Boosting an organization’s healthcare communication and interoperability
Best Way to Contact Justin:
justin@caremesh.com
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A New Era of Healthcare Communication with Justin Sims, President at careMESH was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.
Saul Marquez:
Welcome back to the Outcomes Rocket today. I have the pleasure of hosting Justin Sims. He’s the co-founder, president and COO of careMESH. He spent the first half of his career in the communications industry and ended up as President of AT&T Global Services, which was AT&T International Division with 4000 people spread across 46 countries. Then he jumped ship to health technology business 15 years ago and has been innovating in this space ever since. He was the CEO of Voxiva and led the transition of the company from a developing world focused disease surveillance company to a consumer focused digital health company launching products like Text for Baby, a mobile service supporting over one million pregnant moms, and Text to Quit a program that helped nearly one third of a million people quit smoking. Now at careMESH, he’s focused on making it easy for clinical staff to communicate and share patient information with each other digitally. With his background in the consumer facing side and his experience as president of AT&T and other firms on the consumer facing side, I think that he’s positioned to do just this. Justin, welcome.
Justin Sims:
Well, thank you very much for asking me to participate in this. You know, I think you nailed the bios, so why don’t we just dive in?
Saul Marquez:
I love it. It sounds like a great plan. Justin, so what is it that got you interested in health care?
Justin Sims:
Well, I kind of stumbled in it I guess. It was between high school and university that I found myself in a summer job working in a hospital. I completely loved my time there it was fascinating. I was the job title was Ward Orderly. But I think in America, the janitor, I just loved working in the environment, find it exhilarating, exciting. And at that moment in time, I decided I want to become a doctor. Unfortunately, organic organic chemistry didn’t love me as much as I thought I loved the profession. And I completed. I wasn’t smart enough to become a doctor. So I ended up going into business and spent many years in the communications industry, largely helping businesses organizations in the rush towards digitization. In fact, you know, every sector was focusing massively on digitization except really health care. And I couldn’t at the time understand how an industry that was, I guess so rich in science and technology was so poor and backward, even in information technology. So, you know, I kind of I was fascinated by health care. I wanted to be part of changing that issue. And when I was offered a job back in 2005 running a a disease surveillance company, I jumped at the chance and have been working in this really exciting, invigorating area ever since.
Saul Marquez:
That’s brilliant. And yeah. You know, it’s there’s a lot of talents that are being employed by the health care economy. And running a business is tough. And so, you know, I feel you on the organic chemistry.
Justin Sims:
I think has killed a lot of aspirations of people in healthcare for many decades.
Saul Marquez:
Yeah, but you know what, though? At the same time, there’s a lot of challenges, a lot of real business challenges that need the right minds on them. You’ve done a great job Justin on and really the the work that you’ve done in your previous companies. But now I careMESH, you guys are doing something very unique, very different than I think a lot of the listeners working in these health care environments could benefit from. So tell us what you think is that hot topic that needs to be on leaders agendas and how are you guys approaching it?
Justin Sims:
Well, I’m not going to talk in in medical or health care mumbo jumbo terms. Really, really simply. Twenty years after every other industry turn to digital communications, it’s time to do the same in the United State health, United States health care industry. When you just step back and look at it in simple terms, coordinating care of patients by paper, fax and phone calls is just grossly inefficient. And I think I may be wrong on this, but I think it contributes to the burn out that we hear all of the time from doctors. It certainly contributes to medical errors and waste. The fact that this coordination of patient care is is just so human intensive and there’s so little reliance on on technology to support. And the truth is, there’s really no excuse for that. Everyone now has EHR. They have computers and mobile devices. Over the last five to 10 years, we’ve come a long way in terms of standards. So patient records can be exported from EHRs these formats called CCDAs and and over the last few years, three or four years, there’s been this big move towards the five basic standards so that there really isn’t an excuse now for us to be continuing to rely on paper and fax and phone calls. And for the record, it’s been largely abolished, this inefficient form of communication in other in other countries. If you take my home country, the United Kingdom, the NHS rolled out a system called NHS net about five or six or seven years ago and everyone’s on it. Doctors communicate with each other freely across a secure messaging platform called NHS Net. And in fact, earlier this year, the NHS announced that it was banning the purchase of fax machines in the NHS.
