Smart from the Start

SFTS_Thomas Maddox.mp3: Audio automatically transcribed by Sonix

SFTS_Thomas Maddox.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 providers 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 teams. Today, I'm joined by Dr. Thomas Maddox. Dr. Maddox is the Vice President, Digital Products and Innovation at BJC Healthcare at Washington University School of Medicine in Saint Louis. In this role, he provides strategic oversight and direction of both the BJC-WSM Healthcare Innovation Lab and the BJC Digital Team. He is also a Professor of Medicine and Cardiology at the Washington University School of Medicine. Welcome, Dr. Maddox.

Thomas Maddox:
Thank you. Appreciate the invitation.

Steve Lieber:
Excellent. Looking forward to talking with you. It's always a treat to have someone who has at least a connection to the medical preparation, education, training, and such that really feeds the future of healthcare. And a lot of our conversations around technology obviously is focused on the future. So let's talk a little bit about your read today in terms of what you're seeing, in terms of the people coming out of medical preparation and what is it that we need to be focused on today in preparing them for entering clinical practice that might be different than ten years ago, 15 years ago?

Thomas Maddox:
Sure. I appreciate the question. I think to start with, it's I really enjoy the work that I do on an academic medical center. And I'll say that obviously most of health care is provided through community-based health systems, which is wonderful. But I think we in the academic medical center world have both the advantage and the responsibility, really, of providing some of those newer models of care and doing the research that really provides evidence that those new models really do help really make a meaningful improvement. Obviously, the patient outcomes, but also to the clinicians experience, because we know that the pressures and the intensity of a medical career are only increasing. And we also know that technology has promise to potentially help with that. But in order to understand the right mix of technology and practice, we're going to need innovation labs like the one we have here to experiment with different care models and really bring some of that research rigor that schools of medicine like Wash U have to truly understand the benefit of those models. The final thing is, I think any current graduate of a medical school is by definition a digital native. They've never grown up, they're in their 20s, so they've never grown up without having the internet, without often having at least some form of digital device. And so the idea that they would come to us conducting every other aspect of their life in a heavily digitally enabled way and not have that be a core feature of how they practice medicine. I think it would just be strange and really inefficient and ineffective. So I think efforts around both providing the digital-enabled care models and having them participate in both design and execution is just a requirement in today's day.

Steve Lieber:
You hit on what my first follow-up question was going to be about digital natives in terms of the entering physician workforce, and you just validated that they are coming in with that background doesn't even seem sufficient enough. It's just the way of life, the way they work. It's the way they do everything, as we all have and think about. Over my career, it was predicted that this was going to happen. There will be a time when the incoming physicians, nurses, other clinicians just come to expect it to be there versus it being introduced to them, as we have with previous generations of clinicians.

Thomas Maddox:
That's right. That's exactly right. You know, when I feel around in the hospital, I treat inpatients with cardiac issues. And what I have developed is a habit that I think is really useful, is I'll often bring our technology teams and their background is not medical. It's their designers, their product managers, their technologists, but they are a little younger. They tend to be in their 30s. And I'll bring them with me on clinical rounds, and at the teaching hospital where I round, I usually have house staff with me, medical residents, and fellows who are also in their late 20s, early 30s. So they are contemporaries and what I have them do is join us on rounds so that the technologists get a sense of what is it like to be on the front of patient care and how do we think about it? And how do we organize our work to be able to do that well? And when they look at it through their technologist's eyes, I'm like, why do you do it that way? Or that seems redundant, or what's a fax machine? Other things like that where we're like, no, no, this is part of the reality. And concurrently what they'll do is start talking to their contemporaries on the medical side who say, oh yeah, we have to do these tasks to take care of this patient with our disease. But they already know that they're not doing everything they could digitally. So they'll often ask the technologists, they're like, it would be really great if I had this information that flashed on my phone as I was walking into the patient's room, and it already knew the information I needed to have an effective conversation or design the management plan for this patient. And often what I find is that the crosstalk that our young docs and our young technologists have is just so rich, and they come away with so, so many new ideas of varying degrees of practicality, but it just serves as fodder, and I think speaks to where innovation is going to come from, and that's from our next generation of technologists.

Steve Lieber:
This cross-talk you just mentioned, sounds like it could be part of the concept behind your Innovation Lab, because I think that crosses the boundary of the facility and the School of Medicine. Talk a little bit about that Lab, some of the things you're working on, and what has the promise there, because you mentioned it's an important component that especially in an academic medical center focused on the research and ensuring that practices are, in fact, validated and clinically sound. So talk a little bit about that lab for us.

Thomas Maddox:
Sure. Yeah. I think when the Lab was started, our vision was we know that a lot of digital technologies were maturing and making their way into healthcare, but we weren't yet sure about where it could be best applied and to what end, to optimally support a better experience and better outcomes for the patients and the care teams that are taking care of them. With that overall focus area, we then categorized the way people get care in three different areas. One is people need access to care, or we providing the digital tools that tell them where you can come for care, how you can engage with us, can you have a virtual visit, those sorts of things. The second is and actually the delivery of care itself. And are we appropriately digitizing and using all the information that people bring to us when they're in a clinic or they're in a hospital, so that we know as much as we can about them and their needs, so that we're designing care plans with them that are going to give them their best shot at optimal health. And then the final thing was recognizing that the average person spends far less than 1% of their waking hours in the health care system. They're not sitting in a clinic every day, they're not hopefully not sitting in our hospital every day. They're living their life. But we know that what they do in their life directly impacts how much they're going to need us as a healthcare system. Are they smoking, are they exercising? Are they working in a hazardous environment? Are they in a good social or not a good social situation? So all of these various factors that we know in aggregate contribute to health and will affect the healthcare that they need, can often be visualized and in some cases advised by digital tools. We can start monitoring what people are doing with wearables and activity levels, with air sensor monitors for pollution levels, with sensors in the home to understand, some of the activities that they do that may impact their health. So starting to think about what tools would be useful and practical to help inform that part of their lives, to inform healthcare that's been part of the work. Very practically, we've done a fair amount in our so-called digital front door to improve the information we give our patients and ease their path in getting access to us. We've done a fair amount in both predictive analytics and digital point of care tools to be able to anticipate the kind of care that somebody might need, and then to surface the information for their care team to allow them to effectively treat that patient.

Thomas Maddox:
And then finally, we've done a fair amount of work in so-called remote patient monitoring and using wearables and in-home sensors, primarily with people with chronic disease like diabetes or heart failure to keep tabs on their health. And if they're showing early signs of deterioration, raising the flag for help with their care teams. That's been a lot of it. We've also, like everybody, started to probe into the newer capabilities that are coming out of digital health. Generative AI has a lot of exciting potential, but we're in super early innings there. We also know that some of these digital tools are not only going to be useful for helping patients get good care, but starting to unburden our physician and other healthcare providers that right now are screaming for help in terms of the information overload and just the absolute lack of bandwidth, they have to get their work done in a timely way, and that's really impacting their wellness epidemic levels right now, burnout. And there's probably a role done well for technology to help offload some of that burden. So those are the various areas that we've currently got in our portfolio.

Steve Lieber:
Excellent. Let's touch on that last one. Because the impact on the workforce of life today, the clinical life, the home life, all of this stuff, it leads to some serious challenges. And we do we see burnout and a number of issues in the past. We thought about the need to get out of paper into the digital world. So we were focused really on data collection. That's the way I visualize what the EMR was all about was collecting data. Then we started analyzing it, and next generation was around digital analytics and such. Now you've introduced the generative, the ability to apply actually a new generation tool onto that data that's been collected, some degree of analysis. But now we move in even beyond predictive into generative. One of the I hear some sort of pros and cons sometimes in the conversations. Some clinicians are looking at this as a threat. Others, as you just articulated, it has opportunity to relieve the burden we can use ambient monitoring to. And then AI on top of that to predict which ones we really need to focus on when because of signs and signals. Is it a pro and con? Is there a downside and an upside here in terms of where this next-generation technology is going as it relates to the workforce? Is there something we need to do to prepare them and help them realize this is if we do it right, this is going to be a help?

Thomas Maddox:
Oh, absolutely. I think there's a lot of potential. I think if it's done without deep thought, it will be. I don't know that it'll be harmful, but it'll certainly be less effective than it could be. I would like to tell you categorize sort of our evolution of digital. I'll call it capabilities and information over time. The way I thought about it is we have data collection or digitization, and the drive to give everybody over the last 15 years has been a big part of that. But I would argue the next steps are data curation, data insight, and then data generation. And I think all three are still fairly underdeveloped. And I think if we do this well, all three will address some of the variables that drive physician burnout from a data curation point of view. We have so much information, particularly if you're older and you've had some medical care over the course of your life. If I'm seeing you as a new patient in the hospital or the clinic, I still in a digital way, but I still have to manually comb through your charts. Now there are digital charts. They're no longer the paper charts when I was training, but we still have to comb through them, and they're often an instruction just not easily retrievable. And I think there's a lot of opportunity for us to continue to both organize our structured data in a good way and develop our natural language processing tools that can go and effectively mine the unstructured data, the clinical notes, and the conversations that people have, and synthesize all that into a concise and sort of form factor that I, as a physician, need to truly say, okay, Steve, it's coming to me. And over the past 60 years, here are the various things that have happened to him that have allowed, that have impacted whatever medical condition or medical issue he might be coming to me with, or that predicts that he may run into this down the road. So let's maybe introduce some preventative measures to mitigate or forestall anything happening. We are getting there with predictive analytics, but I think there's a lot more work to do. I still very much rely on my house staff to do that, what I call librarian work, and that's not as necessary with the technologies we have, but we haven't yet designed our technology in a way that sufficiently organizes that information, so the care teams and the patient can use it effectively. I think once, as we continue to work on that with the introduction of generative AI, I think it then maps out the next set of tasks, and that is after I gather that information, after you and I have a conversation and make a plan that works for you. I now need to feed all that information back into your data trail. And right now, what that requires me to do practically just type it all. And that is a huge amount of a time burden on current clinicians. We talked about pajama time or work outside of work time and all these other metrics which speak to the fact there's just too much to do in the time we have. And the reality is we don't need to do this. We still have, under adoption of our voice technologies, to be able to capture ambient conversations.

Thomas Maddox:
And we have under development, like just the beginnings of development, of taking all that ambient information and then putting it into a form that I use a clinical note, maybe a patient education piece for you to think about and read and refer to authorization for your insurance company to pay for the medical care that you need, all the other sort of clerical tasks that need to generate to be able to advance your care. Now, we can see, at least in some of the early signs, that with ambient voice recording, with generative AI analysis and generation of these notes, we might be able to substantially remove a lot of those tasks from a day-to-day job, to where I can focus on what thing that I can only do. And this is why I'm not worried about the robots replacing the doctors you and I, and the relationship we have, and the communication and the empathy and the understanding that I can gain about what you need and how I can help, be your guide and coach in the things to improve your health. That's not something you can outsource. And in fact, if you can remove from my day-to-day the clerical, I'll call it crap to be able to focus on that and give you the attention and the deep consideration that is needed for truly effective partnership for healthcare. That to me would be a game changer, both in job satisfaction and then also obviously in the care that we can provide. I often say the technology isn't replacing anything. That technology actually enables, the humanity of healthcare, doesn't replace it.

Steve Lieber:
Yeah, that's very insightful in recognizing what we've always talked about of operating at the highest level of your license. Take away those things you don't need to do. And there are a lot of them, as you've just articulated, that are well done by machines and such great insight as you look at the work you're doing in the Innovation Lab. And you may not be running up against this, but you're obviously reading about the policy discussions in Washington and Jefferson City or wherever. Are you sensing that you are going to need to move faster than policymakers? Will you move ahead, keeping in mind what they're talking about but can't wait? Or is there a process by which we need to go which says, okay, stick to billing and note taking, but stay out of the clinical area until we get farther down the policy and potentially regulation path. What's your read on on that intersection between policy, regulation and practice?

Thomas Maddox:
Yeah, the reality is healthcare is very much governed by both the regulations and the reimbursement policies that are in place. And people may be frustrated by the characteristics of each of those areas, but you can't operate outside of them. policymakersAt least you can't for very long. And so I think what we're going to have to do is be effective partners with our policymakers in thinking about how do we take what we're seeing as the frontiers of innovation in clinical care, digital health information management, and then advise and work with our policymakers to say what regulatory and reimbursement frameworks would best use these capabilities to do what we're all interested in. And that is providing optimal care at a reasonable cost. On the regulation side, one thing that is truly outdated and that we need to do a better job with is around privacy regulations. And this is obviously a very important area for healthcare because health data is incredibly sensitive, it can be used to ill effect. So we need to make sure that we protect it on behalf of our patients, but with digital tools, as we all know from Big Tech, that has been a bit of a Wild West. And so often what happens is the guardians of privacy and healthcare will look at the wild West of Big Tech, and they're like, that place is a mess.

