Contributing lab leader: Matthew Zachary
A main principle of health justice is the assurance of quality healthcare to all patients, regardless of who they are and where they live. Several organizations and healthcare advocacy professionals are leading the mission for healthcare policy reform - implementing protective laws that are right for the patient.
Over the past 27 years, Matthew Zachary's work has been largely recognized for his commitment to "making healthcare suck less" per the title of his podcast, "Out of Patients". As a cancer survivor, a former advertising agent, and a patient advocate, Matthew shares numerous new and unconventional approaches he's taking to disrupt the healthcare industry and continue to push the advocacy dialogue forward. Read our Q&A below and find out more about his groundbreaking perspective.
Q. How can lab managers and lab directors "make healthcare suck less" - as the goal of your acclaimed podcast, “Out of Patients,” describes?
I would almost say that the customer service part of the healthcare journey gets drowned out. The system needs to be highly efficient and safe, and I think in many cases it’s hard to remember that patients are people. For instance, generally, no one likes waiting areas or waiting rooms because they can be a little cold. I'm not saying fluff it up with feng shui, but something as simple as cushioned seats could enhance the experience.
Patients are very used to doctor's offices – no one's unfamiliar with that experience. Labs are different – more clinical and direct. Lab diagnostic locations don't need to have the same aesthetics that would normally be in a doctor's office, but the environment could be more welcoming to people. Having a kiosk in front that is not managed by a lab professional is not the most inviting environment. Perhaps laboratory staff can take on a customer service role of sorts so the patient feels their needs are being taken care of.
Healthcare is a situation we all get stuck in, whether desired or not. The best case scenario is to make sure people feel they can trust the designated healthcare or lab facility, and that their needs are addressed at the utmost capacity. Making it suck less means addressing pain points the patient highlights when providing feedback.
Q. Based on your experience and the changes you have seen in the healthcare industry, what best practices would you share with leaders in the laboratory space to remain ahead of the curve?
I think financial disclosure upfront is critical. Most people are there by referral or because their doctor ordered a particular test or treatment. Sometimes there are associated costs that aren't fully disclosed. When we talk about health literacy in this country, what does that really mean? It's not just knowing about your disease, it's understanding the financial state you're in when you arrive. It's similar to reading the iTunes terms of service. In most cases, no one actually reads it, they simply click okay. It comes down to clear communication on all fronts. Going back to our theme of customer service.
Lab results can be complex and hard to understand. Oftentimes, you have to wait for the results to go to your doctor, although maybe there's some critical information you need to know about beforehand. Is it possible to have those results disclosed to patients in a safe way that'll help them not be so nervous?
When patients go into these spaces the information tends to go in one ear and out the other. We lose sight of reality and most people don't know how to take good notes in these meetings. The life hack of the day is to use technology, turn on the voice memo app on your phone and record these conversations so you have them later when you talk to your providers.
Additionally, professionals saying you'll have your results in a few days doesn't instill trust, it instills panic in many people. The last thing you want is to wait to see if your lab results reflect something not-so-great happening in your life. Educating patients about their lab results and having compassion when communicating results to alleviate any fears or anxieties is important. I'd love to see that happen in lab diagnostic practices.
Q. Laboratory services are an essential component of quality healthcare delivery. What innovations in the diagnostic field do you see as game-changing for patient care?
The recurring theme of the decade is the impact that the pandemic had on consumer behavior and trust. I always joke about how I'm old enough to remember when eBay came out in the late nineties, and no one trusted the internet with their credit cards. Now here we are buying everything all day, every day with a quick touch on your phones. Thanks to the pandemic we were forced into the adoption of telehealth. The process of implementing telehealth revealed broadband and access issues since not everyone has a fancy computer in their house and their phones might be older models with limited features.
That said, telehealth has become a significant part of society and culture. There's an emergence of healthcare startups and platforms even outside of the realm of diagnostics – mental health telehealth, and psychology telehealth, among others. We need to lean into telehealth in a much more engaging fashion because we already have the buy-in and trust there. It has the potential to save costs and now we’re measuring whether it improves the quality of life and health outcomes as well.
