The Internet of Health Things (IoHT) is touted as a disrupter, enabling healthy lifestyle for the well and treatment for the sick. While the Healthcare Industry is still dealing with many issues including data integration and interoperability, how is IoHT going to help with the intended outcomes including improving access to healthcare, quality of care, operational efficiencies, and customer experience?

Contributor

• • Leah Miller, Chief Information Officer, Medical City Healthcare

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Transcript 

Sanjog Aul [00:01:01]:

Hello, and welcome to this segment on CTN. To learn more, please visit ciotalknetwork.com. And our topic today is How Can IOHT, which is the Internet of Health Things, improve health care? And our guest is Leah Miller, who is the chief information officer with Medical City Healthcare. Hi, Leah. How are you? Great.

Leah Miller [00:01:21]:

How are you doing today?

Sanjog Aul [00:01:23]:

Very good. I like the sunny morning, so it’s a great conversation starter. And, while we are doing that, I’m sure you would be in your office looking at what the next challenge is related to health care. Right? Mhmm. And that said, we have covered this space. It’s one of our favorite areas in terms of health care because it connects to humans. And we know that we are all working together to make it better and have discussed the different data challenges and interoperability challenges and everything else which may be holding us back from be the best. Now with that, keep this IOHT, Internet of Health thing. So we said, why not cover this and see if this is truly a disruptor? Is this really going to turn things around? Am I gonna come in and out of a hospital sooner? So let’s talk about that as a term. What do you think? Is this a terminology being same thing to all people, or there is, even interpretation of this concept? 

Leah Miller [00:02:27]:

Well, I think there’s interpretation. I think what you’re seeing, and for most, if you talk about the Internet of health care things right now, for most, they think more applications. I mean, you look out there and the fastest downloaded applications are health care applications right now. I think the more, hard kind of medical device things that are coming to market are newer, and so people haven’t quite thought about those yet. Although, I mean, I’m wearing my Apple Watch today. I don’t know if you are. Most people wear Fitbits today. We’re all a little obsessed with tracking our health, and so, I think there’s some common understanding, but I think the next evolution of this is still kinda to be seen, and it’s gonna redefine it yet again.

Sanjog Aul [00:03:16]:

So when we say that this is a redefinition, it’s still built upon the core of IoT, right, where machine to machine connectivity and things like that. So we can just think about that as a technical or other thing is that now just because you can connect those machines, you could have some new ways to understand what may be going on with someone or maybe give them an experience. So are there specific use cases that suddenly allows us to make a case for this with the management?

Leah Miller [00:03:48]:

Yeah. I actually if you go out and look, there are people that call this not connecting to machine to machine, but actually connecting patient to patient. And so really, to me, what this movement about is about is, patient empowerment and actually giving, a patient the ability to track their health in a new way, understand it. And, we have long had electronic records in our hospitals, in our physician offices, but this new concept of having for our patients, for us, at home, a medical record where we can see over time what’s going on with our health and imagine having all these data points coming together for us to understand, track, you know, see interpretations even before we’re in the hospital or in our doc’s office. I mean, that’s really what’s at stake. It’s us owning our health in a new way that we’ve never even seen before.

Sanjog Aul [00:04:48]:

And when you talk about that, do you think this is truly gonna be a transformation, a major creative destruction, or just a better mouse trap or I would not wanna really download the play that way, but at the same time, when you bring something new and it is seen just as another technology tool, then you are you have a tendency to build a better mousetrap. But if you see the potential of where it can be taken and the the world the the health care world actually starts embracing in the way it could be, then, yes, we can think about transformation. So how how is this even been invited in this health care house?

Leah Miller [00:05:28]:

So I do believe it’s transformational, and I think it’s transformational because it’s an extension, of what’s going on in our hospitals today. So you probably know, health care was behind in technology. And so in the past, I’d say, 6 to 7 years, it started to catch up. So if you just even look in Medical City Healthcare’s hospitals, we have Visi Mobile, for instance. It is, you know, Internet of health care things that we attach to patients when they’re in the hospitals and do continuous monitoring while they’re here. And instead of having a nurse walk into your room and wake you up in the middle of the night to take your vitals, we’re streaming them real time and watching them. The first week we went live, we actually prevented 2 patient events because of that continuous monitoring. And so things like that that have been going on in the hospitals, things like fall monitoring in the hospitals where we have actually laser sites that watch patients when they’re getting out of the beds to prevent falls, this is the next evolution of that, but take it to the patient’s home. And, actually, the biggest risk in health care, and our physicians will tell you this, 1 of our main mission statements is unparalleled patient service. And physicians will tell you the greatest risk is patients actually not following discharge instructions when they go home or their physician’s advice. And so if, through these devices, we can watch patients’ behaviors at home and not rely on, you know, you come back into the doctor’s office, and we’ve all been there. And I don’t know about you, but I’ve fibbed a little, oh, no. I don’t drink that extra glass of wine, or of course I exercise that much. But I could actually give the physician data points that tell my story. It enables them to manage my health better and for me to manage it better. And to me, that’s transformational. That’s what’s gonna change the health care world. It’s empowering the patients and giving better data to our clinicians.

Sanjog Aul [00:07:33]:

So are we going with the assumption that if I build it, they will come? Means every patient will turn around and wanting to give you the data even though you have a way to connect with them?

Leah Miller [00:07:45]:

Haven’t we already come? I mean, I’m wearing an Apple Watch. I think the rate at what patients are tracking their own data and engaging on their phones, engaging with their devices is already there. And the rate of things like, 1.5 years ago, a new dialysis machine came to market in Europe that actually would allow patients at home connecting to a smart device to do dialysis. Can you imagine for a patient to not have to go and do dialysis and go to a center to do that? I think what’s at stake is the convenience and integration into lifestyle coupled with our own obsession with already tracking our health data, I think it’s already happening. I think it’s just the next step is the connectivity and integration into the care settings of that data.

Sanjog Aul [00:08:40]:

Is it should it be or is it being considered as a point solution? Say, you talked about dialysis and you got other, you know, basically examples where you’ve used connectivity to your advantage, but is this going to for it to be really effective, in short, would it be would we require it to be pervasively, integrated or been implemented as a very fabric of how health care runs, or it will have to be slapped on or bolted on?

Leah Miller [00:09:12]:

You know, I don’t know if it needs to be integrated into everything. I mean and it’s gonna sound a little Pollyanna, but in health care, it’s about human life. Right? And human life is 1 person at a time. And so if I’m integrating with 1 person at a time and, you know, I can save your life or give you a better outcome or your grandmother or my mother, that’s enough. And so is the bigger bang for the buck, everybody? Of course it is. But when we’re talking not about creating widgets or, you know, cool new tech, but when we’re talking about human life, one’s enough.

Sanjog Aul [00:09:54]:

And I totally see that now over a period of time, I’ve had quite a few sessions I facilitated and had shows with the health care leaders. They all agree to it. Now when it comes to the reality of you trying to implement this. Right? Uh-huh. And talk about that, like you talk about population health, you talk about patient centered care or any other initiative, it’s all connecting back to how do you make that happen and on one hand you have this altruistic objective to say, okay, let me change a human life and there’s nothing wrong with it. But then when people start thinking implementation, they start thinking profits or competitive pressures or keeping so then there is a direct conflict. So when we are dealing with things at that level, what should be the manifesto as someone starts thinking of IOHT, as Internet of Health things to be brought home?

Leah Miller [00:10:46]:

I mean, I don’t think there should be a separate manifesto. I think it should integrate into our and you said it, altruistic mission statement already. You know, for us, it’s care and improvement of human life. This is just another protocol to do that. A very transformative one, a game changing one, but it’s gonna happen. And for me, I think at the macro practical way to implement this is not gonna be one data point at a time, not one Internet thing, you know, not one device at a time. It’s we need to get to a place where a patient has their own electronic medical record, EMR, and that our health systems can receive that data like we do data from any other health system. So if you’re transferred to my hospital, I get data, from that hospital transfer in. Why when you’re admitted to my hospital can I not receive data from your personal EMR of my patient? Instead of doing an admission assessment and a nurse asking you 30 questions, why can’t I first take a download from your individual EMR, take that data and validate points? And it’s just getting to the practical point and using premise we already do in IT, but thinking about this Internet of health care things not as individual data points, but we need to look at it as the patient’s own EMR and how do we integrate at the macro level, not the data point level.

