April 4: Today on the Conference channel, it’s an Interview in Action live from ViVe 2023 with Gregg Nicandri, CMIO at University of Rochester Medical Center. How is his medical center viewing care orchestration across various service lines? What kind of questions or pushback does he get from clinicians in the important conversations to enable digital transformation? What emerging technology does he see that offers the most to clinicians?
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This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.interview in action from the:
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You can check them out on our website this week, health.com, now onto this interview.
here we are from Bye for another interview in action, and I'm joined.
Greg Macand, C M I O, university of Rochester Medical Center. How's it going?
Yeah, great to be here. Great to meet you, bill.
Well, I'm looking forward to the conversation, CMIOs, coming to this conference. I'm curious what you're looking for, like when you were getting on the plane, you're thinking these are two or three things I'd like to find out more about what are those things?
for me it's just an opportunity to kind of see all that's out there and available from a technology standpoint. I mean, there's no other place where we get this level of thought leadership and vendors all together in one place.
Have you been a vibe before?
I've not, this is my first time at Vibe.
This is 2,600. So this has grown a lot even since last year was the first one. And this has grown a lot since then. And it's really interesting cuz we're sitting here looking at just this little space here and , this is like the innovators booths and that kind of stuff.
They're pretty small, but each one of those people has a little different take on what they're gonna do to solve the challenges of.
Yeah. Yeah. And it's great talking to everybody and hearing everybody's ideas. So, the challenge I think we're faced with at our health system and probably at most health systems right now is just due to, staffing shortages and provider burnout, and how do you execute on major technology transformation.
When the staff that needs to kind of carry out those plans maybe isn't in the best position to actually engage. And so really kind of looking at solutions that help offload or automate some of the processes to get rid of some of the cognitive burden for our physicians. Let them, get back to doing what.
Into Medicine four which is, listening, educating, communicating, empathizing with their patients,
returning the joy to medicine. I've heard that phrase now, like three or four times. I've had a conversation with your c i. Yeah. And a lot of it has to do with I, I mean, I think the term I keep using now is care orchestration, right?
So we've digitized everything and now it's a matter. Can we I'll give you an example. So when we talk about Amazon, Amazon digitizes these transactions now, we don't think twice about Amazon. Knowing that the package got to our thing or letting us know instantaneously this is going on and that kind of stuff.
We just don't think about the orchestration of, from the time I go on site to do an order, till the time it gets received. And what I'm hearing more and more from health systems is. Can we orchestrate, obviously a much more complex process, but those touch points of, Hey, your appointment's tomorrow. Hey, this is going on.
Hey, here are your lab results. Hey, here's your next scheduled appointment. And those kind of things how are you guys viewing care orchestration across the various service lines.
So we have a pretty comprehensive digital transformation strategy that we've embarked on, probably starting now a little over two years ago with Michael Berg, who's our Chief Digital Officer.
He kind of came up with the strategy and I kind of, the execution arm of that strategy. So, You can have a bunch of technology that you want to layer on, but how do you actually get the people to use the technology? And so I think we've been really good partners and very strategic in figuring out, what is the most usable technology for our patients, for our nurses, for our doctors.
So that, that strategy involves kind of three arms. There's the digital front door which was phase one, phase two was digital patient engagement, and then phase three was transformed. And so, really the last two years we were doing that digital front door, the provider finder the online scheduling, the omnichannel opportunities for patient experience.
So, scheduled telemedicine in person on-demand, telemedicine, e-visit e check-in with kiosks, saving rooming time for our patients. And then all the way through kind of checkout. And I think we've done a really good job. At stringing that together across our organization. So the patients have a pretty unified experience especially within our primary care.
And now we're kind of extending into our specialty care. It's a little bit more difficult for us with our, online scheduling because we're a highly specialized organization with lots of access issues. And so just saying that there's appointments available for you in. Isn't really super helpful for our patients.
So we're trying to figure out now how can we address some of those access issues, through technology.
What kind of questions and what kind of pushback do you get from the clinicians in the conversations that need to happen in order to enable that digital transformation?
I think it's all workflow change.
