Dr. Richard Milani gives an insightful look behind the scenes at how their health system got buy-in for the O Bar, the revolutionary in-person patient engagement experience inside their hospitals. Learn how their clinical team approaches challenges of bringing mobile health to patients who are elderly or less tech-savvy, even when there are 110,000 health and wellness apps out there. Ochsner Health is one of the nation’s health systems proving that a clinical strategy can help achieve the elusive triple aim with health IT’s help.
Show notes
Air Date: March 9, 2016
Guest: Dr. Richard Milani, chief clinical transformation officer, Ochsner Health
| 0:27 | HIMSS report and Jared on #medheads |
| 1:10 | Open API’s ftw |
| 2:55 | Innovate or die |
| 5:01 | Introducing Dr. Richard Milani |
| 9:00 | The O Bar and the problems it addresses |
| 13:42 | When patients tell you you’ve changed their lives |
| 14:00 | “We need to be enhancing the health of the population we serve.” |
| 15:35 | You don’t have to create your own apps |
| 16:23 | You don’t have to write all the books in the library |
| 17:20 | How can health IT move health care forward? |
| 18:23 | What pain points does the clinical community still have about health IT? |
| 20:28 | What do you tell clinicians who are still skeptical about empowering patients? |
| 22:32 | The key to the triple aim |
| 24:20 | Bonus question: If you could join a rock band or music artist for a day, who would it be? |
About Dr. Richard Milani
Dr. Milani brings a unique level of innovation and expertise to his role as Chief Clinical Transformation officer for Ochsner Health System. He is currently Vice-Chairman of the Department of Cardiology, Professor of Medicine, and Epic Physician Champion at Ochsner Health System, Ochsner Clinical School – The University of Queensland School of Medicine in New Orleans, Louisiana.
After receiving his Internal Medicine training at the University of Florida, Dr. Milani completed fellowships in Critical Care Medicine at the University of Florida, Preventive Medicine and Clinical Epidemiology at Harvard University (Massachusetts General Hospital), and Cardiovascular Diseases at Ochsner Clinic Foundation. He is currently on staff in the Department of Cardiology at Ochsner Health System, where his major interests are preventive cardiology, medical informatics, non-invasive imaging, lipidology, cardiac rehabilitation and exercise training.
Dr. Milani’s research interests include the fields of cardiac rehabilitation and prevention, including lipids, hypertension, obesity, and exercise as well as noninvasive testing, encompassing echocardiography and exercise testing. He is the author or co-author of over 500 medical publications including 19 book chapters. Dr. Milani also serves as a frequent lecturer, reviewer for several medical journals, and is on the Editorial Board of American Journal of Cardiology, Vascular Medicine, Preventive Cardiology, and Endovascular Today.
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Full transcription
Jared Johnson: Hello my friends and welcome to the Health IT Marketer podcast, the podcast for the heartbeat of health care. I am your host Jared Johnson of Ultera Digital. This is the first and only podcast dedicated to the health IT marketing community. Welcome aboard.
Well, I’m back from HIMSS, and I had to say what a great trip that was, spending a few days out in the desert, out in bright and sunny gorgeous Las Vegas, enjoying the HIM-sanity. In fact, at the end of the week Neil Versel from MedCity News invited me to be on MedHeads, which is MedCity News’ weekly hangout, along with Sean Carroll and Nancy Fabozzi and I shared a few of these sentiments that I’ll share. I’ll give you my quick report from HIMSS. But I shared some of the sentiments on MedHeads. I’ll also include a link, in fact, to that rebroadcast in the show notes so you can replay it if you’d like to see it.
But on MedHeads, Neil asked us for the best, worst and weirdest things we saw at HIMSS I’m going to adapt that just slightly today. The best thing that I shared on MedHeads, the best thing about HIMSS was this fact of open APIs was the fact that in my mind the winners who are out there on the show floor and in the panels and discussions were not just talking about their products. They were talking about how they connected to other vendors.
So I think that openness and that connectedness that we have talked about for a long time, that interoperability, is no longer a myth. In fact, it’s been well documented by many thought leaders leading up to HIMSS this year that that’s not just something we were talking about. That it is happening. Those platforms and those services, those vendors who get that, who understand that they don’t have to come up with every single solution across an entire care continuum but they can connect to those devices and those platforms and those information management systems, whether it be an HR provider or anyone else.
