A Conversation on the Next 10 Years of Healthcare Transformation

In this episode of The Connected Care Team podcast, Andrew Brooks, M.D., co-founder and CMO of TigerConnect, discusses healthcare transformation's current state and future. Dr. Brooks reflects on the challenges of old communication workflows, the transformation likely to happen in a few years, and the benefits of implementing a clinical collaboration platform.

A solution for healthcare workflow challenges

Andrew Brooks, M.D. and his brother Brad Brooks co-founded TigerConnect twelve years ago to improve the ease of communication in healthcare. At the time, healthcare communication was challenging because healthcare professionals used pagers and faxes as primary communication methods. Their goal was to create a secure HIPAA-compliant platform to enable the same ease of communication within healthcare that people enjoyed in their personal lives.

“We were relying on faxes, pagers all while being able to do very sophisticated things technically. It was that frustration around the way things were being communicated. And we had smartphones that we were all texting in our normal lives, but it just didn't really exist in healthcare.”

Andrew Brooks, M.D.

Reducing clinician burnout

Digital tools have improved how healthcare professionals communicate and collaborate on patient care. However, tools such as EMRs have turned many nurses and doctors into data entry clerks, limiting how much time they can dedicate to patient care and leading to clinician burnout. It’s common today for a physician to spend two hours in the EMR for every hour spent with a patient. With clinical collaboration platforms like TigerConnect that operate outside of EMRs, healthcare professionals can spend less time on data entry and more time on patient care.

“I'm not going to write a lot of things in the EMR that I would say to you as a clinician. But over TigerConnect, because we're not necessarily part of the EMR unless something is chosen to be put in the EMR on a permanent basis, it much more mimics the more natural clinical workflow that we have as doctors and nurses with one another.”

Andrew Brooks, M.D.

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Transcript

[00:00:00] Will O'Connor: With us today on the show we have Dr. Andrew Brooks. Dr. Brooks is the co-founder and chief medical officer of TigerConnect. Dr. Brooks has been in the practice of orthopedic surgery since 1994, specializing in sports medicine, as well as joint reconstruction.

[00:00:20] And he has been an entrepreneur and an investor in healthcare for the last several years as well. And I am proud to call him both a mentor and a friend, and we are thrilled to have you on the show today, Andrew. Welcome.

[00:00:34] Andrew Brooks: Yeah, well, good to be here. And, looking forward to talking. 

[00:00:38] Will O'Connor: Yeah. we're really glad to have you. Let's start a little bit about - you really have a very diverse background in healthcare. Let's start with that. Talk to me a little bit about your background in healthcare.

[00:00:48] Andrew Brooks: Yeah. Well, from the time I was quite young, my father was actually is, is an orthopedic surgeon. I was always fascinated by medicine and healthcare in spending time with my dad. I would go with him very frequently to the hospital on rounds on the weekends and saw his interaction with patients and really never thought about any other career except healthcare and medicine, actually specifically to be a surgeon.

[00:01:19] I went through a normal sort of traditional educational path and then, never really thought about business, but was just very passionate around the areas of healthcare and medicine that I was particularly interested in. And then when I finished my training in the, uh, mid nineties, and started my private practice here in Los Angeles, it was very evident that there was like just massive problems within the system that were creating super, difficult issues in terms of patient care management and efficiency.

[00:01:57] And, that was really kind of what sparked my first interest in trying to resolve issues. It was really out of my own personal frustration. And then through that, I ended up being involved in a number of businesses that I would say every single one was related to personal problems that I saw that I wanted to try and improve the status quo.

[00:02:18] Will O'Connor: Yeah. I mean, you know, in part, I mean, that was certainly the impetus for TigerConnect to get going. What were the specific problems you were seeing in the areas of communication that, that drove you and your brother, Brad to co-found TigerConnect? 

[00:02:34] Andrew Brooks: Yeah. Well, very specifically in communication, we had, you know, at that point a couple, I would say very large macro drivers that was the impetus behind, starting TigerConnect. One is, we were kind of forced into this digital path of, record-keeping. So there was a massive mass more amount of data entry and information that needed to be answered.

[00:03:01] The second macro trend was smartphones became over-indexed and really more - over index when I say that, I mean, as it relates to the healthcare profession and physicians - and that was really where we started was on focusing on physician communication. We’re now equally focused on the entire spectrum: nurses, the outer concentric circles of care within healthcare. But there was just, an arcane, you know, paleolithic era style of communication.

[00:03:34] And we were relying on faxes, pagers all while being able to do very sophisticated things technically. It was that frustration around the way things were being communicated. And we had smartphones that we were all texting in our normal lives, but it just didn't really exist in healthcare.

