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Christopher H. Loo, MD-PhD: So welcome, everybody to this week's podcast episode for the Financial Freedom for Physicians Podcast. And I'm your host, Dr. Christopher Loo. And as usual, we talk about four types of freedom, financial, emotional time, and location freedom. And my mission is to empower everyone to achieve financial freedom early. And so I try to bring guests content and information to help inspire you, empower you, and educate you so that you can be on your journey.
So today we have a guest, Michael Grace. And really, what's interesting is he's going to talk about blending technology, business people, and it's going to be a really fascinating interview. Michael is passionate about the power of technology to transform business, and allow them to be more competitive with reduced costs. So without much ado, Michael, welcome.
Michael Grace: Thank you. Thank you. Glad to be here. Thanks for your podcast. And I love the premise and what you're trying to do, to enable folks to live their best life.
Christopher H. Loo, MD-PhD: Yeah, yeah, no, we were talking backstage. And what's really interesting is initially, it was for physicians, and now it's grown to more of a wider audience. And so I introduced you, but I know you have more to tell us. So tell us about yourself how you got started. And we can go from there?
Michael Grace: Sure. Absolutely. Thank you. So I've kind of grown up in healthcare. For the last 25 years or so I've been either an IT leader on the provider side for really large healthcare systems like Dignity Health or Common Spirit Health, as they're called now. And then on the consulting side for large firms like Deloitte, and smaller firms, to kind of tax accountancy firms like Moss Adams. And I've kind of bounced back and forth rather purposefully, with a mission to really understand the provider space, and what are the needs? With really the goal of, how do we change healthcare? How do we allow providers to spend more time with patients and less on the administrative burden. And then I bounced back over to consulting trying to change things, and then it bounced back over to the provider space and got more intel.
So I've really spent my career, I hate to say trying to change healthcare, because that has a very negative connotation to make healthcare seem like it's broken. But I think it could definitely be better and could definitely provide a better patient experience. And really allow providers to provide more, and the more patients you see, obviously, the more revenue you get. And there's just a lot of waste in that equation of connecting providers with patients. And automation is a great way to kind of automate all the behind the scenes stuff that the patients don't really care about. The providers don't really enjoy it. So let's automate all of that and make this as seamless as possible and bring two people together, both the patient and provider and really have meaningful discussions about their health and their care. Without all the administrative nonsense that we've got in place in health care.
Christopher H. Loo, MD-PhD: Yeah, that's a fantastic introduction, and coming from health care, I really see what you're talking about, and being a consultant. So we'll get started. You are a business consultant and you specialize in digital transformation, but tell the listeners more about what it is and how it fits into your business.
Michael Grace: Absolutely. You know, people will tell you that I hate buzzwords, like digital transformation. It sounds amazing, it sounds like we should all be doing it. And then you say what is digital transformation? And everyone goes, I don't know.
You know, it's really leveraging technology, whether that be software or hardware and really taking that and and doing something meaningful with it right to impact the business whether that's freeing people up from you know, living in spreadsheets and doing data entry and letting them be more present and more patient facing.
It could be, you know, really looking at larger problems like how do we better schedule an OR so that we don't have doctors booking four hours for a procedure when really they never used it more than two hours and every time they book four hours we waste two hours right? We're how we bring tumor boards digital, right? How do we have people collaborating and better patient care in a virtual environment and leverage all the technology that's in place to give a great experience to our providers, so they can give better patient care to their patients.
You know, until very recently, until the pandemic healthcare was kind of in this slow moving method of digital transformation, then the pandemic hit, and it was like, oh, shoot, we need to do this now. And all of a sudden, suddenly, digital transformation happened almost overnight, right? All the providers were able to see their patients remotely using telemedicine. Suddenly, we just, like, at a click of a button. We were suddenly digitally transformed in healthcare. And now that we're stabilizing a little bit on the pandemic, although I don't think we're out. But we're starting to regress, right? It's kind of interesting. People were like, oh, all this technology is too much, I have gotta go back to the normal ways that we provide care. So it's interesting, but that's my passion.
