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Michael Han: (Intro) You don't want to automate a bad process. You want to make the process as clean as possible so that it can be automated, and so that you can actually improve outcomes. Because if all you're doing is automating a bad process, then you're just amplifying the bad outcomes that you get from a bad process.

I'm Sarah Richardson, a former CIO and president of this week Health's 2 2 9 community development where we are dedicated to transforming healthcare at one connection at a time.

Our keynote show is designed to share conference level value with you every week. Now let's jump into the episode

Sarah Richardson: (Main) Welcome to this week health keynote. Today we are joined by Dr. Han, a physician, executive, and health system innovator, currently serving at MultiCare.

Michael Han: Thanks. Thanks for having me. I'm really looking forward to the conversation.

Sarah Richardson: Absolutely. Because you've spoken about the ongoing financial pressures in healthcare. How do you see technology playing a role in both addressing these constraints and improving care delivery?

Michael Han: MultiCare and, other healthcare institutions here in Washington state are really facing some significant headwinds.

We have headwinds in terms of snap funding pressures from 340-b, site neutral payments. And, these headwinds at this point revenue is gonna be a challenge. And so it really is gonna be about controlling costs as much as possible.

On top of that, our labor here is pretty expensive. And to be honest, people who would be medical assistants or front desk staff could probably go to an Amazon fulfillment center and get competitive paid benefits. I think that technology has a significant role to play in the administrative duties that surround the clinical delivery of care.

If we can begin to use technology to address those pain points. I do think that we can reduce our overall costs that are in the system and I think it should result in improved productivity. And so, that's where I'm really hoping that we can apply technology is to the non-sexy, non-clinical stuff.

I think we'll get to the clinical stuff eventually. But this is where I really want to focus my efforts,

Michael Han: I think that this is really important issue to sort of double click on. When Ambient first came out I'm gonna say me, maybe other people had the insight. I thought it was gonna be a great documentation tool and I thought that physicians nurses apps could all benefit from having an ambient solution to help with their day-to-day documentation.

What I didn't realize until a little bit later on was what a treasure trove of unstructured data. The ambient documentation actually was and how it could be used to drive actions both upstream and downstream from the documentation itself.

And so, in the ambulatory setting I think about things in terms of the pre-visit intra-visit and post-visit spaces. So one can imagine where you could have a large language model or artificial intelligence perform in the pre-visit space, perform chart prep. Chart summarization pre charting care gap identification.

And certainly all the results from advanced imaging studies that I suggested to the patient that they get, in that intra visit space. Certainly, documentation the note is going to be the most important part of any sort of ambient clinical documentation tool.

But ICD 10 codes E-and-M codes, CPT codes that are driven off of the documentation teeing up orders in that intra visit space is the direction that we have to go in. And so I think that vendors are looking in this space. I'm super excited about the post-visit space.

And the virtuous cycle really restarts, right? Because before that cardiology visit, if the cardiologist needs an EKG or if the cardiologist needs an echo, prior to seeing that patient, all of those things can be done or can be reviewed prior to the visit.

So that way the patient's encounter is actually as high value as possible. And this is how we're going to be able to extract more and more productivity out of the system. because right now there's too many times where patients show up at a specialist visit or show up at a primary care visit without having had the tests and necessary steps in order to really be there.

And so, I'm really excited about improving the value of that visit in those sort of three areas.

One of the things you and I shared previously was this is the first time in 20 years that the burden is being taken off of the physician.

Michael Han: I actually thought about this little bit since we last talked. Right? And so yeah. HITECH promised a lot and it promised an increase in efficiency.

And I heard someone say at a conference last week that healthcare is the only vertical that became less efficient with digitization. And so, you know, I think back to my residency and so that was, I'm gonna date myself. So that was in the, in the mid to late nineties. I think that there are a couple of areas where there was an increase in efficiency, and one of them was films, radiology films. And so when I was an intern, part of my job was to go and collect the films at the end of every day, on my orthopedic surgery rotation where I had to go and hang the films up on the lightboard for the chief resident and the rest of the team to review at the end of the day.

But it was extremely inefficient for an intern to go down and make sure that all the films were where they needed to be. And so with the advent of PAC systems and the ability for any provider to pull up those images at any time and not have to share those images or not be able to have multiple people.

Look at those same images at the same time is pretty amazing. And along those lines, the second story that I'm gonna tell in terms of increase in efficiency with, the electronic health record was that I was a first year attending, so now six years later, right?

First year attending hot Shot, junior attending. And I was in the heart center writing a consult talk, and I'd seen a patient gotten a consultation. And I was in the paper chart and I was furiously writing my progress note in excellent penmanship. And two hands came over the desk.

