Barbara, a developmental behavioral pediatrician, discussed her company's system that aims to enhance evidence-based care for children. The system, initiated two decades ago with her husband, involves patients completing questionnaires before and between visits, which then triggers in-visit decision support for doctors and offers specific education and resources for patients. The company, located in the greater Baltimore, DC area, is licensed to other clinics and has been utilized by over 55,000 clinicians in various countries. The future implications of AI on this system were also discussed, with Barbara highlighting the potential benefits and challenges of AI in patient education. She emphasized the importance of utilizing reliable information and keeping personally identifiable information confidential when using AI. Barbara's role as a developmental behavioral pediatrician and her work in improving screening tools for autism were also noted.
Barbara Addresses EHR Challenges and Improvements
Barbara discussed the challenges and issues with the current electronic health record system in the United States, highlighting its lack of unity, the high burnout rate among doctors, inequities in healthcare delivery and research, and inadequate interoperability efforts. She also shared her thoughts on potential improvements and the impact of COVID-19 on healthcare, including the positive aspects of telehealth and mRNA vaccines, and the negative effects of disinformation leading to distrust in the system. Lastly, Barbara and Krista emphasized the importance of patient engagement in healthcare, the progress in medicine, and Barbara encouraged listeners to visit their website and participate in a new initiative to improve screening tools for children at 18 months.
Connect with Barbara Howard on Linkedin: https://www.linkedin.com/in/barbara-howard-6806459/
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From
The Top Floor Team
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Welcome to Top Floor, the podcast where we amplify discussions with CEOs and chief executives driving the future of small and medium-sized businesses. Get ready to be inspired and informed and empowered as we delve into the unique minds and journeys of these executive leaders, the one shaping tomorrow's business landscape. I am your host, Dr. Christopher Crawford. In addition to being an adjunct professor for two university MBA programs, I'm also a Vistage Chair. As a chair, I coach leaders in peer advisory groups and in one-to-one executive sessions to make better decisions that lead to better businesses and overall better lives. My guest today is Barbara Howard, the founder and chief executive of Chaddis, which stands for Comprehensive Health and Decision Information System. Chaddis is an online health screening and questionnaire software. They're encouraged as patient engagement and supports providers. Join me as we ascend to the top floor. Welcome, Barbara Howard. I'm so excited to learn more about Chaddis. So let's just dig in. What is it? What do you do? Tell our listeners and watchers. Well, I'm a developmental behavioral pediatrician and I started a company along with my husband and colleague Raymond Sterner. He is also a developmental behavioral pediatrician to create a system to help support pediatricians in doing better evidence-based care, particularly for behavior and development. But it's turned into a system that supports all of the care they provide by having patients complete questionnaires before visits and between visits to bring information into the visit, saving time, providing documentation and triggering both moment of care decision support for the doctor and specific education and resources for the patient based on the answers they give. So, you know, I'm a layman. How does that happen? So what does that look like for the patient or the child on the other end? What does the end result look like? Good question. So the doctor's office asks the patient and teaches them how to log in to the system before the visit. They do questionnaires, which are evidence-based tools, and the doctor sees the scored results and can use that to inform the visit. So if there are problems there, you want to make sure that you talk about those. And if there are no problems, they can focus on things that are other priorities for the visit and make the visit more efficient overall. So how many hospital systems or homes is this information, you know, connecting with currently? Well, this is a business that is licensed to other businesses, so B to B, and it's now in being used by over 5,000 clinicians in 48 states and a little bit in 10 other countries, primarily Canada. We've screened over 23 million patients. That is so amazing. And it's is it located all here in the greater Baltimore DC area, or do you have locations throughout? So the offices are all over the country, as I said, and even in parts of the world. Our servers are now in the cloud, as well as on the ground in Arlington, Virginia, and our staff is scattered all over the country. Wonderful. You started your company about 20 years ago, is that right? Yep, seems like a moment. And what prompted what was that kernel, that ideation that took place? What was your vision? Well, my vision was to improve and has been to improve care for children and their families by having evidence-based information about development and behavior. That was the initial goal, because those things 20 years ago were not being screened for routinely, including things like autism, teenage depression, substance use, the child's actual developmental