Episode 16 : AI in Healthcare:

SFTS_Ed Marx.mp3: Audio automatically transcribed by Sonix

SFTS_Ed Marx.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 HIMS, 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 long-time friend and colleague Ed Marx. Ed brings to us an incredible depth of clinical, business, and digital experience and expertise. He served in C-suite roles at the Cleveland Clinic, New York City Health and Hospitals, Telsa's, Texas Health Resources, and University Hospitals. He has also been on the supplier side as CEO for the consulting firm Divergent Global, CTO for Tech Mahindra Health and Life Sciences, and CIO of the Advisory board. I believe most of us connect with Ed on probably a weekly basis, through his numerous speaking, writing, and podcasting activities, he's authored healthcare bestsellers included Voices of Innovation and Healthcare Digital Transformation. His podcast, Digital Voices, is top 3% globally. His blog, CEO Unplug, has surpassed 1 million views and Ed recently started a YouTube channel. So Ed, thank you for joining us today.

Ed Marx:
Hey Steve, I'm so excited to be with you. You're one of my heroes in healthcare, so it's a double treat.

Steve Lieber:
Uh, you're way too kind. And we do. We go back more than 20 years into my early days at HIMS, and I think that was when you were probably at University Hospital. I think back at the beginning of where we connected.

Ed Marx:
In fact, my big score was I had just taken over as president of the HIMS chapter in North Ohio. You had just become president of HIMS, and I was like, I wrote to you. I said, please come to our chapter. And you did. And it's like we scored. We had the new HIMS CEO out there before anyone else.

Steve Lieber:
And it really was, it was an opportunity for my introduction. I my background has always been healthcare, but technology was a relatively new area for me. And you did. You started me on my path of education and I thank you for that. So let's start our conversation with what's gone over the last 20 to 25 years or so. And in my mind we've actually seen transformation. We talked transformation at all. And obviously if you look over a long enough period, you'll find transformation. What I want to hear from you today as a starting point, Ed, is what are the bright spots? Where have we? And I'll even use the word succeeded.

Ed Marx:
Yeah, because I can be sort of a naysayer sometimes when it comes to this topic, because I still feel we're a little bit further behind than other industries, and I'm always trying to get us to catch up. But that said, to your point, Steve, we've done a lot of fantastic things even in the last ten years. Just the EHR adoption, right? We've seen it. I just saw the latest numbers from ONC, I think 97% of hospitals now are able to have electronic health records. And that's, I think, ten years ago that was like about 25%. And so we've seen dramatic improvement and even move it to the cloud. It seems funny talking about it because it's just a natural thing now. But for healthcare, we're seeing a lot more movement to the cloud, a lot less reliance on our own data centers and things like that. Virtual care is another sort of bright spot, especially during the pandemic, although I'm a little concerned with how we were going backwards quite a bit on the amount of utilization with virtual care, but definitely bright spots. And then the other thing is, I love seeing the emerging leaders, because that's who I was just 20 years ago when you and I were first meeting up. And so it's interesting to watch as these emerging leaders take hold and make more things happen. Accelerate transformation. That's pretty cool. I guess the last bright spot would be that we're starting to embrace the whole concept of human-centered design, patient-centered design, consumer directed type of things. And so I like seeing that as we explore technologies.

Steve Lieber:
Okay. And so we do have to explore the other side of that coin. You know, there are places where we're disappointed, maybe in terms of where we thought things would be by this point in time. So what are those that you would highlight?

Ed Marx:
So my prediction when I was leading digital and strategy at Cleveland Clinic, my prediction and right before the pandemic this was early 2019, was that we'd be at 50%. All outpatient visits would be virtual and during the pandemic, depending on the organization. But I think the average of averages was about 60 to 70%. So I was like, this is really going to happen, unfortunately, it took a pandemic, but it's really happening, right? It really accelerated the pace of change. But then as we look at the numbers after the pandemic went down, we saw those numbers go below 50%, 40%, 25, 15, 10%, depending again on the organization. And so that was a little disappointing. And I know it's not the technology leaders, the reason why we haven't maintained a higher level. There's a lot of different things that go into that. But that's one thing. The whole concept of hospital inside the home, that was another sort of prediction that we were laying out, was like 25% of inpatient days would be at home. And again, during the pandemic, we saw more of that, and we're starting to see it. But it's just always slow, right? We know that it's that the cost is half. We know the quality is the same. We know the experience of the patient and family is much higher. And so I do see organizations that are pushing this and doing like maybe going halfway, like doing it, setting it up in hotels, which is a good halfway step going into the home. But that's the one area. And finally, Steve, sorry you got me going now because one thing is I'm always concerned for my I love provider side. I love all of healthcare life sciences payers, but my heart is on the provider side and the importance of providers. And I just want the reason I'm so passionate about this is I want everyone to get a hold of the importance of doing these things faster, because if we don't do it, we will be, and we're seeing it be disintermediated by other players that don't have necessarily the same heart. And motivation, and I don't want to go past that because I don't want to hurt people's feelings, but no one cares for your community like the people who live in your community.

