Lumeon CEO and Founder Robbie Hughes sat down with Tom Foley of The Virtual Shift podcast to discuss Lumeon’s recent research report, “The New Productivity Era for Perioperative Care.” Listen below to learn more about the report’s key findings and how technology and virtual tools enhance care delivery while reducing care costs.
Read the full transcript below.
Tom Foley 0:13
Welcome to the Virtual Shift, a show that looks at the seismic changes happening in healthcare with virtual care at the epicenter. Join me and my guests as we look at key cultural and policy shifts, impacting how providers payers and patients connect, as well as how care is being reimagined, both for today and the future. Hello, and thanks for tuning in today. I’m your host, Tom Foley. You can learn more about this show by visiting the program on healthcarenowradio.com. Today we have a great guest, Robbie Hughes, Founder and CEO of Lumeon. His organization produced a study, The New Productivity Era for Perioperative Care, a US healthcare leadership research report – it’s a great read. You can find it on their website (Lumeon.com). We’ll give you more information about that in a few. Robbie, welcome to the program.
Robbie Hughes 1:09
Hey, Tom, thanks for having me.
Tom Foley 1:10
So Robbie, interesting read on the on the research. Let me provide some highlights in the report. The executive overview of the report states that there were five key findings: patient volumes are still recovering from the pandemic; staffing, safety, burnout are top of mind; capacity is a major bottleneck; there’s a push for productivity; and there’s a need to look beyond the EHR, which I thought was an interesting point in and of itself. Let’s talk about each one of them. Give us your your insights into the overall report, why you did it, and your findings. We’ll talk to each of these findings in more detail.
Robbie Hughes 1:54
Sure. So we we do these reports fairly regularly, we like to spend a good amount of our time doing primary research into the market and we find that if you talk to people directly, they often have interesting things to say. So this is a repeat of a report that we actually did a year before. And if you go into it, you can see some comparisons around what was happening at the beginning of the pandemic versus what was happening back in November of 2021. Clearly, now, as we get into 2022, the situation continues to evolve. So this is obviously a snapshot in time, but it’s not going to be surprise to anyone really. If you look at it on the ground, people are burnt out. The staffing issues that we see in healthcare are a material issue for both our customers and, frankly, everyone globally. A lot of that is coming from the unpredictability of demand – in other words – patients are scheduling things and they’re getting moved back or they’re getting [cancelled] and demand will appear and disappear. There’s this kind of bow wave of COVID demand that comes in intermittently. And again, that’s depending on where you are in the country. It can be extremely punishing, or it can be relatively kind of endemic (I think that’s the word we’re going to start moving towards). But just as we see now in most businesses, the ability to manage flow, the ability to manage demand, and the ability to understand what you need to plan for is is a real issue. For others who’ll be looking at elective surgery, in particular, this is one of the three key vectors you need to fix if you’re interested in addressing capacity management overall as a health system.
Robbie Hughes 3:39
From a Lumeon point of view, in the world as we see it, we can fundamentally move the the needle on cost of care and quality if we can start addressing some of these variation issues, and our particular approach to eliminating the variability in execution comes from using a lot of automation. We believe that driving automation through weaving it into care delivery — both from the very first point of contact all the way through to once the patient’s been discharged to home — you can use that to plan better, to organize your resources better, to eliminate redundant and wasteful activities and to transform the way that patients perceive their care. If you can do this across the board – you can do this in [patient] access, you can do this in the ED, and you can do this in elective care – then you can actually start load balancing much better across the health system.