That openness of APIs is what’s winning health IT today. I was really encouraged by a lot of the conversations happening at HIMSS. Some of those were a lot of fun. There was the HITMC meet-up on the first day on Monday. There was a health IT chicks meet-up on Tuesday. There was a social media ambassadors meet up on Wednesday where we were able to meet many of the social media ambassadors for HIMSS. I really don’t feel any more at home than when I’m surrounded by hundreds or thousands of other health IT pros, in this in this case 40,000. The attendance was slightly under 42,000 for HIMSS this year.
One of the other themes that I enjoyed was summed up by John Halamka for MedCityNews, actually at the end of the week. He talked about how buzzwords are dead and providers and vendors need to live by the mantra of “innovate or die”. I loved that thought. I think he’s representing the innovation that is out there.
So some of the other meet-ups and discussions and conversations that I saw included a panel discussion sponsored by the crew that manages the HITSM weekly tweet chat. But it had to do with this thought of what innovations are happening, what innovations do we wish were happening right now. If there’s one thing that we could make happen right now to improve health IT, what would it be? So we’re talking about all of these things and I look around the room. It was standing room only. There were a lot of familiar faces out there we were all nodding in agreement.
The panel gave some fantastic answers, I mean, everything from moving towards a universal patient ID to other technologies that liberate the data, smart sensors, semantic language and natural language processing, Internet of Things, evolving government incentives. The answers were phenomenal and as I looked around the room I thought we were having a great time were all nodding in agreement here, but what we do take that and get past this echo chamber, and how do we move outside here and take this story of innovation and health IT out there to the masses?
How do we take that story to the providers and the vendors who are all within our own individual ecosystems and make that story known? That was my thought as I left HIMSS. I was encouraged by the progress that’s being made. I can see the tools that are being developed that are the foundation of the type of care that’s being demanded by patients, consumers, and the provider community.
So that’s what I left HIMSS with, thinking that, and that’s my challenge to keep thinking first off “the innovate or die” mantra for providers and vendors. And then for all of us in health IT, especially in the marketing side, how do we keep telling that story of innovation so that everyone’s aware of the innovations that are happening now, and how they can either implement those in patient care settings or expect that type of innovation in functionality in health IT tools.
So I’m pleased to have as our guest on the program this week Dr. Richard Milani. He’s the Chief Clinical Transformation Officer at Ochsner Health System. Dr.Milani, welcome to the program today.
Dr. Milani: Thanks for having me.
Jared Johnson: We’re excited to talk about digital health and especially from a unique standpoint such as yours where you’ve been involved in a health system with Ochsner Health who has had the opportunity to be involved in some pretty cool digital health initiatives, especially over the last couple of years. Would you like to start off sharing a little bit more about yourself, about your background and your prior experience and what you’re doing now in your current role?
Dr. Milani: Sure. So I am a physician. My training is in preventive medicine in clinical epidemiology, which is basically population health. I also have a background in IT and I also have done fellowship training and in cardiology as well since a lot of what we do on prevention in population health involves cardiovascular care. I was the person that led our health systems rollout of Epic, and so we’ve rolled out Epic across our health system. Now my current role, as you mentioned, is Chief Clinical Transformation Officer and my role is to help our health system sort of move as quickly as we can to the 21st century to try and use digital tools and other tools to help transform how we care for patients.
Jared Johnson: Is that a relatively new role of Chief Clinical Transformation Officer? Has that existed for a while in your organization?
Dr. Milani: No, you’re absolutely right. I am the first one to hold that title in our organization and it’s a relatively new role, even on a national scale, but there are others that I have met that are in the same type of role. So I think what it speaks to is the fact that healthcare is undergoing great transformation and we need really somebody who wakes up in and thinks about nothing more than how we can improve how we care for patients and create not only efficiencies on the caregiver side, but better access and better outcomes on the patient side as well.
Jared Johnson: So what type of interaction does that role play? Are you responsible for communicating those types of initiatives from administrators to IT or to clinical? What kind of role is that?
Dr. Milani: Well, no, I don’t think it’s just a communications role. I mean, our role is to try and invent and innovate new ways of both delivering care and improving care across the patients that we serve. So we have innovation programs in terms of care delivery models both on the inpatient and the outpatient side, and many of them are using technology to be able to not only improve safety and improve care and better outcomes, but also improve caregiver efficiency, so when possible to try and utilize technology to improve care overall.
Jared Johnson: I see and I failed to mention a little bit more about Ochsner Health System itself. What size of health system is it? How many locations do you have, etc.?
Dr. Milani: Right, so we own approximately about a dozen hospitals and then we help manage at least about another half a dozen or so. We have about 40 clinics — outpatient ambulatory facilities. We’re centered in New Orleans. We have about a little over 1,000 employed physicians and then about another 2,500 community physicians that work in any of our hospitals. So we’re based in New Orleans but we’re really focused on health care cross what is called the Gulf South, which is across the broad area of Louisiana and then goes into the southernmost portions of the Mississippi as well.
