This Week Health

May 27, 2022: What's it like being a host for This Week Health TownHall? Join us today for a very special episode with two of our hosts Jake Lancaster, Chief Medical Information Officer at Baptist Memorial Health Care and Brett Oliver, Family Physician and Chief Medical Information Officer at Baptist Health. What is top of mind right now for CMIOs in healthcare right now? How is technology helping with the nursing shortage and clinician burnout? How do you get a group of people who have practiced medicine in a certain way for decades to adopt the EHR? How do you get them to do scheduling in a common way so that you can digitize it and make it a digital workflow? 

Key Points:

  • Burnout and staffing shortages are on the rise
  • Nursing is an area that has been neglected until recently
  • Organizational change management
Transcript

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

Today on This Week Health.

How do we improve the IT process? How can we speed this up? If there's a new AI algorithm, for instance, that comes out, it's probably going to take us, at best, six to nine months to go through our process. Whether it's IT security, vetting of the data, all that kind of stuff. I think with the way things are going towards more algorithms, more external applications to lay over the top, how do we speed that process so that we don't do four or five things a year. We could do more

Thanks for joining us on This Week Health Keynote. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in our mission to develop the next generation of health ???? leaders.

All right today, we have a special episode of keynote. We have two CMIOs I'm excited to talk about. We have Brett Oliver, CMIO for Baptist Health in Kentucky and we have Jake Lancaster, CMIO for Baptist Memorial Healthcare in Tennessee. Two different organizations. Jake recently moved into or has accepted the role of CMO, chief medical officer for the Baptist medical group. And I'm excited to have this conversation, gentlemen, welcome to the show.

Glad to be here. Thanks for having us.

I appreciate you guys coming on. You've been a part of launching the IT town hall show, which is our new podcast on this week health. have you done an interview yet where there's two people or have you only done one-on-ones

I've just done one.

Yeah. It's just a one-on-one for me, but I have two other podcast series that I host and we've done multiple guests before.

Yeah. So it's a little different dynamic. It's doing two or even even three. One of the things I tell people when they come on is the more people that they're on, the more, you just want to focus on your greatest hits. Like what's the one thing you want to get out because if you feel four people on it for a 45 minute podcast, You're only going to get to talk for 10 minutes. So it just reduces the amount of time you talk. I want to, I want to optimize the amount of time that you guys are talking. So what's it like being a host for IT town hall? Jake, we'll start with you. I'm curious. You have some background in doing this, so what's it been like?

Yeah, I guess I've done podcast hosts. Ever since I was in clinical informatics fellowship we started one just to kind of tell people about the fellowship itself. And it was, it was interesting finding guests, bring them on. I would say that's the hardest part to me is reaching out and bringing the guests on. But then once you're in there I guess I've been doing it for two, three years now where it feels natural, it feels like a conversation. And it's, it's pretty exciting to be able to create something and push it out.

Yeah. And that's one of the things I tell people when they come on the show, it's like, I want it to feel like we're sitting at Starbucks having a conversation. And we just happened to turn on the the recorder and we're letting people to just drop in. Cause that's one of the things that happens for you guys in your role is you have some great conversations throughout the day.

It would be interesting, like in a football game to Mike, you guys up through the day and just pull out clips of really cool conversations that you have that well, we'll figure out how to do that in the future. I don't, I don't know if that'll that'll cut it. Brett, what about you? what's it like hosting the show?

I like the microchip idea, by the way. I didn't have any experience before this, so Been a little bit of nerves getting started and just getting to that point where it is just a conversation. I think really once we get past the first question, then it's really becoming more, just a conversation.

In fact, I think you've, you've talked about it before bill, when a lot of times before we start rolling I'm catching up with this friend or colleague of mine and I'm like, hold on, we need to stop. This is exactly what I want to get on camera. But no, I've enjoyed it. I've been pleasantly surprised.

I think everyone I've reached out to has agreed to speak or read to come on and usually enthusiastically. So I, where I thought maybe that would be the challenge that really hasn't it's a little bit of administrative work on that side, but it's been great. So. Yeah, I've enjoyed it so far.

Yeah. This, this is now the podcast that I stream when I work out, which I, I love I love the perspective and I also like the fact that it's really close to where the work's getting done. So we've got some great great interviews at brand who've you interviewed so far.

I've interviewed Andy Trescott sort of globally at Accenture and other health care. I really enjoyed John Lee. He's the digital researcher at the advisory board. Aaron MIRI that I think the a hundred show bill after I realized that I was interviewing him. He's a friend of mine from the high tech committee, a CIO at. That self Jacksonville Michael Atcock. I really liked Michael Michael.