Thomas Maddox:
I don't know what else to do except to say we can't use any of it because it's so messy, and that just completely robs you of the ability to leverage the innovations were seeing. At the same time, we can't allow the Wild West ethos to govern healthcare. I don't think anybody wants that either. So I am encouraged by what we're seeing coming out of Europe and a few of the other countries that are a little bit more progressive about who owns the data, how do you understand its protection, its security, and permissions behind it. Who allows who to have what permission, when? And I think as we start to clarify that on a societal level, we'll need to translate it into healthcare. Most of your listeners probably know that HIPAA was written in the mid-90s, and the technology landscape was markedly different. So it did what it needed to do to a degree then, but it is woefully outdated now and doesn't at all speak to digital privacy and what that means. I think working with policymakers on the regulation side will be really important, particularly on the privacy side, with digital data on the reimbursement side of the move to value-based care, does appear to be progressing, albeit slower than anybody would like. We do know that most of the digital tools, because they are providing predictive insight that they're allowing you to ideally head off medical conditions or at least minimize their complications. That kind of runs at cross purposes of how a lot of healthcare is paid for, because healthcare right now is largely paid, as the more I do to you, the more I get paid. And if you're not as sick, there's less for me to do, and so I get paid less. And I don't think anybody is saying, oh, please continue to get sick so I can make money. But incentives matter. And the fact of the matter is, the system moves everybody in that direction, whether we like it or not. So I think continuing to encourage, I'm actually encouraged by what I see some of the big commercial payers doing where they're setting up more value-based contracts with healthcare systems like ours and say, hey, we think this person will cost as much over the next year, we'll just agree to pay that you manage the best you can and will reward you if they come away pretty healthy at the end of the year. That really starts to align us in saying, okay, so now I do need to invest in some of these tools and information and digital technologies to really keep you as healthy as long as possible, because that is the most cost-effective thing for me to do. In addition to obviously being the right thing to do for you and why you came to us. So I think when we see when we do the ROI of our various innovation pilots, if we study it in an at-risk population, in our accountable care organization, or with an employer who owns the total cost of care of their employees, the ROI is very high. But we also see that just because there is so much volume in our health system and everything we can do to be economical and the care that we provide you, even under a fee-for-service structure, even then, the digital tools often have a smaller but still positive ROI. So I think we can move in both reimbursement schemas, but I think both to maximize the value of these digital tools. And frankly, the best thing for the patient is to as quickly as we can get to more of that value-based framework and let that be a really complimentary incentive to some of the innovations we're seeing in our lab.

Steve Lieber:
Yeah, makes a lot of sense. I want to circle back to one thing you said early on about community-based care versus academic medical centers. We certainly look back into 15 or so years ago. —theThe early adopters of EMS generally came out of medical and academic medical centers. When think about the hems in REM stage seven, the first ones were almost always academic medical centers. The investment was the endowments and the money was there. The research orientation. If we can think back that far, it was new and fell into that R&D category. Our academic medical centers leading the effort again for some of the same reasons in the adoption of these newer generative, and let's just stick with the ubiquitous term right now, for lack of any other, because there are a bunch of other tools as well that might fit in that really out there, innovative category folks like you, where we ought to be looking to see the early findings because it's going to go both ways. Works doesn't work so well, needs to be worked on some more.

Thomas Maddox:
The answer, I think, is the nuance I would, so I would say in general, at least if I understand your question correctly, the leading digital health medical systems in our country are not academic medical centers. And in fact, I think there's some of these bigger health systems that both have an operational priority. And frankly, the resources to really be able to invest and roll out and operationalize a lot of these digital capabilities. I've seen really good things coming out of Ascension. They've been doing a lot of progressive things. Providence out on the West Coast has been doing some really interesting things. Atrium in North Carolina, has just been leading a lot of good things, and even some of our four prophets was speaking to some of the innovation folks at HCA recently, and they're just doing really it's really amazing things, often driven by the fact that there are enormous systems. And if they don't manage well, nobody's operating with huge margins. So if they don't operate well, they're going to get underwater really quickly. That said, it is true that true R&D budgets often still live in academic medical centers, largely in the research arm of the School of Medicine and largely fueled by the grants that come from NIH and other big funders, often the government. The disconnect, but I'm hopeful this will change over time is that often in the research world, your incentive is not to identify new things that then translate to operations. Your incentive is to identify new things and then publish a paper about it and go get a new grant, back to incentives. Incentives matter. So what ends up is you having this sort of isolated cycle of R&D. It's really more R than D. And so it's all these research insights that don't often make it across the street into the healthcare operations.

Thomas Maddox:
And one thing that I've tried to help in our lab, and I've seen peers do this at other AMCs around the country, is can we serve as an application bridge between some of the insights that our researchers are doing and then the operations that the bulk of our employees and our healthcare system are working on every day. And we're lucky that we have a 14-hospital system. Two of them are teaching hospitals and the 12 are community based hospitals. So in some ways, we have the right lab. And what I found in the hot term in AMC is right now is a learning healthcare system, because I think we have the right raw material for a true learning healthcare system that our lab can say, ooh, this is an interesting idea coming out of our researchers. Let's now start to pilot, test, and scale it, see how it works in the wild, in the actual day-to-day healthcare operations, and bring the research methodology in this iterative, sprint-based fashion of collecting the data on how it's working, analyzing it, and feeding those insights back to our research groups. To say to your point, this part worked. This part didn't. Based on that new information, what can we learn and what's version 2.0 and then start setting up this virtuous R&D cycle? And in some ways, I think AMCs are primed to do that. But I will say that it's going to take new mindsets. And sometimes the leaders of AMCs just because they've built their career on the old research paradigm that I've described, it's a little hard for them to flip the model. And so I think that may be one reason why they're lagging a little bit.

Steve Lieber:
Excellent. Great insights. So to wrap up, our listeners or CIOs, CMIOs other clinical leaders, digital health leaders, and their teams, what's your takeaway? What's the one piece to share with the audience as we wrap up here?

Thomas Maddox:
I think the thing that we have gotten religion on, and that I really think is probably a promising approach to realizing that learning healthcare system and seeing where digital technologies can help us out in the quickest and most informed way possible, is that we really adopted the so-called product model that we've learned from Big Tech. And so we have invested in user-centered design, where we get really close to our patients and care teams, conduct ethnographic research, really understand the problems they're trying to solve and the jobs that they need to do. And then we have product teams that are cross-functional teams and use product management philosophy of identifying what are the highest value things we can test and put into production, and see if they work to improve care and do it using some of the agile techniques that software companies use. Coming up with small proofs of concept two week sprints, rigorous collection of data and analysis of that data, and an ongoing cycle of learning to be able to very quickly speak to what the user and the health system needs to deliver healthcare and do it sometimes in a matter of weeks, if not months, rather than the traditional years long time frame. So we've just started moving into that arena. Like I mentioned, we have product teams, we have designers, and we're already starting to see some really good impacts with our primary care patients, as well as with some of our nurses, and bringing digital tools in a really rapid way, and the data proven way that improves their experience and the outcomes. So I would encourage my fellow technologists in healthcare to see if this product model is something that we should continue to bring into healthcare and realize some of the value that it can provide for our patients.

Steve Lieber:
Excellent. Really appreciate that. We have covered a lot of territory in a short period of time, and I really do appreciate the time that you've given us today, Dr. Maddox.

Thomas Maddox:
Now, it's my pleasure. I love doing this stuff, and it's just great that the audience you have are fellow journeymen and women in the software. Excellent.

Steve Lieber:
Thank you. And to our listeners, thank you for joining us today. 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, 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.

Sonix is the world’s most advanced automated transcription, translation, and subtitling platform. Fast, accurate, and affordable.

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 collaboration tools, automated subtitles, automated translation, advanced search, and easily transcribe your Zoom meetings. Try Sonix for free today.

SFTS_Becker's episode (1).mp3: Audio automatically transcribed by Sonix

SFTS_Becker's episode (1).mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

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

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 teams. While at the Becker's Health IT and Revenue Cycle Management Conference in Chicago, we had the opportunity to explore key topics on innovation. In this podcast series, we're giving you a sneak peek into the discussions we had with health system leaders at this event. The key questions we covered during the series are. What is your vision for a smart hospital? How do you see AI and ambient Intelligence enabling you to reimagine your care delivery models? And what is the cost to hospitals of keeping the status quo? We hope you enjoy this abridged version of the insights shared at the conference. First, I want to share the insights. Dr. Gurmeet Sran, Chief Clinical Data Science Officer at Commonspirit Health, shared with us. Dr. Sran, what is your vision for a smart hospital?

Dr. Gurmeet Sran:
Well, thank you for that question. I think it's a very diverse question overall. You know, there's a lot of thoughts around how you can start to use technology. Both either audio-visual AI, augmented intelligence, artificial intelligence to help support a more robust and more dynamic opportunity for patients to give better care. Part of it is really how do we actually start to enable the technology stack, so we can transform these hospitals to be able to become more well-equipped for better patient care? Part of that has a lot to do with how do you actually re-envision the way that the patient rooms should be actually managed, both in terms of the layout of the room, as well as actually the technologies that you need to help enable this care. And then two, we often sort of forget about the fact that the operating rooms and the way that are managed nowadays, often you have hybrid models of how the operating room needs to be managed. All that has to be sort of taken into consideration. The third part, which I think is actually a part of the word hospital itself, this idea of us having a containerized hospital where it's four walls, where physical patients are physically located there, that's becoming a more antiquated idea now. The hospital itself could actually be not only with a physical hospital that we know of today, but it could actually be partially, maybe in a nursing or a rehab facility. It could be the patient's home, some sense actually, you know, now with mobile, mobile technology, people are beginning to think about mobile hospitals or mobile urgent care centers. So that whole sort of trajectory of it's not bounded by the four walls of the hospital anymore. We have to think about digital transformation and all these other care spaces. And a lot of that, as I'm sure you recognize, comes from using telephony and audio-video technology to help enable to help enable that vision to become a reality in the next decade or two.

Steve Lieber:
Dr. Shran, how do you see AI and ambient intelligence enabling you to reimagine your care delivery models?

Dr. Gurmeet Sran:
So sort of following on the question that you just asked, there's a huge opportunity here as it relates to the fact that we have a big workforce shortage, the fact that we're actually concerned that we aren't going to have enough nursing or physician staff to enable patient care in the next decade or two. The other part that has the opportunity around ambient intelligence that how can you centralize the care to remote stations or remote command centers. So getting back to sort of on a per patient basis, as well as then thinking about a population basis on a per patient basis, how do you enable real-time analytics, real-time opportunities to intervene before a quality or a safety event happens, better sort of improve the patient experience, whether it's around sort of ensuring that the family members, the patients are given the information that they need, or at least their requests can be managed at that right time. Part of the idea behind ambient intelligence itself will also, as I mentioned, be around the fact that we don't have enough FTE labor. And so that ability and that power to scale that I think is going to be a super powerful opportunity that's going to actually become probably table stakes in the next decade or so. The other piece that I mentioned on the population side is now, if you actually have ambient technology working at the patient level, you can then also take that same technology that's built up and syndicate that out to command centers. So possibly allowing for more remote-enabled care, remote-enabled care that's not just at your facility, but possibly even care at home care at actually other acute care sites as well. So all of that will probably become a very big sort of opportunity of expansion to enable better patient care as they sort of move into this next decade.

Steve Lieber:
And for our last question, Dr. Shran, what is the cost to hospitals of keeping the status quo?

Dr. Gurmeet Sran:
As we all know, the significant margin problems that all health systems in the nation face as it relates to both top-line and bottom-line opportunities. The status quo is going to actually go and allow for dissolution of sort of health systems as we know it. If we don't think about how to reinvent the care models overall. So I'm not saying anything that probably anybody else has not said, but the fact is that we're seeing such a migration and shift in the definitions of where care can be managed, what it means to actually manage care not only from a medical perspective, but a mental health perspective from a social determinants perspective. And so all of the way that we've been looking at, let's say, medicine being very medically focused and diagnosis focused, that envisionment of redefining what medical care is, is inevitably going to actually change the way that we have manage and care due care redesign over the course of the next couple of years. So simply. Please put this answered very quickly. Status quo will lead to a ultimate dissolution of, I think, the way that health systems practice, if they don't go and they don't reinvigorate and rethink of where they want to go in the future.

