This Week Health

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December 22, 2021: Welcome to one of our End of Year Shows where you get to meet the team behind This Week in Health IT. Bill, Tess, Tracey and Holly take you on a journey through their favorite clips of 2021. Where does the EHR market go from here? How can health systems continue the 2020 momentum of innovation? How can you avoid tech debt? What could happen in Health IT if we Learned from COVID-19? How do you adjust your management style and expectations with the future of remote work? And what does the growing role of digital marketing entail?

Key Points:

00:00:00 - Intro

00:13:30 - Glen Tullman of Transcarent

00:17:00 - CIO Sarah Richardson

00:27:45 - CIO Zafar Chaudry

00:31:30 - Kristin Myers of Mount Sinai

00:40:00 - Craig Richardville of SCL Health

00:44:10 - Angelique Russell, Data Scientist

00:48:00 - Paula Edwards, Data Scientist 

00:49:00 - Epidemiologist John Brownstein


2021 Highlights from the Team at This Week In Health IT

Episode 473: Transcript - December 22, 2021

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Bill Russell: [00:00:00] Today on This Week in Health IT.

Kristin Myers: What we have learnt in the pandemic is it doesn't matter where you work. I think that our employees have choices. They could apply for jobs in Texas and still live in New York if they wanted. So we have to be competitive with that and while I want to hybrid work environment and I definitely see the value of meeting people in person. We need to be flexible because there are some employees who do you not want to come [00:00:30] back to the office. So we'll have to have that flexibility to be competitive.

Bill Russell: Welcome to This Week in Health IT. This is one of our end of the year episodes. I hope you enjoy. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff current and engaged.

I want to thank you again. In December we do a bunch of end of the year episodes.[00:01:00] I think you're going to enjoy them. We do two with our advisors. I did one just me talking through chronologically the news of the year, and then we're going to do two, one where my staff selects the best news day episodes from the year.

The second is you're going to get to meet the team and they're going to come on and talk about things. So this is one of those episodes. Before we get there though I want to remind you that for next year, we have some changes to This Week in Health IT. We're gonna have four channels. Four distinct channels on iTunes next year. We're going to have this week [00:01:30] health academy, this week health community, this week health conference and this week health news. So, if you are already subscribed to the Today show that will become the this week health news show, and you're gonna have the today show and the newsday show in there.

If you're subscribed to This Week in Health IT that will become this week health conference. And that's where we're going to have keynote. And we're going to have solution showcases and some other campaigns around specific topics. This week health academy is new. It's really [00:02:00] around education.

We're gonna have a show called insights in there where we take the highlights from the last four years and we break them down into 10 minute episodes. They're going to air three times a week. I would use this show to mentor people, to talk about what the various leaders in the industry have said over the last four years and how it relates to what you're doing at your health system. I'd also use it to bring people up to speed. If you hire somebody new into healthcare this is a great channel for that. And in this week health community is the channel where we're going to have guest hosts who [00:02:30] are going to tap into their network.

And we have CIOs. We have CMIOs. We have clinical informatics. We have data scientists who I've tapped on the shoulder and asked them if they would essentially interview people within their networks about topics that are a little closer to what you're doing on a daily basis. And we're excited about airing those channels. Again four new channels.

If you're not subscribed to all four of them, you're going to be missing some content. We'd love for you to subscribe to all four. Go ahead and hit [00:03:00] and there's information there on how to subscribe. You can also hit iTunes and search for this week health. Any one of those academy, conference, news or community.

And you can subscribe that way. And we would love to have you be a part of the community again next year. Now onto our show.

Well we turned our production meeting into an episode and today I'm joined by Tracey Miller Tess Kellogg and Holly Russell .The staff of This Week in Health IT. [00:03:30] Welcome to the show. Welcome to this side of the camera. I'm looking forward to this.

Tracey Miller: Welcome. Hi.

Bill Russell: All right. So, yeah, this is going to be fun. I get comments from this group all year about my mannerisms. How I play with my ring. My hands flying around on the camera and all those things. And I really appreciate the comments. It makes me feel better. It makes me self-conscious about what I'm doing while I'm on camera.

But it makes me better as a host. But today we're going to, we're going to turn the tables. We're going to put you guys in front of the camera [00:04:00] and it gives you an opportunity to see what it's like on this side of the world. I really see this as a mentoring opportunity. I've done all of your jobs at some point during the four years of the show. For the first two years, it was just me.

So I did, I did the marketing, I did social media. I did the production, I did all that stuff. And it gave me an appreciation for the things that you do today. I appreciate. It's just the sheer volume of the work and and the quality that you guys turnout every day. But today we're going to turn it around a [00:04:30] little bit and have some fun with it.

So we're going to start with a, with an intro question because the guests, the listeners may not, know you. So here's the intro question. Just share your name, your role at This Week in Health IT. Your experience with US healthcare. Brief experience with SU health care. And I'm going to put you on the spot and ask you to name your favorite guests that you have listened to so far on the show. And we're going to go in order of seniority. So we will start with Tess.

Tess Kellogg: [00:05:00] Hello. Hi, I'm Tess Kellogg. I'm the director of marketing here at This Week in health IT. This is my first role in healthcare. I've been a slew of other industries, so I'm one of those industry outsiders that comes on in. Which will be no surprise with whom my favorite guests are and people you're going to see in this episode. I love the episodes really that we did with SCL Health's Craig Richardville and the conversation they had around digital services and how health IT is evolving. So I'm excited to hear from them today.

