The Need for FHIR-based Patient Reported Outcomes Tools During COVID-19 with Lucienne Ide, Chief Health Innovator of Rimidi: Audio automatically transcribed by Sonix
The Need for FHIR-based Patient Reported Outcomes Tools During COVID-19 with Lucienne Ide, Chief Health Innovator of Rimidi: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Saul Marquez:
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Saul Marquez:
Welcome back to the Outcomes Rocket everyone. Saul Marquez here. Today, I have the privilege of hosting Dr. Lucy Marie Ide. She is the Founder and Chief Health Innovator of Rimidi, a cloud-based software platform that enables personalized management of health conditions across populations. She brings her diverse experiences in medicine, science, venture capital and technology to bear in leading remedies, strategy, and vision. Motivated by the belief that we can do so much better as individuals and industry and society, Lucy left clinical medicine to join the ranks of health care entrepreneurs who are trying to revolutionize an industry that needs it. So today we’re just excited to have a conversation around remote patient monitoring. What does that mean to the populations we serve and how can it better our care as individuals? Well, here we are Lucy, thank you so much for joining us today, and really excited to have this discussion with you.
Dr. Lucie Ide:
Yeah. Thanks so much for having me.
Saul Marquez:
Absolutely. Before we dive into the excellent work that you guys do at Remedy, talk to us a little bit about what motivates you, what keeps your fire lit around health care.
Dr. Lucie Ide:
Sure. So, as you said, I’m a clinician by background and started down this career path and health care really to make an impact on people’s lives, quality of life, health outcomes, and sort of in that journey found that there were all these limitations to my ability as a clinician to be successful due to sort of systemic issues in the way we deliver health care in the US within health systems, extrinsic factors like the way we’re able to bill for health care. And it was really kind of maddening because it felt like it wasn’t right for the clinicians, it wasn’t right for the patients. That’s really what motivates me, that there’s so much potential to both deliver better health outcomes, do so more cost-effectively, and have it be a better experience for all parties that I just decided the best way for me to make an impact on individual patients lives was to move over to sort of these systemic problems and how technology could help support that improvement.
Saul Marquez:
Well, it’s fantastic to hear from a clinician, directly from a physician that had to deal with a lot of these problems. And today we’re faced with those problems. Still, though, I feel like with COVID we’ve gotten better. We’ve accelerated some of the things that should have happened a lot faster. But here we are today. Right. the pandemic is I wouldn’t say we’re done with it. We’re still in the midst of it. We’re about to get a vaccine, but we still like the opioid epidemic is not going to go away. How are we taking care of these patients? So there’s still plenty of opportunities here. Talk to us about what Rimidi is doing, Doctor, to really help improve the health care ecosystem.
Dr. Lucie Ide:
So glad you mentioned sort of these various epidemics. The pandemic we’re having will have a beginning and an end. We all hope. And as you said, it has greatly accelerated a lot of innovation, the adoption of technology, and it will have a lasting mark on the industry. But these other epidemics, the word epidemic, the chronic disease epidemic, is not going away anytime soon. And so from a focus area, we decided to focus on chronic diseases is the sort of subject area that we felt like we could make an impact on. So diabetes, heart disease, obesity in part because those really both affect the majority, the highest percentage of people, but also really drive a lot of the cost in the health care system. And you’ve got to get alignment between outcomes and cost in order to help health systems make the business case for changing the workflows or adopting new technologies. So that’s why that’s our focus area. And then our focus from a sort of programmatic and technology point of view is on improving clinical workflows and sort of improving the availability of the right data and the insights from that data to be presented to the clinician at the right point in that patient visit or sort of in that patient journey, because, as you mentioned, there’s also been this huge transition to virtualization of care due to COVID. That was a path we were going down anyway with telemedicine and remote monitoring that has been accelerated probably five years in the past nine months. And so it’s really the convergence of those two- of chronic diseases and then really data-driven and continuous care of those chronic diseases, all with the end goal of helping clinicians make much more personalized and evidence-based decisions around patient care.
