In a HealthBizTalk podcast hosted by Tony Trenkle, Judy Murphy, a renowned leader in health IT, shares her insights on digital transformation in healthcare.
Transcript Of the Podcast
00:00:00
Welcome to Health Biz Talk, the industry’s leading podcast that brings you today’s top innovators and leading voices in healthcare technology, business and policy.
00:00:09
And here’s your host, Tony Trenkle, former CMS, CIO and health IT industry leader.
00:00:16
Hello Judy, it’s good to see you again.
00:00:20
Hi, Tony.
00:00:22
Okay, I want to introduce everybody to Judy Murphy.
00:00:26
Most of you who tune in on this may know Judy, but anyhow, Judy’s a nurse executive and a health IT leader and she has a long and distinguished history in health and nursing informatics.
00:00:38
I first really got to know Judy when she was Chief nursing officer at IBM Global Healthcare from 2014 to 2020.
00:00:46
And Judy and I worked together there for several years and had a lot of good and interesting times together.
00:00:54
And prior to IBM, Judy worked as Chief Nursing Officer and Deputy National Coordinator for Programmes and Policy at the office of national coordinator for health IT in beautiful downtown DC.
00:01:09
And prior to that, Judy came to ONC after 25 years of health informatics experience at Aurora Healthcare in Wisconsin, which is a large integrated delivery network where she led their application and EHR programme and was an early adopter to Health it.
00:01:27
Judy’s published many, many publications, I guess is for want of a better word, written.
00:01:34
Written for publication.
00:01:35
Had published a number of writings in this field.
00:01:40
She also has won many awards and has been a major leader in the health IT space for many years.
00:01:48
So Judy, welcome again.
00:01:50
And did I miss anything in the story?
00:01:54
No, no.
00:01:55
I could certainly talk a little bit about how I came to get into informatics being.
00:02:01
Yeah, and that’s.
00:02:01
I would like to hear that.
00:02:02
Yes.
00:02:03
Yeah.
00:02:04
So obviously initially when I graduated from nursing school many years ago, 1975 actually.
00:02:11
And I say that because of course there was almost no technology at that point.
00:02:16
And so the first years of my career I worked clinical and then I moved into the in education department where we trained new nurses when they came to the hospital and did continuing ed for nurses.
00:02:27
And in that role I was actually helping with the rollout of mainframe based computerised order entry in the early 1980s.
00:02:38
And it was in that role that I got interested in informatics, particularly because the programmers at that time were, you know, isolated.
00:02:49
This whole idea of, you know, working with the people who actually do the work that’s being automated was, let’s just say, new.
00:02:57
And they built applications for doing things like order entry and results reporting of lab.
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That was our first implementation.
00:03:06
And I remember distinctly looking at the lab result reporting and the only way you could look at lab data was by date.
00:03:16
So you could go in and look at the lab work that was done today and you could look at what was done yesterday and the day before.
00:03:22
But what you couldn’t do was look at the same value over time.
00:03:26
And anybody who’s clinical knows that looking at haemoglobin results or looking at electrolyte results like a potassium, it’s important to look at the trends over time.
00:03:38
Absolutely.
00:03:39
That was kind of my first.
00:03:40
This is going to work.
00:03:41
I mean, it’s better than getting it on paper, but if we’re automating it, we want to be able to do it by date and then also look at it by test.
00:03:50
And so I thought, oh, clinical input’s really going to be important as we start to do radiology order entry and we start to do all sorts of different kinds of things.
00:03:59
And of course this was pre documentation for clinicians.
00:04:03
Yeah.
00:04:04
And so anyway, I actually ended up moving into the computer department in 1983 and the rest is history.
00:04:11
So, yeah, I spent 26 years in the IT department at Aurora Healthcare, starting out with this mainframe order entry.
00:04:19
And you can sort of imagine 20 lines and 80 characters, monochrome, no graphics, and, you know, moving on through the times where we have now the electronic health records.
00:04:33
And I’ve implemented both Cerner, now Oracle, and EPIC at Aurora Healthcare, because we had both.
00:04:40
And yeah, I just love this ability to impact the clinical workflow through the use of automation.
00:04:49
You know, it’s interesting that you say that and I’m deviating a little bit from the script here, but you worked both in the front lines.
00:04:59
Then you worked in onc, which was kind of a policy shop.
00:05:02
Then you worked the IBM, which was a technology shop.
00:05:07
So you’ve kind of moved around different parts of this ecosystem.
00:05:13
So you’ve kind of looked at this whole issue of interoperability from many different angles.
00:05:19
So I guess, you know, one of the things that’s.
00:05:23
Well, I’ve been involved in interoperability for a long time and I guess it’d be interesting for me to hear from you since you’ve looked at the elephant from so many different angles.
00:05:34
What, what is your definition of interoperability and has it evolved over the years or is it kind of the same as you looked at it maybe 20 years ago?