The only challenge is in instances similar to COVID-19 when tests were delivered to your house or you had to go to a pharmacy, those can be misinterpreted, and the results can be varied. When they invent a virtual blood test that can happen over the internet, I think we'll all celebrate in some way. Telehealth and remote monitoring will be inextricably tethered to the real world, especially when diagnostics are only indicators or predictors and require real life professional oversight to confirm accuracy. For now, are there better ways to integrate the trust instilled by telehealth into lab diagnostic best practices?
As a reference point, I am one of the first users of an FDA-approved app in beta that does facial scans for basic vitals. It's pioneering this idea that the technology and cameras on Androids and iPhones can now be used to measure vital signs that you can then send to your doctor. We have Bluetooth tracking armbands for blood pressure, but here's something that reads your pulse and your blood pressure.
There's a fabulous balance between what is working, what society is used to, and how we revive some of the old methods. My kids were just at the pediatrician and they couldn't find a vein in my daughter and they finally located it, but is there a better way? Are technological advancements coming that could eliminate that variable?
Q. How do you see traditional lab diagnostics coming together with digital health apps on patients' phones to improve the diagnostic pathway?
Based on the forced adoption of telehealth, there has been an emergence of platforms that are actually providing real value at a low cost to consumers. Even the mental health platforms such as Headspace, Calm and Talkspace are really working and getting mass adoption.1
I think data sharing is going to be a problem. Where is the trust? Where is the value exchange? My wife uses a platform called Psychiatry. I use it also– it's a telehealth psychiatry app that connects patients with psychiatrists in their region. I did go through four telehealth physicians before I found someone that I trusted and felt comfortable using the app.
I have yet to see how these emerging digital health data platforms are going to integrate with other innovative diagnostic mechanisms that are on the horizon and will appear in the future. I think it all just comes down to providing the user with the rights, the liberties and the disclosures they need to be informed.
I see these all as good problems to have. I'm a student of history and I've been around 27 years as a patient, which is long enough to remember that we didn't have the innovations in healthcare that we do at this time. We're doing much better now.
Q. What are the top 3-5 challenges that you predict labs will face in the next 5 years?
We're certainly going to see staffing issues as a top challenge. Upskilling people is needed to foster more of a consumer experience in the labs.
Unexpected policy changes from payers will be another challenge. We're never going to completely know what those are as they happen randomly. For example, my wife is a teacher for the Board of New York, and we've been on the same health insurance with 50,000 other teachers for 20 years, and all of a sudden the union renegotiated the payer relationships on behalf of 50,000 teachers and school workers. As a result, everyone in the city had to get new insurance. We didn't choose this, it just happened. We had to get all new doctors and all new pediatricians. We had to start from scratch because everything was re-restricted. I had to go from this lab to that lab, with no choice in the matter. Getting the system ready for those seemingly radical and unexpected changes like this is extremely important and it will affect staffing and other key factors in the lab.
Digital transformation can be interpreted as a few nice syllables, and what it means in my opinion is how to take advantage of culture and society shifting into adoption and trust. Again, we're at the mercy of certain things in healthcare. People can make choices on their own in many cases. But there's always going to be that random fact where we're solely reliant on the system to adopt and adapt with us.
Q. Beyond that five years, where do you see healthcare shifting or advancing?
I look at some of the technologies in rare disease and oncology coming down the pipeline and see a shift. Back in the day, your body part determined your outcome. Where was your cancer? Where was your rare disease? Today your genetics may drive those outcomes. A lot of these tests are still getting approvals.
Looking at companies such as 23 and Me that offer DNA testing from a decade ago, most were considered untrustworthy and consumers felt that their data was being sold to the universe. Nowadays, everyone gets their ancestry for Christmas. We are witnessing a cultural, anthropological adoption by consumer behavior.
I'd like to think we're going to be tested for pre-cancers at drugstores by 2030. These at-home tests will be there not to predict your cancer risk, but to predict your pre-cancer risk – a new narrative happening in the entire healthcare system. It's fascinating to think that's where we'll be in 2030. Of course, this changes everything because anything in the diagnostic space or the MedTech space is now in the consumer space. We are bridging those divides.