This Week Health 5 Years

March 15: Today on TownHall, Brett Oliver, Family physician and Chief Medical Information Officer at Baptist Health interviews Aaron Miri, SVP, Chief Digital & Information Officer at Baptist Health Jacksonville. What are the most exciting healthcare technologies out there right now? Everybody is doing retail medicine, so how do you make a patient feel special instead of one of millions? Does your organization have a blocking and tackling approach? Do they focus on talent and leadership development? How do technologists put solutions out there that make sense and transact the business in a safe, secure and friendly manner? How do you convince clinicians to change a workflow with a new technology that you're convinced will make a difference for them?


Today on This Week Health.

What the past 24 months have done has really shine a bright, bright spotlight on the value proposition of information technology. And not just being a transaction based organization. Keep the lights on, make sure claims go through, make sure there's a medical record. But really how do I drive the business. And how do I reinvent the business on a dime and react quickly to changing conditions every day on the front lines.

Welcome to This Week Health Community. This is TownHall a show hosted by leaders on the front lines with 📍 interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels designed to amplify great thinking to propel healthcare forward. We want to thank our show sponsors Olive, Rubrik, Trellix, Hillrom, Medigate and F5 in partnership with Sirius Healthcare for investing in our mission to develop the next generation of health leaders. Now onto our show.

I want to welcome everybody. I'm excited to have Aaron Miri as our guest this week. Aaron is the Chief Digital and Information Officer at Baptist Health, Jacksonville in Jacksonville, Florida. Aaron, thanks joining me today.

Thanks so much for having me Brett. Good as always seeing you. Especially a sister institution with Baptist health, Kentucky.

That's . That's . Which we probably should say we have no. Yeah. There's no affiliation. Organizational relationship other than the name.

Yeah, besides being really guided by a principle, a guiding principle, which is phenomenal. Something bigger than what you are. And it really is a good, true north. I think that's what orients good organizations is belief in that and true mission resounding efforts around the samr things.

Very well said, and I shouldn't have been so flippant with the name cause you're there, there are some guiding principles that are key to our organizations. Well, let's just jump . What I want to know from you and we're friends, but if I had a chance to sit down with you and talk would be technology wise, and what's getting you excited now. I mean, we've just come out of, or hopefully coming out of COVID and some more difficult times. And I'm excited to bring my colleagues in my organization, new technologies that will help.

So maybe talk about things that you guys maybe are implementing now and some things that are on the horizon that you see that really get you excited.

Yeah, it's a super exciting time Brett. And I think, especially in healthcare IT what the past 24 months have done has really shine a bright, bright spotlight on the value proposition of information technology and not just being a transaction based organization. Keep the lights on, make sure claims, go through, make sure there's a medical record, but really how do I drive the business. And how do I reinvent the business on a dime and react quickly to changing conditions every day on the front lines that you know, you and your colleagues are suiting up in N 95 masks and going in and intubating and doing the things you got to do.

So how do we, how do we, as technologists, as digital nativists help, , putting solutions out there that make sense and then transact the business in a safe, secure, friendly manner. And so a few things that we're doing and a few things I'm contemplating. So a few things that we're doing.

Number one, everybody is doing retail medicine. I'm actually tired of the terminology because it's actually part and parcel for what's expected now by the consumers, which is a low friction, high touch, I feel valued and secure relationship with my primary care provider or my specialist provider as a patient.

. So how do I not just feel like one of a million, but I feel special. That this pizza was made just for Aaron, ? That is important. And so that takes every bit of consumer relationship management technique and thoughtfulness and process and partnership with marketing that perhaps wasn't existed before.

Number two, blocking and tackling. How many organizations have we see over the past 24 months that could not pivot to a full telehealth model? That didn't have the capabilities from a data analytics perspective to be able to manage the workforce effectively, remotely and therefore they shuttered their windows or their doors.

Look at how many rural hospitals close in the past 24 months. So end of the day making sure you block and tackle and you have the infrastructure and availability and resiliency baked into your system is no longer a nice to have, but a must have, and boards of directors are smart enough to know quickly that if we can't pivot and go, there's no way this is organization will make it in the future. Then third, is a focus on leadership and talent development. Not just back off as business folks. Physician talent development. Nursing talent development. Investing in your people and growing them. I think we always knew the by-product of one of the most important aspects of your entire organization is people.

And if you could say cliche, like till the cows come home, but the reality is unless you put your money where your mouth. You're investing in them. You're bringing in new talent, train your existing talent on new skillsets that don't become onselete. What kind of business are you and workers are wisening up and going to those businesses like that.

So if you look at three dimensions with Baptist, Jacksonville is really double-clicking and focusing on, it's those three dimensions. On top of the big rocks that we have to do. We just opened up our new pediatric children's tower. All new private rooms. State-of-the-art technology. We go live with a new EMR this July and a brand new, another hospital, and get again for our fleet starting in December of this year.

