Episode 9 : Building, Buying, and Partnering:

Smart from the Start_Alan Smith: Audio automatically transcribed by Sonix

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

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

Steve Lieber:
Hello, and welcome to Smart from the Start. I'm your host, Steve Lieber, and it's my pleasure to bring to you a series of conversations with some of the sharpest minds in health information technology. We'll discuss the smart directions healthcare companies and providers are pursuing to create smart care teams. Today, I'm joined by Alan Smith, a Senior Vice President and CIO for Lifepoint Health. Al leads the organization's information technology services and cybersecurity functions across a more than $9 billion organization, which includes more than 60 acute care hospital campuses, 22 behavioral health hospitals, more than 2000 employed MDs, and more than 30 freestanding inpatient rehab facilities. In his role, he is responsible for implementing information technologies that support Lifepoint's mission and drive the company's innovation, operational performance, and financial excellence. Previously, Al has served as SVP and CIO for RCCH Healthcare Partners and Capella Healthcare, both now part of Lifepoint Health, as well as other leadership positions at Vanguard Health Systems, Cerner Corporation, and vice president of clinical applications for Carolina's Healthcare System. Welcome, Al.

Alan Smith:
Thanks for having me. I'm looking forward to it.

Steve Lieber:
Likewise, coming from Lifepoint and also having worked in facilities that became part of Lifepoint, you're living with, I expect, putting together legacy systems of different brands in terms of, let's just start out with the EHR platforms. Are you moving towards standardization, or, no, this is the hand we've been dealt, and we're working with each one of them with the different varieties that you have. How's that working?

Alan Smith:
Yeah, so definitely, as you said, legacy of a company that has been the product of 3 or 4 mergers over time, and everybody had a little different way that they were dealing with things. So the short answer is, we have just about every EMR that's out there and multiple versions. So we have a lot of disparity, a lot of diversity. That's a challenge. And I will say, we are selectively moving to consistent ones, but not wholesale across everything we might have. So, for instance, on our post-acute care side, we are in the process of implementing a standard EHR across all of our behavioral health and ... On the acute care side, it's a little bit case by case, either because we're being forced because EMR is end of life or the business case can be made. I can bend the cost curve, or there are reasons we do that, but there has to be a business case behind replacing them, so I'm going to live in a world of disparate EMRs for a long time, a long time. I won't get to one anytime soon.

Steve Lieber:
Yeah, well, and as you say, the business case has got to be there. The resources aren't there for us just to rip and replace without that being a key driver. And in your intro, it talks about focus on innovation, operational performance, and financial excellence, so obviously, those are three pillars that you're balancing all the time.

Alan Smith:
Absolutely, absolutely, and I think there's some natural tension there a little bit to be innovative. Can you spend the money? Do you want to spend the money? Do you want to be a fast follower? Do you really want to be cutting-edge? And, you know, I think that's probably a good tension to have—and checks and balances, if you will, a little bit, and depending on what we're working on and how we're doing financially, sometimes it might weigh one way or the other. So that's a good thing, but it has made us be, think, when we think innovation, we try to find partners who are EMR agnostic. I think one of the challenges we have is our EMR vendors, some of them are innovating very quickly. Other ones are not innovating very quickly. And so there's a little bit of a natural tension there of if I've got a more innovative EMR I'm working with, do we go with something that's the same across the enterprise? Because now I'm solving for something that's maybe with an EMR that doesn't have a lot of functionality. So do we go consistent, or do we vary a little bit to take advantages of the EMR that maybe are a little bit more innovative? So that's an ongoing discussion some people will argue for. Well, I just need consistency across the board. But well, if I'm in an epic market, maybe I don't need that because they can do something or a Cerner market, etc. So I think it's forced us to look at EMR agnostic, but I think it's also forced us to not always look for one size fits all. And sometimes, when it makes sense, we vary off that because of the capabilities of the systems that we're working in a local market. The other thing is a little different about us is our acute care hospitals are spread out across 60 hospitals in 20-plus states. So we don't have a lot of regional density where you get like, you know, what's the likelihood that a patient's going to go from somewhere in western Washington to South Carolina? Not a whole lot. So that hurts some of the business case, on why a lot of people say, hey, I got to have one patient record within a geography. We do have some of that, but we're a little bit spread out where some of that dilutes from our operational perspective, whether it's sharing staff, sharing patients, etc., so it makes the business case maybe a little bit harder for us.

