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Uh, Dr. David Butler, principal and Chief digital officer for Ca Partners, uh, welcome David. How's it going? It's going well. Thanks. Thanks for having me on, bill. So you're still, you're still on your, on your way back from the, uh, from the conference it sounds like on, on the way back from the conference. I've left all my bell bottoms and, uh, 79 gear there.

Yep. got popped in my cassette tape and I'm headed to the airport. Yeah, that's me. Well, for, for, uh, listeners who don't know, uh, you do a lot of, uh, consulting, uh, around the EHR, but you, your background is as A-C-M-I-O. Uh, for a lot of different companies. Um, and you've, you've done work at, uh, Cleveland Clinic, uh, New York Health and Hospitals, Guthrie, UCI Health and anything else I'm missing?

This is gonna be a short bio 'cause we only have 20 minutes together, so, yeah, no, no, no problem. I think the biggest thing I, I've been, I've been in Epic, um. User position large for large, uh, healthcare clients, the largest health. Uh, three years ago, vice president over their epic optimization program. And, uh, from there I left to start, uh, consulting with other epic clients that needed, uh, assistance.

So, yeah. Yeah. Well, that's awesome. So, uh, so you know, you, you were in attendance, so, uh, you know, what, what jumped out at you? What were some of the key themes that you're, you're walking away from the conference with? Um, you know, the key things I think are, they're pretty, uh, I've been coming to Epic Scott user group meeting for 17 years now, and so, um, I think Judy and Carl and, and the leadership there, they're still staying spot on as far as, uh, the way they build the software around the patient.

And, uh, this was their 40 year anniversary and, uh, they had just had a chance to say, you know. Highlighted over the 40 years, what they've done to build the software around the patient and how much they've invested in RD research and development. And for a lot of epic clients, if you're an Epic client and you know what that means, and you know all the time that they spend and all of that, if you're not, sometimes it's a bit, uh, cryptic as far as understanding what it, and how does that all work?

It's like, like kinda like Mac, you know, the Mac kind of, so that's, I. And, uh, they also, you know, every year also they, um, once again she emphasized, uh, and everyone, a lot of the, a lot of this was about using what you bought. You know, it's like, we'll, we'll purchase these large, big investments. And, and I, a lot of clients may not be aware of the functionality that, uh, they purchased and, uh, the, the do that and also the.

Talked about some resources that Epic continues to invest in as far as getting, uh, having that client speak to one another, put together papers, documents on how they do certain things, or there's some sepsis to, um, uh, heart failure to population management and, and put those papers, use them and to, and they're available internally on a, something called the Epic Users Web that's available to all clients.

So they were just. A lot of it was reiterating some things that, uh, clients should be using or that are available to them that they may not been aware of. And these are, and it comes with the, kind of comes with the car, you know? Yep. And, and, uh, you know, so some of the patient centered things that, uh, that I'm picking up on are.

Uh, you know, Epic's happy together, unified patient-centered view of MyChart. Uh, you had, uh, MyChart estimates, you had, uh, care everywhere, patient initiated, uh, sharing of the, uh, uh, record. Um, yeah. I'm just throwing out some of the things were, there's some other things that they, they did that you, you heard that you were like, yeah, they're, they're really making movement around this, uh, around patient centered, around helping be more patient centered.

Yeah. You know, uh, I think, I think you, you, you totally rattle off the big ones and those are a lot of, some, sometimes I call epic, some of those words. And, and so non-Epic clients may not know what that mean or even patients that may be listening. So yeah, put, putting the care into the patient's hand is what.

It's about, and that's where it's gonna, it's been about. And so where if you have three different records, like for example, I've moved over four states, me and my family, uh, for various jobs. I have about five different MyChart accounts now. One there. Now I can, one click, I can now see one patient portal and all my data.

And if I go to a doctor somewhere and that doctor does not have Epic, it could be a medical care, it could be of urgent care. I can always share everywhere. I can give them a code. They'll log into a website, not a patient portal. They can log into a website, put in that code because I've given them access to my, my notes or whatever they need, if they need that.

So I think that is, has been the biggest, uh, one of the bigger deals, innovations that I've seen in over like 10 years dealing with Epic as far as, um, on the patient side and, um, without much build or effort on the client side. So. I mean, that's, that, that's pretty exciting stuff to be able to, uh, literally I could leave California, go to, uh, you know, go to Florida, go to a, an epic shop, or, or actually go to anywhere, quite frankly, anywhere.

