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Jeff Lin
Host of Payment Matters
Payment Matters is a monthly radio show focusing on real issues happening in healthcare payments. Jeff chats with industry experts and thought leaders to bring fresh perspectives on how providers, payers and consumers are all tackling the evolving healthcare payments market. Join the conversation on Twitter with #PaymentMatters.

On this episode of Payment Matters, Jeff is joined by author and health IT consultant Edward Marx. During the episode, Jeff and Ed discuss the digital transformation of healthcare, from electronic health records to mobile apps and virtual visits.

Listen to the full episode now, or read the excerpt below. You can also catch Ed Marx at the InstaMed Healthcare Payments Summit 2020, where he will be talking more about the digital transformation of healthcare.

Jeff Lin: Welcome to Payment Matters. I’m your host, Jeff Lin. Thanks for tuning in. Today on the show we talk about the ever-changing landscape of healthcare payments and the impacts to healthcare payers, providers and consumers. You can follow the conversation on Twitter at #paymentmatters and follow me at @JeffBLin.

My guest for today’s episode is Ed Marx. Before becoming a full time healthcare IT consultant and advisor, Ed served as a CIO of the Cleveland Clinic and the advisory board company. His 2019 book, Voices of Innovation: Fulfilling the Promise of IT and Healthcare was the number one bestseller. Edward is currently writing a book on healthcare digital transformation, that’s going to launch in Q2 of next year. Welcome Edward. Once again, thanks for joining us today. Maybe just give a brief background on your experience and health IT. That would be helpful for our listeners.

Edward Marx: Awesome. Well thanks Jeff for having me on Payment Matters. I feel very privileged and honored to be your guest today. I’ve been serving in healthcare for quite some time. I started off as a janitor when I was 16 years old in the healthcare environment. And, even though I was listening to Black Sabbath or something on a Sony Walkman, I just knew that I had a calling to healthcare. And over the years I just kept getting drawn back to it. So, I served in many different vocations along the way within healthcare, from being a combat medic in the army, to being an anesthesia technologist and eventually working my way into the IT space. And so I’ve been a CIO of some large health systems over the last 20 years or so, leading me to where I am today. So I’m just thrilled to be a part of healthcare and a calling that we all have in helping others achieve optimal health.

Jeff Lin: Sounds like you’ve had a pretty broad career in healthcare, from a janitor all the way through CIO of the largest health systems and organizations out there. You’ve seen the digital transformation occurring since you started in healthcare. What do you think has been the biggest digital transformation over the last 10, 20, 30 years?

Ed Marx: So as much as I’d rather talk about some really cool nifty things that are happening today and in the future, you know, if you’d take a look back even over the last 10 years, it’s really the digitization of the health record into electronic format. So even at the beginning of the decade, you know, before the HITECH act and things like that, there were only like 5-10% of physician practices digitized and maybe 25% of healthcare organizations. So, it’s really in the last decade that everyone’s become digitized. You need that as a basis for doing some of the more fun things to talk about. So, when I look back, I think, you know what, that’s probably the single biggest thing that’s happened is the digitization of the electronic health record.

I think the other things that are also tangential that helped make it what it is today and important now and going to the future is really the whole mobile movement, right? Everyone now has a smartphone and so everyone can be mobile with our healthcare and doing virtual visits and things like that. So, I think mobility also came about in the last 10 years, maybe 15 years ago, and really helped shape the way that healthcare is delivered today and tomorrow. And then the cloud of course also became an easier way for us to share records and for people to become mobile. So, I think those are some of the technologies that help sort of usher in this new era that we’re in this new phase of digital transformation.

Jeff Lin: You know, on the topic of digital health records, it’s great to see that transforming. I’ve heard concerns out there about adoption rates, and maybe, people complaining about digital health records. In terms of adoption of these technologies, how has that transformed healthcare, especially on the digital health records side? Have you seen any benefits or results of that?

Ed Marx: Yeah, I think the benefits are pretty clear when you look at patient safety and the quality of care. Now granted, there’s still a long, long ways to go. We know that healthcare – hospitals specifically – are still very dangerous places to go. But I think because of the digitization of records, that’s really been quite helpful in terms of the overall quality of healthcare and the safety of it. So, you know, as a practitioner inside of some of the most prestigious organizations in the world, I’ve seen firsthand the benefits both personally and professionally. I still worked as the anesthesia technologist even as the CIO over the last year and would see firsthand the positive impacts. But there’s definitely a longer way to go.

On the flip side, you know, is how has the digitization of records really impacted us as caregivers, us as employees? There’s a lot of consternation about, “Hey, has it helped us at all?” Has it, or has it made our practice even more difficult, more challenging, leading to longer hours? You know, we talk about the burnout that’s happening in the industry and some of that could be related to the digitization of records. For instance, it might’ve taken me three seconds to write a prescription 10 years ago, but now it takes me 20 clicks and it takes a lot longer. With every advancement there might be something that we need to go back and clean up. So again, it’s been very helpful in terms of quality of care and patient safety, but has it hurt us in terms of the practice of medicine and the time that it takes?

Jeff Lin: You talked about mobile and cloud, and I’ll kind of bucket those together along with digital health records, but you go to these large healthcare IT conferences see the number of apps that are out there an everyone has an app for everything here. How do you see mobility transforming in the next five, 10, 20 years? Do you think this is going to be like a winner-take-all scenario where the large tech behemoths are going to be owning this space? How do you see this playing out from a mobility cloud, digital health record perspective?

