What Higher Ed Can Learn from Healthcare

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Southern New Hampshire University
Office of the President
1230 Elm St, Manchester, NH 03101
December 2017

What Higher Ed Can Learn from Healthcare? - Transcript of Podcast Interview with Kevin Fickenscher
The following is an edited and adapted transcript of this episode.
Brian Fleming:
Hello, everybody, and thank you for listening to this episode of Thinking Outside the Sandbox. My name is Brian Fleming, executive director for the Sandbox here at SNHU, and today we have the privilege of sitting down with Kevin Fickenscher, president and CEO of CREO Solutions, a consulting firm that focuses on leadership and strategy. Kevin, thank you so much for connecting with us and taking the time to talk.
Kevin Fickenscher:
My pleasure to be with you.
Brian:
Kevin, before we jump into some more specific questions, can you tell us a bit about your background and what is CREO Solutions? What kind of work do you all do?
Kevin:
I'm a family physician originally, and I practiced for about a decade back in North Dakota where I grew up. That's where I first got interested in the use of technology for delivering health care services. I then moved into more mainstream management. I was the chief medical officer for a couple of the largest health care systems in the country, one of which was Dignity Healthcare on the West Coast. I was there during the period of the dot-com era, and I had dot-com fever like everybody who lived in San Francisco. I started my own little company, which became a part of another company that merged in with WebMD. I ended up being the chief medical officer for WebMD, which is what took me into the technology field.
From there, I worked in consulting, worked for Ross Perot for a long time. I led his consulting practice. I was the lead for international health care and lived in London, took us into the Middle East, China, India, etc. And then returned home about a decade ago when Barack Obama was elected president and have beendoing consulting and a variety of work related to the use of technology in actually delivering care. I refer to it as telecare because it's actually using the technology to deliver care. I've also been involved in leadership development and strategy work for health care systems.
Brian:
In health care, just like any industry, there has been a "digital revolution," new tools and technologies that have continued to disrupt and change and challenge the industry. Could you talk to us of your observations as you have seen health care continue to go increasingly digital?
Kevin:
I really do fundamentally believe that we're at a very interesting point in the history of mankind. If we think back about all the changes that have occurred in society, we had the Neolithic period that occurred about 15,000 - 20,000 years ago. It lasted for several thousand years. It moved us from being nomadic peoples into being tribal and setting up communities. We then had the industrial revolution, which really moved us from an agrarian society to more of an urban society. And now we have the information revolution, which is upon us, and it's fundamentally changing the whole notion of how, where and who delivers all sorts of services. It's affected literally every industry, manufacturing, logistics, news, media, travel, aviation and it hasn't affected health care in the same way, but it is on the cusp of doing that.
By the way, I should point out the Neolithic period occurred over several millennia. The industrial revolution occurred over a couple of centuries. The information revolution is going to occur over a period of maybe 20 - 30 years. We're in the latter part of that revolution, from my perspective. And so, over the coming decade, I think we're going to see some very dramatic changes in how health care is delivered, who is delivering it, and the tools that are going to be used in supporting it.
Brian:
Just to focus the conversation for a moment on education, imagine yourself talking to education leaders who have had very little engagement outside of our own industry, what do you think is important for us to understand about trends and innovations in health care particularly around digital?
Kevin:
I'm very involved in the education front, as well. I sit on the board of directors of Fielding Graduate University, which is one of the first universities to engage in a more virtual education. We're very cognizant of that issue. As a matter of fact, one of the things that I believe is happening in the education field, along with health care, is that we're the two industries that have sort of lagged behind other industries in terms of changes. I think that education is going to face the same issues.
One of the examples that I use is that I know for a fact that there is some person going to medical school, probably in Africa, who's not going to medical school. What I mean by that is literally the entire curriculum for any number of medical schools is available online. As a very energetic individual, I could go online, I could look at that curriculum, I could find all of the materials to support the education in either anatomy, physiology, chemistry, microbiology, etc, and I could start to go to medical school. The part that I might be missing is the clinical experience, but I would have a lot of the basic sciences available to me online.
The whole notion that you have to go to a place to get your education I think is changing, number one. The whole notion that it's going to be some professor that is trying to get his Nobel Prize is going to be your teacher is changing. I think our whole notion of what it means to be educated is changing. I would also argue that in the world that we're facing that education is not a static experience. It's not something that we get, and we have a degree and that's it. It is very much a continuous process. I know that as a physician, trying to keep up in the literature with the latest ideas, the latest changes, the latest revelations that have occurred is extremely difficult, and I think that applies to education, as well. I think, from my perspective at least, we're undergoing a very dramatic shift in how, where and who is going to be delivering education services as much as health care.
Brian:
When we think about that shift, I think that puts new pressures on higher education to think about itself perhaps in ways that it hasn't. How have you seen that happen within health care? Can you try to help us understand what some of that shift looks like from the health care side, as well?