Sanjog Aul [00:12:09]:

So the very reason this, IoT or IOHT in this case was created so that you’re not looking at individual data points, but more of analytics on the aggregate so that you can find patterns which will help you. So, yeah, I totally see the individual connectivity will help you get data for that individual patient, but you’re trying to to you’re working one patient at a time, but you want to impact the bigger group or community. So if that’s the goal, then how are we kind of making sure that that group objective is kept as a main focus and as a means to an end, you take individual at a time. Because otherwise, nobody’s gonna fund it. If you just talk about, okay. I fixed the life of, or made it incrementally better for one patient, nobody’s gonna fund it. So we will just have this in a sandbox.

Leah Miller [00:13:02]:

And so like any other so we use Medical City Healthcare. So we’re part of, Hospital Corporation of America, 160 hospitals across the country, the biggest data warehouse in the United States. And so we use that from our hospitals to our advantage. We see the result of our protocols and the patient outcomes and can adapt and change those, you know, almost on a real time basis. It’s incredible. So what we’re talking about is just another set of data to do the same thing. And if we integrate it the right way, we’re doing exactly what you’re talking about. If we can integrate at a patient EMR level, we’re not only talking about the protocols, that we’re doing in a care setting, a formal care setting. We could start to watch the protocols, it’s a formal word for it, that a patient does at home. What are the results, when, you know, I go home and I eat this way or my sleep patterns are this way or I take my blood sugars this many times or I mean, you’re just applying big data principles to a new set of protocols or data that the patient’s gathering at home. And if it’s integrated into our EMRs in the hospitals as, you know, just another admission assessment, but from the patient, we could gather data the same way.

Sanjog Aul [00:14:25]:

Let’s take a quick break, listeners. We’ll be right back, and let’s talk about the very competitive mindset that has creeped in into health care. Even though we know we all, as all different health care organizations, are trying to help a patient, one patient at a time, but there is also some revenue side to it. So when we are talking about IOHT, there has to be some sort of an ROI type of calculation that someone will be doing at the top. What does that actually ROI supposed to be? And how we are presenting it? What are the details or results that we are seeing from whatever we have done so far? The proof of concepts of the experimentations we have we may have done, thus far. So please stay tuned, listeners. We’ll be right back and explore.

Sanjog Aul [00:17:15]:

Welcome back. So, Leah, we know that this is a great technology which could help us in different ways, but then you have to take it beyond the sandbox, implement it, do some proof of concepts, and then take it forward. So now we’re talking about improving health care, the access to health care and the quality of care. We’re talking about these two things. Do you think that there could be a proof over time or even through experimentation which says, okay. This does it and which moves us forward in our mission. It will bring some more profit, so let’s go.

Leah Miller [00:17:46]:

Yeah. I mean, I think, you know, we say in Medical City Healthcare quality, we focus on quality and the rest comes. I mean, you provide quality you provide quality outcomes for our patients. It breeds loyalty with the patients and their families. You know, we don’t get the penalties that are starting to be, you know, that you’re starting to see from CMS, etcetera, and it just it trickles down from there. You know? We have 3 strategies, unparalleled patient quality and patient satisfaction are the top two. And so I think it naturally aligns.

Sanjog Aul [00:18:30]:

So when you say that it is naturally aligning, so do you think the organizations are putting money behind this and doing it not only as individuals, but more like a value chain. Right? Because you cannot do it alone. I think so is that happening?

Leah Miller [00:18:48]:

Yeah. I think definitely. I think some of the easiest use cases are things like avoiding readmissions, which we’re penalized for. I mean, there’s definite low hanging fruit with those things that obviously have obvious financial benefit for us. And so, you know, there are things like risk gain sharing and value based purchasing, all that kind of stuff are some of the more obvious use cases to start with.

Sanjog Aul [00:19:17]:

And would you say since health care delivery is always about having a number of ecosystem or value chain partners working together for making sure that the patient comes in and out as quickly as possible and doesn’t come back. So that said, they all have to, in some form or fashion, embrace the same mindset, but even more importantly, the same technology base. So if it’s Internet of health care things we’re talking here, then everyone has to do it unless otherwise and then if we don’t do it, then we will not achieve the true benefit. Do you think they are all coming on board with equal amount of enthusiasm and the investments behind it?

