: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez
Saul Marquez: [00:00:18] Outcomes rocket listeners, welcome back once again to the outcomes rocket podcast where we chat with today’s most successful and inspiring healthcare leaders. I want to invite you to visit outcomesrocket.health/reviews where you could leave us a rating and review on what you thought about today’s podcast because our guest is really amazing today. His name is Dr. Peter Tippett. He is a CEO at healthcelerate he’s involved in health I.T. security and compliance. He’s an entrepreneur has been down this path of an entrepreneur as well as a frontline provider. Our chief medical officer at Horizon Net1 point I mean the guy has an incredible amount of background to help make outcomes better and I thought it would be such a pleasure to have him on. So without further ado I just want to welcome you to the podcast Dr. Tippett.
Dr. Peter Tippett: [00:01:10] Well thank you.
Saul Marquez: [00:01:11] So you know one of the questions that I love kicking off with all of our guests is why health care to begin with?
Dr. Peter Tippett: [00:01:18] You mean why people need to be cured of diseases.
Saul Marquez: [00:01:23] Why did you decide to get into health care to begin with.
Dr. Peter Tippett: [00:01:28] I was drawn to health care by the science of it and the the rigor of it and I liked the people of it. I kind of have a gump has you touched on my background. I kept falling into environments that people were wildly successful. I worked for a guy when I was in college that won the Nobel Prize for sequencing the first protein. And another guy that I worked with synthesize the first protein and he won the prize. Also nice and I worked at another lab but figured out the cholesterol problem and these are all health related organizations so you know I got sucked in because they were exciting people exciting places doing great things might really enjoy helping people get better too.
Saul Marquez: [00:02:10] Wow that’s awesome. You’re very modest Dr. Tippett. That’s one of your distinguishing qualities. You know I do believe that you are the average of your five closest friends and so you keep surrounding yourself with amazing people like Dr. Tippett listeners you will to be successful. So what would you say. Dr. Tippett is a hot topic that should be on every medical leaders agenda today.
Dr. Peter Tippett: [00:02:32] The topic that I’ve been worried about and trying to fix for the last several years boils down to the abysmal state of communication and health care. We in the rest of the world of PCs and the Internet is things like e-mail and chat and Dropbox and we share a word documents and we share messages and we ask each other questions and we tell each other where we are and we leverage the digital world to make our businesses better. And the productivity of the rest of the market place outside of healthcare grew several fold during the 80s and 90s when the whole PC revolution internet revolution happened. Healthcare to get that same growth in productivity didn’t get any growth and productivity. In fact the cost of healthcare has gone up every quarter since we’ve had health care insurance for decades and decades and decades. There hasn’t been a single quarter when it’s gone down. Per capita. Not one that’s good. But that’s not true of anything else. You know the cost of everything else per capita. You know in constant dollars mostly has gone down PCs and computers for sure but also automobiles milk everything is better and cheaper now. Yeah it’s not health care and a lot of that I think has to do with the fact that we haven’t figured out how to leverage that even 10 and 20 year old infrastructures that added so much efficiency to the rest of business.
Saul Marquez: [00:04:02] That’s such a great call out. Dr. Tippett And what advice would you give to the leaders listening on how they could implement this technology that exists.
