Why Workflow, Not Technology, Is Healthcare's Biggest Challenge: A Conversation with NextGen's G. Shah
Download MP3Well, hi, everyone. I'm Daniel Williams, senior editor, at MGMA and host of the MGMA Insights Podcast. We are back with another episode today, and I'm I'm excited about this. We've got G. Shah today.
Daniel Williams:He's chief product and strategy officer at NextGen Healthcare, and he recently presented a really successful webinar at MGMA that's on demand, and we'll talk about that as well. Today, we're going to be discussing why healthcare leaders should redesign workflows around patients and providers. Without further ado, let's bring him into the show. Gee, welcome. Good to talk to you.
G. Shah:Hey, Dan. Great to be here.
Daniel Williams:Yeah. You and I were trying to figure out when that webinar episode ran. I believe it was July 28. All accounts, I've talked to the webinar team. They said, no pressure now, but they said, You were amazing in that.
Daniel Williams:What was it like to interact with the MGMA audience?
G. Shah:It was great. It was really fun to see the level and type of questions that we got. Often you get onto one of these webinars, and it's dead silent. You're like, Oh, do we do now? No one's asking a question.
G. Shah:But everyone was engaged. We got some really hard questions, which are fun to get answers to, but ultimately, it was just nice and interactive, which was what we wanna have at the end of the day.
Daniel Williams:Yeah. I love that. Well, we'll We'll provide direct links to that webinar so people can access that, but for now, let's learn a little bit more about you. What of your career highlights would you want to share? You were telling me about one time reporting to a three star general earlier in your career.
Daniel Williams:I don't know if you want to go back that far, but what are highlights you might want to share with our MGMA listeners right now?
G. Shah:Well, I'd say my background in healthcare spans a pretty wide arc of all the different places where healthcare operates. I've had the opportunity to work in clinical systems, in ambulatory care, in pharmacy, and in payer organizations. And so having had that chance to sit in all those different places over the years, I've done the technology. I've worked in the health system. I've worked with practices.
G. Shah:I've worked directly with with patients and with members, and I've seen how the system works and how the system's complicated. I mean, I what I love about being in health care is it's a thing that we all experience ourselves personally as well as work in it. And so finding a way to triangulate all those different pieces has been fascinating. Today, working at NextGen Healthcare, my role is really about designing the better experience, the better experience for the provider, for the care team, for the ops leader, and for the patient. And you'll hear me say that a lot as we go.
G. Shah:This is about the experience, the tech, the way that we use the tech, the services, all the things that live around it, all really come down to one thing. Healthcare happens in that interface, right, between the patient and the provider and all the things that surround it. We have to make that experience better. So having sat in all these different seats, having seen all these different things, I see the same pattern over and over and over again. It doesn't matter where you sit, it's all about the experience, and that experience is what I'm really looking forward to talking to you about today.
Daniel Williams:Thank you for sharing that. I love the way you presented that. Let's talk about NextGen Healthcare for just a moment as well. For any of our listeners, they may have interfaced with NextGen, but just in case they haven't, tell us about who NextGen is and how it interfaces and impacts medical practice leaders and organizations.
G. Shah:NextGen Healthcare is an intelligent healthcare platform. It's built to simplify ambulatory care, bringing the EHR, practice management, revenue cycle, and patient engagement together in one connected experience. And, again, you'll hear me say it often. Right? This is all about the experience.
G. Shah:So what does that mean in practice? Because that's a great overarching statement. That means things like documentation, billing, all work alongside the patient care, the provider interaction, and the care partnerships. It's all aimed at the same thing, though. Getting to the outcome that makes the most sense from a health perspective for the patient and keeping the providers in business and supporting their financial workflows.
G. Shah:At the end of the day, my goal here, it's less about how do we get technology in front of them. It's more about how do you spend less time doing what you don't wanna do and spend more time doing what you do wanna do. One of those things is patient care. And the other time is don't sit at home in your pajamas and try to do charts. Like, get to the point where we can find the best possible experience for the two.
G. Shah:And that that's what I love about operating a place where the EHR is and the practice management system is because, ultimately, these are the systems that the organizations or the ecosystem use to operate. And so we are that operating system, and the opportunity to change the operating system is what's super exciting.