00:05:46
Oh, I’m not even sure we thought about it 20 years ago.
00:05:48
I mean, I think we thought it was important to be able to get data from other organisations, but we were happy if we could get it on paper, much less, you know, actually, you know, Move it electronically.
00:06:00
I think the biggest thing from a clinician’s point of view related to interoperability is having all the data over time.
00:06:07
And so again, just like I was talking about lab data over time within an individual encounter, it’s really important to think about your life and what happens over time.
00:06:17
So if you’ve got a chronic disease, when was it diagnosed and how was it initially treated?
00:06:22
And then how was it treated and what meds have you been on?
00:06:25
If you’ve got cardiovascular disease, same kind of thing.
00:06:28
So that importance of that historical trend, if you will, of your disease process as well as the treatment for that particular disease becomes important.
00:06:40
And even if you’re not don’t have any chronic diseases or you’re sick, looking at preventive things over time becomes really important.
00:06:48
A mammogram result as an example isn’t valuable unless you can look at it in relationship to previous mammograms.
00:06:57
Yeah.
00:06:57
So this, this need to look at stuff over time.
00:06:59
And because we don’t all go to the exact same hospital and go to the leave and live in the exact same city all of our lives, we don’t have that capability without interoperability.
00:07:12
Now, from a clinician’s point of view, in addition to having the data, it’s where is that data and how does it come up to be displayed for you?
00:07:23
And today the majority of interoperability, although you can get records electronically from another facility, in some cases you have to request them versus them sort of magically or automatically appearing.
00:07:35
And secondly, they often are packaged up kind of in a PDF and put in the record in a different kind of place than the other information that’s like that.
00:07:47
It’s not in your workflow.
00:07:48
So blood pressure, for example, it’s going to be in this document in a paragraph.
00:07:53
It’s not going to be on the flow sheet, you know, right in the blood pressure row.
00:07:59
So that becomes a difficulty because it takes me longer to find the information.
00:08:03
I either have to request it or I have to go look for it.
00:08:06
Now, again, it’s better than not having it at all, but I’m going to be less likely to do all that if it’s a bit of gyration that I have to go through.
00:08:16
Yeah.
00:08:16
And I think I can understand from the clinician standpoint the frustration from a patient standpoint, it’s also frustrating.
00:08:27
One of the things that I’ve noticed is I have a portal now for everything so I can get information, but unless I belong to a integrated health network, I have to go out to multiple portals and I don’t belong to an integrated health network, so I go out to a portal for my test results.
00:08:47
I got a portal for my test, not just test results, but also the interpretation of test results come in through the, the specialist portal.
00:08:59
I’ve got my GP portal, I got my dentist portal, I got my doctor portal and each specialist has a portal.
00:09:06
CMS under Medicare has a.
00:09:09
As a portal.
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So I feel like I’m.
00:09:12
I’m portaled to death, but it’s still very hard to get that entire picture.
00:09:17
And then I find when I deal with clinicians from different health systems, for example, I have a primary care doc who works for Ascension and they have specialists like a cardiologist who works for Hopkins.
00:09:35
And I’ve had to at times even manually take information from one to the other.
00:09:41
And then we’re not talking 20 years ago, we’re talking within the last year or so.
00:09:46
And it’s really unbelievable to me, all the years I’ve worked in this space, how bad, at least from the end user perspective, let alone the clinician who’s trying to deal with, particularly the GP who’s trying to deal with it at a global level.
00:10:05
I don’t know what you’re thoughts on that, I’m sure, personally, first of all.
00:10:10
I am lucky enough to belong to an integrated health network and so all of my stuff is in one place.
00:10:16
And actually that was part of my decision making in selecting the insurance plan that I have.
00:10:23
I’ll admit it, I’m on Medicare and selecting the health system that I was going to be going to.
00:10:28
I wanted to make sure they had the breadth and depth of what I was going to need.
00:10:31
So today I think some patients are actually making decisions based on that.
00:10:35
We shouldn’t have to do that.
00:10:36
And that’s kind of your point.
00:10:38
If you’re in an area that doesn’t have all those specialties or doesn’t have a big integrated system, it’s impossible to do that.
00:10:46
And you’re going to end up with the minimum of two or three portals, if not five or six or seven or eight as you’re describing.
00:10:53
And so I can remember when I was at the federal government, which now is 10 to 12 years ago, there were innovative vendors that were looking at it from the patient’s perspective and actually proposing solutions that would allow the patients to download information from multiple portals and create their own viewer, their own portal.
00:11:16
Yeah, the blue button work well.
00:11:19
Blue button, yes.
00:11:20
It would have been nice if that would have done all that.
00:11:22
But that was still just pieces of it.
00:11:25
I’m actually talking about like full service vendors that were really looking at a true integrated portal for individual from the patient’s point of view that doctors then of course would be, or nurses or any clinician would, would be allowed to use as well.
