FedHealthIT’s President, Susan Sharer, had the opportunity recently to sit down with Leidos’ Health Group President Jonathan Scholl. Scholl began his career building software and was part of building the first web-based electronic health record. Today he drives the Leidos team whose portfolio stretches from bench to bedside and whose team of 7,000+ researchers, clinicians, scientists and technologists are engaged in solving some of the toughest Health challenges. This interview discusses the future of Healthcare, changes in 2020, interoperability and the innovation that will drive change.
What Do You See for the Future of Healthcare?
The challenge associated with the cost of Healthcare has been building for decades. We’re talking about phenomenal growth with very few exceptions. We’re now at a point where Healthcare costs are approaching 20 percent of our GDP and that is creating displacement in other things including defense, education, and citizen disposable income.
We are a rich nation. If we were to spend a higher amount of GDP on health, we should also expect to get higher quality but we are not top tier in that respect. We could even go so far as to say we are barely holding our own. I believe the future of Healthcare will be and should be focused on wrestling with that.
Where Do You See Most Changes Coming in 2020?
Clinicians, nurses and others on the care team don’t have the time to query an app, to then think about how to apply the information they are being given into their many short appointments during the day. I believe what’s ahead in the near term is figuring out how to put meaningful information inside the clinical workflow, leveraging AI and machine learning solutions, and then applying change management to ensure everyone is working smart.
There is generally buy-in to get technology installed but then after you get the technology footprint right you have to think about moving from system A to system B, understanding how it fits into the workflow, how the team works together and then circling back to get input and adjusting accordingly.
Where Do You See the Patient in All of That?
Increasingly patients want to have an optimal consumer experience. The more we can optimize their experience with treatment choices and pricing being delivered to them promptly, the better our health system will be.
It is a simple statement to say a patient should carry his or her health record around. The more complex answer is that the patient needs to be more informed in order to make rational choices. Not every consumer knows how to buy the best diamond because it’s a complex process involving a lot of levels of quality. Healthcare is the same. Especially with long-term chronic or emerging acute conditions, patients will, and should, lean on clinicians and follow their advice.
To be successful we need to address and solve the needs of both. Consumerism matters a lot to stable patients who are in a position to and want to make choices. Those with lower health literacy or who are in more chronic or acute settings may need direct advice more than choices.
How Will Digital Transformation be Different in 2020?
Healthcare IT is a 1990s cul-de-sac. The industry is trying to advance but it has not gone the way of banking, of complex supply chain, even of retail. When it comes to the back office side, we just aren’t there. I think in 2020 and beyond we will see continued advancement to try to get the infrastructure right. Part of that revolves around cyber and although we are talking a lot about it, we need to do more to continue that advancement.
I’m not a believer that a magic app from Silicon Valley that a patient can wear is going to solve Healthcare problems. The role of a complex system integration is as meaningful, or more, than it ever has been. We shouldn’t throw away investments in things we have done but there is a need to further integrate. That’s one of reasons I’m here at Leidos. I believe a high-quality integrator has a role in the integration of health.
We can help the Air Force fly a plane and we never lose the plane. We always know what is happening in the air space and so on. We don’t have that situational awareness about patients like that today but we can and we should.
What Technologies Will Drive Innovation?
Healthcare, when it is not an emergency service, is a convenience service and people want ubiquity. I think technologies of ubiquity, those that are common and exist everywhere, will emerge. Those technologies will not be equipped to handle emergent care so in that case, people will seek convenience.
If you think of a child being sick, parents are not interested in an appointment they can schedule three weeks down the road. Instead they are interested in quick service or almost a self-serve option. That will require a combination of technologies of convenience, precision execution of medicine, and of technology inside clinical workflows that can support decisions that need to be made.
I believe data is going to continue to be an important part of medical research but I don’t believe we need big data solutions. We don’t need new ways to do things, we need new ways to execute what we already know best practice to be, to get better decision making into the workflow and technologies of convenience that can support clinicians with the extra burden that information will bring.
No one has a really good answer for the right use of blockchain in Healthcare. There are experiments going on to identify where it might be appropriately used but I don’t think we can say yet what the future holds. We do know that the cyber posture of health records needs to improve and blockchain is one potential solution.