Bill Russell: [00:05:30] Fantastic. Holly, you don't get seniority, even though you've been with the company twice in your history. Tracey, you get seniority because you have the longest running outside of tests. So, Tracey share those things with the audience.

Tracey Miller: Yeah, I'm Tracey Miller, I'm Producer. Production Manager and actually my first production job in New York, I arrived in 2014 and I was producing corporate videos for AstraZeneca and Bristol-Myers Squibb for their sales team for huge conferences that [00:06:00] they held. And then now yeah I'm back in healthcare on This Week in Health IT. And favorite guests.

I really loved John Brownstein. He's an epidemiologist. And Professor of medicine at Harvard. He's also the chief innovation officer at Boston Children's Hospital and just his insight on COVID and the pandemic are fascinating. I also really like Angelique Russell, who's a data scientist, so I think I'm into that whole data world.

I just find it so [00:06:30] fascinating. The predictive models and how people behave the way they do and what that means for healthcare.

Bill Russell: Yeah, absolutely. And so clearly you have an accent of sorts, so you're more familiar with healthcare from Australia. I would assume. Yes. Yes. Okay. Holly your name, role experience with US healthcare and favorite guests thus far.

Holly Russell: Well, my name is Holly Russell. I am the marketing coordinator here. So I do a lot of[00:07:00] the social media and all that fun stuff. I have been, like you said with This Week in Health IT before back when it was still newer, but I haven't really worked in healthcare very much. But I have a lot of experience I feel through connections, I guess is the way to say it.

I've seen a lot of the inner workings by living with someone who works in healthcare and seeing all that fun stuff. So, my favorite guests you'll see for my clips too. I picked Sarah Richardson. She [00:07:30] definitely edged out because I've met her before and we connected and bonded over makeup. But also I just kind of look up to her as a female CIO and she does a lot, she does a lot of work and she does some really good work for the entire industry so.

Bill Russell: And so a lot of people have met you because you have been the camera person at a, bunch of the conferences. So people might know you a little bit more. Tess, you've been on one of the shows. You came on the 400th episode which is [00:08:00] fantastic. And Tracey, you're going to be heading up our Insights show.

So people are going to hear that wonderful accent next year on the Insights show when we launch that. Here's what we're going to do. Most of your perspectives are as patients, right. As consumers of healthcare for the most part. And I love that. It gives us, you know, I think it's one of the things that when you become an insider, you start to see things and talk and insider ease, and you guys are gonna give us that that great outside perspective that we constantly need to be [00:08:30] reminded of. Here's what we're going to do.

Each of you submitted a few stories. Your favorite moments from the show this year, and what I'm going to do is I'm going to intro them. I'm going to actually play them. And then I'm gonna want the person who nominated the story to talk about, you know, why they, why they put that story out there.

Maybe we could have a brief discussion about it, and then we'll just go onto the next one. I think we have about eight or nine stories. So we'll, we'll go from there. The first story is actually one of my favorite interviews of the year and it was exploring the patient experience with Glen Tullman [00:09:00] of Transcarent. We did that in August. I interviewed him a couple times this year and in this clip, he talks about where the EHR market goes from here. And he has a unique perspective as the former CEO of Allscripts of where this market's going. So I'm going to go ahead and play the clip.

I want to ask you about the EHR market. Where does the EHR market go from here? Do we end up with like three players, four players running the entire operations of [00:09:30] every hospital system in the country. Or do you think we're going to see something different emerge? Is there going to be something that breaks out of the pack?

Glen Tullman: Well, first of all, I would be remiss if I didn't say thank you. You were an early client of ours at Allscripts. You were great in terms of not just being a client but you helped us make the system better. And so thank you for that. There was a lot of innovation that occurred with us working together and we appreciate that.

Where EHRs are today. So first of all, I think that electronic health [00:10:00] records were necessary but not a sufficient condition. We had to get all of the information electronically to take the next step. But the next step was about making the user interface much easier for doctors and other caregivers and on the backend using all this new information to create insights from the data just as we did at Livongo. The industry was moving along.

We had a 20 plus billion dollar [00:10:30] stimulus courtesy of the government. That allowed us to really accelerate adoption, which was critcial. We had to get that information, like trying to take the next steps. But then the industry kind of stagnated. You saw a lot of leaders, the most innovative people in the industry leave.

And so today what you have is electronic health records that are fundamentally big, dumb data repositories that they aren't an easy to [00:11:00] use. I mean, think about having spent the last six years in Silicon valley if you said to anybody, your system is so complex that you need a scribe to help you enter the data. Talking about Epic. They would look at you and say, that's the picture child for bad software. That it's so hard to use, that you need somebody else to operate it.

There's no other software in almost any other industry that's so hard to use that we [00:11:30] need somebody else to sit next to the terminal and use it. And so one, we didn't fix the front end and make it really easy for doctors to use and really valuable. And on the backend, we surely haven't used data science to say to doctors, here's three things about this patient to discuss with her, discuss with him. And here's the recommended treatments. You still use your judgment, but we haven't served that. So most doctors think of the electronic [00:12:00] health record today as a necessary evil, as opposed to a valuable tool. Like when we did e-prescribing at Allscripts eventually doctors understood, you should never write a prescription without drug to drug drug to pregnancy, all the interaction data and knowing whether it's on formulary and you could send it electronically to be filled. So there were no handwriting errors. Doctors grew to love that it was challenging early [00:12:30] on to pry their script pads out of their hands. But when I left, we were doing a few hundred million electronic prescriptions and that we knew saved lives and we knew improved the processes. And so did the doctors. They never had that same feeling about electronic health records because they didn't make them better and smarter.

