The Evolution of EHRs with Cleveland Clinic’s Dr. Eric Boose

Melanie Marcus: Our guest today is Dr. Eric Boose, a family physician and Associate Chief Medical Information Officer at the world-class Cleveland Clinic in Ohio.

Dr. Boose was born and raised in Ohio—on a fruit and vegetable farm—but he did not go into the family business. He was one of the first in his extended family to go into healthcare and become a doctor.

But why? What motivated him? He wanted to help people and know the science behind it. When it comes to primary care in particular, Dr. Boose speaks about the role of the family physician as quote “unique and privileged,” a role that involves multigenerational care, from babies to parents and grandparents.

And at the Cleveland Clinic, Dr. Boose is in the right place to combine his passion for family medicine with new technology designed to improve patient care.

As Dr. Boose relates on today’s episode, when the electronic health record first came onto the scene, it was hard for some physicians to go from paper to the screen, from handwritten notes to mouse clicks. But he got so good at using this new technology that he was recruited to help other physicians at Cleveland Clinic learn and use it.

And so began the tech leadership part of his career.

Now, Dr. Boose is double certified in both family medicine and clinical informatics, and today we’ll hear why the combination of these two dynamic fields can help us find a better way in healthcare.

It is wonderful to have you as a guest on our podcast today, Dr. Boose. Today we're looking at one of the most fundamental and important roles in healthcare. That's the role of a family physician or primary care provider. Now, you've been a family physician for over 25 years, Eric, and you know about caring for patients of all ages.

You also play a role in technology leadership at Cleveland Clinic. So as you have this dual perspective, that should be really interesting for our listeners to hear about in this episode. So Eric, I'm going to start with a big question about healthcare, just to lay the context and then we'll back up and hear more about how you got started.

So here's my question. In your dual role as a family physician and technology leader, what have you learned about healthcare and where it's headed?

Eric Boose: Well, as you can imagine, I think all of us can attest that it's a very, very complicated system. Healthcare has lots of different facets and lots of other things that go on besides regular patient care.

And just knowing from being a primary care physician all the stuff that has to occur outside that patient exam room. Such things as making sure their bills are covered, making sure the insurance approves something, medication authorizations, as well as procedure authorizations. Lots of busy work.

Which I think has been frustrating for a lot of us that are on the front lines of doing the care. But I do see the promise coming of technologies helping us with that because I do feel like over time now that we have a lot of information in our electronic health records that a lot of that data can be used to make some more automation occur. Taking that off the caretakers that are taking care of the patients.

So I see a good future coming. It's been a little bit of a rough decade or two, but I think I can see things turning around where actually technology's going to help us and not get in the way.

Marcus: Oh, that's great to hear. Thanks for starting us out. And you make me think about something we've been thinking about here at Surescripts: Healthcare is all about relationships, right?

It's all about relationships. The care relationship with a patient and the provider and the pharmacist. And then it is the financial relationship. And the financial relationship and care relationship can sometimes cause some friction. But not for lack of good intention, just for lack of process, right? So I think we'll probably get into some of that.

Boose: Yes, I would agree with you on that.

Marcus: Before we get into more of that, because there's so much to talk about and to unravel there, let's talk about you and how you grew up. Like you grew up, I think, in Ohio and you're still in Ohio, right?

Boose: Yeah, actually, I was born and raised here. I grew up on a family fruit and vegetable farm. I was one of the first in our family—which we have a quite extended family—to go into healthcare. And it just stemmed from my passion and love of science and being with people.

And so it's always something that's been on my radar screen when I was going to school. I'm like, “Well, that would be a pretty cool job to be able to help people and know the science behind what the disease or conditions can do and what I can do to help them get better. I went to Chicago at a hospital called MacNeal, which is where I did my family medicine residency. And to your point, I trained then to take care of patients all the way from infancy to end-of-life care.

And that's a big passion of mine. I love being a primary care family physician. Having that longitudinal care of a patient from the beginning of birth and taking care of an entire family. Multigenerational issues come up. And I know when they bring the child to see me, that I know there's some issues going on at home with the parents, and I know that there's a medical condition with the grandparent.

