The Ever-Evolving Future of Healthcare

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We hear a lot about value-based care, lack of access, rising costs and provider burnout. What about artificial intelligence taking notes during visits with patients, doctors sending 3D-printed casts to your home, and cameras in exam rooms allowing specialists to diagnose you without even being present?

We’re not there yet. But we’re headed in a direction that could change what it means to “see a doctor.” At the forefront of this innovation is my good friend, Dr. Judd Hollander. He joined me recently for an insightful conversation about topics just like these.

Interview

Hal: So, Judd, Dr. Hollander, we actually met quite a few years ago when you were the baseball coach for one of my boys, Kyle. And you were actually very instrumental in his growth and the way he is as a person. But I remember standing out in right field with a bunch of other fathers and just observing the way you coach. And I’ve always thought that great coaches make great leaders. So in that respect, Judd, share with us a little bit about yourself and what you do.

Judd: As far as medicine goes, I started my career as an ER doc and got into doing clinical research and at some point realized that growing a clinical research program is kind of the same skill set as growing the business, and honestly, it’s a little bit related to coaching also.

And I moved over to Jefferson almost a decade ago and was charged with beginning and growing a telemedicine program from nothing, opening a chain of urgent care centers and figuring out how we take health care to the patients rather than bring patients to health care.

Hal: You’re now involved in leading telemedicine and the enterprise platform that’s involved, along with urgent care. It takes a certain type of individual to work in emergency medicine or in urgent care. When you’re evaluating potential talent, what do you look for in not only their skills, but in personality traits, whether they be providers or the support staff?

Judd: Emergency medicine is really different than other areas in medicine. If you’re a cardiologist, you know everything in the world about the heart, but you may not know much about the ear, nose, and throat or OBGYN. If you’re in the emergency department, you need to know everything that can happen with a spectrum of conditions over the first 24 to 48 hours.

You need somebody that has a few main traits besides working nights and weekends. You need somebody that can tolerate everyone else they interact with having more expertise on the disease that they’re dealing with, even if it’s not as much expertise about the early management. You need a doctor that’s going to place the patient first and has a tough spine.

You need someone who thrives in uncertainty, because as an ER doc, I am never going to get all the information I want. Most other specialties get the ability to gather all the data, put it together, tie a little bow on it and think about it. We don’t. We never get all of that information. So you need to be able to be tough, be a patient advocate, and be able to deal with uncertainty and, in fact, thrive with uncertainty.

Hal:  Yeah, and today there’s a shortage of providers in health care. How do you attract those type of people?

Judd: You got to hope you find the right fit. I mean, we advertise for positions, but you don’t take someone who wants to be a neurologist or an orthopedic surgeon and make them into an emergency physician. So it really is by getting mentorship and getting exposure to people who might not even know the specialty exists. If you go back 30 or 40 or 50 years, emergency medicine wasn’t a specialty, it was surgeons who dropped out of surgical residencies because they didn’t like the lifestyle or an internist at the tail end of their career that didn’t like office-based practice anymore.

And then we became a real specialty where you had to learn everything about every disease, particularly in the first 48 hours of it. And so now it’s a specialty, and people go into early, so really you could start thinking about it when you’re going in the med school. And so if you let people know it exists, they can choose it as a specialty. So I think it really starts super early in training.

Hal: Are there more patients these days that are coming into receive urgent care or into the emergency department? Are the numbers going up, flat, down?

Judd: So, our numbers are going up for a whole variety of reasons. But some of it has to do with some E.R.s closing, particularly in some rural areas. So the other areas that are left open are growing some volumes. In health care, if you don’t go to the E.R., you’ll go to an office, and then elsewhere for a lab test, then another stop for an x-ray, and then you have to get an appointment back with your doctor, which probably isn’t later the same day with all that stuff done. In the ER, we don’t insist that you pay, we don’t take credit cards, and it doesn’t matter if you have insurance. We see you no matter what with no prior authorization needed. And five hours later, you have an answer most of the time. Of course the E.R.’s going to grow. It’s the only place patients can actually get care without having things slowing down.

Hal: Well, I’m going to stop going to all my specialists and just come to the E.R.

You know, Judd, I’m always for immediate gratification. I don’t have any patience. But I would suppose that the E.R. is for impatient patients, even those who think they have something, but maybe they don’t. They’re in the world of uncertainty and E.R. can give you a greater degree of certainty, or at least give you a path forward. Where’s that all going? What are certain technologies that you’re using or that you want to use in the future?

