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 Welcome to this Week in Health IT events where we amplify great ideas with interviews from the floor. My name is Bill Russell, recovering Healthcare, CIO, and creator of this week in Health. It is set of podcasts and videos dedicated to developing the next generation of health leaders. We wanna thank our founding channel sponsors who make this content possible, health lyrics and VMware.

If you wanna be a part of our mission to develop health leaders, go to the homepage this week, health.com, and click on sponsorship information. This week we're at the health conference in Las Vegas, and one of the things I was trying to do was to identify solutions to problems that my clients and guests on the show have been talking about.

Physician burnout is one of those problems, and I found a happy physician talking about his interaction with a technology platform. And it piqued my interest. So I explored, notable, and was fascinated with how well thought out the solution is, and early results would indicate that they're really doing something exciting here and it's something you're probably gonna wanna take a look at.

In this interview, I sit down with the CEO of notable PNE Edia and the CMIO of Houston Methodist Hospital, Dr. Nicholas Desai, to discuss how this solution is making a difference in patient and physician satisfaction. Have a listen. I hope you enjoy. Here we are from, uh, the health conference, HLTH. Have to pronounce it so everyone knows what we're talking about.

We are here with the CEO of notable. Mm-Hmm. , gentlemen, doctor, practicing physician, right from Houston Methodist. That's correct. I'm this Chief Medical Information Officer, this Methodist. Oh, fantastic. One of the things I'm excited about this conversation is we we're always looking for, with, uh, physician burnout.

We're always looking for technologies that are actually . Making a difference in, uh, in that area. This is pretty exciting. I mean, what you guys are doing is pretty. Pretty neat. So could you give us a little background, uh, a little background on yourself and then on notable itself? Sure. Uh, so I started this company three years ago after my wife, who's a physician, complained about how being a physician is a life not worth living anymore.

she was ready to throw in the towel . Uh, and having been with her through med school, through residency, it's, it's insanely difficult. And then actually, yeah, she got into it because she loved it. Uh, and, and then. The, the thing that she classified herself as was the highest paid data collector in the world.

Um, and had no idea why she was collecting it. 'cause it was basically garbage in, garbage out. Um, and she's like, I've used every possible EMR out there. They're all equally good. There's nothing necessarily wrong with 'em. But they all need to be configured and they all need to actually have a better experience on them.

But she fundamentally didn't believe that they would change fast enough. And so with notable, we've been building using AI at the core to actually build the layer of intelligence that sits on top of your legacy EMRs. It compliments that it doesn't replace it, it's meant to do that. Uh, we use robotic process automation to enable that to happen.

So just like hiring an ma going live with notable is giving the digital assistant accounts on the EMR and then providing a fantastic patient experience that is actually intelligent, kind of like TurboTax for every single patient. Taking that information back, layering it on with the physician, and then using a voice interface on the on, on a watch on a wrist to actually really help assist with that interaction with the EMR.

I'll let you talk to it since you've been using this. Sure. So, so, um, I'd say there's probably one part that he missed that was really the pa, the physician, he just doesn't know the product well. Right. You are . He's not, he's not using it every day like you are. No. But it's also the physician experience.

Right, right. So it's, it's about the. There's this, this connection between both the patient and the provider that has been kind of overburdened with, whether it be EHRs, whether it's regulatory, whether it's clinical, financial, you name it. All these stressors that are placed on that experience that have kind of minimized the, the, the, the output of what it should be.

And so what once was this joyous experience has kind of shifted. So one of the things that notable has allowed us to do is really one focus on . The most important thing, which is our patient and that patient journey that goes from, from beginning to end. So the most common complaint you'll always hear is, I don't always feel like my doctor knows me.

They don't know me, they don't. They used to know me, but now their backs are turned and they're clicking on a keyboard, right? So agnostic to EHR, what have you. This is the world we live in today. . And if you ask most doctors, what's the one thing that you, you don't like doing, you, if you might kind of clear through all the, the, the noise.

