Chief Content Officer,
Techstrong Group


Mike Vizard: Hello and welcome to the latest edition of the Digital CxO Leadership Insights series. I’m your host, Mike Vizard. Today we’re with Dr. Mike Merrill, chief medical officer for Brook Health and co-author of a book called Leadership Is Overcoming the Natural: 52 Maxims To Move Beyond Instinct. Mike, welcome to the show.

Dr. Mike Merrill: Thanks for having me here today.

Mike Vizard: What’s your assessment of our current state of health care and digital transformation? We’ve been talking about all kinds of things for the last few years, and it feels like, shall I say, to be fair, a little hit-and-miss. So what are we missing and what are we getting right?

Dr. Mike Merrill: I think there’s always been sort of a desire to bring computer technology, IT technology over the past many decades into medicine. And the problem is always that medicine is extremely operationally complicated, complex and requires a lot of efficiency for the frontline folks. So one of the main problems is trying not to slow them down. When PalmPilots came out, I was one of the first people on my block and in the city to have a PalmPilot in 1999. Maybe some people are too young to remember that, but the reason I actually used one is because it helped me. Some electronic medical records, when they’re implemented, slow people down, which is… Sometimes you’ve got to do it, but if you really slow down the frontline folks, bad things happen and it frustrates them. So I think a lot of what we’ve got right now is trying to make the tech interface with the operational reality on the front lines in ways that doesn’t slow people down or make them do extra work that is to the side, and not directly to the point of taking care of the patient.

Mike Vizard: It feels like sometimes we don’t think enough about re-engineering the process, and if I go to, I’ll take my doctor’s office for example, they basically put a mobile front end on top of a paper-based process and have not really moved it beyond that. And so it may help them per se, but it doesn’t create a better experience for the patients. So do we need to think through the design of these systems a little bit more? Or are we just on some sort of journey?

Dr. Mike Merrill: I think both. I think things are going to evolve, but I think we need some attention and some intelligence right at that point of care. One of the problems is is that health care is scary. I’m an experienced health care person. I have seen things that I will not describe to you. I get a little nervous when I walk into the hospital to work because there’s so much at stake and there’s so much drama and there’s so much suffering and there are so many things that every single person needs that I get nervous about it. So for somebody like an MBA or a tech engineer to come in and even follow me around could be a really scary thing, and I completely feel that. I completely feel it. But it’s necessary, because otherwise things can be slowed down, for example. The full potential benefit of an intelligent information structure can’t be brought to bear to the front line if we’re not there, if the engineers aren’t there.

Mike Vizard: And we’ve seen this in other vertical industries, right? It’s not uncommon for there to be a divide between the business and IT, in this case it’s the doctor and IT, but the issue is the IT people are not at that point of care, they are not at the operational center, so they don’t have a real firm handle on what to automate how in a way that is helpful.

Dr. Mike Merrill: Absolutely. The analogy I draw is if you had an engineer at a Ford plant who wanted to improve the safety on the line and they were sitting in their cubicle or in their conference room and they thought of something really great. It would be better if they went down and spent some time watching the assembly line rather than just thinking about it.
And again, that’s scary. It doesn’t have to be a lot of time. I’m always inviting administrators and IT people to follow me while I do my work, and most people don’t. And gosh, I wish there would be more. One guy who did, man, we were in the ICU at the hospital where I was working, he solved three major tech problems I had in like 45 minutes, and totally made my life better. And he learned, just for him, to open up the top of that box and look at what’s going on inside there, it was amazing he tells me. He’s doing really well in his career now because I’m hoping that he’s continuing to spend time pulling the box off of clinical care and really being sensitive to what’s going on.

Mike Vizard: Is it a lack of will? Or is it a lack of leadership ultimately that doesn’t encourage these people to get together?

Dr. Mike Merrill: Leadership plays a big role. There are places like Presbyterian in Albuquerque who insists that leaders spend time every month shadowing clinical personnel. I can’t see anything but good come out of that. Leadership’s really important and it’s got to be seen as a legitimate activity. And then the providers likewise have to be willing to have a stranger who doesn’t necessarily walk and talk like everybody else in the ICU hanging around next to them. Not every provider’s suitable for that. So there are a lot of obstacles for that to happen, but it’s very educational both for the clinician and for the person shadowing.

Mike Vizard: There are of course a lot of silos in health care and they’ve evolved over the years, but from an integration perspective, it remains fairly challenging. People are still going to the hospital, and the hospital they went to before that has no idea what the other one knows, and they don’t really have a great handshake for sharing that information. So how do we approach that issue? Which is really more of a back office part of the experience and only one part of the overall equation, but it seems like that’s a space where IT and digital transformation officers should be excelling.

Dr. Mike Merrill: I agree with that. I live in Buffalo, New York where there are two major hospital systems in conflict with each other, and they somehow have chosen different electronic medical records to operate, that do not talk to each other. And so if I usually go to hospital A and now I go to hospital B, sometimes they use faxes to send the information over because it’s HIPAA-compliant, right? It’s rational. You don’t want to get in trouble.
But I think regional cooperation to begin about data sharing is really important. Even something simple like giving people in one hospital system a sign on to the EMR of the other hospital system can help, although it’s obviously not the most effective way. But people live and die… And I’m not exaggerating. I know this sounds dramatic, but people live and die by the availability of medical information. It is absolutely a life or death issue that this information… This isn’t just a matter of convenience. Decisions that hurt people are made with when there is not adequate information. And it’s heartbreaking to see something like that because you’re operating in a system where you can’t take care of the patient in the best way.

Mike Vizard:: In your book, you talk about the loss of trust. What is the ultimate impact on the patient and their relationship with the healthcare provider?