00:11:41
But it was too early and you know, that just never took a foothold at, at all.
00:11:47
And there was a lot of effort actually as I can recall being put through that maybe today that that would make sense.
00:11:55
But what’s the value prop and who pays the money for that?
00:11:58
Right.
00:11:59
I’m not sure that individuals would be willing to say, well I’ll take $20 a month out of my pocket and pay for, you know, a portal.
00:12:07
So not exactly sure what the value prop would, would be for that software and who would foot the bill, you know, would patients actually be willing to do that?
00:12:17
Are they frustrated enough to actually pay to make a change?
00:12:21
I mean, today, of course you can request those records.
00:12:24
You can in many cases download them yourself.
00:12:27
You can certainly send them in many cases again electronically.
00:12:32
But you’re, you’re playing this intermediary, right?
00:12:35
You’re the integrator as a patient.
00:12:38
And, and that’s tough.
00:12:40
And you know, not only tough, it’s, it puts undue burden because then you have to keep track of everything and know, you know, how to mess, mess around with that.
00:12:50
But that is going to be something, I think, that has to be dealt with as we go forward.
00:12:55
That’s why the payer portals are getting more and more popular because at least you can look at what was done.
00:13:02
You can’t see the results typically, but you can see, well, they paid, you know, these 12 providers last year.
00:13:08
So you had care at all those places.
00:13:10
And it’s a way of pulling together, I’ll call it rudimentary consolidation of at least the activities that went on so you won’t forget some, somebody you know yourself.
00:13:20
I think we’re going to see a big upheaval over the next five to 10 years in this particular space.
00:13:26
Looking at things from the patient’s point of view and making it easy for the patient.
00:13:31
Today, you know, we’re still fussing around with clinician dissatisfaction with these tools, you know, a documentation burden on the parts of nurses and doctors.
00:13:41
So we got a ways to resolve that and then also involve the patient more and make things easier for the patient.
00:13:48
Yeah, yeah.
00:13:50
And I think we’ve talked about that for a long time.
00:13:53
I mean, about giving the patient, I mean, I mean, believe me, it’s Better now that I can get the information.
00:13:59
I mean, now I can get test results sometimes quicker than my own provider can get them.
00:14:05
And of course, I may not understand half of it, but at least I can get it.
00:14:08
And of course, we didn’t have that years ago, so we do have better access to information.
00:14:14
It’s just not integrated in a way that we’ve talked about for years.
00:14:19
And I guess, you know, we have things like TEFCA and other things occurring at the national level.
00:14:25
Do you think that they will begin to make a big difference in this in the next few years?
00:14:29
Some of it, I think, is also, you know, culture between, you know, different provider groups and different provider specialties.
00:14:40
They don’t.
00:14:40
They just don’t talk with each other.
00:14:42
At least my experience has been they don’t.
00:14:45
Yeah.
00:14:46
You know what, What I was struck by when you were talking was the role of government.
00:14:51
And I was reminded that before I worked at the government, I mentioned I worked at a health system or healthcare, and at Aurora Healthcare, we were doing the Meaningful Use programme because we wanted to get the meaningful use money.
00:15:05
And many who are listening to this podcast, I’m shocked, sure remember those times.
00:15:10
And I can remember that they put in this portal, patient portal requirement.
00:15:17
You had to have a patient portal and, oh, year one, you had to have at least three patients log into that portal.
00:15:25
It was like three patients, you know, and so, you know who the three patients were.
00:15:29
They were people in it.
00:15:31
But I will say that without that incentive and without that push from the Federal government, I’m not sure we would have had a portal for another five years.
00:15:41
So I think this is an interesting thought.
00:15:43
As we talk about things like TEPECA and the role of government and the role of standards, sometimes we develop things on our own and there’s absolutely no problem as health systems.
00:15:55
In other cases, we need a push.
00:15:57
And I think when we talk about things like the patient portal of years ago, but today, the standards and all the different kinds of standards, you know, not just it’s vocabulary standards and it’s transportation standards, you know, how do we.
00:16:11
How do we actually communicate?
00:16:12
And it’s the standards of what does that mean and where do we put it and all that kind of stuff, there’s a role for government to help in that.
00:16:20
And I think as we think about increasing our interoperability for the purposes of AI, so we have better data for better decision making.
00:16:29
In other words, we’re not just looking at maybe one organisation or one hospital, but we’re looking across organisations and across health systems.
00:16:37
Because now we have data that’s interoperable and we can amalgamate it to run those algorithms to make those recommendations.
00:16:47
The role of standards and interoperability are going to be even higher.
00:16:50
So I actually continue to applaud the government in driving and continuing to drive those kinds of requirements, if you will, of health systems.
00:17:02
Yeah, well, I think looking at the government, I mean certainly with X12, with the HIPAA transaction standards, I mean the government really did push the payers in that area with E prescribing, we really pushed the prescribers in that area which I think, you know, overall went well.
