Smart From The Start

Creating Smart Hospitals with AI and Ambient Intelligence.

The most innovative change-makers in healthcare and technology discuss how AI and Ambient Intelligence have the power to transform healthcare.

“It’s time for healthcare to move at the speed of tech.”

Current care delivery models are reaching a critical breaking point. Can AI, Ambient Sensors, and Accelerated Processing support the intricate systems and operations of modern care environments to create healthier more sustainable healthcare systems?

Meet your Host

Steve Lieber, former CEO of HIMSS

Steve Lieber served as President and CEO of HIMSS, for 18 years, during which time he brought significant growth to the organization and was recognized as one of the Top 100 most influential people in US healthcare. Lieber has been awarded honorary life memberships at HIMSS, the American Hospital Association, and the American Society of Healthcare Risk Management.

Episodes

"I've always viewed the technology really as an enabler to higher quality care that we can provide. I think a lot of these advances have allowed us to utilize our workforce in different ways than just the nurse down the hall or who might be local. Now, we can leverage resources across the entire spectrum of all of our locations." - Bernie Rice

Bernie Rice Chief Information Officer and Senior Vice President at Nemours Children's Health

Episode 29 Balancing High-Tech with High-Touch:

The Future of Pediatric Care

SFTS-Bernie Rice: Audio automatically transcribed by Sonix

SFTS-Bernie Rice: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Intro/Outro:
Welcome to Smart From the Start, presented by Care.ai, the Smart Care Facility, platform company and leader in AI and ambient intelligence for healthcare. Join Steve Lieber, former CEO of HIMSS, as he interviews the brightest minds in the health provider space on truly transformative technologies that are modernizing healthcare.

Steve Lieber:
Hello, and welcome to Smart from the Start! I'm your host, Steve Lieber, and it is my pleasure to bring to you a series of conversations with some of the sharpest minds in health information technology. We'll discuss the smart directions healthcare companies and providers are pursuing to create smart care teams and smart care organizations. Joining me today is Bernie Rice. Bernie is the Chief Information Officer and Senior Vice President at Nemours Children's Health. He joined Nemours in 1999 and has been the CIO there since 2008; and is responsible for the leadership and strategic direction of information systems, supporting Nemours Clinical operations in six states and policy and prevention work in 25 states. Bernie has helped build Nemours into an award-winning organization, most recently achieving HIMSS stage seven for both inpatient and ambulatory operations. Nemours has also been continuously recognized as a most-wired organization by CHIME. Bernie, appreciate you joining us today.

Bernie Rice:
Thanks for having me, Steve.

Steve Lieber:
Great. Well, I've got several directions that we can think about going, but one, we've talked a little bit about this before, ambient monitoring virtual nursing. And as the theme of this podcast is all about using smart to improve clinical operations and patient satisfaction. So that's sort of the direction we want to go today. So, being a pediatric facility, are there some things that we ought to be thinking about issues, considerations related to virtual nursing, ambient monitoring, and such that you need to take into consideration that might not apply in a non-pediatric facility?

Bernie Rice:
Absolutely. In pediatrics, while technology can be the same across all of healthcare, pediatrics accounts for only about 9% of the annual spend in healthcare and brings a variety of challenges compared to adult facilities. One of the bigger challenges that I don't think many people think about is oftentimes, we're not specifically working or talking to the patient because it might be a two-month-old. We're actually talking to the patient's family. So we actually have to consider the patient and the patient's family across that entire experience. You know, if we talk about virtual nursing, we started our program last year leveraging technology we already had installed and been using for years. We configured a few epic screens and packaged that together to give us our first beginnings in virtual nursing. And from a technology perspective, we're really working now towards an advanced camera platform that's going to provide a much richer audio and video experience, along with some future AI capabilities that we're looking forward to. And just to pause on virtual nursing for a minute, I think you're going to see that term broaden and is already broadening to more virtual care. There are other members of the care team who can participate remotely with ambient listening. We started our journey a little over two years ago, really as a wellness perspective for our physicians facing physician burnout.

Bernie Rice:
It's a big epidemic. So we partnered with Nuance Digital Ambient Experience, or Dax technology back then, and in the last few months have been converting all of those users over to the new epic Hycu Copilot functionality. Now that Microsoft has purchased nuance, really positive results on that. You know, again, a difference in speeds with even that technology is, you know, in an adult facility, you have the patient and the provider talking, and in a peace facility, have the patient, mom, and dad, or grandma or someone and sometimes other siblings in the room. So the ambient technology has to be able to record that whole conversation in the right context of who said what. So it's something that they don't have to deal with a lot in the adult facilities. And back on the patient's perspective in pediatrics. Our patients could be tiny infants weighing only 2 or 3 pounds all the way up to an 18-year-old full-grown adult. So imagine the blood pressure cuff or cuffs you might need across that entire spectrum of patient care from that 2-pound baby in their NICU all the way up to that 18-year-old we're seeing.

Steve Lieber:
One size doesn't fit all.

Bernie Rice:
Exactly. And there's probably a dozen cuffs used across that entire spectrum. Again, pediatrics being the smaller portion of healthcare, sometimes the advanced technology is last or late to the pediatric market. And just a few years ago, we had a hard time finding Bluetooth blood pressure cuffs. They were available in the adult space, but there weren't many certified in the pediatric space. I'll give you one last kind of funny example I always think of when we started our clinical command center in Orlando Hospital. We had alarms coming in from one of our patient rooms, and our team videoed into the room, and there's the child jumping up and down in the bed, and the pulse ox meter fell off their finger. You probably don't see that a lot in adult healthcare facilities.

Steve Lieber:
You're right. They're thinking about it as such. You do have certainly, a very different patient not just in size but in behavior and such. And so they're just all kinds of things that if you come out of the adult healthcare world, you just don't even think about it until all of a sudden something like you just described happened. And all it was a kid jumping around on the bed.

Bernie Rice:
Exactly. You see that in the facility, and you might bring in a different part of the care team.

Steve Lieber:
Yeah. Different specialty. Exactly. So you mentioned physician burnout as being a driver in some recent adoptions in talking with others, certainly. Others have identified that among the nursing team as well, changing work styles and preferences, the turnover in nursing, and that sort of thing. So, as you're moving on this journey, can you give us some specifics in terms of what you are finding that you're able to solve? That then translates into a financial advantage. Adoption of technology is expensive. We've got to have both clinical returns as well as financial. So, what are you learning along the way?

Bernie Rice:
Well, it's been a long journey. Implementing new technology is an investment in time and resources, whether that's people or funds. I think technology innovations have always been in our DNA here at Nemours. A couple of examples I'll give you is Google started in 1998. We formed Kidshealth.org in 1995, and it's the premier go-to site for kids' health information around the globe today. So we actually began our EMR journey in 1999 with EPIC, and it helped them develop their system to be more specific to pediatrics. So we've had a long experience with technology and great support from our leadership and our board. But I've always viewed the technology really as an enabler to higher quality care that we can provide. I think a lot of these advances have allowed us to utilize our workforce in different ways than just the nurse down the hall or who might be local. Now, we can leverage resources across the entire spectrum of all of our locations, whether that's radiologists that we have throughout the nation or nursing in different locations. So, as we started our virtual nursing program last year and it has advanced over the months, we have Delaware nurses now videoing into our Florida hospital to do certain tasks for the floor nurses, like discharge instructions and some of those routines that free up the floor nurse. Now, I think you're going to see virtual care or virtual nursing relieve burnout for those nurses as well. We talk about physicians. Well, you know, I think nursing is a really demanding job.

Bernie Rice:
As that population ages or there's a burnout factor, many of them want to get off the floor or just need a break. And so virtual nursing provides that opportunity, or it provides an opportunity for those thinking about retirement or wanting to slow down a bit, a different alternative to get off the floor and maybe just continue their nursing work in a remote fashion. I think the smart care element also helps take some of that cognitive burden and workload off of the staff on the floors. It provides a higher level of physiologic detection remotely. You know, we're able to do remote monitoring to provide safer care, putting our clinical command center up. I can think of an example. Many years ago, we got an alert in a room, and the paramedic videoed into the room. The child was starting to have a seizure, and the mom was asleep in the room and didn't know it at the time. So we quickly alerted the unit staff and the mom who could quickly intervene in that child's condition. So again, it takes away some of that burden of constantly needing to be in the room or eyes on that. You've got someone behind to help, you know, be that extra set of eyes. And while technology is important, we can't do it all remotely. You still need that high-touch healthcare of having that hands-on, personal, high-touch approach.

Steve Lieber:
That's something I hear occasionally, at least, and maybe more often than that. That people are kind of getting carried away with what they think virtual replace. And it's really, I think you said this, it's complementary to the hands-on. They're just certain. Yes. You can have a command center either down the hall or across the country or whatever. That can be anywhere. But there are certain things that require that clinician to be in the room at certain times and such, and it's really trying to get to the point where that intervention and action is maximized. And the other stuff that can be handled in a more economical, efficient way is taken off of them. That's what I'm hearing.

Bernie Rice:
Absolutely. And you get that personal comfort level and reassurance of that provider and that expert in the room with you. That goes a long way.

Steve Lieber:
Yeah. What sort of reaction are you seeing? And again, largely because I'm going to kind of default to the younger end of your age spectrum that you serve. You had a sort of response are you getting from parents and families in terms of how you're utilizing smart technology and the virtual component. Is there a little challenge at first if, and I'm not sure, is there a voice that comes in, you know, the voice of God coming in? They are startled and look around, or I assume there's an introduction and sort of acclamation of the family care circle to all the technology that's going to come to play, but give us a little sense of how people are reacting to this.