I met on the high tech committee. He, he works right now on the payer side of things. I knew him first on the remote patient monitoring side with university of Mississippi's tele-health program. But one of the things I took away from Michael that really hit home was the payer typically. From Jake and mys perspective tends to be kind of the enemy, somebody we're working again.

So we've got to pull things from, and, and while that still may be true, in some instances, I also recognized if somebody's paying for it, Michael is going to have. And if we can foster that relationship, there's probably a more complete dataset with that. I had Coleman Smith Coleman is kind of a legislative regulation guru that that we've had a relationship with at our organization for a number of years.

So that was fun going through something. High-tech CAFCA ADT requirements with him. He can, he can make that the dry stuff interesting there. And then Michael Erickson, who is our CSO and understanding against a lot of times, what I find is this triggers things where I'm weaker and don't have a great understanding to go dig a little bit further and understand how that could make my job a little bit better.

Yeah, it is interesting. And preparing the questions. You do have to have a baseline. Of understanding of the topic. And sometimes I've, I've asked you guys, people like yourselves who are doctors to do certain interviews for me because I sit there and go, you want to talk about what new device that's doing what in oncology? And, and I'm like, I am not the guy to do this interview. I mean, I might I just don't have the training. But that's very rare. A lot of times you can pick up just the. To ask the questions and you're in the same boat as somebody who's listening to the show. It's the first time they're really coming to contact with some of this information. Jake, how about you who've you interviewed so far

Done several. Won't go through, through all of them, but I really tried to find current or former fellows that had worked on some interesting projects that they wanted to showcase. So these are clinical informatics fellows, so positions that are doing current training and informatics.

Some of the ones that were really interesting talking about. Mark gang Marg, Zang, sorry. At Raymond womens who is over there kind of digital innovation hub. He's doing some great work, always very smart guy very knowledgeable about how to do innovation at an organization like that and make it sustainable.

So I thought that was very interesting. Priya Ramaswamy, She is doing some really interesting work on topic that I did not know nearly enough about, which is sustainability informatics which she's using clinical decision support to decrease greenhouse gas emissions from.

So a lot of these or gases are worse, greenhouse gases than CO2. And so she has an algorithm that they use and have spread through all the UC hospitals in California to decrease that those gases, which also saves on costs too. But it also is helping with global warming. So that was a new area for me and something that not really heard, talk about which was fascinating.

And then we have. Several talking about virtual health. So the virtual list, which is a new role, or it seems to be it was really becoming popular in the last couple of years with physicians that just do virtual care. And then remote patient monitoring also is gotten obviously really big over the last couple of years of the pandemic.

And then had Tom Barnett on from my organization and he's our CIO. And so we just talked about several of the initiatives that we're working through is an Oregon.

when I was CIO had this concept and I started doing this, I learned a ton of things in the interview. What have you found that? I don't know, maybe it's a little surprising as being a host. Are you learning things as you're doing these interviews? I assume you are, because I, I learned a ton every time I do one.

Absolutely. I've got, I usually take notes, and so it's kind of that combination. I'm trying to do a good job hosting, but at the same time taking notes, but I need to go back and read about, or learn more of.

Yeah, it's hard. Sometimes though I certainly am very interested in the topic and try to take in as much as I can while they're responding. But also a lot of the times I'm thinking about my next question. And so her kids really tough to to retain it, but you know, some of my other podcasts, I actually did the editing for. And so I get to re-listen to it after it's done. And so I think I retain it a little bit better. The second time.

Most of my shows I will listen to at least twice. I'll do the actual interview, but I have that same problem in that I'm thinking about what's next. And sometimes I'm not a good listener, but when I, as I've done this for a bunch of years, I'm five years into this.

Now I can almost do it with a blank page and it makes me a better listener. And I think it makes me a better interviewer because I can bounce off of some of the things that they're asking, but it just, I've been doing this for five years now, so it's, I think this is, I guess we can call it my profession now.

