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Episode 3: David Bensema on Role of EHR and Government in Innovation and Google Glass in Healthcare

[00:00:00] Bill Russell: [00:00:00] Welcome to This Week in Health I, where we discuss the news information and emerging thought with leaders from across the healthcare industry, this podcast is brought to you by Health Lyrics. This is episode number three. My name is Bill Russell, recovering health care CIO writer, and consultant with the previously mentioned Health Lyrics.

[00:00:28] Today. [00:00:30] I'm joined by David, Dr. David Bensema, former CIO for Baptist health in Kentucky. Welcome David.

[00:00:39] David Bensema: [00:00:39] Thank you very much Bill. I appreciate the chance to be here.

[00:00:42] Bill Russell: [00:00:42] Yeah, I'm looking at looking forward to the discussion. So, but before we get started, why don't you give us a little idea of what you're working on these days and what you're excited about?

[00:00:51] David Bensema: [00:00:51] All right. Well, my number one job now is retirement. And so a lot of travel and time with grandchildren, but it's also offered a chance to do [00:01:00] some more reading. And one of the things I'm very excited about is it's given me a chance to circle back with a number of folks that I've mentored over the years, check in how they're doing and be able to offer myself and my time to help them continue on their journey.

[00:01:17] The other thing that I'm excited about is. The fact that we are now in regards to EHR is at that point where almost every system has a most physicians, offices have them, [00:01:30] even with the pain points, it's a period of enhancement of utilization. It's the time when we're now finally approaching some of the hard questions like interoperability.

[00:01:39] And the end user interface in meaningful ways. And so that has me very excited. This is a great opportunity for folks in it to enhance and better utilize these significant investments that our systems have made.

[00:01:56] Bill Russell: [00:01:56] Wow. So, so retirement, so grandchildren [00:02:00] catching up on your reading. Yeah. You know, and I've heard from a lot of CEOs that they wish they had more time to read and to catch up on the news, which is one of the reasons for this podcast.

[00:02:11] I like, I like the fact that you mentioned catching up with the people that you've mentored over the years. I mean, that, that has to be really rewarding to see people move move up and move on in their careers and. And you know, to, to still have a place to speak into their lives [00:02:30] and, and be support for them. I would imagine that that's pretty rewarding for you.

[00:02:35] David Bensema: [00:02:35] That's an absolute joy and you know, one of the things that I reflect on with. The greatest joy and pride in regards to my time as DMIO CIO at Baptist health is that we had a strong succession plan in place. And when I stepped away, Trisha, Julian and Dr. Brett Oliver stepped in and the system never missed a beat. In fact, it accelerated and that's what I did best was get [00:03:00] out of the way and let some really good people do their job, but having prepared them in advance so they could do the job.

[00:03:07] Bill Russell: [00:03:07] Yeah, that's a, well, that's a great one. Well, I I appreciate the humility in that.

[00:03:12] Getting preparing to step out of the way. It's a good, good thing for a CIO to to take away from this. So let's let's get started. We'll go into our first segment. Let's take a look at what's in the news. So, you know, we each pick a story. I picked this story. It's a. [00:03:30] It's interesting to me. I think it speaks to maybe some feelings that are maybe under the surface out there in the industry.

[00:03:37] The story is, does Epic hinder innovation depends on when you ask. There's a a couple of stories. The there's a story from modern healthcare monitor health care, but there's also a story that was in one of the business journals and you know, the business journal had. The CEO [00:04:00] for Minneapolis based Fairview health systems saying some pretty pretty interesting things.

[00:04:06] He essentially said that the electronic health record well here, let me just read it. It'll make it a lot easier. He said, I will submit that one of the biggest impediments to innovation in healthcare is Epic because of the way that Epic thinks about their intellectual property. Of others that develop on that platform.

[00:04:28] He went on to [00:04:30] say he calls for a March on Madison, Wisconsin. He says Epic has architected an organization that has a belief that all good ideas are in Madison, Wisconsin, and on an, on the off chance that one, one of us think of a good idea. It is still owned by is owned by the Madison, Wisconsin company.

