April 5: Today on Townhall Jake Lancaster, Chief Medical Information Officer at Baptist Memorial Health Care interviews their Chief Information and Digital Officer Tom Barnett. Steve Jobs said technology is at its best when it's invisible. What are Baptists top three technology goals for 2022? The days of an onsite data centers are beginning to be numbered as everybody moves to the cloud. What is Baptist’s cloud strategy? What elements go into their yearly Epic upgrades to increase operational efficiencies? When it comes to cybersecurity, how do they manage both security and usability? And how are they addressing clinician burnout and the staffing shortage?
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Today on This Week Health.
I think it's an interesting time in healthcare IT right now, particularly as we're seeing a lot of technologies begin to mature. Health systems are beginning to gain confidence and be able to step up and embrace some of these newer technologies that are out there.
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Hello, I'm Jake Lancaster, an internal medicine physician, Andy chief medical information officer for Baptist Memorial healthcare out of Memphis, Tennessee. And today I'm going to be having a conversation with Tom Barnett our chief information officer about Baptist priorities for technology for the next year, Tom, how are you doing?
All right, Dr. Lancaster.
Doing fine. You are very well known in this community, but for those who might not know you, can you tell them just a little bit of your background?
Oh, sure. Lifelong it professional. I have existed in industries prior to healthcare but have been in healthcare specifically for the last 15 years. I've worked in health systems in Detroit, Chicago, New York, and now you're in Memphis.
Well, we are very lucky to have you here. And so as we were just talking before we hit record, let's go through a few of our priorities for Baptists over the next year relating to technology. So we'll, we'll start off. I just want to ask you, what is your, your top one to three priorities that you want to see us accomplish over the next year.
I think it's an interesting time in healthcare IT. Right now, particularly as we're seeing a lot of technologies begin to mature. Health systems are beginning to gain confidence and be able to step up and embrace some of these newer technologies that are out there, the predominant one under it. It's I think the the days of an onsite data center are beginning to be a little bit numbered at this point, as everybody begins to move to the cloud and that sort of. Priority for us as well. We are looking at that not only building our cloud strategy for the coming to three to four years or so, but coming up with the immediate steps that we need to address this year, and the first of those is really taking a look at some of our disaster recovery capabilities.
I think a compelling case that's being made. Particularly by a number of health systems that are doing this already, that the cloud, whether it's Amazon web services, Microsoft Azure Virtustream result a number of different vendors that do this, but being able to fail over your EMR. And it's not just your epic stack, but think about everything else that it goes to this, it goes web documents.
Interface engine, a lot of those different technologies, which may have been limited before now have a, a home or a fit in a kind of cloud strategy today. So what we're working through with our teams and our consulting partners is mapping that trajectory into one of those, those cloud environments to provide that as an alternative that while it does increase operating costs, when you go to the cloud, the ability to spin that.
Services that you don't need and kind of just keep it on a pilot light until a disaster against it makes it a fantastic strategy for health systems. So that's the first one that we are eagerly undertaking.
And as part of that cloud strategy also as part of our epic or yearly epic upgrades we're moving to epics hyperdrive, which is more than that web-based platform. Is there any kind of synergy with that, those two initiatives where they would provide some, I guess, operational efficiencies on our side?
Absolutely. So as we're also in parallel with that, looking at changing, kind of what we call our device mix across the health system. So we're going to more of a thin client as opposed to a PC type of deployment. And as you evaluate Citrix versus some of the other virtual desktop type technologies that are out there, I think moving to hyper-drive and it's chromium based approach to doing that certainly gives us a little more flexibility as we look at other products to do desk. Virtualization, even from Microsoft, for example.
So as we began to evaluate that and shifting that overall load for our health system is absolutely something that we are planning and, and making provisions for them. Now, from your perspective, what, from, from the chief medical information officers perspective for Baptist, what would be one of your biggest goals for.