Yeah, no, it certainly seems to make the conversation flow better if, instead of having your pre-written questions, you actually. Ask questions based on what they just responded to. And so it kind of flows naturally like a conversation had probably early on where I was just writing out every single question word for word, and only going based on those it's a little definitely less conversational and a little more.

let's transition to your day jobs. One of the things we try to do with the show is give you guys as much support as possible. I mean, it's essentially, it's you reaching out to somebody, setting up a time, getting on a zoom call, recording it, and then you just give it to us. We produce the whole thing. We try to make it as not cumbersome as possible, but you guys do have like, A real full-time job CMIO for for two health systems, one in Kentucky, one in Tennessee. There's a lot going on. Jake, we'll start with you. Like what's what's top of mind right now for CMIOS In healthcare

it's always been the case, but maybe more so over the pandemic years with burnout rising and staffing shortages so how can we reduce the administrative burden on. Physicians and providers and working a lot more with the nursing staff as well to try to decrease some of their burden.

So we've done all the classic things like decrease alerts, so that. We made a lot of progress early on. We had a million IMR, a million alerts a month across our system. And we've brought that down to just slightly under a hundred thousand, which you know, is a huge improvement.

Most of those were going to the nursing staff and had never been looked at. And so we got a group and were able to take that down, but the nurses are still spending way too much time in the chart. And so helping with that group to really redesign some of that. That workflow. And then for physicians over the last couple of years, it's been with more patients moving and getting more comfortable with the patient portals just that volume of messages that are coming in.

There's been a lot of articles written about it. But we are trying to really stand up and have a stronger process in place so that we can. Dance layer staff. The was respond to those messages without having to involve the physician because they're just getting overwhelmed.

Can I ask something on that? On the alerts that you decrease from the million to a hundred thousand? Did you find that a lot of them were just superfluous, duplicative messages? Or did you have to, as part of that group, did you have your risk, safety approval person there to say, listen, there's only so many things we can look at.

I know this is important, but is it as important as. How did it, I'm just curious, like what was the dynamic in those meetings?

So it's amazing how great our, I think our culture has evolved on this over the last couple of years, we now have our chief risk officer saying we don't need to add another alert. All those alerts get overwritten anyways. And so it's it's worthless to put it out there. We're going to fix this a different way. And so once we had that switch. It's gotten so easy. All you have to do is show them the data about the override rates. How often they're firing they, you show them that they're not being acted on and there's a better way to do this.

And some of them we've had to leave in place. But a lot of them, most of them we've been able to at least tweak. So working with our analysts on ways that we can just make it far for the right person, it doesn't have to fire for everybody and moving them to a different maybe location in the chart. Reducing the numbers that pop up, right. When you go into the chart it's been, we had a lot of great success early on. We've sustained a lot of that success. And yeah, I'm most proud of that kind of culture change within our risk and call.

That's fantastic. We've been doing something similar with our in-basket and does this message need to go to the position in and doesn't need to go to anybody quite frankly.

And it's nice to start seeing that as well from our end to have to have someone agree that this could go to a folder that auto deletes after 30 days, so them could see it if they want to do, they don't have to, they don't have to sign off on it. So thanks for letting me interject there.

Oh, please. I mean, we, we have three hosts on the show. You guys might as well just start asking each other questions, especially if you can learn from each other. I'm sure others could learn the part of that question. I didn't hear the answer to was where a lot of those alerts duplicative or was it just too many?

I wouldn't say well, some of them fired and then we'd get dismissed and they would fire again. So we had to add some lockout periods that were not there. And, but most of them are just individual lurks. They don't overlap in any way. But there was maybe better ways that we had now to deal with the issue that they were trying to solve to begin with.

Some of them were just out of the box alerts that came with the system. And we're not even based on science anymore. And so we could just turn those off. Once we got some sign off from our clinical teams and it was great.

how many years past go live? Are you on your system?

I was not here when we went live, but I think it was sometime 20 12, 20 13.

All right. So you, so you've been optimizing for quite some time to get to this. fantastic. Brett what's top of mind for you.

As far as for CMIOs, I think it really depends on your organization. Like we're going to head down to Jacksonville and give Aaron A. Little help at their epic transition, their go live at the end of July.

So you've got some organizations that, I mean, obviously it's not the only thing, but they're still transitioning over to a system wide EMR, or they're changing EMR. We're not quite as mature as Jake. We've been loud for six years now on our sort of system-wide EHR, epic. But I think there's been a lot of emphasis on what Jake talked about in terms of burnout and provider efficiency and nursing.

I think nursing has been an area that at least for us has been neglect. Until recently to really look at their workflows and what can we do? We've got an epic mastery team that goes to our physicians and helps just ongoing year after year, help them become more efficient with new applications and things.

We don't have that for nurses and granted it's a much broader group and requires more resources, but we're trying to address that. We've had a lot of legislative things in the. 12 and 15 months, or how are you going to information blacking in Kentucky? I don't know if you guys are aware, but we had a house bill.