Bernie Rice:
Yeah, absolutely. We introduced them to the technology when they were admitted to our facility. And so the command center will introduce themselves before they turn on the camera or video in the room. Again, we want to respect privacy and those kinds of things and not startle or not make it seem like we're watching all the time. But I would say folks have been very accepting. And, you know, their younger parents are used to technology everywhere else, whether it's airlines or Chick-fil-A or whatever it may be. They're interacting with technology daily. But I do still. Think they longed for that personal touch. Imagine a new family with a brand new newborn, and they're concerned; you know that care across the wire is important, but you want to have that reassurance in person as well. So I think it's a mix. And, you know, we've certainly seen after COVID that the telehealth rates have fallen off some. And there are certain appointments that people want to be in person for. And there are others who are okay with being remote. So, I think it's a blend. Again, back to I don't think it'll be all one way or the other, and it's kind of situational, but I think parents are very accepting of the technology but still long for that personal interaction.

Speaker2:
Yeah. Along with, exactly. So, several times, you've mentioned the Command center. At one point, I think he even called it Advanced Command Center. My understanding is you installed cameras in rooms ten or more years ago, and so there's an evolution you've gone through here. Talk to us a little bit about going from a camera in the room to an advanced command center. What are we talking about here? Yeah.

Bernie Rice:
You know, bringing that command center to life was a huge step forward back then. We didn't have a digital view into the room ever at that point. But that design started in 2010. We went live in 2012. That was a long time ago. So fast forward to today, and we're asking ourselves, how do we move beyond just the view in the room? You know, I like to think of the technology today being that digital assistant or that other digital presence in the room beyond what just a view from a camera can do. I'll give you a couple of examples. You know, one of the designs in our Orlando hospital and you can see it from the air if you're flying, is the different colors of all the rooms that you can see. It might be green, red, blue, or whatever. And the child, since we've opened, has been able to change the color of the room, either on the touch screen, in their room, or on a remote control. It kind of gives them a sense of control in the room that they have some control over what's going on. Well, imagine now if you could say, hey, Nemours changed the color to green. That is taking that digital assistant approach a step further and integrating it into building management and those kinds of things.

Bernie Rice:
And that's one simple example. But think of the power behind that, of what else you could do through voice control and integration of the systems. And we've tried to keep a very open architecture of all the systems we put in, knowing that we want to integrate these. I really see the next paradigm of that digital assistant leveraging the power of what AI brings to the smart care technologies already in use. I like to think of AI as augmented intelligence. It's not replacing us; it's making us smarter. That digital assistants are to be quicker, faster, and better, but working together. And it's a real game changer, you know? Imagine going into the room now, and the system is documenting for the nurse while they're taking vitals or whatever that may be. So, it could be as simple as documentation. Or one of the things we're looking towards is a simple duress word that we can detect, the staff says, and then dispatch a rapid response team immediately, just on a verbal duress word, instead of a panic button in the room or something like that.

Steve Lieber:
So, as I've made the rounds this late winter and spring at conferences, it seems like everybody's talking about and putting on the backdrop of their booths that they're into virtual care, they're into smart care, they're into AI. There's a lot to wade through. And clearly, you're deep into this. You're looking at and installing a number of different things. How do you wade through all that noise? How do you figure out who's the right technology partner as you're moving into some areas that are somewhat new?

Bernie Rice:
Yeah, there's a lot to wade through. You know, I think what I look towards is a great vision, and the ability to execute are real critical key to success. As I said earlier, technology is expensive. You brought that up. Obviously, cost is always a factor in what we do, especially being a nonprofit children's healthcare. I think one of the absolutely critical components for all the vendors or partners, I like to call certain vendors partners, is someone who's willing to work with us, can implement our vision, and can see where we're going. And they're not just trying to sell us products. That kind of partnership is an absolute must. There's a tremendous number of companies out there, and I think 600 plus a year of new healthcare startups. So it's easy to get caught up in that bright, shiny new object syndrome that everybody talks about. So as you look through those and we talk is okay, have they actually done it in healthcare and have they done it in pediatrics is another question that we can impede to ask. And then I leverage my peers. You know, the Children's Hospital CIOs are a very collaborative group. We're always communicating well together. So we kind of check in with each other and say, hey, what are you doing? What have you tried? So really trying to leverage the power of the Children's Hospital Collective out there to build that network or brain trust together on what we're trying to do?

Steve Lieber:
Are you seeing because you referenced using and I like the label augmented versus artificial leveraging augmented intelligence into work that you're doing? Are you seeing a greater integration versus point solution approach, or is that what you're referring to there when you talk about bringing these things together, that really looking for that more integrated systems versus point solution approach?

Bernie Rice:
I think that's the ideal situation. We already have a very complex environment. We've created lots of system integrations, lots of applications running at the bedside, and technologies closer to the patient than it's ever been. And there's a lot of it there. So the more we bring in point solutions, the more complicated we make that web of service behind the scenes. So we're really trying to leverage our crucial partners, our EMRs, our ERP, of course, our office suite, and all the infrastructure components and the work they're doing in making sure that that works well together. Obviously, they can't do it all. So there are times when we need to find a point solution to fill a specific need, but we just have to be careful of the complexity it brings as the more of those you bring in.

Steve Lieber:
So as you look out and you can define next week, next year, or three years, you know, what's the big thing you're working on to solve that you haven't solved yet? What's the the challenge out there, the use case or whatever that it's like? I got to figure it out; I have to find a technology partner who can help me solve this.

Bernie Rice:
Yeah. You know, it's I think we have to be careful of technology that we're just not trying to do it. So, back to what problem are we trying to solve? I think that is where I keep going back. There's a lot of cool gadgetry and technology, and it's hard for the IT guy sometimes to go, okay, let's not do that. But it's really what problem are we trying to solve? And right now healthcare is a difficult industry. We talked about burnout. Revenue is constantly an issue there. So I come back to a lot of efficiencies; where can we increase efficiencies and do that in a cost-effective way? You know, I think that's where AI and things can help. And as you stated earlier, there's a lot of noise in the market on AI and technology. So what problem are we trying to solve and can we cost-effectively do that? And if I can bend, and my goal is to bend that curve a bit from the cost growth to say, how can I help the company be more efficient or provide safer care at a lower cost? There's a lot to weed through there to find that, I think.

Steve Lieber:
Excellent. So to wrap up, our last question always is the key takeaway, you know, looking for Bernie's key takeaway for our listeners who are folks like you, similar roles, similar organizations, of course, variations in terms of the patient population and such. But what's your key takeaway that you'd like to leave the listeners with?

Bernie Rice:
You know, I think of two things. The two words come to mind: courage and perseverance. We need courage to kind of move not only ourselves but the organization out of our comfort zone. Sometimes, we get stuck in ways. So we've got to have the courage to move forward and the perseverance to stick with it as times get tough. Until we get to the desired end state and I say that perseverance because when the team and the technology are working well, you don't even know it's there. It's when it's not that people notice the technology. So I want to get to the state where it just works, and you don't know it's there. And that's what I strive for—from our IT perspective, helping enable that care in the experience of technology that just works excellently.

Steve Lieber:
I really like that takeaway. Bernie, thank you so much. We're out of time, and I appreciate the time you have given us today. And I know you've got things you've got to get to. So again, thank you so much for being with us today,

Bernie Rice:
Steve, thanks for having me.

Steve Lieber:
You bet. And to our listeners, thank you for joining us. I hope this series helps you make healthcare smarter and move at the speed of tech. Be well.

Intro/Outro:
Thanks for listening to Smart From The Start. For best practices in AI and ambient intelligence, and ways your organization can help lead the era of smart hospitals. Visit us at SmartHospital.ai. And for information on the leading smart care facility platform, visit care.ai.

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"There is no good price for bad care. It's hard to gauge what's value, but if you have to look at that clinical quality and preventing medical errors right up there at the top." - Ralph Johnson

Ralph Johnson Vice President of Informatics and Technology at the Leapfrog Group

Episode 28 Harnessing Technology for Patient Safety:

Insights from Leapfrog

SFTS-Ralph Johnson.mp3: Audio automatically transcribed by Sonix

SFTS-Ralph Johnson.mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Intro/Outro:
Welcome to Smart from the Start, presented by Care.ai, the Smart Care Facility, platform company and leader in AI and ambient intelligence for healthcare. Join Steve Lieber, former CEO of HIMSS, as he interviews the brightest minds in the health provider space on truly transformative technologies that are modernizing healthcare.

Steve Lieber:
Hello and welcome to Smart from the Start. I am your host, Steve Lieber, and it is my pleasure to bring to you a series of conversations with some of the sharpest minds in information technology. We'll discuss the smart directions healthcare companies and providers are pursuing to create smart care teams. Today I'm joined by Ralph Johnson. Ralph currently serves as the Vice President of Informatics and Technology for the Leapfrog Group. At Leapfrog, Ralph is responsible for the organization's technology needs, as well as managing public policy positions for Leapfrog. He joined the group after a 35-year career as a CIO at, in Maine at various hospitals. And as a hospital CEO, Ralph led many hospital and physician practice EMR implementations. He's also led major initiatives to improve patient safety. His career also includes past responsibilities for hospital quality programs, health information management, and risk management. Ralph is past president of the New England HIMSS chapter, which is where we first made our connections some number of years ago, and continues to volunteer for HIMSS at the local and national levels, currently serving on the HIMSS Public Policy Committee. So welcome, Ralph. Good to see you again.

Ralph Johnson:
Hey Steve, it's really great to reconnect with you. I'm looking forward to this discussion today.

Steve Lieber:
I am as well. As I mentioned in the introduction from my time at HIMSS, Ralph was volunteer and, obviously from the introduction, continues as a very active volunteer with HIMSS organization. And, you know, let's start out there. And in terms of talking about public policy, especially as it relates to AI. There's a lot of conversation, certainly in Washington and probably in state capitals all over the country. I was reading recently that Nikki Tripathy is working on an HHS policy for AI Congress, making, you know, all of the execs trot up before they're on the Hill and testify and say, you know, everybody's really focused on this. And so HIMSS has historically been very active in the public policy arena. My longtime good friend Tom Leary, I think, still runs the government affairs program there. Next time you see Tom, give him my best. So what's HIMSS talking about as it relates to AI and public policy? What should we as people in the field be thinking about that's likely to be coming down the path?

