#JoinTheConversation with Dr. Nick van Terheyden at #HIMSS17
This #JoinTheConversation series is brought to you by our partner Experian Health and the episodes were broadcast live in Experian Health’s booth (#3503) at the The HIMSS17 Annual Conference and Exhibition. The interviews were recorded and published to the media player on this page. Please read more about why more than 60% of U.S. hospitals count on Experian Health.
Joe Lavelle: 00:30 I am Joe Lavelle and I’m going solo on this great interview with Dr. Nick Van Terheyden. Dr. Nick, welcome to the show!
Dr. Nick Van Terheyden 00:37 Thanks for having me Joe. It’s great to be here.
Joe Lavelle: 00:39 Well, we appreciate you spending the time. Could you take a few seconds and just give the audience an idea about you and your background?
Dr. Nick Van Terheyden 00:45 Everybody knows me as Dr. Nick. But that’s really part of my social media presence and I am comfortable being called Nick, but I have to tell people that I’m Dr. Nick, because sometimes they don’t know and they don’t make that connection. I’m a physician by training. Most people can tell I didn’t train in this country. I trained in the United Kingdom, I practiced medicine internationally in Australia and in the UK, and have spent the last the 30 years really focused on digital health and the enablement of technology at the intersection between healthcare and the interactions that clinicians have, but then the broader population has.
Joe Lavelle: 01:19 Good deal. And Dr. Nick you’re the Chief Medical Officer of NTT Data, would you give us a 10,000 foot overview of what NTT Data does?
Dr. Nick Van Terheyden 01:26 So NTT Data is an organization that’s homed out of Japan, most people know NTT D0C0MO, that’s the holding organization, very similar to AT&T in the United States. But they have a conglomerate and a large set of organizations that’s well over a hundred billion in terms of revenue and activity. Of that, NTT Data and the US part of that is about a 14 billion sized organization and the healthcare piece is really focused on delivering services, systems integration, and is staffed by this astounding collection of folks, who are really passionate about this and like me have lived and breathed this. If you jump into healthcare and you think you understand it as some of the large organizations that think that they can jump in and do technology discover, it’s not quite as easy as that. So one of the things that we really focus on is living and breathing this stuff, and delivering value to tie all this stuff together and allow our customers our partners, and that’s everything from implementation services all the way through to technology, integration, interfaces, and then providing added value. How do you offer the value that actually allows the clinicians, the patients to get the maximum content and useful knowledge to affect positive outcomes in terms of clinical care?
Joe Lavelle: 02:46 Perfect. One of my favorite things about HIMSS is figuring out when and where you’re going to speak each year. Yesterday you spoke with an executive from Hilton Hotels, what can you tell us about your presentation?
Dr. Nick Van Terheyden 02:55 I was really excited about that and I think HIMSS were too in terms of the profiling that they gave it. They put it in the views from the top, which gets a lot of press and publication. And I think it was because it resonated. And what was interesting about it, it was titled The Best Exotic Marigold Hospital, tie-in obviously to the movie that most people remember and I was excited, I enjoyed it, but really the concept of hospitality. And one of the things that really fascinate me is where you can benefit from the intersection between other industries.
Healthcare is doing things unique, but there’s so much that we can learn and what we were really trying to focus on was bring that knowledge and experience, and I had the privilege of presenting with Natalie Corridor from Hilton worldwide, and learning and sharing their experiences on how they’ve digitally enabled a tight connection with their customers. And whilst people sort of tend to resist this patient as a consumer or a customer, even if you put that to one side you can see a lot of similarities in terms of the hospitality industry and the way that that behaves, and what we can learn to deliver that kind of connection and value in terms of how we deliver care, not just the clinical care, but all the other things. And the interesting thing that came out in that conversation is somebody pointed out in the Q&A section, not everything in healthcare is perfect.
If you go in for a cancer treatment, sometimes we can’t treat you. That’s very troubling for a clinician.
We go to medical school to cure you, but sometimes there isn’t. But that doesn’t mean to say we can’t deliver a fantastic services to the clinical environment to the patient to allow them to feel like they were really cared for, even if we didn’t cure them. And that’s what Hilton does really well, so it was really focused on that interface, very exciting, I love the opportunity to share the stage with one of the brands that I admire and love the experience personally.
