Episode 20 : Data:

SFTS_Scott Mac Lean.mp3: Audio automatically transcribed by Sonix

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

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

Steve Lieber:
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. On these broadcasts, we discuss the smart directions healthcare companies and providers are pursuing to create smart care facilities and teams. Today, we are fortunate to have with us Scott McLean. Scott is Senior Vice President and Chief Information Officer at MedStar Health, responsible for the leadership and vision of information services and clinical engineering. His role includes oversight of informatics applications, implementation and support, integration, infrastructure, security, and telecommunications while ensuring development of collaborative technology solutions. With Digital Transformation, MedStar Institute for Innovation and Performance Improvement and Analytics teams. Previously, Scott was Deputy Chief Information Officer and Vice President of IS Operations for Mass General Brigham in Boston, and he has also served as Chief Information Officer at Newton-Wellesley Hospital and Director of Clinical Systems at Dana-Farber Cancer Institute. Scott and I have shared paths to go way back. We worked together at HIMSS, where he was on the board and board chair, as well as some time that I've spent recently at CHIME, where he currently serves as board chair for that association. Scott, it's good to see you again.

Scott McLean:
Thanks, Steve. I'm happy to be with you.

Steve Lieber:
Yeah, excellent! One of the things that I wanted to spend a little time talking with you about is you do get out and about. I run into you regularly at events and such, and you talk with a lot of folks in the industry. And so, I'm curious as to what are people talking about, what are the things that are top of mind among CIOs today?

Scott McLean:
Well, I think we both know that in the last year, the advent of generative AI has been all abuzz. And I think particularly in the last six months of the conferences we've been at recently, Steve, that this has come into focus, not just about something that's a new technology that's all hyped, but also some real-world applications about it. So I think people notice in your everyday lives that your iPhone and Microsoft 365, these products have a bit of artificial intelligence in them, suggesting words and texts and emails and that sort of thing. I think where we're seeing more direct application in the healthcare space is I saw some really good presentations on generative AI being used for response to the EHR inbox and the patient portal, um, not to be let go with uh, only machine interaction, but only vetted responses then could be used to distribute and ease the burden on providers and other clinicians that are interacting. So we see that, I think we still see a large amount of discussion around data. Data are king and the organization of ourselves, and our data, I think, are key to what we want to accomplish, which is better, safer, more specific healthcare that can reach each of us as individuals and populations to make things better at a lower price. So we hear a lot of conversations around that. And then I think we all know that we are challenged economically in the healthcare provider space. We're challenged with having enough of the right professionals to meet the demands of the population as it ages. And so, I think you hear a lot about virtual technologies that will help assist the caregivers that we do have by having bunkers of experts who can add to the expertise of people in the clinics and on the floors that are taking care of our patients at this point. Lots of exciting things going on, I think the backdrop of all of that, and maybe we'll get to this is it's just economically very challenging amidst all to see here that.

Steve Lieber:
Well, we definitely want to get to that. But I want to start out and with the way you led was, uh, generative AI and just artificial intelligence, sort of the advancement of technology I often talk about. And you and I were there at this stage, some 15 or so years ago. We spent a lot of time digitizing data. It was for those listeners that go back, getting it out of paper and into the machine, so to speak. And now, and your second point about Data King, we're now trying to figure out ways to use it. We've got it digitized and talked about. We've seen the adoption of analytics tools. Clinical decision support was always about that data going in and doing something with it, creating algorithms and that sort of thing. So, what are a couple of examples that are real life at MedStar that you can share with the listeners here about how this stuff is starting to play now? Where are you right now in that journey?