milestones. Those are the kinds of things that were not being looked at in a scientific way, and therefore problems could be missed. So that was the main motivator. And of course, 20 years ago is right when the internet was available to let patients move that process outside of the exam room. So in other words, the problem in pediatric practice is time. Dr. doesn't have time to have people do things during the visit, so we decided this is a way of getting people to do it from home, or even in the waiting room, making it possible to cover those topics during the visit. And what do you see with your crystal ball how AI will continue to impact this? Well, AI has great possibilities for helping with patient education, but one of the things that AI can't do is it can't create new evidence-based tools. And actually, one of the reasons we have to be careful about AI is for people to not get information that comes from unreliable sources. So I think that AI can be a benefit, for example, in translating patient education into a reading level that the family can accept or a language that's the language of choice for the family. I'm in favor of that, but we need to start with reliable information to be in the data from which the AI thinks. And so that's something that we're not talking about very much yet, except it's the training data set for the AI needs to be reliable information. And actually, from the point of view of Chaddis, of course, all private information is kept private, so no personally identifiable information would be put into an AI system. But because we have such a huge database of evidence-based information, Chaddis itself could be a source of training data for AI. That's something we're looking at that haven't started yet. And that's good advice across all channels, news media. Look at where the information originates and who actually writes the original pieces. Where's the empirical data supporting what we're receiving? So thank you so much. Let's go back in time a little bit. Tell me about, I don't know, 12, 13, 14-year-old Barbara. What was she interested in doing at that time? Well, I already wanted to be a pediatrician. I wanted to be a doctor when I was only 9. And I got to do that. I've been blessed to have that opportunity. And then I decided to be a pediatrician certainly by age 13. So what I didn't know at that time was that my desire to help children be healthy and have be able to build on their strengths and avoid problems. I didn't know that it was going to be part of a world of medicine that really was not doing such a good job when I got to that point in my training. So I've had a chance to innovate and make that better. And that's something I'm grateful to have been able to do. What types of things have you helped improve in terms of the delivery of care for children? What areas were you focused on? Well, again, I'm a developmental behavioral pediatrician. And so my goal has been to have better assessment of a child's development so that we're not missing an opportunity to help them have optimal development. That's screening for development. Autism has become a major part of what I do because the rates of children recognized to have autism spectrum disorder has gone up. And we've actually done research to help improve screening tools. That's one of the things we're working on right now is that we have a superior screening tool at an earlier age than anyone else that's in validation right now. So helping detect it because most of these conditions in children do better the earlier you start addressing them. And so my goal has been don't wait until the family is deadly worried. Don't wait until the doctor can see the problem with the child. Look for the signs earlier so that better interventions can occur. Wonderful. So tell me who were your mentors earlier in your career? Who did you look up to or want to be like? Well, not so many people know about T. Berry Brazelton anymore. But I was trained with T. Berry Brazelton and he became a dear friend and colleague and a wonderful mentor for me. That's where I did my fellowship at Boston Children's Hospital which is part of Harvard. So I would say he was one of my main mentors. There were other people at Boston Children's Hospital like Mel Levine who was interested in school age children. So I got some education in that. And Alan Crocker who was interested in children with disabilities. So I was actually in a place where I could get different points of view on the different kinds of problems of development. And I have to say that psychiatrists have also been a big influence on me. That was one of the parts of my fellowship training was to be counseling families and having supervision from child psychiatrists. And that has certainly changed the way I deal with mental health questions in providing supportive materials for pediatricians who are expanding into having to do more about screening and actually addressing mental health concerns. I have to ask were there many women at the time that were forging ahead or were you a maverick? Well, in those days, there were only in my medical school class out of 120, there were only 20 women. And that was at Hopkins where women had an advantage over other medical schools believe it or not. But that's changed now and almost 60% of pediatricians graduating from training programs now are women. But when I was at Boston Children's Hospital, the chairman of the department was actually Mary Ellen Avery, who was a very famous female pediatrician. So it's expanded more and more. And now it's harder to find male pediatricians than it is to find female