Health systems spend billions on transformation that works in the boardroom and collapses at the clinical unit. Dr. Sarah Matt, a surgeon turned health technology executive, explains why most AI and virtual care initiatives fail at adoption rather than design, and how her Five Pillars of Access give leaders a practical way to evaluate what will actually scale. A direct conversation about trust, financial sustainability, and building care models that stick.
Sarah Matt, MD, MBA, Health Technology Strategist, Growth Catalyst, Author, The Borderless Healthcare Revolution
Megan Antonelli, Chief Executive Officer, HealthIMPACT Live
00:00:00 Intro: Welcome to Digital Health talks. Each week we meet with healthcare leaders making an immeasurable difference in equity, access and quality. Hear about what tech is worth investing in and what isn't as we focus on the innovations that deliver. Join Megan Antonelli, Jenny Sharp and Shahid Shah for a weekly no BS deep dive on what's really making an impact in healthcare.
00:00:29 Megan Antonelli: Every year, health systems spend billions on transformation that works perfectly in the boardroom and falls apart six months later on the clinical floor. My guest has been in these rooms and she'll tell you exactly where it breaks. I'm Megan Antonelli, CEO of Health Impact Live, and this is Digital Health Talks. Hi, Sarah. Welcome to the show.
00:00:47 Sarah Matt: Thank you. I'm excited to be here finally.
00:00:50 Megan Antonelli: I am so excited. I know I, I said it in the cold open. It took a little longer to plan one because we finally got to meet in person, which was great at the soy health conference. But two, I actually got the book and got it signed. Yay! And then got to read it, which I will admit, I started on the on the plane and I was like, wow, this is dense. I need to take notes. There is so there are, there's so much in it. And it is so aligned with everything we talk about on health impact and health impact and on digital health talks. Um, that I'm just, I'm just thrilled you're here. So excited to talk about it.
00:01:27 Sarah Matt: Wonderful. I'm so excited that you actually read it. So definitely ready to dig in.
00:01:31 Megan Antonelli: Yeah. Well, you know, and I think, you know, when we set out to do health impact and all of, you know, the conversations that I find are the most important and most meaningful. And technology is when we talk to physicians who are using it, who've adapted to it. And for you, who are you are a surgeon, you've moved into technology leadership. I mean, when that happens, you know, it's because there's problems to fix, right?
00:01:58 Sarah Matt: So, absolutely.
00:01:59 Megan Antonelli: Tell us a little bit about, you know, your story in terms of your background and how you found yourself in a position of technology leadership.
00:02:07 Sarah Matt: Sure. So I was in my surgery residency, and then I was doing my burn fellowship. And in the middle of my fellowship, you know, was half clinical. It was half research. And I realized I had all these other skills. You know, I was getting grant money. Everyone complained as business cases. I was doing all this complex experimentation. Everyone complains it's operations. And so it kind of got me thinking like, what could I do that could be even more impactful than this kind of one on one clinical piece that I'm doing. And so I knew I could do something bigger, but I wasn't quite sure what it was, but I knew at the bedside I was being kind of, I'd say limited. So how could I take care of hundreds, thousands, millions, billions of people every day? And so I made the transition, got my MBA at UT Austin and moved into the tech sector. And so I cut my teeth at NextGen healthcare, working with critical access hospitals during meaningful use. And they were not a bunch of happy clients at all. Margins were really small. Hospitals were closing, the electric electronic medical records were a wreck. Um, but it kind of started my career in the health tech space. So I've been at midsize places like NextGen, a whole bunch of startups with some fun exits. And then I was at Oracle building out their cloud OCI for healthcare and life sciences globally. And then I got to be the only doctor on the Oracle side helping to bring Cerner in. And so being part of that acquisition team was really exciting. Hugest, most I mean, it was a crazy size, you know, twenty nine billion dollars, twenty six zero zero zero people. I don't know if I'll get to do that again. And it was a really, you know, I'd say palpable part of my journey. So I really love that piece. But, you know, through my whole career, I've always still practiced medicine. And so I always did urgent care, charity medicine, and I still do charity medicine here in upstate New York. And I work at a little clinic in a night in New York, taking care of people with no insurance. And we get to write on paper. We don't. Bill. It's actually the most amazing concierge care I can provide to patients who no one else will see. And so when you see the big tech boardroom and the millions that we can push through a contract in twenty four hours versus the patients I see in rural America trying to get care and haven't seen a doctor for ten years, that juxtaposition is, is real. And so when I set out to write the book, I had a lot of interesting experiences across both sides of that to dig into.