Scott McLean:
Sure. Well, I think and I just want to note, as you said, that we spend a lot of time digitizing and I think we have to, as we look forward, also have to look back at what's been accomplished since the high-tech act in the US and really around the world of people valuing getting healthcare data digitized and able to to use it. We still obviously have a lot of bulk data that's not discrete. And there are better tools nowadays for reviewing that natural language processing and whatnot. I think specifically here at MedStar Health, we're focused on a couple of things. One is we want to embrace these new technologies, and with that, I'm referring to artificial intelligence in all its forms. And we know that there are some there's plenty of upside to that, and so we want to embrace it. But there's also some challenges that we hear about bias and the machines making up information and not being able to rely on it. So we're being careful about that. We're looking at policy and possibly some technical controls around it, but I think our environment is aware of the upside opportunity. So, we have various groups within our MedStar Health Research Institute and within our MedStar Institute for Innovation, that are looking at various pilots and how we can utilize these technologies.

Scott McLean:
I think what's hitting the ground right away is less in artificial intelligence, although that's in the background, is we've had some pretty effective use of telesitting to support our caregiving environments where we can use virtual sitters and we're working hard on piloting virtual nursing. Again, this would be to supplement the expertise of the people at the bedside with experienced folks who can deliver that. So we're using a series of technologies to interact with the patient in the room. And this is not just for the nursing care, but also looks to deal with patient education, with food service, schedule of the daycare team, all those kinds of things. And then I think you probably hear people talking about ambient speech recognition. We see we've got several pilots of ambient speech going on, and we see a lot of satisfaction with clinicians and patients around that. And I think that's those packaged tools that we get delivered from our vendors that have artificial intelligence behind them, is really where we're seeing the application today.

Steve Lieber:
Yeah. Well, let's pick up on several of those areas. You mentioned virtual tech, telesetting, virtual nursing. How are you making the choices here, not only in terms of where those are broad topics, but who, and I'm not looking for names in terms of what company or anything like that. But the process that you go through to decide what, where, when, who.

Scott McLean:
A critically important, especially given the limitations, the limitations on economics, but also in the time frames, we have to have successes in these areas and in terms of where in the organization, which clinical areas, that really depends on where the greatest need is in terms of where we might have difficulty recruiting nurses, or the challenge with finding the right people for doing sitting, but also the readiness of that clinical unit. Is it prepared to adopt technology to do the change, people change management, people and process change management, that's necessary? In terms of suppliers, we often look first to the suppliers that we're in biggest relationships with. I think that makes sense. Like most people, we have a request for proposal processes where we do scanning of the environment. We always have people looking at what the latest technologies are and who the suppliers are, and then we select down to a number that we think are most viable that can go through a proposal process. And with that, then like with ambient speech, for example, we're looking at several suppliers, a couple of which have been working with for many years with other products, and that helps us gain trust with them. And they've shown they've demonstrated commitment to working in our clinical environments and getting to know the specifics about our clinicians and how they like to go about things.

Steve Lieber:
So, as I've talked to folks about this, many have talked about different applications in terms of the different pieces of virtual care and technology. And what I also hear people talk about is a little bit of a concern about point solutions and then having to bring all that together. Have you got a thought in that in terms of are you headed towards platforms over point solutions to point solutions have to be installed first, and then you figure out the platforms, help us understand a little bit of that evolution that I think probably occurs through the process of adoption and use.

Scott McLean:
Sure. It's a great question. And as you well know, Steve, this this is ebbed and flowed over our years in healthcare technology. And I think where we stand now is the preferences for platform. I think your EHR and revenue cycle platform, I think we should be guarded to to quickly step away from those. I think that those companies that are delivering these solutions they can't do everything at once, right? But they're looking to provide integrated solutions that make it easy for our clinicians and administrators to adopt it. So, I think we're not quick to deviate from our EHR and frankly, ERP platforms that we've invested significantly in. And then there are just in this space there, just the EHR companies aren't necessarily there yet with that, with their solutions. And so whether it's their partnerships or ones that we find that we bring to them, I think we're able to find some point solutions that who knows how that will evolve in terms of integration, partnerships or acquisitions, that that may serve us well. But I think we do like to be very careful about these things, we want to make smart investments, we have an excellent data integration and extraction team that helps us with integration of various products. And like I say, I think it's a little bit of both with an eye towards moving to the platform in the future. And I think just even in the last five years, we see platform use in various areas; our ticketing system, just that we are bread and butter in IS we use for incident and for request management as a platform that has use in other areas. We are we've outsourced our infrastructure, I think people know. And so they have various technology platforms that help us be able to deploy technologies more rapidly and monitor them and take care of them.

