The biggest problem in healthcare is not the lack of innovation, it is the lack of innovation adoption..
In this episode of Bite the Orange, Manny interviews Christian Milaster, founder and CEO of Ingenium Digital Health Advisors, who shares his thoughts about helping healthcare organizations and systems adopt digital health solutions quickly, optimizing care delivery, and producing better outcomes. After identifying inefficiencies and problems, Ingenium helps define or find the best solution and helps them implement those solutions effectively. Most clients also engage Christian and his team to develop their telehealth or digital health strategy to provide the leadership team with clarity and guidance. In our conversation, Christian explains Ingenium’s telehealth maturity self-assessment tool that allows organizations to identify where they are within a seven-level scale as a starting point and leverage telehealth tools to their advantage. He also shares how to achieve innovation adoption and excellent healthcare delivery with the help of technology. Ingenium counts on a core consulting team and a consortium of experts in the field.
Tune in to learn more about selling and encouraging the adoption of digital health innovations!
FULL EPISODE
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Emmanuel Fombu:
Welcome to Bite the Orange. Through our conversations, we create a roadmap for the future of health with the most impactful leaders in the space. This is your host, Dr. Manny Fombu. Let's make the future of healthcare a reality together.
Emmanuel Fombu:
Good morning, good afternoon, good evening, ladies and gentlemen. Welcome to another episode of Bite the Orange. And today we have a very special guest who has done remarkable things in the field of telehealth. And so today, if you don't know him, I have Christian Milaster with Ingenium Telehealth Advisors, Digital Health Advisors. Is that correct? Christian, welcome to the show.
Christian Milaster:
Thank you so much for having me.
Emmanuel Fombu:
So tell us for those that know you, so who is Christian Milaster?
Christian Milaster:
Well, I'm many things, but I always like to introduce myself that I was born, raised, and educated as an engineer in Germany. I worked for IBM and then came to the US 25 years ago, and then stumbled into healthcare at the Mayo Clinic in Rochester, Minnesota, and got a really great introduction into healthcare and just fell in love with the mission of using my expertise and experience in helping clinicians to deliver extraordinary care. And then 11 years ago had the opportunity to start my own consulting company after leaving Mayo, because I always jokingly say that I found everything at Mayo that I left Germany for, so red tape, bureaucracy, nepotism. So a large academic medical center was a great opportunity for me to learn a lot about good healthcare delivery, but it was not a place for me to bring about fast and quick change. Now things are changing at the Mayo Clinic, but back when I was there, things are moving slower than my pace, and so I said, I want to work with innovative organizations who want to embrace innovation. And so I have opportunistically operated at the intersection of healthcare delivery and technology for the last 15 years. But ultimately over the last ten years, my passion is about enabling the delivery of extraordinary care. And for me, that really means helping the clinicians to practice on top of their license to do what only they can do, to optimize the workflows, to optimize the technology, to optimize so that clinicians are in a place to diagnose and to treat patients given their level of expertise, and I think digital health can be a great help.
Emmanuel Fombu:
That's a, that's an incredible background. As anyone listening who knows, Mayo Clinic is actually at the forefront of innovation on healthcare standards. So you are definitely a great guest on Bite the Orange because that's what we're trying to change, that idea. That we can, distinct technologies exist, we don't need to slow down to adopt them and make sure that we have good outcomes from them. So with that being said, so what was the pain point that you were trying to solve with Ingenium Digital Health Advisors?