Steve Lieber:
So as you're looking at sort of moving beyond the EHR, we kind of been through that a little bit with data analytics. We looked at solutions there. Now we're starting to talk about artificial intelligence and ambient monitoring and that sort of thing. What are you seeing in terms of the solutions out there, especially in a diverse environment like you've got? What's the status of the market right now and some of those newer directions?

Alan Smith:
Yeah, I think if I look at ambient listening in particular, there's a couple of folks that we are piloting. I think part of the challenge is there's so much coming at us. I could spend all my time just looking at new products that claim they can do X, and they're the greatest thing since sliced bread, right? And we talk about, with our innovation committee, how do we fast triage. Because you can spend a lot of time triaging. Every vendor is going to tell you their best side. Half of them are true, half of them aren't. And so how do you do some of that? And then when you make a decision, how do you just say, look, I'm sitting in this space. If I've got a couple of partners, I'm going to pilot, I'm putting the other ones to the side. So we talk about fast triage. We think of yes, no, and not now, and there's a lot of stuff that's sort of not now. I'm busy right now. Let us partner with a couple people. We've got pilots going. If those don't pan out, we'll be back to the table. And if they do, do we really need a third partner? What's the difference between the first two? Unless it's cost or significant functionality, at some point, you've got to kind of cull the herd and get it down just to a couple partners, because you just can't handle everything that might be out there. So that's a couple of ways we look at it. I'd say both in the ambient listening, sort of the virtual assistant, and then also in the, what I would call, when I talk ambient listening, also in sort of like the tele sitting virtual nursing, those types, more of the camera-based AI type things. Again, there are vendors popping up left, right, center, wverybody can figure it out better than the last one. At some point, you got to pick a couple do pilots and then figure out if you're going to scale it or not. Yeah, so lots to do there.

Steve Lieber:
So in that area in particular, ambient monitoring, ambient listening, and all, I see a lot of point solutions. I also see some platforms out there. Are you looking more in the platform that has multiple functionality, or are you working on specific use cases and looking more at a point solution approach?

Alan Smith:
Platforms, clearly platforms. That's one of the big concerns I have is death by a thousand integrations, death by a thousand vendors. At some point, it gets unwieldy, so our preference is platforms, clearly. I don't want to go with the best tele-sitting if they can't support my virtual nursing because I want one set of devices. I want one set, I want one vendor, I want one contract, etcetera, etcetera. So our hope is really to drive the platforms and to minimize that. We're doing that on analytics too, right? I mean, you can think of analytics that can be death by a thousand extracts. So push platforms and then kind of say, why can't you use this? If we can develop it and we can use that platform or that platform can be extended, any of those partners, we'd prefer to do that and maybe even co-develop than we would to have use case-specific partners.

Steve Lieber:
So as you look at perhaps the analytics area, are there lessons learned, just because that one's maybe a half a generation older than we are in ambient and artificial intelligence, you know, in terms of coming out of it, I think clearly one of them you've just articulated there is platform. No, you didn't even hesitate on that question. Any other sort of lessons learned from the analytics area, just because, let's say, we've been farther down that path of installed, used driving different practices in terms of care paths, for example, or whatever? Any takeaways as you start moving into the AI area from your past experiences that you've learned?

