And I think that's something we're working on, but
we haven't really kind of solved the puzzle.
>> You know, Ashish brings up a very important point and
in relating this to when electronic health records were first deployed,
it was represented massive change.
But that change was largely for the providers.
And what we're looking at now with digital medicine and
eHealth is again massive change.
But now it's affecting other areas including our patients.
And so the amount of change that is build into that is really needs to be considered
and when we think about how we're going to deploy it.
As well as when we look at it from a financial perspective because we
still need to keep the lights on and doing everything that we're doing today, but
care delivery is transforming based on the new technologies that are available to us.
And we need to keep pace with it at the same time continuing to keep everything
else running along the way.
>> That's right.
IT isn't always glamorous new technologies, it's as you said, keeping
the lights running, the networking, the telephones, lot of basic essentials.
>> Yes, Gardner Research categorizes IT spending to three categories.
There's run, which you need to run the business on a day-to-day basis.
What you need to grow the business from a scale perspective, so
if you want to increase volume which we need to do for that.
And then transform.
And what do you need to transform the business?
And typically that run piece of the budget is the biggest,
followed by grow and then transform.
And our mission as it were, is to see how can we run more efficiently and
reduce the cost of run by incorporating other technologies, new technologies.
So cloud technologies enable us to shrink that run portion at
least in the capital budget so that we can focus more on the grow and the transform.
>> I see, I see.
So in answer to our earlier discussion, I mean when patients are getting
frustrated that change is not happening fast enough though,
at least that's one high-level way we can kind of explain it to them that
there's just maintaining the current operations is still a huge factor.
>> Well, we have, I'm used to explaining this to people and I think this
is what patients go through, and this has come up in many, many discussions.
When patients go from one, they go to see one provider, and
they provide all their information, and then they're referred to a specialist and
they have to provide all the information again.
And then they're referred for a procedure and
they have to give the information again.
At the same time, I can take the card that's in my wallet and
go to the other side of this planet, put it in the machine, put in four digits,
and get local currency instantly debited to my account within seconds.
And we can't say yes,
we know that you're allergic to penicillin along the care chain efficiently.
>> Well we're getting there.
>> We are.
>> This is a great conversation.
I guess over the last several years, we've had the opportunity on the eHealth
team to try to roll out any of these digital health and eHealth initiatives.
And if somebody were to wake me up at 3 AM in the morning and
say what were the biggest challenges?
There are a few words that really resonate with me.
One is the word pilot.
In many times we launch these efforts as that pilot.
And that by definition makes it small scale, limited, and
there's always the opportunity at the end of it, you can stop it.
The second word is workflow, and I want to link them together.
Because any time a pilot impacts your environment,
if it doesn't address some of the workflow challenges that exist in the healthcare
system on a daily basis, those pilots have a higher tendency to fail.
So we're trying to sort of, pick,
see more in terms of how can we take digital health solutions and
bring them in a workflow environment that is absorbed, that is understood and
also where change can be easy, both from a physician's perspective and
also from the perspective of patients and so many other people that are involved,
the administrators, the nurse practitioners and so on.
So the other, so besides pilot and workflow the other words that again
would come up at 3 AM in the morning would be risk and reimbursement.
Because we are a very highly regulated risk-based industry in terms
of making sure that nothing goes wrong.
And that somehow forces us to be a little hesitant to new tools and
technologies that may impact patient care slightly different.
And those are the barriers that we're continually pounding against both along
with our practitioners as well as with our consumers or the patients.
>> You bring up a great point, and I sometimes think when we're talking about
innovation and new cutting-edge electronics and devices,
I think of Silicon Valley, and Facebook, and Apple and these companies.
Mark Zuckerberg had said,
one of the mantras that Facebook is going to be, move fast and break things.
Is that something that can work in health IT?
Is that something we can adapt, or learn from?
Or should we try to stay away from that?
Ashish, what do you think?
>> So I think our mantra is move fast but don't break things, right?
>> [LAUGH] >> So I think it has to be considered,
as within the perspective of what risk you can take, right?
So there's a concept that's coming in healthcare innovation centers that you,
like we used to have clinical trial research officers,
or CRC, clinical research coordinator to centers to set
up an isolated kind of habitual medicine pilot space, which is away from patients,
but you can have dummy patients or fake patients.
Or you can have employees who can be like patients, especially for FitBit challenges
and all, where you may not break, for example, many things per se.
But I think, that's where the pilot concept started,
where you want to have a little bit isolated pilot.
Which, even if the workflow is not perfect and
thing break, it doesn't impact the mainstream care delivery.
And fortunately, I feel the pilot has gone where it is become so much secluded
that it generalize ability of those pilots really become questionable.