Christian Milaster:
I think the biggest problem in healthcare is not the lack of innovation. We have a mountain, we have a full mountain range of fascinating, fabulous innovation sitting around being proven in small proof-of-concept projects or clinical trials even. But the problem in healthcare is the lack of innovation adoption, or the slow pace of innovation adoption. So we at Ingenium Digital Health Advisors focus on working with organizations who see the need to embrace digital health solutions, but need to figure out, how can we do this in a matter of weeks and months rather than in a matter of months and years? Because healthcare traditionally, and rightfully, is very conservative in embracing change and trying out new things, because it's not just that you miss a shipment or you screw up a hotel night, if the solution does not work in healthcare, you know this as a clinician, then we impact patients' lives, the livelihood or the lives, or the quality of life, and so we got to be rightfully careful, but that doesn't mean that we should shy away from all the innovative solutions that exist. And what, I help organizations is to figure out processes and systems to quickly identify problems first, because that's where it all starts, don't get all wide-eyed and glassy-eyed by the wonderful solutions and sales presentations of digital health vendors. But first, figure out what is the problem you're trying to solve, then find the best solution and then figure out a way how to very quickly implement it by focusing on change management and bringing the clinicians, the nurses, the staff, everybody along because it takes a village to deliver healthcare, and similarly, it takes a village to implement a digital health solution like telehealth in an effective way.
Emmanuel Fombu:
That's quite incredible. So how does that work? Because you have that firsthand experience being in a hospital setting, and there are many listeners who are probably entrepreneurs that have telehealth solutions that they have, and well, remote patient monitoring solutions. Because I think in today's world, telehealth and remote patient monitoring go hand in hand, right? You see what the Teladoc's acquisition, where Teladoc is going into in this space, I think that's very important. So tell me, how do your clients, how do you find clients and how do your clients find you?
Christian Milaster:
The clients find me. I've got a weekly newsletter called Telehealth Tuesday that I publish on LinkedIn and through my mailing list, and so that's how people know about me. And a lot of our referrals come through our network, through connections, and also follow-on engagements with our current clients. I want to talk about the kind of the two areas, the two clients and you mentioned both of them. On the one side, we have, let's start there, the Digital Health Solutions vendor. As an engineer and as a recovering geek, I totally understand the fascination with technology, and I also understand that a lot of the entrepreneurs that are in the healthcare space right now or have entered the healthcare space in the last ten years entered it because they have, they got the digital expertise and they thought, how hard can it be to fix healthcare? We fixed transportation with Uber, we fixed the hotel industry with Airbnb, so let's do this in healthcare, with online trading and with virtual banking and all of that, right? So all the other industries are digitalized or digitized. And how can, how hard can it be in healthcare? Let me tell you, it is very hard. And one of our offerings is that we work with digital health solutions vendors. So may be a platform, may be a service, because their focus, their forte is to develop a great solution that's user friendly, that produces the right outcomes. They also invest a lot of their venture capital money into the sales engine, but what they are not good at and probably should not be good at is actually helping their client, their customer to implement the solution, and I think that's where a lot of the innovation is breaking down. They have a great sales presentation, somebody at the executive level buys into the value proposition of the solution, say, oh yeah, this is great and you've demonstrated it. And these projects here with these clients, yes, we're going to buy it. But then they just say, yeah, the licensing keys for 50 licenses, here's the hardware, the software, whatever is needed, now you go do. And healthcare organizations have no clue how to do it. Project management, process design, workflow design, change management, the, there is no history of rapid adoption of innovation, of constantly. Changing healthcare prides itself of keeping things constant, keeping them the same. There's innovation around data analytics or innovation around hiring practices, and obviously, a lot of strides have been made in the safety realm, but really most parts of a health system, outpatient and inpatient, are really not accustomed to leading innovation. And so that's the second part of our service offerings, is that we work with health systems who want to develop a digital health strategy. What does digital health mean for our organization? They want to develop, maybe starting with a telehealth strategy, right? In the wake of COVID, we really doubled down on it, we hired a telehealth program director, but what is your long-term strategy of how to create to deliver care at a distance as well as in person in a hybrid environment? And then also, what's the longer-term strategy of integrating digital health innovation in a thoughtful and, but in a rapid way? Because if health systems are not doing it, others will come up with ways. Amazon is on its, what I can count fourth or fifth iteration of figuring out how to make a business model out of it. Now they had Amazon Care, shut that down, now they bought one clinic, now they have Amazon Clinic. They're going to innovate because that's what they do, they innovate, and eventually, they and Walgreens and CVS and Dollar General will all come up with interesting ways to siphon off your lucrative patients from your patient panel that make your business model currently work because they can, know how to innovate. And so teaching health systems to innovate and teaching and helping digital health innovators to implement their solution effectively so that you reap the benefits that you sold them on, that is the value proposition that we provide.