It's not the EHR, it's the fact that I've lost touch with that patient. So what notable enables is, hey, it's allowed you to have this using a voice digital assistant to really capture the fluency of that interaction. Just the fidelity of that interaction becomes . Very, very customized for that patient.

But what's better is that the journey doesn't begin when you walk into my office. It occurs before you show up. So you get a customized questionnaire based on your, your issue or what you're coming in for, whether it's a new patient, established patient, a post-op patient where I can customize that experience of asking those questions.

That really kind of helps create that. Wow, okay, this doctor cares about me. Personalizing that journey experience. So you take that now, the patient shows up in the office that captured information, now moves right into the EHR, regardless, agnostic of what solution you use, but right populating right into the correct fields.

So it helps begin that HPI or begins that note creation. Right. So that may sound, wow, that's just one little piece. So that's starting at the intake process. That's right. Right. You start all the way back there. And, uh, I assume you're sending that out. Device agnostic. So, uh, iPhone, iPad, computer. They're giving you information, but now when they show up, they're not set you, you're not asking it three times, right?

So now my, the experience has gone away and almost like I no longer have a, a sliding glass door of telling you a check in anymore, right? You've now enabled me to be your partner and you care about me, begins from before you ever show up in my office. Move fast forward that. Now you take that, and now being able to spend time directly in front of the patient where I can actually not doing this.

Not doing this, not turning my back to you, but rather actually examining you. And with the active and the passive modalities within notable, I'm able to A, use capture items that are regulatory or quality in nature that it's listening for, right? But then it also is capturing the note, if you will, my observations.

It's actually pulling in information directly into the correct areas within the node. By leveraging the tool to essentially be my digital assistant, right? So imagine my digital scribe that's standing there right next to me and multiple ones are putting it in and queuing it in. And that's just an iWatch.

Just an iWatch. Yeah, just an iWatch. And the thing I like about that is how elegant that is, but, but it gets, I'm give you the mic Mac eventually, but it gets better because what's better about this is, that's this. Okay, great. Nick, you've created a note. You've enabled that for me. But what's important in that, which we haven't shared yet, is really the, the what notable can do and what it can drive.

So using RPA . We can now drive from pre-visit knowing what type of patient it is to really queue up items for the provider. So when you walk into my office and you filled out an ex a questionnaire saying, you know, uh, your post-op visit one, Hey, I'm still feeling nauseous, doc. Hey, you know what? Guess what?

When you walk into the office and we're talking, we've built the logic in there to where and when someone says they're nauseous, they may require a medication for that. So guess what pops up the ability to place that order right then and there without ever touching a key, a keyboard. Wow. And saying, order Zofran for my patient.

So Bill gets his script ready and queued up without me ever leaving my eyes off of you as I'm examining you. And then the last part is, and you take the fidelity of that is now finally I'm capturing not just the patient information that's generated by them, but taking the physician components and then taking what would be considered the mundane tasks of the clinical billing financial stuff.

And you can really improve the way your providers learn, how you learn to kind of code that at the end. And you can go front to end from starting with knowing that this is an established patient, a new patient, and or a, uh, a patient who's a post-op patient, or it allows you to do another step as just

Perhaps I just wanted to generate tasks. So when a patient walks into my office today and says, I'm a new patient, I have an ankle injury, and oh, by the way, I've never had x-rays before. If my, in my protocol in my office is I order X-rays, but in a, in any EHR world. You can't just do that, you requires an order, right?

So when you've clicked that, guess what happens? The task is already generated for an order to be done. So a, it speeds up my office time, too. My staff is much more happier. So staff happiness, physician happiness, or patient happiness becomes almost the trifecta that your throughput for the patient experience is now just catapulted to a whole different way of delivering business and delivering care to patients.

So I would imagine my, my. Audience is primarily health IT type people, they're listening to this going, wow, if I could have a doctor that's happy about the experience, that would be acceptable. Yeah. So let's talk about, um, let's talk about scale. Mm-Hmm, . All right. So let's talk about implementing it in scale.

