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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 really thank you for tuning in again and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because we have an amazing guest with us today. She is the co-founder at CareZoom. She's co-founder and CEO there. She's a physician practitioner at Brigham Women's Hospital. She's a graduate of the Harvard Medical School and she's also a graduate of the Harvard Business School known for being mad tech Boston's 40 under 40 in health care. She's a World Economic Forum Global shaper and she's previous director of I.T. and editor in chief at close concerns. She's got a really amazing background in health care and contributed so much. Her name is Dr. Lisa Rotenstein. And Lisa I want to give you a warm welcome. So glad that you've joined us and welcome to the podcast.
: Thanks so much for having me today Saul.
: It's a pleasure Liza, and let's talk about this Dr. Rotenstein, what did I leave out of your podcast introduction there that you want to share with the guests?
: So I think you did a great job. I think you highlighted what I'm working on these days that I'm really passionate about. I'm a clinical fellow and a resident at Brigham and Women's Hospital and internal medicine and through that role have a chance to work on a variety of research and healthcare innovations that I'm excited to talk to you about. And you highlighted Well my work with CareZoom where we are aiming to democratize Healthcare Improvement and really make innovative health care accessible to everybody.
: That's definitely one of the things that I really thought. Man, you know Dr. Rotenstein is doing some amazing things. We call it silo crushing here on the podcast and you're totally crushing silos with your CareZoom platform. Excited to dive into the details of that some more. But why don't you start by telling us a little bit about what got you into health care to begin with?
: Sure. So I would say that what ultimately drew me to healthcare and kept me here is the really unique mix of the ability to work with people, think about their lives and then also think about biology both of which I love and a long time ago actually when I was in high school I had the chance to work at a free clinic in California where I had amazing mentors who are family medicine doctors who I thought were really effectively dealing with both the biological and the social aspects of treating disease in a church that was converted to a clinic every Wednesday afternoon and where doctors were able to provide free care after hours. So that's what started me on this path. And along the way what's kept me here is my relationships with patients who are inspiring and teach me every day and also experiences in diverse parts of health care and seeing how so many people are able to contribute from pharma to big hospitals and then people in the entrepreneurial world who are excited to make a change.
: That's so interesting and it's those heart strings the ability and opportunity to be able to serve patients that is really what drove you into the practice and what's kept you here and a lot of other physicians too, you know. And in this system where we constantly have to reinvent the wheel, the opportunity to share those moments with patients becomes more difficult. So what an opportunity for you and your organization at CareZoom to do something about this. Can you walk us through what exactly CareZoom is and what you're doing?
: I would love to. So CareZoom is an organization that is looking to exactly as you said break down silos and healthcare improvement. We are building a database of healthcare improvement recipes. You know the way you have a recipe for soup but rather a way a recipe for improving your healthcare system and we're starting in primary care. There are innovators across the country you know implementing new technologies in their clinics implementing diabetes prevention programs, new population health management programs and that information can be really siloed and difficult to share. So for example when I was in medical school where part of the passion for this started I was part of a project where we were looking to implement care plans and we had read in the literature all about how great care plans were for patients with complex medical problems. And you know we saw statistically significant results in the literature but when it came time to get information about how you actually roll this out in a clinic that information was harder to find. You go to conferences where people share their work. And yet the information is presented on a poster that then is tucked away somewhere that academic medical literature sometimes doesn't appreciate this kind of work the way it does pure research and on the other hand sometimes consulting is really out of reach for a lot of clinics and so we saw an opportunity to crowdsource the amazing work that people are doing and we're really excited to have started in primary care and to have projects as I mentioned related to diabetes, Behavioral Health, Medical scribes, all sorts of innovations happening all we've started on the east coast and are looking to expand. And then also to bring forward the identities of people who are doing this kind of work without a lot of recognition essentially in the trenches and these are nurses, these are doctors, these are social workers. So we're very excited to feature this work.