It's just a unique and privileged position to be in, to be a part of someone's journey through life.

Marcus: That's great. And then you took a, not a diversion, but you added to that journey by adding technology leadership to your role at Cleveland Clinic where you're the Associate Chief Medical Information Officer.

Can you talk about that journey? What brought you to that role?

Boose: Oh, yeah. I mean, it was sort of fascinating, right? So when I started as a resident and as an early attending, we were on paper charts. We did the old-fashioned writing out prescriptions for patients.

And then I was around the era when the EHRs started coming on to the scene. And so we were one of the first in our area—at that time I was in private practice and the Cleveland Clinic offered what's called a community connector or would have their EHR available for a private physician. So we were one of the first practices to try it out.

I was interested in the technology, the ease of use of connecting with the hospital and back to my office. I signed on and our practice started using it, which is a very hard thing to make that conversion from paper charts to medical records. Electronic medical records—probably most people listening can attest to it—it's a difficult switchover, but once you're actually in the groove, things go pretty well.

And then I started using it and I was pretty good at it. And the team that provided the EHR to me said, “You're really kind of good at this. You're a good teacher. What would you think about coming onto our team and actually working a day a week, helping the other physicians use it better?” And it was nothing on my radar. Informatics was nothing that was familiar to me, or even taught as I was going through training, because it wasn't really a thing. And then I started doing that and I actually kind of enjoyed it. And the other physicians enjoyed it because I was helping them with shortcuts and tips and how to use things better because it is a bit of a struggle.

I get asked to do a little bit more of the informatics work and now it's half of my week. So I spend half my time seeing patients and the other half of the week I will be working in the IT department now as an Associate Chief Medical Information Officer, which I've done for a few years. Which is a great position to have. You kind of act as that liaison of somebody using the system, but also giving guidance and strategy around how to make the system better.

And now there's even a subspecialty in medicine called informatics and you can apply for that board certification if you've had the experience for so many years, which I did. I took a board review course and actually took the boards and got certified in it. So now I'm double-certified in family medicine and clinical informatics.

Marcus: That's interesting. I didn't know that they had a certification in that. That's super interesting. It's just fascinating to talk with you because you've been here since, as you said, before the EMR and now clearly in the optimization of the technology.

So there's probably so much to say to this question, but I'll ask it anyway and you can take it where you'd like. How has the EHR evolved since you first started using it? What are some of the most important evolutions that you've seen?

Boose: I think there's been a lot of change for the good. I think when they first came on the scene, it was a big disruptor in the healthcare industry, as you can imagine. Because I used to write at the hospital as well when I first started. So using paper charts in the hospital, you'd handwrite all of your notes. You could handwrite the orders and hand it off to somebody else to do the data entry piece of it. And then it all kind of reversed and came back to the physician to do the actual data entry. So that was kind of like a big change. Because we're like, “Oh my gosh, I gotta type, I gotta click, I gotta move things around.”

I mean, I think there was some promise there and the thought of like, “Oh gosh, we'll have everything stored in there. And it will help with things like population management and reporting and all these sorts of things.” But it just was a big, big change for a lot of us. And I think in the early stages you actually had to click and change windows—meaning screens—to get to other parts of the program.

The way it has evolved over time, it's kind of got a better layout. You can do more things on one screen. So the efficiencies have been thought about as the physicians gave feedback to the EHRs of, “This is a lot of moving around. It's a lot of what we call cognitive load or a lot of thinking.”

So I think over time a lot of those thoughts have been taken into account for better usability. So it's a little bit less intrusive in the exam room than it was before. It's still a distraction, right? As you're still trying to do some face-to-face time with a patient and also be reviewing their labs and prescribing their meds. But I do feel like the idea of making things easier and more efficient has been taken into account and we are making progress that way.

I always felt too, if you have all the data in there, I always wondered, “Well, why do I have to fill out forms with the data that's already in there? Why can't this electronically talk to the payers or talk to the pharmacy?” And those things have started, right? So the electronic prescribing of medications has been going on for a while, which has been great. I do feel like now we're kind of moving into a different age. Artificial intelligence has started. We have all these new tools for automation. We're just getting started, but you can see how rapidly that could help us in our industry.