We had some legislation passed just last month that said we have essentially, we're going to hold pathology now for 72 hours, but the way the bill was written, it says you must hold the result for 72 hours. If there's a significant likelihood of finding a malignant. Okay. That how do you code for that?

Right. So from a radiology test, if it's a pet scan follow-ups and chemotherapy, probably if it's an x-ray of your hand. No. And so to think, to go through all those different procedure codes and group them has been a challenge, a lot of work on things like that. And then I think for us, it's also, and it's probably common across, but looking, how do we improve the it process? How can we speed this up? If there's a new AI algorithm, for instance, that comes out, it's probably going to take. us At best six to nine months to go through our process whether it's it security vetting of the data, all that kind of stuff. I think with the way things are going towards more algorithms, more external applications to lay over the top, how do we speed that process so that we don't do four or five things a year.

We could do more if operation, we can support it. But that's something that I've been really thinking about, I think, but probably top of mind right now for us is labor costs and efficiencies. That's really going to eat. Resources available to do the things I just mentioned.

???? ???? All right. We'll get back to our show in just a minute. I want to tell you about the podcasts that I am the most excited about right now that I am listening to, as often as I possibly can under that is the town hall show that we launched on the community channel this week health community, and an Arizona Tuesdays and Thursdays. What I've done is I have essentially recruited these great. Hosts who are coming in and they're tapping people in their networks and having conversations with them about the things that are frontline kind of stuff. So it's, it's technical, deep dives, it's hot button issues. It's tactical challenges. it's all the stuff that is happening right there. Where you live on a daily basis. We have some braid hosts on this show. We have Charles Boise. Who's a, data scientist, Craig Richard, bill Lee, Milligan Reed, Stephan, who are all CEOs. We have Jake Lancaster Brett Oliver, who are CMIOs. We have mark Weisman who is a former CMIO and host of the CML podcast. And now a CIO. At title health and we also have the incomparable sushi shade who is fantastic. And I'm really excited about the fact that she's tapping into her network and having some great conversations as well. I'd love for you to tune into these episodes. I am learning a ton myself. You can subscribe on our community channel this week health community. You can do that on iTunes, on Spotify. On Google on Stitcher, you name it, we're out there and you can subscribe there and start having a listen to yourself. All right, let's get back to our show. ???? ????

I was at a conference and there was three CFOs on the panel. And somebody asked a very long question about essentially what's top of mind that can staff and they had like three parts to the thing. And one of the CFOs, half joking, half serious. Okay. All I heard was blah, blah, blah, nurse shortage, blah, blah, blah, traveling nurses, blah, blah, blah, wage inflation.

That's all I heard. And he was half joking, half serious. He's just like you, you don't realize. How acute this issue is and how much we're thinking about it. And I assume that's been dumped somewhat on the CMIO's plate to say, Hey look burnout's a part of that job. Satisfaction is part of that.

EMR usage is part of that reducing alerts as part of that, I mean, the satisfaction amongst nurses, we're seeing some strikes start to hit across the country in various places. So it's starting to bubble to the thing. Is that being. Yeah, I mean, not solely on the CMI, but is that being dropped on your plate as something you need to deal with?

For me, not so much. So I think I've injected myself in our team more than it's been dropped on us per se. It's hard. Traveling nurses that it's not their organization and it's just human nature to maybe not be as engaged or invested into what happens. And so learning the EHR, learning those workflows, learning about the warnings, how to set them up efficiently.

I'm not going to be here in a month, probably. So why would I want to set all that up? I think that kind of thing that drops the training team training as 14 runs up through me. So I think we'd seen that. I don't know Jake, if you have, they dropped that on.

Yeah, it's certainly a shared responsibility and something that I, I work with a large group as, as a part of, so we had a, we have our Efficiency engineers follow some of our nurses around and find where they're spending their time.

And I'll part of that project is still ongoing. We haven't solved it yet, unfortunately. And a large part of what they're doing is spent in the EHR. And so I also worked with our our nursing informatics leaders that are driving the work and. To reduce those alerts, remove flow sheet rows that they don't really need to document on.

Just helping them and thinking of ways that they can reduce it. But they're driving the work. I'm just kind of helping and advising or offering suggestions as I see fit. But we have this nursing redesign task force that is looking at alternative models of care. So Yeah, maybe having a pharmacy tech or a pharmacist do more of delivering the medications.

