AMA PIN IRL at HLTH 2024
Wow this is a blinding light. I can barely see your faces, but it is so good to be here with you today. Wow my name is Amanda azadian. I'm the product manager for the digital health strategy team at the American Medical Association.
And I'm joined today by an incredible group of physicians from across the country that we've been able to bring together through the AM Physician Innovation network. Now, the AM continues to bring physician the physician voice to health. Over a number of years, we have been hosting the Physician Innovation network to engage physician voices in emerging technology seeking to bring better solutions to market. And that has continued as we're seeking to make those solutions work better once they're actually in the clinical workflow. So this panel today will discuss we actually have a double header today for you. Surprise, surprise, in case you didn't notice that on the health agenda, we have a first panel discussing what physicians wish technology designers knew about their practice, about their workflow, about what it means to be actually implementing technology into their care setting.
And then we'll have an extended time for audience Q&A. We were originally in a room that had breakout sessions where we could dialogue and then they upgraded us to an even bigger room. And we're so excited that we can fit more and more of you here. But this will be a really great time to have a question for the physicians in the room and a question for the health care technology designers in the room to be able to have more of a dialogue.
We'll conclude with a panel about digitally enabled value based care and how we can stitch these things together also by my colleagues here. So I want to get a quick pulse on who we have here in the audience. So first of all, physicians, care team members, health care administrators, would you raise your hand.
So I think we have about maybe 40% of the audience being represented by people that are doing the caregiving in the hospital setting or in another clinical setting companies, investors, accelerators and incubators, representatives of those organizations. Can you all. Raise your hand loud and proud. Amazing OK. Maybe like 15% 20% of you here are solution designers.
What about my colleagues. We have a number of folks here from the Center for Health Equity, health solutions, professional satisfaction and practice sustainability here. And these folks are here to talk to you about the work that we do in embedding equity into innovation. So for my am colleagues, would you raise your hand so that folks can know who you are, where you are. OK, they're sitting close to the front just like I asked. Thank you all for being here.
So this program is the next evolution of the Physician Innovation network. As I mentioned, we have 20 physicians here today. You're seeing their faces up on the screen, and it's my pleasure to be able to introduce them. So first off, we have Saleem Afshar. If you can raise your hand and wave right here in the front, who is a head and neck pediatric surgeon at Boston Children's.
He has a background in engineering, human psychology, global health and both a medical and dental degree. He specializes in rare pediatric head and neck conditions and has developed a novel use for AI in his specialty. He specializes. He's an author, mentors companies through the Harvard Innovation Lab and is a member of the United Nations innovation exchange.
He's the CMO of reveal healthtech, an organization supporting health care organizations, adopting and integrating technology more effectively. Thank you so much for being here. Next, we have Michael Albright.
And Thank you for being here. And Dr. Albright is an internal medicine physician completing a clinical informatics fellowship at the University of Kansas Medical Center. And his focus is on rural health, primary care wound and hyperbaric oxygen weight management. He is serving as a clinical champion for the electronic health record implementation and a medical director in hospice care. He's planning to launch a tech driven primary care practice in Kansas City after his fellowship.
So if you're working in that space, Please find Dr. Albright. Adam Bennett. I can't see anything.
You are in the fourth row. Thank you for being here. Hi so Dr. Bennett is the medical director at Northwestern Medicine sports medicine at in Evanston, Illinois.
He's a team physician for almost all of the Chicago professional teams. So if you're a fan from Chicago, definitely connect with him. He is also assistant professor at Northwestern University and has been a part of the AM Physician Innovation network almost since its inception.
So thank you for being such a loyal part of this program as it's evolved over the years. We have Dr. shar Brennan, who is sitting right up front here. Hi Dr. Brennan is an emergency medicine physician serving as the Associate Chief medical information and artificial intelligence officer at the mid-Atlantic Permanente Medical Group. She is on the leadership team at the AI Center of Excellence, regularly contributing to their speaker series. And in case you're trying to take notes of exactly who you have to connect with probably got your badge scanned when you walked in the door here and we will be sharing with you a directory of the physicians that got to participate with us today.
So you can see their faces on the screen. I'm trying to point them out to you so that you can connect with them individually after this event, but definitely know that we will be sharing that with you digitally as well. Dr. Anu Daniel Hi.
Dr. Daniel is a pediatrician and assistant professor of Pediatrics at Stanford University school of medicine. She is also a former medical device founder. So if you're working in that space, you can find her commiserate. She understands your pain. She's also a clinical advisor at Stanford, Biodesign, and enjoys advising both adult and pediatric digital health, diagnostic and medical device companies.
Jonathan Handler is also right there in the front row. He's an emergency medicine physician and clinical informaticist, a senior fellow for innovation at OSF health and has led innovations in medical informatics at Northwestern Microsoft and Baxter. He founded the section of emergency medicine informatics at Northwestern University Feinberg School of Medicine.
We have Dr. Carl kochenderfer right next to him, also from Chicago, who wears a number of different hats at the University of Illinois at Chicago. He's the assistant Vice Chancellor for Health Affairs, CIO and associate CMO, where he founded and led many Enterprise Initiatives. So he cares for hospitalized patients and is a family medicine physician at the University Village clinic holding several informatics patents. So we have folks that are here to talk to you about what it looks like inside a health care organization and can talk to you about what it looks like to engage as you're seeking to implement. Dr. David Nichols.