Marcus: You've been through this from the physician, but probably most of our listeners, including me, have been through this from the patient perspective, right?

Like along the journey from the patient perspective, from paper to EHR to optimization, and even today, what made me think of that is as you talk about: “Why am I filling this out?” Even today, I go to certain provider offices and they make me fill out by hand another form, and I've gotten to the point where I write on the front of it: “This is in your EHR.” I know it’s there!

Boose: You're exactly right. And like, obviously I've been a patient, my kids have been patients, right? So it is that whole perspective of like, “shouldn't this be easier?” Or, “I filled this out through the patient portal before I came in. Why am I reentering the same information?”

And the other thing that occurs, too—I'm sure you can appreciate back when the paper records were there. That was at least on my lap or my desk. I'm still engaging with you. I don't know how many times patients have said, “I don't really like going and seeing these physicians [and I’m] looking at the back of their head the whole time as they're in the computer taking notes.”

And so, we're hoping to kind of reverse that dynamic and bring that joy of medicine back by doing some more face-to-face time. And there's some new technologies helping with that as well, right? So listening to the conversation and writing my notes for me so I don't have to write them or at least draft them, get them ready. And so that's going to be a bit of a game changer, too.

Marcus: That's great. You started to go there with AI. I have not seen that in my doctor's offices yet, but I look forward to it.

Can you talk about what you're excited about in the realm of technology, whether it be AI or telehealth or personalized medicine or prior authorization? What are you excited about?

Boose: Yeah, I mean, kind of all of it right now. And you just kind of touched on a point about the telehealth. While COVID was quite a tough time for all of us, it was definitely a disruptor and accelerator for technology. I mean, we were starting to do virtual visits at the Cleveland Clinic prior to COVID, but man, once COVID hit, everybody had to try it out, including the patients.

So that's gone pretty well over the past couple of years and everybody's gotten more comfortable with that. I do see the promise of different things coming on along the lines of automation as well as artificial intelligence, and they are different to me.

So, automation is the idea that the data is there and it's actually what we call mapped or directed retrievals. So it's sort of like, “I need this lab, I need this med, I need this whatever.” It can go into the EHR and pull that back out. And think about that for something like electronic prior authorization of medications. And we've actually worked early on with Surescripts and OptumRx, which is one of the PBMs, to try and get that automation working.

And so the idea that you could automatically retrieve the things that are needed for the PBM to make a decision on whether or not to cover the medication. That has been a proof of concept that we've been able to bring to fruition, and it's quite amazing. Now, it's going to grow over time. It's a small percentage of medications right now and a small percentage of players in the space. But like, how great would that be?

That is a little bit different than what I see, like artificial intelligence. So artificial intelligence is the idea of creating new content in some way. Same idea with medication prior authorizations, you can also see where the AI would be able to at least pull the information out for the staff or whoever's filling it out to show me the note that shows me the medications and show me this. Just kind of helping retrieve it, but not the same way as an automation where it's kind of a direct pull of back and forth.

But the AI space is exploding not only with summarizing information or answering questions for prior authorization. But we're seeing what's called the Ambient AI listening software that we've started using here at the Cleveland Clinic where it listens to a normal conversation in the exam room and then translates it into a medical-grade note, taking out all the extraneous stuff like, “How are your kids doing? How was your vacation?” But concentrating on what's important for that office visit and having all the relevant medical content in there. It even does non-English languages during the visits and translates to English. This stuff is very fascinating to me. So I see a lot of busy, tedious work being done by automation or AI in the future, and it's just kind of an exciting time.

Marcus: Oh, that is exciting. There may be things happening at my doctor's office that I just don't see quite yet, like behind-the-scenes routing and so forth. I'll have to ask next time, because I'm always looking out for where I experience it.

Well, let's turn to some of the things happening overall in healthcare today. And the first obvious one is this big topic of burnout, at least when it comes to the primary care physician. Now, I'm not suggesting that you are burned out because we did some research and we found that your patients are giving you glowing reviews.