[00:03:53] And then beyond that, because people want to be efficient in their lives, people were naturally gravitating to work arounds with their smartphones. They're either Android or iPhone to make their lives easier and communicate better. But it was all non-HIPAA compliant so when we set out to develop a TigerConnect, it was, you know, looking at how do you make a secure HIPAA-compliant platform that allows the similar kind of ease of communication that we had in our personal lives, but within the healthcare genre and specifically around workflow.

[00:04:35] Will O'Connor: You know, Andrew, you've obviously been involved in a lot of innovation throughout your career. Certainly starting TigerConnect 12 years ago was incredibly innovative at the time, you know, given the state of communication, people using pagers and faxes and the like. What do you see - cause we're really undergoing right now the transformation the pandemic really forced a lot of change in healthcare. What do you perceive for hospitals as the biggest opportunity they have to change in the current environment?

[00:05:12] Andrew Brooks: Without a doubt, you know, as much as there's a fair amount of frustration within the U S health system, as it exists today from the patient side, from a hospital side, you see their profit margins reduced down to low single digits. it's, it's become a rough industry. But where I see this major opportunity, I'm extremely optimistic and bullish over what is going to occur over the next 10 years.

[00:05:43] And there's enormous opportunity, for hospitals and the entire system actually to improve. And the reason why I’m very optimistic is really centered around, you know, several things. One is we went from like, during my training, for the most part, it was a very analog type system. We were writing down things and putting them in paper form, and you'd have to retrieve a chart and move it around and keep the chart.

[00:06:14] If you lost the chart that was the end of it. But we went through essentially a digital transformation that was truly, monumental and very difficult to do, but we've done it. Everything is now digital. A plain x-ray in orthopedic surgeon’s office is digital. Blood record that is a lab result that's drawn. That record is digital. 

[00:06:35] So we've now created a mass amount of digital, information and data. So that's one major thing. The second thing is we have, everybody's carrying around very powerful computers in their pockets. These smart phones that are far more powerful than what we use to put a man on the moon in the late sixties.

[00:07:00] So we all have that as our fingertip and their ubiquitous. And you have tablets. Computers, you can log in anywhere. So that's the other thing. And then you couple that with this very third, relatively new macro trend, which is the whole advent of artificial intelligence and machine learning. So now you have all this information that a human being really would never be able to understand or analyze to inform workflow process, to understand efficiencies, to understand best practices around clinical care delivery and all of that can now be sliced and diced and understood in a way that we could never in the past understand that. 

[00:07:51] So as hospitals deploy a tool like TigerConnect, that's very broad across the system. And that when I say that deploy broad across the entire system, that is really sort of where the critical aspect of this is because what we've learned over the last decade is it isn't just physician to physician communication or nurse or physician. It's the entire system that really starts to make the process ease and simplicity and efficacy, which ultimately results in a patient having a better outcome.

[00:08:26] So, we're entering a golden age of healthcare. I'm completely convinced of that. I see it and it's happening in front of our very eyes and this next 10 years we're going to see it's a revolution that's remarkable. And I'm super excited that we get to be a part of this.

[00:08:45] Will O'Connor: Yeah. I think that'll be a nice thing to hear for, you know, people working in healthcare, but the patients as well. And you mentioned patients a couple of times in your last answer. And I want to ask you specifically about that because I see patients starting to demand the types of digital and real-time interactions in healthcare that they're getting in other industries. What, what tools or framework do you see developing that can make this next age of healthcare more patient centric?  

[00:09:25] Andrew Brooks: Yeah, I think that that's, you know, ultimately that's the most critical thing. The reason why we have healthcare is to care for patients. That's fundamental and foremost to why we exist. Why I went to medical school, why you went to medical school. Why people go to nursing school. Why people that become a tech and so on and so forth.

[00:09:50] So it's the patient really that we serve and we are a service business and you can see over the last 10-20 years, there's more and more consumer driven thought to how things are done. Service is really paramount and we are a service business. And when you think about healthcare and the delivery of it, historically, if we were to apply any of the metrics that are used in a traditional service industry, be it a restaurant, a hotel an airline, a travel experience, where there's rating systems, I believe that the rating system for healthcare, would net a very low score historically. 

[00:10:35] So patients are becoming much more powerful and important because their voices certainly can be heard. But now we have tools that allow us to address that in a different way. And that's through these digital technologies. So if you look at some situation, you know, if you look at stuff from a patient perspective, but when you're working within the system, you know, in, in my surgical practice, I would often have on a typical day, 10 to 14 surgeries I would be doing in a day. A thousand or so cases a year. Well, for me, that's almost a daily occurrence that you're interacting in the operating room, but for a patient that's probably, that's a once in a lifetime.

