Ep. 14: Sheetal Shah, Chief Operating Officer of SymphonyRM. Topic: AI for Patient Engagement
Kathy: Hi everyone, and welcome to episode 14 of the Smarter Healthcare Podcast.
Before we get started, I’d like to say a big thank you to my listeners as we approach the one-year anniversary of this podcast.
When I started this venture in early 2020, it was pre-pandemic. In fact, the topic of Episode 2 was global health, and I talked to Lisa Adams of Dartmouth College about this virus we were hearing about in China. Little did we know how much of an impact it would have on our lives.
I have learned a lot in this past year – about changing plans, about growing an audience, and about finding guests who can share their incredible insights with all of you. I hope you have found it to be as worthwhile an investment of your time as I have found it to be of mine.
And now on to Episode 14. Today’s guest is Sheetal Shah, chief operating officer at SymphonyRM, a healthcare AI startup that is helping health systems improve patient engagement. Sheetal and I talk about the value of data, how health systems can better leverage it in 2021, and the great results his organization helped Virtua Health achieve with technology.
Here’s our conversation.
Kathy: Hi Sheetal, and welcome to the show.
Sheetal: Thank you Kathy, nice to be here. Thanks for inviting me.
Kathy: Could you start by telling me a little bit about SymphonyRM and how you’re working with health systems?
Sheetal: Yeah. SymphonyRM is a technology platform, and ultimately what we do is we help facilitate the relationship between health systems and their customers. I think when organizations use our platform, what they find is we can help improve the outcomes of their community, healthcare outcomes, change the way that customers experience what healthcare is, and then ultimately, we help drive growth. That’s pretty much what we do.
Kathy: And what is the value for systems in leveraging the data that they collect through their EHRs?
Sheetal: Yeah, that’s a great question. I get asked that question a lot, like what’s the value of what meaningful use kind of brought us through – which is get data into a, in a format that can be read electronically. I would say maybe the best way to answer that question is you replace the word healthcare and replace any other industry. Look at Amazon – what do you think, how they value the data they collect through how you shop. And in many ways, they would probably say it’s proprietary, it’s priceless. It allows them to probably identify what consumer interests are and what demand lies in what products. They nudge you when you need something that you don’t know you need, and you probably buy it. So, your question about what the value is for health systems in leveraging the data? Let’s say, healthcare organizations have a significant trove of data that they’re sitting on over the last decade that’s been built. Clinical data, imaging, studies, et cetera. Now the question is can they actually use that data, I think, in a way that consumers – people like us – would want them to use the data to do something about our health. And so if I think about it, I think the value is massive. I think first, I think healthcare organizations are using data today, right? When you go for a visit, they look at your labs, they have context, but how often are you going in to an office visit? It’s a very small percentage of your overall amount of time in a year. So, I think they’re using the data they have, they’re using it for one moment in time, but the true value is how do you use the whole context of the individual to manage the relationship across time versus just in that momentary visit. And I think, personally, I think they have about one to three years to figure out how to do it before they start seeing disrupters come into their space.
Kathy: So I guess a follow-up question to that would be what are some of the limitations in the EHR in leveraging some of that data?
Sheetal: I mean the biggest limitation is the EHR only knows about that visit, that one time that you decided to go in. It’s obviously very different across the spectrum of individuals and the like, but on average, most folks go in once, twice, maybe three times a year, and so the context of the EMR is just that momentary minutes of the months that you are sort of in context of the health system. So, the view of the health system is very micro in the EHR and that’s what they need to figure out how to really transform. How do they get a better holistic view of the individual? But right now, the EHR provides a bit of context but not enough.
Kathy: Can you talk about the campaign that you ran for Virtua Health in New Jersey and how you’re able to leverage that system’s data?
Sheetal: Yeah, thanks for that. Virtua Health is an amazing organization and I think really good leadership can drive a lot of what you see changing in healthcare. CEO is Dennis Pullin, Chief Marketing Officer is Chrisie Scott, and VP Ryan Younger, they came to us with a bit of a challenge. Their goal was to be the heart of their community, and really be the place that you go to for your health. And I don’t say healthcare, I say for your health. And so Chrisie Scott approached it, “Is it possible for us to develop an engagement plan, or a marketing plan, for every individual in our community?” So instead of this concept of an organization basically spraying into the market the same message, is it possible for us to do what Amazon is doing, what CVS is doing, and what these other industries are doing – American Express, Disney - where we personalize the experience for every member of our community. So, the first sort of approach they had was hey look, breast cancer impacts our community, we know it is in many ways something if you catch early it has a huge impact, and I’m not talking financial value, necessarily, there’s that, but also the life years that you add onto real people and their caregivers. So their goal was to increase the number of individuals that come in for a mammogram. And we utilized the EHR data, which again I said is a good foundation stone, we used the EHR data and applied machine learning, artificial intelligence, to instead of just saying, hey let’s…instead of just reaching out to everyone that’s say, forty-plus, which is typically the path, forty-five, for breast cancer screening, they said we can do that, but we want to do something a little different. We want to actually personalize the outreach, we want to identify individuals with the greatest risk, so the EHR data can inform us the individuals with the greatest risk, I’m talking individuals that have a six, seven x greater risk for having breast cancer, and the EHR data is telling us that. It’s looking at the data like no one has before. And then, two, can we personalize the outreach? Can we personalize the outreach that is sort of inclusive of, hey, mammograms offer a significant opportunity to improve your health. And it actually had an amazing return for the organization. And so Virtua Health used our platform to identify the individuals with the greatest risk, engaged those individuals digitally, tied into their access center, and they saw, over eight weeks, they saw a 350% increase in mammograms compared to the control group. And that means - it sounds like a big number – but imagine, those are real people that are coming in, that came in for a mammogram, may have seen material before but this message particularly related to them and they decided to come in. So it led to over a thousand mammograms being scheduled, a significant amount of revenue came in as well for the service line, but when you think about the impact for the community and trying to be the heart of the community, Virtua proved that they’re in it for the long run and to drive health.
