Houston Methodist CMIO: How transformational innovation is 'bringing the joy back to healthcare'

Nicholas Desai, MD, is the chief medical information officer of Houston Methodist, where he leads the health system's wide variety of clinical IT and innovation efforts.

While these initiatives have resulted in impressive tangible results — more than 152,000 electronically scheduled appointments, nearly 198,000 patient-entered clinical updates, more than 8,500 virtual visits and approximately 1,100 telestroke consults, to name a few — Dr. Desai is even more proud of the transformation his team is spearheading not only within Houston Methodist, but across the entire healthcare ecosystem.

"I'm the most blessed to be the guy helping lead and be a part of this large team that is not just at the crossroads of transformational, innovative health IT and traditional models of thinking and marrying them to deliver what's next, but is also bringing the joy back to healthcare in ways that we've not seen in a long time," he said.

Here, Dr. Desai discusses Houston Methodist's focus on continuous disruption, and predicts how technology will transform healthcare in the decade to come. Hint: Expect voice technology and robotic process automation to lead the way.

Editor's note: Responses have been lightly edited for length and clarity.

Question: What does innovation look like at Houston Methodist?

Dr. Nicholas Desai: When the Center for Innovation came to formation, the most interesting part for me, looking in as the chief medical information officer, was the enterprise approach. It wasn't about some folks from the top level or a different side arm of the company trying to do something dedicated just to commercialization, for example. Our job was really to — and I'll use Michelle Stansbury's quote — "disrupt or be disrupted."

That rings true in how the ecosystem of healthcare has evolved: It used to be that your academic accolades and quality outcomes drove how patients found you, but now, patients have become consumers, and they're demanding changes to the healthcare experience. The roles have transformed — and this is a very physician-centric view — from the provider dictating the level of care to, now, the experience and outcomes are directly related to the way healthcare is not just delivered, but how it is felt by patients and, most importantly, how you meet them where they need to be. 

I just finished my year in review report, including what I expected to set forth in 2019 and what 2019 would look like. My goals were to "TIE" it all together, with TIE meaning transparency, interoperability and efficiency. I'm happy to say that in this 12-month period, with the help of so many, we were able to leverage innovation tools to achieve those goals.

But being innovative doesn't mean just coming up with a new widget. In 2020, that TIE philosophy continues, but it now stands for transformation, innovation and evolution. We want to be transformational and innovative, and you must be prepared to evolve. That's the beauty of my organization — that we take the opportunity to shift our culture to where we can engage with patients in real-time, invite convenience and improve experience without ever sacrificing outcomes. From our CEO down, our fundamentals never shift. We focus on fundamentals and intersect innovative tools and technology into those to yield a better experience and outcome for our patients. So, we're changing the way we deliver the same care in a different way for those who may need it, in the time when they need it.

Q: Looking even further ahead, what do you think are going to be some of the biggest trends in health IT over the next decade? 

ND: I think that you're going to see large movement in the next 24 to 36 months in areas where we — not just Houston Methodist, but the entire industry — will be leveraging voice technology — whether it's voice-enabled or voice-driven — and merging that with artificial or augmented intelligence and machine learning. You're going to see lots of cross-pollination of these two different areas. 

For example, Houston Methodist is in the pilot phase of a partnership with Notable. In the old days, your doctor would examine you, then scribble some stuff in a chart and walk away; now, they'll see you, then turn their back to you while clicking away on a computer, and all you see is the back of the white coat. But with the use of voice technology, we can use the Apple Watch as a microphone, if you will, and leverage a tool that marries both natural language processing and [robotic process automation]. These disruptive technologies come together to capture my voice so I can keep examining the patient, never losing sight of them, while the note is transcribed into the right fields of the note using RPA and a bunch of digital bots working in the background.

With that, the patient experience is affected in three different ways: One, I never lose sight of the patient; I'm able to capture the inflections and the nuances that may typically have been lost with the traditional point-and-click methodology. Two, I'm able to focus on educating the patient about what I'm doing and what I expect of them. And three, when we exit that exam room, the patient's information is complete and their orders are ready and queued up, so their exit out of my office is just as easy as when they entered my office. The entire continuum of the experience has changed.

The next thing we'll be working on is around creating new skills with voice assistants. Because people are already using Alexa and other voice-driven skills, I think you're going to see a lot more exploration in this area. We at Methodist are doing this today, and not just at the patient care level — imagine being able to drive an OR patient safety checklist using voice or being able to queue up the housekeeping crew when a patient is discharged without having to physically call someone.

You're going to see a lot of innovation in that space, and I'll tell you, I think that's going to be the most interesting space, because it helps address two things: It increases efficiency for both the provider and the patient and, most importantly, it changes the way the ecosystem is built, because you no longer have to invest in traditional infrastructure such as intercom systems, since you've made it truly on-demand.

So that's probably the first thing, but there will be challenges in implementing those cultural and transactional changes, since they're disrupting the traditional ways of doing things. That's where we're going to find that, as we implement new things, we're going to have internal conflicts about maintaining those traditional core methodologies — if I'm going to move your cheese, it's got to be for the right reason. We've got to have the right people at the table to help us not just create solutions for problems that don't exist, but to help redefine those problems with new solutions.

Q: Is that the key to overcoming those challenges? Having the right people at the table?

ND: That's part one. From a clinical perspective, I think we're seeing a shift in leadership structures, where even within these health tech companies, there are lots of clinicians and providers who are playing a role to drive what process and workflow should and could look like. Even if they're driven by nonclinical groups, those organizations with the aptitude to bring clinical folks to the table to help them take a widget or a toolset and make it clinical-friendly — you're always going to hear about them first.

The other part, which we never talk about, is the fact that we have these large investments in these core operating systems such as the electronic medical record, and those external vendors have very different priorities. We have to find a balance: looking to where we can maximize the tools we have, while also pursuing new ones and pushing our vendor partners to get to the next place. That's going to be the biggest challenge we're going to have, where EHRs and other vendors are going to have a hard time meeting our expectations, but as long as they become and remain flexible enough to allow us to complement their existing systems, I think that's where the sweet spot will occur. Those vendors who really believe in that will always succeed, regardless of size.

Q: What is a trend in health IT or healthcare innovation that we'll no longer see in the next decade?

I think you're going to find that the traditional brick-and-mortar facilities are going to start to slow down. We're going to find new, disruptive ways of delivering care — almost the commercialization of healthcare, with, for example, a virtual clinic in a 24 Hour Fitness or an Equinox.

In the next decade, there won't be places that don't have an EHR or electronic medical record system. And today, interoperability just sucks, but we're going to find ways to break those barriers and ensure that interoperability becomes meaningful, instead of meaningless, so that we can share information more globally and holistically with our providers.

You're going to see, probably, a lot of investments in reducing variations of care. I think you're also going to see access to care won't be as big of a buzzword in the decade to come, because access will become much easier and more convenient for providers as we see the explosion of virtual health services.

We're going to see a ton in robot process automation. In healthcare, it's going to help us complement our physicians and our staff, not replace them. People often assume that bringing in RPA or AI means they're going to lose their jobs, but I always laugh when I hear that because it's not that at all. We're not replacing, we're enhancing.

Those are going to be the big key takeaways. It's going to be about breaking down those complex workflows and work efforts to make them simpler and more user-friendly — more consumable and efficient.

More articles on innovation:
Texas Children's joins Team USA's medical technology, innovation fund
Melinda Gates funnels $50M into gender equity initiatives in tech hubs
UCSF accelerator launches project to improve digital health access

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