[00:04:53] However you, you know, you fast forward two days and this is, this is the [00:05:00] press following up with their health system, with Fairview health system on this, it says despite adding to the sea of complaints about the HR companies, Fairview health system services leaders are optimistic about working with their vendor Epic systems.

[00:05:15] That take on the relationship came a few days after he blasted Epic for hindering technology development. The not-for-profit 11 hospital 11 hospital health system then took a different taxing each our vendor does in fact help innovate. [00:05:30] So what happened you know, James overstepped here and he's trying to walk it back and we should let them walk it back.

[00:05:36] We we've all made these kinds of mistakes in our careers where we. Got out over our skis maybe said something that that we shouldn't have, you know, if your hospital runs on Epic, there's no need to have an adversarial relationship with that vendor. You just, you don't want to have to overcome the complexities of innovating in healthcare while trying to handle a strain relationship with the vendor.

[00:05:58] With that being said [00:06:00] you know, it's an interesting conversation, David, to talk about the, that the place that EHR vendors sorta reside in this innovation play you know, are, do they hold all the cards? Are they you know, are they just a piece of the puzzle and you know, what, what was your experience working with your EHR?

[00:06:25] You don't have to mention them by name, but what was your experience working with your EHR vendor? I mean, [00:06:30] did you feel it was a little of both that they hindered in some areas and moved to Ford, or I'm just curious what, what your experience was.

[00:06:39] David Bensema: [00:06:39] Yeah, I think it is a two-edged sword. I think it hinders innovation in that you're trying to stay with a foundation system.

[00:06:48] You're trying to minimize some of the unnecessary variability out in the markets and in our system, we were really more of a constellation of hospitals when we started [00:07:00] our journey to an integrated EHR back in 2014. And it was a big part of us becoming a system. So we wanted to eliminate some of the variability product, helped that in that it was going to be integrated across our entire system.

[00:07:16] But then there was this feeling by a lot of our users, both nursing finance physicians, that they were getting him in by the foundation system. What they [00:07:30] now see is that in having the product across the system, having standardized so much, they now know the product well enough that they can in fact, innovate off the platform with confidence because they know how it responds.

[00:07:48] They know what their guardrails are. And they're moving fairly quickly through their enhancements. Other people call it optimization. I don't believe you optimize because that's the first, there's an [00:08:00] end point of perfection that you reach you don't, you, you continue to enhance. And that enhancement is actually facilitated by the structure of the EHR.

[00:08:11] And by the fact that it was put in as a foundation product across the system and got us to a common platform and a common starting point. Now we're watching them have enhancements. And in fact had put in a very strong change control [00:08:30] process to make sure that we didn't respond to the opportunities too quickly.

[00:08:36] And to your point, get out over your speed, you know, get, get ahead of ourselves and overrun the change capacity of our clinicians and end users. You have to balance it. So at this point in time, I don't see Baptist health being impaired in its innovative capabilities, but I can see where somebody would feel [00:09:00] that constraining yourself to the foundation system is a block to innovation because you say, if my product can do it, we're going to use it.

[00:09:11] And you don't look at some of the third party softwares out there. You don't look at some of the alternatives. But later you have the opportunity to create those alternatives within the platform.

[00:09:22] Bill Russell: [00:09:22] Yeah, it's a, it's interesting because you know, one of our future guests, ed marks, and I had a conversation, I think about two [00:09:30] years ago and we were just just getting ready to go into our EHR consolidation.

[00:09:36] We had nine different EHR platforms across the 16 hospitals. And I asked them, you know, about we were talking about the, the, the fact that his organization does internal surveys and they had a very high approval rating for the it organization. How is that possible? And he said, well, you have to understand we're we're six years past [00:10:00] our EHR consolidation.

[00:10:02] And he goes, and when you baseline on the day of going live, it's going to be that the lowest point within the organizations. Satisfaction with it, but if you stick with it and you continue to iterate on top of it that you know, you're going to be able to build a pretty good system around the workflows that you know, the clinicians really need.

