This week I am talking to Jay Anders, MD (@medicompdoc), Chief Medical Officer of Medicomp Systems (@medicompsys), and fellow HealthcareNowRadio podcast host. Thanks to a long history in clinical practice blended with a technology focus Jay has keen insight into bringing real change to our healthcare system.
Like me his ability to influence healthcare positively has been amplified by his participation in technology and innovation and how to address the challenges in healthcare without further overwhelming the clinical staff.
We discuss the latest big bet into the healthcare space – Amazon purchasing One Medical which as I noted
https://twitter.com/drnic1/status/1550110121182855169
is no small bet by Amazon on their participation in disrupting healthcare.
We discuss burnout, which much like the idea that people don’t want to work, has been around for a long time
https://twitter.com/paulisci/status/1549527748950892544
But importantly is contributing to further stress and strains on the system adding with large numbers of people leaving the workforce further creating gaps in resource availability. We discuss the challenge of transparency and drug pricing which as Jay points out is much like the price of an airline ticket – very hard to predict (see If Airlines sold Paint).
Listen in to hear our discussion on new entrants to healthcare and what they need to do to bring real and lasting positive change to the system and where we might be able to offer important relief to the beleaguered staff by removing some of the barriers and hurdles to the focus everyone wants to have – on the patient.
Listen live at 4:00 AM, 12:00 Noon, or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
Listen along on HealthcareNowRadio or on SoundCloud
Raw Transcript
Nick van Terheyden
And today I’m delighted to be joined by Dr. Jay Anders. He is the chief medical officer for Medicom. Jay, thanks for joining me today.
Jay Anders
Thanks for having me, Nick. It’s a pleasure.
Nick van Terheyden
As I do with all my guests, I think it’s important to set context. And to do that, tell us a little bit about your career and how you arrived at this point in time.
Jay Anders
That’s it’s kind of an interesting story, at least I think it’s interesting. I dabbled with lots of things in my in my medical career from being head of a large multi specialty group to being medical director of a health plan, as well as being Chief Medical Officer of several iterations of healthcare IT companies. But it all started back when I was actually just out of residency, a colleague of mine who was an emergency room physician, back in the time of next computers, if anybody remembers that box. We decided that we since the ER was kind of fraught with problems, we’re going to make a new ER, electronic medical system. So we started down that road invested several 1000s of dollars and absolutely went nowhere. But the idea stuck. So as I went through my career, I finally after 17 years of full time practice, decided I wanted to get into healthcare IT and I was asked a question when I first started, it was kind of an interesting question. So why do you why do you want to get out of practice? Why did you do this? I said, Well, you think about it this way. You know, in my practice, I saw about five to 6000 patients a year, patient visits plus hospital. And I made hopefully made a difference. In healthcare IT I saw the opportunity to make a difference in hundreds of 1000s of visits, simply because we just haven’t gotten it right yet. And we’re striving there’s been progress. But that’s kind of how I started in my healthcare IT career after being a general internist in the trenches for 17 years.
Nick van Terheyden
So interesting, you bring up a lot of, you know, personal memories. From my perspective, I had a similar sort of sense, you know, my ability to lay hands on individual patients was vastly expanded as I got into the technology side. But I would say my trajectory, and you know, I’ll say culpability at this point, relative to the EMR where you had an experience, and let’s be clear, it it failed. It didn’t work. I had an experience with the EMR where, you know, I saw or perceive this to be this wonderful tool set that we could deliver value, we’d bring information, you know, the single access paper note was clearly insufficient for the purposes of shared care, you know, multi specialty, all of those things. And we rolled out, I was part of a number of rollouts of electronic medical records, I could have been seen at the front cheering everybody on. And in hindsight, I feel like I foisted something on my physician colleagues that was just not sufficiently up to the task. And I’ve been apologizing and trying to fix it ever since. Tell us a little bit about your experiences as you got into the technology piece.
