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August 19, 2021

Change management and embracing telehealth: A Q&A with Bright.md’s Chief Medical Advisor Dr. Edward Abraham

Bright.md Chief Medical Advisor Dr. Edward Abraham We’re delighted to introduce Bright.md’s new Chief Medical Advisor. Dr. Edward Abraham has been on the forefront of technological advances in healthcare throughout his career. Most recently, he served as the CEO of the University of Miami Health System, which generated almost $2.5 billion in revenue and employed more than 10,000 people and 1,300 physicians. Additionally, Dr. Abraham was the Dean of the Miller School of Medicine at the University of Miami, as well as the Dean at North Carolina’s Wake Forest School of Medicine. His background leans heavily into critical care, holding positions that span the east and west coasts.

Currently, Dr. Abraham is also in charge of the academic medicine practice for Guidehouse, a management consulting firm currently servicing the public and commercial sectors. “That gives me some great insight into what’s going on across the landscape of healthcare at the present time, and what health systems and practitioners are looking for,” he said.

We sat down with Dr. Abraham to learn more about common challenges, questions, and concerns he’s hearing from physicians and executives alike. We also discussed increased competition among healthcare systems, and how clinicians should embrace new technologies to deliver better care to their patients.

Q: You have a diverse background in health systems. What were some of the biggest internal questions around innovation, and who were the ones asking those questions?

One of the biggest questions internally right now is, ‘How is this going to help us?’ There’s a fear of change often in many situations, so the issue becomes ‘How does this let us do our jobs better? How do we take better care of patients? How can we become more competitive as a health system? How can we attract patients, and how can we have them stick with us?’

There’s a lot of competition in healthcare, particularly around primary care. Now there are minute clinics, apps, and whatnot, so systems are wondering how to get patients to seek care within their system rather than using those other modalities. As for the people asking those questions, it’s a varied group. Sometimes, it’s a chief strategy officer. Sometimes, it’s a chief medical officer and sometimes, it’s a chief operating officer or a chief financial officer. It really gets down to, ‘How is this going to affect our bottom line? How is this going to help us from a financial point of view?’

Q: You mentioned a fear of change. Can you elaborate more on that? What is the fear and what is it stemming from? Is it mainly clinicians who are more afraid of change, or adopting new technology?

I think it’s primarily coming from clinicians, and for all the reasons you listed—they are uncomfortable with change. They were pushed into using electronic medical records that take up a lot of their time. But I think a lot of them are just change resistant. There are a lot of health systems with physicians not wanting to give up control, even though they don’t need to be doing everything.

Now remember, this also comes back to people—providers, in particular—being burnt out by the pandemic. So, they want something to help them with that, but they’re sort of afraid of change too.

Q: Back in 2010, Meaningful Use was a disruptive time for the industry. Do you see similarities between then and now, especially with regard to EMRs and this push towards digitalization?

EMRs were a major pain point back then and they still are today—they take time away from the patient, not to mention the extra time it takes to input information. It’s cumbersome and adds hours to the day for the average clinician. As for other technologies, I think [clinicians] just don’t know about them, which is the problem. Plus there’s this fear of taking control away. [There needs to be] an understanding that using solutions—like Bright.md—is more like a partnership. It frees up their time, which is a good thing.

As an example, at the University of Miami, we offered scribes to the clinicians so they would spend less time with the EMR. Initially, we had a hard time getting clinicians to sign on to that. But once some of them did, and they realized they weren’t spending three hours a night on notes, then everyone started doing that. Now, they could go home to their families.

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Q: There seems to be this misconception among clinicians that technology is going to negatively impact the business—as in, lost visits, cannibalization of care, and even lost jobs. What’s going on there?

It’s interesting because there’s a shortage of primary care physicians, and every health system is thinking about how they can build their primary care network. And it’s the same thing for the clinicians, nurse practitioners, and physician assistants—they don’t want to be doing routine things. So, I think it’s sort of an irrational fear. There is plenty of business in most places, and with tools like Bright.md, you can spend more time with complex patients. You’re not moving away from the routine, and your job isn’t going to disappear, which is also what I’ve heard.

Q: Putting the pandemic aside, why do you think healthcare systems are investing in virtual care and digital health solutions? What is the driving force behind this?

Health systems want to stay competitive, and individuals want their care immediately; it’s an inconvenience to leave work or take the day off to sit in a clinic waiting room. To get your healthcare addressed almost immediately at home or at work, during the day or at night, is incredibly transformative. There are also a lot of people looking to this technology, which makes success important, along with patient acquisition and retention.

Q: What concerns or hesitations do clinicians have about asynchronous care in particular?

Aside from the fear of change like we discussed, the other thing I’m finding they’re worried about is if they’re going to get the right solution—what if asynchronous care misses something important? How are we going to address that? So talking about the safety net is important too. This is an adjunct to care, it’s not a substitute for care at all. There are checkpoints and quality control, and it doesn’t take up as much of your time having to do routine things.

For instance, it allows you to better hone in. Typically, you build pathways—a patient comes to urgent care for a urinary tract infection and you have a care pathway for this problem, which includes what antibiotics to use, what tests to take, where to send the patient next. In that instance, Bright.md will generate the orders for the chart, but the clinician can also—at any point—look at it and say, ‘I have a problem with this. I want to use a different antibiotic.’ And they can opt out. You have to think of asynchronous care as an addition. It’ll save you time, improve your satisfaction, and it’s not going to take everything away from you.

Clinicians are also so pushed for time. They can’t ask all the questions and gather all the information they’d like to. So the Bright.md approach provides them with much richer insights into what’s going on with their patients. I actually think Bright.md improves quality of care because of its consistency, and also because the questions generated by Bright.md obtain more information than health care providers typically have time to [generate themselves].

Q: What are clinicians looking for in terms of technology investments? What are their priorities?

Clinicians are spending so much time with the EMR that many of them are burned out, and there’s been a lot written about that. So from a technology perspective, they’re looking for help with their day to day activities. They want to spend more time having human contact versus just typing away to enter information in the EMR. I also think they’d like to have a more organized day; they’d like to use their skill sets and practice medicine at a high level. But mainly, clinicians like human interactions and want to care for people, so they’d like to have more of that. As for their relationship with health system leadership, clinicians hope that the technologies chosen will reduce the documentation burden and allow them to be more effective care providers.

Health systems are looking at ways to develop a robust primary care network, which includes answering questions like ‘How can we see patients at lower cost? How can we make sure those patients stay with us? And how can we provide excellent quality care and great patient experience?’ Health systems have to be able to compete effectively and grow. And so, those two priorities aren’t totally opposed to one another. Everyone would like to make sure the right patient goes to the right place at the right time, in the most cost-effective way, which is what Bright.md helps to do.

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