[00:10:22] And over time the the organization will will start to appreciate the platform. I'm [00:10:30] not sure that everybody has sort of experienced it that way, but there's there's obviously good implementations and bad implementations. In California, we did not have necessarily the same environment that you did in that.

[00:10:41] There, there's not an employed physician model, so there's a foundation model, but it means that there's a lot of independent physicians in the state of California. So for our clinically integrated network, we literally, there's not an exaggeration. Literally had a spreadsheet with a hundred different AMRs on it.

[00:10:56] Then we had to figure out a way to build a clinically integrated network [00:11:00] across, which requires data sharing analytics and some, some form of a digital channel to try to engage the patient. And that's really where my thoughts on this are sort of live. I know a lot of people think, Hey, we'll get to a single EHR provider and then we'll be able to do everything we're going to do while that's almost impossible in the state of California.

[00:11:24] And really what I was looking for from the EHR provider for innovation was two things [00:11:30]access to the data by directional where possible and access to present the data back into the workflow. So if I could embed something into the, you know, a tab into Epic or a tab into Cerner where I could present some data back that has gone through maybe machine learning or AI.

[00:11:48] I think we complicate this sometimes. And if the EHR providers could just provide those two things, access to the data that we could start doing some things creatively outside of it. [00:12:00]Maybe move some of the data elements back in and in a way to present it back into the workflow. I think we can see an awful lot of innovation come our way.

[00:12:10] All right. So why don't you, why don't you set up your your story and, and and we'll go from there.

[00:12:17] David Bensema: [00:12:17] Yeah. And so the story that I selected comes out of modern healthcare and multiple other sites that I was looking at the modern healthcare article regarding the health information technology advisory committee.

[00:12:29] [00:12:30] This committee was of course set up by last year's legislation and the cures act. And as with so many things set up by legislation, it's taken nearly a year to have the. The group sit down for their first meeting, which they actually did a weekend a half ago. But my reason for wanting to put this article in was a couple of the quotes which feel a little bit like [00:13:00] me standing on it.

[00:13:02] First tee is a golf course in saying that I just bagged 26 bags of leaves yesterday. I'm making my excuses in case I play poorly. Well, you know, we've all done that. And so the one quote was. Given the lead time prior to the committee's first meeting now more than a year after the signing of cures, it may be challenging for the committee, the ONC and the secretary of HHS to meet all of our, all of the legislative requirements.

[00:13:29] This was Dr. [00:13:30] Steven Lane, a member of the committee. And he's a terrific guy from Sutter health and. Then it goes on, but he's optimistic that the group will successfully and positively guide federal health, it policy and regulations. So I take some hope there. And then the other quote was, as it's currently written, I worry the trusted exchange framework and common agreement is overly prescriptive.

[00:13:56] This came out of the ONC is overly prescriptive. [00:14:00] In ways that might jeopardize sustainability and usability. And this quote was from Sasha Termont the director at Epic systems. So I'm always concerned when we have this new opportunity, those of us in the industry who heard about this opportunity, he got very excited that, Hey, there, they're going to take some information.

[00:14:24] They're going to take input from folks who are boots on the ground. And then the first thing [00:14:30] that comes out is really a little hedging of the bet.

[00:14:33] Bill Russell: [00:14:33] Absolutely. So let's go back and forth a little bit on this. So the 21st century cures act is actually a really good piece of bipartisan legislation that sets up, you know, policies, procedures standards.

[00:14:47] To that will facilitate the exchange of patient records in a secure way between between all entities setting up a network of networks, if you will, that has at [00:15:00] its core. I mean, that's not all, all of what the 21st century cures act, but this is how it's really impacting health it systems. Right now this is sort of you know, they have some voluntary stuff out there, but if this proves it's, it'd be the same as other things, you'll start to see it move into an incentive-based and probably a carrot stick kind of thing.

[00:15:22] So, you know, th th the 21st century cures act. It really does have a lot of potential. I mean, I think we would agree with [00:15:30] that. I mean, yeah. So, and so has a lot of potential, but it took a year to set up this committee, which is kind of amazing and may show the pace at which this thing's moving. My, I guess my question to you is we all agree.

