The Best Way to Improve Medication Adherance with Lori McLean, Vice President, Meducation at First Databank

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: Welcome back once again to the outcomes rocket podcast where we chat with today’s most successful and inspiring health leaders. I want to thank you and I welcome you to go to outcomesrocket.health/reviews to rate and review today’s podcastbecause she is an outstanding contributor to health. My distinguished guests today, her name is Lori McLean. She’s Vice President of Meducation with First Data Bank. For the last 20 years Lori has been building businesses internationally across high tech healthcare and cloud solutions. Her proven track record of driving growth and peak performance spans startup and mature environments. Most recently as CEO, Lori led healthcare software startup polyglots from an investment roadshow through to exit providing significant shareholder return with the acquisition of polyglot by First Data Bank where she is now. She continues to provide leadership in developing and delivering solutions to improve medication adherents and health outcomes. Prior to that Lori built the technology and sales alliance of IBM that spanned 92 countries led a Nortel Canada team to grow sixfold in three years and define and drove the business plan for a successful telecoms joint venture in France. There’s no doubt ladies and gentlemen that she is a mover and shaker in health care and without further Do I want to welcome you to the podcast, Lori.

: Thank you so much, Saul. Thank you very much for inviting me.

: Absolutely. So is there anything you want to fill in there that I may have missed from your bio?

: No I think you covered it. Thank you.

: Awesome. Good good. So one of the things that I love hearing from our guests is the why you know why did you decide to get into healthcare care to begin with.

: No kidding. What my role leading polyglot on meducation was was actually my first foray into healthcare. Prior to that before 2009 I was always in technology and cloud applications and things like that. But I actually reached a point where I thought I decided, I decided I wanted what I did to be more meaningful to others. So it kind of poking around and I met the most amazing team on this in this company called polyglots with this really amazing meducation solution that all described later there was just no turning back. There was no looking back. There was no turning away. And honestly since then no working in the healthcare industry where everyone is focused on helping people when they most need help is just an energizing on a constant daily basis and fantastic.

: That’s wonderful, Lori and there’s no doubt you can definitely get that which you search for is just giving and helping those in need. So you dove into this new company. Your first foray into health care and time just zipped right by. What do you think a hot topic should be on every medical leaders agenda today is and how are you guys addressing it?

: As far as I’m concerned the topic that should be number one number two and number three on everybody’s agenda is improving medication adherence. Let me let me quickly explain why. An amazing number of patients failed to adhere to the medication instructions and were just talking about medication instructions not to like medical instructions generally. So medication instructions alone.

: Yes.

: It’s estimated that about 80 percent of patients make an error taking medications.

: Staggering.

: Up to 60 percent stop using the medication before they should. And overall this is huge. About half of half of all patients in the U.S. are non adhering to the medication instructions and the consequences are staggering really as medication nonappearance is the single biggest contributor to avoidable health care costs. It’s estimated that almost 300 me we’ve heard some of that 300 billion with a b dollars in avoidable health care spent every year and medication adherence has been associated or is associated with one hundred twenty five thousand deaths per year. Ten percent of hospitalized patients and almost 23 percent of nursing home conditions. So you just think about some of those numbers think about the cost and our health care system on a per capita basis is not exactly leading the world. And these are the kind of things that just this one single issue that is the biggest contributor to avoidable healthcare costs. And one of the you know the biggest contributors to patients being is here and their medications is just being able to understand their instructions. If you think about the instructions you get when you pick up a prescription at the pharmacy if you’ve had the pleasure of being in a hospital recently and you think of that pack of paper that you’re given when you leave these instructions are not useful. They’re almost always in English. They’re usually written in some Cluj of medical jargon and legally used.

: Yes.

: And they have more to do with you know covering some legal liability than actually helping a patient understand what they must do when they get home. And so what we’ve done and it’s not just me it’s an amazing team that I work with but we’ve developed a software application that produces patient specific medication and instructions and calendars at fifth grade reading level. More than 20 languages but designed to reduce medication errors and improve inherent. These aren’t statically plus things like that. This is your calendar of your medications. You know what you’re supposed to do. Morning noon evening bedtime a little simple grid. This is your instructions. You know you’re taking your by X and for this reason twice a day and your kid is taking it now once today for another reason, another form. These are very very patients specifics so we integrate this application with your pharmacy or hospital or clinic I.T. system and then use the data from the patient’s record to automatically create these instructions and they can be in Swahili, they can be in English, they can be in Russian. Regardless of the language they’ll always be simplified to the fifth grade reading level. You can raise the font for your you know elderly patients that kind of thing. And they’re all created from with in a by a health care provider from within their clinical workflow. So without interrupting what they have to do and the point is is that you know the solution called education has proven to increase medication here and improve health outcomes and reduce hospital admission rates. And so we’re very excited about it. A lot of people using it now and it’s our contribution to trying to address what I think is what I think is the most important issue in healthcare today.

