Empowering Healthcare: A Dive into Clinical Decision Support

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[00:00:46] Hello there and welcome to the HIT Like a Girl Podcast. My name is Joy Rios. This

[00:01:01] is a show where we get to talk about how the crazy complicated world of healthcare

[00:01:05] is. We all trying to put the 30,000 or 300,000 however big you think it is, the

[00:01:12] puzzle pieces together. So each one of our guests gets to bring a piece of their

[00:01:16] expertise and share their piece of the puzzle with our listeners. So I'm excited

[00:01:20] for today's guest. Julie, can you please take a moment to introduce yourself?

[00:01:24] Hi everybody. I'm Julie Frey and I head up the provider product at Welter's Cuba

[00:01:29] Health. And I'm super, super excited to be here today and to talk all things

[00:01:34] healthcare and women in healthcare. It's very exciting.

[00:01:37] All right. Can you please share the name of your organization again? Because I

[00:01:41] feel like people and I'm including myself in this, it's like hard to pronounce

[00:01:46] and want to understand what you guys do there because you do a lot.

[00:01:49] Of course, of course. It's Walter's Coover is how you say it. It's originally

[00:01:53] a Dutch company, hence the spelling. I actually made an internal push that I

[00:01:58] said maybe we should just rebrand as WK. I feel like people would like feel

[00:02:02] more comfortable saying the name but that didn't get any traction. So we are

[00:02:06] a company that's actually much broader than healthcare. We have four

[00:02:09] different divisions. We're global in nature so just order of magnitude

[00:02:13] things like 20,000 employees. Originally, as I said, a Dutch

[00:02:17] company. We specialize in all things information and technology for

[00:02:23] professionals and so healthcare is one of them. We have another one

[00:02:27] that's tax and accounting, another one that's legal and a final one that's

[00:02:31] compliance and related assets. And yes, I'm in the healthcare division.

[00:02:36] We have a number of product categories but just in terms of orienting

[00:02:39] yourself around where I work, we're focused on clinical decision support.

[00:02:43] So really solutions at the point of care for clinicians. We also have a

[00:02:48] set of patient engagement tools so just the patient component of that.

[00:02:52] Okay. So now when we think about the assets that you have, can you

[00:02:55] explain what that is? Because I'm bringing this up for two reasons.

[00:02:59] We do, so like a girl pod, we have a book club and our book club is really

[00:03:02] geeky. Like we do federal rules and their

[00:03:06] drafts and there's two women that are from your

[00:03:08] organization that have done a little bit of

[00:03:11] helping me understand what you guys do but I want to hear from you too.

[00:03:14] Sure, I'm excited too. Let me tell you something when you tell me

[00:03:18] if I can help give other examples. We have evidence-based content

[00:03:22] which is integrated into a set of tools and it is available at the point of care

[00:03:26] to help clinicians make decisions. So if you think of it as an example,

[00:03:31] you're a clinician, you have a patient in front of you, the patient has,

[00:03:34] you've diagnosed the patient that's having a certain condition and you

[00:03:38] either want to double check or you want some support in trying

[00:03:41] to decide what is the best treatment path for that patient. You go

[00:03:45] into our tool, there's clinical components of our

[00:03:47] tools, there's drug components. A lot of it is kind of making decisions

[00:03:51] around drugs and dosing but it's well beyond that.

[00:03:54] We provide you that guidance in those answers and so at the most simple

[00:03:58] that's what it is. It's all point of care related.

[00:04:00] If you think of it more broadly around different types of tools that a

[00:04:04] clinician might access, these are the ones where you've got

[00:04:07] 15 minutes with a patient and you need to quickly get to

[00:04:10] get to a decision. So it's got to be like massive

[00:04:13] amounts of data like a data library that is pointing a clinician to the

[00:04:17] right piece at the right time. You've got it. So that's why the

[00:04:22] interface is actually intentionally very, very simple.