Alan Smith:
Well, I think you hit on one. One was the platform. I think initially, we definitely had use case-specific analytics, and everybody could pitch something, and eventually, you had to collapse to some things. I think for us, we are not typically a development shop. We'll co-develop with people, and we'll partner with you, we'll help ideate, etc., but we're looking for people that can deliver a full solution, not just tech, but come with the people to build it, process technology, etc. And when I say platform, those are the types of things we've kind of looked at, getting internal resources to build analytics or getting internal resources to do tele-sitting. It's probably not going to happen, at least not out of the gate. We want to outsource some of those things and leverage others' best thinking, best practices, and other skill sets as well. So those are a couple of things I think we learned through the analytics piece. Having said that, I think the analytics is getting a whole another boost now with AI and ChatGPT and LMS, etc. So there's almost like a resurgence a little bit on analytics. And can we do a lot more predictive and a lot less retrospective? So it's kind of like we had foundational analytics, and now I see AI kind of pushing us forward into what I would call more predictive and more assistive real-time analytics. So I think we're almost going through a second round on that side as well, so it's been interesting.

Steve Lieber:
Yeah, totally agree with you. Because, certainly, in the past, your analytics applications would give you information that then required someone to study, analyze further, and draw conclusions.

Alan Smith:
Right.

Steve Lieber:
Now we've got applications that are kind of coming in on top of that and doing those steps that carry our thinking a little bit further before it ever gets to us to look at.

Alan Smith:
Kind of looking down the road, right, skating to where the puck is going to be, not where it is. And we're seeing a lot of use cases and a lot of interest from our operators in that, right? Don't just tell me things about labor management. Tell me what my forecast, for me, what my demand is going to be, and how many nurses I need two days from now based on OR cases and discharges and ER throughput this time of year, etc., etc., etc. So it's getting a lot more complicated, but to me, it's a lot more fun, because we're starting to answer some really cool questions, not just sort of, well, what happened yesterday?

Steve Lieber:
Well, yeah, and it does. It allows us because of, just like the original concepts behind EHRs, that it allowed us to collect a lot of data and be able to retrieve it. Now, we're able to analyze a lot of data and work with it. And it really does kind of carry us further into a more exciting place and start to anticipate directions that patients might go or whatever. And so, I think you're right. It's sort of a rebirth of the analytics area as we add this new machine learning piece on top of it. It's very exciting.

Alan Smith:
It's kind of, like we're finally getting to the payoff for all the work we all did through MU-one, MU-two, slogging through data and codifying and all this stuff that we all took a lot of grief for, and we're finally getting to the oh, I get it. That's why we did this.

Steve Lieber:
That's why we did well. And we talked about it at the time. You know, you got to get out of paper, you got to digitize it so that, and here we are, we're now at doing that. That's a good, good point. In my notes, I've got a reference here to Lifepoint Forward, an incubator area in the organization. Talk a little bit about what that is and what you're up to.

Alan Smith:
Yeah, that's interesting. So Lifepoint Forward is really our innovation platform, if you will, and in that, we really do three different things. We build, we do have an incubator, and I'll come back to that; we buy, we make strategic investments in partner, especially if they want to co-develop; and then we do the traditional partner, right? The traditional contract, we're going to ride you for everything across the enterprise. So there are sort of like build, there's co-invest or invest where we might actually get warrants or put equity in, and then there's sort of the traditional partnership. Probably the most interesting or unique of those is the 25M-health. So that's a partnership with a company called 25 Madison and Lifepoint, and we basically each put money in and create an incubator. They actually sit on the second floor right here below me, so I get to talk to them quite often. And the thought here was, Lifepoint is big enough, and we have enough issues that if we have an issue and they can use us, they can find things that either we keep to ourselves and we keep the IP but it's good for us, it's efficient, it's creating efficiencies for us and in workflow, etc., or they may build something, and we may spin that out as a commercial enterprise at some point. One of the interesting parts about us is, because we run so many different EMRs, we like to say, if you can make it here, you can make it anywhere, because I get lots of vendors come in and go, well, you know, here's how I interface with Epic. I'm like, great, what does that do for Meditech magic? Nothing. Paragon? Doesn't do anything. It's harder to make it here and to work scale here because of all the diversity or disparity, but at the same time, if you can do it here, you pretty much have hit just about everything you're going to hit in the marketplace. There might be some, but you've hit an awful lot of it. So it's been an interesting partnership with them where they go out into our hospitals, they work with frontline clinicians, and they're looking for incubation, new ideas that they can build software that, again, we either keep the IP because it's something we want to keep or something it'll be commercialized later. So that's been really interesting that I have not had the chance to do that in my career. We're not a development shop, so now there's people on the second floor who are development. So if we've got a big idea now, we can potentially do it. So that's been really interesting. And then the whole equity thing, you know, we've got a number of partners where we've made strategic investments, and health is one Loyal Health is another, and there's other Bio Intelligence. There's others. One of the discussions we have when we entertain a new vendor partner is what's your capitalization structure? Are you looking for capital? And some of those things? I'm not on the investment committee, but that's been kind of interesting to learn about those things as well. And in the past, until about three years ago, that just wasn't part of the conversation for us. That's been fun as well, yeah.

