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Podcast Library > NextGen Advisors Podcasts > New Year Reflections and Healthcare Predictions for 2022

January 6, 2022

New Year Reflections and Healthcare Predictions for 2022

The new year represents a significant transition for the NextGen Advisors with Dr. Betty’s retirement. Listen here for Dr. Betty Rabinowitz’s reflections on a career well spent and the Advisors predictions for 2022.

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Transcript

Dr. Martin Lustick:

Hello, this is Dr. Martin Lustick, senior vice president and principal with NextGen Advisors. Once again, joined by my fellow advisors, Graham Brown and Dr. Betty Rabinowitz. Welcome to both of you.

Dr. Betty Rabinowitz:

Hey, Marty.

Graham Brown:

Hello, Marty.

Dr. Martin Lustick:

The new year represents a significant transition for the advisors with Betty's retirement. We'd like to take this opportunity to ask Betty to reflect on her career well spent. And we'll also look forward with our predictions for the coming year. Betty, including your training, your career has spanned six decades by my calculation. As everyone knows healthcare is undergone dramatic change in that time. As you look back what appear to you as the most significant changes?

Dr. Betty Rabinowitz:

So, first Marty, the six decades are still in dispute. I think you're counting fractions of decades on each side as a full decade. So I just wanted to go on record regarding that. Having said that, it certainly has, my career has spanned some amazing changes in healthcare. Some of them in the clinical realm, some of them in the policy payments structure of healthcare. The one I'd like to focus on just because of the last years in my career, which I've spent in the health information technology space and the last few years at NextGen, clearly to me, one of the biggest changes is the role of information, data, and technology in healthcare. I started my career practicing both in the hospital setting and in the office in paper charts that were only in our office. There was no sharing of information. There was no automatic flow of information. Lab results came once a day when the courier dropped them off from the lab in paper. Fast forward, here we are with sophisticated integrated connected systems that bring data in real time from multiple sources in the healthcare system. A patient can hit the emergency room at a certain time of day and a message will flow through to the primary care physician's office, labs flow 24/7. Clearly population health information at the large patient group level has become available. Whereas that was completely unavailable when I started my career. The entire focus was on the individual, the single patient in front of you. Now you can think of all of your diabetics in one group and find common denominators and trends. And so to me that has been both daunting and incredibly exciting development.

Dr. Martin Lustick:

It's interesting as you talk about it, Betty, it makes me think about how as much as the way we keep medical records has changed, our ability as physicians to use it as a source of something to complain about hasn't. I remember back when we were looking for a note from the specialist and we didn't know where in the paper chart it was stored. And we were searching through the paper chart to find the note, didn't know if it was there. And now we complain the same way about the electronic record, even though everything is right at our fingertips. If it's not perfectly easy to find, we find a way to make that a problem as well. So when you think about things that haven't changed, what jumps out to you as like the most important things that actually are not terribly different than they were?

Dr. Betty Rabinowitz:

To me in good medicine what hasn't changed is the centrality, the focus, the importance of the patient. And the way we have to structure what we do, how we do it in a way that honors and respects that central tenant. That it's the relationship between a care provider of any type, whether it's a physician, a nurse practitioner, a nurse, a PA, and the person seeking their help as a patient. And that has a history of thousands of years and a history that needs to be evolved and changed and, but respected and nonetheless. That's the center.

Graham Brown:

One of the things that you and Marty were just discussing the lamenting around how to find certain information in a record, that's really not the kind of care that you were trained to do initially, right? It didn't incorporate all of these technology elements and how that impacts your work on a day to day basis. So, would be interested to hear you reflect on how you kind of adapted to how you were trained and kind of the Hippocratic oath and how you were going to approach your medical career with all of the adoption of technology, because you've been at the forefront of that. And you brought a lot of these tools and solutions into your own clinical practice, and then spearheaded that. How did you get your head around that and why did that path become clear to you?