So that's still coming. So what we're seeing is coming out of Silicon Valley there's [00:13:00] some leading companies. Trameer happens to be one of them. And what they do is they sit on top of an Epic or a Cerner or an Allscripts, and they are the apps layer. So they make it easy to write apps, to interact, to do all the things, to do the data science. So I don't think we're going to rip out the Epics and Cerners, but I do think all of the innovation is going to come around. It's not going to come from them.

Bill Russell: So there you have [00:13:30] it. Glen Tulman talking about the EHR. Tracey, you picked this one and nothing like starting with a nice, controversial one. Why, why did you pick this one?

Tracey Miller: Well Glenn Tullman, he's such an inspirational figure in healthcare. First of all, I love the name of his new company, Transcarent. It's basically transparent care.

I've had some experiences in the American healthcare system where I've gotten a huge lab bill, you know, a month later, in the mail. And I was shocked. It doesn't happen in other countries. So I do think [00:14:00] that the US health system has to be much more transparent and I really like his take on the EHR market.

It's obviously a huge topic right now. He calls it a big dumb data repository that isn't easy to use. He says most doctors think of it as today as a necessary evil, as opposed to a valuable tool. So it just has to get better. So I love his viewpoint that, you know, he's spent a lot of time in Silicon valley and he's not saying that Epic [00:14:30] and Cerner are going to be replaced, but the innovation that's coming from the valley is going to compliment the current platforms. So yeah, I really, I really like his thoughts and ideas on that.

Bill Russell: So you guys have each experienced the EHR. None of you have used it, but each of you has experienced it in some way. I mean, what's your, and you've also heard a lot of episodes about the EHR and its use on the clinician side. What's your experience with the EHR?

Holly Russell: I think it's funny because I live in an area where there's a lot of nurses. [00:15:00] I mean, there's a lot of nurses everywhere, but the first thing I'll mention is, oh, I worked for a health IT podcast and they'll be like, oh, I'm a nurse.

But yeah, we talk about things such as the EHR and they're like, oh, let me tell you about my EHR. Like immediately, like the first thing they want to talk about. And it's fun because I actually can join the conversation now. But yeah. I, I personally have seen some of those things in like, the telehealth visits I've had and different things like that.

The amount of times that I've had to say the same [00:15:30] thing to a one doctor that I already said to the doctor, I just talked to like a week ago. It's like, okay, this doctor sent me to you. Did he communicate anything with you? No. Do you have any information about me? No.

I've already given it to you. How many times? So when is it going to be accessible to each other? What's the point of giving you all this information if you're not going to have it?

Bill Russell: Right, right. And Tess, I'm sure you have similar stories.

Tess Kellogg: Yeah. Yeah. I mean a lifetime [00:16:00] of chronic pain management, very similar, where you are repeating the same things.

And what we'll see with the clip that we have coming up that I chose is when we talk about the difficulties with the EHR, you're actually talking about two different consumer groups. You're talking about the user experience on the end of the patient. And the pain points. I have friends as well as soon as you start talking about healthcare, I just sit back.

I don't even get to talk anymore. I just listen to what they have to say, but then you're also, you're dealing with the [00:16:30] people putting things into the HR and you're listening to the people who are experiencing the pain points without actually dealing with the technology. And being the patient.

Bill Russell: It's interesting cause you all give a patient perspective on it and I think that's, that's refreshing and important to the industry.

But I think if we had clinicians here and we tried to make the case that the EHR is a phenomenal piece of software you'd find some that would say, yeah, it is pretty phenomenal. We can do some things today that we couldn't do before, but generally you're going to get more of those conversations where they go, [00:17:00] oh man, it has a long way to go.

We still have a long way to go with regard to this. You know, we could rest on this one topic alone here. But we're going to move on to the next one. The next one, embracing the future of healthcare with CIO Sarah Richardson. And in this clip, what we ended up talking about is we created an awful lot of momentum in 2020.

The pandemic opened us up to do a lot of innovation, do it very rapidly. And a lot of health systems are very proud of what we did. And we discuss in this clip how to keep [00:17:30] that momentum going.

What do you think the lasting impact of the pandemic is going to be on health IT?

Sarah Richardson: I love this question because I created like six questions from it. And that's only because not to be annoying and answer a question with a question but it really got me thinking about some of the things we need to be prepared for because you know how are we actually accelerating digital engagement and digital health?

And I'm not just talking about telemedicine. Like what are the things we're actually doing that we're seeing are stickiness and, you know lifetime [00:18:00] value of some of the things we're bringing forward. What's really important is constantly planning for unknowns in that crisis management space and continued disruption.

We weren't very good about putting disruption in place, because you had to go through like 50 committees to do it. Some of the time you actually decided what you were going to do, it really wasn't disruptive. It was just like a relief to finally get it in place. You weren't even excited about some of the things that we're putting in place.

So you've got to create more of that startup kind of mindset and the ability for people to be like, good enough, gives us a [00:18:30] minimum viable product to test out and try and either do it or not do it. We would talk about it, but we didn't actually do it in a lot of organizations. There's always this hesitancy to disrupt things because disruption can actually lead to either it's not gonna be profitable or you're gonna make somebody mad or whatever reasons.

But I feel like we were able to ditch some of the bureaucracy around some of our decision making, but I think really it's how you make investments and changes in your IT workforce. And what does it look like over the next 24 months? [00:19:00] I've never met anybody in my company in person. Anybody. I interviewed on Zoom.

