Healthcare companies are becoming more data-driven than ever. With that comes the ability to offer a more personalized care journey for consumers. Combining perspectives of both the consumer and the health system are key to reshaping every step of the journey.
Join Dr. Daniel Derman, Chief Innovation Executive at Northwestern Memorial Hospital, and Chris Hemphill, Podcast Host of Hello Healthcare, as they discuss advances in innovative and hyper-personalization in healthcare.
This conversation is brought to you by Actium Health in partnership with the Forum for Healthcare Strategists.
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Dr. Daniel Derman
Chief Innovation Executive
Northwestern Memorial Hospital
Daniel Derman (00:00):
We need to figure out how to be there when a patient wants what they want, where they want it, when they want it, how they want it. And I would argue we even want to be there before they even know they want it or need it. And what that looks like is in a hyper personalized experience, how can we tell you that you are going to be a diabetic five years before you declare yourself as an overt diabetic?
Chris Hemphill (00:38):
Hello Healthcare. I am excited to be joined by Dr. Daniel Derman, who is the chief innovation executive at Northwestern Medicine. Daniel is a practicing physician in internal medicine. And when we use the term innovation, obviously means so many things to so many different people. There’s all kinds of different paths that we can go. But what I wanted to talk with Daniel about, and you’ve been in that role for 27?
Daniel Derman (01:06):
Actually in a month, it will be 38 years at one place, at Northwestern Memorial. I’ve had a number of different responsibilities besides running a primary care office. For the last six years, I’ve been the chief innovation executive.
Chris Hemphill (01:21):
Excellent. So what excites me about that, especially the last six years that you mentioned, is that in healthcare, there’s a mixture of risk aversion, which I think is very valid in a lot of cases. It’s an extremely regulated industry, but there’s the huge question of when we start looking at innovation, where do we go? What’s our guiding star? What guides the path that we take? And Dr. Daniel and I have been having some good conversation on what it means to focus on the patient, how to personalize our offerings and basically, where that’s going with the overall patient experience. So with that, Daniel, you’re the best to introduce yourself. Just wanted to get your perspective on your background and what’s brought you down this path of focusing on innovation so totally.
Daniel Derman (02:13):
Got it. And I’m going to come back to the innovation and you brought up a really important point, but you want a little bit about background in terms of I’m a practicing internist, been at Northwestern my whole career. I didn’t have any particular expertise in innovation when they tapped me to do this. My CEO knew that we were doing everything we could with the way healthcare systems were built and the ecosystem was operating, but we didn’t have anyone who was out there thinking about how the world’s going to change and how we could prepare to do that. And in my prior life at the hospital system, I introduced a lot of new, innovative ideas, but the real reason they tapped me was that I really understood operations. And one of the challenges with innovation is in many places, innovation is out there on an island, not connected to the main part of the hospital system.
So they’re out there finding answers without actually asking question. I get an answer and now I go find someone who’s going to ask the question, if that makes sense. So I find this new cool technology, and then I go looking, “Is there anyone at Northwestern that wants to use it?” Well, that’s backwards, as they say. And I learned and have a lot of scars in my back through time that the really right way to do this is talk to, embed yourself with the operators to find out what their problems are. And then go try to find solutions, be it companies or new ideas generated by our own faculty and staff to try to answer those most pressing needs.
Anytime I came up and found a new technology and then went to find a sponsor or a champion, they almost always didn’t take hold. So I would say that’s one of the principal lessons is let innovation start with the operators. And any project we do now always has an operator attached to our hip. Now, one other thing you brought out in the introduction, which was really wise, and I don’t know if you realized it, but innovation… Well, the way that medicine is designed is we use something that’s called evidence-based medicine. Theoretically, a drug does not touch the body until we’ve proven that it’s safe and that there’s a benefit to it. That’s what we call evidence based. We don’t do something to any human being until we’ve proven that it’s safe. Well, now let’s think about innovation. Innovation means taking a risk. It means doing something that isn’t proven. You couldn’t get two cultures that are less designed to coexist than evidence-based medicine and innovation. And not only is it our clinicians that are evidence-based, but that ethos has worked its way into the administrative group as well.
We just don’t do things in healthcare, unless we have an idea that it’s going to work and a really good idea that it’s going to work. So the idea of trying new things does not really sit well. And for us, so with that being the issue, I go back to the way that we solve that, is by bringing the operators in early so that we can try something. And one of the watchwords or the phrases in innovation is fail fast. Try something. If it doesn’t work, modify it, modify it again, and if it doesn’t work, move on to something else.