Leah Miller [00:20:00]:

I think there’s enthusiasm and interest. I think, and excitement. I think the first adopters will be your big physician practices, because patient compliance is a more obvious priority there, and the chronic disease management happens normally outside of your acute care settings. And I think there’s going to be a lot of people that disagree with me on this one. A lot. But I think in this particular instance, for the first time with this set of technology, the most important partner that agrees with this is the patient. And so even if some of the other, you know, partners in the community, etc. aren’t there, if the patient’s on board and our health system can integrate with their what I’m calling the patient EMR, there is still a ton of value. Enough value that we’d see the results even without other partners playing.

Sanjog Aul [00:21:08]:

So now coming to the technical side of it, we know, as we are going through the transformation in health care and we are trying to go after patient centered care, population health, and other form of objectives, we keep coming back to the data security, data integration, interoperability, and that has yet to be cracked as a problem because somewhere, things are falling apart or there’s not enough camaraderie which people say there is, but when it comes down to the brass tacks, there doesn’t seem to be. So if you have all of that going on and then you drop this bomb, which is blobs of data that this is gonna generate and somebody has to make sense of it is this not setting ourselves up for failure? Are we not supposed to be making ourselves ready or crack those smaller problem before you take on a big one?

Leah Miller [00:22:02]:

No. I don’t think so. I think for a couple of reasons. I think the reward outweighs the risk in this one, and I think if you talk to other health care in acute settings, CIOs, what we’ll say I was on a panel a while ago in the Dallas market, and we were all talking about the reason some of us don’t or haven’t been able to prioritize talking to each other as much is because when a patient’s in our hospitals, we want to ensure all of our own systems are talking to each other, because when that patient has an episode of care in our hospital, we need to make sure we keep them safe and make sure that episode of care goes flawlessly or as flawlessly as it can. So that’s priority one for us. And so I think that’s where you’ve seen a lot of tactical focus, and I can speak for our hospitals, that’s much better than it’s ever been. And I think most of our acute care settings, for I would hope all the health systems out there is starting to get to that point. And so I know we’re starting to now play more in the HIE space and play more, talking to other health systems. And so I think, I think we’re at a better place than we ever have been. And I think again, this trend, this taking on this risk, if you will, you could look at it as managing it in an episode of care and getting the data. The data is so valuable for that episode of care, and then when the patient leaves that episode of care, if the patient can carry their own EMR, it’s transferable from episode of care to episode of care. Because if they can take their own Internet of things into their EMR, why can’t they take some of my data from their hospital stay into that EMR? I mean, it really could turn, what we think about as interoperability or talking to each other on its head, and does the patient’s own EMR become the source of truth instead of our systems?

Sanjog Aul [00:24:00]:

I think you could what you’ve just said, if you can do it, then you’ve cracked all problems at once.

Leah Miller [00:24:06]:

Yeah. And it would be incredible.

Sanjog Aul [00:24:08]:

Yeah. That’s what I’m saying. So because the way you said it, could IOHT trigger moving that patient data away from or the ownership away from the systems because that’s what they have been all along talking about. Do you think the IOHT has the potential to suddenly change that or turn it around and give it to patient without having any implications related to the regulations or compliance? What needs to change for people to relinquish that control? Because it looks like almost a control war when it comes to who owns the data and how it should translate, etcetera. 

Leah Miller [00:24:46]:

A control war. When you say control war, between whom in your mind?

Sanjog Aul [00:24:50]:

Basically, when we are saying who has whose data. So if I go from one system to another as a patient Mhmm. Those people do not actually, send everything they have. They may send some things, but not everything. Mhmm. And or different things are available at different levels. There is no central approach. So that’s what I keep hearing. The interoperability has been challenged because there is never one version of the truth of a patient data and where the patient doesn’t have control on what happens to them and or what data is created for them and where can they, you know, get access to it.

Leah Miller [00:25:22]:

I don’t think it’s a control thing at all. I think it’s just a logistics problem, to be really honest. When you have how many EMRs out there in the market, and, yeah, we have standards of how they talk to each other, but we all we’re all in IT. We know the devil’s in the details. And I don’t think it’s a control thing. I think it’s a logistics problem. And if we could get to, you know, patients are complicated. They move around. They travel. And, you know, think of the younger generations. Most don’t have a medical home or a PCP. If we could get to a place where their medical record travels with them, I think all the health systems would want that. I don’t I do not think even the health systems in the Dallas market, I don’t think any of us would have a problem with that.

Sanjog Aul [00:26:16]:

So you just don’t see a central place or a central approach to dumping some of the data there for the right reasons, keeping it secure, and letting the patient have ownership of it wherever the person goes. It’s like a Social Security number, a bloated Social Security number, which has got all data contained in it. So you think IOHT could be the answer to that?

