Originally Published: Nov 30, 2023
YouTube: https://youtu.be/wPCy9rVRxdE?si=8L23VPEWBycmIbG_
In this exciting episode of Digital Health Talks, we're thrilled to host healthcare and hospitality expert, Dr. Peter C. Yesawich, as they unveil the secrets of their forthcoming book, "Hospitable Healthcare: Just What the Patient Ordered!" (Indigo River Publishing, September 5, 2023).
Join us as we explore how healthcare experiences can be transformed by borrowing principles from the hospitality industry. Most of us can attest to the stark contrast between our interactions with hospitals and those with hotels, resorts, and restaurants. But what if healthcare providers served us with the same level of hospitality? Dr. Yesawich dive deep into this intriguing concept.
Together, we'll journey through 24 common service touchpoints shared by the worlds of hospitality and healthcare, where they introduce their innovative PAEER model (Prepare, Anticipate, Engage, Evaluate, Reward). This model is grounded in the principles the hospitality industry has used to create exceptional guest experiences, and it holds the promise of revolutionizing patient care.
Michael Millenson, President, Health Quality Advisors LLC
Megan Antonelli, Chief Executive Officer, HealthIMPACT
Janae Sharp, Founder, The Sharp Index, Moderator
GMT20231117-172205_Recording
[00:00:00]
Janae Sharp: Thank you for joining us at Health Impact Live. I'm Janae Sharpe. I'm the founder of the Sharp Index and nonprofit dedicated to improving physician mental health. And I am honored today to [00:00:36] sit down with Michael Milson, a thought leader. An activist, an author, an elapsed journalist from years ago.
And I'm looking forward to learning more from you about radical patient engagement. I'd love if you could introduce yourself and talk a little bit about your work.
Michael Millenson: Sure. I started off as a healthcare journalist and then wrote demanding medical excellence, doctors and accountability in the information age.
back in 1997 and ended up leaving journalism, going to consulting, activism health services research policy work all of that, all centered around how [00:01:12] can we make patients lives better? How can we make care higher quality and safer? And how can we be more patient centered? So all of it has to do with improving the quality of medical care for patients.
And what I saw a few years ago was the semantic web was giving patients more personalized information that could help them be independent of the information that was controlled by the physicians and help give themselves better care. And a lot of people say well that's only the more activated ones you know you're a PhD from Stanford, but what [00:01:48] folks also don't see and I've seen since I was a health benefits consultant for a number of years, is that employers.
And others are providing these tools to their employees who don't have to be super sophisticated. And when you put all that together, you get a new model that's not patient centered care, but what I call collaborative health. And collaborative health is not collaborative care, which is where actually doctors and nurses, talk to each other.
But what it is where the patient And the physician or the health [00:02:24] system have a different kind of relationship. And this was something that I wrote for the British Medical Journal back in 2017 that caused the editor to say, this is where we're going in the future. And now when we have AI and a lot of the things that we're seeing that are just sprouting into all sorts of different platforms is really starting to come true.
So what I see. is collaborative health as a framework by which the essential good parts of the doctor patient relationship can be preserved and so we [00:03:00] don't have chaos of information everywhere where frankly profit seeking entities kind of distort the whole thing. So that's kind of where I'm concentrating now.
Janae Sharp: Right. I like what you said about, we need to make sure that we have patient centered care without, profit seeking entities. Going back to what you said earlier, there's a lot of information out there, and there are memes everywhere talking about Dr. Google and the searches that you make, and I've heard from physicians, there's It's dangerous when you think you have a medical degree and you just Googled it.
And I've seen that in my own life, like with my kids, they Google something, they know all [00:03:36] about it. I'm like, I'm pretty sure you don't have cancer, but you did Google that.
Michael Millenson: I've done the same where I've been absolutely certain and absolutely wrong.
Janae Sharp: Yeah, absolutely certain.
Absolutely wrong. So I'd love to talk a little bit more about that. Let's dive into what you mean by that. Like what is patient collaboration or, what was it you said?
Michael Millenson: So let me give you an example. We tend to think of Dr. Google, but what I'm talking about is platforms that now are personalized based on your own medical information.
So one example is a platform called outcomes for [00:04:12] me, which is a platform that's available free to patients and also has a counselor actually free and you can contact by online or telephone. And they take your medical information that you can now get from your record, right? Because of the legislation allowing that.
They put it into an AI powered algorithm, not chat GPT, but natural language processing, or what we can call old fashioned. AI. And then you can take that and they run it against a database of evidence on cancer from the National Comprehensive Care [00:04:48] Network and then they make recommendations. So that's something that's very different than googling your cancer and going to your doctor.
