#6: Will telemedicine disappear after the pandemic and what is its future in hospitals | Marquese T. Davis, Director of IT in Cornell Scott Hill Health Center

Published on February 1, 2022

Our special guest Marquese T. Davis talks about the use of telemedicine, the attitude of doctors to new technologies, the stages of selecting a software vendor. You’ll learn more about system integration, leveraging resources, leadership, and cultivating relationships in corporate and nonprofit fields. And so, will telemedicine increase or disappear after the pandemic? Enjoy the listening!

In this episode, we will answer the following questions:

01:20 background of Cornell Scott Hill Health Center

02:01 how telemedicine is used in Cornell Scott Hill Health Center

03:07 providing rapid comprehensive care as one of the biggest challenges of the organization

04:42 nurturing and developing healthcare technologies as the main focus of Cornell Scott Hill Health Center

05:48 choosing telemedicine vendors: Why are clinical teams so essential?

09:57 complexity in the current market and their perspective

13:41 process of choosing the vendor

15:02 privacy and security - regular security audits as one of the most important things

18:04 big issue in healthcare: using many software systems by one organization. Advantages and disadvantages of Epic EMR

22:51 the future of telemedicine: will it increase or disappear after a pandemic?

25:21 centered patient data

28:23 telemedicine as one of the technology trends in the next 3-5 years

29:44 primary advice to other professionals who would like to develop or implement technology in healthcare

31:55 Rapid Fire Round (3 questions)



Marquese T. Davis LinkedIn: https://www.linkedin.com/in/marquesedavis/

Cornell Scott Hill Health Center LinkedIn: https://www.linkedin.com/company/cornell-scott---hill-health-corporation/


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Ivan Dunskiy: Hello everyone. And welcome to another episode of the HealthTech Beat podcast. The mission of our podcast is to show the real-life challenges of implementing technology in healthcare. The podcast is sponsored by Demigos, a company that develops IT solutions for healthcare startups and companies.

For more information, you can check demigos.com. My name is Ivan Dunskiy, and I am joined by an honored guest Marquese Davis, a director of information technology at Cornell Scott-Hill Health Center with over 21 years of experience in the IT industry. Marquese started as the IT director in healthcare at the age of 24. One of the youngest IT executives in Connecticut, leading multiple million-dollar projects and technology deployments. His knowledge spans system integration, leveraging resources, leadership, and cultivating relationships in corporate and nonprofit fields. Marquese, thank you for being here.

Marquese Davis: Thank you for having me, Ivan. 

Ivan Dunskiy: How are you today? 

Marquese Davis: I'm doing well, sir. How are you?

[01:20] background of Cornell Scott Hill Health Center

Ivan Dunskiy: I'm good as well. Could you please give a brief background of your organization and what you do at Cornell Scott-Hill Health Center? 

Marquese Davis: Sure. So Cornell Scott-Hill Health Center has been around a little over 50 years. We serve around 36,000 patients within the New Haven area, with a total of about 230 unique visits a year. We have about 10 locations. My department supports about 600 users from IT infrastructure, privacy and security, and telecommunication, including telemedicine. 

[02:01] using telemedicine in Cornell Scott Hill Health Center

Ivan Dunskiy: Great. So you mentioned telemedicine. Could you please tell us how do you use it in the organization?

Marquese Davis: Right now, and I think like with most medical organizations, and here in the states, we're looking at telemedicine a little bit differently. But right now, we're using platforms such as Doximity to deliver clinical services to our patients within our service areas. And those platforms like Doximity have been very valuable to delivering care and increasing care continuity around the organization and within the community that we serve.

Ivan Dunskiy: And just to step back just for an understanding. Am I right that you provide both inpatient and outpatient services?

Marquese Davis: We mainly provide outpatient services. We have some programs, such as our detox services, where we keep some of our patients for a short period, but a good majority of our services are outpatient services. 

[03:07] providing rapid comprehensive care as one of the biggest challenges of the organization 

Ivan Dunskiy: What do you think are your organization's most significant challenges currently if you could share with us? 

Marquese Davis: From a technology perspective, I would say... 

Ivan Dunskiy: No, in general, what do you think are the most crucial things their organization is willing to overcome and resolve?

