Roundtables

always involves changing the way you do the work. I'm a physician by training. When I was training, we'd sit with the patient, do the history, make eye contact and record notes while talking with the pa- tient. Today, if you have an EMR in the hospital, most history is done on the computer. Physi- cians look at the computer screen instead of at the patient. at is something that has struck me — a very simple thing. Although technology is critically import- ant, it does change relationships between healthcare providers and patients. We have to con- sider that as we think about how we design exam rooms, how we make rounds and how we com- municate with patients. SS: Montefiore was an early adopter of EHRs to link our broad network of hospitals and ambulatory centers throughout the community and provide the best possible healthcare to a wide and diverse population. We embarked on a multiyear adoption of Epic this year aer careful analysis of our current systems and our future trajectory in order to drive optimum pa- tient outcomes. Our challenge is to successfully support a massive IT restructuring while maintain- ing a high level of care delivery throughout our system. Tech- nology is a great enabler. We use technology to identify those most at risk to manage their chronic conditions and therefore coordi- nate and ensure the safest possi- ble care. WT: I think the key is figuring out how to use technology to optimize interaction with our pa- tients. We try to engage and build relationships with patients not just when they're in our clinics and hospitals, but when they're not being seen, as well. Epic, our electronic health record, is a great example of using technol- ogy to enable patients to take a more active role in their health- care, whether through online appointments and prescription refills, interfacing with physicians easier or accessing clinical notes. We also have a strong telemed- icine network throughout our state to allow patients to access high-quality care no matter where they are. I think we can learn from other industries how to use technology to build stronger relationships with our patients, too. If you look at Amazon, for example, they are constantly trying to build a re- lationship with their customers, whether they are buying or not. ey send suggestions to them, they put potential items in front of them based on their history. ere is a lot to be learned from that success. We do still find it challenging to know everything that's happen- ing with a patient because some still seek services with other systems. It is critically important for our providers to understand the complete picture of a patient's health so that we can deliver the highest quality care and a great patient experience. DW: e first thing that strikes me is how do we pay for all this emerging new technology? It's wonderful, it is making lives easier, but there is a significant cost to it at the time when we are trying to bring the cost of health- care down. We really have to challenge efficacy of technology. Does it reduce cost or improve health? A big challenge is how do we afford technology going for- ward in the current configuration of the healthcare system? I'm not optimistic about that. Where is technology underuti- lized? To me it's prevention, wellness and early detection — where you have biggest potential savings. Yes, we've made prog- ress, but there is so much more we could do. When people have genetic predispositions, how do we intervene and keep it from materializing? We also haven't done enough to eradicate infec- tious disease. Every time we seem to get on top of it, some new infectious disease pops up. Top Priorities, Challenges & Innovation in Healthcare 5

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