So it's not like there's anything not. We're just hanging out at the beach as much as you would think in Florida, we could do that. We could today, but the reality is that a lot of good work going on. On a future perspective. What am I watching? I really am watching where does blockchain actually go?

I've always believed that an immutable stack is probably the key to actually doing distributed identity at the edge. The way we've always wanted to, to be able to tell that this patient really is patient Aaron. I don't have a relationship with him, but he needs to get his COVID-19 vaccine shot. And I need to know that it really was him that needs it for the first time or whatever it may be.

We can't do that today, . With the absence of a unique patient identifier. That's forbidden by law therefore, we've always kind of winged it and healthcare, which leads to a lot of errors and a lot of issues. That's just the reality of it. I'm also watching closely autonomous delivery, ? We are investing in robots for our hospitals to automate a lot of nursing tasks, this very moment. We're looking at the same thing for drone delivery. I know a lot of health systems, especially on the east coast have gone that route for very low utilization, high cost drugs to make sure it's securely shipped in a very timely manner. From being basically created or compounded and then sent to the site that needs it.

So it's almost like a pneumatic tube of the 1980s. So I think, I think autonomous delivery will help alleviate a lot of burden on our workforce. And then last but not least really looking at ambient analytics, meaning what are you doing? What are you saying? How are you interacting with a computer any given day?

If you look at the behavior patterns the way folks engage with technology, you can pick up trends. And so suddenly Aaron comes in in the morning and is on Google looking for signs of self depression, do I need to intervene with a patient port outcome and help him out before his potential worst case scenario as an employee?

Maybe. So how can we take these analytics that we're starting to see in our workforce, particularly when they're remote and ensure that we always have. . Not where you're being creepy and spying on them, but you're truly there to help them and their mental wellbeing, which is now emerging and I wish it always had as one of the worst plagues affecting all of human history and humankind, which is mental illness.

How do we help people when they need it before they even need it? So a lot of these trends, as they're getting smarter now not just adding more tech to add tech, but actually talking about these things, having those conversations, I think we've opened up the doors to this just because of what's happened. And now there's an awareness and visibility to it. All the way to the board.

That's fantastic. I mean, it gets me so excited to be able to help my colleagues that are on the frontline and see things differently. I'd like to back up a bit because this Chief Digital Officer role for you, correct me if I'm wrong, but that was a new piece to your job.

Where, where you came from before you were the CIO. Now it's this dual role. And so one of the questions, or one of the challenges that we often have is with a new technology, a new application, whatever. Guess what? Today, patients we're seeing, they we're taken care of. And as a clinician, I got through my day. But you know, with a different technology, different application, whatever it might be, I could make it your job better, easier, more, whatever it might be. Give you more time. What approach do you take? Does the Chief Digital Officer role play into this? How do you approach that with your clinicians, with your nurses? Maybe it's even back office accountants to get them to change a workflow with a new technology that you're convinced will make a difference for them.

Well, something that I appreciate about clinicians and I, and I learned this in many, many, many years of watching my mother as a NICU nurse and the stories that she would tell me as a kid coming home and how frustrated she was that something didn't work. Now back then, technology wasn't as today, what it is today, we're talking about a telephone not ringing or a light box, not turning on to see an x-ray. But to the reality of it, technology has to work.

. So before I can go talk about a net new wiz-bang pair of socks, we can go buy and put on and stay warmer longer. If what you have currently in hand, doesn't transact, how in the world am I going to expect you as a clinician to trust me? . So number one is, do we do what we're supposed to do? Well, do we actually do it well?

. So making sure that we are transacting in the today's world, as well as we possibly can and what their gaps on. Do we all agree on what that gap is? It is so easy for us to say, well, just go spend another 250, $300 million in putting in a new electronic medical record. Yeah, those days are basically over. We're not spending that kind of money anymore in healthcare.

And for those who are or going through that process now, it'd probably be the last traunch of a giant electronic medical record change or something like that for a long, long, long time. So the reality is what you're putting in place now are either homegrown created solutions, ? So you have some sort of dev ops development team, or you are enhancing existing workflow with an order set or some sort of standing order or something that is really meaningful to clinicians.

But the key to all of that is what I just said, meaningful. The only way I'm going to know this affects Dr. Oliver in the course of care is to shadow you and say, Dr. Oliver, that is actually make a difference for you as having ambient listening, microphones baked into your primary care office, allow you not to dictate as much.

Sure. So now voice dictation to you becomes relevant and meaningful because it saved you 30 minutes of time, an hour of time, whatever, which you don't not getting any more of every second saved for you matters. So to the degree of it, what you're seeing is a level of intelligence and hyper-awareness that healthcare IT organizations maybe historically hadn't had to have because you're slamming in giant multimillion dollar systems.