What can we do with automation? What can we do with expanding the role of our patient care techs and such so it's which are all these other positions that are just mentioned are also in short supply. So it's, it's a hard but I am involved in that work. It's certainly not, I wouldn't say it's dropped on me, but I'm part of the team that's looking for.

From a documentation standpoint, I've seen Dale Sanders talk a lot about this. how much of it is mean I'm not gonna use the right word here. I was going to say superficialis, and that, that would probably be the wrong word, but how much of it is driven by regulatory that isn't necessarily.

Necessary for clinical outcomes or to drive clinical outcomes. It's more just for regulatory compliance and measurement and potentially some payment, that kind of stuff. How much of the documentation do you think still falls into that category?

So are you talking about for physicians, for nurses, for whom?

Well we were talking about nurses. I was more talking in general, so, I mean, is it different for both groups?

Well, there's a lot of overlap, but so we've been thinking, think along with everybody trying to reduce documentation across the system we started with physicians with the new ENM coding changes that occurred last year on the ambulatory side, which essentially reduced what was required for billing for these services.

And there's been a study that was done a year later looking at this and there's been no changes in the length of documentation. I personally led an effort to do this at our organization. I've met the only way that I really got traction was meeting one-on-one with individual physicians and adjusting their templates themselves.

My myself. No it's because everybody has their own. And so a lot of, I guess, different themes came up out of that. So some were happy to reduce documentation. It didn't reduce any time spent in the chart. All we were able to do is reduce what was automatically generated within our EMR. And so it was hard to convince them that this was necessarily something that was going to save them time when it's just auto-generated dumps in there.

And. It's been the same amount of time creating their actual in-person implant inpatient side. It's it's a little bit different. Those have not changed yet. I think they're going to change in January of next year, potentially, but I imagine it's going to be this same thing where it's a lot of what's in, there was initially built for billing and payment. A lot of it is quality. A lot of it is regulatory that we have to put in there. And that's kind of where the ma the highest amount of time comes in. I think it's with some of the quality documentation. The total length is a lot of it's driven by just our templates that we started out with and meet some of these billing requirements that aren't necessarily.

Relevant or anymore, at least for the outpatient side. And just a lot of old habits die hard and it's hard to get them to switch on the nursing side. Yes. I would say a lot of what we're seeing was initially put there by maybe legal or risk or quality trying to capture something because. Yeah. If you need to capture certain quality metrics on every get Ned.

You're going to add that to the nurse, screening questionnaire, and that just keeps getting longer and longer. I would say a lot of that maybe come from joint commission type work that comes out. I know every time we have a survey, we. Yeah, add another flow sheet road to nursing intake.

It seems or some other component that they're being added to. And so it's it's a combination of both regulatory billing and very, very little of it, unfortunately is telling the narrative of what is actually going on with the patient that supports the clinical care. I would say.

It's interesting. Brett, would you add anything to that?

I would just maybe add a little bit that I also have colleagues that, and these are some that I think we can help the Jake and I, and our teams can help because they're not very efficient in the. And so what do they do? Every note is a mini chart. I'm going to bring in everything.

So next time I see the patient. I've got this many chart in my last note, many, and it's 12 pages long, but, and then there's that, as Jake said, the two sentences that I really want to read to see what happened to that patient. Those are the most recalcitrant, difficult people to get to change. Because I remember before the EHR, I would get a 10 or 15 page letter in the mail from them on their consultant.

That's just the way they practice everything from. They had strep throat when they were 18. Too it's it's, those are the toughest ones there. And I would agree with him that everybody's quality metric. Just as that one. It's just that one little thing, bill. I just want you to check this box and said you counseled them on smoking or whatever it might be, but everybody's box and everybody's little nugget ends up this humongous pile on a nurse.

And when they request that. One of the things that I'm trying to do is when one of those quality items or metrics are presented, number one is there's something we can automatically do. Can we pull this from a different area? That's probably the most important thing, but then to, just from a cultural shift to say, okay, here's the 67.

Literally 67 things that this person already has to do on a mission of this patient. You're going to be 68. Are you okay with that? Or is there something we can take off this list? Because it we've got to shift that it's, it's the path of least resistance, whether it's a medication warning that we were talking about or a quality metric, put it in the EHR, forced them to do.

That's easy on the operational people. Right. Just make it happen. I think that it's more challenging to say, is there another way that you can get that you need to add an FTE, that's going to ask these questions or counsel the patients, whatever, whatever it might be. But yeah, it's, it's an issue. I was excited when those new EDM changes came out and then kind of reality hit after a few months like this isn't going anywhere. Unfortunately.