Judd: So, imagine a day where you think you have symptoms. You go online to a symptom checker, it takes you to the end, and it says, “You might have this or that, do you want to see somebody?”

And so the next step might be you need to text with a physician or have what we call asynchronous care—text, email back and forth—and they can put your mind at ease from looking over your record and asking you some questions.

Or maybe it’s a little more urgent and you could see somebody from telemedicine. We have people 24/seven 365 standing by to see people. So instead of going into the E.R. to get the x-ray, you could go in anywhere and get the x-ray, but I could see the image and loop back on it and give you a call back and tell you what it is.

We’re going to begin an inpatient telemedicine program at Jefferson in the next couple of weeks. There are going to be rooms with cameras in the room so the expert doesn’t need to come to the hospital, but the expertise could be delivered to the patient. That will stop us from sending patients who need an expert to another hospital and save the ambulance and travel time.

And looking toward the future—and we’re not doing this because it’s held up with federal regulations—but there are “hospital-at-home” programs where you are admitted to the hospital in your home and all the care that you need will come to your house and get delivered to you. Ten years from now, maybe most people have a 3D printer. You fell and need a splint so your provider connects to your 3D printer and your print it at home. So we’re going to get to the point that I could deliver emergency expertise to you almost wherever you are without you having to come to the emergency room.

Hal: Yeah, that’s interesting what you’re thinking about in the future and how scalable will that be. So you have people that are making quick decisions, you know, in the E.R. and urgent care, whatever the setting might be, overseeing all that. How much does your gut play in your thought process?

Judd: So, I think you have to trust your gut, but not make decisions based on your gut. And I can remember individual patient examples during my life.

I go back 20 years, 30 years on this woman, she came in and she had nothing really obviously wrong with her, but I knew there was something wrong with her. She spent 360 days in the hospital, and thank God I didn’t send her home. She had a stomach ulcer that ruptured posteriorly, which is an area where you don’t necessarily feel a lot of pain, but it gives you a ton of complications.

One of the things I do try, particularly in emergency medicine, to teach people, there’s a quote attributed to Colin Powell, which is referred to as the 40/70 rule, which is, if you don’t know 40% of the information that you think you should know, you’re going to make a really bad mistake. If you wait for more than 70%, they’re going to invade and kill you. And so, you have to find the sweet spot. There is a little bit of intuition and trusting your gut that goes into almost every decision. But you can’t make it only from your gut.

Hal: And now you have the advent of artificial intelligence. Some say it’s going to think for you. How do doctors and providers in general think about A.I. taking away what they do and their importance, their relationship with the patient, so on and so forth.

Judd: So it’s a really interesting, highly complex area. A.I. is probably not going to tell you what’s wrong with you at any point in the near future as a sole entity. But what it can do in health care is help doctors write notes. So right now, patients get to see their notes, right? But why are the notes written? The notes are written so it could be billed.

And so, a note is really a billing entity, not anything for Hal Rosenbluth to read and have any clue what’s going on with him. But imagine if we had a conversation, and there could be one note written that’s accurate that goes out to the insurance company to pay and one note written that’s accurate that Hal could read and know what the heck the doc’s talking about. A.I. can be great with things like that.

Hal: So what advice would you give to a 25-year-old who’s thinking about going into medicine, especially into the areas that you oversee? What should they be thinking?

Judd: Well, I think you have to think, how are you going to make a dent? I think it’s really hard when you’re 25 to think about what you’re going to be like at the end of your life. But, we’re all here on this earth. We’re going to leave a legacy. We’re going to help mentor some people.

It’s always been my belief that the more people I could teach and the more people I could mentor, the bigger the impact I’m going to have. I could take care of the one patient in front of me. But if I teach 100 people to take care of patients, then I’m going to leave a little more of a legacy.

So on the patient-care side, that’s the way I think about it. Regarding leadership and personal growth, I think people need to spend more time looking at their weaknesses rather than their strengths. And so, I’m successful because of the people around me, and I’m smart enough to know what I’m not really good at and surround myself with others who compliment my skill set.

Making Waves is a series of conversations between New Ocean Health Solutions CEO Hal Rosenbluth and a variety of executives from a wide range of industries and areas of expertise. The below article has been edited for length and clarity from the podcast version of Hal’s interview with Dr. Judd Hollander.