Dr. Peter Tippett: [00:04:12] Now. Well I was on what was called the PITAC the president Information Technology Advisory Committee which is but that first. Oh and see when that started was started with this presidential charge to go figure out how we could add computers to health care and get something like web banking got when they had computers to banking gadgets. And we said you know if you could do but roughly had parity with what banking with computing by doing a similar analogous stuff with healthcare we’d wind up with wildly better outcomes. People live longer and be healthier wildly lower cost. Our estimate was 70 billion dollars a year of savings in thing but after our committee ended the Institute of Medicine thought that it was more like six or seven hundred billion. Just while costs. And we’d have a whole new kind of science. We know that what we now call precision medicine but you wouldn’t have to do studies to find out answers to things you could just look them up across populations. But other than that it probably wouldn’t be worth doing so we wind up with huge benefits across all aspects of this and all of our businesses will be more efficient. So what’s the advice the advice boiled down to digitize everybody and make it possible for everybody to communicate medical records and messages seamlessly. At the time I thought that both of those were great ideas and they’d achieve the goal. I knew that it was going to be hard and I thought that installing Amar’s is going to be the easier of the two steps but I didn’t think that the digital communication was going to stay as broken as it has for as long as it has. I mean the P in hippo is portability hippo sharing records. It wasn’t about privacy. Privacy was just the mechanism to make it easier for people to understand the basics so they could more easily share medical records and messages. And that’s 20 going on 22 years ago now.
Saul Marquez: [00:06:11] Now that’s and that’s amazing I think a lot of people don’t actually either know that or think about it they just kind of gotten stuck in the privacy aspect of hippa.
Dr. Peter Tippett: [00:06:21] Right. So we blame the lack of medical record sharing on Heppell we blame it on standards problems. We blame it on business issues through a hospital aid of and give all its medical records to a hospital because it’s a competitive thing we blame it on vendor issues because the vendor doesn’t want to operate with vendor bids because otherwise I’ll beat them in the marketplace. We blame it on all these things. And I call this the myriad problems probably are a dozen categories of problems for why we haven’t gotten there. But in the end it boils down to productivity. In the end it boils down to value. In the end it boils down to improving patient outcomes and to the extent that we can make our companies better reduce our costs improve our efficiency maybe get paid more. In all cases now especially with the switch to quality and switch to CEOs you know we actually get paid to know more about our patients and to not duplicate tests and. And even if that’s only eight or 10 percent of our revenue now it’s easier to show that that communication if you make it working really does add to the bottom line not just detract and we’re going to get all the benefits the all the other industries go out on the Internet that the health care has not gotten to two plus fold improvements in productivity. That’s going to happen too. It’s just that we can’t imagine that and don’t want to count on it.
Saul Marquez: [00:07:43] That’s right. And that’s such a great call out. And as you guys take steps toward alleviating some of these these challenges Dr. Tippett what would you say an example of how healthcelerate and your team. You had a chance to meet Kathryn Thomas so there she was wonderful on the rest of your team over there. What would you say you guys are doing to help improve outcomes.
Dr. Peter Tippett: [00:08:05] Well we’ve done the healthcelerate that we’ve we’ve decided to try and make a general purpose platform that could make it possible for any clinician or anybody who works for a clinician to get a medical record of any EMR and get it to any other clinician in the country and do it without that recipient even knowing that help separate exist without them installing anything without them buying anything without them going through nine yards of stuff just like FedEx 40 years ago said if it absolutely positively has to be there overnight. Give it to us and we’ll get it where it needs to go. That’s what helps already is doing for medical messages like texts or e-mail like things or medical records like what you get out of your EMR. Get the other one and when it gets there the recipient ought to be able to put it in our EMR so that it becomes native to their own EMR. So we want to make this thing that would work no matter who no matter what in any way shape or form with medical messages or records of any size and make it interoperable essentially with all the Amar’s and make it work whether or not anybody installed anything or bought anything. Now that’s a high order. Hey we know we know the networks are not particularly valuable if they don’t have many members. If you had a telephone and you were the only guy with a telephone you would have anybody to call. And that’s roughly where we are with these HA’s or with these data sharing networks like that vendors have put together or that others have put together. They don’t tend to get to the tiny players even HA’s the best run do well with the hospital but not with the small practices the vendor networks work with their own vendor but they don’t work for the other vendors. The networks that are joined together by institutions tend to be bigger institutions but not tiny and certainly not small practices and we wind up with one way flow of information but that’s largely because the value of a network is the cube of the number of users of the network unless you can give it to everybody. It doesn’t work. So you need to build something that’s got that instantly makes it possible for you to get a record to anybody in the country whether that recipient knows it or not. And that’s I realize this is kind of hard to explain but basically we’ve bind all the standards like direct and access and and fire and all the things that meaningful use required and are already installed and working even though nobody’s really using them. We took those plus all the things that we learned how to do across the last 20 years of the internet like you know how to download a file and how to upload what to do e-mail and how to do texting those we all understand how that works.