I just went to my daughter's graduation down at Baylor and a whole row of people got their masters and a couple of PhDs and organizational change management. And my wife leans over and goes, what's that fluffy degree? I'm like that degree is everything. I mean, it's like you think the CIO does, does technology work, they don't do technology work.

They do organizational change management. What you guys just described as organizational change management. It's like, how do you get a group of people that have practiced medicine in a certain way for decades to adopt the EHR? To utilize it the most effective way. How do you get people to do a common intake form?

How do you get them to do scheduling in a common way so that you can digitize it and make it a digital workflow? I mean, all these things it, the job ends up being more of a, I've said this time and time, again, more of a leadership job than a technology job.

Oh a hundred percent. I agree with that.

just to go off what you just said, finding a common way to do a certain thing as a standard way so like you said earlier, we've been live on that big four. Close to a decade or more now. And one of the things that was promised with that when all of these new EHRs almost any EHR is, oh, you can customize it so much. You can do anything you want. Everybody's got their own template, everybody's got their own order set. Everybody's got their own workflow. Every screen is personalized, but then when you set back 10 years later, Really wish there was just one way that you could write a note or one way that you could do this one workflow.

That was the best practice and standard. And I think a lot of places are trying to get to that, but it's hard when the product is built on the versatility and the customization and personalization that is out there. And so it's it's a challenge.

You have to remember how we trained. At least I'm older than UJ, but like, When we train, we're trained to be this island that stands by itself two in the morning, we take care of it there's nobody to call. There's no one to take care. And that mindset is, well, I know what's best. I'm going to create my note the way I want it. It's not just kind of this it outlet back when you had paper trucks. I bet it was the same way. We just didn't have visualization into. Yeah.

There there's part of me wishes the EHR could only handle so many order sets. Right? Hey, the max is a hundred. Sorry. We can't go to 101 and let's, let's talk through this a little bit. I remember meeting with my CMIO. He was in charge of getting the order sets right before our go live. And I was complaining about something someday and he said it was one of those.

You think your jobs are, you should see my job. And I sat in on one, just one of those meetings where they were trying to get the order sets. Right. That was. That was the most brutal meeting. I think I've sat in, in, in this six or so years, and these are colleagues and they, what they practice. I don't, I'm not saying they practice medicine so differently, but they have different viewpoints on what is the best care and how do you go about it.

And that sort of dictates how you build those, those order sets. And it was, it was I, I have the utmost respect for him driving the consensus around a lot of those order sets. Now I'd like to go by. I think if we're eight years later, since we did that go live, I bet you those order sets of balloons we consolidated significantly about by two, they ballooned up again.

All right. Hey since I have you guys here, is, is the role evolving or changing at all? I mean, we've talked about this optimization piece. I've talked to some CMIOs at conferences lately and some of them are picking up some of the. Engagement digital side either, either on the clinician side engaging patients or even going as far as to help select technology and that kind of stuff. Are you seeing that, that evolution as well?

I think what's interesting about that role, as you would think. After a couple of decades, it would have consolidated down to a a one pager on here's the job description. At least when I talked to our colleagues across the country, it really varies by your organization.

For instance, with us now that we're six, seven years post live. I'm not really in that at the elbow support kind of role. I have teams that do that and I'm engaged in what how we're going to address things and what are our projects. But for us, we don't have a chief digital officer or chief innovation officer, and those are areas that I just have found interesting and have just naturally drifted in kind of partnering with our chief strategy officer and some of the digital health.

Well, the digital health kind of reports up to me. So yeah, I've been engaged in the, those technologies. And I really get excited about that. While still maintaining the responsibility over the EHR optimization. But that's kind of all the work. I know some of my colleagues, they're still doing some of the, at the elbow, really getting into the weeds with that.

So I think it really varies on your organization. I don't know how much, like

yeah, I would say it varies based on the organizational need. And so for me is it's changed. I've been with this organization for three years now. And so in the beginning, it started off with optimization was our big focus and never really went away.

Then when the pandemic hit, we had a greater need for analytics and visualization of data, which was a skill set that I had. And so I took on a larger role with. Front. And as it seems, as with, with burnout rising and nursing turnover, and like we just said, now it's going back and swing back to a little bit more optimization finding different ways to enhance those workflows.

