During Day 1 of HxRefactored 2017, Medgadget had a chance to sit down with two panelists from the Improving the Clinician Experience panel session to learn more about their work. The interviewees were Roy Smythe, CMO of Health Informatics at Philips, and Julie Rish, PhD, Director of Patient Experience Best Practices at Cleveland Clinic.
Mike Batista, Medgadget: During the panel you mentioned how Philips is good at developing “stuff” but not necessarily healthcare processes. Tell us more about what Philips is specifically doing today to enhance the clinical experience?
Roy Smythe: Philips is attacking this issues of clinical and administrative burden in two ways. First, we have a number of technologies in our product portfolio where we are putting advanced informatics in place to make the physician’s job easier. For example, through IntelliSight and IntelliSpace, our pathology and radiology platforms can pull up images of interest both on request and automatically based on what the provider looked at previously for a given patient. In some cases, we can even have our systems taking measurements on those images before the physician needs to request them. The result alleviates workflow burden on the physician. Our next step in this area is providing decision support to the provider. Second, we are active in connected care with direct to consumer solutions and platforms for providers. One of the biggest ways to improve clinical workflow is to remove effort the clinician does not need to do because the patient can do it his or herself. We’re seeing clear applications to do this already in use cases with lower acuity patients.
Medgadget: To your second point, if information capture is being trusted to the patient, how do you address the challenges of patient-reported data accuracy and reliability?
Smythe: We recognize the inherent challenges of putting technology in the hands of patients and have a huge R&D effort around making sure data is collected in the right way. Data reproducibility and integrity are all a part of what we do. Additionally, while we do deploy some technologies direct to consumer, much of our technologies first go through the funnel of the provider.
Medgadget: A lot of what we’re talking about at this conference relies on the collection, use, and analysis of healthcare data. Where are we in terms of effectively leveraging all this information that is becoming available to both patients and providers?
Smythe: I think about it in a framework I call the Three Waves of Healthcare or three time periods of how we’re going to use data in healthcare. The first wave is effective collection and curation of data. That’s where we are today. Despite what the type says, we’re still working on best practices to collect and ensure data integrity. The second wave is when clinicians will use the data collected to deliver better are to patients. There have been some early adopters and early wins in this vein but it’s still the early days of this taking place. Finally, where we all want to be, is the third wave where insights come full circle back to patients. There are three billion people around the world being monitored. We need to get to a point where we don’t always need the intervention of a provider to provide valuable insight back to the patient but we need to go through the first and second waves to get there.
Medgadget: How would you respond to the claim that many digital health companies out there today would probably argue that we are already in the third wave of providing personalized, high-value feedback and insight to patients based on self-reported and passively collected data?
Smythe: The future I’m talking about and the things that companies like Philips are actively working on goes beyond the limited data you can get from apps. I’m talking about being able to look at everything including medical images, genetic profiles, historical vitals, and self-reported data from a patient when analyzing an individual’s status and providing feedback. Even if you have all that information about a specific patient, meaningful insights are hard to generate when you’re looking at an n of 1. The kind of feedback you can provide a patient only gets useful when the numbers get big. Those are things we’re looking forward to in the third wave that we’re still not seeing at scale today. A quote from the famous Dr. William Osler characterizes this point, “We are constantly misled by the ease with which our minds fall into the ruts of one or two experiences.” Certain things have been shown to be useful in the direct to consumer context but there are insights out there that we don’t even know we can provide yet when we look at all the data across large populations. While we might not know what that insight will be yet, we know it will be compelling.
Medgadget: Philips clearly has a bold vision and an exciting trajectory ahead of it. Is Philips growing a lot of these capabilities in house or are partnerships with smaller and early stage companies part of that strategy?
Smythe: Philips brings a lot of capabilities under one roof: engineering, acute care, consumer technology, informatics, and, recently, genomics, among others. We also began as an innovation company and today we spend a full 10% of revenue on R&D which is pretty big considering the size of our company. That said, we know we’re not going to do it all ourselves. One reason I joined Philips is due to how active the company is engaging in a constellation of partnerships, mergers, and acquisitions. We’re constantly evaluating growth stage companies and technology as potential partners as well as potential development targets. When you look across the continuum of care from prevention to aging in place, no one has it all. One way we keep the company fresh is to actively look around at what else is going on around us and form the relationships that make the most sense to driving our overall vision.
