Design Everything: Conversations with Jay Parkinson, MD (Part 2)

Jay Parkinson, MD is the Chief Designer at Crossover Health. In the first post of our interview series with Jay, he spoke about the changing expectations of patients, and how in response, healthcare needs to be digital. In this post, he talks about the impact of this on practice, on providers, and what he where he wants to see primary care evolve to include smart transactions.

We spoke about the changing nature and expectations of communication in healthcare. How does this change the design of the practice?

All of the technology in healthcare is designed around the office visit. It’s not set up for an email thread, that kicks off some project management, that results in real time chats. For example, let’s say that right now you have pneumonia.  The “urgent care generation” heads to the urgent care center, gets a diagnosis and some medication, and leaves with the orders to follow up with their primary care physician (which is booked out for the next 3+ weeks). But aside from the acute lung infection situation, there is  a lot of life that happens in the moments and days between diagnosis and recovery, which leads to a lot of questions. We need to have an entire process designed to capture that complete experience, the needs it creates, and all those “in between” care moments.

In the case of the pneumonia, it needs to be treated as a “project” that is managed over time, in a structured way.  As a physician, I must look at that project and see: 1) what are the moving parts, 2) what’s the status of each, 3) how often do I need to communicate, and 4) how do I steadily march towards completion and resolution. We’re building a platform from the ground up to power a seamless digital and physical experience which supports this multi-channel approach, and captures all the “in betweens”. That means you might be talking to or messaging your doctor online, and they may decide you need to be seen in person in one of their centers. That online conversation is immediately accessible to the care team in the center, so when you arrive, you just pick up the care conversation where you left off, only now, it’s in person. The conversation is the documentation. 

The business model of Crossover unlocks rational care. Once you have a business model that supports doing the right thing, as opposed to the most things, you start doing that right thing. And now, the right thing is to communicate and problem-solve creatively, and digitally, using all the tools available.

Are physicians ready for this?

It’s funny, as a doctor, you find yourself doing the same thing over and over. For example, you see a couple of patients a day with abdominal pain. You ask the same questions, over and over, and the patient has to sit back and fire responses at you without even having the opportunity to think. What if we automated that back and forth instead, and asked a standardized set of questions? It would free up hours per day, enabling both patients and doctors to have more meaningful communication, and a better overall conversation.

I think a certain percentage of doctors are absolutely ready and willing to shift how they communicate. It’s not every one of them, and that’s okay. This is a massive change in healthcare—and it takes typically 15 years for evidence-based changes to percolate through a physician community and become best practice. Really, you just need a small percentage of docs who are thinking the same way; people who acknowledge that healthcare is broken and there’s got to be a better way to do this. So yeah, a lot of doctors are reaching out and saying, “my day to day is terrible, I don’t have enough time with my patients”. All you have to do is show them the way to redesign how they spend their time, and they’re ready and willing to change.

Where would you place your energies next?

Well, once we’ve fixed the doctor-patient communication and built trust, I’d look at the doctor’s place in the value chain. I’ve always thought that the doctor is the real consumer of healthcare. They’re the ones writing the orders, the patient just pay the bills. The physician is actually the consumer, or maybe more descriptively the physician is the personal health shopper and the patient just pays the bills. Physicians need to know who is affected by what they order, that the product will be effective, the relative cost—and the entire transaction should be online. 

The last piece—the online transaction—is significant. In healthcare, the doctor’s order is just some abstract thing that happens in the EMR. It’s got no intelligence around it, and no monetary value. We need to start looking at a doctor’s order as a smart, online transaction. The order can be the catalyst for a flurry of behind-the-scenes costs, so we need to ensure that the are as cost-effective and efficient as possible.  

Can you give an example?

What if a doctor could price shop before they write an order? If they could compare options, and see that a brain MRI at one location is $700, and it’s $4,000 at another, maybe it would eliminate the split-second, blind ordering that happens today. That cost difference buys a lot of primary care for people. Rather than referring patients to a golf buddy, or someone they know from the hospital, they could be ordering in a much more intelligent—and patient-centric—manner. 

Come to think of it—why are the physicians the ones writing orders at all? Unless it’s a very rare situation, why should the doctor be the one to decide where a patient gets that brain MRI done? Why can’t a care navigator come in, wrap their arms around that patient and that order and say, “Based on the data and the quality metrics, you should get it done here, rather than there. And? It just so happens to be $3,000 cheaper.” I like to think of that order being put into a type of purgatory—until it can be made intelligent based on measured data, and then it gets executed.

What was in the Crossover DNA that made them the right partner for you?

To me, a company is just a group of people with a shared vision and mission. That’s what attracted me—it’s the people that were not just passionate with ideas, but also had the skills to execute them. Combine that with the business model that unlocks rational care, and a leadership team that clearly sees the opportunity to combine online and physical experiences. It was really a no-brainer.

What is your role as Chief Designer at Crossover Health?

To me, design is a process. If you don’t design a process, you’re going to get something and that’s typically what healthcare looks like right now. But if you sit back and say, what’s the process of care delivery, and then you map it out, study each step, and ask: Does this step need to be here? Can we automate this? Can we make this error-proof? That’s when you start seeing progress in the process. When we design each step, and then design the technology to support each step, we start seeing a more fluid progression, and that is what will make life much simpler for both doctors and patients. That’s really what I’m focused on here.

So how does it feel going from a Williamsburg hipster to a SoCal surfer dude?

Being a midwestern boy, I’m terrified of the ocean, so the surfer statement is a bit of a misnomer. But I’m really loving California right now. I’ve never lived in the area, and it’s just out of control beautiful. New York had its time and place in my life. It’s a very transient city, so it’s been nice to see a real community here in SoCal, where I actually meet and get to know my neighbors, and enjoy all the activities that a beach town has to offer. It’s just been a blast!

Many thanks to Jay for taking the time to be interviewed, the Crossover Creative team for putting together the video, and for Peter Heywood (one of our long-standing brand advisors and business consultants) who helped conduct these interviews.