We all want to overcome barriers to good healthcare, but how are we going to get there? We asked Vivian S. Lee, President of the health platforms unit of Verily, and author of “The Long Fix: Solving America’s Health Care Crisis with Strategies that Work for Everyone." You won't want to miss hearing from this inspiring changemaker. She may even share which book she might be working on next.
Title: Reimagining the future of healthcare
Guests: Vivian Lee, MD, PhD, MBA, President of Verily Health
Host: Christine Parent, Associate Vice President, MEDITECH
Vivian: I'm very optimistic, you can probably tell from the title of my book. It's The Long Fix, it is a little long but we do have a fix at the end of it and I think here again it very much is tied to the data that we have access to, especially the data coming from our electronic health records and how we use the data to drive performance improvement and lower the costs of care.
Christine: Welcome to another episode of MEDITECH podcasts, we’re the leaders in healthcare technology empowering you to be a more informed healthcare, consumer and provider. Hear the latest from our friends and colleagues on topics we think you should know about.
Today I'm joined by Vivian S. Lee, President of the Health Platforms Unit of Verily. An alphabet company focused on Precision Health, author of The Long Fix - Solving America's Health Care Crisis with Strategies That Work for Everyone. Former CEO of the University of Utah's Health System and Dean of the Medical School and Harvard Medical School's senior lecturer, Vivian is internationally recognized as a thought leader in health technology Payer and Care Delivery Systems. She's an elected member of the highly prestigious National Academy of Medicine and has authored more than 200 peer-reviewed articles. I had the pleasure of meeting Vivian recently as she was a featured speaker at our MEDITECH-LIVE customer event. Welcome Vivian, glad to have you.
Vivian: It's wonderful to be with you, thank you.
Christine: Tell us what was your inspiration for writing this book, who is your intended audience, and what do you hope people will take away from it?
Vivian: Well you know, I set about writing this book, The Long Fix, initially with our medical students in mind when I was at the University of Utah and I was the dean of the medical school. I welcomed the brand new medical students to our profession and I realized that they had so much potential. They had so much energy. They were coming into healthcare really wanting to help solve many of our intractable problems and yet they didn't really understand how healthcare worked and if they had an education like I did, they might not understand it for another decade or two.
I really wanted to correct that, I wanted to address that and I actually put together a series of lectures for those starting out medical students to just get them a little bit caught up to speed on how healthcare really worked, and once I started doing that, I realized that many of us even practicing in medicine or working in allied professions didn't totally understand how the business worked either and I thought to myself, well it's no wonder our healthcare doesn't really work. If people inside don't really understand it then, how can we possibly go about fixing it and so that's how I started and my overall hope is that people will recognize that, yes, there are a lot of challenges in our healthcare system.
Overall, we're really a collection of people who are deeply committed to doing good things and now that I think we understand many of the problems and as we all focus our attention on trying to solve them, people, for example, in the electronic health record business like MEDITECH or people in the tech business like Verily, if we all link arms and we understand the model, then we can really set about making a brighter future for us all.
Christine: Verily's purpose is about bringing the promise of Precision Health to everyone, every day. What does that mean for you as you lead the health platform business at Verily?
Vivian: Well, I love that question because I really love that goal. The goal of bringing the promise of Precision Health to everyone, every day. We've been talking a lot about Precision medicine for a long time in healthcare, really thinking about the fact that everybody's biology is different. Our genomics are different and understanding that through science but at Verily, we really want to expand that definition to health overall and we recognize that people may not only be biologically different but our social circumstances are different. Our economics are different. What matters to us is different, what matters to us today might be different from what matters to us in six months. Right now, I may be focused on getting into that outfit for this wedding that I have to go to, for example.
You know we're motivated by different things so how do we really engage people in health in a way that matters to them? In a way that matches their specific conditions. In a way that's convenient and accessible, and at Verily, we bridge that. We bridge the science and discovery side of that into that day-to-day practice and access to healthcare for everyone. Particularly in health platforms, which is the area that I'm the most focused on. It's about using technology, for example, that's available on your phone, on your smartphone through apps, teleradiology, telemedicine, telepsychiatry all the kinds of ways in which we can connect doctors with patients through our phone and through our apps and computers that we saw was so helpful during the pandemic and then just really making the tools easy and accessible and culturally sensitive so that everyone has access to health care regardless of who they are.
Christine: There is so much we all still need to accomplish in healthcare and electronic medical records are just one albeit important piece. Where do you see EHRs fitting into the equation for improving lives?
Vivian: I remember life before EHRs when we all had our paper records and the paper charts. We'd go to the nursing station and someone else would be having the chart and then there'd be somebody writing their chicken scratch in there and nobody could read it. I mean it was amazing that we really tried to practice medicine that way. EHRs are absolutely vital. I mean they are the largest treasure trove of data about patients and when the HITECH act was passed, you know and really we moved into this whole digital world in healthcare. It started to help us realize that we could really modernize medicine in the way that most other businesses have already undergone actually, you know whether it's banking or online retail or almost anything right?