Saul Marquez:
That’s really great. And we’ve really I think, taken a step forward in our step away from episodic care to kind of continuum the continuum of care, taking care of people, not just visiting for visits, just and taking care of people across the continuum of care, so I feel like there was some touch of that in your response and maybe how you guys do things, but I would love to learn a little bit more about what you guys do different and better than what’s available today.
Dr. Lucie Ide:
Well, exactly as you said. Today’s health care system delivery system is very transactional because it was built around this sort of framework. The clinicians and health systems could only get paid for basically doing a procedure or having an episode of care, a visit with a patient. And you didn’t get paid for doing anything else. You didn’t get paid for the follow-up phone calls and for thinking about the patient’s case after hours and the systems as we move to electronic medical records were therefore architected to support that use case. They were basically built their billing systems to help capture the intervention at a specific episode of care. Evaluation and management of diabetes for 20 minutes gets billed X amount of money. For I&D drainage gets billed Y amount of money. And that is so in conflict with the way health care really needs to be delivered, especially for these chronic health conditions, which is a continuous model of care that acknowledges that patients live with these health conditions every day, not just the two to four days a year when they happen to walk through the doors of the doctor’s office. And so is payment models have been slowly and very slowly shifting to acknowledge that and sort of the pay for outcomes versus fee for service. We’ve got to adopt the technology that underlies that care delivery as well. And so I think that’s where remote monitoring, telemedicine trends are really in line with acknowledging that much more continuous model of care delivery. And that’s why we are really focused on enabling those workflows around continuity of care and remote monitoring.
Saul Marquez:
Now, that’s really interesting Dr. Ide. Remote monitoring means a lot to a lot of different people. It’s just one of those terms that is now so heavy. And what does it mean specifically? There’s remote monitoring of people that say they need it because they’re getting opioids in the medicine area and we don’t want them to code or there’s the people that we’re talking about, chronic diseases. So. So what would you say your niche is. Who are you guys focused on? Is that all of them help us understand that?
Dr. Lucie Ide:
Yeah, we’ve gone on this journey and we started focused around diabetes care and did a lot of innovating and iterating around that use case and really understanding what does it take to support sort of the entirety of that patient journey. Remote monitoring is a big piece of that right. People with diabetes are asked to test their blood glucose at home, keep track of that hypothetically for the past 30 years, bring that into their doctor’s office so they can be informed by what’s happening. And that really hasn’t happened because it was hugely inconvenient for somebody to keep it in a little notebook and remember to bring it to the doctor or the doctor to have the time or incentive to really even take a look at it and try to figure out the patterns. But I bring that up because remote monitoring what we discovered is just a piece of it. Right. And by remote monitoring, I generally mean sort of using patient-generated health data. It could be from a medical device like a blood glucose meter or blood pressure cuff.
Dr. Lucie Ide:
It could be sleep and activity data. It could be noninvasive. Vital signs data from sensors in the home. It could be patient, reported outcomes, all of that. That’s helping sort of tell the story of what’s happening with that patient. And yet doctors don’t really need more data. They’re inundated with all the evidence that they need to be responsible for reading and all the data that’s in the electronic medical record. So we’ve had our job and our niche is really to help synthesize, aggregate that data with the EMR, synthesize the data to drive the insights around it. And so that’s why clinical decision support became a big part of our platform and our approach as well. I think it’s hard to do remote monitoring without really robust clinical decision support built around it, because you’ve got to get efficiency of the team who’s helping monitor these patients. And those two things have to go together to get that workflow efficiency.
Saul Marquez:
Yeah, now that’s really interesting. And so if you had to focus on where you believe you guys have improved outcomes the most or even improve business operations are on business innovation, what would you say that is?
Dr. Lucie Ide:
Yeah, so I think, again, it’s this intersection of improving clinical outcomes while driving workflow efficiency. A client told me that very early on and it didn’t fully make sense to me. And they said, even if you can improve our outcomes if you can make us more efficient, help us manage more patients with the same or fewer resources, that would be a huge success. But if you think about it from a health system. Their most expensive cost is their people right? Its man-hours of nurses, doctors and pharmacists. And so that’s sort of the Holy Grail is improving patient outcomes. So we’ve been able to move the numbers on the percent of the population with, say, diabetes, their diabetes is under control or hypertension or their hypertension is under control, but at the same time, being accountable for making that as efficient, if not more efficient, than the workflow that was there before we started the program.
