Digital health technology challenges and opportunities

Speaker 1 (00:02):

Thank you, Tom. Our next segment focuses on the challenges and opportunities of digital health technology, and joining me is Preston Raulerson, who is Senior Vice President for technology consulting at Optum. Welcome, Preston.

Speaker 2 (00:18):

Thanks so much for having me. I'm really excited to talk to you today.

Speaker 1 (00:23):

All right. Well, to begin with, you've worked in and consulted on health IT for a long time. How do you think about the endless waves of hot technology? So gen AI is the latest, but in a long line of them.

Speaker 2 (00:40):

I think one of the things I reflect back on, because you're right, there's the flavor of the week when it comes to technology has been part of this industry for decades now, but I've benefited from really focusing on healthcare technology for my whole career, and there is a core element within healthcare technology that's still driven around how are we caring for patients and providers better? And that is, I think, a driving principle for how we adopt new tools and technology. Sometimes I think it can be a little distracting for us with the flashiest widget that we might see at a conference here and there, but at the end, those fundamentals are always the same. And I think as long as you have a really strong focus on the strategic roadmap that you have within your organization, it's really going to help you make the most of any tool, whether it's emerging or whether it's the one that you've had on the shelf for five years.

Speaker 1 (01:39):

Well, what are the keys to coming up with that roadmap and to integrating different technologies?

Speaker 2 (01:46):

I said this before, and I really believe this, there is a lens of operations of clinical, of revenue cycle and experience. That lens is not new, and like I just said, healthcare has been around for a really long time and these problems that we've faced, they are an evolution of the same problems that we've had for decades. The way that I think you drive value most succinctly from your investments is really starting with this view of what are you trying to achieve? What are you trying to solve for? Where are your problems, your opportunities within an organization? And then it becomes really easy to walk down into what are the tools that you need, what's the implementation of change that you need to drive in order to address those problems? I think when you do that, you avoid a bucket of shiny object, a widget digitized approach to investment, and instead you have something that you can ask all of your leadership and frankly all of your end users, your providers, and your patients to more easily wrap their arms around because it's fundamentally healthcare, not tool-based.

Speaker 1 (02:59):

We'll talk about the path for our audience. How specifically can they find that focus on value, and can you give an experience with a specific digital technology, not necessarily gen ai?

Speaker 2 (03:17):

Yeah, I guess where I would start is once you have a really clearly defined opportunity, I think working backwards and we see different organizations, some take a more quantitative approach with CBAs, doing an analysis of ROI is always healthy, but sometimes that can be an impediment to really adopting technology that doesn't yet have a pure proven ROI that you can quantitatively introduce and say, okay, this is going to pay for itself in two years if you really want to be cutting edge. And on the front end of adoption of technology and ai, emerging technology is certainly in this category. I think it's looking at fundamentals and saying, okay, are we addressing these problems in a way that feels right and does it have alignment to the operational and financial metrics that we have? And you asked for an example two come to mind. I was just talking about this the other day.

Speaker 2 (04:15):

There is an opportunity, and it is, I would say novel in how we're dealing with it, but it's been there for forever. It's how do you take a growing amount of data for patients and distill it more quickly with less hands in it so that a provider in the moment of caring for a patient can actually be more equipped to provide great care, higher quality, great care. That as a problem has been around for a while and it's only going to get worse. And I say worse because the amount of data available for each patient is only going to grow. And so the ability to use ai, whether it's gene ai, whether it's automation, whether it's machine learning to present the data in a way to a provider without having to have multiple hands that are then handing off this information or distillation of that information, creates an opportunity for a provider to be more effective and for a patient, it creates an opportunity for that patient to absorb the care that a provider's recommending and actually adapt to it. That is one of the gaps that we've seen. And you asked something other than Gen ai that happens to be a gen AI example, but in that methodology creating an automated summary of data for provider to work from as a huge improvement on outcomes, we've seen it. It's not necessarily, like I said, a novel problem, but it is a novel approach to it that technology allows us to lean into today.

Speaker 1 (05:53):

So you touched on quality, cost, patient experience, these are all essentials of care delivery. How can healthcare leaders prioritize among them and think about trade-offs?

Speaker 2 (06:09):

Yeah, it is a great question. I think every healthcare organization goes through a slightly different iteration of how they manage all of these things together. Optum UnitedHealth group, we call this the quadruple aim. It's really hard for an organization to say we're only going to address one. I think the best tools and the best choices for investment and really roadmap development includes the combination of all of these, and I've yet to see a properly deployed emerging technology that doesn't have benefits in all of those areas. I think where you really have to lean into the opportunity is to make sure that you are not so distracted by the value in one area that you actually forget the investment needed to hit all the others, whether it's quadruple aim, whether it's the principle of three within healthcare, making sure that you are making that co-investment, whether it's within training, whether it's within education, whether it's within communication.