Robbie Hughes 4:36
And so it’s that lens that we take to this report. And again, the variability drives into demand, which drives into planning drives into capacity, which drives into productivity, and so on, and so on. So I think all of that is well known and what I think is good about this report, is it really put some numbers and some specifics around some of those those challenges. But also I think it’s interesting to look at how people are addressing some of these these problems on the ground. And, again, I think there are sort of first-order and second-order problems here to be to be thought about. The first-order ones, being as a health system, [or] as a surgical leader, or someone in access, just dealing with the problems in front of you, that’s a really big issue. And there are a lot of solutions that people are putting in now that are going to help them to some extent wrestle with that kind of demand. But I think as we’re now in the second year of the pandemic, we need to start looking beyond the basics, beyond those first-order problems, and start thinking really about what that second-order problem is going to look like. How do we make it sustainable? How do we make it scalable? How do we think about the Target Operating Model? What [do] the services of the future look like that are going to stick around?Rather than just taking what we’ve done and making it virtual, taking a face-to-face visit and making a video consult, for example, that might buy us a bit of time, but it’s not going to be the long-term way that we end up doing things.
Tom Foley 6:02
So one of the findings in the report, you talk about patient confidence to begin with. Obviously with COVID, people are hesitant to even go to a doctor’s office for that matter. So yes, virtual care becomes a prevalent solution to that. But when you’re talking about surgeries, and giving patients confidence in the fact that it’s safe to have surgery, what do you say to that?
Unknown Speaker 6:31
Well, I should say I’m not a physician, so I can’t speak to the clinical points around it. But what I can say is the confidence at an individual level really comes from a number of different areas. If I think about this as a patient, a way to break my confidence — a way to confuse me, a way to make sure that I’m likely to do the wrong thing — is to break promises, is to not engage me in the right way, is to ask me to do things that are unreasonable. We talk in this industry a lot about being patient-centered and for me, a lot of this comes back to that it’s understanding that a particular process or a particular protocol needs to be focused on the needs of the patient. I’ve listened to many of your podcasts; I like the example you give around the typical Medicare patient with five chronic diseases. It’s very clear that what’s going to work for them, it’s not going to work for a person who’s stuck in an office, mid 20s, a marathon runner, for example. So the confidence of that patient – that they will do the right thing – versus the confidence of your complex patient (the way those things are going to be measured, the those things are going to be delivered) is going to be different. And ultimately, it comes back to keeping the promises you make to that patient, but recognizing that those promises are going to be different. And then that comes back to “how do I design a service that’s responsive to the individual patient’s needs, and is engaging them on their terms, meeting them where they are?” as I as I think the phrase goes. And in surgery, back to your question, what that means is having some way of weaving different capabilities, different engagement strategies, different personalization approaches into your systems into your processes, so that you can say, “well, you know, this patient is responding well to these sorts of questions, and so we’ll carry on doing that,” whereas “this other patient, it’s not working, so we need to adjust.” And I think this is one of the hardest things about healthcare, it’s very easy from an operational point of view to to do this one-size-fits-all thing where every patient is treated the same way. But we know that’s expensive. We know it’s inefficient. And we know that it is not going to give us that patient-centered care that we need. The right thing to do is to try to personalize it to the needs of the patient, but the operational burden of having processes that change based on every patient that comes through, that’s a real issue. That’s a really difficult thing to do. And the technology that allows us to do that is only now starting to emerge. And again, that’s that’s really, that’s where [Lumeon comes] from, that’s the lens we apply to it. And as we think about what does the future look like, we think technologies that allow you to have that personalization capability that sits on top of your EHR, that’s going to be the thing that differentiates and gives patients the confidence and the quality of care that they really need.
Tom Foley 9:30
So lay out for me and for the audience. When you talk about technology, can you highlight your vision as to what type of technologies would be sitting on top of an EHR? We’ll talk about the the findings about the EHR in and of itself, as you say, the EHR alone won’t meet the needs. I’m really interested in understanding what your vision is, as to how you see the reimagination of the delivery of care in this particular space.
Robbie Hughes 10:00
Well, let’s start with where we are today and what we’ve got. So we’ve put in these EHRs. They’re phenomenal systems for documentation and billing, and they allow us to drive effectively, a common understanding — hopefully, assuming we’re using it consistently — of what’s actually happened. And that’s fine. That’s a laudable thing to do – it’s necessary for quality, it’s necessary for billing, it’s necessary for regulation, etc.