[00:04:25] Maybe this helps you just have a search bar effectively and you search

[00:04:28] for something fairly specific and that's what

[00:04:31] comes up and like there's no bells and whistles, there's nothing else

[00:04:34] there we're trying to declutter and not add any more burden onto the

[00:04:37] clinician. We see ourselves kind of we're

[00:04:40] squarely on the side of the clinician. It's kind of in some ways

[00:04:43] recreating what I think many clinicians experienced 30 years ago

[00:04:47] if you were in a small institution and you weren't sure about something you

[00:04:50] know stick your head out the room and you'd ask

[00:04:53] your colleague, hey I was thinking of

[00:04:55] treating with this drug what do you think and that you could consult

[00:04:59] for a second informally and you could come back.

[00:05:01] That's effectively what we're working to do at scale.

[00:05:04] Okay so that's super powerful. Imagine like I'm just thinking of the

[00:05:08] amount of information that if I could ask anybody

[00:05:11] okay is this the right choice? Is this the right

[00:05:13] Well in any direction like that's insanely

[00:05:17] powerful at the time of care. Maybe just for those in the audience that

[00:05:21] are in healthcare, the main the flagship brand in this

[00:05:24] portfolio is up to date. I'm so impressed that they

[00:05:28] got that name probably 30 years ago or more it's such an effective name it

[00:05:31] literally is that so it's this huge library of content and then one

[00:05:36] of our other assets is incorporating new information so as

[00:05:39] things change bringing in new information and helping doctors

[00:05:42] literally stay up to date. Well and it's something that

[00:05:47] one of the reasons that I've been so excited to work with these products

[00:05:50] is it's such a mission-driven organization

[00:05:53] and clinicians really love it. So one of the fascinating

[00:05:57] things here is I think clinicians today have to deal with so many tools

[00:06:00] they have to spend so much time in the EHR.

[00:06:03] Much of it let's say is begrudgingly so what's so special about working

[00:06:07] on up to date is clinicians love to use it.

[00:06:09] We're not making them jump through hoops we're just there to build their

[00:06:12] confidence to help them to help them help the patients.

[00:06:14] That's really our mission. I imagine that there's a play there on

[00:06:17] burnout too right if you're in a position to help the clinician get

[00:06:21] what they need and help them do what they need

[00:06:24] faster and with more confidence like you're

[00:06:27] playing into their own well-being. Absolutely absolutely

[00:06:31] and we hear that consistently we run surveys and another type of

[00:06:35] kind of structured survey called the Net Promoter Score which is

[00:06:38] really trying to understand kind of how our users think about us

[00:06:42] every year consistently. I've never I've worked across many products in my

[00:06:45] career and I've never seen anything like this. People really feel

[00:06:48] really good about using our tool and like we're helping them. That's amazing

[00:06:52] tell me more. I mean I guess like ultimately what I mean is like

[00:06:57] technology is playing a role in alleviating burnout

[00:07:01] so pull that threat. Clinicians have more patience than they've ever had

[00:07:07] they have more pressure on other kind of administrative steps

[00:07:11] around documentation connecting with a pair, reporting

[00:07:14] all kinds of metrics coming from all directions. They have less time than

[00:07:18] ever to consult they have less time than ever

[00:07:21] to refresh themselves. The kind of body of knowledge and evidence is

[00:07:26] growing at exponential rates so even if it didn't have all those other

[00:07:29] pressures I mentioned you can't your journal once a month

[00:07:33] you know in your specialty and scan it and feel like you're up to date

[00:07:36] things are changing faster and in a much more complex way and again as I

[00:07:40] said just the volume. Our mission is to reduce that

[00:07:45] and to support them at scale. I think the next frontier because

[00:07:49] I'm always saying I mean I'm really proud of our history and

[00:07:52] our legacy and the relationship that we have with you know over two million

