Keep Health Tech Simple … Or Else

Health tech companies seem to forget that the last thing a provider wants is something to distract them from caring for their patients, according to Dr. Mike Greiwe, a practicing orthopedic surgeon with OrthoCincy, and founder of the OrthoLive telemedicine platform. As both a practitioner and a tech guru, Dr. Greiwe understands how to help health IT get to the point where the benefits outweigh the pain points. In this episode, you’ll learn why telemedicine needs a champion on the team, how practices and health tech companies can create partnerships to benefit both sides, and how to plan growth when no one knows if 2021 will be a rebound year.

Full Transcript

Announcer: It’s time to think differently about healthcare, but how do we keep up? The days of yesterday’s medicine are long gone and we’re left trying to figure out where to go from here. With all the talk about politics and technology, it can be easy to forget that healthcare is still all about humans, and many of those humans have unbelievable stories to tell. Here, we leave the policy debates to the other guys and focus instead on the people and ideas that are changing the way we address our health. It’s time to navigate the new landscape of healthcare together and hear some amazing stories along the way. Ready for a breath of fresh air? It’s time for your paradigm shift.

Michael: Welcome to the “Paradigm Shift of Healthcare” and thank you for listening. I’m Michael Roberts here today with my co-hosts, Scott Zeitzer and Jared Johnson. On today’s episode, we’re speaking with Mike Greiwe. Mike is a surgeon by day and tech guru by night. He’s a practicing orthopedic surgeon with OrthoCincy near Cincinnati, Ohio, and the founder of the OrthoLive Telemedicine Platform. Mike, thank you so much for coming on the show today. 

Mike: Thanks so much for having me, Mike. I appreciate it. Great to be here. 

Michael: Absolutely. Absolutely. So, you know, as a provider and as a developer, as a health tech developer, you’ve got a pretty interesting perspective on how both of these sides can kind of work together to help the patient out. So, you know, I’d love to know a little bit about how 2020 was for ortho for OrthoLive, in particular, and you know, how did you guys handle change over the course of the pandemic and how did you respond to all that change that so rapidly came at everybody through this last year? 

Mike: Yeah. I mean, it was a roller coaster of a year, that’s for sure. We actually were founded back in 2016 and had been growing, you know, steadily, but when the pandemic really hit you know, full force, it was really all hands on deck and we had to bring on a ton more people, we added support people, we had to add bandwidth. We had our server crash, you know, in the early days a couple of times. I mean, it was literally like I felt like a tidal wave had just crashed down upon my house because we were up till 2:00, 3:00 in the morning, myself and my chief operations guy, just, you know, handling the things that needed to be done to make sure everybody was able to communicate with their physicians. But man, it was a wild ride, but we got through it, and I think came out a little stronger, you know, for all of us. So, it was good.

Michael: We’re moving out of 2020 into 2021 as we’re recording this right at the beginning of the year, you know, what are the biggest challenges right now do you think for just health tech companies in general, in the midst of everything that’s going on right now? Like we’ve kind of gotten past some of the pandemic, but man, we still got a long way to go. Where do health tech companies sit in the middle of all this?

Mike: Yeah. It’s a good question. Right now, no one is quite sure how much of a rebound we will have in terms of digital technology. I mean, digital technology has been utilized probably more than ever in healthcare at this present moment, right? We hit a peak in terms of our use of digital technology, probably in the May timeframe and then things sort of ebbed into the fall, but then we’re back again and things are being utilized again to an unprecedented level. So, kind of understanding, I think where the new normal is going to sit is going to be, to me the most interesting thing for health tech companies to try to observe and sort of stay ahead of the curve on because there is going to be kind of a new set point and we need to be able to respond to that. And patients are going to be a lot more, I think desiring that perfect solution or that, you know, no-touch solution if you will in the future. So, having digital technology at their fingertips is something that’s important to them and we’ll see how you know, far it goes.

Scott: Yeah. You know, doc, it’s interesting you say the new norm and I agree with you, if you would have asked yourself, you know, how many people do you think you can get involved with telehealth specifically? You probably had some sort of set goal. This is what I expect to do, etc. And then all of a sudden, you know, people were afraid to go in for good reason and telehealth became not only a good choice, but all of the insurance providers embraced it as an alternative way to see patients. So, you know, what do you think the new norm is? Do you think that telehealth is you know, finally going to get its grip hold so to speak, especially in orthopedics?

