INTRO COMMENTS: Hello and welcome to Modern Healthcare’s Next Up, the podcast for emerging healthcare leaders. My name is Kadesha Smith, I'm your host. I’m also the CEO of CareContent, a digital strategy agency for healthcare organizations.
Welcome back from the holiday break, welcome back to our podcast.
Today, we’ll be discussing the future of the healthcare space over the next 4 years and how the transition to the Biden/Harris administration may shape these expectations.
Healthcare organizations are becoming increasingly focused on innovative technology solutions like telehealth, enhanced electronic health records, and partnerships with technology companies.
With this focus has come changes to the C-suite — A Modern Healthcare article reports that there was an approximate 40% increase in the number of telehealth leadership roles in the healthcare system between early 2019 and early 2020.
The innovations in technology have blossomed further during the COVID-19 pandemic. As the new vaccines roll out and we inch toward a return to normalcy, we expect that many of these innovations are here to stay.
But as aspiring healthcare leaders rise through the ranks over the next 4 years, what should they be expecting in regard to technology? How should hospitals be approaching the use of innovative technology now and in the future, and what do they need to anticipate as we head into a new Biden/Harris administration?
In this episode, we are speaking to Dr. Karen DeSalvo. Dr. DeSalvo served in Health and Human Services under the Obama Administration. She led the Office of the National Coordinator for Health Information Technology between 2014 and 2016. And then last year, she joined Google as its first Chief Health Officer.
She is speaking with us about what new and aspiring healthcare leaders can expect over the next 4 years when it comes to innovations in healthcare technology.
Let’s hear from Dr. Karen DeSalvo.
MODERN HEALTHCARE: Hello Dr. Karen DeSalvo. How are you doing?
DR. KAREN DESALVO: Well, I'm doing great Kadesha. Thank you so much for having me on the podcast. I'm looking forward to our conversation.
MODERN HEALTHCARE: Thank you so much for making the time. And as you know, we're here to talk about sort of what to expect with telehealth and healthcare technology, especially over the next four years. But before we get into any of that, I would love to know more about your job. You know, Google's first Chief Health Officer, can you tell our listeners what problem where you have selected to solve in this position?
DR. KAREN DESALVO: I feel very grateful to have the opportunity to work at the company ,and also, especially in this time of the pandemic, which maybe we can take a minute to talk about.
My background, as you may know, is in a mix of medicine and public health and technology. And this job is a chance to bring all that together. And think about how a company with the expertise in engineering and artificial intelligence and the opportunity to provide good information to consumers all around the world can meet up with clinical expertise from my team, to make sure that we're providing trusted authoritative information on our very surfaces like search, or YouTube, and also bring the best evidence-based approaches and industry rigor to developing healthcare products and do all of that with a lens of equity. The pandemic added an additional layer of work this past year, which was really also about Google or health and safety.
So, taking on that more traditional role of a Chief Medical Officer for a global corporation and guiding and advising how we're going to protect Googlers whether they're in the office or working from home.
MODERN HEALTHCARE: Before we get started with our discussion, I do just want to lay out some data points to kind of frame our conversation. First is that, an August Modern Healthcare article reported that from early 2019 to early 2020, there was about a 40% increase in telehealth leadership roles in hospital C-suites. Telehealth skyrocketed during the pandemic, and a recent study found that 83% of patients are likely to keep using it even after this pandemic returns to whatever normalcy is.
Another data point to frame our discussion is that there's a trend of hospitals partnering with technology companies. We've reported on collaborations like Google Health and Mayo Clinic partnering to research radiation therapy. The American Medical Association has been connecting physicians with digital health startups to spur development of new technologies.
Another data point is that only about 8 million Americans have been vaccinated as of this recording. And this is much lower than Operation Warp Speed's promise to distribute vaccines to 20 million people by December. Hospitals may be able to use their electronic health records to overcome some of the distribution challenges. But clearly, this is an area where innovation is needed.
So, first question to you is, you know, technology solutions kind of exploded during the pandemic, allowing patients to check in for their appointments via mobile app, texting when their room is ready, they can bypass talking to people at the front desk and in the waiting room. What are your predictions about the types of solutions that will last after this pandemic?