: So interesting Dr. Rotenstein and it's awesome that you said you know what, I see the problem and I'm not just going to sit here and complain about it I'm going to roll up my sleeves and create something to solve this problem. And listeners, I really want to just highlight here what Lisa has done and I welcome you as well to do the same thing. If you see a problem don't just look at the problem like crash on the side of the road pull over and see what you could do because at the end of the day the fixes in our health care system are going to come from us. So the onus is on us so kudos to you and your team Dr. Rotenstein for taking the initiative.
: Thanks Saul and I would say kudos to the people doing this work every day. And as I mentioned so we're going to be publishing this database shortly and we're also building an expert network because we feel like there and we've been told there is great value in peer to peer conversations. So we invite listeners to visit our site at CareZooming.com and to sign up to either be part of our expert network or get advice from our network of innovators.
: That's awesome. What a great invitation. Listeners, take Dr. Rotenstein up on that, CareZooming.com. We'll also be leaving that link along with the transcript of our podcast and any other resources that are mentioned here in the show notes. So if you're driving don't worry about that you'll always be able to reference the show notes for that but it's simple it's CareZooming.com. So tell us a little bit about how you and your team there are creating results and improving outcomes by what you're doing your work there.
: Yeah I would love to, then I'd love to tell you about our team at CareZooming and then I'd love to tell you a little bit about the work I've done at Brigham as well to create results in a similar vein. So we have already at CareZoom started connecting innovators across the country to each other. Just the other day, you know we got a request of somebody looking to take on a hospital improvement project and were able to give them some of the nitty gritty details from a variety of implementation projects that we have in our database. And we've also uncovered and featured work that hasn't otherwise made it into the medical literature and been able to publicize the identities of people who you know aren't publishing their work every day but really are doing valuable things on the front lines and have a lot to contribute to Healthcare Improvement. So I would say that's where our main focus is and that's what we're really excited about delivering. And on the flip side I would say that some of the most exciting work that I have done at Brigham and Women's Hospital focused on innovation has actually been in implementing I.T. tools into daily care. So one project that I'd love to feature which is a part of where the idea for CareZooming came from as well had to do with implementation of decision support tools into oncology care. And so you know I was part of a team that saw a need to improve prescription of short course radiation among patients with cancer and we had realized that although there were society guidelines saying that short courses of radiation were just as effective as longer ones in patients who needed radiation of bone metastases in busy academic medical center with many providers delivering care. There was real variation in how often this was executed upon and so we built a clinical decision support tool linked to the EMR to guide providers through the decision of how much radiation to give. And a year after rolling this out into daily workflow we found that appropriate prescription of short courses of radiation which are easier for patients to tolerate have less side effects and overall are thought to be more beneficial at the end of life. So the proportion of patients getting that had doubled and had increased significantly which is really exciting. So these are the kinds of innovations that I'm really featured on and looking to learn about from across the country.
: That's wonderful and it's great that you're both aggregating best practices and you're aggregating innovators to help improve this waste of resources. So there's no doubt as you as you alluded earlier you know there's there's a ton of people doing so much hard work and they're oftentimes unappreciated. Oftentimes what they do is not replicated. Sometimes even within the same system. I'm excited to see what you and your team can do to make sure that those best practices get shared and applied to folks across the nation. So I love it. I think your work is pretty amazing.
: Thanks Saul.
: So let's take a look at sort of the history here and sort of what got you and your team to this point can you share with the listeners a time when you had a setback, feel like we learned a lot more from our setbacks and our successes. And then what you learned from that setback?
: I would love to share it and I'll actually share it from something that I worked on prior to CareZoom. But that has definitely shaped the way that I have approached this particular venture. So when I was in business school we worked on several classmates of mine and I worked on an app. And we knew that there was a problem with people who had elderly family members aggregating their meds, understanding who all of their providers and getting all of their information in the same place. And we put a lot of resources into creating an app with a great interface and thinking about all of the people who could use it. And I would say that the place where we felt short was listening well enough to our end user and also thinking about how our technology would interface with end users daily actions. And so although we ended up having a great piece of technology when it came time to thinking about who would adopt this and who would pay for this. You know it turns out that people didn't really want another app healthcare systems taking care of elderly patients didn't want something they wouldn't plug into their EMR. And so it was an important lesson for my team and I to really listen before we started innovating that the needs on the ground should drive the innovation rather than vice versa. And that's something that I've taken forward and think about all the time with CareZoom.
