The Impact of Digital Fatigue on Health Care

[MUSIC PLAYING] Hi, everyone. You're watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD. COVID has impacted all aspects of our life and it certainly has impacted health care. And some people will say it's accelerated changes that we've needed, especially in terms of digital innovation. My guest today is Dr. Ash Zenooz, who is the Chief Medical Officer and General Manager at Salesforce. Dr. Zenooz, thanks for joining me.

Thank you so much for having me.

Let's start off with what has the impact of digital innovation been on health care? How has it accelerated over these past eight months?

I would say just looking at let's say telehealth, it's being utilized across a broad population. It's being utilized by providers, I think insurance companies are starting to realize that this is a great way to engage both their members and their employees. You're starting to see decentralized clinical trials come into the picture, pharmaceutical companies are engaging remotely. We're living in a remote world and people are thinking about how to live, work, and see their clinicians and take part in life from a remote world.

Another way to think about the impact of telehealth is it's really gone from about 2% of physician visits in February to like 80, 90% in May and June and now it's coming down to about 50%, where it will land we're not completely sure but we know it's not going to be in the single digits as it was before. Something that people have been talking about is that telehealth is really going to have to help in this mental health pandemic that we're having now and that will continue post COVID. You've been writing about that on LinkedIn and some other areas, how is telehealth going to play a role in this mental health pandemic?

Absolutely. I think when we think about telehealth, oftentimes we've just sort of been thinking about the one to one video visits and it's at the point of care and we haven't really been thinking about a broader ecosystem. But I think with the pandemic and the fact that we've had to hunker down over the last nine months, people are starting to one, realize that you need more than just telehealth. In order for it to actually be functional, you need an entire virtual care ecosystem that is much more than telehealth.

And number two, I think we talked about-- touched on this a little bit earlier, people are living and working from home. And so there is definitely an increase in folks needing to access mental health services without having to go in. And partly that's because of fatigue of working from home, there's a lack of work life balance, we hear this a lot across different companies when we talk to folks now.

We're having children-- I know I have my kids taking school from home, so I'm managing being a teacher and the Chief Medical Officer of a big company and just living my life. And I think a lot of these types of factors are definitely increasing the need for folks to access mental health services and we need to make it easy and we need to make it such that it is no longer just a one time call, it needs to have continuity and I think that's what we're seeing.

And now we are seeing rapid acceleration of startups in the space, growth in the space, providers are starting to engage and it's been fairly positive, the uptake has been positive. You get to maintain your relationship with your therapist, your clinician, even though you're at home. The positive thing I've heard from the clinicians is that they get to see in your home, they get to see who lives around you, how you're living, it gives indications to things that they didn't have before. So it's actually been a very positive response. And I think there's a lot more to be done in this space beyond just a telehealth virtual visit for mental health.

JOHN WHYTE: And digital innovation is really changing expectations isn't it? Because why should you have to drive or take public transportation and wait for 30 minutes until you're seen and then have to do all that back if you can do it from the comfort of your home and it's equally as effective? We need to do more studies on that but we need to think that through.

The other thing I wanted to ask your opinion about is you mentioned about decentralized trials and that it's not just about telehealth, it's also about wearables and sensors and trackers. And you've talked about remote patient monitoring but how do we take all this unstructured data that is hard to interpret it, and I still see patients and my clinical colleagues will be like, I don't want all that data. I don't want your sleep score. I don't want all the steps. It doesn't feed into the health system. I don't have time to interpret it. I don't have time to interpret glucose measurements. So how is this accumulation of data that we're getting from all of this in some ways, self care, feeding into the health system? How do we manage it all from a machine learning, from a data optimization perspective?

I think you're hitting the root cause of what's coming, the much bigger cause of burnout for clinicians. As a patient I want to share all of my data with my clinician, including my Fitbit, my weight scale, and all of the things that I use in my day-to-day. But, yes, absolutely, I think already we've got a tsunami of data that's hitting the clinicians, with EHR data, EMR data, et cetera, that they have to analyze and look through lots of different pages but now you've got all those IoT data. And I think the data that already exists I would say most of it as you and I can agree is to your point, unstructured data. It's dark data that we really can't use for real time analytics, for data at the point of care.

These are all problems we definitely need to solve but I do believe that there are a couple of areas that we need to stop talking about it and do something about it. Disparities are one thing I think we could talk about that at some point. But I think the need to be able to have the appropriate data at the point of care for clinicians that are caring for the patients is much needed. We definitely need to be talking about interoperability standards in health care. We need to make sure that we don't have siloed point solutions that are bringing more and more data.