Yeah and I think that there's a critical step which is what we're seeing, right now. This sort of transition of EHRs from in the beginning was just “okay, let's just create these EHRs and be able to use them” and now companies like MEDITECH are thinking, “okay how can we take the next steps?” How can we make the data more accessible to people? How can we add additional data, for example, to make it even richer? Understand more about people's social backgrounds, collect more information directly from patients maybe even layering a little bit of costing data on top of that, that's something that we're very interested in at Verily so that we can understand the cost of care, so that we can help reduce those costs and then also starting to think about, okay, we have all this data, how do we make the data really actionable? How do we extract insights from the data so that a patient gets the right information at the right time?
Let's say before they're coming in for a procedure, they know, hey you know nutrition is really important so that you can recover well from this operation. Let's make sure that we give you a couple of extra of those special milkshakes that can kind of boost your nutrition, or help a physician understand. Here are some patients that were especially worried about that, who might be at higher risk for a bad outcome. Let's just pay a little more attention to those patients. Those are the kind of tools that I know MEDITECH and Verily are definitely working on.
Christine: The rapid proliferation of digital apps in healthcare is both chaotic and interesting. What do you see as the biggest benefits to the availability of so many apps and also what cautions and advice do you have for healthcare organizations as they navigate through which ones to use?
Vivian: That is such a fantastic question because as I discussed when I gave the keynote talk at the MEDITECH conference. In 2020, there were more than 90,000 new health apps that came onto the market that came into the Play Store and so on. 90,000 that works out to be 250 a day. Can you imagine that? That is mind-blowing. What's interesting about it is you said chaotic. That's a really interesting word because clearly there's just been this explosion, this revolution, and what's interesting about it is, it means that there are a lot of people thinking about health who have the right technology background to build digital apps and they're quite creative. Sometimes successfully creative, sometimes maybe not so successfully creative but certainly, there's a lot of energy in this field right now which I think is really great and especially if it's coming from people who understand patients as people, as consumers, and really try to make it very user-friendly, very accessible.
Now the downside, as you alluded to is you know, how does a healthcare provider or healthcare organization navigate through this? Well, I think the most important thing is to set a very high expectation that before you implement any kind of healthcare app, just like before you implement any kind of new healthcare process that you have really good data, that there's really good evidence in legitimate scientific publications that this particular app or this piece of technology actually benefits patients. Benefits the kinds of patients that you're caring for and really, the more sophisticated digital programs, of course, the businesses that we run into within Verily and in some of our other businesses definitely strive to meet that expectation. Do conduct serious research, measure the outcomes of patients, and really quantify that input in a very justifiable way. I think that's probably the most important thing that healthcare organizations can do.
Christine: Where do you see AI and machine learning making the strongest positive impact for providers and patients and what does this kind of innovation look like across Verily?
Vivian: Well, this actually ties back to your question earlier about EHRs. If it weren't for EHRs, we wouldn't be able to think about AI and machine learning because they're really just tools for analyzing large data sets, and the better the data, the higher quality of the data, the more powerful these AI and machine learning tools are and they're really proliferating and they're now being developed for really every dimension of healthcare from things like improving workflow and reducing the burden on clinicians with let's say voice recognition and natural language processing that can automatically generate notes, for example. To improving quality and safety, where there are programs that can detect early on that there might be a safety issue about to emerge, for example, with a patient.
Some of the areas that we've been focusing on in Verily are around early detection of conditions that might just be starting to emerge for patients, for example, and also really advancing this notion of Precision Health in addition to some of the workflow opportunities as well I mean.One example is in the work that we've done in partnership with our colleagues at Google Health. Google is a sister company to Verily. We're one of the bets of the alphabet family and in Google.
Some of the researchers there in the machine learning team came up with some algorithms to look at the images of the retina in people who have diabetes. As you may know, one of the complications of diabetes is that it can affect the back of your eye and lead to this condition called diabetic retinopathy and unfortunately they're just not enough ophthalmologists out there to look at all of these retinal pictures that need to be taken regularly for our diabetic patients and so our colleagues at Google Health developed a machine learning algorithm to automatically interpret those images and determine whether a patient might need further follow-up.
Interestingly, when they did that study which was published again in one of our leading medical journals again to that point about evidence, interestingly, they then did a second study that showed that not only could the algorithm, the computer figure out or diagnose diabetic retinopathy, it actually could identify other things about the patients as well including their risk of having a cardiovascular event because what they're looking at in the back of the eye are just blood vessels and those blood vessels are affected just like all the other blood vessels in the body when you have say high blood pressure or other conditions like that.
