Affordable Equitable Healthcare for Everyone
This week I am talking to Miles Romney, CTO and co-founder of eVisit (@eVisit). Miles has an unusual and interesting background, he is a health IT expert who also produces Broadway musicals and has even won a Tony Award. His diversity brings some unique insights to the world of healthcare where he started his early career but has taken several sojourns into other areas including Cybersecurity, video and audio and performing as an opera singer and building an investment group 42nd Club that has been one of the most prolific producers on Broadway.
Focusing on the second biggest problem facing our world, Miles looked to find solutions to delivering affordable equitable access to healthcare for everyone where eVisit has focused on connecting local providers with their patients answering one of the push backs we hear around Telehealth that has divorced patents form their existing health care teams. He shares their statistics of usage that go far beyond the initial x12 increase they saw from COVID19 that signals Telehealth is here to stay and going to expand
You can hear him talk about the key method of innovation that is Incremental and have to listen in to be inspired with the great opportunities that exist for solving world problems. As he points out we have made incredible progress (think nutrition, agricultural, travel, energy, resources and technology) and it has only gotten faster and better and now we are going to apply this to healthcare. It won’t be trouble free and we still have challenges but he has an exciting vision for a full on Star Trek Medical Bay in your home (a vision that he and I share) that will ultimately make the recurring debate over healthcare as a right or privilege moot.
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.
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Raw Transcript
Nick van Terheyden
And today I’m delighted to be joined by miles Romney. He is the CTO and founder of evisit. miles. Thanks for joining me today.
Miles Romney
Absolutely my pleasure to be here.
Nick van Terheyden
So I’m, I’m kind of excited about this. This is a unique position for me. I’m pretty sure that I don’t have anybody in my connection or network that I can say is, from the Broadway musical industry, or indeed, in your case has won a Tony Award. That’s pretty incredible. But you’re still linked to medicine. Tell us a little bit about your journey because it’s entirely unique and I think entirely relevant as well.
Miles Romney
Oh, absolutely. It’s diversity despite is the spice of life. I’ve lived by that mantra since I was very young. I had my first full time programming gig when I was 13. I got started in healthcare when I was very young, I wrote the first Electronic Health Record system for wireless mobile devices in clinic. We sold that to BlueCross BlueShield. Then I continued along the technology track and went into security specifically built out secured document and data transmission and storage methodologies to answer what were in those days the new HIPAA requirements and then got specifically in a video and audio where security were concerned and architected packet streaming encryption systems for video and audio over the web. Simultaneously though, I have an artists temperament I’ve always been in love with with music and and performing in film. So I got it I got a degree in vocal performance. And, and it masters work in that area as well and have sung as an opera singer on four continents. And then from from an investment standpoint, want really wanted to be involved with Broadway. And it became clear that the best way to do that, from my perspective was really be the one writing the checks. That insight came from a longtime dear friend of mine, Phil Kenny, the the real inspiration for the group that that we’ve built 42nd Club was his and we’ve gone about then it just building up a network of investors that we have been put into Broadway shows as investors The idea being that to diversify their investments, so rather than putting in half a million dollars into a single show all your eggs in one basket, being able to diversify that across a number of shows and end up doing better in the end. So that really is where the Broadway tie in, has has come in. But 42nd Club has grown to be one of the most prolific producers on Broadway. We’ve had over a dozen Tony wins and over over 50 nominations. So it’s a that has been a lot of fun. But it’s a technology has continued to be really my bread and butter, where I’m applying most of my creativity, though, then I did go into the entertainment industry with it for about 15 years and work very heavily in video and audio in the entertainment area built out to a streaming the consumer streaming systems for ESPN and Electronic Arts and Blizzard Entertainment. DirecTV a number of others, built and sold a couple of media companies animation studio, ran a film distributor at all, however, with a strong technical component to them. And I got to a point though, when as much as I’m in love with what entertainment does, I I believe that maybe