Top 10 Takeaways From Silicon Valley Healthcare CEOs

I've been a part of some great healthcare technology discussions while at HealthLeaders Media, but perhaps none covered more ground and got to the heart of more issues in less time than a meeting last week between some of Silicon Valley's top healthcare entrepreneurs and four top executives—three of them CEOs—representing healthcare providers with a Valley presence.

Hosted by the University of California, San Francisco, this 100-minute meeting of minds got right to the promise and the pitfalls of technology in healthcare, and highlighted just what an inflection point we've reached as 2012 draws to a close.

For one thing, I was struck by how many hospitals are taking selected tech startups under their wing, offering business advice and intimate glimpses for a lucky few developers into their particular workflow challenges.

For another, I was struck by the intricate knowledge these top executives had about technology. Gone are the days when the CEO left all that to the CIO or the CFO. These industry captains know their way around Meaningful Use and cloud computing.

It also struck me that the current explosion of investment in healthcare tech startups is going to run into a buzzsaw at some point, because the savviest CEOs know that stitching together best-of-breed tech solutions must give way to integrated, interoperable systems. The continued success of "big box" EMR suites this year points the way. But as one CEO said, "Epic is successful not because it's so good, but because the others are so bad."

With that, here's my top 10 list of takeaways from HealthTech Conference 2012:

1. The tsunami of change. "The mandate is, we bring these large, diverse, disparate organizations together very quickly, urgently, to try to have single-minded purpose in trying to improve community health," says Tomi Ryba, president and CEO of El Camino Hospital in Mountain View, CA. "And to do that urgently, we are bringing totally different cultures together, and government structures together, and then to be able to quickly achieve the triple aim by making sure that we keep our eye on quality, service, and affordability all at the same time. It's like a tsunami of change."



2. AICUs are coming. Meet the ambulatory intensive care unit, or AICU. "This is a complex-care medical home," says Amir Dan Rubin, president and CEO of Stanford Hospital and Clinics at Stanford University. "I call it concierge care for sick people." Rubin says Stanford intends to "spend more time and effort with people who we think we could prevent downstream complications from happening. So there we have leveraged our electronic data warehouse and we're tracking data over time across the continuum. That might be diabetes, cholesterol, blood pressure, [and] emergency visits." But AICUs introduce interesting, unanswered questions. "Does this population want a Fitbit? Do they want to be monitored? Some maybe, some maybe not. If it's your grandma, what should you attach to her? Maybe it's a phone call. Maybe it's an office visit. Maybe it's a health coach. I think there's a lot to be learned there. At some level, that field is in its infancy."

3. Nurse practitioner clinicians, bring your doctorate. The U.S. will be short 45,000 primary care physicians by 2020, Ryba says, and the shortage is felt more or less keenly depending on where you live. Ryba says 250 nurse practitioner-led clinics have popped up around the U.S., but in 2015, nurse practitioners will be required to have a doctorate. But since the alternative may be no primary care at all, expect to see more of it.



4. Technology to monitor medication compliance. Home monitoring of blood pressure and weight is catching on, but Ryba hasn't yet seen effective technology that can monitor medication compliance. "In the hospitals, every single patient goes home with the med in their hands, and we're doing that now, and we're making sure those meds follow them to skilled nursing facilities," she says. "But in the home, I think that we don't have the technology that really does influence behavior" to make sure those medications are taken.



5. Medical school takes too long. "What if it took half the time?" Rubin asks. "When you cut a year or two down, do you have more people?" He points to the writing of Stanford economist Victor Fuchs on this issue.



6. Specialists are headed for call centers. "Technology gives us the opportunity to do things that couldn't be thought about," Rubin says. "Maybe you could just do rounds on your iPad or iPhone or whatever the device is." If the physician needs to consult with a specialist, the days of waiting four hours for a call back may be numbered. "Maybe a specialist is sitting in a call center" and the physician brings up the specialist on a screen in the patient's hospital room. "There's a tremendous opportunity to transform how we train, how we work as teams, to leverage the technology, and to change the way we deliver healthcare," he says.

7. Tell the total patient story with technology. "We have fundamental EMRs in place, and we have them in hospitals and in ambulatory care settings, but what we don't have is the coming together in a meaningful way that actually tells you the story of the total patient at different episodes," Ryba says. "If there was a way with payers, with providers, with businesses, to really come together on some type of common platform that actually tracks life, life episodes, [and] life changes" and stresses prevention efforts, that would make a big difference, she says.



8. Expect government requirements to change as the science changes. "It's dangerous when the government says, Here are the processes that you should be ranked on, and then you find five years later, ‘Oh never mind, those were irrelevant,'" Rubin says. "Documentation of smoking cessation advice is just a joke. That you have a checkbox at admissions, and really what you should have been looking at are these three or four prime comorbidities." There's "tons of room for innovation" in technology that can track multiple chronic comorbidities or different disease categories, he says.



9. The care team social network. Instead of physically collocating team members from different disciplines, another panelist suggested a technological equivalent. "We're using Salesforce Chatter to allow providers in a confidential way to share their thoughts across the continuum," says Mark R. Laret, CEO of UCSF Medical Center in San Francisco. "It's been very helpful."



10. Free technology is never really free. "Companies underestimate the cost that we bear to do something for free," Rubin says. "When you think you're giving us something for free, we're probably spending $300,000 to get that thing for free, in internal costs, just given our cost structure." Rubin says it's a matter of priorities. "I just had all the dermatologists in my office yesterday, because they don't like the order entry in the Epic workflow. If you can fix that, it would be a good one. I could work on that project for them, or I could get my IT people to spend the time doing [some] gainsharing analysis" with a technology vendor offering a solution to some other problem. "Which one am I going to choose?" Rubin asks.