Saul Marquez:
And that that was I mean, that’s something that totally kills providers. I mean, it’s just are they doing it efficiently? Right. So you’ve been able to move the needle on some of these critical chronic diseases like diabetes. Why is it that you’re able to do that? You know, what is it about the platform, your team that enables you guys to do that?
Dr. Lucie Ide:
Yes, I think you have to create this is a two-person dance of managing chronic diseases between the patient and the clinician. And I wholeheartedly believe that. That nobody there’s a lot of talk about self-management and the quantified self and all of this. I don’t think any of us want to be sort of out on our own managing our health care without the advice and insights from our physician.
Dr. Lucie Ide:
At the same time, it’s really hard for physicians to manage these chronic diseases without an educated and engaged patient. And so I think the secret sauce is sort of through the platform creating this connectivity in this virtuous feedback cycle of you onboard a patient to a program and say, hey, we’re going to be able to monitor your blood glucose. We’re going to able to monitor your blood pressure at home and intervene when we see that it’s not going well. And that might be that you’re not testing it, that you haven’t taken your blood pressure in a week and your doctor told you about the importance of monitoring your blood pressure, but at the same time, there’s got to be something in it for the patient, right?. I think we ask a lot of patients and sometimes we place a lot of blame on patients with chronic diseases. And so I always think, you know, what’s in it for both parties. And if you can align those incentives that there’s something in it for the patient, they feel more supported. They see that they’re actually getting better on something that they’ve struggled with potentially for years. And from the clinicians’ point of view, very gratified by improving the outcomes, but equally by being able to go home and have dinner with their family at the end of the night because their workflow has been reasonable.
Saul Marquez:
Yeah, that’s really well said. And so where does the payer fit into all of this?
Dr. Lucie Ide:
So, you know, it’s a great question because at the end of the day, the payers are really the ones who have the most financial incentive to see improvements in the management of these chronic diseases. As I mentioned at the beginning, these are what drive the majority of the payers’ cost and represent a lot of the avoidable cost and health care. The friction that I have seen in health care has been this alignment between payers and providers. We’ve seen progress with some of the early ACO models. I think we’re going to see more progress as we’re sort of entering Value-Based Care 2.0 because you’ve got to have the payers have to recognize that the providers are the ones who deliver health care. And the providers need to not just feel like payers are sort of sending them nasty letters saying these patients on your panel aren’t well managed right? They need to get aligned, just like we talked about patients and providers being aligned to providers and the payers need to be aligned and acknowledged what each brings to the table.
Saul Marquez:
Yeah, I love that you mentioned that. And it is that challenge and you mentioned that earlier, Doctor, the dance. And I think that there the third one at the dance and just trying to figure out that whole picture and the flow is critical. It sounds like you guys are doing a really nice job of providing analytics and data and results for them to say, wow, there’s something here, something we get excited about. So with all the experience and the work that you guys have done, what would you say is one of the setbacks you’ve experienced that has been character-forming, what was the learning?
Dr. Lucie Ide:
So I think one of the biggest challenges working in health tech is the really slow adoption of technology and frankly, anything in health care. And from a clinical point of view, this is one of the foundational issues that I constantly come back to is there was an Institute of Medicine study looking at how long does it take for new evidence to be adopted into everyday practice? And it was 17 years. So a new drug has been offered a new medical device, a new protocol. We’re just not very good at adopting new evidence in clinical practice. And I think sometimes that can be for good reason, Right. that there that clinicians are risk-averse because we’re talking about people’s health and people’s lives.
