Neil Jordan has had a front row seat to the changing role of tech and consumer-focused initiatives in healthcare. For nine years he served as Microsoft’s efforts in this space as the general manager of health for Microsoft Worldwide Public Sector, and much more recently stepped into the role of its general manager for retail health innovation. Here, he’s looking to grapple with the growing trend of healthcare consumerism as big-name retailers like CVS, Walgreens Boots and CVS are using tech to offer patients a new avenue into care.
Jordan took to the Connected Health Conference main stage this morning with HIMSS Chief Technology and Innovation Officer Steve Wretling to answer a battery of rapid-fire questions regarding his top-level views on where retail brands fall within the digital health landscape, as well as a handful of deeper dives on Microsoft’s role in that market, pragmatic implementations and data curation.
The below Q&A has been edited for brevity.
Wretling: Do you prefer the term consumer or patient?
Jordan: Easy — consumer. There’s a great article by a guy called David Champeaux on LinkedIn, if you ever want to read his reasoning. He says 1% patient, 99% consumer. Love it.
Wretling: Biggest barrier to adoption?
Jordan: I’m going to answer it broadly and say fear. I think there’s a lot of people who think disruption has a negative connotation, but I think it’s actually an opportunity to work in partnership [with] providers and payers in the community, and make a synergistic relationship.
Wretling: Have you ever participated in a virtual visit?
Jordan: Yes, multiple times, and they are great as long as they are connected to the rest of the health system. They are not great if they exist in a silo.
Wretling: Big data or small data?
Jordan: Both, and always interoperable. We’re doing a lot of work around FHIR in that space too.
Wretling: Favorite health app?
A: Actually, to me, it’s never about the app. It’s about the experience. [I have] a Motiv Ring, if anyone’s seen that device before. I like that because of the way it works with the app.
Wretling: Other than consumers, who is your biggest stakeholder? Provider, payer, digital, regulators?
Jordan: Regulators, because there are a lot of regulations that need to be updated around many things, particularly in the States. And then also startups — there are some really fantastic new technologies that are coming into the space because a lot of the systems that we’ve traditionally built are not serving some of the new experiences [startups] are trying to make.
Wretling: What are you most excited about in digital health?
Jordan: I’m really excited about the opportunity to shift the focus and truly start to get to this idea of knowing and understanding the consumer in a personal way. I’ve always said that … the idea of personalized health is not just about understanding someone genomically and phenotypically, but actually understanding all of the other life habits and behaviors that they have that affects how well they do or do not work inside the health system.
Wretling: If you could change one thing in healthcare today, what would it be?
Jordan: In the digital health realm, there’s still too much belief that digital health means deploying the latest and greatest system of record … and once we’ve done that, we’re done. These things are important for that foundation and all, but the real focus needs to be on the systems of engagement and the systems of insight that enable us to derive value from all that data that’s being collected.
Wretling: Disruptors or disruptions to keep an eye on?
Jordan: This disruption term — I just think we have to be careful about that mindset that says disruption equals something is going to disrupt me, and that is bad.
But I actually love a lot of the smaller retail clinics and what they’re doing. I think what Forward is doing in this space is really, really interesting. I strongly think that if you just pick up the current primary care environment and drop it into a Walgreens or a Walmart or whatever, we’re not necessarily making much change. I think the way that someone like Forward, or Babylon in the UK, has really thought [about] and changed the experience I think is actually going to be very positive, and again I think it’s a disruption that we should embrace and that we shouldn’t be fearful of.
Wretling: What do you think the least recognized change agent in healthcare is?
Jordan: I’m going to say nurses. Underserved, under-recognized in terms of their roles and, again, when you look to the capability of what we can do in the retail health world, so much of that can be done with nurses and nurse practitioners. They just hold such an important part whether in the clinic or the home or of course the hospital, but they’re such an important part in the process.
Wretling: In terms of priorities, how do you view innovation versus pragmatic implementation in the digital health space?
Jordan: I think the two actually are really married together. I think there’s a lot of innovation that has to happen around the pragmatic application of technologies as well. You look at the basic bar around security and management of data and privacy, I think there’s actually a lot of innovation that could be brought both to the thinking around that and the template-izing of how that gets done. I also think … there’s a lot of work that can be done, and needs to be done, in really, really understanding the consumer. … We know that a lot of the problem in the system is the level of adherence to prevention are not where they need to be. And we also know in our experience in Microsoft with Healthvault, we discovered quite how little the average consumer cares about their healthcare record and that level of engagement. Therefore, I think there’s a lot of innovation that’s needed not just on the clinical data but on the logistical navigation around the system.