And the analytics is not, it's still important, but it's not something they're asking me for every day, like they were. And so it just kind of varies with. Yeah, with how the organization is, what they need. I think at the time, and you've got to have a skillset that can support a

so CMIO role. If I were to simplify it, is it the intersection of data, the EHR and the clinician is that that's traditionally what it's been. And then it's driven by if you're, if your Providence. 70, 80 hospitals and umpteen billion, you probably have a staff that's doing the elbow support, but essentially the role probably evolves if you're that big.

And if you are I mean, you guys, I put you guys in the, in the mid category Baptist Memorial is a billion and a half Baptist Kentucky. What do you guys about. About four. Yeah. And even that's in the mid category now you see atrium and advocate coming together. That's going to be 16 billion and The top 25, I think are 8 billion or more in terms of net, patient revenue. So that's sort of that mid category. So you guys are really describing what the CMIO role looks like. It's, it's one of those that is driven by by need and maturity of the organization. I would, I would guess it's Fred, I'm curious, during the pandemic, did your role change pretty dramatically for, for a period of time?

Yes. I think I was definitely more in the weeds then than I am now in terms of how, I guess we were rolling things out so quickly, you couldn't count on the team to go through your normal processes and sleep at night, knowing these things had been looked at and you were jumping in and saying, I'll pilot it. Let's go turn it on. Let's try it. I'll do it. Let's go. So yeah, absolutely.

Well, let me ask you, but I'm giving you both opportunity for two things. One is I want to hear what you're most proud of that your team has accomplished something that people who are listening to this might look here and go. That's interesting. I, I I'd love to be able to do that. And then I'm going to, the closing question is going to be, I I'd love to hear some forward leaning kind of stuff. What do you think's gonna happen the next three to three to 10 years. I'll come back to that question. Let's start with Well at Breville service, you w w what are you most proud of that your health system has been able to accomplish over the last couple of years that you think your peers might benefit from hearing.

Well, it may be more esoteric. My answer may be more esoteric than providing a direct benefit. I mean, I'm certainly proud of some of the discrete things we were doing. I was just sitting in on a lung cancer screening meeting this morning, where we talked about even during the pandemic, we increased our lung cancer screening rates.

Now, Kentucky, we've got a lot of work to do there, but we, we screen workforce in the nation and lung cancer screening rates and that increased during the pandemic, so there's some discrete victories that I really liked. Of course. All the digital services that every organization stood up so quickly.

I think that what I'm most proud of is the way we were able to respond to it. If you had laid this out in a, in a word problem and said, here's what's going to happen, and what do you think the chances are you standing these things up and three days, six days, five days and, and successfully. Not a chance.

Are you kidding me? Just the legal review alone. It's going to take six weeks and then we're going to have to not at all to see the laser focus in that cultural response to the patient needs. I think that's what I was most proud of. So it's not a, it may not be the the sexiest answer in terms of a follow-up oh, I can do that on my own.

But that, that was really neat to see. And then the question becomes, how do you maintain that? You can't, you can't be quite that laser focused. You've got more to do, but I think as an organization, we often have to sit back and say, you know what, we're doing too much. Maybe we should do less and do it better and do it faster and more efficient than.

That was gonna be my followup. You anticipated my follow on question, which is how have you been able to maintain that at the sense of urgency is never going to be as high as it was during the pandemic. The focus is probably never going to be as, I mean, we dropped everything and said, oh, this is what we're going to do and again, that's never going to be as great, but is there an appetite within your health system? To identify a few areas and keep that sense of urgency and that focus.

I think it's something that we have to continually bring up and bring forward. The analogy I would give is in primary care, everybody wants us to do something with the patient in the office. There's a hundred different quality metrics, all this kind of stuff where we've had the most success is when we said we're going to do five and we'd have a group come together and pick the five. But if you're six, it's not going to be the top part. And you're seven and that's, those are hard conversations to have because 6, 7, 10, they're not bad things.

They're still really important to patient care, but you can only do so much. And so let's address those five a year later. Look at that. We're killing it. That's fantastic. Let's go to another five and, and kind of moving forward, but reminding people that their ideas, their priorities aren't bad.

They're just, we have to prioritize. It, I think gets that better than almost any department, because we're the limiting resource for a lot of these projects. And I get tired of answering my colleagues, like, well, it said no about this. It did not say no, that's not in our job description. We don't say no, we might've been the ones that told you.

No, cause there was no money or there was no project bandwidth, but we're there to support everybody else. I think it has to come from senior leadership to say, to keep that focus. And these are going to be the priorities, at least that's how it's worked best, like in our medical group, for instance, with those quality metrics,

Jake, what are you most proud of? Do you think your peers might benefit from?

