Gain provider buy-in on innovations through reducing physician burden

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In this episode you’ll discover:

• How automated patient care/guidance supports patient-provider partnerships and eases burdens on providers/staff

• How to address labor shortages with technology

• How automating the right aspects of pre-and post-surgery care paths can provide better outcomes for patients with less burden on clinicians

Learn more from Carrie and Rebecca: 

Healthcare insights (monthly email) | Telehealth/Virtual Care Mgmt Update (biweekly LinkedIn update)

Website | Carrie on LinkedIn | Rebecca on LinkedIn | NGL on LinkedIn

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Find out more about Wellbe

Connect with James Dias on LinkedIn

Discover how Nixon Gwilt Law helps hospitals and health systems innovate

Read the transcript:

Carrie Nixon (00:16):

Hello everyone and welcome to today's episode of Decoding Healthcare Innovation. I'm Carrie Nixon. I'm one of the co-hosts of Decoding Healthcare Innovation, and I am pleased to be joined today by James Dias, the founder of and CEO of Wellbe. Wellbe is a healthcare technology company that provides workflow solutions to make the care journey of patients easier and more productive, both for patients and for providers. James has a belief that technology, when it's creatively applied, can improve life experiences, and he's created a business model to reshape personal health management around those life experiences. He's the co-inventor of Guided Care Path and leads Wellbe's innovations program to empower people and providers with new tools to improve health. James, like many of our guests, is an entrepreneur at heart. He's launched several new businesses over his career, including the media site lecture recorder, which is the leading video learning appliance in companies and universities around the world. But today we're really going to be focusing on healthcare. James, welcome to the show.

James Dias (01:28):

Thank you, Carrie. Appreciate the invitation. Delighted to be here.

Carrie Nixon (01:33):

Absolutely, yes, it's my pleasure. So I'd like to start off James by asking you to tell us a little bit about your latest sort of health tech company, Wellbe. Go into a little more detail than what I just did in describing it as to what motivated you to start the company and what it really does for physicians and patients.

James Dias (01:57):

Yeah, I mean it's based on the premise, about a decade ago we sat around thinking about what healthcare would look like if patients had a hand in inventing it, and that's where we got started. We put our thoughts and ideas together to put it, to assemble the kind of a patient perspective of healthcare. Let's look at it through the shoes of the patient. The patient unfortunately has not been a very key actor in the design of care models and the way things are routinely operationalized. I think it's only a more recent phenomenon in the broad trajectory of healthcare delivery where patients have been brought in into the conversation. But we're living with the legacy of a systems and ways of work that were designed mostly around the providers. And so when we got started as a company, that was our wondering if you will, we were thinking what would it look like. And why would we be wondering that?

(03:05):

Because primarily we as patients were sort of concerned with some of the experiences we were having looking around and at some of the other sectors and the economy and consumers were doing much better using information technology to include to interact with their service providers. And we were wondering why is it that in healthcare that seems such a problem? It seems to be so much more complicated. So being an entrepreneur, no noting a problem at hand and having the right chops to go in and study it and try to find solutions. I took it on. We took it on. So here we are and we do have a very distinctly patient focused approach to our work. We partner with clinicians to devise methods to make healthcare simpler for patients. That's the bottom line. Can we simplify the healthcare experience? And some of the things that some people have to go through when they have setbacks in their health are rather complicated, <laugh>, rather complicated. I mean, for a professional it's easy to manage that, but for the average Joe, Jane it's not that simple. It requires a lot of work and a lot of understanding about how to work with the machine. So we've tried to take all of that complexity, simplify it, and make it easier for patients to get the care they need.

Carrie Nixon (04:30):

I love that approach. I think you are absolutely right that our system was not really designed around the patient experience and ignores some of the complexities that patients often find themselves in the midst of dealing with during what's, what's often a time of crisis. So I'm interested specifically, what types of interactions does your platform allow with the patients that makes this sort of journey easier?

