Technology in healthcare has never been more top of mind. As the world gradually emerges from the global pandemic, we’ve seen how it can help us solve hard problems, as well as where there’s still work to be done. From artificial intelligence (AI) modeling the virus’ trajectory to telehealth visits for routine care, tech is fundamentally changing how healthcare is designed and delivered. Together, Microsoft and PwC are committed to delivering on tech’s promise.
Microsoft’s global chief medical officer, Dr. David Rhew — an infectious disease specialist who is also a computer scientist with six US patents related to clinical decision support systems and electronic health records (EHRs) — recently joined Will Perry, leader of PwC’s healthcare technology practice, to talk with PwC’s Tech Effect about how data analytics, cloud computing and AI are changing healthcare as we know it.
Dr. David Rhew, Microsoft Global Chief Medical Officer
Will Perry, PwC US Healthcare Technology Consulting Leader
Tech Effect: David, many people know that tech companies like Microsoft have a really important role to play in the health ecosystem, but they might be surprised to learn that that requires clinical resources. So why does Microsoft have a chief medical officer and what’s your role in the technology and innovation space?
David Rhew: Technology in healthcare is often in the context of a healthcare provider and an EHR. What we’ve found is that technology can enable much more than that. It can help extend care outside of the hospital and the clinic into the home, everywhere we are — which may involve multiple technologies. And, as we start thinking about how technology can be used more broadly by more people, different technologies need to be integrated into a common platform. This is where a lot of the larger companies have realized that technologies can be leveraged to be better applied to improve the experience, to enable a more seamless flow of data and hopefully allow for more proactive care.
“Technologies can be leveraged to improve the experience, to enable a more seamless flow of data and allow for more proactive care.”
Tech Effect: Integration of technology into health makes a lot of sense. It’s something that’s very much needed. Let’s switch gears to one of the most pressing issues of the moment — turning COVID-19 vaccines into vaccinations. While many Americans are fully vaccinated, public health officials would say there’s still a ways to go to reach herd immunity. And it’s actually really difficult sometimes to reach certain patient populations and communities. Will, how can technology connect those harder-to-reach patient populations, such as those on Medicaid or in rural areas?
Will Perry: My mind immediately goes to digital channels. Digital channels are practically ubiquitous now. Vulnerable or otherwise, disadvantaged populations are increasingly using digital channels in many aspects of their lives. Health plans have recognized this, and providers are coming around to it as well. And some state and local government agencies are getting pretty good at this. I was vaccinated in a rural county health department in Georgia and they did a first-class job with digital engagement, solicitation, enrollment and follow-up after the vaccines — all predicated on opt-in texting. So it can be done if we decide that it’s important and we deploy these resources there.
Tech Effect: David, anything you want to add?
David Rhew: We’ve seen different sets of challenges relative to the vaccine rollout. Early on, it was about getting as many shots into as many arms as quickly as possible. That meant that we had to have technologies that were designed to handle large volumes of communications, being able to receive the inputs from individuals. In fact, a lot of times the demand to get questions about the vaccines answered and people trying to find out where vaccinations could be delivered was so great that it overwhelmed the system. That was an opportunity to leverage things such as chatbot and cloud-based technologies. We’ve certainly seen great advantages in terms of deploying them, making the care more streamlined.
This also exposed the need for us to be able to have direct engagement with the consumers — appointments and digital reminders through text, and being able to understand exactly when those appointments can be delivered. We’re now moving into another phase of vaccinations, around that extra push to directly reach out to the individuals who need the vaccines the most. Because of a variety of variables that were hard to control, people have not always been able to schedule or receive the vaccine. What we’ve realized is that empowering people who are in the communities, working directly with these individuals who have questions and would like the vaccine, is so vital.
We’ve realized we need to bring the technology to them to empower the folks with the tools. That could be in the form of pop-up clinics that we’re standing up in a variety of different settings. It could be in the form of providing resources where they can have questions answered readily, even telehealth and telemedicine could be used as means to provide some of that additional care.
Across the board, we’re seeing an extra push into these communities and it’s about empowerment.
Tech Effect: Will, this sounds a lot like the consumer healthcare experience. How do you view that journey of the consumer healthcare experience and how technology plays a role in that?
