Smart From The Start

SFTS-Russell Branzell: Audio automatically transcribed by Sonix

SFTS-Russell Branzell: 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's 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 team. Today, I'm joined by a long-time friend and colleague, Russ Branzell, for a lot of our audience. Russ, you know, they may know who we are and what some of our shared past is, but I'll give a little more intro because there are a few people out there that'll be new to our world. Russ is the CEO and president of CHIME and has been since 2013, and Russ and I overlap during the last four years of my time as a CEO at HIMSS. Russ also is past previously CEO at the Colorado Health Medical Group, former CIO, and also a retired United States Air Force officer. So Russ, welcome and it's great to see you.

Russell Branzell:
Well, Steve, it's a pleasure to see you and a pleasure to be on your program. Thanks for having me.

Steve Lieber:
You bet. For our audience, Russ and I actually have shared the stage literally around the world. We have had some great times during the period we overlapped between HIMSS and CHIME, and in fact, I refer to it. Russ, I don't know that I've ever said it in front of you as kind of the golden age and the relationship between HIMSS and CHIME, and I really do treasure the years that we had where we collaborated. And that's where I want to go with. My first question is talking about CHIME because I did, I developed a very strong respect for CHIME and what you've done there and the culture, not only of the staff, because also, in full disclosure, I've done some work for Russ since I retired from HIMSS. And so, you know, you've got a great connection between CHIME and the CIOs. And it's like, how have you been able to do that? I mean, it's the gold standard of what associations seek to achieve.

Russell Branzell:
Yeah, I'd love to take credit for that. But I'll give a little bit of credit or a lot of credit to the forefathers, and I guess it would be for mothers as well. That really started intentionally, something different. There's places in our industry for all kinds of different associations and trade shows and those kinds of things. But I know a person you know very well, John Glasser, the first chair of CHIME, a mentor of mine for I don't know how many years, probably 17 years, was a mentor of mine. He had an idea for something different, along with some of his peers, and that was a place that could become a trusted relational environment, a place where we could come cry on each other's shoulders when we needed to vent when we needed to, but also find a way to build each other up. And I think those seeds of thought and success planted now 32 years ago were right on spot. And I think we've never lost that as we've grown and changed some of the, in there a long time ago. People don't like the loss of some of the things that may have started back then, but all change occurs, and most of it probably occurs for good. But I think what's really interesting is there is still a massive desire, especially now in these eras of digital health, where things become virtual, and we're doing events like this where we're just on a computer screen with each other. There still is a desire for close relational contact, and that doesn't always mean in person, but it also means it has to still be significant and meaningful. And the things that we do to take care of each other in this life during some really hard jobs and some really tough situations in organizations like battling through COVID wasn't just to deal with the situation, but rather to help the people through the process. And I think that's what's always been special about this organization and will be special long after I'm gone. And that is it always ends up being about the people in the family, and we intentionally refer to it that way. The family that takes care of each other.

Steve Lieber:
Yeah, and I can attest that culture extends through the staff, or as you prefer to call it, the team that works for CHIME. That same sort of feeling of family very much exists, uh, at that level as well. You were a member of CHIME for a long time before you became the CEO. You've seen a lot of your former CIO yourself. What are you seeing in the healthcare executive today? What do they have to do differently? Or what are they doing differently? Or who are they that's different? What's different in terms of that world today?