00:17:23
I think with the, in the clinical side, you know, with the, with the coming of fire and the government’s push with the fire standards, I believe that’s really moving us down that way.
00:17:36
And CMS and ONC have combined together on a number of regulations related to that.
00:17:42
So I see the government as having several roles.
00:17:46
One is, you know, the Grand Convener, which ONC does very well, which is bringing the spirit groups together that come around either formally or informally.
00:17:57
CMS also does a decent job with that at various times and other parts of HHS do that.
00:18:04
Second would be the, like the meaningful use where they actually pay or provide incentives through the CMS Medicare payment system to really promote change.
00:18:19
And then third, of course is the punitive, the stick side of the equation where they actually make, you know, some types of oversight and penalties that can adhere to those who don’t cooperate.
00:18:35
But then there’s another role that government can play too.
00:18:38
They’re a major buyer of health care in this country.
00:18:41
And one of the things I always pushed when I was in the government and even.
00:18:46
And when I left the government, you have CMS with Medicare, you’ve got the states and CMS with Medicaid, you’ve got the Office of Personnel Management which runs the Federal Employees Health Programme.
00:18:59
You’ve got va, I mean just within the federal.
00:19:03
And you got of course Tricare with dod.
00:19:05
So just within the federal government.
00:19:08
My idea was why don’t, at least internally, can’t several of the government agencies say you take OPM and cms, you’ve got a lot of people retired from the federal government who are under the Federal Employees Health Programme and also get Medicare either as a primary or secondary.
00:19:26
Why not at least take that part, that’s several million retirees that you could take and start doing some of these changes on that scale and then expand it?
00:19:38
I mean, I just think that there’s a number of Roles that government can play.
00:19:42
You and I played a role in some of these government moves to promote.
00:19:47
But I, it feels to me like a lot of it has been kind of, and some of it I know is political, but this is more of a bipartisan issue.
00:19:56
It seems like it’s had a lot of starts and stops.
00:20:00
Sometimes money flows, sometimes it doesn’t.
00:20:02
Sometimes CMS puts in regulations, but they don’t put any teeth behind them either because of lack of funding or because of lack of willpower.
00:20:14
And there just seems to be a short term focus in a lot of these areas.
00:20:20
You know, Mickey’s been doing a great job since he’s been over at hhs, but once he leaves, the next person comes in may have a entirely different idea of how to do things.
00:20:31
So it just seems to me there’s a kind of a lack of continuity.
00:20:34
So when we talk about the government role, I’ve seen it play a lot of different roles.
00:20:38
But is there any role that you think they should play more of that they’re not doing now or less of than what they’re doing now?
00:20:47
Well, first of all, you bring up a good point.
00:20:49
They are a payer themselves.
00:20:53
So oftentimes where they go, people follow.
00:20:56
And so one of the things that I know drives me absolutely nuts, absolutely nuts is prior authorization.
00:21:04
And of course that’s in their gun sights right now.
00:21:07
You know, my husband just had open heart surgery earlier this year and some of the things, you know, they were just easy.
00:21:15
You know, everything just, it got ordered, it got done, blah, blah, blah, blah.
00:21:19
Then there were other things like, you know, he had a sternal dehiscence and that’s the separation of the, the sternum for those who aren’t clinical, who might be listening and you know, they could only diagnose that with a ct.
00:21:33
And I had to get prior off for a CT of the chest.
00:21:37
And it’s like, what do you mean it can’t be seen on an X ray?
00:21:41
We think this is what’s going on.
00:21:43
You can feel it, you know, upon palpation when you’re, when you’re feeling his chest.
00:21:48
But we had to get prior authentic.
00:21:50
Well, the average person, it would have taken a week to 10 days.
00:21:54
Not me.
00:21:55
You can imagine it took 24 hours for me to get that prior off done because I called and called and called and called, but the average priority person isn’t going to do that.
00:22:02
So anyway, that’s been in my gun sights and it’s in the gunsites of the federal government too.
00:22:07
So I Think they’re going to do some of the moving to electronic prior auth that’s a step in the right direction.
00:22:14
And then maybe gold carding, you know, certain physicians, when they create their orders, they, they always do it for the right reasons.
00:22:23
And so let’s just let those pass through.
00:22:25
We’re not going to question them.
00:22:27
If we’re the insurance company, I’d like to see it completely eliminated.
00:22:32
But you know, we got to take steps at a time.
00:22:36
And anyway that’s an example where I believe the government can set the tone by expecting it for Medicare, Medicaid, you know, va, et cetera, get rid of it for them.
00:22:46
And then everybody else is going to look and say well should we keep doing this?
00:22:50
You know, maybe we should be following government.
00:22:52
And oftentimes where the government goes with their situation in terms of being an insurance provider, the other payers follow.
00:22:59
So we can only hope.
