charges in to healthcare with Health Cloud — interview with CMO Joshua Newman

Joshua Newman, MD --Salesforce's Chief Medical Officer

Joshua Newman, MD –Salesforce’s Chief Medical Officer announced its move into healthcare this week with Health Cloud, which aims to help providers manage patient relationships, not just patient records.

I asked Joshua Newman, MD, MSHS, who is Salesforce’s Chief Medical Officer and GM of Healthcare and Life Sciences to comment in more detail.

1) I think of Salesforce as a platform for sales teams to manage their leads. But it sounds like you have gone beyond that. Please explain.

Yes, that’s correct. We started in sales force automation (SFA) and are now the world’s No. 1 customer relationship management (CRM) company, which means that we help our customers connect with their customers — everything from sales to service to marketing to analytics. But it’s not like we just woke up one day and decided to take on healthcare. As healthcare becomes consumerized, organizations are in need of better CRM tools to connect and engage with patients. We’ve been serving healthcare companies for more than 15 years now, starting with life sciences firms — who obviously have a lot of salespeople — and now with many of the top providers and plans in the industry. It’s just that these companies previously needed to customize our products to work in their environments, and with Health Cloud we’re building much of that functionality out-of-the-box for the first time. We’re taking our experience in CRM and applying it to patient relationship management.

2) What is Health Cloud?

Salesforce Health Cloud is a cloud-based software designed for healthcare organizations. Built on Salesforce Service Cloud — the world’s #1 customer service and support application — the product gives providers a more precise view of a patient’s demographic, lifestyle and health information to better serve their needs. In doing so, it provides a complete view of patient data, including EMR information, medical devices, wearables and more. And Health Cloud also enables smarter care decisions through features like the Timeline view to visualizes a patient’s health over time. Finally, it allows providers to connect to a patient’s full care network, whether inside or outside the hospital. The Patient Caregiver Map visualizes relationships, and enables providers to collaborate with outpatient clinics, home caregivers and others to ensure the patient receives consistent, high-quality care.

3) How does Health Cloud differ from the offerings for other verticals? What’s unique about health?

Healthcare is such a different beast. The industry is ahead in the technologies used to conduct medicine — genetic testing and targeted cancer drugs and diagnostic imaging– yet woefully behind when it comes to the technologies used to manage patient relationships. Fortunately, for the first time in history, healthcare IT is shifting toward the patient. Payment and reimbursement is also distinct in healthcare. The Affordable Care Act (ACA) is pressuring providers to compete for patients like never before. And outcome-based reimbursement means providers receive Medicare and Medicaid funding based on process and quality metrics and not merely by the number of procedures. Finally, patient expectations in healthcare are slightly different and are shifting. Uber, Amazon and others have defined what a quality experience can be. Yet healthcare still often fails to consider patients as if they were customers. We think Health Cloud is the product for this unique moment, for this unique industry.

4) As a patient, am I a sales prospect?

Yes and no. As I said, providers are treating patients as customers for the first time in this environment — or “prospects,” as you say. And this is really a good thing, in that it means they are competing for their business in the way they communicate and the quality of care that they deliver. That is resulting in part to improvements in patient experience and outcomes.

5) What opportunities does health reform present? How are you addressing them?

With both the Affordable Care Act (ACA) and employers demanding more healthcare transparency, health providers need stronger patient engagement. ACA enabled health insurance for 16 million Americans, and subsequent court cases secured coverage for 6.2 million. This means that healthcare providers need to take lessons from consumer companies, as more people than ever before are prospective patients. Healthcare providers have an opportunity to change how they approach patient relationships. Salesforce Health Cloud also helps providers meet patients’ tech-savvy demands through its mobile capabilities. It enables providers to give concierge medicine focused on patient preference and satisfaction. Caregivers can follow up with patients once they leave the clinic, whether it’s an email, phone call reminder or message on a mobile app.

6) How does the health cloud offering differ from partner solutions —like Evariant and Veeva— that are build on your platform?

We’ve obviously built a partner ecosystem around Health Cloud, whether it’s companies like MuleSoft who help with integration into legacy EMRs, or systems integrators like Accenture and Deloitte who assist with content, implementation and more. It’s true that some aspects of partner solutions may compete with some aspects of Health Cloud — this is inevitable in the technology industry — but for the most part, we consider Health Cloud to be a platform for other partners to extend the product’s functionality. And, at the end of the day, it’s about giving customers what they want, so we leave it up to them to implement the solution that best fits their needs.