One review says, “I know there is a shortage of doctors, so there are long wait times, but Dr. Boose is worth the wait.” So, what does it take these days for a family practitioner, a family physician to get five out of five stars from his patients?

Boose: I think like any physician that has a good practice going, you need to surround yourself with the right people and the right technology. And I'm very fortunate in the sense that I have really good staff around me to help me take care of my patients. Because we do need a nurse checking on people to make sure they're doing okay if they call in. Or I need a good nurse practitioner as a good partner with me to be able to help care for a large volume of patients. And so that makes a big difference.

And then the technology helps keep them connected. I think now a lot of patients feel a lot more connected with the idea of using a patient portal or even they can do all kinds of things in there. They can send me a message, they can ask for a refill. I think that has made much less friction for the patient of trying to make an appointment or trying to get ahold of me, or like I said, asking for the refill that's running out.

And so I think by giving that full kind of human touch from having a good support staff with me, to also having technology help bring the whole picture around the patient, I think they've really appreciated that connection that occurs.

Marcus: Right. And yet you must have felt, maybe not now, but throughout your career, some element of this burnout, and that must be what you bring to your job and technology as well. You can feel it. So you bring it. So how do you overcome those symptoms? How do you think about that?

Boose: Burnout is definitely a big trend that we're quite worried about. And I think where burnout is stemming from is a couple different things.

One is the pressure to see as many patients as you can. Because most places are still on kind of a revenue producing [model]. You only get paid for the office visit or the virtual visit that you're doing. It doesn't pay for a lot of the other types of care that occur. And so, when you're doing that face-to-face visit with the patient—but then you're going back to your desk and then you have six messages and eight phone calls to answer and 25 refills sitting there for you—it just feels like a lot. And we are looking at different ways of providing care and we did start a couple years ago charging for patient portal messages. Because a lot of care was occurring during those messages. Sometimes a brand-new problem and the patient, for whatever reason, doesn't want to come in for a visit or do an actual visit, but I could probably provide the care, asking enough questions.

And so we've looked at doing these other models of getting paid for the work that we're doing because there's just so much work that's occurring outside of that transactional office or virtual visit. And so what some physicians have been doing, which is unfortunate, is they're cutting back on the amount of time they're spending. Which is tough because I think there's not enough primary care physicians to really go around right now. And so now you're talking about physicians cutting back on their time, that's less access for the patients. It becomes a bad cycle.

And I think part of it was also, it was taking more time with all the data entry into the EHR and all the other things that you had to be doing. That's why I'm thinking that there is some promise now with some of the technologies that are coming out to take some of that off of their plate.

Marcus: Right. So, you know, I have a nephew who's doing his residency right now in primary care. What would you tell a young doctor fresh out of medical school or a resident who wants to excel in primary care?

Boose: It's interesting, too, because there's been a whole comment around training costs of going to medical school, the debt they come out in. And unfortunately, that seems to be deterring some folks from going into it, which I consider a very privileged, exciting career and I wouldn't want that to hold people back.

And we definitely need a lot of good primary care physicians out there for all the reasons I mentioned before. For access and taking care of patients and preventing disease before it gets to a point that it needs to have a specialist. All those sorts of things. But I would just say truly embrace all the training as you're going through and embrace technologies. You may be hesitant at first to try something out, but be willing to try it out and see if it could help you with your day. And make good relationships with people. People that you work with and the patients that you take care of. The more engaged you become and the better your relationships are, it's just more rewarding all around for the patient and for you to be in this privileged position of helping that patient get through their life with the best health that they can.

Marcus: Right. And seeing that generational experience of healthcare, which is amazing.

So one of the things he shared with me when he was in medical school going through all the training was he said, “Aunt Melanie, we see almost every EHR because we're in different offices across the city.” And so, that was interesting.

Boose: Yeah, it's becoming interesting now because I think before, in the day when you would go from place to place using paper records, it was pretty normal. They were kind of all set up the same. You kind of wrote your notes the same. But you're right. As you may be rotating around—and I think younger generations handle it a little bit better than older generations—but that's changing because everybody's getting used to using technology all the time.