Saul Marquez:
Is that right?
Justin Sims:
And it is absolutely right. And they set another goal, which is to abolish the use of fax in the NHS by the thirty first of March next year, seven months away. Can you imagine abolishing the use of fax in the United States health care industry with such a short focus? But it can be done and we in careMESH are really focused on helping that communications revolution take place. Moving people onto digital communications, helping them find each other through our national provider directory. And then just giving them the simple means to communicate, exchange patient records. Do things in a in a way in which all other industries have have migrated towards over the last couple of decades.
Saul Marquez:
Well, I think that’s an impeccable opportunity to do this. I mean, by the way, when you said abolish fax machines, I could just you know, while this isn’t live, I could hear all the listeners just cheer.
Justin Sims:
I’m like, I’m not sure I would say all the listeners, because fax is a really important part of practice workflows. And in a way, I think it’s all about figuring out how to wean people off the fax machine on digital communications. And what the NHS has done to some extent, I think is a bit of a shock, southern shock for people. And there needs to be a migration path. But yeah, eventually. I mean, can you imagine in 10 years time people listening to this podcast and thinking, did people really use faxes 10 years ago in the US health care industry? It’s obviously a mainstay of the industry right now.
Saul Marquez:
That’s a good call out. Justin, thanks for level setting there. And I think it’s I mean, I can envision that future. You know, it’s from patients to to providers to payers. The efficiencies that could be gained could be really enormous to outcomes. And also bottom line. So I’d love if you could share with the listeners how this is currently working and what types of improvements you guys have seen by employing these systems.
Justin Sims:
Yeah. Well, what if I told you that the technology existed right now to let any EHR user fire up the messaging system that forms part of any modern EHR system, such a directory that contains information on every single doctor in the country, plus three or four million other people who just happened to be registered in that directory that a clinical staff and send them a message. That message could be a referral or a discharge summary. They could attach a beautifully formatted patient record. And, you know, in the US, one thing that is is challenging is moving big images around die come in images. They could just attach that to this person to person message that they’re composing. And then what have I would tell you that at the receiving end, that message would arrive. According to the recipient’s preferences, perhaps it would go directly into their own EHR messaging system. A lot of doctors don’t want that. A lot of doctors don’t utilize that component of their EHR.. So instead, they might choose to have it routed into a secure mailbox, monitored by their assistants or into an app on their iPhone or Android device. And then when they actually go ahead and open the message that they’ve been sent, that includes a patient record attachment. What did that patient record attachment was like, something they’d never seen before in terms of EHR technology. It wasn’t just tables and greets of data that they had to wait through, but instead it put the most important information at the top of the screen. It let them search the record using Google style searches. It presented data in a familiar format. Well, doctors are trained when they go through med school and nurses as well to write down CBC complete blood count or the metabolic panel using these things called Fishbone diagrams. It’s basically just shorthand for writing down results. What if the information was presented that way? And this would basically mean if if that technology which exists today was implemented, a sender would never have to feel guilty for not sending a transition of care for one of their patients when they’re discharged from hospital, for example. And they wouldn’t have to scurry around looking for fax numbers to send information to. They wouldn’t need to worry about if they were using the direct secure messaging protocol or secure e-mail protocol. That is in use. And in some parts of the U.S. industry, they wouldn’t need to worry about whether or not it was actually received or read by the recipient. And then the CIO who’s worrying about, for example, whether they’re meeting that promoting interoperability targets for digital transactions like referrals and transitions and care, that they were able to just fire up a report and actually see that everything was flowing digitally. And all of this exists today, some from from our perspective, it’s actually not hard to integrate and implement into any EHR workflow. It can be done quickly. In fact, if I give you a real, really specific example, last December, we got a call from a provider group that was really struggling to hit its promoting interoperability target for referrals. And it was December. The year was coming to an end. The reporting period was coming to an end. And they told us we’ve got 20 days to deliver 80 percent of our referrals digitally. And they’d been achieving about 13 percent. And so we we rushed in. We implemented our solution and we hit 87 percent of referrals sent in that 20 day period digitally. So it doesn’t have to be a heavy lift. It can be done quickly without extraordinary investment by customers. And it can really improve quite dramatically the efficiency within a practice.