[00:15:47] I have yet to talk to somebody who said, you know, interoperability is an important. And it's not something we were all striving for. So we all agree that it is, is the government going to be able to move this as fast [00:16:00] as the industries currently, do you think the industry is going to move faster? Or, or the innovators are going to move faster than, than maybe the government can get this thing in place.

[00:16:10] David Bensema: [00:16:10] I think the industry's going to continue to find business case that requires interoperability to function well, whether it's for your CIN network or it's for some other care management. I don't think population health is possible in a really meaningful way without [00:16:30] interoperability. So I think the industry is going to push really hard.

[00:16:33] I do take heart that there are some very good people when you read the entire list. You look at some of the Lake appointees to some of the folks who were announced in November, like Robert, Bob farmer president of the American medical association but global chief medical officer for DXC technology who has been a voice for a very long time in it from medicine.

[00:16:58] And then you look at [00:17:00] Steve out of Louisville who was Mitch McConnell's appointment. And Steve led a very successful. Epic implementation in Norton healthcare and has done a lot of great things with his team to move their use forward. There are some folks who have a real can-do attitude, and so I hold hope that this group will find themselves invigorated by each other's presence.

[00:17:26] Go through the storming and norming process of any group, but [00:17:30] hopefully have their meeting cadence be fast enough. Be frequent enough. That they can catch up with no, where we thought they should be, but they are not because of the delay in putting the group together. Now that the groups together, I hope they themselves start to call for more frequent interaction so they can get to the next stage quickly.

[00:17:52] Cause there's a lot of can-do people here and, you know, bill you, I lived can do with our implementations and [00:18:00] we had to. Focus our teams to attitude, not on focusing on the negatives or on the impediments. So I, I think this group has great potential. I would have liked to have seen a slightly more positive initial article, but I bet we're going to see some good stuff coming out of them.

[00:18:18] Bill Russell: [00:18:18] Yeah. I as well, I know some people on that, on that, in that group and that I would love to be at that table. That's an exciting group of people and I think they're, they're really [00:18:30] You know, well positioned to do something. And then I'll close this out with you know, Genevieve Morris is the principal, deputy national coordinator for health information technology at the ONC.

[00:18:40] I don't know how she fits that on a business card, but it's a great quote. She says and again, we've all been saying this. We have to shift the market from competing on holding data itself to providing services on that data. And you know, that goes It goes all the way back to I think we've all [00:19:00] been sort of thinking that and saying that but even, you know, Todd park back when he was CTO or C I or CTO for the federal government came up with a blue button and some other things.

[00:19:10] And his whole mantra was that whole idea of stop competing on the data and, and make it available. All right, so let's move to our second segment. We talked about either a leadership topic or emerging technology, you know, if you agree to come back on here, you know, we'll, we'll talk about mentoring, I think in one of our next [00:19:30] get togethers.

[00:19:30] But today we want to take a look at at Google glass. So I'm gonna let you you know, Google glass you know, is something that w we thought Google had sort of killed off, but it has. New life within healthcare. Why don't you give us a little idea of how it's being used in healthcare and, and you know, maybe how it's addressing some of the challenges that, that health systems might face.

[00:19:54] David Bensema: [00:19:54] Yeah. So several years ago, a lot of us were excited about Google glass. We had a couple of our [00:20:00] physicians who were wanting to use it, and we tried to do some internal piloting and use voice command to move the cursor around and allow them to use it. There were some glitches and some difficulties, and I think other industries found similar issues and we thought it was folding, but there's folks like Augmedix who have partnered with in this case Sutter health is one of the groups that's [00:20:30] kind of leading the charge in looking at how could this be used in healthcare? How could this help to enhance the physicians utilization of the EHR? Get the EHR somewhat more out of their way by using Google glass with Offsite real-time scribing and reduce the paperwork or the input time at the end of the day for the physicians.

