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Podcast Recap: Mandy Long on Intrepid Healthcare


Joe: Welcome back to Intrepid Healthcare. I’m your host Joe Lavelle and I’m really looking forward to this conversation with another trailblazing innovator. We’re going to get right to it today. We’re joined by Mandy Long, Vice President of Product Management at Modernizing Medicine. Mandy, welcome to the show!
Mandy: Thanks for having me, Joe!

Joe: Thanks for making the time to be with us today. Before we start the discussion, can you tell the audience about you and your background?
Mandy: Sure, I am currently the Vice President of Product Management for Modernizing Medicine. I have spent my entire career in the healthcare technology space. Prior to Modernizing Medicine, I was Vice President of Product Management for PassPort Health Communications, which is now Experien Health, and prior to that I did implementations and a little bit of product at Epic.

Joe: And then if you could remind the audience what you guys do at Modernizing Medicine.
Mandy: Modernizing Medicine is really the next generation of healthcare technology. We are specialty-specific, we’re a data-driven and cloud-based EHR and practice management system that really caters to the surgical specialty. We’re different for a lot of reasons but I think a couple that are most interesting is that we are we are built by a team of specialty physicians and practice management professionals. So there’s really no translation between what the end user needs and what gets into the product. Our docs built that right in for us.

Joe: That’s outstanding. And the first topic I want to get into is user experience. How would you define user experience? Why is UX so important for those physicians, their staff and the patients.
Mandy: User experience (UX) is really the holistic view of how a person uses a product. And for the purposes of how we look at healthcare technology, it’s not just about how the software itself works, it is also about how the software is configured or implemented or used from a workflow standpoint and trained to end users. So when I think about really UX  and the user experience as a whole, we look at the end to end relationship for an end user of our product as it relates to the impact and the importance for really physicians and staff as well as well as their patients. For physicians and for the folks who are really using our product on a day to day basis or any product for that matter, UX is the key to whether or not they can really be successful and effective and how they practice medicine.
So an example for you would be, if I am a physician who’s trying to document a visit with a patient and I have to spend most of my time sitting in front of a keyboard and looking in front of a screen and I’m not really looking at the patient, it’s difficult for me to care for the person as a whole. I’m really relying then on verbal cues and what the patient is telling me in between turning around and trying to glance at them rather than having an optimized user experience. It gives me something for example like a native tablet where I can interact directly with the patient and in a touch-based environment, I can document and diagnose and treat that patient as a whole person rather than what I am just seeing in front of me on a screen.

Joe: What are the risks of having a poor UX?
Mandy: Bad UX is as costly as I think any other problem and in some cases, I think it’s riskier. Poor user experience can introduce something as benign as potentially taking me a couple of extra clicks to do a particular workflow. I think that’s what people think about initially, but the ripple effect is that it can be very detrimental in some cases if the user experience isn’t optimal. Because I may miss critical data, related to a patient and that can tie into things like patient safety. Or as a patient for example, if I have bad user experience on the portal, I may not understand all of the aspects of my medical records, and so when I’m trying to translate that to a different clinical user who I’m seeing, God forbid in an emergent environment, I may miss pieces of data that are really critical in order for them to treat me appropriately. So UX ties just as much as any other big items we’re seeing talked about in the space, whether it be interoperability, security, the sort of core functionality of a product, if you don’t have good UX, then users can’t be successful in treating their patients. And patients can’t be successful in understanding and being empowered to participate in their care.

Joe: Mandy, I know you pride yourself in your innovation. How can health IT innovation improve patient and customer experience?
Mandy: I think everybody plays a role in User Experience, and that’s something I certainly spend a lot of time talking about here at Modernizing Medicine, and it’s something that I think our industry is starting to spend more time talking about. It’s not just on the developers, whether it be an EHR provider or another piece of technology. It’s not just on them to to create an optimal user experience. Like I talked about earlier, the selection, so those who are purchasing technology, or even the implementation of technology is just as important. So if I make decisions on how I am going to configure it, I need to involve the people that are leveraging it every day.

I think that’s really the key. You need to go to the end user and you need to make sure you’re solving the problem that is in front of them and not the problem as you believe you understand it. So doing a really good job at listening and then doing an even better job of validating. So there are methodologies out there and I think the one that most folks are familiar with are user centered design (UCD). That’s something that technology vendors like Modernizing Medicine use, and it helps us to ensure that the solutions that we develop and subsequently deploy to the market are the ones that really do meet the user need.