Dr. Lucie Ide:
But I think it is misapplied to the adoption of new technology that sort of the risk framework in clinical medicine bleeds over into, oh, my gosh, could we possibly purchase this cloud-based software, we need to have eighty-five people in the health system look at it and sign off. So health care’s got to catch up to other industries in terms of adoption cycles around technology. And that’s frustrating and character-building when you’re in the industry.
Saul Marquez:
You know, we all go through it. And Dr. Ide, obviously, as a tech company and health care, you’re going through it listeners. You go through it. But it’s having that clarity in how you deliver your message, how you deliver your solution that gets you past that. And obviously, Dr. Ide’s team at Rimidi is doing a fantastic job of that. What are you most excited about today?
Dr. Lucie Ide:
The very difficult year that has been 2020, I think one of the personally most exciting things to me is that every American, almost every day for the past nine months has been thinking about and talking about medicine, science, and public health in a way that the general public has never thought about those topics. That’s really exciting to me, because not only is it accelerating adoption of technology, but there’s data out showing that applications to med school, applications to master’s programs in public health are through the roof now. Dr. Fauci is everybody’s role model, and I’m excited about that because we have all these new mines coming into the industry wanting to make an impact, understanding how important medicine and science and public health are for all of our daily lives. And I think there will be a lasting impact of that focus.
Saul Marquez:
Well said. It is exciting and we are seeing a lot more people. Gosh, I mean, on the podcast, we’ve just had so many people coming from even different industries, finance, and retail, trying to say, hey, how can we do our best here to make this better? It affects all of us. I had one guest Dr. Ide say you’re in business, but you’re in a health care business even if you’re not in health care. The biggest spend that you have aside from labor is your health care costs. So if you’re not becoming a health care expert you’re missing. And so, yeah, I love what you said about that. It is becoming the centerpiece. It is the centerpiece even in our holiday cards this year. We’re writing have a healthy new year, you know, because it’s the center and it’s so important. So I couldn’t have said it better. And so when you think about the next chapter for Rimidi and our health care audience here today, what closing thoughts would you give us? And what are you guys thinking about? What should be what should we be walking away with here?
Dr. Lucie Ide:
You know, I think if we look forward to the next year and I think about sort of lessons learned from this year in this giant health care experiment we’ve all lived through is sort of the importance of just continuing to make progress and starting. And I think about the amazing feat of the vaccine going from novel virus to vaccines delivered within the same calendar year. And that’s because a whole bunch of scientists just started working on that, not knowing if they would be successful, not knowing what was going to happen with this virus, probably having no idea how impactful the virus was going to be. But they started day one at the beginning of 2020. And I think the same is true of technology. All of you out there who have ideas of ways it could improve the system and you’re not really sure if it’s the right idea or the best idea like just start down a path. You’ll be wrong on some things, you’ll be Right. on others, you’ll continue to iterate on it, but you’ll never come up with that next great breakthrough idea. It’s if you don’t take the first step.
Saul Marquez:
I think that’s so awesome. Very inspiring closing thought there, Doctor. I would even take it a step further too and say just start implementing stuff like what you guys offer.
Dr. Lucie Ide:
We say that to clients all the time, just start somewhere. It start with a small group of doctors. A small group of patients we’ll collectively learn together how this works and your system, we’ll make adjustments to the workflow. But we’ll never know how what kind of impact it can have if we don’t start.
Saul Marquez:
Well, if you’re listening to this, I think we’ve given you some nudges. So we really hope that you take us up on that check out Rimidi, they’re at Rimidi.com. You can also go to OutcomesRocket. Health. Type in Rimidi. You’ll see the full transcript with the Show notes, links on how to get in touch with Dr. Ide and the team there. But I actually didn’t ask you, Doctor, what’s the best way for folks to get in touch with you or your team?
Dr. Lucie Ide:
Website’s great, as you said, or folks can reach out to me on LinkedIn or Twitter and I’m @Lucienne on both.
Saul Marquez:
Outstanding. There you have it, folks. Make sure to connect. And Dr. Ide, really appreciate you spending some time with us today, this has been a really, really fascinating discussion. Thanks. And have a healthy New Year.
Saul Marquez:
Thank you. You too.
Saul Marquez:
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