Steve Lieber:
Now I want to invite you to listen in to a conversation we had with Bryan Sisk, Senior Vice President and Chief Nursing Executive at Memorial Hermann. Brian, what is your vision for a smart hospital?

Bryan Sisk:
You know, it's interesting because there's a lot of noise out there in the system right now. You know, we're just having this conversation around the show here. It's you know, it really is getting down to I think we have a lot of energy in this space, especially from frontline nurses all the way up through leaders. It really is getting down to those things that truly provide value to both of our nurses and to the patients, and that's an interesting place to be, right? It's it's because we all we see a lot of innovation that comes through, especially since Covid, right? All these new bells and whistles. But the adoption sometimes lags because it actually creates extra work on the frontline or it's not valuable to the patient. And so it really is finding that sweet spot in between those two.

Steve Lieber:
For our next question, Brian, how do you see AI and ambient intelligence enabling you to reimagine your care delivery models?

Bryan Sisk:
Yeah, so part of our nursing strategy is reimagine is actually one of the buckets. And we put a lot of energy into that with our frontline nurses, because they really want to be a part of reimagining their health care environment. And that really comes down to like everything from the number of times that patients have to press the call bell. Can we eliminate some of that? Can we be more proactive? Can AI help us in some of this ambient monitoring that's out there now? Identify the needs of the patients. We see a lot of things with falls and pressure injuries that I think this is a prime space that would be very beneficial to those that are actually delivering that care.

Steve Lieber:
And for our last question, what is the cost to hospitals of keeping the status quo?

Bryan Sisk:
So I say this all the time. What we have now is a much smarter workforce. You can't underestimate how dialed-in that nurses docs are in the technology that is out there on the horizon. Some of it's true, some of it's not true. We realize that. Right. But it really is. It's going to be a differentiator in these spaces. Because if I can work for an organization that has some of these tools and it makes my job easier, I will probably migrate that way or stay with that company. So I think that's going to have a huge implication as we kind of go down this pathway.

Steve Lieber:
In our conversation with Dr. Nick Patel, Founder and CEO of Stealth Consulting, we covered some of the same themes and picked up on some great ideas for innovation that you can also think about and apply at your health system. Dr. Patel, what is your vision for a smart hospital?

Nick Patel:
Yeah, the future smart hospital needs to be contiguous with not only just what happens on the acute space, but also on the ambulatory space. A smart hospital should be able to know when someone is getting sick at home, alert the right people, and then bring that person seamlessly from the home into the acute bed, bypassing ERs and wait times there and directly into an acute bed to get that treatment quickest. And honestly, when that sort of thing happens, the treatment needs to start not only at the hospital, but actually starts at the home through telemedicine, the EMS, transport all the way to the acute space.

Steve Lieber:
Nick, how do you see AI and ambient intelligence enabling you to reimagine your care delivery models?

Nick Patel:
I've been practicing for 20 years, and what I can tell you, health systems even now do a lot of manual tasks, and there are thousands and thousands of tasks that a person has to do for one patient visit, just from the checking in process to the the nursing intake, to the provider, to the checkout process. And then that's exponentially increased if you go to the site. So what we can use AI is not only to get insights, but to drive the patient to the right avenue of care, use automation to make sense of the large data sets from wearables and other chronic disease states coming in, and then make sure that person gets the right avenue of care and gets alerted proactively when they're going the wrong path. Let's not wait for someone to actually have high sugar that puts them in DKA. Let's see this person's sugars actually been going up. Let's increase the treatment. Let's make sure that person talks to a pharmacist. Let's make sure it talks to a nutritionist all virtually. In order for that person to avert an organ damage from chronic kidney disease, blindness, heart disease. Et cetera. So it's all about using effective, clean data to drive automation and get the insights from AI.

Steve Lieber:
And for a final question, Dr. Patel, what do you see as the cost to hospitals of keeping the status quo?

Nick Patel:
Most hospitals currently, are still working, like if they're in the 80s. Even though we've had the high-tech act, the EHR come out, the cost is huge because the population has changed. If we don't change how we take care of our patients and move to more value based care, more proactive care, more wellness care, then we're going to continue to have sicker and sicker patients in our hospitals, and our beds are going to continue to overflow. So the cost for a health system not to do anything and modernize and digitally transform is could be a threat for them to actually close, because there's no way that they can keep up with the cost of healthcare, the cost of inflation, the ever growing population of our patients, the hard and the fact that is continue to have a nursing shortage. So we have to do things in a different way. We have to modernize how we transform care. We need to make sure that we have patients, have proactive care and seamless care without having to see have a person see them. So it's all about that narrow margin that health systems have. Average health system has 2 to 3% margin. And if you modernize and transform your business to do things that require less people skill and more asynchronous skills and virtual care, you're going to improve access. You're going to actually bring in more commercial payers. The consumers are going to want to come to your health system. You're going to retain, and you're going to do better from a reimbursement perspective, because you're actually building much better quality to the patient.

Steve Lieber:
Reed Smith, Chief Consumer Officer at Ardent Health Services, shares his experience from the lens of the consumer of health care. Reed, for our first question, what is your vision for a smart hospital?

Reed Smith:
You know, smart hospital is an interesting term. I think a lot of people probably try to tie that back to technology specifically, and that is part of it. But I think a lot of it is how we educate and train our clinicians and the other people that operationalize, you know, what we do on a daily basis. So when we think about smart hospitals, it's not that it's not a virtual hospital or something to that effect, but how do we take that technology and actually leverage that against the people and the processes and even the education, so we can better care for the communities that we serve.

Steve Lieber:
How do you see AI and ambient intelligence enabling you to reimagine your care delivery models?

Reed Smith:
AI is interesting, I think it's hard to, you know, go to a conference or a webinar and, you know, this isn't on the agenda. So you take that and the ambient monitoring piece. And I think what we're doing is actually trying to solve real issues that we have in the hospital. So you take labor for example. There's not enough nurses. I've been doing this for 20 years. There's never been enough nurses. I'm not sure we'll ever have enough nurses. So how can you use these to actually enable virtual clinicians, virtual nursing, things like that, where we can actually take some of the administrative burden off those people that are there in person and allow them to really maximize. We talked a lot about pricing at the height of your license. You know, how do we actually do that in a way that we're caring for the patient, actually bringing in their care team, their family members, things like that. So again, we can be more predictive. We can head off potential things like falls, for example, but then also care for them in a very systematic way that allows them to feel supported and hopefully goes home quicker. They heal faster, things like that.

Steve Lieber:
And for our last question, Reed, what do you see as the cost to hospitals of keeping the status quo?

Reed Smith:
You know, if we just keep doing what we're doing, we're probably going to keep getting what we're getting right, or however that analogy goes. And so I don't think we can, you know, our chief medical officer, I've heard him say a few times now that he never wants to be called innovative, always. He's even doing what he's doing. He says we have to. Right? So I don't think we can keep doing what we're doing. I think that's. Really, we run the risk of being irrelevant at some point. I think hospitals will always they'll always be a need and that higher acuity. But how do we actually use all these technologies, these new processes, to really become more consumer-centric? And that's whether they're in the home and the evolving side of care, or they're in our hospitals or otherwise. So if we stay where we are, we run the risk of being out of business, quite honestly.

Steve Lieber:
Dr. Bill Feaster, former Health Information Officer at Children's Hospital of Orange County, kicks off the questions with a candid approach that got right into the opportunities we have. So, Dr. Feaster, for our first question, what is your vision for a smart hospital?

Bill Feaster:
Well, I would say the way we operate our hospitals right now is sort of the furthest thing from being smart and that basically we do things the same way we did them when I started my practice in 1981. We have staff in the same way, and often that staffing is regulated by the state. We have processes that are all pretty much the same. We've inserted electronic medical records into our care since then, but we haven't really been able to use them in any sort of intelligent way. So I think the whole industry is ripe for completely redoing what we do now and trying to add some intelligence in it. So instead of just operating, can we operate intelligently in the future?

Steve Lieber:
Our next question is how do you see AI and ambient intelligence enabling you to reimagine your care delivery models?

Bill Feaster:
Well, we've been applying intelligence to our care of patients for some time now. We started our data science journey about five years ago, doing predictive analytics and applying it back to health care. But in the last year, there has just been a quantum leap in intelligence capabilities through the use of generative AI. The ChatGPTs of the world and the other AI tools, of which some are now really focusing on healthcare. So the application of those tools in the right way, the correct way to healthcare that both preserves privacy but also gives true intelligence, I think is going to be a game changer moving forward.

Steve Lieber:
And for our last question, Dr. Feaster, what do you see as the cost to hospitals of keeping the status quo?

Bill Feaster:
Well, the cost of hospitals right now with our current status quo is unacceptable. We can't function much longer because our costs are all increasing. Our providers are sort of getting swamped by costs in their practices. Everything is not, you know, it's not a sustainable solution. Nobody wants to pay what we're going to need to charge to keep doing things the way we're doing them now. So I don't think healthcare has a choice but to transform and try to figure out ways to not only staff smarter but use staff or smartly. Like, for example, physicians currently are kind of the top of the food chain, and I appreciate that being a physician. But at the same time, with the advance of mid-level practitioners, if we can get intelligent tools in their hands to try to decrease the divide in knowledge between the two groups, we're going to be able to let the mid-level practitioners just have more and more responsibility over care and try to balance out some of our other shortages.

Steve Lieber:
Finally, we wrapped up the sessions with Arz Raheem, Senior Director at the Digital Transformation Office at Montefiore Health System, who focused his responses on ways we can transform healthcare today. Arz, what is your vision for a smart hospital?

Arz Raheem:
My vision for a smart hospital is to incorporate new technologies. I mean, we're at the Becker's Conference today. I've been speaking to a lot of different people talking about generative AI, talking about AI, ambient technology, you know, things that have been around for a while as well. So my vision is to incorporate all of that and to look at pain points within the health system that we have. So my role is I oversee digital transformation, and it's a good space to be in because we're outside of IT. But we sit very, very closely with the faculty practice group. We listen to the clinicians, to the physicians, to our operations staff, and we try and understand the pain points that they have in their workflows, both operational and clinical, and try and address that with the right technology. And sometimes technology is not even the answer. But we want to make sure that we address that with the right technology by listening to the folks that are actually undergoing the actual problems.

Steve Lieber:
For our next question, how do you see AI and ambient intelligence enabling you to reimagine your care delivery models?

Arz Raheem:
I think it's really exciting space to be in with digital transformation and ambient technology. You know, I've been talking to care.ai, and we've been working with some other organizations that do ambient technology and, you know, have the technology to listen in to a conversation with a provider and a patient. So that kind of technology is a win-win, not only for the patient, because I think it's a patient satisfier. And I'll go into that in a second. But it's also something that can really reduce physician burnout. We are desperately trying to address physician burnout. What we have is we have a situation where pajama time and our hospital is through the roof. We have folks who are switching on Netflix at the end of the day and catching up with their notes and doing all their charting. When ambient technology has the ability to listen into the conversation, to create. Do you do the charting for you? Do the medical note for you, and it requires minutes, if that, for a physician to quickly look at what the what's been suggested, check it, post it, and it saves a lot of time. It's an opportunity to see more patients as well. And obviously, it reduces pajama time and physician burnout as well. So I think that's what excites me about ambient technology today in healthcare.

Steve Lieber:
And for our last question hours, what is the cost to hospitals of keeping the status quo?

Arz Raheem:
That's an interesting one. Cost to hospitals is really it's a trade-off. Do you want to stand still and hope that where we are is sufficient, or do you want to explore new technology? Do you want to look at generative AI? It's a really tough question to answer because healthcare has historically moved very, very slowly. I used to work in finance before it was very, very fast-paced, but healthcare is a little bit slow and healthcare is comfortable, I think, with being a little bit slow, but I think things like generative AI, it's ChatGPT. It's not even a year old and everyone in this conference is talking about it, talking about conversational AI. So I think you can either. Take a risk and jump on that bandwagon. But you have to be very, very careful about making sure that you select the right technology for your hospital, for your patient demographic. Otherwise, you lose that patient demographic. Not all this technology is the right technology for your particular patient demographic, so you have to make sure that you have the right strategy if you like. And I think the strategy has to be a change in culture, of a culture of innovation versus a culture of maintenance and preservation that we've had for so long.

Steve Lieber:
Well, folks, that's a wrap. We hope you enjoyed the insights from these health system leaders on today's podcast. We are always in search for insights from the brightest minds in healthcare that could help us move healthcare forward at the speed of tech. A big thanks to all of those that participated and a thank you for joining me today. Until next time.