I want to point you out. There you are. Who is practicing family medicine at Jefferson Hospital.
He also leads a health care technology meetup group in Philly. So if you're local to that area, you can find him. He also co-founded a value based cardiac rehab and chronic care management company.
So he also knows what it looks like to be a physician founder. Dr. Brett Oliver, who joined our panel earlier this morning, is a family physician and CMO at Baptist Health in Louisville, Kentucky he advocates for digital health policies through the ONC federal health it Advisory committee and through epics care everywhere governance council. Now, you guys know I need this iPad because there are so many incredible physicians that have joined us. We have Dr. Jessica porion right here in the front row. She is an attending physician, pediatrician and clinical informatics fellow at UCSF caring for sick kids in both the office based acute care setting, as well as the emergency room.
She has a background in brain and cognitive sciences and spent three years in health care consulting before jumping into medicine. She is currently focusing her research on patient rights, data privacy and antibiotic stewardship in pediatrics. Edmundo Robinson is sitting right next to her. Thank you for being here. Dr. Robinson is an academic hospitalist
at Moffitt Cancer Center, where he founded and led the digital the Center for Digital health and co-founded cancer x. For any of you who have participated in that program, welcome. It's great to have you here. Dr. Robinson is also a professor at the University of Florida's Morsani College of medicine, and he recently founded a organization called Downeast digital, seeking to focus on embedding equity in innovation, where he's currently serving as the CEO.
Dr. Srinivasan Suresh joined our panel this morning. Hi, Suresh. He is a pediatrician at UPMC, wearing a lot of different hats at that organization. He has a business background. He's a Ted speaker. He serves as the chair of the Council on clinical informatics clinical information technology for the AAP, and he's a professor of Pediatrics and emergency medicine at the University of Pittsburgh.
He's wearing a number of leadership hats, as I mentioned, currently, and specifically as the CMO at UPMC Children's Hospital. Dr. Michelle Thomas joined our panel earlier this morning. So if you were able to participate in that, she's right over there. Thank you, Dr. Thomas. She is a primary care physician and clinical informaticist focusing on ambulatory care and physician well-being.
She is serving at BJC medical group. She's been in that CMI icmbio role since 2011 and as the Associate Chief clinical officer since 2022. She serves as clinical faculty at the Washington University and focuses on provider efficiency and wellness, seeking to reduce the administrative burden. So if any of you have solutions that are seeking to reduce that burden, she's a great person to talk to about what really is meaningful in terms of those metrics.
Reducing the cognitive burdens is something that our team is very, very passionate about to those documentation and patient communication related issues. Dr. Caroline yang here from Boston. My home town, is a hospitalist at Brigham and Women's Hospital. She's serving as the associate clinical director for their health at home program.
So she's delivering acute inpatient care directly into the home and serving as faculty at Harvard Medical School. As a writer, advisor and representative. She is really advocating in the health policy realm, both at the Mass Medical Society and within the AM. Dr. John Dayton, who you will hear from on our panel today, is right here in the front row. Dr. Dayton is an emergency physician
at Intermountain Healthcare and faculty at Stanford. He's helping health care technology companies translate their digital therapeutics and AI operational tools into care delivery systems through the Stanford emergency medicine innovation symposium, which you might be familiar with. They have pitch events and other hackathons.
He also co-founded Utah's society for physician entrepreneurs, and he advises companies independently as well as through Intermountain ventures. Jennie Bethel is right next to him, and Dr. Bethel is a urologist and clinical informaticist she's very passionate about bringing that specialty care to those that need it and making sure that we expand that access. She's focused on patient safety, translating physician needs to tech solutions and improving patient outcomes. She serves in various roles on Medical boards and currently as the CMO at Allied Health. Michael Hahn, who's also here on the front row, is a urologist and clinical information.
Assist he's serving as the CMIO at MultiCare health system, where he is also the interim Vice President of enterprise applications. You'll get to hear more from Dr. Hahn on the panel that we have for you today.
And last but not least, we have Dr. Hoberman, an internal medicine physician currently serving as the CIO for the Permanente Medical Group managing technology strategy, integration and innovation. You guys, this is an incredible group. I'm so glad that you can all be here. And I'm seeing the room fill out.
There's some more chairs if you want to come on up. There's plenty of space. It's really an honor to be able to double the size of this program this year. We brought 10 physicians to health in the past.
We sort of rapid fire introduced them to say, what do you wish health care technology designers knew. But what we want to do is really make sure that you understand who's here and get the chance to connect with them precisely based on what specific questions you have. So if you're a health care solution designer in the room, there will be time with a free mic to voice some of your questions. And then physicians and other care team members that are in the room. What we're hoping is that this is a forum for you to be able to share what you need, what it looks like for technology to really work within your practice. And we have physicians that are working on that from so many different perspectives, some of them as the users saying, well, I really like my team and my human team that is working with me.
We want that to be enhanced by technology. So that we work like a more well, well-oiled machine. I've learned a lot about this space in the last year as we were able to bring on a new member of our team this year, Dr. Margaret laszewski.