Marquese Davis: I would say, being able to ramp up the services that we provide for our clients throughout the area. I lived in the community we served in, born and raised in the area. So I'm very familiar with the organization and its services.

And I have close friends and family that use the services as well. But I think just being able to address the community's needs rapidly, with a comprehensive care solution and plan in place, is the case for most organizations, especially community-based health centers in the United States.

But, I would say, just providing very rapid comprehensive care. 

Ivan Dunskiy: Do you experience high demand at the moment?

Marquese Davis: Yes. Especially with COVID. And the variants popping up, we have seen an increase in visits. We have noticed an increase in COVID vaccinations as well.

But the organization has been able to respond to those issues very quickly. It has an impact on our ability to operate as an organization. And the IT department has been able to keep up with the demand as well. 

[04:42] nurturing and developing healthcare technologies as the main focus of Cornell Scott Hill Health Center

Ivan Dunskiy: Got it. And what is your main focus from a technology perspective right now?

Marquese Davis: I think my main focus is one of the things that I like to do with any organization is just making sure that the department's strategic plan also aligns with the organization's strategic plan. It's challenging to deliver IT solutions that aren't in line with what the organization is doing overall.

At the moment, we're identifying opportunities where we can find and deliver care via telemedicine, so we can touch as many folks as we can within the community and the service area. So, finding and nurturing those telemedicine solutions we currently have and looking for these new technologies on the horizon to see how they are truly implemented within the company.

[05:48] choosing telemedicine vendors: Why are clinical teams so essential?

Ivan Dunskiy: And I think that that could be very relevant to our listeners, especially those who develop telemedicine solutions. Could you please give a background of how you choose different telemedicine vendors and how the solution and services are approved within the organization?

Marquese Davis: It takes a lot of communication and partnership with our clinical teams. I always tell folks, the IT departments, IT leadership, isn't necessarily the folks you always go to solve a business problem. We have to communicate, connect, and understand the issues before identifying a solution.

So, really cultivating those relationships within a healthcare organization, your clinical teams are essential. Get to know them very well. So that once you do identify a solution, it fits their needs, it fits their workflows. And I think that creates a sustainable and meaningful long-term solution.

And it makes the clinicians happy at the end of the day. So I think that's important as well. 

Ivan Dunskiy: And patients as well. I know that often it is a disconnect between decision-makers and clinicians. So how exactly do you ensure that you choose the product that clinicians and patients will use?

Marquese Davis: And again, I think it goes back to this cultivating those relationships and allowing those clinicians to have a representation in a voice through the entire process.

From identifying the vendor and having a part in the implementation process. We don't know the workflows of those clinical departments. We provide technology solutions to assist and complement their workflow, but we don't own those workflows.

So we want to make sure that when we select a solution, there's representation from those clinical departments. And with the hope that they actually champion and drive portions of the implementation as well. 

Ivan Dunskiy: And these clinicians are busy people. Do you ask them to try different solutions and tell their feedback, or how specifically does that happen?

Marquese Davis: Historically, when I've done implementations for technology solutions, clinicians are very apprehensive about really taking a large role in those types of implementations. But I'd let them know that it's just as important for them to have a role in the implementation because, ultimately, this will be the tool they will be using every day to take care of their patients.

This is the tool they will use to help them with their productivity. So while it might be uncomfortable in the beginning, I think it's precious for them to play a significant role during the implementation, not to say that they have to do any programming or configurations or anything like that, but making sure that they understand the pros and cons of each solution that's out there in the market and in each solution that we're vetting.

Ivan Dunskiy: And in the end, you let them decide what to choose?

Marquese Davis: I don't make the decision. I help them understand what's available. I help them understand the functionality of those solutions, but ultimately, it's not up to IT leadership regarding what is selected. We do provide some guidance around.

Here is what will work best for our environment. So we kind of weed out those vendors that don't fit our organization. And we present the ones that fit with our IT framework. And so, then at that point, we give the clinicians and the clinical leadership the opportunity to figure out which solution works best for them.

Because again, ultimately, IT folks, we're not going to use those solutions. We'll support them. We can help 99.99% of the solutions out there. So it balls down to what is most comfortable for those clinical teams. 