: Wow. That’s great. And there’s no doubt that you’re all in on this project. And listeners. I had a chance to meet with Lori and she showed me how her form looks when the form is given to the patient. It is just a very simple thing to read and to understand. I recently picked up my grandfather from the hospital he was getting a pacemaker. And the nurse walk me through the instructions and I’ll tell you what my head was spinning Lori.

: I know. I know. I mean my mom came out of the hospital and I made her a little you know calendar like this of her meducation calendar for her. She laminated it left right size around around her home. But anyhow she she I mean she at the end of the day she had ended up in a nursing home because she hadn’t taken her meds properly. So it’s not just a language issue. They are sick they may have diminished cognitive function. They’re not you know when we when we speak about our ability to understand these instructions, it’s dynamic. You and I have really great health literacy. The term we use health literacy but you know when you’re sick and you’re half drugged out coming up you know coming out of the hospital you’re concerned you’re worrying about getting home. You don’t have great comprehension you don’t remember all the things that the doctors tell doctors and nurses about. And so yeah you know I don’t think it’s just for just for people with poor reading and in your poor English skills. I think it’s us for everybody for all of us.

: It’s a must and providers. You’re listening to this. What are you doing today to improve your medication adherents? Have you taken a look at all the options that are out there, if you haven’t, I strongly suggest you take a look at what Lori and her team are up to at the end of the podcast here will will provide a link for you to have a place to access and get information about the way the system works and what it can do for you and your patients. Lori maybe you could walk us through some of the ways maybe some of the numbers and stories of how you have improved outcomes with the system.

: So I’ll actually speak about some other things that our clients have done. I haven’t actually funded any studies on my own. I’ve just let my clients sort of build up various you know build the studies and and and various pilots. So university scientists in Philly they did a study where they showed that patients were twice as likely to actually read medication versus standard medication instructions. Ok so lots of not really good enough but it’s Step 1 twice as likely to read. In the same study, they also showed that they had a much better understanding of when to take medication how many times a day that kind of thing. OK. And so improved medication and understanding. But the most important part of this study was that patients were half as likely to miss a dose. So patients that were referring to medication instructions were half as likely to miss a dose of the medication than if they were using the standard stuff that we provide them at the pharmacy in the hospital. So you know real impact on medication adherence and the correlation between medication adherence and health outcomes is irrefutable. There was another study done at the Durham V.A. Medical Center. I’m actually in Durham North Carolina so this is kind of up the street. It is a six month study of that with cardiovascular disease and at three months. So just a single piece of paper just a calendar of their meds was automatically created from there from their patient records in the clinic EHR at three months. There was a 77 percent reduction in these that reporting that they forgot to take their heart med.

: Huge.

: It’s huge. And at six months they were a clinical trend showing decreases in patients blood pressure and body weight. You know but that just is just the P.I. on that study actually is wrapping up a three year study of medication where we’ll actually have it. You have have study results that take us all the way to health outcomes. But we know that relation between how it comes and then between medication adherence and and how come.

: That’s pretty amazing, Lori. You know just thinking through aspect of behavior management you know it’s just so hard to do that and it and you know you guys have kept it so simple with hate. Keep this reading level between fifth and eighth grade make it simple and you’ll see the results. And it sounds like you guys are definitely seeing them.

