Unlock the secrets behind the integration of artificial intelligence and automation in healthcare with Dr. Colin Banas, Chief Medical Officer of Dr First. This episode promises to enlighten you on how Dr First is revolutionizing intelligent medication management from its pioneering days in e-prescribing. Dr. Banas shares the crucial steps taken, including the acquisition of MindShift Technologies, to streamline the complexities of specialty medications and prior authorizations. Learn how these advancements reduce cognitive burdens on healthcare providers, improve medication safety, and enhance patient adherence, ultimately leading to better health outcomes.
Discover the transformative power of AI as we discuss its long-standing role in healthcare and its continuous evolution with technologies like robotic process automation (RPA). Dr. Banas explains how Dr First is leveraging RPA to automate mundane tasks, freeing up healthcare providers to focus on patient care. We also tackle the importance of human oversight to address patient-specific nuances, ensuring a balanced approach to tech-driven solutions. Hear about the extensive integration with over 270 EHRs and the unification of medical and pharmacy benefits, making healthcare more cohesive and accessible for patients. This episode is a deep dive into how cutting-edge technology is reshaping the healthcare landscape, benefiting both providers and patients alike.
Unlock the secrets behind the integration of artificial intelligence and automation in healthcare with Dr. Colin Banas, Chief Medical Officer of Dr First. This episode promises to enlighten you on how Dr First is revolutionizing intelligent medication management from its pioneering days in e-prescribing. Dr. Banas shares the crucial steps taken, including the acquisition of MindShift Technologies, to streamline the complexities of specialty medications and prior authorizations. Learn how these advancements reduce cognitive burdens on healthcare providers, improve medication safety, and enhance patient adherence, ultimately leading to better health outcomes.
Discover the transformative power of AI as we discuss its long-standing role in healthcare and its continuous evolution with technologies like robotic process automation (RPA). Dr. Banas explains how Dr First is leveraging RPA to automate mundane tasks, freeing up healthcare providers to focus on patient care. We also tackle the importance of human oversight to address patient-specific nuances, ensuring a balanced approach to tech-driven solutions. Hear about the extensive integration with over 270 EHRs and the unification of medical and pharmacy benefits, making healthcare more cohesive and accessible for patients. This episode is a deep dive into how cutting-edge technology is reshaping the healthcare landscape, benefiting both providers and patients alike.
More at https://linktr.ee/EvanKirstel
Speaker 1:
Hey everybody, happy Monday. It's Evan and Irma here from Avera Health. Today we have an important topic, fascinating guest around empowering patients and providers to achieve better health. Who couldn't want more than that Today with Dr First Colin, how are you?
Speaker 2:
Hey, hello everyone. Thank you for having me.
Speaker 1:
Well, thanks for being here, Thanks for the work you do. Let's, of course, start with introductions. Maybe introduce yourself and Dr First. What is the mission and the big idea?
Speaker 2:
Yeah, sure. So again Colin Banas. I am the chief medical officer for Dr First. So I am an internal medicine physician by training and previously a CMIO at a large academic health system, but joined Dr First over five years ago as their chief medical officer to help drive innovation and strategy. And for those who don't know and hopefully most folks do but Dr First is a 24-year-old company pioneering in what we call intelligent medication management. So the company actually started as an e-prescribing company back in the year 2000. So, but this is before meaningful use, before a large scale EHR adoption. They were leading the way in digital transmission of prescriptions. But over the course of two decades you can imagine that you are making a lot of connections with pharmacies, with payers, with providers, et cetera. And so from that platform of e-prescribing blossomed into an entire suite of solutions centered around intelligent medication management. So medication safety, medication adherence, removing the friction in the prescribing processes. So it's a pretty exciting time to be part of the company.
Speaker 3:
Oh, quite a history here, Pioneering technology back in, you know, decades ago. So moving on to more recent times. So Dr First recently acquired MindShift Technologies. Could you elaborate on the strategic reasons behind this acquisition and how it aligns with Dr First's long-term goals and mission?
