Patient-Centered Care Technology with Elizabeth Lamont, MD of Salient Care

Patient-Centered Care Technology

Elizabeth Lamont, MD is the Founder of Salient Care, an IT company that focuses on patient-centered care technology.

As an oncologist and scientist, Elizabeth uses technology to help patients with cancer and has recently launched the My Health Team app. Patients with cancer are treated by large oncology teams, which can be overwhelming to keep track of. Patients complained of not knowing how many providers were on their team, let alone how to reach them. Salient Care’s My Health Team app makes it easy for patients to keep track of – and connect with – their entire oncology team.

In this podcast interview, Elizabeth and I discuss:

  • How Salient Care’s app reflects the trend towards patient engagement
  • Why it was important to address their 2-sided market: oncologists and patients
  • Where the push towards patient-centered care is heading

This is an episode of Healthcare Lead Generation with Jennifer Michelle, a podcast that mixes lead generation tips with interviews of healthcare IT disruptors, innovative healthcare providers and health sector company leaders. Follow the podcast and #HCLeadGen to learn about growth strategies and navigating change in the healthcare sector.

Patient-Centered Care Technology with Elizabeth Lamont, MD of Salient Care (Podcast Transcript)

Jennifer: 00:04 Hi, everybody! I’m Jennifer with Michelle Marketing Strategies where I specialize in helping healthcare IT and provider organizations grow their companies and get more leads. Today in Healthcare Lead Generation, we are talking with Dr. Elizabeth Lamont of Salient Care. Elizabeth is a medical oncologist and scientist who founded Salient Care with the idea of producing patient centered care technology, including the My Health Team app. You can find her at salientcareLLC.com. And today we’re going to be talking about patient-centered care technology for oncology patients. So let’s dive in. Elizabeth, it is such a pleasure to have you on the podcast. Welcome.

Elizabeth: 00:04 Thank you, Jennifer.

Jennifer: 00:49 To orient our listeners, let’s start with a little bit about what the trends are. I know there’s a movement out there about patient engagement, about improving patient experience that has so much to do with your work. How is that trend impacting your ability to get your message across or to have people be receptive to it?

Elizabeth: 01:05 Well, I think it’s a new area that has gained a lot of traction based on some policy changes that the Centers for Medicare and Medicaid Services have made. They now explicitly value patient satisfaction in terms of the hospital or healthcare experience, improvements in population health and a third item, which is decreased utilization of care. What they are doing is reimbursing hospitals at the end of the year if they have improved on each of those indices. So, the hospitals realize that there is money to be made in making patients feel very satisfied with their care, along with those other items.

Jennifer: 02:10 I love that. It has traditionally been the afterthought. They had to like their care? They had to have a good experience with it? Like, oh, was that part of it? I agree with you. I think that has been a very big issue. So when you talk about these trends and how they’re actually affecting what you do, because I know, for instance, the My Health Team app is … in fact, why don’t you tell people a little bit about that and then we can go into it?

Elizabeth: 02:41 Sure. So, this was motivated by an interest in pursuing some funding from an agency called PCORI, which President Obama set up. Patient Centered Outcomes Research Institute. And it’s fabulous, it’ s a funding agency. We had wanted to put in a grant for it and decided to do some sort of what I would call hypothesis-generating conversations with patients. So we went to the chemotherapy suite and talked to patients who had just started chemotherapy for the first time. Almost all of them were newly-diagnosed patients with cancer. And we said, “Hey, how’s it going?”

Jennifer: 03:34 Interesting question there, Elizabeth. Interesting question.

Elizabeth: 03:42 We didn’t want to bring any of sort of our own thoughts to this because that’s the whole point. That we don’t know, that they know and there are challenges they’re facing that we just can’t see.

Jennifer: 03:59 You know, I love that. I love that you did that because I think, too often, companies skip over that part. And since my work is marketing, I’m frequently telling clients, let’s go back to the beginning. What is it that your client would say? What is the person you’re trying to reach thinking? And how do they communicate about this and what are they feeling? So I think that’s brilliant. So what did you find out from them?