My passion is to really understand the business problem, what does the provider want to do? What does the organization want to do? What problem were we trying to solve? And then let me dig into my bag of tricks of technology and bring things like RPA, or process automation, or sometimes you just have a terrible process. Or maybe you have bad people, and you just need somebody to come in and go, Hey, sorry to say, but this person, they're a little over their head, and they just aren't cutting it. Right. It's easier for a consultant to do that, than somebody who's in the day to day.
Christopher H. Loo, MD-PhD: Yeah. You mentioned something called robotic process automation, RPA. Briefly, just describe what it is and why it's a game changer?
Michael Grace: Love it. So RPA. You know, the other misnomer, I think around technology is that it's really expensive, and nobody can afford it. Robotic process automation, the software for it is relatively consumable and affordable for a license. And I call it digital labor. So it's like adding an actual person to your workforce that can go around and do tasks that your staff doesn't want to do. It can do things like open and read emails through OCR scanning. It can send emails, it can process files, it can go get files, it can do computational analysis.
It really can do anything that you do on a computer, it can log into Epic, or Cerner or all scripts or any of the systems that you use. It can wait, right like if you're like, Oh, I've got to send Dr. Loo a file. And when I get it back, then I need to go do this, right. You're like, ah, robotic process automation can't do that. What if it takes them three days or five days or 10 days? It actually can.
It's a form of artificial intelligence. I hate using that term also, because it's not really intelligent. And it doesn't have feelings, although it can do sentiment analysis. If Dr. Loo types me an email in all caps, using several expletives and I can sentiment analysis that Dr. Loo is pretty upset with me, I better pay attention to that email, and route it differently. It can do all of that. So it's really advanced, started about 15 years ago in Europe. In the financial industry, all the big banks in the US use a lot of it. Healthcare is a little laggard, right. We're probably on it just getting started on that journey along with things like retail and such, where other industries have been further along.
So it's relatively inexpensive, it's relatively quick to deploy. A few months, less than $25,000 for a license, depending on the technology. And you know, you literally can automate an FTE is worth the work, or two or three with just one robot license. So it becomes a bit of a game changer. And I used to say that RPA, and that type of technology used to be a competitive advantage. And that's no longer the case, right? It's now really a competitive necessity. Because all the other players are doing it, your competitors are doing it. So if you're not at least paying attention to it and seeing how you can integrate it into your process, you're going to be outpaced right, and these other folks are going to be able to do things faster and cheaper. They're going to have higher client satisfaction. And lower costs, right. And we all know in business that's that's that's a that's a losing situation if you're on the other end of that.
Christopher H. Loo, MD-PhD: Yeah. Yeah. It's quite interesting. I was reading one book by Peter Diamandis talking about just software as a service, and AI as a service, and talking about companies moving into the fourth industrial age. And he was saying that, it’ll be a necessity, such as you mentioned, that companies that don't implement these SaaS or AI, you’ll either survive, or you'll be out of business. So that's quite interesting.
You know, you talk a lot about technology and you know, digital transformation. But in your work, you really focus on other things. And you describe something as the focus should not be on technology. What do you mean by that, and expand on that?
Michael Grace: That's a great question. The software vendors are not your friends. Meaning if you type in, if you're following along at home, and you open a Google browser, and you type in RPA, you're going to be overwhelmed by everybody claiming they've got the panacea for whatever your problem is, right? If you need to solve a business process, they can fix it. If you need to solve a technology issue, they can fix it. And people get like, sold, right, they get sold by the software vendors, obviously, that their platform can fix everything.
What they wind up doing, right. And we I've seen it so many times in healthcare is, they believe, and they buy a bunch of licenses, they buy technology. And then when it comes time to add that technology solution to their business problem, it tends to fall short. Right?