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.

Sonix is the world’s most advanced automated transcription, translation, and subtitling platform. Fast, accurate, and affordable.

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 transcribe multiple languages, secure transcription and file storage, powerful integrations and APIs, automated translation, and easily transcribe your Zoom meetings. Try Sonix for free today.

Smart from the Start_John Glaser: Audio automatically transcribed by Sonix

Smart from the Start_John Glaser: 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 longtime friend, and I dare to say colleague, John Glaser, an individual known by many of you, but let me give you a little brief intro in terms of John's background. John is an Executive-in-Residence at the Harvard Medical School, and previously served in several senior executive roles in both vendor and provider organizations. He is a former Senior Vice President of Population Health at Cerner Corporation, Chief Executive Officer of Siemens Health Services, and Chief Information Officer at Partners Healthcare. John also has a long history in leading the professional associations in the area of health information technology. He was the founding chair of the College of Healthcare Information Management Executives, CHIME, and the past president of the Healthcare Information and Management Systems Society, HIMS, and a former chair of the board of the American Telemedicine Association. John, welcome.

John Glaser:
Thank you. Steve. It's a great pleasure. And you're correct, you and I are long-standing and good colleagues and friends, so it's a pleasure to spend some time with you.

Steve Lieber:
I appreciate that, and really, as I do look back over years, that we don't need to articulate how many. It's been a lot of fun, and you are certainly someone that I always look forward to running into at conferences and other places to tap into your thinking about what's going on, and that's exactly what we're going to do today. What I'd like to start out with is your role as an educator. You've done a lot of speaking in a variety of roles at HIMSS and CHIME conferences, CHIME bootcamps, Wharton, other places where you've been on faculty. So what are you seeing in terms of both the state of education for practicing? So we're not talking on the pure academic side, but on the practicing side. And what are we seeing coming out of the programs today?

John Glaser:
Well, Steve, first of all, I really enjoy education. It's a lot of fun, and particularly at the postgraduate master's level and the executive education level, etc., and so I think I'm having a simple ton ... for a dozen years. And so what you could see is in the 12 years ago, very interested in the electronic health record, what was going on. Meaningful use was here, and now that's yesterday's news for most of these students. They're interested in AI, they're interested in mobile devices, and things like that. So obviously, what you teach and talk about moves as the technology moves, AI was not as big of a topic a dozen years ago as it is now. And when you get into executive education, they've got scar tissue, they've been around the track, they've been in big organizations. They know how politics can be hard, and change can be hard, and so, and they're very action-oriented. So they're much more interested in, well, how do I do this and how do I do that. There's a lot of focus these days, Steve, on digital transformation. What does that mean? How do we do it? Why is it so hard? Why is, why does it fail so often, etc.? So I enjoy helping those people be better, more effective, and more knowledgeable. And I'll give you an example that they had, sometimes organizations think about digital transformation, it's a project that has a beginning and an end, and the answer is there is no end. You will always be transformed, okay? And that's just the kind of insight and understanding that can happen. And obviously, particularly in the Harvard, we, and I think the Zoom technology is better than I would have thought, although not as good as in person, but still, you can get people from across the planet, so in the courses I teach, two-thirds are from outside the US, and so there's a variety of experiences. So the person who's the CEO of a hospital in Mongolia is talking to the person who is a pharmacy rep in the Middle East, and it's interesting how much they learn from each other. So I think as a field moves, the topics move, and as they get more senior and more organizational exposure, they tend to be more focused on practical how to do various things, etc. And I do think you who teach, and I who teach, you can have a broad impact. We've taught in one of my courses 800 people this year. That's good. So I hope they're not screwed up by this process, but nonetheless, that's 800 people are probably going to be more effective than they were before.

Steve Lieber:
Yeah, so one of the things that that I've heard, especially around clinicians, and I would expect in your programs, you're going to have a mix of pure management types as well as clinicians who have an interest in other aspects other than pure clinical practice, is that the expectation that, the technological expectation when they walk into a provider organization, say, is higher today in terms of what they're expecting to find in the way of tools because of how they grew up, is that pretty valid?

John Glaser:
Well, I think that's quite fair. So I mean, in the, when I first began, there was a generation of clinicians who had never really had any exposure to the technology, were suspicious of it, had to be trained about it, viewed it with a bit of apprehension, and dread, etc. And pretty soon after they started using it, their fears were confirmed, you know, you know, yikes, this ... etc. But I think you've got a generation now, I was looking at some data yesterday, the average teenager in the US spends five hours a day on social media on average in games, etc. So they are expected to be useful, they expect it to be easy to use, they expect that it will help in lots of ways, and sometimes they're really quite taken aback when they get into our organizations, and they say, golly, this stuff has been around since the Stone Age, and it's complicated and hard to do. So I do think in the clinicians, the sort of familiarity and expectations are different. The other thing I think Steve has gone on is if you go into the boardroom. When I first began in this field, which is in the mid-80s, as a CIO, boards really didn't have a clue about AI. They didn't grow up with it, they didn't really understand it. It was a, you know, expense every now and then screwed up and caused all kinds of havoc. And now you've got board members who are in their 40s, and they grew up with this stuff. They expect it to be strategically compelling. They know it's hard. So you've got some seasoned, insightful people at the board level that you just really didn't have 30 years ago.

Steve Lieber:
Let this great insight, hadn't really thought about that at the board level. Certainly, we're faced with it daily in terms of our teams and ongoing operations, but from a higher strategic and governance level, you're absolutely right. That generation has changed or is changing as well. You got several things there that I want to unpack. One, you mentioned history in terms of people with clinicians that when we started to install certain things 15, 20 years ago, it didn't quite turn out the way they were expecting, and there was a lot of resistance. Let's start there in terms of what we learned from the EHR implementation process because, I mean, you were very involved in terms of all aspects, from being an installer and a provider organization to being a seller in a company deeply involved in the policy as well, and government regulation and that sort of thing, and advising numerous government officials and administrations. So as we look back, I'm going to believe that we're going to say, yeah, it was all worth it. In fact, it probably was the necessary foundation for us to be able to do what we're doing today, but your take on that, what we went through.

John Glaser:
Well, I think, Steve, it clearly a necessary foundation. I mean, it's hard to, you and I couldn't sit here and say, boy, healthcare would be better off if we all went back to paper. What that would, boy, what a sigh of relief and what an improvement we see, come on. Now, that doesn't mean we don't have a lot of issues with what we have, but nobody would say that with any, really, a straight face here. I think a couple of things have been learned over the years, one of which is the surest way to screw it up is to have the people who are expected to be using the system to believe that they are victims. You're doing this to them. They have no say. They're being dragged along, kicking and screaming. And I don't care who you are, be a doctor, you could be a banker or an auto mechanic, you're not going to like that, period. So the thing you learn is you've got to engage them, and you've got to give them control. One of the things you see, see when you do, when you look at when digital transformation is when they happen and are successful, why are they successful? And most aren't. They're only about a third are. Two-thirds fail at a variety of levels, etc., but one of the things that you see as a success factor is they push the driving of the project as low as possible. They put the people on the front lines in charge. Now, they have a broad direction. We're going to go left versus right, but nonetheless, the format that it's going to take, that's your call and you put them in charge. So you take them out of victims' end of being the drivers, and that has an amazing impact on what they will do. So that's sort of one part. The other part is you say, listen, the change that we have is a never-ending incremental process. We're going to take a step and assess, take a step and assess, take a step and assess. We're going to iterate our way incrementally. We've got a big step, tiny little baby steps. So that eases the burden of familiarity because I'm not really going to be scared to death if there's such a big leap, we're going to take it, and I'm in control of the assessment and what we do next, etc. So the other is that when you introduce the change, you do so over periods of time. The one thing that, the digital transformation takes years, decades, it's not like you do it in two years, and you're done, you're a brand new spanking organization, looks really different than you were before. So give them control and move it incrementally in steps that sort of help them move along with that stuff, and then you get rid of barriers to degree to give them time, to give them money. You make sure the vendors know what they're doing. If things screw up, you help go in there and rescue the team to go along the way, or it strikes me, Steve, is the things that you and I learned doing implementation. That generation that succeeds us will learn all over again, and the generation that succeeds them will learn all over again. You know, I remember talking to a guy, Warren McFarland, who is a professor at the Harvard Business School, 50 years in IT, and I said, Warren, I know the technology's changed in 50 years, but what hasn't? He said two things. Timing still matters. You can be too early or too late to the market. And the second organizations are hard to change. It's like raising kids, the things you learn, raising and being a father your father learned, and your kids as fathers will learn all over again. So the other thing we learn is that every generation is going to go through the same relearning of this sort of highly experiential process.

Steve Lieber:
Yeah, yeah. We hope that there's something we passed on that you don't have to go through because I went through it for you, but there are limits to how far they talked about.

John Glaser:
You know, raising a kid. Sure, you'll do book learning, you'll talk to some colleagues, but you're still going to go through it, you know, in your own way.

Steve Lieber:
Yeah. So in several of your comments, you've talked about iteration as well as people walking into healthcare and finding out exactly how far along healthcare is compared to other places. And healthcare does regularly get bashed for being behind the curve, slow to adopt new technology, status quo driven, and that sort of thing. Is this fair and sort of give me a further elaboration on some points you've made in terms of where healthcare is and why we may have to do things a particular way and that sort? But we do, we get beat up on this point a lot.

John Glaser:
Yeah, and I think, by and large, it's unfair. I mean, if you think we get beat up, we don't spend enough. And they say, well, if you actually look at the spending, it's pretty middle of the pack here. It's not as high as banking or insurance, but it's not way down in the bottom 5%, that's for darn sure, etc. And so you got to be careful with the implication that healthcare is full of a bunch of laggards and Neanderthals who really don't want to move. That's not true at all. You've got some of the brightest, most driven people in the world running these things and wanting to do a good job here. I think a couple of things get in the way, one of which, the incentive system is still volume-based, by and large. So why would I spend money on this stuff or go through the implementation agony if there's no real upside? Come on, let's get real about this kind of stuff. You know, we're progressively moving to value-based care, and that may help. The second is if you look at the nature of the work, it is arguably the most complex industry that exists, the knowledge domain, massive in its size and growing exponentially. The nature of the work from very routine, run a chemistry test to, how do we do a really complex diagnosis. The political structures are complicated. It's one of the few, there are only three social economic goods in our industry today religion, education, and healthcare. We have to balance the societal mission with the economic mission, etc. So you say this, and golly, it's got a knowledge base, it's complex, its processes are complex, it's politically complex, it's got the wrong incentives. Hello, the IT will not be as far along as in other industries where those factors are lessened or more relaxed. All industries are complicated, I got it, but you could argue that we're trying to automate something which has no peers in terms of complexity. We've still got to get on with it because there's a lot we can do, etc., but we shouldn't bash ourselves because we're not moving that fast because it's not possible to move that fast, not in a thoughtful way and an effective way.

Steve Lieber:
Well, and I think there are a lot of things we can point to, of successes and advances in terms of the technology and the impact on outcomes and such that really do indicate that this is not, as you said, a laggard sector.

John Glaser:
Yeah. I mean, you look at the sort of extraordinary adoption of telehealth in the pandemic. Holy smokes. In a very short period of time overnight that fundamentally went up, etc. And you say that that did some real good. It was probably a little too fast and a little rough around the edges in some cases, but still, that did some real good.

Steve Lieber:
But we add to it, as like, you had no choice. You couldn't let anybody in the place, so you had to reach out.

John Glaser:
Doctors were coming in, opinions were coming in. You had to do something.

Steve Lieber:
Yeah, yeah. As we look over the past 15, 20 years and really it's continuing today, we've seen multiple occasions of non-healthcare companies coming into healthcare. And in the past, a lot of them made it for a year or two, and then they disappear, and then 2 or 3 or 5 or 6 years later they came back and that, that sort of thing. We're seeing it again, and it may be in some slightly different configurations in terms of more partnerships between big non-healthcare tech and provider organizations. What are you seeing in terms of non-healthcare tech coming into the healthcare sector? What's the outlook there?