00:04:42 Megan Antonelli: Yeah. Well, what different perspectives. And I think, you know, it really speaks to where we are in healthcare right now, right? I mean, and, and maybe we've always been here, but there's a certain amplification to it, you know, because I think that we're seeing the promise of technology and that access to technology and what it's capable of at, you know, in urban areas at big medical, you know, academic medical institutions, like all of that is there. And then on the other side of it, there's so much that isn't available to people for so many reasons. And I mean, you're literally living it, doing it, breathing it. And I think that comes out so much in the book. And I think the, you know, when I first saw the title Borderless Healthcare Revolution, and we, you know, talk a lot about healthcare, um, you know, healthcare everywhere. I thought, oh my God, same, same, but you're talking about a lot more. You're talking about the geographic barriers, the cultural barriers, and even the, you know, the change management piece of it, which you get into a lot. Um, so tell us a little bit about, about that in terms of, you know, that kind of broader sense of what you talk about in the book.
00:05:49 Sarah Matt: Yeah. So healthcare access feels squishy. And if you talk to people about access, they're all thinking about something different. Um, but one thing that's true is that if you ask a room full of anyone, anyone, if they've had access problems in health care, they will all say yes. And it could be for their parent, their kid, their friend. So it's one of those topics where everyone can come together. Having felt that pain and suffering themselves, now I split access into five different pillars geographic, financial, cultural trust and knowledge and digital. And oftentimes we think about one of those geography is really easy to think about, oh, they can't get here. But it's not just that. Can they afford the copay? Are we speaking the right language? Can they access your portal? All those different pieces kind of come into it. So it's really a systems view on the whole thing. And what I've found is that a lot of healthcare systems tend to focus on one of those pillars because it's hard to do them all. I get that too. But it's again, a systems approach. So if you only aim at one pillar, you're probably not going to solve your problem because it's all very interrelated.
00:06:59 Megan Antonelli: Right? And I think, you know, when I think about those five pillars in terms of geography, financial, the trust, the knowledge, the cultural, the digital. Digital is one you can pay to fix. You can.
00:07:12 Sarah Matt: Exactly. Exactly.
00:07:14 Megan Antonelli: You know, it's it's sort of that clear path. Cultural. That's a lot harder. You know, I mean, there's a lot of trust.
00:07:20 Sarah Matt: I mean, how do you measure trust? Right. That's difficult. And if you're trying to fund these things, it's easy to put a line in the budget for a digital product. Putting a line in the budget for trust, that's not going to work for you. Right.
00:07:34 Megan Antonelli: Right. No, I mean, definitely not in healthcare. Probably not. Not even not.
00:07:39 Sarah Matt: Anywhere, anywhere. Anywhere.
00:07:40 Megan Antonelli: Right. Um, we in terms of industries, we might be the softest, but we're not that soft. And there is, you know, um, but I think, and it goes back to kind of that the shiny object syndrome that healthcare has, you know, going after the tech. It's, it's not, it's not mal intentioned. It's well-intentioned. It's it's I've got a problem. I can fix it with this. But that creates something that you talk about a lot too, in terms of that pilot and kind of where we're constantly testing and trying, but we haven't addressed these core kind of cultural, systemic issues that are really what's propagating the problems in health care.
00:08:20 Sarah Matt: So when I was at Oracle, Larry Ellison used to say this on meetings. He'd say, the tech is easy. And I remember being like, what are you talking about? We're dying here. We're trying our best. But the tech really is the easy part. And I think that's what we forget about these technical tools. I'm never concerned about the tech. Either it's going to work or not. We can fix it or not. It's just time and money. But the programmatic pieces around it are where the technologies fail. How do we get people to adopt it? How do we make sure people are educated enough to utilize it? And in health systems, that pilot piece is rampant because it's easy to start a pilot. Do it for three months or whatever. There's a nice end to it. You put it in the easiest department with the most enthusiastic leaders, and it's going to succeed. But when you try to bring that pilot to scale now working in a different building a different organization with doctors and nurses who absolutely don't want to use it, then it gets a lot more difficult. And that change management piece is really hard. And to be an innovative company, you have to have innovative leadership. And that is also a organizational culture piece as well. Right.
