Episode 29 : Balancing High-Tech with High-Touch:

SFTS-Bernie Rice: Audio automatically transcribed by Sonix

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

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

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

Bernie Rice:
Thanks for having me, Steve.

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

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

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

Steve Lieber:
One size doesn't fit all.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bernie Rice:
Steve, thanks for having me.

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

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

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