Speaker 2 (07:11):

It might actually help round out this value case or this RO. I talked about the relative gap in quantitative ROI for emerging technology just because there's not enough reps in the industry, but the qualitative value for these things, they are there and as we're walking through it, as they're being developed, they do address. So so many of these, I hate to use the word problem. I told you that before Ed when we talked to use the word problem because we don't live in problems. We live in opportunities. Problems are just the highlighters one, but there are so many of these opportunities within healthcare that have been around for decades that I think each of these tool sets that are being developed and how they're being deployed, they really do have a holistic benefit that raises the tide for all of these areas. And I think it goes back to an implementation methodology, a benefit realization approach that really allows you to address it is key to it.

Speaker 1 (08:16):

Well, when we chatted in the past, you contrasted switching costs of technologies with transition costs, which I found very interesting. Would you tell our audience more about these concepts?

Speaker 2 (08:32):

Yeah, I think there is implementation, and I come from a technology background. I've been doing implementation of technology in some way, shape or form for decades now, but when I think about the actual change management that you as an organization have to go through, there is this focus that's required in order to maximize the benefit of what you're deploying, but it's also to manage what you are asking each individual to do. Nobody's not busy. I know that's a double negative. I went to public school in the south, so forgive me, but nobody's not busy in healthcare. We have squeezed so much inefficiency out of the processes to date that we are really asking people to do more and more and more with less and less and less, and I'm glad that we're getting to this moment where we're trying to augment it with tools that help them be more efficient.

Speaker 2 (09:26):

But when I think about the switching costs, moving away from one technology to another, if you have this view that really says, okay, we have 15 different tools and we are going to migrate them into one, well, that's great if you do two things with it. One is if you make sure that you have the right strategic approach to consolidating those 15 into one, but the second is what do you do with those 15 when you get there? You have to condense them down and sunset them, and you have to force people to use the one true north that you're now building workflow around. You're building training around. You're building a future experience and operational and clinical flow around. I see so many organizations where they go out and they have a set of 15 tools, widget workflows, call 'em whatever you want to call 'em.

Speaker 2 (10:20):

They have them sitting there and they're good. Guess what? When you bought 'em 2, 3, 4 years ago, they were best of breed then. And then the shiniest thing at HIMSS or Vive or pick your conference, somebody buys it and you deploy it. Well, not only are you now asking your end users to adapt to this new thing, you're not cleaning up what they were using before. You're not addressing things in a holistic way. You're not developing a cohesive workflow, operational flow, clinical flow for your patients and your providers. What you're doing is you're tacking something on that's not a successful way to drive value, and it might show up. You might still have some ROI that's showing up in a siloed view of that one use case. But what you're actually doing for the organization is you're creating this huge burden of transformation that you're not properly co-investing in.

Speaker 2 (11:12):

And so when I talked about it before, you can have these small deployments and this I say widget digitized approach. You can have these small deployments in a widget digitized approach and be successful in just this lens of was this tool successful? Check the box and you're still going to wake up a year later and you're going to have a more inefficient workflow with a higher burden on your clinicians, on your patients, on your operators, and you are not fundamentally going to be in a better spot. You're just going to have little bright spots sprinkled throughout the darkness, and I don't think that's the right way to approach it.

Speaker 1 (11:49):

Yeah, that's the bane of healthcare. CIOs, we have time for one more quick question. Just building on what you were talking about a moment ago. New technologies add costs. They also increase cybersecurity risks. How should our audience general balance, risk, value, or risk and opportunities within L it?

Speaker 2 (12:16):

This is a big question and I want to address it thoughtfully. I don't think anybody in the, I'd actually be really surprised if there's anybody left in the US that has not been affected by some type of cyber event as you approach this. I think part of this is picking the right partner, picking the right vendor, and having a fundamental strategy that addresses an audit and compliance approach over time in a thoughtful way across a well portfolioed ecosystem. But frankly, you have somebody that's taking it just as seriously as you are. I think that's the best that you can do right now. There is no easy answer. There's no easy button for this one. This is just going to be a forever task for all of us. Pick the right partners that have the same view as you, and I think you'll find yourself in a better spot than most.

Speaker 1 (13:10):

Well, Preston, thank you. This has been a really interesting, insightful conversation. I got a lot out of it. I know that our audience has as well.

Speaker 2 (13:20):

Yeah. Thanks so much, ed. I love these conversations because we get to talk about what next, while also thinking about the lessons we've learned and what came before. It's the right spot. Thanks so much for having me.

Speaker 1 (13:35):

Well, now it is my pleasure to welcome my colleague Dr. Nata Mota, who is executive editor for NDGM Catalyst, also an associate physician at Brigham and Women's Hospital and assistant professor at Harvard Medical School.