She is a pediatrician and clinical informaticist that joined us at the AM. She was before joining the AM. Dr. laszewski was the CIO for Novant Health. She's a nationally recognized leader in health care informatics, and she's serving as she also serves as a member of the advisory board for the Association of Medical directors of information systems, or amds, if you're familiar with that acronym. In 2021, she was inducted as a fellow of the American Medical informatics Association, and in 2023 she received the HIMSS amda's changemaker in health care physician executive award. Dr. laszewski is one of the inaugural members
of the physician advisory board at Epic and currently sits on the Epic physician wellness advisory board. I'd like to invite Dr. Lozovatsky up to share more about our digital health innovation strategy, and then we'll roll right into the panel. So thank you all so much for being here.
Thank you, Amanda. And Thank you, everybody, for being here. And you're not kidding. These lights are bright. It is my pleasure to be the facilitator of this panel and of the activities that we're going to be doing here today.
I am thrilled to have all of you in the room with us. And what we want to talk about is something that's very near and dear to my heart as I continue to practice and see patients, and that is making technology work for physicians and for all members of the care team, because we know that technology is integral to our ability to care for patients. And so it's really important for all of us to partner and work on making technology as much of an enabler for clinical care as we can.
The am has conducted research to understand a little bit better, what are the forces that are impacting the future of health care. And as you see all of these things on the screen, I really like this image because it reminds me of when I step into my medical hat, when I walk into a hospital to care for patients. These are all of the things that I'm thinking about. And it is a lot of forces that are impacting our clinicians today.
There is, as you look at all of this, there's many questions that we have as we walk into the hospital that we're trying to process, and we call that cognitive burden. And it's something that we all experience and understand. And what our team at the AM focuses on is how do we decrease that cognitive burden that our clinicians are experiencing. And we want to empower our physicians to optimize the use of existing emerging technologies. We want to ensure that technology truly enables us to care for patients because that's why we went into medicine in the first place.
And we want to help facilitate physician leadership in this space. So that physicians have a voice in all aspects of technology life cycle. I want to back up a little bit and just give you a little bit of a framework of who this team is from the AM and some of the other people that you're going to see later in the second panel.
So this is a strategic framework from the AM and you see a few things on the screen. So the three buckets of work that we think about is the focus on decreasing chronic disease, removing obstacles and professional development. And our team sits in the removing obstacles piece of this. We call ourselves professional satisfaction and practice sustainability, which is a mouthful. So we say ps two, and that is the digital health team is one of the groups within ps two.
So really, we are in the mission area focused on supporting physicians in their ability to care for patients. And the two panel discussions that you will hear from today, the first one is the Physician Innovation network, which again, is making technology work for physicians. And the second one is going to focus on the digitally enabled care within to promote value based care. And so both of these teams sit within ps two in that removing obstacles bucket of the AM. As I mentioned, we at DOMA do a lot of research. And as we asked our physician colleagues, what are the questions that you have when you think about technology, these are the four questions that they came up with.
And this research was done in 2016 and we are looking to repeat it. And it will be interesting to see how the questions have evolved. But these are the questions that we consider when we think about the physician voice within technology.
Does the technology work. And I think that question remains very pertinent in our clinical environment. Will it work. In my practice.
And we think about the various specialties that exist within health care, the needs of a cardiologist are going to be very different than the needs of a pediatrician or a urologist. And so that is a very critical aspect of how we evaluate technology. Will I receive payment and will I be liable. All these were the questions that were top of mind for our colleagues. And as we think about the development of technology, which is what we're going to talk about today, we always keep these four questions top of mind.
As Amanda mentioned, I joined the AM almost a year ago now, and we asked ourselves, what are the questions today. And we will continue to think about how these questions evolve. And we also asked, what are the needs today within our health care environment for physicians when it comes to technology. And we've been thinking about the evolution of those needs. And I want to share a little bit about the vision and the mission of our team, specifically within digital health. And really, I think the summary sentence at the top encompasses what we're trying to accomplish, which is make technology work for physicians.
We want it to be seamless and trustworthy. And so we think about a time where technology will be reliable and again will enable our ability to care for patients to achieve. And we say the quadruple aim, it's now the quintuple aim, but to provide care to our patients, that is the highest quality where we can improve patient satisfaction, clinician satisfaction, be as efficient as possible to minimize cost and to be in a place where technology in the background is assisting us in the things that we need to do to care for patients. And we want to facilitate the optimization of health care technology. As we all it's not perfect today, and there's a lot of opportunity to continue to think about how to support our colleagues.
We also want to think about innovation, and this is what this conference is all about. Where is the puck going and how do we ensure that as we bring these technologies to the clinical environments, they are optimally integrated into existing workflows. And that we're thinking about the goal of the patient being at the end of all of this and supporting our clinicians in all care settings.
We know that a small practice and a large integrated health system may have different needs, and yet we want to support all of our physicians. So that they can care for their patients. I want to take a minute to highlight the role of clinical informatics. And you you've heard this term as Amanda was introducing some of the physicians that are here. Clinical informatics was recognized as a board certified subspecialty a little over 10 years ago.