Saul Marquez: [00:10:41] Yes.
Dr. Peter Tippett: [00:10:42] We combine that sort of mind the memory the muscle memory of how the new text messaging with how to get things and the EMR layered on top of that sort of issues to deal with privacy and security and regulatory compliance and Hipple compliant and interoperability so that that could all be invisible in the background and made it so that a person could solve the problem whether or not the I.T. department want to get involved. So if a doctor somewhere says oh my god this patient’s going back home I just cured her of a weird disease and I really want that doctor to know what’s going on. Wouldn’t it be great if the doctor could do what the doctor wants to do which is get the record off to the non-competitive other caretaker and keep it in a digital form so that they can have the best chance of continuing with the high quality care. Same for getting your better billing. You know if you’re operating in a quality head world you get paid for knowing whether or not you’re diabetic had an eye exam or a foot exam or in a 1C or the right number of other tests. The same is true for other kinds of chronic diseases you don’t need to do those tests yourself. In fact if you did them all yourself you wouldn’t make enough on the incremental money to pay for the incremental work you did. But if you can figure out the result from the ophthalmologist or the podiatrist or the hospital or the other doctors in the circle that that patient has already met without have been to redo the work you could get the value and get the payment as your bonus money. And the only thing you really need to make that happen is to be able to communicate. The other thing that’s weird about this communication thing is that somehow in healthcare we decide that all the data will wind up in one place and everybody would get it from that place. That’s sort of the mode of an HIV or anymore right. But that’s not how it works in our businesses. You know if you have an employee who did a great presentation at some conference somewhere and you say I want to use that presentation of yours at this place I’m going to go to a meeting and you don’t go download it from some central place for your company. Keep everything to ask the employee and the employee gives it to you right time. The employee might even say if you like that when you’re going like this one even better. This is more about what you see let people think this is what the P and C was. This is personally enabling folks it’s enabling that person to the value right. And that’s why PCs dominate over mainframes because the the mainframe model is that I.T. thinks about all the problems and solves them for everyone. The PC model is that that’s true but also individuals can go solve their own problems with tools and local power. And all we’re really trying to do on the wholesalers side is add the personal part for the caretaker and giving them some value and the proposition of sharing records or getting records or adding value to the other care provider. When doctors brief each other on patients that they do endlessly they pride themselves in giving the shortest possible story with the most possible information. They call it the bullet train and doctors do that when we sent us mail to each other. Right. And then a transfer summary or some kind of a referral. We prided ourselves in creating as small as possible a summary of the patient problem and the questions that we really want answered and then the person who took that referral was pride themselves and taking all that information figuring out the real nugget of it and providing back a synthetic answer of the shortest possible way to do the best for your patient. That’s the history. Like we just need to enable that for our care providers and they’ll take care of it themselves.
Saul Marquez: [00:14:24] Yeah. Yeah this is a really interesting and appreciate you sharing the history and putting it together with the beliefs that currently exists about what technology should do. I think a lot of people take these things for granted right now. We expect to find information in this central repository. Well it’s not there. So let’s abandon that belief.