Leah Miller [00:26:37]:

I think it could be the catalyst to make it happen. I think there’s finally I don’t think it’s the answer. I think it’s the catalyst that makes it happen because it’s finally got our patients excited and engaged about it, and it’s becoming less mystifying. They have a platform to utilize it. They can touch it. They can feel it. They’re starting to get used to interacting in a digital way. They’re understanding more than they ever have. I think it’s the catalyst.

Sanjog Aul [00:27:04]:

So coming to the original world of IoT within manufacturing, we know we used it for, of course, finding trends, but also automation was a big thing and also predictive maintenance. Now here we’re talking about human beings, but still, we are not trying to automate something within them, but the processes which will allow them to have some efficiencies in the operations. Because you know what? Cost is also a factor. So if all if you can get efficiencies which could bring you savings or a better experience, that helps everyone. But then is there a way to actually say that IOHT is gonna provide operational efficiencies, which in turn would be savings or abilities that we can pass along to the patient?

Leah Miller [00:27:44]:

I believe so because I think one of the biggest problems in health care is making sure patients choose the right care setting. I can’t tell you how many conversations we have. It’s about, you know, how do we educate patients when the right time to go to a virtual, not virtual, an urgent care versus an emergency room versus their PCP is? And this is a neutralizer. If they don’t even have to go to a brick and mortar care setting, because they can have a virtual consult and they can transmit labs and other clinical data through a device that’s efficient and lower cost for everyone involved, and much more convenient for the patient. So it’s just natural that there are going to be cost savings. 

Sanjog Aul [00:28:32]:

And are these cost savings understood and they are enough that somebody’s going to be willing to invest upfront and then they know that they could recover over a period of time? Because it’s business also.

Leah Miller [00:28:45]:

I don’t know. I think it’s too soon to tell. I think logic tells us, yes, it makes sense in the long term, but I think it’s too soon to tell. I think we can all sit and talk about it, and we get it, but I think it’s too soon to really be able to sit down, do a hard ROI, and really be able to project what kind of cost savings would be.

Sanjog Aul [00:29:11]:

Sure and then let’s take a quick break, listeners. We’ll be right back. And let’s talk about the adoption curve or what’s the playbook looking like? So if we had to really bring this in, and, yes, we did speak about that. Yes. It could create improvement in health care in different stages. How do you get start getting adopted, start seeing those improvements so that you get that incremental funding? So it is made mainstream in the next couple of years. And we cannot just go big bang with this. So if you have to go incremental, you have to show wins. Where are the wins? Please stay tuned, listeners.we’ll right back.

Sanjog Aul [00:31:52]:

Welcome back. So, Leah, as I mentioned about the wins. So this is something which you cannot just do in a big bang fashion. And so you have to be able to experiment with it, and then there are still people evaluating it till the time they don’t feel comfortable. They’re not gonna invest in it. So it’s like any other venture. What’s the playbook for someone maybe who’s in your shoes or someone who’s your business counterpart to take this and get it evaluated and adopted to the degree they can while this whole IOHT itself is evolving? 

Leah Miller [00:32:30]:

Yeah. I think for us, it’s about meeting our patients where they are, and by that, we’re seeing generational differences. And so in our patients that are in their 30s or younger, if we take telehealth, or virtual visits, for instance, what we’re seeing is that patients in their 30s and below are okay not interacting with their physician. Let’s say I wake up in the morning. I think I have a UTI. I’m okay filling out an adapted intake form with my health information, having my physician review it, in their office, sending back a response with care instructions, and if needed, getting a prescription to my pharmacy. That is how I’d like my care for low acuity things to happen. If I’m in my 40s, I want some interaction. I at least want to talk to a human, about what’s going on in my world. If I’m in my 50s or older, I want a video conference. I want to see the person that’s going to evaluate my care, and I want to talk to them. So I think this revolution is about starting by, in small increments, meeting our patients where they are and picking specific use cases, whether it be telehealth for one, whether it be going after avoiding readmission. Diabetes, many don’t know, diabetes is the 1st comorbidity for any hospital stay in the United States. And so what that means, if you go into the hospital and you have diabetes, no matter what else goes on, you have a higher risk of not coming out of the hospital. And so that’s a wonderful use case, to go after with this kind of technology because most of managing diabetes happens at home. And so, again, meeting patients where they are and enabling them to manage their own health.

