Design Everything: Conversations with Jay Parkinson, MD (Part 1)

Jay Parkinson, MD joined Crossover earlier this year as our Chief Designer after we acquired his groundbreaking virtual primary care technology in February 2019. I’m sure a lot of you have met Jay, read his prolific writings, followed him on Twitter, or seen him keenly engage audiences over the years. He first rose to prominence in 2007, when he launched a virtual practice in Brooklyn which upended so many of the conventions of primary care that still, maybe not surprisingly, hold true today. Things like the misplaced focus on the “visit”, the poor integration of technology into clinical practice, and more generally, the transactional treatment of patients. Jay expanded on these ideas with Sherpaa Health, moving the first (and often only) point of contact online, hugely enhancing access and simplifying the experience for patients. Sherpaa shares with other great technological advances an incredibly seamless and elegant front-end experience, supported almost invisibly by a lot of technology, smart workflows, and hard work. 

We are thrilled to bring his expertise onboard and look forward to the way his learnings will accelerate our efforts in bringing forward the Connected System of Health. Jay joined the team to help us realize our shared vision of how healthcare should be—what it must be—to ensure it is affordable, engaging, and relevant. He’s in charge of mapping out and delivering the full-stack approach to our offering, fully leveraging Service Design principles and processes. Jay sat down with Peter Heywood a few weeks ago to share some (and believe me, these are just some) of his thoughts. This is the first of two posts, where he talks about what he learned at Sherpaa, and where clinical practice is heading in this Digital-First era.

What’s your biggest aspiration for healthcare?

Whenever you see the jobs report coming out from the federal government, healthcare is always in a huge boom. We’re hiring people like there’s no tomorrow and we’re hiring those people because our processes are becoming more and more complex. But we’re going to reach a point where adding people creates no new value; rather, it just maintains the complexity. Really, what I want to say is this: “How can we get 2x the efficiency and better NPS scores with half the people? How do you maintain the humanity of good, old-fashioned healthcare in a world that could be made more efficient through technology and a redesigned process?”

What were your biggest takeaways from the Sherpaa experience?

The biggest takeaway from Sherpaa for me was that 70% of things never need to happen in person. We collected that data point from day one. That means that 70% of all of the visits that are happening out in the wild, in all the doctors’ offices, urgent care centers, and ER’s simply don’t need to happen. What if we could free up 70% of those appointments and give that time back to the doctors so they can spend it doing other, or more meaningful work? That to me is just huge. 

What do you think you were missing?

There are companies out there like Warby Parker that are born on the internet, so they design their experience around the internet. They then come to the realization that physical stores are important to the process as well, so they start building physical stores. It’s interesting because that’s how I’ve been thinking about what we’re doing at Crossover. Sherpaa was, in many ways, a practice born on the internet. However, it had limitations. Whenever I do need to have a patient be seen in person, I had to send them to a PCP (that was typically booked out for weeks), or I had to send them to an urgent care center. The ability to have this Digital-First experience that can then be converted into physical visit, is really everything. That’s what healthcare is at Crossover, a combination of online and in-person.

How will behaviors shift so that people prefer interacting in a “Digital-First” way?

I think it’s kind of an assumption that people prefer the office visit. Nobody’s ever given them anything else, so right now across America, across the world, really, the primary means of communicating and problem solving is still the office visit. We’re just saying that this really needs to change. We are going to try to give folks something else. What people prefer is someone who is genuinely concerned, cares about them, and can communicate with them in many different ways. Sometimes it’s looking in your eyes and putting a hand on your shoulder to comfort you; other times it’s just “I’m here for you” at 6PM when you’re freaking out; or, it’s just knowing you need a phone call or a message sent back to you.

For a patient, it’s all about immediacy, not a visit. You can fire up Lyft and get a driver here in about 3 minutes. In healthcare, it’s days to weeks to months to get a visit. People are becoming used to getting what they need fast, so that’s how we’re designing our process here at Crossover. We are basically responding to that need by saying, instead of waiting 24-48 hours for an oral conversation to happen in a clinic, we will respond to you in 15 minutes. That way, you’re not sitting at your desk trying to work while totally distracted by that weird headache you think is something serious (and likely isn’t).

Is it then really just about immediacy?

Well, to me, the most significant thing in humankind for centuries has been how we communicate. So much of it today is asynchronous. It’s me synchronously communicating with you, but it’s also me asynchronously getting things done like calling a Lyft. That to me is just as important as the printing press.

Crossover was always focused on a physical visit, and they’ve dabbled in video visits, but what’s interesting is that no matter where you have an oral conversation, there’s really no efficiency gained. The only way I can make a doctor more efficient is by reducing the amount of time they see a patient. Bringing asynchronous processes to Crossover allows us to standardize how we ask questions and create care plans, so that doctors can focus less on the mundane, repetitive things and more on the human to human connection and the issues and conversations that really matter. Primary care is all about communication. It’s just two people talking, two people connecting. If I can make that communication far more efficient, so that everyone has a better understanding of the situation, gaps in care should be significantly decreased.

You know, it’s interesting, one stat I learned early in my post-residency career is that good research showed that people forget 85% of what their doctor said in the oral conversation, which means I’m only 15% good at communicating with my patients. They typically hear what’s scariest to them, or they hear what they want to hear. So converting the oral conversation into a primarily written format makes me markedly more effective, because a patient can log in and read the entire thread after the visit, at their own pace, anytime they want. And if that thread includes all of the conversations that take place in between the actual in person visits, then it provides the patient and the provider an even more complete picture.

So it’s not just a digital model?

Of course not. It just knowing when to be in person. People definitely don’t want to go in and talk to the doctor if they don’t need to. People are living their lives, they have jobs, they have families—why do you want to waste two hours of your life just to have a two-minute conversation? 

Sometimes, however, in person is entirely necessary and crucial for the relationship. You just use the right tool for the problem, every single time. For sure, if it’s a highly-emotional situation, you’ve got to look them in the eyes. But if it’s a “Here are your test results and what they mean” and they’re not super significant to the patient, don’t physically bring them back into the office. We have that luxury here at Crossover because we’re just paid in a different way, so we can do the right thing, the rational thing, every time. 

To see the rest of the interview, please jump to Jay Parkinson, MD Interview Part 2