But you're right. You have to almost kind of refocus like, “Oh yeah, the button for this is over on the right side, whereas I use it in this and it's on the left side and this is how I find the results and this is how I do a refill.”

Marcus: So, Cleveland Clinic is obviously widely known as a world-class health system. So what in your opinion, makes it world-class?

And then what can others learn from your experience at Cleveland Clinic that they can take with them around using technology?

Boose: Yeah, I mean, I think it's been interesting for me because I started off in private practice and then sort of became employed by one of the Cleveland Clinic regional hospitals, and then eventually employed by the entire system itself. And so I've seen different levels and how that felt.

I think the exciting part about being part of a place like the Cleveland Clinic is that they're always willing to innovate and think about new ways of doing things. And I think that's very exciting and energizing for those of us that work here. We're always looking at ways to make things better.

We're always a little bit more interested in trying something early to see if it's going to work. I think don't be afraid to try out some of these new technologies that are out there. I think it's very important. Everybody's a little bit like, “Hmm, let's see how it goes.” But a lot of these new tools are helping the physician so well that I would hate for somebody to miss out by somebody saying, “Well, let's wait a few years and see how this all layers out.”

But I think that's one of the things the clinic has done very well. I mean, not that we ever rush into things. We do our due diligence and make sure things are there, but we're like, “There is a new way of doing things. We should be looking at it to see if it's somewhere that fits in here.” And then, we love to act as a leader to kind of show others. And we’re willing to share our ideas or show how things are working well here and help others along as well.

Marcus: I love that. And the way that you just talked about it goes so well with the whole goal of this podcast, which is about thinking that there has to be a better way. And that is what we've appreciated clearly about working with the Cleveland Clinic, is you're always thinking about, “What's the next innovation? How can we do this better?”

All right, so let's talk about your role. What is your role as the Associate Chief Medical Information Officer? Can you talk about what you do for our listeners?

Boose: Yeah. We're fortunate at the Cleveland Clinic. We actually have quite a large informatics physician team. We have a Chief Medical Information Officer who kind of oversees all the physicians and works in tandem with our Chief Information Officer and Chief Digital Officer for really leading the charge in strategy and technology implementation.

And then as it kind of comes down, there are three Associate Chief Medical Information Officers, of which I'm one. And I kind of focus more on the outpatient space, population management, patient experience. Just because naturally I do more outpatient work, so it kind of jives very well. And then we have another tier. We have quite a few physicians that are what we call Medical Directors, where they actually will lead teams in their applications or those areas. So for instance, we have a Medical Director in ambulatory, a Medical Director in what we call patient journey. And so they will kind of help guide a lot of things that are occurring in those spaces.

And then it kind of comes up to the next level, which is us as Associates. But we all enjoy the position because it's acting as that liaison of not only letting the IT teams know what the physicians and the clinical folks would like or why it's important to them, but we also translate back from the IT teams of like, “Well, I understand that's what you kinda want to happen, but there's the technology barriers or what's going on.” And so you kind of help translate back and forth for those two different sectors, which are the clinical teams and the IT teams to kind of bridge that gap and help everybody work together.

Marcus: Yeah, it sounds pretty fun the way you describe it. So you're focused on the outpatient, population management, patient experience. What are your top priorities in that area?

Boose: Well, it always comes down to both technology for the caregivers and for the patient. So whatever I can do for an outpatient.

So that goes for everything from, “Can we help them get an appointment easier? Can we help with the throughput as the patient comes in?” And to your point, not ask the same questions that they may have already answered in the patient portal or just answered in another appointment earlier in the day, which is obviously very, very annoying and draining on the patient like, “I already went through my medicines three times today. Why are we doing it a fourth time?” So whatever we can do to provide the information to the caregivers to make that as seamless and as quick and as elegant as possible, is always on my thought process.