[00:21:00] [00:20:59] And this company is trying to look at what this can look like. There's a lot of potential in the technology but we can talk about some of the concerns that are not. Mentioned in the, at least the article that I had pulled up concerns about what are the difficulties of adoption what needs to still be overcome and you know, what are the next steps? [00:21:30]

[00:21:30] But I think Google glass is a technology that it staff ought to be aware of. And, you know, the first thing they ought to know about is what it's going to be needed for support. And you're more on the tech end than I ever was as a physician who came into the CIO role. But you can probably speak to some of the things that it teams ought to know.

[00:21:52] Bill Russell: [00:21:52] Yeah. So this is you know, it's an interesting technology and we were we were piloting this in our. [00:22:00] In our medical group, when towards, towards my departure with the health system and, you know, it's, it's really kind of a basic technology it's you know, for all of its all of its cutting edge aspects of it.

[00:22:15] And I think the guys at automatics are doing a phenomenal job, really getting the word out there. I mean, you mentioned Sutter, obviously dignity and just a ton of others. I mean, th they're, they're really getting the word out there and using it, but at the end of the day, [00:22:30] it maybe it's changed since I've looked at it a year and a half, two years ago.

[00:22:33] But it was a glorified dictation system, but let's, let's be clear. The value is in and breaking down that barrier between the physician and patient, because instead of staring at a screen, Now they're actually looking at the patient. And even though they might have these glasses on, they you know, it's being recorded, it's being it's being transcribed by somebody.

[00:22:58] So you, you don't have to [00:23:00] hire scribes. You you know, you typically, you have a recording of the session and you have the ability to to go back. And I think there's also some creative things where you can actually take that recording between the doctor and the patient, and actually give that to the patient.

[00:23:14] For those patients who may forget what goes on in that, in that environment, it's actually very basic technology, but with a powerful a powerful outcome in terms of, you know, this whole physician [00:23:30] burnout and physicians having to sit in front of the computer and the breaking down the wall between the physician and patient.

[00:23:36] I think those are probably the most exciting things. And because it's so simple, it's not overly difficult. To to implement or maintain it's, but it is there are a bunch of little compliance things, but the best thing about that are other health systems we've gotten through it. And you just have to, you know, you have to ask the right questions to make sure your compliance people are at the table and, [00:24:00] and work it through.

[00:24:01] And then and then also understand, I think it's not for every doctor, not every physician or clinician is going to put these glasses on and. And you use them. There are some that just won't do it. So, I mean, that's, that was my experience with it. You know, w where do you think it, how, if you were going to bring in a technology like this into your health system, how would you go about doing it?

[00:24:27] I mean, would there be a [00:24:30] w what process would you follow to bring it in.

[00:24:33] David Bensema: [00:24:33] First I'd have to do a gauging of Interest among the physicians can make sure that I could find some physician champions some early adopters. And I think we'd have to do a pilot, a proof of concept and then generate the buzz internally.

[00:24:51] I used to joke that I liked to function on the green principle. I wanted somebody to get jealous of what I was doing or what I had because [00:25:00] nothing causes people to be more avid for adoption than jealousness and. You know, so it it's worked in a lot of areas. And so I would pilot it with a couple of early adopters and get the buzz.

[00:25:14] The harder part is of course getting. The commitment of financing at this time when everyone's still recovering from their initial implementations of technology. And they're looking at their physician employment group as [00:25:30] a significant financial impact in a negative way. If you look strictly at what salaries are and what the reimbursements are within the group that most groups are losing some money in the system, and we all know how people have cost shifted.

[00:25:45] But convincing the C-suite would be, I think the hardest part, I think getting a couple of position pilots, easy getting through the security and permissions aspects, some of the compliance, you talked [00:26:00] about complicated, but not complex. It's just followed the dots, you know, just do things in the proper step sequence.

[00:26:08] But then getting the buy-in from the. Senior leadership in getting them to not micromanage it because if adoption is slow or if it's a hockey stick type curve, you know, you have to just let them stay out of the way and let it evolve naturally. I think you're right. It's not for every [00:26:30] physician.

[00:26:30] I think patients will actually have. More comfort with it, maybe because they don't fully understand it all, but mostly because they get their doctor back, I think patients would be more favorably inclined towards it. Then the general physician population initially. I think the other area that you have to think about is.

