[Benjamin Schwartz, MD, FAAOS]

Ryan,

I do a fair amount of work mentoring health tech startups. It is pretty clear to me that for these solutions to work best and for tech to have its greatest impact on healthcare, each side has to have a working understanding of the other.

I think medical staff has been so turned off by the clunkiness of EMRs and frustration with things like voice recognition that are supposed to make life easier but instead decrease productivity and increase frustration. Of course, that doesn’t have to be the case.

The corollary argument is that IT professionals and those working on the tech side of digital health have to understand the uniqueness of technology in medicine. Things that make sense in theory from an IT perspective may not fit well when practically applied to care delivery.

IMO, it should be mandatory for IT/digital health innovators to spend a week shadowing a doctor in the clinic/hospital and for doctors to take workshops on health tech principles. Finding a common ground is absolutely critical to success. Digital health is here to stay and we have to find a way to make it work.

[Ryan Grabow]

I agree with you both.

I think another problem that speaks to Benjamin’s comment that the IT/Tech startup people should shadow a doctor is that THEY THINK THEY CAN DO IT BETTER!

Many of the non-medical founders of IT and Health Tech are in college or just out of college and want to change the world. They target healthcare and study the “problems” by reading articles about the inefficiencies of healthcare and what patients want.

Unfortunately, in my experience, they have no idea about healthcare, sickness, illness, or insurance. They are too young and don’t even go to the doctor unless they have an injury.

WE are often seen as THE BAD GUY! The rich doctors who run up costs due to unnecessary tests and surgeries and kill people with avoidable medical errors. (This is how we have been portrayed in the media in the past.)

I think it would be great if the county or state medical societies could reach out to their members to find out who would be willing to allow health tech entrepreneurs to shadow them in their clinics. (We may be willing, but since they are not students, or those interested in medicine, many of our colleagues may balk at this opportunity.) It would require more time than the typical one day visit that some doctors offer to local politicians and civic leaders.

One way to quickly get physicians interested in helping is to offer a little equity to those docs willing to open up their practice and teach these individuals.

[Benjamin Schwartz, MD, FAAOS]

Agreed. Pre-COVID I volunteered to have any health tech startup employees shadow me in clinic without any takers.

Also agree that there has been somewhat of a false narrative painted that all American healthcare is poor quality and the byproduct of greed and incompetence. As we know, the reality is far more complex. There is a reason healthcare is difficult to disrupt and many have failed. It is not as simple as it is made out to be which is something that tends to befuddle those with non-clinical backgrounds.

[Branden Robinson]

I have worked in a number of digital startup and if you watch the number of investors in this arena it is a little disturbing. Most of the startups are on a path to get rich instead of a path to really solve complex healthcare problems. Just look at the number of companies that do the exact same thing and believe they have the secret sauce to change the world. Its all really under the disguise to sellout to the highest paying insurer. This is the problem I have seen when working with digital healthcare startups when they tried to pitch their solution to me. They don’t really know the problems that persist in healthcare and the what or they why of what they are addressing.

[Ryan Wakefield]

So these are all great things regarding health tech startups, but what about an established hospital? If you take my original post and apply it to an established hospital, does that change any of your thoughts, opinions, or approaches?

[Benjamin Schwartz, MD, FAAOS]

Yes. I think hospitals that are successful in adopting health tech will be able to get physicians and IT to work together.

All of the admins understand they need to embrace technology but few of them know how. Identify a physician champion and have that person work closely with the IT Department. I’m currently reading Tom Lawry’s book on AI in Healthcare (referenced in another discussion thread here). It deals with this very question. Good read.

[Ryan Wakefield]

Thank you sir. I have found the book and will just have to save up for it now since it is $50 and all. But thank you very much. I truly do appreciate it. I look forward to learning more from you and other users on this forum about technology and Healthcare. 🙂

[Benjamin Schwartz, MD, FAAOS]

$50? Wow. I think Amazon let me rent it for $9.

[Ricky Krajewski]

Healthcare is shades of grey, data science loves black and white. Makes the back end extremely disorganized.

[Benjamin Schwartz, MD, FAAOS]

I think that’s exactly the point and why we will never be able to remove the healthcare provider from the equation. Medicine will always be an art and not a science. As Tom Lawry writes in his book we have “artificial intelligence” but are a long way from “artificial wisdom.”

[Justin Martin]

It’s also another big disconnect in this space especially. Everyone thinks of AI as “black box magic”, not understanding that in order to have your AI work, it has to be properly configured and fed the right kind and amounts of data to get what you’re wanting out of it.

That takes you right back to the provider/expert/artist and having the tech (folks and then the tech itself) understand the problems to solve at a more fundamental level.

[Ricky Krajewski]

“right kind of data” definitely key.

@benjamin-schwartz-md-faaos — what are your thoughts on MMT? my opinion- invalid data, no interrater reliability. Sad that this is the standard for measuring strength improvements throughout rehab

@justin-martin – I’ll go back and forth with agencies regarding “note corrections” … I want this process to be automated but seems to me that it is still a manual process in order to allow companies to exploit medicare– have you had similar experiences? Please share, would love to find a way to economize this process

[Justin Martin]

Definitely a good point, lots of these data entry / management companies rely on the deep pockets of their healthcare clients to maintain an overhead instead of seeking operational efficiencies on their own end.

I’d love to hear some more details on the note correction process, sounds like there could be some ways to improve that efficiency.

[Ricky Krajewski]

Process is as follows:

1. Complete therapy note
2. Submit
3. Agency reviews manually
4. Agency responds with corrections (change therapy frequency, add more goals, elaborate on your clinical summary)
5. Make associated corrections and resubmit.

The changes almost always are in regards to the free text inputs…basically “say this so we get paid” … have you come across situations like this?

[Benjamin Schwartz, MD, FAAOS]

Yep. I sign reams of these orders and documents that are multiple pages long and include things I never directly told them to do all so the agency can bill the insurance company and/or Medicare. That’s why I am slowly getting away from any home services or home PT (clinically there is plenty of evidence this isn’t needed).

[Justin Martin]

I’m curious what the incentive is for the agencies to be friction points/barriers instead of resolution points. You’d think that on their end they could develop a system that proactively prompts and encourages the submitting user to provide their base level of detail for a successful “ticket” or claim.

If they’re unwilling and unable then maybe it’s something you could track on your end. Looking at all the counterpoints they raise, datify that, and use that insight to make your process more likely to be accepted.