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Today on This Week Health.

He said, "we have a clinician shortage and that will probably follow us for the rest of our careers." And it's the first time I had heard, I'd heard somebody sort of articulate that, that this is probably the new norm.

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, 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.

All right. We're here with Dr. Joseph Evans with a CMIO with Sentara health. How are you doing? I'm doing great. It's good to finally catch up with you. We caught up with each other. Actually, we met for the first time down in Naples. Yeah. You were down on a family vacation. That's kind of interesting.

Ran into you and recognized your voice.

I know. Which is interesting. Having somebody come up behind you and go, I know that voice, but so yeah, so you listened to the podcast. So what's top of mind for you Sentara it, tell us a little about Sentara what's top of mind.

Yeah. So Sentara is a 12 hospital system, integrated delivery network, and mostly focused in Southeastern of Virginia and Northeastern North Carolina with a couple of markets in the center of the state.

We have a health plan about a million lives. We have a clinically integrated network that is a mix of employed and independent of. So yeah, that in a quick one is Sentara, I think from a standpoint of what's top of mind. I think, at the conference this morning, we talked about. Tom Lee talked to us about engagement, resilience.

And I think some of the CEOs that spoke, talked about the importance of culture, and I think one of the things to get that is to really help our system perform better, because I think all the resilience we can build into people, if you keep putting them in the same system there, it's doomed to fail.

So I think, some of our big initiatives this year have been around clinician experience around. A couple of small trials of help using AI machine learning to help the documentation ambulatory inpatient on the ambulatory side, we're looking at a big in-basket project to try to get rid of, a a lot of notes that in messages that come to our clinicians don't really need to come.

So trying to, to work on reducing that burden. We're also, relentlessly working on our decision support, especially the interruptive decision support. So there's not a lot of, a lot of pop-ups that keep hitting us

what's interesting. So gene woods was up there. The CEO panel was up there and Jean said something and it hadn't really crossed my mind until he said it.

He said, we have a clinician shortage and that will probably follow us for the rest of our careers. And it's the first time I had heard, I'd heard somebody sort of articulate that, that this is probably the new norm, not. Not the stress that they're under and those kinds of things we've got address the culture we've got address.

Some of the divisiveness that exists in our, just our general culture of people coming in and saying things and being let's just say not civil. But, that shortage being sort of a permanent new state really puts a lot of pressure to say, all right, how can we make these people more effective?

How can we Reduce the pajama time. You can't expect these people to, to work all night. And there were some other stats that, that they were thrown out in terms of resilience, physician resilience, and, and part of that is having engagement. But part of that was also recovery of being able to step away.

So is that where a majority of the time is, being spent from a technology perspective is how do we reduce the burden of overall practice.

Yeah. I mean, I think, in basket is a piece for ambulatory and certainly for ambulatory documentation. And I think, some of the folks that I work with, it's by choice, some people, if you have young kids at home, you might want to go straight home and get your kids off the bus and then you do it.

But I've talked to others and I think kind of the, the pajama time, or maybe a better measure is kind of notes completed on the same day. And that's why we're trying to leverage some of these AI. Machine learning solutions to help take away some of that documentation burden.

And I think another part of it is again, all these messages and what we can centralize, because if we're going to have to do potentially more with less people, you know what? We can work as a team with kind of refill protocols and that sort of thing so that our physicians and APS never even have to get those messages.

So talk to me about AI and notes. Now you've mentioned that a couple times. Treat me as if I don't understand what you're talking about, because I'm not entirely sure I do understand what you're talking about. So what is, what does that look like to apply AI to the nodes to complete the note, or what are we talking about?

Yeah. So in the ambulatory space, we're going to partner with a trial with nuance and their Dax solution or dragon ambient experience which allows the clinician to basically put their smartphone on the. table Have a dialogue with their patient. All that information will go up to the cloud where today a, another clinician will read it and proof it.

And then it'll come back down to the author who will then make some final edits. And based on those edits, it'll get some order in the next time it composes the new.

So you took away, all the keyboard time and sure. I'm now face-to-face I contact out the whole time. That's going to be very interesting.

I'm glad you mentioned a nuance back since they were a sponsor of the show, at the HIMSS conference I went in, they have that booth where they, they show that off and it really is kind of fascinating because , if you go back a couple years, they would say, Hey, you can use it for this specialty in this specialty.

And it seems like that number of areas that you can use a solution like that. Yeah, it has grown pretty dramatically over the last couple of years.

Yeah. I mean, I know we haven't planned in all of our markets with an orthopedic surgeon and a cardiologist, so really a full breadth. I think the lion's share of our primary care, internal medicine, family medicine.

How do you grow adoption? So it's, it's, I mean, you're talking about a program that has a lot of potential. I assume you have to get buy in on a lot of different levels. What does that look like? Is.

Honestly, we've been a DMO customer of nuances for a long time, and I think there's still some people that are just, they would rather type, you know what I mean?

I think all of us can talk faster than we can type, but you know, some people, you, you can really just show the benefit. We have some early wins and say, look for this physician who had a lot of fines for not completing notes in a timely manner. Look what we were able to do with that.

And just think even if you weren't a person that wasn't able to complete your notes. It'll buy you more time back with your family out of the office.

Yeah. Which goes back to the to the burnout. Is there any other areas that you're applying technology specifically?

We're certainly, we're on a continuous journey around clinical performance improvement, clinical variation.

And we're looking at some different solutions around episodes of care, whether it be spine surgery, some heart Tavers and those types of procedures to kind of collect data points along the way. Yeah.

It's interesting. Cause you there's so many, there are so many point solutions. Are we having, is that still a challenge that we have so many of those point solutions and integrating them all into a cohesive, full unit?

Between our, our health plan and, the various service lines, we have a pretty good collection now. So we're really trying to kind of consolidate that look at who really stands out. Maybe try to come down with a handful of enterprise solutions,

any predictive models you guys are looking at, or implementing.

Yeah, we our sepsis model is still a homegrown model from many, many years ago. We have epic Subsys model running in the background. Collecting comparative data. We are going to use an operational model in our EDS to help with medication reconciliation. So it's a model that predicts an ed patient likely to be admitted.

We use pharmacy techs in our EDS to help get a medication history, but they can obviously see everybody in the ed. So this way we can kind of triage that precious resource.

Okay. Well, I want to thank you for your time. It's great to meet somebody who actually listens to the show. Appreciate it.

Thank you Bill.

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