So right now everybody is struggling with staffing shortages and we've always had this difficulties with burnout, but over the last couple of years with the pandemic, it's really become acute. So us, like many others are focusing on ways we can reduce burden to the providers within the EMR was always, has been a priority. But certainly more of it's gotten a lot more senior level attention this year than, than previously. So large initiative on our nursing side to reduce a nursing documentation burden. know, If we look at our efficiency metrics compared to our peers, we are kind of way outside of the norm and we're trying to get well inside the green to even better. So we have a big project ongoing right now, led bar nursing leadership to, to reduce some of that documentation burden. And then at the same time us like many others have seen. Physicians get more in basket messages, messages from patients than they typically would.
This is, goes and coincides with more patients doing virtual care and more patients getting signed up for our patient portal. And so we've been inundated with with more and more patient messages. So looking at ways that we can redesign. One, our technology. So we reduce that message burden and only get the right messages to the right people at the right time.
But also just revamping the way we build out our processes to support that, that growing area. So that again, just take more that kind of administrative burden off of the physicians. So a couple of our big priorities on that side. Excellent. So security has always been a big issue within healthcare. But again, it seems to be more cute over the last couple of years. Does this Baptist have any big initiatives related to improving our security over the next year?
Absolutely. I think in the former world, particularly with, with data centers, when everybody were we're on site Security was different. But now as a result of the last two years, we've got a number of folks, just like any organization that are working remotely working in hybrid models. So now how we access and connect with our employees, our partners and our customers is constantly undergoing change. And I think that introduces new security risk points to consider that we did, we have before as well as an evolving security footprint for how we need to evolve and embrace things. And as I mentioned before, even moving to the cloud, all of the permutations and variables of complexity that come in with them certainly makes the security landscape even more complex.
I've used this line before, but I really like it. It's no matter how well you do in security You can't stand, stand still. I mean, you're constantly having to raise your game. So the minute you build around your, your health system, the perfect 10 foot wall as soon as you wake up the next morning, the bad guys who've shown up in the 11 foot ladder.
So it's constantly evolving and that's exactly what we're doing. We're connecting with our peers. What are others hearing? What are others trying? What are others doing? We're evaluating internally kind of what do those new landscapes look like? What do those new thread opportunities look like? And we're constantly trying to evolve and enhance our security technology. Healthcare is not going to get any easier. So I think as, as that complexity continues to go up our ability to keep that dust as safe as we can and, and and to close as many of those doors as we can. Always going to be one of the top priorities.
And how do you balance security and usability? There's always been a large pushback from the provider community on any sort of security measures of within our technology password log out requirements and such, but I feel like providers have gotten a little bit. Over the last few years when we rolled out multi-factor authentication, there was much less noise than I was expecting.
Most had been used to it from interacting with banks and others and outside sectors. But still it's, there is a sense that with the burnout, with all the other user usability issues that we have how do we balance and make sure that we don't make it too onerous to, for the providers to get into this system?
Absolutely. So apart part of the way you can do that. And you're absolutely right. We have become conditioned as a society. I mean, everything we do is now with our smartphone and we always have double checks to do or codes that are pushed and so forth. But the other thing that we can do is leverage a couple of things.
And I think I'll come back to cloud as well. Number one is, is analyzing workflows. I keep coming back to that, but workflow to me is always front and center to everything that we're doing and making sure that we kind of close the doors around the things that aren't as necessary and then utilize techniques to make sure that the higher flow workflow in this case of a position.
Is as secure as we can make it without being intrusive. To the extent that we can, things like thing about tap matches in addition to push alerts or push approvals to the phone particularly as you approached devices, those kinds of things, where you make them just in time injected into the moment and. Non-obtrusive type of verification. I think those combined with cloud technologies and that's where we get into artificial intelligence, the ability to ingest log files, the ability to ingest patterns, even for yourself as. And be able to look for things that step outside of that pattern rather than make you validate per se.
Once you're inside a building every little door that you need to go through, maybe there's an opportunity where we can validate you periodically as you're moving through that, but the minute you begin to do things that are out of the norm or out of your behavior, then be able to offer a higher level of scrutiny and intrusive from your perspective to just validate your truly who you are. So I think there is a balancing game. The easiest way to keep all its systems as secure as possible is just make sure nobody has an ID to get into them. They just don't tend to beams. So striking that balance, but then leveraging those technologies.
Machine learning and AI attributes that are out there, I think is one of the ways to help make them higher security, but able to live with now from the chief medical information officers perspective. What's next on your list for the year?