I work on Zoom. I have literally not met anyone face to face. And so how you can actually curate and build relationships. And how do you build trust when you've never met somebody in person? Like you don't get to break bread, you don't get to have a beverage. You don't get to go bowling yet. Do those things that you might do for team building.

We're getting there. I believe [00:19:30] if nothing else, that the lasting impact on health IT is our ability to be innovative and try things in a new and different way and not have to let bureaucracy and red tape be one of the dictations about how we are willing to try something. But also we have a truly distributed workforce and I worked in that environment for a lot of years, so I was comfortable with it, but now we really can say, we actually need somebody for three months.

Let's contract out this one piece of the puzzle or let's go pull this over here or [00:20:00] hey, we can be in 23 different States and be on the same team and get things accomplished and done because you're willing to go that extra mile sometimes because hey, so-and-so wants to go to their kid's soccer game and they live in Florida that's 2:00pm for me, 5:00pm for them, but they're willing to get back online at seven after the game is over before dinner. And it's like, you start to make these trade-offs because you're all trying to achieve the same thing, but you're getting to live your life at the same time.

And that's what I've loved about what's [00:20:30] happened is we all get to live our lives and do our jobs and create new opportunities to make things happen we couldn't do before.

Bill Russell: Holly, you chose this one and I guess it's because you haven't gone bowling with the entire team and that's what really resonated with you or is there something else?

Holly Russell: Oh yeah, no, it's the bowling for sure. No, I think it's really interesting. She talks about disruption in the beginning and I think healthcare fears disruption, which is understandable because unlike other companies where they might [00:21:00] just lose profit healthcare is a system where you lose lives if you mess up.

And so I understand the fear for disruption but Healthcare has to grow and change. Society is growing and changing. I mean, you do talk to Sarah who literally hasn't met anyone on her team in person yet. That is completely different than it was two, three years ago. And so we have to change and be able to adapt to these systems in the society that we have.

And I love [00:21:30] her innovative thought around it. And just the willingness to let's jump in. We've seen through the pandemic that health systems can innovate quickly. You know, in the past it's taken a long time, but the pandemic really pushed healthcare to say, Hey, we have to innovate now. And I can say like, telehealth visits, I did telehealth visits before the pandemic and I did not like them. It felt very much like, oh, get her on the phone, get her off the phone, give her some medication. It was like, okay, do you even know what's wrong with [00:22:00] me kind of thing. Versus I had to go to a telehealth visit during the pandemic and you could tell the difference. You could tell that they had put in processes that the doctor actually had read what I had sent beforehand. And when we were talking, there was a conversation versus just, Hey, let me get you a prescription and get you out of here. And so things like that are huge, that we can see disruption can happen in healthcare and it can be a good thing.

Bill Russell: Yeah, we're going to talk about the changing work environment and work from home in a [00:22:30] later clip. So I'm going to leave that topic for later. Cause essentially on this call, we represent four different states. We've been together from time to time, but at the end of the day for the most part we've been apart. And this is a probably atypical Zoom call for health systems and health system leaders these days.

And it was striking to hear that as a new CIO, she had met very few people within the organization, if not most of the people that she interacts with on a daily basis. All right. The next one [00:23:00] is about human centered design to improve experience.

So, Holly, you've mentioned the experience a little bit and Tess you picked this clip out and I'm going to go ahead and play it real quick.

Human centered design advocate. What is human centered design? Why does it need an advocate and where does it come into play in healthcare?

Paula Edwards: So my PhD is actually in human integrated systems, which is about how do you design systems that have people and technology working together to accomplish a [00:23:30] goal? And human centered design is what a lot of the methods and tools that are used in that space to make sure that you have your end user front and center at every stage of trying to design your system so that you make sure that it's going to work efficiently and effectively for the intended user. So a lot of what you hear now with user experience has a lot of its foundation in human center design methods. And a lot of what you see in agile methods is actually very much founded [00:24:00] in some of the user centered design methods. It's how do you get your user and those key stakeholders involved early and often through the design life cycle so that they can provide input, tell you where you got it right. Where you got it wrong. Really provide valuable insight into the context in which the system is going to be used. And I think your question about why is it important in healthcare? I think electronic health records are the perfect example of why we need more user centered design in [00:24:30] healthcare because the early versions, the early iterations of the current generation of electronic health records really did not use user centered design methods when they design their systems.

And once you have poor usability baked in, it's really hard to recover from that. So that's why some of the usability is so bad there.

Bill Russell: Wow. That gets us right back to where we were before isn't it? On the EHR usability. Tess you chose this one, give us, give us a little rundown.

Tess Kellogg: Right? Of course, as a marketing professional in a healthcare [00:25:00] world, this is something that appeals to me greatly. Right. And it's interesting because I own UX UI in our organization.

I work with people to make those things happen and thinking about how when it comes to tools, successful tools for humans are not happening in a silo, but iterating within teams and getting feedback. And I think it's a propensity, not just in healthcare, but in a lot of different industries to say, this is the way we've always done it.[00:25:30]

Or to get sunk cost fallacy, and think we've developed this tool. And therefore we have to, you know, shove it in and getting it to work. You know Square peg round hole kind of situation. And when you actually are collaborating with maybe it's your clinicians, maybe it's garnering patient feedback, whatever it is actually understanding how those touch points go through to completion if the technology is successful is what allows IT to alleviate pain points within their health [00:26:00]system instead of add on to them.

