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Dec 18, 2023

It’s no secret: healthcare systems are overburdenedcould cloud capabilities really provide some of the needed reprieve? Could the right data presented at the right time reduce costs and improve operations, ease the administrative burden on clinicians and payers, and help improve the patient experience? Two experts discuss use cases on cloud-enabled intuitive assistance, streamlining and vetting data, how cloud-enabled technologies are benefiting the whole patient experience, and more.

Michelle Flemmings, M.D., industry executive director, Healthcare North America Cloud Infrastructure 

Sarah Matt, M.D., vice president of Oracle Health product strategy

Hear them talk about:  
•    What’s going on in the healthcare industry right now (0:24)

•    Using cloud and other technologies to improve workplace experience and retain healthcare workers (1:15)

•    Challenges and concerns when moving from rules-based applications and tools to more predictive forecasting and AI (2:54)

•    Working with clients going through the transition of bringing together disparate data sources separated by geography, organization, privacy, and security (4:27)

•    Harnessing cloud capabilities for clinical trials (7:24)

•    How to build trust around privacy and security for cloud and AIand how cloud can be a secure mechanism to bring forth that trust (10:05)

•    Opportunities in leveraging the cloud for healthcare (14:24)

Notable quotes:  

“I think that cloud has a great availability of information, but it also has the functionality whereby it can hopefully look at the system overall, if it's dialed in right, and then predict what's necessary and then take out the rest of the chaos. You know, taking in the signal and taking out the noise.” – Michelle Flemmings

“Now with the potential of AI using thoughtful implementation to support our providers from burnout, empower our patients to lead their healthcare teams, make those right decisions using trusted information that's fit for purpose, it changes the entire landscape.” – Michelle Flemmings

“We need to make certain that we're not replacing that trust that has been in the provider relationships so long and then got compromised when we did start going digital. There's an opportunity here to rebuild that, and magnify that, and still broaden our ability to care for more patients.” – Michelle Flemmings

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Episode Transcript:

00:00:00 Dr. Sarah Matt
You're listening to Perspectives on Health and Tech, a podcast by Oracle where we have conversations on creating a connected healthcare world where everyone thrives. I'm Dr. Sarah Matt. I'm the VP of Oracle Health product strategy. And with me today, I have Dr. Michelle Flemmings from our OCI team. So, Michelle, I know we've been hearing a lot about cloud capabilities for healthcare. Can you get us a bit of an overview of what's really going on in the industry right now?

00:00:24 Dr. Michelle Flemmings
Well, Sarah, thank you for that question. I have had the pleasure of meeting with a lot of our clients and being at several events recently and top of mind is cost containment especially with the economy as it is, and the cost continuing to rise. Second, a very close second, is achieving and maintaining operational efficiency that will help support that cost containment.

Things around process improvement, throughput, driving patient outcomes, improving quality performance as well. And then I think, honestly, the one that really surprised me the most is road mapping around the implementation of AI and wanting to establish the right partnerships in order to know that they're doing it in the right way.

You know, in a race not to be last, they got to be they're busy road mapping but they also have to assess the readiness for change. And I think that's where I'm having the best conversations.

00:01:15 Sarah Matt
Interesting. So we talk about cost containment as a start. I know that over the last couple of years, especially when COVID hit, we had huge issues with not just supply chain but the supply of our workers.
So we think about utilizing cloud and some of our technologies to improve not only the experience of our workers, but how do you keep and retain them? What have you seen as really effective mechanisms, especially in healthcare?

00:01:37 Michelle Flemmings
Oh goodness, that is a double-edged sword. Having worked with a lot of systems and in a lot of digital tools that support our care of patients, you have to be careful in the balance. You don't want to be very disruptive in the way of inset and alerts, but you also don't want to overload with minutia and tab hopping and logins and so forth.

Where the sweet spot is is intuitive assistance and uplift for productivity as well as insight speaking specifically around things such as items that occur in the background. So I'm seeing a patient, they know that this patient has a hip fracture and automatically, based on the fact that the patient weighed 125 pounds and is, you know, five-feet-three, this patient will need this size of prosthesis and it automatically taps out two supply chain to identify the location and availability. Those sorts of items that are intuitive and in the background and I don't have to touch another tab are important.

Additionally, clinical decision support—the right information at the right time that doesn't disrupt my brain processes and my thoughts, because anytime a provider is interrupted, an opportunity for omission and errors.

00:02:54 Sarah Matt
So I know when I see patients—I still do charity care on the side—it is a very difficult job for all providers to keep up with the latest and the greatest when it comes to new literature, new guidelines, and that most hospital systems are doing whatever they can within the application space, whether it's their electronic medical record or otherwise, to assist with some of those areas.

When we think about moving from rules-based applications and tools to more predictive forecasting and AI, what do you think are some of the challenges and concerns that health organizations really need to think about?

