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It's not digital health. It's it's health. if we look at the technology as the thing we're going to layer on rather than looking at the technologies that we have available to us that can actually change the way the care is delivered.

I think that is the moment we have here what is it we're actually trying to do what is the right way to do that. With the tools we have available to us,

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let's switch gears a little bit in the sense that I wanted to talk kind of money side of things, because as I'm sure anyone listening to this knows, healthcare system finances \ are a challenge right now.

And for the foreseeable future, from your alls perspective at advisory board or yours personally, how does this impact the digital health? Industry, the scene, both short term and long term from both a health care organization standpoint as well as the vendors.

So there is a, real tension in this situation.

And I don't mean a tension between health care organizations and vendors. Although, of course, there is some of that. I mean, the tension is between. how everyone's goals and incentives are aligning right now. Largely healthcare organizations want to invest. They want to make use of digital tools.

They want to build on the momentum that they created during COVID, where, largely a lot of technologies were proven. I think more importantly, organizations also realized that like, hey, when we all hold hands and we agree and we decide that we can do stuff, like we can work a lot faster than we ever gave ourselves credit for.

I'm thinking here of. organizations who told me things like, we got through our five year strategic plan for telehealth in 10 days, right? I mean, all those, those are the things that are possible. We should probably not move that fast all the time as the way we operate, but wanting to sustain that momentum and knowing that both consumer expectations are higher than ever for how they will receive.

any kind of services, including healthcare services. We're not going to get a pass anymore. That it's, it's just healthcare. So it's naturally going to be slower or worse or whatever on the terms of the digital experience. At the same time, they don't have the resources. And even if they do have the resources, there are two big things.

Holding them back. One is so many organizations are trying so hard to stabilize operations, both in terms of any sort of financial difficulty that they're having or in terms of like we just don't have enough people to do the work. We've got, people practicing in places they probably shouldn't be we can't get people through the system because we don't have beds or we don't have appointments.

And at the same time, in addition to sort of all of the stabilizing that they're trying to do, they are very afraid of spending their few resources in a way that doesn't yield results. So very skeptical, very unwilling to take any sort of risk that they could invite by By investing in a new solution, whether that is a, like an operational risk, like, does it actually work or a like change management risk?

On top of potentially, the financial risk of the investment and of the return. So, there's that on the, healthcare organization side. And at the same time, the many companies in the digital health space have reached a point where they really need new revenue. they went public or they were funded.

At a time when everyone is very enthusiastic and willing to take a chance and very generous in the way that they were funding these organizations. And now they are having to sell into a market that is very skeptical, that is very risk averse, and that is certainly not generous in what they're able to, to provide and what they're looking for.

So you've got, a real mismatch between the buyers and sellers. compounded by all of the things that make those relationships hard, even absent those other pressures? Does the healthcare organization understand its problem? Do they have all of the people internally aligned around their goals?

Is the vendor really able to support what they say they're able to support? Are they just out there selling to everybody? are they actually finding a good, partner, both as, In terms of the organization, but also having someone, internally who can help them navigate, not just the contracting process, but the workflows and the implementations, those all are basic things.

that are hard to do in the best of times. I call them out to you because we've done some work to look at them. I call them out not because they're revolutionary, but because they're just not getting done. And all of the other pressures around those organizations make it harder to get those done at the same time that it raises the stakes for not getting them done.

As you were talking about from the vendor's perspective, it made me think, you know, a lot of these startups, these digital health companies, were just created in the last four or five years. And I wonder, did this COVID period of time that was just very unique to the speed with which we moved.

To get legal review in a week, you know, all these things that were just happening because we were all so focused on that. Did that give these vendors, these startups, a false sense of the way that we typically work? Even if we moved 25% faster than we did pre-COVID it's still not anywhere near what was happening at that time.

And they're like, oh, they make decisions, we should be able to close six deals this year. Do you see that affecting those business plans? That historically, we just don't move like that. I'm not saying we shouldn't move more quickly,

but

no, I think, I think you're absolutely right. I think for many organizations, it, it, were given sort of, a false expectation of, how sustainable that would be.

But I think that's also true for investors, especially investors who are coming to healthcare because of all of the. Demand for digital solutions that covid required and seemed to suggest were going to be the wave of the future. I do think those things will exist in the future. You and I have talked before.

Like, we're not going to talk about digital health in a few years. We're just going to talk about health. This is going to be what we do. But I think for a lot of organizations who were not accustomed to working in the legacy healthcare system, which is pretty high bound by what we've always done.

I do think that set up some expectations that were, probably not realistic.