Jared Johnson: Very good. Let’s start off talking about one specific, I’d call it an achievement. One thing that the public caught notice of that Ochsner did a couple of years ago and that’s establishing the O Bar, basically a genius bar of a physical location where patients are able to work with staff to have apps put on their mobile devices. Can you tell us a bit more about it and how did you get buy-in to implement that type of program?
Dr. Milani: Yeah. You began to describe it well. So what are the issues? The first, let’s describe the issues and then how O Bar could be a solution. So one issue is that there is currently about 110,000 health and wellness apps out there in the in the universe and there’s been a couple of studies that have evaluated least a sampling of these that found that there are some that are really very, very helpful and some may be moderately helpful, and some that are probably not too valuable at all. So that’s one issue.
So how does the average consumer that doesn’t have a health background be able to separate the wheat from the chaff so to speak, to discern which ones would be the better suited for them? Then he second issue that really does exist is one of technology and to some extent even technophobia. But certainly the what may be perceived as a complex nature of technology and it can be a barrier to many people that would benefit from technology.
A great example, and I’m not trying to be stereotypical or disparaging, but often older individuals sometimes will develop technophobia or a fear of certain new technologies because they’re not used to it, so much so that even the AARP, the American Association of Retired Persons, has actually put around the country what they call “tech workshops”, which is workshops where older individuals as part of AARP could understand how to do what you and I might consider relatively routine things, whether it be using a tablet or email or any of the number of apps and technologies that exist today for the average person.
So that’s a way of sort of reducing the barrier to entry. It’s reducing that hurdle. We felt that obviously technology can help a lot of people, especially those with chronic disease, for them to be able to get more involved in their own care, to not be so reliant always on the health system but to be able to take control or at least partial control over their own health.
So the idea was to be able to solve both those problems and that’s where the O Bar was conceived. So the O Bar is literally something kind of like the Genius Bar. It’s a bar in a retail area. Not a bar where you drink obviously, where we have half a dozen or so iPads on that are mounted. We’ve loaded onto them several hundred apps that are broken down by category that subject matter experts have evaluated and felt that these are among the good ones.
So if you are a diabetic or you wanted to lose weight or you wanted to improve your nutrition or whatever it might be or issues around women’s health or pregnancy or any of those kind of things, you’d have a curated set of apps that we know that probably has a good chance of being reasonably effective and that other patients have felt to be useful as well.
Secondly, there’s a “genius” as you pointed out, an expert behind the bar, that can help and assist not only in guiding you, but should you have an issue with technology, they could take all the pain points away. They can load the app on your on your smartphone or tablet. They can help you in terms of the set up. We do sell wireless devices that can transmit information directly into the EMR so it could be a wireless blood pressure cuff or a glucometer or a weight scale. But any of these kind of things that people wanted to buy, we can actually help them set it up and have them, if they chose to, have that information directly inputted it into their EMR for their healthcare team or physician to see.
So a lot of those pain points are done. It’s free of charge. Obviously if there’s a device and it has a cost, then you’re just paying whatever that is. But the service that’s provided is certainly a free charge. I can tell you, we’ve had some great success.
Now, again, the kind of data I can feed to anybody listening is that they’re anecdotes because, again, this is information that’s held through HIPAA that we can’t really go and access an individual’s information. We’ve had many, many, many patients come to us and tell us how much an app or this kind of information has really changed our lives and how it’s helped them accomplish things that they otherwise wouldn’t have been able to accomplish.
Jared Johnson: So that kind of sounds like mission accomplished, when patients can come up to tell you that you have helped them improve their health and change their life. So I imagine that wasn’t a quick process. I’m being a little facetious here. I know it’s not an easy process to get buy-in for an idea like that. Can you give us any insight on what it took to get this thing going?
Dr. Milani: Well, it first took a concept and also even some national survey data that suggested that patients are interested in getting more involved in their own care. Kind of the steps that I kind of lead you through during the discussion, this was never meant to be, nor is it, a profitable venture. If anything, it’s a money losing venture if you look at it just in terms of dollars and cents. But we’re not-for-profit, not that we’re here to just throw money away, but the idea being is that we need to be enhancing the health of the population we serve.
We think that this is providing the capability for our patients to enhance their health and learn more about their own disease processes. So it is an investment that we make in our patients and that’s the way we look at it. I’m very fortunate to have a very forward thinking CEO and board of directors that embrace this and really felt it was a great experiment to try, and if it didn’t work then no problem, but if it did, then all the better. Thus far it’s been it’s been very successful for us. In fact, we’re actually expanding the number of locations where we have O Bars.