7) There are a variety of healthcare IT solutions out there, and many providers are investing heavily in EHR. How does health cloud work in that environment? What is the level of integration, cooperation, and rivalry?

EHRs do an important job. They are critical for ensuring the right data is captured for internal processes like billing and procedures within a clinical environment. But they do not help organizations manage the complexities of patient relationships. Today’s health systems need to make the shift from revenue cycle management and electronic health records, to building stronger patient relationships. With our open API, metadata-driven platform, providers can use Salesforce as an engagement layer on top of their legacy EMR systems. It gives them additional CRM, mobile and social capabilities, and they benefit from new innovations from Salesforce delivered three times a year.

8) Can you provide a couple of success stories?

Centura Health is using Health Cloud for several unique use cases. Centura Health’s oncology nurse navigators work in silos and leadership lacks visibility into the volume/ROI of work. Centura will use Health Cloud to align all oncology nurses onto a single platform, standardizing workflow and reporting to achieve better patient outcomes. Also, Centura Health has entered into bundled payment agreements with Centers for Medicaid and Medicare (CMS), and is turning to Health Cloud to track metrics for the post-acute portion of this process to include stays, outpatient therapy, home care, and avoidable emergency department revisits or readmissions.

9) What unexpected challenges have you faced in health?

I think the biggest challenge is extracting data from legacy EMRs, as they aren’t built with open APIs like most modern cloud-based platforms. Of course, we’re also seeing many middleware companies tackling this API problem, whether it’s replicating EMR data into separate data stores or building new interfaces to modernize the approaches of EMRs. The other challenge is the conservative culture and slow pace of change in medicine.  We are actually all very grateful for this culture. It served us very well in an era when people were literally selling snake oil.  However, we as patients need faster innovation and responsiveness to the changes in the world, and frankly, my colleagues in medicine have been clamoring for a more agile and nimble processes also – Learning System is how the IOM terms it. The healthcare industry has worked a certain way for so long now — and frankly has fallen behind in certain aspects — that it’s going to take great tools to enable change and the strength of consumerization and reimbursement changes to push providers into changing their ways. We’re excited about the possibilities, so is the industry.

10) How are customers implementing Health Cloud? Is it all or nothing or are there ways to experiment?

Health Cloud hasn’t officially launched yet, so it’s hard to tell with 100 percent accuracy. But I think we’ll see a similar adoption path to how cloud-based CRM technology — like that of Salesforce — was adopted years ago. Organizations tested Salesforce on certain use cases and departments, and eventually it spread to entire companies, buoyed by its ease-of-use and popularity with end users. I think we’ll see the same thing with Health Cloud.

By healthcare business consultant David E. Williams, president of Health Business Group.

Deloitte’s Harry Greenspun on the ‘bright future’ of connected care (podcast)

Harry Greenspun, MD

Harry Greenspun, MD

I enjoyed Dr. Harry Greenspun’s talk at Qualcomm Life’s Connect2015 yesterday in San Diego, so asked him to expand on his remarks in this podcast interview. Harry directs Deloitte’s Center for Health Solutions, which provides insights on the evolving environment for healthcare stakeholders.

Here’s what we covered:

  1. (0:12) What is the Deloitte Center for Health Solutions?
  2. (0:46) You said patients care about service levels, not the quality of care. Is that true for sick patients and for parents seeking diagnoses for their kids?
  3. (2:03) Now that payments are changing to value-based, will that make an impact on care delivery?
  4. (2:59) You said we have “good quality measures” and cited the famous Bill Clinton heart surgery example. Is that really true, even in the case of the Clintons?
  5. (4:45) Will the future of healthcare really look like the present for consumer oriented businesses? Or is healthcare different than examples you cited, like Chipotle?


By healthcare business consultant David E. Williams, president of Health Business Group.

Computer aided diagnosis for mental health: two important strides

Advancing the state of the art

Advancing the state of the art

Researchers are using modern technologies to develop advanced tools to assist with the assessment of mental health problems. We hear a lot about “big data” and genetic sequencing, which can be expensive and complex, but there are also promising tools that are not so pricey or complex, even if they do employ components of big data and genetics.

Two examples caught my eye this week:

The speech analysis program was tested on 34 subjects, so we’ll have to see if the results hold up. But the idea makes sense. Well trained clinicians can already assess disjointed speech patterns and reach similar conclusions. But the computer seems to do an even better job, and more importantly, could ultimately make such techniques feasible for a much broader population who don’t have ready access to psychiatric services. And all while lowering the cost of assessment dramatically.