Russell Branzell:
Yeah, it's interesting because you even used the term at the beginning, the roles of the CIO. And I almost don't even use that term anymore because there's so many other titles. And this concept of being a digital health leader really expands way beyond. And sure, there's plenty of stills that have the title CIO and still do the traditional job, but there's chief digital officers and chief data officers and chief analytics officers, and all these really revolve around this concept that we're living in a world of digitization, that things that were built for the last 30 years are now coming to fruition, and we are now leading in a different way. I said it silly as I personally had my own little medical situation recently, and I was watching as I was inside one of the local hospitals in Georgia and I watched and went, you know what? We have digital housekeeping now and we have digital admittance cards. And we have, you know what? Everything in this hospital is digital. And they don't realize they are, but the revolution's actually occurred and they do their jobs differently. I mean, housekeeping, literally walking around with an iPad so they know which room to go to the fastest. And their whole workflow is mapped, and they can order their supplies to wait for them to the next room. An amazing conversation with a housekeeper. When I was a CIO, I would have never had a conversation with a housekeeper about how to use electronic workflow documents and ordering their supplies to be waiting for them when they get to the next room. It would have been about are you happy here or do you have good benefits? That kind of stuff. It would have never been about digital workflow, and I think what we're seeing now is even if they have the title of CIO, they've become the master digital architect and workflow specialist for their organization, and they know just about everything that's going on in an organization. They created the digital blueprint for these organizations, and now they have to manage to that digital blueprint and help these organizations become something different than they've traditionally been. That is an amazing amount of pressure on these people. They have become the stress-based change agents and organizations that I don't think I had to do. I had to figure out how to implement technology and put EMRs in and all those other kinds of things. I didn't have to figure out how to get an organization to act and look differently to the consumer-facing front.

Steve Lieber:
So, is that going to play out differently in CHIME? Is this an indication that CHIME needs to think about more than the CIO, or are you already?

Russell Branzell:
We already are. If you look at the CHIME logo on it, it doesn't say CIO anywhere on it. Matter of fact, here's where I give again our founders credit. Never once in the years of CHIME, even when I was a CIO, never once was a vision or a mission statement. Ever used the word CIO or technology? And we went back and looked as far back as we could. Never once did it say a group of CIOs. It just said leaders managing these things. And I think that's the reality of where we are now. Yes, a certain percentage of our membership have the title or had the title CIOs, but we have a whole lot of other people now. The other difference was when I was a CIO, I was the CIO, and then we had people that worked for me. Today, CIOs have people work for them. The difference is those people are executives now. They're CTOs and CISOs and CIOs and CTOs or whatever the title is, and these people are seasoned professionals. It's the C-suite of the CIO or the chief digital officer, whatever the title might be, they're six, seven, eight people that operate at the same level I did 15 years ago inside an organization. And some organizations, organizations say as big as, say, Crysta's. It might be 100 people where they used to have one member that was probably eligible for CHIME membership. Now, maybe it's 20, or 30, or 40, or 100 because they are digital leaders, and they need the environment to grow, foster, and network across the globe.

Steve Lieber:
What I'm hearing is increased complexity, more significant broader scope of responsibility, bigger challenges, a lot of things that both are challenges as well as opportunities. Over the past few years, we've seen a few fairly notable chief information executives, regardless of title, move out of the provider setting and move into companies. Is this any different? Is this a trend that's always played out, or are we seeing more of it now? What's going on within the provider end of the profession?

Russell Branzell:
Yeah, I think we're seeing a couple of things emerging. And, you know, we used to use somewhat rhetorically, but sometimes also seriously, we used to call it the light side and the dark side. Oh, they left the CIO world and went to the vendor world. I've never liked those terms, but I also don't like other terms at all. But I'm starting to see that as a very natural way that it would occur. People are leaving positions and transitioning, not because they just want to leave this job and go do something else. They're doing it because they need to understand that world to be successful in their jobs, and I think that's much different. We have 2 or 3 very notable, very seasoned digital health leaders in very large, very successful organizations. No one would have ever dreamt they were going to leave, and they leave to go become the head of healthcare of a major corporation. And you talk to them a year or two later and go. This learning curve was straight up. It was like the first day you were a CIO again because you're learning a whole new world. You're learning the business of healthcare, and we often don't learn the business of healthcare inside a health system. We learn healthcare inside the health system, not the business of healthcare, and I think that's a great learning experience for people. I'm doing a mentoring session tomorrow with a person who's been left. The CIO role has been on the vendor side for a few years, and now wants to know what's next. And I think that's the other change is right or wrong, depending on your perspective in generational shift, and you and I are a little bit of the older generation. Admittedly, next-generation leaders coming up, we're going to see them change jobs a lot, probably three and done, three and done, three and done. Why not? Because they're not loyal. They want a new experience and a new challenge, and I think we're going to see it.