Daniel Williams:When we think about healthcare organizations, they've invested heavily in technology. We're gonna talk about that. Many are dealing with a lot of challenges, though. Administrative burden, staffing shortages, disconnected workflows, financial pressures, on and on and on. When you take a step back, G, you see, as you were talking about, you've worn a lot of hats.
Daniel Williams:You've seen healthcare from a lot of different angles and points of view. What do you identify as the biggest challenge right now? What's going on out there?
G. Shah:I'll contextualize my answer Technology like has evolved dramatically over the last twenty, thirty years. I mean, the things that we see now were like science fiction back in the day. But the way that the work gets done hasn't really changed. So healthcare organizations have gotten really, really good at thinking about the answer to the question that's right in front of them. We have to do interoperability.
G. Shah:So let's buy an interoperability solution. Meaningful uses here. We gotta do a portal. Okay. Let's go buy a portal solution.
G. Shah:We have to do something around billing. We have to do something around the patient workflow. Let's buy a solution. Let's buy a solution. And so what's happened is we've gotten really good at just stacking all these things on top of each other.
G. Shah:But what we've never done is stepped back and looked at it and said, well, wait a second. What does this end to end workflow look like anyway? Not the patched version, the actual version. Like, how is it being experienced by the provider? How is it being experienced by the patient?
G. Shah:And should it be that way at all? So I would say the meta here is we don't have a technology problem in healthcare. We have a workflow problem. And the bigger thing is we've normalized all these broken workflows. Like, we're okay with it now.
G. Shah:We're just there. It's been that way. Fine. Off we go. This is our opportunity to take a step back.
G. Shah:And you talked about the recent webinar that we did a couple days ago. It was fascinating there as we had a group of physicians and we had an operational leader with us. And what's interesting is they said the same thing just from their various different places. It's not about documentation. It's not about making things faster from an operating workflow perspective.
G. Shah:It is the workflow that surrounds that action of how I got the document and how it carried through the system. And that's kind of the light bulb I want everyone to have here. It's not one single thing. It's not one point or one point solution. It is that end to end.
G. Shah:And that reframing really helps illustrate why we have change these broken workflows, or at least change the way we think about how to change those broken workflows. Because if we keep going the way we're going, we're just gonna keep breaking stuff, and that's ultimately what we don't wanna do.
Daniel Williams:Right. When you were saying that, it took me back to about three and a half years ago, I'm sure you're going to remember this, when Southwest Airlines just shut down. Their system completely shut down. I know this because my daughter was at home. It was over the holidays, and she had to get back to California, and the flights were gone.
Daniel Williams:When we all read about it, what we learned was something that I think resonates with what you were talking about. They built a process, a computer program in the system. They built on top of that. They built on top of that, and on top of that wobblier and wobblier ground. It really comes to something that you've shared with me.
Daniel Williams:You said people look at, Hey, let's fix this existing process. In that case, it was this existing computer program, as opposed to really stepping back and going, wait a minute, let's rethink what we actually want to accomplish here. I see your head nodding. I hope there's something, some wheels turning here. Tell me what you're thinking about, what you would like to share about that, and that idea of let's not just add on to what this process is or make a tweak here and there, but let's really step back from it and redefine what we're trying to do.
G. Shah:Yeah. On one side, it's easy to say this by looking back, Right?
Daniel Williams:Like, know? Sure.
G. Shah:It is like, was that the right thing to do or not? But but but I would say this. At the time, and I'm sure this is the same thing that happened with Southwest, it was the right decision to make. So no one made a bad decision. They just made a decision from a different mindset or a different framework.
G. Shah:And so we started stacking point solutions because it made sense at the time, whether it was a financial driver, whether it was a schedule driver, whether it was, oh, boy. Alright. I mean, I have no other way to do this, so I'm gonna go go back and do that. The mind shift is this. And this is, by the way, something I think about every day.
G. Shah:Look at the workflow and say, let's think about it now. It's 2026. We have so many tools available to us. I mean, we're so many minutes into our conversation, and we haven't said that one word yet. Right?
G. Shah:We haven't said AI. But it is it is so fundamental to this conversation. Yeah. Yeah. It it's like, think about it now.
