Episode 22 : Future-Ready Healthcare:

SFTS_Lacy Knight.mp3: Audio automatically transcribed by Sonix

SFTS_Lacy Knight.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:
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. On this podcast, we discuss the smart directions healthcare companies and providers are pursuing to create smart care teams. Today I am joined by Doctor Lacy Knight. Doctor Knight is the Chief Health Information Officer at Piedmont Healthcare, joining the system in January 2020. As CHIO, Doctor Knight's focus is ensuring that the clinical technology is effective and efficient for clinicians, and aligned with the organization's strategic goals for quality, safety, and service. Doctor Knight has spent 20 years in the Northern Illinois Chicago area as a Chief Medical Information Officer, Emergency Services Medical Director, independent consultant, and emergency physician. Welcome, Doctor Knight.

Lacy Knight:
Good morning Steve. It's great to see you and be here. Thank you for having me.

Steve Lieber:
What I want to start out with, Lacy, is I did a little research on you beforehand and listened to a podcast you did just about a year ago at ViVE in Nashville, and you touched on a number of the themes that we're going to talk about here today, in particular, AI machine learning, data-analytics was something you focused on as well as some other things. And so what I want to do is, okay, we're a year later, and recognizing healthcare doesn't move in such a pace that we may see dramatic change from one year ago. But the question really is, how do you see things one year later? Are people talking about the same things? What do we know more that we didn't know a year ago? Kind of give us a view of the world that you've seen over the last 12 months.

Lacy Knight:
What I'll say is, last year there was a lot of curiosity, and AI and even automation were viewed as things that were an opportunity. So those that had the time and interest would go forward, and today it feels more like a burning platform. So if you don't have some dedicated effort to figure out how to take advantage of these types of tools, that you'll be quickly left behind. And I think post-COVID, one year is feels like an extremely long time. And I know that at least the way I spend my time these days, I spend a lot of time thinking about where we need to invest in different types of technologies. A lot more time than I was spending a year ago. Additionally, there's probably 100 times as many vendors and products in this space than there were just a year ago. So it's become a lot more difficult, and time-intensive, to figure out what are the right solutions for.

Steve Lieber:
You mentioned post-Covid, and I was just looking back in your bio, you joined in January 2020 at Piedmont, and clearly, the agenda you had in January was probably pretty different than what you were dealing with in March, April, and May. And that talk a little bit about what happened in that time period as it related to the technologies you were planning on working on and optimizing versus what really had to be done to take care of the patients of the day.

Lacy Knight:
I started with this mindset that I would have time to get to know the systems and the people and go out and visit. And very shortly after arriving, everything went remote, and certain functions that were, probably less essential to the day-to-day getting through the next wave of patients became available resources and expertise. And so, for me, I ended up meeting a lot of people that became available to help in our technology response to Covid, that I probably would have taken a lot longer to meet folks on the strategy team or marketing team that we were not actively looking at developing strategies in Covid, we're trying to get through to the next day. And really bright people helped us stand up our ambulatory virtual visit solutions, which allowed us to take care of patients without getting the patient sick or the doctor sick. I think most health systems were doing something like that, but our timeline would have normally been several months of planning for something like that, and for us, it amounted to about ten days to get something stood up. And then within the next, I think, 6 to 8 weeks, we had cycled through three other types of solutions to get to the platform that we're using today, with that. So that timeline, I wish, I would love to say that was a temporary mindset in terms of timeline, but what it taught us is that if we have focus on the things that we want to achieve, we can eliminate the barriers and the obstacles to to moving things forward. So I think that mindset has certainly stayed with us.

Steve Lieber:
That's an interesting point there, you made really two, two significant examples of the learning from the Covid period: one, that you can move quickly and all, and that it has remained the mentality. And you even mentioned the platform that you cycled through several variations before you landed on the one that really worked best, but is also the one you're using today. So clearly a very difficult, understated, obviously period. But out of it has come some things that really are continuing to show benefits to the institution, to patients, and to clinicians today.