And so I opened up the rings of the binder that was holding the chart together, and I pulled out my progress note, closed the rings, and handed it to the senior attending. Right. That I couldn't review whatever else was in the chart. Right? And so again the ability to simultaneously review data and enter in data into a chart, I think that those promises were really fulfilled by the HITECH Act and implementation of that, we'll call it EHR 1.0, right?

And Malcolm Gladwell, he talks about we don't need more data, we need more understanding. So, if we remove the burden of entering in data. I think that this gives physicians, nurses, apps more bandwidth to understand and analyze the data. We're washing data and if these tools can help us to analyze and gain insights, it will result in better outcomes for the patient.

And I think that, the first data that we've seen come out of our trials with ambient technology here at MultiCare was that, that we have not seen a decrease in time in chart. We can track that on a individual provider level but we have seen a decrease in time in documentation.

Sarah Richardson: And at the same time, it's pretty much comes down to the triangle of the people process and technology aspect. Yeah. Of digital transformation, which is really critical. And so how do you see your role of the Chief Medical Information Officer serving as a keystone in this triad?

Michael Han: I think that informatics really sits in the middle of it. And so, we're gonna sort of expound on this people process and technology framework in terms of the people, I think that the CMIO or informatics in general has to help the people understand the wiifm, right?

I think that the process part is actually a lot of fun, right? The process part is where you work with your stakeholders to create the most efficient workflow. and I think that technology or the introduction of new technology it's an opportunity for you to really examine the existing workflow and optimize the workflow with technology in mind, right? Because what you don't want to do is that you don't want to automate chaos. You don't want to automate a bad process.

You want to make the process as clean as possible so that it can be automated, and so that you can actually improve outcomes. Because if all you're doing is automating a bad process, then you're just amplifying the bad outcomes that you get from a bad process. And so I think that the process part

other stakeholders in his department and other departments. And already he's heard back from other departments saying, no, that solution won't work for us. And so, you know, I went back to the stakeholder who asked for that particular enhancement and I said, this is the issue in terms of coming at us with a solution.

What we really enjoy doing as informaticists is come at me with your problem and let's try and develop a solution together, as opposed to coming up with a solution and saying, this needs to be implemented. becuase nine times outta 10, it doesn't work for everyone else.

It's just not gonna work, right? It's not gonna be adopted. And two to three years, if there's no operational or clinical champion for that piece of technology too many times I've seen it with her on the vine.

Sarah Richardson: A hundred percent that the people aspect is gonna be the hardest component. How do you bring the ideas forward though? Because if the technology's there and we can get people on board to a degree, that whole process component where the people are involved How do you expose them to ideas they may not know about because they've been with the health system for a long time, or the world they know is X, Y, Z. When you think about creating like an easy button, you've mentioned that concept to me before, that helps to drive adoption. What does it actually look like in process and practice?

Michael Han: I think it is guiding your end user to the problem that you're trying to solve. Right. What is the root cause Of whatever it is that is bothering you that you believe that this piece of technology is the solution, or you believe that this change in process is the solution, or you believe that this change in people is the solution.

And let's look at the problem try together right in collaboration with your customer to try and come up with a solution. And I think that once they become so, they identify the problem that they're trying to solve and you work together to solve that problem.

I think that's when you get the easy button when it comes to technology. Because if you start solving for problems that they don't necessarily have or you think that they have then you're a solution looking for a problem. And I think that the key here in terms of adoption is being a solution to a problem that they've actually helped to identify and really wanna solve.

Michael Han: Yeah. So in my previous role most of my peers did know me as a physician and as a urologist. And so it was the credibility was already there as a clinician here at MultiCare. I never practiced at MultiCare. I have yet to practice at MultiCare.

I do have friends here at MultiCare, and so that has helped in some arenas just through personal networks. And so I think that sort of personal networking is always important because they can help to vouch for you as a physician executive. I think that

And it's doing what you say you're going to do and securing those small wins at the very beginning. So that way they begin to trust you more and more. One of my mentors when I was a resident, told me, in, in your first couple of years of practice don't bite off more than you can chew in terms of of surgical cases that are super difficult.

Make sure that people out there know that you can do the, I'm not gonna say easier stuff, but the more routine things as opposed to the super complicated things. And so I think that the same thing goes for taking on a role as a physician leader in an institution where you have not practiced

Sarah Richardson: well and as a board certified urologist and surgeon, you've had a unique intimate connection to patient care. How has that influenced your approach to leadership and healthcare technology, especially now that you're not. Putting your hands in the patient, as you have said before, which is the ultimate level of trust that a physician can have with their patient.