And then when it gets to reaching out to the patients, we don't want to bombard patients with a lot of messaging, but we want to make sure it's intentional, it's done at the right time, or at least collected together. So if there's three things that we want to remind the patient about, be thoughtful that we send it at the right time and we bring the information together so that poor patient's not getting five notifications today all about something different to the point where they're just going to start ignoring it. We really want to make sure that we're keeping them in the loop. But not overdoing it with them to make sure that they're staying on track.

Marcus: Right. That makes sense. That's great. So what do you worry most about as a CMIO?

Boose: We've had a big discussion around the idea of technology in general and looking at all the artificial intelligence and things along those lines. We want to make sure that we're introducing things that are very ethical, make sure we have some guardrails around it. A lot of the technology’s coming. So that's been on our mind a lot lately. Now as we started using some of the tools and trying them out, we're seeing the promise of them and the help that they are providing. So we're getting very excited about it.

But there are always healthy skeptics, and there should be, around how do you know that the information it’s bringing forward or the information it’s creating is true to form of what really reflects what's going on with the patient? But we also worry about the omission, like if it provides a summary to you, what about if it forgot that last point?

So that's the kind of thing that nowadays are kind of keeping us awake at night. We want to make sure that we're introducing the right things at the right times.

Marcus: Sure. Yeah. We think a lot about this at Surescripts, too, as any technology company or any healthcare company is right now.

How do you use AI? For the process or administrative process? Safer for the clinical process? That's where you were kind of headed. That's where you need more boundaries because you're talking about patient care.

So how do you see the practice of medicine and health technology being more intertwined and what does it mean for care quality?

Boose: I think one of the advantages that things like AI do have in the industry though, is that we deal with a lot of information, right? So a patient may come in for a consultation from across the world. I may have a lot of information to go through. But even the patients that we take care of day to day in primary care, there's a lot of reviewing of all the information. “Make sure you don't miss that there was a finding on an X-ray from last year that wasn't followed up on.” Or making sure that their care gaps are all taken care of. So I think that’s the advantage of AI. With quality, it could be that it provides you with almost like a patient briefing when you open that record up of like, “Hey, don't forget to follow up on this. And remember, they're supposed to have their colonoscopy now. And their medications are coming due, and we're not always sure they're filling them on time from what the stats are showing us.” So I think that insight kind of briefing I think will be very helpful for not forgetting things personalized in the care just to them and really helping the physician take care of the patient the best that they can.

I don't think we'd ever really want those tools to be without human oversight, right? Those would just be things that kind of help guide you and you can take them or leave them. And that's kind of how we're seeing a lot of these AI tools. Like yes, they can create a draft of the office visit, but we would never let that be accepted into the medical record until you reviewed it and edited it and make sure it was truly accurate.

And I don't think we'd ever want to waver from that. I think the human oversight of the true intelligence, supervising the artificial intelligence will always be very important.

Marcus: You've talked about the Ambient AI and you've given us a few examples of what AI might do.

What other things do you see in the near term that are exciting around AI?

Boose: Yeah, so right now the Ambient’s listening to the conversation and creating the documentation for the visit. The next level that will be coming pretty soon is it's listening to the conversation and the patient says to you, “Hey, I need a renewal on my blood pressure medication.”

And I tell the patient I want to check these labs and have an X-ray done. As it's listening to that, it's going to actually get my orders ready for me. And so they'll be sitting there in a pending state so I don't have to go type in to find those medications or to do the renewal. A lot of those things will be sitting in a section for me to review, saying, “It sounds like the patient needs this refilled. It sounds like you ordered these labs and this X-ray.” And with one click I'll be able to accept those. So that's pretty exciting.

Also, I like the idea of patient summarization. So the idea is that “I haven't seen you in six months. What happened with you in the past six months?” So right now I have to go into chart review and I look at a whole bunch of tabs and try to find out, “Did you go to the ER? And what was going on then? And what was the specialist saying that you followed up with?” And all that sort of stuff. That will come together in a nice summarization. And those are coming in the near term.

And also when it gets into prior authorizations. There's some work going on with artificial intelligence as well of gathering the information and maybe helping you fill out that electronic form of how severe is the rheumatoid arthritis or things like that, and can pull things forward.