And it's really important for us to think about how do we integrate the physician voice in the development design, implementation, adoption of technologies, and how do we ensure we have the physicians that are trained in this field that can bring together the needs of the health care systems, the needs of our clinicians and our patients, and help to evaluate and design these technologies and to help us talk about the role of clinical informatics and the role of physicians in this space, we are going to talk about today. What do physicians wish health care, technology designers. Understood, and I know there's a lot of designers in the audience, and so I'm really looking forward to having this conversation with our fantastic panel of four physicians who I am going to invite to come up and join me here. I just heard someone else mention how bright it is. All right. Well, Thank you for being here and for sharing your time and expertise with our audience.
I'm going to start by asking each of you to introduce yourselves. Tell us a little bit more about your background and share a little bit about your current role in your organization. And we are going to start with Dr. Dayton. Hate to rehash since you got our intros earlier, but I'm an emergency physician with Stanford and Intermountain Health. My focus is on health care innovation, and I do that as an investor and also helping startups and more established companies build tools that will be helpful for patients and physicians.
And I'm Jennie Bethel. I'm a double board certified in neurology and informatics. And with that dual background in clinical and technology and data, I support companies and bringing solutions that really matter to the health care experience.
So I serve as the very proud chief medical officer of Allied health, where we have built out a clinical intake tool to improve office efficiencies and help physicians with some of the documentation burden that we've talked about. Hi, my name is Michael Hahn. I am a urologist by training.
I never thought that there would be two of us up here, but I guess there are. So if anyone has a kidney stone, I think you'll be well taken care of. I am currently the Chief medical information officer at MultiCare health system.
We are an idea based out of Tacoma, Washington. I also have the privilege of serving as the Vice President for our enterprise applications, which is for those of you who don't it's basically all the analysts that take care of our electronic health record, amongst other third party applications. As of now, I think that more than anything else, I'm focused on the blocking and tackling that needs to happen at a very tactical level at large health systems that have grown in an inorganic fashion and the challenges that come with adding hospitals in order to achieve the growth that's necessary. And it's been a compelling challenge. And hopefully we can all together make a lot of meaningful change for our patients. Hi, everybody.
My name is Brian Hoberman. I'm a hospitalist by background. I've been working in health care technology for around 20 years. I work within Kaiser Permanente, where today I'm the CIO.
Both of the Permanente Medical Group, which is the Northern California Medical group, as well as the Permanente Federation, which represents all of the Permanente Medical groups around the country, is a complex, multi entity organization, and I work with colleagues within Kaiser Foundation hospital and health plan it who manage many aspects of our infrastructure and together between the medical groups and the health plan and the IT folks, we're responsible for all the care delivery it and clinical equipment and so on that we use across the enterprise. Thank you. Each of you wear a lot of hats, which is fantastic. And so you can provide some really interesting perspectives on this question that I want to ask you.
We often as clinicians, when we serve in an administrative role or in a leadership role within a company, have a lot of goals from our leaders that we're trying to accomplish. And sometimes they may be aligned with the needs of the clinicians, and at times they may be at odds with those needs. So can you share a little bit about how do you balance these conflicting needs of the clinicians. Sometimes the patient and the administrative roles that you each hold and we can go down the line. But Please feel free to jump in if you have something to add.
We have an interesting lab at Stanford where we are able to help early stage companies focused on acute care emergency medicine based where they come to us and we partner with them. A nice thing about that this is built around identifying the goals of Stanford, the goals of emergency medicine department, working with companies specifically that address those needs. And then it's a nice opportunity to give those companies some high level feedback pilot what they're doing and see if that's something that can be expanded. We saw a lot of investment dollars spent earlier in the decade on promising digital health companies that never quite made it to market.
And so one of the biggest things for these early companies is making sure hey, a lot of times the physicians are not going to be the purchasers, but they're the stakeholders. So it needs to be something that's usable for them, makes their lives easier. There's a recent trend called click neutrality where we don't want another tool. We don't want to have to open up another screen. We don't need another burden. We need something that integrates, but we have a chance to work with these companies, give them feedback, but also collect data, something that helps them as they work towards FDA clearance or work towards CMS coverage, which is helpful for the early companies, but also helps us be aware of early companies, companies that are meeting our needs and our goals and work together to synergistic way.
Yeah to add to that, I think as physicians and physician leaders and executive physicians, we have this unique opportunity every time we enter into one of those conversations to be the consummate advocate for our patients. And other physicians. And so sometimes I think when those priorities are at odds, if you think back just to. when it comes down to it, Medicine very simply is for the patient. And we all became doctors to help a patient.
And I think that sometimes that breaks down some of those barriers a little bit. And so that's why it's always nice to have physicians in those important conversations. Otherwise, we've all been a part of places where initiatives have gotten pushed forward without the physician voice.
And just like technology, if it tries to get pushed forward without a physician voice, it will fail. And so I think that that's how you break down some of those barriers, is you come back to say like, is this good for our patients. And if it is, usually you can find some common ground there. I think I'm most thoughtful about prioritization and how we align priorities and how we make sure that we're all walking towards the same goal. We struggle with. I mean, sometimes there are strategic goals that are put in front of us that we may not necessarily understand, that don't align with where we want to go or what direction we want to go in.