Lacy Knight:
I think we figured out at least I think we figured out what we need to be prepared for the future. So the skill sets may be different, but you've got to be able to respond and think with some level of agility while also planning long-term. So I think one of the things I'm proud of with our response was that we knew that the first solution, the one we could get out the door in ten days, was not going to be sustainable. It was a little bit labor intensive for the medical assistants and for the physicians, and for the patients, but it was the fastest way that we could respond. And we knew that if we didn't respond quickly, then we were not going be able to care for patients in the way that we expected. But we estimated how much time our clinicians would be able to, and patients would be able to tolerate the platform and immediately started working on what the next improvement was going to be. And so I feel like these days, while everything's happening faster, we still have to maintain some sort of a long-range view so that the decisions that we might make quickly have enduring outcomes and benefits.

Steve Lieber:
Also, in looking at your background, I see reference a lot of experience with electronic health records and working to optimize their value, both for clinicians in terms of addressing workflow and such as well as patients and such. You talked a lot about various advanced technologies in terms of AI and machine learning. And so, how are you looking at the EHRs in relation to this? Are you looking to them to be the solution, or are they a platform in which you'll integrate other technologies? Where do you see and you may not even have a decision yet in terms of exactly where Piedmont is going on some of these things, and it may vary. So talk a little bit about that relationship of where we're going with what we've spent the last 20 years on, which is digitizing health records into the electronic health record.

Lacy Knight:
One of the probably the most unique circumstances that we're in with the advance advancement of these large language models and prevalence of AI, can almost call it, there's almost universal access. So if you have an app today, yesterday, you didn't have access to these types of models. Well, today, you do relatively easily, and most of the population has some familiarity with it. A few years ago, there might have been a few different types of companies that were really much further ahead than some of the other ones. And today, everybody's in the same bucket where they're trying to figure out as quickly as possible how to take advantage of those tools, and that means that everybody's learning at the same time. Health systems are trying to figure out how do we implement these types of technologies and where do we get the best benefit from them? While vendors, including EHR vendors and smaller ones, are trying to figure out how they can leverage it to provide the most value? And so we're trying to pay attention to all of it. The way we think about it is really to think about where we have the greatest challenges or the greatest opportunities that align with our strategies.

Lacy Knight:
And then we look for opportunities to address those. And as I mentioned, a long-term solutions that we may be able to implement quickly. And in many cases, the EHR is going to be the best thing for our clinical teams. They are already used to using the we're an Epic shop, so they're already used to using Epic. And so the upskilling that's required to be able to train our clinical staff is pretty small. We have the opportunity to build these tools into existing workflows so as to the extent possible, we're going to piggyback on our EHR and take advantage of the types of things that they're bringing forward. Some things very quickly, some things maybe not as quickly as we would like to see. And so that's where we may look to some other partners to help augment some of other systems. And I think additionally, the EHR is really focused on that patient care side, but the technologies have opportunities to improve non-clinical operations like our service centers for information services or HR service centers, and some of the operational efficiencies that we think are important to continue in the future.

Steve Lieber:
Early on in our conversation here, when we were talking about what's happened over the last year, you mentioned there probably hundreds of more companies today than there were a year ago in these areas. Creates a tremendous challenge for folks like you in tasked with the responsibility of addressing those problems that are identified or getting making sure you're in alignment with strategy and that sort of thing. You are having to make vendor selections. How are you wading through all of that with so many new entries into the market? And so let's just make the assumption, okay? An area has been decided because that's obviously the first part of this is okay; what is it we need to solve for? And then you start looking at the marketplace for who does that. What are some of the thoughts you have about how you work through that in narrowing down your vendor selection?

Lacy Knight:
I wish I could tell you that it was there was a science to it. It certainly is more of an art for us. We have lots of inputs for things, so we will maybe float a topic out, like clinical documentation is pretty, pretty prevalent now that a lot of different types of vendors are in that space. And a lot of, uh, my peers and other organizations are also looking at it. So, we hear a lot from physicians about companies we should be looking at. We hear from, uh, hospital operators, and there's a lot of information in the media. And so I think for us, we are trying to get really smart about these domains as quick to the extent we can. So maybe some rapid meetings with the types of vendors talking to peers about their experience with different groups. And then, we're at this place where we have to decide for a given solution. Are we okay with a series of really narrow market solutions? So they solve a specific problem really well. They go super deep into that versus do we want to go to a platform that might require a little bit more development or a little bit more time and more internal resources and upskilling to be able to get to that? I think for each solution, it depends on, probably the depth of expertise, some level of estimation around how much time do we have to figure it out. So for the clinical documentation piece, we know that healthcare providers. I have a lot of frustration and burnout related to documentation burden. So, for us, this is something that we have to figure out really quickly. And so it's not something that we are going to look to try to do some internal development or look for platform for those types of things. We're looking for folks that have specific depth of expertise in solving that problem that we can we may be able to implement very quickly and receive some benefits to the clinicians in terms of burnout.