So I always say, let's focus first on the business problem, right? Let's really look at what is the problem? And what do we want the answer to be right? You told me the perfect state of how you want your business to be, or how to operate, or the experience for your patient? And then let me kind of solve that. And we usually start with, how are you doing in the current state? We look for problems in the business process. That has nothing to do with technology, right? You just might have an old or outdated process that just needs to be updated. That's free, by the way, right? Like it's free for you to look at your own processes and fix those. You don't need me or technology to do that. So fix your process first. And then really look at what is the automation opportunity, right? Is it something like could it be chatbots? Could it be RPA? Could it be you just need some automation technology, like a power automaton that oh, by the way, you might already own?
But don't get hung up on all the different tools, right? Because when you look at a business process, that tends to be really long. Think of a patient that wants to go see a physician, right? There's all kinds of steps that happen in getting that patient in front of that physician. So when you think about that, then you have to look at it and go okay, well, we could automate this because maybe they want to not call the doctor's office, maybe they want to talk to a chatbot. Or maybe they want to be able to schedule online. Right? Those are two different technologies, one vendor isn't going to solve both those problems generally. And then, maybe we need to automate getting the physician the patient files, so that the physicians are prepared to see the patient, right. That can be an automation technology, like a power automator or an RPA.
So don't get hung up on the how or what technology to bring to bear because chances are, you need a quiver full of a variety of different arrows to solve the business problem. Focus on what is my business problem? And then go find a solution provider that's really vested in your interest and not trying to sell you software and products. Don't buy the technology until you really figure out what it is you're trying to solve for.
Christopher H. Loo, MD-PhD: I like that. Yeah, really the problem and then find the solution to that, and may not be technology could be people, it could be software, anything. So that's very insightful.
Now, in today's healthcare, I know doctors say, or almost everybody says, the system is broken. You know, it's very bureaucratic and cumbersome, and very slow, inefficient, and very expensive. So if I’m a healthcare CEO and I want to bring my organization into the 21st century, what are some game changing technologies organizations should be looking at?
Michael Grace: First off, all we just went through, I'd say, the last decade, we probably spent a decade working on what we thought was a transformational technology, which was EHRs, right? We're like, we're gonna Modernize Healthcare, and we're gonna get an EHR, all you did is take a bunch of paper and make it really difficult to discern and get to an access and such and then you put it in this massive system. Like Epic, people are so excited about Epic. Unless you’re a user of Epic, and then you're like, oh, okay, it's alright. But it still really doesn't transform healthcare, right? And we spent billions and trillions of dollars doing all this EHR training. And I don't care if you're a small physician practice, right, you have an EHR. Or if you're a provider in a really large space, or you're a patient, and you go to the doctor, right, you're interacting in some way with these large monolith EHR systems that honestly aren't transformational. They didn't transform anything, right, the patient experience is relatively still the same.
So really, when I look at it, I really look at trying to transform healthcare again, in that person to person context, right. So I've deployed systems where the physician doesn't stand behind, we used to call them cows, right, or WoWs, or workstations on wheels. These big barriers to the physician being anywhere near the patient, right. Gone are the days where the physician actually reaches out and touches the patient, because like, we've got all this craziness there. But you know, getting the EHR on tablets so that the physician can sit next to the patient, and show the patient, your X ray is here, and you're sitting next to the patient, not projecting on some wall, right? We've done things with registration, right where you walk in, and there's a huge line of people waiting to talk to a receptionist to give them their insurance information. Are you kidding me? Like what century are we in? Right?
I'm probably under NDA, and I'm probably going to break it. But it's so cool. I'm just going to talk about it. Anyway, We've partnered with a system that you might see in the airport. They wear checkered shirts, and they do biometric identification. And what we did is, we said, hey, how can we keep like their insurance card information and a payment card on file? And then we could just have a couple of terminals, and they could walk up. We could biometrically identify that Michael Grace is here for his appointment. We could use automation, and we could verify that his insurance is valid. We could understand what his copay is, we could tell him like, would you like to pay your $35 copay? Yes, I would. Click. Okay. They've now paid their copay, right? All in a matter of seconds. Oh, and then we can send a text to the provider and let the provider know. Hey, Michael Grace is in the waiting room. And oh, while we were biometrically identifying him, we took a picture of his face. Here's what he looks like. So when you open the door, you don't go, Michael Grace? Michael Grace? Is Michael Grace out here? Right?