pediatricians. That's not such a bad change. Yeah, we're seeing more and more women in general in medical school and across the board. So that's great to see. Do you have a particular leader either within the health care or given the fact that you're a founder of your own organization or outside of the health reading area that you follow? Is there some leadership person that you follow or that when you see something they've written you say, I need to look at that. We usually ask a question about who you're reading right now. Well, there are leaders in business and there are leaders in medicine. And I think one of the leaders in business that I admire, sort of admire, is Steve Jobs, because of how he was able to pivot when his first attempts at making portable computers, now known as laptops, and he was able to pivot and change his whole company to deal with that. And of course, the Apple products have been a wonderful addition to the world. Now, in medicine, gosh, there are many. Dr. Razzleton that I mentioned is certainly one of them. I admire pediatricians and other physicians who take a leadership role in transforming the way the health care system works because it still needs a lot of work. There's a lot about the health care system that's primitive and doesn't serve patients very well. And I admire people who can stick in there. Jack Shonkoff being one of those leaders in health care that I admire who I actually got to train with and then work with later. Let's talk about pain points. Every industry has some pain points. What do you see as pain points in your industry, either currently or something you've got your eye on coming in the future? Well, you mentioned AI, but let me just say something about electronic health records. So I actually heard a presentation by the former Secretary of Health and Human Services who said that their reason for making electronic health records, having a motivator for physicians to adopt electronic health records was in order to have the data so that you could document the quality of care and outcomes. So that was the goal. Now, what they did was they actually paid doctors to adopt electronic health records. And then what came after that was a sequence of requirements called meaningful use requirements. But in the United States, we love wagon trains, right? Everybody can go off into the West in their own Conestoga wagon. And what happened is we now have over 200 electronic health records. So the pain point is it's not a unified system and it was created by engineers, not clinicians. So the electronic record is partly responsible for a 50% burnout rate among clinicians. I'm not just talking about pediatricians. I'm talking about all doctors. Doctors are difficult to acquire, train, they're expensive. Okay, they're very critical infrastructure for the United States health care system to have 50% of them burning out, partly because of the documentation burden and the way the electronic records work is a huge problem in America. So I would say that's one of the biggest issues right now. Now, of course, inequities in health care is another huge problem. And so a lot of advances are mostly are more available to people of higher education and higher income than they are to lower income people or immigrants, for example. And so I think that that kind of disparity in the delivery of health care and in the research that is the foundation of appropriate treatment, those are other big problems in health care. And of course, I don't have to tell you or anybody else that health care is really expensive. It's the health care debt is the most common reason for going bankrupt in America. And that's a huge problem as well. So did I give you enough ammunition there? Oh my goodness, you gave me a lot of ammunition. What's being done as far as you know, in terms of what is taking place right now to make these 200 different programs for health care records communicate with each other? Well, there has been some effort called interoperability. But the requirements have been sort of trivial to start with. And they're supposed to build over time. But because they are built in over time, the electronic records can do the minimal amount to make interoperability and not go to the most substantial part of really showing records. So the second thing that's happened is something called health information exchange, which are the health health information highways. This has been particularly valuable for things like making sure that information from emergency room visits or information about misuse of medications. That's like addiction. It's been particularly good for that. It's not been very helpful in pediatrics. So a health information exchange really hasn't lived up to its billing, like what it should be able to do. I'm still hopeful. We have to be. We don't have any other choice, right? It's out there. It's the clap. Go ahead. It can be advocates though. Right. In other words, letting people know that it's not doing everything it could or that it's promised to do or that would make it useful. I think it's an important advocacy thing to take on also. If you could go back and change one decision over the course of your illustrious career, and it still has many, many miles to go, what decision would that be and what would you do differently if you could. If I were to change a decision I made, I don't know. I've been pretty fortunate. It's hard to say. I think that if I were more devoted to advocacy in the politics, I could probably be making a bigger difference than I am. So I am making a big difference, actually much bigger than I thought I