Elizabeth: 04:34 There were a lot of good things they had to say, particularly about the nurses in the infusion suite who are amazing. We didn’t know ahead of time, but they did mention five areas that were problems. Ironically, the hospital had four programs for those already. So they were newly diagnosed. They didn’t know about those yet. So we were able to pass on that information to the leadership to say, “Hey, you know, people are asking for these things that we have, so we need to do a better job about getting the message out.” But the fifth, this thing was really quite stunning and makes complete sense, but, you know, if you’re not a patient, you’re not going to realize that. And it was, they did not know who their team was. They said everyone keeps asking me who my team is. And then they pulled out 10 business cards and they said, is this my team? And if so, who do I call if there’s a problem with this chemotherapy, which was literally dripping into their veins as we were talking to them.

Jennifer: 06:01 So let me just slow down on that a little bit. For those who are listening, who maybe are not as familiar with oncology treatment. So it sounds like, obviously, you do need a whole team of people to help. Are these people who are kind of on the sidelines of the treatment or is this team really someone that the patient could contact if they needed to?

Elizabeth: 06:20 So that’s a great question. What the team is in general is a combination of specialists in cancer. Most people who have cancer nowadays, solid tumors like breast cancer or colon cancer are curable and they’re cured with a combination of surgery, chemotherapy and radiation often.

Elizabeth: 06:52 So the team members tend to be surgeons, radiation doctors and chemotherapy doctors, as well as the junior people who are being trained by them and social workers and nutritionists. So one could imagine a patient could have 10 cards and all 10 people are on the “team” but they have different roles.

Jennifer: 07:21 Would a patient be able to connect with any of them? Would they be able to reach out to the nutritionist on their own? Would they be able to call the radiation specialist? I mean, if they’re getting business cards, I’m assuming that that’s the design.

Elizabeth: 07:38 That would be the idea but it was clear from talking to patients that they really did not understand which role each card was related to and it probably had to do with kind of this medical speak that we use, of course.

Elizabeth: 08:08 So we developed an app that has a picture, has a space for a picture of the doctor as well as their name, what they do in lay language. So not “oncologist” but “chemotherapy doctor.” And a hotlink for a non-emergent issue, a hot link for an emergent issue and then a link to our email system.

Jennifer: 08:36 Oh, that’s brilliant.

Elizabeth: 08:36 Thank you.

Jennifer: 08:40 So it’s one of those things – so simple, but you know, when you are going through that, I can only imagine how overwhelmed you would feel and not even feeling you know who to contact must just be so much more isolating and panicking.

Elizabeth: 08:57 Oh, it must be terrifying. I mean I just feel terrible for all the people who had gone through that for all those years with that same feeling. So the other kind of attractive aspect is that sometimes our patients travel quite a distance for their care and perhaps a problem happens closer to their home. They go to the local emergency room, they or their family member can show the ER doc the team and the ER doc can very quickly realize this is a cancer patient. And reach out to one of us rather than, perhaps, miss something that we see commonly – we’re at a big referral center – and improve the quality of care. And perhaps really improve people’s survival.

Jennifer: 09:59 Absolutely. No, I think that’s brilliant. You know, when I volunteer on the ambulance that we always like it when they say “this is my doctor” and, if it’s an hour where we could reach them, we would always do that if there’s something unusual going on because they know that particular case. So with things as specific as cancer care, other specialties are not going to understand all the different things that could be going on. I think that just closes that circle for them so that they can continue to get that good care, even if they wind up in the ER. I think that’s fantastic. So how has the reception of it been? Are the patients getting that that’s helpful? Are the doctors involved on the team being receptive to it, too?

Elizabeth: 10:46 So it’s a good question. There has been a lot of enthusiasm for it. We changed computer systems a couple years ago and there’s kind of a long line for implementation of different types of apps, among other things. So, figured out a way to actually circumvent the need for the computer system to be involved. And so it’s very exciting and the team I work with are working on it now and I think in the long run, it’ll be worth the wait. I will say there have been something like 4,000 downloads in China on one day, so I think there’s a hospital in China that has figured out how to make it easy because, right now, the patient has to type everything in using the card. And what we want to do is make it easy. We want to have it all set up so that they can drop the doctors into the phone.

Elizabeth: 12:12 Right now we’re not at that point, but we will be quite soon.