Ralph Johnson:
Yeah, it's a good question because I think the Public Policy Committee is just starting to embrace this as something they've got to really take some action on. Just in February, they formed a workgroup to start formulating a plan, and they've already come out with a first draft of principles. They're really focused on clinical applications, although some on the workgroup are questioning whether it should be expanded to include administrative and non-clinical workflows. But coming from the Leapfrog Group stage, personally, I'm really pleased to see an emphasis on patient care and patient safety. I see the workgroup recognizes a need for requirements to monitor introduction of bias and model drift post-deployment. You know, how do you monitor and stay on top to make sure that you don't perpetuate the biases that currently exist in healthcare?

Steve Lieber:
Clearly kind of see it going. You mentioned principles and all. And so bias and ensuring that the AI engine doesn't introduce particular biases and that sort of thing. Elaborate a little bit more on that, because I'd be willing to assume here, and you can help us, that in the field, people are already utilizing tools in certain ways. And so, in a sense, practice is ahead of policy here, which are oftentimes, as we know, is the case. So a little more elaboration on that.

Ralph Johnson:
Sure. So at Leapfrog, one of our major areas of study is maternity care. And we know that for example, black women have a 40% higher chance of having a serious error happen during prenatal and postnatal and childbirth. That's an inherent bias that's been built into our system. How do you use AI to remove that, so that you don't see that part of the AI actually showing up in the system?

Steve Lieber:
So on something like that help me understand. I want to kind of peek under the curtain at Leapfrog a little bit. How is the organization thinking about how it's going to bring this into its metrics? And so, kind of help us understand, okay, got you, got where you're going on public policy here. Okay. Now how's Leapfrog thinking they might translate that?

Ralph Johnson:
So there's a couple of areas that we're looking at that we hope it'll be helpful. But you've got like you said, peek under the covers. The way Leapfrog works, we're actually a pretty small organization with a lot of support. And part of that support is that we have expert panels on a number of different topics. And so it's really will turn to those expert panels to help us understand where AI is going to fold into the models.

Steve Lieber:
Excellent. Good. So as I think about Leapfrog, I mean, certainly quality is probably the thing I remember most. I also remember back in the day at HIMSS Analytics, we did some correlation studies between Leapfrog metrics and MREM stages and all, and found that there was a correlation there. What are you seeing in terms of what's going on more broadly, not just AI, but more broadly out in the field around quality and technology? And, you know, what are you folks talking about in terms of where Leapfrog is headed beyond AI specifically?

Ralph Johnson:
I'm glad you asked that, because that's actually a new emphasis that we have here. We have had a long-standing interest in computerized physician order entry. But that's about as far as we've gone, actually, on the electronic side of things with the patient safety and preventing medical errors. And we're really starting to study now how we can, especially with the explosion of AI coming out, how we can start embracing more of the electronic medical record technology into preventing medical errors for many years. And I hate to say it, Steve, going to HIMSS, I would see, what are you doing? What, how are you using decision support in your systems? And it was primarily to increase revenue or increase physician or provider productivity, which equals revenue. And I was always discouraged at the emphasis on looking at revenue as the end-all and be-all, when really the patient should be at the center of that. And I was pleasantly surprised, I think in Orlando, recently at HIMSS 24, I saw much more evidence of companies presenting technology just for the purpose of improving patient safety and patient care.

Steve Lieber:
That's great to hear. I didn't make it to HIMSS this year, but I have been reading more and sort of picking up on what you just identified there in a trend towards, you know, we've talked patient is at the center of care, but we didn't really practice it that way. And so I'm encouraged to hear you say that at the HIMSS conference, you're seeing that sort of trend. Ralph, just taking a short digression here, Ralph sits on a national advisory panel that Care.ai has sponsored for the building of a smart hospital maturity model. And in the feedback we're getting from that group so far, it is consistently: are you focused on how smart technology is impacting the patient's experience? Make sure the model includes a component that measures patient engagement and patient activation and this sort of thing. And you're right. You know, over the years we've seen a different focus on some of these technologies and all. So how does patient experience and such, factor into Leapfrog. Is there a metric that exists already or is that also a new direction?

Ralph Johnson:
No. You know, part of our model for years has been to incorporate the Hcap scores from CMS into our methodology and how we do the scoring. My boss, though, you know, on picking up on what you said, my boss has a really good saying that there is no good price for bad care. It's hard to gauge what's value, but if you have to look at that clinical quality and preventing medical errors right up there at the top.

Steve Lieber:
Excellent. Good. So let's stay with the HIMSS conference this year, in terms of: what are other takeaways? What can you share with the audience here of things that you are seeing and hearing in terms of various activities? I know, I think they still do or used to had a day focused on public policy, starting with public policy breakfast and government speakers and that sort of thing. So, you know, just give us some insights and some takeaways of what you saw this year.

Ralph Johnson:
First thing I noted was that especially among my former CIO colleagues, there is a strong recognition that they can't sit back and watch how this unfolds. Everybody's got to jump in and embrace this. How you do that, you know, how do you do it without really opening up new risks? But finding opportunities is the challenge that a lot of them are facing. So it'd be good to see how that plays out. I think the second big thing I noted, and I actually shared this with our CEO yesterday, is that a lot of organizations are focused on the governance of AI and setting up a governance model right up front and making sure that it's all-encompassing with the right stakeholders, because you've got to have this. And what that plays into is another hat that I wore previously that you noted is risk management. I actually sat with some people who are in the risk arena and they're concerned about how do you, not only govern this, but how do you monitor and track it? You know, they're used to things like the security logs and the EMR to go back and defend when something bad happened in the hospital. What if something bad happens because of a poorly written AI model? How are you going to mitigate that risk? And make sure that it's trackable. I could foresee at some time you could use AI to actually trigger nurse protocol orders, and one of those orders was inappropriate. How do you go back and find out where does the responsibility lie in that bad order?

Steve Lieber:
Yeah, we're certainly going to go through a period of significant transition from no machine interaction to, okay, what is the right balance of when human intervention is required versus the points at which machine can drive some thinking at all? This is, I'm going to carry it out a little farther here. Is anybody talking about, from a risk standpoint, the risk of not doing AI? In other words, is there an argument out there, not yet necessarily, but thinking ahead that not having a technology that would have predicted the direction of patient is going or something and not utilizing that or whatever? Am I going down a bad path here in terms of risk management or something here? But I just, you know, not using technology is a question as well as using technology.

Ralph Johnson:
Actually, I think you're looking into the crystal ball a little bit further out than what I was hearing, but I can see it steamrolling right to that point quickly, Steve. I think that's recognized in what I said earlier about the fact that to a person, the CIOs I spoke with recognize that they have to embrace this. They can't let it. They can't sit back and watch and see how it unfolds.

Steve Lieber:
Yeah, in my understanding, in terms of some of the readings I've done and chatting with some folks, your two major EMR vendors also are heading down this path in terms of embedding it into their products. I remember reading back last summer that Epic had said, Well, we're going to start out with administrative tasks and we're actually going to embed. So did you get a sense of that in terms of the technologies? And more and more are, and I'm trying to go beyond the hype part, because I would be willing to bet that almost every booth at HIMSS this year had AI on their backdrop, but that aside, in reality, is industry moving along at a rapid pace and bringing this day that you say I may be looking at in the crystal ball out into the future, but it may come faster than we think.

Ralph Johnson:
Yeah, absolutely. I spoke with people at both of those major vendors, had good conversations, and they're clearly down this track of embracing AI and how are we going to incorporate it into the EMR and staying ahead of it rather than trying to. It's got to be a competitive advantage to them.

Steve Lieber:
Sure. And I would expect that when we look at data analytics tools, I mean, that's going to be another place, you mentioned physician computerized physician order entry, there are a lot of places where the opportunity for machine learning is obvious. Now, how it's done, how it's governed, the principles upon which it's based, and that sort of thing are all there. But to me, this has the appearance of one of the more major transformational developments that we've seen, and kind of take it back to the early 2000 time period, we both remember in terms of the digitization of health records getting away from paper. And, you know, that was a transformational moment in time. I'm kind of sensing it here. Do you sense that as well?

Ralph Johnson:
Oh, absolutely. But it's funny you bring that up because as you pointed out, we've both been around long enough to know that AI is this year's buzzword, right? It's actually been something we've been utilizing for over ten years. The difference is the computing power is exponentially stronger than it was. CPOE is a great example. We were deploying that a long time ago; alerting providers when they were prescribing or ordering a medication that there's a potential adverse event, you know, and trying to prevent those errors. Leapfrog recognized the importance of that technology a long time ago. We actually have developed a tool that ONC recognizes as a great tool to test your CPOE system or its safety aspects. And we've had that in place for a long time. You know, almost 50% of preventable medical errors that happen in hospitals are medication-related. Now, if we can apply AI to that, again, with that exponentially faster computing power we have, think of how many medication errors we could prevent and really reduce that number.

Steve Lieber:
You know, I really like the way you gave that somewhat look-back perspective and tied it into today, because we do, I think at times get a little anxious. We'll use that word in terms of where this is going, but in reality, it is a journey that healthcare has been on for a decade-plus, going on two decades now in terms of utilizing technology to inform, alert, even give direction in terms of what we should do and how we should react to patient conditions and that sort of thing. And certainly, the expanded capabilities of what we are able to do creates a different world. But it is, I think, is, you know, paraphrasing what you said, it is continuing on a path that we've been. This is not totally new territory. Yes, some of the tools and they're certainly their capabilities are new, but this is something that we ought to be somewhat familiar with.