[00:26:55] Who are you working with? And are you working with them every day? And then what happens when you're [00:27:00] scribed a remote scribe is out ill. It's no different than when my medical assistant, without ill. When I was in practice, you don't function as well. And how prepared are the physicians go back in and actually utilize the EHR if necessary?

[00:27:16] That's the thing I think is going to create some bumps in the road. They're not insurmountable. You just have to be aware of them.

[00:27:23] Bill Russell: [00:27:23] Yep, absolutely exciting technology. We'll have to keep an eye on it. I agree with you that [00:27:30] you know, if you don't have hard dollar savings, I loved my CFO. She was, she was wonderful.

[00:27:36] We had a great relationship but she she was a stickler for hard dollar numbers. And the challenge with some of those projects that she noted is if they're calling for hard dollar numbers, it means you have to force adoption. And when you have to force adoption, It creates a a different dynamic than if it just gets pulled through naturally the organization.

[00:27:56] But yeah. So look for the hard dollar savings that's going to get it [00:28:00] through funding, but the, the, the softer aspects of this, I think are the more exciting things, physician burnout and breaking down that barrier. So you just have to make the case, have to get in front of leadership and say, this is worth doing and proven out with pilots.

[00:28:16] So. Exciting stuff. So let's let's go to our final segment. Favorite social media posts for the week. I'll let you as our guests give you a nomination for for your favorite social media posts for this week.

[00:28:30] [00:28:29] David Bensema: [00:28:29] Thank you. Yeah. I had a chance to see one from, at Sony on LinkedIn. And he's been with Googled before Motorola et cetera.

[00:28:42] But his comment was a lot of social media is platform for discussions, bereft of the kind of empathy and nuance that an in-person conversation has. So he first get trolled for something you didn't mean, then have no way of explaining yourself without finding yourself, shouting into ether. And finally, you wonder why you spoke in the [00:29:00] first place.

[00:29:01] A lot of my posts get a lot of love and affection, but I personally find them without strong opinions land, almost colorless. Good enough to provide a window to life, but not a complete expression of what I really feel. Maybe that is because I don't write well enough to articulate with nuance or maybe social posts are not the best medium to view.

[00:29:20] So as I read that, I thought, you know, I've done some of those posts, but I've also done some where I'm stronger worded. And I think people have to have the [00:29:30] courage of their convictions. But I think it's also a little bit of a reminder of the rule that we had in our, I sent two emails. You've sent two emails.

[00:29:42] You need to get on the phone because emails don't carry the nuance. Neither the social platform, their starting points. I think we need to remind ourselves, these are simply starting points. Getting on the phone is necessary for the health of your organization.

[00:30:00] [00:29:59] Bill Russell: [00:29:59] Yeah. And I think we use that. Thanks for sharing that. That's a, that's a great post then. And I think we've all been there. I have a couple people at troll. My posts and constantly are commenting how it has ruined has ruined healthcare. And you know, I, I understand where they're coming from, but you know, social media platforms, probably not the best place to definitely not the best place to pick a fight and definitely not a good place to Try to have that discussion in an open dialogue.

[00:30:28] So I appreciate you sharing that. [00:30:30] I'll take us home with something a little, a little not, not as philosophical as yours. It's Justin Eisenberg. Who's an executive recruiter posted a story on KTV u.com in and out. Burger reveals managers make $160,000 on average to which he says I should have gone to hamburger, university and.

[00:30:55] You know, I'm not even going to comment on that. It's it stands on its own. [00:31:00] It's amazing to me, that managers make that much. And you know, and when I was going to school, it was a big thing. I don't know. Maybe, maybe now that college degrees are starting to focus on, on running franchises or being managers and franchises.

[00:31:15] We will see that's all for this week. Thank you, David, for joining us and please join us next week when. Sue Schade from Sturbridge advisors. We'll be here. Remember to follow us on [00:31:30] twitter@thisweekandhitcheckoutournewwebsiteatthisweekinhealthit.com and subscribe to the podcast on Apple podcasts or Google play. Thanks for joining us. That's all for now.