Rohan Kulkarni, vice president of healthcare strategy and portfolio at Conduent,speaks here about Conduent’s healthcare strategy and the company’s move to brand following its separation from Xerox. While doing so, he steps back to look briefly at aspects of healthcare technology’s past then pivots to its future and what he’s most excited about in the space and how he hopes to be part of it. Finally, he describes wheat he would pursue if he were healthcare’s king, and what that would look like and how he would change the sector for the best impact to the patient.
You’re the vice president of healthcare strategy and portfolio at Conduent. Can you explain what the role entails, and how you approach it?
The transformation in healthcare that is occurring is generational and provides for unprecedented opportunities. As the head of healthcare strategy, I am responsible for identifying those opportunities that are relevant to us and help strengthen our portfolio. I then design and develop a strategy in collaboration with our business leaders that will help meet our growth goals.
Tell me how Conduent plays in healthcare and how its solutions specifically impact the point of care.
Conduent has perhaps the broadest solutions portfolio in the healthcare services, allowing us to connect the entire healthcare ecosystem.
Conduent provides solutions that help our clients overcome industry obstacles, including inefficient processes, inaccessible data, regulatory mandates and challenging economics so they can focus on improving patient lives through better, affordable, accessible healthcare. Our solutions are all designed to help our clients manage the health of their patient populations so they can improve healthcare outcomes. We help make the transition to value-based care models a reality, and we work with healthcare professionals to design solutions that meet their specific needs.
Conduent is dedicated to the efficiency of claims accuracy, facilitating bill payments and risk assessments, communicating benefits, driving medication adherence, improving patient engagement and technology education, and delivering on quality and care data across medical systems. Our solutions are designed to reduce preventable readmission rates for defined population sets, control costs by executing proactive engagement and provide ongoing management for patients with chronic conditions.
Conduent just completed its separation from Xerox. What does that mean for your company and for your customers? Why the move and why the rebrand? Why not build on the power of the Xerox brand?
When reviewing the products and services offered across the business, we determined creating two independent, standalone entities – Xerox and Conduent – would give us the ability to create greater shareholder and customer value. The separation is based on a structural view of two of our businesses and with simpler, more focused organizations, we’ll be able to adapt to market demands and ensure we’re positioning the business to deliver tailored solutions based on our clients’ evolving needs.
How has healthcare IT transformed throughout your career? How has Conduent been involved in healthcare’s evolution?
I think most of the healthcare industry expected healthcare IT to be a driving force in improving how providers deliver solutions to their patients, but I don’t think we expected the rate of change to be so dramatic, especially over the last decade or so. We’ve seen vast improvements in how providers use health IT with the advent of electronic health records, mobile health technologies, telemedicine, wearables, analytics, etc., to improve communication with patients, personalize care and drive healthier outcomes. Since our introduction to the healthcare space, we’ve been helping businesses and governments better harness the influx of information to enable transformation. From the back office processes like billing and payments, to using Big Data to drive medication adherence, assessing risk and improving patient engagement, our solutions meet today’s challenges and prepare healthcare organizations to meet tomorrow’s needs.
What are you most concerned about in regard to healthcare’s future?
Healthcare economics continue to be single dimensional in that the focus is on the demand side, i.e., insurance. The Affordable Care Act (ACA), while it has streamlined the demand side, it has not addressed supply side, e.g., hospital charges, cost of medication etc. in any meaningful manner. As such, much of the debate in the public domain about healthcare is unlikely to make progress until both sides of the equation are discussed.
Advances in technology have fundamentally altered and inarguably improved the way we drive, shop and travel. Just ask anybody who uses Google Maps, Foodler or Uber.
Sadly, however, information technology has failed to deliver so far in the most crucial service of all – healthcare. This is at least partly because electronic health records (EHR) systems grew out of the computer systems that run the hospital’s inner workings — patient scheduling, admission and discharge, staff payroll and accounts receivable. For system designers, physicians’ needs were an afterthought, which is problematic because physicians are, after all, the linchpin of the healthcare delivery system.
To begin pulling healthcare IT out of the past, we must first take a look at how it supports physicians. The short answer today is “not well.” In fact, EHRs are creating as much frustration as benefit. Problems include poor presentation of patient data, fragmented information sources and unwieldy user interfaces that require dozens of mouse clicks or screen taps. It’s no wonder more than half of physicians who responded to a recent survey claimed their EHR system had negative impacts on costs, efficiency and productivity – three things IT should help, not hinder. These issues not only affect physicians’ professional satisfaction, they contribute to the phenomenon of physician burnout, which is a growing concern across healthcare. Studies show some 30 percent of primary-care physicians age 35 to 49 plan to leave medicine, and there’s an expected shortage of 25,000 surgeons by 2025. A Mayo Clinic study released earlier this year directly connected the burnout problem to physicians’ use of EHRs.
Today’s EHRs have done little more than “pave the cow paths.” We’ve gotten rid of paper in the hospital and made processes electronic, which is why EHRs can legitimately claim to have reduced transcription errors. But eliminating paper is just table stakes; the critical next phase is to do for healthcare what Uber has done for transportation: Reinvent the process so it’s optimized for and native to the technology that enables it.