James Dias (05:02):

So if you look at the typical journey of a patient who is going through some procedure or some kind of health treatment there are numerous there. There's an array of different things that need to get done. Some of them require physical interactions with a care provider. You got to be in the room, they've got to touch you and assess you and watch your movement and things like that. But there are many other adjunct things that really don't require you to have a physical presence there. Scheduling the appointments, for example, completing intake forms, there's an whole array of things that encapsulate the interaction with the health providers that often get, could be great candidates for new technologies to come in and create more convenient ways for people to work, which haven't quite been adopted yet. So when you look at a whole range of things that are done in healthcare today the things that require physical presence should continue to do that. But the question that needs to be asked is why are we doing everything that way? I mean, why are we doing everything that requires someone to come to a place to get it done? And largely, and there are obviously areas where people have made advancements in this area, but largely as an industry, we still rely very, very highly on place-based activity. Like people coming to a place handed a clipboard, getting something done or getting clipboard, the

(06:36):

clipboard rules healthcare, it is a standard operating practice. Even in some organizations <laugh>, some very highly reputable organizations that have made phenomenal investments in technology, the clipboard still prevails. So those are the kinds of questions we started asking. Can we strike that balance by bringing technology where it was appropriate, where consumers are frankly ready and really asking for it and strike that balance with the more place-based or physical interactions. So kind of a hybrid model, if you will, of care delivery where interactions could be conduct, some interactions could be conducted online and some interactions would be conducted in place.

Carrie Nixon (07:20):

So that really resonates with me. I think with me. I think it's not only the emphasis on we have to always go somewhere to do a healthcare activity, but it's also, so that's certainly an issue, but it also, everything has to be done manually by a person, for example, handing you the clipboard to fill out the form. And that's a very, very small example, but it seems to me that there are tasks that are very standardized that either a nurse or a physician or a clinician would typically do manually, that might not always have to be done manually, right?

James Dias (08:12):

No, we are living proof that it can be done in these new ways. We've been doing it for many years. I'll cite a little study we did a few years ago where we assembled about 10 navigators. These are people that are typically nurses that are responsible for guiding the patients through their programs of care, making sure they're properly prepared for surgery and after surgery they make sure that the recovery is going well. So they have a whole series of different touchpoints with the patients along the way. So this is maybe a six week to 12 week type of journey depending on the procedure, but they have a whole series of touchpoints to ensure that the patients are properly prepared for everything they need to do. So we gave them a survey a few years ago and asked them first to list out all the different types of touchpoints they did, and they were like, okay, I got to call the person to do this and I got to remind them to do that, and I got to get this form done for them and this thing, that thing.

(09:11):

And they listed out these, and I think they were about 27 different or 28 different items that were on average. How many of them then we asked them to list how many of these items do you think technology could essentially assist you with? It turned out there was about 45%, so almost about half of the things that they had to do on a regular basis for hundreds and hundreds of patients, day in and day out, day in and day out they said they would be comfortable and they would value having some kind of assistance to do these things using technology. And they also fundamentally believed that there were enough people on the other side, patients, consumers that were ready and able. I mean, it's a two-part equation. The patients have to be ready as well. Patients have been ready for years. The providers on the other hand are a little slower on the uptake.

Carrie Nixon (10:05):

Yeah, so that's a key point. It has been my experience in interacting with some physicians that there is anxiousness and fear around the use of digital health technology, especially any type of automated functionality. There is a fear of being replaced and becoming irrelevant. So I don't want to, I do these things manually because if my patient sees some of these things happening in an automated function, in an automated format, I'm going to become irrelevant and not important to that patient. How do you overcome that fear with physicians and clinicians?

James Dias (10:55):

Yeah, I think you're putting your finger on it, and to some extent, it's a function of their training and it's a function of their mission, their personal mission is to care for people and that care, that definition of care that today is cultivated among the physician community, among the provider community is very human interaction is central to it. And so it's routinely seen that I must interact with the patient directly to be able to deliver that. That's part of their training. So I think the physician culture largely around the world, not just in the United States, is very much trained to interact with the patients directly and as much as possible to do that. I think that a couple of other factors we've uncovered over the years, one of them is there's a general attitude that patients are not reliable. The patients, not all patients are reliable.