Steve Lieber:
You know, you're crossing year 11 or 12 in this role. I was at HIMSS for almost 18. Those are numbers that are far more likely to be seen in the future with this group. And I think you make a great point there. It's the experience they're looking for. And it's not a matter of, I'm unhappy with this organization or disloyal, but it's the experience and the opportunity to broaden your horizons and experiences. Absolutely. You mentioned the business of healthcare, and reading an article recently out of Becker's, talked about the trend, which is not particularly new, of small independent hospitals being brought into large systems. And I ran the numbers, and using AHA numbers and Becker numbers, I come up with the ten largest healthcare systems, own or operate nearly 20% of all US hospitals. Does that have any meaning? Does that have any indication of what is going to happen in healthcare, or is it just a statistic?

Russell Branzell:
Well, there's always been at least a spotlight on mergers and acquisitions and what that can do. And you remember the days of the old Columbia before it was AHA, and they'd buy a bunch, and then they would sell a bunch, and they would buy a bunch, and they would sell a bunch, and they'd go, hey, we want to be in the X market, and they go, no, we don't get rid of them as fast as you can. So, I don't think this is a new phenomenon. I think what is new is there was at least a perspective or a perception that you needed to be a certain size from a financial to be able to bond and all the other kind of things. From a money perspective, you needed to be at $5 billion or $2 billion, but I'm not sure that's still as accurate as it was. You could do it through affiliations and partnerships. We've got a person on our board comes from a very successful single hospital, small system, and they're doing just fine, and they don't have any desire to join up with anybody. But you are seeing organizations figure out how big they want to be and how they want to compete, but you're also seeing the government getting a lot stricter about market consolidation. They don't want you buying your competitor across the street. It's okay to move out into a new market, but don't buy all your competitors in. Just pick an example, the general Atlanta area. So, what are we going to see in the future for mergers and acquisitions? I think we're going to see big systems continue to get bigger. I think we're going to see the critical access in the world find a way to partner better, but they're still going to want to stay critical access and worlds. And that's not the business of these big systems and these big academics. Those require an amazing amount of resources and focus that they're probably not going to want to be in that business, or at least that level of complexity of working in those smaller markets because it's just not the margin and the effort there for them to do that. So yes, it's an impact. We've seen it a little less as the government's tightened their screws down a little bit recently on some of these mergers and acquisitions and denying them, but we're also seeing maybe a little bit more geographical dispersion with these large systems where maybe they're mostly had been in the southeast. Now they're going to look at the Midwest or the West or the North and say, I'm not allowed to grow in my market, but I can grow geographically across the country.

Steve Lieber:
Yeah, CHIME does boot camp, and so you got an insight in terms of the developing professional along not only boot camps but other certifications and programs. Are you seeing a different kind of person coming into these roles, and is it related to the changing business of healthcare, or what are you seeing in terms of the professional and him or herself?

Russell Branzell:
Well, this was kind of like when I would look around when I was in the military, and I'd go, why is everybody so young? And I feel so old because they are so young, and I am that old, and I'm starting to realize that they're not getting younger. I'm getting older. What I do see is a different breed of person. And I don't say that to ever disparage the people that came along with me and the people that came before me. These are young, hungry leaders and professionals who are very, very articulate, sharp, and intelligent in a much earlier age. These are people getting their first CIO gigs in their 30s and 40s, where the average age of getting your first job was maybe in your late 40s, but usually in your 50s. That comes with both some pressure because they're learning jobs before, maybe they've gotten all the scars of life in business world, but it also does the other thing, they're doing things at an age that is not normal for a business leader, historically. Example, they're still raising young kids. They're still in an early stage in their family's life. They're having to get these jobs by moving a lot. What's weird is it's almost like where I was an officer in the military, where you're moving every 24 or 36 months and you've got kids. You're trying to balance that stuff. It's kind of the same lifestyle for them. They're living a different world than they ever have, but the technology is not emerging anymore to the same pace it was for the 20 years or so that I did that job, where something new was popping up every single day, and the systems were changing so fast, like EMRs. What we're seeing now is these people are trying to figure out how to do healthcare different, not put systems in.