Speaker 2:
Yeah, I think it's a perfect synergy. So the acquisition of MindShift is centered around the explosion in specialty medications. So obviously we all have seen it, we probably even experienced it the prescribing of specialty medications, and typically specialty meds, require additional steps in order to get our patients on therapy and keep them on therapy, typically in the form of prior authorizations and connecting patients with assistance programs and things of that nature. And so if you go to where the puck is heading, which is this explosion in specialty medications, you realize it would make a lot of sense to acquire technology and partner with folks who have a foothold in that space. And so MindShift is a AI-based technology that helps with the prior authorization process, and it does so in two realms actually.
Speaker 2:
So I think a lot of folks listening and watching are probably familiar with the pharmacy benefit of our insurance plans. So we go to the pharmacy, they run our insurance, they hand us our pills and out we go. That's the prescription, the pharmacy benefit. But there's also a lot of these specialty medications rely on the medical benefit. So and those are typically in the past medical benefit is things like your hospitalizations, your emergency department visits, et cetera. But now it's expanding out to these specialty medications because a lot of them are injections or infusions or things of that nature, and the great thing about MindShift is that it has the ability to do both. So this is a unique platform with the ability to not only help adjudicate prescription benefits, but also these complex medical benefits, and then it uses artificial intelligence to help improve and augment the process on both sides of the equation, so removing friction not only for the provider, but also for the patients, and even the opportunity to help on the payer side as well.
Speaker 1:
Fantastic. Let's talk about the provider first and we'll move on to patients what was or what is currently broken? You mentioned friction I guess it's a nice way to put it but what are the challenges providers have with specialty medications and how do you see yourself helping?
Speaker 2:
Yeah, I think friction and frustration is a big part of it. In fact, your users can look, this is the listeners users. Wow, sorry guys.
Speaker 2:
The AMA just put out a survey last week around the benefits and perceptions, or perceived benefits or hindrances, around prior authorization, and it is staggering 25% of providers think that the prior authorization process has led to a serious adverse event.
Speaker 2:
Over 90% of them think that it has led to a delay in therapy or abandonment in therapy altogether, and so obviously there's some legitimate reasons that the prior authorization process exists, but there's also a perception that it's really difficult, perhaps unnecessarily so, to the effect where a lot of practices are hiring entire teams of people to handle the prior authorization process, to make these phone calls, to do things on fax machines, to go interact with all of the various portals that are out there.
Speaker 2:
And wouldn't it be nice if someone could step in the middle of all this on behalf of the providers, start to consolidate not only the various experiences out there on the pair landscape, but also unify the experience for the providers? And then, of course, no conversation around health technology would be complete without talking about AI. And so how can we leverage the artificial intelligence platforms, the robotic process automation, rpa. How can we automate those things into the process? To you know, take what might be a seven day delay on behalf of the provider all the way down to less than one day, and so this is an exciting area because there's so much opportunity.
Speaker 3:
That's really great. So you know talking more about patient impacts. Obviously going from seven days to a day significantly improves patient experience and reduces the frustration. But maybe talk a little bit more about specific use cases. Maybe some people don't even know what specialty medications are. Specialty medications are, so can you talk about how they fit into the overall treatment plans and health outcomes and how your approach benefits patients in particular?
Speaker 2:
Yeah, that's a great question. So I think the very first thing starts with education, right? So you mentioned, patients might not fully understand what a specialty medication is. What are the things on their end that they have to fulfill in order to start therapy? What are the various consents? What are you know, if you've ever heard, of a REMS program, which is an education program where both parties have to demonstrate a certain competency around the medication before the medication can be dispensed?
Speaker 2:
So we have a patient engagement platform that actually kicks off right at the moment of prescription inception. So, basically, what will happen is I write a prescription so, in this case, a specialty medication, let's call it a GLP-1, you know the Ozempics and the Wagobe's of the world and as soon as I write that prescription, I am sending a personalized SMS text message to the patient that delivers an app-like experience. So we don't make them go to the app store. All they have to do is punch in their date of birth in order to verify who they are, and then we give them an app-like experience. And the reason this is important is because it addresses what I would say are the three big barriers to prescription adherence for our patients.
Speaker 2:
Number one is education. So a patient doesn't understand what the specialty med is, patient doesn't understand what services there are available, patient doesn't understand potential side effects or the reason why this is so important. So at the very onset, we're going to deliver educational content and it's going to be personalized and tailored to that patient and to that prescription. So that's number one, that's the education barrier. The second is cost. Right, how can we make sure that the patients are able to afford this medication?