Will Perry: We always start with the market and the consumer. We anchor on that and work our way from the outside in. We start with the obvious statement that expectations have shifted dramatically in terms of how everyone expects interactions in any industry. Healthcare is no exception.
Conceptually, this means digital omnichannel personal engagement, where the healthcare organization understands that different people want to engage and be engaged differently based on their unique situation and preferences. Providers have historically offered one way of engagement and expected the consumer to conform. Consumers’ changing expectations means flipping that script.
There are leading organizations out there that have recognized that, and they’ve done a wonderful job starting that journey. Others are now really starting to see that there’s been a shift in that locus of control, and they’re really recognizing that that is a core competency they need to have instead of something that’s nice to have. Payers, on the other hand, have historically been reactive to utilization after the emergence of the need for care. From their viewpoint this really means advocating for the health and wellness of their members and proactively using the data they have at their disposal and digital channels to drive a very modern experience.
Tech Effect: Some of our own HRI research revealed recently that more than half of consumers who used telehealth during the pandemic encountered at least one challenge, such as not knowing what their next step was or something along those lines. Any thoughts on how technology might be able to help solve these types of navigation issues?
Will Perry: I suspect that was probably an artifact of everyone going digital and virtual overnight and doing a yeoman’s job to stand up processes and infrastructure that they never dreamed of in a short amount of time. What was probably overlooked a little bit was having a thoughtful understanding of the patient journey. From inception to completion, helping the patient or the family member appreciate where they were in that journey, so that they could intuit what was next and then be prompted with appropriate reminders and follow-ups.
The technology is absolutely there, and certain organizations have done a beautiful job of it, where they had the chance to really think through it before the virus hit. That’s probably one of those areas of clean-up that everyone’s looking at now — and hopefully it just becomes commonplace going forward.
Tech Effect: The digital health journey is often paved with health data. We’re collecting it everywhere, from the EMR to remote monitoring to personal connected devices. But the age-old challenge is what do we do with it all? And how do we create a journey based on that data? Turning to you, David, what’s the next frontier for tech in healthcare — such as advanced analytics and AI — and how are we going to pivot from collecting all of this data to really using it for prediction and improving health?
David Rhew: There are tremendous opportunities to identify which of the data sets are most valuable and meaningful to help us deliver better outcomes. We have a lot of different data points, but some are much more important than others so we should focus on them. There’s a lot of data out there that remains unstructured in nature that we could potentially leverage natural language processing (NLP) to turn it into structured, usable data.
There are also things such as voice AI, the ability to take a conversation, convert that not only from voice to text but also to help us understand contextually what it means and integrate that into an EHR. There’s also AI that can perform text analytics, looking at progress notes and the clinical literature — the full text of the literature — and finding articles and information from large data sets.
This is an emerging area that has tremendous upside because it gives us an opportunity to start looking at some of the data and identifying those incredibly important aspects of care that have been missed or could have been missed. This is where we’re starting to see not just AI engines for a one-time alert but tools allowing us to understand that clinical decision support, embedding it within the clinical workflow and understanding how the different individuals within the entire ecosystem need to be informed with the right information at the right time. That combination of AI and decision support, and the tools for coordination of care and collaboration, are going to lead to a more effective way to deliver this information and create better health outcomes.
“The combination of AI and decision support, and the tools for coordination of care and collaboration are going to lead to a more effective way to deliver information and create better health outcomes.”
Will Perry: We’re beginning to see the application of what is the emergence of “hospital at home” and how we begin to connect the edge of the cloud into the core. We use the data to drive wellness and take it from passive monitoring to active intervention — for example, helping an individual who’s on the verge of diabetes from becoming a diabetic or actively monitoring an at-home post-procedure to try to drive a better outcome and a far more enjoyable and less expensive environment. That changes the game for where care is provided and the quality of care after medical procedures or other treatment.
Tech Effect: So what do we need to do in order to bring better healthcare to the consumer using technology in a post-pandemic world?
David Rhew: One way we can think about it is, first, do we really understand the individual patient — the consumer — and where they are on their journey? A large part of that has to do with finding ways we can acquire the relevant data about each person. It could be from an EHR, a remote monitoring device or a genetic profile. It could be from the environment. There are so many different aspects of an individual that paint a 360-degree view of them. Then, once we have that information, it’s about applying the AI and the analytics and the understanding. We can start with simply dashboarding and looking at how individuals are doing.