Doesn't have to be an epic shop and give them access. Uh, patient initiated care everywhere. It just means you know, that it aggregates that data and makes it available wherever I'm receiving care, which is pretty exciting stuff. Um, via website. That's what's crazy, right? The vo web portal. Not, you don't have to log in Citrix and all this other crazy stuff that we're so used to in healthcare, you know, how that, you know, so Yeah.

You know, you know how that goes. Uh, you know, for those, for those, for those people not able to attend, I mean, what's the. What's the one or two things that you would say, Hey, you, you should really look into this, that, you know, uh, I don't know, maybe Cosmos or, I, I don't, I don't, I don't know what they talked about, but actually I have a good idea.

They, I've read a lot of articles written . Yeah. No, no, no, no. You, it's fine. Yeah. So what, what are those one or two things? I think the, I think the one, the one thing that was really impressive was Cosmos and Cosmos is this, you could just imagine, uh, uh, clients that say, you know, wanna do research, all this data that's embarrassed Epic, uh, all over Epic is probably, guess what?

60 to 7% of embedded patients. Some data that lives in Epic at some point in time or something like that. I. Driving through those databases trying to find a researcher or, or like cases, sometimes you get an end sample of two if you're within one organization. But if you can now scour cosmos to say, okay, for all patients that I treated for sarcoid with this medicine first line, this was where it ended up, or for this type of medicine.

Uh, they gave a really good example. Phil Lindeman, who's over the analytics, was really sharp. He gave an example like just how you could look at Cosmos and ask a question to say, does this medicine in 10 year timeline, would it, what is the chance of it leading to say dementia versus this medicine versus this medicine?

So those are really difficult type things to do today and research type studies, a longitudinal study. So that was really powerful and I think that's pretty much, I feel like Judy's moonshot, which is a great one to have. And uh, so yeah, so Cosmos is huge, but also I think for clients that are not even there, that's all future stuff.

I think the biggest thing that I see over and over and that even, you know, is that clients have bought a Lexus, but they keep taking it to Jiffy Lube. , you know, and I think Epic is trying to say, stop taking the Jiffy Lube. We're Lexus, not Lexus. You know? You know the analogy, meaning you already paid for this.

You bought it. Here it is. Here it is. And stop. Innovat and start imitating because a lot of your colleagues over here have already done it, built it, and in the system, and it's working, and they're putting points on the board. But you may not be aware of that. So they were bringing more awareness to things like the CEO handbook where the CEOs can flip through financial handbooks, what other companies are seeing, how they decrease AR days or cost or control, things like that.

So I think that's just been a consistent message I that I heard, and I think clients just need to ask the question, Hey, you know, if I was a client and. If they're hearing this, it's just like Asher BFF is a, is a weird term that Epic uses best friend forever. Okay, . So just say, Hey, can I talk to my BFF? Or you know, can I get on the next call with my BFF?

And then they can go from there. That's the way I think about it. So. I think the analogy you're, you're searching for is they, they bought a a 50 room house and they're only using three of the rooms and it's like Exactly. Yes. Epic saying, Hey, you know what, you don't have to live in the kitchen in that one bedroom.

You actually purchased a 50 room house. Why don't you go explore the rest of it? And uh, I think the other thing exactly, yeah. But you drive home, which is. Really true is Epic does a good job of building community. I mean, 10,000 people there. Uh, a lot of great presentations, uh, from organizations sharing what they've learned, how they've moved the, uh, physician experience forward, how they're addressing usability and, uh.

They're building runbooks and playbooks and, and those kinds of things. Um, plus if you develop things, there's ways to share it through their, uh, their network. And I'm talking as someone who was not an Epic client, uh, and just looking in and saying, Hey, this is, they've built a very good community of people that, that share.

And that's, that's a, that's a strong message. It. It is, it is. And I think I've been part of that community so long. I forget how, uh, normal it, how abnormal that is. I'll say that. I mean just, you know, in this space, it, it, it can be. Uh, so, um, I was, I was looking at something and, you know, one of the, gosh, you know, golly kind of things was they, they talked about or, or demonstrated voice recognition, uh, doing more command and control kind of stuff, uh, within the Uhhuh

I, I know that's futures, but sometimes I like to talk about futures. 'cause people are like, really? We're gonna, we're gonna get to a day where the physician's controlling Epic with their voice. Uh, give us a little idea. Yeah. , I, I assume that Yeah, that was one, that was one where I rolled my eyes just a second.

But I also knew how close Epic is to that, just from pre previous. Demos at HIMSS where they demoed this like a year ago. The Epic voice assistant, you know, and then work a nuance, kind of working with nuance to do a lot of that. Right. So, and we've been here, Amazon and other companies, send them the conversation capturing, uh, if you will.