00:23:02
But that’s in the gun sites right now and I think we’re going to see significant changes in that as a specific example over the next couple of years.
00:23:10
Yeah, and I think, I think you make a good point.
00:23:12
I, and I had a previous podcast where I talked to Mark Scrimshire and I’ve seen this myself when I was working at cms.
00:23:21
If the government can mandate or strongly encourage changes in the government health programmes, then it becomes more of a business solution for the industry because the industry says well, we’re not going to do things one way with CMS or with Medicaid and do it another way with our, our commercial business.
00:23:45
And, and all of a sudden changes start to get made.
00:23:48
So I think, I think that’s, that’s one area.
00:23:50
I agree with you that the other thing we used to talk about in the, in when I was in the government was what we call the North Star.
00:23:56
And part of that was saying okay, this is where we want to go eventually.
00:24:02
And what are the incremental steps along the way?
00:24:05
And then how do we promote those incremental steps?
00:24:07
We start with, you know, voluntary programmes, we start with, you know, some incentives.
00:24:14
We start with a little bit of stick and then we gradually, as more of the industry adopts it, then we increase the, the pressure on industry to go the rest of the way.
00:24:26
Sometimes it takes legislation, sometimes can be done through regulation.
00:24:31
But then we hopefully get to the North Star.
00:24:34
We never we did with, with ehr adoption.
00:24:38
I think in terms of adopting we got to where we wanted to be.
00:24:41
In terms of usage, I think you would agree we still have a ways to go but at least we got there where everybody hasn’t is using EHRs now for the most part.
00:24:54
And there’s certainly a lot more work that’s done electronically now than it was done even a few years ago.
00:25:02
Yeah, you know, I mean, I think to me it’s kind of like the typewriter moving to word processing.
00:25:07
Right, right.
00:25:08
You know, along with the transition from a typewriter to word processing, what happens?
00:25:14
Your expectations change.
00:25:16
The quality of the kind of document you expect changes.
00:25:20
You don’t expect any typos, you don’t expect any misspelt words.
00:25:25
You expect it just changes because you should be fixing it and reprinting it if it’s a printed document.
00:25:32
So the same thing has happened with the ehr.
00:25:35
As we’ve migrated from paper to electronic, what we expect the electronic to be able to do has just bushwound, you know, compared to what we expected when we were looking at a paper document.
00:25:49
And so those expectations just keep changing.
00:25:52
And I think that’s just the nature of the beast, so to say.
00:25:56
Have we transformed healthcare with electronic health records?
00:26:00
Of course we have.
00:26:01
The way we look at things today is completely different.
00:26:03
The way we expect data to flow and the way we can, you know, know, look things up and send information to patients and ask questions and, you know, all that stuff has changed.
00:26:13
Are we all feeling it?
00:26:15
Are we all feeling that our quality of care has improved and that the burden on documentation has changed?
00:26:22
You know, for, for clinicians, you know, I think a lot of people think the burden’s worse, you know, than it was when you could scare.
00:26:31
Yeah.
00:26:32
And so, you know, there’s this.
00:26:34
Yeah.
00:26:34
But the expectations have continued to change.
00:26:37
And so, you know, you always have to look at yourself in relationship to what’s going on right at that, at that moment.
00:26:44
And we definitely have to look at better tools.
00:26:46
I mean, we did take paper and sort of automate the paper and that’s, you know, not the world’s best thing.
00:26:51
So now that we’ve got pretty broad, broad spread implementation, it’s going to be really important for us to dive down and start to look at how do we actually transform form health care through the use of all the different new tools that we actually have today.
00:27:10
We still do so many different things.
00:27:12
I went to the doctor yesterday and had a mammogram and it was like, you know, I cheque in and they give me a piece of paper.
00:27:22
I know, I know.
00:27:24
Oh, paperclip to it is like four labels.
00:27:26
You know, I don’t know what those labels are for you know, anyway, it’s just kind of funny and you pass the paper to.
00:27:33
So, you know, have we actually transformed all of our processes?
00:27:37
No.
00:27:37
Have we made an impact?
00:27:38
Of course we have.
00:27:39
You know, of course certain things are much more efficient.
00:27:42
And by the way, I sit here today less than 24 hours after having my mammogram and I have the results.
00:27:48
You know, I looked him up in the portable for you and I started doing our taping.
00:27:52
So that would have never happened on paper, right?
00:27:55
Because they would have been mailing me the result if it was normal.
00:27:59
And so that would have taken out two weeks or something like that.
00:28:01
And if it was, you know, negative, then they would have called me.
00:28:06
And of course nothing happens on the phone anymore, everything happens electronically.
00:28:10
So, you know, we’ve made a big impact.
00:28:12
We have farther to go, you know.
00:28:14
Yeah, yeah, I agree.
00:28:16
And a couple, few weeks ago I got a MRI on my heart.