Emmanuel Fombu:
With that being said, I think you have a very unique perspective. So if someone, a vendor in digital health, telemedicine, or telehealth is one vertical across the multiple offerings, so how does someone approach a hospital or health system to actually sell a solution like this? Do you go to an individual clinician? Do you go to the chief technology officer? How do you sell? How do you approach?
Christian Milaster:
Selling to a hospital system or a health system is a very convoluted and complex process, and it also changes with every organization. The more mature organizations actually, unfortunately, have really shielded the actual users of the digital health solutions from the decision-making process. And they have procurement teams, they have purchasing teams, right? They have technicians and administrators and operations people and executive leaders making those decisions. And in most organizations, the actual end users of the solution are not involved to the extent in the decision-making process. So I think as a digital health vendor, you should, from the very first moment, insist on having the actual users to be part of the decision-making process. Now the final details of the terms and of how this is being paid for and all of that, that can be sorted out later. But the first thing as a digital health solutions vendor is to make sure that you are talking to the people who will actually use your solution because that's where the change management starts. On the health system side, similarly, you got to make sure, actually, what I teach our clients is, before you seek any vendor or any solution is, you got to define your own solution first, you got to define your own workflow. What experience do you want physicians to have? What experience do you want patients to have? The nurses, the schedulers, whoever is involved in this process, the people who are refurbishing the ... equipment, right? You design, you set your expectations, and then you go out into the marketplace and then you take a look at what is the best solution that fits our paradigm, our line of thinking. Because the last thing you want to do is having to adopt the mindset of some Silicon Valley startup that thought this way of delivering healthcare would be a great idea. You gotta really be conscious about how you want to integrate the digital health solution into your workflow, into your culture, and then find the right solution that fits it. Now you may have to make accommodations, you may have to change your process because the right solution may not be out there, but at least you go in as a much more informed consumer to find the right solution for you rather than just being at the beck and call of whatever they came up with in their solution.
Emmanuel Fombu:
Definitely, I agree with you on that piece, and that's why I really like what you're doing at Ingenium Digital Health Advisors, with your company, because my company, like I mentioned prior to the show, but the listeners did not hear that part, right, but I have a company, Marche Health, and the idea is that marketplace, right? But we have multiple categories, and telehealth being one category in the marketplace, because today we don't have a central marketplace really. We have Google, or you go on LinkedIn and you find out, it's very random how things happen. So what we are doing is bringing together all these companies, but it's very importantly upfront, like you said, like what you do to help these health systems understand what the problem is and so identify the right solution because there's no one-size-fits-all, right? One health system might be in an urban area, one could be in a rural area, and it could be all different solutions. With that being said, I realized on your website you have actually like a new telehealth maturity self-assessment.
Christian Milaster:
Yes.
Emmanuel Fombu:
Actually, I think about six, six levels. Can you talk to me about that?