Joe: That’s right. I appreciate you sharing that. As important as experience is, outcomes are even more important. How can health IT innovation improve patient outcomes?
Mandy: So for patient outcomes, I think really, there’s a lot of discussion about this in the industry as well, the key is the data. Whether you talk about UX or you want to talk about as it relates to visualization or analytics, the ability to take the data that’s documented in a particular system and visualize it and make it available to a clinical user at the point of care in a way that is  consumable and specific to that patient is the key to improving patient outcomes. Even as a patient from my perspective, if I’m seeing a physician it’s so much more powerful if that physician has more than just the knowledge that it’s in their head, if they can actually rely on the system to take a deeper look at how patients like me have been treated and then make decisions that help to facilitate better outcomes for me. We can talk about whether that may be age, gender, socioeconomic status, what are the things that influence my health overall? And what are patients like me, how are we being treated and what are our outcomes so that we can make decisions for me that actually make the most sense given who I am as a person.

Joe: Tell me about how you’re using technology to improve care and empower patients? And how is Modernizing Medicine is doing it and being so successful at it?
Mandy: There are a couple of things that we’re doing and some big strategies for us that were in 2016 that are carrying over in 2017. A couple that I’d highlight is, one is our outcomes systems. We have a feature and we have technology that is built into EMA, our EHR that really does show how a patient is really improving and/or declining or not improving over time. So if a physician is documenting that in the system, as they’re treating me as the patient, the physician is then able to actually visualize that and see that over time, so that they can start tweak how I’m being treated to ensure that I’m actually getting better.
A couple of other things that we are doing, I think Dr. Michael Sherling, in a previous discussion with you talked about telemedicine, as being another key to really helping to improve outcomes especially for patients who really aren’t close to a specialist office or who may instead of talking to a healthcare professional may go out into the Internet in hopes to find the right answer. And things like telemedicine help to engage patients and help to make sure that we’re following through on their care and that we’re seeing the results of the recommendation we’re making as clinical providers.
A couple of other things that we are doing in a broader sense are around analytics and population health. So if you think of the power of data, then something that is unique about Modernizing Medicine’s software is that it is all structured. Meaning that as a user leverages our technology and they’re tapping through the system as it’s all touch-based, we’re storing and capturing that data discretely on the backend which means that we’re able to glean knowledge and information and share that back to the provider in a way back to the provider, in a way virtually no other vendor is capable of doing because it is all structured. And so when I talked earlier about being able to get me as a patient, what are the factors that are sort of more than just I am ‘X’ number of years old and I am a female. Being able to drill into more of some of the details of who I am as an individual. We have a feature that’s called Grand Rounds™ , that really looks at more than just the basics of who a patient is, and that’s really because we have discrete data so we can look at things like comorbidities and be able to make great prescribing recommendations and give providers recommendations about what works for patients like the ones sitting in front of them.
Joe: I loved my conversation with Dr. Sherling and the reason why is, I really got the sense that you weren’t just slapping on the telemedicine module onto your software, you were thinking of it terms of patient engagement how you could change the life and change the way patients engage with your physicians. I’m a patient and I want it designed around me because I’m the one that pays for healthcare. So if I need an appointment, at 7 at night I want to be able to get an appointment at 7 at night. I don’t want to wait until three Thursdays from now to get that. I think telemedicine is one of the enabling technologies to really be able to do those kind of things. The fact that you guys were really the pioneer or one of the pioneers to build telemedicine right into your applications and workflow, I think is huge and I’m sure you’re reaping the benefit years later as you’re years ahead of others that have kind of slapped on a telemedicine application to their regular way of working. How have you found your customers and their patients appreciating your telemedicine solution?
Mandy: It is something I am certainly proud of and is a lot of what you articulated is that we were very early to market in our belief that telemedicine as the future of how patients were going to be able to engage with clinicians even if they didn’t want to wait on the three month wait list and had a relatively urgent case or something that needed to have looked at.
Telemedicine is a great way for the patient and their provider to engage on their own terms and on their own time. And I’m a patient as well and I’m a mother, and I can tell you from the perspective of a mother, my children happen to be young so they’re great at getting sick, and they never get sick at three in the afternoon. It just doesn’t happen. So a platform like telemedicine, empowers me as a parent and even as a patient myself, to say, “hey can I get you after hours to just give me an opinion on this?” Is this something that is concerning enough for me to need to act on it now or can I act on it later? And if we can act on it now, I can do it from the comfort of my own home rather than having to find a way to schlep three children under three in a car to an urgent care at whatever time of night. So I think that from the patient experience standpoint, it’s a lot better. And there’s good news for telemedicine as a whole. With the 21st Century Cures Act, that really was just put into law not too long ago, really gives telemedicine a big boost. There’s language in the Act that looks at telemedicine reimbursement which I think then is a big hinderance to the uptake, because from a physician’s standpoint, their time is precious and they want to be able to see patients, but we’ve historically incentivized volume, and so if I am not being reimbursed at the same rate that I would be for an in person visit, then I’m incentivized as a physician to do in person visits. The Cures Act is looking to address that. I have very high hopes for telemedicine taking off even more in 2018 and 2019, and I think Modernizing Medicine is very well positioned to play a big role in that.