00:28:21
I have a congenital heart condition and I got the, did the MRI at one in the afternoon and by I was doing the podcast with Mark Scrimshire several hours later I’d already gotten the results of it in the portal.
00:28:34
So I mean that never would have happened years ago, would have taken days or even weeks.
00:28:39
So I’m not going to be, you know, I’m not going to be totally negative on it.
00:28:44
I think part of the challenge we have here is we have certain once you get more tools, your expectations grow bigger.
00:28:54
So what we thought was, you know, normal a few years ago is considered substandard now.
00:29:01
And you know, so, so it’s just going to continue to change.
00:29:06
And so what if, if you put on your crystal ball, you know, we’re now in the, in the world of generative AI, we’re getting into more personalised medicine, more personalised medications, certainly a lot of things that are, you know, of course the, the weight loss drugs, other things that have just come along in the last few years, but they tend to be very expensive in a lot of cases and there’s a question of whether the, the government or other major payers will cover them.
00:29:41
And if they don’t, then we end up in a, you know, a two tiered health system where those who can afford it, can afford it.
00:29:49
But, but I, and so from a patient standpoint I can see that.
00:29:53
But, but what about nurses and the clinicians, but particularly nurses, as we move into some of these changing areas that really create more of a personalised medicine and, and less of a reliance on hospitals and other traditional, you know, places of service, what what do you see coming?
00:30:16
If we were having the same conversation in 2034, what would you see as different inpatient care and, and the role of nurses?
00:30:26
So we’ve been saying this for years, but I’m finally thinking, I’m starting to believe it, and that is that, that the majority of care is no longer going to be provided in hospitals and that we really will have a continuum of care.
00:30:43
There will be some kind of help hub or health centre where we’ll go for our preventive things.
00:30:50
We may see a nurse, we may see a pa, we may see a doctor.
00:30:55
It all depends on, you know, what we’re being seen for and what we’re going there for.
00:30:59
Maybe that’s where we have our exercise class or our rehab post surgery.
00:31:05
But the hub of activity, if you will, related to health is going to move out of the hospital.
00:31:11
And today a huge percentage of nurses work in the hospital.
00:31:17
If you go to a clinic to see a physician, 90 some percent of the time, if there’s an ancillary person, which there usually is, it’s going to be a medical assistant, right?
00:31:31
Somebody that’s, that’s been trained with maybe a year’s worth of training, maybe something even less.
00:31:38
There are very few regular nurses that work in sub acute care or in ambulatory care settings.
00:31:46
Let me ask you a question, Judy, Can I stop you just a minute?
00:31:48
Sure, sure.
00:31:49
You know, we’ve been talking about this for a while, but I’ve noticed over the last few years Target has gotten rid of its, you know, it’s healthcare practises.
00:31:58
We’ve seen Walmart exit, we’ve seen Amazon exit, we’ve seen CVS and Walgreen exit at least scale back.
00:32:06
They all thought we were going to have these in store clinics where everybody go to, and then they’d buy, you know, other things from the store.
00:32:13
But I, it seems to me there’s been a lot of retrenching over the past couple of years and some of these urgent care facilities have expanded, but the ones that were, were gonna, you know, that Walmart and the others were gonna take over the world.
00:32:29
It never happened.
00:32:30
So why, you know, given what you were just saying, why hasn’t, why did that become such a failure in these places?
00:32:37
So I think that there’s increased faith on the part of patients in health systems and not in, you know, the pharmacy or the Target or the, you know, this concept of primary care hasn’t completely taken off, but it certainly started to build and we are seeing many people who do in Fact have primary care physicians today who are their centre, if you will, of activity and that’s who they go to annually and that’s who then refers them out to other things.
00:33:13
I think we’ll be seeing nurse practitioners playing in that role increasingly as well for people, depending on what kind of conditions they have.
00:33:22
Part of our issue is that people don’t do that until they start getting chronic diseases or until they’re older.
00:33:27
We don’t have 20 somethings having primary care physicians.
00:33:31
So they’re the ones when something’s wrong, they go to that, you know, acute, I call it acute care, but it’s not acute care, it’s urgent care.
00:33:40
Urgent care they call them.
00:33:41
Yeah, yeah.
00:33:42
And so, you know, those were the people I think that participated often in and you know, the targets and those kinds of things.
00:33:49
So I believe, and again, it’s hard to know for sure if value based care continues to grow.
00:33:57
This idea of health and wellness, invested interest in keeping yourself out of the hospital is going to continue to grow on the part of patients and on the part of providers, nurses and doctors.
00:34:11
And that’s going to proliferate and increase the activity that would take place in that primary care setting.
00:34:18
And I think that’s going to be happening.
00:34:21
But you are absolutely correct when you say, we’ve been talking about this for a while.
00:34:25
What do you think?
00:34:26
10 years?
00:34:26
I mean, seriously, at least, at least 10 years.