[00:11:18] Very often, and it's a scary, stressful kind of experience. So there's a lot of consternation and stress, if you will, around how patients feel when they come into the system. And we have tools now to be able to have them feel connected prior to an event, during an event and then after an event, so they can reach back out.

[00:11:40] And very often it's these, it's just a very small reassurance or a question or some type of concern that they have. But historically it's been very difficult for them to reach back to the origins of where their care was provided. But now we have tools where, you know, TigerConnect initiates a - like we have that patient facing portion of our application that essentially opens up a channel that could be set for an event. It could be a day long, or it could be five days long, but the patient can stay now connected to the system. If they have a question, they have an issue around a bandage, a wound, a question about a result.

[00:12:27] They have an ability now to reach back and stay connected. And I think that that is huge, because there is just so much in clinical practice that I saw over the years that really someone just needs to be reassured, or just has a very simple question that the anxiety that tends to build up around that sort of feeling isolated and disconnected has been profound historically. And we're working on improving that and it's going to improve. It is improving.

[00:12:56] Will O'Connor: Yeah, you can see that it is. And it's, you know, it's welcome improvement. But I agree with you, you know, certainly patients are starting to get more engaged and they're expecting, you know, the, these types of interactions. You know, we talked we talked a bit about technology, but in my experience, it's been a little bit of a double-edged sword in medicine, particularly for nurses and physicians. And there's technologies that have been very enabling and help us take better care of patients.

[00:13:25] And then there's others that have required what I would consider to be a complete paradigm shift in the way medicine is practiced. I mean, it's common today for a physician to spend two hours in the EMR for every hour they're with the patient. And when you and I trained that was not the case. It was much different. There was no way you were spending two hours in the chart for every hour you were spending with the patient, especially in ortho, right? So, you know, as a physician, talk to me specifically about the impact of TigerConnect on the lives and the experience in working for physicians and for nurses.

[00:14:06] Andrew Brooks: Yeah. I agree with what you said around the aspect of the punitive elements of some of the EMR pathways, if you will. And you know, there's been, there's been historically where EMRs were really the primary source of communication. A sense that, you're driven down a very, you know, labyrinthian type of path. And, you know, instead of being able to be a physician or a nurse or some kind of care provider, you're now relegated to being essentially a data entry clerk and it's absurd and ridiculous because there's a lot of things that just simply don't need to be added into the equation that an EMR forces you to do.

[00:14:55] And that's understandable because an EMR, if you think about an EMR in general, it was never really set out to be a workflow tool. There were systems of record the revenue cycle management tools but they are not systems of action or systems of, workflow improvement. So with TigerConnect, you know, from the very get-go the DNA of the product and the technology has been first and foremost, a mobile first strategy, which differs very much from what an EMR does. 

[00:15:30] It's also intentionally has been set out to be lightweight and purpose-built for getting answers to like getting information to the right person, getting at the right time, getting an answer to that information and then allowing the people involved in the care around that particular patient to act on it so that t things can move through without being, bottle-necked around difficulties and just simply acting on data. 

[00:16:03] So, I think of TigerConnect really more as a, you know, it's palliative to care providers within the system because it's really the tool that allows you to do your work. It's outside of the EMR. And it's designed very importantly from the beginning with a natural workflow thought in to at its core. And people, I would say in general, have this notion that healthcare delivery is very formal and you must put this in and that in and this, this, that, but the reality of it as you know, a lot of healthcare is less formal.

[00:16:43] We want to just say something: ‘Will, you know, I've got this patient and, I'd like you to just run by, I think they're a little bit, whatever. Can you take a look and just let me know before they discharge?’ I'm not going to write a lot of things in the EMR that I would say to you as a clinician, but over TigerConnect because we're not necessarily, part of the EMR, unless something is chosen to be put in the EMR on a permanent basis. It much more mimics the more natural clinical workflow that we have as doctors and nurses with one another. 

[00:17:20] And to that end, It really assuages the stress. And, there's a lot of stuff that you just want to get off your plate and get an answer to. So by knowing, oh, ‘Who's the person that's on call for this? Who's the person - how do I reach so-and-son in some particular role?’ We can now move that information, with tremendous efficiency and that in and of itself is hugely relieves a lot of burden.

[00:17:44] Will O'Connor: Oh, yeah. I mean, I, that's a question you hear, you know, in every hospital every day who is covering. Right? Who is covering, who is the doctor covering? Who's the nurse covering, who's the nurse manager, right? Who's covering a host and it could be a dozen different people for any, any single patient. I think, you know, providing an easy answer to that question along with the seamless ability to then reach out to that person. You know, I agree with you. I think it's something that's very valuable, to physicians and to nurses in particular. 