Steve Lieber:
Great. You've touched on workforce a couple of times. One, in terms of that part of the economic pressures that that you're faced with. And we'll get to that part in a minute. But I want to touch on another piece you talked about in terms of where who's ready to adopt technology, what sort of strategies do you employ to get that input and to understand where the various clinical departments are, who's ready, how they're going to react to it in that sort of thing. What are your processes for making sure that you're getting that connection to the end user?

Scott McLean:
Sure. I think a lot of it comes down to relationships, and fortunately, we have a number of people. We have a large applications analyst team that works with our EHR and other clinical systems that have been at this for many years, adopting the EHR. And so those relationships with our clinical users are deep-seated. And I think it also helps that the organizations, and most organizations have done this now, have adopted a universal EHR revenue cycle system. So you get a lot of data from the EHR vendor, and how users are interacting with it, who might be doing well or struggling could use some coaching with it. So those that gives us data points about who to approach. And then it's our operational partners. You think about operational management, nursing leadership, physician leadership that have eyes on a particular discipline or clinic or hospital floor that may be doing well with a certain operation or may be struggling and could use help with a technology pilot. So those are some of the ways that we go about it. I think a lot of it has to do with relationship knowledge over the years on how various hospital or floor or clinic has adopted something. People who are technology champions that are in those areas who are willing to embrace and work with us as we go through the process right of planning, designing, building, and testing it, training people, and hopefully having a successful outcome.

Steve Lieber:
You mentioned clinical leaders, and that sends me now into a little bit of a different tangent on this question about input at a strategy level, is there a conversation that involves a group of people to start you off in a direction? Help us understand a little bit about before you ever get down to which clinical department, what's the process? What's the discussion? Who are the players, where the roadmap, if it's that formalized, gets established in terms of adopting new technologies like this?

Scott McLean:
That's a great question, Steve. And one of the reasons I think you and I have talked about this, one of the reasons I was very interested in coming to MedStar Health is governance. I think the organization's really well governed and organized well from a board and board committee standpoint. And then our MedStar Health executive team, led by our CEO, talks a lot about strategy, leadership and execution. And so that conversation in the president's the CEO's cabinet is really where that strategy comes to formation. And we get a lot of good direction from that group. So part of that group is our CMO, our CNO, our president of the MedStar Medical Group, our operational leaders for the hospitals and clinical and business areas. And generally, an idea around a clinical technology would come through our CMO, CNO, COO, who are all clinicians, our president of the MedStar Medical Group, if it's a financial issue, something that revenue cycle or something operational that has to do with administration, that will often come from our COO again or our CFO. And I think that those leaders give us significant focus and direction based on board governance. And then we have a leadership team of which I'm part of that helps, bring that strategy into execution. And that's how we are able to figure out where to go, as you say, who to work with, what technologies might be best, and really bring about a solution. So we're big. We're a $8 billion, 30,000 person organization, ten hospitals. So there is a lot going on at any given time. But it's very impressive how we can get significant direction and be able to.

Steve Lieber:
I really appreciate you bringing that governance into this, because it is, especially when you just missed the steps there on how big of an operation this is. You've got to bring some governance structure and order to things so that you're not all flying off in, in multiple different directions. Back to staffing, you and I've talked about this, the challenges in terms of staff burnout, satisfaction shortages. You talked earlier about using virtual nursing - virtual technology to help solve that. So over the past at least year or two, we've been talking about this. Are we getting into a better situation? Is it getting worse? And your challenges are even more difficult to solve for now than they were before. Where are we in this cycle around the challenges we all have with staffing?