Chris Hemphill (05:53):
A lot of the points that you bring up too, they really resonate with me because I’m going to call myself guilty or I’ll call the healthcare tech industry guilty on one aspect of here’s the problem. We make things sound cool. If we say that artificial intelligence is like the solution to all these… Well, it’s extremely awesome, extremely powerful technology, then [inaudible 00:06:16], people will start looking for, “Well, I want to use natural language processing, or I want to use these technologies.” But the point that you’re bringing up so powerfully is for what? If we’re starting with just how great that technology sounds, those shiny objects, then it’s kind of that solution, “Well hey, we bought this thing and now that’s our hammer.” And everything starts looking like a nail.
Daniel Derman (06:40):
Chris Hemphill (06:41):
But by starting from the operator’s perspective, by understanding… well, when you say operator, who are you referring to exactly when you say that?
Daniel Derman (06:49):
So those are the people in the trenches that are actually dealing. So my example is with the healthcare system. It could be a payer. It could be a new tech company. It doesn’t matter, but the person who’s in the trenches who has really tried to figure out. So let me give you something in context today. I think everybody knows with COVID and the epidemic that labor shortages are a tremendous problem, and particularly in nursing. So our use of contract nurses has gone way up in the last 12 months or longer. So now, we’re looking at and very focused to go out and find a digital solution or a technology solution that would help alleviate the need to use contract nursing, which comes in at a very exorbitant rate. So right now we’re piloting a new technology that we developed that is a remote nurse with listening that could listen in and do the documentation.
I don’t know if people know this, but a typical nurse on a shift will spend anywhere from 48% to 56% of his or her time documenting in the electronic medical record. If we can have a remote nurse listening in doing some of that documentation and take half that off their plate, we’ve now returned 50%, half of that, we’ve returned 25% productivity to the healthcare system. They could do with it what they want. They may say, “Nurse, we are now going to give you 25% more time at the bedside.” They may cut the FTE count of who they have to have in a shift by 25%. We don’t actually care how they do it. Let them make the best decision for them, but we’ve given them the tools to do that. So that’s an example. And by the way, now getting to what you’re talking about, AI down the road, we start with remote nurses who are listening in, but eventually we’re going to use AI and listening to document that all without the need for a human being.
So don’t get me going about AI, but if you did, I would say one has to be very, very careful. It’s kind of corny to say this, but it’s really augmented intelligence rather than artificial intelligence. And it gives the person that’s involved with it the ability to operate at a higher level of their degree. So my example with the remote nurse or the AI use with that is now we don’t take half of a shift for a nurse to just document, “I gave the patient subq heparin.”, but something else or someone else does that so the nurse can do only what the nurse could do and that’s discharge instructions, “Do you understand Mrs. Jones, that when you go home, you have to do this with your bandage or that with your bandage?” That’s a really good use of the nursing skill rather than documenting, “I gave subq heparin.”
Chris Hemphill (09:52):
And I got to say reading into the subtext of what you’re saying and the focus on operational results, the focus on staffing capacity when addressing these technologies, if you’re reading the subtext, then you’re getting a really good education in how to approach this innovation and business in general. So one question that I wanted to get into, since we all of a sudden got into a conversation on personalization, I’d like to just riff on this personalization concept and first start off with your perspective on when you’re referring to personalization, because it’s something that a lot of people seek. There’s a lot of different answers to that question. What’s the perspective that you have on personalization?
Daniel Derman (10:40):
So let me start very big picture and I’ll kind of show my age because the examples I’m going to give, you could probably come up with much better examples than me, but let’s put a team photo picture up. And let’s have Amazon in the picture, GrubHub, HelloFresh, Airbnb and a healthcare system. What entity that I just described doesn’t fit in that team photo? Healthcare. We don’t do anything. And again, there’s better examples in the ones I gave. I’m showing my age as 63 year old male. There’s probably better examples. But the fact is all of those companies do a much better job of understanding who you are than we do in healthcare. Now granted, I can get up on my high healthcare horse and tell you, “But we’re so much more complicated than all these other ones. They have it easy when you’re just trying to figure out where do you want to rent a place or where are you going to be picked up?”