: Yes that’s right. I’ll tell you. I have to always have to jump in with this one because it might be my one of my proudest moments ever was San Francisco General Hospital. This is a pilot’s disability pilot of education. And they divided a bunch of high risk patients into a control group and a study group. Yes the control group received the standard medication instructions and discharge counseling and then the study group or counseled the pharmacy led study counselors pharmacists using education. So this is really warms my little heart here. 26 percent of the patients that receive the standard instructions were readmitted less than 30 days after they left the hospital 26 percent over a quarter. That’s way too high a number of patients back in the hospital for the same reason they came in for. Okay, so they left the hospital they got sick again less than a month later. Only 8 percent of patients receiving education were readmitted within 30 days. That’s a 70 percent difference in readmission rates. So we know we know we can keep people out of the hospital. We know we can keep them healthy. We know we can have an impact because then it is not just the fact that they were readmitted and you know there’s probably penalties for that. But they stayed out of the healthcare system they stayed at home they took their meds properly they stayed healthy. And that’s that’s our core fundamental overarching objective all the time.

: That’s amazing and just the difference that it made. I mean 8 percent versus 26 percent. That’s huge.

: Imagine if we could propagate that to every health care institution across the country and that that’s what we’re working on.

: Amazing. I love it. And you know as the results keep coming Lori, I have no doubt that you guys will definitely get a foothold of the entire hospital system in the United States. And so when you guys you know it really helped see the way that it’s laid out would you be able to share a snippet of that for the listeners so we could include in the show notes?

: Oh yes absolutely. Absolutely.

: Awesome. Will Make sure to do that. And so you took us down one of your proudest moments. Lori, I feel like oftentimes we learn more from our setbacks and failures can you take us through a time when you had a set back and what you learned from it?

: You know I always think my biggest mistake was not living with was more personal and professional. I was something my biggest mistake was not moving into health care sooner. What the jump don’t fall spell and to help there there. But to your question rather than dodging your question you are completely underestimated the effort and well actually the imperative of integrating with charts. I knew it was going to be important that education be accessible from by you know by healthcare providers, clinicians, nurses, pharmacists from within their workflow that you know we just needed to look like we were part of the epic or the stirner or the paragon or the sunrise or whatever Cerner McKesson you know system. And so I just didn’t recognize you know maybe how important that was and how much work it would be. And now we’re there that probably cost a year probably cost me a year in speed to market but I don’t know how much I’ve probably got to save myself a year if I buy recognized and addressed it more quickly. But the marketplace has also changed a lot. All those names I mentioned are now you know many of them are opening up and making it a lot easier for third party applications like like meducation to integrate. Now you know we’re integrated with Cerner really nice when they’re epic paragon. We used to be the Kesten paragon of scrypt sunrise, clinical works, Athena. And you know we have and others tha’s now just basically looks almost like a feature from within those good organizations I.T. systems which is really makes all the difference in the world to people who are wanting to use it. And you know counting clicks things like that you get to what you click. You’ve won the game.

: That’s awesome. And listeners just a note to take here from Lori’s story. Lori, thank you for sharing that. She could have saved a year and now the market is changing so it’s a testament to how fast things can move. But also how slow they can move and how planning ahead can help you really save time and get to market faster. You shared an amazing story there, Lori. Tell us about an exciting project that you’re working on today.

: Oh gosh. Well we’re you know told you that some of the outcomes that had attempted a general hospital. Right now most of what we do with meducation relies on a health care provider to generate the materials and make them education instructions. Part of that discharge instruction package or make it make medication. The piece of paper that you’re given when medication is dispensed from the pharmacy or whatever. So we’re building out now patients facing application don’t think about a medication reminder app there’s dozens of them out there. But we’re talking because we because of our success integrating with Epic’s, Cerner, McKesson, scripts, you know Athena, etc. We have the ability to pay for a patient’s medication or agent information the medication information and other information from their health care record. So you know it’s traditionally been very difficult to get your own healthcare data out of your healthcare providers I.T. system you know they hide behind the hipper requirements and all the rest of that stuff there’s lots of good reasons why it’s difficult there’s a lot of lousy reasons was difficult and now we have the ability because of our relationship having overcome my my little stumble there with the relationship we have with these folks. Then there’s we can now pull a patient’s information out of their health care record and provide it to them so that they can will present it to them in the form of a very patient friendly application where they can see their med list either instructions massage it share their healthcare data, their healthcare habits with their other providers with their family caregivers. But we’re going to what I’m most excited about is getting control of that data into the hands of patients and that I think is the next phase of what we’re going to be doing health care industry is frankly evolving so fast.

: That’s really cool, Lori. And as we as we dive into the next phase of interoperability we’ve got some deadlines coming up looks like 2019. They push that by year to make these things open. So it’s pretty exciting that you guys are already working on it and just that so think about the power of being able to share that information. You’re on vacation and you need to see the doctor. I’ll just pull out your app and you’re able to show exactly what you’re doing.