Scott McLean:
Sure. I mean, on the one hand, it's a real issue. These are real things with, um, just regular employment. And then we know about the issues of shortages for various physician and nursing disciplines. And I think those are real put up against the aging population that happily, is living longer, we got to take care of people longer. So I'm generally an optimist, and I'm sure this varies by region of the country and world. I think, generally, people work in not-for-profit healthcare because they're motivated by the mission, and we have the privilege of being the largest healthcare provider in the nation's capital area. And I think people enjoy that mission, being part of an organization that is able to take care of people from screening through ambulatory to inpatient care and rehabilitation. So I think we enjoy people's good favor, by sticking to that mission and being able to have the resources because we, I think, navigated well through Covid. So we can do this. I just think it's getting a little bit better in terms of, obviously the post-Covid period, that was very challenging. I feel like the latter part of last year, this new year, people are writing a ship a little bit, just anecdotally, in their personal lives and energy for what we're doing. I think, again, we've got opportunity, right, because against the realities of the demographics, we are going to have to transform how we deliver care. And we have smart people who are working on that, not just us, but across the country and world. This is happening, and I do believe we'll come up with solutions. We have a history, a track record of being able to solve big problems, and I think we'll be able to do that. It's going to take time and money. And just like any big problem that the government or corporation is trying to solve, we have to remain disciplined at it and impatient about how long it's going to take. And we have obviously short, medium, and long term objectives to be able to meet them.

Steve Lieber:
One more problem I'll throw at you before we wrap up here. And that's financial constraints. Again, we've all talked about this, and I think going back to 25 years that I've been hanging around your crowd, we've been talking about financial constraints and cuts to budgets and that sort of thing the entire time. I'm going to test your optimism here in terms of what your outlook. How do you feel about the future in terms of industry wide? I won't pin you down at MedStar Health specifically, but generally speaking, what's the outlook here?

Scott McLean:
Well, again, I'm an optimist, I think because it's a big problem and I don't think there's an easy solution. I'm not sure single payer payment system is the answer or going further with what we have. I think one thing about it is that there's a lot of money in the system, right? And there is a lot of investment in healthcare, from the country's standpoint, it's one of the adages I've heard is that the wealthier we are, the more of any good we want. That includes healthcare. So Americans spend a lot of money on healthcare. I think that there's certainly opportunity for efficiencies, not just administrative efficiencies, but clinical efficiencies. And I think we're just beginning to scratch the surface of the opportunity with population management, with using the data, we have to appropriately test, appropriately, intervene, use the appropriate therapies and more personalized therapies. The more information we have about specifics on people and what interventions work. So I will always be optimistic about the opportunity that we have there. And it's partly why I keep working in this industry. And I would just add, Steve, also, we've heard a lot about social determinants in the last several years. And I think there's we know that there's so much about health that happens outside the healthcare system. And I would just say a theme that I've been focused on is really about reconciliation. I do a lot of work in my community, in church and in Baltimore, and conversations come up all the time about resources and opportunities that people can have to be well and stay out of the clinic, stay out of the hospitals. And so I think one of the things every organization has their we call it equity and inclusion and diversity. Our initiatives around that, we're starting to get our associates more involved in communities, right? And they're interested in people's wellness outside the hospital. It's a collective effort. I think it has a lot to do with how people treat each other, not just here at work and clinically, but in our communities and how we can be better all together.

Steve Lieber:
Great. Thanks. To wrap up here, Scott, our listeners are folks that are physicians like you and related. And we like to close with an insight. Your takeaway, the thing that you'd like to leave behind with the audience, what Scott's leave behind for our audience.

Scott McLean:
Sure. I would just build more on what I said about I think we have to be patient, right. Some of this American healthcare system is huge, and transformation of how we deliver care and taking advantage of the data and the opportunities, thinking about social determinants, that's going to take time and money, and we have sometimes acute things like Covid we have to deal with right away and we adjust to that. But I think laboring at this long term is what we need. And again, I think thinking beyond the healthcare system to how we take care of people in the communities and environment before they even get there is what I leave behind.

Steve Lieber:
Excellent, Scott, really do appreciate your time today. It is always a treat to catch up with you. I think maybe I'll see you at the end of February at ViVe this year.

Scott McLean:
Absolutely looking forward to it. It'll be great.

Steve Lieber:
Excellent, great. Well, again, 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.

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