Steve Lieber:
Really insightful because I've seen a lot of time thinking about point solutions versus platforms and really was headed in a little different direction, not recognizing the immediacy that you might have to solve a problem, in which case, okay, bring something in. Recognizing much as you did during Covid. This is not a long-term solution, but it's an immediate solution because we have an immediate need, and then we can take a little more time to move into that platform environment or whatever. That's really a good insight. You mentioned, have mentioned, several times conversations with clinicians. And so, how are they talking about the changing environment in terms of technology? Are you getting encouragement? Yeah, go out there and bring more in. Are you getting resistance? It's like, okay, we've got enough new stuff in here. Give us time to catch your breath. What's the mentality, the sort of psychological thinking that's going on at the front lines as it relates to the sort of things we've been talking about here?

Lacy Knight:
It's all over the place. There's certainly a lot of familiarity with it. I'd read something a couple of months ago, I don't know the current data, but that ChatGPT was only known by maybe 25% of the population in the world. I don't know what it is today, but I do know that almost every clinician I've interacted with is familiar with these technologies has considered it, those that are independent physicians may have implemented some of these things into their practices. And so there is excitement. I think there's a strong confidence that we need to be doing certain things to make the care of patients a lot easier. But I think there's also some concerns around data privacy and how that's going to work. There's some concern that organizations will implement technologies that are more disruptive and impact the kind of patient-clinician relationship, and these are all types of things that we are taking into consideration when we look for solutions and the ease of implementation, what the impact is going to be to the patients in addition to the impacts of providers. But I think it's, I would say, cautious optimism. And without question, the physicians and nurses believe we should be doing something.

Steve Lieber:
That's a great insight. And I just reflect back over my rather long career that at one time it was, I'm going to retire before I'm going to tackle this new thing you're bringing in, which was the electronic health record. We've got a change in that time. We really do have a change of generation among clinicians. Yes, there are some of my crowd still around, but I would expect that the, and I think you just touched on it, that there is a different expectation today than we had 20 years ago in terms of there are solutions out there in technology, and I'm expecting you to go out there and look, look at them and bring them to me and help me care for my patients better and even make my clinical workflows easier. And so I think the expectation, as you just touched on, I think really has changed, which I think is very positive for healthcare.

Lacy Knight:
I think it may even be different by different communities. So I think those that spend a lot of time documenting on paper before moving to electronic health record that didn't grow up typing might have a little bit more demand for these ambient solutions related to documentation. And those that are younger, that are digital natives, who perceive that they type really well, sometimes think that it may not be an advantage to them, but they might be more interested in tools that improve diagnostic accuracy, something that I haven't heard as much from those that have three decades of experience taking care of patients. So I think, what we're going to find is that we need a variety of different types of tools, and we are going to need to be able to accommodate a lot of different types of positions on this. And not everybody's going to like the same tools that we implement. They'll they'll fit certain populations but not others.

Steve Lieber:
Not a surprise. I mean, we are people, and we all have different places in our careers where we are at a particular time. And that I think recognizing that there are those differences probably helps you be more successful in bringing solutions to varying populations. You recognizing I have to message this in a way that my audience understands it and is willing to recognize and accept it. I think that's very insightful. One of the areas we like to touch on here is ambient technology. In terms of virtual care, virtual nursing within the facility, ambient monitoring sensors, and such. Where is Piedmont in terms of looking at this specific area in terms of where you're going with that?

