Episode Transcript
[00:00:00] Speaker A: You welcome to PG Pulse Press Gainy's podcast on all things healthcare, tech and human experience. In this podcast, we'll be joined by some of the best and brightest minds in the industry to discuss challenges, share insights, and innovate the future of healthcare. Thanks for tuning in. We hope you enjoy the conversation.
[00:00:21] Speaker B: Welcome to the second day of HX 24. We have a great session and our topic is around digital transformation. Let's try to bring it down to action and what makes it real. And I figured the only way to really get a real perspective was to get a nurse, evangelist and two CIOs up here on the panel with me.
[00:00:42] Speaker C: Hello, everyone. I'm Emily Berry. I work at Epic.
[00:00:45] Speaker D: Good afternoon, everyone. I'm Daniel Barcee. I'm chief information officer of common spirit.
[00:00:50] Speaker E: Hi everyone. My name is Navelet Madison. I'm the chief digital and information officer at Orlando Hell.
[00:00:55] Speaker B: Let's jump into our topic of digital transformation. And lots gets written about it. Lots gets spoken about digital transformation. Let's put a little bit of detail and some focus. Let's start with what you're each excited about and what really sort of makes you sort of want to look forward and get involved in all the technology can offer. Maybe, Emily, you'll start.
[00:01:17] Speaker C: Happy to start.
So, of course, one of the things that we're working on at Epic is how to leverage Gen AI. And in that gen AI category, I think one of the most exciting things that our team recently showed me was a proof of concept around how you could take patient education materials and patient instructions and immediately put them in the person's native language and grade level. And when I thought about empowering patients and promoting health equity, it just took my breath away. So when I think about the tools that are out there and where we're going, it's those kinds of use cases that get me most excited.
[00:01:53] Speaker B: That's great, Daniel.
[00:01:55] Speaker D: I'm excited about technology that's not so cutting edge, but is more embedded in what we do. So I'm the CIO who doesn't want to go out and buy more technology. I mentioned before that we're complex. We've got 19 electronic health records. So think about optimizing 19 different instances and electronic health records. It's really difficult to do. So we're trying to get down to one. We need one ERP, we need one of this, one of that instead of many. And when it comes to advanced technology, I'm not excited about new startups that we're bolting on or new processes. We're forcing nurses or doctors to jump into. I just want it embedded in what we do. What we need to do is adopt things that nudge us to excellence in the tools that we have. So I'm most excited about technology that's going to come embedded in what we use every day.
[00:02:43] Speaker E: Yeah, I'm most excited about the fact that technology is more and more becoming a game changer for our clinicians and our physicians. So, again, back to I'm there with you. I really don't need a lot of tools. I don't need a lot of technology, but taking a platform approach and then using that to be able to have physicians get more pajama time.
[00:03:06] Speaker B: Daniel, I want to pick up on something that you said. I've been a long admirer of your work at Yale, New York Presbyterian. Now at common spirit, you've often talked about how it's easy to get distracted with a big, shiny object. I know you sort of touched on it, but how do you sort of set priorities? How do you figure out how to take an organization as big as common spirit and get it pointed not only in the right direction, but pointed together?
[00:03:33] Speaker D: Well, I'll share one thing that I like sharing, a little bit of a story. I read about a really great photographer who worked for National Geographic, and somebody asked him once, what's the best camera in the world expect to hear? Like a Nikon SLR with an f two stop lens or something like that? And the response was, the best camera in the world is the one that you have in your hands when you need to take a picture. And that really stuck with me. And so it's not about an exciting new tool that a physician needs to go and log into when he or she needs to do something. It's what's there in the moment. And so much to answer your question about what we have in technology and what we need is what's there every step of the way. When I joined common spirit, I thought, boy, we're big and complex. How do we wrap our minds around meeting our needs at the same time advancing with the most advanced AI and chat GPT and tools like that? And so we created a model that's based on Maslow's hierarchy. So everybody knows Maslow's hierarchy. You have your basic needs, physiological needs, food, air, water, shelter. And then you have companionship and then love and then self actualization. So you move up the scale. To me, the advanced technology we're talking about, the AI, is the self actualization at the very tip of the pyramid. But you need everything below that to work to get there. You can't go out and spend $100 million on AI and think our health system is going to run really well now. Right. What you need is the core infrastructure that's up and reliable. It's easy for everyone to log into. You've got the security, you've got the communications, you've got the EHR and the ERP. And then you've got the data on top. So that's my focus. To use that model to say let's meet all of our needs, not just focus on the bright and shiny.