DR. KAREN DESALVO: It's such an interesting time during this pandemic because the forcing function of needing to rely on a digital first approach for healthcare systems has accelerated what many have wanted to do for a long time. And it's clear that, given the option, as you described in the data, consumers really do prefer something that can be accessed more conveniently for their regular lives. We're learning that convenience is really important and that there are things that can be done virtually, sometimes telephonically, but sometimes with video, sometimes asynchronously via text or email or chat bots, that allow people to continue school or work or caring for family members or loved ones, or just frankly, to not have to go out into the world right now, which is something we people are trying to avoid, and still get the care that they need. We've learned that the technology can work. We've learned that people are desirous of it. And we've learned that there are ways that the healthcare system can very quickly shift its strategies and its tactics, so that it can be more accessible to consumers and patients in the ways that they want them to be.
So I, like many people, anticipate that there will be a thread of this continuing. It's not that we invented a ton of new things during the pandemic. We just put a lot of things that have been kind of on the shelf or in an experimentation stage much more to the forefront. I mean, we're going to need new data infrastructure to support these connections. That's, in and of itself, an entirely additional topic, but you kind of touched on it when you mentioned the vaccines, because that's an example where there can be care received — that's a COVID vaccine — but the record of that care should be integrated into a person's personal health record, so that they have access to that when they need it, but also that their doctor or their clinician knows that it occurred.
So, there's going to be other ways we'll have to remind ourselves that we have to tell the story of somebody's healthcare experiences and health experiences across their lifespan. And they won't all happen in a bricks and mortar of a clinic or a hospital any longer. And I think this has just accelerated our recognition that there's going to be a need for that and demand by consumers.
MODERN HEALTHCARE: And that connectivity is crucial. So, that leads perfectly into the next question about just how healthcare organizations and provider organizations can leverage electronic health records, especially as they begin rolling out COVID-19 vaccines for the public. Do you have any thoughts on how EHRs could improve the distribution process?
DR. KAREN DESALVO: We don't necessarily need to think about it as the only solution set because there are some other really interesting ways that the world is thinking about tracking the digital record that people were vaccinated, pricing some articles about a digital card in your digital wallet for e-commerce interest is, particularly interested. On the other hand, for healthcare reasons, need a continuity record.
And so clearly, having an opportunity to include the record of your vaccination in your EHR, particularly for purposes of your personal health record, that you can access through your portal, I think is just going to be a really important tool because people need to know they were vaccinated. They're going to have to, in some cases, prove they were if they want to, for example, do international travel.
MODERN HEALTHCARE: Yep.
DR. KAREN DESALVO: But they'll also need to know what the second dose needs to be for those vaccines that are required double dose. Was it a Pfizer, Moderna? Eventually, it'll be an AstraZeneca Oxford vaccine, maybe a Novavax. So, there will be a variety of vaccines on the marketplace, and you'll need to get a second dose of the same one, so there's this sort of continuity of the dosing regimen. And then of course, there's probably also opportunity — which is already being leveraged by the FDA and others — to track on post-marketing surveillance for safety, for example, or for side effects of the vaccine.
So, we can think about it as what the individual person needs, what the system needs to know how to be prepared to give that person the right next dose of the right vaccine, but then also, how can we use that underlying data in the EHR, as a way to understand the impact of the vaccine for population health improvements, for interrupting COVID transmission, and then looking at the long term safety and side effects of the vaccines themselves?
MODERN HEALTHCARE: Absolutely. During one of our recent episodes with Michael Dowling —- he's the CEO of Northwell Health in the New York City metro area — he said that there was a lot of frivolous state policies that were pretty much scrapped so that more COVID patients could receive care. We may see this so that more people can receive vaccinations. You've worked with President Joe Biden — how do you think his administration will impact regulation over technology and medicine?
DR. KAREN DESALVO: You know, one of the things about disasters is we often learn of the many things that we can do, but we thought we couldn't. There's so many good examples of this in Health IT. We've seen this time and time again in disasters, whether it's a hurricane or a wildfire or some other event where interoperability, the connection of EHRs, or health information exchanges across state lines can happen almost overnight, in order to — because people have a shared mission to do the right thing and get people into care or service or make sure that they don't have any gaps in their care. It's very similar in the pandemic, I think we're seeing.