00:09:31 Megan Antonelli: Well, and and I mean, to go back to the trust thing and, and I think that the challenge of trust in healthcare, right. And we, I mean, and we're seeing it only get worse because of AI and sort of the adoption and the rapid adoption of that. But the problem has been there since it began. And that there is this the layers of mistrust, whether it's, you know, and and it's not the patient to the physician, although yes, that exists and maybe has gotten worse. The lack of physician trusting the system, physician trusting the organization. I mean, we've created that because we've been irresponsible in how we've implemented things, changed things. You know, you know, kind of created a system that doesn't necessarily support the best care and the best care being given. So to go back to kind of what organizations can do or what we should be thinking about with trust, what can we do? You know, I mean, is there an element of there needs to be a change of how we talk about all of this, whether it's technology adoption or evidence based care in general. How do we move the needle there?
00:10:42 Sarah Matt: So whether it's internal or external with patients, I think it's interesting. People don't just wake up one day and say, I don't trust healthcare. They have receipts. And so as doctors or nurses in a hospital, you've seen pilot after pilot go through. It's taken a ton of your time. It hasn't gotten scaled. You feel like you wasted or you're doing extra login and this and that. So when someone comes next and says, we're going to do a pilot, of course you're reasonably going to say, I don't think so. If you're on the outside of that, if you're in a patient population that has historically been poorly treated by the health care system, which told you to trust them and it didn't work out, again, you have the receipts. Of course, you're reasonably going to say, well, I don't really trust this system. Why should I bother? And so I think we just have to remember that we can't just erase all the stuff we've done internally or externally. And so building trust, you can't buy it. And you can't just say you're going to get it in six months. It's a cultural change and you actually have to prove it right.
00:11:48 Megan Antonelli: And that's hard in organizations that have so many layers to them. And then the complexity, excuse me, and the complexity of all of that, I think, is really tough. And the relationship between the hospital and their clinicians and, and kind of where technology comes in. And I do think that, you know, since, I mean, you mentioned, you know, that meaningful use and that implementation of EHRs, I think we've come a long way. I think that there are, um, you know, stakeholder, multi stakeholder organizations within the, you know, within the groups that are making purchasing decisions that are assessing what's needed, you know, so there's a consensus that's coming in to kind of build that trust. What are you seeing on the day to day? Um, as you kind of, you know, do you agree with what I've just said? Is that, is that really happening? Is it, um, you know, is it happening everywhere or only in some of the bigger organizations that can afford that, that layer?
00:12:44 Sarah Matt: It's interesting. Yeah. You know, again, from a physician and nursing and other healthcare staff perspective, there's that one. And then there's also the patient perspective on trusting the system. Um, I was just doing an in-person book club on my book last night, and I asked everyone who has had an absolutely amazing experience in health care, tell me about it. These are the, you know, stories of trust. And each one of them involved a personal relationship with an actual provider. So they didn't say anything about money or devices or tech. It was all about that relationship. And again, that kind of goes back to how we practice medicine a long time ago, which is really that provider to patient relationship. And we kind of take that thought process and bring it internally. Our nurses and doctors, they're losing out on some of that provider to patient interaction. There's a lot more administrative work than when I went to school. There's a ton more liability and legal pieces and compliance. And there's a ton of documentation, which is it's not fun. Documentation is not fun. So you have your most expensive asset, your people in a hospital system that are the most educated. And now you're making them do clerical work. So when we think about bringing the tech in, the nurses and doctors have been promised efficiency before. They've been promised all these different pieces before. I think they still want to have something come in that actually works. But now they're not going to listen to the vendor. And oftentimes they're not going to listen to the chief medical officer instead. You don't need just one clinical champion. You need several because you need a small coalition of folks who are very invested in the solution and can actually verbally and, you know, spread that word to other doctors, other nurses and say, hey, it worked for me. You should check this out. Because without that relational kind of thought process, it's just another email. It's just another text. It's just more spam in your life, if you will. And I think that people are looking for that personal recommendation now from people they trust. Right.