[00:05:19] Speaker B: Got it? Makes a lot of sense. Now let you have, I think a somewhat similar philosophy you've come through a year. We've collected a lot of hardware, hymns awards, most wired awards, some epic awards. And I think we were talking about it. You mentioned the idea that it's not again about one big thing, it's about a lot of small things and sort of having a plan. Tell us a little bit more about that execution, how we get things done with the everybody focused on let's do digital transformation.
[00:05:48] Speaker E: Absolutely. I'll double down on what Daniel just said. It's really working to make sure that your foundation is strong and it's solid, it's rationalized.
I came into the organization six years ago and we had over 2000 applications. We had desperate EHR, definitely not as much as you have right now. And so we really needed to get our house in order, so we built out that foundation. And so that's why it was not just one product, because epic was our big thing.
We had to replace all of those disparate EMRs with one comprehensive health record and we chose epic. But in order to do that, we had to make sure our wireless was good. All our PCs were moved the data center out and moved things into the cloud. We solidified that. And then we say we're taking a platform approach when we put epic in. Can epic do it? Can epic do it? Good enough?
[00:06:47] Speaker B: Emily, you and I have spoken quite a bit in the past about nursing, the impact of nursing. I think it would be fair to say that if you're not going to get the nurses on board, it's probably not going to happen yet. We're faced with all this technology. Gen AI, you brought it up. Everybody is thinking that, okay, maybe we're going to use these automagical solutions of the computer replacing humans. I think I would be correct in saying that healthcare is a pretty labor intense industry. Give me some thoughts in terms of how you think this massive amount of technology with perhaps this promise to reduce labor is going to meet a labor force in healthcare.
[00:07:28] Speaker C: Yeah, I think the thought that I've got around Gen AI and really any of those tools, predictive models for the nudge decision support, those are members of the team and what will be left behind, and this is me quoting others, but I really agree with it. What we'll left behind is the people who don't know how to use those tools effectively in their role. And so, in fact, in the Maslow's hierarchy, one of the things I think a lot about is, do we have a workforce that's ready to use these tools and ready to think about the team in a really different way, where you may have things related to AI, you may have different kinds of skill mix, you may even have a robot, as we're seeing now in some of our organizations. So I think that's one of the pieces is building from the ground up, is do we have a workforce that's ready because the technology is ready?
The other piece I would think about is thinking bigger. So particularly in nursing right now, there's a lot of really great ideas related to how do we use this to improve the handoff shift to shift, or how do we use it to draft a note and make it a little faster at the end of the shift to have the goals automatically completed. Those are great projects and they're a great place to start, but honestly, it's not big enough, particularly when you think about the work of nursing and really the work of care coordination. I love the discussion earlier from the Tampa general CEO. And what I mean by that is thinking bigger would mean really thinking about using these tools for interoperability to expose the whole team's work. So a much bigger set of information, putting it right in the workflow and letting us really pick up that holy grail of the patient's story, not just across our organization, but really across our communities, so that we can start focusing on things like functional health and like the person's goals. Because at the end of the day, that's where the value really is. We won't change that curve without getting to those pieces. And that's where nursing sweet spot is. And I also think it's where patients want to be.
They want to work on their goals, on not just what we think they should be working on. So all that to say, I guess, darren, I'm pretty excited about where we're headed, but I do think it's thinking about these technologies as a member of the team and then really understanding your scope relative to those team members, including the patient, because this tool, they'll take advantage of this tool too, I think, and be empowered by it.
[00:09:59] Speaker B: Okay, well, I'm going to sharpen the question and get ready because I'm going to throw it to everybody. So is Genai going to replace people in healthcare?
[00:10:07] Speaker C: No, I don't think so. I don't think so. I think it'll be a solid team member, but I don't think it'll replace people.
I think it'll replace people again who don't know how to use it effectively or who organizations haven't really figured out the right use cases. I love Nebula's analogy of several small things. That makes a lot of sense to me, but I don't think it'll replace people.
[00:10:28] Speaker D: Okay, Daniel, I do like to focus on people. I've got to put a plug in here. If we're talking about patient experience, I've had the great opportunity to work with people like Rick Evans in New York Presbyterian and Kami Clemens Brown at common spirit. And it's people who make things happen. Nurses make it happen. And so you got to figure out what's going to do to the workforce.
[00:10:50] Speaker B: All right, for that.