the biggest thing that sets us apart from other animals is our storytelling, that our stories are central to what we are who we are as human beings. So entertainment to me is really more than entertainment. It is the it’s kind of the the oral tradition almost that it’s how we it’s how we build a continuity generation to generation and turn ourselves into as humanity and multi generational organism. The but I got to a point where I really wanted to get back into healthcare to solve what I see is the second biggest problem in the world, which is the high cost and spotty availability of health care. And that’s when I connected with Brett Larsen, who had a similar vision was just coming out of a company that sold to teladoc. About seven, eight years ago, staff doctors was the name of that group. He came out with a with a very strong thesis. He was heading marketing over there. He talked to about 5000 people who fell out of the funnel who came in to get telehealth visit and then decided not to and discovered that what they were most concerned about was that they were going to be seeing providers that they had no connection to the no them to know anything about their histories and learning about their futures had no ability really to contribute to their holistic care and wellness. So we got into telehealth and not only that, but but the major players At that point and they’re they’re big gorillas today to the animals in the teladoc. We have great respect for they’ve primed the market, they have tackled ated people to the idea of telehealth, they’re doing some great things, but they are disrupting it in in one very significant unhealthy way. And that is that they are really divorcing patients from their local existing care teams. And rather than promoting the industry to go towards long term holistic care and wellness, they’re breaking things up into discrete episodes, that we think it really stands to break the system moving forward. So we built our solution out to put into the hands of existing hospital systems and clinics so that they can continue caring for patients, they’ve proven to the world that they’re the ones who are best suited to do it. They’ve also proven to the world that they need more efficient ways to deliver it, costs are skyrocketing availability is not as wide as any of us would like. So our our vision has been to simplify healthcare delivery to everyone everywhere, by building out technology that we can then put into the hands of networks, payers, doctors who who are already doing great work caring for their patients. And and that really brings us to today, telehealth, in this telehealth being that we another reason why we chose telehealth is it’s it is something that people are are very open minded to adopting, which changes their existing healthcare workflows, which then introduces a lot of opportunities to to build efficiencies into other areas. So where, where where a lot of companies so my call themselves telehealth companies and leave it at that. We we don’t like that we were we were recently named by Forrester is the leader in the telehealth market, the sole leader in the telehealth market. A lot of companies would see that as an arrival point. It’s a starting point for us telehealth point telehealth is really just where we’re, that’s where I see the journey begins. But the journey ends far into the future with with a host of other innovations that will come to market. Some of them will be from a visit, some of them will not. And this is in fact what I really love about your podcast is that you you highlight technical areas, some of which and healthcare, some of which are not, and which don’t tend to be Eureka, epiphany is in and of themselves. It’s It’s It’s small innovations building on small innovations, which add up to something much, much bigger. I love that. That’s the approach that that we take at evisit. And you’re shining a light on it and brilliant.
Nick van Terheyden
Well, thank you for that. I mean, obviously I’ve I’m I’m passionate around the incremental approach, I get pushback, occasionally people say no, we’ve got to reach for the moon. And you know, and I don’t disagree with that. I think, you know, the space program that I know, you share. Clearly, some insights and interest in, you know, was driven by that sort of reach, but they still got there through those small things all the way, you know, they kept blocking and tackling. So, you know, always the approach, you just speed up that sort of cycle. I want to go back to the telehealth, comment that you made and just get your thoughts around there. So I would have said and you know, I felt like I was saying this for an extended period of time telehealth was two years away for the last 10 years. And still is. But I think that’s changed. And I’m curious to know, if you feel the same that the the pandemic COVID-19 has been. It’s certainly been an inflection point. But is it a permanent one? Do you think there’s a real flexing towards acceptance and a shift away? Or are we going to go Alright, that’s all over. Let’s go back to the the old way of doing things.