(11:58):

And then there's some truth in that. There are plenty of patients who don't follow the doctor's orders, for example, don't do this, don't do that, can't do this, can't do that. Maybe they don't have the wherewithal or the technology to do it. So there is a very high prevalence of this. The manual way, the physical way, the in place way is the most reliable way to do it. I, when you compare the clipboard to some kind of EMR based way of doing your intake to coming to a clinic, I think you'll find that if you survey the physicians, it's not that they don't, don't think the EMR way is reasonable or applicable. I think you'll find that most people will say, yeah, but most of my patients won't do it. And so in an industry that needs very, very high levels of compliance or getting things done the right way, I think they've come to rely more heavily on these manual ways because they can get more people that way.

(13:01):

It's a lowest common denominator type of an approach. But what's happening over the years is that gap is closing. More and more people are becoming comfortable, they're becoming reliable at getting things done. So we had to go to some lengths over the years to create software and create user experiences that helped people in a wide range of scales, in a wide range of abilities to get things done and essentially raise this reliably. Physicians are usually quite surprised when they hear the statistics of how many people reliably get all the things done. So we have very strong metrics that we share with the physician community that says, yeah, you've got over 70% of the people that are enrolling on these systems, and then you've got 85%, 90% of the people that are getting things done. I think that's often a surprising fact, but it's not a widely held truth, if you will in the physician community.

Carrie Nixon (13:59):

Yeah. Well, I mean, I hear all the time about the dramatic weight of administrative burden that physicians and their staff feel on their shoulders, right? And my sense as we've been discussing is that these technologies can help to lift some of that administrative burden. I remember talking to a rheumatologist not long ago who told me that she saw patients for x, y, z time and then went home and spent another three hours per evening doing all of this paperwork and documentation and follow up and so on and so forth. My sense is that if physicians see technology as something that is actually easing the burden on them and therefore, and allowing them to practice at the top of their license, that's sort of the pitch that needs to be made. I think everyone wants to practice at the top of their license. So I don't know what your experience with that has been.

James Dias (15:10):

No, again, very good point. Yeah, I've opportunity to speak with physicians all the time, and I think that is a rather disturbing <laugh> fact for of life now that they spend a lot of time in administrative functions, and clearly the question that should be asked is whether all of that documentation is necessary. Certainly some of it is necessary for coding and billing. These are cases and you've got to do the right paperwork to get the right reimbursement. So there's a certain amount of that that has to get done. But on top of that, this seems to be a lot of documentation that's going on and more and more documentation that seems to get piled on. And then when you look at the other side of the equation, which is people who have to rely on or use that information that is supposedly put in the system, they can't get to it or it's very hard to work with or very hard to understand.

(16:11):

So I think this is one of the paradoxes of digital technology is it can create enormous amounts of data and it can also demand that people put in a lot of stuff. But is that stuff all being useful? Is it really necessary? I think that's a good question. We don't spend a lot of time we're not an EMR. We live alongside one. It's a compliment. We're a compliment to the EMR, but this is a perennial problem that we see with a lot of people, and it tends to rub off on all technologies. The attitudes you have towards, hey, that we brought this big technology in and it's sort of created a burst of work. Almost always I think all other vendors get asked the question whether your technology is also going to create a lot of work. So there's this reaction, <laugh> that adopting technology can mean more work for people, which is in very, as I said, very paradoxical because it, it's like, hey, we are trying to reduce the amount of work, but the perception is, and it's based on facts

(17:18):

many people find that they're doing actually more work. So I think a lot of people that's another barrier to adoption is a lot of people's concern in the healthcare industry that with each new technology that's coming in there's more work. And that's why we try to relay as much as possible that no, we're trying to automate that work that that's the answer to it. The work has to get done, but can it be automated? That's the question. Do you need to do it? Can we automate it? And that's a new conversation that's now taking place, especially under the current pressure points of labor shortages and stuff like that. I think people are starting to look at that question a little bit more.