Jay Anders
Well, there was very interesting, it kind of started out the same way yours did in the fact that one of the early EMRs was in a company named emigrate, which is out of business wealth, got sold and sold and sold. first started out by having a unified view of a medical record, that’s all it was to do was to bring disparate pieces of medical information together, which we’re still trying to do. But it that’s how it started. And it grew, and it got better. And one of the things that was very obvious from the very beginning, is that when we started to involve one of the reasons I got involved with that company is they wanted a physician representative to the physician provider community. So they wanted someone to go out there and talk to Doc’s. So I took that roll on. But what was interesting is after we start really started talking to the people that were going to use these systems, things started to shift. And what I mean by that is the functionality had to keep up with the physicians workflow and thought process and not start to suck them down in a rabbit hole, which is what usually these systems did for a while they still do to a certain degree, but it’s getting better So talking to them and starting to involve them and have their own physician advisory board. And I’ve had that with every company I’ve worked for now, because I set it up, it was remarkable to see the input they have when they’re asked, because who knows better what they’re doing with a patient than the person providing the care. It’s amazing. So with that it, you know, working on well, what’s the next iteration of workflow enhancements and presentation enhancements, and those kinds of things to really make that process better, and to actually advance the care of a patient. Because when EMR started out, everybody knows this, they were billing mechanisms, that’s what they did. That’s all they did well, and sometimes not so well. But that’s what they were created for. They were never created for patient care. And when you start to introduce that patient care aspect into this, workflow it into these systems, and you start to give physicians something back, that actually helps them do their job, or the nurses give it pick up, pick up provider, you really start to see amazing change. And what I mean by that is people start to enjoy using things as opposed to oh, I’ve got a document another note. And I’ve said that many colleagues, I said, I didn’t go to medical school to write a note never did, I went to see and treat patients. That’s what I was trying to do. So help me do that. And I think, as we keep continuing down that road of enhancing that capability, giving the information to folks when they need it, getting it gathered together from all the disparate places that resides, we’re going to see a little bit of a renaissance.
Nick van Terheyden
So I think, as I sort of unpack this electronic medical record, and, you know, the current pressures on our clinical staff, the thing that pervades, throughout that I hear and, you know, often is attributed to the electronic medical record, and I think it certainly does contribute is, well, this is burnout, you know, we put our residents, they end up in the basement of the hospital, they spend 70% of their time looking at a screen, not at the patient, you know, to your point, that’s not what they went to medical school. And, you know, there’s a almost a pointing the finger at the electronic medical record. But then I cast my mind back and I practice pre electronic medical record era. And it was paper notes. And I know I was burnt out. So it’s not new. It’s not just the electronic medical record, but it certainly contributes. So if we’re to change the way that we practice medicine, is technology, can it be part of the solution? Because it feels like it wasn’t as we introduced this, I mean, I think you’re right, bringing the information together was essential. Because if I was picked one thing, it was finding information in the the days of the paper notes, because as you were talking about it, I’m just cast my mind back to the number of times we do a ward round. And so where are the lab results, no card fine or not to save lives? Now, I think that’s probably not true, better search functions. But we’ve maybe overlaid more, is it because of the additional administrative overload? What Where do you see as addressing this so that we can start to deliver what exactly you and I went to medical school for, which was to treat the patient, not the system.
Jay Anders
That’s very interesting. And I think technology does have a part in this. One of the things that I have seen that’s happened over the years is all of the oversight that is put on the practice of medicine. And when I mean practice of medicine, I mean in every aspect of it. So we’ve got quality measures, we’ve got Star measures, we’ve got a health plan that’s got certain guidelines they want you to follow. There’s all of that buzzing around you. And there’s really nothing right now that were there some but not enough of things to help you fix that or do something about that. Wouldn’t it be nice to be able to just practice medicine, because most of us know what to do 98% of the time we do. It’s the 2% of the time maybe to look something up or guideline or whatever to get all the details. But wouldn’t it be nice to practice medicine with all that stuff, just kind of get done in the background? And then maybe something comes up and says, Well, you missed this one thing. You’ve done these 42 things in the normal work of what you’ve done. But here’s the two things you didn’t have er s, and they’re part of some guidelines somewhere, wherever that you have to. And when the patients present, you have that happen. That’s not the way it is today. And I think that’s part of adding burnout, to the practice and the delivery of care. Because clinicians have to bear in mind that if they don’t do it correctly, someone’s going to call, someone’s going to say, hey, you missed x, because of some quality measure, or some note requirement, or something along those lines, as opposed to why can’t we just practice medicine and let that automatically happen? Technology can do that. I know it can. I’ve seen examples of it. I work for a company that provides part of that. So I I’m very encouraged that that could actually alleviate some of that burnout, because you’re right, it’s not the electronic health record that’s burning people out totally. It’s all the pursuade everything else that has to be addressed around a practice of medicine in today’s world.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Dr. Jay Anders, he’s the Chief Medical Officer for medicomp. We were just talking about burnout and the contribution of the electronic medical record technology is, you know, at least potentially part of the solution, but it’s certainly been part of the problem for sure. And, you know, I always cast out so I think about other industries, other places and, you know, contextually to right now we’ve just seen a big, you know, to use the poker analogy, it’s not all in but it was definitely a big bet. And a big raise with Amazon now moving into the space. And they’ve clearly been in we’ve seen a number of others. They’re a technology company that to me, gets an easy experience. I mean, there’s a reason that people shop on Amazon, it’s it’s just I, you know, I can do it everywhere I can you know, it, it works one place, and the other things show up. It’s just and it’s gotten better over time. Is that what’s been missing? Have we missed that customer? And in this case, I guess patient centric is, do you think that that’s going to really start to bring about a change that individual patients and importantly, clinicians will go, Wow, I’m now starting to feel the positive impact of this?