Cloud offers a lot of efficiencies but there is also a great responsibility on the part of cloud providers when it comes to security. Walking through a hospital you can see medical devices with varying levels of cyber posture sharing information with other devices. Should that all go to the cloud? Protecting the security of all of those devices is critical.
Talk to Us About Interoperability
One example that comes to mind is the work we are doing to support the DoD and the VA in delivering a fully integrated Healthcare delivery system – MHS GENESIS. The terms interoperable and integrated are often used interchangeably, but they are two completely different concepts. People talk about data sharing between the DoD and VA in terms of interoperability, but really the goal is to establish a single, integrated system for both agencies. You don’t have two different systems talking to one another, you have a single, integrated electronic health record. The role of the public, of Congress and the DoD’s Defense Healthcare Management Systems Modernization (DHMSM) Program Executive Office should be holding teams to that, enforcing the idea of maintaining the same system, of not deviating away from that.
One the challenges we face in deploying the MHS GENESIS system is ensuring that interfaces outside of the system are fully interoperable to ensure a smooth user experience for both the patient and the clinicians and providers delivering care. On the innovation side, advancements of standards have allowed for a better exchange of data, but we still see silos in technology vendors and that isn’t practical. We need innovative thinking in terms of developing interoperable solutions between these divergent systems.
Tell us About Some of the Challenges
Advancement has to be configured for unique medical requirements but based on technology that has been proven to work. DHA has stood tall to ensure consistency, to say they will not meet a different standard here compared with there. Instead, DHA chose to set the same standard of care for every member before they automated – and it should be noted that in the commercial world they do not do what DoD does regarding setting standards of care prior to implementation. DHA achieved the heaviest lift I have seen on schedule and budget. It was a move that was both brave and important. That presents huge change management challenges however. That human side remains the biggest challenge.
It has been proven that the technology can be installed. What we need now is to do it faster and better, more securely.
Tell Us About Leidos in Terms of Focus and Collaboration
We are very deliberate at setting dates, times and meetings to think about future strategies of business and innovative thinking. We are always thinking in the context of our customers and what more we can bring to help them meet their mission. Our investment in QTC Medical Services increased by 20x the number of cases that can be auto-established compared with manually-established using data intelligence. Part of our mission is to reinvest part of our earnings to better support our clients, through technology, through new and better portals and so on.
In terms of collaboration, we are equally deliberate and focused. As part of our Leidos Partnership for Defense Health, which includes Cerner, Accenture, Henry Schein One, and dozens of other business partners with equally meaningful roles, we maintain a relationship that is professional and collegial. We are committed to communication that is frequent and recurring to ensure we are all moving forward on the same path and toward the same goal of easing the burden for DoD and taking on what we can.
We may not be the surgeons who hold the scalpel or the caregiver to put a cold compress on the patient but there are many of us who have served and whose kids have been born into the system we are now working in, whether it be DoD or VA, from the view of FDA and the food and medicines it protects, the Government Healthcare through Medicare or Social Security. In many ways, working in this industry, we are participating in the caregiving process. We should all look in the mirror and recognize that this is a great time to be involved and a great day for being a caregiver!
About Jonathan Scholl
Jonathan W. Scholl currently serves as President of the Health Group and is responsible for leading several thousand employees providing services and solutions in health information technology, population health risk management and case management, health analytics, life sciences, and public health. Prior to joining Leidos in 2015, Scholl served as Chief Strategy Officer for Texas Health Resources (THR), one of the largest non-profit Healthcare delivery systems in the country. At THR, Scholl led strategy, business development, strategic marketing, and oversaw operations for physician joint-ventures. Before THR, Scholl was a Partner and Managing Director with The Boston Consulting Group, where he spent 15 years. At BCG, Scholl worked in a number of industries including health, information technology, financial services, consumer products, telecom, and ultimately serving as Head of the North American Healthcare Provider practice. Prior, Scholl served as Vice President for Applications Development for the TenFold Healthcare Group, building large-scale mission critical software products in the health industry, and worked for Octel Communications in manufacturing immediately after leaving the Naval Service.