You can simply walk over to the person and say, Oh, Hi, I'm Dr. Loo, would you like to come back now? Totally a transformational experience, right. Think about that kind of experience from a patient perspective, versus the insanity that we do today. Right? So we can change healthcare in a lot of ways that are meaningful to the patient, leveraging technology for not a lot of cost. I think we're just resistant to that kind of change. We’re a little too pre-bought into the EHR is going to save the world. And I think we're all starting to realize that the EHR isn't probably coming to our rescue anytime soon. If anything, it makes our life a little bit more complicated. So, so there's, there's, there's changes coming. I think there's a lot of small startups, if you really look at healthcare and look at the startup space, a lot of companies in that startup space with really great ideas on ways to transform that patient experience and provide better healthcare.
Christopher H. Loo, MD-PhD: Yeah, there's so many opportunities for game changing innovation technology, software, systems, processes. There's actually a joke among physicians, the whole healthcare community, that the Epic, The Cerner System has just turned everybody into clicking buttons. And we’re just waiting for the insurance companies to bill more and charge more. So it was really it was really four just so the hospitals could build more and charge more and increase revenue. And there wasn't really anything to change.
Michael Grace: It's crazy, right? I had to go because I was serving a local hospital here in Arizona, down in southern Arizona, and they required a TB test, and I couldn't find my copy. So I had to go to CVS, I had to go get a TB test. Right? They gave me the shot. And then that I was sitting there, and I was like, Can I go? And she's like, she's just diligently like on her keyboard. And I'm like, what? It took 10 seconds for the shot. It took her 10 minutes to do all the documentation that she gave me a shot, right? And then when I came back for the reading, I walked in, sat down and she looks at my arm and goes, you’re negative, okay? And then she goes [mimics typing on keyboard]. What are you doing? And 10 minutes again, where she's like I've got a document that you're negative. I'm like, this is insane, right? And it's all the EHR. So the EHR has created a real barrier.
My wife is an ICU nurse now, like a transplant coordinator, and I just watch all the stuff that she has to do, right? It's, it's crazy, like, Oh, I've got to document in the Donor Network, I got to document in the EHR, I got a document here, document there, blah, blah, blah. And then she creates a shadow chart so she and her physician can talk about the position. And it's a paper chart. And I'm like, Are you kidding me? You're using Epic and Cerner, like, what are you doing? And you have a paper chart? That's the most important thing in her life. She carries them around. Right? That tells me that the EHR has failed, right? If we're printing stuff out to create shadow charts and stuff. Yeah. Epic, funny joke, epic failure on the part of the EHR.
Christopher H. Loo, MD-PhD: Yeah, we could share so many stories.
Michael Grace: Yeah, I mean, patients should really demand better, right? Like they should really hold their providers accountable to use better technology for their care, right. And I think the silent player in this space is Apple. Apple's been kind of absent by purpose, right. Apple waits for the right moment to disrupt. And I think it's coming from everything that I'm hearing, they've silently been getting their watch really honed in. So now a watch can do an EKG. They've got fall detection and EMS notification into their watches and their wearables. And Apple is slowly coming around the corner, I think very silently to not draw attention. But I think Apple's gonna enter the healthcare space here in a big way pretty soon. And you know, what, like, the rest of their products, it's just gonna work.
Christopher H. Loo, MD-PhD: Yeah. If healthcare organizations hire designers and engineers with the same mentality that you see at Apple, or Google, or any of the big tech companies, I think we could progress so much faster. And now that we’re on that subject. It's quite interesting. How do you see that healthcare can improve by leveraging technology?