Um, one second I wanna. Can you hear that? My alarm going off? It was like a . I saw that. I, um, did not. Okay. So, um, yeah, so that was really cool. They did a demonstration basically of a conversation type that a patient and a doctor would have and how it would not only you could say, Hey, epic order amoxicillin.

Hey Epic, can you go ahead and sign this patient up for something? I think some people are calling it digs, for example, say, epic, can you order the CALM app for this person? Or Epic, you know, things like that. You could see it kinda load up order. It would actually put the order in. Right. That is like a, that's a place where we've been, uh, that's a holy grail almost

That's, that's pretty cool stuff, right? Yeah. And, um, and it, it'll delete, it will relieve the doctor of having it back to the patient and all those things that we, we, we get railed on and press Ganey, uh, you know, , uh, surveys and things like that. The patient say, oh, Dr. Butler was awesome. Then they said, but the computer gets in the way.

Well, my computer saved your life a little bit, but I had to kinda look through it, you know. Sorry, you know, , so, yeah. Yeah. And so, uh, they, they showed the voice assistant and how they're advancing that a lot of, one, one demo they showed was a very future demo. So I think a lot of folks may have felt like, not a lot of folks, but a couple of us said, oh, that was, that wasn't real.

That was vaporware. And that, and that big did get on stage after that and explain like, that was future, that's where they were going, but we're. This is live now, like Epic voice assistant that's live today. So, and I think about a lot of clients are using that, so, well, you're, you're on the road heading back.

So I've, I've, you know, two questions which will get more into the pragmatic, uh, the first being, you know, what, talk to, talk to us about the conversation around physician burnout. What, what you heard at the conference, how epic's addressing that. Yeah, so physician burnout. Yeah, I, um, I'm a proponent, this is one where, um, I like, you know, you.

Multifaceted things that go into physician burnout from feelings of loss of control, uh, you know, uh, just a computer to more tasks of going to the doctor that should go to the nurse. So they did address, just briefly, just, uh, uh, some things that can help with physician burnout and what Epic can do versus what.

I think the clients need to be doing, to be quite honest, and I see Epic is continuing to improve their user interface to make things easier for the doctor. They're also continuing to make, um, the things that the physicians and clients are asking for, for, uh, available and also turned on. Meaning that way you, they're not dependent on, let's say Epic does something and then the client takes the upgrade, upgrade, but if the client decides, don't turn that on, because we think, we don't feel like training our doctors or our doctors may not like it.

Well, we've already vetted that pretty good up here, you know, at Epic. And so they want those things turned on. And I think a lot of doctors like that, that concept. And I think a lot of companies do too. And that'll also help them to, uh, manage their software, manage all the, the extra support that they have available, uh, a lot easier.

So, uh, those are some things and, and also just like. Note bloat. You know, note bloats a big deal. You know when you don't, when you're looking for something in the chart, they showed the tools that were being used, the tools that weren't being used, and they showed some reports that you can ask Epic for.

Epic tracks every click inside of its thing. They called it signal. How do you use your signal data to focus on those physicians that may need help? Let's say there's after hours called pajama time and it says, Hey, this doctor that has pajama that uh, has two hours pajama time each night. These are your areas where you wanna focus and here's some little quick e-learning type things that they may want to benefit from.

And that's pretty focused type of . That's some pretty focused, uh, help, I would say. And these are just out of the box, epic, it's free. So things like that. So that was pretty cool. So out outside of that, what are, what are your, you know, what were people talking about on the floor? What are some challenges that health systems are having that they're either, either challenges or things they're excited about?

Uh, that you heard as you sort of walked around in your bell bottoms and whatnot. Yeah. You know, um, I, I think overall the, the actual, the, the, the quality of the presentations, you know, this is, God knows how many, like three or 400, I can't even know. I don't know how many presentations there were, but I think, uh, a lot of population health stuff, you know, also, a lot of new clients came on, you know, that were trans.

They were switching from on Cerner, Allscripts, or whatever. So they always have that kind of floating through to show all the new clients welcoming them. And so they were in the audience. So there were just different generations of Epic clients in the audience and, and having Epic to figure out. You know, or having them figure out what is relevant to them right now and their maturity in this thing.

Right? So I felt like that, that there was a positive vibe as far as that everybody could find what they needed, where they were, uh, if they were getting ready to install, uh, if they were post live, uh, there was things that were being presented that they could sit in on and network. A-C-M-I-O from this hospital, get their number, uh, set up a WebEx later on with them to see how do they do this or that.