Miles Romney
Yeah. That is a great question. It’s a question that’s on a lot of people’s minds right now, I can say that the data indicates that it’s here to stay. Certainly, around April of last year, we saw the biggest spike our utilization almost overnight was up 12x. It didn’t. It didn’t hang out there. It dropped from 12x down to about about 8x. But then it has continued to incrementally climb from there, to a point where we’re actually projecting even with only a modest growth. Over cue one’s numbers from this year, we’re projecting that will will double the number of encounters with patients this year that we had last year, even even coming out of COVID it was one of the advantages to the and I hate to I’d love to like I’m an incurable optimist. I like to find silver linings. The the pandemic clearly has been a tragedy on a number of fronts, and it’s a huge difficulty for the United States and everyone around the world. But as pandemics go looking at it from a historical standpoint, a very, very small number of people, that percentage measured by percentage of the population has been impacted. And it’s been a particular mercy works where children are concerned, in fact, over 500,000 deaths in the United States only to COVID, under 300 children who have died. So that has been a mercy. This has given us all an opportunity, in my mind, to it’s a kind of a dry run, to look at what it takes to be healthier in the future to be prepared for this kind of a pandemic. And when we’re, we’re, I am an optimist, but I also recognize that there’s an increasing number of biotech labs around the world, DIY, biotech and tech is becoming a thing, that bio engineered bio hazards are absolutely going to be a major challenge of the next century. And something like this COVID pandemic has taught us now the protocols that need to be in place in order to deal with this kind of thing. So that when something far deadlier comes along, of course, we hope it won’t, but if it does, we’re now far better deal prepared to deal with it. And hospital systems and patients alike. Have have now they have a taste for, for for remote interactions across the board. That’s that I mean, a lot many people are predicting the business traveler is going to be way down that we’re going to be interacting remotely now or video conference much more than we were before. On the healthcare side. You know, it’s it’s not unusual at all, to see patients going to the press, when they call their doctor and are told that they can’t have a telehealth visit. And doctors actually take heat for not offering that as a as a service. We also have a lot of hospital systems who adopt a temporary solutions that were very quick to deploy the web conferencing solutions that which are great at what they do that the zooms and the Google meats and the Microsoft Teams. But video conferencing is to what a company like evisit does, as a park benches to a hospital. Sure, you can choose to have a conversation with a patient under under God’s blue sky with with grass and trees and birds singing around you. But if you want to make it efficient, and provide a high quality of care, then it’s going to require not only physical infrastructure, but a personnel infrastructure, it all has to be well coordinated. Patients are coming in, they’re seeing a patient access representative sometimes sitting down with someone from billing first, sitting in the waiting room, filling out their registration intake paperwork and seeing triage nurse having their vitals taken finally seeing the doctor maybe to then going back to talk to somebody at checkout, sometimes, sometimes on to get labs after that. So it’s that entire continuum, that that is so important when we talk about the idea of telehealth in virtual care. And what really sets it apart from video conferencing, the value that telehealth brings is, is only in very small part in the actual video interaction that happens most of the value comes before and after that video interaction. So in In short, this, this, and I might just highlight one case study and this was before COVID even but but it demonstrates the kinds of gains and efficiency that people are finding as a result of adopting telehealth, which, because of COVID, they have had a very, very compelling incentive to do so. So they’re they’re starting to realize some of those benefits. There’s a client of ours a clinic outside of Detroit got 30 primary care providers, they almost immediately upon adopting our solution, they they were seeing close to 1000 visits per month. They and that carried that carried on even today, two years later, they’re doing even more than that volume. But the specific workflow that we recommended for them to take was to shift all of their follow up visits for prescription refills to virtual visits. They’ve got patients who are taking a schedule to drugs like Adderall and Ritalin, and the state of Michigan requires that they have monthly follow ups, those follow ups weren’t always happening, which means that they weren’t fully compliant, and meant that patients weren’t getting the care to level that, that they really needed. And in some cases, their prescriptions were being delayed it by moving that to a virtual workflow. Patients didn’t have to try to come into the office, it was easier for providers to make those visits short and sweet, and get more of them onto their schedules. Within a year. They had done over 12,000 visits 75% of which were these return. These follow up visits for prescription refills and have realized a million dollars in new incremental revenue. They hadn’t seen before. Because they were booking those appointments and getting reimbursed for them as they weren’t before. So it COVID has allowed everybody to experience some of that, that there are so many encounters that just do not need to be face to face that it’s safer for them not to be face to face, a patient may not come in and get in there, there’ll be at risk of sick.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist and today I’m talking to miles Romney, he’s the CTO and founder of he visit, we were just talking about the sort of opportunities that came about as a result of, you know, the challenging pandemic that sort of swept over the world. I think you’re entirely right, I always try and find that silver lining throughout. And again, it’s it’s a inflection point and a springboard moment in my mind to sort of allow us to expand out into these new areas. And I wanted to get to some of the thoughts that you had in terms of the future of medicine, you shared your background in terms of some of the experience, you know, the areas of work, tell us a little bit about what you see and where things are going or where they should go. Let’s say that not where they’re going currently, but where they have the opportunity to go from a healthcare standpoint, particularly in the medical or the virtual healthcare setting.