: Exactly exactly. Incredibly powerful and you know they have to be can be so much more social ability to share it with parents to share it with their kids, their family caregivers, for parents to you know well seem to be dealing with aging parents right now. And so we want to be able to share those things and not have this onerous permission system that you know really share my data with my husband I think it took me a rewind to me it took me a lot of time and effort to be able to share data just between husband-wife. I mean you know they were all becoming so much more social. Now the other aspect.

: Wow yeah that’s really interesting. Glad you guys are working on that. You guys know how to stay ahead of the curve. So let’s pretend you and I are building a medical leadership course, Lori and what it takes to be successful in medicine today. It’s the 1 0 1 or the ABCs of Lori McLean. And so I’ve got four questions lightning round style and then followed by a book and a podcast that you recommend to the listeners. You ready.

: OK good.

: All right. What’s the best way to improve health outcomes?

: I’ve said it before improved medication inherence. It is the single biggest contributor to avoidable health care costs in this country which means this is where we have the greatest opportunity to improve our patients health.

: What is the biggest mistake or a pitfall to avoid?

: Avoid assuming that patients are like you or us. We and our friends are college educated. We read English very well so we’re extremely healthcare literate okay but 44 million adults in this country read below the 8th grade reading level. Another 22 million adults are limited English proficient and we have a growing elderly population with vision challenges and sometimes diminished cognitive function. It’s just one in three Americans and people in the U.S. has called low health literacy and it’s so it’s much too easy for us to forget that a vast portion of our country and our patients are not as fortunate as us. They’re not as educated as us. They’re not health literate as us.

: That’s powerful.

: That’s what we need to avoid.

: It’s powerful. How do we stay relevant in healthcare despite constant change?

: Listen to customers. I think it is not just is not enough specific to healthcare customers are the very very best means to prioritize your development, choices or opportunities. They’re the best means to prioritize everything you do.

: What’s one area of focus should drive everything in health?

: Improving healthcare through understanding everything we do here at meducation is about overcoming low health literacy to try to improve medication adherence and then I won’t repeat all the follow on. We know the staggering consequences that could be staggering negative right now and could be staggeringly positive if we fix this issue.

: That’s awesome. And Laurie what would you say a book and a podcast that you recommend to the listeners?

: The toughest question you ask. Probably the most influential nonfiction book that I’ve read in the last was probably Thinking fast, thinking slow by David Kahneman and really just rereading that frequently and it is the most enjoyable fiction recently I was in the last year or two is probably up late. We cannot see the empty meter.

: Very cool. Very cool I love it. So listeners you’ll be able to find these resources at outcomesrocket.health/meducation. Lori, did you have a podcast that you want to recommend?

: I don’t. I read a lot of audio books but I’m not a podcast person.

: And you go well it’s all good. It’s one of the reasons we ask the question and just want to spread the podcast love Lori so at least outcomes rocket…

: Recommend one for me.

: I just published an article about the eight most amazing podcasts in healthcare.

: Really?

: Yeah yeah. So I will go ahead and send you that Laurie and also included in the show notes which I think you’ll enjoy very much.

: Thank you so much. That’s great.

: Absolutely. Lory, this has been a ton of fun. I wish we could keep talking but we’ve got the 30 minute mark there so I love if you could just conclude by sharing a closing thought and then the best place where the listeners can get in touch with you or follow you.

: Well I really, you share my interest in improving health care and by improving medication adherence and will probably put these Mashona well but I can be reached at lmclean@sdbhealth.com or 9 1 9 6 5 3 4 3 8 7. And this is the. There’s no silver bullet out there. This is an ecosystem and the multifactorial way please. We all work together to achieve this.

: Lori, it’s been awesome. Listeners. She shared her best way to contact her. Here’s a willing leader in health that wants to contribute to improve Haitian adherents with the use of take are up on it and see what happens. So and solaria just want to say thank you again for making time to be with us and looking forward to staying in touch.

: Thank you so much for having me, Saul.

Thanks for tuning into the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don’t forget to check out the amazing Healthcare Thinkathon where we could get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is implementation is innovation. Just go to outcomesrocket.health/conference that’s outcomesrocket.health/conference be one of the 200 that will participate. Looking forward to seeing you there.

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