G. Shah:With the AI, with cloud computing, with all the other things that we know have come in and now happening, you almost have to say, wait a second. Is this how it should work? And again, the thing that I challenge myself with here too is healthcare, unlike many other places that I've worked, the end result of the workflow is something that impacts the person directly. And this is one of the fundamental principles I have for my team here at NextGen, but what I've always had with my teams. Point number one is we are building products that touch people, and those people are us.
G. Shah:It's it's ourselves. It's our spouses, our partners, our families, our children, our communities. And so we almost have to be able to take that step back and say, what is the right way to do this in the tools, that toolset that we have, in the way that we have to do it today? Because, ultimately, you want that experience to be well. The the flip side of that is when we accept the broken workflows or the debt.
G. Shah:Right? Because there's a lot of debt in the system. It's not like those work workflows just live on and don't have an impact. They accrue interest, which I hate having to say. But that interest is administrative burden.
G. Shah:It's staff frustration. It's provider burnout. And so we almost have to take that step back and say, wait a minute. Let's think about redesigning it. One point that I'll make here too, and I'll I'll carry it on, is with AI, we can't just go down the path of creating the point solution.
G. Shah:I often say it's like, you need to sprinkle magic AI dust over everything. Right? Of course. And that's gonna solve the problem. It's not.
G. Shah:Because if it's broken, it just means it's broken faster. And something that's faster that's broken is still broken. So we have to really rethink, especially now with AI in the mix, how do we rethink that workflow? How do we ensure that we make the right decisions and then we carry it end to end instead of looking at each one of those individual points?
Daniel Williams:I knew we'd get to AI initially, though, but there we go. There we go. Now, in sharing some information back and forth, you shared that the future of healthcare depends on redesigning workflows around patients and providers, and not around technology. So help us unpack that. What do you mean by that?
G. Shah:That really starts with the idea that what we deliver are experiences. And that's a mind shift. Because often we talk about we have a problem, or we have a technology solution. Or we talk about the technology itself, which is fascinating. And, like, I live in the Bay Area.
G. Shah:I live in San Francisco. I can throw a rock out my window, and I'll probably hit somebody that works in AI. Right? Or I'll I my favorite example is this. I drive across the Bay Bridge every so often, and where in other cities I might see billboards for restaurants or some type of consumer good, we have billboards for AI products.
G. Shah:So we talk about tech, but tech is not the solution. Tech is not anything more than a set of tools that allow us to get to the solution. And so another one of these mindset shifts is the technology is here to enable care. It is not to define how the care is given. And for a lot of organizations, it's flipped.
G. Shah:The providers are adapting to software. They're adapting to the software's workflows instead of the software intelligently understanding how the providers work and finding that right balance. The other thing I'd say, and this I think is the the place I want our industry to get to, the best technology is not one that asks for your attention. It's the technology that disappears. It's there, but you don't see it.
G. Shah:It's there, but it's operating in the background. And there's this famous meme of a child going to their pediatrician, and, you know, they they drew a picture of their experience. And the the picture was of the pediatrician looking looking at them from the side because what was that pediatrician doing? They were looking at the screen. They weren't talking directly to the patient.
G. Shah:And I think we've all had that experience where our provider's not nose to nose to us. They're there's our nose to their ear.
Daniel Williams:Yep.
G. Shah:That's and and when I go back and say, wait. Really great health care happens in that interface, That interface is not nose to ear. It's nose to nose. It's knee to knee. It's eye to eye.
G. Shah:And so that's how the software, that's how the technology has to work. It has to return us to that ability where when I go see my doctor, I'm looking at her or him face to face. I'm having a real human conversation, but she or he is empowered, is informed, has all the information so that we can have a great conversation about what matters most to the most both of us, which is getting me well and getting him or her paid and letting them get me well. Right? Those things all work together.
G. Shah:The technology has to be able to support that. And we seem in some cases to not think about that way. So that's my challenge to everyone. Think about that experience. Think about what we want that interface to be.
G. Shah:That's how we should design the solutions that we have in front of us.
Daniel Williams:You're talking about that patient experience. Let's frame it with the idea of workflows that you were talking about earlier. If there are workflow issues, how is that impacting? How is that affecting that patient experience? What's an example or something you might want to share with us?
G. Shah:Sure. I'll start by saying this. The patients almost never see our workflows, but they absolutely experience them. So, this idea that we have these broken or sub optimized workflows eventually become a patient problem. And so I'll give you a couple examples.
