Outcomes Rocket_Dr. Tate Erlinger: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Saul Marquez:
Hey everybody, Saul Marquez here, and welcome back to the Outcomes Rocket. Appreciate you tuning in. Today, I have a special treat for you. We have the amazing Dr. Tate Erlinger. He trained in internal medicine at the University of Chicago Pritzker School of Medicine and completed a fellowship in clinical research at Johns Hopkins School of Medicine. He also completed a master’s in public health at the Johns Hopkins Bloomberg School of Public Health. Dr. Erlinger has authored or co-authored several peer-reviewed publications and book chapters and has worked in a variety of leadership roles in health care informatics and clinical analytics, including large provider organizations, public health, and commercial clinical solutions. He currently serves as Vice President of Clinical Analytics at Elsevier Clinical Solutions, and we’re going to be touching on a lot of the hot buttons and topics that are affecting today’s clinicians as well as health systems. So, super privileged to have you here on the podcast today Dr. Erlinger. Thanks for joining us.
Dr. Tate Erlinger:
Oh, thanks, Saul. It’s a pleasure to be with you.
Saul Marquez:
So, you know, one of the things that, that we love to cover before getting into the main show is really what makes the health leaders in our industry tick. So specifically to you, what inspires your work in health care?
Dr. Tate Erlinger:
I think for me, I chose to go into healthcare without any direct family knowledge of it. So there’s no one in my family who was in healthcare and went in for, I think, what amounts to a simple but common reason. I went into healthcare to try to help people, and it was the most direct way to do that. And I also enjoyed the science behind it. So I enjoyed what I was learning and what I saw of medicine, which was not firsthand necessarily all the time, thank goodness, I was usually healthy as a kid.
Saul Marquez:
Yeah, for sure. Yeah. You know and so, as we, and it’s interesting, right? I mean, in the field, a lot of physicians like yourself have found ways to scale the impact that you make, and so you made that move several times in your career, and today you’re with Elsevier. I’d love to hear more about what the company is doing to add value to the healthcare ecosystem.
Dr. Tate Erlinger:
Yeah, so that’s correct. I went into medicine really with the intention of really staying in direct clinical practice, but as I went through, I started to be exposed to aspects of healthcare that I, or medicine in general that I just wasn’t aware of when I first started the journey, and that included being exposed to researchers who were doing outcomes research, which was really appealing to me. So I studied clinical research methods and practiced, and did that for the first half of my career, really. And I was familiar with Elsevier at that time from the publication’s point of view, from the journals and books that they would produce. And as I went along in my career because I had learned some analytics methods with biostatistics and epidemiology in my research career, and what was happening in parallel was, we were transitioning off of paper into a digital information system, essentially, electronic health records. And with that evolution came an increasing focus and attention to the kind of data and analytics that could be derived from those systems, so, so from that transition. And, so I got pulled along in, in the course of the evolution of that because I had a strange skillset relative to a lot of providers. I had training in biostatistics and epidemiology and methods, and so forth. So, as that evolution was occurring, there was an increased focus on data, data quality, data acquisition, data management, and all of that sort of came along in parallel with my career trajectory, so I ended up getting pulled into different areas that I thought were interesting. And simultaneously, I think Elsevier was transitioning itself from a publication company that was historically books and journals and peer-review and print publications to also changing to digital formats, to changing to adding clinical solutions and content and also layering on top of that, analytics. And so I think we are, where you see companies like Elsevier, but Elsevier specifically moving, is in part, is in taking that information that was contained in text and journals or summary statements like pathways and putting those into the workflow of clinicians. And we call that work clinical decision support broadly, but it’s basically taking the massive information that’s available out there and too much for any one person to consume or master in an instantaneous way and trying to make that information available on-demand to help with decision making or help with education or to help with training and so forth. So I think there’s been, those are kind of two parallel tracks that both the company and I were on, sort of independently.
Saul Marquez:
Yeah. Yeah. And that’s, you know, that, empowering clinicians is key, and helping them do it in a way that is sort of like invisible, is even more key, because they already have to deal with the EHR and everything else.
Dr. Tate Erlinger:
Yeah. And there’s been a lot of changes in health care, but one of the changes that started many, many years ago, I mean, several decades ago was sort of increasing the number of patients you’re seeing. So actually decreasing the time that you have with each patient, so it can be challenging to have a human relationship and conversation in a clinical setting, as most people know. But it becomes even more complicated when you’re distracted, when your attention is not focused. It’s like talking to someone who’s on their phone all the time, it’s a bit annoying for everybody.