[09:57] complexity in the current market and their perspective

Ivan Dunskiy: And I'm just wondering, are you considering any custom solutions or off-the-shelf solutions only?

Marquese Davis: That's been a discussion that's been popping up within the last month or so. Most organizations have come from the school of thought that if the product doesn't exist, there has to be some vendor or another solution out there that we can purchase to close the gap. But I think now, as you know, healthcare becomes a little bit more complex, we're delivering more complex types of services, the needs become a little different. We're coming into an era where we need to build some in-house applications.

Maybe not on a full scale where we have a dev-ops department or internal development team turning out those applications. But I think we're getting closer to that point where, as we have more advanced analytics and alike, those needs will expand a little more. 

Ivan Dunskiy: So that you control the data and you can get some custom analytics, for example, from the data, right? 

Marquese Davis: Exactly. 

Ivan Dunskiy: And you mentioned the complexity. So what kind of complexity do you see in the current market, and what is your perspective on that? 

Marquese Davis: When I say complexity, there's a vast area of complexity that we address, not only as an organization but just within the IT department.

But we have a very complex population as it regards to care. We are being able to address those needs of that population rapidly in a meaningful way and make sure that the technology solutions that we have in place also complement those deliveries of care.

One of the more complex things that I see that we're going to be dealing with for quite some time is security and privacy. Ensure that we have an established IT framework to build a solid foundation around fundamental security practices moving forward.

Ivan Dunskiy: Does that mean you want to address diverse groups of patients? Is that the complexity you're talking about? 

Marquese Davis: Well, diverse. I think the population has a very diverse set of needs. We have to make sure that we have the infrastructure to address those needs.

Ivan Dunskiy: And of course, when you have that, you need to adjust to those needs, which not necessarily always could be covered by the shelf solution. So that's why you're considering. 

Marquese Davis: Right. And again, nurturing and establishing those relationships with those clinical teams becomes essential at that point. You don't always get the information you need quickly from specific organizations or departments within the company. But being able to have those conversations kind of off the cuff, with the medical director or department saying: what are the issues you're struggling with this month? Is there something that the IT department or leadership can assist you with? We can help you remove these barriers. Those conversations or communications often don't always come through an email or trouble ticket. One of the things that I like to do is have regular meetings, whether once a month or every other month, with members of the clinical leadership to understand their wants and needs. 

[13:41] process of choosing the vendor

Ivan Dunskiy: Maybe to make priorities. And could you please explain the process of actually choosing a vendor? Do you have a scoring system, or what is the process looks like? 

Marquese Davis: I've had processes vary from organization to organization. So it's a little bit different with this organization that I'm with right now. As I mentioned before, I've been there at the moment for three and a half months.

There aren't too many barriers when it comes to selecting vendors. And it depends on what type of vendor it is. So, if it's a clinical vendor, I involve the clinical teams and clinical leadership to make sure that this makes sense for them.

But when it comes to any IT solutions specifically for the IT department, I'm pretty much the last stop for that. I evaluate the needs of the organization, and department's needs, making sure that whatever solution we are selecting, It's sustainable and makes sense overall for the organization's strategic plan.

So, whether it be security and privacy, or even training modules that will assist us with security and privacy for new employees, it's a bit difficult to answer because it depends on where the solution will be implemented.

[15:02] privacy and security - regular security audits as one of the most important things

Ivan Dunskiy: I understand. You also mentioned privacy and security, and obviously, that's a very big deal in healthcare. Could you please share with us how you ensure that in your organization? Or what is your process of choosing vendors look like? How do you check them?

Marquese Davis: So one of the things that I've been doing over the years is identifying applications that we have internally. That we can move to the cloud, moving applications to the cloud reduces and mitigates the risk that we have internally.

The other thing that I encourage folks to do is regular security audits. Security audits can help you identify gaps that you might not necessarily see day by day. But doing regular security assessments will help you identify some of those things that you might've missed during deployment, whether software or hardware.

But I think that's one of the most important things to shore up the security framework within the organization eliminate access to applications and files for folks that don't need it and change your mindset around security in general.

Many folks see this as another thing: I don't want to do it, but maybe we can get by? You really can't get by, especially in healthcare. Folks have to change their mindsets around how security and privacy impact healthcare organizations.