Miles Romney
Yeah. And that’s it say, I am a futurist, I love to paint the paint the future by looking at current trends, what what’s in danger of happening if they continue, and what can happen if the good ones that continue and are really built upon. I’m also an optimist. So I like to I like to focus on the positive ones. But I also like to convince people that the positive ones are positive. There’s a lot of negativity negativity floating around. So sometimes when I paint a beautiful future, I get some pushback from people who view the present. Very pessimistically. And so they wonder how we can get from here to a big bright tomorrow. So I like to just highlight some things that people don’t realize that by 2100, yes, population is growing. And we’re projected to have over 10 billion people on the planet Earth. But if you look at what has just happened in the last 200 years, life expectancy, almost worldwide is increased has doubled, gone from 40 years, up to over 80. In the crop yields have more than tripled for some staple crops. It’s estimated that over the next 30, some odd years an area the size of India will be returned to nature because of worldwide improvements in agricultural techniques. literacy, if you look at literacy today versus literacy in 1800, it’s been a complete swap, that in 1800, there was 90% illiteracy. Today, there’s nearly 90% literacy worldwide. And looking at but then comparing that to the number of hours on average that we’re working with, which is half as many. So we’re we’re in the beautiful thing about innovation, as compared to population is it actually increases per capita as population increases. So the more people we have on the planet Earth, the more innovation we have, the more beautiful technologies, innovations in workflows, lifestyles travel come about. Which means that that we’re actually using not only per capita, in many countries, we’re using less energy and fewer natural resources than we were 50 years ago. But in countries like Britain, where they’ve seen a something on the nature on the order of a 30% population increase over the last couple of decades, they’re actually seeing something on the order of a 10% decrease in aggregate energy usage across across the entire country. So like I say, I’d like to set the stage with everything that’s going right in the world, that we really we have more peace, more freedom, more prosperity, more education, more longevity, higher energy efficiency and higher quality of life than any other time in history. It is the greatest time in the history of the world to be alive.
Nick van Terheyden
And before you go on. I want to say, I agree with you. But if you listen to the news, you’d think that wasn’t true. Right? That’s great.
