Part 1: Getting to know Sylvia Romm, MD, Chief Innovation Officer at Atlantic Health System
JUAN PABLO: You are the Chief Innovation Officer at Atlantic Health System, a board-certified pediatrician, you've been involved with startups, you're now in charge of massive innovation projects -- I'd love to hear from you about the things you've chosen to focus on and also how you got into the digital innovation space in the first place.
SYLVIA: A lot of people ask how I moved from the clinical world into digital health and the startup world, and now to innovation. I was a pediatric hospitalist, post-residency, when I initially started looking into digital health. I was about to have my second child and didn't have paid maternity leave. I wanted to spend my 12 weeks of FMLA at home, and I also wanted to continue to see patients. I became aware of a company focusing on video visits that was just starting up, and I joined them as a medical director.
In my time there I realized more and more that the people who really need to have care in a convenient and fast way are new parents. It's so hard to get out the house, and you have so many questions and need those problems to be resolved quickly. So as a labor of love I started a company focused on breastfeeding support for new moms (it was called Milk On Tap at the time). Pretty quickly, two things happened: we started to move from breastfeeding to nutrition support, and we became a partner with American Well (AmWell).
While I was at AmWell I was exposed to digital health at work in health systems across the country. I talked to leaders in health systems and help them think about how they could use digital health to meet their strategic goals. I really got to see how different groups function and learn best practices from leaders in digital health field.
I then came here to Atlantic as CIO, and one of my many hats here is discerning how we can to use digital tools to help us take care of our communities, to help communication between providers and patients, and how to make digital health a great experience for the people who are seeking care and patients.
Part 2: Response to COVID-19
JUAN PABLO: Atlantic Health is obviously at the epicenter of the pandemic. How have you been shaping their response to COVID-19 through technology and innovation?
SYLVIA: The work that I do at Atlantic is ambulatory facing and primarily about easing access to care for people, and in a lot of ways setting up alternative sites of care. At the beginning of this, I was actively helping Atlantic set up drive-through testing, a chat bot self-assessment, I worked with the nurse and physician hotline and helped implement virtual care.
Even before the Covid wave hit, we started to see some really interesting results from our drive-through testing. Testing just team members and first responders, we were getting 45-50% positive rates. The false negative rates have been back and forth, but generally around 30% -- so if you're thinking about the percentage of people who experienced symptoms and tested positive the numbers are quite high. When you're in this New York/New Jersey area that has a robust community transmission, you do run into a lot of people that have had it. Not everybody that gets it has symptoms, there are many people that have it and are asymptomatic.
JUAN PABLO: You shared with me that you recently had the definition of a personal experience with COVID-19. Can you share with folks what happened?
Like many of my colleagues, I did get Covid. They say that physicians make bad patients. The was one day that I was stressed and my husband told me that he was going to take my phone and computer away if he heard me on any more meetings -- this is as I was laying on my stomach to get better oxygenation.
The disease presents in multiple different ways. I had muscle aches and GI problems as well as a lot of chills and the feeling of on oncoming fever, and a really bad headache (we're actually learning a lot more now about the neurological effects of the virus). My heart rate shot up and I had problems breathing.
As people have asked me about my story, there is one thing that I want to point out. I have massive privilege. I'm a physician, I'm in the medical community, I understood what was going on, I have a safe place to stay, I have people to look out for me and someone to watch my children. I had a Pulse Ox -- not only could I get it but I could read and understand it. It's moments like this that you realize how much privilege can change the way the course of the disease progresses and how you feel about it and get through it. I was in pain but I was never truly scared that something catastrophic was going to happen and that I wouldn't know the next steps and what I should do.
JUAN PABLO: You make a great point. The numbers of people who haven't been able to receive care that they need hasn't even been tallied yet. We need to address those high numbers and be proactive about getting those people access to care.
Part 3: How COVID-19 has changed healthcare
JUAN PABLO: Has COVID-19 changed anything that you were already thinking about or implementing as CIO? How are you thinking about the strategic blocks around technology and innovation driven virtualization?
SYLVIA: We had decided on a 2020/2021 roadmap around digital patient engagement, making Atlantic's digital front door really useful and person-friendly, and getting more people on board. We had a lot of different capabilities that we'd been trying to stand up for awhile, and then overnight huge parts of it got enacted -- maybe not the way we were expecting but at a much larger scale than we were expecting.