We've been talking about interoperability for 15 years. Are you optimistic that COVID is going to finally cause us to see the importance of it?

Well, I think part of it is technology, but part of it is just behavior of all of the people that are part of this political ecosystem. And I think COVID definitely makes us all realize that we can no longer behave in ways where we're unwilling to exchange data for the sake of the patient. And if this pandemic has taught us anything, I think we need to realize that there must be more data sharing, more collaboration between all of the different entities of the ecosystem

And hopefully members of government are also listening to this, to our conversation, because I think that's a really another important factor, not only should they write regulation to ask different entities, like providers and payers and pharma to share data but I think they should incentivize so that it can happen. We should incentivize partnerships also between technology providers and hospital providers so that we can learn how to make best use of this data using AI, ML technology, et cetera.

Are you optimistic it'll look different six months from now, is it a year from now, is it two years, when do you think we'll really start to see significant movement?

Oh, I'm not sure if it's six months from now, I think I actually expect things to go backwards a little bit once we have vaccines, and people start going out and mixing in the world. But I do think that this is a really important component that will be advanced. So I think we need to continue to push while there's urgency. We've obviously seen CMS kind of drop some of the requirements so that we can enable telehealth. We've had providers, I mean, private payers, that have gotten on board and we need that to continue, we need innovation to continue. But all of that requires time and money and effort and I would say, probably not six months from now. And I also think it depends what you're talking about. In radiology, there's been drastic uptake of algorithms in use. We are looking at stroke patients and brain bleeds, when you're looking at AI/ML for radiology imaging, but it's not the same everywhere else.

I want to ask you about this concept of digital fatigue. And you briefly touched upon it a little earlier. So here we're saying we want all of this innovation, we want all these digital tools to help improve health care. Yet, we're also learning from our clinical colleagues who were burned out before COVID, COVID certainly has given a double, if not, triple whammy, and now we're having all this digital innovation that they can't necessarily keep up with. What's the impact in terms of burnout and fatigue and how do we address it?

I think there are a couple of things. One, I think initially as you and I know, most of the technology that we use in the provider systems like EHRs, did not have front line workers and clinicians at the table when they were developing these workflows. It wasn't meant for us, it was meant for exchanging data to get paid and now we've become the predominant users of the system.

And so I think we can learn from that a lot. And instead of spending more time with our patients, we're spending a ton of time as data entry folks. And I think now is a great opportunity for technology companies to say, let's engage the folks that we are serving, let's do partnerships in designing these new technologies that are coming out in support of the patients and providers, let's engage patients. And I think, so number one, we have to have the people that are involved that will be using it at the table in the design process, we have user-centric design. We must ensure that we learn from all our failures early and those are positive things and we should make sure there is transparency. I think a lot of times when we know we have issues with the EHR we don't make them public. That's a lesson we must really learn and we should publicize it.

And then internally if we're going to be rolling out tools to our clinicians, we should actually remove some of the other tools and lessen the burden and we should be measuring those things and we should be actively communicating. Change management was on the list always but not of the utmost importance. And I think we definitely need to take change management very, very seriously if we're going to put in any more technology into the provider organizations.

And finally, I want to ask you about your own personal story, you're a physician that's in a non-traditional role for physicians, as am I. What was your journey to get to where you are today?

Honestly, if you had talked to me 10 years ago, I would have said I would not be here. I love being a clinician. I'm a radiologist. I love the practice of medicine and seeing people, and patients. But I think a few years ago when my mom became a part of the health care system it made me realize that the system is, in fact broken and we must enable not only better delivery of care but ease for our patients that are sick.

And so that led me down the path. I spent some time in the United States Senate working on legislation. I've spent some time in government at the Department of Veterans Affairs, scaling different programs and now I'm at Salesforce as the Chief Medical Officer. And to me, all of these things ultimately, is about like what are we going to do to make the lives of patients better? How are we going to improve ease of use and care of the patients ultimately.

Well, Dr. Ashwini Zenooz, I want to thank you for taking the time to share your insights about how digital innovation in the setting of COVID is impacting our health care delivery, how it may continue to, but what we also need to be alert for in terms of burnout. So thanks for taking the time today.

Appreciate you having me.

And I want to thank our viewers for watching. If you have a question about the impact of COVID, drop us a line. You can send it to drjohnatwebmd.net And we might answer your question on one of our shows. Thanks for watching.