And so I usually step back to what problem it is that we're trying to solve. And how we can partner with our operational colleagues and our clinical colleagues to come together to create a solution as opposed to bringing forward a solution that's looking for a problem. And so I'm not sure if I answered your question, but that's I think it's really alignment of those priorities. And I think that I heard this morning from this morning's panel how you use service lines and how those service lines can help craft priorities together with it in the room to really make sure that we're all marching in the same direction.
It took a little bit of time to think through what conflicts we manage because for the most part, people are really oriented towards the quadruple aim. And so it's good fun work because we like making patients happy. We like making clinicians happy. We like financial health. So generally or the conflict ends up maybe, if you can call it conflict at the line where you cut off, what are you going to be able to invest in this year. And because we can't support everything all at once.
And we can't support everybody's priorities all at once. So we have to pick the priorities that best align with the overall business strategy and where we think the most value is. And that takes a lot of thought and. Sometimes people who work in health care, it see opportunities that the folks who run operations don't see because the folks who run operations are never going to understand the health care it as well as the IT folks. And part of our job is to do the translation and explanation and get to the place where we're all in agreement about this is the direction that makes the most sense for us. I wouldn't call it conflict.
I would just call it a lot of work. The other area that comes to mind when you think about conflict is an age old dilemma, which is on the one hand, there's no end of demand to make it better. People are constantly asking for us to make it better and they're also asking us to stop changing things. So balancing that is pretty tricky. And it takes a lot of explanation sometimes because when you're KP has almost 300,000 employees.
And when you're dealing with scope that large, once you've made those prioritization decisions and you've made changes that hit folks in the. Wait a minute. You mean I have to learn a new way to do my job, that can create some angst and we have to manage that.
So let me ask you a follow up question on that. A couple of follow up questions and you guys can jump in. The first one is you mentioned a really important tension. People want to see improvement and yet we often hear that don't move my cheese comment. How do you manage that. What are some strategies that you've found that are effective.
And then the other tension that we often feel is the cost versus benefit tension. How do you manage those things of it so long along the first question, how do you manage The tension. I think. You have to be really intentional about where you're going to improve. One of the biggest things in Biodesign, as you start with a need start with a big need because as you mentioned don't want someone to bring something to you and say this is a solution that's looking for a problem you want to start out with your greatest need for your patients or for your department.
But once you have that, the next thing you need to be your next thing you need to do is be very intentional about the pilot. We've heard about all these pilots that get set up and they don't recruit enough patients or they don't run long enough or they don't have very specific goals. And I think you need to set that at the very beginning. Say, we're going to work together for this period of time. We need to get this number of patients to get any kind of statistical significance or to see if it's moving the needle at all. But that's a major factor for how you can make sure it's an effective way of working with your time and working with your partnership and addressing those service lines.
Yet to add to that. I think it's setting up those mutual goals are super important. So that your clinicians understand what it looks like as well as your technologies understand what is success here. So if you think about it and you go, all right, well, if value is quality over cost, are we looking at cost measures to call this a success or are we looking at quality measures. And then we have to agree upon what is quality here.
And you had a good point when you were bringing up some of the cognitive load for your physicians. And some of this is hard to measure except for we know that physicians are burnout. And it's not just physicians. It's their it's their staff. So are we implementing a solution that can help with that whole care continuum and making sure that we're getting those metrics right so that we can again, all be able to identify success at the other end. I think it's really important.
I'm going to double click on the partnership and collaboration thing. I mean, it's super important to partner and collaborate with the people who are at the sharp end, who are delivering the care in order to effectively implement change. And so if you don't include them in the conversation from the get go, I think it makes for very difficult times for any organization trying to implement that change.
But I also want to reiterate what Brian said here, which is no one knows it as much as it. And so at some point, there does have to be a deference to expertise. But that deference to expertise has to be earned. It's not given. And I think it's earned by successful execution.
And so we have to earn that trust. We haven't necessarily earned that trust yet. But I'm hopeful that as we get more physicians into this space who understand patient needs and physician needs that will be able to move further along that journey. Learning how to do health care. It is daunting when I bring somebody new onto the team.
I tell them it's like starting a fellowship and it can take several years to learn this. And that is counterintuitive because everybody uses health care it and everybody thinks they understand health care it. So one of the things that we did to solve this change management program problem was we recruited about 1 in every 10 physicians to be part of health care. And this is something you can do in Kaiser Permanente that I don't know if you can do in other organizations.
But we created we basically made it so that if you're working within a department chance, if it's a large department, chances are at least one doctor in the Department has extra technology training and is linked to the technology teams. And we do this along specialty lines. So how in the world of adult and family medicine, which is what we call family practice and internal medicine, there's one person who chairs that whole arena and works really closely with the Center group who are like the core informatics docs.
And then that person works with actually several hundred adult and family medicine kind of technology experts. And we really rely on these folks as both the docs here, efferent and afferent, to help us understand what's going on with the end users and the folks who support them and what do they need and what do we need them to know when we're introducing changes. So the key to all change management for us is tap you on the shoulder and talk to you in person. I love that. That's fantastic that you are gathering the voices of your clinicians to try to understand what is the problem that we need to solve. And there are a lot of folks in the audience that may be asking, what are some of the things in your organizations that you're tackling.