We want to look at individuals in a very personalized way — looking for trends and opportunities to predict what’s likely to happen based on the patterns we’ve seen with other individuals in similar situations. The ability to analyze large data sets can help us identify opportunities for early intervention.
Finally, we have to tie back into the third piece, which is the care coordination and collaboration, and all the tools we use every day — it’s mobile phones and apps or EHRs or other communication tools like Teams for Telehealth — these are all potential ways to gather and analyze health information so we can act upon it. There’s a continuous cycle of learning, so once the actions are made, it provides new insights as to how individuals are doing, and we can continue to learn from that. That’s where machine learning and deep learning algorithms can be very helpful.
Tech Effect: So it’s clear that we need to engage the consumer on this journey. How do we engage them while also engendering their trust to bring them into the process?
Will Perry: The industry has wrestled with this question for some time and hasn’t landed perfectly just yet. It starts with zooming out on the concept of trust, which can take a few principle forms, one of which is the notion of reliability — predictability. Consumers need to be able to control their information and feel sure it will be kept secure and used for their benefit. They want healthcare payers and providers to put them first in the digital equation. As an industry, we talk about transparency, but we often stop a little bit short of what consumers need: that safe feeling, that it is very reliable and predictable. Those are the table stakes in really starting to engender trust.
“As an industry, we talk about transparency, but we often stop a little bit short of what consumers need: that safe feeling, that it is very reliable and predictable. Those are the table stakes in really starting to engender trust.”
Tech Effect: One final question. What technology that we know about today will have the greatest impact on the health system of tomorrow?
David Rhew: I think we’re on the cutting edge of how AI can be used to improve all of our lives. Largely, the reason we haven’t been able to leverage it was access to the appropriate data sets. With interoperability rules being enforced, new data sets being developed from unstructured to now structured data, and with our ability to start looking at the individual from multiple different angles, we’re now at the point where we can start leveraging those tools.
We’re making significant advancements in multiple areas. As we start thinking about how AI is going to transform lives, it will start with improving individuals’ and consumers’ experiences. Providers won’t have to spend as much administrative time doing the things that oftentimes take away from patient care, allowing us to become more streamlined and efficient in how we’re able to do things. All of that is going to be optimized with different technologies and AI is going to help us down that path.
Will Perry: It strikes me that there are a lot of things out there that are ubiquitous today, but when they first hit the market, nobody knew what to do with them. Cell phones, for example, had been around for a while before mobile really launched. Even the internet was here for 15 or 20 years before consumers or businesses began to use it.
With that in mind, I think it’s blockchain. We’re only on the cusp of figuring out the ideal implementations of blockchain and how it can be used in ways we haven’t imagined. Consider all the activity around non-fungible tokens (NFTs) lately. Nobody was dreaming that up, but it’s an example of how blockchain becomes an underlying vehicle for changing how we look at the ownership of information. It could help make the healthcare ecosystem more secure and portable, which is something we’ve all talked about and dreamed about.
Dr. David C. Rhew is the global chief medical officer and vice president of healthcare for Microsoft. He is adjunct professor at Stanford University; holds six US technology patents that enable authoring, mapping, and integration of clinical decision support into electronic health records; and has been recognized as one of the 50 most influential clinical executives by Modern Healthcare. Dr. Rhew has served on the National Quality Forum’s executive committee for consensus standards and approval, Chaired the Consumer Technology Association health technology board, and sits on the governing committee for NESTcc (National Evaluation System for health Technology coordinating center), the medical device advisory group for the FDA, CMS, and NIH.
Will Perry is a partner at PwC and serves as the US Healthcare Technology Consulting Leader. In this role, Will leads a team that serves providers, payors, academic medical centers and pharma/life sciences companies by creating competitive advantage and transformational change through technology enablement. Will and his colleagues at PwC do this by leading with a business-first point of view, rooted in a multi-competency mindset that challenges and changes our client’s structure, people, process and technology to enable market strategies; create new business competencies/capabilities; create competitive advantage; and unlock value.
This interview has been edited for length and clarity.