There's a lot of promise, a lot of innovation, and at Verily what we've done with Google is we've developed this camera for looking at the back of the eye and we hope that in the future that camera will also be able to implement some of these machine learning tools as well.
Christine: Another Innovation, Precision medicine holds great promise. What do you think will be the key to overcoming any barriers to its implementation?
Vivian: As we mentioned at the very beginning, Precision Health, which is a broader term that includes Precision medicine is really core to how we think about advancing health for all Americans and for people all over the world, and one of the challenges in Precision medicine well, there are a couple of challenges that I'll talk about. One is just simply being able to make the discoveries to identify the drugs or the new stem cell treatments or the new gene therapies that are what constitute a lot of precision medicine now and really make sure that they can get into the market quickly.
It takes decades often between a discovery and its actual implementation for the benefit of patients and one big part of our business at Verily, the clinical studies platform is all about accelerating that, it's about helping pharmaceutical companies and medical device companies, scientists who've made these great discoveries accelerate the clinical trials process to reach many more patients than they otherwise could. Many more diverse patients so that these therapies can and diagnostics can get to the market faster. That's one big area that we're working on in Verily and that's one of the big barriers that we're hoping we can help overcome and another one is the fact that I think Precision medicine is something that can be associated with pretty high costs. Some of the stem cell therapies, for example, or gene therapies can be very expensive. We can't afford to do that for everybody if we don't have a broader picture of how we reduce healthcare costs and in the health platform side of the business, we're very focused on how do we reduce those costs of care? How do we, for example, focus a lot more on prevention, preventing the complications of diabetes or high blood pressure for example, and also how do we reduce waste. You know in our healthcare systems at least 30 percent of our spend in healthcare systems is waste. How do we recover some of that waste so that then we can afford Precision Medicine and Precision Health for everyone?
Christine: Well hospital margins are already tight. Experts are talking about an impending financial crisis like nothing that's been seen in decades. Given this climate, what do you think needs to happen differently with the healthcare payment and reimbursement models?
Vivian: I devote a fair amount of my book, The Long Fix, on this topic of how do we actually tackle the crisis of healthcare costs, and actually I'm very optimistic you could probably tell from the title of my book it's The Long Fix. It is a little long but we do have a fix at the end of it and I think here again it very much is tied to the data that we have access to, especially the data coming from our electronic health records and how we use the data to drive performance improvement and lower the costs of care.
Most of us who have been living in healthcare for a long time recognize that those two go hand in hand. As we improve quality, we have fewer complications, we have fewer readmissions. We have shorter lengths of stay in the hospital. Those are all less costly, so higher quality leads to lower costs in healthcare, and right now I mean this is a big part of what we're doing in Verily. We have a business called Verily Value Suite that is directly focused on this, which is taking the data that is coming out of our electronic health records like our MEDITECH systems for example and surfacing insights, layering a little bit of machine learning, and AI as we talked about earlier to help our providers and clinicians improve outcomes and then also engage our patients using some of that technology that we talked about earlier, also with patient-facing apps.
A really engaging tool that our user centered-design people are such experts at within Verily and across the alphabet family. In order to engage patients to help, to help them get better outcomes, there's actually a lot of data that shows that if you engage patients and you help them get a little tuned up before an operation and have better understanding of what happens when they go home afterwards so that they can get better care and be cared for by their family members, they actually do better. And so if we can do both those things, leverage the data to help our providers and engage patients through tools like our value suite and others, then I think we can see significant reductions in costs, and in many of those reductions can fall to the health system's bottom line to in order to improve their overall margins.
And then lastly from a payer perspective because you also asked about payment models, I think it's really important for payers to reward hospitals for making the right investments. To invest in digital technologies, to invest in their EHRs, and these new tools that are going to drive performance Improvement. If the payers invest in the hospitals, it's like that old maxim about teaching a person to fish right? You need to make sure that they've made the right investments in their infrastructure so that they continue to drive that improvement that those payers are looking forward to.
Christine: Where do you see healthcare in 10 years? What is the sequel to The Long Fix?
Vivian: I see healthcare okay in the next 10 years really focused on the world outside of the hospital extending to the ambulatory and prevention side and to the post-acute health at home side and the question is how can we actually build on our EHRs to be able to collect data in those two settings? More in the home setting given kind of where we are today, given the technology that is available today, and given the fact that we are an aging population. We want to age at home. We want to be healthy at home and hopefully, we can both keep ourselves healthier through prevention but also through better care in the home setting. I think the sequel could be maybe not The Long Fix, but maybe the long and healthy life. How about that?
Christine: Thanks for listening. Stay informed and subscribe to MEDITECH podcasts and be sure to check out our resource page for links from this episode. We'll talk to you next time.