So going to keep coming back to usability and improving the, the providers experience with, especially the electronic medical record. So a couple of different projects that we've been working on last year with the change in the ENM coding guidelines.
We. We thought there was going to be a great opportunity to improve our physician's experience with notes. And so we had a big project through reduce the documentation burden and we developed new templates. We worked with a lot of different physician groups and we're, we're able to make some, some real strides and reducing that burden.
But recently the I believe it was an article in the annals of internal medicine. They analyze actually. Since the change occurred and with ENM coding guidelines, the difference in time spend in notes from a large. Selection, the physician population, not just a single center and found that the notes were about the same size.
They spend about the same amount of time and notes. The only difference was that the physicians were able to increase the level of service charge from, from a three to a four in most circumstances. So really no change in the documentation burden. So we're taking a little bit. A different approach this year.
We, we are holidaying, Dax, dragon, ambient experience from nuance so that we can try to automate some of that note writing process. It's I know a lot of other places have I've already rolled out their, their pilot, but we're starting that hopefully this spring with about 15 providers where. The AI will listen to that patient position conversation generate a note, they'll have another third-party position review that note first, make any edits that are necessary and then put it back into the epic for our physicians to just review and sign. I'm really hoping that that goes a long way that that virtual ambient scribed goes a long way. And in reducing that, that burden on the position. So very excited about that approach. And that's something we'll be focused on in the coming months.
That sounds like an exciting program to undertake.
Yeah. You mentioned three priorities as far as the next few years for, for Baptists from premiere standpoint. What's the third one?
So the third one is part of the other hat that I wear in the chief information officer role, as I'm also have digital responsibilities. So chief digital officer as well, part of that revolves around. If we're going to really engage, there's a lot of things that are competing for our patients today, as you and I both know a and not the least of which is the growth of Amazon is they're beginning to reach out. And the tele video services, particularly in the primary care space engaging our patients. Really means looking at their journeys. So we really want to make sure that we're understanding what our patients want to do with us, as well as understanding what that journey should look like. So in order to optimize something, you've got to first know what it is today.
So we're working with an external firm to do a couple of things. We're doing some focus groups with some some patients in a couple of our market spaces, as well as mapping. Kind of a digitally laying out. What does that journey look like today and why do we want it to look like in the future? And then once we understand what that smooth or seamless journey experience should be for the patient and how we want to make that as simple as possible least number of clicks and so forth, but the patient, now we can look at what kind of, which technologies do we pull into that? I think it's an overused phrase, but Steve jobs said technology is at its best when it's invisible. And that's one thing that I've always cringed with patients is that they're too aware of the different handoffs between different technologies they engage with, or when they're trying to do business with the health system, the ideal state would be that you can get to what you need very quickly. And then it's kind of pulled you along and anticipates your needs along the way that you may have been handed off between two, three or four different technologies on the surface. That way to make that cohesive this, to start with a good sound end to end patient experience journey. And that's what we're focusing on this year in anticipation of, of that driving some of our other digital strategies.
Well, that is, that is fantastic. Is there anything else that we need to tell the audience about what we're planning on doing in the next three or four years?
I think that's that's pretty much it, I think probably from both of our perspectives, we always are sensitive to the cost component so optimizing and trying to find streamlined ways of doing anything, whether it's how we utilize technology where we can streamline physician time, where I can decrease the complexity or a technology stack, but it's supporting all of our frontline caregivers. That's an overriding theme, and I think it's, it's perennial. We were doing that year in and year out going forward, but that will definitely be an overriding another priority for us to handle.
Yeah. As part of some of those efficiency projects that I was mentioning, we, we were able to go in and try to assign a price tag to some of those minutes and hours for nursing time and doing the same for physician time, just so we can make it, make it stand out to our. Our financial wizards about how much time is really being wasted with unnecessary activities. So that along with using the data from the EHR and several other components to find opportunities for cost savings especially over these last couple of years with, with salaries and such going up.
So those are definitely some, some things that are always going to be sensitive too. Absolutely. Well, thanks again, enjoyed the conversation and I will see you down the hall. Thank you everybody for listening.
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