Jennifer: 12:15 It sounds like it’s still something that people are seeing the use of and that the concept is resonating with them.

Elizabeth: 12:22 Yes. And actually I use it and I think it’s great because you don’t have to go through your phone book to find people. You just go to this one app and it’s just quick and wonderful.

Jennifer: 12:38 I love that. So let’s talk about some of the other things. For all those who are listening, I’ve spoken to Elizabeth before, so I’m kind of referring to that conversation. But we’d spoken about there being multiple layers of customers in healthcare. That there’s the people you have to reach – the oncologists and the teams – and then there’s also the patients and their families. What is it like reaching out to those two different groups? Because I know that the app is just one of many different products that Salient Care is working on. So how is it reaching out to them? Especially, oncologists don’t have a lot of free time even for their patients, let alone anything else. So what is that process like?

Elizabeth: 13:29 So that’s a really great question. And what motivates the design of any of our products is it has to make life easier for the doctor and save them time, right? It can’t add anything onto their flow because they are strapped. And then it has to improve the patient experience. In one of our products, it’s improving communication between the inpatient team and the family because that is something that’s really, really tough. When we round on patients, it’s not at a given time. It’s sort of like when we get to the patient. And so it’s very hard.

Elizabeth: 14:37 I have a good friend who, basically, drove this home for me with her own experience. I also get ideas for some of these innovations from friends and family who’ve experienced this, but what this does well, it adds no extra time and it potentially will lead to a much shorter length of stay and people being on the same page – family, patient and doctors, right from the beginning.

Jennifer: 15:18 Do you find that families are eager to talk with you and help you come up with ideas of what would work for them? Do they want to participate?

Elizabeth: 15:28 Oh, for this particular intervention, they were thrilled. And the doctors, the management, doctors and nurses on the oncology floor, were thrilled and wanted to see a pilot, and the patients were thrilled. So it’s this thing where everybody has to win for it to be useful and the thought of being able to save doctor’s time so that they can actually spend more of it talking to patients is really the goal.

Jennifer: 16:11 I just read another article on NPR this morning about that and how that lack of time and the obstacles and the technology requirements, which documentation is posing are causing such levels of stress and burnout in physicians. It’s crazy. It’s out of control.

Elizabeth: 16:28 It really is. And I feel so sad for the new doctors who are coming through because they don’t know how much they’re missing.

Jennifer: 16:38 Well, they sense that they’re missing something.

Elizabeth: 16:40 I don’t know that. I don’t know that they do, you know what I mean? I mean they’re wonderful. Gosh, they’re such talented people and yet they don’t know how good it used to be, to be able to sit down and talk to the patient and really get to know them. There just isn’t time.

Jennifer: 17:07 When you think about it, the new doctors, they’re probably just in their mid-twenties. They may never have seen a doctor that spent more than five or 10 minutes with them. That’s right. They might think that that’s reasonable and not understand what they’re missing. And you know, I always think – again, my background’s Epidemiology but I volunteer at the rescue – and it’s at the rescue that I really see things that you read about, but you don’t get until you see them. Like, you wouldn’t know from a 10-minute conversation what I can see in five seconds or even half a second just walking into someone’s home and say, okay, they’re having real difficulties just taking care of the home. They’re not able to feed themselves because they’re clearly not able to cook or something’s going on here where they’re so sick, you can tell basic things aren’t getting done. And it’s hard to convey that, especially because people want to put their best foot forward sometimes when they meet their team. Nobody wants to to say that they are ill, which is so ironic I find.

Elizabeth: 18:06 Yes, I agree with you.

Jennifer: 18:08 So interesting. So let me ask you this now. The oncologist, the oncology teams that are so strapped for time, I’m sure they loved the idea of anything that will save them time, but do they have the time to try it out? Are they interested in helping with the hope that it would save time in the future? Do they even have time to get a response? I mean, how, how does that work?

Elizabeth: 18:34 Well, I think the idea would be that you do a small pilot – I think we had talked about three patients – and if the leadership is behind it, then it’s something that’s going to happen. One thing that I am a little worried about with HIT, in general, is I haven’t seen a lot of studies to see if it improves patient care, patient satisfaction. If it does nothing, if it makes it worse.