Ralph Johnson:
15 years ago, would we think that speech recognition would be where it is now? No. You know, it was the bane of providers. They wanted to embrace speech recognition, to get away from the transcription and everything else. But then they'd get frustrated with all the editing they'd have to do because the speech recognition was so terrible. But now here we are. Now we're looking at large language models using that and ambient listening opportunities, because we've got such better computing power and ability to tackle that.

Steve Lieber:
Absolutely. The ambient listening and ambient monitoring is a big piece of sort of the smart technology and smart care team movement that's moving us much more to capture of information and patient activity and that sort of thing. Put it into a platform and give us some analysis, and then from that action can occur both whether by machine or human interaction and all. It's all part of a big package. That's a great insight there, Ralph, I appreciate it. So to wrap up here, we're at the end of our time, sort of you come from the world that our listeners are a part of: CIOs and CMIOs and Chief Digital Officers and such. So what's your takeaway from where you sit today in terms of what you would say to your former colleagues out there in the field as the big piece that you want to leave with them?

Ralph Johnson:
I would say it's heat, my earlier remarks about having good governance as you deploy it. Make sure you engage all the right stakeholders in that process, you know, the physicians, mid-levels, nurses, even radiology and lab representatives. I mean, there's AI opportunities there as well. And make sure you include the quality leaders as well as if, you know, larger organizations have Ephesus; engage those Ephesus in the process as well.

Steve Lieber:
Ralph, this has been a great catch-up. I really appreciate it; the insights you have coming out of the provider world, as well as the work you're doing at Leapfrog. Really do appreciate the opportunity you've given us today to have this conversation.

Ralph Johnson:
Well, thank you, Steve. I really appreciate catching up again. It's a really important topic, and I was happy to give you Leapfrog's perspective on how we embrace this.

Steve Lieber:
Excellent. And to our listeners, thank you for joining us. I hope this series helps you make healthcare smarter and move at the speed of tech. Be well.

Intro/Outro:
Thanks for listening to Smart from the Start. For best practices in AI, in ambient intelligence, and ways your organization can help lead the era of smart hospitals, visit us at SmartHospital.ai, and for information on the leading Smart Care Facility platform, visit Care.ai.

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"The idea is to try to bring some common sense to this area of smart care facilities and technology. What is it that systems ought to do in terms of bringing about a smarter way of doing health care?" - Steve Lieber

Steve Lieber Independent Consultant

Episode 27 A Revolutionary Framework for Smart Care Technology

SFTS_Steve Lieber: Audio automatically transcribed by Sonix

SFTS_Steve Lieber: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Intro/Outro:
Welcome to Smart from the Start, presented by care.ai, the Smart Care Facility, platform company and leader in AI and ambient intelligence for healthcare. Join Steve Lieber, former CEO of HIMSSS, as he interviews the brightest minds in the health provider space on truly transformative technologies that are modernizing healthcare.

Saul Marquez:
Hey, everybody, welcome back! I'm so excited to have Steve Lieber in the podcast. I learn so much from Steve every time we hang out and every time he's on the podcast, so I'm excited to have him back. For those of you that haven't had a chance to know about Steve, I, first of all, I'd be surprised. But if you haven't, let me tell you a little bit about him before we kick off today's podcast. He's a seasoned healthcare management executive with 40 years plus of experience in healthcare, primarily in the healthcare association management area. He served as president and CEO at HIMSS for nearly 18 years, and currently works as an independent consultant with notable clients such as CRI, the Healthcare Information Management Executives, also known as CHIME, and other well-known entities. Steve, so glad you're back.

Steve Lieber:
Thank you so much, Saul. It's great to be back with you. I always enjoy the chances we have to connect and talk about things that are going on in healthcare, and really happy to be back with you today.

Saul Marquez:
Yeah, likewise. And Steve, you always I don't know, you're just really good at staying ahead of the game, not necessarily going to where the puck is going, but you have a lot to do with directing where the puck goes. And certainly excited to be chatting with you yet on another topic. Today, we're going to be covering this idea of creating this smart hospital maturity model. It's a new concept that just came out. Talk to us a little bit more about it.

Steve Lieber:
I'm going to digress, maybe 15, 20 years here, and it'll be quick in back in 2004, '05, '06, that era, we looked at what was happening in healthcare. And at that point, electronic medical records were really starting to catch on in terms of people recognizing the importance of digitizing health records and that sort of thing. So at HIMSS, we developed the EMR adoption model. Now's the executive responsible for the creation of HIMSS analytics, which was the birthplace of EMRAM. Well, now fast forward to the current time period. And this past fall at the CHIME Fall Forum, I was talking with Chakri Toleti, who's the founder and CEO of care.ai, care.ai's company in the virtual nursing smart care facility, ambient Monitoring space. And Chakri and I were talking about it, and he said, I know your background with EMRAM. What do you think about coming up with some way of measuring how facilities are adopting smart care technology? So we started talking about it, and what what has happened is what we just have announced very recently, which is the development of the smart hospital maturity model. And the idea here is there's a lot of noise in this space. It's a new area. And yeah, you're right, it is directing the direction that healthcare is going, that sort of thing, by emphasizing things like we did with EMRAM. And the idea is to try to bring some common sense to this area of smart care facilities and technology. What is it that systems ought to do in terms of bringing about a smarter way of doing healthcare? And that's, that smartness is going to be measured on a couple of dimensions. One, of course, is clinical care. Let's be smart about it so that we are utilizing the best care processes, the best technologies to achieve the best outcome. It's also about efficiency. When we think about using smart technologies in our homes, for example, it makes us more efficient. We have the intelligence of devices doing things for us, and therefore we're more effective as well as more efficient. It's bringing order to all of that instead of hospitals and care facilities being left on their own just thinking, okay, what do we do? And there's so much here. You start out with the buzzword of the month, AI, and you and I both were at ViVE recently and people were throwing that term around like candy. And what does it mean? And it, quite honestly, it means different things to different people. Well, let's bring some better knowledge, some intelligence into this whole area. And that's the concept behind the model.

Saul Marquez:
I really love this idea, Steve, and really the opportunity that health system leaders have to start putting some logic and organizational principles and a measurement scale around where do I sit and how do I progress, who's involved in this? And like, who's putting the work together? Tell us a little bit more about the work being done.

Steve Lieber:
Sure. As I mentioned, Chakri Toleti at care.ai is really the person who birthed the concept. And so he said, Steve, and in your role as an independent consultant, would you work with us? You've got a background EMRAM. You know what it takes to put something like this together? They brought me on to work on this project. Full disclosure I was already working with them on some other things, and care.ai is bankrolling this. They're providing the financial underwriting for this. But in one of our objectives, or actually even better word, here's guiding principles is this is objective. It is vendor-neutral. care.ai may be providing the financial resources to bring this all together, but the clear direction from them is this is not about care.ai. This is about the area of smart care teams and smart care facilities. So we went to CHIME again, as you mentioned in my introduction, and the organization that I had done some consulting work with, and in fact, I served as their Executive Vice President and Chief Analytics officer for about three years after I left him, helping them build their capabilities in this area of survey research and help upgrade and bring into a more current status their digital health most wired survey. So we went to CHIME and said, okay, CHIME, we're interested in doing a sponsorship with you because you've got platforms that will help make this more visible to hospitals. You've got great relationship with the CIO community, and getting their engagement is going to be a key part of this. And so, care.ai signed a sponsorship agreement with CHIME to help leverage their executives who are involved in survey research and have the experience with digital health most wired. As a matter of fact, the guy over there, Lauren Pettit, used to work with me at HIMSS Analytics. He's got a background with EMRAM. So again, there's expertise there that CHIME's bringing into the project. We've got over 40 healthcare executives from around the country, so MDS, RNs, CIOs, digital officers, innovation officers, CEOs, CFOs, wanting to make sure we really cover the whole area of all of the professions that are involved in the care process, to be advisors to us on this project. Yeah, I've got experience, but I needed front-line people really playing the more significant role of what's the model look like, what are the areas we're going to cover in that sort of thing. And so as over 40 advisors that are working on this and from every major healthcare system that you can think of, not for-profit, huge national systems to small regional systems and specialty hospitals like children's hospitals and such. And so really we have, and it's also not a group that we're finished assembling. We are welcoming others to come into the project to help guide us on this. So it really is a very broad group that's directing the project in terms of the subject matter and the details. And then we've also reached out to some other organizations American Organization of Nurse Leaders, AOL, HFMA, which is financial management group Leapfrog. Those are three organizations that we have talked to, and they have now put an individual on the advisory panel. I don't want to overstate their involvement. There's not organizational endorsement, but at this point, but they do want to participate in it. They see the value of what we're doing, and so that's the group that really is involved in this. And it's a, almost a year-long project from conception to our really completing our first cycle. We're in the process right now of defining what is the model itself, what's the scope, how far in terms of breadth, how deep do you go in terms of topics, and that sort of thing. And we've got some elements that we've already landed on that I'm glad to share with you, but just one other thing, in terms of high level, what the model is, one thing in terms of coming up with a measurement, as you mentioned. We also want to be able to provide back to the facilities that participate in the survey, which drives the scoring of the model with an analytical piece back to them. We want to be able to show them. Here's where your opportunities are. Here's where your gaps are. Here are the things you ought to be thinking about in terms of next steps. And it, certainly a key objective is finding a credible designation for smart care facilities, but it's also about providing them with actionable analysis that illustrates their strengths and weaknesses, and so I'd say we're in this process. And what we will be doing is, this summer, we will have finished the model for what I'll call first round or beta testing, when we will send the survey out and anyone, any facilities can participate in it. It's not limited to just those who have been involved in the project, so that by the CHIME Fall Forum this coming November, we'll be able to talk about what we found, what's going on out there. And really, I think bringing some significant insights into the market as to what really is going on here, more than just simply anecdotal comments that we hear along the way.

