← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Roberta Schwartz, PhD, Executive Vice President and Chief Innovation Officer at Houston Methodist
00:22:01
Loading summary
Transcript20 lines
- [00:00]
A
This is Scott Becker with the Becker's Healthcare podcast. Today for me is a little bit like old home week in that I get to interview someone, a brilliant person who's a licensed clinical professional counselor who works at Endeavor Health. We're interviewing today Andrea Fisher. And the way that I the reason, I mean that it's like old home week is that Andrea, at one point prior to going to back to school, to grad school 15 years ago to become a clinical therapist and a professional, licensed clinical professional counselor, you used to work with us in another business. And Andrea is just a wonderful, brilliant person. So we're so excited to have her with us today. Andrea, can you tell us a little bit about what you do and about the Endeavor system and how you work?
- [00:45]
B
So thank you so much for having me. First of all, I am a healthcare administrator kind of through and through now. Been at this about 33 years. Started my career for a year in managed care and then transferred to the government and worked for what is now cms. Went back and did consulting for about five years with a group called APM that was bought by cse, one of the largest healthcare consulting companies in the United States at that time, and then went in House at Mount Sinai and then 24 years ago had the honor of coming to Houston Methodist as a kind of junior executive, have grown up through and currently run our large academic medical center, kind of that thousand bed hospital that is in the Texas Medical center, and serve as our chief innovation officer for the aid hospital system.
- [01:40]
A
I mean, thank you. It's been a remarkable career and what a transformative move from Mount Sinai to Houston Methodist. And Roberta, take a moment, talk about innovation and really focus on what are you most excited about today. Like what are you watching most excited about today? I know Dr. Wood and your team have an incredibly interesting, innovative institution. And what are you most excited about currently?
- [02:05]
B
Oh my goodness. You know, I think that the speed by which we are now moving in almost every area is what is the most exciting? The maturation from a. I mean, we've been working at speech, going computer type to Voice. Now it was like slow and then now it's like you moved from the local train to the acela. You're now on a bullet train of development. When they said that really EPIC was going to mature, really nurse voice by next year, I was insanely excited that we're going to get there. I wrote to EPIC yesterday to basically say, okay, if nursing is there next year, do you think in three years I'll have almost everybody at Voice because quite honestly, I have a building going up in 27, 28. Can I not put computers in the room? Can I skip on putting computers right outside? Because the majority of this is going to be you holding your phone and basically just speaking. And everything will be documented. People can't stop talking about that. But it's not just that. It's the maturation of AI in cameras. It's what we're doing in the operating room to kind of watch all the movements. A place that was really much of a black box before and everything was. It was a nurse in the corner, your quote unquote documenter, who basically sat there doing it. You still have physicians leaving the or going outside and transcribing their op notes. The fact that all of that is, is maturing. And really quickly, the information about what's happening is going from video to, to your phone to let the PACU know that the patient's ready to come out. The predictive analytics that we're doing with a variety of companies is spectacular. They just basically dumped me a file and said, hey, we think we can find, you know, 39 conditions present on admissions and get people going if we can just get that workflow to the right people at the right time. And I was like, I'm sorry, you did what? You know, it's. It's spectacular. And again, what excites me the most is, is the speed of that maturation, the speed of where it's going from. Oh, they can do one thing, they can do it pretty well. Do. They can do 20 things at one time, and they can do it insanely well. And that's. It's. I am people. I'm almost overwhelmed, which people can't believe because I can work like crazy hours. But people are almost amazed that I am getting overwhelmed by just trying to.
- [04:54]
A
Keep up and talk about that, because that seems to be such a part of this technology is now moving so fast. How quickly are nurses, techs, physicians, administrative leaders able to adopt and pick stuff up? Is it. Are they. I mean, I see sort of in certain clinical fields, I feel like oncologists, for example, are just overwhelmed today with information overload. What about sort of just. And all these everyday things that are being implemented so quickly, are they taking a load off of people? Are they the balance of that, the people side of all the transformation?
- [05:34]
B
So some things are no brainers and it's super quick and you don't even have to. You get a little bit of pushback right at the beginning when we put in virtual Nursing. When we, even when we put these cameras in the operating rooms, there was anywhere from two weeks to 60 days of pushback. At the end of that, everyone's just completely bought in. I was sending a note to our, our CFO this morning. So we were having conversations about ambient voice. And the comments from doctors are, you can pry this out of my cold, dead hands. Now, again, right at the beginning, there's a whole bunch of doctors saying, I don't think that'll be worthwhile because I type very quickly, will I type super quickly. And I can tell you, even my typing can't keep up with voice when it's really, really good. So as these things go in, if you're not asking for enormous amounts of change management and you're making that cognitive load less and you're speeding up the workflows, they get adopted pretty quickly. But then let's go to the opposite side. Let's, let's just take the opposite way. If you remember, Scott, during COVID we were able to get 80 to 85% of our visits online. And depressingly for me, we're back down in the 20%. That's very distressing. Right? Why didn't we.