For example, if we want to do a mass vaccination campaign, we're going to need to leverage the workforce resources that are on the front lines and perhaps most proximate to most people, like pharmacists. So, there was some rule-making around allowing the vaccine to be given without a physician prescription, and by a pharmacist. You think states change their rules and scope expectations to accommodate that mass vaccination, and that's just probably good vaccine practice across the country for those US Preventive Services Task Force recommended vaccines that we know are on the vaccine schedule and we know folks ought to get. There shouldn't be a bunch of hoops to get through.
Telehealth is another example, where we, as a country, decided that we needed to make sure people could work across state lines or that some of the licensure expectations, perhaps were not meeting the needs of patients and consumers and community. So, some of those changes that happen quickly, in an emergency, I do hope will stick because there are environments and in which — always you want to protect people, right? That's the goal. On the other hand, sometimes they're actually interfering with people's health outcomes.
And I think that the incoming administration, I certainly can't speak for them, but I would say, knowing the continuity of Information Technology Policy, across the Republican and Democratic administrations for the last, say, 15 years, has been fairly consistent. Meaning mostly angled towards improving access to information and data for consumers and patients, to give them more agency. Finding ways to route continuity of care, to reduce barriers to interoperability, and increasingly, over time, do that in a way that is about harmonized standards and seeing that there are governance expectations nationally that allow data to flow between systems.
From an interoperability standpoint, my expectation is there'll be further push in a similar direction, harmonized standards, expectations for health systems to share data, especially with consumers. And beyond that, I think we're seeing a lot of signals in some of the other technology areas that may continue into this administration. And, you know, we've talked about telehealth. Clearly, there's a lot of will in the healthcare community, the payer community, and then the consumer community, and then I'll say policy also, to see that telehealth is still a front-and-center option for consumers. And finding ways to make sure that unnecessary barriers aren't in the way. And, you know, that's about accessing care and making it affordable for consumers, but also making sure that it's not being abused, so that there's good catch on things like fraud and abuse.
So, I would expect in some of these areas, more continuity than people might expect, given the interest on the part of consumers and policymakers to continue this press forward to make care more accessible and available for people.
MODERN HEALTHCARE: And with that, sort of press forward, obviously, there's a lot of excitement. Like you said, you're able to do things at a much faster clip than we normally would have. It's like my grandmother used to say: It's amazing what you will do when you have to. But at the same time, there's a need for caution, right? There's a need for vetting some of these new innovations.
What general criteria should healthcare executives use to evaluate whether the latest and greatest tech innovation is really worth their time?
DR. KAREN DESALVO: Yeah, I really feel for leaders in healthcare systems. This is such a big job for them. Because you know, you're every day, especially right now, there's so in the middle of trying to deal with the healthcare crisis in front of them, which is about COVID but also the challenges of making sure they're meeting the needs of their patients with chronic disease or episodes, that requires urgent attention, like cancer or trauma. So, there's that, and then there is also working to get vaccinations accomplished for not only their own employee base, but for their patients and, in some cases, for the community.
So, there's all that going on. And then in the background, there's how are we going to continue to navigate this new digital health world? I think that the general guidance is to begin to create a strategic framework that lets you pull signal from the noise. A lot of companies are going to come at people with ideas, and one of those big strategic questions are, does this fit in with our strategic priorities? Does it improve the health or care of our patients? Is it going to solve some important problems that our providers have, whether that's our nurses or social workers are doctors? And really to stay focused in all those areas as much as possible on what are the problems we're trying to solve? And is this a solution that meets it? I think it's very easy to get enamored with solutions and cool, interesting technology that really doesn't solve a problem that might actually add more layers of complexity or create more problems.
And I think just one other comment I want to make on this, which is something that venture capital firms know well, and probably people looking at technology. It's not just about the technology. It's about the people who are building it, their beliefs, their value system, you know, finding partners that believe in things that you care about, like equity and product inclusion, or really, very consumer centric efforts. These are all ways that it's not just this, you know, machine that goes bling. It's also built by people who have experience in the field or people who are, have a background or value system that aligns with our own health system. So, we can trust them and work with them going forward.