Steve Lieber:
Let's try to unpack a little bit about some of those barriers, because I agree with you and I both have been in the business long enough that we probably have gotten to the point now where we're impatient and maybe for a very good reason, because healthcare traditionally is known to be slow to adopt in that sort of thing. And you hear the arguments, well, we're dealing with people's lives, and so we have to be careful and that sort of thing start to see a little bit of the fail fast mentality in some areas and all. But what are you sensing as being some of those major barriers that people are dealing with and, any strategies, on how you overcome those?

Ed Marx:
Yeah. So for sure the obvious one is the payment system. So as much as I'm into a hospital in the home and doing things differently, the payment systems haven't necessarily kept pace. I do see change. The government is doing CMS is doing a lot of innovative programs. It's just not fast enough for me. But they are doing more programs and checking it out. So far it's been there's good success to show from it, so I think we're definitely headed that way. But we're slow to adopt these new payment systems. We're a large country, and we have a lot of different health plans, and we're not a single-payer system where maybe it would work faster. So we have to work with it in that environment. But that's very slow to change. But we are headed in the right direction, the ones. So that's not as much as in our control, although we all have policies and policy wonks and lobbyists that help us out. The second area that I think we do have more capability in is what we can do ourselves in our local communities, in our hospitals, in our health systems, whether it's local or it's a larger health system that spans multiple states. But I think it comes to change management, right? We always hear that people don't like change, and there's various philosophies on that particular statement. But it's true that change is a challenge. And so when you're introducing, hey, this is a new way we're going to do things well, we've always done it this way. We're wired to do it. We have all this process. We've done all these six sigmas, you know. So it's like hard to like pivot and change and it's easier just to go to work every day and just do what you did yesterday. And I think that's a big part of it. So it requires really transformative leaders to come in and say, no, we are going to make this pivot. We are going to change. I serve on the board of Summa Health and I love the CEO. He's super into technology, which is great. And he's created this board now that's very supportive of tech. And so you see some of that I can watch it firsthand where he you're dealing with again, like any other health system, people who've been there for a long time and they're wonderful, lovely people. Nothing against them. They're just used to doing it a certain way. And so you have a transformative leader who builds a leadership team around him, develops the mission and vision, catalyzes everyone to make the change. So it's starting to happen, but that's something you can impact. You can't blame the government on that one. It's like, no, you can do something. So those are like two areas change and the government and payment system that are sort of obstacles, Steve. But at least in both of them I gave you a couple ideas what you can do, but especially in the second one and change management, it comes down to leadership of the organization.

Steve Lieber:
Yeah. And I think you touched on it in terms of changing demographics in leadership roles. You see younger people coming into the industry. And at least from my perspective, I'm sensing a little more urgency, mainly because I think their background is more technologically based than ours was. We had to learn it, yes. While we were at the same time running the organizations and such, they come in with a greater expectation of things being in perhaps a different place than they find when they walk in the door.

Ed Marx:
Yeah, no, that's true. There's a lot of change. A lot of you could look at them as tailwinds or headwinds. I like to look at them as tailwinds to push us along rather than something to fight. And that is right. The whole disintermediation I was foreshadowing earlier in the conversation where you have big tech coming in now and they are challenging, right? Amazon has its own virtual care capabilities, and they're mixing it with also the physical presence. So it's a kind of a hybrid I can go on and on Best Buy right. For a home hospital at home there's like I've been tracking these. I have like a tracker of like 25 different retail tech coming in and disrupting things. And they're doing things the right way that they learn from other parts of different industries. Very consumer-oriented, human-centered design. Hey, you want to have your appointments on the weekends because you're working during the week. Of course, you want them at night. Of course, just these some of these things are so simple. Others are tech-enabled, but it's all real. And they're starting to take off the take off the edges all the high margin type of activities go to ambulatory, ambulatory surgery, any sort of ambulatory care, all that has been siphoned off of these health systems. And pretty soon all they'll be left with is high acuity care. And the problem is who's directing that? So who's directing it? Right? Are the payers who now have the majority of physicians under their control? And so you see these changes. So yeah, I think hospital leaders are finally getting smart to the fact that, okay, I didn't really want to push the change thing. I there's only so much I could do with government. But my gosh, if we want to stay viable, we've got to make dramatic change. We've got to change now. And so I think that is, Steve, to your point, a big catalyst. I like to again, I like to look at it as a tailwind, not necessarily a headwind.

