Supporting Clinicians with Adam Carewe, Formerly of Kaiser Permanente
This is part of our weekly executive insights series where Elion CEO Bobby Guelich speaks with healthcare leaders about their tech priorities and learnings. For more, become a member and sign up for our email here.
Given your prior role as CMIO at the Colorado Permanente Medical Group, and your side hustle with NerdMDs, you have a unique vantage point into the healthcare IT landscape. What’s your take on GenAI in healthcare at the moment?
The large language models like OpenAI have just blown the doors off. The demos they’ve shown are mind-blowing. The problem is, now everyone just wants to create some sort of product that uses that technology instead of actually trying to dramatically shift the way care is delivered.
I think as physicians and technologists we have to think, “How can we actually fix healthcare using this type of technology?” Morgan Cheatham had a substack that talked about AI’s problem of just making a faster horse. How do we do for healthcare what Amazon did for E-commerce? How do we fundamentally change healthcare delivery while still accomplishing the same thing: as a patient you have a concern, and you need to get your concern addressed by a physician.
You’ve talked to a lot of different GenAI companies. Are there any you’re particularly excited about?
Pieces: They were doing a lot with AI before AI was feeling mainstream. On the one hand, I’m sure they’re worried that Epic is just going to catch up. But what’s unique about them is I think they can keep that competitive advantage and head-start moat to stay ahead of Epic.
Abridge and all the ambient AI companies: They’re doing a lot of the same things, but what’s going to differentiate them is the next layer of thinking. How do they allow personalization and automation? Right now these companies aren’t getting 100% adoption anywhere that they’re rolled out because they’re not perfect yet. In that arms race, I think it’s going to come down to who can keep that innovation edge or create something the others can’t.
Droxi has a very cool technology stack and I think they’re solving inbasket in a really exceptional way. If they keep the competitive headstart over Epic or athenahealth, they have a shot.
Putting your CMIO hat on, you were often in the position of deciding, “Should we wait for Epic to deliver this functionality, should we look externally, or should we build it ourselves?” So I’m curious how you thought about that decision and how you would advise both sides of that equation—the CMIOs making this decision and the companies trying to sell to them.
Typically I would say that if something is on Epic’s roadmap, let’s not even consider buying from someone else. But then there are shades of gray; you might go ahead and solve it if it’s just a hope or plan on Epic’s roadmap. But if it’s already in active development at all, I wouldn’t go elsewhere.
So in my position, I would look both at our priorities and Epic’s roadmap, and if Epic is going to be solving something soon I’m going to focus on another priority in the near term.
Now I advise companies on what they need to say to capture the attention of the specific subset of leaders they’re talking to. There are two things I steer them toward.
You say, “We recognize this is in Epic or Cerner’s pipeline but we have a product right now.” So if there’s urgency on the buyer’s part, you have an advantage.
Or, if you have something on Epic’s roadmap, you need to be thinking 6-12 months ahead into how your product is going to continue to be better than Epic’s. I think that’s where these vendors really do have a chance to get and keep those contracts.
I typically advise against homegrown solutions. In my experience, they tend to stagnate over time because they lack ongoing development resources. Epic and external solutions quickly catch up, so you either need to pivot or pull the plug entirely.
I’m curious if there are any areas where you see white space today for new solutions to be developed?
I still don’t think there’s as much effort right now in the startup space focused on really amazingly improving value-based care. I know that’s weird, because there are so many value-based care companies, but they’re going after the current model, like Medicare Advantage.
When I say value-based care, I’m talking about solving the patient’s problem without them having to come in. But our health system doesn’t fit with that right now; if you prevent a bunch of people from going to the hospital, the hospital is going to go out of business. If you’re in fee-for-service medicine, if you don’t fill up your schedule, you’re not going to make as much.
I also think the “food is health” movement and personalized medicine are on the cusp of becoming really big in mainstream healthcare. If we can connect that into VBC, there are all these downstream value benefits to society.
Anything in particular you think would be interesting to share with healthcare technology buyers or vendors in this audience?
As a physician, I understand that health systems have to have a margin, but there has to be a more concerted effort to support the people that are delivering healthcare. Nurses, physicians, and all other clinicians feel like they’re just a cog. They’re asked to see more, do more, and continue stretching thinner. My advice for high level executives is make your planning and efforts fit into supporting your people. Because if you don’t, those people are going to leave.
To go a little deeper, support can mean many different things. Could you name one or two big things that someone sitting in one of those seats could do to better support their clinicians?
I’m not talking about financial support or vouchers for food delivery. I’m talking about involving the people on the frontlines in making decisions. If you show genuinely that you care and want to hear their problems, I think that is one of the best ways to show support. If you empower the frontlines to feel like they’re actually driving decisions and changes and they have a little autonomy, that is going to make them feel more supported than anything else.
I’m curious if you have a specific example where you saw that go well?
What I saw success with as a CMIO was in having a group of physician informatics/tech champions. Our medical group supported them with a small amount of non-clinical time, which is nearly unheard of, because if physicians aren’t seeing patients, they’re not making money. We got so many insights and actionable things we could change from this group, because they were on the frontlines, talking to other people on the frontlines. And we did this all digitally, so these champions had access to our team to bubble things up quickly, and we could filter things down to them as well. Our satisfaction with the EHR among end users was in the 99th percentile nationwide, due in part to these efforts.