Saul Marquez:
So, Justin, I mean, this is this is great. I mean, the ability to communicate digitally is a wonderful thing. Why do you think there’s been such a chokehold on being able to get it done?
Justin Sims:
Well, I think there are many reasons and to some extent I hinted at one of them earlier, clinical practices are difficult to change when you have clinical practices that are based upon paper based workflows. And then, yeah, there’s going to be resistance to that. I think another reason that has been hard to change is that there’s been this belief that the solution to this challenge or problem is already here. So it’s called direct secure email. The challenge would direct is only about half of doctors have it. And truthfully, only about 10 percent of those doctors actually know they have it, know they have a capability to deliver mass messages electronically. And then there’s this absence of of a directory, the ability for people to find the person that they want to communicate with and then communicate with them regardless of whether or not they have an established form of digital communications. Everyone wants a solution that solves the 100 percent of the problem, not 37 percent of the problem. People wrong to use their EHR messengers too, naturally to communicate with people in the outside world. If they can only do it 37 percent of the time when they know that they can do it 100 percent of the time through fax. So I think those are some of the contributory factors.
Saul Marquez:
I’m really I’m really curious about this. And thank you for that. I appreciate the the the lay of the land, so to speak, to understand the problem and why it hasn’t been done makes a ton of sense. Let’s let’s hone in to the national provider directory, because that seems like a like a huge opportunity to enable the communication.
Justin Sims:
Yeah, absolutely. I again, I I’m going to go back to the NHS example in the U.K. when when they laid out that communication strategy, this move to digitization, they realized that they needed a directory. People weren’t going to find each other by calling about sending them a fax, saying, can you please send me your electronic information, they needed that directory. In the US, there is no natural hub for a provider directory. And and so there are many organizations that create their own. In fact, pretty much everyone creates their own directory. What we’ve done is we’ve pulled information together from all of the official sources, from NPI, from PCOS which is physician compare CNS database, from state medical boards, from hospitals and provider groups. We’ve pulled all of that information into our directory. We’ve then transformed it. We’ve turned everything into fire records and and then we’ve put in place a mechanism to constantly keep that information up to date. So this is a directory that thousands of times a day actually ends up getting updated by one of the data feeds. The importance of fire can’t be understated because it’s based on the fire standard. It means it can be integrated with already quite a few EHRs that have implemented that standard for they put their own directories. And it also means that we can offer the directory as a service, not just as a dump of data. In other words, the EHR or the web application that is reliant on that directory doesn’t need to download the data or the entire database. They can query our system through a fire query, find the practitioner information, pull it down as a standard fire record and then consume and use it. So so the directory is a really important component of what we do and how to solve this communications challenge.
Saul Marquez:
That’s fascinating. And I definitely see the value of of that because if you don’t have the person who you’re going to send it to. What’s the point? And the user. But I guess the user rates of the secure email, I did not know they were so low.
Justin Sims:
Oh, well, if you look at some of the data that comes out of some of the industry bodies, you’d think that everyone was using direct, secure messaging all day long. A large amount of the messages that are sent through direct are really machine to person. There are several related messages to inform a doctor thee’s some new lab results or prescription information or ADTs. And that isn’t really what the original vision behind direct was. The original vision behind Direct was a person to person communication platform. And for that you need a real, really powerful way of connecting people and filling in the gaps where someone doesn’t have direct making sure that the sender can still use the messaging interface that they used to utilize.