Christian Milaster:
For sure, yes, early on we wanted to, love the maturity model, and for those listeners who are not familiar with maturity models, the maturity is the capability to do things really well and independently, that's the general definition of maturity. And a maturity model helps you to identify where on the spectrum you are. If we look at human maturity, we have the crawl, we have the walk, we have the run, we have the jump, the skip, and the soar. We're still working on soaring to, in our evolution, but, and you can't start sprinting before you learn how to walk or even how to stand, right? So the idea behind the capability or maturity model was, I gleaned from the software development industry where originally came from, I developed one for project management and requirements engineering, and then I applied it to telehealth as well. And the idea is that you would have a, different levels where you can find yourself at, and because there are certain things you have to put in place first before you can jump on the bigger things, right? Before you have a digital health strategy, I would advise what's your telehealth strategy? Let's start with the one thing that everybody is now doing, now in primary care specialty care to a lesser extent, and behavioral care to a greater extent, but let's just optimize your telehealth strategy and then iterate on that to develop your digital health strategy, as an example. The seven levels that I'm differentiating is, they start out at the bottom with chaotic and emerging. Those were organizations who, that's where a lot of organizations were in the wake of COVID who hadn't really invested in telehealth before. And it goes all the way up to strategic and transformative, and that's, that is the highest level. The level that I'm, we're currently working with a number of clients on bringing them to is the level four, which is integrated, which means that telehealth is fully integrated into the healthcare delivery mechanisms. So you have in-person care, you have virtual care, you have data integration, you have EHR integration, you have schedule integration, it's integrated in the mindset of the people so that the physician says, hey, for your follow-up appointment, why don't we do telehealth? So that's the full integration. Once you get to this level four, that opens the door for you to actually then think about the strategic use of telehealth. How can you use telehealth to grow your market, to grow your access, to increase patient satisfaction, to improve outcomes, to recruit staff that want to work in an innovative organization? So really then it's no longer the tail wagging the dog, it's the dog wagging the tail. It's the organization deciding we want to leverage telehealth strategically to achieve our objectives. And then level six, where very few organizations are at, UVA is one example, and then Lehigh Valley is another example, they're thinking about, they're not asking the question around how do we want to do healthcare? But they're asking, how can we use digital health to have a better relationship with our patients and serve them better? So they're starting really to use telehealth, and then by extension digital health, in a transformative fashion to reinvent what a health system of the future could look like. So there's, they're looking first at what solutions are out there that we should be working towards being able to leverage. And so that's a marching order on my website, IngeniumDigitalHealth.com. In the resources section, I have a white paper and a self-assessment on telehealth maturity. It's a quick ten-question survey and it's a good starting point to get oriented, or just reach out to me in the show notes through the contact information. Happy to have a quick call about the maturity of your organization when it comes to telehealth and to digital health.
Emmanuel Fombu:
Which was great, incredible advicek, everyone, that's interested in a particular topic to definitely check out your website, IngeniumDigitalHealth.com, we'll have this in the show notes as well. But this is quite amazing, I really like the work that you're doing here. I think this is one of the great examples of what we're talking about pushing forward to make sure that digital health becomes the future of healthcare, and it's better for the patients. At the end of the day, is the patient is at the center of it. So thank you, Christian, for joining us today, but one more thing that I'd like to talk about is, you've put together a great team of advisors and experts on that, yeah, so it's quite incredible. So how does it work? So the advisors work for you? How does this work?
Christian Milaster:
Sure, no, thank you for that question. Yeah, if you scroll down on the homepage, you'll see the team, and we're in the process of revising this, but we have a core consulting team where we work on our engagements. But for the last eight years, I've been collecting experts in digital health and in telehealth as part of what I call the Ingenium Healthcare Advisor Consortium. They're solopreneurs, they're experts in their own field, and we meet on a regular basis to just form our own internal community because sometimes as a solopreneur it can be lonely. And I'm actually now shifting into building a boutique consulting firm but, so I have a level of a number of experts in different areas. There's somebody, an MD/JD, who is an expert in digital health law for the last almost 30 years, there's an expert in digital variables who's out of Australia. I've got some people in Germany because of my German heritage, and then a lot of individuals here in the US that focus on economics or on impact assessments and data analytics. Again, if you need an expert in digital health, I, they may be on the consortium, or the consortium members may know somebody who is an expert in that particular field. And so we're building, we're having projects and engagements where we involve and include those advisors in our work with our clients.
Emmanuel Fombu:
This is quite incredible, and I see you have a great digital health taxonomy, right, so not just, you have digital health, there's a place you have precision medicine, health IT, personal fitness as a whole map, that you look at it from a whole ecosystem, right? So you're not just focusing on telemedicine, correct?