Sanjog Aul [00:34:22]:

And based on what you just said, that means you’ve got couple of different generations, and that whole pattern hasn’t changed on what they want versus what they don’t want. So should we truly try to experiment with the generation which is going to cause more upheavals or more extra cost, if you will, just to make your case? Because you’re not truly going ahead full steam with this IOHT yet. Would you go with the population which inherently doesn’t want to change or change the way they wanna do it? And so IOHT can only do so much, and you’re spending money. So would you can we be smarter with even sandboxing?

Leah Miller [00:34:59]:

I guess you could. I mean so if I look at my mom, for instance, one of the most tech savvy people I know, and so I don’t know. That’s hard. Because I think if you look at a macro level, it would be tempting to do that. But, again, it’s about the individual patient, but the struggle is, how do you sandbox it at a macro level while meeting individual patient needs? And I think, you know okay, so I’m rambling a bit. But health care is a relationship business, and I think we have to trust our clinicians to understand, whether they’re in our hospital or doctor’s office, to understand that, Hey, Leah’s tech savvy. No matter how old she is, she would respond to this kind of protocol. Or Lacey over here is not as tech savvy even though she’s a millennial, and so we’re not gonna do this protocol with her. And so I think in all of this, we can’t lose the relationship part of health care.

Sanjog Aul [00:35:58]:

And you’re so right about it. It just when you’re trying to adopt something, if you do it in a very small population then it is not justifiable as a business. But if you try to do across the board, then it falls through the cracks. People will give it thumbs down, and it doesn’t go anywhere. So this is true with any new thing that you wanna put out there and get the feeler. So if I were to ask you one all the responses that I got from you, of course, are based on all the discussions your organization may have had with patients. But what are patients saying? What do they truly want and have if this something like this is even touted in front of them, what is their reaction?

Leah Miller [00:36:35]:

I think they’re intrigued and excited. I think they’re intrigued and excited and willing to try it. I think much of it depends on how sick they are. So if you’re talking with a pretty healthy patient that is doing okay, they’re all for it. If you’re talking to a very acute patient that has had long term problems, it’s a different thing, and so it really depends on the patient population. And maybe instead of going after a demographic to do this, you actually go after a chronic disease or wellness population. Maybe we try to implement this technology, not demographically, but we go after our well population to manage them or our diabetes population. Maybe that’s the answer to going after a macro level implementation.

Sanjog Aul [00:37:30]:

And if you were to look at the approach, what has been tested, and it is showing better signs than others in terms of getting something like IOHT adopted or at least tried by a patient base, what is the approach that is most favorable so far? 

Leah Miller [00:37:51]:

I am so sorry. You cut out just a little bit. Could you repeat the question for me? And I apologize 

Sanjog Aul [00:37:56]:

for that. No no worries. So, basically, when you are trying with the patient, so they did give you the feedback. What has been the best way, that has been tested to see if IOHT what type of use cases when tried have been the most conducive and have been the most favored by the patients so that they get to take a taste of it?

Leah Miller [00:38:17]:

I think it’s the easiest and most practical, and so I don’t know. So the one I talked about in the hospital care setting, Visi Mobile, which is, you know, connected in the hospital. The others are much more practical. So the biggest hits have been, if you’re gonna go to the ED, what do you dread the most? The wait time. And so it’s things like being able to push wait times to their phones. If you’re going to go to one of our CareNow urgent cares, it’s things like doing a web check-in and having someone call you. It’s the small integrations to start that are leading to bigger things like, answer these five questions that are going to be pushed to your phone so we can see if you’re at risk for readmission for heart failure. It’s easing them in a piece at a time, so they don’t see it as a disruption to what’s going on. We’ve explored things like Ginger.io, which is an application that passively collects data on patients, and so there’s no active integration. And so I think it’s the easing in and the more obvious use cases to start that gradually integrate our patients into doing this. Again, meeting them where they are. And so, we don’t startle them with, you know, strapping equipment to them and asking them to connect it to their iPhone as they leave the hospital. 

Sanjog Aul [00:39:47]:

And coming to customer experience, so we know that customer experience has to be improved, and, of course, health care always tends to try to do that and using different technologies. So is there a direct correlation between IOHT getting implemented or adopted at a certain threshold level before it’ll start impacting the customer experience?