Jared Johnson: Oh great, yeah, that was one thing I was going to ask is how it’s gone since then, because how long ago was it that this thing launched?
Dr. Milani: About two years ago.
Jared Johnson: Okay, and you say you’re expanding it to other areas.
Dr. Milani: We’ve added a second one and now we have about two more on the docket that we’re going to open up in the next 12 months.
Jared Johnson: Fantastic. Well, one thing that really intrigued me is this fact of, you and I were just speaking about it before the interview about how some providers will hear this much and say, “Yes, we see how that can be beneficial and how that can help impact our patients’ health on a regular basis. But does that mean we have to go out and now go create a custom suite of apps or think of something that’s going to take a considerable amount of time and resources and budget and create all these brand new tools?”
You’re saying that the O Bar, this whole concept was centered on the fact that there are so many tools out there already, we’re going to help you sift through those. What would you say to providers when they’re at that point and they’re saying, “Okay, what do we do now?” You’re saying they don’t have to create a whole custom suite of apps. They can work with the thousands of apps and connected devices that are already out there?
Dr. Milani: Absolutely. I mean, think of it as opening up a library. You don’t have to write all the books that are in the library. What you want to do is create a vehicle by which people can access the information held within the library, and that’s really all this is. It’s a resource guided by a librarian for lack of a better analogy, where we don’t have to write the books. We don’t have to write the apps or develop the technology. What we need to do is curate it and provide it in a way that makes it very easy to digest for our patients and we think can be helpful to them.
Jared Johnson: Fantastic. I think that’s a big point for our listeners is that that can be successful and that it has been successful for you. You mentioned that one of those options is being able to bring in a device whether it’s a smart scale or a remote monitoring device and they can connect it and you can tie it into a patient’s EHR for example. So that brings in health IT and their role. In your mind, what role does health IT play in transforming healthcare?
Dr. Milani: Well, I think health IT has the capability of playing an enormous role. I mean, again, what IT can do for us is to create efficiencies and create awareness and reduce the amount of burden that’s currently being placed on the humans, which are the caregivers, whether they be nurses or doctors or APPs or whatever they may be. So health IT has enormous capabilities for us. We can use health IT to identify patients at risk or when patients are changing course, to know which patients we need to intervene when and where.
We can use health IT to create feedback both to patients about how well they’re doing as well as to provider teams in terms of how well they’re doing. Health IT can help reduce the actual burden of work that currently is being occupied by labor, human labor. So I think health IT has enormous potential.
Jared Johnson: Are the specific pain points that you’re still hearing from the clinical side that health IT is either helping or making worse, are there certain pain points that you’re hearing about still a lot right now?
Dr. Milani: Well, I mean, everybody always has the same pain points about an EMR and they’re taking time to have to input information and so on and so forth in the EMR. I think where health IT on the ambulatory side can be invaluable is in patient generated health data. So you think about how we see patients currently. They make an appointment, they come see you for their chronic disease problem two, three, maybe even four times in a year. That’s two or three or four times where you collect biologic information about that person, and now you’re trying to make judgments on that, and you expect those judgments to be the same throughout the entire year.
Well, we know that chronic disease changes on a daily if certainly a weekly basis. Yet, “We’ll see you back in three or six months.” Well, how can we course correct should things start getting worse or even better? How can I pull back? We won’t know that unless we have data that’s coming in in a more regular fashion that’s continuous.
So I think the first thing that health IT can provide for us is a vehicle for collecting information directly from the patient, whether that be subjective or objective biologic data. Then with appropriate algorithms to be able to take the data and determine whether or not things are directly going better or worse or in-between, and then determining at that point whether what interventions need to be done. So they can create awareness and appropriate feedback and appropriate intervention at the time it’s needed.
Jared Johnson: What would you say to clinicians who are who are skeptical still about using digital health apps or finding ways to empower patients? What would you say to them?
Dr. Milani: Well, I think we have to determine what the reasons are why they’re skeptical. So is it because the information is not secure, or is the information not valid, or what I hear the most is that the information is too much. So that we have all this flood of data coming in, we don’t know how we’re going to possibly manage it. So the concern that I’ve heard the most often voiced is that the physician is burdened too much as it is, and now if you flood the physician, and particularly the primary care physician with this enormity of data, then how are we going to possibly manage that? I think that’s an appropriate concern.