Carrie Nixon (17:58):

I was just going to say that I'm reading all the time now about the sort of dramatic labor shortages across the healthcare industry that at all levels from the highest level physicians to front office staff, and to the degree I would think this would be a very, very important way, and maybe it's going to be a forcing mechanism, right? This would be a very important argument for adopting technology that is going to automate a lot of work that was typically manually done, either because the technology didn't exist before or because there was some, there's just the let's do it how we've always, there's that inertia, let's just do it how we've always done it.

James Dias (18:49):

That's right. Well, the inertia gets the job done. Thousands of patients come through hospitals over there and the experience not good standing. They have successful outcomes. They do have good surgeries. Surgeons and doctors do get good output and outcomes. So I think the question is whether we can operate and do things more efficiently and whether we can actually improve the patient experience. But that seems to some people, at least to be sort of an incremental question rather than the central question. The central question to a physician is always, can I get the right care to my patient and can I make sure that this patient has a safe and good outcome from the treatment or procedure? And there's been millions and millions of dollars and a lot of time invested in current models. And those models actually work for all intents and purposes.

(19:50):

They work and they're very reliable and they do things, but they take a lot of work. They take more work than perhaps needs to be, and maybe someone can connect the dots and go, well, what's this doing to our bottom lines and our margins and things like that. There are people preoccupied with the questions, but from the physicians and clinical, from the clinical community's point of view, what we do now largely works. And so when you try to convince people to make big changes, there's costs and change management as well. So I think that's the competing forces, if you will. If the things that they were doing today were not working I think we would have the kind of crises that would drive a lot of transformation change. But the things they're doing today, thankfully, by the way, because we all benefit from that they work in from a clinical point of view remarkably well operationally, experientially question mark.

Carrie Nixon (20:48):

Yeah. Yeah. Well, you mentioned surgery just a moment ago surgical episodes, and when you think of surgery, you think of a patient going into the hospital having the surgery and leaving, but there's actually a lot more to it than that. There's sort of necessary preparation leading up to surgery, and then there's really important information and care that needs to happen after surgery. Have you all honed in on that area a little bit? Are there ways that you have come up with to maybe automate some of this pre and post-surgery work to make things easier on the clinician and the manual labor front and while also sort of helping the patient along?

James Dias (21:40):

Yes that's exactly the area that we have been focused in. And we have made enormous gains on automating many of the functions that are required to prepare the patients for both their surgery and very importantly, their recovery. It's a process. So you go and have the surgery, but then you got to make sure that the next 10 days goes well, right? There are no infections and no challenges, and patients don't have setbacks and end up back in the hospital. So we have been looking at patient preparation as a central thesis to all of our work over the years and asking what's involved in preparing those patients, and then looking at all of the aspects of that preparation. Sometimes it's education, sometimes it's specific instructions that are given to the patients at certain times. Sometimes it's getting assessments done to make sure the patient understands or has all the right conditions in place for it.

(22:37):

All of those things I just cited are now fully automated on fully automated workflows. So many, many programs that have bought platforms like ours can put those things in and significantly reduce their labor burden. And in fact, I would say to the delight of their teams, <laugh>, a lot of their teams taking this stuff off to cite that navigation study that we did a few years ago can now focus really on complex patients and doing more care. So if they're not burdened by these administrative things or these more mundane things the nurses can essentially work to the top of their title. So yes, the automation exists. It's been around for several years now. There's great evidence that it can work, well save time but there's also great evidence that patients are taking to this very well. And when you look at the satisfaction, the patient satisfaction about this, it's very high. They prefer to be able to get education delivered to them this way do their forms on their own time before they come to the clinic and have to sit in a waiting room and work with the clipboard, et cetera, et cetera, et cetera. So the consumer patient is rapidly adopting these things and signaling that, Hey, keep going, put the foot on the gas. It's all about really getting the provider community more comfortable with these tools, but also with the benefits that come from it.