00:03:31 Michelle Flemmings
Wow. Overload of information we have that now we need to prevent it. Especially when you start doing predictive. If we're going to do that, we need to be very dialed in on our resources, our sources of information and eliminate duplication. As well, make certain that it's not just raw data that you're bringing in, and then you leave it to be sorted by the individual.

So any ability to bring in items that are useful that are already vetted somewhere in the system and provide the right-size solution is going to be key. It can't just be everything that you bring in. I think that cloud has a great availability of information, but it also has the functionality whereby it can hopefully look at the system overall, if it's dialed in right, and then predict what's necessary and then take out the rest of the chaos. You know, taking in the signal and taking out the noise.

00:04:27 Sarah Matt
When we think about large healthcare organizations or even small healthcare organizations, especially United States, cloud is becoming a lot more necessary, if you will, because we're moving from a lot of extremely siloed on-prem installations of whatever it might be into an extremely connected environment and the HIEs of the past and the present may not give you enough of what you're looking for from a connectivity perspective. What I'm seeing a lot, and I'm wondering what your thought process is, is that payers, providers, even pharma, are all moving to systems where they're actually utilizing PaaS (Platform as a Service) to bring together some of those disparate pieces, whether it's in a data lake, a data lake house, whatever you want to call it. But they have so many different systems that are either separated by geography, separated by organization and separated by privacy and security, and they're trying to figure out the best ways to bring that disparate data together. How are you assisting some of those clients that you've been seeing in moving through that transition?

00:05:27 Michelle Flemmings
Absolutely. We start with, for lack of a better word, an audit of their inventory. What do they have? What do they utilize and where does it sit? How is it connected? Is it connected in a manner that works for you now? If so, great, we won't mess with that. But if it's not connected and you need to go ahead and log into something else or open up another platform, that doesn't work.

What we then go to is examine and evaluate in partnership with our clients. What else are you trying to achieve? What are the near misses that you have now that you're experiencing and are frustrated or struggling to capture? And what is your Nirvana?

And then we make a path with them from those starting from that basis. It needs to be end-to-end, is honestly where I think that we need to take our clients and go with them for success. It needs to be everything that starts with the patient walking in the door. In the case of the provider and how do we do dispositions that makes sense and prevent readmission.

In the case of payer, how do we get the first-time right rate for claim submission, but then also put automations that are thoughtful, meaningful, and impactful in that the prior authorization process and in the payment process. How do we help them to remove the, now primarily retrospective, review of claims for potential fraud, bring it into more contemporaneous—then in cases where possible, how do we bring it to being anticipatory? So we're identifying patterns that would be consistent with possible fraud? 

And then for patients, how do we help our clients to provide for patients a whole health patient experience that empowers them with the right tools, helps them make the right decisions for themselves and help them to guide their care team to support those decisions so that they can have their best outcomes and they can live their lives and return back to life, as opposed to being sick and in the hospital?

00:07:24 Sarah Matt
You just mentioned a number of really interesting use cases. I think the most important thing I found is that every institution has to decide what is their priority, what is the most important use case they're going to focus on, because if they're focused on clinical trial access as opposed to retain providers or leveraging the cloud for patient insights, that would start perhaps in a different department with different data elements, etc.

You know when you think about kind of the cloud capabilities making a huge difference for some of these areas, let's pick on clinical trial access for a second. You know, what are some really interesting ways you've seen folks really harness the cloud for those capabilities?

00:08:04 Michelle Flemmings
That's a great question. As a physician, my personal experience was that you can't know everything, and things change so much in that capability. So we have to be cognizant of the volume of data, but also the need to remember that these things exist and that's very difficult, especially when you're dealing with large numbers of patients and you have a huge workload.

I believe, and there are ways of bringing in that information as the patient goes through the journey. My sister had breast cancer; ended up with bilateral mastectomy. The last thing on her mind when she was in the hospital was anything about clinical trials. She was so concerned about the possibility of passing away while in the hospital. I think it would be very important to, before she even gets admitted, we know when she's coming in, let's start putting out some of the information about clinical trials to our patients with instructions and opportunities to speak with a nurse navigator or physician to walk through the process. Let them know what's available when their mind is able to be settled and concentrate on this. Give them expectations for when they're in the hospital about helping to make some of these decisions and maybe even starting care while they're in that hospitalization, to not delay any further treatment.

With the use of items such as conversational Gen AI, rather you could give instructions and more education, preparing them for the conversations in the hospital. As well, I think giving them some insights about what the capabilities are, even in a broader expanse than just their facility, maybe they through referral or maybe they through alternative care options bringing that technology to the patient is something I think that they deserve in a manner that meets them where they are. For their level of their level of understanding, but also gives them the opportunity then to connect back with their trusted source of care for questions.