would, because screening 23 million children and helping the doctors know that there's suicidal or they may be autistic or they're depressed. I feel as though that's been a very substantial contribution and that can grow. So I guess if I had more business savvy and had accelerated the growth of our company more, we would be serving more than 23 million children and would have expanded into more of adult care and specialty care and be making more of a difference. But I haven't given up yet. So I would say that not understanding the, well, what's necessary to grow a business fast was probably one of the things I would say that I would like to change. Living here and practicing and working and having your business here in the Baltimore area, what changes have you seen if any that may become systemic or carryovers from what we experienced with COVID-19? Is there something in the healthcare arena that you believe has permanently changed due to that? Yeah, some big things. So some good things, I would say that the acceptance of telehealth has provided more access for people, especially people who need repeated visits for things. Mental health is one of the places that's benefited the most, but also rural health has benefited. And so that's really important. And it's very important that we keep the rules that allow for telehealth and expand them so that people can have telehealth across borders of states. So that's a mistake that they haven't done that yet. Another thing that's been a huge benefit of COVID is the recognition of mRNA vaccines and what was possible is almost miraculous. So even though we lost millions of people to COVID, there are millions more we didn't lose to COVID because of the effectiveness of these vaccines. And the technology for that is being addressing now cancer and other diseases in a very profound way that I'm really very happy about. The biggest problem from COVID is the disinformation that happened because there's been a degrading of trust in the healthcare system, which is really not completely appropriate, but the pandemic was not handled well. And it's not our last pandemic. It wasn't our first pandemic either. As a matter of fact, 1918, there was another huge pandemic. But we're going to have more and more pandemics. And if people are suspicious of vaccines and of the government and don't trust the government to handle it, and if the government doesn't step up and do a better job than it did last time of information and vaccine distribution and personal protective equipment distribution, then we will have failed to learn the lesson from COVID. Thank you for sharing that. So what is most inspiring for you today in terms of health care? What inspires you? Well, I'm inspired by the progress, some of which I just talked about, vaccine, genomics, and the rate of change in medicine is very large. But the rate of adoption of innovation leaves a lot to be desired. And actually, chatters has been stated to be one of the best examples of learning health systems, where data can actually change practice in a shorter period of time. The story in the past has been it takes 17 years for a new innovation in health care to make it to the level of care. We should be able to do better than that, and learning health systems is a way to do better than that, where the data can continually update doctors on what they should be doing and on what kinds of medications and technologies need to be developed. Barbara, I'm inspired by you. And I truly am, and you make me feel so positive about what can we can see coming forward. What I'd like to do is, what have I not asked you about chatters, or what do you feel that people need to know that I haven't asked you about? What would you like to share? Well, I would like to share to the people who might be listening for patients, which is like everybody, like we're all patients some of the time, and that is that helping the doctor by providing information before the visit really makes a difference in the quality of care they can receive. So when people are too casual, they say, "Oh no, one more form," to fill out, they're missing an opportunity to be able to have a doctor who can focus on the real needs they have, those that they're stating that they need, which are also expressed in pre-visit questionnaires, and those that they don't realize they need, such as the detection of autism and young children where they may not have suspected it at all. So I'd like it for people to contribute and be more engaged in their health care, because they get better care when they do that. Thank you for that. This has been so inspiring, and I've learned so much. We've had a wonderful chat with Barbara Howard with Chaddis. Barbara, how can people get in touch with you if they want to learn more about your company or about you? Well, our website is chaddis.com, c-h-a-d-i-s.com. My email is behoward@chaddis.com, and I hope that you'll check out the website and think about how it can help you and your family or people you know get the right care. I do want to talk about our autism discovery and product, though. So I think earlier that we've developed a new screen for children at 18 months that promises from our preliminary data to be twice as good as other parent report screens at 18 months, but we are recruiting practices to participate in that project. And so if you're interested in that and you have a pediatric practice, that's something that I would encourage you to look into. Pediatricians, are those who manage pediatric offices? Please, please follow up with Barbara. She needs your data. Barbara Howard, thank you so much.
