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Today we have another interview in action from the conferences that just happened down here in Miami and Orlando. My name is bill Russell. I'm a former CIO for a 16 hospital system and creator of this week health, a set of channels dedicated to keeping health it staff current and engaged. We want to thank our show sponsors who are investing in developing the next generation of health leaders, Gordian dynamics, Quill health tau site nuance, Canaan, medical, and current health. Check them out at this week. health.com/today.
Alright, here we are for another interviews in action. there's a couple of these we didn't get to do at the HIMS conference. And this is one of those today. We're going to talk with Matthew Roman, Chief Digital Strategy Officer for Duke Health and Mike McSherry, Chief Executive Officer and Co-Founder for Xealth Inc. Gentlemen welcome to the show. It's good to finally catch up. Our schedules were kind of busy during the conference and busy.
Well, I'm looking forward to us. You guys did a presentation together, improving care program results with digital health. Let me just give people a little excerpts. So they, they have an understanding of what we're going to talk about.
So, little bit of this. Digital health value includes helping engage clinicians with their patients in ways that are replicable across team specialties. Duke implemented a digital health platform integrated with the EHR to make the rollout near seamless, easily repeatable and using existing resources leveraging automation when possible. This is delivered several benefits across specialties, including reduced patient appointment, no shows, which saved hundreds of clinical hours, increased engagement with educational content and raised program participation and new surgical patients. Those were fantastic results. Matthew, I guess we'll start with you. Tell us about the program. Tell us about what you guys did at the.
Yeah, thanks bill. It's a pleasure to talk with you today and my nice to see you again. Well, so so basically this program is the first step for us in personalizing or customizing the care that we deliver to patients.
We've had for many, many years, like many health systems across the country, I'm sure have had internally developed resources and educational materials and programs that providers in our departments and divisions and clinics across the health system have had handy that have struggled with getting the materials disseminated or distributed to the patients.
And so what this tool with this program has enabled for us is giving us a rules-based engine to automate distribution of some of those assets. And then also make it much easier when when there's not an automation print ability to be able to still distribute those things, those tools, or those assets to patients and leave them in the patient portal where they can be easily found and remain durable to patients for subsequent use.
When I use the term digital asset here, it could be any number of things. It can be links to a webpage that we've developed or we've vetted, and we feel it's appropriate for a patient in a certain clinical condition. It could be a specific person education. It could be referral to, or awareness of a program that somebody else within our health system or an adjacent clinical partner might have available to the patient.
It could be any number of things. And so this tool is flexible to give us the opportunity to be able to deliver assets agnostic, to the type of asset, to the patients based on rules. And then again, it gives us some flexibility to be able to live with them rather manually to. So that's how we've been able to do this with some replication.
And there there's specific examples throughout about how we've gotten some adoption and then be able to use these very same sort of success stories or use cases to then spread laterally into other parts of our health systems.
So is it any digital asset? Is it a video, a website, PDF.
It could be any. and again, the handy thing about it is so in the old days, not very many years ago, I walk out of a visit with my provider. I might have something on a piece of paper. It might even have a URL on it, a static URL and a piece of paper. But what we're able to do is deliver this content to the patients in the portal, so that it's active and it's interactive.
And in my opinion, one of the most one of the most attractive things about it, is it somewhat personalized or customized to the patient's clinical journey? And so this is our first step and what we hope to be a long journey to making sure that the portal itself is rather customized to each individual self journey so that my portal is specific and unique to me and my health goals.
And yours is specific to you and yours and the conversations that you have with your provider. This is a platform that helps us to be able to realize.
and Mike, we'll get to you in a second. Rules-based rules-based and automation. It's really interesting to me. Is it rules-based and automated based on fields from the EHR essentially that are triggering.
Primarily in today's world. That's true. Yes. And so some of the rules are very, very simple simply if, if appointment is scheduled with this provider, then issues, this. A simple example of that might be when when we have a patient schedule with one of our providers for the very first time provided that that patient has never met, we will send an introductory video of that provider, welcoming that patient to his or her clinic.
And, and that provider will say, this is Dr. So-and-so. And my background is art it's this and my clinical interests are these. And I'm looking forward to caring for you, that sort of thing, a very simple video clip, just to welcome the patient to the, to the clinic, which is based on nothing more than scheduling a visit with that particular provider as a friend.
So Mike, this has been the vision for, Xealth for quite some time, but are you surprised at the different use cases and how people are, expanding the use
Yeah. We're, we're working across dozen of provider systems now. I mean, duke was one of our first several customers. And so we we'd been on a, a fun, long journey with Matt and done a lot of things at duke itself. I think, I think we did 50 different use cases or initiatives at duke last year. And over the course of working with them for several years, we've done hundreds We've integrated like 50, some different vendor solutions.