Uh, I'll give it back to you. Um, you know, is, is every health system gonna have to customize this and build their own workflows and those kind of things? Yeah, sure. So, you know, just like a digital assistant works section, you wanna think about it as something that needs to plug in your existing workflows and then come with out of the box skill.

So a great example of this would be, uh, uh, our integration, uh, with, with your system, your, your, uh, system of record, which is fabulous and you guys have actually configured it really well, um, was 13 hours, uh, to go live. Uh, and then really just focusing in on 13 hours. 13 hours period. Uh. And, uh, that allows us to now, instead of working on an 18 month timeline for the integration, we can actually use that time to identify what workflows work for you, refine the solutions we can come out of the box with.

Here's the skill for, uh, the intake for a patient that's coming in for, uh, a joint replacement. On Medicare, we know it's a bundle payment. The notable assistant will automatically put in the 9 9 0 2 4 codes. We'll queue up the X-rays for you. We'll actually queue up the history for you, but now you might want to configure it slightly.

I think that's important. Uh, that's incredibly critical for locality. That's incredibly critical for every physician to be able to tweak that to their liking. And so, uh, we do provide that. And then one of the key elements, we only work with enterprises, we're we're working with some of the largest, uh, enterprise health systems.

Uh, it's important to have a dedicated customer success person that's actually, if not more than one . That's actually there at the elbow, making sure that things are actually deployed the right way. The thing, you know, the, the elegance of this, and I I I'm not paid by you in any way, shape or form. And this, um, the, I, I like a handful of these things.

One is you have the, the front end, which is easy for them to, to interact with, and you get those questions out there. Um, you've thought through the, the workflow, I like the elegance of the watch. 'cause you know, at HIMSS we saw, and, and I'm a huge fan of nuance in some of the things they're doing. But they're, they were looking at, you know, building out these rooms with pretty elaborate, uh, cameras and, and audio and those kind of things.

Well, that's expensive and it's fixed. Um, the watch is, is so elegant that the, uh, crew's coming out right now. But, uh, the other thing is the, uh, RPA at the, at the, at the source, uh, replaces an awful lot of . Just, just manual typing and clicks and Absolutely. And I think it's, it's best way to say that, um, what this has done, the way I kind of share when I talk to others who are interested solutions like theirs is really about the way we've gone on our journey to restore clinical efficiency has been to emulate, iterate, and then innovate, right?

Like, so if you take that, and that's what they've been able to let us do is . Email your processes, right? Let's iterate to what you're doing. Let's see if it works or not, because just 'cause you did it doesn't mean that's the way you should do it. And then let's innovate new solutions within that confines of those constraints so that your providers feel the least amount of burden it has, the least amount of lift.

And then operationally, our patients see a seamless experience, right? But that's part of that. And then so . Having that customer experience person is great, but I think the other part of it is we can't just say, okay, we're done. 13 hours, we're done. It's really about cur curating and curing feeding really goes into this, right?

And so it's like anything, when I talk to others, it's uh, it's not just turning on the keys. You gotta learn how to understand it, be willing to play with it, to understand where you need to, where you need to craft your story to really resonate to scale. So for us, we've done this. There's one more thing I just want to add to that, which is utilize the time for integration on iteration, which is so much better.

Uh, and then the second part of it is once the skill taught, it never leaves you. Uh, it's not like the ma that went on vacation or the person that is actually surfing Facebook and put in the wrong order to actually, oh, this is an Anthem patient. We, we actually send labs to Quest. I was distracted. I sent the labs to LabCorp.

Oh my God, that patient had a terrible experience. So it never leaves you. So I'm gonna put you on the spot. Okay. And that is, um, is your wife using it yet? Yes, she is. She's, oh my God. Uh, absolutely she is. And uh, it's actually given her so much confidence that she now is leaving her practice to start her own.

She's like, this is actually learning the rules, and I don't even need an administrative staff behind it. I can actually start fresh. So, yeah, you gave us some statistic earlier. Like for every . Billion dollars that healthcare makes. They have eight times the amount of administrative overhead. So it is, uh, so I, I, I come from outside healthcare.