Tom Foley 10:27
Let me stop you there, if you don’t mind. So I come from the EHR industry, and I was around when we first started the adoption here in the US. And many don’t know – but you know – it was really not a very well thought out launch. Because it was “we have this Recovery Act, let’s put money into the High Tech Act and get everybody to adopt an EHR.” But at the time, 50% of all EHR deployments were failing, right? So it was a combination of things. We’re now 11 years later, and things are obviously much better. But still, 11 years later, we have physicians that don’t like that tool, because they spend too much time heads down fingers on keyboards, we talked earlier about that patient-centric care, you don’t give patient-centric care when you got to spend half of your visit with your head down and fingers on the keyboard. Thoughts on that? Yes, EHR dead? I guess is the question.
Robbie Hughes 11:23
I think the EHR never delivered what people expected it to do. I think it delivered exactly what it was intended to do. And if you go back in time to the 80s and 90s, and you look at the way some of these systems, predominantly two major systems, were designed. These are rich order comm systems that are very good at having effectively siloed departments that sit within a technology stack, and you communicate with other departments through effectively a back-end messaging bus, it’s integrated within the EHR. But it’s designed around the model that the human is the person driving the process, the human is the person documenting what’s happening and the human is the person responsible for the care being delivered. But if we think about this idea around patient centric-care, is it reasonable that we expect not just a single human but an entire team of people to seamlessly coordinate every single thing that needs to happen all the time, but on the basis that every single one of those actions is going to change depending on what the patient specifically needs? I don’t think that’s a reasonable ask. I don’t think that having best practice alerts, and tasking and all these various different modes of “nagging” that we’ve built into these systems to tell people to do “the right thing,” is a sustainable way of making this work. And I think in particular, one of the reasons that people get frustrated with EHRs is, the documentation burden that comes with it. You can more or less eliminate the documentation burden, provided you have some sort of consistent process and Interaction Guidance is leading the user through the various handoffs. In other words, if I go in and I fill out my bit, then I go to the next person and they fill out their bit, and so on and so forth, the documentation that comes out of that is minimal, because what needs to go in and what’s being handed off to the next person is very clean and very well understood. The problem with that is building that out and doing it in a way that’s such that it morphs to the needs of every patient, it’s just not what they were built to do. There are systems that do that, but it’s not what an EHR is. So, for me, what’s my vision? I think the EHR does a great job for the regulatory points, the billing, the documentation, such that it is, I think there is a lot we can do on that. And I know if you were to ask the guys at Oracle that are talking about voice-activated interfaces, and Cerner and all those kinds of things, which I’m sure is great. But for me, it’s about documentation. It’s really about consistency, so that we can be very clear that all the right things have been done. And once you start touching on that problem, then you’re into the world of, “what are the right things that need to get done for this patient, at this time?” And then you’re kind of backing out into a world of, what I would term “orchestration,” which is I need to understand for this patient with this presentation in this context, what needs to happen and who needs to do it. And I don’t think that care teams reasonably can do that. So I think that’s a really really good job for technology for an overlay system, for an orchestration system that can sensitively understand the specific needs of each patient, to task the right people with the right actions and feedback loops at the right time and do that seamlessly again and again and again, creating this personalization. That’s what I believe the future needs and having delivered it ourselves, I can see the efficiencies that brings and the benefit it brings.
Tom Foley 14:54
That’s a great word, “orchestration.” Orchestration across the continuous care model is critical because and to your point, we’re talking about alert fatigue within a clinical setting. But you know, patients get alert fatigue, too, right? The reimagination of delivery of care and care into the home, it’s not about pounding the patient with alerts every day as to what they did and didn’t do. It’s an easy thing to do. But it’s not necessarily an orchestrated ensemble of how we get to a better delivery care model. In one of the points that you highlight in the report you talk about burnout, staff burnout. Does staff burnout contribute — and because I have nieces, and nephews, and sisters in law, and a lot of people in health care — and I hear this story all the time, they always want to do the right thing. Of course they do, right? That’s the the burning desire, when you’re in healthcare is to change someone’s outcomes and to get them on a better path. So I get that, but sometimes burnout in and of itself creates the lack of availability, if you will, to achieve that orchestration. Thoughts on that?