00:10:05 Sarah Matt
In the healthcare space we have done a lot of things maybe not so great over the many decades and hundreds of years that have led up to today, and many groups are still leery of the healthcare system. Add on to that a layer of technology and AI that most people cannot even begin to grasp. Understand because it's kind of a black box in a lot of ways. 

How do you think folks are thinking about cloud technology and AI? I know there's still lots of concerns about privacy and security. You know, when you think about those areas and how we can assist in building that trust, what are your thoughts on how cloud can actually be a secure mechanism to bring forth that trust?

00:10:47 Michelle Flemmings
First off, I think that we need to put more information out in the places where our patients and future patients are looking at data now. We need to make certain that the right information is out there on the most popular websites where people do their searches before coming into the hospital and then change their perspective. We need to talk about the security. We need to let them know that their information isn't going to end up on some social media channel or and also portray to them and let them know that we are deserving of their trust because we do this very well in other industries, especially in the financial industry with regard to security. I think that's first and foremost.

We also, though importantly need to build the trust of the providers. There are several that are in fear of their jobs disappearing because they'll be replaced by the machine.

Our patients sometimes believe that the machine is going to have some sort of a decision-making mode that is going to tell the physician you know I'm no longer worth taking care of. I'm a dead-end so no longer give any time to my care and instead devote your time to someone else.

So starting with the right information about the security, especially your personal health information, securing and demonstrating capabilities along with the health information exchanges and platforms.
Pulling in that information into portals, driving patients to that portal with trust at the provider level and at the individual organizational level is going to be important as well because a lot of folks, it's going to be seeing and feeling and experiencing that's going to build the trust.

00:12:25 Sarah Matt
That's a great thought process there, Dr. Flemings. I know this has been a really interesting conversation. I want to ask one more question. Let's end this one on a positive note. So when we look forward, what are the opportunities that you're the most excited about in leveraging the cloud for healthcare?

00:12:41 Michelle Flemmings
Oh, wow. Oh, wow. Yeah, shame this is the last one. Truth is, I am most excited about all things AI. I am a child of the 60s. And for me, I remember when I had my first little calculator—I thought that was mind-blowing.

Now with the potential of AI using thoughtful implementation to support our providers from burnout, empower our patients to lead their healthcare teams, make those right decisions using trusted information that's fit for purpose, it changes the entire landscape.

Honestly, I do believe, especially when you talk about productivity and augmentation of workforce, that has to be top of mind. How do we put that into our workflow so that it helps and doesn't hinder and that it also doesn't overload with extra information?

I think that is really where it lies. Maybe it also considered tapping some of the information that's in pre-hospital systems. I believe as an ER physician that the bedside is where the care starts and that sometimes that bed side happens to be at the roadside. We need to use AI and our capabilities to bring in that information because sometimes that is key to decision-making for the physicians.

Also, I live in a very, very rural area in southwest Colorado. I think that GenAI and virtual care should go hand in hand and that we can help better support our patients who live in areas distant from hospitals, especially at smaller hospitals that’s closed—extend that care, improve outcomes, maybe bridge some of the gaps between healthcare and retail sources that are trying to now invest in healthcare. Make it better, fortify it with some clinical expertise from some of our organizations, but utilize the infrastructure that's already in place, maybe, especially if you want to consider this: primary care and behavioral health. I think we can make huge inroads in those and provide care, right where people live.

00:14:40 Sarah Matt
I can't agree with you more. I think for me, I feel like we're really at the precipice. We have so many tools that are at our disposal. The data is now becoming more clear. How can we bring things together and effective means throughout healthcare organizations to really gain that value. I think over the last decade or so, we've been inching along from a digital perspective, inching along, we'll say, journey to AI. Here we are, I think now every healthcare organization is going to have to decide how they want to interact with it, how they're going to prioritize it and how we're going to keep the focus on the patient.

00:15:17 Michelle Flemmings    
Totally. In closing, with focus on the patient, I would offer two recommendations. When it comes to AI, I believe that going slowly is actually going quickly. We need to be iterative like you said, about where we go and how we institute and how we implement, because sometimes those small and impactful wins will build the security and the belief in the system for the overall organization and also drive that to our patient.

Second, I think that we need to make certain about that, keeping the human in healthcare, in all portions of healthcare. We need to make certain that we're not replacing that trust that has been in the provider relationships so long and then got compromised when we did start going digital. There's an opportunity here to rebuild that, and magnify that, and still broaden our ability to care for more patients.

00:16:11 Sarah Matt
Doctor Flemings, thank you so much for joining us today.

00:16:14 Michelle Flemmings
Thank you, Sarah. It was my pleasure.

00:16:16 Sarah Matt
Thank you all for joining us on this very exciting podcast discussion. Please be sure to subscribe to Perspectives on Health and Tech podcast for more insights from industry experts, visit or follow Oracle Health on social media.