In this episode, Buch sits down for an in-depth conversation with Dr. Muthu Alagappan, CMO at Notable. Among other things, the two discuss how healthcare suffers from the DMV effect, how artificial intelligence and machine learning are impacting the industry, the challenges associated with depending on an EHR to be a one-stop-shop for all technology innovation, and more.

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Bri Buch leads solutions development and product strategy in patient access and digital engagement at Notable. Previously she served as a consultant and strategic advisor to over 20 leading healthcare organizations on digital health transformation and digital front-door strategy. Prior to this, Bri worked at Epic Systems, leading EHR installations around the globe. She was integral to the debut of Epic’s predictive analytics suite, launching the first five AI analytics models for Epic customers and training internal teams on commercialization and deployment. Bri holds degrees in Public Health and Economics from the College of William and Mary, a Master's degree from the London School of Economics, and a certificate in Managing Innovative Technology from the University of Oxford.

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0:03:16.8: Dr. Alagappan asks what do you think some of the biggest challenges in healthcare are today?

0:03:56.7: Bri Buch: “I'm really laser-focused on two issues right now. And they are, how do patients access care and then how do providers get paid for that care? And even within both of those, we could talk about equity of care access across different patient populations, and right patient to right doctor, right provider matching, and even the amount of kind of manual work or humans required to get a bill out the door and make sure that bill is accurate.”

0:05:09.0: Bri Buch: “But even beyond that, something that I spend a lot of time thinking about is, why are we not getting better, right? Even in my training in economics and policy, we spend a lot of times looking at these questions and they haven't gone away.”

0:05:53.0: Dr. Alagappan asks “Why do you think digital technology has failed to meet its expectation in the last 20, 25 years?”

0:07:29.7: Bri Buch: “...we have this idea that healthcare and specifically healthcare access is inherently something worth investing in that we don't necessarily hold it to a high standard of outcomes, right? We don't necessarily measure on the backend, are we getting patients in at the rate we need to? Are we keeping patients in the system? And the dollars that are funneled in are not necessarily held to the same standard of are they achieving the outcomes we want to see? I think the second case is oftentimes, something I think of maybe the DMV effect, right? We have a consumer population that need this service. And sometimes, there's competition for those patients, but oftentimes there's kind of one group that can take care of their needs or see them in a geographic location.”

0:08:29.6: Bri Buch: “...we need to switch from saying, ‘okay, this technology is going to replace a workflow’ to, ‘how is it going to enhance, augment or improve a workflow alongside the humans that are currently doing these tasks?’”

0:09:39.4: Dr. Alagappan: I haven't heard that before, and I think it's very true. And so you're describing the DMV effect as not having to improve your process because you sort of own that geography.

0:14:25.9: Dr. Alagappan talks about Bri’s work to help healthcare organizations big and small implement automation technology, asking, “What advice would you give to those organizations or other organizations looking at automation as a potential solution?”

0:15:02.8: Bri Buch: “I think there are three things that come top of mind and really are general trends I see across organizations regardless of size, shape, geography that they serve. And I think the first is, getting really clear on what problem the automation is intended to solve.”

0:16:04.7: Bri Buch: “I think the second I'd say is, understanding that as organizations are evaluating, thinking about going into the space or maybe advancing into this space, that not all automation is created equal. I think there was a kind of V1 version of automation in healthcare, which was almost looking for different pixels on the screen as part of scripts, oftentimes robotic process automation.”

0:16:55.0: Bri Buch: “And these types of workflows are maybe just as brittle as some of the old technologies that we're looking to replace. And then there's a lot of different types of automation now, some that are backed by machine vision, computer vision, that are able to be flexible as screens change, as EHRs change, as technology changes. And it's important to know how to ask about and get into the differences between those different types of automation.”

0:17:33.0: Bri Buch: “...the third I would say that comes up a lot in the patient access realm is standardization as part of the process of implementing automation. And oftentimes we hear organizations, they'll say, ‘I would love to implement this, I would love to work with you in this area, but I don't feel that I can until we've done some internal rework or centralization of our processes.’ And I would actually challenge that and say, oftentimes automation can be a great forcing function and source of maybe a catalyst for a system to actually undergo some of that work to bring disparate groups back together.”

0:18:37.0: Dr. Alagappan asks: “And so as someone who works with hundreds of health systems to implement automation, what use cases do you see as the best place to start for automation? Where do you recommend people look first?”