Steve Lieber:
Yeah, let's pick up on that thought because we are seeing I think you're absolutely right. We are seeing how people are doing healthcare differently. You talked earlier about everything from housekeeping through surgery is all digital and that sort. And so, as we kind of look at what's emerging now in the topic of conversation that's coming up most often is virtual care, artificial intelligence, the merging of the two using AI within through multiple other applications. We are at some point on that infamous Gartner hype cycle. What's your read in terms of what you're hearing in the field about how people are feeling about the emergence of machine-assisted healthcare is what I'll call it now versus falling back on the AI term. But clearly, you know, there is a movement here where clinicians are gaining new points of reference and input in their clinical decision-making from machine learning.

Russell Branzell:
So part of this is a little bit like the past. I remember when the internet was the cool new thing. And what are we going to do with this internet thing and how will that affect healthcare? And it was a thing. It wasn't just the way we did business. And so I think what we're going to see is a natural maturation similar to that. I do think there's one fundamental difference. I think when you saw the internet, it was just piece and parcel to the information age. I think what we're seeing now is a fundamental economic shift in our economic revolutions. We're moving out of the information age, and most economists talk about this now, into a whole new era of business. It will be, for lack of better term, the AI age, where it's not just how do we figure out how to better to have people answer phones or we use a little bit of care management, it does a little bit of predictive modeling for re-admittance or in the hospital for sepsis. Those are all amazing and great things. I think we're barely scratching the surface. If you look at the world of all of it converging: robotics, AI, software, self-learning, all this stuff together. Fundamental way we live will change. No different than we went from the basics of a cottage industry to having steam power, to having the information age and mass production, all these kinds of things; we're going to see the next major change. You and I just happen to be, our careers are kind of ending at the end of the information age and the beginning of the others, but you and I don't remember when the information age started, but just was there sometime, and they didn't call it the Information age for decades. Well, we're in a new economic revolution. We just don't know it, just like we didn't know it back then. And so I think things are going to fundamentally and significantly change. I mean, there's I'll give you a short example as I finish this answer up. There's so many people going out there saying, you know what, jobs aren't going to disappear because of AI, and my answer is baloney. Tons of jobs are going to disappear. Jobs are disappearing today. Well, no AI is going to replace a doctor. Yes, it will. It's just a matter of time. There are tasks today that are doctor does. They don't need to do anymore because I can do it better, faster, with better results at some point. Guess what? The doctor's going to completely lose their job because of advanced technology. A nurse is going to completely change. Why do we need that? Because we have a shrinking work population like we've never seen in the history of humanity, and we need jobs to disappear, and we're going to have to do it at a pace that none of us understand. The labor statistics that came out Friday, maybe it was yesterday. Unexpected job growth of 280,000 jobs, with an unexpected exit to retirement of 420,000 jobs. No one on the TV talked about that. That's net negative. That means there was a whole lot of people no longer doing jobs. Your most experienced, seasoned workers. And they're people like you, Steve, who are boomers, who were I always use this term. It sounds derogatory, but I say we were dumb enough as boomers to work 18-hour days, six days, seven days a week. The next generations aren't going to do that. So they got to find two workers to replace the Steve. It's wrong. We have to fundamentally, economically change the way business is conducted.

Steve Lieber:
Yeah, total agreement with you there. And yeah, jobs are going to disappear. They're also going to be some that are replaced with something that doesn't even exist today in terms of people that are leveraging technology tools and resources that are being developed. Just a little tease to our audience, I'm working with Russ's team on the development of a model that is going to assess how facilities are adopting these technologies that, as Russ said, literally are changing the way healthcare is being delivered, and so more to come on that for sure. And thank you, Russ, for lending CHIME support and your team to that effort. So in wrapping up, Russ, we want to speak to the folks we know best. So, you know, the CIOs, the CDOs, the CMIO, CNIOs and all their the folks that typically tune in. What's the Russ Branzell best piece of advice? Best insight? The takeaway from today's conversation that you'd like to pass on?