Joe: Great, I’m glad you mentioned the 21st Century cures Act. What are the most important factors for vendors, for providers and patients in the 21st Century Cures Act?
Mandy: So from a vendor standpoint, the 21st Century Cures Act gets at some of the heart where we have really struggled as an industry to empower and achieve the type of outcomes that we know we’re capable of helping physicians communities to get at. And interoperability is a big, strong resonating component of that. There’s the standards that we’re looking at seeing this trust of exchange framework. We want this common agreement, right? What is the standard going to be? There’s a lot of options out there. And the great news is I think folks have been working on it in the industry for awhile. There’s the interoperability showcase at HIMSS, the community whether it be the EHRA, or other vendor associations, it’s a hot topic because the ability to move data effectively between systems is the key. Going back to a personal example for me, so my daughter has Turner Syndrome. And so we have a wide spectrum of specialists that we need to see on a regular basis, and I’m still in the position in 2017 of having the patient bible. I have a big four inch binder that’s full of all the paper versions of the medical records I’ve been able to get that I bring with me to every visit to try and ensure that we don’t do too much redundant testing and that everyone is aware of the latest and greatest, and interoperability solves that problem for me as a mother and even as a patient. And so the ability for us to get to some kind of standard is really exciting. And I think that what the Cures Act gets at is as well, is the ramifications of a vendor doesn’t participate. So there’s real language and consequence in there for vendors around this thing called data blocking. So if you’re seen as participating in data blocking, you can receive a penalty up to a million dollars per violation. From a vendor standpoint, that’s a real incentive. I’m hopeful and I think that in the association communities I participate in, what I really love hearing is that I think that most of the vendors that are out there,  we’re trying to do it and have been. So Modernizing Medicine for example, is a contributor member of the CommonWell Health Alliance and it’s because we believe really strongly in the power being able to move data effectively. So from a vendor standpoint I think those are a couple of things.
There’s some other stuff in there that is interesting that I think we’re going to learn a lot more about. Usability is a new topic. I know we talked about that a little bit earlier. That’s kind of new in the way that they are looking at having it as a part of attestation and certification, that you follow the principles behind User Centered Design (UCD). That’s something that we’re going to watch in terms of how does that manifest. Is that something that is metrics based and measurable? Is it something that vendors have to just sort of attest to as a part of their certification processes? I think we’ll learn more as the workgroups start to get established. There’s language in there around security as you’d expect with a lot of what’s happening in just technology in general. Cybersecurity is critical and it’s certainly seen and gets attention in Cures. But for me I think I like many vendors, we’re looking really, really closely at interoperability because it’s such a big component of Cures and it’s a such a big component of really the future of the industry.
It sort of hits two points that I’m really passionate about. And one of which we talked about earlier is usability. Interoperability only works if you can make it usable. So a question you asked me earlier, was what are some of the risks to usability? And really interoperability is the risk. Because if I can move data between systems, but that data doesn’t reconcile the right way or it’s not really shown or visualized in a way for the end user that’s consumable, then we really haven’t improved the user experience and we really haven’t done much with the data. So I think we really shouldn’t think of them as being too mutually exclusive, because they tie so closely together.
Joe: Absolutely. Well since you got my soapbox on interoperability out, I’m going to jump up on it with you. I feel like Meaningful Use (MU) failed. We can say that by putting interoperability in, it should have been in Meaningful Use Version 1. The fact that we’re giving every doctor and every hospital an EMR system and they can’t talk to each other, never made any sense to me. I’ve been talking about that since 2010, but now we have the opportunity and I’m going to stop complaining about it and start doing something about it like creating a series on our show to do that. As a vendor why is interoperability so important for improving patient care and improving outcomes?
Mandy: Well if you look at it from a specialist’s perspective so dermatology, which is a specialty that we have a high degree of presence in. A dermatologist only sees a sliver of that patient. Because I may present for acne or I may present for a rash, but that might not tell the full story of me. Do I have hyperthyroidism? Or am I also being treated by a gastroenterologist? Do I have high cholesterol? What is the story of me as a whole? And for a physician there’s been plenty of articles and studies done recently on physician burnout and sort of the administrative burden of technology that is contributing to physician burnout. Interoperability gets at that. So having a super efficient piece of technology or an EHR to document it, is definitely a part of it, but also being able to reduce redundant documentation is another part. If I were just seen for example in the emergency department two weeks ago, and they took my history and vitals and they got some background on me in terms of the medications I am actively on, why if I presented to a specialist’s office two weeks later, why should I have to give the same list again? Right, so patients are still filling out paper forms in the front office when that data is all readily available. We just can’t figure out a way to move it. That I think when you get at what we are really trying to solve for, we’re really trying to free up providers to be able to spend time with patients so that they can actually do what they were trained to do and do what they want to do which is be able to improve patient outcomes by working with the patient as a whole, not living in this sort of perpetual sort of cloud of needing to enter more and more documentation that may or may not be even relevant to the patient’s case that they’re treating. So a good example I was looking at HIStalk earlier, there was an article written about the fact where she was talking about really the quality programs in terms of all this documentation you need to enter. But it doesn’t really matter if there’s smoking present in the house if the toddler just fell and bumped his head on the dresser? Right, I’m still going to stitch him up and it’s not really relevant information for me.  So we’ve got to figure a way to get that cut down and I think that interoperability is going to help.