Bill Russell: You know, we, we talked a lot about experience this year. It came up over and over again because organizations are finally recognizing how important experience is. We always recognize how important it was on the campus.

Right? So we had greeters and we built phenomenal, beautiful buildings with nice spaces for people to wait and that kind of stuff. And then it started to permeate the digital conversation because so much health went digital [00:26:30] over the last year and a half, and people realize, Hey, you know what? This experience doesn't match the billion dollar campus that we just put up with all the amenities and whatnot, and we had to step back, but that's a, that's a different set of skills isn't it Tess? I mean, to really look at the digital experience and gain the feedback from the user and redesign it. I mean, that's a different muscle that we have to develop within healthcare in order to do that effectively.

Tess Kellogg: Yeah. And I think it's something that's been developed across all [00:27:00] industries. It's not something that just healthcare has struggled with. I mean, you're looking at sit down restaurants that started doing takeout over the past two years. They're not fast food restaurants. They never had, you know, Uber eats going out, but now they do. And so maybe they had those foundations in place that made that adoption quicker and easier. But maybe healthcare being behind the eight ball before COVID-19 is now playing catch up a bit more seriously.

Bill Russell: Yeah, well, Tracey, this next one kind of surprises me that you picked this. I'm gonna go ahead and play the clip.

It [00:27:30] sounds like movement to the cloud, application rationalization. You're really trying to avoid tech debt. Do you measure tech debt and try to eliminate it? Is that a goal?

Zafar Chaudry: Yeah because I think what people fail to do in the healthcare IT space is if you've got seven, eight, 900, a thousand applications, how often are you reviewing those applications for updates, upgrades, bringing it up to the right version?

You don't. You tend to run some software for a really long time and then realize it's either [00:28:00]out of date or the company was so small that there was three people hanging out somewhere and you can't find them anymore to even provide support. So those systems then generate what I would call that technical debt.

You know technically I've got 788 systems that require some sort of upgrade every three to five years. If I don't do that, then they will age and they will cost me more and more to support. And in some cases could fall over and I can't support [00:28:30] them because the vendor isn't even providing support on that particular version.

So yes. I think you have to look at that. But going to a board and saying I need funding to refresh 700 plus systems isn't going to be viewed as at the top. Well, you know, it's important, especially for the clinical system, but at the same time that price tag is so astronomical that people tend to avoid that.

And it really depends as a person leading a group of technologists, it really [00:29:00] depends how long you're in an organization for. Right. Because if I was in my organization and I changed my role every two years, that I probably wouldn't have to worry about that refresher systems. But if you stick around long enough, then you have to own that system, refresh and work with the clinicians to do that. And every refresh turns into a sort of mini major project.

Bill Russell: Zafar Chaudry. Dr. Zafar Chaudry. So Tracey, I'm really proud that you selected a clip on tech debt, but why did [00:29:30] you select that?

Tracey Miller: Everything's so complicated these days in a digital world. And I think the healthcare industry, you know, having 900 applications in one health system is insane. How did the doctors and nurses keep on top of that? But I do think that healthcare is very reactionary so they don't often have time to delve into, okay which applications do we need? Which ones avoid? Obviously there's another whole thing about contracts.

What contracts do we still have open? So I [00:30:00] do think it's just really important for healthcare to simplify. And like Tess said, you know, they're playing catch up. COVID-19 really accelerated that catch up. But I think if they're still going to have thousands of applications, then it's just going to make that process way more complicated.

Bill Russell: It is a significant number of applications and we've all personally experienced tech debt. Right? So at some point you're sitting there going, why can't I connect this phone to this computer and the phones [00:30:30] only what, four years old or whatever, or the cable doesn't work or that kind of stuff. Well, you multiply that out by a thousand applications across 16 hospitals and it becomes a very real problem when people are saying, Hey, look, I want my information to go from here to here.

And I want this to happen. I want all these things to happen. And at some point. What you run into is that tech debt. You run into that old piece of hardware that's not giving you the information you need. Or you run into that old interoperability framework that you can't move the information [00:31:00]around.

And the thing I love about just having that as one of the is you know, I, I think people recognize when you go to a hospital that there's somethings amiss here in the back office. Like we're still doing things by fax and whatnot. Something's still amiss. And I think that kind of clip for those people who aren't in healthcare, they go, oh, okay.

I get it. There's a lot of old stuff in hospitals and that's, what's leading to the some of these things. All right now, we're going to get to work from home a little bit. [00:31:30] And I look forward to this clip from Kristen Myers.

Talk to me about adjusting maybe your management style or your team helping them to adjust their management style with work from home. This is very different meeting people in this format. Very different than meeting in a room and the energy that can get brainstorming ideas and meeting and going out to lunch and those kinds of things. So how did your team adjust from a management approach?

Kristin Myers: Yeah, I think that the key to remote working is really communication [00:32:00] and being transparent and making sure that you're available to your team. And checking in with them and making sure that everything's okay, that they're not struggling. I think that a lot of things happened last year, whether it was the pandemic, I mean people were impacted by the loss of loved ones. We had social upheaval. I mean, there was so much going on that it was very stressful for many of the [00:32:30] team members. So I think as managers making sure that we checked in with them constantly I think is important, but being transparent, communicating, I think always important, but doing it more frequently.

Bill Russell: It's interesting. I was just reading a study. Microsoft came out with their annual study on work and the work trend index for 2021. And it predicts that 41% of workers are considering leaving their current employers. When you hear those kinds of statistics does [00:33:00] that create concern for you or do you feel like you're on top of the retention aspect?