Christian Milaster:
Correct, we're focusing on two things: enabling the delivery of extraordinary care, and so that is just general process improvement at its core, but it's always with an eye towards leveraging technology to make the processes and workflows more efficient and more effective; and the other is to accelerate the adoption of digital health innovation, and that oftentimes starts at the leadership level. My business partner, Kathy LeTendre, also has a great level of expertise as a former healthcare administrator in building high-performing executive leadership teams, and especially at the smaller organizations, the smaller health systems, that level of expertise is needed to, for example, we're working with a community health center on transforming them into a model health center of the future, it's a multiyear effort and we're building that. But those capabilities on the leadership level are also needed to enable the delivery of extraordinary care. So we're not just focusing on telehealth, we're focusing on excellence in healthcare delivery and excellence in healthcare leadership as well.
Emmanuel Fombu:
And that is quite incredible. So if you have the telehealth, I know we running over some time here, but the telehealth maturity self-assessment, that's the same platform or the same structure, can you use that on every health IT kind of solution that exists?
Christian Milaster:
It would have to be adopted to the different environments. Again, most interests right now, these days, comes in our community through telehealth. So I have built some, and I'm currently building, some digital health strategies. Built one for our rural organization in Maine, a health system in Maine, and building one for one rural organization in Vermont right now. But yeah, the principles are applicable in the same way in that the levels are the same, it's just the definitions of the levels will be different when it comes to digital health than for telehealth. But we can also talk about any of your contacts in, on your marketplace, Marche Health can also work with us to identify how can they help the organizations to see what maturity level they are at, because that can inform their sales approach as well.
Emmanuel Fombu:
This is quite incredible. Thanks a lot, Christian ..., and thanks for taking the time to join us today. I think anyone in this particular space of digital health, I know we all have a big challenge selling to health systems and it's great to have someone like Christian with that experience help the health system side understand how to sell. Even as a clinician, I find it difficult to sell to health systems and I work with pharma, find it difficult to sell there. So thanks a lot, it takes a great engineer from Germany to solve this problem. Thank you, Christian, and I hope to have you back again.
Christian Milaster:
Thank you, Manny. Really appreciate it.
Emmanuel Fombu:
Thank you for listening to Bite the Orange. If you want to change healthcare with us, please contact us at info@EmmanuelFombu.com or you can visit us at EmmanuelFombu.com or BiteTheOrange.com. If you liked this episode and want more information about us, you can also visit us at EmmanuelFombu.com.
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About Christian Milaster:
Christian Milaster is passionate about enabling the delivery of extraordinary care. He relentlessly advocates for bringing satisfaction to the medical profession by applying systems thinking and implementing systems engineering solutions.
Rooted in German engineering, Christian designs and implements pragmatic improvement and optimization solutions, drawing from various disciplines, including design thinking, agile, Lean, Baldrige, requirements engineering, servant project management, and others.
Christian is the CEO of Ingenium Digital Health Advisors, a boutique advisory and consulting firm focused on leveraging digital health to enable the delivery of extraordinary care. Ingenium comprises a 6-person consulting team and a consortium of over a dozen expert advisors.
Born, raised, and educated as an engineer in Germany, Christian started his career at IBM Global Services before joining the Mayo Clinic in 2000. He worked for 12 years in various roles before launching Ingenium. He resides near Annapolis, Maryland, with his wife and two daughters.
Things You’ll Learn:
Healthcare organizations need help implementing digital health solutions effectively.
Ingenium’s clients reach out to the company as they tend to receive the Telehealth Tuesday Articles that Christian publishes on LinkedIn and through his mailing list.
A digital health vendor should insist organizations, from the very first moment, on having users be part of the decision-making process.
Maturity is the capability to do things well and independently, and it can be applied to digital health with the help of a Telehealth Maturity Assessment Model.
Ingenium’s Telehealth Maturity classifies organizations within seven levels, the lowest being “chaotic and emerging” and the highest “strategic and transformative”.
Ingenium works to bring its clients to level four of Telehealth Maturity, where telehealth is fully integrated into the healthcare delivery mechanisms.