Yes. And that's the kind of thing or being independent. Another example where somebody an older person Is living alone, and they put there's something they can buy for themselves or a health plan might do. They put sensors into the apartment not cameras but sensors. And when you get up in the middle of night a bunch of times, the algorithm says this person may have an You didn't urinary tract infection.
They contact a nurse. That's not [00:05:24] your family doctor. And somebody comes and looks at you. Well, that's medical care and it's outside the traditional system, just like the other one is health advice outside the traditional system, but it's not googling. It's based on Your personalized data being analyzed.
It doesn't make it perfect, but it often makes it just as good or better than what your doctor would get from just talking to you. That changes the relationship. But what I want is a system whereby We connect people, right? We don't need more fragmentation. And so right now, if you're [00:06:00] working for a company that has a care management company to help with your diabetes, right?
That medical record never makes it to your primary care physician. And then you change companies and nobody has it, right? Or you do something online and all the rest of that. And I think what we need is a holistic kind of system that takes into account the things that I can get on my own and the things that I'm getting through the system.
I want to add one last point, which I think is really important. When I talk about a collaborative health relationship, I do not use cliches like you're the ceo of your life or we're co producing and [00:06:36] all the rest of that because you're not co producing your heart surgery i'm sorry and when you go into the er after being hit by a car i mean you it
Janae Sharp: depends because they might have done a lot of
Michael Millenson: things you don't have a preference for sutures or staples and what i use is a couple of medical ethicists quill and brody who talked about a relationship that's based on the evidence, the patient's preferences and values, and the physician's experience.
And I love that because it values the physician's experience because not everything is a cut and dry. It makes sure the evidence in there [00:07:12] and it values the patient's preferences and values. And importantly, It's dynamic. So the example I use is sometimes it's a shared decision making process and sometimes it's not just like sometimes in a marriage.
Sometimes you just go. Yes, dear.
Janae Sharp: Yeah, because you gotta you just gotta just pick to go with one person. So only one person's unhappy instead of two. That's what they say, right?
Michael Millenson: Exactly. And that's what I love is a collaboration that is dynamic. And if you [00:07:48] want to go doctor. whatever you want, the doctor doesn't say, well, if you check Google, no, I mean, so, so you have a chance to have a relationship that's based on the patient's preferences and values and on the doctor's experience and on the evidence.
And that's the model I'd love to see. That's not didactic, but is based in the real world, but also is based on the shifting technology and the semantic web. It ain't Dr. Google searches, doctor. It's something a lot different than that. Right.
Megan Antonelli: I'd love to,
Janae Sharp: there are two things I want to touch on about that.
One is I want to talk some about the challenges with [00:08:24] adoption and also I want to talk a little bit about, separately, about about research and about getting that data, that is helping you make those decisions. I love the idea that we're not being called the CEO of our health. I get that.
I'm like, wow,
I'm in charge, huh? Well, that's going to be a nightmare.
Like, like, I don't want to have all my data in my pocket. Like I want to just have it magically appear when I need it or just no. And there are lots of questions that we can ask there. So I'd love to know what your experience is, like what.
What are the challenges here? [00:09:00] Like, what are people, that's not been my experience in healthcare. Why do you think that is,
Michael Millenson: Well, it turns out that interoperability is not really good if you want to keep the patients coming to your healthcare system and charging them for your services so they don't go elsewhere, right?
Right. What's fascinating what's happening with AI and what's happening earlier is it's breaking down the geographical barriers to information. It's breaking down some of the barriers between wellness care, health, and medical treatment. We're starting to break down some of the socio economic [00:09:36] barriers.
And what we need is new roles for everyone and new rules for everyone based on the new information environment. And that's a really tough adjustment because it's tough to tell people rather than having cliches about power. And it is a sharing of power. There's no question about it. You still need to respect the doctor.
Right now, it may be that your doctor doesn't deserve as much respect because he or she doesn't actually understand the evidence, but it needs to be done in a respectful way. Right. And you can't overwhelm physicians with too much information. [00:10:12] So how do we create data intermediaries? How do we create true interoperability when it's in the economic interest of a lot of folks not to have it?
And those are difficult questions. The only way that happens is if there's a vision for a framework that push patients in a collaborative way at the center. Otherwise, I'm afraid what we get is a lot of rhetoric about patient centeredness that actually has to do with customer service, rather than sharing clinical power.
Right. So, being patient centered [00:10:48] that says you order your medication, and I get it to you within 12 hours or 12 minutes or whatever. That's great, that's patient centered in a customer service way. Sharing the power over clinical decision making, sharing the power that allows you to take charge of your health in a different way, sharing the power that says I may get information from different people than you and it's just as valid, that can be very threatening to organizations that have a lot of political and economic power.