Dr. Betty Rabinowitz:

My sense is that I think Marty alluded to something really extremely important. We idealize the days before technology or some physicians idealized those days. And really there was nothing particularly ideal. You couldn't read handwriting's, the information was not available when you needed it. I can remember being incredibly frustrated, stepping out of the room three times during a patient visit to find a piece of paper, or a referral letter, or a consult note, and looking for labs that weren't there. And so in a certain way, technology wins when it becomes, an enabling tool does not become the center of the activity, the clinical activity, it just is there. And in a certain way, fades into a very comfortable background. And I think with many physicians now with the new generation of electronic health records, with other tools, virtual visit tools, data sharing, collaboration tools, decision support tools, that's happening to a great extent. You don't hear the technology being the topic of discussion like it was in 2006, when we went on electronic health records. Every physician meeting started, ended, in the middle of it, was concerns about the EHR, concerns about the technology. It's past now. It's now part of the routine. It's there and doing much better. I think technology has evolved very positively in that regard and the best technology is the one that you don't notice.

Dr. Martin Lustick:

Yeah. I think that's a great way to put it Betty. One thing that struck me in the last couple years we've been working together is what I would call your fearless curiosity. It seems to me a consistent quality that you apply to issues large and small in every situation with everyone you meet. Can you talk a little bit more about the role of curiosity in the different things you've done in your career?

Dr. Betty Rabinowitz:

It's an interesting observation, Marty. I think in the clinical work I did, I can remember telling residents that after they've seen 10 otitis external, infections of the outer ear, they will be extremely bored and used to seeing external otitis. It's a pretty easy diagnosis to make. There's nothing very fascinating about it. If they are not curious about the human attached to that ear and their story, they shouldn't be in primary care because the gift of primary care is that it's there to interact, to connect, to follow, to work with people over time. And that curiosity about people's stories was just such a big part of my satisfaction with my clinical career. I enjoyed it thoroughly. It was meaningful. And then when technology showed up and I kind of understood the potential of what it could lend, I was continuously curious about making it better, understanding it more thoroughly, figuring out new ways to use it. So to me, this theme has been continuous, has served me well, has been the source of my satisfaction and enjoyment with everything that I've done.

Graham Brown:

Here we are at the end of 2021, beginning of 2022. And there's been just traumatic change within the world of healthcare delivery over the past two years, as a result of the COVID pandemic that's ripped the world. Be interested to learn from each of you, what you think some of the coming year might bring for the world of healthcare. What's going to change? What's going to stay the same? What are the trends that might be emerging in your mind? Would love to hear any predictions or thoughts about the year ahead.

Dr. Betty Rabinowitz:

It's interesting reflecting on this question. When we were talking about the podcast before. I think that COVID has kind of pushed some sort of a reset button for healthcare that is going to take some time to kind of recover. I think we still have a difficult few months ahead. I'm optimistic. Maybe that even though we're in a very active period now with COVID, that things will start improving after Omicron. And that there will be a time of some relative quiet, that things will just take some time to return to normal, staffing will need to be replenished and re-energized, hospitals will need to kind of regroup and go back to a new normal. So I don't see 22 as a dramatically impactful year in terms of change or innovation, or I think it's going to be a year of recovery. I hope that's the case. And that the following year will return some of the themes of advanced payment models, value instead of volume, the movement to more patient involvement and engagement. I think all of that is there and active and will return. I think this is going to otherwise be a relatively kind of regroup year. And I hope that the powers that be allow the health system actually to regroup rather than rapid fire come down with additional requirements and rules. And that there's some ability to pause, rest, regroup, and then innovate and regenerate after.

Dr. Martin Lustick:

Right. I agree with what you're saying, Betty. A couple things though I would add. One is I would say maybe it's more hope than believe that it will actually happen, but I do think that one of the potential silver linings of what the healthcare delivery system has gone through is some added pressure on the government and payers to reduce the red tape in the delivery system. To look for ways to free up the resources to be able to focus on delivery and care. The other thing that I think is in the background, what's occurred within the pharmaceutical industry with the focus on finding treatments for COVID, I think it's just set an enormously rapid foundation for the development of innovative treatments for viral illness in general, that I think is going to continue to accelerate this year and would be surprised if it doesn't begin to have impact in the clinical setting even during this year.