Russell Branzell:
Well, I think this goes back to the golden rule, and it's the golden rule of health. It. And we can get enamored with the shiny things and the technology and the buildings and the process. Healthcare is a human business, and it sounds weird to talk about it, from a tech association. You ran a tech association. The success of those organizations were never about the show. They were never about the whatever we were doing. It was about relationships. And we live in a world where people crave meaningful relationships. And I think that's true as much as ever in a patient care environment, despite the technology, it's just as much with the technology organizations out there and the vendor community, the people that succeed both business. But also, I'd say there's another way of judging success in life are the people that put people first and then figure out the rest of it, and I think people are desirous of that more than they've ever been. It's, we're what, three years post-COVID? And I don't think we've gotten back to being humans like we were before. I hope we can, but I think if we can do that and if we can put the human beings back in healthcare and use technology to take some burden and stress off people, we've got a chance to fix a pretty broken system in a meaningful way. And that's not just a US problem. That is a global problem. You traveled the world. I've traveled the world. There's nothing unique about the United States. It's nothing unique because our payment system and we're fee-for-service, you can go to the most socialized medicine place in the world. They got the exact same problems we got. So that does tell you that we got a chance to fix a global problem, and I think we're going to do it.

Steve Lieber:
Early in this conversation, you attributed CHIME's success and its culture of relationships to the forefathers and mothers of CHIME, but you epitomize it. You are the master of the relationship, and you have certainly furthered the organization. And certainly, I really treasure and honor the opportunity to call you friend and colleague, and I certainly do appreciate you being with us today.

Russell Branzell:
Well, thank you, Steve. You've been all of those things and a great mentor to me for my life. So, I will always be in your debt.

Steve Lieber:
Great, thank you. 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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SFTS-Thomas Bentley: Audio automatically transcribed by Sonix

SFTS-Thomas Bentley: 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 Tom Bentley. Tom is the Chief Information and Digital Transformation Officer for the Ohio State University Wexner Medical Center. Tom began his career with the Medical Center in 1994 as an analyst. Prior to serving as CIO, he led the Health System Informatics team responsible for patient care and administrative applications across Wexner's patient care, education, and research mission. He is also responsible for IT governance and strategic planning. Tom, welcome.

Thomas Bentley:
Welcome. Happy to be here, Steve.

Steve Lieber:
Great. Well, I'm looking forward to this conversation. Wexner is obviously a well-known, well-respected healthcare institution, and you guys are engaged in some stuff over there that I think will be quite interesting to our audience. So, let's start out by reading your background and bio. It does reference your role in the development and implementation of the electronic medical record there at Wexner. And certainly, from 1994 to now, you've lived the somewhat pre-EHR era and sort of the post-era as well. Let's look ahead. So you've lived with, and what's the major platform you operate on? Epic?

Thomas Bentley:
Yeah. Oh yes. We're an Epic shot.

Steve Lieber:
Yeah. So, as you look ahead, it's not like I'm looking forward to telling you whether or not you see yourself staying with Epic. It's not really the direction, but where is it going in terms of what we have always called the foundational technology of the EHR? Where is that headed?

Thomas Bentley:
Steve, I think it's a really interesting question. I think that the EHR traditionally meant basic physician order entry and documentation, and that certainly holds true. But I think now we see the boundaries pushing into so many other aspects of the business, even systems and operations that were always deemed maybe clinical engineering in nature or facilities in nature, whether it be a nurse call system or now RTLS. But those boundaries of what we consider clinical systems in an EHR are expanding to every facet of the business and the clinical operations.

Steve Lieber:
So, are those things? I'm really heading down a path here of point solutions versus integrated platforms and that sort of thing. Are you seeing a stronger emphasis on integrated applications into the platforms versus point solutions standalone? Is that a trend?

Thomas Bentley:
Well, I think it's a really good point, and I think it's something CIOs across the country and organizations all struggle with balancing really innovative point solutions but also making sure that it really integrates back in with the foundational platform systems of the organization. For us, it's Epic and a few others. But I think we see advancements in some of these point systems, and sometimes, it'll introduce an advantage for a period of time. But then the question is always, okay, how do we then incorporate it and make sure the information is integrated with our core systems? I think we hear that over and over from the physician and nursing communities in particular. Don't make me look at another system. Having an additional log-in makes me leave Epic to do the kinds of things I need to do.