G. Shah:When because we don't have great connectivity between systems, a referral gets provided by a primary going to a specialist, and it takes two, three days a week because the handoff doesn't happen, the patient doesn't see that. What it feels like is, why is it taking me so long to get into my specialist? My specialist is gonna help me with this particular issue that I wanna deal with. It's when you walk in and you get handed the clipboard, and the clipboard is the same information you had every single time you went for an encounter. Like, why do I have to fill this out again?
G. Shah:Why am I getting asked the same question over and over and over again? They don't see that that's a data integration gap or a gap in being able to pull information from various different places. They're experiencing the frustration of sitting and waiting in the room trying to fill out a piece of paper that looks like the piece of paper they filled out the last time. And from the providers, not having all that information when they walk in the door and having to go to the end of their day, fill out all their documentation, not spend time with their families, impacts the core experience because that provider is either rushing through the encounter because they're trying to figure everything out on the front end, or they're tired. They're less present because they spent all their time the night before going through all of their documentation.
G. Shah:So every one of these broken workflows becomes a patient problem. Those examples are just the things that we experience every day. It gets deeper that in that when you start thinking about what happens from an operational perspective, what happens from the financial perspective. But that is just, again, that core patient experience that I know you don't wanna have, certainly I don't wanna have, and we don't wanna have any one of the people that are around us or loved ones to have either.
Daniel Williams:Sticking with information then, you have talked previously about the importance of creating trusted information across the entire organization. What does that mean? What do you mean by trusted information? Help us understand that aspect of it, and please elaborate on that.
G. Shah:Healthcare has so much data. We have more data now than we've ever had before, and it comes from various different places, but it's not trusted. When I say that, when I'm operating in my clinic or my practice and that information is coming in from someplace external, I see that the data's coming in. How do I understand its provenance? How do I understand who did it and why?
G. Shah:And how do I ensure that what it is is exactly what I need? That is what's trust. And so before I talk about how you fix that, what happens when we don't trust the data? Well, that's where a lot of this workflow burden and a lot of this debt comes in. If I don't trust the data, I'm gonna recreate it.
G. Shah:I'm gonna reverify it. I'm gonna ask the question over and over and over again. I'm gonna send out for duplicate labs. I might even send out for duplicate imaging. We can't continue to operate in a place where I do the work in one place, and it has to then turn around and get done over and over and over again.
G. Shah:So one way to solve this is that idea of trusted interoperability. We have the ability to interrupt information back and forth. There are mechanisms, whether it's through mechanisms like Mirth Connect or others, where we can take information, we understand its source, we can guarantee provenance and bring it over. We have the APIs. We have the technology to make that happen, but it's not just those tech pieces that make it work.
G. Shah:It's the idea that we have to explain the data is coming from a trusted source. Here's how and why, and here's how it comes up into your workflow. The last piece I'll say there is it's not just looking at the data. Like, no one wants to sit there and say, okay. Now let me look at the screen for fifteen minutes.
G. Shah:It's about taking that data, understanding its source, understanding that it's trusted, and getting it in front of the right people at the right time, whether it's in a pre encounter state or a post encounter state so that it's trusted data being used to do something so it doesn't have to be reproduced. What's the net result of that trusted data? I'm not reproducing information. I'm not making the patient wait or have to redo tests or have to redo imaging. And ultimately, I have a better view of what's going on with that patient across their life cycle from everything they did before to where they're gonna go after.
G. Shah:So ultimately, I can provide better care, or I can enable the provider to provide better care.
Daniel Williams:You launched into AI earlier, so I don't I want to just go right back to where you want to think about it from this perspective. When we're thinking about AI, I sound like a broken record for our listeners who listen to every episode. They're going, here he goes with AI again, but I think this is really important, and I want to get your perspective on this. There are, as you mentioned earlier, some really great tools, these AI tools that are out there that can help people do their jobs better. Let's think about it like this.
Daniel Williams:If you're at a medical practice, you're not a technology expert, and you're inundated with all of these quote, tools. What do you do? How do you make the right decision on which tool to get? Is there a decision tree? Is there a process to go through, or do you just hire a consultant to help you out?
Daniel Williams:I mean, just so you don't make the wrong decision, or spend money on something that maybe you didn't need per se, and you really needed to be focusing on an AI tool in another area.