Jennifer: 19:23 Interesting. I guess I think so much of different platforms, but you’re talking about if it would directly benefit the patient experience in some way. Interesting. Why do you think that is?

Elizabeth: 19:36 Well, I’m coming from being a medical oncologist where we do treatment trials and one of the first types of treatment trials we do is a Phase One trial. And it looks for whether or not there’s excess toxicity and at what level. And so the lens that I’m using to look at this new HIT is sort of the oncologists lens. Are we making things better, are we doing nothing? Are we making things worse? You know, it’s only if we’re making things better that we should move forward. So I think there needs to be more systematic study of all this panoply of apps that are out there because maybe some of them are doing harm, right? I mean, that’s a possibility if you haven’t studied it.

Jennifer: 20:29 No, I agree. And I always remember from grad school, this wonderful visual example they gave of some intervention that was studied. And if you didn’t compare it, if you just saw it on the line chart, it had this great beautiful curve upwards and you’re like, wow, look at the impact! And then they compared it to the control and the control was so much higher. So it actually made things worse – and that’s why they always drilled it in: you have to have a comparison group. In fact, I always remember my favorite joke, which is how many epidemiologists does it take to screw in a light bulb? And the answer is … compared to what? So I mean, that’s just an old joke. I know. That’s kind of you to laugh. But that’s something I’m always thinking about – it looks good but, if you don’t have a comparison, it’s nothing. The more data we have, the more we will know about what it’s doing. I just think this is fascinating. I know we touched on this a little bit at the beginning. I want to go back to what you were talking about, some of the reimbursement trends and I know that that’s a big issue. I was just thinking, over the next 12 months, between legislative changes and -healthcare in our country has been in such an uproar – what are you seeing as some of the impacts on patient-centered care and a movement towards that?

Elizabeth: 21:54 Well, it’s interesting that you mentioned this because just the other day I was reading in the news that CMS is revisiting the idea.

Jennifer: 21:54 Yes, the measures.

Elizabeth: 22:09 The requirements. So there are requirements regarding documentation that take quite a lot of time and that’s time that could be spent sitting and talking to a patient. So if you’re needing to essentially be a doctor to the chart for billing purposes, then you’re not being a doctor to the patient. And so I think CMS is realizing this huge time sink and that these very, very well-intentioned policy changes, were put in. So I think they are going to pull those away and perhaps substitute them for something that actually is much more meaningful and patient-centric. That is my hope.

Jennifer: 23:08 I hope so, too. I, I seem to recall that they had gotten rid of a whole bunch of duplicate things and just tried to make it a lot more precise in what they were asking people to document. But am I remembering that right? I just scanned this yesterday so I’m a little new on it.

Elizabeth: 23:32 Yes, it offered a glimmer of hope, it said something like CMS is revisiting the current recommendations in favor of – trying to think of the phrase – but sort of …

Jennifer: 23:47 Time-consuming data collection?

Elizabeth: 23:51 Yeah, something that had to do with saying certain phrases and that kind of thing and all of that takes time and it can’t be a template. It has to be typed and anyway, it sounds like they’re maybe going to scale back on that, which I think would be great.
New Speaker: 24:14 That’s excellent. That really is because you’ve got to find a balance point and it didn’t sound like we had it. Hopefully, this is a step in the right direction. Elizabeth, thank you so much for coming on this podcast and sharing with us. I think it’s just been amazing to hear what you’re doing and to hear how just a small bit of technology that’s really totally focused on the patient’s needs and what they’re really experiencing can make a whole, huge difference even in something as severe as oncology treatment, as cancer treatment. I think that’s incredible and I’m glad to hear there are people like you working on that.

Elizabeth: 24:14 Oh, that’s so nice. Thank you.

Jennifer: 24:58 It’s awesome. For everyone listening, you can learn more about Elizabeth’s work at salientcareLLC.com. This is Dr. Elizabeth Lamont. She’s a medical oncologist and scientist who founded Salient Care and, through that company, produces patient-centered care technology, including the My Health Team app. And I am your host, Jennifer Michelle of MichelleMarketingStrategies.com, where I specialize in helping healthcare IT and provider organizations get more leads and achieve their growth objectives. I hope you all enjoyed today’s podcast. Catch you next time!