Kristin Myers: No I think that what we have learnt in the pandemic is it doesn't matter where you work really. And I think that our employees have choices. They could apply for jobs in Texas and still live in New York if they wanted Or move wherever they want to and work at any facility in the country.

So we have to be competitive with [00:33:30] that and while I want to hybrid work environment and I definitely see the value of meeting people in person like I did even today. We need to be flexible also because there are some employees who do you not want to come back to the office and want to continue to work remotely. So we'll have to have that flexibility to be competitive.

Bill Russell: We're going to have to have that flexibility to be competitive. Talk about why you selected that one. [00:34:00] Holly.

Holly Russell: I think for me, it's just the idea that. I mean, once again, you have a CIO of a large health system in New York, and she talks about making herself available.

Talks about making herself transparent, and I think anybody who's had a boss ever can relate to the fact of feeling miscommunication from their boss, feeling like their boss, isn't telling them everything. And yet you see that she took it very seriously to include her [00:34:30] team in decisions, to communicate with our team and be available with our team and also be flexible for her team. CIOs have a million plates that they're juggling, but to have that mindset of understanding that humans are human. Everyone is different. Everyone needs different things. And to be able to have that flexibility for people to, you know, take care of their children in the morning and then hop on the meeting later, or take their family somewhere or take care of a [00:35:00] doctor's appointment or anything like that.

Even Sarah talked about it in her clip, like being able to have that flexibility just addresses the fact that humans are not robots. I am not a person who wakes up at six in the morning and works really well versus Bill, I know you work at 5:00am and it's great for you. So we're not both working at the same times, but remote work allows it so that when I wake up and get your emails, I'm able to respond and work at the time that I need. And that works so much better. I [00:35:30] think it brings the productivity to a higher level.

Bill Russell: So what's been the hardest thing. I throw this out to the three of you. What's the hardest thing of working remotely. I assume you've all worked in an office environment and now this is pretty much a remote environment where even if I had an office, we wouldn't, none of us would go to it.

We're in four different states here and the other people Michelle's not on this call and she's in another state even even further. So, but you've been in, in those environments, the office environments. [00:36:00] What's been the hardest thing of adapting to remote work?

Tess Kellogg: So my position before this, I was in a role where my boss joked about us being chained to our desks, because it was a role where if you were not sitting at your desk, you were not seen to be performing, correct, like being able to perform your role.

And so it was very jarring for me, maybe coming into a position like this, where Bill, we start off in the same place. We had some meetings in person, and then you flew off to Florida. And eventually I flew out to Ohio and [00:36:30] now we're at least at the same time zone. But the biggest adjustment, especially before Tracey joined our team and now obviously we're even bigger of a team, was you're no longer getting those touchpoints consistently checking in. You maybe, if you have one, depending if you're in an agile environment, how many calls you have a day, but it might be something where you feel like you can't just pop on over to your boss's office if you have a question. Something I was in the habit of doing like 15 times a day at my previous role. And [00:37:00] no offense, Bill, you don't text back very quickly. , it is something, something that I've had to grow as a skillset, but also as our team has grown the amount of people that are there to collaborate with, give feedback, allow you to make sure you're going in the right direction and have an area of expertise that might be more refined than what mine is. That's definitely helped.

Bill Russell: It's interesting. I mean, you talked about the manager saying chained to the desk kind of thing. And you came from an old school industry just to be fair. But th e, the role of [00:37:30] the manager became so critical during the pandemic, the communication, the touch points that you talk about became so critical.

And then the culture changed pretty dramatically. Even in our organization. It was me by myself for about two years. You and I really doing this thing for about a year of just you and I going back and forth, constantly talking, texting all that. Then we added Tracey and it added a little bit different dynamic.

And then just in the last couple of months, we added two more people and[00:38:00] that cultural change We have to always be thinking about the communication channels, always thinking about how we're going to be doing those touch points, making sure you have the information you need to be successful. And also just having those personal touch points where, you know, you know, that you're valued by the company you're valued by whoever you're reporting into and all those things are so important.

Anybody else want to comment on that? I tend to cut these things off in the interest of time, but you know, what else has been [00:38:30] really hard about working remotely do you think?

Tracey Miller: I think what you said, our team's good at, we kind of know what is going on in each other's lives, not to a really personal point, but you know, we know if we're going on vacation or your wedding anniversary is coming up.

But I've worked in offices for years and years. And I have to say, my closest friends are from work. You know, in New York, I would say 60% of my friends I've met in offices and, you just develop this incredibly strong [00:39:00] bond and you go out for lunch together, and if you're stressed out, you can grab them for a coffee or in the hallway for a hug or a chat.

So, you know, that in-person is invaluable, but I personally love working remotely. I do love the freedom, but I do miss that deep, deep connection that you get, even if you just wink at someone walking to get your coffee. It's yeah, it's an amazing experience.

Bill Russell: And you've had some interesting jobs, but we will save that for another episode at other time. All right Tess we're going to go on and [00:39:30] we're going to hear from Craig Richardville.

You're not the first to talk about the relationship between the chief marketing officer with regard to digital. So talk a little bit more about how you organize. You have a steering committee or a governance group. Is this part of IT or did you keep it separate from IT? Is it highly integrated? What does it look like?

Craig Richardville: Well, I'd say the culture here is very collaborative and we don't really draw a lot of different lines, but so the way that we've brought this together was really just sitting down and wanted to make sure that it was a focus of the [00:40:00] work.