Lacy Knight:
So I will tell you, a year ago, we were early in thinking about it, and now we were rolling out virtual nursing throughout our entire health system in our med surg units will complete that rollout at the end of the year, and we selected an option that would include the ability to use some sort of ambient technology. In order to do that, we think it's important in order to make life simpler for some of the nursing staff, is to augment their capabilities by having digital technologies provide some support or identification for patients that might be either at risk for falls or virtual sitting programs is something that we've been talking about. We're probably not as far yet as I think I'd like to be, but we are making technology decisions in a manner that allows us to think about removing some effort from on the part of the nurses and then augmenting their capabilities without overburdening them with a number of different types of alerts.

Steve Lieber:
In this area, going back to our earlier conversation about platforms versus point solutions, what was your thinking on this? Is this an immediate we needed a point solution, and we're doing that and we'll let it evolve. Or did you start out with we've got a little more time here, and let's think about it a little more enterprise systematically.

Lacy Knight:
This was something that we were trying to do both. So we did not perceive that there's a lot of time. The virtual nursing component is something that we brought in to address the nursing staffing challenges that are today. Um, and it's been great. Our early feedback in the three hospitals where we've started this has been very positive from both nurses and for patients. One of those things that hits all the different types of buckets we were looking at in terms of patient satisfaction, patient experience, understanding instructions, more accurate capture of the medication history, and then providing additional support for the bedside nurses that we think is going to long term, impact our ability to recruit nurses and help nurses stay at the bedside for longer. But we knew that we didn't want to just look at cameras, so to speak, because the technology was out there to do a little bit more. And so, we planned for things that we have not yet implemented, including the capability to provide remote or virtual sitting capabilities within these devices. So we made sure we have a pan, tilt, and zoom camera that can be used day-one for virtual nursing. But we also have fixed cameras on these devices that can allow for the virtual sitting component. And then we also selected a solution that has an ambient ability to do some early fall detection. Have not turned that on yet, but we're we know that that may be some of the beginning of this type of tool, but more will come. I think, once we start to figure out how we can leverage it and integrate it into the nurse's workflow, there'll be a lot of different ways that we try to augment the nurse's capabilities through technology.

Steve Lieber:
Well, we will want to come back to you in six months. And when you're farther down that path because it sounds like you do have some early results in terms of the impact that this is having, particularly on your clinical staff, which I know is a key objective with installing this type of technology as well as the value it has in terms of patient care. And so we'll be interested in hearing more about that rollout in terms of how it went and what you learned from it.

Lacy Knight:
Yeah, thanks. I will tell you, to date, we estimate that we've recovered about 1600 nursing hours from the bedside nurses.

Steve Lieber:
Excellent. And at this point, you're at what point of rollout of this in terms of how much of the organization?

Lacy Knight:
Um, we probably have, I would say less than 10% of our beds installed. So by the end of the year, we'll complete all of our medical-surgical units.

Steve Lieber:
To wrap up, we'd like to close with a very broad question to give the guest a chance to really share a significant insight. Our audience are folks like you, CIOs, CMIOs, CNIOs and such. And, what's Lacy Knight's big takeaway here to to share with our audience.

Lacy Knight:
So I'm going to mention three things that I will admit we're thinking about and still trying to figure out. The third item you've heard me mention a couple of times, but I want to reiterate it. So the first one is, with all these new technologies, we are trying to figure out how to develop organizational competency so that it's not a select group that understands the tools and the capabilities, but that it becomes a way of how healthcare organizations are just thinking about solving problems from the beginning in a way that we can leverage technology a little bit better. I think the second part that we have not figured out is the technical competency piece. So how much do we want to rely on outside parties versus how much internal technical expertise do we want to have? Because that will shift our buy versus build strategy for that. And then the last thing I think is really about the skill set of your leaders to be able to plan for long term so that you make decisions quickly that you know, are going to have lasting effects, but you're able to do that with some degree of agility and respond to the market and, and demands as you need.

Steve Lieber:
Excellent. I think those are three very valid points that apply in any setting as areas where we really need to pay attention and, and focus on. So Lacy, thank you for your time today. This really has been a wonderful conversation, very insightful. And you really especially talking about some of the things that you're actively involved in right now, I think really has great insights for our audience. I really do appreciate your time today.

Lacy Knight:
Thank you Steve, I had a great time and I appreciate you considering me for this excellent interview.

Steve Lieber:
Yeah. 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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