[00:18:25] What do you, what are you seeing in terms of, I know we've, we've talked about physician burnout before, but we're seeing a lot of, of nurse burnout this year. Talk to me a little bit about what you're seeing there, what your thoughts are, and maybe how we can address tha problem.

[00:18:40] Andrew Brooks: Yeah, nurses, you know, nurses are the unsung heroes of healthcare and, nurses are, you know, set out to essentially be advocates for the patients. And it's a different mindset of training that nurses have then physicians have, and without nurses, we would have no healthcare. But what's happened over the last few years with nurses is, you know, we have, we have this whole sort of stop start type of thing going on, have having gone on with the pandemic that, I believe we're at the tail end of now.

[00:19:19] There's just been a tremendous amount of stress that's been added to the normal work that a nurse has to do. So the burnout rates there, we have a nurse shortage in this country. Unquestionably. So nurses are being tasked to do far more with far fewer resources. So the burnout aspect of, you know, data entry requirements, and then having to follow up to get something done for a patient that they're responsible for is quite profound. 

[00:19:54] And a tool like TigerConnect, you know, it really does help to move things along so that they can get an answer. Take care of the patient, take care of the business at hand. Not wonder, I put a phone call out to a physician to get an answer back on what we should do for an order or so something like that. They can message the person directly.

[00:20:19] And even that, another thing, you know, look, I mean, there's so many things I can just go over. But you look at something that's just as simple as a handoff from one shift to the other. You know, with our tool, just the handoff process in of itself now is far more accurate, far more efficient and, has the oncoming person who's inheriting that role know what the history was. So when they step into it, everything is really seamless and it's set out to really try to make the lives better. 

[00:20:51] If we don't have happy care workers within the health system - and by that, I mean, everything from cafeteria workers to environmental services, techs, phlebotomist, transport, LVNs, RNs medicine systems, nurse assistants, physicians, I mean, it's literally the entire spectrum. But if the people who are providing care are burned out and unhappy, and exhausted we're in trouble as, you know, potential patients and as a system. So this is a very, very major, area of focus at TigerConnect, as you know, on how do we actually reduce burnout and what things can we do to make the lives of people within the system, fundamentally easier and better to allow people just to do their jobs. it's probably the most important thing we can do.

[00:21:46] Will O'Connor: I agree with you. That was, I was a fantastic answer and I agree. And there is a, there is a lot we can do. I think, you know, especially for a nurse, this technology, in terms of their job is life-changing, right? To be able to have, you know, what's going on with all their patients in the palm of their hand, you know, and see what alerts are coming in and be able to triage in their own head. What is most important? What do I need to do for each patient? And who do I need to tend to first, is an incredible gift I think to give to a nurse in an environment where, you know, they're being constantly interrupted.

[00:22:29] And there's that, you know, I'm sure you are just saw that case of that nurse who was found guilty of criminally negligent homicide for a medication error, which she reported. It’s had devastating impact on peer review. And you know, why would you go and be a nurse when that is the type of thing that can happen? I think the work that TigerConnect is doing to help nurses is incredibly important. 

[00:22:54] Andrew Brooks: Yeah, I agree with you on that. I think it's very, I'm very mindful of the fact that it isn't something that, you know, the people that are drawn to medicine from the care side, not to sound trite or glib about this, but I do truly believe that most of them came to it from some kind of a calling of sorts where you feel like this is something that I want to do with my life.

[00:23:24] There were a lot of things that you can do in life, from a work perspective but the calling, if you will, to be a care provider, to other people for healthcare, is profound and very deep. And, and a lot of the driving force, I believe, as to why people go through such a, a long training process, you know, over a decade to be a surgeon, nursing, you know, it could be anywhere between four to nine years. So it's, these are long periods of training and you just don't simply command, oh, we need 5,000 more nurses in this area. And boom, that happens. It takes a long time. And when people leave the profession, it's devastating because, these are people that have spent a lot of time, but then a whole new crop has to come through and try and replace that.

[00:24:22] So really the best thing we can do is to just make the job more, what people set out to do when they chose to pursue that profession. And that is to give people tools, to allow care of patients and not be data entry clerks, and be able to have their patients, not be stressed, have a good experience and leave better. And we, you know, we, we have unbelievable technical care in this country. You can put a small catheter in someone's wrist. You could thread it up to their heart. You can zap their node sinoatrial node in their heart, change their rhythm and totally change somebody's life. 