: That's amazing and really appreciate you sharing that. Dr. Rotenstein you know it's something that happens all too often. You know we get excited with with our ability to do something and we don't get that feedback from our users. And we've all fallen victim to it and I thank you for your courage for bringing that one up so that the listeners if you guys have not had a chance to really get enough feedback please do it because you don't want to waste time, you don't want to waste money before you put a solution out to market and then find out it doesn't work. Build it with your end users in mind and find out the other key that that Lisa mentioned to us is who's going to pay for it. What a great lesson. What about the other side of things? The successes. I know you've had a lot of successes very early on. Can you give us one of your proudest medical leadership experiences today?
: I would love to. So I would love to talk about one of the studies that I did in my role as a clinical fellow at Brigham and Women's Hospital. So a team of my colleagues and I conducted a study of depression in medical students and we found after doing a meta analysis of studies worldwide that 27 percent of medical students were depressed, clinically depressed and that only a small percentage of them had sought treatment and that a significant proportion of them actually had suicidal ideation. And beyond the publicity that came around the study which was published in JAMA in 2016, I was most proud of the way that it changed conversation. I was excited to hear from my colleagues about workshops that were being held with medical students and other trainees to talk about depression, to talk about coping and also to see the response thereafter from institutions who are really examining the systems in which trainees were experiencing health care and how those could be changed. And it was just meaningful to see the ripple effect of that which I continue to see in my clinical training these days. You know I see doctors more often talking about wellness about mental health and really examining what we should be doing differently.
: Absolutely. And I'm really glad you brought that up. We oftentimes forget that there's a whole population of medical students going through the same things that the physicians are going through. And if there's a way for us to start earlier, awareness is the key. And so, I love it. If there's a way to link to your study Dr. Rotenstein if you could provide that or somehow give me a link to share with the listeners I think that would be a wonderful one for them to read.
: I would love to and I would say that our same team is currently working on a study of burnout and depression in attending physicians. And what we've interestingly found is high rates of burnout in the 30 percent range among the attending physicians and very similar rates of depression and attendings as in medical students. And as has been shown in residence previously suggesting you know what we might intuitively know that the working environment that you're in on a daily basis shapes both your experience of training and then also your mental health. What we're excited to show that that holds around the world across genders, across specialties and is something we need to continue tackling.
: Absolutely. And so Lisa for the physicians, the physician leaders, the residents listening what message would you give to them?
: I would tell them that there is not going to be an easy fix to this problem. With that there has been a lot of movement forward already. At least for trainee's work hours. There are a significant step forward, but it's something we have to be paying attention to and part of it from my perspective does have to do with wellness initiatives which many institutions are undertaking but it also has to do systems of care in which we work which is you know how I actually see all of my work linking together that on a daily basis. Your doctors are dealing with difficult electronic medical records systems. They're seeing patients who are still struggling through the health care system. They want to tackle chronic disease and often don't have the resources to. And so I believe that a big portion of ensuring physician wellness has to do with optimizing systems of care which is you know how I tie everything back to CareZoom and the health care system we want to have in the future.
: That's great. And what percentage of that would help if you said you know what it's OK to talk about it. Like you're not superhuman and we don't expect you to be. Talk about it.
: A significant proportion I would say. And it's getting easier to talk about it. But there is still a part of training where there are long hours and you have to tough it out and it's hard to say what part of that is a necessary part of training where you do have to have the stamina to provide care to patients in difficult situations versus a constraint of our system that has to do with financing and what resources we have to provide care versus we really could change and we need to talk about more openly on a daily basis and be constructive together as we think about this.
: Totally listeners, if you're a physician you're not complaining you're communicating. And I think that's a big step in making this better. What would you say an exciting project that you're working on today is?