Speaker 2:
And so that is the big one where we can deliver copay assistance programs, pharma assistance programs, even connect them directly to the hub in order to enroll them into those engagement type programs, and we can do things like leverage electronic signature directly on your phone in order to, you know, give consent for these things and so, you know, giving them the education and giving them the ability to afford their medication. And then the third one is actually around reminders. We can actually set up reminders on behalf of the patient to say, hey, don't forget, this prescription is out there waiting for you. Or hey, remind me again in a day that I need to go pick this up. So those are the three big barriers to prescription adherence and we can deliver that in a personalized way directly to the patient, and I think that's really important and actually over the course of my five years at Dr, First, we've shownest firsthand to the challenges of getting prior authorization.
Speaker 1:
What a nightmare. And it's not even solved yet. Speaking of AI and automation, it's funny to talk about these topics, which very 21st century modern topics applied to a system running on fax machines and voicemail and telephone calls. But you maybe talk about the role of AI and automation from the MindShift platform standpoint and also how it's actually being used to the degree you're comfortable. Obviously we're a lot of IT and tech geeks here, so we don't have to get into the bits and bytes, but maybe give us some color into how that works.
Speaker 2:
Yeah, that's good because I can know enough to be dangerous in terms of the bits and the bytes. But you know, I've been doing healthcare informatics over two decades now. Ever since finishing my residency, I dove right into electronic health records and the CMIA role, etc. I have never seen a technology so widely hyped but also so widely adopted as some of the things that we're seeing around AI, particularly the LLMs, the chat GPTs, etc. Now it is important to remember that AI in healthcare has been around for decades.
Speaker 2:
You know some form of decision support, things that are guiding the provider and the prescriber. That stuff has been around. This is just sort of the next generation of it and you know, actually prior to LLM and the chat GPT, rpa robotic process automation actually had a lot of traction and a lot of success stories as well, and a lot of what MindShift does is around that RPA. It goes out and sees you know the various websites that are involved in prior authorizations for various prescriptions and then does things like screen scraping technology to understand where to populate the fields on behalf of the doctor, on behalf of the patient.
Speaker 1:
Oh, wow.
Speaker 2:
Yeah, and so you know, not everything it's important to remember. Not everything in AI is chat, gpt. There is a lot of decision support and a lot of other flavors of AI. That being said, I'll go back to my original statement, which is I've never seen something take off quite as much as what we're seeing in the LLM land off quite as much as what we're seeing in the LLM land. In fact, I just gave my annual literature review at a CMIO conference last week in California, and I would say three quarters of the papers that I covered with my colleague were around LLM and AI.
Speaker 2:
What's really important to remember around the hype cycle for these sorts of things is that some of this stuff isn't quite ready for prime time yet. This is one of those trust but verify type technologies. It's a great jumpstart on automating a lot of these processes, but we're still at the point where we need to keep the human in the loop. We're not doing things on behalf of the doctor or on behalf of the prescriber. We're doing them to tee it up so that some of the mundane can be taken out of the equation, so that the things that require higher cognition can be focused on, and so I think that's really important. That's a philosophy at Dr. First is that all of our AI technologies are still human in the loop. We're not committing anything to databases on behalf of doctors or on behalf of patients until a doctor, a nurse, a pharmacist actually reviews it and verifies it to commit it to the record. And I think that's important at this time, as these technologies are evolving.
Speaker 3:
That's really interesting about the human in the loop, because that's one of the fears actually of us patients and as a patient advocate, about outsourcing some of the things, even like prior authorizations, to algorithms and how they might be very quick to decide that something is not approved without understanding all the nuances of a specific case, specific patient, et cetera. So that brings me to this other area I wanted to explore more deeply with you, and that's improving access and affordability. So you mentioned how, with MindShift, you now use the strategy of combining medical and pharmacy benefits, while they were typically just siloed and separated. So how does that combining of these processes really enhances access, affordability? You know you talked about some of these things, but maybe give us even more of an understanding of yeah, I think it's about a unified experience, experience.