Kathy: That’s amazing. Now I’m curious as to how you helped determine some of those risk factors. Is it that the EHR had captured that these are people who have tested positive for a certain gene that increases their likelihood of breast cancer, or is it looking at other factors such as, I don’t know, obesity, or prior mammograms? I’m just wondering what some of those factors are that are going into that.
Sheetal: Yeah. So one is there’s no general holistic model out there right now that you can apply to every community. Every community is different. Our model was based off of, using machine learning, so it’s learning off of the data that’s in the EHR for that community, there were factors, or features, as our data scientists call it, that did have a higher impact to predicting individuals would ultimately get diagnosed with breast cancer, things like BMI, certain lab readings, and the like. So the model itself learns from the data that’s in the community of individuals that have been diagnosed before, learns off of certain aspects to that, and then helps inform that this individual has potentially this percentage greater risk for breast cancer. It’s, again, if you go from where health care delivers this today, you usually fall into a care gap, right? A payer or provider, they look at best practices, they look at, “Well, a mammogram’s great for individuals that are 45 and above, female.” And then, so that’s the basic, and then there’s usually that secondary tier, the secondary tier is something like, have you had a history in your family of individuals having, say, breast cancer. And there’s a lot of models out there that are best practices, like the Tyrer-Cuzick Model, the Gail Model. Taking those elements, but then applying the third tier, which is let’s look in the data. Let’s look in the data to see if there’s features that seem to articulate that this individual has greater risk, and then put them through the regular process that we have, which is let’s get the mammogram in. So, we’re looking at a wide range of elements of data that are in the electronic health record, and again, they’re localized, they’re designed for the community that the health system serves.
Kathy: Now I know you talked about how they were able to schedule a thousand mammograms. Do you have any statistics on what are the greater number of breast cancer incidences that they found compared to the norm, or…?
Sheetal: Yeah, there are those, there’s definitely that data set, and I think that would be a great next podcast with the Virtua Health team and their clinical team, but there are real people in there and I think that’s what inspires us to work with Virtua Health, and how Dennis, Chrisie, and Ryan have really told us to bring what’s best for their community through our technology but they have been able to extract real people’s stories, and I gotta tell you, that’s what brings my team into work every day. It’s in those stories of those individuals that we see: Opened an e-mail at 8:30 in the morning on their iPhone, saw the message that was sent, a few hours later clicked on it, opened it, got the mammogram scheduled, and then unfortunately, there was something that was seen in the study, and they came back in and they got treated. There are stories in there and I think it would make a great next podcast with the Virtua Health team.
Kathy: Yeah, that’s great. It’s nice to see not just the number but seeing how that applies to actual lives that you’ve been able to impact. (Absolutely.) Let’s pivot a little bit to COVID-19. Do you think health care organizations will put a different value on their data following COVID-19 and if so, how?
Sheetal: I would almost turn that around and say if healthcare organizations don’t use the data or what’s not in the data – and I’ll kind of go into that in a second – in the next year, we’re letting down a whole nation. And what I mean by that is I just, over the break here, the holiday break, I was reading the Journal of the American College of Surgeons, that came out, the December 17th issue, there’s been a 46% drop in the number of cancer diagnoses across the most common six cancers in this year. Cancer hasn’t gone away, but there’s been a 46% drop in the diagnoses. And you know what that is – people are hesitant to go in. Many healthcare organizations have stopped elective or preventative screenings because of what we’re going through right now. And so, did cancer go away? No, I think screenings are down 50+% in many markets. No-shows, like even if you’re scheduled for a screening, I was reading are up from what’s normally about 15%, they’re up to 40%. So do healthcare organizations value their data differently with this post-COVID era we’re all hoping for in 2021? Absolutely. Because guess what – we don’t have unlimited access to imaging. We don’t have unlimited access to engage individuals a certain way. They must – they must – if you look at it from a healthcare quality perspective, an outcomes perspective, they need to prioritize the outreach that they do once everything sort of comes back to normal. There’s going to be folks that are hesitant to come in, there are individuals that have a greater risk that put this off, and the way they communicate and engage with their community, it needs to be prioritized, it needs to be personalized, and they have to get proactive. They can’t just assume an individual will come in because they were expected to. So absolutely. Will they put a different value? I do hope so.