Robbie Hughes 16:16
So I would turn it the other way round. I think the point you’re making is that, in order to create that change, in order to create that personalization, you need more resources, not less. And the way I would turn it back to you is to say, I think that’s true in a world where we aren’t delivering enough care to each patient. But I think what experience tells us is that we are often delivering too much care to each patient, or indeed inappropriate care. I’ll give you an example within the context of surgery: if you were to look at our solution applied for the orchestration of the periop journey, one of the immediate benefits — and when I say immediate, I mean, when this thing is switched on within the first week of being activated — it will yield somewhere between a 60 and 100% lift in productivity for the care team. And the reason it does that is by very selectively ensuring that it’s tasking the right members of the care team with the right activities specifically for each patient. And the way that’s the reason this works is that if you were to look at patients coming in for surgery, not all patients need every test. If a patient doesn’t need a test, why would you bring them in? If the patient record has already [captured] much of the information you need in order to screen them, why don’t you reuse that if it’s still valid? If there’s information you can pull in from other systems, why wouldn’t you use that? And if you just keep applying that logic over and over and over again, what you’re able to do is effectively engage the patient, get them to answer a few questions, pull the rest of their medical record, pull it all together, and then in the space of about 14 milliseconds, you can say whether the patient needs even to have any contact with a nurse or not. And then depending on your case mix, you will either have some modest increase, or if you’ve got a very low risk population, a hugely increased productivity mix. And that will change month by month as your case mix changes, it will go up and down. But the point about well orchestrated care is that we’re trying to very precisely orchestrate the right care for each patient, rather than trying to put every single patient through this kind of factory model [just] because operationally, it’s the right thing to do. When it turns out, it’s inefficient, it’s expensive, and it’s just a really terrible experience for the patient.
Tom Foley 18:50
It’s interesting to hear you say that, because immediately comes to mind is there’s clinical protocols to be followed. And what you might be suggesting — I could be wrong — , is that sometimes, the clinical protocol is a guideline (which I would agree with) as opposed to an absolute must do. To your point, if I already have an x-ray within the last week, and it’s relevant, why take another x-ray? Right?
Robbie Hughes 19:20
Yeah, that’s right, but just to be crystal clear, I’m not for a second advocating that you don’t follow the guidelines. What I’m suggesting is that if you actually read the guidelines and follow them precisely, you’ll find that much of what you thought you had to do, you probably don’t because it will determine what relevant means, and it will determine what appropriate means and to follow that robustly. Then you’ll actually find that you’re doing too many things.
Tom Foley 19:46
I’m with you 100% I’m just trying to put myself in the in the shoes of a nurse and think whether or not with those objectivities in place, one would say, “yeah, I want to have that objectivity.” But if [they] don’t do it, and something happens, the liability is — and their job security, frankly — out the door. So there’s this balance. I agree 100% with what you’re saying, I just think that the practicality is sometimes is that nurses and doctors aren’t given that flexibility to be objective in their decision making, and be supported at when things don’t necessarily go the way they anticipate, in the context of patient’s health outcomes.