Saul Marquez:
It is.
Dr. Tate Erlinger:
And so…
Saul Marquez:
Like, are you paying attention?
Dr. Tate Erlinger:
Right. And I don’t think that’s the choice that physicians want, wanted initially. There are advantages to the digital world, of course, but we also have to find ways to establish and maintain relationships over time, which is basically what the patient-doctor relationship is, is it’s, it’s a long-term, typically, relationship, at least with primary care.
Saul Marquez:
Yep. Yeah. No, that’s great. And so there’s, there’s a report, the Clinician of the Future Report. I’m fascinated by this, and I think that maybe this is a good opportunity to talk about that, Dr. Erlinger? Tell us what that is, I was shocked when I heard about this and I was like, we got to, we’ve got to have a conversation.
Dr. Tate Erlinger:
Yeah. So this was a report that was put out after, I’m going to summarize the method very briefly, but it was a series of surveys and interviews in the US, China, so it was, and in Europe, and it was intended to be a broad slice of healthcare. So healthcare leaders but also workers. And it was compiled into a large report. And I think some of it was, clearly, we were seeing signals of these things clearly prior to COVID. This was done during COVID, and so it certainly raised the issue, in my mind at least, whether some of the trends that we were seeing got accelerated or amplified during COVID, which was a stressful time for both patients, but also the health care system and health care workers. And so some, you know, there are some interesting findings in there, but they’re not unique to COVID. They may have been somewhat amplified to some extent. It’s hard to know, but if we continue to do this survey in the future, it will be interesting to see the trend. But you’re right, there were some very dramatic numbers in there, like a large turnover in the health care workforce or plan turnover, in both physicians and nurses, the feeling of the importance of technology, but also the disruption of technology in that relationship sense, and also the need for empathy, obviously, in a clinical situation, but challenges, challenges achieving that, when you have … Coming into that visit, or to that encounter.
Saul Marquez:
Yeah, the numbers are staggering. And it’s sad, it’s sad. A lot of these people, hats off to everybody that’s listening that is a clinician. Thank you for what you did and continue to do, for, to help us through this terrible pandemic, which feels like we’re on the other side of, but the battle still continues. Now everybody’s overloaded. And so what are your thoughts on that, Dr. Erlinger, around what can we do different or better around that? Does the research suggest any solutions?
Dr. Tate Erlinger:
Yeah, I think that, I think it primarily points to a call to action. In other words, I don’t think that the report was necessarily highlighting a specific solution, but it sort of hinted at different possible avenues. So, for example, one of the things that was highlighted was as medicine becomes more digital, so let’s take an example like telehealth. Telehealth was clearly very useful during COVID. It allowed for, I mean, I still see patients and I see patients who are largely in an underserved population. And that was critical for them because transportation to and from clinic is a major, major issue with or without COVID. And so having telehealth capabilities was a huge help. However, there was also some indications in the report that that interfered with sort of the ability to convey empathy or the ability to have a longer, more meaningful relationship. And that’s certainly true, I think most people can relate to the difference between, you know, online meetings versus in-person meetings. There’s certainly a role for it, though. So I don’t think the issue necessarily has to be all telehealth or no telehealth. I think it’s an issue of the timing and integration of things, but with an eye towards sustaining that relationship over time. And…
Saul Marquez:
Yes.
Dr. Tate Erlinger:
And having people feel heard and having physicians being able to focus and to concentrate, that’s one example. Another thing that came out in the, that you just mentioned, Saul, was the high turnover rate. So there is something like, many, high proportion. So maybe half of clinicians in general, I’m sort of summarizing some numbers here, anticipate either leaving, or soon, meaning immediately or in the very near future, direct patient care, that’s alarming.
Saul Marquez:
Yeah.