Dr. Peter Tippett: [00:14:49] You know what we really want and when you think about it in every other respect we want a central repository where it makes sense and we want to be able to ask questions to fill in the gaps. So if you’re working in an intensive care unit and somebody comes in from three counties away and you know you’re trying to save their life you’re doing a very complex set of you know intensive care interventions. The simple question about something that might have happened two years ago. You see a weird thing on or weird thing on an MRI or you know you’ve got some question wouldn’t it be nice if you could just fire off a question to the doctor three counties away or three states away or three without one of them and say did this EKG look like this before and an answer. I mean it’s a simple thing but this is how we all behave in business in business we provide each other with data we provide each of the portals we share information where it’s appropriate. But in the end that high bandwidth communication comes because we can tweet each other or text each other or e-mail each other or say this that file that contains the information you’re looking for. It’s on page 27 and we don’t need to repeat it all terribly. We don’t need that. It doesn’t matter that our Yem ours aren’t exactly the same. It’s humans that were solving the problem for that matter and now they can reengage 27 they can even cut and pasted and centage make it even easier right now.
Saul Marquez: [00:16:17] Dr. Tippett this is really great and I love how you can keep things so simple. I mean there’s beauty to that throughout the process. You guys how separate have spent time in refining your systems hasn’t always been pretty. Can you share a time when you had a setback and what you learned from it.
Dr. Peter Tippett: [00:16:35] We’re trying to do something very complicated by making it simple and the analogy I like to use is the iPod. You know Apple came out with the iPod and really that was an MP 3 player and but Microsoft hadn’t and P3 player already was gorgeous and it had a nice farm actor and well-designed targets and Logitech had an MP 3 player. They’re not tiny companies they’ve got great marketing budgets and so on but it turned out that Apple completely cleaned up the market with the iPod. This is before the iPhone. And what they wanted doing was the reason that that worked for them isn’t because they’re a better design engineering firm and have more cache in the market it’s because they also decided they had to solve the problem of how you’re going to get this music in the first place right. What are you going to do about the CDs you’ve got left and the ability to rip them they decide they solve the problem of Mac versus PC by making things work on both platforms. They decide how to get music purchased from the people who made the music. And so they talked to over half of them and got them to provide their music in a Bucha track. They sold a dozen different probably solved legal problems and regulatory problems them buying problems and interoperability problems and sharing problems and library consolidation problems and sharing with it over time because they solved these I call them the seven hard problems they solved these this range of problem then the market tipped to make it so that it worked. And the iPod and the iPhone and music through iTunes and the whole thing worked what everybody else has been doing in this market is solving a piece of the problem. And it’s very difficult to figure out what the scope of a problem is in advance. Right. Totally. It clearly includes things like hyper compliance and the ability to let people in on a network without spending a day or two getting their identity proofing working in the medical credentialing and passports and driver’s license questions and yes all that stuff that is required and you know you still have to do strong identity. You have stuff to do strong security stuff to make sure that people won’t screw up with the data you give them about a patient and make it compliant with it. You have to make it so that when they make mistakes it doesn’t cause security problems to make it so that even if you send a record to a random doctor in the middle of nowhere that doctor throws his phone in a taxi cab and sends it off to HHS and they take it out and look at it that even though the doctor saw the patient record there 20 minutes ago when it went up on the front step of the investigator the data is no longer there. It is safe. We have to solve all these problems and the mistakes we’ve made boiled down to that combination of making these things look simple but actually work that’s really hard. You know we’ve been at this now and have Sellery for two and a half almost two and a half years and almost all of our time is spent on making whatever we thought were simple even simple or making something that looked like yeah that should work. But as soon as you show it to somebody we don’t know what to do next. And if I had to look at a manual I’m not going to do anything. Yeah that’s why we decided that e-mail should be a metaphor because people know what to do. Totally right. And it works out to be a metaphor or this is a text or email but it looks like text and e-mail and people know what to do uploading and downloading things. People kind of know how to do that. Yes. And you know if somebody sends a PowerPoint to somebody else by e-mail they know how to do that. Why can’t we make that be the same metaphor as sending a medical record. It could be automated it could be built in so that it just happens automatically and pops up inside your own EMR or but why wouldn’t we also make it possible so that can happen annually. And one other thing that really surprised us. We hired a UI design user interface designer. Yes. Done this three times now in a year and a half. And each time we make a quantum leap in improvement we wanted doctors or clerks in doctors offices to be able to pick which portion of a record that was sent to the other doctor or if you receive a medical record from somebody which portion I’m going to put in my own EMR because you don’t want all 600 pages. I just want the you know the labs problem list of medalists a couple of other things. So we had to make that selecting of the subset or whatever