Leah Miller [00:40:10]:

I think there could be, especially if you think about, generations of care. So if you think about millennials starting to take care of baby boomer aging parents or the sandwich generation that take care of small children and take care of aging parents, I think patient satisfaction could be greatly improved for them by, especially convenience lifestyle integration of these technologies and allowing them to better manage not only their own health care, but their entire families. And so I don’t know if it’s a true saturation point across an entire population, like in the Dallas Fort Worth area, or who would truly be integration within a family unit.

Sanjog Aul [00:41:04]:

And where it is and where the level of adoption is? How long do you think it is before you will be in a position to collect enough in terms of quantity of data for you to do a reasonable amount of analysis and predictive analytics, if you will, to be able to impact customer experience? Because if you are just collecting smaller amount, that doesn’t really cut it.

Leah Miller [00:41:31]:

That’s a good question. To me, the big game changer is gonna be when we can truly get a patient EMR, you know, the first part of it and integrate it. And so that’s probably 5 years away, at least. I mean, to truly be the kind of big game changer where we’re managing a population and changing protocols and the wow factor of it, I think there’s gonna be smaller wins along the way, but until we can have a patient walk in and accept their EMR data as their admission assessments, I think it’s gonna be much smaller wins.

Sanjog Aul [00:42:10]:

And when you are looking at the holy grail, if you will, if you found IOHT enabled health care, what would that look like? That’s something and that is something which is practical, but it is chunked out. So if I say 2 years down, given the way it is, what we are looking at, what is the kind of experience we could expect with IOHT enabled health care?

Leah Miller [00:42:36]:

I think a lot fewer in office doctor visits. I think the practical side for our patients would be fewer brick and mortar visits, less readmissions in our hospitals, better chronic disease management. It’s going to be all about the patients managing their lifestyle differently and being in our care settings managing their symptoms differently. I mean, it’s truly what ACOs are supposed to do, keep our patients well.

Sanjog Aul [00:43:12]:

Let’s take a quick break, listeners. We’ll be right back, and let’s talk about how do you make sure that while it’s a great technology, it really we are ready for it and get ready to adopt. And what are the related challenges which will prevent us from getting the most value out of it as even if it’s still evolving. Please stay tuned, listeners. We’ll be right back and discuss.

Sanjog Aul [00:45:41]:

Welcome back. So we did talk about, yes, there could be potential improvements, and there could be some changes that we can see even 2 years down the line if we did our job well. How do you go about getting this whole IOHT embraced and adopted within our organization so that we can serve the patient. And one very interesting question that came up is once you have IOHT connected with the patient, that means they are dealing with technology, with devices, and you name it, to collect data from them. What happens if those devices go bad or something else happens to the technology? You’re not expecting the patient to crack that problem. That’s your problem. Or whose problem is it? Because there could be 3 different providers offering those technologies or those probes, if you will, which is collecting patient data.

Leah Miller [00:46:28]:

It’s a fascinating question. It’s gonna put health care IT professionals in a very unique circumstance because what’s at risk for the patients is their health. They’re not technology professionals, so exactly what you’re saying. Do they call the hospital? Do they call the manufacturer? Do they call their doctor’s office? And are we ready for these kind of calls, for technical support for patients that have very different levels of technical expertise. We’re getting into a consumer space that health care IT professionals, for the most part, have not been in before. Are our durable medical equipment rental places going to have Genius Bars in them? Could our hospitals have classes or have kind of a Genius Bar staffing for orientation on this? It’s a whole different consumer kind of sector of technology for health care.

Sanjog Aul [00:47:28]:

So would you think, like, as a healthy human being, of course, I like the autonomy. I like the the ability to control. But when I’m a patient, then I really don’t care as much about control or whatever I’m doing at any given time. I just want to get well. And that process is where somebody needs to be by yourself, and that’s the word care is part of the health care. When you put everything, the onus is on the patient. What is the how can we at least take some onus of that for someone who’s an ailing patient at that time? And maybe should we say that this is only for the healthy people and not for the ailing?