And it spans from articles, videos to apps or digital therapeutics to devices because not only do we prescribe things, but then we monitor the patient's usage into it. So RPM platform kits, or glucometers, or C-PAP devices, whatever. And then more broadly we've done meal delivery services or Amazon e-com products or.
Medline pre-surgical kits or transportation. So we're kind of agnostic as to what the clinical teams want to engage the patients with. And on some of that know, if I go back a little bit to that, rules-based we do roles basic and simple appointment type or the patient's clinical condition or inclusion as well as exclusion criteria.
For example, you don't want to send a weight loss program to someone That's pregnant per se. but then there are a number of external databases that we can also do an eligibility check against, and that could be payer coverage. So let's prescribe this app when it's a clinical benefit to the patient, but also there's a covered entity paying for it on behalf of that patient.
Or let's send it to the patient when they have the clinical eligibility, but there's a match for a clinical trial that might be eligible for the patient. So we're not only getting more sophisticated on the targeting and engagement with the patients, but also on the. Breadth of different use cases or care interventions that, that the hospital systems want to engage patients with.
it is a true platform and that if you had social determinants data, you could build rules off the social determinants data. If you had genomics data, you build rules off the genomics data and you could deliver. Certain certain messages, certain assets out to those to those patients in, in a way that that they're ready to receive it in a customized way. Is that, is that how you're thinking about it? Matt.
Really exactly how we're thinking about it. And Mike, and I've talked about this for a long time and and I think you, I think you summarized it very nicely. In fact, what we're hoping to do, I use the term personalized care at the moment. And that to me is is, is to the left on the continuum of further down, the continuum will become more and more.
It's a little bit of a semantic, but as we get more and more data on which to build these rules and get smarter about building our rules and get more and more of a robust asset library from which to choose, then we can get very, very granular and make this very precise to, to an individual's care journey.
And so that is exactly where I hope this, this can go is that we can, we can write rules on more data. Multiple datasets and then and then pick from a more and more robust data asset library to to provide assets to the patient.
Well talk about the clinician experience. It sounds like you're, you're saving them hours with no shows. that's always a win increased engagement with educational content. I assume that's going to drive up a program or drive up outcomes and adherence to to the care protocols that they're prescribing. And just the overall participation in programs and stuff like that. Talk about the, the, clinical experience with this in terms of saving time, in terms of their engagement with the overall.
And there's a, there's a lot there. My call start and you might want to supplement some of my comments, but there's an awful lot there. Actually, we build these rules with our providers. And so if you, if you use the term protocolized distribution of these assets, they all, all these protocols are all these rules that allow us to automate, send of assets to the patients on behalf of the providers are, are very thoroughly vetted by the provider group.
and so that's the first thing when we can, we automate the setup. Based on the rules to allow the provider to not have to think about what assets are available in this particular clinical condition or situation, and then not have to search the asset library for them to then make it available.
And that would be the provider or an extension of the providers. So we can save time on the front end by simplifying the district. Mike mentioned a reference to a bit ago, the monitor side. So the providers also can view into how the patients interact with these assets when they come back to, to see the.
And so we're an epic shop. And so when the provider is documenting in the epic encounter they have a tabbed on the epic encounter to be able to to look into the digital care platform, to see to measure the patient's. And then also we can save time for the extenders as well for patient education where the extenders aren't having to look through physical file drawers for educational material or URLs to web-based content and such don't want to distribute those things fairly standardly and fairly consistently.
And then the last thing is is a bit of a time savings, but it's also a potential clinical outcome bonus. And that being the empirical data and at least some of the data that's in the literature is quoting this way that engaged patient has better. And so if we can enable that engagement by making resources and assets available to them at the tip of their fingers, if we control them into the portal with value added content and make it worth the effort to come into the portal with some frequency and some repetition to continuously or repeatedly, or at least occasionally engage with the content that we believe is valuable, we believe we'll be able to show improved clinical outcomes.
And with those improved clinical outcomes comes better. Financial behavior performance and all these other things too. So there's legacy or there's, there's a long series of potential positive outcomes the way we're measuring.
Yeah. Mike, do you want to, do you want to talk a little bit about the experienced the clinician?
Yeah. I mean, I think Matt captured much of it. We want to reduce clinical burden and we all know the burnout and the repetitive tasks. And so, as Matt said, if we can automate as much as possible and on, on the monitoring side, it's not. Dr. John is thinking, oh, I prescribed an app to Steve last week.