They have a much easier job, but the fact is they do a great job and we do a terrible job of it. So let me start by saying that is that we need to figure out how to be there when a patient wants what they want, where they want it, when they want it, how they want it. And I would argue, we even want to be there before they even know they want it or need it. And what that looks like is in a hyper personalized experience, how can we tell you that you are going to be a diabetic five years before you declare yourself as an overt diabetic? And what might we know about you that says you’re at high risk and you know what? You may have colon cancer before you ever go and get a colonoscopy that proves that you have colon cancer because I’ve noticed or I can track that your blood count has slowly been drifting down that we used AI to determine that rather than the skillset of an individual provider, who has to look at that and go, “Hey, it’s gone down by a little bit.”, because most people blow that off.
So I think understanding and providing all that experience for a patient, it’s what I call a patient CRM. Nobody has that. People do different parts of that really well. I’m sure there are healthcare systems out there that have a beautiful kiosk system right now, so that when you go in, they don’t have to give you that old clipboard where you fill in your name and your allergies and the medicines you’re on. There are people that do a really great job of that today. Some do, some don’t, but that’s at the bottom of the pyramid. We got to do all that really well. We have to know what your preferences are.
Do we want to contact you by email, by text, by phone? Those are all simple stuff. What language you use? You’ve been an inpatient. So we know that you’re a pescatarian, not to give you meat. That’s table stakes. As you go up the ladder, we know more and more about you and help your navigation be personalized for you. At the top of the pyramid today are all the omics, genomics, and it’s what do we know about you and your DNA that’s going to say what’s going to happen to you in the future? Right now, that’s the top of the pyramid, so to speak about what we might know about you, but chances are there’s something else that’s going to replace that. So as I said, there are different people that do a good job of bits and pieces of this, but nobody has put that all together in what I call a clinical CRM and for us as incumbents, i.e. those that now take care of a lot of patients, if we want to maintain that position, we’re going to need to figure that out because a lot of people disruptors are nipping at our heels that are doing a better job at it than we are in components of it.
My challenge is to figure out how to do across the board, a great job of that across the lifetime of a patient. So how do we do a great job of that with wellness? With a chronic disease like diabetes or rheumatoid arthritis? A time when you have an acute serious illness, like we found breast cancer or colon cancer, you had a stroke? How do we do a good job across all that continuum? That’s really, to me, the holy grail of a hyper personalized experience.
Chris Hemphill (15:02):
Well, I love that description. And I think that one thing that we can zoom in on is you say that some folks are doing it well in pieces and parts. Could you describe when you say pieces and parts, is that by category of illness or is it by some other operation? What would you say is that the pieces and parts that are coming, starting to show up?
Daniel Derman (15:27):
So I described some of those already, for instance, this idea of a kiosk so that we know who you are and you don’t have to repeat. It’s maddening to everybody that everywhere you go, you got to pull out your insurance card again. You got to show your driver’s license. That’s very simple stuff. But there are many healthcare systems that are also doing these patient journeys. They’re mapping out, for instance, in the world of a heart attack, they’re mapping out the whole journey of a patient and they’re knocking down barriers so that a patient and their family can have an expedited great experience. If it’s a cancer, God forbid, or a heart attack, I’m not critical. Those are perfect examples of doing a great job and we have to be doing those activities. But in a lot of places, those are in a vacuum. They’re responding to specific patient journeys for a particular illness or set of challenges that a patient has. I’m looking to think about how we might do that more globally and fit those in under a general rubric of putting together a hyper personalized experience.
Chris Hemphill (16:33):
So do you see that as potentially one approach that is able to be generalized or do you see it as a collection of different approaches and responses to different [inaudible 00:16:46]?
Daniel Derman (16:45):
Yeah, honestly I’m sorting that through right now. That’s exactly the work that my team and I are doing. I think one way could be just doing these individual ones and then figuring out how to string them together. I’m worried, knowing how healthcare works a lot of times, that it’s so idiosyncratic that once you build one for cardiology, congratulations, you have it for cardiology. And the Venn diagram between how you build it for cardiology and how you build it for cancer is going to have an overlap of 20%, 30% instead of an overlap of 80%, 90%. So that’s just some early thoughts. I’m not sure and the jury’s out on it. I know a lot of places that are building these journeys and we may do something similar like that, but that’s the challenge I’m having now is trying to figure that out.
Chris Hemphill (17:33):
And perhaps there’s an overlap in pathways that doesn’t match up entirely, but if there’s the same underlying structure behind that. So let’s say that your cardiology path involves outreach at these specific times and bringing for these specific conditions and things like that. It strikes me that these idiosyncrasies, the reason why it is so fragmented is because the reality that there’s so many different solutions.