[00:25:13] But historically, if you asked the cardiologist for that report on what was done, the next question is ‘what's your fax number?’ It's ludicrous. So, so most of the stuff that we are doing at TigerConnect is quite prosaic. We are not doing, we are not landing a rocket on a lily pad in the middle of the Pacific ocean after sending it into orbital space. We're just moving information and getting a simple answer. And that in and of itself, it sounds ludicrous to be even having this conversation given the technical state of healthcare.

[00:25:53] But we haven't had a company that's been focused really on workflow, exclusively as we have for the last decade. And this is really really important work that we're doing. As simple as it sounds, it's complicated.

[00:26:05] Will O'Connor: Andrew you've been good throughout your career at seeing around the corner, having a bit of a crystal ball, if you will, and have been able to, you know, see what's coming next to and adapt and address needs where there are needs. What is, what is next for TigerConnect? What do you see as the next big opportunities that TigerConnect can go after to help? 

[00:26:37] Andrew Brooks: Yeah. I think it's on two fronts. There's a number of things, but I think for TigerConnect like the next major stuff that we're going to be doing is firstly ingesting more and more artificial intelligence machine learning data to take processes and improve the processes. You know, one of the great things about TigerConnect is we're very widely dispersed across the country. And a lot of healthcare delivery, although, you know, we talk about the US healthcare system as a system, if you will. You know, similar, like we talk about a weather system, we're not really a system in the sense of an organized system across the country. We're more of a series of microclimates and what's done very well in one particular area may not even be done in another area. 

[00:27:29] So one of the things that, you know, we have a tremendous opportunity and I'm grateful to be able to be involved in this is we can see - we have an opportunity to look at organizations that have high functioning processes and systems that are creating much better outcomes and making the lives of their, caregivers within the system and everyone that works within the system better.

[00:27:52] So we have an ability now to understand this through some of the new endeavors that we've launched with TigerConnect with our machine learning and AI insight tools that is going to allow us to now cross pollinate what are best practices to allow you to actually affect this particular change? One hospital may have an issue around, you know, readmission rates.

[00:28:18] They may have an issue around, stroke care management. They may have an issue around surgical workflow, but because of the dispersity, if you will, of our tool and our experience around the country and working with really some of the best minds who are running large health systems, we're in a very unique position to be able to now influence that and transport that.

[00:28:41] So that's one thing. A second thing is the patient outreach aspect. You know, we have that very elegant aspect to be able to reach out to the patient, which is very seamless to the application. It’s just inherent and native to the app. You don't have to leave the application. And for the patient in terms of the communication our strategy around an app-less ability to be connected is very, very important because I think people are inundated with having to download different softwares and apps to remember passwords.

[00:29:14] And in this case, they get an SMS text, a link is attached and allows that conversation to be open and stay on their phone for whatever period of time that’s set for. I think that's very huge because there's a big aspect as I mentioned earlier around patients feeling untethered to the system, which results in anxiety, dissatisfaction, potentially coming back to the ER, unnecessarily when it could have been handled simply by, uh, a message, a phone or a video.

[00:29:42] And then, you know, lastly around the corner, there’s unbelievable companies that are doing incredible work around insights around this data that I referenced at the outset of our conversation where there's AI information on drug combinations that are best. There’s AI indications that are being worked on now around, you know, a radiologist let's say is having to dictate a whole bunch of reports. And that's, there's a shortage of radiologists in this country. So a radiologist let's say, maybe has to read 60 to 70 scans a day. Well, each time they've got to list a bunch of impressions. I just saw technology recently, they have developed a tool to allow the impression to be auto-generated by this AI machine, just based on what the findings were through the scan.

[00:30:40] And normally that would, if you think about that over, you know, minutes, a day, you're taking, you know, one or two minutes to dictate the impression. If a machine can do it, you've now saved one to two hours and there's lots and lots of you know, that those are two small examples of where you're seeing this interaction, this intersection of AI and workflow come together and this is where, things are really going to be stepped up and markedly improved going forward. 

[00:31:14] So I'm super excited about this next decade. We're truly, as I said earlier at this, just the the genesis, if you will of what is going to be, um, an amazing 10 years.

[00:31:27] Will O'Connor: Yeah, it certainly sounds like it's, it's going to be, and Andrew, we, we really appreciate your insight and, Thank you. very, very much for joining us on the show today. We will look forward to having you, you, back and talk about more developments and the great work TigerConnect is doing, so thank you.

[00:31:47] Andrew Brooks: Yeah, no. Will, always great to talk to you and you're a thoughtful leader as it relates to, this process. And, I know you understand it at a level that, many don’t and, I always appreciate talking to you about that. 

[00:32:03] Will O'Connor: Thank you.