Again, I think it needs to be validated and reviewed by a human person. And so I think that's actually coming in the near term as well. Those things with artificial intelligence I see are coming very soon.

What's to come? That's what's exciting. Again, going back to almost having sort of a chat bot or something going on on the side in the patient's record like, “Hey, I wanna prescribe this medication. Do you know on their formulary what's covered? What's their least copay? What's their prior authorization status on this?” And it could just tell me for this patient's program and their insurance plan. Maybe recommending try one of these medications and on their plan, this is the one that's covered.

Marcus: Right. You're also looking at the patient experience. How do you see engaging the patient in these technologies?

Boose: We've been using the Ambient AI for documentation of our notes, and I've actually had some kind of fun comments from the patients because they can see all of our notes on their patient portal or MyChart.

And so I even had a patient the other day who said, “Gosh, Dr. Boose, your notes are so much more thorough now.” Because I wasn't using maybe as many abbreviations or I'd be more succinct. Whereas the Ambient actually kind of lays it out really nicely, even for the patient to read.

And I think they'll also play a role, too, in just validating things as well. I think they'll be able to see some changes on their side. I'm thinking that in the future, in the patient portal that they're using, whether that's MyChart or another EHR entry point for the patient, but it's going to also probably have a chat bot or assistant for them. Like basically, “Hey, you're coming into your chart. What do you need? Do you need to refill a med? Do you need to look at your chest X-ray?” It'll kind of guide them there so they don't have to go through menus and figure out where to go to see stuff.

I think it's just going to become very easy for them. They can probably even talk to it, right? And just be like, “Hey, I had those labs done yesterday. How did they look?” Or sometimes they like having information around help with interpretation. Sometimes they see the labs before I see them, and they have a question about like, what does that indice in the CBC [complete blood count] mean?

Well, they could probably have some help from something giving a little support saying, “Well, here's the translation of the CBC if you want to know in the meantime until Dr. Boose answers your message.” So I see a lot of that kind of aid coming along as well, too.

Marcus: Oh, that's interesting. That is a direct use case. I sit there with my phone and my blood test and then I sit there with another laptop and like, “Uh, CBC, what's happening?”

Boose: And you always get a little bit worried because you see the flag there and you don't know if it means something, if it's high or low. And so you get a little bit nervous until the doctor sees it.

Marcus: Well, now's my favorite part of the podcast. It's when we look at the world through rose-colored glasses and we leave with some inspiration. So if you could snap your fingers and have a major issue in healthcare solved, what would it be?

Boose: Ooh, that's a really good one, right? There's lots of things that come to mind with that.

I did kind of laugh the other day. My father sent me a snippet of “The Jetsons” because it was showing all the things that they had predicted in the future on that show and what was occurring. And they showed a snippet of them doing a video visit, right? And then they—it just scanned the son and told him exactly what's going on for the day, right? “Oh, he’s got this virus, here's a medication to take,” and all that kind of stuff. And I snicker, but now I'm also thinking like, you can actually see acceleration of some of that happening in the future with technology in the sense that—these are a couple fascinating tidbits that I've learned about.

So now with artificial intelligence, it can actually read a lot of images and give you diagnoses, vital signs. It's kind of fascinating. So, a couple of use cases. One has been around retinal imaging where they can actually look at a retinal image and predict what your blood pressure is within a couple points and what your blood sugar is within a couple points, and tell if you're male or female, tell if you've had any hypertension issues or diabetes, which I think is totally fascinating.

Because they were able to send through all these images, thousands of images, and their medical records to go through and teach the computer. And now I can actually just read them. Can you imagine coming in for your exam? And now you're not going to get your blood pressure taken, they're just going to scan your retina! Basically take all your vital signs and do those sorts of things.

And they're also doing these things with chest X-rays and CT scans and picking up on things where maybe the human eye is focused on what they came in for, which was the pain that's happening in this area. But now it's scanning the whole thing and picking up little tidbits of things like, “Hey, it looks like they may have a calcium deposit in their coronary arteries. And that might need to be followed up on for heart disease” and things like that. So I think we're going to see like this kind of two-tiered effect of like, you're going to have a screening done, or you're going to have some artificial intelligence that reviews everything and then you're going to see the actual physician is the next line.