Joe Lavelle: 04:51 Perfect, thanks for the great overview. I want to jump right into probably the most common conversation. People are talking about the movement from fee to service to fee for value. What trends are you seeing, is it talk? Are things really happening?
Dr. Nick Van Terheyden 05:06 My sense is that everybody believes that this is the right direction. I think there’s still pockets of resistance, and there’s a lot of impetus in the industry that says this is the way that we’ve done it. There’s a lot of money tied up in that pay to do things, and it can be hard to shift the direction. But ultimately we know that we can’t afford that mechanism, because if you just pay to do stuff, you get what you incent. And that’s what we’ve gotten in the healthcare system.
And the opportunity with a value based system is to focus on the outcomes, and I think all parts of the industry, everything from the physicians through to hospitals, providers, even the pharmaceutical industry is saying, I’m no longer producing a drug, I’m producing a solution or I’m solving a problem. And that’s especially relevant to them as they sort of come to these microceuticals and this precision medicine, where it’s no longer a blockbuster drug that treats millions of patients, it may be for 3 or 4. How do you then define the value and reconcile that, so that they make money? They have to make money, people think that’s ugly, but the reality is that’s the way that we deliver service. I couldn’t have gone to medical school if I couldn’t pay for it, and it’s the same in hospitals, so we have to change the system.
I think it’s moving, it’s moving a lot slower than it should or needed to, but the opportunity is there and I think the impetus with, importantly what I see as the silver tsunami, the baby boomers, that are that bulge in the pyramid of people that are forced change all the other areas of industry like education, housing, all those things happened as a result of the baby boomers, and I think that’s what’s driving it, it’s the patience that are really driving this.
Joe Lavelle 06:47 I’ve always really appreciated that you kind of followed the macro strategies that we’re going on in the industry, what are you thinking about the new political landscape and maybe what’s going to happen with the ACA?
Dr. Nick Van Terheyden 06:59 My safest answer is to say I don’t discuss politics, and if you look at my feet you’ll see that I steer clear. I think one of the most important aspects of politics is to really try and sit or live in the other person shoes, whatever that opinion is, and one of the things that really troubles me about social media and I said this in one of the interviews that I did leading up to HIMSS is we need to be respectful of those other opinions. Everybody has a valid, genuine opinion; they must have a reason for it. I don’t think anybody starts out with bad intentions. There may be a small minority, but the vast majority, we all have a good intention, so we have to understand that.
That’s my baseline in all of this. I try and see the positive in most things. My glass is always been full, it’s half full of water and half full air or actually mine is half full of whisky. Scottish malt to be clear, those that know me, will know that that’s true. So I look at the changes and people are concerned about where this is going to go, and one of the most positive things I heard about our new administration is disruption. And I know disruption can be a negative, but I think disruption is what we need in this industry. And I,f you take the view that there is a good intention, people are not trying to harm or damage, then if we can disrupt, and maybe it requires this just radical disruption to the existing status quo to really shake things up.
So my hope is that we’re going to see this. I know there’s a lot of fear, uncertainty, doubt that sort of surrounds this, but that’s the world we live in. This is our elected government and I respect that. I’m an immigrant and I’m proud to be here, and I have great faith in the system that was created many years ago by the founders.
Joe Lavelle 08:37 Very well said, I couldn’t agree more. I think one of the problems with where the ACA sits today, it was one sided and rushed through or slammed down one side’s throat, instead of collaborating. And whatever we do next, we got to collaborate, and we got to work together and trust that everybody has the best of intentions. There are parts of the ACA that we can’t get rid of, and we all need to fight for and there are parts that are just broken.
Dr. Nick Van Terheyden 09:04 Right and I think that’s exactly right. So when you look at the history, a lot of people forget some of that history, but you captured some of the essence from other people’s perspective where they felt that this was rammed down. I think most people agree. I know I do because I’ve got college aged kids, I’ll take one I hope non-controversial example, but putting my kids on my medical insurance just seems like really good stuff. I don’t mind paying for it, I think it makes sense. They are not really high risks typically, but they need to be insured. That was a great thing, and now I don’t have to worry about my kids in college being insured.