Patients and physicians can and should advocate for such change. Today, patients have access to a vast body of information—the notes a doctor took, quality of care rankings, the level of personalization provided—and it’s only going to increase. As Lygeia Ricciardi, former director of the Office of Consumer eHealth at ONC said, “Getting access to personal health information is the start of engaging patients to be full partners in their care.”
Joanne Rohde is the chief executive officer and co-founder of Axial Exchange. She brings 30 years of experience to her role and has grown companies using “disruptive business models.” Prior to Axial Exchange, she served as the COO and director of health IT strategy at Red Hat, as well as was the CIO of UBS Investment Banking IT. She’s passionate about healthcare because it’s personal; healthcare is a personal business and with the advent of patient engagement, healthcare is even more so personal than its ever been.
Here she discusses the reasoning for her venturing into to healthcare and Axial’s creation, the company’s mission, what “patient engagement” is to her, how “patient engagement” is changing healthcare and Axial’s solution set. Finally, she addresses what she feels are the most pressing issues facing the healthcare as a whole. Her perspectives are deeply insightful; the following is well worth the read.
Can you tell us about yourself and your background prior to starting Axial Exchange? Why healthcare?
I spent most of my career in finance and technology. If I had a personal tagline, it would be that I like to build disruptive businesses in old industries. I did this in finance, with a company called O’Connor and Associates, which brought derivatives and computers to the financial industry when derivatives were still used to hedge real transactions. Then at Red Hat, we brought the benefits of open source to the enterprise, revolutionizing the software industry. Healthcare is one of the most inefficient industries in our country, and it affects every one of us. It is ripe for disruption.
What was your motivation in starting Axial Exchange? Perhaps you can tell me more about your entrepreneurial spirit and journey. Do you have other plans for new business lines in the works presently?
I was COO of a rapidly growing global technology company, Red Hat, when I became ill. Over the course of two years I became too sick to walk up a flight of stairs. I was in constant pain, and couldn’t speak properly. It took two years and 10 doctors to properly diagnose me. As I went from doctor to doctor, it became clear that I was starting over with each doctor — they couldn’t share information, and that lack of information sharing made it difficult for them and for me. It was also apparent that when I would go into their offices, they’d take tests and check symptoms, but they were point-in-time analysis — if I had a bad situation a week prior, it wouldn’t be captured. It occurred to me that my story was in part every American’s story and the current system frustrated both doctors and patients alike.
We are just at the beginning of what we can do to improve the patient-doctor experience. The rapid advances of wearable devices is our current area of focus. We want patients to understand their own health patterns, and to securely share that key biometric information with their physicians so each appointment can be fact-based, not “recall” based. Our next area of focus is real-time case management. What if you could get in touch with a recently released cardiac patient precisely when they were at the most risk instead of waiting for a crisis that lands them back in the hospital? These kind of timely, specific interventions can be a reality with the integration of our application back to the care managers.
Guest post by Brandee Norris, assistant professor healthcare administration and management school of business and technology, Trevecca Nazarene University.
The health information technology (HIT) industry is on the verge of a dramatic dawning. As more healthcare organizations transition to paperless systems and to meaningful use of a certified electronic health record (EHR), the need to ensure the safety and integrity of healthcare data and to eliminate the risk of health IT breaches increases. In the past five years, the Department of Health and Human Services reported more than 800 breaches of healthcare patient data, breaches that affected more than 30 million patients. Breaches in electronic healthcare data cause serious negative outcomes for patients, stakeholders, and organizations—both public and private—and result in millions of dollars in fines and losses.
As the use of HIT systems increases within the healthcare industry, hospitals and providers of private practices are seeking effective methods to enhance data storage and streamline access to patient information without jeopardizing the privacy of the data. A possible solution to this problem is the transference of protected health information from a local system’s network to a cloud-based electronic medical records (EMR) service. Cloud computing may be categorized as private or public. Based on HIPAA regulations, professionals in the healthcare industry continue to dispute the legitimacy of public cloud computing and compliance with specific requirements of the HIPAA.
Contrary to provisions mandated by HIPAA, cloud-based platforms could accommodate the growing needs of healthcare organizations and provide flexibility to adapt to frequent changes, while providing significant cost savings. The primary objectives of using any variation of a cloud-based program are efficient leveraging of healthcare information, enhancement of patient experience, versatility for providers, and improved clinical outcomes. Cloud-based programs permit 24-hour patient access to electronic records.
Consumers in the 21st century prefer convenient methods to access healthcare services and manage personal information. Consequently, healthcare organizations have adopted patient-centered models to deliver health care and increase provider-patient communication. In addition, cloud-based platforms can facilitate the use of mobile devices, such as smartphones and iPads, allowing patients and providers to access health software applications. The number of healthcare consumers using smartphones to access health information soared from more than 60 million to more than70 million in the last two years. Anderson projects an estimated 20 percent annual increase of software application sales during the next five years.