I’ve always thought it was quite primitive and even bizarre for clinicians to assess suicide risk by asking patients if they were thinking of killing themselves. So I’m pleased that a new tool combines a series of questions about energy level, feelings and accomplishments and uncertainty with a blood biomarker test. Again, this approach could ultimately be simpler and cheaper to administer, and more consistent than existing methods.

We won’t be replacing physicians any time soon, but these new approaches are emblematic of what we can expect as developers make better use of available data, analytics approaches, and distribution methods. I’m most excited about increased diagnostic accuracy, earlier availability of information, more widespread availabilty, and lower cost.

Image courtesy of Ambro at

By healthcare business consultant David E. Williams, president of Health Business Group.

Massachusetts hospitals are making money — I’m quoted

The Massachusetts Center for Health Information and Analysis has released its 2014 profile of hospital financial performance. Profits are up moderately overall by various measurers, despite drops in inpatient stays, outpatient visits, and emergency department utilization. What’s going on?

As I told the Boston Globe (State hospitals report $1.2 billion in earnings):

“The health care system as a whole and the state’s biggest hospitals in particular have gotten the message that they need to control expenses.”

Hospitals saw this coming and have been making serious efforts to increase efficiency and control expenses in the face of healthcare reform. It’s encouraging to see that they are passing their first tests, as there will be more to follow.

As usual, many of the comments on the Globe’s website lament the big money made in medicine. But to put things in perspective, the whole Massachusetts hospital industry made less money in 2014 than some individual hedge fund managers.

By healthcare business consultant David E. Williams, president of Health Business Group.


Wal-Mart provides evidence Obamacare is working

What's in your basket?

What’s in your basket?

From a Wall Street Journal blog:

Wal-Mart Stores Inc.’s took a hit from the Affordable Care Act during the second-quarter.

The Bentonville, Ark.-based retailer said its pharmacy business had reduced margins, which hurt earnings at the U.S. business.

What does this mean? It means that Wal-Mart’s core customers, lower middle class families with median household income of around $45,000, are benefiting from the Affordable Care Act. Some have gained Medicaid coverage under the ACA’s expanded eligibility requirements, others have purchased policies on the public exchange, and some young adults have retained coverage under their parents’ policies. All of those people have prescription drug coverage and many are probably filling their prescriptions at Wal-Mart.

All else being equal, many of the newly covered should have extra disposable income. They could be spending some of that extra income at Wal-Mart, and maybe they are. But net/net consumers may be benefiting more from expanded insurance coverage than Wal-Mart. That’s not a bad thing in my book.

Image courtesy of atibodyphoto at



Ready for the eyeSelfie for diagnosing health problems?

Ok Google, am I healthy?

Ok Google, am I healthy?

I spoke last night to a friend who lamented that his teenage daughter seemed fixated on taking selfies of her eyeball with his phone. He found these when he went to review his stored photos. I thought it was a little odd but suggested that maybe she was looking for just the right shot to send off to an ophthalmology lab for diagnosis.

I may not be far from the truth. Today’s Boston Globe included MIT Camera Culture Group develops the ‘eyeSelfie’ to help monitor eye health. Sure enough, my suspicions were confirmed:

Researchers at the Camera Culture Group, headed by Ramesh Raskar at the MIT Media Lab, have designed the eyeSelfie, an inexpensive hand-held device for taking a photograph of the retina, the optic nerve, and the vasculature, which is located all the way at the back of one’s eye.

Digital snapshots of the interior of the eye can help physicians detect and treat vision-threatening diseases such as glaucoma, macular degeneration, and diabetic retinopathy early. New research indicates that the snapshots can also be used to identify risks factors for hypertension, heart disease, multiple sclerosis, and Alzheimer’s disease.

Taking this back into the realm of speculation, let’s imagine that Google decides to use its new image recognition initiative to automatically analyze eyeball photos, like those of my friend’s daughter. If the technology improves enough it could give Google vastly more insight into users’ health status. It goes way beyond my speculation from eight years ago (What if Google finds out you have cancer before you do?) about Google’s ability to guess a person’s illness from search logs, even if the user hasn’t been diagnosed yet.

I could take this further. Right now the MIT camera is a specialized unit and it still takes a bit of jiggering to get a clear shot that can be analyzed. But as camera technology improves perhaps we’ll get to the point where we can analyze even regular smartphone snapshots, zooming in on the eyeballs of everyone in the frame and assessing their health status.

That will take a while but we should be prepared for when we get there.

Image courtesy of Serge Bertasius Photography at

By healthcare business consultant David E. Williams, president of Health Business Group.