: So I'm definitely excited first of all about CareZoom and I would encourage listeners who have done innovation work to get in touch, we would love to feature your work and especially as we build out our expert network to have you be part of that network. Something else that I'm working on at the Brigham currently is thinking about how to improve care for really complex patients during their transitions of care and when they're in the hospital. So working with several teams to think about how do we put together care plans to maximize how we take care of the 1% of patients who have multiple medical and social .. and thus actually account for 50% of healthcare costs. And how do we support these patients during their transitions of care? How do we have them go safely from the hospital back out of the hospital to the outpatient world? Maybe they'll go to a rehab facility. And how do we put in place systems of care that ensure that their outcomes are the best they can be?
: Outstanding. Lisa that's super exciting and from the front lines doing some major silo crushing all the way to the straight of offices we got a crush these silos to continue making health care better for ourselves but also the people that we care about most, our children, our parents, our grandparents. And Lisa. your efforts here are extremely awesome and I just encourage you and your team to continue the amazing work.
: Thanks. This is what gets me up every morning and what I'm passionate about. And so would love to hear from other people who are excited about this type of work.
: Absolutely. So Lisa getting close to the end here. We've got the leadership course we're going to put it together right now. It's a syllabus. The 101 of Dr. Lisa Rotenstein. And so I've got four questions lightning round style for you followed by your favorite book and your favorite podcast. You ready?
: I'm ready.
: What's the best way to improve healthcare outcomes?
: I would say leveraging collective knowledge and paying attention to all the different stakeholders and how they can work together.
: What's the biggest mistake or pitfall to avoid?
: Putting I.T. into health care and expecting it to change healthcare without paying attention to the system around the Information Technology.
: How do you stay relevant as an organization despite constant change?
: Pay attention to current trends in legislation legislation is always changing but it determines so much of payment and health care and also listen to the patient and have a laser focus on the patient because they're who we should be driving our efforts towards.
: What's one area of focus that should drive everything in a health organization?
: I would say improving healthcare systems which can affect as much of health as a drug can or even more.
: What book and what podcasts would you recommend as part of the syllabus Dr Ottenstein?
: I would listen to an American sickness by Elizabeth Rosenthal which provides a really great deep dive into the multiple players that affect health care from insurance companies, to doctors to hospitals. But I think does it in a really person focused way and provides vignettes that will stick with you and will remind you about why we do the work we do on a daily basis.
: Super interesting recommendation and the book?
: American sickness was the book in terms of the podcast. That's OK in terms of the podcast. I would recommend review of systems which is a podcast about improving primary care and it is actually now cosponsored by the Center for Primary Care at Harvard Medical School. Hairiness features people across the country who are changing primary care systems and also on a weekly basis highlights important literature not space so you can stay up to date in primary care improvement.
: Outstanding. Lisa thank you so much for that. Listeners these recommendations are amazing and if you want to just level up I recommend that you check them out. We've got links for them. Just go to outcomesrocket.health/carezoom and you're going to find all of the resources that Dr. Rotenstein shared with us as well as her bio. The transcript, links to her business, links to the podcast, links to the book. Everything is going to be there but make sure you take action and go check that out and also take her invitation. Do some collaboration with her and reach out if you find what she's doing is interesting. So just want to say thank you so much Dr. Rotenstein if you can just leave us with a closing thought and then the best place where the listeners can get in touch.
: Great. Thanks so much for having me. My closing thought would be that there is power in everybody involved in health care from the patients who use it on a daily basis to the people working in it to the scientists who are powering in and we have a collective responsibility I would say to collaborate to move things forward. The best way for people to get in touch with me is my email which I'll provide to Saul and will be on the website. You can also reach me on LinkedIn or Twitter at @Lisa-Rotenstein on Twitter and then Soul link to my LinkedIn page.
: Outstanding. Will do that for you Dr. Rotenstein. So thankful that you spent some time with us today and super excited to stay in touch.
: Thanks so much I hope you have a wonderful afternoon.Thanks for tuning in to 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 can 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.
Recommended Book and Podcast:
Best Way to Contact Lisa:
LinkedIn: Lisa Rotenstein