Giovanni Piedimonte, MD, FAAP, FCCP, serves as Chief, Global Pediatric Research Operations for Cleveland Clinic Foundation; Professor & Chair of Pediatrics, Cleveland Clinic Lerner College of Medicine; and Director, Center for Pediatric Research for Lerner Research Institute.
On April 3rd, Dr. Piedimonte will speak at Becker's Hospital Review 10th Annual Meeting. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place April 1-4, 2019 in Chicago.
To learn more about the conference and Dr. Piedimonte's session, click here.
Question: What do innovators/entrepreneurs from outside healthcare need to better understand about hospital and health system leaders?
Giovanni Piedimonte: There is no doubt that the healthcare industry is way behind when it comes to technological innovation, and painfully slower in the adoption of new ideas and paradigms. This delay is in significant part caused by “cultural inertia” and resistance to change, which is much more significant in our ecosystem than in other areas of modern society. However, it is critical that innovators and entrepreneurs understand that, for anything to work in the highly complex world of healthcare users, it’s got to be easy! In particular, patients and caregivers can’t be expected to be tech gurus. The majority of our patients are not PhDs, but still need to have a full understanding of what they need to do to stay healthy, how to get better when they are ill, and how to effectively access and interact with their healthcare providers. Importantly, no matter how disruptive the innovation implemented by any healthcare system, patient engagement and satisfaction will always be critical to better medical and financial outcomes.
On the other hand, doctors, nurses, and other caregivers can’t be expected to manage myriads of applications and devices operating on different platforms that lack interoperability. Time is our most precious resource, and healthcare professionals are increasingly being pulled in too many directions and expected to master fundamentally new knowledge in biology, medicine, computer sciences, business performance, etc., all together and all with the same tight deadlines. One of the most striking paradoxes of today’s medicine is that the same technology that is supposed to make our lives better and easier frequently turns to be more complicated and time-consuming...just ask any practicing physician - especially the more senior ones - about using Electronic Health Records! There is a limit to what we can learn and do, especially when we have to balance work with family and personal well-being. Beyond that threshold looms the risk of physical and psychological burnout, perhaps the worst threat we have to face in healthcare today. I am convinced that people eventually will do the right thing to improve their health and the health of their patients, but only if it’s easy and can be balanced with the many other needs and demands of today’s life.
Q: Healthcare takes a lot of heat for not innovating quickly. What's your take on this?
GP: I think right now there is much confusion about technological innovation in healthcare. Too much attention to sexy buzzwords and little focus on substance and practicality. In particular, many new tools sound and look exciting, but then fail to meet the day-to-day needs and demands of the average patients and caregivers. Comes to mind the first generation of telehealth applications (just ten years ago...but it seems like a century!) that were burdened with operational issues and connectivity hiccups, workflows not supported by traditional EHR modules, and lack of user-friendliness both for providers and patients. Even more importantly, services were not reimbursed despite the substantial time commitment of physicians and nurses involved. Today’s telehealth has improved on many of these fronts, and its adoption will rapidly increase with the new CMS PFS driving a shift to a true virtual care model, but there is still ample margin – and need - for continuing improvement. Fundamentally, for innovation to be embraced meaningfully and on a large scale, customers and payers need to see the value in terms of usefulness, effectiveness and – last but not least – a return of investment. Moving forward, it is essential for healthcare to learn from the digital expectations set by other industries. More and more, our patients are becoming used to the almost flawless convenience and practicality of watching Netflix, searching on Google, buying from Amazon, or working with Apple.
Furthermore, these technology powerhouses are already extending their footprints in the healthcare space with “one-stop virtual platforms” that aim at bringing healthcare industry up to speed with the rest of the “Internet of Things” world we live in. Patients will continue to demand a more consumer-driven experience on par with online shopping (“digital front door”). This process will accelerate rapidly with the gradual entry into the healthcare marketplace of more than 100 million customers comprising late Millennials (Gen Y.1, currently 31 million people in the U.S.) and Gen Z (nearly 74 million in the U.S.), who are partially or completely native to the digital revolution. Healthcare will experience a “Darwinian” evolution that will grant survival only to those who will be fit enough to match the technological advantages already provided by other industries. Like all revolutions throughout history, the digital healthcare revolution will not be easy and will have a substantial social cost, but it is inevitable and eventually will morph into much better healthcare delivery options for future generations.
Q: Tell us about the last meaningful interaction you had with a patient.
GP: For almost three decades, I have dedicated my clinical work to pediatric patients with respiratory conditions, from birth to adolescence and young adulthood. As they are usually accompanied by one or both parents, my clinical practice provides me with a unique vantage point to observe the “generational gap” when it comes to the adoption of new technologies. A few weeks ago, I introduced to one of my adolescent patients the option of using a new device for inhaling her daily medications while receiving real-time feedback about her inhalation technique and storing all relevant medical information in the “cloud.” I saw a spark in her eyes, so I kept chatting about the rapid technological advances of digital medicine that will soon allow her to have all medical records at her fingertips using blockchain, interact with robotic doctors and nurses, and have therapies precisely targeted to her personal needs. Her mother kept looking at me with concern, and expressed her angst and distrust for the machines that threaten to “take over the world.” The girl just shouted: “Cool!” The next generations give me hope and make me more optimistic about our “digital future,” but it won’t be easy for them. Our children will have to deal with new accelerations in a world where artificial intelligence moving at the exponential speed of the Moore’s Law will increasingly outpace human intelligence, and learn to interface with unfathomable technological progress that it’s just now entering the ”second half of the chessboard.” They will also have to deal with the social instability deriving from rapid spread of automation, which, according to Bain & Co., may eliminate by 2030 as many as 20-25% of current jobs (equivalent to 40 million displaced workers), hitting middle- to low-income workers the hardest and depressing wage growth for many more workers. Indeed, healthcare will be one of the areas most affected by machine learning, which will certainly optimize workflows and will make back-office functions (Human Resources, Revenue Cycle, Supply Chain, etc.) run more smoothly and inexpensively, but will also eliminate hundreds of thousands of jobs. Finally, they will have to find the way to pay for the increasingly exorbitant costs of highly precise therapies like CAR-T that promise to cure cancer, diabetes, and many other epidemic diseases, but currently cost more than $500K per patient. Notwithstanding all these challenges, I am among those optimists convinced our “cool” new generations would find the way to harness the infinite potential of “AI” (Artificial Intelligence) into becoming the “IA” (Intelligent Assistance) we all need to give humanity a better future.