Jay Anders
I believe it is. Amazon definitely has the horsepower, as does Google and Microsoft and Dell Oracle buying Cerner. There’s a lot of this going on right now everybody’s got their own little way of doing it. When you talk about patient focused versus practice, focus, that’s a really good distinction, because I believe as we really start to focus on patient care, treating the patient, making them better, making them not get sick, through preventative health care, we actually will save money, our patients will be happier and will be happier, because we’re not dealing with disasters. And that’s, you know, as a general internist, every week or so I would have an absolute catastrophe walk in the door and have to deal with it. But that’s not the normal way of doing things. So when you think about Amazon, I think about banking for that matter. You think about Amazon, you get this beautiful experience, user experience, before you do what you’re going to do, which is order a product. So if that’s the approach, we take in healthcare, it, we’re looking for a great user experience. And quite frankly, there’s several users patients are one providers or another. If we provide that. I can’t help but believe that the whole practice of medicine will not be as onerous as it is now portrayed to be. But it’s gonna take a multi system approach to get that done. So it’d be interesting to see what Amazon actually does. We talked a little bit before about drug pricing, and drugs and providing those and, you know, everybody has their different way of doing things. And it’s almost like airline tickets, you don’t know how much you’re going to pay and who’s going to cover it and who’s going to do whatever, if that were more transparent. And I think the non transparency is also a burnout element. When you just don’t know what the outcomes going to be when you write a prescription. Which is, are they going to be able to pay for it? Are they going to eat whatever you want them to take the drugs so if they gotta get it and they got to pay for it, and if the insurer Aren’t companies involved and all that nonsense? I think that’s part of the lack of transparency really leads to burnout. Yeah,
Nick van Terheyden
and let’s pick up for a second because you cited some of the other players that, you know, potentially have the scope to step into this and deliver a better experience all round. So Google, and Cerner and Oracle, and so forth, but I’m gonna push back a little bit and say, I feel like I saw Microsoft, and Google’s stepping into this few years ago, we’re gonna fix healthcare, and I’m just gonna, you know, not to be mean. But they did step back out, I felt with their tail between their legs. So, is Amazon. Different? You think is I mean, I want to be hopeful to be clear, because I think, you know, this is an entirely altruistic I need it to work for me. And I want it to work for my colleagues, I want it to work for my daughter who’s just entering the profession. But I’ve the you know, I’ve just got this little bird on my shoulder go. No, I think I’ve seen this before.
Jay Anders
You have, and we all have. I’m hopeful. I believe that a healthy competition in this regard, will further things along better and more quickly. So I’m hoping that Amazon will take some of their supply chain knowledge and experience and apply it. Are we assured of that? Absolutely. Not that and that’s the fear I have. Money does not solve this issue. Being ingenious, and, and thinking outside the box and transparent, we’ll, and we’ll just wait and see.
Nick van Terheyden
So if you were to pick threads of you know, elements of areas where we have seen value, we’ve seen improvements in your past, and I’m sure you’ve seen instances where we have turned the corner or move the needle, what what stands out to you as things that really make a difference in the healthcare space to improve things?