I guess patient experience matters, but technically from finance and FinTech, I used to run min.com quick and TUR tax, uh, products that you've probably heard of, uh, one in four mortgages actually goes through technology that me and my, my team at notable actually helped build, uh, and. What we found, which was absurd, was for every billion dollars worth of revenue, there's eight x more human capital that goes into healthcare.

And as a patient, what's insane is it actually isn't going into our care. It isn't going to personalizing our care. It is . I need the patient to fill out these forms. Then I'm gonna type in these forms into the EMR. Right? Then I'm going to ask the patient, uh, do you have these medications that I'm gonna type in those patient medications?

Then the doctor's going to actually have an admin staff of at least four running around them. Yeah. Then there's the billing team. Then there's the claims team, then there's the claims adjudicator. Then there's the chart chase chaser. So this is Cloud-based. It's absurd. Easy to, if you close the sale, the, I mean, the hardest part is contracting, but once you get through contracting, then you're

Ready to go. Do you wanna talk about the, uh, the, the Go Live piece? 'cause it was relatively, I think your IT team was surprised. Yeah. So most folks, um, assume this would be a multi-month project. They all are. Um, and this was not so I'll, I'll give one very specific example. We met on a Friday. We spoke about, uh, we're gonna pause the Go live.

Notable does not have two factor authentication built out. We gotta wait Monday morning, 9:00 AM. I sent them a message, when can we test the two-factor authentication? That's already done. They couldn't understand that. So to tell you that what's different and unique is that this, they're just very agile in their ability to deliver.

For us as an organization, it was an easy lift. Um, I think, but that can't get minimized. I think that part there is, you gotta have make, have the right IT players at the table. You need to have security, you need to have these folks. One, because this is net new. Many organizations don't understand how it can be that fluid and easy.

Yeah. And so for us, minimal lift has been really nothing but really, um, you know, care and feeding to them of what we really need them to do. And, and there have been cases where with large institutions that, uh, . We'll, we'll announce very soon. Uh, Houston Methodist actually sets the bar. We came in with RPA, they're like, boom.

Yep, we get RPA. We're doing it the right way. Go. We already have a protocol we spend and we like to actually have these conversations with security compliance early, um, and share our certifications, share our protocols. And there's things, when you move trillions of dollars in finance, you actually build the right way.

Right. Um, but what was, it's also. Our job and, and to, and hopefully you guys to help us in educating the market on how this is safe, how bots are actually good. Uh, the number of questions I get from some yes. Uh, from, from folks that haven't been, that I would say aren't actually on the leading edge and don't understand where the world is going through automation.

Um, I mean the Alaska's humorous things like what if there's a bot uprising? Uh, and these are actual questions that, uh, and. Uh, it, it's, it's important to acknowledge, uh, but for people to think about digital assistance are the way that we're gonna drive out that wastage through a fabulous experience. My other favorite is the 20 page security questionnaire that you look at and you're like, they're not gonna validate any of this.

I'm just gonna, I mean, your team obviously did, which is great, but I, I, I just, I looked at my team at one point. I'm like. Okay, we've got it. We've gotta do something with this 20 page questionnaire on security. 'cause I'm not even sure we know what the answers mean to some of these things. Sure. It's like, well, it covers our liability.

Yeah. But that's not what we're about. We're about actual success, not the appearance of success. So does this make us more secure? Anyway, that's a whole nother thing. Um, well, hey, congratulations. It, it sounds like a great solution. You sound like a happy doc. We want more of you and, uh, thanks for the time.

I know. Thank you. You're. Potential quiet right now. So thank you. Thank you. Thanks. I hope you've enjoyed the conversation. If you would like to recommend a guest or someone to be on the show, you can do that. From our homepage, uh, recommend a guest is about three quarters of the way. Down on the homepage.

Please check that out. And don't forget to 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 show is a production of this week in Health It for more great content, you can check out our website this week, health.com, or the YouTube channel, which you can get to from our homepage as well.

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