Leah Miller [00:48:12]:

No. I don’t think so, because we talk about it in our hospitals, you know, because when people are in our hospitals, we have a lot of discussion about this, how to care for our patients at sometimes the worst time in their life, some of the most anxiety ridden times in their life when people are coming in and out of their hospital rooms, they don’t know what’s going on, lack of control. And actually, in some of the scariest instances, most people want some semblance of control. And so we purposely do things in acute care settings to try to give them some control. And so whether that be putting on whiteboards, here’s what’s going to happen today, giving them preferences they can do, even though they’re small things, they really do help reduce anxiety for patients. So it may seem counterintuitive, but I think maybe giving some control even to some of the sick patients on that journey may actually help reduce anxiety and help with the healing process, because all the other data and the way we structure the health care setting, is set up to do that. 

Sanjog Aul [00:49:17]:

Now coming back to the adoption and the very getting ready of getting ready for IOHT, what do you think is the starting point? Are you calling to the CEO’s office and say, guys, let’s do something, or you go back to the CEO and say, I wanna try this, and this is what I need the funding for. And then you rally up the troops and give them marching orders. What are you doing with IOHT?

Leah Miller [00:49:42]:

Yeah. And so we have a governance body made up of our different executives at our hospitals. And what we do is we go out and search what are the coming trends in the space and many others, and we come and we show use cases. So once a quarter, we come and say, This is what’s going on. This is what another health system’s using. This is, you know we’ve done everything from Google Glasses coming to three d printings to help blind patients see their babies to, you know, Internet of health care things. We’re going and finding the latest, greatest cutting edge technology and bringing it to our health care executives and framing it around use cases and how it can help with the care and improvement of human life and saying, this is how we see it. Do you agree? Is there a place for it in our health system? And some of them we’ve gone, and we’ve gone big. We have everything from Alexa in some of our patient rooms, so, birthing mom can control lights and music, to Apple TV to consult with their family and a doctor, to much more elaborate things, to Visi Mobile I talked about earlier. And so, health care IT professionals need to be out there, in my opinion, and bringing these things back to their health care executives and talking through here’s how it applies to our health care settings for our patients.

Sanjog Aul [00:51:12]:

And would you say there are any upfront changes to people, processes, and tools that you need to do to essentially even get ready with this IOHT? What are you doing internally in your shop?

Leah Miller [00:51:26]:

I mean, it’s just fundamental good change management. I mean, there’s nothing earth shattering about it. The biggest thing would be is really, can we prepare our systems to receive the data? That would be the unique thing. But everything else from people and processes would be good change management. There’s nothing unique.

Sanjog Aul [00:51:47]:

So that is within your IT department. When you see that the training and approach to how people deal with the patients when they know that they are there is some more information available with the patient, what is the clinical staff doing, if you will, if this was incorporated?

Leah Miller [00:52:07]:

Yeah. So there have been a couple interesting things. We recently went live with a product we call iMobile that puts mobile devices in all of our nurses’ hands to better manage care in a faster way. And it was an interesting dynamic for us to have to educate patients that their nurses weren’t ignoring them and chatting on phones, that we actually had to have a conversation of we are managing your care differently in a mobile manner so you get it faster. And so there are more unique challenges when technology comes more in direct contact with patients and their clinicians in the care setting. So you’re right, there are some unique things that have happened that we’ve had to prepare and have to have more proactive conversations with patients.

Sanjog Aul [00:52:54]:

So one last question. While we know that IOHT itself is evolving, but it definitely shows promise, So what do you think should be the changes in the compliance regulations or any mindset, of the stakeholders within the health care organization so they all come together to make the most of this?

Leah Miller [00:53:13]:

I think the most obvious one would be a change to the meaningful use regulation, and to start to add, potentially some compliance about accepting a patient EMR. There’s lots of regulation in it about accepting data from other health systems, accepting, you know, making sure we’re at a certain level of being electronic, so to speak. But I think if we start to put in there, can we accept patients’ data electronically directly from their own EMR, it would be fascinating to see if that was a catalyst.

Sanjog Aul [00:53:50]:

On behalf of the show and our listeners, thanks so much, Leah, for sharing your views on the current state of health care, how IOHT, which is Internet of Health Things can actually be leveraged for best outcome and what’s being done about it. Thank you so much.

Leah Miller [00:54:03]:

Thank you.

Sanjog Aul [00:54:05]:

And listeners, please like us on Facebook, search for CTN, and be sure to follow us on Twitter and LinkedIn. Thank you again for listening to this segment on CTN. This is Sanjog Aul, your talk show host. Till next week, take care, and God bless.