00:34:29
And then the thing with primary care, you know, one of the reasons for high tech was to increase and why David Blumenthal came to ONC was to increase the money and ability to recruit more primary care docs.
00:34:43
But we still have a primary care doctor shortage and the average age of the primary care doctors, I assume is probably much older than the average age of the specialist.
00:34:55
So.
00:34:56
And of course we know in the rural areas it’s become even more of a problem over the last 10 years.
00:35:01
Not just with hospitals closing, which gets all the headlines, but also the lack of primary care doctors.
00:35:08
So I hear what you’re saying, but if we’re pushing everybody towards a model where there’s not enough doctors because of either they don’t get the same pay that specialists do, or other reasons.
00:35:20
Some, some doctors want more, you know, quality of lifetime and other things.
00:35:26
I mean, are we going to get to that model or is it going to be, or is everybody just going to go to a nurse practitioner and just go to a doctor if they have serious health conditions?
00:35:38
I think for those of us who do do annual visits and for those of us who, you know, do have primary care physicians, I think the value of that and having a relationship with that individual becomes really clear, but what they do also becomes very clear.
00:35:54
And, yes, that these are great roles for nurse practitioners or doctorates, nurses with doctorates in nursing practise.
00:36:02
And so expanding the pool of who’s considered to be that primary clinician for you and who can help you in where you kind of work, your health world around is, in fact, going to start to change, I think.
00:36:17
Now, again, I’m not good at predicting the future better than anybody else, but I start to see some little inklings of change in that.
00:36:29
Using my husband as an example, we don’t see the cardiologist every time we go in.
00:36:34
He has a very excellent nurse practitioner that we see for most of the visits and then he only sees the cardiologist once a year.
00:36:43
And so, you know, I think we’re going to see those kinds of things where there’s teams providing the care and depending on what’s going on with you, you see the team member that’s most appropriate for what’s going on.
00:36:55
And when I look at what happens, for example, with my husband in a visit and in an encounter with the nurse practitioner, as compared to the physician, it’s completely different because that nurse practitioner is breadth and depth more talking about lifestyle, talking about the rehab and how is it working and did that med really bother you?
00:37:15
And this and that.
00:37:16
Whereas the doctor’s time was always so short, there wasn’t really a good conversation.
00:37:21
It was like, what’s going on?
00:37:23
Everything okay, great.
00:37:24
Not changing your meds, move on.
00:37:26
Because they were motivated by these very tight time frames.
00:37:30
Right.
00:37:30
So this, this team concept, I think, is going to be evolving and that’s going to change the way I think we think about the visit and the way we manage it, if you will.
00:37:45
Yeah.
00:37:45
And.
00:37:46
And I guess somewhat tied to that, but a little bit different.
00:37:52
I’ve noticed in our area, there’s a big movement towards concierge doctors and a lot of.
00:38:01
So a lot of people, when their primary care doctor retires, they have a hard time finding another primary care doctor and a lot of them move towards a concierge doctor.
00:38:12
And is that something that you think is going to tie in with what you were just talking about with teams, or is that just going to be a separate anomaly that may mainly people who are higher income are going to gravitate towards?
00:38:27
What do you think about that whole thing?
00:38:28
Because it really kind of does away with a lot of, you know, we talk about the government programmes and the role of the payers and stuff.
00:38:35
But these.
00:38:36
These folks are kind of, you know, going outside the system, at least in.
00:38:40
Some ways, and they’re more highly compensated and therefore they understand, like in every other way of our life, it’s competitive.
00:38:48
And if I want to keep a patient, what do I have to do?
00:38:51
I have to be nice to them, I have to share information with them, I have to give them all breadth and depth of information and, you know, make sure they understand what’s going on with them.
00:39:01
Those traits should be integrated into our health systems.
00:39:05
For all the encounters that we have, all of our encounters should be thought of as concierge, if you will.
00:39:13
And because it is a business, because patients are going to be, excuse me, more likely to do things if they understand them and if they believe in the person who’s talking to them and they feel they have a relationship with that individual.
00:39:30
So I think this team approaches.
00:39:33
Now I’ve got a cough.
00:39:36
I think this team approach is.
00:39:38
Is going to help create that seeing the right kind of person at the right time for the right duration, with the best kind of information, whether it’s teaching or whether it’s the short, you know, gee, something’s really wrong with me and I.
00:39:51
I have to see somebody immediately and everything in between.
00:39:55
Yeah, I.
00:39:56
I think.
00:39:56
I think I agree with you.
00:39:57
I think the relationship.
00:39:58
I have a primary care doc I’ve used for many years as well, and, and we do have a relationship.
00:40:04
I don’t always agree with him, but we have a, you know, relationship that’s built up over the last 30 years.
00:40:11
But a lot of the work done now is done by teams, like you said.
00:40:16
But a lot, at least for me, I get a different person on the team each time.