Dr. Betty Rabinowitz:

Interestingly, Marty, as you were speaking, I was thinking that from NextGen's perspective, this is going to be a very exciting year. There is a lot of momentum and kind of energy going into areas like interoperability, connectivity, connectedness, patient focus, patient engagement, patient autonomy, patient empowerment, which isn't stopping. So on the technology end because in a certain way we have participated in these difficult two years, in many ways, along with our clients. But I think the energy in the health information technology industry is there and active and moving forward with great Gusto. So I think from a technology perspective, you're going to have a very interesting year in describing some of the innovations and exciting things that are going to come about.

Graham Brown:

Yeah. From my perspective, those are certainly big factors at play. And the length of the pandemic, I think surprise some of us in. Initially when, back in March 2020, this was all evolving around us, I had an expectation myself, personally, that it was going to be a much shorter window of time before the pandemic was kind of addressed and was under control. And we would be moving out of it. The fact that it has extended for as long as it did, I think it's has as a result, had a lot of long term implications for the healthcare delivery system. When you were speaking about the impact on hospital employees and health system workers, while we've seen a huge enrollment of new individuals wanting to go into nursing school and wanting to go into medical school, it's going to take years until those folks are graduates and they come and help replenish the workforce that's getting exhausted and drained from their experience over the last two years. So I foresee us going through this period of, I hope you're right, stabilization, where people kind of step back and take a breath and regroup and try to just prioritize good care and getting things back to normal. And hopefully not having a lot of change around the edges so that we do have a period of time where both the workforce, but we can step back at a big picture from a policy perspective or from an administrative systems perspective and say, we have this incredible view now of what worked well and what we might want to change in the healthcare world, given what we experienced during the pandemic. So how do we deliver care more directly and more conveniently to the consumer? What do the elements that came about through telehealth, through the use of virtual visits, through the ability to interact with a portal through your phone. With so many more users of those solutions and those approaches now that to your point, they now just sit in the background of how care is provided and they're just enablers. They're how we do things now. And they become part of the rudimentary instead of the abstract. And I hope those things will come more into the common and just be enabled then by the powers that be, as you say, from a regulatory perspective, from a policy perspective. That we cut the red tape, make those things easy and kind of remove the administrative burden out of the system of care that both providers and patients have to struggle with today.

Dr. Betty Rabinowitz:

Yeah. I was thinking, we found so many parallels to the large flu pandemic at the beginning of the last century. I wonder what happened in healthcare when the pandemic subsided then. If it was an impetus for development or change or things just picked up and went back to normal. There have been so many parallels in the public's response and it's amazing how history has repeated itself because as you were speaking, I thought to myself, it's amazing how in some ways humans and systems bounce back so quickly and go back to status quo ante very quickly without remembering many of the lessons or learning many of the lessons and kind of go back to previous follies quite quickly. So time will tell.

Dr. Martin Lustick:

Sounds like a good topic for a future podcast when we'll bring you back as a guest, Betty.

Graham Brown:

There we go.

Dr. Martin Lustick:

So, before we close Betty, Graham, and I do want to thank you for being such a wonderful colleague, and mentor, and friend. And for our listeners, we do want to assure you that even though she's retiring, this will not be the last you hear from Dr. Betty Rabinowitz. We do plan to have her back as a guest for future podcasts. Graham, did you want to make a comment before we close?

Graham Brown:

Would echo those thoughts, Marty. It's been a great joy for us to be able to work together under Betty's leadership and wish her all of the best and happiness in her next stage.

Dr. Betty Rabinowitz:

Thank you. And it has been one of the highlights of my career. Thanks to our listeners for joining us on a regular basis. And I know our paths will cross again. Thank you.

Dr. Martin Lustick:

Thanks. Thanks everyone. And have a great day.