MODERN HEALTHCARE: That probably can eliminate some of the distraction of the shiny new thing, like does this really resonate with what we're about? Absolutely.
Let's talk about protecting patient data in the midst of all of this connectivity and technology innovation. We know that Google has, this is something that's come in the news about protecting patient data, especially as you partner with other health systems. With that in mind, you've kind of already touched on this, but could you say more about what hospitals should look for in a partner? And what are some red flags?
DR. KAREN DESALVO: The partnership component of this, especially if you're looking at doing something that is going to be over the long run, it's important to know that you're aligned with that organization and with the people that work there. You want to be able to trust those partners. That's one thing.
The other comment I'd make, hopefully obvious to people but is, you should definitely ask the hard questions before you get married. You know, sometimes sometimes there's all this love and trust, and then you sign a contract that doesn't really protect either party because you trust the other party, but people do leave. And so you have to make sure that whatever you're contractually working from is something that very good lawyers on both sides will have asked those hard questions and thought through because those contingencies will certainly arise. So, it is about sort of trust and relationship. But you also have to have a really strong underpinning where you've asked some of these difficult questions of the "what if?" might happen.
And I think the other part about finding good partners is that you have to have a sense of whether success looks the same for you both. And this goes into kind of the hard question option. But it is one of the things that tech certainly struggles with as it goes into the healthcare space. And I'll be kind of explicit about this. One is, you know, there's some tech options, which are, "We want to enable the current system and make it more efficient." There's other tech approaches, which is, "We want to help you get to a system that's more, say, value-based or consumer-oriented." And that's certainly where Google is. Our interest in finding and working with partners is, of course, we want to, where we can be helpful in the near term.
But on the other hand, where a lot of our partners when they come to us is, what is the future going to look like? And how can we help not just get there but build it? What does it mean, if we want to think about building artificial intelligence models to identify breast cancer? How can we do that together in a way that is not just bringing great engineering capabilities to bear but doing it in a way that respects patient autonomy and privacy and has a fairness in the models in mind? These are all things that when you build that future, you want to know, with your partner, yeah, what we want is to eliminate disparities. And we want to make care less costly, so that we're pulling savings out of the system. And if you can be aligned into that future, then you can kind of back into, "What are the steps that we need to take together to build that?"
MODERN HEALTHCARE: Start with the result. Okay.
Many healthcare providers are worried about consumer channels — Facebook, YouTube, false information, especially during a pandemic? Can you give us your thoughts on how hospitals can use their digital presence to mitigate some of the misinformation that's often spread?
DR. KAREN DESALVO: Yeah, this is one of the reasons I came to Google, actually. For many doctors, it's the “Dr. Google.” In fact, one of my doctor friends, when she heard I got the job, she sent me a mug that said, don't basically think about Dr. Google. Which is — the point being, we want to make sure that not only on our surfaces, like search, or YouTube, consumers are getting the best quality information that they can. We take down harmful information where that makes sense. But very importantly, we do this in partnership, we, Google, with authoritative organizations. In the pandemic, for example, it's public health organizations, like the World Health Organization or the CDC.
In other cases, we've partnered with groups like Mayo or Harvard, to make sure that the information that is surfaced, say, in something we would call a knowledge panel. It's a way that when you search on the homepage, in some areas like in mental health or diabetes, you'll find an image that is a knowledge panel which often has links.
I think the point there is that, we, Google, are a place that people come every day to get health information. So, as a public health healthcare person, I'm going to have to say it's like a dream. Because so many people are asking us questions, and now our job is to help them get the best information, which often exists. It's just that people don't know how to find it exactly.
And so I think, for healthcare systems, they have a very similar opportunity, frankly, especially systems that have been in community or have relationship and community. People will think, "Oh, I have a question about whatever topic," and they'll go to the website of their healthcare system first to see if there's good information about a vaccine or about diabetes. So, my point here is that those healthcare systems don't need to think that they have to create all that content because there's already good content out there from places like the American Diabetes Association or NAMI or the CDC, I think it's helpful for consumers that they can be pointed to some of that existing good content. That's maybe a timesaver but also a way that there's a consistency of information and drumbeat that people can get across the country to hear some of the same messages from some of those same trusted, unbiased authorities. So, I would encourage healthcare systems to think about.