00:14:59 Megan Antonelli: Especially as we look at sort of AI, right? I mean, the AI has kind of brought in this whole other layer of trust. You know, whether it's in our own personal lives and what we're reading online and everything else. But also here in terms of, is the AI going to be capturing what I'm doing? And is that going to be held against me? Is that going to be, you know, the tool versus the the risk of the tool? And you know, what, what liability exists? So those layers are, um, you know, you know, it's, it's really heady to begin to even think about, you know, how much the organization is going to have to change to protect physicians as we adopt AI. I mean, I think I heard, you know, in a conversation we had, um, in February talking about will we get to a point? And I don't even know, we might already be there. It's June where if you're not using AI, there's a liability because the AI is going to be capturing information that's better, right? I mean, there's just so much to what AI can and will do in terms of that risk, in terms of the trust, in terms of the capture, that I'm not smart enough to do it. Talk about it. I think about it.
00:16:11 Sarah Matt: Well, I think we're smart enough to.
00:16:15 Break: You're listening to digital health talks. When we return, we'll continue our discussion on how technology is revolutionizing healthcare delivery. Stay with us to hear more insights on creating sustainable, patient centered digital health solutions.
00:16:34 Sarah Matt: I think that where I see the biggest friction is that we live in a very litigious society. Unfortunately, this is how the United States is. And so when a new tool is brought into a healthcare system, well, if you use it or don't, the healthcare system made that decision. Are they liable? Oh, but the doctor's using it. Are they liable if it doesn't go well or if they didn't use it. And, you know, the doctors, unfortunately or fortunately, it's their medical license. So if something goes wrong, they have the right to sue, but they don't have the right to win. And so they are putting their license on the line every day for technology decisions that maybe no clinician even had a say in. And so I think that the incentive structure and the liability structure are currently very chaotic, and it's hard for doctors to be properly compensated for the liability they're taking on. And so we're going to see a lot of cases that come through. There's going to be a lot of, I'd say, formality that starts coming through as well. Some vendors are going to take more liability, but it's going to cost money. A lot more individuals will decide if they're going to take liability or not. And that pushback will also be interesting.
00:17:43 Megan Antonelli: Mhm. Now, as you and your, um, other than writing the book and kind of getting out there and speaking at lots of conferences, um, you know, you're obviously Helping, uh, innovators and vendors, um, kind of navigate this as you're, you know, what are you seeing out there in terms of, you know, what they're missing, what they need, you know, in terms of getting to that next, you know, getting outside of palatitis, getting to being able to scale, what are, what are they, what are the few things they're missing and what are they doing? Right?
00:18:18 Sarah Matt: I have arm wrestled with so many founders over the last couple of years around integration into the existing workflow. Yes, it's hard to get integrated into epic. Yes, it's hard to get integrated into Cerner or whatever it is that the hospital systems are utilizing. But if you don't at least have a plan for it, it's going to nip you in the butt cheek because every organization, they are already committed to their EMR of choice. It's not going anywhere. And so if you can't produce your solution within an existing workflow and they have to sign in over here differently or, you know, go to another computer. It's not going to fly. And so if you want to move from a little pilot with enthusiastic people to broad adoption at scale, it needs to be easy. And I know that sounds ridiculous, but as consumers, we don't read the iPhone user manual. There is none that comes with your iPhone, right? If you have to have a user manual for your solution, maybe you should rethink it, right?
00:19:24 Megan Antonelli: Yeah. No, and I think that I've certainly been hearing that often. And the challenges of that are, you know, it is hard. And it's, it's, they don't necessarily want you to be part of their ecosystem. And then there's the element where I think we're seeing a lot now where these bigger companies are, you know, they often just then offer that tool and offer that solution. So do you have words of wisdom for those who are maybe thinking about their ideas or how to think outside of what you know, how how to build the moat that protects them from Epic and Oracle just kind of doing what they do.