And that was the focus. Now it's about getting smarter. And hospital boards don't want to see you spending that kind of money without a very clear, defined ROI. And more importantly, that the patients and physicians that are utilizing this actually are happy because otherwise it's just a waste.

A hundred percent. Did you find if your organization was well-prepared for COVID? I don't know that any of us could have been well-prepared perhaps that's not the word, but you were able to pivot say to the video visits and things easily without using a third-party vendor. Do you find that the clinicians experience was good. And in the end, that's going to be a positive to what you were speaking of the trust factor. Like, wow. They handled that. They got that rolled up and stood up in three days and while it wasn't perfect, it was great to help me care for my patients. Do you think COVID has helped that or hurt it? Or dependent upon your organization?

So I think it's all the above. Be very honest with you. I think it's helped in that it brought awareness to the importance that telehealth and telemedicine can be to an organization, both from a sustainability perspective, as well as clinical caregivers. A lot of physicians particularly had reservations before COVID about the efficacy of telemedicine. Like how well can I really diagnose Aaron and how well can I expect Aaron to actually get, I never see him face to face. Completely understandable. Completely understandable mindset of, let me just be safe and sorry. I do believe clinicians go into this business because they truly want to help people.

So, so to the degree of it, with that, that now relaxed for lack of a better term because of situational issues. . COVID 19. And we could not see folks in person, even those that were reluctant, suddenly got to experience consumer based telemedicine or telehealth solutions and say, oh, this really is effortless.

And wow Aaron actually did get better. And I now have the data to show for that. And when he presents back to me in six to eight weeks and his knee really is getting better because now I really can trust him to do PT at home because having to drive all the way in to do this, I now trusted. So I think it helped in that situation.

It hurt, because everybody started saying telehealth and telemedicine. Every top technology company, even like Best Buy. Which confused the whole organization and the whole industry as to what is actually telehealth and telemedicine. One of the things I do is teach the CHIME Seattle Bott Camp. And I actually specifically call out, like stop saying these two terms interchangeably.

They don't mean the same thing. And it's interesting that folks really do think it's it's that simple. And I wish it were. However we have being the healthcare industry have made it so complex to transact care at some of these telehealth solutions, which can also do telemedicine simply fall apart.

They were never designed to do some of those robust remote patient analytics and monitoring and all continuous patient monitoring that now telehealth and thus telemedicine require. So what you're finding is a convergence in the industry and a lot of companies buying each other up and what actually really is telehealth and telemedicine is very different than what it may have been in 2020, because people don't have an awareness to it.

So that's how it hurt. And I, then I would say depending on organization, which is if you had the finances to dabble and try different solutions, you're in a much better position, but a lot of FQHCs or hospitals with basically no margin had to wing it. . I'm not entirely sure you know what you look like now, if you never had the ability to sort of double down and say, I'm going to go in all in on this one task regardless of good or bad and make it work for my workflows because that's where it really hits the road. . That's where it really happens is where is it in the course of care?

Yeah, I see that a lot in the, in the affiliated independent practices that we have throughout our state. They took their meaningful use money. They were sold a bill of goods with a particular EMR and now they're stuck. They don't have the margin to go out and replace. Whether it's for video visits or what have you. Any kind of digital medicine.

That's . But look at what you guys did, ? Baptist Kentucky. Very smart. You went after I believe it was the FCC grant money, ? You guys were awarded a large sum of money to put in a new state of the art telemedicine solution to serve the rural populations of Kentucky and really help those that were disenfranchised with this disadvantage. That's a smart thing to do. ? So even organizations you gus don't have high margins, but you, you make an effort to keep the doors open.

You could invest in multiple technologies. You still did the thing by trying to do what's for the consumer. For the patient and standardized, . That's good leadership. That's, that's being thoughtful and proactive and not just doing a scattershot approach before organizations don't even have that ability to apply for those grants. I am concerned because what, what does that look like? What does your experience look like in rural Florida? I mean, what does it look like? . So

I think it becomes more and more, it's just another tick in the box or the column of how it's difficult to be in private practice in 2022`.

. Which is, which is sad, ? Because I believe in freedom of choice, I believe in freedom of business. I believe that you should not have some heavy hand telling you thou shalt do this unless that's the life you choose to go into. But the reality is so many independent offices and practices. It's so complex. And so bureaucratic these days.

I ran a solo office for a few years. I had a small private practice for a number of years and it just became more and more difficult. I'm happy with the choice that I made but to your point, it does sadden me that it's become very difficult to do it on your own.