John Glaser:
Well, I think Steve, we will continue to have it. Perhaps the rest of time, organizations that say, Jesus, a gazillion-dollar industry is all messed up. They really could use our help. We did a great over in this other industry. We'll just sort of port it in and they hit the like the old and the Greek mythology, the sirens who lead you on to the rocks. And you will always have that kind of aspect. I do think, and actually, I'm working on this article now, which basically says if you look at, quote, industries that have been, quote, disrupted, who disrupted them and to what degree did they really get disrupted? And you might think, and it turns out that the incumbents in the industry are largely the disruptors. It's the incumbents who drive the disruption and they affect the incumbents emerge stronger than they were before. You go through banking. Bank of America is still huge. JPMorgan is still a huge. Morgan Stanley is still huge. You go into insurance company Cigna still huge, all these etc. So what you don't really see, if the occasion you do like a taxi cab business where someone comes in and the incumbents disappear or get clobbered and all this kind of stuff here, etc. So I think one of the things that sort of we, the broader ecosystem in healthcare have to appreciate is the incumbents, the providers actually have a lot of strengths here, and if they're smart about it, they'll lead the disruption and they're beginning to do that. You see that in the patient experience or virtual care, etc. So where we'll work effectively is not when you have incumbent disruptor battling each other, as we say, we're going to work together to make this happen. I appreciate health system, you will be the driver because you can scale and you understand all this complexity that I really don't. But I'm here to help apply my technology and my resources, etc., to make that happen. So what I do think we're seeing, Steve, is a generation of both big Googles and the Microsofts and the Amazons startups coming through that, if they're smart, are humbler about what they know and don't know, and also realize that the disruption is through their customers, not them, largely, they'll help with that. They can bring all kinds of stuff that will go through that, that will work. And I see that sort of humility or appreciation more so now than we saw over the decades before.

Steve Lieber:
Yeah. As I listen to you, I'm struck by you continuing to be a student of healthcare. I mean, in your references, in terms of your continued reading as well as your teaching and that sort of thing. So let's talk about where things are going. And you've got an insight, One, you've got significant history, but your current, you're looking ahead and that sort of thing. Everybody's talking about artificial intelligence, and you can't have a conversation in healthcare without talking about it. And we all know the Gartner hype cycle and where we are on that cycle is up for some discussion, but I think we're in the hype area.

John Glaser:
Sure.

Steve Lieber:
What you read in terms of where this is going, its value, its contribution, its impact.

John Glaser:
Yeah, I think it's interesting, Steve, is, if you go back over the use of computers in the business community writ large, go back to the 60s, I think you see about every ten years a major technology innovation occurs that changes the world. The mainframe in the 60s, the minis in the 70s, the networked personal computers in the 80s, the 90s' was the web. You know, Google was founded in 1998. The 2000s was the mobile device. The iPhone debuted in 2007. I mean you could argue 2100 was kind of the internet of things, and here we're in this era of AI. So it's one, it's a big deal. And it's like its predecessors, the world will be different because of this thing. You know, you and I know how big, how different the world is because of the web. And you think about what that meant, and so there you go, it's big. And you're right, we all know there's the hype cycle and we got a lot of unwarranted optimism. And we've got some pessimism too. Hallucinations will kill people, this kind of stuff here. It's got to go on here. I do think, and when you look at it, it takes a very long period of time for mature use to really be understood of a technology. It takes decades, frankly, and it's still evolving. So when you look at the web and we're still learning about using of the internet for screwing up the political process, you can still see we're learning a lot in the last couple of years about how that's gone on, etc. So I think we will be learning for quite some time about AI, what to do. My general advice to health systems, and we do this through the Scottsdale Institute, etc., is you got to go through a year process of learning, try things, talk to your colleagues, go to conferences, read, whatever it is, or talk to consultants. Invite Google, Microsoft, all those people in to give you an overview of what they're up to, but learn and share that learning and begin to cut your teeth on it. Now, I think what we'll see, Steve, one, is we see areas where it's in place now. I mean chatbots. The Google lady who gets you map makes sure you don't get lost. You know it's all over the place already and pretty mature use. And you can see some examples like digital therapeutics for people dealing with postpartum depression. Wow, that's just really cool. You know how slick that stuff is? I think most of that use will be there and that kind of consumer-oriented stuff, but also in these sort of administrative areas of healthcare. And so this is completing the note for the doctor, this is looking at utilization management or prior authorization, etc. And largely because the ROI can be clearer about what's really I'm going to get here. If it makes a mistake, it's less consequential than hurting somebody along the way, and so that's where we'll cut it. And I think this notion of robot doc is a little farfetched, etc., but so that may be a little further out that we have to go to make all this stuff happen. So anyway, I think we'll creep, but we'll start with the administrative side, plus the stuff that's already ingrained, and in what we.

Steve Lieber:
Yeah, Judy Faulkner just last month at, announced that Epic's focus with artificial intelligence was going to be on in-basket notes, coding reimbursement, this or so administrative functions, and that sort of thing. And so it seems like that is the direction at least major players like that.

John Glaser:
Yeah, and I think, Steve, a couple of things. One is we have to be thoughtful enough to realize there's different classes of AI. There's the generative stuff, which summarizes a note. That's different from the stuff that says predict, that says, by the way, John Glaser is going to be a real estate heading south, frankly, on his care. We look a little wobbly here, which is different from what I call classification, which basically says AI, this is a tumor of the following type, you know, or pattern. So anyway, all three are in play, although we're all excited about generative at this point. The other thing is striking to me too, is on the one hand, Steve, we say it's going to transform healthcare. Oh, for God's sakes, I hate that word. We're going to disrupt the hell out of it. And I say, well, over time, but if you look at it's going to summarize the in-basket note, that's transformational. Now, that's a good thing to do, don't get me wrong here, but the point is we're taking really modest steps initially. That's fine. That's where you start, you know, and transformation happens over time. It's not this big step function where all of a sudden you go from being 6 feet tall to 12 feet tall. It's just not what happens in these kinds of things. So in a way, they look pretty modest, but they're the start. That's how you, that's how this stuff works.

Steve Lieber:
And you build on that, yeah. You sat in the CIO chair, you've also sat in the CEO of a company chair at major platform organizations like Siemens and Cerner. As we look at technologies as they've come in, there are usually a whole lot of players, and then there are big players in the same space. We'll use data analytics as an area, and as I just mentioned, Epic has identified what they're going to do in terms of building into the platform AI. Is that the likely trajectory that there are going to be point solutions as well as platform solutions? And again, looking at it from both perspectives, as you've been, where would you advise CIOs to be looking in terms of as you bring technology in, make sure it goes into the platform? Yeah, you're going to need some point solutions. It'll be a blend. What's your your take on that?

John Glaser:
I think what is particularly wise is to be at either end of the spectrum. You might say boy vendor X doesn't have it, I ain't interested. I'm true blue, you know that. Come on, that's a little, I mean, I appreciate the purity, but that's a little too much. The other is hey man it's FHIR-based, we can stitch all kinds of stuff together. Well, let's get real about how that really does work or fits into the workflow etc. One of it's striking to me, and particularly if you look at the growth of health systems, they're just getting larger, more sophisticated, etc. Which, that means is, they now have the IT talent that actually can afford and understands how to deal with different technologies. They may be true to their vendor, but they're not so true if they're not willing to try different things. So my general view of an idea is it's fine and expected that you will go out and work with companies that aren't as large as Epic or Oracle, Cerner or Meditech, etc., that have really cool ideas. And you want to do that because you want to learn and you want for all. This is really a breakthrough technology of some form. If they're going to get acquired and part of a larger monolith. So I do think you ought to be don't go wild and bring everything in that you can, but it's certainly prudent and smart to go out and to work with small, medium-sized companies that really have cool and innovative ideas. Not all the smart people live in Madison, Wisconsin, or Kansas City. I mean, there are some smart people, they don't all live there, and so you got to be, you tap into this sort of rich set of talent that exists across the board.

Steve Lieber:
Excellent. So, John, to wrap up, our listeners are CIOs, CMIOs, CNIOs, Chief Digital Officers, and that whole crowd. So what's your takeaway here? What's the one thing that you'd want to share with that group that you think might be something that they can take away?

John Glaser:
Well, I think first of all, it's just a really exciting time. I'm always, wish I had another, who knows how long they'll live or you will live to see. But golly, this much more interesting than it was 30 years ago, that's for darn sure, etc. I think the basic and it sounds kind of almost slogan-like here is, there's no question that technology can really improve the delivery of care, the financier care, the accessibility of care. So we all understand and appreciate how potent this stuff is, and it's getting more potent all the time here, etc. So you're in a remarkable position to help your organization achieve its mission, its goals, its that are delivering care. You really are. That being said, you've got to remember a couple of things. One is the skill, the bar on skills. Having been with China for a long time, it used to be that if you were, got a letter grade A as a CIO ten years ago, because your communication skill, your team building skills, that's a letter B today. The bar just keeps getting raised, not just for you, but for the C-suite writ large. So you just keep working on your skills and you know, this, that, and the other because the bar gets raised and it needs to, etc. The other thing to remember is a digital the adoption of the technology is a team sport. It's a sport that you do in conjunction with chief medical officer, chief nursing officer, CFO, etc, and the frontline, back to the earlier comment that we do here. So you've got to be, just remember it's not yes, it's you, I got it, but it's really you, the member of a team, and who knows how to pull together a team and get the team to work effectively, not only your team, but laterally across the organization. That kind of team here, so unappreciated, the sort of remarkable opportunity you have to shape healthcare. Do keep working on your skills, and do remember that it is a team sport. And we do that, and over the course of time, we'll make all kinds of progress.

Steve Lieber:
Outstanding. John, as always, it is an absolute treat to be able to spend time with you, and I certainly do appreciate you being with us today.

John Glaser:
Well, thanks. It's a pleasure to spend time with you and great questions, and I hope people find the answers interesting. I'll look forward to seeing you next time we get together.

Steve Lieber:
Excellent. Thank you. And to our listeners, thank you for joining us. I hope this series does help 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.

Sonix is the world’s most advanced automated transcription, translation, and subtitling platform. Fast, accurate, and affordable.

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 enterprise-grade admin tools, world-class support, powerful integrations and APIs, transcribe multiple languages, and easily transcribe your Zoom meetings. Try Sonix for free today.

SFTS_Tressa Springmann.mp3: Audio automatically transcribed by Sonix

SFTS_Tressa Springmann.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 providers 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 provider organizations are pursuing to create smart care teams. Today, I'm joined by Tressa Springman. Tressa has served as the Chief Information Officer of LifeBridge since 2012, and became its also became its Chief Digital Officer in 2020. Tressa is on the board of Chime, vice chair of the Shared Services Committee and chairman of the Technology Committee for Maryland State Health Information Exchange, and adjunct professor at Mount Saint Mary's University—past president of Maryland HIMS, among other roles and recognitions. Prior to joining LifeBridge Health, Tressa served as vice president and chief information officer for Greater Baltimore Medical Center and also held information technology positions at Integrated Health Services, Georgetown University Hospital, and other provider organizations and tech companies. Welcome, Tressa.

Tressa Springmann:
Thanks for having me, Steve. I'm looking forward to our discussion today.

Steve Lieber:
I am too, actually, for our listeners. Tressa and I have worked on a project or two before in her capacity on the board at Chime, and I have been a strategic advisor to Chime, and one of those places we're going to explore a little later in the conversation is the role of the CIO and how it's changing and that sort. So it's something I actually trust and have worked on before, and we'll pick up that conversation. But what I'd like to start out with is you and your current role. And as I introduced you, you started out as CIO and then added Chief Digital Officer; what are the differences or the different expectations? What changed there in terms of your role at LifeBridge?

Tressa Springmann:
Thank you for the question. I think, Steve, as new areas of focus come on the scene in provider organizations, typically, the leadership team settles through on how they want to go after it. As leaders, we all know that typically when we have something we need to focus on or capitalize on, we typically go a little bit deeper. But depending on the organization and the scope and the scale of the new body of work, or any extra focus or energy the organization wants, we've seen this cycle in the past. I started out in IT when there wasn't a CTO role or when I, as a result of HIPAA for a short period of time, was also the CISO in my organization. The Chief Analytics Officer is something we're seeing depending on the scale or scope of an organization. And frankly, with the new hype and reality around the excitement behind AI, even the Chief Artificial Intelligence Officer is being discussed. I guess what I would say is when digital started becoming a thing in our organization, we became very intentional about what was different for us. And we believed what was different was this whole new dimension of our technology serving our consumers and our community on the past, as we were all very comfortable in IT supporting the employees in an organization, including the clinicians that used all of our systems, but really putting into place tools and an entire appropriate support structure for JQ public to use these tools that were deploying was a whole different dimension. And as we looked at that journey, and initially, it was truly a digital consumer journey, I was asked to partner with our marketing or CMO or Chief Marketing Officer on this work, and he has taken a different focus and dimension. And I've been asked really to take the lead on. Once a consumer becomes a patient, how do we make sure that our technology tools are in line with our overall IT strategy? And this relationship with marketing has really grown. I think what I would observe, Steve, and even most recently, we're going down the path of bringing forward and revisiting our IT strategic planning process, which most organizations do every so often, or when they alter their key company strategies in that effort. I'm actually seeing that the organizations I'm reaching out to, are now calling these a digital plan, not an IT plan. So that vernacular of digital is actually, in some ways, becoming more the mainstream of how we are looking at and referring to the technology that enables a provider organization.