Steve Lieber:
So as you work in what is Incubator Lab, so to speak, what's it like to move that into operations? What are some of the things you have to go through, you need to go through, in order to bring it to life?

Alan Smith:
Yeah. I mean, I think first and foremost, right? It's got to be something that our front-line clinicians or operators are interested in, obviously. So they spend a lot of their time with front-line clinicians in particular, saying, what are your pain points? We start there. This isn't usually "Hey, Al had a great idea." That's not usually where this comes from. I'm more on the back side going, okay, how are we going to operationalize this? And we thought of this. How are we going to get the data out? Do we have to put data back in and doing some of those things? So we're part of that process. But it is not an IT-driven process at all. It's what's going to move the needle in terms of operators, and then IT's kind of the back side saying, okay, how can we operationalize it, and where does the data have to be, does it be secure etc., etc., etc. So it starts clearly with them, because if they're not going to buy in, then it's kind of a waste of time. So that's really what drives it. I think it's interesting because the post-acute, and we've got a sister company who does LTACs, so their needs aren't always the same. So are we going to focus acute, post-acute, where are we? There's only so many calories, but we're always looking at those types of things as well. So it's an interesting process. It works relatively well, but we've spent a lot of time with them, and you know, there's also trust there too, right? So they come to us quickly, especially if they're going to innovate. If they hear something, they'll pull us in relatively early to kind of give it a sanity check. How are we going to make this work? There's a lot of great ideas, but if can't do it and if can't inter-operate with my EMR, they start to fall flat. So we're pretty early, but we are not the driver of it.

Steve Lieber:
So what's the mood in the workforce today? Where are we in terms of how people are dealing with technology, dealing with change? Because this usually, if not almost always, impacts workflow and changes workflow as well. Talk a little bit about the personal side of this.

Alan Smith:
Yeah. Where are we with workforce? I mean, coming out of COVID, no big shock, we're like everybody else, a lot of burned-out folks. That was a rough, rough road to hoe, so a lot of turnover. We're starting to see that come down. I think people are open to change, but they're cautious, and they feel like the last couple of years were pretty rough on them. So there's always this little bit of like, how much change can people take? I think a lot of that comes back to leadership, and that's at our local facilities. Can they get people excited about change? Can they sell the case for change or not? Not every CEO is change-friendly, if you will. Not every CNO is change-friendly. You've got to have those leaders. But I think people are realizing we've got to operate differently, and we've got to change the way we do it and are open to it. But I think there's still this balance where people are still pretty burnt out, if you will, or tired from COVID. And now there's a lot of financial pressures, and that's causing a lot of, I think, natural tension there, but I think people are open to it. But it is a challenge to balance all that. It's easy to sit in the ivory tower and say, we're just going to innovate all this stuff. Great in the front lines, like, wait a minute, hold on. So that's why again, we start with engaging clinicians on the front side. If a facility and a group of nurses are willing, there's no point in going on this. We need to find somebody else to go with.