Joe: What are you seeing as the barriers to why the industry has struggled to achieve seamless interoperability as a vendor?
Mandy: From my perspective I think it is a couple of things. One is the lack of standards. There’s been a lot of options made available, some of which I think have gained more traction than others. So The CCDA is a good example of something I actually think has gotten a decent amount of traction. We’re seeing that pretty well-used with direct messaging so I think there’s a potential platform for us to see that built out more, but you see that other standards out there are going to be the future or what types of standards around APIs and services are going to be pushed. There’s a lot of options and with flexibility comes benefit and cost. It could be great because you have multiple ways to move data, but it’s really expensive for a vendor to implement a ton of different ways to integrate. Standards is definitely one piece I think that’s seen us really be challenged.
The second piece is really the structure of the data. So EHR vendors, we all have different database schemas and we may or may not have an easy way of aligning that data which is why standards become important, but when you look at the quantity of sort of free text that’s out there, how do you move a free text note over appropriately into another system? Modernizing Medicine is all structured how do we take that? Where do we put that? And then how do we serve that up in a way to a physician that actually enables them to consume it and make good decisions off of it.
The one other thing that I’ll note, that I wish it wasn’t just a study in Cures, I wish we were actually going to get some traction and go do it right away, is around the patient identification. That’s a big one. If you can’t figure out the right patient and do matching then it kind of doesn’t matter, because I’m not confident that the data I am getting across is for the right patient and it may re-route as it comes across the bridge or you potentially run the risk of getting the wrong data on the wrong patient.
Joe: Which is happening all the time. We had two different people on our show and I just released a blog post this week on that problem and that good news is that there are other efforts with the patient ID not as much teeth as the Cures Act but hopefully we’ll continue to make progress on that after the CHIME National Patient ID Challenge finishes, and we learn really some technical alternatives to solving the real problem versus everybody thinking well that you just create another number like the social security number. I think CHIME was brilliant in creating this challenge in that people really got to come up with solutions in the real world that overcome other communications problems, structure problems, standards problems, for us as we go forward so rather then sending a committee to Washington to design it and have it not work, we’re actually giving a pilot phase with the CHIME National Patient ID Challenge, so kudos to them for that.

Mandy: Yeah I agree I am very excited about that. I think the key is not in another number. We have plenty of numbers associated with patient records and what we need to figure out is how am I “Mandy Long” regardless of where I’m seen. And it probably has to something to do with who I am as Mandy Long and it’s not an arbitrary identifier. So am also very excited to see the outcome of that.
Joe: We’re definitely going to have to bring you back. You have so much great information. I want to tell everyone to go out to, bookmark the site, keep up with the great things Dr. Sherling, Mandy and their team are doing at Modernizing Medicine. There’s new great thought leadership out there almost every week and you won’t regret bookmarking it and keeping up with what they’re doing. Mandy, thanks so much for stopping by. So great to have you!
Mandy: Thank you so much for having me!

To listen to the full interview podcast, click here.