Yeah. We've talked about it already, but the focus on the reduction in burden over the last couple of years and really. It's the mindset shift from some of our senior leaders within the organization where they're now talking about how to reduce this, this administrative burden for our nurses and our physicians weekly meetings.

In prior years, probably just would never really bubbled to the surface for them. I mean, physician burnout, nursing burnout is always been talked about, but not the hyperintense focus that it seems to have now where it's a priority for the organization. It should have been in the past, but it's just a hyperintense focus now.

And so that reduction in alerts that I described before is one piece of something that I'm really proud that we've been able to do as an organization over the past couple of years. And I'm really looking forward to continuing that work over the next couple of years. It's only really beginning and we've got a lot more work to do.

And I'm just happy that our organization is supporting that effort and wanting us to, to assign a dollar figure to that administrative burden reduction. That is something that they're we're reporting out at some of our cost reduction meeting. Yeah, we reduced this amount of burden.

It saved this nurse one, two minutes. What does that in actual real dollars. And so it's been good to have those conversations and realize that yes, this, this amount of time that we're putting on the providers and clinicians is costing us money. And it's the right thing to do.

All right. Quick, quick exit question, What are you looking at that you think is going to impact healthcare next three years? And what's maybe a little bit more forward-leaning 10 years out that you're saying, we're keeping an eye on these things.

So three years, I still think it's going to be staffing shortages. I don't think we're getting out of that in the next year. And so. What can we do as a system in healthcare to reduce. Reduce the shortages or make them less acute through automation through workflow process improvements, I think is going to still be the main focus over the next three years that we can have the most impact.

And three, 10 year cycle. We're still gonna see a lot more stuff move out of the hospital, into the outpatient setting and how can technology continue, which is already doing remote patient monitoring hospital at home. How can we augment and take care of patients where they really want to be taken care of outside of outside of the hospital?

Yeah. That's fantastic. Brett, you get the last word 3, 10 years.

Yeah. I would agree with what Jake had said. I think also, I think we'll see a better use of data. We've been so focused on the exchange of the data that the quality of that exchange I think has been neglected. And so putting insights into workflows easier access to clinical trials, things like that, that better use of the data will happen in the next few years. I think we'll see that continue to expanded use of voice, which will help some of the things that Jake was talking about in terms of burnout and efficiencies. I think it's, it's interesting that I'm not supposed to text and drive.

Usually the CEO is not taking minutes of a meeting because they are distracted that you're not multitasking. Doesn't work yet. Jake and I were supposed to sit in front of a patient, listen to your, your, the dialogue. Start creating a differential diagnosis, a treatment plan. I know at the same time, let me get my quality metrics down and create a note So I think the more we can use voice, the more cognitive burden decrease that we'll see. And I agree with Jake, a continued emphasis outside of our walls, whether that be remote patient monitoring, self care modules that a patient can assign themselves, they don't need me to do that for med adherence and things along those lines, and just care from home, whether it's delivery of medications by drones, whatever that patient experience.

That's the one thing that. The pandemic has done in a positive direction to kick us in the seat of the pants is raising that patient expectation of the experience, how we got away with being on hold for 30 minutes to schedule an appointment with your primary care provider when you can schedule anything else online.

I don't know, but we don't anymore. That that floor is raised. And I think we'll continue to see that patient experience.

Yeah, I've been talking to some people about voice and I, I think we think it's on a, a linear curve getting better, getting better, getting better. some of the new AI technologies that they are working with. I think we're going to see an exponential curve on that. it's really interesting what they're doing with video. It's really interesting what they're doing with audio and I hope we will see some of that come to fruition in the next. Two to three years. So you guys don't have to type a note while you're listening to the patient. That would be fantastic. Gentlemen, I want to thank you. I want to thank you for your participation in town hall. I also want to thank you for your time today and sharing your experience. look forward to seeing you guys in person someday.

That would be good.

What a great discussion. If you know someone that might benefit from a channel like this, from these kinds of discussions, go ahead and forward them a note. I know if I were a CIO today, I would have every one of my team members listening to a show like this one. It's conference level value every week. They can subscribe on our website thisweekhealth.com or wherever you listen to podcasts. Apple, Google, Overcast, everywhere. Go ahead. Subscribe today. Send a note to someone and have them subscribe as well. We want to thank our Keynote sponsors who are investing in our mission to develop the next generation of health leaders. Those are Sirius Healthcare. VMware, Transcarent, Press Ganey, Semperis and Veritas. Thanks for listening. That's all for now.

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