Dr. Tate Erlinger:
But that leads to is, it leads to not just shortages, but it leads to, that kind of scarcity leads to patterns of like traveling nurses, where you have to tap into temporary workforce or you have to tap in, all of which sort of has a compounding effect. What is the answer? I don’t know that I have a direct answer to that, but one of the indications, an answer, is to try to do, as you said at the outset of this, how can we improve that relationship? How do we improve information flow without disturbing, without interfering with the clinician workflow? How do we educate from the very beginning, pre-med all the way through med school, onward? How do we educate and train clinicians of the future on technology, on how technology, how some of this technology works, which can be quite complicated, but how they relate to it? How does it factor into their daily, daily activities? And that’s a challenge because it isn’t like learning a single software system. It’s like learning an ever-changing system, so it is changing. There’s always modifications going on and each of those modifications advances standardized care, but, or is an attempt to do that. But it also is disruptive in a complex, complex workflow like health care. And health care is complex because so many people are involved with that interaction. It’s not just the patient or the doctor, it’s the patient and many doctors and nurses and pharmacists and support staff and case management, etc. So it’s not one person really. There’s the physician who might be guiding the care, but there are many, many individuals. If you go to just a routine clinic visit that will come in contact with the patient, they’re all working in these systems. So it’s not just the EHR either. Just to make one last point, it’s advances in technology within your field. So, advances in surgical materials, surgical approaches, robotic approaches, there’s just a myriad of technical advances occurring in healthcare at any given moment. And that’s tough to keep track of and to live inside. And so we have to sort of figure out how to expose and train early on in the health care journey so that there’s some level of comfort and there’s some level of feedback so that vendors who are producing these innovations can understand how to modify them.
Saul Marquez:
Yeah, very well said, Dr. Erlinger. And you know, you mentioned adaptability. And I’ll tell you, you know, that is such a keyword in this environment. And, you know, I heard this actually last weekend, it’s critical that to have success, you have IQ, but it’s also critical to have EQ. The thing that we don’t talk about too much is AQ, what is your adaptability quotient? And I think that’s something that needs to be measured, that’s something that needs to be trained, that’s something that needs to be talked about to your point, right? Because if we’re going to have success and be resilient, that one’s key. And so on that point, we talk about setbacks here. You know, one of the key things we talk about is, hey, what challenges have you had? And so curious about, you know, what, what’s the biggest setback you’ve run into and what key learning came out of that.
Dr. Tate Erlinger:
Setback, you mean, so, in terms of adaptability?
Saul Marquez:
Yeah. Yeah. I mean, you know, I mean, that’s the theme here. Could be anything. Yeah.
Dr. Tate Erlinger:
Yeah, I think the yeah. You’re hitting a very fundamental point in health care but in probably any field but it’s your ability to deal with change and to adapt to change, to give feedback along the way. So one thing about health care is at least four physicians where, that were trained in my era, and I think today still, there, there’s a high emphasis on physician autonomy. There’s a high emphasis on physician decision-making. And what we’ve seen is, over the years is, as we’ve transitioned from fee for service, so pay, payment for volume of patients and services provided to payment for quality. So there are, there are many efforts that have been going on for quite a while now, but are still being worked into health care at a large scale. There’s just a continuing shift towards quality. Well, what that does is that sounds wonderful, but that quality has to be measured. For something to be measured, there has to be data put into some system in order for it to be there, to be a calculation of some sort. And there’s a feeling that a lot of that was impinging on autonomy. It was second-guessing, a complex clinical choice. And you’re making a global assumption about quality from the few metrics that many people thought, well, this doesn’t even represent true quality, it’s just what you can measure. It doesn’t necessarily mean that is quality.
Saul Marquez:
Right.
Dr. Tate Erlinger:
And so I think one of the hardest things to adapt to continually is, I’m using quality as an example, but it’s where does autonomy fit in, to the paradigm, how much will be dictated from some other entity or from, and then how does that get judged or looked at? So there’s been an increasing focus on, because of the quality movement, which, by the way, I fully support, but we have to figure out how to do that in a way that’s fair, less about punishment, more about moving to something, more about going to something rather than going away from something. And so I think that’s been one challenge. I do remember early on, there’s been lots of challenges of, and this is a challenge, not in a bad way. This is actually a good challenge when, as the Internet was coming up and more and more information was being put online about drugs, medications, tests, you know, so forth, patients started to come in with printouts. And this was in the nineties, early, early 2000, people would come in with, people started coming in more and more and more. And it was this interesting tidal wave of a more informed patient, which was refreshing on one hand and challenging on another, because you’re in the moment having to respond to something that you may not have seen or that you, and you don’t know the source of the information. You’re not sure really what you’re responding to other than the person has a concern about this and they read it online. And, you know, those are, to me, that’s a good, healthy interaction to have. But it is challenging.
Saul Marquez:
Yeah.
Dr. Tate Erlinger:
It is, it is sometimes challenging, but that’s challenging in a good way. That’s, that to me is the patient taking charge of their own health care, and it’s part of the relationship. It’s just part of the relationship.
Saul Marquez:
Yeah. Great, great examples there. I appreciate that. You know, and so as the challenges come, we got to figure out ways to tackle them. What would you say is a healthcare trend or technology that’s going to change healthcare as we know it today?