Dr. Mike Merrill: Of the loss of trust, I mean, health care is alienating. It is scary, and it’s expensive, and when you’re a patient, it can seem predatory because you just show up in the emergency room and you get all these bills that are sort of taking away your social security income or making you go bankrupt for a health care provider. For me, it’s a Tuesday, for the person I’m taking care of it’s like the worst day of their life or one of the worst days of their life sometimes.
And it’s morally wrong for us to allow that experience to be an alienating… Or like I say, if you want to find out if your mom’s going to live or die, you don’t want to go to the Department of Motor Vehicles and have that kind of experience. That’s just wrong. We need friendly people on the front lines and we need people who can… We need navigators who can take the edge off this horrible experience that people… Being sick is bad enough on its own, isn’t it? Being sick really stinks, but then you have a cold person come in or somebody who makes you sign something, even somebody who’s a little rude, it can really affect you emotionally when you’re in a vulnerable state. We don’t want that.

Mike Vizard: And it’s usually, for better or worse, somebody from billing who’s just trying to get some paperwork done, who’s got themselves in the middle of this conversation.

Dr. Mike Merrill: They’re just doing their jobs. You don’t hire a billing person because they have the highest level of social skills. You hire them so that they can take care of the money so that the hospital can keep running. So these are all rational decisions. There are well-intentioned people all over the healthcare system who are trying to do the right thing, but the way it comes together sometimes just erodes trust.

Mike Vizard: What do you think the impact of artificial intelligence is going to be on this whole equation? There’s certainly massive amounts of data, a lot of it is sensitive data, but can we throw algorithms in some of this stuff and maybe have a better outcome?

Dr. Mike Merrill: Absolutely. There is so much that… Especially, I’m always trained as a primary care doctor. I can’t do it because you have to do 45 minutes of work every 15 minutes. Most of that work is collecting information from across multiple data platforms, integrating it, and then you do what you’re paid to do, which is to make intelligent decisions and recommendations to the patient. AI could so easily, even current models right now, and this is being worked on, start to summarize massive amounts of information. Find out what’s missed. Maybe you had a CAT scan a year and a half ago where there was an abnormal nodule in your lung that nobody followed up on. Well, I want to know about that if you’re my patient. God forbid that should happen, but it happens.
So AI could be a great safety net. It can help with diagnosis, for some people it might be able to replace a doctor, okay, great, I don’t mind, but I think for a while though, the other thing about AI is you’re going to have to have an AI and a human being to help manage the relationship between this vast amount of knowledge and intelligence and a normal human being. So that’s sort of the way we see it at Brook, the company that I’m CMO of. You can have AI, but you can’t have just AI. It’s a human business. You’ve got to have people.

Mike Vizard: Do you think we can have maybe continuous checkups? And I ask the question because once a year you go to the doctor, they run a bunch of tests and then they tell you, “You’re not likely to die today because of this, that, and the other, but you’ve got to watch out for this, this, and this.” But we can collect that data from all kinds of sources in our daily life and maybe share that through so that I’m not waiting once a year for some battery of tests to be run and executed, I’m getting a more real time assessment. And then people will change their behaviors and wind up living longer hopefully, and at least cross your fingers.

Dr. Mike Merrill: Absolutely. There’s a big distance between doctor’s office visits, there’s a lot of time there, and usually you have like 15 minutes with your provider and then you’re left to implement it for six months. That’s hard. And that’s what we do at Brook, is we work with people, give somebody a buddy, a nurse to work with on a weekly basis to get things done, to bring data back if your blood pressure suddenly shoots out of control, we’ll know. The diagnosis that that’s the most important on us is heart failure because small changes in physiological parameters and heart failure can lead to rapid decompensation and to hospitalization. So our goal is to make heart failure something you are never hospitalized for so that you don’t have to go in the hospital and have that alienating experience and get your $2,000 copay and millions of surprise bills. But no, absolutely. It’s a big distance between visits. And there’s a lot that could be done in that space.

Mike Vizard: It almost sounds like we have our heads wrapped around what should be done, the how of it continues to elude us. So what’s your best advice to folks about how to turn these visions of what we want to have happen into reality? Because I feel like we’re kind of close, but there’s something in the way.

Dr. Mike Merrill: I’ve been thinking about the health care system for 30 years, and it keeps coming down to this gap between engineers, administrators, MBAs, the CEO, and the people who are doing the work on the front line. I think we need to come together, and not just in a conference room, we need to come together in the emergency room, in the primary care office, in the lab and really find answers that work.
And there’s a lot of knowledge out there you can get from frontline people. Any good business will do that. Any good business is going to listen to the frontline folks, work with the frontline folks, support the frontline folks because they are the people who interact with the customers. That’s what you do. In healthcare we have a barrier, and the barrier is cultural, providers versus administration, and the barrier is that the product is a little scary. I don’t know if you’ve ever seen a cardiac arrest, that it is not a chill situation. But I think those are things… There’s cultural differences and there’s this fearsomeness sometimes of the actual product that’s being created on the front lines. Fearfulness.

Mike Vizard: All right, folks. Well, you heard it here. On the plus side, there’s hope.

Dr. Mike Merrill: There is.

Mike Vizard: At least we have some sense of what the issues are and we have some sort of notion about maybe how to go fix that. The challenge, of course-

Dr. Mike Merrill: There’s a lot of hope. I agree with you there.

Mike Vizard: The challenge is, as usual, the execution. So that’s apparently where we should be focusing our digital transformation efforts in health care, because in no other vertical industry does the phrase mission-critical application actually mean mission-critical. Hey, Mike, thanks for being on the show.

Dr. Mike Merrill: Thanks for having me.

Mike Vizard: All right. And thank you all for watching the latest episode of the Digital CxO Leadership Insights series. You can find this episode and others on our website. We invite you to check them all out. Until then, we’ll see you next time.