[00:10:51] Speaker D: Applause one, I'm not even a clinician. That's great. You have to make sure that the clinicians, especially in the nurses, are brought into what happens. I'm not fearful for jobs with technology. I do feel like it'll help with what we do. But if you think about introductions of major technologies, it never fundamentally changed the workforce. The analogy I like to use is from 1900 to 1915, the number of horse and buggies versus automobiles in the United States in an inverse right on top and on bottom. But there was not in 19 seven a major layoff of horse and buggy drivers. Everybody's kind of picked up how to drive a car, right?
[00:11:30] Speaker E: Yeah.
[00:11:30] Speaker D: And over time, we all just got better and better at it.
If you learned how to drive a Model T, then by the 30s you knew how to drive a Packard and you never had to go to driving school. All of us started off with a mobile phone, then a flip phone and then a BlackBerry and then an iPhone. None of us went to school for it. The technology kept coming along and made us much more efficient. So I think the technology is going to get more and more advanced, but I think that only the most advanced of us need to know how to program it. The rest of us are just following along, moving up a step. So I'm not afraid of impact of technology on the workforce, I think we.
[00:12:08] Speaker C: Just become knowledge workers. I mean, we're already knowledge workers. It's just a new generation of knowledge worker is my take.
[00:12:16] Speaker E: The words that we're using are that generative AI or AI in general will augment. So you'll hear things like copilot, it will automate. I have seen where some of my, I don't have a lot of programmers, but tasks that would take them two weeks to do, they can do in 4 hours right now because they can generate code and it will optimize. Right. So the ambient EHR is a big deal, right. The fact that a physician can use their phone to generate notes and then it can go into the EHR, that's how AI is really making a difference. It's not going to replace physicians, it will not replace nurses or anyone else or anybody in it who might be fearful of this. It's going to augment them, it's going to automate and it's going to optimize what they do.
[00:13:05] Speaker B: So is this, Emily, one of these paths where we're going to get everybody back to the top of their license? One of our favorite phrases to utter in healthcare?
[00:13:12] Speaker E: Yeah.
[00:13:12] Speaker C: I was just thinking, for those of you who like lean, I agree with Daniel. I think it's going to take a lot of waste out of the system, which should move everybody to higher value work, maybe not even higher scope of practice work or full license work, but just everybody working to much higher value work. And I think one of the pieces of higher value work is maybe just as a counterpoint that maybe there is a human that answers the phone or a human that has one more minute to talk to the patient and talk to the family. So that as we're saving time, I worry a little bit that that translates into you can take one more patient on your caseload, or you can round on one more patient, or you can kind of fit one more x ray in. And I'm hoping that some percentage of this time goes to higher value work, which is engaging and learning and supporting the family. And how we do that and how we measure that, I'm not entirely sure, but that is my hope. When we think about taking the waste.
[00:14:06] Speaker B: Out of the system, and I think that our fear is that we're all in agreement that we have to leave the humanity and we have to put the people sort of at the center. How are we going to adopt all of this technology while really sort of maintaining that at the end of the day, it's really about the humanity for the patient. And demonstrating caring. I think some of you have sort of talked a little bit about this idea of the best technology disappears into the background. Give me some thoughts about how we're going to go ahead and do that and really leverage technology in that way.
[00:14:42] Speaker E: I can get started, and I think we were talking just before we came up here about we can have all of these great technology. They're pretty slick, and we put it in front of a physician or in front of a nurse, and if they don't adopt it, if we don't train them, and if we don't help them to get through it and also make it easier, I heard. I think another word that was used is ease of use. We are very big on that. So that's some of the ways that I think we have to make sure that all of this technology and all of these capabilities and artificial intelligence, the human at it, they will still have to adapt to it. And change is hard for people. Change management is hard. So we also have to work on that as hard as we work on investing in new tools and technologies.
[00:15:29] Speaker D: I think we need to be respectful of our workforce and our patients and acknowledge that there are no quick fixes. There is technology that will help improve and perhaps give minutes back, or as Novelte said, have some fixes help us along the way. But I think being honest about it is really important.
Darren Novelt and I were all CIOs at one point before we moved to Prescani, and at some point in our career we were all asked, well, why do we need to buy Cerner? Why do we need to invest in epic or in all scripts? I understand that in 2004, Google is going to make a platform that'll lay over on top of all of this, and can't we just wait until Google solves that problem? And the answer is, unfortunately, no. We have to do the hard work of the core infrastructure so that the technology allows us to advance what we do. And I think that's the best way of acknowledging what happens.