Ivan Dunskiy: And how regular these security audits should be, you think? 

Marquese Davis: Depending on the organization at least once a year, but if there are issues or historical issues within the organization that has impacted their ability to deliver care, I would say six months, but I wouldn't recommend getting a security audit six months.

Once you get to a point where you feel that due diligence has been done, I think once a year should suffice for most organizations. 

Ivan Dunskiy: And do you provide any checklists for those organizations? What do you expect from these audits? Or do you just let them do their job and define the audit's plan and strategy?

Marquese Davis: Most vendors come in with a predefined plan for what they're going to audit. I think that it is okay to allow some additional information to be added in that audit, especially if you had concerns about whether it's PHI or some HIPAA violations that might've happened within the last 24 months. It's safe and fairly reasonable to ask the vendor to hone in or focus more on a particular area related to security if you feel that it's necessary.

[18:04] big issue in healthcare: using many software systems by one organization. Advantages and disadvantages of Epic EMR

Ivan Dunskiy: And let's talk about the fragmentation of software. So it is a big issue in healthcare that organization has many software systems in place for different purposes. What is your, like, how is this situation in your current organization? 

Marquese Davis: So that's an issue and a challenge for many healthcare organizations. And luckily for us, we have a partnership with Yale University. So we use Epic as our EMR. As a result, our instance of Epic is connected to other healthcare providers within the city of New Haven and the Yale network. So many of our clients see some of those providers outside of our organization.

Their medical record is already integrated. So, providing that layer of continuity of care for the clients, the entire health record is critical. So we don't run into any issues around, Integration or we don't have to bill any HL7 or FHIR interfaces to have those clinical records shared across providers.

Ivan Dunskiy: And are you personally happy with Epic? 

Marquese Davis: Like any other EMR, Epic has its pros and cons, but I think for right now, Epic has served the organization very well because it is an instance of Yale's Epic, we don't have as much control over it, but when it comes to reporting, and being able to do the configurations that we need to do to serve our clients and run the organization, Epic has been a great product.

Ivan Dunskiy: And as from a telemedicine perspective, would that be like a separate application that would be connected to Epic? Or how do you see the setting of that? 

Marquese Davis: It would be a separate application right now. We're transitioning in and using Doximity. From what I understand, Doximity does have some Epic integration, so we're looking to see how those integrations will work with the clinical workflow. But we're still in the early stages around that. 

Ivan Dunskiy: So you still choosing the vendor? And what is your point on data interoperability in healthcare in general? How do you see that that could be solved? Is this only by using a solution like Epic, or are there other solutions you see? If, for example, a company cannot afford Epic or Cerner. 

Marquese Davis: Data interoperability is a real challenge for smaller organizations. They can't afford Epic or Cerner. And this is something that I've been in conversations with folks over the last decade, trying to figure out the best way to close that gap around interoperability around healthcare information.

I think what's most important, and this is really at a federal state level, is for organizations to utilize their health information exchanges as much as possible to assist with the transmission of that information. And also making sure if interoperability is an important element of providing care. Selecting vendors that have a strong history of providing those types of interfaces so that if you do need to exchange information with your local HIE, that vendor can interface with them fairly easily. But the challenge in a lot of cases, I know here for Connecticut, there's just certain health information you can't transfer to a state HIE such as mental health and substance abuse information. I believe there's some legislation to try to release and remove some of those barriers for that. However, primary care information is easily transmitted through HL7 and FHIR. 

But working in the healthcare industry for over 17 years and dealing with these interoperability challenges for about the same time, it's not easily addressed unless you're dealing with organizations on the same platform, like Epic.

Ivan Dunskiy: So your point is, if you can't afford Epic, for example, you need to think of it from a strategic perspective and choose solutions, depending on your demands and depending on your existing technologies. 

Marquese Davis: Absolutely. I think that's essential.

[22:51] the future of telemedicine: will it increase or disappear after a pandemic?

Ivan Dunskiy: And turning back to the telemedicine, what is your personal intake on how do you see can we expect that this telemedicine adoption will increase in the future with this ease of regulations and so on or things would get back to normal as it was before COVID? 