Kathy: What do you think is the biggest opportunity healthcare systems have that they’re not leveraging right now?
Sheetal: Yeah, that’s a good question. I think…I think it’s the relationship. I think the biggest opportunity healthcare systems have that they’re not leveraging is the relationship. It’s like today’s traditional healthcare providers look like they’re about to miss the boat. And what I mean by that is, what like, last week, Kathy, that Amazon announced they’re getting into primary care? So there’s these disruptors at the edge that know a thing or two about influencing behavior. Amazon reminds me when my baby’s diapers need to be repurchased. They have a subscribe and save package. They’re reminding me, and influencing my behavior. But they’re getting into primary care. Now if they take those same tactics, think about that. They’re not thinking about driving visit volume through some sort of a Prime healthcare type offering, Amazon Prime healthcare offering, they’re not trying to drive those visits. What they’re trying to do is form a relationship. And once you form a relationship, they want to take the driver’s seat of navigating you through your healthcare journey. So if I look at today’s traditional healthcare organizations, they’re not – they haven’t been managing relationships, they’ve really been serving that model as, ‘We’ll build a beautiful lobby and patients will come to us.’ There’s disrupters at the edge that right now are not looking to take your patients but they’re ready to take the relationship, which is even worth more. So if you look at, sort of, what’s happened, and how did we get here? So if you look at what’s happened, I will admit I as a kid watched ‘Little House On The Prairie’. There was a doctor on that show, right, and was always known in the community and you’d run into them everywhere. Today, providers are stretched thin. They don’t work in the same way. And because of that, since they’re stretched thin and managing thousands of patients in a panel, the relationships almost become stale. So I believe, I think today’s health systems have a few years to fundamentally change the way they operate and move from this concept of patient- or visit-focused relationship engagement to one where they start leveraging data to get proactive, to drive access, to use data to proactively engage an individual in the interests of their health. Not healthcare but the interest of their health. And patients still trust their provider. That’s what they have. They have a relationship, the patient has a relationship with their provider, now it’s all about leveraging it in a way that empowers both the consumer, but then also the provider. I think providers are obviously burnt out, technology I think in many ways hasn’t been working for them, and this is the time for the technology to work for the provider versus the other way around. That’s what I think has sort of been the, sort of what the biggest opportunity is that they should actually turn into – and actually leverage.
Kathy: I find it so interesting that so often we talk about how technology takes away from relationships but you’re really talking about using technology to strengthen the relationship.
Sheetal: That’s a great perspective – absolutely, that’s right.
Kathy: Where do you see data playing the biggest role in healthcare in 2021?
Sheetal: I think the role of data, the biggest aspect of it in 2021 is, look we went through a year that many will remember as one of the most disruptive in everything, and everyhow, what we do, and the like, right? The way we shop, the way our kids learn, the way we work, everything. 2020 has been rough. And so, data I think going into the next year I think this might have been the turning point for an industry that really was a laggard in how they operate. And what I mean by that is – I would say healthcare did do an amazing thing in this last year. They went from this concept of televisits and telehealth programs and probably within three or four weeks I’ve never seen the industry move as fast as it did in March and April where they launched these massive telehealth campaigns. I mean you were seeing astronomical numbers of visits happening, like thousand percent increase in the number of video visits and the like. Now, that’s great. You have sort of that innovation mindset, wow, things can happen fast. 2021 I think what needs to happen is that organizations need to use the data that’s in their EHR, they need to couple that with machine learning, an AI platform for instance, and then use that information to strengthen the relationship they have with the members of their community. Especially with what we’ve gone through. You’re going to have to rebuild those relationships, you’re going to have to prioritize what you engage those individuals about, but that I think is sort of the biggest role that data has. It’s prioritizing the engagement, it’s orchestrating the engagement, to ultimately drive better access, better outcomes, and make sure some of these health systems stay afloat.
Kathy: Now let’s look ahead five years. Where do you see your company making the biggest impact in Health IT?
Sheetal: I think our greatest impact is going to be actually outside of IT. I think IT is going to be a tool, but I see us in five years having next-best actions, which is a core feature of our platform, that is for every customer of a health system, we’ve identified a next-best action. If we had the privilege to engage this individual, what is it that we’d want to talk about? I see us in five years having a next-best action for every individual in the United States and that’s where I think our impact will be greater than just technology. I think we’re going to be adding life years in our community by engaging individuals for the right reason, using technology to drive that engagement, and ultimately drive growth, loyalty, and quality. Making healthcare proactive and personal again.
Kathy: Sheetal, this was a really interesting conversation, thank you so much for coming on here.
Sheetal: Absolutely, thanks Kathy.
Kathy: Thank you for joining me for this episode of the Smarter Healthcare Podcast.
To learn more about Sheetal’s work at SymphonyRM, you can follow him on Twitter @sheetalshah. Follow the company on Twitter @SymphonyRM.
You can also follow me on Twitter @ksucich or @smarthcpodcast. Feel free to get in touch with comments or guest suggestions.
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Thanks for listening!