Dr. Tate Erlinger:
I think one broad way to conceive of, what I think, and this is just my opinion…
Saul Marquez:
Yeah.
Dr. Tate Erlinger:
So I am old enough to have practiced when things were on paper and where the only thing on the computer was maybe lab results that we could go log in and get lab results. But everything else was on paper and we were all waiting for the charts to be free so we could document and somebody else had it … And so that was the challenge there, but of course, now lots of people can look at the chart at the same time, lots of caregivers can look at the chart at the same time if that’s no longer an issue. But at the time we were pretty mobile. So in other words, you would stop to write a note, but otherwise, medicine, you’re always moving. You’re moving from room to room. If you’re in the hospital, you’re walking from room, floor to floor, and it was a very mobile profession. And with the evolution of electronic health worker, records, what happened is we got tethered. And initially we were tethered to a monitor on a desk because there wasn’t iPads, there weren’t smartphones of this caliber. So we went through a process of being sort of somewhat roaming around doing your work to suddenly having to tether yourself to a monitor, and that became the thing that you, that became the real estate, not the chart anymore, but the actual chair and the monitor became something. And what we’ve seen is there’s a gradual untethering again, so there’s a movement towards mobility. I always think that the future, that I want anyway, is to walk into a room and be able, just like on Star Trek, to just say Computer and have the computer kind of like Alexa, but have the computer there to assist, but otherwise, be invisible, right? So the relationship persists. Now, we’re not quite there in terms of voice recognition and in terms of natural language processing, especially in healthcare, but we’re making strides. And so I kind of see this world in the future of, increasing focus on removing the appearance of technology from the relationship but having the technology being of assistance. So if I need to know the latest treatment for type two diabetes in a certain scenario, that’s easily accessible to me at the point of care, but it doesn’t take me 20 minutes to find it.
Saul Marquez:
Yeah. Yeah. You know, and actually, on that topic. I’m curious, you know, what Microsoft will do with their acquisition of Nuance scaling that to provide that sort of environment for you guys.
Dr. Tate Erlinger:
Yeah. There’s a lot of activity in this space and of course in the general public, things like Echo and Alexa, you know, all of these things are out there. I know, you know, and, they’re being trialled and sampled, I’m sure, in clinical settings. And so I think we’re going to continue to see that and I think we’re going to continue to see the evolution of that technology. But my hope is that that, that kind of evolution, that kind of sort of puts technology very present in the world, but not visible. Not, not, I’m not talking to you while I’m typing.
Saul Marquez:
Totally.
Dr. Tate Erlinger:
That would be a great, that would be a good Christmas present for a lot of us.
Saul Marquez:
All right, by this December.
Dr. Tate Erlinger:
Right, right, right.
Saul Marquez:
Let’s get it done. No, this was great. Fantastic conversation. Very insightful. You know, so this report, obviously, folks, you’ll have a chance to access it. We’ll leave a link to it in the show notes. But what closing thoughts would you leave us with, and what’s the best place the listeners could connect with you? Follow you, the work that you guys do at Elsevier?
Dr. Tate Erlinger:
Yeah, I think for the latter. I think there’s the website, obviously, and LinkedIn are probably the best ways to connect to the business. There are, and my personal LinkedIn is out there as well. In terms of the sort of closing thoughts, I feel like one thing I don’t want to leave the listener with is a sense of gloom and doom or negativity. So healthcare has always gone through ups and downs and challenges, and it will always be there and we will always evolve. I think what I would love to leave the audience with, is sort of, yeah, these are real challenges, you know, but they’re are challenges that you can participate in, and it’s a really rewarding profession despite those challenges. Every profession has challenges, but there’s very few, there are just very few professions where you have the ability to be with people in their most critical good times and bad times. And it’s, and it’s unique. So I don’t want people to walk away, even though this report has some calls to action in it, I think that’s, that’s a call to participate. You know, that’s a call.
Saul Marquez:
I agree.
Dr. Tate Erlinger:
To share and a solution. So, so that’s what I would like to just leave the group with.
Saul Marquez:
Well, that’s a great call to action. And also closing thought, Dr. Erlinger, just want to thank you for spending time with us today. Certainly excited to dig in deeper with this report, but also the work that Elsevier is doing. So, folks, make sure you check out the show notes, stay engaged. Elsevier is doing some fantastic work along with Dr. Erlinger and his team. Can’t thank you enough, Dr. Erlinger. Appreciate you joining us.
Dr. Tate Erlinger:
Thanks Saul. It’s been a real pleasure.
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