Kevin:
Well, let's look at it first of all from the standpoint of the patient, and then let's look at it from the standpoint of the profession. From the patient's side, if we ratchet back 30 years, literally the way a patient was cared for is that they had to physically go to a place generally called a clinic or a hospital or an emergency room. They had to be seen by the people that were there to take care of them, the nurses, the pharmacists, the physicians, etc. And they were evaluated. All sorts of tests were done. Data was gathered, frequently on paper, and that was put together. A lot of times some of the data was missing when it came time for the physician to look at the information, but we did a pretty good job and we managed care and people got better as we took care of them.
Now, ratchet forward 30 years and I can tell you that, for example, if we take the problem of congestive heart failure, which is the most common admission into a hospital in the United States, that literally there are four stages of congestive heart failure. There's stage one, two, three and four. For literally stages one and two, I can manage those problems at home. They don't need to come to the clinic. They don't need to come to the ER or the hospital.
How do I do that? Well, every morning when a patient gets up, they step on a scale, they step off. When they step off, the data goes into a computer system in the cloud. They then take a little device about the size of quarter, maybe three time thicker than a quarter, they squeeze it, they hold it for 10 seconds. As a result of that, we get a one-lead EKG, we get an oxygen saturation level, and we get a pulse. There's now a new device that you put on the chest that's like a Band-Aid and it gathers electrolytes. Electrolytes are like your potassium, your sodium, your carbon dioxide levels, etc. With that information, I can basically manage stage one and two congestive heart failure. I know when people are getting worse as a result of looking at those parameters, and then talking with the individual over the phone. That is a radically different approach than what we did 30 years ago where those people ended up coming into the hospital, being taken care of, etc.
In the same manner, the professions have also been challenged in that the question becomes who can provide that service? If we have tools, I refer to them as clinically augmented intelligence tools, computers, that provide guidance and help us ferret information and go through the protocols and say, "This particular patient really, given their history, is more at risk of going into stage three than another person. Therefore, we need to be more aggressive in our treatment. Let's send out the home health nurse to do a physical visit." But it's a home health nurse going out to the home to do a visit rather than trying to drag the patient into the clinic to see a physician, and then having that home health nurse interact with the physician. So who's delivering the care is changing.
Now, as a result of that, we're seeing changes in the professions and the challenges. Much of the discussion in health care is around the notion of how do we get people to practice at the top of their license, in other words at their maximum capability? It’s very clear that a nurse practitioner using guidelines and protocols can perform about 90% of what a family physician does. It's the 10% is the difference between a nurse practitioner and a family physician. That is a margin that's getting smaller and smaller. Those are some of the challenges that we face. I think on the personal side, there's an increasing expectation of being able to give services in the home, in the environment that they want. Then, on the professional side, we're seeing a change in the pressures, if you will, or the challenges, if you will, of what it means to be a doctor, to be a nurse, to be a nurse practitioner, etc. I would imagine that the same thing applies to education, as well.
I was talking with a young woman that I go to church with and she's enrolled in her PhD program on a virtual basis. She's studying ecology. She did all this search. She decided that she didn't want to move from Maine and she enrolled in her program and she's very happy. She's studying turtles and all sorts of interesting things. That wouldn't have been possible even 10 years ago. The question is who is involved in teaching her about turtles? She's finding professors all over the country that are involved in performing that. She's doing her education on a virtual basis, but she's reaching out to other people who can also help her with her PhD thesis, as an example.
Brian:
Along those lines, I think there's also now this emerging space of using AR and VR and IOT sensors, etc. What are you seeing happening around some of these more cutting edge, almost futurist types of tools and technologies?
Kevin:
Sure. Let me give an example. I've done some work with MITRE Corporation, which is a company that provides research services to the federal government. One of the projects that they were involved in is a project for the Veterans Administration where over the course of 18 months we captured the data of experts in PTSD, post-traumatic stress syndrome, and individuals who had PTSD. By capturing that audio information only, we were able to teach the computer how to diagnose PTSD as well as the experts with a 95% concurrence rate. What that means is that the computer was as effective, essentially, as the experts, which means that they were far better than a general practitioner out in the field. The computer is better at diagnosing PTSD than just your average person who doesn't have much experience in working in the field.
What was interesting is that the computer actually got better at predicting those individuals that were at risk of committing suicide, which is a very powerful tool. That's the kind of tool that I refer to as a clinically augmented intelligence tool. It is a tool that really says, "Hey, Dr. Fickenscher, based on the audio conversations, have you thought about depression on this patient? Have you thought about early stage Parkinson's disease?" There's any number of problems that could be cued up, if you will, by audio.
Adding that kind of skill or that kind of capability to things like virtual reality I think is very exciting, but I think we're at the very formative stages of things like virtual reality. It's just coming to the forefront now, and how that is going to be used I don't think we have a lot of clarity at this point. There's a lot of experimentation with the tool, but I don't think that it's actually being used in clinical settings at this point.
Brian:
I know in higher ed we're familiar with a lot of these emerging technologies I think that there's a growing sentiment within higher ed that we are to look to other industries like health care to see how the tools are used.
Kevin:
Can I just jump in on that, Brian.