Robbie Hughes 20:38
I think the interesting word you hit on there is, “supported.” If I’m a nurse and I’ve got a long list of patients to get through. And one of the first things I’ve got to do is determine whether or not this patient needs to come in, probably what I’m going to do is go into the record, have a look, and if I can’t find what I’m looking for within a couple of minutes, I’m probably going to order it. Because I don’t want to take a chance that it’s not there or that I missed something. And that’s the right thing to do. There’s a natural human bias towards being conservative for all the reasons you point out. But, if I flip this around the other way – if we know it’s there, if we can see it, if we can read the result, and we know that it’s valid, we don’t need to order it, nor do we need to waste the nurses time looking for it. The problem is that because we’ve got these documentation systems that are largely full of free text, and where things aren’t structured, aren’t filed in a consistent way, it’s actually much harder to find the information we need, in order to do this well, than it should be. And so people are pressed for time, and they don’t do it. And so they tend to order more, they tend to err on that side of, I guess of safety. But the the reality is that we’ve got to be very clear about the problem we’re solving. What good looks like is that we know we are robustly applying the correct care to every patient. And unfortunately, we make that a lot harder than it needs to be. Because, you know, we stuff everything into the EHR and hope for the best. And what’s kind of worse is that we have a reimbursement system that pays us for doing that. So the more we stuff in there, the more we get paid. And unfortunately, the driving, the overwhelming driving factor that characterizes care delivery today is: there’s too many patients and not enough staff. You can have 1000 bed hospital, it won’t be staffed to run 1000 beds today, there probably is the hospital in the country, it’s got full staffing available today for their beds. And so when we can think about ways of delivering care that don’t force our care team to do these extra things like go rustling through the EHRs to try and find things — this is all wasted time. This is not nurses operating at the top of their license. This is why people hate this stuff, because it’s getting in the way of trying to do the right thing. But again, the alternative, even the request we’re making of them, which is, “I want you for this procedure where the patient looks like this with these conditions and these medications and other data. I want you to do this one thing.” I mean, even that that’s an unreasonable request.
Tom Foley 23:25
So we have about two minutes left. Guide the audience in what you would advise health systems to do in the context of layering technology that helps orchestrate the delivery of care, which maximizes the right physical resources and people resources to do their thing, but yet allows technology to offset and do the more mundane things and collectively be an orchestrated delivery apparatus.
Robbie Hughes 24:06
There’s a great temptation to think about technology as a digital veneer that sits on top of whatever it is you’re doing. I’m going to do my job the normal way and I’m going to apply technology over the top and everything’s going to be better. I can promise you, that’s not going to be the case. It’s gonna be more expensive, it’s gonna be more error prone, and it’s not gonna deliver the outcome you expect. So I would think of technology in the context of service design. I would think about it in terms of what happens when you can take the benefit of automation and orchestration, and you can design a service that works in a different way. So it’s not about texting your patients. It’s not about providing another mode of engagement. It’s about trying to weave these technologies and these additional modes of access, or decisioning, or handoff or whatever it is into specifically-designed workflows so that you can get the benefit from it. We have a customer that does the most amazing thing they took 80% of the costs out of their care delivery by virtualizing a process. When in fact, the engagement with the patient is entirely on paper, the mode of operation on the ground is broadly the same, except that they condense three visits into one. All they did was they shifted a high-end physician engagement into a low-end physician engagement, but they added a case review externally. And they turned a large complex process into a very simple thing, by “virtualizing” it and in fact, that service redesign, massively improved quality and massively improved the patient experience and cut the cost of the overall service. Now, that for me is a really, really good use of technology, because what they put together there could not have been done without orchestration technology to bind it together. But the way that was perceived by the patient, and this was an ophthalmology service, which is why the paper, the ophthalmology, patients with cataracts and glaucoma, that they’re not a good fit for your traditional smartphone apps and things like that. So let’s not pretend that they would be. But the outcome delivered was phenomenal. So my number one piece of advice is focus on the goal that you’ve got. Is it cutting cost? Is it driving quality? Is it improving productivity, the care team? Whatever it is, but use that as your lens, and then think about the entire service around that, and then how you weave technology into support and sustain that service. Don’t start with technology and think about where you can apply it, do it the other way around.
Tom Foley 26:36
Very interesting. Robbie, we’ll have to leave it there. Robbie Hughes, founder and CEO of Lumeon. And I believe it’s lumeon.com. You can also find the research report on on their website. Robbie, thanks again for your time, your great insights. I hope people flock to your website and learn more about the good things that you’re doing because it is compelling. For sure. So Robbie, thanks again for joining us. I’ll talk to you soon.
Robbie Hughes 27:03
Tom, thank you for having me.