G. Shah:It's a great example of where the thought process starts to change a little bit. You're right. We are awash with AI tools. Each one of those, I like to think of them as a point solution. I've solved this one particular piece, But when we think about the care workflow or we think about the patient workflow or the intake workflow, any one of those experiences that we have, if you're optimizing and fixing one little piece of it, which is inevitably what that person coming in and and pitching their AI tools to you is telling you, they're kind of missing missing the point again.
G. Shah:Right? Because it does not sit by itself. Every one of those solutions touches one part of the workflow. So it doesn't mean that you don't use them. It means you step back and say, well, wait a minute.
G. Shah:Let's take a look at this workflow end to end. Am I optimizing every one of these pieces? Probably. Is that optimization connected? Because as we talked about before, you have to have the data to go from step to step to step in the workflow.
G. Shah:You have to have the context to go from step to step to step in the workflow. So just by dropping in one AI tool, all you're doing is fixing one one very specific piece. If that tool can't integrate from the left side to the right side of the workflow, if it's not transiting data in the right way, if it's not transiting its output to the right place, what have you done? You've just optimized one particular piece. You've actually broken the workflow that much more.
G. Shah:So the the decision tree really does start with, okay. That's a great idea. I should fix this particular part of the workflow. I should fix this idea of automated referral scheduling. Great.
G. Shah:That doesn't happen with one data point. I need to understand a lot of information about what the patient is. I need to understand their insurance. I need to understand what they need. The AI can feed that, but it has to do a forward integration.
G. Shah:Right? The data's gotta come in. It's gotta be trusted. The AI can do its magic. And then it's gotta turn around and get that information out to someplace else.
G. Shah:That is the mindset. That is how you make the decision. Can that tool do that? Or do you wanna do that one tool, or do you wanna take a more integrated approach and look at something that does end to end? What I would say is this.
G. Shah:The rubric here is look at the workflow, redesign it to what you want it to be from an ideal state first, then apply the AI. Doing it the other way, that just means you're speeding up something. And If you're speeding it broken, like I said before, it's just broken faster, but you might actually be speeding up the wrong thing when you look at it from end to end.
Daniel Williams:Yeah. I have a final question for you here. This one, we kind of turn the wheel in a different direction. I just love to end these conversations. We talk a lot about work, but we're not automatons.
Daniel Williams:We're human beings here. What does g Sha do when you're not solving healthcare problems? What do you like to do? Do you have a passion, a hobby, anything out there where you like to spend your time?
G. Shah:Well, I if if anyone looks at my LinkedIn, my headline will give you that straight answer. My first job in life is to be a husband and a father. Yeah. And that is what I do every hour of every day, even when I'm at work, because that's it. Right?
G. Shah:I have a family, and and I love being around my family. My daughter is doing what little girls do. I'm a ballet dad, which I'm sure some of your listeners are kinda nod their heads, say, oh, I know what you're going through now, g. But in addition to that, I I love being outdoors. I kayak, which is a a unique piece to piece because you're out there by yourself.
G. Shah:But this is gonna sound super nerdy to everybody. I'm a product guy. Oh, yeah. And so I think about problems like this everywhere I go. And it is you know, you there are problems everywhere to be solved in the world.
G. Shah:I just love being able to go out there and talk to people about solving. And so in that sense, I like to spend time with companies in health care that are very early in their journey because I've had this opportunity to see where people fail. And, honestly, innovation happens on the ground, whether it's whether it's with providers, with physician executives, with these startups. So I also, in addition, spent a fair amount of time working with startups in the industry to say, let's let's not have you focus on the wrong thing. Let me help you think through where you want to go.
G. Shah:That just helps me feel like there's a place for innovation to happen, in addition to all the great work that I've been doing here at NextGen.
Daniel Williams:All right. Well, Jisha, it has been so much fun getting to catch up with you. You for joining us on the show.
G. Shah:Thank you. Thank you for having me.
Daniel Williams:All right. Well, G's, webinar, it's On Demand on mgma.com. I'm gonna give you the whole title, Healthcare is Normalized Broken Workflows, how high performing practices are redefining what's possible. You can go to mgma.com/webinars or just search for it, and you can find it on our site. I will also provide a direct link to that webinar in our episode show notes.
Daniel Williams:So until then, everybody, thank you so much for being MGMA Podcast listeners.