you got what you were going to push into your EMR. We had to make that easy. And the first couple of times everybody thought it was wildly easy and they were all excited about it but we got another designer who really made the medical record that you were selecting from pop. It looked gorgeous it had these Fishbone things that when doctors take notes on 3 by 5 cards the next market they have shorthand way of writing down labs and we put that same shorthand on the screen and they have shorthand ways of organizing things so metaphor the love search almost all the EMR’s aren’t as good at search as Google is for example why wouldn’t we improve Snickets so people could search for one thing they were looking for and look at things in so order and then look at Fishbone sort of lab results and other things and widgets things that would would put things in a view that you’re particularly interested in whether you’re a pediatrician and want to see growth charts or whether you’re an ophthalmologist want to hear you know some summary of something or maybe or call the clerk and you want to see which parts of the patient record are missing from the viewpoint getting calls a point whatever that is. It’d be nice to have those things pop for you. Mrs. we’ve built that interface and started testing it. People said this is the best looking I’ve never seen local data. Look this Chrispin clean and before can I use this to just look at my own medical record. And we said Well can’t you look at your own EMR on your mobile phone right now. And they said no and it didn’t occur to us that the vast majority of doctors have no way to get the data of their EMR untruthfully or a tablet. But it didn’t occur to you to totally asses that value was there. And it also was simple and an organized Apple. There’s a great word for a way that in a way that was custom to the individual the initial goal was to simplify some selecting the part you wanted and finding just the day we were looking for. And as soon as we made it easy for people to find a value they said well if I’m on call and somebody who goes to another doctor across town calls me because I’m on call for the other doctor Montone about flummox and feeling in their chest. I don’t know what flummoxing feeling is what the heck is that right now. But if I could look at the chart and see if this person ever used the word flummoxed before and all of a sudden I typed that as a search term and pops up whatever that person said to that doctor last year last month. I can quickly figure out whether this is similar to what’s happened before or not. Yeah and on. And it’s just this notion of combining search which by the way Google showed us search works really well and people said it’s not new right. It’s how it’s how we added value to the rest of our Internet experience. Right. Great communication models that we also understand was enough to really get over that hurdle.
Saul Marquez: [00:23:47] That’s excellent and a great example. Dr. Tippett On how you could just you know just listen man and you don’t know what you don’t know and you guys dove into it and found another opportunity to vote you say today is an exciting project or focus within accelerate that you guys are focused on now.
Dr. Peter Tippett: [00:24:04] Well we’re we’re really focused on getting this thing out at scale. Right. We’d like to make it so that any doctor or nurse or nurse practitioner or anybody working for any of those people can get any message or record to or from anybody else and make it so that it feels seamless to both ends of that transaction. And it’s working well. But you know if this works really well it’ll be as ubiquitous as Gmail or anything else that we all use all the time and track. So we’re really really working at looking for the actual underlying value that really drives things because nobody had to push anybody to use email. Nobody had to bribe them with twenty dollars a month to produce e-mail or bird processing or any others. It was so obvious that everybody just said I’m going to write. And so we really are spending our energy trying to make sure that we have multiple points of value so that when people find different people will find different value for different reasons. Some people might like texting each other some inside or outside your hostel or texting some doctor. A thousand miles away and making that work. Other people might like the ability to look at their own medical record. But we’re discovering when you get down under the covers what are the real problems and what are the names of those people that care coordination or referral management or even figuring out whether the insurance company is going to pay or not. You know this sort of quality metrics are you know the degree of words around these because people are building giant workflows around each of these things and all of them boiled down to good communication and an easy way of seeing the information so that you can act on it. Right. So to the extent that we extend what we’ve got which is basic communication basic interoperability basic sharing of medical records and messengers and add little things that sort of do a lightweight job of referral management or figuring out where the insurance company is going to pay for this procedure or not and get people into the quick way of getting something back and forth. We have a we talked to a farmer a pharmacy the other day that shows a picture of the pharmacist 40 years ago and the pharmacist was talking to the patient and the current picture of the same pharmacist in the same store as a pharmacist with the phone cradled under their ear and chin. On the one hand and both hands on the keyboard they’re spending their whole time talking to somebody to try and see what they can give this matter that are finding out from one position where they want it this way or that way or going back to their insurer and figuring out whether this will be paid for or not. Why on earth can’t they send a text and ask that question. The answer will come back out of phase the other band when the other time it’s ready it might be a month and a half from now. But in that movie the half you could have done something else. That’s right. That’s right. That is again how we get our productivity working and all the other parts of business.