[00:07:56] clinicians globally but the next frontier I think is if you

[00:08:00] want to reduce that burden further and you're not an EHR or

[00:08:05] another kind of documenting tool the next frontier is connecting it more to

[00:08:08] the patient piece and that's kind of one of the

[00:08:11] philosophies of why we've been investing on the patient education and

[00:08:14] engagement side because I think if you want to reduce it further

[00:08:17] it's how do you support that shared decision making between the clinician

[00:08:20] and the patient, how do you enable confidence on the

[00:08:23] patient side and the decisions that the clinicians making

[00:08:26] how do you empower the patient to take more control themselves

[00:08:29] a lot a lot of conditions that clinicians are treating in the US in

[00:08:33] particular is chronic based there's a big big big patient component of those

[00:08:37] conditions and I think if we start to support

[00:08:41] and empower them in line with how we're empowering clinicians that's when

[00:08:44] you kind of unlock the next level of helping helping a bit on clinician

[00:08:49] clinician burnouts and related struggles. I love that I mean it's

[00:08:52] basically well is that a whole different set

[00:08:55] of data because you're like okay they've got up-to-date data about a

[00:08:58] particular condition but then there's a whole other

[00:09:01] library about what do you do with that like those are two

[00:09:04] very different conversations. We have a huge

[00:09:07] internal project we talk about internally as like a harmonization project

[00:09:11] but it's really thinking through if you have these disparate assets and

[00:09:14] historically I think vendors have thought of you know there's patient

[00:09:17] things and there's clinician things again as I said the future to me it's

[00:09:20] all the care team and I think the patient is part of that care team

[00:09:24] and I think for a long time we've heard buzzwords of you know patient

[00:09:26] centricity and and kind of digital tools enabling them

[00:09:30] and there's great progress on that but I think the kind of way you like unlock

[00:09:34] the next level is where you start to think about connecting the clinician

[00:09:37] the patient and that's a big part of what we're doing so

[00:09:39] if we're advising the clinician in this way and we're guiding them

[00:09:43] what kind of challenges do they face in actually being able to

[00:09:46] to treat the patients if they if we can give them the right guidance and

[00:09:49] they buy in and they support our recommendations

[00:09:52] then how do we get that to the patient how do we facilitate the

[00:09:55] conversation there's all kinds of different nuances there and I think

[00:09:59] that's kind of the the next big set of work that we're doing

[00:10:02] okay so something that's coming up for me is whole patient care

[00:10:07] and the way and and so when we talk about like okay in a patient journey

[00:10:11] if they come in something's wrong with their head

[00:10:13] but they're going to see the doctor but they actually also have something

[00:10:16] wrong with their stomach or their foot like that person that doctor that

[00:10:19] they're they're talking to might not be able to

[00:10:22] support them in their whole care and their how does what you guys do

[00:10:27] a wk is what i'm going to say you're perfect I love it

[00:10:32] support that like can the patient's whole experience and

[00:10:36] you know setting up a clinician to better care for

[00:10:39] the entire human and not just a special part of them

[00:10:43] what you're describing I think what we see in our customer base is this is

[00:10:47] particularly happening in primary care

[00:10:49] so there's this huge supply as you i'm sure you're familiar huge supply

[00:10:52] demand gap between you know providers and patients

[00:10:56] the kind of nexus of that is happening in primary care when you can't get to a

[00:10:59] specialist when you can't get the help you need

[00:11:01] or you go to primary care these pcps are now dealing with a

[00:11:06] range of conditions you have another you have a couple of other factors

[00:11:10] that are playing in here we have an aging population

[00:11:13] we have a greater greater percent of our population that has multiple

[00:11:16] chronic conditions and other ailments that are happening

[00:11:19] these primary these pcps have 15 minutes and so when we speak to them

[00:11:23] and we say like how are you dealing with this

[00:11:25] they say to be candid we have folks with five seven things that we could