Because our solution designers here really want to understand what are the needs that clinicians have. And so I'd love for each of you to share a few of the needs that you are thinking about today and potential technology solutions that you would be interested in learning more about. As an emergency physician, being able to get up to speed on a patient very rapidly is very important to me.
So if someone that's already been seen in your health system, it's not a big deal because you've got a good record and your electronic system. And you can see their history. What's more concerning is if you're seeing a patient that's from a different area or they're from or they're traveling and you're new to them, you need to have a way to get up to speed really quick. And so we talked about pain points earlier.
One of the things that I really am interested in is interoperability of health data. I actually consult a group called Zeus that's focused on doing that for transitions of care. So do you think that makes life easier. We were talking about what's good technology, what's bad technology.
And, I colleague of mine worked at a hospital where they're like, our physicians are so burnt out, we've got to help them. And so they made them all download this app and then they had to log whether they use the app to meditate. And it's like you just gave them like two extra boxes and like, that's not helpful at all. But things that help with your flow and that's one thing that I talk with companies about when I advise them is to talk to physicians early on and say, is this number one, is this a pain point for you. Know number two, how do we seamlessly integrate this into your workflow. Because that's the key.
Otherwise, it's not going to get adopted. And so I look at, with all the hype with the AI, I think there's a lot of great opportunities that are there. But I think the big things are for operational metric tools like in the emergency department, can we match. Can we use some predictive analytics so we can figure out what are our volumes, where are we staffing accordingly. Are there ways to transition that and things along those lines with operational nature.
So I think there's a lot of benefits for AI. I'm really, really interested in interoperable health data. Those are areas of interest to me that I have. So a quick story about a company who asked me my input about their product. They said, hey, we built this amazing product, but doctors won't use it.
Why won't they use it. And I said, well, how many doctors did you have involved in building it. They're like none that there's your problem. So I think you have a great question is, what are we thinking about within practices and what are some of the needs there.
And I'll tell you, we have so many point solutions that push into practices, so many. I mean, it becomes countless. And there is human glue that is holding all of those things together. And so I'm thinking a lot about. So physician burnout obviously gets pushed way into the spotlight, but I'm looking at, turnover and front desk turnover and all of those pieces that actually complete the care journey. And how are we keeping all of those really important people engaged in health care and taking care of patients and building technology that takes away some of those point solutions and looks at the whole continuum.
And I think that your point to interoperability and getting some of those records is really important because that again, is just one more piece to it. So I think that those clinical efficiencies are always on my mind because I think that that's part of what stresses physicians in their office, whether they don't have the records. So I can't care for the patient in the manner that I want to care for them or they're running behind.
And, they're sitting there waiting to see a patient because they're stuck somewhere else in the system. So that's really, I think, what weighs on my mind when I'm looking at a lot of these technology and AI solutions and where they can help with that process. Yeah, I'm going to double click on the data and interoperability. I our hospital system is half of our hospital system is in Northwest Washington in Northwest Washington. We have at least two instances of Cerner and probably seven instances of Epic. And if you look at those nine different instances of those major records, I can guarantee you that there are nine different medication lists and they don't align.
And why are we still at a point where we can't provide a single source of truth for something as simple and as important as a medication list. It's inexcusable at this point that we haven't been able to get that data distilled from electronic health record data. Pharmacy benefit manager data pharmacy data, claims data in order to provide a list to our physicians at the right time, at the right place and the right patient. So that way we can provide the right care for that patient. I mean, I'm a urologist. I hate DOACs.
I'll never like DOACs, but they're going to remain on the medication list and I need to know when they're taking them and when they last took them. And if we can't provide that kind of data to our physicians, we haven't done them a service. And so that looking at the data across these systems and being able to provide a single source of truth is the windmill that I will continue to tilt at.
So I like ducks. And for those of you who don't know what they are, don't worry about it. I think that every organization has the challenges of what's their technology debt, what's the history and how did they get. There is such an interesting story. But now, OK, now this is what you have now, for example, with us, in California were divided up into our Northern California and our Southern California regions. And they're so gigantic that when we deployed Epic 20 years ago, we had to deploy six instances of Epic in each one of the regions.
And so right now, we're undergoing consolidation into two California regions because we're still too big for one California instance of Epic, it's going to be two instances of Epic. That's a really great example, some of the challenges that you face are just kind of what did you inherit from what was possible in the past. And then other challenges that you face are like, what are you inheriting from opportunities of right now. So figuring out how to use AI is a really fun problem. It's a really fun problem because there's some incredibly exciting things that we probably will be able to do with AI. And then you have to figure out is like now the right time or are we ready to jump in with both feet or should we wait a while Because what everybody told us we should be doing last year is different than what they're telling us right now.
So there's a tremendous amount of historical burden and a tremendous amount of now burden that's based on just the legacy and the uncertainty and mapping your way through that is a big part of the job, especially because it turns out everybody's got an opinion and everybody has a little bit different information. And so making these decisions in uncertainty about these very complicated things is a lot of work, especially if you're in an organization like mine, which is consensus driven. You've each highlighted a lot of the challenges that we're experiencing in the clinical spaces. I always remind my colleagues that we are no longer chasing paper charts to get the vitals for the patients. So that is a win.