And that's why I think you need a vision that gets government involved and gets patients involved. That's my idealistic [00:11:24] take, anyway.
Janae Sharp: Yeah, I mean, people have said, like, you sometimes need policy to enforce sharing.
Michael Millenson: Well, that's exactly it is that it took for sharing to share medical record information.
And the objections were often sincere, but at the same time, now that I have electronic control of my record. I can go anywhere. And particularly, I've written about AI enabling patient independence. I've read virtually everything I can in all the medical journals and all the experts by PhDs and everything.
And [00:12:00] all of them, 100 percent of what I've read talk about AI this way. It will enable us to be better physicians and it will give better information to our patients, but you better be careful. They're going to be misled. No one has written, you know what, they may be able to get information that's just as reliable as what I know without me.
And an example I give is there was a medical journal, where they did a natural language processing, reading patient's medical records, and they were able to predict with up to 90 [00:12:36] percent certainty, cancer mortality, within six months, five years, for all types of cancer. And I reached out to the authors of that journal, and I said, If you put your algorithm online, and I have an app, right, I get your algorithm via FHIR, and then I apply that to my own medical record, would that work?
And they said, well, yeah, it would. So think of what that does to the relationship. If I as a patient can have a peer reviewed medical journal quality [00:13:12] algorithm that starts to talk about the risk of death from cancer, or about my heart attack risk, or about my recovery from some sort of disease, or by the way, about my risks in surgery, and that's online right now.
That changes the relationship a lot. You can't accuse me of Googling something that wasn't right then and we're not ready for that. We're not ready for the power sharing. And I want to make sure that power sharing isn't just shut down as dangerous, but that it's welcomed and made to be constructive.
So So, I understand. I [00:13:48] understand why this can be dangerous, but it's coming. And therefore, let's share power in a constructive way, as opposed to having all sorts of other things happen. At least that's my hope.
Janae Sharp: Yeah. When we talk about that, it sounds like the data infrastructure necessary to share some of that power is here in some places are being developed.
And I like that vision that you have. What are the steps that people need to take? You said we're not ready.
Michael Millenson: Well, we're not ready for the implications of all of that because we have, frankly, now we have all the big healthcare systems [00:14:24] consolidating and we have the Amazons and the Walmarts and the CVS's and Walgreens.
They did not spend billions of dollars to assemble networks. In order to say, You know what? Get your care wherever you want. That, that's not what, that's not what they did. And so we need to ensure that our data capabilities keep up. That's the first thing. So for instance, if you talk to the people who are really deep into the informatics world.
They will tell you that despite fire, things are not interoperable now. That despite all the kind of different ways we're supposed to be interoperable, [00:15:00] it's not true. That even different versions of epic can't talk to each other. And these are things that the informatics people talk. about amongst themselves.
And there are all these voluntary groups of stakeholders that are supposed to fix it within a year or two years, the lifetime of Methuselah, whatever. And these groups have been around for a long time. There needs to be some urgency. There needs to be saying, look, some of this is a technical problem.
There's no doubt about that. But a lot of it is a problem of. willpower, right? And that's analogous to some of [00:15:36] what I wrote back in Demanding Medical Excellence. Not putting the evidence into operation for patient care is sometimes a matter of technology, but often a matter of willpower. Not wanting to upset the old ways because this can be so disruptive because this can be so disruptive that should be both an incentive to do this and also for some people it's a disincentive because they hope they can put off the future that's disruptive and I don't think that's going to happen.
But on the other hand, I don't own a [00:16:12] multi billion dollar healthcare system, so, they have to balance that.
Janae Sharp: Yeah there, people are incentivized to have things remain in a way that benefits them the most.
Michael Millenson: Non disrupt, non disruptive disruption is what all the big players want. So, by disruption, they mean, The money that the people over there are getting will now be disrupted and flow to me.
That's one kind of disruption, and maybe it's a justified disruption. But another kind of disruption is, oh wait, my business model is going to have to change, as well as those other people who I think I'm smarter than. That's a [00:16:48] tough disruption.
Janae Sharp: That's a harder one. Like, I mean, I've also experienced like massive life disruption and it still is hard.
Like it's still a giant backlash. So how do you have a vision for the future of where that's going to land? Or are you hopeful?
Michael Millenson: One group has been suggested to me to start with. And, since I'm not, a McKinsey consultant, I don't have a 10 point plan that you can hire me for multi millions of dollars.
It's unfortunately, I'm not that kind of consultant...
