Erik Wagner is Senior Director of Provider Strategy, Healthcare and Life Sciences at Salesforce, which has sponsored Health:Further for the past three years. Learn more about Salesforce’s healthcare solutions here. Erik has about three decades of experience in healthcare, working in multiple areas that all tend to revolve around healthcare IT. So he has a great understanding of what the digital side of healthcare looks like these days. In this conversation, we talk about the state of health IT in general, why a lot of supposedly consumer-friendly platforms (like patient portals) don’t work, and the difference between just “checking boxes” and actually designing to engage people. Erik also talks about how Salesforce is used in the healthcare industry to solve some of these problems and give providers insight into the patients coming through their doors. It’s patient engagement in real time.
To define the terms, what does Salesforce mean when you use the term “provider?”
It’s broad for Salesforce. In the relation of my role of provider is an organization or in concept an individual that’s treating a patient. So it could be an orthodontist, it could be a dental organization as well as of course, what we would think of as traditional healthcare: hospitals, outpatient clinics, home health agencies. So anything in that care continuum of treating the patient is what we would consider a provider.
How is the consumerization of healthcare changing how providers think about their health IT solutions?
In a nutshell, the challenge is that there are more options digitally. So if we set healthcare aside for just a second and look at retail and as you mentioned Amazon and how they’ve really changed the way retail is being done. People now are being engaged before they walk in the store. They understand in many cases what they want before they walk in and now we’re actually even ordering online. So they’re really going to the store in some cases just to pick up whatever it is and move on. So there’s this engagement that’s happening in a retail and consumerization perspective and that’s starting to bleed over into healthcare.
A few years ago, the concept was that we just needed to be better as an organization than the clinic or hospital just down the street. And then we’ll be better than them, so everything is okay. But what’s happening now is McKinsey did a study and they showed that the expectations people are receiving everywhere in their life, whether that’s in retail, whether that’s at a hotel or an airline or whatever, they’re bringing those expectations into the healthcare organization. So now the hospital is compared to Amazon and Delta and Marriott and all of these other places.
What are the consequences of these cross-industry expectations?
What’s now started to feed into employee burnout is that with the pressure that’s being put on [them] having to enter all of this information into the EHR and really, there’s this disconnect that’s happened between the caregiver and the patient because now there’s this emphasis on getting information entered into the EHR.
Well, now the patient comes in and expects to be treated just as well as they did at Nordstrom or Delta. So now there’s this added pressure on the clinicians. Now, not only do I have this pressure that I’m less efficient than I was. [At the same time] I’m being paid less because the margins are going down because CMS is now paying less for each procedure, so I need to see more patients, but at the same time the patient’s expectations are higher. So you have this collision course of how can we do it better? How can I engage my patients better and not burn out. What’s happening is it’s becoming so difficult that it’s just not pleasurable anymore.
[In addition] there are numbers that I saw just recently that there’s an average of 30 hospitals closing their doors every year because of financial problems. They can’t afford to stay open because there’s, again, a lot of factors that are playing into this but, the fact of the matter is now there’s a huge portion of the population in rural areas that are having a harder time to get healthcare. So now you’ve got to think about that funnel and how can we get the people that need to be at the hospital that just need to be at the hospital. […] So this is where you starting into technologies with telehealth. There’s a lot more emphasis on home healthcare and all of these things. How can we take the pressure and alleviate it off the hospitals? So there’s this seismic shift that’s happening in healthcare and without the right technology, it’s going to be a really, really rocky ride.
But there are so many pieces of technology out there. Why don’t they work better?
The EHR was created and has morphed into these huge monolithic ERP [Enterprise Resource Planning] type systems. They have an incredible place and by no means should they go anywhere, but the problem is we’re expecting them to do something that they weren’t designed to do. […] Trying to get an EHR to be an engagement platform and be even flexible is not something that should be expected.
[In addition, EHRs] were designed in such a way to meet meaningful use criteria. So it’s the concept of studying for a test. [I]f people aren’t familiar with this process is there’s a list of things that the EHR has to do and then what software vendors did and do is create a workflow or create an application that meets that checkbox.
Once you’ve checked all the boxes, you’re now certified for meaningful use. Well, by the way, when you go through meaningful use certification, you don’t even have to show it end to end. You just showed with each piece that it works, so what you’ve done now as you build this system where there’s no workflow, you’re handing someone a system that’s just been built to check boxes […] The reason that the patient portals are so horrible is because why? It was a checkbox that said […] a certain amount of people, patients must have access to your patient portal and the patient portal has to be able to display x. So people said, okay, it does x, here’s the landing page. And everyone who’s been to the doctor’s office and they’re like, please sign up for our patient portal. Everybody’s just trying to check the box. It’s not engaging. There’s no real two way traffic. There’s no check back. “How are you doing?” There’s no followup now. [W]e’re trying to expect the EHR now to be an engaging software development platform that it wasn’t designed to be.
How does a CRM (customer relationship management) system like Salesforce help these problems?
We talk about what does the ‘C’ mean to you? So I’m in healthcare, of course, and ‘C’ can be a patient, it can be a member, it could even be, ‘C’ for consumer, depending on where you are and what you’re doing.But the CRM has a much more expansive footprint than people give it credit for. So people think about, okay, well there’s a sales process so we’re now selling something and I need to know my customer or my patient because there’s that process. Well, the thing is, if you now look at service, if you look at acquisition and marketing all the way through the process, through post-discharge or post-visit, you need to engage [the consumer] and continue that journey all the way along.
A CRM really is this end to end solution from, acquisition and marketing on the front end to be able to let [people] know what it is that you have to offer as an organization and maybe why they should come [to you]. So from a marketing campaign, bringing them through the right journey. In many instances the first place a patient will have contact is the call center. So now having an incredible service, a suite to be able to give a patient a 360 degree review. When the person calls in, we know what marketing campaign they came from, we know that they were here two weeks ago, we know that they have a daughter. Maybe there’s some challenges around putting food on the table for the entire month or maybe they have some transportation problems, but now we can have a conversation with the patient just as we’re talking to them about the reason they came in. We understand people take the day off from work, maybe they’ve driven 30 or 40 or even farther to come. Well, why not have them make two or three appointments while they’re coming in, understand that maybe they need their yearly mammogram or their flu shot or their colonoscopy or whatever these things are. But let’s engage them in a conversation so that they don’t feel like they’re just the next person in the line.
How do you use all the data you’re collecting?
Listen in for Erik’s answer