Technology-Driven Healthcare Presents New Opportunities for Leadership

Aaron Neinstein, MD

About 500 people receive care from the University of California, San Francisco (UCSF) following a lung transplant, and they live all over the western U.S. We used to fly pulmonologists to Boise, Portland, and Reno to meet with patients. Now, we send patients a home spirometer. A simple web app texts them once a week to collect patient-reported outcomes, such as by screening for shortness of breath, cough, or other symptoms that might signal organ rejection. This program has allowed us to reduce by 25 percent the frequency with which these patients have to come to San Francisco to receive some form of in-person care.

Strategic uses of digital technologies enable care model innovations that expand access for patients, relieve administrative burdens, and enable clinicians to practice to the tops of their licenses. These new care models layer together a mix of medical professionals, staff members, and asynchronous technologies to engage patients.

Remote Care Programs Must Benefit Three Domains

While this program has been successful, the road is littered with successful pilots that have struggled to scale. And, in talking with colleagues and peers around the country, I’ve heard how many of us have been challenged to develop successful, scalable, sustainable remote patient monitoring programs. What has made our virtual lung transplant care program successful?

Successful virtual care and remote monitoring programs demonstrate benefit in three domains:

1. Value to patient care and experience.
2. Value to care teams.
3. Economic value.

Programs that are able to demonstrate benefit in only one or two of these tend to fail.

Measure Rigorously to Improve the Patient Experience

One failing of our last decade with EHRs was the mistaken belief that we could deploy new technology and that alone would solve our problems. Sears and Blockbuster learned this lesson the hard way. They saw only the tip of the iceberg of customer experiences like e-commerce and web-delivered streaming video but failed to do the work that Amazon and Netflix did: Using digital to capture data to illuminate the customer experience, enabling experimentation and iterative improvements. As we create a new experience for our patients at UCSF, like web self-scheduling, we are trying to heed these lessons. We now dedicate a team to understanding the end-to-end customer journey, armed with very granular analytics to understand that experience. And members of that team do not quickly move on to the next project, but instead become experts focused on continually improving, in perpetuity, the new patient experience of seeking care with us.

They ask questions like:

• What words did the patient search to find care?
• How might we improve our web content to better serve their interests and needs?
• Once at our website, where did they experience friction?
• Which step in the process led to the highest rates of abandonment or frustration?

This team is focused on the data illuminating this specific experience, working to wring the next bit of friction out of that process.

From Pipeline to Platform: Excel at Core Capabilities, Partner for Others

As you start looking at the end-to-end experience, you quickly realize that a Google search is increasingly people’s front door to healthcare. To create cohesive patient experiences, we must recognize that we cannot and should not try to control the patient’s entire experience within our own digital environment. We have to look through the lens of the patient and enable a seamless, integrated “click and mortar” experience that weaves in and out of the digital and physical environments, and in and out of the care environments we control. Doing this well requires examining which core capabilities and competencies require us to excel, and where we need to partner to bring other capabilities to patients that help them achieve high-quality care outcomes. We need to rethink our business models and shift away from being pipeline businesses to thinking of ourselves as platforms that are focused on delivering outcomes.

For instance, rather than thinking about operating a lab, we should think about delivering a diagnostic testing capability to support our patients’ care outcomes. Through this lens, does a patient actually have to come to my lab where they’re going to pay me to draw blood? Or would a higher-value outcome result if I sent a home phlebotomist from a third-party partner to make the process easier for the patient while getting the same test result?

Live the Dream of Technology-Enabled Healthcare

Where do we want to be in 10 years? We want to ingest genomics data and patient-reported symptoms and use wearables to understand people’s physiologic states. We want to use machine learning to crunch data to understand which precise cohort someone belongs to, matching them to just the right treatment plan for them. We then want to leverage data to individualize the patient’s experience to support them in staying on track in that treatment plan all throughout their journey.

We’re a long way from that. Many institutions, like UCSF, have launched the earliest stages of developing this capability by instituting command centers. Right now, these are focused on optimizing flow throughout our hospital and care networks, understanding things like availability of imaging or hospital beds to identify efficiencies. Someday, these command centers may become the central nervous system to support that future-state vision of coordinating and routing care and care plans across the patient spectrum.

If all of this seems a bit daunting, it is. While artificial intelligence (AI) may someday be ready to enable that future state, at present the best AI use cases are focused on the administrative burdens, the organizational “rocks in our shoes,” like prior authorization, supply chain management, or revenue cycle analysis. We should focus on those AI use cases that help relieve administrative burdens and enable doctors to spend more time forming relationships with our patients.

We Must Transform Our Organizations

As healthcare organizations, we cannot look at our new patient portal app and pat ourselves on the back. If we thought EHR implementations were difficult, what we have to do in the coming decade is so much harder. When we deployed EHRs, we largely put new technology on legacy processes and workflows. To make the leap with digital, as leaders, we now must transform the culture in our organizations to learn to become digital organizations that know how to create and use data.

This transformation starts with operational excellence and standardization. Next, an organization must bring in and develop new skills and types of talent. Consider designers, service designers, data scientists, product managers, digital marketers: Healthcare organizations commonly don’t even have job descriptions for these types of roles, but people with this expertise can help us build the teams, the processes, and the culture of data literacy to help us understand how to ask the right questions of data. By illuminating our patients’ care journeys with data, we can identify and remove friction points and barriers, and help personalize experiences that adapt to and support the needs of each individual patient.

To learn more, watch Dr. Neinstein’s presentation, “Improving Clinical Care Through the Application of Digital Technologies.” This presentation was part of the Executive Advisory Board meeting hosted by TDC Group in August 2022:

Aaron Neinstein, MD, is Vice President, Digital Health, at University of California, San Francisco (UCSF) Health, Senior Director at the UCSF Center for Digital Health Innovation, and Associate Professor of Medicine at UCSF.

This article was developed from Dr. Neinstein’s presentation and discussion at the 2022 Executive Advisory Board meeting, hosted by TDC Group. Get plugged in to the latest trends, data, guidance, and viewpoints from industry experts at Leading Voices in Healthcare.