Kevin:
I think that every university should have a cohort of people whose function it is to be constantly surveilling the environment on the technologies that could potentially affect their approach towards education. That is an essential function. Now, I don't necessarily believe that has to be done by each university on its own. I actually believe it would be better if a couple of like-minded universities got together and said, "We're going to create a collaborative to do this environmental scanning." And the reason I suggest that as a strategic initiative is that innovation in technology is changing so very rapidly that it's really hard to keep up. Assigning four or five people to the project is insufficient to keep track of all of the changes that are occurring in the technology front. I just wanted to put that in. 
Brian:
That raises a question that I think a lot of educators ask and is on the skills side, what is the world that we're training our students for? If we think about students that are going into health care, medicine and allied health, etc, but I think just more broadly as we think about a world where these technologies such as AR and VR and augmented intelligence are more prevalent, what should we be doing and where are there potentially gaps in our current education and training model?
Kevin:
Well, I think that at the outset, from a foundational standpoint, we need to be teaching people to be continuous learners. I have to say, at least in my personal experience, I don't think that was necessarily the focus of my education historically. Now, maybe things have changed in universities, but I don't think so. A lot of the focus is around the endpoint of getting a degree, completing a thesis. These are endpoints and they're sort of like, "Oh, I did it." Well, no, you're just starting, would be my argument. So continuous learning and learning how to learn continuously and learning how to sift through the plethora of information that is becoming available and trying to figure out. For example, given all the stuff that we've experienced over the last couple years with the internet and the reliability of information that's out there, how does one sift through that information? How does one make a determination on whether on some piece of information is accurate or not? Those are the critical kinds of skills that are going to be important.
I would also argue, at least in the health care space, that we need to be thinking about how do we train and support people to become what I call health care virtualists? What I mean by that is somebody that doesn't necessarily physically touch the patient, but is looking at data about the patient, is probably talking to the patient, is looking at physiologic parameters of the patient and having a totally different interaction with an individual on a virtual basis. I would argue that it takes a different set of skills, a different set of sensitivities, a different sieve, if you will, of looking at the data to be a good virtualist than it does to be somebody sitting in a room with a patient.
Brian:
One of the natural questions that often comes up is does this signal a loss of jobs? Does this signal a gain in jobs? I think a lot of the research that I've seen suggests that in this new era of digital and virtual, there will in fact be more jobs. It's just that the skills and the competencies needed to do those jobs change.
Kevin:
Absolutely.
Brian:
Are the robots eating everybody's jobs or are they just changing our jobs?
Kevin:
Oh, I just think they're changing our jobs. As a matter of fact, I was on a panel here a couple weeks ago and I made a fairly provocative statement. I said that family physicians, if they don't embrace the changes that are occurring around things like virtualist care, the family physicians will become the coal miners of health care in the next decade. What I meant by that is that I think it's disingenuous to suggest that coal mining is going to come back, from my perspective. Rather, what we need to be doing is taking those individuals and giving them new skills, new knowledge, new capabilities, new talents, new professions. That's part of what I think is going to be occurring. I think we're going to see a dramatic increase to the number of jobs because mining data is actually more difficult, in some respects, than mining physical coal, as an example.
Brian:
Along those lines, is what is your recommendation for education circles? What do we do about this? What is our mandate moving forward?
Kevin:
I think that there is a need for universities to move beyond the physical parameters of their institutions and start to think about how they could collaborate with other like-minded institutions, because the sum is greater than the parts would be my argument. That's one. I also think we need to be rethinking how we even educate our educators, along the lines of what I was talking about with the virtualist health care providers. What about the virtualist educators? I think it takes a certain new set of skills, a new set of capabilities to be able to be an effective teacher of students on a virtual basis. And yet, I don't think there's that much focus on that aspect in higher education, at least I haven't seen it.
I do believe, also, for example there are a lot of very interesting higher education institutions particularly at the undergraduate level that have provided very innovative undergraduate educational experiences for their students. I'm thinking of some of the small colleges. And they're really struggling. I think they need to think about how they can come together and figure out how they can reduce their cost by sharing some of the back-end capabilities so that the front end is sustained and is stronger.
Brian:
As a final question, and we ask this often with folks on this podcast, as you look out to the future are you hopeful? Are you optimistic? Are you concerned? What are your thoughts?
Kevin:
When I was admitted to medical school, one of the requirements at the University of North Dakota Medical School is that everybody was required to take the MMPI, the Minnesota Multiphasic Inventory. I remember at the admissions committee when we were being asked our questions, the psychologist who was the person who evaluated everybody said, "Kevin, it's very clear that you look at the world with rose-tinted glasses." And I continue to do that. I mean, I'm a very optimistic person. I really have embraced technology because I think that it is at the core of what medicine really is all about. When you stop and think about medicine, literally for the last 300, 400, 500 years, medicine has been at the forefront of adopting new technologies, whether it's the stethoscope or ultrasound or radiology or antiseptic capabilities, etc. I mean, all of those were "new technologies" at the time. I think we're facing the same thing now, so I'm actually very optimistic.
Brian:
Thank you so much for speaking with us, Kevin. Really appreciate you taking the time.
Kevin:
My pleasure, Brian.