Michael Grace: And I love what you said about designers, right? Because anytime I go to a customer or client, whether it be a large healthcare system, or providers they always want to tell me what they're doing today. And I always go, this is awesome. And they bring in boxes of stuff, and they want to show me and I'm like, I wouldn't be here if it was going great, right. You wouldn't have called me. So I appreciate you gathering all this stuff. But I don't want to talk about that. Right. I want to do what designers do.
I want to talk about what you want your patient experience to be like? How do you want that to go? And then I try to tell heartfelt stories that give people goosebumps, right? I look for goosebumps-moments, because healthcare should be that way, right? People don't seek out health care, other than physical and routine care, they generally don't seek out health care when they're perfectly healthy, right. Something's wrong, they don't feel good. They're having some sort of an issue. We need to care. We need to get out from behind technology, and connect a person with a person providing great care, and figure out a way to get the technology to catch up to that moment. Behind the scenes, there should not be a barrier between the two people to do it.
We've explored things with a company called Nuance that does a software that we use in the medical world called Dragon Medical One. It's a great dictation software, it's kind of like Siri for physicians, it just happens to understand all the large complex words that we use in medicine to make ourselves sound impressive. And you know, we've done things like room monitors, right? We monitor everything that happens in the room. And we've proven that if we monitor the entire room, we can fill out the chart, we can appropriately build the codes for insurance, we can capture the procedures that happened, we can capture all the stuff that was used. And why isn't that technology being used? A) because of the liability to the physicians if something happens that's wrong, right. Unfortunately, right, we're in a sue-crazy world. And the physician was trying to do the right thing. And you know what, they're sorry, Dr. Loo, but you're human. Right? And occasionally you might make a mistake. It's not intentional, but because of that, right? We were like, oh, we can't, we can't capture all this because there's no way to get out of this. Even though it could totally eliminate, well not totally, but it could 75-80% eliminate the need for charting, eliminate the need for billing, why it could all just happen. But the fear of that, and HIPAA, and there were a couple of other reasons why it couldn't happen, right. But we're poised on the edge. I think technology will be a game changer in healthcare. We just need to get back to being humans and trust each other and realize that physicians have the intent of trying to help but they're human. You know, your care providers. They're human. There's, there's all kinds of stories, right? We just are experiencing on the news, the story of the nurse who pushed the wrong drug, right? That wasn't her intent. And the EMR was down, right. There was no drug warning or such because the EMR was down, but yet she was prosecuted. Right. And the intent, I think, was, we gotta get back to the spirit of intent of what we're trying to do in healthcare, and then let technology come alongside the provider space and, and help them.
Christopher H. Loo, MD-PhD: Yeah, yeah. And it's been a fantastic, fantastic conversation. And you have a lot of experience and knowledge in healthcare IT and consulting, and it would be very fascinating for future topics. So I know people will want to reach out to you to get a hold of you, work with you, how can people do that?
Michael Grace: So I, like Dr. Loo, am a podcaster, blogger and content creator, partially around healthcare, much like yourself. It's just about putting knowledge out there that hopefully helps people. So the best way to probably find me personally is on my podcast, which is out at TechProUnicorn.com. And then, my company is RPIC.com, or RPIConsultants.com, either of those two ways you'll be able to get a hold of me.
Christopher H. Loo, MD-PhD: So for all the listeners, all the resources will be included in the show notes. So it's been a fantastic conversation, and we look forward to having you as a guest in the future.
Michael Grace: Awesome. Thank you.
Christopher H. Loo, MD-PhD: Many thanks again for being here. If you’re new, you can find me online at Christopher H. Loo, MD-PhD, where I have links to other episodes or links to online resources that will support you on your financial literacy journey. I’ll see you there in on next week’s show. While I bring you thoroughly vetted information on this show regarding a variety of financial topics, I cannot promise you a one size fits all solution. This is why I caution you to continue to learn. Educate yourself and seek professional advice unique to your situation. If you want to talk to me, I welcome it. Please reach out via my website or email at Chris@drchrisloomdphd.com. I read and personally respond to all of my emails. Talk soon!
Editor's note: This transcript has been edited for brevity and clarity.