[00:16:21] Speaker B: I'm going to pull on the thread of the power of technology, and we all know that AI is fueled by data and large amounts of that. I'm sort of thinking about how this is all going to work in healthcare and some responsibility that we all have to make sure that that data is the correct data. I think we've all learned to use the word hallucination in a new context. Tell me a little bit about how you're all thinking about ensuring the data is safe and it's the right data as we begin to put lots of energy around what AI can do for us.
[00:16:54] Speaker C: Daniel's looking at me for some reason, very dangerous.
[00:16:57] Speaker D: You go first.
[00:16:59] Speaker C: So I think, first and foremost, like any clinical decision support tool, there needs to be engagement of the clinicians who are helping to author or helping to apply that tool. So even piggybacking on your last question, Darren, I think if the nurses aren't at the table to understand what it is first and foremost, and then how it works, I think that's where the real risk is. The second risk, of course, is the ease of use question that was brought up on the last panel, really making sure that it's the right time, the right place. And does the person on the other end really, are they the right person? And I think it goes back to this knowledge worker idea in my mind, where in that Maslow's hierarchy, we need a workforce who can be brought into that table and appreciate or understand and full participants. And today I'm not sure. That's always the case with our nursing workforce. And so we need to invest in them on why these tools exist, how they work. So I think bringing the folks to the table, making sure that they're educated to know what it is that they're looking at, getting it into the right place in the right time, of course. And then the transparency, right at the end of the day, it needs to be really transparent what's happening. How did we get to that number? How do we get to that recommendation? And who generated it? Is it powered by common spirit? Is it powered by epic? So it's that transparency, right in the workflow. I think the piece that groups also oftentimes miss and that we've been focusing a lot on is then what's the response? So there's sort of the alerting in the response, but then what do we do about that? How are we going to measure and monitor it and make sure that that closed loop is always happening with really high reliability?
So to that end, the care and feeding of these tools, I think it's been pretty easy to kind of get live and go live and sort of keep moving. I think these are the types of tools that are going to really force a level of rigor, not just on maintenance, the way that you might think of taking an upgrade, but really understanding how they're working and what their impact is. So those are probably the three or four things, I think, that make a big difference in how to use the tools effectively.
[00:19:10] Speaker E: It is. And some of the things that we're doing is engaging the patients in the design of the experience that they will have. So I'll work with our marketing team and our design team when we're going to be doing anything that will impact my chart or impact how they will interact virtually through a virtual visit or virtual sitting for their family. We ask the patients, we have a committee, a patient, I forget what it's called, but our marketing team runs a group that they go out and they say how give us some input into doing this.
[00:19:49] Speaker B: I don't want to brag, but they use our digital tools.
Well, I have one more question, and given our theme of the day, I took the liberty of asking chat GPT for the question I typed into the prompt. Give me a list of some fun AI questions I could ask on this panel.
Here we go.
[00:20:12] Speaker E: We're starting at that.
[00:20:13] Speaker B: We're going to be the judge of whether these are truly fun or not. All right, we'll do this as a somewhat lightning round. So the euphemistic one answer, but a sentence is sort of fine. So here we go with the first one. If AI had a superpower, what would it be really?
[00:20:31] Speaker E: It's to put the human back in the interaction. Doctors are not typing instead of looking at the patients, or the nurses are not having to write on sheets of paper and all of that and really putting the human back so they can interact with the patients.
[00:20:46] Speaker B: All right.
[00:20:47] Speaker D: AI would give us a true picture of what, Monday through Friday, our real capacity is and our patient load and our provider capacity.
[00:20:58] Speaker C: I'm going to go old school. People probably can guess how old I am. So wonder twin powers. Has anybody watched the wonder activate activate? The activate. So do you remember when one twin would say form of a bucket and the other twin would say shape of water, and then they would put the fire out? And so when I was, I think that's what's going to happen. I think we're going to have these incredible tools with AI, plus the power of a really smart clinician, and we're going to put the fire out.
[00:21:25] Speaker B: Join me in thanking our distinguished panel.
Appreciate it. Thank you, everyone.
[00:21:31] Speaker A: That's a wrap. Thank you for joining us today, and special thanks to our guests for sharing their time and insights. Stay tuned for our next episode, which will be released soon. In the meantime, visit info prescainy.com resources to browse our content library, where you'll find more information on the human experience and a lot more.