So I think just in general, that just pushing together all that big clients and, and, and making it so that they have a, a venue or forum where it's, it's open, it's free, it's fun. I mean, you know, it's fun and, and flowing and, uh, so I think that was just some, the vibe that I got, you know, but that's kind of, every year there's no one topic that was really hot.

I didn't think that was on the floor because, I mean, of course, APIs, app s that's always hot, right? You know, that's gonna be the thing. But I find that there's, and 90% of clients don't care about that right now because they're trying to just get their doctors to get c hf, heart failure and some of those quality measures with the tools they have.

So that's, uh, what I. I I my take on it, you know, it's intering, it's interesting, I, I I refer to it as a conference every now and then, and it's not really a conference. It is a user group meeting and they are very different, uh, very different animals. I mean, a user group meeting is really around getting the most out of the tools that you have and connecting your users, uh, in a way that they can collaborate and, and talk, and, and that's what Epic does.

A. A really good job of, and that's why it feels a little different than a, a conference, although it, it looked like it was a lot of fun. Did you go on the, uh, on, on the Merry-Go-Round and other things there, ? Yeah. Yeah. You know what? I grew up in a small town. We had something called the Reels Fair. I was in Texas, you know, reels fair every summer we were there, you know, and uh, yeah, I went, I did the Merry-Go-round.

I, I, I had say that, I think I went in and posted that too, just to, I'm growing into my own now. I got on the Merry-Go-round. I said it, it came out. Just don't tell my brother. the last thing. And, and you know, Twitter has a couple people talking about this. So Judy made some comments about, uh, the O-N-C-C-M-S, uh, type, uh, you know, the interoperability and the, um.

Uh, the, uh, 21st Century Cures Act and whatnot. Uh, you know, I mean, what's the general, what's the, what's the general feeling around that? Is that, is, is there, I mean, is there a lot of conversation around it, or is it, like you're saying, which is, you know, a lot of health systems are, you know, just trying to just get the basic blocking and tackling down and this is something for the heavyweights to really, uh, weigh in on.

I, I think, I think in general, what the clients are saying, the folks that are here, that came to the conference, that's not on their radar. I, at the ONC and all the, the, you know, the alphabet soup, the government will do whatever, right? That's cool. Uh, that, but I think more importantly, what, what the gist is, is that Epic was just epic.

Epic gave the message to say, look. If you're gonna, if we're gonna start giving out, if we're gonna start, uh, sending out all this patient data, right. To everybody, any app that wants it, it feels like, and I feel the same way. And, and that those these app companies that have, whether it's freeware, shareware, ego wear, uh, what is their accountability to that patient data and it's as simple as that.

And now Epic is, you know, they're like, look, they, their only skin game is to say before you, you know, put a spigot in here and just out all this. Does the patient really understand what that means? And I, and everyone, I don't want, uh, any app taking my data that I don't feel that I don't really know all the fine prints, you know?

And especially if I know that. Um, when I go to another place, I got something like Share Everywhere or whatever, and they can know what's going on with me and provide the care. And so, I don't know, I think that's as simple as I heard it. And of course it gets very difficult in the fire and, and all the other things like that, that some of the companies, uh, are really being, wanna be innovative and they're very innovative in that space.

And what it should mean to you as far as how your data is shared. Who is it shared with, how is it used? Things like that, you know? And, and yeah. So, absolutely. Well, David, thanks, uh, thanks for taking the time to pull over to the side of the road to have this conversation, . Yeah, no, no, thanks. Thanks for asking me for, for my opinion, you know, always, uh, willing to help.

So. Dave Butler, to my opinion, . Is there any way that, uh, people can follow you or, uh, get ahold of you or Oh, definitely. Yeah, definitely. I'm at Twitter, uh, at David, uh, Butler, MD on Twitter. I'm on LinkedIn. Look me up. Follow me. I definitely always posting something weird or goofy, uh, that deals with medical, informatics, it, healthcare, you know, I try to keep it with it, keep it fun and not troll too bad, but there you go.

Yeah. All right, sounds good. I wanna thank David for joining us, uh, and I hope he has a, uh, safe travels back. He actually pulled over to a Starbucks on the side of the road to, uh, have that conversation. I really appreciate him doing that. Uh, please come back every Friday for more great interviews with influencers.

And don't forget, every Tuesday we take a look at the news. Which is impacting health it. This shows a production of this week in Health It. For more great content, you can check out the website this week, health.com, or the YouTube channel this week, health.com, and just go ahead and click on one of the links up top.

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