Saul Marquez:
Well, Steve, that's very exciting, and what a great crew you guys have assembled and still open to recruiting more. So for anybody listening that is intrigued by this project, is is thinking about these things around smart hospitals, ways to improve and optimize, certainly a fantastic opportunity to learn more. In the show notes, we'll leave ways to reach out to Steve and the group on ways you could get engaged. But Steve, as people think about this, the insights that are going to come out of this sounds like also maybe a benchmarking component so that they know where they stand in terms of the maturity model. Why should people want to learn more? Why is this so important?

Steve Lieber:
I think clearly we see the value of having an element of machine learning have a role, and I'm being somewhat careful here in selecting my term's just one, because we're so new in understanding what role will machine learning take in healthcare. We know that having computing power that can analyze mountains of data that we could never process through our own labors, we need machines to help us plow through all that, to find trends and patterns and that sort of thing. So, you know, the value is to help them to understand how that can be done and how others are doing. And as you say, there is an element of benchmarking here, but it's also helping organizations understand where within the facility these sorts of technologies can be utilized and what the benefits are in different places. So the model is built around three major components. Humans, so recognizing that in the care process there are people involved of course. And there are really two types: patients and care team. We've got elements of the model that's focused on how you use smart technology in support of patients and the family care circle around them. We also want to explore how smart technology impacts and can be utilized by the care teams. So that's the people dimension. The next dimension is in environments. So we have locations where technology is going to be used, common areas. So waiting rooms, what do you do in waiting rooms in terms of having smart technology in the in terms of kiosks and other sort of things? You have the emergency department, you have your inpatient rooms, you have ambulatory facilities, clinics and labs and that sort of thing. You have long term and post-acute care facilities still part of the care continuum, and then you have what we're calling residential spaces. That's not only the home, but it's also places like hospice and such. When we start to think about healthcare in a big macro sort of perspective, not just simply what goes on this one incident, you go and see a doctor or admitted to a hospital. There is a huge continuum that technology and smart technology can run all the way through. And then we also have things that we got to be taking into consideration, such as the actual technologies themselves, infrastructure. How are the facilities, both hospital or clinics or whatever, wired to even accomplish all of this sort of stuff? And then we've got processes; so the third dimension, humans, environments, and processes. So we've got things like strategy, you know, what's the facility strategy. So in all of these areas, we're going to go through a process of examination. Now, again, it's a lot of areas, and you've got we've got to avoid survey fatigue of people seeing a survey. Like, I just can't even tackle this. There's so many questions. It's really working at finding the key questions so that on all of these dimensions, an organization can see what's happening, and where they are, and what the opportunities are. So that's why it's going to be in-depth. It's going to be insightful, and it's really going to help them think about where they're going as they look at adopting new technologies, smart technologies, and ultimately looking at the future. How far do we go in having intelligent technologies influence processes in healthcare, both administrative as well as clinical? So it covers a lot, and that's what the value is back to an organization, is not just looking at the one place where care.ai is with an ambient. It's not that it really is looking across the whole spectrum of healthcare.

Saul Marquez:
That's really insightful, Steve. And I love the framework of people, environments and process and really just putting it in these buckets. That really drives after an operational strategy, the approach that an organization is taking. And then are we left with the playbook like does this become a playbook, Steve?

Steve Lieber:
Maybe. And I hesitate there in saying yes. The way we're designing the scoring is that it does show a progression. It's going to start out with very limited to no in smart technologies up to the highest level, which will be the vision, I think is probably the best word here of the advisory panel of what the future of healthcare will be as it relates to smart care facilities. It will be a level that no one, there will not be a single facility in the world, which will be that we really are wanting to try to lay out a vision. Now, it's not going to be so detailed as to exactly where and what and that sort of thing because we don't know. Sure, there's a learning process, and the definition of that ultimate level will change over time, but each of the levels do build upon the one before. In a sense, yes, there is a roadmap. And just to give a quick example, at the lowest level you're really measuring what are called point solutions, a solution that solves one problem. That's really the lowest level of technology in this space from point solutions, then you then go to platforms. And platforms are a combination of point solutions, all feeding into a common command center or platform. And so you start to get a sense of how we're building this framework that really does build upon the one before. And so, in that respect, it is sort of a roadmap. It will not be so detailed as to say you should or must start here. The next thing you add is this, and then the next you add is that. It's more of a conceptual framework or roadmap.

Saul Marquez:
Yeah, it's a conceptual framework that shows progression, right, if you're maturing in the model. Love that. Not super interesting, Steve. I love how you think about things. I think it's great. This initiative is a fantastic one to really help a lot of organizations seeking this type of definition, and ways to put handles on something that doesn't yet to progress in these efforts to become better, efficient, more tailored to patients and the clinician burnout, which is really key.

Steve Lieber:
Yeah, and as we're, and you referenced this early on, we're all learning this kind of at the same time. Yeah, there are few places that are a little farther along, and we're certainly tapping into them. They sit on our advisory panel, but nobody has this figured out. There is no one who knows where we need to end up, and so it's a learning process. And that's a key role for associations, is bringing together people that, under ordinary circumstances, might have competitive interests both on the company's side as well as on the provider side, but bring them together in the interest of serving a common good. And that's what associations do, is bring together people, bring minds together so that you come out with things that really benefit society as a whole.

Saul Marquez:
That's fantastic, Steve, I can't thank you enough for coming on to share this exciting news with all of us. If anybody wants to learn more or participate, what's the best place for them to reach out to do that?

Steve Lieber:
Directly to me. I'm the one who's leading the project. And so I'm the point person for folks to reach out to to learn more about it, to see about getting involved. And as they buy, we're aiming for roughly July, we'll be out with the survey, and we'll certainly, through our various avenues, promote participation, which will be no charge. This is all about building knowledge. And at that point, certainly another opportunity because it is going to be something of an iterative process. We're going to learn from first round of surveys of things that we want to spend more time on and such. And so engaging in this and being a part now or this summer when we start to do data collection, there's great benefit to healthcare in general, and I think specifically to those that participate.

Saul Marquez:
Love it, Steve. Certainly want to thank you again. And folks, if this is of interest in the show notes, we'll leave. Best ways to get in touch with Steve. Steve will share those with us. And in the show notes, you'll find them there if you're driving and this sounds interesting, hit pause, pull over, send them a note, or if you're on a jog, maybe now's the time for a break, but certainly, some fantastic work being done here become a part of it. That's the best way that you, too, can help shape the future of healthcare. Steve, thank you so much for sharing this with us today.

Steve Lieber:
Always a treat, Saul. Thank you.

Intro/Outro:
Thanks for listening to Smart from the Start. For best practices in AI, and ambient intelligence, and ways your organization can help lead the era of smart hospitals, visit us at SmartHospital.ai, and for information on the leading Smart Care Facility platform, visit care.ai.

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"It is all about value and adoption. You really can't get much value without adoption, but adoption without value is just letting a thousand flowers wilt. So the truest measure of your success is that everybody loves your digital offering and would storm into your office if you took it away." - Dr. Lee Schwamm

Dr. Lee Schwamm Chief Digital Health Officer and Associate Dean, Digital Strategy and Transformation at Yale New Haven Health System

Episode 26 Feet on the Ground, Head in the Clouds:

Designing Digital Health with Real-World Engagement

SFTS-Lee Schwamm: Audio automatically transcribed by Sonix

SFTS-Lee Schwamm: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Intro/Outro:
Welcome to Smart from the Start, presented by Care.ai, the Smart Care Facility, platform company and leader in AI and ambient intelligence for healthcare. Join Steve Lieber, former CEO of HIMSS, as he interviews the brightest minds in the health provider space on truly transformative technologies that are modernizing healthcare.

Steve Lieber:
Hello, and welcome to Smart from the Start! I'm your host, Steve Lieber, and it is my pleasure to bring to you a series of conversations with some of the sharpest minds in health information technology. We'll discuss the smart directions healthcare companies and providers are pursuing to create smart care teams. Today I'm joined by Dr. Lee Schwamm. Dr. Schwamm is Associate Dean for Digital Strategy and Transformation and a professor for Bioinformatics and Data Sciences at Yale School of Medicine, and he is Senior Vice President, Chief Digital Officer for Yale New Haven Health System. In this role, he's leading the development of a new digital health strategy for the school and the health system, and serves as an influential physician, leader and agent of change for the adoption of virtual care and digital enablement throughout the enterprise. Before joining Yale, Doctor Schwamm was at the Mass General Brigham Health System in academic and administrative leadership roles and a professor of neurology at Harvard Medical School. Welcome, Doctor Schwamm.

Lee Schwamm:
Welcome, Steve. It's a pleasure to be here.

Steve Lieber:
I am really looking forward to this conversation because of the multiple roles that you have. We want to first talk about digital health strategy. So you teach it, you develop it, you implement it, you're deeply involved in it. So let's talk about developing and implementing digital health strategies. What are some of the key things that our listeners ought to know about that part of sort of the upfront work that needs to be done as we move forward on this journey?

Lee Schwamm:
I wish I could distill it all into one sentence, but let me aim for a few really core principles and strategies. I think maybe the first concept is feet on the ground, head in the clouds. You can't design these kinds of digital enablements at 30,000ft and not be deeply engaged with the actual methods by which care is delivered. I think we have made a fundamental blunder in the design and execution of electronic health records because they work great from 30,000ft, but what they do to the workflow in the direct patient provider interaction has been very distorting and has caused moral injury for many physicians who spend more time staring at the computer screen than at the patient's face when they're in a room with just the two of them. I mean, your grandmother and mine would have said nothing is ruder than to stare at a computer while someone's trying to tell you their innermost feelings and fears. So we got to get that right. So, I am a practicing stroke neurologist. I practiced my entire career, and my entry into digital health was to develop and scale Telestroke, which was a digital reconstruction of an acute stroke encounter so we could deliver advice at a distance and treat patients with time critical disease. And I've kept my practice from really that fundamental reason that you have to walk in the shoes of the people who will use your product to make sure that you are delivering an excellent experience, not a mediocre experience. The second big thing I would say is fundamentally, it is all about value and adoption. You really can't get much value without adoption, but adoption without value is just letting a thousand flowers wilt.