Carrie Nixon (24:02):

Yeah, absolutely. I, I think about sort of pre and post-surgery, it has got to be useful for the navigators or the nurses that are responsible for checking in on those patients before and after to be able to actually hone in on problems rather than just doing the manual thing that the tasks that they just sort of have to do. And listen, I'll certainly say as someone with an aging parent or anyone in your family who may have a medical condition, I much prefer having to have access being able to have access electronically or be able to be interface electronically or virtually and have information at my fingertips that way that are going to allow me to also be of assistance, right? And helping with that patient.

James Dias (25:06):

For most people who go in for a procedure, this is a very novel experience for them. I mean, we don't have these procedures every week or every month. I mean, that's a different class of patient who has a chronic illness, who has a very high degree of interaction with the clinical community. And those patients actually over time build new skills and habits on how to manage their diseases and how to manage their care, that that's a different clash. But we tend to work more with the people that are coming into these procedures for the first time. The first time I'm getting a hip replacement or a first time I'm getting a cardiac stent or the first time I'm having a baby, whatever it is. And so this is a very novel experience for people, and the biggest concern is the uncertainty and what do I need to know?

(25:56):

What do I need to do? And of course, one complicating factor today for most clinical teams is patients are curious, and if you don't tell them the things that they need to know, there is another source out there. We jokingly refer to it as Dr. Google. They can get second opinions on anything they want, anytime they want. So that's a tension that's been created as well, that patients are going to close their information gaps, their knowledge gaps by going to something that is one click away. And providers, on the other hand, have not made that information easy and accessible to their patients. So it's not there. There's a big gap to be closed between what does my provider need to tell me and what do I need to know from my provider? And if I don't get it when I need it, then I'm going to go somewhere else.

(26:52):

So the orthopedic community, for example, I'll give them a lot of credit, I think made this realization years ago and decided to make an intensive effort on education, a lot of education in their bill, creating classes for education, all kinds of things to close that gap. And I think you've been very much more successful at preparing patients for their hip and knee surgeries than some of the other specialties that are out there that don't really do a good job, but specialty by specialty, you have groups of clinic, the clinical community has either made is much more, more better at this than some others. But we automated regardless. I mean, we've gone into the orthopedic community broadly across the country and helped the orthopedic community really automate things that they spend a lot of hours doing and requiring a lot of people to come in. Again, I said class, well, that class is not online.

(27:46):

That class is actually something that you have to come to. Now, the real irony in all of this is that because of Covid, a lot of those organizations have to modify their place-based strategies and to go online. And it'll be interesting to see whether there are residual effects of that, where they want to continue that way. There's some evidence, early evidence that there is some things that are reverting, so they're not sticking as much as they did. It was looked at as a temporary had to do it that way. But now that things are getting back to normal, let's go back the other way. It'll be interesting to see how consumers take to that kind of stuff. They're the other player here.

Carrie Nixon (28:28):

Yeah. My suspicion is consumers may not like that a whole heck of a lot. Right, exactly. If they're now familiar with logging on and doing a virtual session and they don't have to fight traffic and find a parking space somewhere live, they're not going to like that. Well, so I've appreciated this conversation, James. This is a topic near and dear to my heart. How do we relieve the burdens on clinicians in a way that makes sense, both for providers and for the patients? And I think that you have really demonstrated that it's possible and there is hope, so I really appreciate that.

James Dias (29:08):

Yeah, no, you're welcome. Thank you. I'm glad to share those ideas and notes with you.

Carrie Nixon (29:14):

Excellent. Well, thank you so much for being a guest on Decoding Healthcare Innovation, and to our audience, please join us next time. We'll have some show notes that are in this episode that can tell you a little bit more about James and some other things that we talked about in the show. So check those out and follow us, and we'll see you next time on Decoding Healthcare Innovation. Thank you.