What's a technology or an area , that you really like, or that maybe people aren't as aware of or talking about that you think is going to be really important.

I think it's more of a use case than a specific technology, but I think anything that allows patients.

or plan members like if you're on the health plan side, it's the same sort of thing. Anything that lets them effectively self-serve I'm very excited about that. We talked about sort of the patient intake kind of thing before that is a, that is a kind of self-service like I'm, sort of queuing myself up.

Into the, the workflow of, of the practice or, or the, hospital. I also think, and this is sort of like the third rail of physician engagement, but I think self-scheduling certainly when we have asked consumers, even when we have asked our own colleagues, what's your biggest hangup about patient experience?

It is. Either I don't know how much I'm going to pay before I go to the clinician, or I cannot self-schedule Everything else, everything else now allows you to self-schedule Like, you can, that is not a problem. And we still cannot do that in healthcare for reasons, and I get it, but we've reached a point.

Where I don't think we have the luxury of resisting anything that is an effective self-service And I would include things like asynchronous telehealth here. I think we have reached a point where the pressures on the workforce and the the need for productivity from our clinical and supportive staff is so high that the industry really needs to get its hands around these technologies and work on making them better instead of trying to keep them at arm's length.

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See, that's where

I think this, AI, or even just a dynamic questionnaire, quite frankly, would be the key. Because to your point, some of my subspecialty colleagues, they're like, well, I need to know this, this, this, and this before they get scheduled. And they're just questions and they're questions that normally you can get from the chart.

And so instead of having the staff member do it during these hours, Let the patient do it 24 7. And I would bet you you get a more consistent approach to it as well. But again, , that's adding a layer of technology to that. Cause in primary care, it's generally more accepted I would argue, I think we're just used to, well, you can tell me what they're coming in for, but I never know what's in the door.

Right. And there's a little bit of acceptance to that. When we went live with Online scheduling for primary care. I can remember one of my physician colleagues and leadership, actually we're six weeks into it. And he asked, he said, Brett, when are we going live with that online scheduling? And I said, Hey, we already are.

And there's a few, like you can tell the patients generally are a little bit more wordy for the reason that they're being seen for versus a staff member. And that's about the only little, like little tip off on your schedule that they were, it was online. So, but. Then you get into some of these subspecialties where demand and access is a real issue.

They want to make sure that it's a legitimate reason for them to be seeing them. And so I get that, but I think we can overcome it, but there's a, there's definitely a cultural fear from the

provider side on it.

I think that's also interesting when we think about sort of the, cultural and the mindset that exists within healthcare.

We're going to reach a point where there is generation of physicians who are in practice and they may already be, I'm trying to, I'm trying to do the math here in my head real quick, Brett, but like they may already be in med school or be in residency who never went to school without Google when we get to that point.

An EMR that is not functionally searchable is no longer acceptable. We're going to get to that point with CHAT GPT2. And so I think that those are the kinds of shifts that are coming, that may already be here. And I'm not sure that, we are ready for that at levels of leadership within healthcare organizations.

That's

fair. That's fair. One of the question for you. That's challenged me because I don't have an answer. I don't even know where to start with it. But where is the activity? AI, digital health for nursing, right? Like, and where can it help? We've got, do you think this nursing kind of crisis that's hit it, will that put more focus on it?

I haven't felt that yet, even though it's been 18, 24 months of, this nursing crisis. I feel like we're missing the boat here, but I'm curious, you have obviously a different, broader perspective. Where is that happening? Please tell

me.

Well, 100%. I think this is a great question. And I, would love to know where is the activity to support nurses.

I mean, we see a ton of investment and attention to Providing technology to assist the physician and in many ways like I totally understand that because of the complexity of the work and also the direct relationship to our payment mechanisms all run through the physician totally makes sense in the same way on the revenue side.

There's also a lot of tools to support patients. Right, and thinking about how we can help them to adhere, or as I said, make appointments, how to make it easier for them to get in, but ultimately that is about how do we make it easier to capture the dollars related to those services.

I think. Part of the challenge is that so much of that middle, like if you look at physicians up here and patients down here, so much of that middle filled with nurses and all of our allied health professionals is invisible in. A lot of ways, both in terms of billing and in terms of mindset. And in as much as there is not the investment in how do we solve those problems.

I think there's just a lack of attention to how, do we deal with those problems. Now, to your point, I do think there is a lot of opportunity for AI and better workflows to take a lot of the productivity syncs out of some nursing workflows. I say some because, at the core, a lot of what we ask nurses, RNs and LPNs to do is.