The other thing I would say if I'm going to snap my fingers is getting rid of all the bureaucracy, right? Which is all the idea of paperwork and it's not even paperwork anymore, it's electronic transactions. But dealing with a variety of different insurance companies and different formularies and all those sorts of things, wouldn't that be nice if it was all just streamlined and helped you not have to deal [with it all]? Just take care of the patient and what you recommended. That would be a really great thing to see in the future where it is kind of frictionless.

Marcus: For sure. For everyone, including patients.

Boose: Yes. Patients, too.

Marcus: So what gives you the most hope and inspiration that healthcare can, in fact, heal itself?

Boose: What I'm seeing now, which is wonderful to see, is kind of going back to basics. That face-to-face, looking at a patient, having that conversation, relaxing your brain to remember everything. Really staying on task and not worrying about all the other stuff that needs to occur. Like I said, the data entry and all that sort of stuff.

I mean, that's what everybody wants. The patients want that. We want that. It's just where it needs to be, again, of that personalized conversational care so you can really, truly listen to the patient and find out what's going on with them.

Marcus: Absolutely. Well, we've had an amazing conversation that's just kind of run the gamut. Is there anything we haven't talked about that you want to make sure we do?

Boose: Well, I guess one thing I would say. Going back a little bit when I was talking about the automation around electronic prior authorization of medications, we did have kind of a unique scenario where in this day and age, of course, we're all doing a lot of virtual visits. It's just not the same as sitting down face-to-face in a conference room and kind of battling it out.

And we did have a very unique situation when we were trying to figure out how could we possibly automate some of this electronic prior authorization. We were fortunate enough to have representation from Surescripts and Optum all together in a room. And they saw what was occurring on their end and we saw what was occurring on our end. So Optum learned what the pain was in the clinical office. I mean, they were all right there in my office talking to my staff who does prior authorizations. Surescripts was there too, listening to what's going on and trying to figure out like, “How can we make all this work?”

And I think my staff was sort of intrigued with what Optum has to deal with as a PBM. Like they're not really trying to block the medications. They're just trying to see “Is this appropriate for that patient?” And things like that. So once you had everybody in there having that conversation—we probably don't do this enough, right? [Where] everybody sits around a table, brainstorms together to try and solution to make it better for everybody. And there was something about being there in-person on site, all hanging out together. If we could do more of that to try and solve some of the problems in healthcare, it would be amazing.

Marcus: I love that you brought that up, bringing different points of view together in a room, physically in a room, watching the process from all different points of view.

That is the way to solve problems systemically and not point to point. Thank you for bringing that up, and we were honored to be in the room and doing that work with you and with OptumRx.

Thank you so much for a great conversation. I'm really looking forward to what the future brings around AI and some of the innovation and prior auth that we're doing together and what we're going to do for the patient experience in the end as well as the provider experience.

So thank you very much.

Boose: Well, thanks for having me today.

Marcus: I want to end this episode with a reference to the title of this podcast. The title is “There's a Better Way.” And I believe that. But the “better way” isn’t shiny new technology all on its own, as cool as that might be. It's not innovating for the sake of innovation.

The goal of innovation in healthcare is to improve the lives of patients and those who care for them, like Dr. Boose. And to do that, we must bring different people and their various perspectives together, physically, in an actual room. That's how we solve problems systemically.

It's not hard to see what it takes for a family physician to get five out of five stars from his patients, as Dr. Boose does. You surround yourself with the right people and the right technology, he says. In light of what we heard today, his answer makes perfect sense.

It takes easing the administrative burden so physicians can focus on the patient. It takes, as he says, going back to basics. To personalized conversational care. So you can really listen to the patient and find out what's going on with them.

Meaningful innovation and thoughtful collaboration. More and more, these things are enabling physicians to get back to basics, and that's what gives Dr. Boose hope that healthcare can heal itself.