Steve Lieber:
If I'm hearing you correctly, the coming together of IT and digital or digital is IT and IT is digital. In other words, the differences are not so pronounced. And really they really do move hand in hand. And I guess most everything nowadays with technology is digital. So there's just it becomes something of an artificial separation when you push it into two different camps.

Tressa Springmann:
Yeah. And I think it dovetails with our call to action to be part of that senior team and a strategist. If we want to put everything under the IT umbrella or tent as we become digital as opposed to just doing digital, we're going to have this bloated IT function in an organization, and we've left people behind. We've not supported them in their own change process for digital enablement, whether it's in supply chain, in marketing, in research, etcetera.

Steve Lieber:
I won't ask you to say whether or not your colleagues are prepared for this change. I won't put you in that spot, but I'll ask it about you. Were there things that you had to do, or was it pretty natural in terms of moving into this role with an external consumer-facing responsibility as well as internal? How did you make the transition?

Tressa Springmann:
I'm still managing the transition, Steve. One aspect is creating a whole support structure in a very tough workforce and economically challenging time to make sure that if we're going to put these digital tools in the hands of our consumers that are well beyond just function feature of a portal, that we've got the right support measures for it. The alternative to that, and I think many people are hearing this, is that becomes a balance between what your employees and providers may want and what is expected of us by our patients. So there's that element. And then there's the second element, which is the question you were going to ask me, and this idea. Look, here's my example. 15 years ago, I had an IT function that was there to completely support nursing as we digitized their documentation process. Now, as our nurses are coming out of nursing school, this is the way they do it. They don't learn to do it on paper, they don't. This is just the way it's done. And each one of us is on a different change journey. And the same is true with my peers in this organization and externally. And I think part of our call to action, knowing how dynamic things are, is to dig deep on ourselves, being a change agent, and creating this readiness for the rest of the organization, including our peers on the executive team.

Steve Lieber:
Great insight, dynamic organization, change agent. What stresses man's view on change? Is it a stepwise logical sequence of events? Is it crazy, out-of-control transformation? Talk about your philosophy around change and actually what you're having to deal with, regardless of what your philosophy might be?

Tressa Springmann:
I think I'll repeat myself quite a bit, because my commitment to the organization I'm in is to do whatever is required in order for us to achieve our objectives. And I would say that each organization struggles on this change journey differently. But here's how I look at it, Steve. Most of us are really good at implementing technology. We have the project plan. We know how to get a charter going, manage an issues list, and we get to go live. And then everyone has this massive disappointment when six months later, no one's using the tool. So that implementation to adoption is phase one. That really was a wake-up call for me saying, where have we missed the boat? We've put a tool into place, but we haven't changed the way people are thinking. And frankly, even if we doubled down on that, what we really need to get to, and this isn't just adoption, but it's outcomes. So I've really spent the last couple of years studying Croci. I did some teaching in the Chime university around change to understand and develop a point of view on how to be a leader, where we're talking about outcome, accomplishment, and not just the go live date.

Steve Lieber:
Yeah, you're absolutely right. Let's not be measured on did you implement or not? But what did you get out of it? What was the result? What was the outcome?

Tressa Springmann:
finger-pointingAnd listen, a lot of times it can devolve in an organization into finger-pointing about, we spent all this money, and we didn't accomplish what we wanted. And why didn't you? And this wasn't nice job. We've got to get past that and get alignment way up front about surfacing and identifying barriers, not to going live but to getting and achieving the outcomes that our organization is expecting of us.

Steve Lieber:
Excellent. Totally agree there. So one of the things that we hear a lot about, and it's probably not probably it is the hype word of the year in iIT is artificial intelligence. Now you can't have a conversation without it coming up. And so, how are you separating the real from the hype around artificial intelligence and give us a little insight about where LifeBridge is in terms of looking at this as a tool?

Tressa Springmann:
So if you don't mind, I'm going to start with your last question and then move up to hype because think, like a lot of my peers, we've been using a lot of artificial intelligence tools for a long time, depending on how you're defining them. I take a definition from golly, maybe an article by Harvard Business Review. It was probably 4 or 5 years ago, and it talks about this spectrum of artificial intelligence. And in its most basic form, we're talking about robotic process automation, where there's not really any intelligence or learning, it's just rote repetition, but it makes us more effective. It's a way to automate, get things done more quickly. But then there's a whole maturity curve all the way up to more prescriptive AI, where the tool itself may not even have human in the loop and really is making the judgment calls. And so most of us have been playing down at this lower end of robotic process automation at like bridge. We've implemented bots for IS in revenue cycle or got a few things launching in the EHR space and recruitment. And by the way, with all this workforce pressure, as long as it extends our reach without but with good human oversight, it really allows us to do more with less. We have crept up on that maturity curve. Most folks are using alerts, they're using clinical algorithms, etcetera, etcetera. I would argue that to, external influencers started to occur that really brought into view a whole different understanding of what this could become. The first was the generative AI, and at the turn of this year, this acknowledgment that there are these learning tools out there and people have begun to use them, and they have access to lots and lots of data, FYI. So there was a heightened public awareness about this capability and frankly, about how this capability might be hitting a data source for its guidance that wasn't really curated. A large language model, that's just the public internet, if you will. I think that combined with our workforce shortages and, honestly, this pressure on all of us to really provide and to find performance improvement dollars, the economic pressure has tempted everybody to look at some of these tools in a manner in which perhaps we weren't using the right caution. From our perspective, I think in response to these early 2023 happenings, we decided to more formally put into place a governance process to really start educating and defining and coming up with our own vernacular about what is artificial intelligence. Look, I think you and I would both agree. Here's another example. At Lifebridge, in imaging, we're using a tool that goes through, and it compares diagnostic images to a massive portfolio of historical images.

Tressa Springmann:
And it serves up to the radiologist whether or not and the probability that it's just a normal compared to the thousands of images it's compared that image to. At the end, our radiologist is making the rendering of normal or abnormal, but they're getting the benefit of this process where it's not just relying on their personal experience, but this vast library of images. I think you and I both can hear that story and say, wow, that's a great use, very effective. And at the end of the day, it's still the clinician making the call. They're using it predictively, not prescriptively. And those are the types of things where we want to, ideally, with the excitement of the promise of this, commit to bringing joy back to medicine, whether or not it's through cleaning up someone's message box or message center, or being able to use these tools to cull vast amounts of information that otherwise the clinician themself is just not humanly possible to stay on top of. But not release our providers or our associates with their obligation that at the end of the day, the output of whatever tool they use, a generative AI tool or a calculator that they still own, the responsibility of the decision that's rendered.

Steve Lieber:
I think I can interpret from that an answer to the first part of my question. Good use case and a governance process will do the weeding out between the hype and the real because you will be able to evaluate tools in the context of what you're trying to accomplish versus just looking at AI tools randomly and trying to decide, okay, is that real or not? If you start out with the good use case and people in the field who know what they're trying to accomplish, you should be able to identify the better path. I will make a subjective judgment about which tools, but that sort of process is really a good guiding principle to hitting it down the right path with AI.

Tressa Springmann:
Yeah, I think you summarized it a lot better than I did. You pulled me back to point. Thank you.

Steve Lieber:
You're too nice. Virtual care became a necessity during Covid crisis and the lockdown and all that you had to. You no longer were seeing regular patients in inpatient facilities. A lot of remote care and that sort of thing. What I'm hearing is a lot of organizations have seen a decline in the amount of remote care or virtual care as compared to the lockdown period, but maybe more than before. So it hasn't gone back to to old baseline or anything. So, what's been your experience in terms of what's happened in virtual care?

Tressa Springmann:
Honestly, we're seeing a shift. I think if you look at you're absolutely right. The pandemic came about, and we had the benefit, or perhaps the foolish promise that we'd already made all those investments, especially in our physician practices, and nobody used them. They were just sitting out there. So we looked at as though we were really brilliant at the time. But in fact, back to that change conversation. There hadn't been a burning platform. The pandemic helped us with that. And you're right, our strictly our use cases around telehealth, predominantly in our practice setting, have diminished and then leveled out. They're a lot lower than they were when people were afraid to get out of their car or afraid to go see a doctor. However, in some respects, the cat's out of the bag. People have identified that technology wasn't the problem. And if you, Steve Lieber, decide that you physically want to go in and see your primary care doctor on the regular, but as it relates to getting a prescription for your son, who always has seasonal allergies in the spring, and for that, you just as soon not have to take a day off work, but just do something that's a little more convenient and in fact, maybe even just text base an asynchronous type interaction. We need to be able to offer those choices. You've seen the low-acuity food fight from others in the industry that are much more disruptive in terms of trying to offer very convenient choices and alternatives to traditional care.

Tressa Springmann:
So I guess what I would say is we've seen a shift. We are seeing people want choices and partake using asynchronous use cases. You've seen, and we've seen a lot of growth around remote patient monitoring. And although hospital at homes not reimbursed in Maryland, I know we're hearing some great use cases around that. When we think of telemedicine, whether it's interactive ICAM virtual type care or RPM remote patient monitoring, I actually think our denominator is bigger, but the use cases have become very different. Back to my comment about workforce shortages and about the economics, I think that it was really only recently where we were pulled. I know my team was pulled very much out of our physician practices and refocused on our hospitals to identify something that would make complete sense to you and me, which is why don't we have two way audio and video in every patient room? And as long as the patient consents, whether it's their family, whether it's a subspecialist based on a very unique care condition, they may have etcetera. We don't want to slow down length of stay or getting the right clinician to the bedside if it's because of a physical barrier. So that has really led to a bit of a pivot in these types of use cases.

Steve Lieber:
So carrying that out a little further into a specific area of ambient monitoring and virtual nursing, it's an area that I've talked a little bit before we started recording this session. Tell me a little bit about your experiences in this area.

Tressa Springmann:
Sure. I think I mentioned before, but perhaps not on this discussion. I have a digital care team that has both non-clinical and clinical agents in Manila, and then actually have some employees in Israel, and that and a number of mid-levels here in the US. And they really represent what we started seeing before the pandemic, which was especially social work, behavioral health. There have been access issues there for as long as I can remember. Before the whole pandemic, we had deployed as many of our peers had telestroke, tele-behavioral, and my certified social workers and behavioral health specialists in Israel were providing that seven-by-24 by 24 coverage to our ERS. So. I liken it to how we used to have different lab systems and radiology systems and pharmacy systems, and then we ended up with a whole integrated EMR. So five, six years ago, we deploy these carts everywhere that needed a virtual presence. And now what we've identified is I've got a robot going into an inpatient room, so my hospitalist can really cover 3 or 4 different physical sites. I've got a nurse or a pastoral care representative walking in with an iPad so that someone's family member who's half a world away but still wants to have a conversation with a loved one who's unable to do something on their own phone, or even a tele sitter for someone who we've got some concerns over the only way to make sure that we are, as an IT leader, propagating five different types of technology and support models is to recognize that in the future, or at least until our patients are so acute that this ability for them to interact does not exist. Instead of trying to enable the use case, let's more effectively technologically enable the patient's room, and then we aren't limited to those points of interaction.

Steve Lieber:
As we were talking beforehand. You talked about the role of stakeholders in making choices about directions you were going, particularly in the ambient monitoring. I thought that was a real good insight. And I'd like for you to repeat that here, because I think it's a good takeaway about how to approach projects.

Tressa Springmann:
Great. Yeah. And actually, it feeds back into my digital care team. Steve, when you specifically ask about virtual nursing, we're on our do over about a year and a half ago, we deployed technology to one of our hospitals in order to really make available some of our US-prepared nursing resources in Israel. But to do so virtually and take some of that documentation burden for the admission, assessment or packaging up all the discharge paperwork and really doing a fine job with discharge instructions with that patient before discharge. And boy, we learned a couple lessons and we learned them the hard way. And that's why we are on our do-over. And look I recognize, different cultures may not run into these same barriers where they may deal with them differently. But we learned two very important things. Number one, the IT people couldn't decide on the technology, and you would think we'd learn this long ago, Steve. But I was really pushing for solutions where that equipment in the room was non-proprietary. I kept thinking about struggling to get in there to repair things while there's a patient in a bed, having to worry about multiple device types and any given patient room. But at the end of the day, the way the system interacted with the bedside caregivers was so very important that they really led the way on the final solution and what they were comfortable with.