Mike: Yeah. I absolutely do. And you know, in orthopedics, people thought I was sort of crazy to start a telemedicine company. I mean, 2016, they really were scratching their heads. And I knew there was a good use for telemedicine inside orthopedics and really across medicine. And there was slow adoption, but adoption was real. I have graphs I could show the audience, you know, where you basically had a doubling of telemedicine use over a period from like 2017 to 2019. And then, of course, this past year, it’s gone up by 10 times. So, I think telemedicine has seen its day and now probably the genie won’t be put back in the bottle. You know what I mean? Like it’s out, people want to use it, and smart practitioners are utilizing it to help differentiate themselves inside their marketplace right now. So, I actually think we’re going to see a continued surge of telemedicine, although we will probably rebound and come down a little bit from the peaks that we’ve seen, but I still think that it’s going to continue to be used at a pretty high level.

Scott: Look, I happen to agree with you. I unfortunately needed a wrist surgery. I had a Smith’s fracture for anybody out there and it got taken care of. And there were a couple of times when I was coming in and I actually do the marketing for the hand surgeon. And I was like, you know, “Doc, should you think about telemedicine because how many times do you have to see me twist my hand back and forth?” And he was like, “Shut up and go do the X-ray.” Walk me through that, you know, some instances where, you know, because I know orthopods, I always make jokes with them. I’ll ask them something like, “What do you think of this line?” And the response is, “Well, you know, I need an AP and a lateral before I can tell you.” So, talk to me a little bit about that, you know, because you’re going to get some patients coming back but you’re not going to get that standard X-ray. Like, it’s a little different, right?

Mike: Absolutely. I mean, there are some no-brainer orthopedic telemedicine uses out there and I’ll just give you the top two that come to mind. So, the first no-brainer is post-operative recheck appointments where you don’t need an X-ray. So, there’s a lot of, you know, arthroscopic surgery that we do that’s all soft tissue that no X-ray gets taken at post-operative period, and we’re really just checking the wound, making sure the patient’s progressing well with physical therapy or their own home exercises. And that is probably the best use case of telemedicine services that I can think of because you think about the patient’s in pain, not wanting to really, you know, drive over to the office and you know, maybe go up and down some stairs to get into the office and you know, wait around. So, that’s a great use case, I think a post-op visit.

And then you think about all this digital technology we have from a radiograph perspective and from MRI perspective, we have been calling patients on their MRI results for a long period of time, but it’s really nice to share with them their actual MRI and do it over telemedicine. So, that’s another great use case, and one that we’ve seen just, you know, hugely used over the pandemic using the orthologs software is that MRI follow-up because they can annotate, they can kind of circle and show what’s going on. And the patient almost has a better idea than even in the office because my hand’s not over the screen and I’m not, you know, kind of waving my hand around some, you know, generic images. They can actually see what I’m pointing to with my cursor. That’s actually been a great use case as well in the imaging follow-up realm.

So, those are two big use cases. There’s even one more, I think, which is injection follow-up. So, we like to see how patients have responded to, for instance, cortisone injections or lubricating injections and you know, six weeks later, we’re not going to do another injection, but we want to see how our patient’s doing. So, it’s really a, “Hi, how are you, how are things going with the injection?” So that you know which direction to move, whether you’re going to do surgery, you’re going to do something non-surgical. So, I think that’s actually another great use case as well.

Scott: And we’re very focused on orthopedics, obviously. I mean, the people you’re talking to involve with orthopedic, so like you’re an orthopedic surgeon, but I can just imagine just how many, you know, standard physician and surgeon case uses there can be where everybody’s happier with this. Are you seeing a better integration now with the healthcare payers, you know, the insurance companies as well?

Mike: Absolutely. They have embraced things and did a great job really of turning on all the payment resources, you know, early in the pandemic and you know, the administration that was in place at point, I think really tried to push for that, and that was good. We did see pretty much parity laws lifted across the country. And prior to the pandemic, there were 37 states that had parity laws for telemedicine, meaning that in-office visit was equal to a telemedicine visit. And then, of course, the pandemic hit and everybody opened those up. And so, we have seen a great reimbursement for all the payers really across the spectrum with telemedicine. That’s been a nice benefit as well of the pandemic is seeing a lot of these laws get lifted and that’s been good for everybody.