I mean right. You're changing what they normally do every day.
moving my cheese and they're gonna come up me a whole bunch of times, Greg, how many times are you gonna move my cheese? Like, it's just you're constantly asking them to do something different.
And the cognitive burden of learning something new is not something that we can really discount and. I think we kind of, through the pandemic,
it's, It's been one of the things that's attributed to burnout. I mean, people just going, you know what, enough I'm done.
Yeah, I think we put a lot of projects on pause during the pandemic to focus on really important transformative system-wide projects.
And we proved that we could execute on them quickly because we needed to. But now there's kind of nine other silos within the medical center that have had pet projects that have been on pause for so long that they also want them executed on equally as quickly and. I'm finding myself having to say, all right, we need to really, you know, details matter, especially when it comes to the providers.
You have to think about, how this impacts the way they're scheduled, the way they can see patients, the type of care they delivered, whether it's how they actually wanna practice medicine. I think we're trying to give people options and opportunities to kind of, have choice in how they work or how they want to work.
So choice give me an idea of what's the promise? So when you're talking to clinicians and you're saying, look, we are gonna do these things. And it creates a much better experience for the consumer. Because you describe a lot of things that are really good for the consumer. It's like, look online, scheduling, automation, of appointments and all those things.
What's the upside on the clinician side for them?
I don't think it's a one-to-one on upside, so, there is an upside in that if we do it right, you're gonna see more of the type of patients that you want to see and we're getting better. So at our organization, we capture patient reported outcomes PROMIS data on all of our patients.
And so we have a really good measure of health. So as we talk about transforming from healthcare delivery to delivering health, we actually are measuring it because that's what we wanna improve. From an appointment standpoint, we can actually look at, okay, which providers are actually able to deliver better health outcomes for their patients?
What are they comfortable seeing? You can start actually using some of those triage pathways to get providerS Kind of the patient types that, they're good at taking care of, and obviously that's gonna make them happier. So that's one promise that we can deliver. But I think the other thing we're doing is just saying, Hey, we're also gonna be delivering technology to make your job easier.
We're gonna be looking at, things like Dax to help with. Documentation burden in-basket is a huge problem. We're going through a very big in-basket kind of redesign to try to lessen some of that burden and try to get people working at the top of their license to help offload some of that from providers, things like that. 📍one is on CSO priorities for:
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it's amazing how it feels like there's still. Work to do, even though we're making a lot of progress, because I mean, as you described some of these things, I'm just thinking through from a data standpoint, from a nomenclature standpoint, from an adoption standpoint, from a, we have so many complex things.
Is there anywhere where complex things that we have to bring together in order to orchestrate. I guess the question, and we'll call this the closing question, and it's not it's not gonna be an easy one, and it's essentially what technology do you think at this point as you're looking out at this landscape?
Offers the most promise to the clinician.
think it's the technology we're gonna see next year. It's, GPT four. The ability for that to automate so much of what we do in terms of chart abstraction just, through the chart, find these certain things that are gonna be
important because the clinicians are for my visit,
because we have the clinicians.
Doing so much documentation at this point. That's the burden that we want to alleviate the
Yeah I think you can, yeah. It'll help with chart review. It'll help with documentation, it'll help with inva. I think there's gonna be a lot of great stuff to come from that.
Yeah. I'm really bullish on this and I, it's interesting cause I talk to a lot of clinicians and they look at me and they go, look, this thing isn't, it can't replace a doctor.
I'm like, , we don't want it to replace a doctor. We want it to be a minion to take the millions of little tasks that we do and to say, And each clinician's a little different. They might say, you know what? I want that minion to do 60% of my task. And another one might say, if you can get it to do 90, I'm fine.
Have it do 90. I, I'd rather be looking at the patient, talking to them, looking at the family, having a conversation than, spending all that time in there making sure is that note correct. And doing all that stuff. Yeah. So I agree with you. I like the promise with Greg.
Fantastic. I appreciate the time.
Another great interview. I wanna thank everybody who spent time with us at the conference. I love hearing from people on the front lines and it's phenomenal that they've taken the time to share their wisdom and experience with the community. It is greatly appreciated.
We wanna thank our partners, CDW, Rubrik, Sectra and Trellix, who invest in our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.