Saul Marquez:
So, Justin, so just understanding this a little bit deeper, does it matter if, for instance, you know, somebody is on Epic or Cerner or maybe there are, you know, a private practice that’s on a smaller EHR. How does that work if the charge is different?
Justin Sims:
Well, so the most important thing to understand is that for the sender, we make the experience completely invisible to them. For the sender, instead of going into that EHR messenger, looking up in a directory and trying to find somebody, and they and they have very few practitioners listed in that directory from the outside world, suddenly they see nearly five million practitioners in the directory. They can select depression practitioner and send. If the individual at the receiving end has a direct messenger, then of course will deliver the message through through direct. If they don’t, we’ll deliver it another way. In 100 percent of the cases will ensure that we create a digital version of the communication that the recipient can access and access free of charge even if we have to inform them. There I say it by fax the patient record waiting for them to be retrieved.
Saul Marquez:
Fascinating. Fascinating. Wow. So. So, you know, it just it’s pretty interesting stuff that you guys are up to the magic behind the scenes that makes it all work as something that if you’re a provider, you don’t have to worry about it because you careMESH is doing this. If you guys remember a little over almost two years ago, we had Dr. Tippett on the podcast. We dove deep into this. And two years later, we’re revisiting this with Justin because it is just I mean that the progress that has been made by careMESH is impressive. And so really want to give you and the team over there, Justin, some huge kudos for for the for the massive improvements you made and such a little time.
Justin Sims:
Well, I appreciate that. You know, two years ago, it was it was very much an idea with a working product side. And we’ve really spent the time to build out a very robust and rounded product. And and, you know, we’ve we’ve taken some battle scars talking to customers and working with customers in particular hospitals about how to solve this problem. Many of our assumptions about how to address it proved to be incorrect. So we we had to adjust course and refine until we came up with a solution that really worked. So tell us about that. Justin, I love to hear of a setback that you guys had and what you learned from it.
Justin Sims:
Well, look, if you’re an innovator, you have to get used to failure and if you’ve never failed. You’ve never innovated. Anyone tells you that if they fail to find a solution and built it and it was a rip roaring success, probably was either very, very lucky or very, very liberal with the truth. I think that’s the secret of success for any an innovator by the way, is is to have a short memory for every failure. You’ve got to pick yourself up. You do need a memory long enough to figure out what caused the failure and then forget how you feel, believe in yourself and try again. As to the specific challenge, I’m actually going to go and talk about my lost company for a second or two because… My company was called Voxiva and we built a whole series of digital behavioral change programs. One was called CAF Life and it was focused on diabetes management and I think it was just playing brilliant. It was it was so far ahead of anything else that had been done in in digital diabetes management. It was packed full of innovations. Customer consumers loved it. People living with diabetes loved it. It had a rock solid, randomized controlled study that showed the impact on A1C.. In fact, it was the whole point percentage point improvement in A1C for people use the program. But here’s the issue. We couldn’t sell it. We went to payers and providers and we thought that we had a value proposition for them because it improved health outcomes. But the issue we found with it was it didn’t address the financial pain point. And because it didn’t address that near-term short, sharp pain point that the payers and the providers were worrying about, we couldn’t sell it. So in the end, we actually had to grossly simplify the product, strip out a lot of the advance functionality and get it focused on improving the scores for people living with diabetes, get them into their annual retinal eye exam. As an example, I’ll get them to add their. Once seat checked every every six months. And with that, the product actually did sell, it didn’t sell as much as we wanted it to. But nevertheless, that was my I guess my everlasting lesson from my long and distinguished list of failures is, you know, you as you’re developing a new solution in the US health care industry. You’ve got to be able to focus on the financial pain. And if you can, then the successful stem from that.
Saul Marquez:
I think that’s such a great call out, Justin, and as we all sit here and think about that, know, what does that mean to you? How are you addressing that financial pain point? Efficiently, effectively. You’ve got to make it easy for people to buy. And, you know, it’s one thing to sell. But if you make it easy for them to buy. By framing it out in a way that doesn’t dress that I think success ensues. Great feedback from from Justin for everybody to take back to your office to do something about it today. What would you say is your most proud experience to date?