Saul Marquez: [00:27:02] I love it. Now this is a great example. Dr. tip you’re just calling out the things that we need to be demanding from our communications systems and you guys are working on so that’s exciting. I’m really excited to see how things develop over there and having these types of resources that make things simple available to any provider that wants it. So let’s pretend you and I are building a medical leadership course on what it takes to be successful. It’s the one I want or the ABC of Dr. Peter Tippett. So I’ve got four questions for you there. Lightning round style. And then we’ll end it with a book that you recommend for the listeners. You ready.
Dr. Peter Tippett: [00:27:43] Ok.
Saul Marquez: [00:27:45] All right. What is the best way to improve health care outcomes.
Dr. Peter Tippett: [00:27:49] Communicate better.
Saul Marquez: [00:27:50] What is the biggest mistake that lives or you and I and it was a doctor and I love it. It’s priceless. What’s the biggest mistake or pitfalls to avoid.
Dr. Peter Tippett: [00:28:00] I would avoid big system mentality and let’s get into person the person mentality.
Saul Marquez: [00:28:05] How do you stay relevant as an organization. Despite constant change.
Dr. Peter Tippett: [00:28:09] I think you drive change to stay relevant.
Saul Marquez: [00:28:12] And finally what’s the one area of focus that should drive everything else in the organization.
Dr. Peter Tippett: [00:28:16] It’s focused on the Patient Focus on the person’s focus on the individual. Make it happen for them. Everything else follows.
Saul Marquez: [00:28:23] What book would you recommend to the listeners. Dr. Tippett.
Dr. Peter Tippett: [00:28:26] You know what I was thinking about this and I was involved I wrote a cover recommendation for a book called How to measure anything by Hubbard. Nice it’s kind of a book that helps people do to hysterics when you only have three people you need a thousand person or 500 or some large numbers to do the typical analysis of whatever. But it turns out if you take a few people who actually know the space you can ask them to estimate the statistics for any given question and you can come up with at least as good an answer by taking smart people and putting them together. It’s a great book.
Saul Marquez: [00:29:02] Well they haven’t listeners and Dr. Tibbett thank you for that recommendation. Don’t worry about writing it down everybody. Just go to outcomesrocket.health/drpeter. Just do D R P E T E R and you’re going to be able to find all the show notes, links to healthcelerate there’s a link to this book. Dr. Tippett This has been so much fun. Before we conclude I’d love if you just shared a closing thought with the listeners and the best place where they could get a hold of you or follow you.
Dr. Peter Tippett: [00:29:30] Well I’m at healthcelerate.com I’m ptippett Like firstname.lastname@example.org and I think you know the best thing you could possibly do is keep your head up and do the work on behalf of your patients and your employees.
Saul Marquez: [00:29:43] Thank you so much Dr. Tippett. And listeners. Take the man up on checking out the cool things that they have going on over there. And again Dr. Tippett just want to say a big thank you from everybody.
Dr. Peter Tippett: [00:29:53] Thank you.
: [00:29:58] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.
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