Lee Schwamm:
So the truest measure of your success is that everybody loves your digital offering and would storm into your office if you took it away. If you have a digital offering that you think is really cool and is, you know, just the cat's meow, but only a handful of people use it. And if you turned it off and no one noticed, like that's not value. No matter how elegant it looks to you, that's really where we have to be at this. We have to marry these sort of ideal notions of digital enablement with the sort of sort of pragmatism. It's got to work for real people in real life. And then there has to be financial sustainability. Gone are the days in healthcare where we can do things because it's fun or because it's think it adds some quality, but it costs us a lot of money that we never recover. We have to tie these initiatives to the core initiatives of the organization. A lot of my colleagues who have a separate strategic plan for digital, and I always say no, there is no separate strategic plan for digital. The strategic plan is the enterprise strategic plan. You infuse that plan with the art of the possible. Your job is to digitally enable what the enterprise has identified as its strategic objectives. Then, you don't have to worry about the budget for those interventions. They're baked into the deliverables, and they are a fundamental part of the strategy. You never want to be a secondary thought in this process. You want to be helping to shape the art of the possible, and then delivering on that promise so that your health system is successful.

Steve Lieber:
I think that this last point is outstanding in terms of the statement you made, which is there's not a separate digital strategy. It is the strategy because we certainly recognize that digital technology is woven through everything. And so. It's just a natural progression of thinking that I think you've hit on there, that it's totally integrated. But if you think about it separately, you're sort of a second thought. I really like the way you pointed that out.

Lee Schwamm:
Let me add two brief things to that. One of the byproducts of this, which ideally is a very disciplined approach to implementation, is that you start to force upstream a change in the way your healthcare executives think about projects and project design. They can't just have their head in the clouds with no feet on the ground. They have to understand the implications of saying, we want X; we want to modernize, you know, access. Okay, well, then you need to tell me who's in the tent, who's out of the tent, who gets the tool, who doesn't get the tool. How does that strategic objective actually play out in real life? That brings a level of disciplined thinking to the enterprise strategy, which it sometimes lacks in healthcare. And I think that makes the organization healthier. The other comment I would make, or the observation I would have, is that when I studied the whole implementation of the Toyota Lean methodology concepts, one of the things that struck me the most was not so much the changes that happen in the factory, because you control everything in the factory, and it's a very interesting and important approach to improving the quality and the production concept.

Lee Schwamm:
But actually, what was most interesting to me was they then had to go out and work with all their suppliers to bring them into the just in time production model. So it's not enough to do your own thing in your own domain. You then have to work upstream to all your suppliers, whether that's the board, your clinician, stakeholders, you know, the joint Commission and get them aligned with this mission. Because if they're not aligned with your production process, you won't be maximally successful. So it's really a tremendous focus on business engagement. And one of the things we've done at Yale with our information technology team is we've transformed it into what we call digital and technology solutions. We're very focused now on solutions, and we're organized into experience pillars. So we have a patient experience, a care team experience, an employee experience, and a researcher and analyst experience. And we try to align our product delivery through the lens of that experienced user who is trying to have an integrated and seamless connection with us.

Steve Lieber:
We loaded a lot there that I again, kind of like you in the opening. I wish I could get all this all in because you really want to touch on the clinical teams in terms of how you're bringing them into the conversation, the end user, so to speak, the person that all of this is being done for, how they're intersecting with it as well. So, let's start with the care team. And you did you made the comment about the way that EMRs were originally developed and the shortcoming to be tactful in terms of of how they were designed. So, as you're moving into, I'm sure we can safely call this a next-generation level of technology. This is more than just iterations of a previous as we move into virtual and smart care teams and such; what are you hearing from clinicians and frontline staff about what they're looking for how they're reacting to them? You made the comment. We have gotten to the point with some of our technologies that they will yell and scream if you tried to take it away, which is a long way from where we were maybe 15, 18 years ago, which was, okay, I can wait this out and retire before I have to. But so, bring us up to date in terms of challenges, obstacles, or opportunities you're sensing with the care team.

Lee Schwamm:
Yes, I think we're hearing from everybody is I want to do my job in a different way. That lets me focus on the things I trained to do and really add value in the things I'm spending my time on. Can you make the other stuff either go away or happen automatically in the background? And can you reassemble my work in such a way that I have more joy in performing it? And I think the answer to that is very much yes. I think ambient listening, powered by large language models, is a breakthrough technology that is going to infuse everything we do, and at some point in the future, we won't even talk about it because it'll just be how we do what we do. I think that's really important. Let me pause for a moment and just dwell on that just for a second. Because large language models for the first time, in my opinion, represent an opportunity for the unskilled worker to execute complex tasks simply by writing or speaking in plain human language. We've never had that before. We've had progressive approaches to that, but we are now at a point where a fairly sophisticated set of tasks can happen by voice command. Now, we had a version of that when I trained. It was called verbal order.

Lee Schwamm:
You just said. As a doctor, let's give x, y, z, let's do a, b, c. And somebody wrote it down, and somebody did it. I think that's what people want. And they want the ability to have the administrative components of tasks where they are not directly influencing the care itself to be moved into the background and taken off their plates. I think nurses feel this tremendously. I think doctors feel this tremendously, and we've got to get better and figure that out. So that's one big bucket. I think this is sort of ambient documentation. The other one is let's recombine how the work is done and where the work is done. So we all know from the pandemic you can do a lot of work from sitting in front of a computer on the beach, you know, in your home, at a second office. Doesn't matter where you are; there's a lot you can do, but there's some stuff you can't. How do we deconstruct the clinical encounter and say which parts benefit most from continuous, direct, face-to-face or pixel-to-pixel interaction, and could be done by a different role group in the same care team mix, and which parts require me to put my hands on the patient to clean and bathe the patient. You're going to be touching that patient.

Lee Schwamm:
You can't do that remotely. But that doesn't also require the level of skill of a 20-year career nurse. On the other hand, admissions and discharges. There's a lot of time spent collecting and curating that information, and the bedside nurse is often interrupted in the middle of that to go rush over and see a patient who's become acutely ill or has some other urgent need. So, both parties are being poorly served by that. So we are embarking on a nursing care redesign model, and we are thinking about how do people spend their time, what are they actually doing, and how can we recombine that to deliver not only better value for the health care system but a better experience for the nurse. How do we keep that nurse who's been working for 20 years and is ready to quit healthcare? How do we keep that nurse engaged? How do we create a new opportunity for them? How do we remotely supervise the 30% of our workforce that is brand new in nursing? They're coming right out of nursing school. We have tremendous nursing shortages. How do we shorten that flight path of getting off the runway and getting into orbit? How do we shorten that for a new graduate? By pairing them, perhaps with a virtual mentor who can be available whenever a mentor is needed, but not standing around waiting when they're not needed? So it's really about, you could call it productivity but I don't think that's the right way to capture it.

Lee Schwamm:
It's really about maximizing the value that people add when they're in an interaction, in a healthcare interaction. So that's kind of the inpatient experience at the bedside. But let's just amp that up one. Let's put a video capability in every patient room. Now when you get admitted to the hospital, your primary care doctor, if you're lucky, will come once while you're there and poke in on you and see if everything's okay. But most of the time, you won't. The hospitalists will care for you. And maybe if you're lucky, they'll talk to your primary care doc, or they'll exchange an email. What if your primary care doc could just beam into the video at your bedside? Hey, Steve, you know, I know you had the kidney stone. I'm so sorry. Anything I can do? Any concerns you have, I'll make sure that the team knows A, B, and C, right? Amazing. The pharmacist can come to your bedside virtually and say, Steve, you're going to be starting on this new, very complicated medication that suppresses your immune system for this treatment of this cancer that you have.

Lee Schwamm:
I'd like to explain it to you a little bit and answer any questions you have, and review your other medicines with you to make sure that none of them have a bad interaction. All these things that we don't do because it's just too expensive and logistically complicated to move all the moving pieces around and make them be in the same room at the same time, those start to go away, they melt away, and then we move up the value chain to the consultants. This every hospital has to have a team of neurologists around in the hospital every day. When I was at Mass General Brigham, we proved the answer to that was no. You could have neurology consultation in any hospital in our network. By the same team of highly trained research-published cream-of-the-crop neurologists serving our entire network of community hospitals, that was better value for the patient was better value for the health system. And we even showed that we could shorten the length of stay because you get an expert the first time and you get the expert early in the course of the care. So those are some examples of how I think we're going to be able to leverage technology to modernize the business cycle.

Steve Lieber:
Again, kind of harking back to the early days of EMR. We ran into a lot of resistance. Are there similar sorts of issues of resistance? I mean, you articulated extremely well the opportunities and the upside potential, and certainly workforce issues are paramount in everybody's minds in terms of burnout and turnover and that sort. What are we having to worry about in terms of resistance to these technologies?