Speaker 2:
I think it's not fair to ask the doctor or the patient to know where to go to find these resources, to know where to go to fill out this form on behalf of this particular prescription, but this one over here is a different set of benefits on behalf. What if we can unify the experience? And so that's, you know, that's the vision at the provider level and also at the patient level. So if I can take all the clutter in the background and we keep track of it on behalf of you, so that all we're delivering to you is what you need to do and we're taking the cognitive burden around, go here, go there, fill this out, fill it, it doesn't matter. We're doing that on our end so that we can deliver a simplified experience for both parties on our end.
Speaker 2:
And that's really the idea of a lot of the technology at Dr. First is, how can we reduce friction? How can we make prescribing and adherence a joyous process? A joyful process, you know, and that's hard to say because a lot of times we're dealing with patients at their absolute worst, you know, with some of these prescriptions. So let's do our job to make this as easy as possible. And you know, let's get rid of the fax machine, let's get rid of the paper. I can't believe we're still talking about this in 2024, when really we thought we would have this solved, you know, back with meaningful use in 2011.
Speaker 3:
And it seems like by putting doctor first, like that's in your name, it almost sounds like maybe it's a patient first, because by improving experience overall for the providers, of course, patients benefit tremendously.
Speaker 2:
So anyway, I just want to throw that in there, a thousand percent, it is the entire ecosystem that is going to benefit, and that is really our focus.
Speaker 1:
Fantastic. And on a separate note, you integrate with hundreds of EHRs. That's pretty impressive. Talk about that integration, how it works and how that's helping with outcomes and improved engagement.
Speaker 2:
Yeah. So the e-prescribing platform and some of the other solutions we have, we have deep integrations into over 270 different EHRs. So a lot of people might say, wow, I didn't think there were 270 unique EHRs out there, because we can usually rattle off the big four, which we do do integrations with as well, but there are also a lot of smaller or a lot of specialty EHRs out there. Think about a specialty EHR around oncology or rheumatology or gastroenterology and we have integrations into those EHR platforms.
Speaker 2:
And what's great about the Dr First platform and breadth of our solution suite is that at this moment in time, we are touching one in four prescriptions in one way, shape or form, with a goal to be touching one in three by the end of next year, and so that's a lot of volume going through those pipes. That's a lot of touch points on behalf of providers, on behalf of patients, and so these deep integrations and this volume gives us the opportunity to not only improve and have a continuous learning ecosystem but also to, as I mentioned, touch a large number of patients. And then, as we continue to acquire assets, as we continue to grow our platform, we're only going to continue to get stronger in our solution set platform we're only going to continue to get stronger in our solution set.
Speaker 3:
Wow, that's quite a scale, both integration, with so many EHRs processing one and four prescriptions, moving on to one and three, or touching touching, as you said.
Speaker 2:
Yeah, it's like the industry's best kept secret is the breadth of the Dr First platform. Yeah, so let's talk about industry more broadly, you know?
Speaker 3:
best kept secret is the breadth of the Dr First platform. Yeah, so let's talk about industry more broadly. So, from your vantage point, what are some of the current trends in healthcare technology, or where is it all going? Obviously, you're going to continue to innovate, but what do you see more broadly as particular few areas of great excitement where healthcare technology is going?
Speaker 2:
I think there's a lot of growth in the algorithm space. So a lot of the papers that I reviewed, as I mentioned a little while ago, a lot of the papers touched on improving algorithms. So you know, five years ago I would review papers that said the sepsis algorithm from this major EHR is a total bust. You might as well flip a coin. And, if anything, we're making it worse because we're popping up all of these alerts in front of our doctors and our nurses and we're distracting them and giving them alert fatigue. Well, fast forward five years. We're actually getting better. We're getting better to the point where my colleague at UC San Diego is using sepsis algorithms to improve mortality upwards of 5% and improve bundle compliance around sepsis greater than 10%. 10%. You know that's real and that is not something that I foresaw five years ago. So I think algorithms are continuing to grow.