Tressa Springmann:
Then it makes sense. We were looking at it from a very practical and technological platform, and they were really looking at it as from a frame of reference, is this going to help me or make my day-to-day even more annoying? Because now instead of doing the admission assessment or do the discharge planning, I'm actually going to become like the IT tech because this isn't working effectively for me. So lesson one is, no matter how quickly you think you're going to solve something for someone, you really can't ever speak for them. And then number two, and this was definitely more cultural because my team in Israel, they're amazing care providers, but the care team at this hospital really felt very strongly that they wanted to at least begin the process with clinicians who had familiarity with the way they delivered care in that organization. So while we still have plans of widening the lens across our entire health system, and I've heard many who've done it successfully, what we learned is, at least when we begin the journey with a particular organization, that we can't overstate the importance of starting with individuals who not only know that organization or know that nursing culture, but in fact may even know how that single unit operates.

Steve Lieber:
You may have answered my last question, but I'm going to give you another opportunity to give that sort of overall perspective piece of advice our listeners or people like you, other CIOs and CTOs and all, and what you leave behind here and as you gave two great ones right there, but you may have something else that you could share with the listeners. That is something that you can you've taken away from your experiences that you think has some value to them.

Tressa Springmann:
Here's a spoiler alert for the audience, Steve sent me this question in advance, and I've really been turning it over in my mind as I think not only of our successes, but also things we could have done better. I would have to say in the context because we run hard every day like everybody else, three things are down, there are four crises. There's something on your boss's desk that you have to attend to. I think my particular advice would be to really recenter yourself frequently on what matters most for you, what matters most for your organization, and what's going to matter most for your patients. And that really helps frame in some of these examples that I've provided, where we might not be focusing on what matters most, like in this last example, this recognition that in order for change not only to be implemented but to be adopted and ideally to get our outcomes, that what mattered most here was not losing sight of the people that it was going to impact.

Steve Lieber:
Tressa, as always, this has been a fantastic conversation. I love talking with you. You are such a direct and very clear spokesperson for good IT, Strategic Management, and operations. I certainly have enjoyed the occasions you and I have had to work together at Chime, and I just really appreciate you being on this session with me today.

Tressa Springmann:
Thanks very much. It looks like you have quite the lineup and as always, your questions were spot-on and extremely relevant to what we're dealing with today Steve. So I appreciate your really kind words. I hope someone in the audience takes a moment to get a learning or two from it. But most importantly, I appreciate the opportunity to share time with you today. Thanks.

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 smartospital.ai and for information on the leading smart care facility platform, visit care.ai.

Sonix is the world’s most advanced automated transcription, translation, and subtitling platform. Fast, accurate, and affordable.

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 powerful integrations and APIs, automatic transcription software, upload many different filetypes, enterprise-grade admin tools, and easily transcribe your Zoom meetings. Try Sonix for free today.

Smart From The Start-Crossover Special Eric Wallis.mp3: Audio automatically transcribed by Sonix

Smart From The Start-Crossover Special Eric Wallis.mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Steve Lieber:
Welcome to a special holiday edition of Smart From the Start, I am Steve Lieber and I hope you are all gearing up for a wonderful holiday season with friends and family. Today we have something a bit different for you. Instead of our usual episode, we're treating you to a special crossover event. I'm thrilled to introduce Molly McCarthy, the former Chief Nursing Officer at Microsoft, and her podcast, The Smart Care Team Spotlight. Also presented by care.ai, Molly hosts a series of conversations with some of the most innovative nursing thought leaders across healthcare. I encourage you to listen and subscribe and share her podcast with your clinical peers as well. To give you a sample of one of her many compelling guests. Today, I am excited to share an illuminating episode with Eric Wallis, the Chief nursing executive at Henry Ford Health. His enlightening insights into the challenges of our current nursing environment, and transformational opportunities to reimagine models of care through smart technologies like ambient monitoring, AI, and virtual nursing, making it a perfect complementary fit for our smart from the start community. So sit back, relax, and enjoy this special. Let's dive into the wonderful world of healthcare innovation with Eric Wallace on the Smart Care Team Spotlight, and I wish you all a joyous holiday season. And of course, enjoy the show.

Intro/Outro:
Welcome to the Smart Care Team Spotlight presented by care.ai, the smart care facility, platform company and leader in AI and ambient intelligence for healthcare. Join Molly McCarthy, former CMO of Microsoft, as she interviews the brightest minds in healthcare about the transformational promise of AI and ambient intelligence for care teams.

Molly McCarthy:
Too often, technology makes caregivers lives harder, not easier. It's time for smart technology to empower care with a more human touch. We are so fortunate today to have Eric Wallis, senior vice president and system chief nursing officer for Henry Ford Health System, as our guest on the Smart Care Team Spotlight. Eric has a passion for building culture and improving healthcare delivery to benefit both patients and clinicians. He's a transformational leader who engages all team members through innovative practices in collaboration. Henry Ford Health System and their 33,000 team members serve a growing number of customers across 250 locations throughout Michigan, including five acute care hospitals, two destination facilities for complex cancer care and orthopedics and sports medicine care, three behavioral health facilities, primary care and urgent care centers. Welcome, Eric, and thank you so much for joining us today, and I hope I got your introduction correct. Anything that you want to add?

Eric Wallis:
No, that sounds great Molly. We've got an amazing team of folks, and I'm very privileged to have the opportunity to work with them each and every day.

Molly McCarthy:
Great. Just to get started here, I know that you've been a bedside nurse and worked your way up through different clinical specialties, hospital operations across both academic centers and community hospitals, and truly understand the challenging realities of the current caregiver workforce crisis. Really better than most out there. So with that in mind, I just wanted to ask you how you're thinking about this particular crisis at this time. Post COVID and any strategies that you've prioritized across your health system to really address not only the issues, but the opportunities created by workforce challenges, workforce shortages, rather, and challenges for caregivers as well as the patients and hospitals.

Eric Wallis:
Molly, I think it's a it's an interesting time in health care and certainly within nursing as well. I think when we think about Henry Ford's response to the crisis that we've been in, we put it in a few different buckets. And so the first bucket is we know that today there's not enough people in the workforce. And so looking at our partnerships with our academic partners and really thinking about how do we fix the pipeline, we know that even today there are more people applying for nursing school than are actually our spots in the nursing programs across this country. We've got to be part of the solution and figuring out how do we get more folks that want to work in that space so that the schools can actually open up enrollment? And we've had some great partnerships. We're in a partnership with Michigan State University. We're actually just started this summer. We're now some of our bedside team members. Bedside nurses are not acting as clinical faculty and a partnership that we have so that we're leasing or giving some of their time to Michigan State so that they can increase the size of their nursing school enrollment. We've got to look at those kinds of, I think, unique opportunities, unique practices to truly increase the size of the nursing workforce, so that that's one of the things that we have to do.

Eric Wallis:
The second thing that I think is really key for not only us, but any health system in the current environment is we have to keep the talent that we have. We have to be in a space where we're actively listening to our front line nurses, actively listening to what their concerns are, the challenges that they're facing, and really putting in not only solutions to solve some of those issues, but engaging them in the work as we go forward. I'm really proud that our health system, all of our acute care hospitals are either magnet hospitals or on the magnet journey. And I think that's a key piece of our success. We've actually cut our nurse turnover from 2022 to 2023 this year, almost in half through working with our folks. And it's a lot of different solutions that I've come up and some of them are unique to to Henry Ford Health. Some of those are things that would work anywhere. I think the key piece of that is the listening and really trying to address those concerns that our folks have, and making sure that we're creating an environment where our nurses feel like they're being heard and that they've got a great relationship with that frontline manager. Some of those are not new kind of things, but it's kind of going back to the basics and kind of reestablishing great practices that we know work now that we're post-pandemic.

Eric Wallis:
And I think that really leads into the third thing that I would say. Which is part of what we hear as we listen to our front line nurses, is that we've got to make technology work for them. For a very long time in my career, what we have seen is new technology comes in the market, the EHRs improve, and really what they have done for a very long time is actually add to the workload of our bedside nurses. That's part of the challenge in what their real experiences have been. What I'm excited about is I think we're at a tipping point. We're at a point where technology can now actually start to take workload away, and if we design the right practices that we work with the right partners, then we actually have the opportunity to make it easier for our bedside nurses to do what they love to do, which is actually take care of put their hands on patients. I think that has really been a big focus of ours, is looking at how do we use this incredible investment that we've made in technology to actually make work better for our frontline teams?

Molly McCarthy:
Thank you. Yeah. First of all, congratulations on cutting your nurse turnover in half from 2022 to 2023. I actually haven't heard a lot of that. So that's wonderful. Second of all, I just really wanted to hone in on that third point around technology. I mentioned at the beginning of our conversation today that technology can really increase the burden that our clinicians, nurses look face every day, and whether it be the EMR or just an onslaught of multiple-point solutions that can further fragment our system. And I want to hone in on the tech piece a little bit more, thinking about how there's been a lot of hype more recently around generative AI and predictive AI-based applications. What are your thoughts around AI helping to overcome technology burden and what benefits do you see? Or do you anticipate this type of technology? As you mentioned, taking away workload from nurses?

Eric Wallis:
It's an interesting time because I'm probably like most nurse leaders across the country; there's really not a day that goes by that I don't get a email, a call, some kind of sales pitch from some company that now is touting their AI. And I think when you start to weed into it, you find a lot of the same things that we found with technology over the course of my career. Some of it is vaporware. It's something that people have imagined, but they haven't actually made it work yet. Or when you actually start to dig in what they're doing, it's really not artificial intelligence. It's the same systems that we've had for years and years. So I think that it's an exciting time, but it's a moment where we have to be really thoughtful about the partners that we're choosing, the technology that we're putting in place, and does it really help us to solve our problems? Because I think, as you mentioned, Molly, adding another piece of technology that layers on top of all the other things that we're asking our nurses to use, may just make things more complex and may not actually solve the problem. In addition, I think we have to be thoughtful that when we buy some of these technology health systems, we are famous for buying it and never really turning on its full power. So we have something that doesn't quite meet our needs, frustrates everybody, and we wonder why did we purchase this? I think integrate it in the first place.

Eric Wallis:
That being said, what's exciting when you start to look at some of the artificial intelligence technologies that are coming to the market, they are starting to do things like actually learn Right. to machine learning, where they're looking at the same patterns of things over and over again, and understanding that when A happens, B is about to happen and we can do something about that. So those are the kinds of things that are exciting to me, things that technologies and artificial intelligence that integrates with the workflow of the nurse. So it's not one more thing that the nurse has to go out and do but isn't. And wouldn't it be amazing that when the artificial intelligence and the sensor that's potentially sitting in a smart room notices that a patient is doing something that's going to probably lead to them getting out of bed and maybe falling, that not only can it alert, but can it alert the right people who are the closest to the room, who can take action in a required amount of time to actually stop the event from happening, as opposed to just a blast to everybody who's on the floor who may not be the right folks to be notified. It's that kind of thoughtful intelligence that gets to the right intervention at the right place, at the right time. That I think is the game changer that's coming in front of us.

Eric Wallis:
I think our health system, every health system in the country right now, is trying to figure out what the heck is virtual nursing, and it's one thing to go through and put a camera in every single patient room. That's great, but what are you going to do with it? What are the interventions that it can do? And are you just adding additional cost because few of us are in a position to just take on additional cost in our health systems? How do we use that technology to actually, um, support the workflow of our nurses take. Way, the things that aren't value-added, and then really get a user friendly not only for the nurse, but for the patient and the family member who are there in the room, who have to interact with this technology and feel like it's adding value to their overall care as well. It's a lot of different elements, but I think we're at a place where there's a lot of different things being tried and a lot of different opportunities, and I think the key skill for us as nurse executives right now is to try to kind of wade through all of it. And again, I partner with our frontline teams to understand what the problems we're really trying to solve are, and then how do we pick the technologies that are going to help us solve those specific problems, or maybe even things we haven't thought of yet?