[00:11:29] we could you know we could support them on and i'm just thinking about like

[00:11:32] what is the most acute what is the most critical and i just do not have

[00:11:36] time to deal with the rest like i don't have time if it can kind of

[00:11:39] mean if there's a kind of a maintenance type situation i'm like

[00:11:42] letting that continue until i can see them next which is just so sad i

[00:11:46] don't think that's what how pcps want to make patients

[00:11:50] better they want to provide the best care

[00:11:52] they want to provide evidence-based care and they're limited when those sorts of

[00:11:55] things happen so one of the ways that we're thinking

[00:11:58] about it is particularly on our patient engagement tools we're thinking

[00:12:01] about how do we no matter what the support is

[00:12:06] so let's imagine a clinician is providing some patient

[00:12:10] engagement around a chronic condition because that is as i said a lot of

[00:12:13] what care is about these days we are thinking about the whole

[00:12:17] patients in that context and one of the big components that comes up all

[00:12:20] the time is mental health and mental health challenges and need for mental

[00:12:24] health so as while this is a a product for the

[00:12:27] patient around a particular chronic condition

[00:12:30] we're kind of embedding components of mental health and other things to

[00:12:34] kind of support the whole patient as they you know make decisions about

[00:12:37] treatment and things like that for chronic conditions so i think we're

[00:12:40] trying to infuse it in everything we're doing i

[00:12:43] don't think you can compartmentalize i think that's kind of

[00:12:47] where things start to break down or how how things were thought of before you

[00:12:50] know in a kind of siloed manner so it's the

[00:12:53] whole care team including the patient and it's thinking about the whole

[00:12:56] patient as opposed to just the most acute

[00:12:58] acute thing well and i love the idea of also leading a little bit with

[00:13:01] the mental health aspect because i feel like you know regardless

[00:13:04] of what's going on with your body if you can't like wrap your head

[00:13:08] around it exactly that's a major issue so can we

[00:13:11] talk about like basically the mental health

[00:13:14] perspective too because that seems to be one that is

[00:13:17] more prominent these days for good reason

[00:13:20] what is like the increased demand specifically for mental health care on

[00:13:25] primary care physicians you know it goes back to supply demand gap

[00:13:29] that's certainly one component of it historically

[00:13:32] well there's multiple comments historically many patients wouldn't see

[00:13:35] care and i think a little bit kind of

[00:13:37] accelerated by covered there's more of an acceptance and a support of

[00:13:41] treating patients with mental health conditions and so patients are more

[00:13:43] comfortable coming forward i think covered exacerbated

[00:13:46] many components of mental health as well so the supply to

[00:13:50] the mod gap has exacerbated and now again as we describe this becomes a

[00:13:54] pcp problem i saw a incredible stat i think

[00:13:59] approximately 80 percent of antidepressants are prescribed by pcps

[00:14:04] which i was just like shocked by again there's

[00:14:07] there's many other more complex mental health conditions that

[00:14:10] specialists are prescribing for but you know kind of unipolar depression

[00:14:14] 80 percent of antidepressants are prescribed by pcps

[00:14:17] so the pressure on pcps here is particularly acute

[00:14:21] and exactly as you said what they what our customers say to us is if we

[00:14:25] can't support them on mental health when we're trying to manage a bunch

[00:14:28] of other chronic and other conditions it becomes so much harder medication

[00:14:31] adherence becomes harder it exacerbates all kinds of other

[00:14:35] conditions and so when we speak this is kind of interesting but

[00:14:38] there's a disconnect if you speak to kind of

[00:14:40] executives in some of these health systems their perspective is

[00:14:43] pcps can only do so much they've only received so much mental health training

[00:14:47] as part of their border training and you know they need to they need to

[00:14:51] refer and to refer out to specialists when it becomes

[00:14:54] too tough for them but if we speak to our users they say

[00:14:57] they say something else which is they say like there's no one to refer