00:20:02 Sarah Matt: So that's hard because they already own the health care systems. So you really need to consider where the real gap is and where the real pain point is. Um, you know, proper product management. We're talking to users, we're talking to customers. And it's also the first activity to get cut during hard times in tech. And so having run product teams all over the world, some engineers have never, you know, been in a hospital except when they were born. And so you really have to do the work in product development leadership to bring your builders into the ecosystem so they really understand it. And so when we think about designing to differentiate, first, you need the clinical voice in there early. So you don't make these ridiculous, I'd say off language, off operating model choices from the beginning. The second thing I would suggest is I can build an app using my AI of choice today. Prototyping is super easy. Getting something to scale that takes work. And so you really need to figure out what your problem is and how you're truly differentiating yourself. Because if Epic or Cerner can just build it, then it's almost not worth it to you and your IP. I know a lot of people are very excited about their patents, but a patent is a right to sue. It's not a right to win. And so if you think that your tiny startup with three people is going to go up against an epic, well, I will get my popcorn. I can't wait to watch that. Right?
00:21:37 Megan Antonelli: Yeah, it is tough. You know, I am I am happy to be someone who convenes and, and, and keeps the conversation going, um, to assist, but it would be a tough place to be right now. I mean, I think in any technology innovation space. It's not just healthcare where, you know, this power to build has become, you know, literally ubiquitous that anybody can sit down at a computer and start building that app. What, you know, then what, what does a larger org, you know, try to do to fix it? And that that piece around adoption, you know, building trust, building coalitions, you know, building the relationships that are required to actually make the change that's, you know, that's kind of the, the unique value you can bring right now. You know, and that's, that's where the difference will be. Um, in that, I mean, in the book, you talk obviously a lot about geography, right? And you yourself as a surgeon work in, in rural New York. And there's a lot going on with the Rural Health Care transformation program and a lot of attention being focused there. What do you see as the opportunities there, you know, because there's certainly I mean, if there was ever a rural health gold rush, you know, that's kind of adjacent to this AI gold rush that happened, that is happening. It's there. But is it there? Like what? What are they really going to be able, you know, what are some companies going to be able to do? And, and what is your thinking on that? Because I know you have, um, an interesting perspective on that, on the geographic barriers and what that means in healthcare.
00:23:21 Sarah Matt: So we've seen so many rural health systems go under in the last five, ten years. And part of it is you need numbers to get operating dollars to stay alive. And you need workers in your hospital system to do the work. And so it's a lot different math than the larger organizations. Now you hear about all the funding for rural health, but what I'm seeing is I don't see startups getting much funding for rural health. Um, so while it sounds great, I'm not seeing it come to fruition. So I'm sure there's pockets where things are working well, but I'm just not seeing huge, you know, piles of, you know, funding going to really innovative pieces that are going to help thousands that are going to do something that's actually going to keep the hospital open. Now, I think that the folks that are going to be the most successful will market their new product or their solution to gain the rural health dollars, but whatever they're building will actually work in other ways too, for urban environments, etc.. So it may be that they first aim at rural from a grant, from a funding perspective for those. But also knowing full well that they actually can utilize the market in more urban areas as well, so that they'll have the numbers later. So if you're just doing it for rural, I think you're going to have a tough time because again, numbers are low, pockets are small. and I'm just not seeing the funding kind of convert. Um, I would love to be proven wrong.
00:24:57 Megan Antonelli: Mhm. Well, and I think to go back to the whole elements of trust and culture, you know, technology and access isn't what it isn't the main barrier, right? I mean, we can overcome that, but we've been able to overcome that for years with technology. It's it's the cultural, the education, you know, just the desire to care at that level. Um, you know, that is challenging. And then of course, transportation for the care that is truly needed to be in the hospital that, you know, those pieces of it. Um, you know, don't, you can't build an app for that. And if you can, then maybe you'll make a lot of money.
00:25:39 Sarah Matt: It's hard. And I think, you know, transportation is a really good example because transportation is a clinical necessity is something that makes sense when you talk about it, but no one really wants to fund it. And so if you think about bringing people to care, well, if you want to do it in a brick and mortar, well then how are you going to get them there? And assuming that your population, whether they're rural or urban, you know, taking three buses and taking a day to do that might not be possible. Just like driving fifty miles might not be possible. And so I think one of the biggest things that healthcare organizations can do today is really double down on their current investments. So hospitals went gangbusters with telehealth during Covid. We brought things into, you know, workflows. We got all the equipment, etc., in a matter of weeks or a month during Covid. So the telehealth infrastructure is actually alive and well in most health systems. Back in Covid, we had upwards of thirty plus percent of patients utilizing it, and now it's dwindled way back down. So we need to probably reconsider the assets we're already paying for, the assets that are already integrated into our workflows and how we can actually extend ourselves, extend the ability for doctors and nurses to care for patients, and extend our patients ability to be seen. Right.