Janae Sharp: And we can disrupt that for you. We'll make you one.
Michael Millenson: Okay good. I hope [00:17:24] you can fix that. One area that you might start with is in pediatrics, and I'll tell you why. In pediatrics, the patients are the kids, and the parents are very involved, right?
And we have models in which the Parents are giving information that the health care system accepts. It has been done at Cincinnati Children's is one of the examples. They've been a terrific group, both in quality of care and in really patient collaboration. So you take some of the models where we've been doing this and sort of Yeah, old fashioned way, as it [00:18:00] were, and you say, how could we generate this to an even greater degree of collaboration in a way that was even more taking into account wearables or taking into account things you do online in a different way?
How can we take people who already want to be collaborative, because the pediatricians are very much that way, and take it up to a different level? So I think you work things out in a region in which Both the patients and the clinicians and the health system and the payers are all incentivized for collaboration, and all have kind of a zeitgeist [00:18:36] to be collaborative.
I would not start, with orthopedic surgery, for instance. So, so yeah, you started an area which is culturally and maybe someplace which also geographically is culturally ready to do this. And you make mistakes and you understand technical challenges and you build from a vision.
into something that works. And I think this is coming in oncology in a lot of ways. Whether oncologists are ready for this, I don't really know. I think it's a difficult kind of space, but it's a space that's fast moving informationally [00:19:12] because of course the information is such high priority to everyone.
Janae Sharp: Yeah. I think it's also a sticky, it's a sticky place for people. Where there's a lot of motivation, to work on that. And it's also incredibly devastating and extensive. So it could also have a business case.
Michael Millenson: Absolutely. And in fact, in the example that I gave earlier, the woman who found out, who used this platform that I talked to, found out that a particular drug that her doctor recommended, that she was not so anxious to take because of side effects, that there was an alternative drug that studies have [00:19:48] been out on that had fewer side effects, and the doctor was happy to accept that.
And, In the second example with the same patient, she was reluctant to do a certain kind of therapy that her doctor recommended, again, because of side effects and all the rest, and she was still working. And when she saw some of the evidence for it that was independent of her doctor, that came from this platform, she went to her doctor and said, I'm ready to do it.
So doctors believe often that patients getting information elsewhere will gum up the works. Sometimes it can make things better. Right. [00:20:24] Sometimes, especially remember, we're not talking about randomly searching the web that says you should drink bleach for your COVID. We're talking about semantic web in responsible platforms that look at your personalized medical information and not, and use that against the evidence.
That's very different. Not infallible. But a very different kind of relationship. New rules, new roles.
Janae Sharp: I like that. New rules, a new role. So tell me, you are going to be part of the NODE Health Conference and speak about this [00:21:00] and sit down with experts and I'm looking forward to hearing that and hearing more about these new rule, rules and roles about oncology care. What are you looking forward to? Can you tell us about your vision?
Michael Millenson: I like the Node Conference. I've been a couple of times. I like it because it's informal. People talk to each other. You get a lot of ideas. There's a lot of interaction. And too often conferences are vehicles for making statements that you've made everywhere else.
And yeah, obviously there's some of that, but it's also a chance to really talk to people. So I'm really looking [00:21:36] forward to the, to, to the node conference. And, the other thing that helps it is when people are among others who they sort of. like and trust, they relax a little bit more and it's a smaller group.
And that, that's much better than some of the, Oh, I'm on a big stage and I'm going to say what I always say and then leave. That's why the way I said at the beginning of this discussion about the difference between meeting room reality and in the trenches reality. And it turns out what people say in a PowerPoint.
isn't always what's happening in real life. Who knew?
Janae Sharp: I'm not always going to put my real life in a [00:22:12] powerPoint.
Michael Millenson: Well, also, the problem is people present about a project in all seriousness, and the project is something that happened a year ago, two years ago. They don't really have results. They only are presenting a small slice of what it is.
And if you want to talk about real change, you need to ask the tough questions. And certainly when I've spoken to people about collaborative health. I welcome people asking me questions and saying, you know what, here's what you haven't thought of, because that's how we get to a place of something that works in real life.
And you can't be wedded to your concept without letting real life intervene. [00:22:48]
Janae Sharp: Yeah. I love that. Like as a soundbite, you can't just be wedded to your concept outside of real life. So thank you so much for your time today and for your work, and we need more people. We need more visionaries who are going to work to make sure that the roles and responsibilities of the future meet our capacity and our needs.
Michael Millenson: Thank you so much. I appreciate the time and I'm looking forward to the conference.
Janae Sharp: Yes, it's going to be great. [00:23:24]