Stuff that cannot be automated, right? It will be stuff that is at the bedside that is with the patient. And that's great. Like we could automate completely around them and just have them do that. Like that, that'd be a great goal. I think that, is incredibly important. There's a lot of stuff that we can do to take things off their plate.

The flip side of that is, and I had, I'm interested to see how you respond to this, Brett. I heard a nurse leader the other day say, We are great at coming up with nursing solution to doctor problems.

I mean, that's true. I think you go back to what you said. When the dollar, when the revenue, the reimbursement really hinges on how that physician performs.

Which is really not true. That whole continuum is how the performance goes, right? But that perception is it's there. You tend to ignore that layer in between at your own peril. And so my hope is a silver lining from this labor issue is, while some of that cost has gone down some, it's still incredibly expensive right now, the labor costs.

And maybe now there's an ROI. That organizations will look at where before they're like, well, tell me how is that going to make the doctor more efficient because that's ultimately how I know that's not what we're saying. We're like patient care length of stay, not having to train 100 new nurses because they're burning out and leaving, you know what, where is that.

So maybe, maybe that's the silver line there. I don't know, but I know in my own organization, it's sort of like, what are we doing now the nurses? That's what I'm asking and trying to figure out. So I was, I was curious, I was hoping for some solutions that were out there. I

mean,

are technologies that, leverage some of the things that we've been working on, I have heard a lot about virtual nursing and certainly, I think there are specific use cases and there is real value there.

There's probably not the solution that, has the most leverage. I think one of the things that, my team has, my team has been working on this for, for several months now, and they honestly, Brett are kind of. What's the right word? I was going to say frustrated, but I think the word is probably closer to dismayed that there's not more here specifically for nurses.

and this is what I was talking about with the mindset shift, like so much of what. Is ostensibly billed as valuable for nurses is really just downstream benefit of a tool. We gave the doc, which is not wrong. Like, sure, I'm sure a lot of that works. But when we take stuff away from the nurses, off their plate, what usually happens is we just replace it with something else, right?

We replace it with another process that we haven't automated yet, or we haven't solved for yet. Or we, , Fill up their workflow with something else that still keeps them from doing the care that only they can provide on top of license.

Right. So go back to your virtual care or your virtual nursing example.

A lot of organizations, well, at least a handful that I've seen in great detail. One of their goals was to reduce FTEs. Let's take that burden off of the nurses so we can either expand their, you know, patient ratio is going to expand or, we don't have to have as many nurses on the floor.

You're filling their time with something else when they're whenever and there's definitely utility to removing. having to pass a tray of food, when they're in our, like, that just doesn't make any sense to me, except in some kind of emergency that you would want your RN doing that. But you're exactly right.

And, and, and I get it. It's like, they're part of the, the widget that's in between. And I'm trying to, decrease that so I can make my budget, but you know, that opens up a whole nother can of worms is like what you need to get out of the hospital. And not take care of their and

think differently in that regard as well.

Well, and it also goes back to what we were talking about. It's not it. It's not digital health. It's it's health. I think that's part of it. Like we if we look at the technology as the thing we're going to layer on rather than looking at the technologies that we have available to us that can actually change the way the care is delivered.

I think that is the moment we have here to really think about as we said earlier what is it we're actually trying to do what is the right way to do that. With the tools we have available to us, not which are the pieces of this manual workflow that I can cut out and just string together a different manual workflow that is longer and maybe worse.

Yeah, it makes

total sense. Redesign your workflow, understanding what tools are available to make that happen, and then, but then go back and apply the tools

to it rather than.

And that's, and like, it's easy for me to say. here. I mean, obviously that is super hard, but that is the opportunity that we have. I think that's where the long lever is here.

If we want to make a dent in this, like this was not something that COVID caused. This was always a problem. COVID just sort of revealed and probably accelerated some of the consequences of this. This has been a problem that has been a long time coming. So it will be a problem that takes a long time to unwind.

And I think that that is probably Opportunity for a lot of these technologies to mature as we learn how to make this better over time.

A hundred percent.

The analogy I was thinking of as you said that was when you roll out an e h r a new e h r particularly when you've not had an enterprise wide one, there are a lot of corners, nooks and crannies that you'd rather not shine that light on, that you find, you know, workflows that are.

Holy moly, you can't do that. It's a little bit like you've got to re evaluate what your workflow is before you apply ] , this new process to 100%. Well, John, this is awesome. I don't want to take up any more of your time. I feel like we could talk for a couple more hours here. And so we'll have to get back sooner than this last time.

But thank you so much for your time and your insights. I

really appreciate you being here today.

Thanks so much, Brett. It was great to talk to you. All right. Take care.

Thanks.

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