- [06:59]
A
Give me a second as to why is it so much further back down? Do patients just enjoy much more sitting and visiting with the doctor? Or why has that gone so far back in the other direction?
- [07:11]
B
Personal opinion?
- [07:13]
A
Yes, please.
- [07:14]
B
That's what doctors wanted. And doctors believed that that was better. There's an awful lot. I always say, if you, if you're not touching the patient, there's an awful lot that we can do on a camera. So. So we built a computer highway. A camera highway. Sorry. Around our hospital, there's camera in every room. There's camera in every operating room. Our cameras, if they're not, if we can't hang them in the rooms, we have carts. Had a conversation with. We're implementing as of January 1, palliative care on the highway because our palliative care doctors can't be here 7, 24. And oftentimes patients come in on a Thursday night at 8 o' clock at night or a Friday, and we don't want them to wait until Monday to see a palliative care doctor. So we're implementing virtual palliative care. Great, right? It's fantastic. I sat down with two of our palliative care doctors. Could not imagine that end of life conversations could happen on a camera. I get you, but I can tell you I was, I have been, as I said, around this for 33 years. So I heard that if we implemented Telepsych that the patients would all hear voices. And I heard that there was no way a stroke doctor was going to be able to look at movements on a camera in the same way that they could do it, they could do it in person. All of those things have not necessarily turned out to be true. So you've got to find those believers, those people who jump in and basically get in there and say, I can do this. And we're seeing that. But unfortunately for me, it's like chipping away at a big wall with a plastic spoon. And I'd really like either a sledgehammer or a big pickaxe. I can do it more quickly. But it's that change management feature of how we're doing our business. We also need to do a better job of what we're calling care traffic control, which is which patients need to come in and which patients can be seen in a virtual fashion. So if we can better identify using AI summarization of information and say, look, you can stay home. You. You need to come in, I think we could help our doctors, again, ease that cognitive load of them making that decision in advance, because right now, how they're making that decision, they have to go through your chart in advance, they have to read everything, they have to review everything, they have to look at your labs, they have to make a decision, and then they have to let their scheduler know that you can stay home and they can just do this with you over a camera. Now, it's not helping that the government is rolling back the regulations and, and rolling back the payments. I think they're turning this off at a time that they should be speeding it up. So I am very distressed about what's happening right now in the telemedicine payment world.
- [10:08]
A
Thank you very, very much. And talk a little bit about government reimbursement and potential impacts on innovation, because we're seeing a similar thing with hospital at home and some other things where, for the moment, pay is being rolled back or not happening because the government shutdown and so forth. Any thoughts as how the government impacts. And this is not a knock on the Republicans or the Democrats, I quite frankly have plenty of negativity towards both. And that's my own perspective, not yours, whatever. But. But how does the government changes have an impact on innovation?
- [10:39]
B
Yeah. So, I mean, everyone to a certain extent will follow the money. I mean, I hate to say that that's true, but if that is available, then in an era where we have a shortage of supply of doctors and you want to maximize what doctors are able to do to say to them you can only do, you're only going to get paid if they come in person, that's a little harsh. And if we want to at night centralize one doctor to serve eight hospital system to say to them, you won't get paid if you camera into a room, that's really kind of distressing. Hospital at home While it was important in particularly really, really busy areas, there were very few programs hospital at home that were over 50 patients. These were fairly small and very resource intense programs. That's different than our ability to spread both through remote monitoring and through lots of different modalities. Care we believe in this care coordination, care traffic control where we can watch large swaths of the population and avoid having them go to higher levels of care. We have data that will show you that when we watch a bio button with the vital signs that we can actually not only reduce mortality, but we can reduce the amount of time that someone is spending going to a higher level of care. When we look at our virtual ICU unpublished data, but we are in the process of publishing it, we will show you that there's a much improved quality. And when I say much, I'm saying a lot. When we have people watching, having a second set of eyes on those patients. Now we just, we are believers, we have jumped into the deep end of the pool and we have done this regardless of whether or not all of that is paid for. But I would tell you what, other people haven't been able to do that. And I think what is going to be hard is if we split this into the haves and have nots of these type of technologies. I think these are the types of things that we can from centralized hubs like a Houston Methodist, like other people who are in that level of sophistication, be able to spread that to people who may not be able to mount those huge efforts in their community and do a good job for them.
- [13:17]
A
Thank you. You made such an interesting point on certain technology being accessible or not accessible to some systems, some people and so forth. And this reflects a larger challenge, an evolving challenge in our healthcare system as a whole. I mean there are so many pieces to this, but we at least think of it as a two tier health system between those that are on commercial or Medicaid or Medicare versus Medicaid and impoverished and just indigent. You know, I mean clearly some systems do a great job of trying to make sure that that's not such separate tiers that people who are indigent poor Medicaid great care as well. But throughout the country there's certainly a ton of places where people that have less means are getting less access to care. And it's similar to a point in technology. Systems that can afford it can get certain types of technology, certain can't. That will cause a big difference in tiering. Then we even see now between those that are not on Medicaid, not in agent. There are more and more tiers within the commercial population too between people paying for concierge versus not versus all kinds of administrative fees that a certain portion of the population can afford and a certain portion can't. Insurance costs are going up to 25, 30,000 a year. For families making less than 100,000, which is the vast majority of American families. Those are really high numbers. And I think your point on technology access dovetails well into a lot of these issues because that's an evolving issue too, where you got 60% of systems making some mark and 40% not. Then you very much get to a spot where those that could afford this systems are going to have better and better technology versus those that can't. And that's not, I don't know there's anything we could do about that. But any, any thoughts as you see that divide happening as well.