Jay Anders
That’s a very interesting question. I’m going to put on one of my old hats for just a moment as a health plan, Medical Director back in the old days, and I can say that no, we had a lot of things that we had to see are pre authorized before we did. And it just wasted time and extreme amount of resources and utterly ticked off patients and physicians. I mean, it just didn’t work at all anywhere. And it was done. As we’ve talked about before, to save the insurance company, my order to make sure that we’re delivering the care at the appropriate levels, that’s the party line that is starting to go a certain things are no longer have to be pre authorized. We talked a little bit about that. And that, by far and away relieves a lot of stress for both patients and clinicians. I think that’s very helpful. I think some of the movement I have seen in drug pricing, and drug fulfillment has also helped move the needle a little bit. I’ve also seen that they are now finally starting to develop standards for interoperability. Now that’s in its infancy. And it’s got a lot of potholes. But that also is a movement forward, which I think is going to really enhance medical care in the future. So I think it’s combination of a lot of things I do. But some of those are the things I see moving that needle just take away some of the administrative nonsense that is required for us to deliver care as as a physician, and patients to receive that care as patients because nothing is any worse than saying I think you have something really bad. And I have to order this very expensive test to figure that out. We’ll get back to you in two or three weeks till we get the insurance company and say it’s okay. I mean, that is complete and utter crazy making for everyone involved.
Nick van Terheyden
So radical thought around here and you know, one of the reasons that I feel we move to this lowest common denominator all the time and you know, prior authors are good example of that where, you know, 99% of the population is trying to do good, they’re not, you know, I don’t think people don’t get up with the intention of deceiving the system, you know, squeezing for maximum value for personal whatever, I just don’t buy that. There are small exceptions. But what ends up happening is, every time somebody does it, we find that the system goes, Oh, my God, I hadn’t thought about this as a route around to, you know, deceive the system and squeeze money out. So we must put a new control in place. And again, I think about other industries, and for me, education is one where testing and not getting into other testings, right or whatever. But what I thought was really interesting that they did, instead of focusing on the process of the test, you know, and we do see that way, you know, you go through metal detectors, you know, the almost strip search to make sure you’re not bringing in elements to cheat the system, but they use statistical analysis posts, the event to say, we can see that people are cheating here. And instead of focusing on, let’s change the whole system for everybody, let’s fix it in the back end, and accept that there will be some cheating in the system. But we will catch it and you know, deal with it subsequently, is that perhaps the way to think about this, and the way that technology could help us in the future,
Jay Anders
I really liked that idea. It is, it is synonymous with the taking off your shoes at the airport, we had one person sit there and hit down a bomb in their shoe, now everybody’s taking their shoes off, still still taking their shoes off. So now it’s the same thing in healthcare. And I’m gonna call it reimbursement because it reimbursement is much multiple different things. You have a person get around the system by doing X, make the penalties for that severe and put systems in place to prove it. So what the money has been paid out, but you can get the money back. I mean, it’s it’s part of it’s part of the process. So don’t penalize everybody, for 2% 3% 5% of bad actors in the system, that that just doesn’t work.
Nick van Terheyden
Yeah, I like that. And I think the I just maybe disagree with the percentages, I’m I guess I’m more on the hopeful side that it’s less than 1%. But you might be right. How many people are focusing on that? So as you think about the future, what are you excited about? Where do you see this going, you know, what what, you know, keeps you driving to a positive outcome for healthcare and for, you know, our population?
Jay Anders
Well, one of the things that I never had, even in a multi specialty group practice with a unified medical record was a real complete picture of a patient’s story, because to be clinics in town, there’s stuff over there and stuff over here. One of the things that really excites me is starting to get a unified picture of a patient’s health and all of their data elements together. So wherever you go, and whatever you have, the physician or the team who’s treating you know that so you wind up in an emergency room, passed out, no history, they get to a system that says, oh, Jay takes this, this, this, and he’s had this and this done. And, you know, everything they need to know about Jay is right there. So whether J can’t talk or not, or Jays wife’s not there, whatever, it’ll be there. That’s exciting. To me, that takes a lot of moving parts to do. Data’s got to be, you know, standardized, there’s got to be a standardized protocol, there’s got to be a transmitting, there’s got to be a way to find it. So that really excites me about healthcare moving forward. It’s not going to be just one thing, but I think getting the medical record together, it’s going to go a long way to really move the needle both for quality and satisfaction.
Nick van Terheyden
I think it was really interesting about that concept was the the company that you talked about, which ultimately disappeared, right, which that was their sole purpose was to bring all of that information together. So what’s old is new again, I think, you know, there’s there’s not a physician on this planet that wouldn’t want that capability to be able to deliver the best possible care. And I think the one thing maybe I would add is with the appropriate level of security and the ability to get to it without sick Hearing it so much that you can’t get to it because you can’t unlock the key to get to the information. But I think we can do that. And I think technology can help. Unfortunately, as usual, we’ve run out of time just remains for me to thank you for joining me on the show. Jay. Thanks for joining me.
Jay Anders
Thank you, Nick for having me. It’s been a pleasure.