Scott: Yeah. I couldn’t agree more. It is better for everybody. Just like you mentioned, if you’re in pain, but you’re doing better and your post-surgery and honestly, all you’re doing is making sure that like you mentioned, the wound care is good and you’re moving okay. Why do you want to get up and get into the car and drive everybody crazy just to go like, ‘Yeah, that’s a good incision I made. Huh?”

Mike: Yeah. I mean, it’s crazy. The data suggests…I was looking at a study how long people just sort of spend, you know, when they’re going to the doctor’s office and it’s like an hour and 20 minutes that they would spend…sorry, it’s 120 minutes that they would spend actually, you know, waiting and seeing the doctor and getting back home. So, they drive and it takes that amount of time. With telemedicine, you’re talking about 15, 20 minutes that they’re spending doing the visit. So, it’s a great time savings for them.

Scott: I couldn’t agree more. And because I control all the healthcare companies, I’ll just make sure that they continue to pay like they should, kind of go from there. You know, we do talk to a lot of practices, not just about say telemedicine, a lot of things that are coming up. What do you tell other practices as a practitioner yourself about looking out for getting it integrated, looking for the next thing, whatever that is, and in your particular case, you’re focused obviously on telehealth and how to integrate it, but there’s a lot out there. What kind of advice do you have for them?

Mike: Well, practices need efficiency, and for a long time, you know, health IT has been the bane of, you know, surgeons and physicians experiences for a long while, right? And I think finally, we’re getting to a point where IT in healthcare is making a difference and making physicians and patients happier. But part of that happiness comes from the provider side from integration and from being able to integrate some of these systems and pulling them all together as this interoperability concept is important when it comes to not having people do redundant things. So, to me, it is so critical for us to be able to pull these things and make sure that they’re easily able to be interoperable.

So, OrthoLive and Spring Health Live, our telehealth platforms, they’re all HL7 FHIR interoperable, which is kind of the new standard to be able to make everything crosstalk. But I think for practices that is, I think really, really important. You’ve got to have the ability to bring everything together and there’s multiple disparate systems that they’re trying to do that with. So, having one system that does a lot of things is actually really nice too, and I think you’re seeing a lot of health IT companies do that right now. They’re pulling in telemedicine, they’re pulling in scheduling, they’re pulling in, you know, web-based appointments and everything’s being done through one system which practices like two. So, that’s key.

Scott: Yeah. I couldn’t agree more. 

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Michael: Everybody, I always appreciate that you tune in, that you’re listening to the show here. I wanted to let you know that we have set up a new newsletter that you can get to at paradigmshift.health, that’s paradigmshift.health. You can go there, and the reason that we’ve got this newsletter is that we’d like to send out a few extra pieces of information with the show. We also have the full transcript for every single episode that we do. And we can let you know that through email, we can let you know, also if we have like a good quote card to be able to show for every episode. So, check that out if you’d like, paradigmshift.health. Thanks so much.

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Scott: Do you have any tips for…I’ll turn it the other way, you know? You spend a lot of time basically selling the idea that you have and how to integrate it. So, let’s start with that before I ask that second question, which is basically how do you help practices? How do you get the word out to the practices now, especially in COVID? Are you still going to these meetings and talking to other people, like how do you get the word out?

Mike: It’s been difficult because there’s no shows anymore. You know, the Academy was canceled. We had a lot of the different places where we would typically get the word out, you know, but a lot of it has to do with word of mouth. I mean, we still utilize a lot of the forums out there. So, there are practice groups that talk amongst each other about how they’re dealing with the pandemic. That was a big avenue for us to use. So, you know, a lot of these…like the MGMA was still communicating with practices. Practices were really relying on them. We worked with the MGMA to do some work. We worked with The OrthoForum.

We did a lot of, you know, work just to sort of tell people, “Hey, you know, here’s how to help deal with this. Even if you’re not using, you know, our company, here’s some helpful tips and tricks and what we’re doing to make things better at our institution.” So, you know, just trying to educate people, webinars, podcasts, you know, things like that, LinkedIn, social media, you know, that’s the way to get the word out. And a lot of the shows and different things I think they are going to see less overall volume potential in the future, and we’re going to be turning more to the digital marketing and that vein of advertising in the future.

Scott: Sure. Yeah. I don’t disagree with you. Then I’ll put yourself in the seat of taking a look at other technologies as a practitioner, what do you look for?

Mike: Oh God, just make it easy for me, please. Yeah. Seriously.

Scott: Yeah.