We want to highlight the wins and we have all of these Pebbles in our shoes on a daily basis that each of you eloquently described. And we have a lot of technology designers here that probably approach you regularly with solutions to some of the things that you had mentioned, often offering pilots. I think the concept of a pilot most folks have an opinion on. And so I wanted to ask you to share your thoughts as you are approached by potential solutions.
What are some of the things that go through your head. What is the most optimal way for you and your roles to partner with solution designers that are hoping to pilot their technology in your organization. Sure I spoke a little bit about this earlier, but I think the big thing is it has to be something that addresses a pain point. And so that rather than scattershot and saying we want to just try cool stuff in our ER, we're really specific.
Say we're trying to solve problem a, B, and C, where are there companies in that space that are addressing that. How are they looking at it. You do they have data from other partners that they've worked with.
And if that's the case, and it's a good fit and we bring them in, we want to be really intentional about that pilot. Here's our goal. In our department, our goal is to fix this problem. How does your how does your solution help with that. And I think if you start out trying to tackle your big problems, being very specific about who you work with, and what their methodology is and setting goals together, I think that's the best way to do it. Jen mentioned the company that didn't have a physician on board.
And it's kind of like a big thing for me. I talked to companies that either have physician founders or physician advisors. If you don't have a physician at some level, you're a tech company. If you have a physician, you're a health care company. And so that's a huge thing for me. I want to work with the companies that have done the research and have the right folks involved in forming their decision of how they're building that solution.
I think that's really well said. Are you a tech company or are you a health care company. And so when I look at pilots, I look at it very surgically risk, benefits, alternatives. What are the risks of me doing this. Pilot have you done it other places successfully.
How much are you going to interfere with the current workflow. What virtualized security risks associated with it. And then what are the benefits. What's the problem that we're trying to solve. What are the metrics we're going to be there and then the alternatives. If I don't do this, what will happen.
Or is there another solution that's similar. And so I think it's kind of a good framework to go into it with. And Yes, if you're getting ready to pilot into a practice or into a hospital, what experience do you have with understanding that. It's like if you want to go and tell a restaurant what they should do in their kitchen, but all you've ever been is a patron and eating their food and you've never been a sous chef, you've never been a hostess, you've never been a Busser.
You can't tell them what to do. Behind closed doors. I think the same is true in health care is you really have to understand where that fits in operationally, because the pilot will fail every time if you interfere with where they are.
I'm going to go back to two. Don't be a solution. Looking for a problem, partner.
Partner with our operators. Partner with our physicians in order to develop a solution to a problem that is a pebble in their shoe. Now, one of my friends in the Pacific Northwest, he says that he's the CMI. No as opposed to the CMO. So I think that the other part of that is that don't make me into the CMI. No make sure that we're part of the conversation when you are with those operators or with physicians coming up or partnering with a solution to their problem.
Because there's many a time right, where I have to say no because they didn't make it through a vendor security questionnaire because their coders were in the Ukraine. I mean, and my CISO said, we're not doing this. We can't do this. Mike get us involved.
Get informaticists physician informaticists health care informaticists nursing informaticists in early on the conversation, we have had vendors literally tell our operators don't worry, you don't have to talk to it. They can integrate this. It's so easy. OK, don't say that.
But again, it's about partnership. It's about collaboration. If you engage with physicians, operators and informatics and it will get a better result for your pilot and for a long term relationship because that's what you're really trying to form here. I agree with all those things you guys said. I think a pilots in two ways. There's the we're going to deploy something big, but we need to learn a lot more about it.
So we're going to pilot it ourselves. And chances are that's not the type of pilot that you're talking about that the vendors that interested in. But that's really important for us because there's a lot we don't know that we're going to learn.
And when we do spread things, we spread it massively and we better have learned. As that's it's like test flying an airplane before you mass produce it. The other kind of pilot that we're. I just agree with what you said that when vendors, salespeople, County executives go to operational executives and tell them it's going to be easy and we'll just pilot it at your facility or in your department, that is a really good way to alienate the IT executives.
The chances are you're going to lose some credibility when you do that and you're going to lose a lot of trust. So I do not recommend that you can get the interest of the Ops executives and have the ops executives come talk to us about it. And unfortunately, that may not lead to a sale because we're going to probably tell them, well, no, we have this other plan that's coming that you hadn't heard about and they're like I didn't know about that. But once a pilot has started out in the field that we don't know about, it immune system is going to probably try to eradicate it and then build up defenses against it. Love that. I was hoping that you bring that perspective from the CIO lens, so that's fantastic.
Can you share as a follow up to that question, some of the metrics that you're thinking about, both quantitative and qualitative, perhaps as you're evaluating these technologies. Yeah, one of the most important things in the emergency department is time. If I have six patients that check in at an hour, I've got to get up to speed. I've got to see them. Maybe some of them are going to need procedures.
So anything that saves me time. And so that's a nice, easy one. You can have it in minutes and that's a nice way to do it. The other one is you can look at things like if you have a specific problem, that there's an administrative burden. And this goes back to time as well. Is this a solution that takes away.
