we’re also a state with a lot of health care disparities rural population as I said many times

the legislature was had a lot of foresight and was very gracious in their

funding to the state they funded us well enough that we could equip sites so

today we we build networks and we equip primary care officers and we create the access that I’m so passionate about

creating but with today’s buzz words of innovation and integration and I think

the video has really good product direction right now especially with some of the the new direction that we saw

today that Mark shared with us in five years I see a patient anywhere in our state regardless of who their provider

is picking up their phone saying I need a visit this is why I need a visit getting a response and starting that

initial communication with the healthcare system of their choice virtually and then if there need to be

brought into the healthcare system and so be it we’re starting to see a little

inkling of that today with starting with E consoles as an example but in five

years I see it completely integrated into the larger healthcare systems and people choosing to get their healthcare

in that manner terrific I’m gonna challenge my panelists and all of you in

the audience to think even bigger technologies exist today that are not

widely spread through the healthcare ecosystem one of the cool things about what I do

is I get to spend a lot of time looking at the coolest technologies that are incubating and just a couple of the

things I’ve seen recently one virtual reality as a replacement for opioid pain

management is in the process of getting FDA approval so you know the idea that

you’ve got someone with chronic pain recovering from surgery you know we look

at the opioid crisis in this country you know VR as an actual technology that

we can start to deploy sometime in the next 12 months in a prescriptive way

also serves as a virtual engagement opportunity so you know kind of twofold

opportunity there are another great thing that I’ve seen actually in practice and some of our high risk

facilities is you can get a little sticker thermometer and send it home

with a patient it integrates into your analytics so that when that patient’s temperature hits ninety nine point four

it triggers an alert in the system so you flag the patient for risk of

septicemia before they would have picked up the phone and college you probably before the patient realized that they were even not feeling great so

septicemia costs us millions and millions of dollars every year the idea that we could intervene earlier when

most cases once they’re diagnosed extra require event as a way to treat them which is very high cost is a huge

opportunity so think about virtual care not just as

you know kind of your Eve is ‘its and engagement opportunities but how does it serve as a connection point and a

engagement layer for integrating a growing internet of things that enables

us to better quantify understand and intervene at earlier stages of disease

so I was thinking with Michael instead talking along those lines that he can looking looking down the road all of us

have a incredible smartphone in our pockets and the notion you’re talking

about the patient getting to decide when to make the when to make the connection is Ceri to decide hey Steve noticing

arrhythmia here you might know you might want to see a cardiologist Siri actually does do that today yes no and so I you

know look at a situation where where your own device is monitoring you and

especially for chronic chronic conditions keeping in touch with your with your provider and I’m in the

background and not you know not needing to raise your hand until something you know tell them tell the device isn’t

yeah now it’s time yep absolutely the other thing that we haven’t really talked about much there’s a another arm

of my job it’s Regional Development and I spend a lot of time in our rural communities and we have critical access

hospitals and rural hospitals that are closing their doors and they are starving and they are dying and they have great nurses they have dedicated

people there in these little pockets and we desperately need them and I go in there and they have empty beds and I

know we’ve got people that have been waiting eight hours in the emergency room for a bed and I think how can we there’s got to be a way to do this

better and they can’t afford to stay open we’re busting at the seams so I think again many time they’re sending we get a

tremendous amount of patients transferred in every day that if they just have that 10-minute look from a

specialist or somebody to validate with their plan of care is they can keep that patient which is better for their

business it’s better for us it’s better for the family member to stay close to their faith and their family and their

friends and so I really think being able to you know like yours home I access increase that access locally where

people are is so important because we have people in our connect counties there are 30 minutes away from us they will not cross the Leon County line

because that’s going to the big city they won’t do it I am NOT going to doctor in that city on that driving in that traffic I’m not going in there and

you know tell us your traffic is not like for most cities so but they just won’t do it and so if this gives them a

way to access the care they need closer at home just pulling in those pieces and really enabling a lot of those family

practitioners to be that quarterback for care and pull in the other pieces when they need it will reach a lot more

people earlier in their continuum of their health and get the services where they need it awesome I want to give you

all our last couple of minutes to ask some questions before we let these fabulous people get

off the stage yep in the front just to repeat for the

audience the question is essentially are any folks engaging patients in the

design and implementation of these programs to get that stakeholder buy-in earlier though MUSC is currently

constructing a new Children’s Hospital and we want it to be a state-of-the-art Children’s Hospital lots of great

specialists from day one we involved patients we have one patient that has

over a thousand hours of community service to MUSC in the design of patient

rooms and the interaction of the physicians this lady her name’s Kelly

Lloyd delivered twin babies at 24 weeks and spent the next 80 days in a row in

our Children’s Hospital and Kelly was a very successful businesswoman she quit

her job to consult with morc on how to treat patients better and be more

patient centric and to this day Kelly has over a thousand hours of community service to our hospital and is on the

board to design the new Children’s Hospital and is involved with almost every single detail so that’s a yes

and you guys haven’t packed in unfortunately we are out of time I know myself and the speakers will be around

for a bit today if you have questions you want to chase us down for we would

love to talk to you and I want to thank my esteemed colleagues for their time up here with me today thank you


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