Justin Sims:
Well, I’m only two years into careMESH, so, you know, ask me that question and two or three years time and I’ll answer you by saying we manage to solve the communications challenge in the U.S. health care industry. But so but here and now, I think that the proudest experience I’ve had to date was it started about six or seven years ago when the company I was running built a smoking cessation program called Text to Quit. It used text messages to guide and encourage people to kick the habit. We ended up teaming up with Optum Health to offer it and provide it to quite a lot of state quit lines. These are the 1 800 Quit Now services that all the states run to encourage them to quit smoking. And we we enrolled about 300000 people in the program. Now, the amount that I described had a randomized controlled study, a pretty large scale one associated with that. And we proved the program roughly doubled quit rates. So if you extrapolate all of that, of the 300000 people enrolled in the program, we increased the number of people that quit smoking by about 30000 people. And if you take 10 years as the average life expectancy, you add to someone that quit smoking. We added about three hundred thousand years of life onto those peoples some life expectancy. So I’m not sure I’ll ever do anything that increases life expectancy by quite so much. But what that does demonstrate is the power of digital communications. And, you know, you certainly couldn’t do that with with paper and fax.
Saul Marquez:
While that’s meaningful. Justin and a lot of a lot of life years extended and lots to be thankful for. But underlying that success is that leap into digital communication. And I love that you’re still so hyper focused on that with careMESH and not excited to learn what you believe is the companies most exciting project that that you’re focused on.
Justin Sims:
Well, clearly, you know, we’ve talked about digital communications, but the foundation to that, we we also talked about the fire directory. We knew when we started this that we couldn’t solve digital communications problem without having that directory. But it’s not just a database. It’s a set of services. One of the key things behind that, we figured out that if we wanted to contact every doctor in the country to verify the contact information and it took 10 minutes to verify each doctor’s contact information, we figured out that we would need 64 people working this for a full year before we had a up to date directory. And by the way, doctors changed their contact information in the places of work very regularly, maybe 25 or 30 percent of that would be out date within a year. So one of the things that we decided to do with the directory was not just create the best database we possibly could, but also make it so that whenever someone wanted to send a communication using information within the directory, we would go through an algorithmic way of validating the strength of the contact information. And if we won really, really, really certain, the contact information we had was correct. We cue the message and go out and validate the contact information ourselves. So that’s an example of a directory service that’s associated with a directory database. We think that’s a really important thing to again alleviate the hassle, but that clinical staff face every day of figuring out who it is that they’re trying to communicate with. So, you know, really, the directory is a core component of what we do. The District of Columbia is the first geography where a directory is now available as part of the D.C. Health Information Exchange. Basically, all Medicaid providers in the district now have access to it. And we’re also working with a bunch of hospitals. So that going back to the description I made earlier of our service, any EHR user can send referrals and discharges literally to anyone in the country. Right from there, the messenger and again, that that leverages the directory and the whole process can also be automated. If necessary. In Florida, there is a new law just passed into into law, signed into law by the governor back in July that requires hospitals to inform PCPS when one of their patients is admitted or discharged from hospital. Now, the Florida law didn’t actually say this is how you need to implement it, just said you’ve got to figure out how to communicate that information to the PCV. And, you know, traditional ADT services would require the PCP to share with the hospital that patient panel there must a patient index of a patient’s. Well, that that doesn’t cut it for this Florida law. They can’t. The hospitals can’t be reliant on the PCPs providing that information. So instead, if they change their intake process to use our directory to ask the patient who that PCP is, we can then deliver the the intake or discharge information. We can leverage the directory to push that information directly to the PCP. So it can be done on an automatic basis as well as on a peer to peer basis.
Saul Marquez:
That’s very useful, especially for the Floridians at this point.