Is this a solution that like gives me more time with patients or is this a solution. That's like another thing I've got to click through and it's another administrative burden. And so I'm away from patients. So that's really how I evaluate it, is I need time in general, but particularly time with patients as opposed to time at a computer. Yeah I mean, I think that we all want more time.
So I think that that's an incredibly valuable metric any time you're putting it in there. You said click neutrality. It's not even like a 0 game, right. You want a negative game at this point. And so those are some of the things that you can measure.
I think that satisfaction scores here matter too. So if patients are involved somewhere in that technology, I want to know that the patients thought that this was a good experience. I care a lot about that one because it's not the tech company that's going to be seen as good or bad based upon that interface. It's my practice. It's me. And so I think that's really important.
It's also super important to me if it goes through the staff or if it's physicians that are interacting with it, how satisfied are they with it or is it more frustrating or stressful for them. And then I think that you do need some other like hard measures. And that's where it just sort of depends upon the product and how you measure quality with the product. I think that it depends, right. And so top line, we're always going to go to well, does it generate revenue. And usually most of these initiatives don't generate revenue.
They're not accretive. Well, then does it save cost. OK are you able to repurpose FTEs to a different role. Are you able to save money elsewhere and be very intentional about making sure that you follow through with whatever it is that you put in your pro forma And then and then I think equally important is, well, how did it impact the physician.
And I think that a lot of us have gathered a lot of really good data on ambient clinical documentation. And it certainly aligns with what I heard this morning. At MultiCare, we have not seen an overall decrease in the time and chart, but we have seen a decrease in time and notes and we've seen an increase in chart review and an increase time in orders. And so for me, if the primary care doc is actually reading the urology note, that's a win, right. Because it's the most important note in the chart.
OK maybe not. But it is I think that can feed the narrative that our physicians are doing the more important action oriented things in the chart as opposed to documentation. And finally, I think it comes down to and we're continuing to survey our physicians as well in terms of their satisfaction with the electronic health record and different initiatives on a micro basis.
And so I think you have to include all of those sorts of metrics in the way that we look at how a solution is good or not. So good. Metric design is really hard, especially prospectively. It's easy to just kind of lean back and say, well, it's all financial. But a lot of times what the finance executives think is measurable financial wouldn't be measurable to patients or physicians. And so it can become really challenging to get on the same page about that.
And part of the strategy is to articulate to all these different stakeholders who have different ideas about what they might measure, what the higher goals are and how those higher goals align with the overall organizational goals and really the cultural identity of the company. Who are we and what is it that we're trying to accomplish as a mission together. That's hard to do because some of that stuff is really hard to measure. The other thing I'll mention about metrics is that if folks come at us with, well, here's a set of metrics that we should apply to every project. It's like, no, no, these projects are really different. They work in different parts of the organization.
And when you're caring for a population of patients, the diversity of the population we're caring for is not just the diversity as we all think of diversity and but the diversity that we're talking about pre birth to end of life and everything in between. It's just too overwhelmingly complicated to say, OK, let's apply a single high level metric set to that. So we need to be smarter than that. And so I really try to be careful that we don't take simplistic KPIs or other kinds of things. And use those because they end up mixing people up about what we're really trying to accomplish.
Thank you all. Really great points. We've spent a lot of time today talking about how can technology support the physician day to day workflows to care for patients. I do want to ask one final question before we get to audience questions and discussion time. One of the topics we talk less about is the evolving payer practices, and the physicians need to navigate the changes in payment and reimbursement.
So can you talk a little bit about your view of the role of technology in supporting these payment models that are changing. And I can address that from my advisory role with Zeus. One of the things that we look at as we bring a lot of structured data together. And so that's very nice. If you're doing a transition of care for a patient, you can see what their history is and how you can address that. But the other nice thing is if you take a pano of patients, you can also go through that and say, for your annual wellness visit, how many of these patients have not had a hemoglobin C This year.
And rather than setting appointments by who's ever calling or is ever making the appointment, be really intentional about saying, well, here's 15 metrics we need for the year. Let's make this appointment with this person that's missing five of them. Let's get a plan to get that done before the end of the year, because a lot of it is situations, particularly with CMS, where if you don't have particular boxes checked, you miss out on that reimbursement in general.
And so I think you have to be really proactive and saying, let's address these active concerns of the patients that we have. But at the same time, as things shift toward prevention models and a certain amount of money for a panel of patients, I think you have to be really careful how you're utilizing your time and spending that with the patients to make sure you can maximize, maximize their health. And then also in turn, that should maximize your reimbursement as well. For my emergency department hat, I can't really speak to that.
I get paid when I show up and I take care of patients and sometimes they have better insurance than others. But I'm always there. And I don't really have the option of saying, I'll only take care of these patients today and not these. But if you have a group practice or particularly if you're another type of specialist, that becomes very critical how you address the patients that you see and how you maximize your time with them. Yeah so if you think about data out of an EHR, 80% is unstructured. For those who don't know like unstructured data.
Is all the stuff we write. And it's very hard to glean value and understanding from that information. So when I started working with Allied health, that was one of the priorities was making sure that all the patient information we had come in came in as structured data. And then you have the opposite of that, wh
2024-11-21 06:44