And so we created a steering committee. It's a digital services steering committee. Salesforce, for example, is a component of that steering committee. And then what we did is we looked at the different resources that we had in the company. And we brought all the resources together. The human resources and the budgets go along with that.

And we put all that into one area and move that into IT. And so an actually we changed our name from IT to ITBS. So we're information technology and digital [00:40:30] services. And with that what we did was we didn't add to our current investment. What we did was I repurposed positions, several different of our administrative positions created an opportunity for a digital vice president position.

And then we filled that position with somebody from the outside to come in to lead that now newly merged team that's coming together. But when we look at the steering committee that we've put together, there's the person there that's for communication. There's a person there that runs marketing strategies [00:41:00] there.

Some of our operational groups are there, so it really is a very multi-disciplinary group coming together. All for the purposes of digital services.

Bill Russell: It's interesting cause this has come up a couple of times this year. Marketing has taken a more prominent role in healthcare and it's done so for a couple of reasons. One is we're interacting more directly with our consumers. And then the second is we had to figure out how to get information out there and get people in line to get a vaccine.

And [00:41:30] we started looking at the marketing people have said, Hey, thanks for buying those billboards at the baseball stadium. But gosh, we have to do so much more than that now. How are we going to actually get people in line for this vaccine? And I assume you picked this because you're a marketing person and you appreciate the fact that marketing is taking an elevated role in healthcare.

Tess Kellogg: Well, that's definitely a part of it, but to quote the John Halamka quote that rolls at the beginning of our YouTube channel, which all of us on this call have heard so many times. The role of the CIO has changed totally. We were software [00:42:00] developers. We could tell you how much Ram to use. Do you think any of that matters anymore?

John Halamka said it, not me. It is so interesting to me to see how digital has started to have this umbrella that encompasses the technical IT technologies, as well as some of the marketing initiatives that a healthcare organization has to undertake. But the point that stuck out to me the most about what Craig talked about is that he looked at his company and saw who had the skills to help build this team [00:42:30] and reworked them into roles that were going to be useful for the new direction of the company. Not to say that healthcare is the only company that struggles with seeing outside players as bogeyman that are coming in to take the jobs. That outside talent or hiring outside the industry, oh, they can't understand us or they're going to come in and displace people at my company who I care about. Being able to rework and identified that talent already within your organization and then maybe finding one person who's going to lead [00:43:00] up that, which is what I believe they did at his health system is they bought a VP of Digital Services to come in from outside the industry, and then manage the team that already understood their health system already understood the challenges, but was able to utilize a new skillset in this new direction that the health system had to go to find success.

Bill Russell: Yeah, Craig is a really innovative leader and I love the way that he has brought all those things together around digital services and and making all that work. So I want to keep going, cause I want to get to some of these clips. This is Angelique Russell.[00:43:30]

All right. I want to talk some data science concepts with you. Since I have you on the line, you wrote an article you said model drift, concept trips, historic time bias when working with healthcare data to train predictive models. It's always prudent to have an extra hold of recent data to make sure the accuracy is the same across time. Help us to understand those three concepts and what you're talking about about holding some data back.

Angelique Russell: Yeah. Healthcare, so when you're doing predictive analytics in healthcare, there are two signals that you're picking up on. [00:44:00] There's an individual is like a biometrics, right? Like you might think of your vital signs as revealing that you're going downhill or declining. And your lab values can be that way, but there are also a number, there's an overlap there. So there's your vital signs. And then there's your lab values. Your lab values actually overlap with the treatment domain, right? Because a physician making a treatment decision is going to order lab values to monitor the effects of that treatment and also to [00:44:30] confirm the justification for that treatment.

And once you get into the treatment domain, this is very subjective data. Based on how you are being treated, you will have a different data set. So if we're talking about sepsis and it was pre 2011, I think it was there were others drugs that were on the market that were pulled from the market. Xigris I think, just fell out of my brain, but there was a big change [00:45:00] in treatment in 2011. So treatment decisions that might predict in your algorithm would no longer predict after that point in time. And that's just, that's one big decision, but treatment guidelines and order sets, which are how a health system or a hospital standardizes the treatment that patients receive these change all the time.

And these changes can result in and drift in your model if you're [00:45:30] detecting decisions, treatments, labs that are no longer available after a certain point in time, your model might be really predictive when those indicators are available and then drift. There is also another example I gave in that post of historic bias related to just general scientific knowledge.

And we could see some of this in the COVID pandemic. So early in the pandemic, we believed we were having [00:46:00] a very bad flu year. And the very bad flu year myths continued long after we knew that we were in a pandemic because we didn't have testing available. If you recall, there was a real strict criteria for who could be tested for COVID.

So even among hospitalized patients we were never really quite certain who had COVID and who had a bad case of influenza in the beginning until the patterns emerged and became just very obvious to the care teams. So there was an [00:46:30] inflection point after that we kind of knew just looking at a CT who has COVID and who doesn't have COVID with severe pneumonia, but there was before that point, we didn't know. So the data was frequently mislabeled. We had cases that looked like COVID, but were labeled as influenza. Influenza is not always tested. So there isn't always a confirmatory test to rely on and that mislabeled data can send [00:47:00] all kinds of wonky signals if what you're trying to do is for example detect COVID.

Bill Russell: Man. I love that episode and I love that episode because it followed the other episode that we did with Paula Edwards and you know, Paula Edwards is a brilliant data scientists, and then you had Angelique Russell in back-to-back episodes. And I thought that was just great indication of what women are doing in healthcare.