[00:15:00] them to if i refer them they're just going to come back or

[00:15:04] they're not going to take the other medicines that we've prescribed

[00:15:06] by the conditions we have to be better equipped to support them in

[00:15:11] the short term at least while there's this demand supply gap it's the only

[00:15:14] way to move forward and so it's been interesting to hear

[00:15:16] that and so what we've been thinking about a lot is

[00:15:20] we have for many many years had a huge library of

[00:15:23] clinical and drug content and patient engagement tools around mental health

[00:15:27] that's not new what we're what we've invested in

[00:15:30] significantly and continue to invest is how do we build out that set of

[00:15:34] tools how do we make it more comprehensive

[00:15:36] one of the things that's been very interesting recently and it's a project

[00:15:39] i'm working on just to make this kind of more specific and pointed is

[00:15:44] one of the specific challenges pcps are facing is around

[00:15:48] cross-tapering so a patient's on a drug you want to move them to the drugs

[00:15:53] not working you want to move them to another drug

[00:15:56] you've got to remember all the different combinations of the different

[00:15:58] drugs you can move them one to the other the different dosing as

[00:16:02] you're tapering them from one and ramping up from the other one what you

[00:16:05] have to do you have to do a bunch of math in your head there's many

[00:16:08] many drugs that you could take and so as an example we've always had

[00:16:11] information around cross-tapering but we're now like building a cross-tapering

[00:16:15] tool where they don't even have to think

[00:16:17] you know so i think we're trying to get really pointed at helping

[00:16:20] some of the areas that have been particularly difficult for pcps

[00:16:23] i think that one thing that we all suffer from i'm definitely including

[00:16:27] myself in this is just like drinking from the fire host like

[00:16:30] there's just so much to know and understand if you

[00:16:34] really want to be supportive and helpful of people it's just like you

[00:16:37] also have to be thoughtful about you know what is accurate information

[00:16:41] what is useful information and how can you get it to at the right time

[00:16:44] at the right time to the right people and it sounds like that's what

[00:16:48] you guys do just we're not inventing medicine we are trying to

[00:16:52] distill it and focus it and give clarity and transparency around the

[00:16:57] grade of the evidence and the source of the evidence so

[00:17:01] that clinicians can build confidence in the decisions they're making and

[00:17:05] then that supports kind of the patient engagement piece as well okay so can i

[00:17:08] ask you a personal question of course of course absolutely what did you

[00:17:13] study how did you get your job like what is your own trajectory

[00:17:17] in like how you got to where you are now to get to do what you get to do

[00:17:21] i heard some of your prior podcasts and i think maybe

[00:17:25] i got here the same way some of some of you other guests i kind of

[00:17:28] found my way into health care so it wasn't like a calling i mean i

[00:17:31] studied economics i grew up in south africa i studied

[00:17:34] economics i worked in different industries unrelated to health care

[00:17:39] i actually joined walter's clover in corporate strategy and so i was

[00:17:43] thinking about mna and business turnarounds and

[00:17:45] portfolio management and all these these things

[00:17:49] and one of our four divisions is health as i as i said

[00:17:53] and i ended up just doing a lot of work in our health division

[00:17:56] and i loved it and i never felt such intrinsic motivation

[00:18:01] and i felt really proud about the mission-driven nature we really really

[00:18:07] while we're a public company you know there's pnls that i would pretend

[00:18:11] otherwise but there's such a philosophy around

[00:18:14] doing the right thing for the clinician doing it in an unbiased way

[00:18:18] we have so much energy and thought has been put into

[00:18:22] how to ensure that we lead by the evidence and we lead by what's most

[00:18:26] critical for the clinician and it was just so inspiring to see

[00:18:30] and it was so inspiring to see the reach that we had and so anyway i worked on

[00:18:34] multiple projects i worked on projects looking at our international strategy i