Steve Lieber:
Yeah. So on that point of, you know, don't make me log into another one and such, at times, I think we've deployed technology which actually has made caregivers' work and lives harder, not easier. Are we solving that problem? Are we better today? Have we learned from a generation of IT installations? What's the readout on the floor in terms of what you do to them or with them?

Thomas Bentley:
Yeah, it's such a great point. I think for so long, the things that we were introducing into healthcare, yes, we were making the care safer. We were maybe making the entire care process more efficient, and more robust. But were we helping the physicians, the nurses, or others with their day going easier? I don't know that we were. I think we hear over and over from those folks that I didn't go to med school, or I didn't go to nursing school to spend 70% of my day on the computer and documenting and doing a lot of laborious tasks. And I think, for the first time, to the heart of your question, I think. Maybe in the last 12 months or so, and as we look toward the future, we can start to peel away a lot of those tasks that could be reduced by efficient clinical systems, by AI, by more mobile technologies, those kinds of things. Really, our goal in so many of the discussions is how we can return those minutes to the caregiver to be either with their patient or get home on time so they can have dinner with their family or they actually get that full lunch break. And I think, for the first time, the technologies are really starting to be able to address that.

Steve Lieber:
Yeah, that leads directly into the next area I wanted to go into. And sort of the broad terminology of virtual nursing. And absolutely, the whole idea here is how we create solutions and such, work processes, and workflow that allow machines to do things that aren't necessary for a person to do. It's so basic, so routine. It's certainly not at the top of licensure and that sort of thing. And so, you know, using ambient technology and such to free nurses up from their routine tasks, you indicated that that's in your thinking. Talk to us a little bit about where you see Wexner going in this sort of area.

Thomas Bentley:
Yeah, we're really invested in and aggressively pursuing the AI-based ambient technologies, specifically just because we see the workflow that clinicians are doing right now, whether it's a nurse on the inpatient side or a physician in the ambulatory setting, they're having the conversations with the patient, they're doing the clinical pieces they need to do. And then there's this whole extra step after that to document and record everything they just did, or they try to do them simultaneously. It's just not a great experience for the patient or the provider. So, we really believe that the ambient technology is going to bring those together and make it both a better experience and a more efficient experience for the clinician. I think that the technology is progressing a little faster for the ambulatory setting, and I think we'll see the benefits there first. But I think very soon to follow will be that inpatient impact whether it be virtual nursing or ambient listening for the nursing. I mean, I think it will take a number of forms as the technology advances, but I think the potential return for nursing could be very significant.

Steve Lieber:
Yeah. In these conversations that I've had, one of the things that comes up often is trying to address workforce issues through this technology. Yeah, you just articulated the clinical benefits and such, as well. But back to our earlier conversation about burnout, dissatisfaction, turnover, etc. And, you know, the idea of being able to bring in tools like this so that nursing can get to nursing. Physicians can get into medicine and have real opportunities there. One of the things that I have heard that a couple of people are trying and want to get your reaction because it may be a little farther along than where you are in setting up the ambient, monitoring, ambient listening types of technologies, having it in an integrated solution that works off of a command center, and people are putting those command centers in different places, could be on the floor but could be in a nurse's home because you don't need to be. That's the whole point of virtual care. You don't need to be on-site. What are your thoughts about those sorts of what I would call innovative approaches in terms of the monitoring and the human side of virtual care not being right there?