Lee Schwamm:
Yes, absolutely. And we would be foolish to think that there won't be. And I wouldn't even say resistance. Let's just call it concern, because resistance sort of implies that they are obstinate or that they're sort of acting out of purely self-interest. I think we have to make sure that what we do is safe and effective. We have to compare that to our current human-based systems, which we know are highly fallible. Let's not kid ourselves that we're not comparing automation to perfect. We're comparing automation to random, hopefully, good outcomes with well-meaning people. But that is not a high reliability system. So, we have to look at the workforce and what their current skill set is. If we can't upskill the workforce to help them take advantage of these tools, we run the risk of creating a new cadre of jobs we can't fill and losing a bunch of employees who can no longer be effective for us. That's bad. So, one of the reasons I'm so excited about these large language models is because they represent an opportunity to be an interface between our workforce and a greater degree of automation and capability that will help bridge that gap. We can use those tools to actually train this next generation of workforce to engage more effectively with their work. So I'm optimistic we can overcome that. But I will just be very transparent right when I grow up. As a kid in New York City, I lived in an apartment building. There was an elevator operator, and they would manually, you know, you remember this, I'm sure because we're the same age, they would guide your elevator to your floor, and if they were really great, it would just perfectly match when it landed. And if not, they had to go up or down or, you know, a little bit up and down.

Lee Schwamm:
Then we got a fancy new automatic elevator. We still had an elevator, man. He came in. He would push the floor for you to your floor. And then, over time, it became clear that didn't make sense. Right? So there are some elevator operators who won't be doing that anymore, right? There's going to be stuff in back office processing that these tools are going to do largely unsupervised or with many fewer supervisors than they currently have. And so I think we have to be cognizant of the fact that it is incumbent on us to upskill the workforce and to allow them to continue to transition with us as we implement. So, we cannot try to swallow more innovation, automation, disruption than the organization can tolerate. So, pick your battles carefully so they are not battles. Find those sweet spots where the workforce is yearning for change, not just you. And I think that's where you really succeed. That's why nurses have to be leading the nursing care redesign model, and we are enabling them. There is no separate digital strategy for virtual nursing. There is a nursing strategy which digital will support. That's our job, Steve. If we come in with these tools and say, guess what? Tomorrow, here's how you do your job; we will all fail. We have to say instead, hey, Sarah, John, Fred, how could your work be done better? What are your ideas for where there's low-value work? What would you do if you could design this magically to make it better? And then you can say, wow, we can do some of that with you. Not for you, but with you.

Steve Lieber:
Yeah. That's outstanding. The answers you just gave there really are very applicable to our wrap up question, but I'm going to come back and ask for one more piece of advice. So, you know, our listeners or folks like you and all. And so from your experience and all, an essay in the past number of minutes, here are a number of key pieces of advice. But one takeaway here, in terms of what you'd like to leave with the audience.

Lee Schwamm:
I would say be part of the we, not the them. Walk the floors, sit in the offices with the care teams, watch the care being observed, demonstrate your interest and your ability to listen to those individuals on the front line who are delivering the care so they feel your part of their team. Because once you're part of the them in the corporate office, mistrust abounds and resistance increases. So be a we, not a them.

Steve Lieber:
That's just spot on. I really do like that. We've been with doctor Lee Schwamm from Yale New Haven, and had a wonderful conversation here about a number of key topics. Lee, I really do want to thank you for your time today.

Lee Schwamm:
Well, it's been a pleasure, Steve, and happy to come back anytime.

Steve Lieber:
And to our listeners, thank you for joining us. I hope this series helps you make healthcare smarter and move at the speed of tech. Be well.

Intro/Outro:
Thanks for listening to Smart From The Start. For best practices in AI and ambient intelligence, and ways your organization can help lead the era of smart hospitals. Visit us at SmartHospital.ai. And for information on the leading smart care facility platform, visit care.ai.

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"The most valuable asset that any healthcare organization has is the people. So when you're thinking about labor challenges , you're thinking about burnout and all of these types of headlines that are making the news, technology or an enabling type of fabric can help, it could help do or to decrease burden or decrease anxiety or add efficiencies. Thats what we're seeking." - Rebecca Stametz

Rebecca Stametz VP of Digital Transformation at Geisinger

Episode 25 The Pulse of Innovation:

Live from ViVE 2024 Part 02

SFTS-Live From ViVE pt2.mp3: Audio automatically transcribed by Sonix

SFTS-Live From ViVE pt2.mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Intro/Outro:
Welcome to Smart From the Start, presented by Care.ai, the smart care facility, platform company, and leader in AI and ambient intelligence for health care. Join Steve Lieber, former CEO of HIMSS, as he interviews the brightest minds in the health provider space on truly transformative technologies that are modernizing health care.

Steve Lieber:
Hello, I'm Steve Lieber, and I'm delighted to extend a warm welcome to you for this special miniseries broadcasting live from ViVe in Los Angeles, where the energy and excitement are palpable. ViVe 2024 isn't just an event; it's a convergence of minds, ideas, and innovations in health information technology. Over 8,000 passionate individuals have gathered here to experience firsthand the cutting-edge advancements shaping the future of healthcare. From February 25th to 28th, Los Angeles served as the epicenter of digital health, with ViVe leading the charge. We're on the ground to bring you exclusive interviews with the thought leaders, innovators, and decision-makers shaping the future of healthcare live from ViVe. So settle in, unwind, and join us as we explore the business of healthcare and the boundless possibilities ahead. Welcome to live from ViVe 2024.

Steve Lieber:
We're talking with David Graham at LifeBridge Health. And so, David, their first question to you is there's a lot of stuff going on on the floor here, a lot of buzz about new products, a lot of people that we've known for years and all. What are you seeing out there? What really brings you and what are you looking for?

David Graham:
You know, my main objectives of being here really is looking at the AI space. And my look at the AI space is across every aspect of clinical care and clinical workflow and process. I'm looking for ways not only that we can improve the efficiencies of our EHR, our documentation, our summaries within the chart, how we use the tool, but also how can we capitalize on other clinical workflows and processes. People think as a physician, I'm focused just on the docs and what I can do for the docs. It's really about the whole clinical care team. What can we do for our nurses? What about a respiratory therapist or a physical therapist? How can we all become parts of a greater utility and efficiency which just gets us really to the ultimate goal, which is better efficiency for our patients, better outcomes for our patients, which can lead to better financial outcomes for us?

Steve Lieber:
Great. Lead into my follow-up question, which is about workforce. And obviously, in hospital and healthcare settings, clinical workforce is what we're all focused on. Yeah, support team is absolutely critical, but dealing with shortages, turnover, satisfaction, burnout, all of those sorts of things. What are you thinking about at LifeBridge Health in terms of how you're going to use AI and virtual care to address some of those workforce challenges and obstacles that we're dealing with?

David Graham:
We see it as a really valuable tool, essential for our workforce challenges. We know we're not going to, even if I could get the funding to go out and hire ten new people, I wouldn't be able to find them no matter what they're looking for, Steve. And so really, it's about extending our workforce. And I see that as positive in two ways of extending our workforce. It's using virtual care to maximize the efficiency and effectiveness of a nurse or a physician, and for that matter, in what they're doing. But it's also keeping people in the workforce longer. If I can take a semi-retired nurse who maybe has hip or knee issues and can have her in a room where she can manage or he can manage many patients in the virtual setting, we've extended their likelihood of being happy with their job. We've extended their ability to be a part of our workforce, and we broaden the care that we can give for our patients. So it's really, it's an extension of our existing workforce.

Steve Lieber:
Yeah. You're mentioning that in terms of extending the workforce and creating new situations, new environments for them to work in, and the idea of a command center where you can monitor multiple patients. And then what I'm hearing in talking with some folks around here is sort of the overlay of AI onto that to start giving us meaningful alerts and awareness so that one person can watch a whole lot of patients because there is a machine assistance. And I think we got to think of it that way. It's not a replacement, right? It's an assistant. And it really does allow us to extend our expertise over a larger population.

David Graham:
Right. And I think that's really valuable, not just in a nursing statement, a physician setting. If one of our ICUs is 50 miles from another, how can we extend our physicians in that capacity and that command center as well? How do we really use the AI to lower the cognitive burden, which goes along with documentation burden? People think it's just a number of clicks you have to make; that's the burden. It's a cognitive burden of having to see all the data and figure it out. Let's let AI summarize that for us. Put in front of us: What are potential actions? I'm always going to be the human in the loop. We always need that human.

Steve Lieber:
We always got to have that piece.

David Graham:
How do we make it so that we're increasing our efficiency and increasing our effectiveness, which I'm always going to measure in patient outcomes?

Steve Lieber:
Yeah, that's really great insight. And so what's the reaction you're getting out on the floor in terms of the technology that you're talking about? I can remember, you know, back in the day when we were bringing out electronic medical records and the reaction physicians in particular, and nurses too gave it to us in terms of that rollout. One, we've learned and, you know, these are not technology or IT projects; they are full team clinical projects. Get them involved at the beginning. But what are you sensing in terms of the workflow and how they're reacting to this?

David Graham:
I'm seeing a lot of interest in it because people see and understand it's what we've been trying to get to. You know, after being so frustrated by putting those electronic health records in, people were saying, Why can't it give me the data that I expect? You've got all this data in there. Why can't it give it to me? Now they're seeing an opportunity to get it delivered to them with insights. They're excited for it. I can't keep a door strong enough to keep people from breaking it down on the nursing side and the physician. Provider side, wanting to have these tools, and wanting to work with us to find more. I'm having people coming to me saying, I'd love to go to a meeting like that because I'm going to wander around the booths and get everybody's cards. So there's excitement.

Steve Lieber:
Well, and one of the things I've heard in talking with people like you in these conversations is once you've introduced some of this technology, it's: you're not taking this away. Is that the reaction?

David Graham:
It is, but in a positive way. You know, once you put an electronic health record, you go back a year later and tell them you're going to take it away. And they say, No. You know, they didn't want to get to that point.

Steve Lieber:
There's a learning curve.