Healthcare providers have suggested that significant benefits could occur for patients using mobile software applications to monitor their health status. Currently, numerous types of health software applications exist that are free or obtainable at a reasonable fee. Last year, healthcare providers used health software applications for obtaining diagnostic test results, sending alerts for patients to self- medicate, track and monitor levels of chronic pain, and store vital signs and emergency contact information. Consumers should be aware that a compatible operating system and adequate storage space are required to download health software applications to a mobile device.
When looking forward, it sometimes helps to look back; sometimes.
Though the past is not always an indicator of things to come, sometimes we’re able to find a little guidance in the hindsight.
Much is being written by folks like myself in response to HIMSS asking the question of where Health IT is going to be a year from now, on the anniversary of second annual National Health IT Week.
Unlike several of my counterparts — perhaps I’ll be considered less of a forward thinker because of it — but instead of fast forwarding one year, I’d like to go back one year to formulate a response.
In May 2011, I had the pleasure of helping draft a column for my then boss for Imaging Economics magazine. The piece, one of my favorites, seemed to strike a chord, even if just with my office colleagues.
Nevertheless, this piece essentially answers the very question asked by HIMSS, a year before the asking.
And so, as we wrote back then, I’ll begin here again, with an encore of the piece as a response.
“Here’s how I see it: Healthcare is a world of major transition. Like life, there is some unpredictability, and most likely, there always will be.”
We continue: “Yet, during this time – call it one of change, progress, upheaval — we must continue focusing on creating a more mobile and connected place in which physicians and their patients share tools. We need to encourage a greater, more vested conversation, where health information exchanges and practice and patient portals are used, secure messaging and 24-hour access to records and patient data for the patient and their physician.”
This observation, according to my best estimate, couldn’t be any timelier.
We continue again:
“I see a healthcare environment that mirrors the rest of the world. Where, as a patient, I can see my labs at 3 a.m., can query my doctor and request refills; if I’m up for it, pay bills anywhere there’s a connection. I see this as accepted and practiced, in the practice of medicine. Always. Any time. Now.”
Perhaps we’re there now; perhaps not. Regardless, we’re talking about it and, given another year, I might be able to more profoundly announce, “Always. Any time. Now!”
If I remember correctly, in helping write this next section I spoke for myself: “But, here’s what I know: Patients are demanding greater ownership of their care and records (I was). They (I) want the always, any time, now. I also know that physicians – along with constant pressure of requirements and reform – need solutions they can trust; technology tools that are intuitive that help them provide the highest quality of care, all while meeting their patients’ needs.”
It seems nothing has changed in more than a year. I suspect little will change in another. Reform continues as we move past Stage 1 and into Stage 2, which are more rigorous than their predecessors. It will consume hours of healthcare professionals’ time. They will toil and try, and try and toil.
Despite the continuing and conflicting headlines, patients do want to get more involved in their care, but they need a reason to buy in; and physicians need tools that are going to improve their lives. They need more efficiency, more powerful and intuitive solutions. They need to start responding to survey that asks “What is the best system to use?” rather than “What is the least complex system to try to operate?”
Let me jump ahead now. “Physicians realize their sway within the healthcare market, both as practitioners and consumers, and they realize – like their patients — how technological connections enhance their experiences in other areas of their lives (read: paying bills online, online banking, booking appointments with the DMV through a website, purchasing movie tickets through a phone, etc.). This understanding of using technology as a tool is helping them improve and streamline their practices and, ultimately (for the better), engage their patients in care. “
Finally, here we get to the heart of the matter: “Technology by itself won’t improve patient care. Physicians know this – we all know this – and physicians play the key role in providing higher quality of patient care, but using technology as a tool to improve care improves outcomes, according to the physicians and patients I speak with. And, to me, that means improved outcomes equates to improved quality of care.”
“So, it makes sense that the practice of medicine is changing with technology, which calls for an adjustment of its perceptions in the space.”
And, to the tune of Paul Harvey, here’s the rest of the story:
“Because, as more attention flows into the market – with reform and regulation – it’s time to decide where the future of healthcare is going to be. Connection and interoperable features that drive ownership of patient care may be rooted in the patient-centered medical home and accountable-care organizations, but for that, more needs to be done. We have to be able to share data – again, that’s where connectivity comes in — and we’ll have to be able to move records quickly and efficiently, all while trying to remove the shackles from providers attempting to do what they sought the schooling and expertise for: To practice medicine.”
“All of this begins with the electronic record – other tools are essential, too, including patient portals; physician referring portals with the ability for images and notes to be accessed from anywhere there’s a connection; labs; refills and appointments through one interface, a seamless integration between practitioner and patient – is where I think we need to be, so we can move forward with the rest of the marketplace (meaning: banks, media and communication segments). With the value perceived in being able to share and communicate endlessly and with ease socially, we have to reach these heights in the practice of medicine.”
“Technology helps make lives better. Though, as noted above, technology doesn’t make doctors (or people of all kinds, for that matter) better, it just makes it easier for them to do their jobs (and live their lives). It won’t happen overnight, but I can see even better healthcare attained.”
And so, the encore performance may actually be a sign of things to come.