For example, we hadn't really ramped up telemedicine/video visits as a health system. We were getting the technology in place -- we had technology before that wasn't working the way we wanted it to -- we were looking at different ways to have providers communicate with their patients. Ultimately we were planning on rolling out video visits that were embedded in existing workflows sometime in the fall.
Then overnight, our health system and systems all over the country started rapidly transitioning to virtual care. There were clinics that decided on Friday to switch all of their visits from physical to virtual by the following Monday -- essentially no time at all. At the same time reimbursements and regulatory barriers fell, so everyone was using, appropriately, whatever tech they could find just to be able to communicate with their patients and see them and set up virtual visits. We've now already beaten our predictions for 2021 -- our goals for the entirety of next year -- that's the good news. We're now doing on average of 3000 telemedicine visits a day.
Now the question is how to pull of these different modalities together to create a unified experience. Right now we're talking about how to get people to come back into the office, and how to realize that there's a lot about their health that patients should be thinking about. Patients should be talking to their doctors about diet and nutrition, or establishing a connection with a primary care provider to set up screenings for a month or two in the future. Many offices are open for these kinds of things, and what we're talking about as a health system is how to let people know and encourage them to start coming back in. With so many modalities and different front doors, it's as a health system to kick start this unified approach.
JUAN PABLO: The entrepreneurs are seeing this massive spike in telemedicine and digital health, etc., in this moment but the industry at large is worried that this might just be a blimp that goes up and comes right back down post-Covid. Have we addressed the concerns of the naysayers and laggard adopters about whether telemedicine is possible or safe, or do you think that these entrenched interests will return?
SYLVIA: I don't think we can return to the way things were. Too much has changed. I don't think the regulatory and reimbursement can go back -- there will be too much protest. With those barriers down, it will allow people to continue to do work without such high activation energy. So I think we're going to see is that it will fall somewhere in between. There is a false dichotomy between digital care and in-person care -- in reality it should be a spectrum. Any given person needs a different means of communication. There may be one person that wants to communicate, and appropriately communicates, entirely digitally, and another person who's more split, all the way to someone who wants and needs 100% in-person care. If you truly have seamless integration between digital and in-person care, you really should be able to address the needs of any person on that spectrum and deliver care to any person, at the time they need it. Digital care is certainly going to be a part of what health systems do in the future.
JUAN PABLO: So giving people options for how they receive care will be a strategy and standard in the delivery of care?
SYLVIA: Yes, especially as people are realizing the subtlety around virtual care and telemedicine.
Part 4: Insights on healthcare procurement
JUAN PABLO: Let's talk about procurement for consuming innovative projects. There's a lot of barriers to starting new projects in innovation healthcare. Right now there's a COVID-19 related pile where things get fast tracked in the health system, and if you're not on that pile then good luck getting anything signed for the rest of the year. How do you see procurement in general changing because of COVID-19 and this new normal that we're in?
SYLVIA: We started to see across the board the concept that there are certain utilities that need to be provided to a health system at a very large scale: health systems want something that's tried and true, preferably launched in 60 other health systems before, they don't want it to fail, they want it to work perfectly the first day it's launched. There are lots of things that fall under that category, but the reality is that most health systems have treated everything that way for a very long time. But if we only do things that have been in use for five years then we're actually not doing anything on the innovative edge.
Health systems simultaneously want to be the first to do something and have all the RCTs behind it to support its efficacy. But you can't do that. Instead, they need to realize that there's a difference between clinical risk and business risk. You don't want to try things willy-nilly clinically, but there's lots you can do in terms of business, workflow, and modalities that don't fall into the bucket of clinical risk. How do you take workflows or care models, for example, and put them in a pathway that is a much faster launch? And then, instead of launching and stepping away, launch and learn and iterate -- maybe change or even stop after 6 months. If you're never stopping anything that you doing, then you're probably not innovating. Even in research, you can spend years doing everything right and then realize that you've been asking the wrong question. You might start something with the best intentions and then realize that it doesn't work for you or the people that you're trying to help, so you need to create an agile environment on the backend after launch. This is something that we're thinking about a lot as its been highlighted by Covid -- some things have been broken down and other things built up, and we're going to have to re-assess at the end of all this.
JUAN PABLO: It's giving people the space to fail -- to separate business failure from clinical failure to keep patients safe but allow ourselves to iterate and learn about what can be added on or enhanced in the delivery of care.
Interested in hearing more? Contact Dr. Sylvia Romm on Linkedin here, or tweet at her @Sylvia_Romm.