Marquese Davis: No, I believe telemedicine is here to stay. I know earlier on, during the pandemic, there was a question of whether or not Medicaid was going to be around at this time in 2021 when the pandemic started, but I don't think telemedicine has gone anywhere.

Organizations, especially governments at the federal and state level, understand that telemedicine has removed barriers for folks who had disparities in getting to their healthcare provider. Telemedicine has reduced the number of no-shows for a lot of organizations.

So now folks are showing up to their appointments where they weren't as much before. And I think as a convenience for patients, they're enjoying the fact that they don't have to leave their homes to participate in a healthcare visit. So I feel it's here to stay. 

Ivan Dunskiy: And do you see that this is worse or the same on the physician level? Do all physicians accept this change and want to use it? 

Marquese Davis: From the physicians that I have spoken to over the last year and a half, they seem to enjoy it. I think they're able to see patients on a more regular basis, especially those acute patients that they wouldn't necessarily be able to see before. I think they feel much better about delivering care via the telehealth model.

Ivan Dunskiy: There are opinions that, like the older population of physicians, they are not very okay with using telemedicine and are still used to paper and things like that. 

Marquese Davis: Right. And so you'll still get those comments. I heard those comments even before COVID around just EHR implementations. The older population of clinicians did not want to use EMR because they were used to paper.

But I think there's a learning curve for anything. And I think many folks are getting used to the telemedicine delivery model. 

[25:21] centered patient data

Ivan Dunskiy: Evolution is going forward. What is your opinion on this topic of centered patient data? The patient can transfer their data from provider to provider, from insurance to insurance. What is your idea like? Do you see that that is happening? 

Marquese Davis: I've had this conversation with a couple of folks, and I think that when a patient has the ability to have some control over their clinical data is good. I think it's empowering.

However, I think about privacy and security as well. And I am making sure that there's some education around moving your data from provider to provider. Having access to some measures and controls in place would also be critical. But I'm a little more concerned about it. I support clients and patients to access their data, the transmission, and the actual tangible control of that information. So I don't know the answer to that right now. We don't run into that a lot. Whenever a client wants to move their information from one provider to another, we release data, and we have a process for that.

It's a little bit different. For other care settings, whether it's substance abuse or mental health, it depends.

Ivan Dunskiy: And what if a patient comes to you with their data? What is the process? So you said that you have a process when they want to change from you to another one, but what if he comes to you from another one? 

Marquese Davis: Usually, the way I understand it, that is when we have clients that come in from another provider, say they come from out of state, and they have a folder of PHI, we usually scan that information into Epic.

We can have a historical record of that information. Now, technically, we can't tell the patient that okay, now that we have it scanned into Epic. Now we need to take the physical copies from you. Technically it's still in legally the patient's information.

So, we hope and trust that the patient understands the importance of protecting their health information. But again, I think it boils down to providing education around how to manage your personal health information. 

Ivan Dunskiy: I think that's quite a significant shift the mindset that you as a patient need to store all your data in the storage that you trust, and you have that ability to transfer your data. So that's a kind of a change of mindset, and that takes time. 

Marquese Davis: And I think just like healthcare organizations have to change the mindset of how they're protecting manage data, the same goes for clients as well. We, as clients, need to figure out ways to manage particular data better. 

[28:23] telemedicine as one of the technology trends in the next 3-5 years 

Ivan Dunskiy: What technology trends do you see in healthcare in the next three, five years? 

Marquese Davis: As healthcare organizations handle high-risk cases over long distances for non-acute services, patients will drive the need for more proactive healthcare.

So the expansion of telehealth services will be critical for all healthcare organizations. Patient portals, having patients have access to healthcare information in a digital form and submit information to their providers electronically.

And also remote patient monitoring. I think that will also become one that starts to evolve over the coming years. Especially as we begin to expand telemedicine, you're going to see folks needing to take their blood pressure remotely, BMI, being able to monitor and manage high blood pressure remotely. So I see that becoming one of the trends or a few of the trends that will evolve over the next three to five years.

Ivan Dunskiy: So you expect that we will see more and more tech products, the space.

[29:44] primary advice to other professionals who would like to develop or implement technology in healthcare

And we are coming to the end of the interview. What kind of advice can you give to other professionals who want to develop their product for a healthcare organization like yours, and what do they need to consider? 