Mike: I mean, I’ll just break it down like that. I mean, if you can just make it simple, I mean, you have my ear at least, okay? I mean, if you’re going to make it really complicated for me as a practitioner, I mean, I’m shut down. I will shut down immediately because the last thing a provider wants or needs is something that’s going to distract them from taking care of their patients, and that’s all they have time for. I mean, they are literally overwhelmed. We have, you know, in this country problems with depression, physician suicide, you know, we have issues with overworked physicians and overworked healthcare providers, and, you know, we don’t want to contribute to that. As a healthcare IT person, what you want to do is solve their issues. And so, if you can start solving pain points for me, then I’m going to be a happy guy, you know.

Scott: Yeah. I think that’s a great advice at its core. Save me some time, make my day a little easier.

Mike: Yes. A hundred percent. That is the key. 

Jared: Yeah. I mean, Mike, that’s so true. And when we think about both sides of this, I mean, I think most people only have a lens into either the practitioner side or the health tech side. And so, even just having this shared perspective, I don’t think we can emphasize that enough to realize that at the end of the day, both sides are just trying to meet a need in some way or another. And I’m just curious, in general, like, you know, what else is on your radar screen right now? Just in general, like from the provider side. You know, so we’d talk about, you were mentioning just some of the mental health state of what’s going on with a lot of physicians now. I do see that. We’ve heard that from other guests who we’ve had on the show that this last year was very difficult in ways that no one expected. And so, you just add that onto the existing pressures that are on anyone, on any practice to grow things and to do ultimately what they want to do, which is to help patients. So, what else is on the radar screen that we just haven’t talked about? Like, what’s getting providers excited and what’s making them worried?

Mike: Yeah. That’s a great question, Jared. I mean, to me, and I’m just taking it from my perspective here at OrthoCincy and what we’ve been thinking about. I mean, it’s really difficult to plan any growth strategies right now. I mean, we want to grow and, you know, we’ve actually hired a couple of physicians but, you know, ultimately, we’re worried about where is that growth going to lead us and is 2021 going to be a rebound year? Are we going to kind of you know stabilize? You know, where are we going to be? And you mentioned kind of the other aspect, which is, I think the stress aspect of dealing with the pandemic and the mask wearing and getting your temperature checked every day and, you know, getting your vaccine and worried about, you know, issues from the vaccine and you know, all those things, but ultimately, how do you run your business?

I mean, there’s no definite answers right now. We haven’t really kind of come to a closure with this pandemic yet. And because of that, it leaves everybody sorta, “Do we grow?” You know, “Do we push to try to grow right now?” I mean, clearly everybody took a hit this year. I think that’s, you know, obvious. You know, very few practices probably were growing in the midst of this, but people are worried about how they’re going to continue to grow and have good competition, I think within their marketplace, at least compete well within their marketplace to put it that way. So, you know, I think that’s on my mind as a practitioner and as we think about bringing on new physicians, are we ready to do that, and those types of things? That’s, you know, a challenge.

Scott: Yeah. We talk to a lot of practices, doc, where that conversation’s happening. Like when do I “turn it back on,” whatever it is, you know, the marketing campaign, the hiring of new people, dealing with what I’ll call the post-COVID? We’re not post COVID yet, we’re still definitely in COVID. It was the same thing for me running a small business. I do think those who can focus to have enough time to start focusing on what’s going to happen when we “turn it back on,” they’ll get a jump on some other people. So, my best advice is if you can take a little time away to think about that, that makes a lot of sense, which can be a tall order depending on where you are in the country without a doubt. Because, you know, ultimately, you’re right. You know, you’re getting up at the crack of dawn, you’re seeing patients, you’re getting, you know, your temperature checked when you walk into the clinic, when you walk out of the clinic. When you walk into the hospital, you want to make sure you, of course, don’t want to hurt your patient in any way, and then you’re hoping to get the vaccine. That’s a good question. Doc, did you get your vaccine yet, your first shot?

Mike: I actually did. You know, I got my first one, I think, on the 23rd. And I just got my second one, actually, just before I came on the show here.

Scott: There you go. All right.

Mike: So, top of mind. That’s why I brought it up. But yeah.

Scott: Well, that’s a good thing because I think, you know, the sooner you get yours, the sooner I’ll get mine and the sooner we’ll get back to normal so to speak.

Mike: Exactly.

Scott: I look at that as a positive. 

Mike: I agree. I agree. 