00:40:20
So I don’t have.
00:40:22
I don’t have a team that I deal with all the time.
00:40:24
I have a doctor I deal with.
00:40:26
But 90% of the work up front is done by this team.
00:40:31
And some of these people rush you through tests.
00:40:33
Some of them, you know, treat you differently than others.
00:40:38
So you.
00:40:39
You get.
00:40:39
I.
00:40:40
I feel partial.
00:40:41
You get it partially.
00:40:42
But even if you have your own doc, if you have different nurses or others assisting, you really get a different experience every time you go in there.
00:40:53
At least it’s been my experience.
00:40:54
Which is the opposite of concierge medicine.
00:40:56
Exactly.
00:40:57
And so the team should be as consistent as the primary provider.
00:41:01
And that’s something that, again, you know, we really, really, really need to work on.
00:41:07
And if, in fact, I have to worry about recruiting and retaining patients and imagine if everybody had to think about that, just like hospitals because of, you know, the exit interviews and getting good scores and people are looking up those scores.
00:41:22
Right.
00:41:22
The same thing should be and is beginning to happen with providers, you know, and it often happens with specialists.
00:41:28
We don’t go to a specialist, I don’t think that we haven’t researched and look at their reviews.
00:41:33
You know, the same thing is going to be true with this team.
00:41:35
I think, you know, we’re going to become more consumer like in our behaviour as compared to feeling like we’re, you know, this is what we have to do and you know, well, it’s the only person I can see kind of thing.
00:41:49
Right, right.
00:41:51
So I do believe that consumer behaviour on the part of patients is going to start ramping up.
00:41:58
I hope you’re right, Judy.
00:41:59
I think there’s certainly some good signs.
00:42:01
Well, we’re almost out of time and appreciate all the insights you’ve given over the last 40 or so minutes.
00:42:09
I just got a couple real quick questions, we can get some quick answers.
00:42:12
One is, so when you’re not busy thinking about healthcare, what, what on the personal side keeps you going during the day?
00:42:20
I know you have grandchildren and I.
00:42:22
Do, the one year old, four year old and seven year old.
00:42:25
And yes, yes, they, they keep me, they’re geographically close and they keep me very, very busy.
00:42:33
But I’ve always loved travel and that’s the other thing.
00:42:35
Both my husband and I travel together a fair amount and, and then the places he doesn’t want to go or doesn’t like to go, I go with my daughter who lives in Colorado but she loves to travel, lived in Singapore for five years.
00:42:49
So we go all different kinds of places.
00:42:52
In fact, we were just last month in Iceland.
00:42:55
So yeah, travel is, is a passion.
00:42:58
Great, great.
00:42:59
So, and the final question is if people want to find out more about, you know, getting information on, on what you are interested in or just areas of interest that based on some of the subjects we’ve talked about, what websites, books or publications would you recommend people go to?
00:43:21
Yeah, so first of all, organisational participation is important.
00:43:25
So if you’re in the informatics area and clinician, I would suggest amia, the American Medical Informatics association, becoming a member and participating in their conferences and.
00:43:39
Or they have publications, they have a daily publication as well as weekly publications, policy and advocacy newsletter.
00:43:46
So that’s certainly a way I keep up on what’s going on and that is where I personally participate on several committees, the health Information management system.
00:43:56
Society is also healthcare informatics, but not clinician based.
00:44:00
So that always has a bit more of a bent toward the IT side and the CIOs and the CMIOS and CNIOs, etc.
00:44:08
And then from a.
00:44:10
Yeah, books.
00:44:11
Yeah.
00:44:11
You know, by the time they get published, you know, if you’re looking for an opinion piece, you know, there’s some very interesting, you know, books on the market right now.
00:44:19
I’m particularly interested in looking at things from a patient’s point of view.
00:44:22
So Chris, Chris Ross and Ed Marks published a book.
00:44:29
It’s got the word diagnosed in it.
00:44:31
It’s longer than that.
00:44:32
But they talk about being patients and both of them were previous.
00:44:37
Well, Chris is a CIO and Ed was a cio.
00:44:41
So they talk about being patients and looking at things from a patient’s point of view and how it has impacted that.
00:44:46
That’s an interesting opinion piece that I think folks might be interested in.
00:44:53
Daytoday, I keep track through newsletters.
00:44:56
Amy has a newsletter, Hims has a newsletter.
00:44:58
And then I follow Becker’s.
00:45:00
You know, Becker’s has a couple of different.
00:45:02
One for clinicians, one for health IT people that are working in the computer area.
00:45:08
And so I think an online newsletter, receiving that weekly or daily might be a good way to keep up with what’s going on.
00:45:15
Well, great.
00:45:16
Judy, thank you very much for taking the time and appreciate it and hope to see you soon.
00:45:22
You got it.
00:45:23
It’s been great.
00:45:24
Thank you.
00:45:25
Thanks.
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