David Graham:
There is. They want to get it in and they want to do it right away. And they'll never give it up. They'll never give it back. You know, there is the fact of safety. People are worried about how we're going to make sure that we've got the right tool that's really been vetted, that has the right lack of bias and everything else. But once they get using it, then they love the fact that they can be more efficient. And really, what we're giving them is time back with a patient. And that's the key.

Steve Lieber:
So are you sensing that we're moving a little quicker in terms of technology in health care? We've often been criticized as laggards compared to other industries and that sort of thing. Are we kind of getting past that mentality of, Well, status quo will be okay for a while? Can we pass?

David Graham:
I think we are. I think we're getting to the point where for so long we've done things in such a waterfall-slow, methodical, sequential way. We can do things in parallel, we can do things in a much more agile way and get to the end result quicker. And if we don't get to the result we need, fail fast and move on to the next. And that's, I think, a change in mentality health care's needed for 30 years. I think we're getting there. I think the advent of the tools that allow us to make that paradigm shift are a big advantage. So it's melding those together and let's get it better for our patients.

Steve Lieber:
Excellent. We're talking with Doctor David Graham, LifeBridge Health. Thanks for joining us.

Steve Lieber:
We're here now talking with Rebecca Stametz. Becky, good to see you. She's at Geisinger. And so we want to start out in kind of getting your impression of what's going on on the exhibit floor here. A lot of stuff, a lot of activity. This is the first day of ViVe conference when we're talking and doing this recording. So what brought you here? What are you seeing?

Rebecca Stametz:
Happy to be here. So first thanks, Steve. Nice to see you. Yeah. ViVe's an exciting time. Just got here last night, oh, actually two nights ago. And this is the first day on the floor, so. Yeah, I mean, there's a couple big themes that I'm picking up on as I kind of maneuver and have meetings and look at the show on the floor. One is absolutely AI. I'm sure that is no surprise to you or anyone who is watching this podcast prediction, making smart decisions, whether it's generative AI, right, creating new content, or NLP, or different types of just smart ways to do things. This is about prediction. This is about personalization. So I'm seeing that. I'm also not seeing it all on the clinical side. I'm seeing revenue management. I'm seeing HR. So we're thinking about front stage. We're also seeing I think a lot backstage.

Steve Lieber:
Well to achieve that efficient, effective system you got to look all over the place. It's not just on the clinical side.

Rebecca Stametz:
Yeah, absolutely. These smart technologies, right, or these emerging technologies is going to help every single person in some form or fashion, work smarter, work better, maybe more efficiently, provide those experiences. And I think that's what we're seeing here today. That's one big theme. The other big thing is just around care at home. I'm seeing that, right? Whether it's a telemedicine type of purview or that ranging definition, I'm seeing a lot of those types of aspects. How do you provide virtual care; virtual care in-patient, virtual care outpatient, asynchronously, synchronously, through remote patient monitoring, you're seeing those types of themes pop up.

Steve Lieber:
Yeah. Well, in the geography Geisinger works in, that's probably very important to you guys. Just thinking about Pennsylvania and where you are, you've got a lot of territory you're covering not all of it by far being urban.

Rebecca Stametz:
Yeah, absolutely. I mean, I think at Geisinger, especially from an innovation perspective or just a core mission, we are about making better health easy, and we want to be able to provide the best experiences for anyone who seeks our care. But ultimately, also we want to be able to provide the best working environment and the best types of tool sets for the people who are providing those types of cares and services. So it's really coming together for me. Back to virtual care. Absolutely. When you think about ease of use and you think about those types of better experiences, I think the more that we can do for people at home, in the places where they're most comfortable and not having to drive maybe, is optimal.

Steve Lieber:
Yeah. So you talk about the environment in the institution and the people that are involved there. Everybody I talk to is, you know, fairly close to the top is talking about workforce issues. We got shortages, we got burnout, we got turnover, we got dissatisfaction. I mean, there's just a lot that we need to focus on. What are some of the thinking at Geisinger in terms of how you're dealing with those workforce issues?

Rebecca Stametz:
I think about this day and night, Steve. I mean, the most valuable asset that any healthcare organization has is the people. That is it, right? So when you're thinking about labor challenges, you're thinking about burnout and all of these types of headlines that are making the news, technology or an enabling type of fabric can help, it could help do or to decrease burden or decrease anxiety or add efficiencies. Right? That's what we're seeking. But it's not really always just about that technology. The technology is not a strategy, right? It is a way to enable a broader strategy. So I think the key is really thinking about what these new care models could possibly do, thinking about inpatient nursing, for example, on providing maybe more efficiency or providing decreased burden or the joy of medicine, quite frankly, in some of that day-to-day work.

Steve Lieber:
Yeah. Trying to get to the point where we have everybody working at the top of their licensure, taking away the tasks that ought to be handled either automatically or by a different degreed or licensed individual. And there are, there are workflow processes that we need to address, as well as some technology that we can bring into it. You sit on our advisory panel for New Smart Hospital Maturity model that we just announced this morning at ViVe. And so give us your thought in terms of what the future might look like? What do we need to head towards? What do we need to do to? Help folks understand the challenges and the opportunities of getting to a better place in terms of how we deliver care.

Rebecca Stametz:
Yeah. I mean, when you think about an independent type of model, right, whether that's smart hospital or whether that's other domains, it's always valuable for people like me in my position or my counterparts, whether it's nursing leadership or IT leadership or facility leadership to have an independent view on what could be best in class, what type of decision should be made, what is in and out of scope, and there's just a bounce off our own ideas. Every type of situation is going to be different. What Geisinger is potentially doing as it relates to either modernizing or building new facilities, is going to be different than the other types of people who may have access to these types of artifacts. So I'm looking forward to it. I think it's valuable. I think from a smart hospital facility, it's a big portion of our work. Understanding, again, back to your point on labor challenges or nursing efficiencies or working within that space, we want to make right decisions that benefit our patients, that benefit our operators, that benefit our leadership, so that we could enable better care.

Steve Lieber:
Excellent. Thank you, Stametz from Geisinger. Sure. Appreciate you being with us today. Thank you very much for joining us.

Rebecca Stametz:
Thank you.

Steve Lieber:
We are with Atul Kanvinde from Shepherd Center. Atul and I've known each other for quite some time over the years in the various roles that we've been in. And so I want to start out, Atul, in terms of we're here at ViVe, there's a lot of stuff going out here on the floor behind us. What's the big imperative that you are thinking about as you came to ViVe this year?

Atul Kanvinde:
This is my first ViVe, so I'm actually fortunate to come to LA and to ViVe. I'm impressed. I think the smaller community conversations are very impressive versus the largeness of other conferences. And I get to talk with Steve and get to see and talk very intimately on things we are suffering with or struggling with. I'll see, I think the day tomorrow will be a good idea to understand how this fits into the larger scheme of things. But so far, so good. I'm enjoying it.

Steve Lieber:
Excellent, good. So before we came on camera, we were talking about ambient technology and some of the issues that you're thinking about at Shepherd Center. And so tell us a little bit about where you're going as you're thinking about the ambient technology, virtual care, and that sort of whole area of what we're calling smart care teams or smart care facilities.

Atul Kanvinde:
Thanks for asking. So I'm in this role for just two months, and before I joined, we had implemented a camera for observing patients, which is good. But then as I was trying to understand the full ecosystem, I realized that the way it was installed or set up may not fit us for the long term, the other needs. And I think we have talked about the word platform, and then it puts us in a difficult state to make the point again to clinical operations, saying, Well, we may have to need another system or another camera for the long-term needs of virtual care, remote monitoring, for risk, patient engagement. And I think the idea is to look at the holistic picture. I'm trying to use less of the word use cases intentionally because it puts us in an unintentional silo, because there's an answer to a use case. But when we look at the full vision where we want to be? Where, can I remotely do something because I cannot be physically present? What are the needs? What platform will fit the needs? Can we make it efficient and then get the results from it? So I think that will help me set the tone, if you will, a roadmap of sorts for the next three years so we can be not painting ourselves in the proverbial corner.

Steve Lieber:
Yeah. So you know historically the RAF-1 healthcare's been, you're slow to adopt, you know, you're behind the curve and that sort of thing. Is it any different today? Are people recognizing a greater imperative that status quo won't work and we need to move a little faster? Or are we still challenged with some of the same issues that we always have?

Atul Kanvinde:
I remain skeptical, and I say this because maybe it will be this time around we'll make a difference. But we have heard this before. We have talked about this for 10, 15 years. I think some people are saying that AI or this capability to use artificial intelligence to make things better, is creating a compelling reason to truly find opportunities. In some capacity, as an engineer, I look at this as automation. When you write an algorithm, it is automation, but when you make it intelligent, I don't need to program it, now I'm seeing potential. So I think skepticism is acceptable, but we cannot just not do anything. So I'm hopeful. But we'll have to see.

Steve Lieber:
Yeah. Well as you said, you know, we've been down these paths before and we get excited and we think there's going to be transformational change. And it takes a whole lot longer than we believed it should have ought to. But we're also in an industry where we got to be careful.

Atul Kanvinde:
That is true. And that may be the reason why we do not adapt quickly because of the risk.

Steve Lieber:
That's right. Good. Atul, thanks so much. It's great to see you.

Atul Kanvinde:
Thank you.

Steve Lieber:
And thank you for joining us.

Atul Kanvinde:
Thank you.

Intro/Outro:
Thanks for listening to Smart From the Start. For best practices in AI and ambient intelligence, and ways your organization can help lead the era of smart hospitals, visit us at smarthospital.ai, and for information on the leading smart care facility platform, visit care.ai.

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care.ai is the artificial intelligence company redefining how care is delivered with its Smart Care Facility Platform and Always-aware Ambient Intelligent Sensors. care.ai’s solutions transform physical spaces into self-aware smart care environments to autonomously enhance and optimize clinical and operational workflows, delivering a transformative approach to virtual care models, including Virtual Nursing.