Molly McCarthy:
Now, I love that. I think that sifting through the noise, so to speak, of what's coming at you every day, is really important, and to really trust and have the relationship with the partners out there, that working together to really solve the issues. And you really dug into a little bit of where I was going next, which really is around thinking about virtual nursing. What does that mean? Even with you and in your health system? I talked to some people. I think it's having a robot come in or what's having a camera. And so it's a terme that might be thrown around AI and that it's nebulous and means something different to different people. So I would love to hear a little bit more about what you're specifically doing at Henry Ford around that. And what use cases are you prioritizing for your nurses? I think that's really important. And the other piece I think that I heard is really looking at that technology that's integrating into the workflow, that's not creating new workflows.

Eric Wallis:
Yeah, I would say our position in Henry Ford's position when we think about virtual nursing has been we don't quite want to be on the bleeding edge of the technology. And I'm grateful. I've had lots of great conversations with CNAs from around the country and some of the things that they're thinking about and how they're starting to to run some of their pilots, and even now starting to bring some things to scale for us. What we're moving toward is we're we're kind of just in that islet phase where what we are looking at is how do we partner with a technology company, put the right camera sensor in the patient room, and allow a virtual nurse who is part of the team on the floor, not sitting on the floor, because we've learned that if they're too close by, then it's too easy to go down the hall and say, hey, we're a little short today. Can you step out and help us do this work? So building that model in a way that we're thinking about hubs in each one of our hospitals, um, that have a kind of a virtual command center that will allow those nurses to be just a little bit separate, but still know the culture, know the people, know the goings on within their site, and allow that nurse at the bedside to think about what is top of license work for the nurse at the bedside.

Eric Wallis:
We want them to be doing the things that require them to put their hands and touch patients, and skills that a registered nurse is uniquely qualified to do. We want the virtual nurse to be able to take away those things that maybe aren't top of license work, but maybe their data entry. They are things that suck up the time of our bedside nurses. So we know that two of the busiest times for any patient is when they're being discharged. So how do we pull that work away of going through those questionnaires and just manually entering data into the virtual nurse can do that and allow the nurse at the bedside to think, concentrate more on things like the plan of care. And how do we prepare you for procedures and tests and get you ready to go home and really be thinking about some of those more in depth questions? We know things like nursing education on new medications, new procedures. Again, that's something that a virtual nurse can drop in and do really well in collaboration in a team model, the nurse at the bedside.

Eric Wallis:
So those are some of the things that we're thinking about. We know the great thing about partnering with a company that has not only the camera, but things like artificial intelligence, is that those artificial intelligence pieces can help us to pay for the model for virtual nursing. If you have artificial intelligence that can reduce falls, that can maybe eliminate the need for patient sitters, for patients who are confused, um, that can tell you if a patient hasn't been turning in bed enough and that their risk for a pressure ulcer. So at some of those things that add to the cost of care, if we can use artificial intelligence to tell us when that patients at risk or when there's a potential for something that we don't want to happen, then those things, those savings can actually help pay for some of the care model. On the other side, for things like virtual nursing, I think it's a mixture of the really high tech and the really, I won't call it low tech, but really thoughtful thinking about what is the work of a of a registered nurse and what do you really need to have at the bedside, and what can you do, maybe virtually from a distance?

Molly McCarthy:
One thing that I heard you talk about even before. Before we start talking about virtual nurses around the I component, which I think is so key, is we don't need to alert every nurse on the floor. We don't need to distract them, etc. but we need to with that intelligence. We're directing it, as you mentioned, to the right person at the right time, about the right patient and what needs to happen. We all know that a patient fall is a null event, so I think that's critical. It really goes beyond the camera.

Eric Wallis:
An alert fatigue is there's been lots of research right? That it's one of the most challenging things that we've dealt with in healthcare over the last number of years, whether it's telemetry systems or cell phones that all of our nurses are now carrying, and texts and messages that they get notifications from EHR. So how do we again, how do you glean down and get rid of some of the noise so that they really have actionable things that are coming to them? And again, I think that's one of the places where artificial intelligence can really help, is help to filter all that noise and say, what are the things that are really meaningful and are going to actually have an impact on the way we care for this patient?

Molly McCarthy:
I think some of the use cases you mentioned ADT admit discharge transfer, some of the education, etc.. Are there any other use cases that you've seen above and beyond some of those? For example, I've heard about just even patient safety use cases that really impact patient safety. I'm wondering if you think that anecdotally sorry.

Eric Wallis:
No, absolutely. I think one of the ones that I'm most excited about is I'd maybe see not so much patient safety, but safety of our team. We're all in a place right now where we I say society today has lost the ability to be empathetic. And we see that even within our own team, when people come into the hospital, the level of anxiety and the level of frustration and just violence that have been going on in health care has been a little bit out of control. When you think about the ability of something like artificial intelligence, who's ambiently just watching the room to say, hey, this patient is known, right? To have some tendency to be a little bit aggressive or violent. And if we have a staff member in the room and they've got their back turned doing something on a computer or doing getting meds ready, and the patient starts to approach them, it can alert them to say, hey, you might have a problem. We want you to be safe. Things like code words to keep people safe. And an example that's been used is if you have a key phrase that says something like, there's cake in the break room, that could be a key phrase that the ambient listening could hear and know that there's a problem. And I need to notify security to come to this room right away. So I think that's one of the things that's probably been most exciting to me and to some of our staff, is that having that extra layer of security to keep them safe is one of the things that they are most passionate about in the environment that we've been working in for the last couple of.

Molly McCarthy:
Years, and I know that's part of the quintuple aim as well, ensuring that caregiver experience is positive. And unfortunately, we're at a point where that's critical for our staff. Thank you. That's really gives me a great picture and our listeners, a great picture of what you're doing. I'm curious, you mentioned you're in the pilot phase. And just in general, I've seen a lot of technology in pilot phase. And you mentioned even at the beginning, if you're going to adopt a technology, you want to use it, you want to see the impact. How do you envision scaling this across all five systems or even beyond?

Eric Wallis:
I think that's why we've probably spent a little bit more time getting to this pilot phase than maybe some others. Is that one of the things that we are really passionate about is making sure that any technology that we're bringing in integrates really well with our electronic health record. We're an epic shop, and so we want to make sure that this isn't just, again, an add on system that is going to make life more complex. And so we took more time trying to make sure that we are choosing a solution that can integrate, and that actually is going to make life simple and makes it easier for us to go to scale. We're right now in the midst of presenting a business case across the enterprise. I think one of the things that we have learned is that health care of the future is going to involve smart patient rooms, and that all the things that we want to do are going to be possible without having that camera and sensor in each one of our patient rooms. So we're probably like a lot of healthcare systems. We've got a mixed bag. We have some sites, some rooms, some buildings that have a lot of technology and others where we're a little bit behind. So again, trying to find a partner that has not just here's the way that we deploy it and this is the only way it can be.

Eric Wallis:
But having someone that can bring us different tools for the different situations that we're in has been a big piece of this as well. And then, like I said, really deciding on what you think your model is going to be and understanding, especially when you start talking about things like virtual nursing, it would be easy to say. That we're going to put a bunch of nurses in a command center somewhere in Southeast Michigan, and they're going to provide all this care across the enterprise. The reality is, they don't have that relationship, that when you start talking about team models of nursing, you really do want to know and trust the person that's on the other end of the camera or standing there in the room. And so we thought it was important to try to find that kind of happy medium between this is somebody who's just out of an assignment today and they're but they're sitting on the unit trying to do this virtual thing and having that full command center. So we're thinking about hubs at each of our sites. And I think that we've really tried to design the pilot thinking about the end in mind. And is the pilot going to really tell us whether this end design that we're going to use is actually going to work or not? And I'm sure we're going to learn things as we go along and make some tweaks and changes.

Eric Wallis:
But we thought this was a great place for us to start. The interesting thing is, I'd say there's a lot of different things in this space of AI and virtual nursing that are going on. So I mentioned that as one pilot. We've actually just recently stood up a first virtual ICU. As crazy as this sounds, I was a virtual. I worked at an ICU in the late 90s that had a virtual ICU, but there really aren't any in the state of Michigan. We were trying to fill in that hole, and we've got one of our hospitals live, the second one coming up here in about a month to start virtual ICU, and again with our partner epic. So we're not using a third party to do this, which I think is kind of unique. But we're excited to bring that additional artificial intelligence and early warning systems, machine learning that is embedded within Epic into our ICU space. So we've got a couple of different things going on at this time, and we're also spreading virtual sitting for all of our patients. And again, doing that internally rather than doing it through a third party. It's kind of a busy time right now for us and and trying to move into the space of virtual care.

Molly McCarthy:
That's exciting. And I think you talked early on in our conversation today about three different ways that you're really addressing and looking at some of the workforce challenges. The first one was the pipeline of more nurses, and the second one was keeping talent that we have. And I'm curious to see if you seen just in thinking about your more seasoned nurses or some of your nurses who might want to try different, you know, skills within their career and how they've accepted or really learned from the virtual nursing model. Just wondering if that in terms of retaining or even attracting.

Eric Wallis:
Yeah, it was interesting when we started our virtual ICU, obviously our hope was that we wanted the best and brightest of our ICU nurses to maybe come in and step into those virtual roles. I'm excited to say I don't have a nurse in our virtual ICU that's got less than eight years of ICU experience, which is, you know, exceeded our expectations. We were hoping everybody would have at least two, but it took us a little while. People were not sure with this virtual nursing thing actually is. And so it was kind of funny when we posted the positions, we sat back and we thought we'd have people rushing in, and what we found was no one was applying and we had to go back and actually helped people understand what virtual nursing looked like and what it felt like. Today, I've got a waiting list, and we've been doing this for six months because people have now seen it, they've touched it, they understand what the benefit of it is and people want to be part of it. And so I think there is a little bit of that change management cycle. You know, nurses are just like everybody else.

Eric Wallis:
Sometimes we're a little cautious until we actually see it working, see what it's going to look like. So I think trying to find ways to again get the team engaged in not just that, hey, we're going to do this and we want your input, but really help the design, it help to understand what it looks like and what the different roles are. We spent a ton of time both in our pilot for virtual nursing and our virtual ICU, designing workflows, getting their input and having teams kind of do that front-end change management so that we can be successful. And we were thrilled. The feedback that we've gotten from our virtual ICU being stood up has been universally positive. People feel supported. People feel like they've got a better environment to work in, and we're actually seeing it easier to recruit nurses to the ICUs that now have the virtual component, because they know that they've got that resource there to support their practice. And so that's been one of the great, I would call it, side effects of starting to do this work.

Molly McCarthy:
That's wonderful. And I think you mentioned early on in terms of keeping your talent, just listening and including them in the design of the workflow is so key. Otherwise, we know that the tech will just sit there at the end of the day. So many great happenings within your system, it's exciting. So congratulations! I do want to. Unfortunately, we do have to wrap it up and I would love for you just as you think about our listeners. Cno Cneos. Many of your peers and their teams just to think about all the lessons that you've learned throughout your amazing career. And if you could pinpoint one at this day and age where we are with health care. Just a piece of advice, a practical piece of advice for your colleagues, what would it be?

Eric Wallis:
I think that all of these things, no matter whether you're talking about virtual care or whether you're talking about becoming a magnet hospital or anything that you're trying to implement, it's really spending the time on the front end with the change management process. I've learned through my career, as much as I hate to sometimes slow down and get a document, a change management plan in place before we go forward, it has served me so well across my career that really taking that time and understanding who all your stakeholders are, who needs to be on the team, what outcomes are you trying to achieve? And oh, by the way, how are you going to make sure that once it's implemented that it's actually working, having all of those details and spending the time planning that on the front end will make the outcome so much better, as opposed to kind of the ready, shoot, aim version that we sometimes have to use in crisis. So I think really understanding change management science, having a plan for it and taking the time to work through that plan before you get started is something that I think is well worth it, and makes these kind of endeavors go much more smoothly. Yeah, I.

Molly McCarthy:
Couldn't agree 10% with you just because it's so critical not just to design and then deploy, but really work cohesively across the entire continuum and spectrum, and inclusion of the clinicians in that process is critical. Eric, thank you so much for your time today and your insights, and we look forward to sharing them with our listeners, and we hope to see you soon again on the Smart Care Team podcast. Thank you.

Eric Wallis:
Thank you. It's been great.

Intro/Outro:
Thanks for listening to the Smart Care Team Spotlight for best practices in AI and Ambient Intelligence, and ways your organization can help lead the era of smart care teams. Visit us at virtualnursing.com. For information on the leading smart care facility platform, visit care.ai.

Sonix is the world’s most advanced automated transcription, translation, and subtitling platform. Fast, accurate, and affordable.

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 secure transcription and file storage, powerful integrations and APIs, enterprise-grade admin tools, collaboration tools, and easily transcribe your Zoom meetings. Try Sonix for free today.