I wonder if he downloaded it. If the clinician cares about anything from that app or compliance or data, then we can trigger alerting mechanisms. So if, if threshold datas is exceeded or non-compliant or whatever, we can trigger a number of alerting mechanisms for the care team to intervene on behalf of that patient with different escalation paths.
So we, we try to make it seamless to enroll the patient in, in digital experience. And that could be disease, state management, or a better prep before an appointment or surgery or consult, or discharge from a certain procedure automatically enrolled them in the PT or OT rehab program, whatever simplify the whole onboarding experience for patients, but then be able to monitor and hold that compliance level data.
we do great work with Matt, but holistically where we're going dozens of provider systems. And I want to be the benchmarking of digital health effectiveness. And I want to know what diabetes app works best for age, gender, ethnicity, cultural geo kind of segmentations.
And we're not there yet, but I want to get into more quantitative and algorithmic prescribing of services. Based upon the likely outcome that those different solutions can provide, because so much of this is behavioral change and that's going to play into cultural in different segmentation, psychographics for what tools work best with different patient population.
So I wouldn't, I wouldn't take you down a path that a CIO would normally take you down, which is, I don't want to implement a thousand solutions. I want to implement as few as possible. You're a platform and I'm sitting there going, all right. So you're delivering stuff into the patient portal. That's great. Can I use it to trigger other things that text messages to patients and those kinds of things?
I think conceptually the answer is yes. The whole idea. One of the, one of the big value propositions of this to us a few years ago, when we first met with Mike and his team, was that very, a reusability of the platform.
And and so the ability, even the concept of being able to reuse interfaces so that I don't have to write an API to every application we want to create, we write an API to itself. And then sepsis, as a middleware in between, there is very attractive. And and the platform plays that you described bill is of course, attractive to us system.
Yeah, especially today with the cost of systems, but also the complexity. I mean, to reduce the number of systems that you actually have to have to work with is exceptional. it's pretty exciting. What you're doing Mike, the last thing I want to touch on with you is that vision that you gave us for measuring the effectiveness of digital health programs, is it just a matter of getting more data to, to identify which digital programs are more effective and amongst different demographics and that kind of stuff. That data would be incredibly valuable to spread across the entire industry. I would think.
Yeah, that's our goal, and it is a matter of capturing more data. I mean, there are several vendors that have launched it six, eight different systems. And so we're capturing data on knowing the enrollment rates, whether it's automated or manually prescribed and the engagement levels against different patient demographics and segmentations.
And so it's just a matter of capturing more data to whereby we start building analytic models that would then give recommendations based upon that data. We were working with. Most of the largest ideas in the country and the academics, and some of them are doing some clinical research. We sit at the outcome level, we see all the engagement and, and track the, the vitals or clinical data statistics that these devices or apps are creating a generating for the patient.
And we're ultimately trying to marry up to outcome level. For these patients. And when we get that flywheel effect going, we think that this is only going to increasingly become more valuable as a solution, an aggregate solution for a different provider systems.
Matt we'll, we'll give you the last word here. What's next for the platform?
We, look to expand. There's a generic answer, but I think it's actually a true answer. We look to expand the depth and breadth. And by that, what I mean is take the successful use cases that we've we've implemented, learn from them and spread to similar types of content with, with with other divisions.
And then we're also looking to to expand with more and more types of assets. I used the term robust digital asset library. And so that to me is actually a really important thing because to Mike's point, some patients interact and interface better with an interactive web page. Some patients will respond better or react more effectively to a PDF document or.
And so we shouldn't be able to have a more robust library to, to deliver to patients across this platform so that we can become not only granular in our distribution of assets, but also granular effect in our own back. And then all along the way we're measuring those measuring the effect of those impacts on the measuring the effectiveness of those assets so that we can continue to build. I like my analogy before.
Yeah, you can always do some AB testing. See what works That's phenomenal. Mike, Matt, I want to thank you for your time and we'll have to catch up in person at the next conference and see what progress you guys are making in this program. So thank you again for your time. Really appreciate it.
Thank you very much.
Another great interview. I want to thank everybody who spent time with us at the conferences. It is phenomenal that you shared your wisdom and your experience with the community, and it is greatly appreciated. We also want to thank our channel sponsors who are investing in our mission to develop the next generation of health leaders, Gordian dynamics, Quill health tau site nuance, Canon medical, and current health. Check them out at this week. health.com/today. Thanks for listening. That's all for now.