Actually it became a bigger problem because the colleges all said, Oh, no! You’ve got to prove it, because otherwise we’re going to force insurance down your throat. So there was a little bit of a backlashes a result to that, but that was just administrative, but it was a good thing.
Joe Lavelle 09:52 Absolutely. It’s always tough to separate the buzz and the hype from the real things here at HIMSS. Another big buzz word is patient engagement. As you serve you clients, what’s really happening with patient engagement? How are we engaging patients or are we are just putting up portals and giving them data?
Dr. Nick Van Terheyden 10:09 I’ve said this a number of times and it continues to trouble me. It was a surprising data point that suggested that this patient engagement and the inclusion importantly, so you’ve had patients on the show. I’m privileged to wear one of Regina Holliday’s Walking Gallery jackets, True advocates. epatientDave, I sort of have cited him in my presentation, but the number of patients included in these kind of conferences remains stubbornly low. And that’s sad, and that’s despite, I think HIMSS has tried really hard to be inclusive and incorporate that as other conferences have, and that’s one of the things that I think we have to fix.
Ultimately, everybody here is a patient. I think sometimes folks forget that. Healthcare is personal, so we’re all looking at this through a lens of our professional lives, but I look at it through patient’s eyes, and then I’ve engaged in the systems internationally, because of my background and my parents, that other systems, so I have this perspective. As Leonard Kiff said, it’s the most undervalued asset that we have. It is an essential asset that you can apply in this space. And that’s why I think that baby boomer bulge is truly going to have this impact, because they’re now arriving at the healthcare system and really using it in large numbers.
And I think most of them are going, wait, what? What? And that’s going to force change. So if you want to see the power and the reason, irrespective of politics. There’s nothing more powerful than the power of the people who are saying, wait. This isn’t right, we need to fix that. And that’s what they did with other things, so that’s where my positive, my hope comes.
Joe Lavelle 11:43 Yeah, and if you combine that with us in the bulge that are assuming a higher and higher percentage of cost. Before the ACA, I started my own business and I was paying $425 a month for my family’s health care coverage. It was a “super gold” plan, $25 deductibles. Well, through the Blues plan in Alabama our rate last year went up to $1,700. We’re on the Bronze plan now, there’s no deductibles left we’re just paying until we get to $8,500.
Dr. Nick Van Terheyden 12:15 Yup. You’re on a essentially the same plan that I have through my employer, I elected to go to it early, there’s was a choice. I think there is still a choice, but I’m on a high-deductible plan. And that’s the other thing that drives the baby boomer generation, is we cost shift. And I will shout out to Dan Munro and Casino Healthcare, outstanding book that really sort of covers this. If you want an education, and comprehend this, and really get to the history and why we reach this point, that’s one of the points that he has made. We’ve essentially shifted, and that’s part of the pain that people feeling is that we are now responsible.
The good news is instead of me shopping for a car that somebody else is paying for, I’m shopping for a car that I’m paying for, and that makes me much more cost sensitive. There are some downsides, I’ve seen it personally. I will tell you, I think I have at least two fractures that I never bothered to get treated. Minor issues in my mind, I know some people will probably listen to this and go, oh, My God! So that was my personal choice, they were things that I couldn’t do anything, but I avoided the cost as a result of that. And I’m in a cost fight personally with organizations that billed me for what was essentially a screening procedure that I shouldn’t be paying for, but it got coded and it’s now months later. So there are some consequences, but that I think is going to be part of what we see driving change.
Joe Lavelle 13:27 Absolutely. Another buzz word this year is analytics. If we’re to do a tag cloud on the words in everyone’s booth; I bet 99% have the word analytics somewhere in there. How do you see providers using analytics? Are they just scratching the surface or are they really digging in and making value for patients?
Dr. Nick Van Terheyden 13:46 The issue with analytics for me boils down to just making a bigger haystack that’s occurred with all of this data. I’m a big fan of all data not big data. I think we need to capture everything. My analogy is that the medical record is a piece of string, and what we used to get was these tiny little segments from the string, and that didn’t really deliver a lot of information. Your blood pressure when you walk into the office, if it’s like mine, wooh! goes way up. That’s not really valuable versus measuring blood pressure over a conserted period of time. For me it’s always being a filter, it’s never a data problem, it’s a filter problem.