Miles Romney
That’s right, exactly. And the biggest problem and we got you know, problems we got growing debt, growing cost of health care, growing cost of education, growing urban crowding, growing transportation costs, increased environmental strain, but the biggest problem I identify is growing expectations. That expectations today are set so high, that even though we have so much going for us, we all expect it to be trouble free. So if that is that’s something that we’ve got to deal with. The but but healthcare and virtual care is in such a brilliant position to be able to leverage the world’s greatest assets assets against its most dangerous liabilities. That’s where my, my vision for the future and 2050 comes in. I fully expect that yet that most everyone, if you don’t have one in your own bathroom, you’re going to be able to access one at work, or at the YMCA, or any number of other places, many people are going to be able to just walk into their bathroom, step into the shower, you’re going to hear the hum of something like a full body CT scan, or MRI technology that’s non invasive, at which which measures the state of your body right there. While you’re standing up, you’ll feel the soft nudge of few instruments that are gathering other vitals and measuring measuring your blood chemistry. And then based on your blood chemistry synthesize right there on the spot, will be a customized cocktail that gets injected via painless transdermal infuser that have your vitamins, your antioxidants, and your beta blockers and your TNF inhibitors and your relaxes anything else that you need that is tailored specifically for you that in that moment, then all of that gets passed into machine learning models that then evaluate your health, track your status towards your long term health and care to health, health care and wellness goals, and then pass that information on to vetting and review by flesh and blood doctors that are local. And, and from there, you’re in a beautiful position to essentially outsource your your health care almost entirely. And your body can be the you know, as well tuned as it as a Ferrari. It’d be one aspect of that, that we really like to emphasize, I like to emphasize personally, we like to emphasize it evisit is that this is actually non threatening to doctors. Doctors are an important class of non knowledge workers. We see, though, that we are the whole industry is looking at ways to make healthcare workflows more efficient with machine learning, Ai, the what we don’t see replacing anytime soon, even by 2030 is doctors that they are going to continue to be essential to patients and in their care teams. So all these tools that are being built are beautiful and set us up for for a bright future. But we’re going to need to still rely upon the expertise, a lot of people who are already working in healthcare today.
Nick van Terheyden
Yeah, I think you’re absolutely spot on the enormous potential of the technological innovation. And, you know, I bristle a little bit when we talk artificial intelligence, because it implies that replacement, it’s more augmentation, and the capabilities that sort of replace the things that we don’t need to do, you know, to your point as some of the other examples where you just, you fill in the gaps, but allow people to sort of spend the time, I think, is extraordinary, and some of the innovations that I’ve seen, start to lend towards that. I mean, we’ve seen, you know, in the case of waste, you know, sampling of waste that is, you know, suddenly people are much more interested in thanks to COVID. But you know, it’s not a new process, we look for metabolites and the excretions that can start to give us indicators. We know they exist. I mean, there are dogs that can detect cancer, there’s a I’ve just had this discussion recently a cat that can detect somebody that’s going to die very famous in a home. They’re finding signals, we need to understand those signals, I think very exciting. So we’ve got a minute left. Describe your future that the ideal future, as you see it.
Miles Romney
It it will involve two really critical elements. one the biggest problem that I see and where I mentioned the second biggest problem The biggest problem in the world is clean and renewable energy. And with that we can solve so many other problems transportation gets solved. many aspects of healthcare get installed overcrowded gets solved, overcrowding gets solved waste disposal, get salt, water, water purification, desalination gets solved. So that’s, that’s number one. Number two is is healthcare, but for a really, really interesting reasons. First, is that First off, we just want to be healthier, we want to live longer, but also healthcare is also a problem, maybe the hottest of political footballs and the discussion of whether it should be treated as a right or a privilege and a capitalistic system. That my I see this. Again, as an optimist. I see this as a temporary problem that technology is bringing, it may get a little worse before it gets better. But technology is ultimately the curve that it said that it’s on is going to democratize the available Have of healthcare to a point where it’s not, it’s not the hugely expensive percentage of GDP, that it is today. So it then is accessible to everyone. And it doesn’t have to be the central point of every talk of government involvement in our lives. So a future where we we have clean renewable energy, and where we have ready access to, to healthcare, and we are, it’s managed far more proactively less reactively than it is today. And just the change of those two things will mean that we have so much more room so much more time and hopefully an opportunity to to mend some of the bridges that we’ve burned over the last decade from a from a social standpoint.
Nick van Terheyden
Fantastic. Unfortunately, as usual, we’ve run out of time. It just remains for me to thank you for joining me fantastic conversation. Myles. Thanks very much. Thank
Miles Romney
you so much.