Steve Lieber:
Yeah. Do you find at times that because you've got those champions, you'll roll it out in one place and not another, even if the platforms are the same or whatever? I mean, is there a judgment call you make where you kind of look at the environment and say, okay, I think it's going to fly here, but let's wait because we've got to be able to show them more? We need results before we tackle that group.

Alan Smith:
Absolutely. The reality of it, I mean, for instance, if you've got a facility, you just turned over their CNO and the new ones, and there's probably not the right time to bring something in, they're still trying to get their sea legs underneath, so there's absolutely certain markets where we're focused on. We've not gone to like, you know HCA, and some people kind of innovate. There's 2 or 3 hospitals that they say those are innovation centers. We've not done that yet. That's an open dialogue right now. Is that a better way to do it, or do you just, can any one of our hospitals handle that, or do we need to spread the load? And I don't know that we have the right answer for that now. Sometimes, it depends on what the innovation is too, and where you're going.

Steve Lieber:
Sure, that makes all the sense in the world. You know, our listeners are folks like you, CIOs, CMIOs, CNIOs, other information technology and digital health leaders. What's your takeaway? What's the message you've got to share with your colleagues that you're doing, you've learned that you'd like to share?

Alan Smith:
I'll throw out two things, if that's okay. One is, be humble. I don't know everything, no way, and none of us do, especially at the HSC. Be humble. We don't know everything. We need to engage our clinicians. We also need to take good lessons, learn from outside our industry. We aren't the leaders in innovation in many cases, so we need to be humble and try to learn from others and make that the tent, if you will, big, get lots of good ideas from lots of people. The second thing I'll say is just keep pushing forward. We talked about fast triage, but fast fail. Innovation, you're going to fail some. I mean, we've incubated some things that we had to just terminate. It wasn't going to work. We piloted, it didn't work, make the call, move on, let's go to the next thing. I think sometimes that's really hard when, especially if it was your idea or you're part of it, it's like, this is going to work, it makes sense. But at some point, you've got to cut bait, move on, go to the next thing. So I look at it as we collectively win, we collectively fail, and with innovation, you're going to fail some. You're not going to throw a perfect game, you're not going to hit every ball. So just keep moving forward, and as long as you're making incremental progress, that's good. Keep doing that. Change is difficult. You're going to have some failures, regroup, learn from them, keep moving forward, and don't stop pushing on it.

Steve Lieber:
Yeah. And you mentioned earlier trust and creating that safe environment where it's okay to fail. If that's the way it plays out, nobody's going to get punished for that, but it's like, find the answer right or wrong quickly and then, as you say, move on, but creating that trusting environment where everybody's comfortable and believes that's the way it actually will happen.

Alan Smith:
Yeah, I think the other part of that is, have clear KPIs going in, right? How are you going to measure success or failure, right?

Steve Lieber:
What does it look like?

Alan Smith:
If you don't have good KPIs, everything looks good, right? And I say that sometimes we get a little too granular, and we push the financial KPIs. We go, you got to get it directionally correct. You got to get it correct. Sometimes, we can go too long nitpicking those down to everything. Sometimes, just get it close, come back, get the real data and come back and then make a call after the fact, but you got to measure it.

Steve Lieber:
Absolutely. Yeah, if you don't know what you're trying to accomplish, you don't know what to measure, and you don't know whether you've made it there or not, great insight. Now, this has been a great conversation. I really do appreciate your time today.

Alan Smith:
Hey, thanks. This was great. This was fun. It's fun to kind of think about some of the things we're doing and take the time out to talk about them a little bit, so I appreciate your asking me.

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

Intro/Outro:
Thanks for listening to Smart from the Start. For best practices in AI 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 secure transcription and file storage, transcribe multiple languages, collaboration tools, generate automated summaries powered by AI, and easily transcribe your Zoom meetings. Try Sonix for free today.