[00:18:38] worked on many different things and in corporate

[00:18:40] strategy which was what i spent a couple of years in at walter's clover

[00:18:43] before you do this really interesting project

[00:18:46] you come up with a recommendation and then you have to hand it over to

[00:18:49] the business right and you say here this is what we should do we did

[00:18:52] this analysis like we recommend this like you know whatever it is

[00:18:55] you'd like hand your baby over you know and then you've got to move on

[00:18:58] to the next thing and at one point probably almost three years ago two and a

[00:19:02] half years ago the the priusy of the current business

[00:19:06] unit i'm in she was like aren't you tired of doing that aren't

[00:19:09] you like are you ready to come and get your

[00:19:11] hands dirty and move to the operating side

[00:19:14] i had since i had at that point spent several years working

[00:19:17] specifically in healthcare strategy and i was like you know i'm i'm so

[00:19:21] ready i'm so ready and uh and so i moved over that was

[00:19:25] really it and i i moved over and i um have been focusing on our provider

[00:19:29] strategy ever since that's what i live and

[00:19:32] breathe and it's been very inspiring walter's clover health is is run by

[00:19:36] women and actually in fact walter's clover

[00:19:39] overall is run by a woman nancy mckinstry is incredibly inspiring and

[00:19:42] so i don't know i never thought i would

[00:19:44] end up here to be honest it wasn't like

[00:19:46] you know when i was six years old this was my dream but it it happened

[00:19:49] very organically and what feels right about it as i

[00:19:53] mentioned is the intrinsic motivation i have

[00:19:58] so much energy this doesn't feel like a burden it doesn't feel like i

[00:20:02] i'm really really excited about it and i feel like there's just so much

[00:20:06] opportunity to do good and we have i feel like we also

[00:20:08] have a responsibility there's such a reach

[00:20:11] we're in like really all the big health systems in the u.s we're in

[00:20:14] many many internationally and so the decisions we make impact

[00:20:17] you know millions of clinicians and and as a result many more millions of

[00:20:21] patients i mean that's a really empowering place to

[00:20:24] sit right and one thing i love about health care i feel like oh once you're

[00:20:27] in it's so hard to get out because of that

[00:20:30] intrinsic purpose that you feel like wow we are faced with some really big

[00:20:34] challenges but then the flip side is that there's

[00:20:37] also some really good opportunities to do

[00:20:40] good yeah well julie if people want to follow your work and

[00:20:43] work with you or somehow get involved like how would you direct

[00:20:46] them probably these days the best way to reach me is on linkedin

[00:20:49] i'm julie fray on linkedin i don't believe there's many many others i

[00:20:53] would be so happy to engage i've figured out a way to connect with

[00:20:57] lots of women within waltz's cuvr and again it's like a very female

[00:21:01] oriented organization and that's one of the reasons i stayed and i loved

[00:21:04] it i have not cracked the knot i'm like

[00:21:07] beyond that and i would so love to do that

[00:21:09] yeah i'll share with you we actually do have a linkedin group for

[00:21:12] guests and listeners to connect it's the whole intention behind it is

[00:21:17] just to expand people's networks there's not that much activity that goes on

[00:21:21] but it's allowing people to kind of connect on linkedin to get to know

[00:21:25] people and expand our networks so i can help you crack that nut

[00:21:29] thank you that's fantastic thanks so much thanks yeah my pleasure well

[00:21:33] thank you for joining and thank you for sharing your

[00:21:35] expertise i really appreciate it yes thanks for having me it's been a

[00:21:38] pleasure thanks for listening you can learn more about us or this

[00:21:43] guest by going to our website or visiting us on any of the socials with

[00:21:47] the handle hit like a girl pod thanks again see you soon again thank

[00:21:51] you so much for listening to the hit like a girl podcast

[00:21:54] i am truly grateful for you and i'm wondering if you could do me a quick

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[00:22:11] out so much i'm the show's host joy rios and i'll see you next time