Finally, I think there will also be what I’ll call marketplaces and exchanges of patient data — if you’ve read the book '21 Lessons for the 21st Century' by Yuval Noah Harari, he talks about the fact that the currency of the future is actually going to be data, and the market for that will be very much personally owned. I think if you can get the right incentives back to the individual for giving up their data — not just their clinical data — and benefitting them as part of that and also building trust with them, then I think there will be this combination of innovation and pragmatism combined.
Wretling: What role will educating patients have in stimulating that?
Jordan: Massive. I think education is a loaded word, it implies that I know things and you don’t know things right? I think a lot of the stimulation comes out of not just education but behaviorally understanding, motivating, and through that educating and nurturing the patients. A lot has been written around that.
Wretling: Stepping back, how would you describe Microsoft’s strategy in health today?
Jordan: The broad strategy is in three things: What can we do to help people get better value out of data, what can we do to make tools that make data much more accessible, interoperable, compliant and private? Huge amounts of work in that space just in the basic cloud systems to enable much easier work, and it’s great to work with the Googles and the Amazons, AWS specifically, and Salesforce, IBM, other people to create as much liquidity and fluidity inside this packet of compliance and private data.
Number two is put tools in place to help care workers. A lot of the work we’re doing to build healthcare-specific extensions to things like Teams, things like Dynamics, to assist with care coordination are really important. There’s actually an announcement going out today … specific around the use of voice AI and ambient computing technology. We’re partnering with a major force in this area to enable much easier understanding of the verbal communication between a physician or somebody in a call center, and a patient.
And number three is really setting the basis for precision medicine … and not just around data and AI. We recently did a massive partnership with an organization called Adaptive Biotechnologies that’s doing work in the immunomics and antigen space, and really trying to, again, advance in partnerships with a lot of people who are out there this dream we have around truly understanding the individual at the omic level.
Wretling: On this topic of data and topic of trustworthiness, the patient and physician bond is so key that trust is built into the care process. There’s this element needed around a trust framework — what are your thoughts around what that means and what it should be?
Jordan: My first comment is that you only get to blow trust once, you only get to get it wrong once. There’s good reasons to be thoughtful if not cautious around this — we’ve actually built a whole kind of trust and ethics framework that we’ve published externally around here. What does the health system look like in 2020, and what are the things we need to look towards to really understand trust?
Number two, I’d say that the relationship between the caregiver, provider and patient in this case is one of the most trusted elements out there. To go back to the retailer side of things, I think the smart retailers are understanding that and using [it] in a positive way — working with providers in the community, to become part of that trust circle, using the brand to do that rather than actively competing.
Finally, from a technical perspective, at Microsoft we have a kind of trust and ethics board in terms of healthcare [on] not just what computing can do but what it should do. Brad Smith, who’s our chief council, just wrote a book called Tools and Weapons, which is really about understanding not just in healthcare but beyond that what the underlying capabilities of technology are, getting more transparent about that. It’s only two years since the Cambridge Analytica thing really hit the news. In a different space, but the collective consciousness of our understanding how data is and is not being used is getting more in the public eye. I was with Kroger recently … and getting in the healthcare thing, they think food is medicine. And what’s really interesting in their work is how much information the consumer is actually willing to give up if they’re very clear about how that data is being used and not being used. So that transparency, that clarity and simplification of how the data gets used inside these very complex circulations, I think, is going to be critical to build trust.
Wretling: Where do you see the market in 10 years?
Jordan: I’ll start with retail — I think retail will become, absolutely, a massive part of the world [of] the digital and physical frontend of healthcare because of their digital and physical proximity.
I think that the systems of record, particularly the EHR vendors, are going to have to make a massive shift into generating value through systems of engagement and systems of insight. And some of them are doing that, some of them will make it, some of them will not.
The provider world is going to [continue to be] both a physical incantation of itself, but also will have to become a digital [one] for all of their customers.
I think consumers will absolutely become the owners and aggregators of data, adn there will be whole marketplaces for that.
Pharma will become a much more signed up part of the value-based pricing of healthcare — they’re going to have to do that, there’s no choice about that.
And payers — for starters, what is a payer, what isn’t a payer, who is going to change? I won’t go into too much detail, but there are retailers that are absolutely going to end up being payers and will have their own payment models outside of traditional insurance models. That will absolutely happen, so payers are going to have to become a much stronger partner in the wellness side of healthcare.
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