- [15:08]
B
Right. The one thing that's amazing when you step back is that almost every American has a cell phone. That means that access can be brought to them. And if access can be brought to them in a much less expensive or I should say cost effective manner, then we should be bringing it to them. The same thing within hospitals. I have a hundred bed hospital and I have a thousand bed hospital in our system and we have almost every bed size in between. In the big hospital you can obviously have a body. But in our 100 bed hospital we need a fraction of a body. In our 300 bed hospital, we need five fractions of a body. If you think about your world in that manner once you basically can say okay, I can beam those fractions from a centralized location. You can do a better job in your use of resources. Now the problem is if you then say, oh well, the person that's the fraction of the body coming over the camera won't get paid. That's going to make this more complicated to be able to, if you think about it, beam a very small fraction of a body into a 10 bed hospital in a rural area. But as or you know, a fraction of a visit that is five minutes long. Right. On a cell phone or using the information that we've got to pay you and say, hey, Scott, you need to come into the hospital now. We are looking at your wearable. We need to see you immediately. Right. Not wait until you have the event. Well, we're watching all this telltale signs. If you come in now, we can take care of this very quickly. So I think there's a lot of work that we can do. But part of it starts with people believing, people maturing the technologies, people believing in these technologies, people doing the change management to make these technologies hum and sing. And I am honored to be in a place that we are doing that. That's the most amazing part of being at Houston Methodist is that they are allowing us to jump into that in such a big way from our board of directors on down, really saying, bring it on, bring on the next thing. And we have been able sometimes, sometimes it's rocky. Sometimes, sometimes I go to sleep at night and I'm like, oh, yeah, yeah, what did I do today? But, you know, in many cases, we have been able to bring in that change management. And once we do it, we rarely look back and say the old way was better than the way we're doing it now.
- [18:05]
A
Thank you so much, Roberta. Some of the discussion about access and payment for telehealth services or it's obviously so needed in certain places because rural health, you just can't get full bodies out to certain places and can't afford them. Nor are there sometimes doctors that want to go out there, but you need them. And if you do it telephonically, it may not be perfect, but it's a huge step in the right direction. But if health systems are forced to cover all the costs of that because it's not reimbursed, then it's very hard to do. And it reminds me of discussion years ago around care coordination where systems knew they needed more care coordination, but there was no one paying for it directly. So it came out of the hospital budgets. It became harder to make happen. And so I think a lot of these discussions just dovetail nicely together. But. But what a fascinating time and challenge.
- [18:54]
B
Yeah, I mean, we. That old Chinese proverb, although someone tracked back and said it may, may or may not have been may you live in interesting times. We certainly are living in exciting times. And to, you know, I was enjoying the latest acquired episode on, you know, AI and, And recognizing that this revolution that we're seeing, you know, is. Has all happened within my lifetime. And I can't even imagine what the Next, you know, 10, 20 years are going to bring. It's exciting to imagine a world where this does look, look very different than the one that we have today. We will still need doctors, we will still need hospitals, but we can just as you're seeing now, the, the information that we've got is starting to work for people rather than people working for putting in the information that we've got. And, and we have to go back and be thankful to the people who actually made the revolution in electronic medical records happened. But now to look at what's coming on top of these with these new language models is insanely exciting.
- [20:04]
A
I just can't tell you how much I love that last point you made. And I agree with you on exciting, sometimes scary, sometimes challenging. But this point of the technology working for people versus people having to work the technology so hard is such a chasm point in terms of being able to get over the chasm to make this all work. That actually feels like it's working for you versus your to put so much into it to get it to work for you. I think that just that point and you said it much better than I did, I think it's just really well put.
- [20:39]
B
Rarely can I say something better than you. So you know, if that's the moment I'll go with exciting there but, but I'm certainly looking forward. We've, we've been starting to roll out our kind of three year bets on which technologies will mature in the next three years and where we really believe the separation will be what can truly get adopted within those next three years. Not that there isn't going to be something that doesn't come in but we did this three years ago which led to our kind of smart hospital and we're doing it now and looking at the intelligent healthcare system of the future. And really when we talk about system rolling in kind of those larger features of what it is to take care of this system population. And so we are loving the fact that we were able to sit down and we really, really press on the entire team within Houston Methodist and many of our partners to look at what, what three years out will bring. So I'm excited to bring that to Becker's next next week.
- [21:43]
A
Roberta, we are so appreciative of what you do and joining us. Thank you so much for joining us on the Beckers healthcare podcast. I know I kept you longer than expected. Thank you so much for joining us.
- [21:54]
B
It truly is.