So this is what once again how I think we need to reorganize ourselves from a care team. We’ve created an IPU model, an integrated practice unit of non-physician care teams that help to analyze the data and make interventions. So it’s not be a burden it’s actually a relief for the primary care physician or the whatever physician may be involved in the care of that patient. So the data comes in goes through an analytics engine. It goes to all those machinations that I referred to earlier, and then the analytics engine tells the care team, “These are people you need to be concerned about and these the ones you want to focus in on today.”
That care team, whether they be a clinical pharmacist or a health coach or a nurse, can then contact that patient and then make whatever appropriate interventions are necessary, including medication change or lifestyle recommendations or even an appointment for the clinic. So I think that, and we’ve been able to manage the data very securely. So security has not been an issue. We’re using only HIPAA-compliant interfaces.
Certainly the information is available to anybody on the care team, including the physician any time they want to utilize it. So I think it’s okay to be skeptical. We just have to address what the issues are specifically and show them how it can be utilized to make care more effective and more efficient.
Jared Johnson: In closing up, we’re wrapping up here. But is there anything else you’d like to share with a health IT audience just in thinking about digital health and their role in it?
Dr. Milani: Well, I think the key is this, and that is if we had this triple aim, we want to be able to improve the patient experience, improve access and so forth, improve quality and safety, and then finally of course trying to reduce the cost of care, throwing more buildings and staff at it is certainly not going to be the way there. What we what we need is a different model of delivering care for our patients. I think health IT combined with a different delivery model can be very, very cost effective, provide access and improve quality and safety. So there is a way to do this and health IT is an integral component of that.
So I wouldn’t be looking to to necessarily try and run away from this. I think it’s going to be an important part of our future, and it shows great promise in terms of improving patient satisfaction and actually patient engagement and activation. So we measure that and we’ve seen patient activation engagement go up as a result of these interventions that we’ve talked about. So patients are very excited about it. That the uptake is very high. They’re more now engaged in their care.
They feel like they have more time that they can spend with the health system, unlike the short amount of time they have with their physician. But yet this is all complimentary of the physician and the physician’s practice. This does not displace it this is another tool in the arm [inaudible 00:24:04] for the physician to be able to better manage the chronic disease patients.
Jared Johnson: Well, I appreciate that and I know Oschner Health, a lot of other providers a lot of other health systems look up to you guys to your team as an example of digital health working and moving forward so I appreciate your time today.
In closing up, I’ve got a bonus question which is usually a little bit of fun and it has nothing to do with health IT or marketing or or anything like that. It’s just simply if you could join any rock band or music artist for a day, who would that be?
Dr. Milani: I think I’d probably pick up on Trombone Shorty. Trombone Shorty is a New Orleans great. He’s a wonderful guy, a great jazz musician. Hanging around with him and his music for a day would surely be a great experience.
Jared Johnson: All right! All right! I like that local. That’s very cool. Well, Dr. Milani, thanks for being with us and if anyone has any questions that they’d like to ask you or have any follow ups with you, is there way they can reach you?
Dr. Milani: Sure I can be reached at Ochsner and my e-mail address is rmilani [at] ochsner.org.
Jared Johnson: Well, thanks for joining us and have a great day, Dr Milani.
Dr. Milani: Thank you. Thanks, Jared.
Jared Johnson: Well, that wraps up our program this week. Let me know as usual what you thought about this week’s program. Let me know what you liked, what you did like, who you’d like to hear from the future, what topics you’d like me to share. Reach out on Twitter @JaredPiano and ping me there it’s J-A-R-E-D P-I-A-N-O, @JaredPiano. Let me know what you thought.
Then before you even close up or turn off your phone, feel free to navigate over to iTunes, navigate to the home page of this program, which is Health IT Marketer and leave a quick review. Leave a review there, subscribe on iTunes. You can also listen to us on Stitcher Radio or in Podbean or find archived episodes at healthITmarketer.com.
In fact, keep checking those show notes. I post a recap of each episode on the all ulterablog.com. That’s ulterablog.com. I’ve added transcripts for several of our most popular and most recent episodes, including those from guests such as e-Patient Dave deBronkart and Dr. Wendy Sue Swanson, who’s known as SeattleMamaDoc, and the Doc Smitty, Dr. Justin Smith from Cook Children’s.
I’ll be adding more in the coming weeks for some of our other recent guests so keep checking back for those. Most importantly, keep telling the story of innovation in health IT. Ladies and gentlemen, it has been real this week. Until next time, I’m Jared Johnson and you’ve been listening to the Health IT Marketer podcast. This program is sponsored by Ultera Digital Marketing Consulting. Take your content further. For a full archive go to healthITmarketer.com. That’s healthITmarketer.com. Thanks for tuning in and I’ll talk to you again next week.