Analytics is the filter in this that allows us to present information as knowledge that is actionable for the clinicians. And that’s one of the things that we focus on. How do you deliver that in a way that doesn’t overwhelm the physician, the patient, the PT, the pharma, whoever it is, with all this additional data that I think is absolutely necessary and valid, and in some instances we don’t fully understand, that’s part of to me the opportunity, I know lots of people (say) what’s the point in collecting it? We don’t understand it? Well I don’t know that that’s the right strategy. I think we should capture it and if we never use it, that’s okay. There’s not really a high cost in storing this. What can we derive from that? We are already seeing signals and data that is truly astounding to me. As you look at the wearable devices the track your activity, I know that the companies that are looking on that have seen signals that are three weeks before an injury occurs, before it actually occurs.
Joe Lavelle 15:17 Wow!
Dr. Nick Van Terheyden 15:18 Now, that’s not science, that’s not data. It needs investigation, but that’s really exciting. Wouldn’t you want that?
Joe Lavelle 15:25 Absolutely.
Dr. Nick Van Terheyden 15:26 Hey! You’re going to get injured in 3 weeks Joe. You need to do something different. Take it easy.
Joe Lavelle 15:30 When we started talking about analytics 4 or 5 years ago, we talked about the possibilities. But now you can go to several places in here and they’ll tell you, we reduced sepsis deaths by 78%. Well, maybe those patients died of something else, but that’s meaningful.
Dr. Nick Van Terheyden 15:48 Absolutely.
Joe Lavelle 15:49 If that’s my mom, if that’s your dad, that’s meaningful and that’s why way back when that’s why I get out in healthcare, I’m sure as a physician that’s why you got in to healthcare. To change people outcomes.
Dr. Nick Van Terheyden 15:59 Absolutely. We have a great example that even sort of preempts that, so one of the analytics projects that we worked on were the preoperative analytics, and gathering all the information not just the clinical information, but everything that the patients would allow for us. And what’s really fascinating about that is that we were able to, what changed was where we focused the resources on the people that were at most risk, from post-operative surgical infection. This was in the abdominal area, which is the highest risk, because you’re dealing with essentially bugs, so it’s a challenging area. And they saw this astounding level of reduction in terms of post-operative surgical infection. That’s real benefit, so much so that they expanded it long passed the abdominal system, they are looking at other surgical areas. So there’s real value in predictive elements.
And I know it’s a buzz word and it gets abused, and you can look at it in sort of hype cycle that a lot of people are familiar with. But ultimately without data we can’t make decisions. Lord Kelvin said that back in the 1800s. Somebody said there was somebody before that, but I don’t know. I know it is Lord Kelvin, he’s a British guy so I have to quote him. Without data, you have no decision making process.
Joe Lavelle 17:10 Absolutely. We always bring our crystal ball here to HIMSS and we ask our guest to look into it. How do you see health care evolving in the next 3 to 5 years? What of these buzz words are really going to take and really have really impact on the quality of healthcare and really change people lives?
Dr. Nick Van Terheyden 17:26 My crystal ball is cloudy like everybody else’s, and my predictions … the best that I can assess. I look at the short term. Clearly I think disruption from the political landscape. From a technology standpoint, I think there are some breakouts. I’d like to give a shout out to the FDA, I think they’ve done a good job of sort of providing a pathway from non-regulated to regulated for these devices and apps and so forth. And there is a lot of frustration from the clinical community that this stuff doesn’t really deliver value and we have to sort of regulate in and it’s got to have accuracy, and I think there’s value in that, but there’s still value on the data that is not regulated to some extent, not always.
And also not necessarily at clinical grade, although I think that’s important, and it depends on the decision. If you’re making a decision to give insulin or not you need to know what the glucose level is accurately. If I’m just measuring your pulse and looking at it over time, I don’t necessarily need that. So I think that’s the sort of short term breakout is going to be these devices and the integration. The key to that in my mind is integrating into a single perspective or a single plat(form). If you have to step outside of your normal workflow… Workflow is key, if you fail to take account to that you’re missing the opportunity to really drive it.