Thomas Bentley:
You know, it's such an interesting topic, and it has evolved, as you know, in various ways and paces and different aspects of healthcare. But, you know, at Ohio State, we're having discussions. We are taking a little step back and saying, what does effective patient surveillance look like? And it takes a lot of forms. In some ways, we look at our most acute patients and say, we want to be watching cardiac monitoring in a very acute way, in other less acute situations, we may be just monitoring pulse oximetry and some basic vital signs. And that's one area we feel that AI and trending and things like that can really help augment how that is done safely and effectively. But then, if you even take a step back from that, we certainly have populations we're monitoring that are doing various home biometric monitoring, whether it be blood pressure or many others. And that's certainly something you watch on a slightly different scale and acuteness. But, you know, we look at our cancer population and certainly have unique needs. But I think if we start to look at all of those use cases as a whole and say, how do we effectively surveil our patients in the right way with the right technologies? I do envision a type of a center that could be off-site from the medical center that deals with the most acute. Still, I think certainly there are a lot of scenarios where you suggest in your question where we have expert nurses or others that could be working from their home to help with either virtual nursing or maybe helping to surveil large populations of patients with AI, augmented alerts and things like that, to really keep an eye on broad numbers of populations based on the needs of the patient at the time.

Steve Lieber:
Yeah, you're absolutely right. And as I say in conversations I've had where a couple of places have put this in place, they're finding that they are able to retain nurses because they still want to stay engaged. They have expertise and want to contribute, but they simply don't want to be at the bedside in the hospital. And, you know, various other personal factors are playing in and are having some interesting success with those approaches. So you've mentioned a couple of times using AI, and certainly, there's a lot of conversation here. You know, exactly where on Gartner's hype cycle we are is maybe up for a little debate, but it's up there. So you've certainly referenced using AI-assisted tools when you're looking at trends and monitoring and that sort of thing, how are you identifying what, where, and who? You know, there are a lot of people out there claiming a lot of things. It has to be a lot of noise to pore through to figure out where, what, and who to do next.

Thomas Bentley:
It's such a good question, and I smile as you ask it, because I think the hype cycle is such an interesting component that all CIOs across the country are dealing with. I think the hype cycle is at an absolute peak and hard to describe, but at the same time, it's real.

Steve Lieber:
It's real. Yeah. This is not something that's not real and not going to happen. But will it do everything everybody's saying it's going to?

Thomas Bentley:
Exactly. And to do it safely and effectively, I think, is so important. I think we want to be aggressive but cautious. You know, I think one question or one thought that comes to mind as you ask is, if it really goes back to one of the earlier points you asked about the integration with the rest of our platform systems because there are some pretty advanced solutions that we've looked at that are very standalone, or they require you to sync all your data to them and work within those kinds of systems and platforms. There may be some advantages there, but in reality, our core platforms are epic and others, and that's where our physicians work and spend all of their time. So, if we're going to surveil our patients, that's one of the first questions we ask when we look at various AI opportunities. How well do you connect with our EMR? How seamless is it for those alerts to appear for the clinicians? Even as we look into advanced solutions that may be video or audio-based, it's really the same point. How well does it tie in with those core systems? And if it's innovative and doesn't do those types of things, it's not something we're typically interested in.

Steve Lieber:
That's a great insight. Tom, for a closing question, we asked the same thing. The people who listen to this are folks like you. So, what's your single most important practical piece of advice for other CIOs, CMIOs, CIOs, CNIOs, and the like?

Thomas Bentley:
I think it has a long-term vision, and in this business, maybe a 2—to 3-year vision of the clinical platforms that you want to have to work in a really robust way, get the maximum use out of those, and be careful of adding additional platforms, products, and complexities into your environment until you're really sure they're safe and can tie together with those other solutions.

Steve Lieber:
Yeah, that's a great insight. Certainly, following that is going to pay dividends in terms of your success of adoption and implementation and the reaction out in the care settings in terms of what you are doing as a partner with clinicians. That's a great insight. I appreciate that. Tom, it's great seeing you. I really do appreciate your time today. This has been a great conversation.

Thomas Bentley:
Great talking with you, Steve. Thanks for it.

Steve Lieber:
You bet. Thank you for joining us, and to our listeners, 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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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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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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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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Automatically convert your mp3 files to text (txt file), Microsoft Word (docx file), and SubRip Subtitle (srt file) in minutes.

Sonix has many features that you'd love including automatic transcription software, collaboration tools, secure transcription and file storage, transcribe multiple languages, and easily transcribe your Zoom meetings. Try Sonix for free today.