0:19:20.0: Bri Buch says, “I think there are a few key areas that I'd call out that are helpful when you're looking for what to automate. And the first would be kind of two core buckets, one being unseen manual work, so places that you just...You have open job recs constantly, you're often hiring for those roles, you're training, maybe there's high attrition there. And then the second would be places that there would be manual work occurring, but there's not even enough staff to work that workflow.”

0:20:40.9: Bri Buch: “And then maybe the last one I'll add in is, anywhere you have multiple systems that don't talk to each other, because in healthcare, we often take a human band-aid and put them between two different disparate systems, and that's another great use case for automation where it can ease the flow of information without needing to take another FTE or staff member.”

0:22:29.7: Dr. Alagappan asks: “Where do you see common pitfalls or mistakes that organizations make when it comes to implementing automation?”

0:24:13.8: Bri Buch: “One of the common pitfalls of not seeing the benefits of automation is teaching staff what not to do. Or maybe put another way, teaching staff how to interact with automation and see themselves as the gut check, the kind of human analysis to make sure that what is there is correct, but to not go ahead and do the same work.”

0:25:33.5: Dr. Alagappan asks “If you put yourself in the shoes of a health system executive, how do you justify paying for new technology or investing in automation when you're already operating perhaps at a loss and are under significant financial pressure? How do you justify that or make that case to yourself?”

0:26:48.0: Bri Buch: “...it reminds me a little bit of a saying in tech, I think this came out of IBM in the computer age, that you don't get fired for buying IBM. And the idea here was, if a CIO is implementing IBM as a technology, regardless of the outcomes, it's a safe bet. And I think in healthcare, we sort of attribute that mentality to EHR first. I have these technologies, I have these tools, and if I go with that as my strategy, I can't lose. Even with everything going on around me, that is kind of the safe path as we try to navigate these waters. But I think there's a hidden cost that comes with this mentality, and oftentimes it's hidden costs of needing a staff of an organization's own IT teams, needing additional hardware, long times for rollouts.”

0:32:00.8: Dr. Alagappan asks what do you think of health systems depending on an EHR to be a one-stop shop for all technology solution needs?

0:33:22.4: Bri Buch: “I have to go deep and think through the core competency of a tool. What is it designed to solve, what is it trying to solve for? And for the EHR, that primarily has been three things. It's a system of record, it's a practice management software, and it's a billing suite. And more and more today, the organizations I talk to have those three in one. But at the end of the day, that has primarily been the core competency for a system of record, and that's been true for the past 10 years and throughout my experience. But, what a system of record is not, is a system of action, and a system to actually act on information within that system of record.”

0:36:18.1: Bri Buch: “And what we're actually doing when we try to use the EHR as our system of action, is we're introducing friction into the patient experience. We're taking a tool with one core competency and trying to use it to accomplish a different goal.”

0:37:28.1: Dr. Alagappan asks what patient access should look like in healthcare versus what it does look like at present.

0:38:32.8: Bri Buch says, “I think the current default is if you need patient access, it's very reactive, as opposed to proactive. We just expect the patient will come to us and they will call in. And typically the call-in is between the hours of 9:00 and 5:00, and maybe there are 10 minutes of hold time. There's kind of all these barriers and this friction. And I think what we need to do is invert this paradigm to say, ‘A patient only calls the health system for support when the system breaks. So how can we provide other tools so that the patient... They're only calling us as a last resort?’”

0:41:15.3: Dr. Alagappan asks where artificial intelligence and machine learning stand to make a difference in healthcare moving forward.

0:42:06.8: Bri Buch: “I see a lot of promise in the AI/ML world to really help us move the needle on more sophisticated patient and provider matching, symptom-to-visit type matching, allocation of visit types on templates.”

0:43:11.0: Bri Buch: “I think AI and ML have a lot of abilities, but again, we need to look beyond maybe V1, which is things like static decision trees or basic chatbots and really say, ‘How can we use machine learning systems that take knowledge from a patient's workflow or interaction seeking care? From what they put in as the symptom, to what the provider writes in the note, to what the outcome of the visit is, and then have a feedback loop pulling that back into the next patient who comes in and looks for care and how we direct them to care.’”

0:45:29.7: END

Relevant links

• Bri Buch on LinkedIn
• Dr. Alagappan on LinkedIn and Twitter
• Notable on LinkedIn
• Notable Perspectives