Let's say you don't have internal resources at a Baptist to stand up some kind of video visit or asynchronous care or whatever it might be. And so you go to a vendor and clearly, as we all know, probably anybody listening to this, the billions of dollars that are being invested by venture capital and others in different solutions. One of the things that troubles me or that concerns me, at least in theory, is we have spent all this time, meaningful use money, all the things that you and I talk about, interoperability, to get the record together. To get it in one place, whether it be with the patient, be with the physician. We can have discussions about that as well, but I'm concerned we're going backwards with this because there's no motivation for some of these companies to get the information back to a central repository. Again, maybe a patient, maybe it'd be their primary care physician. I mean, we have an internal application that we're using for our employees that will go nameless that I'm like, how does the primary care physician know about that?

And, oh, you'll get a monthly report. It hasn't happened. So I'm concerned we've got all these silos of character. We just spent the last decade, decade and a half breaking down these silos, trying to get TEFCA and things like that organized. Do you see that? Do you have conversations with startups and other companies along those lines? I'm just curious your thoughts on it.

Great question Brett. And very, very, very astute of you as always. You're exactly . I, I agree with you and I do feel like we're going backwards and here's, here's why. It's not so much a technology challenge to make the technology talk to each other in plain English, as much as other competitive advantages in businesses and economies that have spun up that truly we're talking about billions and billions and billions of dollars if not more, that's tough to walk away from. Example, de-identified data in bulk is big business, ? Tens of millions. Just look at the publicly filed eight K's of various companies that are publicly traded that deal with healthcare data and how much they sell the identified data, which is permissible under HIPAA to fake pharma.

That's just part of their bottom line. You're asking these folks to give up tens of millions of dollars a quarter when. Beholden to the shareholder value. I mean, that's, it's an interesting conversation, ? So we're looking at it from the good of a complete intact medical record. What does that do for patient Aaron?

What does do for course of care? What does do for Dr. Oliver providing care to Aaron. All those sorts of things, which are the thing to do. The reality is you just disrupted a multi-billion dollar organization and industry predicated on data silos and selling those silos for premium because I'm the only person who can get this claims data from. Or this 529 data from or whatever it may be.

Okay. . So that's one. Two, is the landscape of these healthcare IT systems were never designed initially to transact with each other. . We forced it with meaningful use. . Which when we would have viewed demo transmits, it would became view and download. Remember that? Because we were like, this is too difficult.

. Then VDT became a threshold, like 20% to like one. . So, okay. Like what, what are you going to do with that? . So the reality is we have a very decentralized again, I believe in individual choice, I believe in freedom of business, but when it comes to certain rules of the road, we sort of shot ourselves in the foot by up front and saying like, look, we want you to drive wherever you want to, but the speed limit is the speed limit. Like tou got to abide by the speed limit, but go to whatever road you want and drive. If you want to drive to Alaska, go for it. Just don't go over 75 miles an hour. We never did that. We simply said, here's the road, go drive it or go create a road. . And drive however fast you want. And now after the fact we're trying to teach the world, Hey, wait, whoa, whoa, whoa. Like, this is how we do this in the way.

It's never gonna work. . It's never going to work. So the reality is we have to get better and not go backwards and stop incentivizing bad behavior.

Yeah. The complexity is how do we, how do we make that happen? I, I shudder at the thought of more regulations quite frankly, but at some point there has to be some guidance there. If we're going to transform into a more value based care nation, which at least where I am, we have some value-based care contracts, but it's still a fee for service world.

We have a lot of, you and I both have a lot of colleagues that are payer side that are brilliant, that are trying to transform the world.

So it's not like let's, let's blame the big, bad payer or the covered entity or the big bad government. The reality is it's the industry. This is the way the industry works. And so we get into this situation of folks wanting to finger point and say, well it's the hospital's problem. It's they're the ones who do surprise billing.

Actually. That's not how it works. ? And so those make great by-lines for the newspapers. It doesn't actually help anybody in healthcare. And the reality is to your point Brett, that the more we can surface as to what the realities are, I do believe various lawmakers, folks on the Hill, others are listening.

We've done an industry have done a terrible job of articulating in plain English. Here is the reality of what's broken. Like enough of the technical talk and APIs and HL7. Like nobody cares. People cared did Dr. Oliver get errands records from Texas when you see me in Florida. That's what you care about.

That's what actually matters. Not all this other stuff and making it work. Nobody cares how the road was made. Just make sure there's no potholes on it. Okay. So we have to get better about telling the stories, which is the value of the high tech and the other things that we do, because that's the conduit, going back to industry.

Well, Aaron, my friend, as always love talking with you. Wish you were closer. I know Jacksonville's got themselves quite a blessing in your leadership down there.

Come visit sometimes, especially when you gotta get out of the cold.

You got it. You got it. We'll talk soon.

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