Something you might have heard about recently was Philips moving its R&D hub here to Cambridge, MA. Now, our entire digital innovation hub is here as well as our artificial intelligence and genomics teams. This puts us in an optimal position to actively grow the kinds of partnership opportunities I mentioned.
Medgadget: Finally, you mentioned during your panel talk that innovation inherently requires a disruption of existing clinical workflows. Can you elaborate since, from the perspective of an early stage company, we’re often encouraged to work within existing workflows as much as possible.
Smythe: Let’s clarify the difference between iterative innovation and transformational innovation. People always take existing processes and find ways to make them more efficient, that’s iterative innovation which is beneficial, but maybe not disruptive. What you always need to ask yourself is whether the process you’re optimizing should even exist at all, should or can it be changed dramatically? If it can be scrapped and a completely new process put in place, while that might be harder, that’s when you achieve transformational innovation and have the potential to make an even more significant impact. It’s important to know which camp you fall into when implementing a new innovation.
Mike Batista, Medgadget: Tell us about the role of the Patient Experience Best Practices group at the Cleveland Clinic.
Julie Rish, PhD: In my group at the Cleveland Clinic, we care about patients, as do clinicians, but recognize they are not always included in the design of clinical practices, spaces, and workflows. So our role is to include them at the forefront of these discussions to get their direct feedback and input. To do this, we find ways to partner with patients and bring them into advisory councils. The key is figuring out what the needs of patients really are. Efforts around better documentation and transparency are great, but do patients really value them? Those are the questions we seek to answer. Patient perspectives and input have always been taken into account in a tangential way. We’re taking steps to make patient involvement more intentional.
Medgadget: What are some examples of areas where patient input has been eye-opening?
Julie: We’ve had a chance to get patient input on the processes of documentation, billing, and transparency as well as on the physical design of spaces where they encounter their clinical teams. In the case of our physical spaces, it was really interesting to hear that patients and providers wanted the same thing, an opportunity for intimate, human conversation. While we might image spaces for encounters with bell and whistles, at the core, what patients valued was the relationship they built with their provider in the space. So once that insight is uncovered, you start to think about things like how to we minimize the provider needing to turn their back to the patient during an encounter and other things which might hamper relationship building. Another thing we’re doing is putting patients on committees. If we are interested in patient feedback to improve readmissions and discharge, we’ll get patients willing to be part of committees who are working to figure out solutions to these challenges. Having patients as part of the conversation in all these examples has been invaluable.
Medgadget: How is the Cleveland Clinic acting on this clear, direct patient feedback? As a large clinical organization, I imagine change takes time to implement.
Julie: As we’ve started to implement patient programs, the feedback generated is being used as the basis for core concepts the clinic can build on moving forward. Big systems like ours inherently take time to enact change but we’re working hard to see change come to fruition. We’re already thinking about current physical spaces and locations within the clinic. It’s been exciting to see that, when possible, the system is beginning to implement new standards based on this patient feedback.
Medgadget: You’ve talked a bit about the patient experience within the clinical system. Have you begun thinking about things like remote patient monitoring or other programs where there is an important patient experience outside the four walls of the clinic?
Julie: The patient experience beyond the clinical system is something we’re working towards today at the system level. We feel very passionate about the fact that we should be connecting and partnering with the community we serve as well as the one we hope to serve. Today there are efforts within different departments to engage patients beyond the clinic but we’re planning to do more to implement strategies across the system in the future. Speaking of thinking about the patient experience beyond Cleveland Clinic, we’re also looking at generating feedback on experiences from patients and clinicians in our community clinics. These efforts align with our objectives to implement holistic strategies around precision medicine and enhance transitions of care between Cleveland Clinic and local community clinics.
Medgadget: When insights are uncovered, does Cleveland Clinic take the approach of implementing innovation in house or are partnerships an important part of the strategy?
Julie: Cleveland does a lot of innovation and is getting more into the generation and ownership of intellectual property. That said, a lot of our innovation comes from physical technologies like medical devices. Cleveland Clinic is constantly investing in innovation both through partnerships and spin offs of internal projects. Beyond our own efforts, Cleveland Clinic has a good history of learning from others and going to where great work is being done to align with or emulate proven success. Our work on patient experience is a testament to the fact that we know we don’t know everything and need to bring in the right perspectives to figure things out and innovate.