I would also just make a point that one of the other challenges that health systems have is they want to be a consumer-facing organization and have a B2C strategy. It's very hard. It's one thing to have people come to you and look up information. I think your portal is a pathway. But it's also, it's true that it's difficult, I think, for healthcare systems to have their B2B channels, which has to do with things like supplies and procurement. There's their provider relationship, and there's consumer, and the consumer is somewhat fluid. So, it's not that I'm saying don't do it, because I definitely think that people should keep working on it. On the other hand, what I hear from consumers and patients is, they want to make sure that the healthcare system is getting the healthcare part right. And the messaging part, sometimes they can find from other sources. Perhaps that's the most succinct way to sometimes say it. It's that we don't have to be all things to all people.
MODERN HEALTHCARE: When consumers come to your website, or your social media, they want to know specifically about your services and your doctors.
DR. KAREN DESALVO: Yeah.
MODERN HEALTHCARE: That's where you invest in creating the original content. But the healthcare 101 stuff, that's already been done. Lead people to that, and to your point, it does create that consistency to mitigate the spread of that false information.
DR. KAREN DESALVO: It is also true, I think, that healthcare systems sometimes need to go a layer deeper and not just put up the thing that seems to resonate with them — them being the administrative team or the clinical team. But if their patient population looks different than them — if they're from communities of color, if they're from different socioeconomic strata, if they have different language, different languages as the first language — just be a little thoughtful is all I would say. There's a turn of the crank there, right? It's like, yeah, this is the good information we can get from said source. Does this maybe meet these expectations of our community population? And that is where, like a community advisory board can be super helpful to have that added reality check of, "If you thought this was good information — it's biased, or it's confusing, or it doesn't really speak to the way that I would think about this health challenge." So, I would encourage adding some consumer advice from a more structured advisory board.
MODERN HEALTHCARE: As the new administration comes in, and social media companies have started to really increase calling out false data, what changes can we expect to see in terms of health information available online?
DR. KAREN DESALVO: One of the things that surprises folks is that digital social media companies have so much reach, and it's so easy for information to get people down the wrong path, or hopefully the right path. I would not have thought of Google as being as much of a public health company as it is. The public health information that we put up on YouTube about COVID that directs people to World Health or CDC or NHS — National Health Service — more than 400 billion impressions.
MODERN HEALTHCARE: Wow.
DR. KAREN DESALVO: So, when I tell you people are coming to look on our services for information, they are coming. Search, very similar. Story that will push forward, you know, or amplify what the CDC is saying, or the FDA needs to say about vaccines. This has been for us a really important time for us to strengthen those relationships with the authoritative bodies like the CDC or state health authorities, and make sure that we're amplifying those messages.
My hope and expectation is that our company will continue to do that to be a partner to public health, especially public health authorities and work with them in ways that not only helped to raise good information, but also allow us to remove harmful information when it makes sense. And then all the ways in between that we can be helpful.
So, I think, count us in as partners in the public health ecosystem and in wanting to amplify really good information to people and make sure that where we can, we're going to work on services like YouTube to build out content that can reach audiences. For us, it's not just about the healthcare space, it's really about the health space. Because, it's not just going to be important in the pandemic. When we come out of this pandemic, we're going to have big health challenges down the road. We're going to have a pent-up demand for chronic disease, around substance use disorder, as well as other mental health challenges. And so we stand ready to be helpful beyond just this pandemic period, but into the next phase.
OUTRO COMMENTS: Thank you, Dr. Karen DeSalvo, for discussing what leaders can expect over the next 4 years when it comes to innovations in healthcare technology, especially as the new administration settles in.
Again, I’m your host, Kadesha Smith, CEO of CareContent. We help healthcare systems reach their growth goals through digital strategy and content.
I invite you to go to modernhealthcare.com to read more about what it takes to become a C-suite leader in today’s healthcare system.
Look for more episodes of Next Up at modernhealthcare.com/podcasts, or subscribe at Apple podcasts or your preferred podcatcher. Thanks again for listening.