And we talk about the fact that in a lot of rooms that we go into [00:47:30] in healthcare, especially in the technology rooms, it's mostly male. But in this case, what we saw is two phenomenal minds, really taking healthcare forward. Tracey, you pick this one. Why did you pick this one besides a great last name?

Tracey Miller: Yeah, again, just data science fascinates me and the way that it can change dramatically in healthcare. With COVID obviously they didn't have the resources for testing or didn't know what the symptoms were. So it's obviously unraveling. But it's pretty [00:48:00] incredible once they finally do figure it out what it can detect what it can predict. So I just, I just find this topic fascinating. I don't completely understand it, but I'm learning.

Bill Russell: Yeah. I'm going to skip to the last one in the interest of time. It's John Brownstein.

Five years from now what will it look like if we take these lessons and apply them well? And you can talk about any of the different areas in terms of surveillance, in terms of public health or that kind of stuff. What will it look like in five years? If we learn the right lessons?

John Brownstein: Well, [00:48:30] listen, I think that we have to do it a better job of investing in the public health workforce. Clearly we have seen major gaps in sort of talented people that can respond. That public health departments are severely underfunded and resort under-resourced. I mean, we're expecting public health departments right now to maintain surveillance and efforts. But while at the same time now roll out a vaccine. It's it just doesn't work well. I mean, I understand the need to have [00:49:00] distributed and local based public health, but this level of distributed effort, it creates so much dysfunction and unevenness of resourcing in terms of public health.

So hopefully some of the new supports that's coming in at the federal level will help to even the playing field. I think that, of course we need to strengthen our ability to respond to, to global threats. Over the last several years, we've had significant underfunding of efforts. I was part of a [00:49:30]project funded by USA ID to look for novel coronaviruses in populations. And that project was defunded last summer. So bad timing to defund a novel coronavirus surveillance project, right before a pandemic, but that happened. And so hopefully some of these larger efforts that are involved in sort of field-based surveillance, identify new viruses or efforts that are above strengthening global public health surveillance.

And then I think at a federal level there's this hope and a push right now to invest in sort of a [00:50:00] national disease forecasting center, which apply the same with the principles from weather, where you're tracking, where you're both now casting, but also forecasting. And in this case it would be diseases.

What is the outlook and how do we bring the discipline of disease surveillance and modeling and bring that to a federal level where we have full visibility on what is happening across the wide spectrum of pathogens. I mean, the likelihood that we're going to see another pandemic is significant.

Who [00:50:30] knows what the timing will be for that, but hopefully core sort of underlying resources will come to sort of make sure that we are ready. And then again, then the last thing I would just mentioned is diagnostics. We have not done a good enough job to fund and develop at home rapid connected diagnostics that can give us that quick view of what's happening on a population level. Those are things that we should have been implementing years ago. And, I think there's real technology that could be put out.

Bill Russell: I have to appreciate [00:51:00] John Brownstein, if nothing else, for the Fauci pillow behind him, which is one of the more interesting backgrounds that we had this year. You know, final thoughts. You know, those are the clips that you guys selected. I appreciate you pulling those clips together. That's a great cross-section of some of the conversations, the diversity of the conversations we had And just the, the great experts that gave their time to the community. So I appreciate you selecting those. I'm just going to go around last, last comments. Any of you to, to close out the year.

Tracey Miller: I think [00:51:30] that healthcare has come a really long way. And I think, there's a lot of negativity on the industry, but I think we really have to applaud how far it's come just in the last year and a half, two years. It's been incredible.

Tess Kellogg: And I think 2021 was going to be a very telling year because 2020 forced us to innovate, to accommodate in ways we would not have thought ourselves ever needing to. But in 2021, we proved that not only are we not going to snap back, but we're going to have to continue to do innovation [00:52:00] to accommodate the continued pressure's on health systems. So I think going into 2022, we can expect only continued momentum instead of diminishing.

Bill Russell: Holly, anything to add?

Holly Russell: I think my final thought was, I think it's interesting that none of us picked any clips on interoperability, because that was something that was probably talked about most, I feel like this year. But I mean, in that idea, Both Tess and Tracy are correct. Like healthcare has made giant [00:52:30]leaps in the past two years. It's really exciting to see the conversations that are happening and know that there are people in healthcare right now, seeing these problems and addressing these problems, not just sitting back and letting them happen.

Bill Russell: We did have a clip on tech debt. We didn't have interoperability. We did not have cybersecurity. So very interesting that no one pulled a clip on cybersecurity. Although we did cover it pretty in-depth on the news day. end of the year clips. I want to thank you [00:53:00] guys. We couldn't do this without you, and really appreciate all the work that you've done this year.

And looking forward to next year, we're going to do some really fun things with the new channels and look forward to sharing that with the community. Again, thank you. Thanks for doing this show. I know it's not in your comfort zone and I appreciate you coming out of that to share your thoughts with the industry. Thank you very much.

What a great discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your [00:53:30] team, your staff. I know if I were a CIO today, I would have every one of my team members listening to this show. It's conference level value every week. They can subscribe on our website or they can go wherever you listen to podcasts, Apple, Google, Overcast, which is what I use, Spotify, Stitcher. You name it. We're out there. They can find us. Go ahead. Subscribe today. Send a note to someone and have them subscribe as well. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health IT [00:54:00] leaders. Those are VMware, Hill-Rom, StarBridge Advisers, Aruba and McAfee. Thanks for listening. That's all for now.


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