Steve Lieber:
Yeah. You touched on some of those new players, relatively speaking, coming into the market. And again, we've seen that over the past generation or more companies that weren't in healthcare coming to healthcare in the past. They were gone in five years or less. Yeah. Are you seeing a little different pattern this time? Are they smarter? Are they taking the time to understand healthcare before jumping in? But what are you seeing in terms of those what we'll call disruptors, for lack of a better label to put on them right now?

Ed Marx:
Yeah, I think they're learning, and they're massive companies as you know, that are very profitable. So they've got the margin to experiment, to innovate. And we all know the failed examples. They were probably on the HIMS stage, right, talking about the great things, how they're going to change healthcare. And then they never did, but they kept at it and kept learning. And then I think they've done some smart things. They've hired some smart people, right? They hired smart clinicians, former tech leaders from the provider side. I think that helps a lot and gives them a lot more credibility, gives them a lot more insight. And I think tech is getting better, it's getting faste, it's getting more ubiquitous, it's getting more scalable. So I think all those things coming together is going to help make them much more successful than they've been in the past, so I would not brush them off. It's too late anyway, especially when you look at AI. Oops, I said the word AI before you did. What they've done with AI is not something that is going to be easily replicated by a health system trying to do it by themselves, as an example, or a traditional EHR vendor; adding AI don't think that's going to work anymore. I think there is going to be disruption, AI is just one example.

Steve Lieber:
Yeah, well you did, you opened the door, and of course, we couldn't spend 15 minutes here without talking about artificial intelligence and such. So the way I look at it is we spent a long time digitizing information. We needed to get it going far enough back out of paper into an electronic record. Now and for some time we want to use it. And that's what I see, AI driving is the use of that digital data and actually bringing some additional I'll even use the R-word here research into decision-making because it can look across so many things. So what's your outlook on AI short term? Where are we right now? What are the opportunities and risks? And I think long term, we all believe that it has a significant role in the future of healthcare delivery.

Ed Marx:
Yeah, yeah. But hype like blockchain, although I heard blockchain coming back, there was a very prominent speaker I heard not too long ago talking about blockchain. I was like, oh, that's pretty interesting. But yeah, I don't think this is Blockchain 2. Oh, this is going to be much more pervasive. And yeah, in fact, I think Rock Health or someone recently came out and suggested that we were at the top already of the hype cycle, which is a good sign. If that were true, that we're going to come down into the trough of disillusionment reality type stuff, and you actually get stuff done. So there is a lot of hype, and I'd be happy to know or to think that we are, you know, on top of that hype, and there's not much more to go. So we could really concentrate. And then, you know, the final sort of premise I'll give before answering your question is, I think it's much like the time of the Gold Rush. Who was the big winners in the gold rush? It wasn't gold people getting money out of the streams because that ended up, uh, sort of getting a bus if you think about the gold rush in California. But it was like Levi's. Levi's was the big winner, right? Because they these all these workers needed better clothing. And that's how Levi's was born and other industries. And I heard someone use a similar analogy related to like the large language models of refrigeration. Who was the big winner from refrigeration? It was Coca-Cola. It was the services, the products that came after refrigeration. Because now you can have a cold Coke or a cold beer. You could use beer analogy or whatever it might be. If you didn't have the ability for refrigeration, beer might not be as popular as it is today than what not. So I think that groundwork has been laid down as LLM capability, and now it's like, who's going to harvest it? And is it? We could talk all sorts of vendors. I try to avoid specific vendors, but not that they're bad, but I don't want to seem to promote anyone over someone else. But there are some vendors that are doing it now, like they're adding to the LLM very specific language models for healthcare. So it's all the big ones that are obvious Amazon, Google, Microsoft, they're all adding to that and then creating these products that may become the new Coke or the new beer of some sort, Budweiser or whatever. And so I think it's to come, but really good early successes so far that we've been doing for a while in imaging, especially with pathology lab radiology, been doing it for a while. I've been doing I can say I've been doing AI because I helped implement these systems for the last ten years, and they're quite remarkable and have done a lot to help with clinician burnout, help improve quality, help improve productivity, reduce cost. I mean, it's great stuff. And then obviously the ambient voice now is kind of the latest rage with the AI capabilities that we're seeing there and then the ability to write notes, right? There were some studies done that we're all familiar with where physicians are encumbered with so many inbox messages. And so now AI has ability to write them even better than a physician could have. Summaries of all the data, right? You get so much data as a clinician, you know, they're not looking at all the data. There's no way they could. And it's all summer. It can be all summarized for them. So those are some early indications, I think the future. and we were envisioning this again when I was at the Cleveland Clinic day, where when you're having that ambient experience with your clinician looking at them, eye and eye, they might have an earpiece that is giving them more information based on what they're hearing in real-time and looking at your DNA and other test results and other studies that have been done on patients like you all in real-time, so they know the next best question to ask, so that that encounter will be so much more productive. Because we all know it's a big guess. That's why it's the Art of medicine, not the science. And this will help make it even more science-based and really be a great help to clinicians and give them a lot more confidence and give you as a patient a lot more confidence, because we all know stories where things didn't go well and it came to really negative outcomes because people didn't have all the information they needed. So I think that's one of the really cool places that we're headed. But all of these around hat leveraging it to improve the overall experience of the customer. Like, do you know me? Like they don't really know, they still don't know me. I still Steve, I don't know if you have the same experience, but despite the fact I won't name the health systems because I was part of those health systems. But that's where I go to today for my healthcare, and I still get a clipboard at the end, and it just kills me. Even though everything is automated and we made so many investments, it just always disheartens me. I'm always like giving a sad face whenever that happens, but I think we're going to start to know the patient a lot better. We're going to get a lot of different inputs about the patient, so we don't have to ask all the same redundant questions all the time. So the patient experience is going to get much better. And then obviously the clinician we already gave some examples, but it's going to make the clinician world much much better. So reduce burnout again improve quality patient safety. It's just limitless really what can happen. And again I have high confidence this time because of the tech is there. In the past the tech wasn't there. We weren't fast enough, it wasn't enterprise, it wasn't scale. But now it's there and it's getting better, it's self-learning. So I'm a big believer in really excited.