Scott: We spend a lot of time talking to medical device companies and pharma companies, and I always start with like…when they always say stuff like, well, how do we communicate with the surgeon? How do we communicate with the physician? I always say like, “Well, what do you have that’s going to make their day easier? If e-visit is about freeing some time up, if it’s about helping communicate features and benefits of X, you know, whatever it is that they’re selling, so that from a patient’s perspective, rather than, you know, from the orthopod’s perspective, because that happens a lot, it’s like, “Hey, here are the features and benefits of this total joint.” You know, you’re looking and you’re going, “Yeah, that’s great. I understand it. But I don’t have a fellowship in this.” I got to explain this to my patient, right?

Mike: Right. Right. It’s gotta be simplified. And I think simplified for the provider make it easy for them, but also the patient has to have that, you know, ease of use too, and also the knowledge of this, you know, the simplicity of it, right? And if you can break it down into its simplest terms for patients, then I think you’re really helping them tremendously, but same thing for providers. I mean, the message has to be clear and simple. You know, when you’re selling things, it’s gotta be very crystal clear what it is that you know, is going to help and, you know, even if you can simplify it into three or four words. I mean, that would be ideal. That’s I think good advice for sure for those people that are out there, you know, selling or whatever.

Scott: Well, I can tell you, you know, as a patient of an orthopod and working with lots of orthopods, telehealth I hope is here to stay. It really made my day easier. And working with a lot of other orthopedic surgeons, it was really more of a habit thing. You know, once they kind of altered what they were doing and kind of embraced it, it made life a lot easier. And some advice that I personally would give to any practice that’s thinking about this, and doc, I’m kind of curious what you think, but it’s like, it’s not just for the surgeon to learn it, it’s for the practice to learn it, right, and integrate it.

Mike: Yeah, that’s right. I mean, you have to have kind of a champion inside your practice. I guess, number one, if you got the urge to go ahead and do it, and most practices had to do it, right? So, they’ve even been sort of forced to.

Scott: Necessity, yeah.

Mike: Yeah. Exactly. They have to have a leader with it and you have to have sort of some protocols that you use. So, how do you do your scheduling? You know, are you going to integrate, are you going to bring it in through your EHR or PM system and then have the schedule backfill that way? Are you going to you know, have somebody dedicated that’s going to schedule everything? How do you make sure that there’s accuracy with the phone numbers and emails that you’re putting in because if you put inaccurate information, the patient aren’t going to get the reminders? There’s really a lot of keys to finding the right solution with telemedicine. You know, there are different solutions out there. Some solutions are incredibly complicated, others are very simple.

And so, finding that right solution, making sure that you’re doing things right, as you set things up within your practice to make sure you have a great practice flow with regards to telemedicine. Making sure, you know, if you’re going to be seeing new patients that you have insurance to do that because you may need some writers there. So, there’s a lot of, you know, keys that kind of go into it, but having somebody that’s going to say, yeah, this is my baby. I’m going to take this to the finish line is really critical. And maybe it’s, you know, a physician and also an administrator so that, you know, the little details can be taken care of.

Jared: Is there anything else that we haven’t mentioned yet that excites you for this coming year? You know, that really is on the radar screen as well that we haven’t mentioned yet. 

Mike: Oh, we’re excited about educating patients. That’s kind of what’s up next for us, Jared. So, we’re really down with you know, educating patients, getting them information, and helping them when they have had a procedure, and I think that’s what’s next for us. And we’re actually super excited about that because you know, there hasn’t been great success of educational platforms in the past year because they just don’t reimburse. Like you don’t get reimbursed for educating people, and that’s too bad, you know, because people need to know more about whatever procedure they’re having. If they’re having a baby, they should know as much as they need to from their doctor’s office. And so, we’re really keen on that. And I think that’s what’s next for us. We’re super excited about, you know, bringing out some education and doing a great job getting patients and doctors on the same page.

Scott: Awesome. 

Michael: Mike, this has really been helpful. Like I said, we really do kind of get into that conversation of just talking to a provider or just talking to a health tech person. So, really is awesome to have kind of all of that rolled into one person. So, thanks so much for bringing that today. We really appreciate it. 

Mike: Cool. I’m glad I could do that. 

Michael: Absolutely. Guys, thanks everybody for listening. We’ll have the transcripts of the show online and you can always go back and take a look for that. And we just look forward to a great year being able to talk more with you. Thanks, everybody.

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