Innovator Spotlight: Jen Magaziner — Vice President of Digital Health, Boston Children’s Hospital
When it comes to driving impactful digital transformation, few things are more valuable than getting the on-the-ground perspective of colleagues and peers. Innovator Spotlight is a series from AVIA featuring interviews with the people on the front lines of this crucial work: leaders from our Member health systems tasked with putting digital transformation into practice and driving the industry forward.
This Innovator Spotlight highlights the work of John Rochelle, System Director for Digital Strategy and Innovation at the University of Kansas Health System. John shared his insights on the challenges of transitioning to virtual care, the barriers to innovation, and his health system’s goals for the coming year.
The pandemic created a window of opportunity for virtual care. Within three weeks, we set up 2,000 providers and clinicians with Zoom accounts. We averaged 2,000 or more Zoom appointments a day throughout the bulk of the pandemic. That’s gradually declined; today, it makes up 10.6 % of ambulatory engagements.
Now we’re organizationally trying to figure out how to fit in virtual care. When do you do it? If you’ve got a clinic trying to fit in X number of appointments per day, what’s the right model to continue doing that?
With virtual visits, physicians can work from wherever they need to, and it frees up clinic space. There’s some merit in that, but we still have a reimbursement issue. If we can’t earn as much for virtual visits as for in-person visits, that’s a difficult position from both a sustainability and compensation perspective. Even though our consumers want it, we can’t force a department, clinic, or physician to deliver X amount of telehealth per month without addressing those issues.
But we’ve had some notable successes. As the pandemic began, we added tools that helped patients find doctors and an appointment reminder system, WellHealth. The next iteration is bidirectional texting, which will help patients find a doc and schedule appointments online. There’s more to do in WellHealth messaging. We’re getting there.
We’re financially constrained, so we’ve carefully selected the projects that we want to make progress on if not fully implement. We’re pressing ahead with on-demand primary care visits. We currently offer asynchronous e-visits, where patients fill in a web form and someone gets back to them within X hours. We’ve learned that people want to speak to a doctor, whether by text or facilitated with a chatbot.
We’re looking at virtual care and navigation (virtual triage) —AI-enabled triage based on clinical protocols that enable us to direct people to emergent or urgent care or to schedule an appointment, video or otherwise.
Another priority is enterprise-wide patient education. This is gaining a head of steam because of a focus on ways to reduce readmissions. We can do more to get people better prepared. When they’re in recovery from a procedure, that’s not the time to give them or their caregiver any information, because they won’t remember it. You’ve got to be able to engage with them afterward. Some people respond to digitally shared information, and some still want a piece of paper to take home. If we’re serious about avoiding readmissions, we need a common platform that can meet the requirements of varying stakeholders. Patient education is an ongoing project that we will keep planning through the next year.
As with everything we do, education isn’t just digital. For example, we would like to see the majority of our appointments made online, either through the web or a smartphone. But there will always be people who don’t have a device. I’m amazed by the number of people who have poor broadband access or bad connectivity or who just don’t have a device—and it’s not just consumers in rural areas. You can’t base a strategy solely on digital when some of your population can’t use it. You’ve got to have the traditional ways of communication as well. You’ve got to cater to two groups: people who are comfortable with technology and who have access to it and those who aren’t comfortable and don’t have access.
Culture. You’ve got to be prepared to take risk—managed risk, that is, because you can’t put your patients at risk. You’ve also got to have imagination. You’ve got to set aside your preconceived notions of how you currently do business in order to uncover the potential for doing it in a different way. Our challenge is that being wedded to what works tends to lead to us into saying “If it ain’t broke, don’t fix it.”
But this is changing slowly. The younger generations of clinicians and nurses are challenging our unwillingness to change the traditional way of thinking about healthcare—patients come to a building, sit, and listen to you. This process may still be appropriate in certain cases, but today it’s far more interactive. People are far more inquisitive and want to take more responsibility. If patients are mainly coming into our office for annual checkups, that’s good for us. But we’ve also got to figure out how we can focus on the folks who really need to be sitting in the chair.
First, be patient. There is no big bang.
Second, take an incremental approach both in terms of what you want to achieve and its implementation, because the people we’re trying to help—ultimately patients and physicians, IT folks, and nurses—they’ve got a day job to do. We can’t overload them.
Finally, in terms of innovative ideas, be like a guerilla. Try and work within the system to change the system rather than overtly challenging the system. That takes practice. You’ve got to be careful how you do it. That’s the model that I try to follow.
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