Marquese Davis: Get as much feedback as possible for people that consume your tech. Remove any barriers build relationships within your organization.

That's how you're going to build and deliver meaningful solutions. As I mentioned before, IT leadership doesn't necessarily decide what to choose. We make recommendations. And support the folks that are going to make those decisions, we need to provide them with as much information as possible.

We need to continue to cultivate those relationships. So we can help them remove those barriers to provide a very high quality of care. 

Ivan Dunskiy: You mentioned that they need to get the feedback as much as possible. People in healthcare are busy. So what is the best way to get as much feedback as they can? 

Marquese Davis: Make time on your calendar just to meet with people. As tedious as it could be, or as it can be, it's critical to do those basic one-on-ones with the medical director or with the chief medical officer to understand their wants and needs. We're all busy, but we can allocate that time, investing in that time to meet with those folks. Help in the long run. 

Ivan Dunskiy: And do you think medical directors are the best contact to show the product? Or is it better to start, for example, from physicians?

Marquese Davis: There needs to be representation at each level. So maybe not necessarily the medical director, but someone within her leadership team. Also, a department head could be a physician assistant. But I think there needs to be some leadership of some representation from the clinical team to help make those decisions. 

[31:55] Rapid Fire Round (3 questions)

Ivan Dunskiy: You mean decision-makers? Appreciate that advice and your vision on that. I want to end the interview with the Rapid Fire Round exercise. I will ask you several questions, and you will answer whatever you want. Do you code yourself? Because I noticed that you have a GitHub account with some activity. 

Marquese Davis: I do. I mostly code on Python and Ruby. But I haven't done anything lately. 

Ivan Dunskiy: Is it like a hobby or just you're researching something? 

Marquese Davis: It's a little bit of both. I have deployed some web applications internally at organizations that I've worked for before.

I'm also an entrepreneur at heart. So I'm always trying out different platforms and frameworks for web applications. Mostly around data analytics and other microservices within web apps. 

Ivan Dunskiy: That's great. Do you think by the way that a director of information technology should code? 

Marquese Davis: Absolutely no. Not full-time. 

Ivan Dunskiy: Do you have a hobby? 

Marquese Davis: Yes. I love to travel. 

Ivan Dunskiy: And what is the location that impressed you the most? 

Marquese Davis: Toronto, Canada. It impressed me a lot because I grew up here in the Northeast. I'm about an hour away from New York. Toronto reminded me of New York, but it cleaner version of New York.

Ivan Dunskiy: And what is your favorite book? 

Marquese Davis: My favorite book is "Start With Why" by Simon Sinek. 

Ivan Dunskiy: That's a great one. He already has a video and a Ted talk about that. 

Marquese Davis: I saw that. I got to check it out. I haven't seen it yet, but I did run across it. 

Ivan Dunskiy: I assume in the book, he goes more in-depth into the topic.

And what is the one piece of advice you would give to your 20-year-old self? 

Marquese Davis: Everything will be okay. Don't worry about it. You're doing everything you need to do. Just keep moving forward. 

Ivan Dunskiy: That's a very positive way to end the interview. Thank you, Marquez. Thank you for giving that perspective of how the director of information technology sees things in healthcare organizations.

I think those insights you gave were beneficial for people who want to develop a product for the space, and I'm like what questions they need to ask themselves. And thank you, of course, for giving you a perspective on the trends and technology developments in the nearest future. Before we finish, what is the best way to get in touch with you if people want to connect? 

Marquese Davis: The best way to get in touch with me would be on my LinkedIn profile. Just type Marquese Davis.

Ivan Dunskiy: Thank you. I will also include all of this in the resources section as always. Thank you, Marquese, thank you to all listeners, and we'll see you in the next episodes. 

Who is behind the HealthTech Beat podcast

We are a team of IT professionals who like sharing technical knowledge with healthcare industry people.

At Demigos, we generate ideas on how to improve product performance, design, and positioning based on our experience building complex health tech solutions.

Check our blog with articles on the related topics, and our cases in healthtech. Also, connect the podcast host and the CEO of Demigos Ivan Dunskiy on Linkedin.