Speaker 2:
I also think if you look at some of the legislation and some of the things that the Office of the National Coordinator is doing, you're going to continue to see an attempt to get out in front of this to make sure that it's regulated appropriately, that good algorithm is a transparent algorithm, so that folks will know if I adopt this, it does or does not apply to my particular patient population or, if I adopt this, this is how it is arriving at their particular recommendations on behalf of the provider. So I think you're going to see a diminishment in the black box type AI where you sort of throw it over the fence and the AI makes a recommendation and nobody knows where that came from. I think transparency is going to start to be key, and I think that is something that Dr First embraces as well. Transparency is very important for our providers and for our patients to understand where we are arriving at these conclusions. And then I'm also I think you know I'd be remiss if I didn't say you're going to continue to see the chat GPTs, the LLMs. You know we're at chat GPT-4 now. Chat GPT-5 is probably going to be on the level of someone with a PhD in terms of their ability to provide solutions and rationale for some of those recommendations.
Speaker 2:
What I look forward to very much so around the LLMs, is the ability to summarize, and summarize with accuracy and precision. So go back to when I was a resident and a medical student. It was all on paper, it was. If I wanted outside records, it was an act of God to you know, get on the phone and get this stuff faxed over to me, and to some extent it still is, but for a lot of health systems they have pipes. Now they're getting a lot of this external information.
Speaker 2:
They're getting a lot of the CCDs from their sister hospitals or their folks across town, and so we went from a paucity of information to sometimes a glut of information. And wouldn't it be nice if we could throw that into an engine and get a very succinct summary to save what I used to do as a hospitalist? And get a very succinct summary to save what I used to do as a hospitalist, which is, you know, two hours of chart review for that transfer coming in, just to tease out the key points around the blood cultures and the echocardiogram results and the CT scan. So I think summarization is coming very, very soon. You see some folks playing in that space right now is coming very, very soon. You see some folks playing in that space right now. You just got to be careful. As I go back to my earlier comment, you know you got to verify and then ambient listening is taking off like wildfire. I think almost every hospital I've talked to has at least a pilot in the ambient listening space, which is a great opportunity to reduce provider burden.
Speaker 1:
Wow. Well, you're describing such a compelling vision of the future, and a lot of it's today which is even more exciting, or right around the corner. What about you personally? What are you looking forward to in your practice, in your professional duties? What's up over the summer and beyond?
Speaker 2:
Yeah, you know. So, back to that ambient listening comment, and some of the things that we're working on at Dr First is the idea of not only the ambient listening helping me create my note, which is, of course, painful and very specific, but help me create my orders. Or, for Dr First, help me create my prescription. So you know, you come to see me. I think you have Lyme disease. You know, hey, I prescribed, which is a certain application we have on our mobile phones. Hey, I prescribed write Evan for doxycycline for Lyme disease, 10 day course. And all I have to do is look at it and say, oh yeah, let's send it to the Walgreens that he always goes to. So right now the app saves you a whole bunch of clicks and keystrokes and phone call pain. But what I just described would save you even more and it would make it fun and reduce medical error, right.
Speaker 3:
So that's.
Speaker 2:
It would make it fun. And so we have the privilege of sitting on top of a lot of data around prescriptions and we know how to make those prescriptions formed correctly and we know what is inside and outside of bounds, and so we have a unique opportunity to do this sort of voice technology safely and effectively, and so I'm excited about that. This summer, I'm very excited about MindShift, that team, joining the Dr First family. It's been great and so it's. You know it's the summer of AI, although it's probably been the last three summers of AI if you go back and look at some of the literature.
Speaker 3:
Yeah, and I saw some of those photos of you having fun. After reviewing those articles, it sounds like a party.
Speaker 2:
You know it's, it's a unique place where you can get, you know, a couple hundred CMIOs all together and and really nerd out. And so I think you're referring to my, my Twitter feed, or I guess we call it X now. But yeah, guys, follow me on X, colin underscore Dennis. Here we go.
Speaker 1:
We have fun? Fantastic, yeah, we do, and your enthusiasm is so infectious and inspiring, so we look forward to frequent updates. Keep us in the loop.
Speaker 2:
Oh, absolutely. I'll keep the human in the loop and I can wax awake on this stuff all day. So I love it, you do.
Speaker 1:
I'll keep the human in the loop and I can wax my way on this stuff all day, you do. I realize that We'll schedule an hour next time, but we'll get back to patients and providers, dr First. Thank you so much, colin.
Speaker 3:
Hey, thanks Evan and thanks Evan, thanks everyone for watching and listening.
Speaker 1:
Follow Colin. Follow at Dr First on Twitter. I still call it Twitter, yeah, and look forward to seeing you in person soon. Take.