Justin Sims:
Well, it’s probably something that will expand elsewhere. And how can you coordinate the care of patients? How can care teams collaborate with each other if they don’t know that one of their patients is being admitted or discharged from hospital? So I don’t. I think it’s a trend that we’re going to see in other states as well.
Saul Marquez:
I think that’s a good call out. And again, not the, you know, pigeonholing the solution to this, but it’s a great example of of a lot of applications that this could have. And I mean, in my head just went to like, you know, you got a yelp and either or any city you’re wanting to get access to food or services. The directory is the power of that service with the same same goes for trying to get information from practitioner and a practitioner. This directory is as crucial and amazing work that you guys have done to piece it together and and make it dynamic. Justin, getting close to the end of the interview here. I love if we could just go through a couple lightning round questions followed by a book that you recommend to our listeners.
Justin Sims:
Okay. Shooed away.
Saul Marquez:
All right. What’s the best way to improve health care outcomes?
Justin Sims:
Well, it’s obvious. I’m going to say digital care team collaboration, meaning that the patient’s home care team should be able to communicate with each other and share information digitally.
Saul Marquez:
What’s the biggest mistake or pitfall to avoid?
Justin Sims:
On that one, I think it’s assuming that clinical processes can be easily changed, even if that change makes sense. So. So just banning the fax machine isn’t going to work. Weaning the users off the fax machine, just like I described smokers being weaned off nicotine is is probably a better approach.
Saul Marquez:
Great call out, how do you stay relevant as an organization despite constant change?
Justin Sims:
That’s easy. Be the innovator, be the first. Just as we are with the nation’s first fire based directory.
Saul Marquez:
And focus on the financial pain point Right..
Justin Sims:
Absolutely.
Saul Marquez:
While you’re the innovator. Focus on that financial pain point. Great message there. And what is the one area of focus that drives everything at careMESH?
Justin Sims:
Well, I think that the people listening to this podcast will have figured that one out by now. It’s not directory, in fact. Well, it’s not something that we use externally. We have a slogan internally called Directory First. It’s basically we ask the team to think about the directory in first of all, and everything that they do. It’s really all not no style. It’s what guides everything that we do.
Saul Marquez:
That’s brilliant. And, you know, I recorded an interview the other day and the guest shared a Winston Churchill quote, and he said, if you have a great point, give it a big, great whack. And once you’ve done that, whack it again. And when you’ve done that, just whack it one more time. And then the great words of Churchhill, I think you’ve done just that.
Justin Sims:
Justin, I’ve never actually heard Churchill use the word whack, but a word for it.
Saul Marquez:
And maybe it was a different word, but a smack, whack or a hit, whatever it might be. So what book would you recommend to the listeners, Justin?
Justin Sims:
They’re going to love this one. A printed version about provider directory. Ok, I guess I’m going to you, though. Thirty five million pages. It’s a heavy read.
Saul Marquez:
Oh, my goodness. Good thing is digital, right..
Justin Sims:
Absolutely. It’ll certainly send you to sleep at night.
Saul Marquez:
I love it. Justin, before we conclude, I love if you could just leave us with the closing thought and where the listeners could go. Check you guys out for more information and get in touch.
Justin Sims:
Sure. Well, the closing thought, I’m going to encourage any of the listeners to get a careMESH.com and take a look at my most recent blog, because I think the title kind of encapsulates what we’re talking about. The title of the blog is is called Interoperability Without a Directory is Like Blue Cheese Without Celery. So the two absolutely go hand. And, you know, I’d love for people to reach out to me. You can, of course, reach out to me by fax. I’m kidding. I reach out to me by email at Justin@caremesh.com. And I’d like to welcome those contacts and I’d welcome anyone who wants to challenge me on some of the things I’ve been saying to them.
Saul Marquez:
I love it. Justin, hey, I really appreciate that. That humorous note here at the end. And folks, hope you took a lot from this, but it’s not the end. Reach out to careMESH. Find out how you could improve your communications. And Justin, just want to give you a huge thanks for joining us today.
Justin Sims:
Oh, thank you, Saul. It’s been a pleasure.
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