Daniel Derman (18:08):
So here’s an example for instance, take cardiology, oncology, cancer, or a stroke. In all of those, nutrition plays a very important role. Probably by the way, parenthetically, the providers don’t give it enough homage of how important it is, but we’ll leave that aside. But those are the things that you can build the unit or the bolt on of how nutrition fits in, where it may vary a little bit. Cancer may be four degrees off of it, but probably, 80%, 90% of the essence of it is the same platform. And then you just do some tweaking to fit what are the needs of a stroke versus cardiology versus oncology as an example.
Chris Hemphill (18:52):
Yeah, and when we bring it back to that patient CRM perspective, it just seems like the foundation that we would need is something that you have a general foundation that can do all these sorts of things, but it has to be really flexible to these.
Daniel Derman (19:08):
Right, and that is the idea of a platform. Listen, everyone talks about a platform. The ideal platform is something exactly that. It’s a platform for which you stand on or you build off of that gives you anywhere from probably 60% to 80% of what you need and you tweak the rest, but that’s a lot different than a point solution where you build it, and it specifically applies only for cardiology at Northwestern. That’s really not helpful for other disease states or if you go outside of Northwestern.
Chris Hemphill (19:39):
Indeed, indeed. So the way that you describe this, I want people to have something tangible as a way. We know that hyper personalization to the degree that we’re discussing, that’s a ways off and who knows if it’s going to be a platform that enables this versus a network of different approaches, best of breed. I’m leaning towards a platform that enables that, but that’s the subject of another conversation. For this conversation, I wanted people to be able to have a good sense on let’s take one of these pockets of personalization that we discussed. How about we dissect that, break that down into what’s a good approach to pursuing that innovation versus the types of things that we should avoid in this case?
Daniel Derman (20:25):
This will continue with the theme that I think I hit was understanding who the customers are for your innovation. And I spoke already a lot about this hyper personalized experience. And you’ll notice that I was very focused on the customer, the consumer, the patient, but I will tell you that if you build a module and a platform that has as your target, only the customer and the patient, it’s going to fail because it’s not going to work for the provider’s side, who is inevitably part of the equation. So it’s a dual challenge, and I’d say that’s probably what I’d end with is the idea of always thinking about who your target audience are and who you need to satisfy. Because if you have two key customers and you only satisfy one of them, it ain’t going to work.
So if I built a system that is beautiful for the client, the patient, but doesn’t address the needs and doesn’t work for the provider, it ain’t going to work. The whole thing will fall apart, even though it’s beautifully designed for the patient. So as an example, I guess I’d leave people with this idea of KYC, know your customer, but really understand who your customer is and who could sabotage or prevent success and making sure that you bring them in that journey early, because the other factor is once I get really wedded into something and then I bring an operator who has an observation, I’m less willing to take that into account or modify what I do, because I’ve now built a world that I’m very invested in. That’s another reason why bringing those people in early before you become invested is a real measure for success.
Chris Hemphill (22:19):
So know your customer and know your operator, it sounds like.
Daniel Derman (22:23):
That’s right. Well, in this case, know your customer is bifurcated and understanding that you have in this hyper personalized, you really have two sets of customers.
Chris Hemphill (22:33):
Yeah, excellent way to phrase it. And gosh, I think this is the tip of the iceberg of a really awesome conversation. I bet a lot of people watching, listening will think that too. So for the people that want to continue the conversation or hear from you, is there a way that they can get in touch or follow some of the things that you’re doing?
Daniel Derman (22:52):
Well, I don’t do podcasts, but do you have the ability to make my email available?
Chris Hemphill (22:57):
Yeah, we can pop that on the screen.
Daniel Derman (22:58):
If you put that on the screen, I’m happy to respond.
Chris Hemphill (23:00):
Okay. Well again, thank you very much for joining in with us. Really love the conversation and hoping to have more soon.
Daniel Derman (23:09):
Great. Thank you very much. I enjoyed it too. Thank you.
Chris Hemphill (23:13):
And for the folks that enjoyed this conversation, a lot of what Dr. Derman was talking about, especially the need and the concept for a new platform that can be hyper personalized, it reminds me of a conversation we had last year with Dr. John Glaser, who was CEO of Siemens, and I believe is a innovation fellow for Harvard Medical School. But either way, that conversation is available on the screen and in the show notes. It was called It’s Time for a New Type of EHR. So it really gets down into a vision on what we should be pursuing. Thank you for spending a little bit of time with me and Dr. Daniel Derman. And until we see you next time, hello.
Speaker 3 (24:03):
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