Steve Lieber:
That's great to hear. Ed and I do I share that view as well. I think in some respects we can say, okay, we laid a pretty good foundation over the past number of years, and now this stuff coming in on top of that foundation really has some great opportunities. And you're reinforcing what I'm hearing in these podcasts that there is a great deal of optimism, recognizing that there is a learning cycle. You have to do that with the new employee. It's no different people versus machines and that sort of thing. There is a learning cycle and a learning curve that goes on here. So let's just wrap up because you've really touched on so many things. I really could spend the whole afternoon talking with you, but I know you've got other things you need to head to. But just to close this out here, our listeners are people like you, they are CIOs, CMIO's, they're industry supplier people, others. What we're looking for as a closer on these podcasts is a takeaway. Ed Marx's takeaway for those folks that are facing these challenges and these opportunities on a daily basis.

Ed Marx:
Yeah, I'll give you two. So when you were speaking to sort of jump to mind. One is take risks, I think one of the reasons, Steve, we're behind and we talked about culture, we talked about payment systems and stuff like that. But the other thing is leaders are afraid to take risks. And we probably got to where we were like, maybe made the move to manager director, maybe even to VP because we took risks and people noticed are like, dang and Steve, he's pretty sharp, I mean, look, that decision he made and it was probably an outlier decision, other people were afraid to make it and they're still directors. And I know that was certainly happened to me. I was the one who was taken making smart base risk decisions that paid off most of the time and got promoted. But we get to a certain place where then we get scared or like, oh, I don't want to lose my CIO position, I don't want to stop being CEO or whatever it is, and we become risk averse because you ever scratch your head, like, how did that person become CEO or CIO? And you scratch your head because what are they doing? Were they at one time they were this vibrant leader taking calculated risk, and then they stopped because they got scared of losing their job. So I think one thing is don't worry about losing your job, man. If you're doing the right thing, things will work out. So take risk. The second thing, and maybe the most important one, is always never forget to connect the head to the heart. We're in this, I think we got into this somewhere along the way because we knew we were doing good. We were doing good for people. We were helping people. Even on our worst day, I remember coming home, we always do the happy sad at the dinner table, like, what's the one best thing that happened to you today? What's the one saddest thing? Because then you want to celebrate the happiness. And if anything's sad, you want to support the person. So it's like even on the saddest day, even on the worst workday, I knew that my team had been part of saving someone's life, that they helped improve the quality of life for someone, that they helped improve the quality for a clinician made their life easier. So it's like we can never forget that our mission when we serve in tech or digital, in healthcare, ultimately, is to help save lives, improve quality care, the whole mission-driven aspect. And when we get into the minutia and then in the little fights and fiefdoms that occur within silos and we get aggravated, don't ever lose sight that at the end of all this is a patient and a family. So that's my final takeaway.

Steve Lieber:
Those are great. And you hit on two very important pieces, both the intellectual side and the emotional side. And that is what we're all made up of is at least those two components. So Ed, this has been a fantastic conversation. It is such a treat to to connect with you today and have this time that, that we were able to spend together.

Ed Marx:
Yeah, likewise. Thank you for having me, Steve. Again, you're one of my heroes and I couldn't resist the opportunity to spend this time with you.

Steve Lieber:
Thank you, I appreciate that. And to our listeners, thank you for joining us. I hope this series helps you make health care 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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