00:26:59 Megan Antonelli: One hundred percent. No, I mean, I think that that's that's exactly it. So when we we have a few minutes left and normally we ask what's good in healthcare, but I think, um, given your perspective and kind of the book, I wanted to ask something a little bit more forward looking in terms of, you know, what does. And, and, you know, say, let's put ourselves in twenty thirty, you know, maybe that's too soon. Twenty thirty five, I don't know. It's moving fast for the first time ever. Um, what and the borderless healthcare framework has, has taken hold. And then what, what does that mean the healthcare system looks for looks like for patients and, and physicians that it, you know, sort of is different from today.
00:27:41 Sarah Matt: So regardless of all the problems, I remain very optimistic about healthcare. So that's what keeps me going. And to me, and you've probably heard me say this. I really do believe it's a design problem and design problems can be fixed. So I think we look at the pillars. If we just fix one, we're not going to hit it. So if I just fix all the digital, I'm going to have all these problems. If I just get rid of all the medical debt, I'm still going to have all these pieces. Um, what I'd say in five years, it'll probably look very much the same. However, I think that a lot of people have been waiting for a new technology or federal legislation or. And instead, I think that we really need to consider how our own organizations can improve patient outcomes and improve our bottom line, and not just wait. So the problems that we have today, they're not going away. And so instead of waiting like we normally would for the next piece of, you know, CMS policy or this or that, I think that organizations are going to start doing this. More grassroots efforts, smaller coalitions, unlikely partnerships between municipalities, hospital systems, tech companies to solve these problems. And it will probably be done regionally. So I don't see this happening across the entire United States. I see parts of it working in new ways to make things happen. So as an example, when we think about transportation, how can we get transportation funded? Well, it's really hard for me to get cabs. It's really hard for me to get Uber vouchers, but people are funding technology and transportation. So a reframe would be, all right, how can I get transportation innovation funded? Ah, so whether it's autonomous vehicles or the use of drones for medication, transportation, whatever it is, think about the funding landscape and be realistic about how can I get this funded? How can I get the same result using different words? And so while I don't see a huge transformation in the next five years, it will absolutely be different than it is today. Right.
00:29:47 Megan Antonelli: Yeah. No, I think there's just there's a lot of promise. And it is, I think, with focus on the pillars that you, you know, lay out in the book so well in terms of geography and financial and trust and knowledge, and then that cultural and digital piece, if we can, you know, just move the lever a little on all of them, right? We moved the digital this much. Now we've just got to come, you know, with the others a little bit. And maybe in some cases that requires policy changes and in others it requires, you know, internal, real, real looks at the design. But I love, I mean, the, the design issues, which, you know, I think we've talked about a bit in, you know, in healthcare, you know, are, are what makes the technology, you know, sort of broken upon arrival to some degree because we have to fix that system that's underlying it. So I love that. Um, before we wrap up, tell our, our audience where they can find the book, follow your work, uh, get in touch.
00:30:47 Sarah Matt: Great. So the borderless Health Care Revolution is published by Wiley. So it's available everywhere books are sold. You can check me out on doctor dot com, or you can look at me at my profile on LinkedIn where I have my major platform.
00:31:00 Megan Antonelli: Yes, I recommend everyone follow Sarah on LinkedIn. She has fabulous things to say. Um, great commentary on the events and conferences that she does attend, but also just her perspective is, uh, fantastic and really just opens your mind around healthcare. So thank you so much, Sarah. It's been a pleasure. Uh, to our audience, if this conversation got you thinking and this is, that's the whole point. That's why we're here. Share it with someone who needs to hear it. Subscribe to Digital Health Talks. Follow us on YouTube at Health Impact Live and visit us at Health Impact live dot com. This is Megan Antonelli and this is Digital Health Talks. Let's keep fixing health care one conversation at a time.
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