Now, there’s a few exceptions and the iPhones are great one. 7 or 8 years ago this wasn’t what we used, but it was so brilliant, everybody took it up and we chucked out our other phones and went to this whole thing without a keyboard. Mostly it has to fit in, so it has to be integrated and that’s the key asset. And then if I want to go way out there, artificial intelligence for me is the wrong term, it’s augmented intelligence that’s really going to drive the value. We are not driving people out, when you go and see your physician, you want the physician you don’t want the technology, so we have an opportunity to augment that. The idea that any clinician or any patients can process all this knowledge, (is) completely and utterly preposterous at the point that we are at. We want to bring the right information, right time for the decision making at the point of care or at the point of the decision. We do that with technology, we do that with mobile devices.
But I think we’re going to see augmented intelligence, and then some of the drone technology and remote delivery and telemedicine is really I think going to take off. It’s not going to replace, but it is going to extend. Most people would say they’ll take a telehealth visit if it was paid for or whatever, versus hauling in 20 minutes, finding parking, paying for parking, sitting in a wait(ing room, etc). Intelligent use of all of this is really going to, I think, facilitate a much smoother frictionless experience.
Joe Lavelle 20:03 Good deal. And our last question for you Dr. Nick, what are your top two or three goals while you’re here at HIMSS?
Dr. Nick Van Terheyden 20:08 I always enjoy HIMSS, but there’s an element of terror. I achieved, I think it was almost 20,000 steps yesterday and that was without a run in the morning, which I just couldn’t take so there is a challenge relative to that. The real positive is people are here, I get to connect, I get to meet people in person, you’re one of them. You and I have not physically met, although I certainly feel like I know you. Social media is an enabler like technology is. It’s not about the media, it’s not about Twitter or LinkedIn, it’s about connecting people. We would not be having, well we might have had this discussion. But mostly I don’t think so and its open doors internationally, so it’s making those real connections and that builds, it continues and that’s the beauty of the social media post the show.
Then it’s obviously the educational opportunities to learn from others and understand. And my privilege this year was to share some of my experiences, so I had a good time doing that. And then finally it’s walking the halls to just see, and I know some of these people will pop up and disappear, but some of them are going to pop up and explode. I’m sure, and I wish I could go back, I’ve been to many of these probably have too and see the small booths that we’re over in the nosebleed section, that are now big booths on the main isle. And it’s finding those individuals not that the others are not important or interesting, but not everybody makes it. But seeing that and being part of that experience for me is the real positive.
I want to add one other thing and it’s only because you mentioned it, but I’m just going to say Roll Tide and I’m not a big US football fan, but my son is actually at the University of Alabama. I didn’t even know there was sports going on Saturdays in the United States, and wow, there’s this whole thing and it’s really exciting and by the way, Roll Tide.
Joe Lavelle 21:50 I wish I could tell you stories about that, moving to Alabama and football, we are house divided between Arkansas, where I went. Alabama, who my wife follows and Auburn, who my son wants to go and be the starting quarterback in 8 more years.
Dr. Nick Van Terheyden 22:04 Well, it’s been a really exciting journey for me to learn and understand that. I went to the stadium there, I just want to tell you, that is bigger than Wembley Stadium. Maybe it’s not with the new one, but certainly the old one. Wow! Wow!
Joe Lavelle 22:16 It’s amazing for sure. All right Dr. Nick, we’re going to wrap it up. Before we let you go, what’s the best way for people to contact you or connect with you on social media?
Dr. Nick Van Terheyden 22:24 My Twitter handle is @drnic1. I’m on LinkedIn and I’m on Facebook, and you can find all of my contact details. I’m pretty much an open connector. I love the opportunity to talk and connect with people wherever they come from.
Joe Lavelle 22:40 Absolutely and we all thank you for that Dr. Nick. It was a great pleasure having you on, thanks for taking the time today.
Dr. Nick Van Terheyden 22:45 Thanks for having me.
Joe Lavelle 22:46 Sure thing. That wraps this live broadcast, again we want to shout out a quick thanks to our sponsor Experian Health. On behalf of Dr. Nick, and myself we will be back from Orlando.
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