Ed Marx: I do think we’re going to see a consolidation of vendors that are providing services. You know, if you think about it, we’re one of the only industries where there is such a multitude of players in the space, if you will. If you look at automotive, there’s maybe four or five car companies, automotive companies that control 80% of the market. If you look at retail, there’s probably four or five large retailers or clothing companies that have a large portion of the market. When you look at healthcare, you can take the four or five biggest healthcare providers, you’d have, I think the percentage is like 10% of the population of the United States. And you can extend this to software as well where there’s not one provider that’s going to provide everything or, or four that are going to provide everything. So I think you’re going to see a continued consolidation of providers and things related to provision of care, like software. And eventually you’ll get down to some more dominant players. Today, because of the ubiquitous nature of the cloud and the ability for everyone to develop an app, you’ve seen a proliferation of that. I think it’s really going to start consolidating because it’s going to come down to experience, right? What’s driving all of this is the user experience or the patient experience, the caregiver experience. And if you make it difficult for the patient to interact with your health system, you may lose that patient.

So now let me just, I gave you kind of a general answer, but I want to get a little bit more specific really here from the experience perspective. So imagine if you were trying to navigate my hospital and you went to the app store and you had 25 different apps for a hospital, which is not unusual. It would be very difficult for me as a patient in my experience to navigate. Now imagine if I went to the app store and I found the one app, but it had everything within it that I needed and that’s where we’re headed. So I think gone will be the days where there’s multiple apps for multiple things and there’s a lot of repetitive mess and it’s going to be down to just a single sort of application where everything that you need to interact with a healthcare system will be taken care of in a single app to enable your mobility and experience.

Jeff Lin: Do you view this single app or single consumer app to be done by the government, done by this particular health system, or done by a third-party vendor? Who is best equipped to create this single experience for the consumer?

Ed Marx: I think for the foreseeable future it’s going to be the health system, the hospital that is sort of driving this, but that’s going to consolidate as well in the future. Today it’s just on a practical matter. You know, even where I came from, you could have gone on to the app store. So the example I was giving you was a real example and you found 27 different ways to interact with our health system. Well, it was very confusing to the experience, and so now there’s one way. It’s very convenient. It makes it really easy to engage and interact and that’s what you need to make sure you know, you take care of that wholeness and wellness of people and population. Not everyone may be able to do that, so some will become very reliant on their vendors to provide some aspects of that capability. So you’re going to start seeing that consolidation. I don’t see a government role in this, so I see some going to the vendors, some going to their individual organizations that might be big enough to develop something like that. But eventually I think they’ll all start to come together and I’m not prepared to venture a guess on exactly how that’s going to transpire. But I think in the next three to five years, what I described is definitely going to continue to happen and evolve.

Jeff Lin: As digital health records gain momentum, it’s almost like a snowball rolling down the hill. Data is coming out of the snowball and it’s growing and then now you have the cloud and now the data can be stored in the cloud and now the data is assessable everywhere. We’re starting to hear a lot more about AI because there’s just too much data. What’s your opinion of AI and have you seen any benefits?

Ed Marx: Yeah, I think we’re in the early stages. So what we talked about, you know, in the last 10, 20 years, what are some of the big things, and we sort of focused in on, you know, the digitization of records. Well, that created a lot of data. And so I think we’re in the early stages. I know some people, we think we’re fairly advanced, but healthcare in general is behind other industries in terms of analytics. So while some other industries may have been doing sort of AI machine learning for a few years now, I think we’re just getting into it and it’s very exciting. I’ve been blessed to be a part of some organizations where we were doing some – we had AI capabilities and what we called it was Augmented Intelligence. Not Artificial Intelligence because the way we see it and the way I personally view it is that technology is there to augment the clinician, the caregiver in terms of delivering the care. Because ultimately we are still human and we still have empathy and empathetic care is healing care. And you know, I don’t think you want to get in a situation where you take out completely and you lose that empathy because a machine can’t love on a person the way that someone, a real person can. And so that’s why we prefer to call it augmented. So how do we augment care using data and advanced analytics? There are real use cases out there today. Now it’s not advanced everywhere, but that’s coming. I think if you were to ask questions, you know, what’s coming in the next decade, I would say we’re going to see the fruition. We’re going to see the fruit of AI and voice and some other technologies to really help digitally transform the care that we get.

So to go back to the question – an example would be in the past, if you had a particular type of tumor, you would get the same treatment as everyone else because that’s what we knew to do best. That was best practice even though that radiation treatment was only 50% effective, but it’s the best that we knew. So you would get that same treatment and hopefully you are on the 50% side of effectiveness. Well, using AI and looking over the history of our patients and their outcomes, we are able to look at the data and then add the Augmented Intelligence to it to where we were able to uniquely identify the best treatment for that particular tumor. It went up to 98% in terms of efficacy. So think about that: in the past it was 50/50, but now it’s 98% chance that the radiation treatment you received would be effective. So we’re seeing that in a lot of different areas of precision medicine and even on the administrative side as well. And on the payments side, we’re starting to see applications of AI. But I, as much as I love payment and you know, we have to have the revenue cycle part, what really gets me excited is how do we save lives with this technology or how do we improve lives? And that’s one example, but there’s many like that out there.

About the Host

Jeff Lin is Senior Vice President of Product Management at InstaMed. As head of Product Management, Jeff leads the ongoing product innovation of InstaMed’s healthcare payment solutions. This includes the exploration, evolution and execution of InstaMed products that further simplify the healthcare payments process. Before joining InstaMed, Jeff was an executive at Accenture, where he led multiple enterprise projects for multiple Fortune 100 companies. Jeff’s experience and expertise include a deep focus in the areas of product management, product strategy, product marketing and developing strategic partnerships. Jeff graduated from UCLA with a Bachelor of Science in Microbiology and Molecular Genetics. In his free time, Jeff enjoys spending time with his wife and sons and traveling and dining around the world. Jeff earned the Eagle Scout ranking as a Boy Scout and is an avid fan of any activities in the California sunshine.

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