Help me with patience in identifying with patients as well as identifying with other providers. That's the, dare I say, the people part of the equation. Right? Be a good person and apply what you learned in kindergarten, right? I think that the other thing that I took away is teamwork.

Atul Gawande in one of his articles, pointed out how many people are necessary for one surgeon to do their work. Right? And so there's a pre-op nurse, there's an intraoperative circulating nurse, there is a scrub tech or a scrub nurse, there's an anesthesiologist, there's an anesthesiology tech, there's a post-op nurse.

Right. And, the same Atul Gawande, published that article near the end of my residency in terms of surgical pauses, reducing morbidity and mortality in the perioperative space. And, at the same time, Malcolm Gladwell came out with a amazing vignette about the 747 the crashed in Guam

And how important flattening the hierarchy in the cockpit was. And, you know, Atul Gawande did the same thing in terms of flattening the hierarchy in the operating room. in terms terms of the 747, that hierarchy resulted in hundreds of people dying unnecessarily. You know, in operating rooms around the world, I don't think it would be an exaggeration to say that thousands of lives have been saved by flattening the hierarchy really saying, we're all part of a team and we need to work together in order to get to where we want to go.

Sarah Richardson: That is so prescient for the types of conversations that need to translate, especially in the decision making space.

Michael Han: I think about that, surgical pause, right? I think about you go into the boardroom and if you don't know everybody, right?

You gotta start with introductions, and I try and get people to use my first name. Some people don't but I think it's super important in the boardroom to flatten the hierarchy and try and include everyone in the conversation because I think that everyone has an important viewpoint when it comes to the matters at hand.

And no matter where you are in terms of seniority no matter what letters come after your name. I think that, that's very important. The other thing is learning and not forgetting that it's a different skillset.

It's a different knowledge base. That you have to tap to be successful in the boardroom. And so I've always loved to read I'm a lifelong learner by nature. And so, I like to hear about how other people have tackled those problems.

Michael Han: Any one of us can be a patient. And any one of our family members could be a patient and I have been a patient my family members have been patients and that could be a loved one that is the next patient that's being treated or the next customer that's being treated at your facility.

And how you would want care delivered to your loved one. I think that the second thing is, and I've seen this implemented to varying degrees of success at different places is the safety story. And how different events, may lead to an untoward outcome for a patient.

And starting administrative meetings with a safety story or reflection on what it is that we do, I think it does an important job in fulfilling that, that need to keep us centered on the fact that what we're doing is truly special. And dare I say intimate in terms of caring for others.

Michael Han: For me, the most exciting, and I said this earlier, right, that I don't want my tech girlfriends to focus on the clinical delivery of medicine, right? Of clinical delivery of health that I want them to focus on the non-sexy stuff, right? The administrative tasks, the scheduling, the appointing, the referrals, the prior authorization stuff that none of us want to deal with, right?

But I am gonna say that. For wide swaths of the world, there is no access to physicians or nurses to even wide swaths of America, right? There are healthcare deserts where people have difficulty accessing, specialty care. And we're not even talking about tertiary or quaternary care and so the promise, and again, it's a promise at this point of being able to deliver,

I think that the second is the understanding and the analytics.

We are washing data. And there's no way that we can analyze the data that we have in hand. Right? And so, the first time that I got an Apple watch. I showed the chief of primary care, the Apple Watch, and I said, look, it's monitoring my heart rate and it's amazing.

And I said, how do we get this data in front of the primary care docs and the primary care doc? She looked at me, she said, Mike, I don't want to know. I have too much data in front of me. So the ability to digest all of this data and summarize it in a way that is useful to a physician.

And the thought of video to text, right? Where again, you now you're taking that documentation burden away from a surgeon, where your surgery is video taped. And I realize we're probably far from this, but maybe not that far, right? Where we have multiple angles of the surgery that being videotaped taped is probably, I'm dating myself, right?

Recorded we'll call it recorded, right recorded where you have multiple angles of the surgery being recorded. And an operative note being generated from that video recording. I don't think that we're that far off. But where do I think that system should focus next?

I think they should focus on the administrative, non-sexy stuff. Is really, because I think that's where the technology is at right now. But I think that all of this is coming, right? What do we say that we overestimate?

What's gonna happen in the next two years, but underestimate what's gonna happen in the next 10. So, I'm just gonna hedge and say, five to 10 years, it's gonna be amazing.

There are no, there's no desk space for the extra documentation because it's all being captured and synthesized and utilized appropriately, and so the too much data becomes the ability to bring those perspectives together. Make better decisions and really have the patient and the providers have access to that information simultaneously.

So it's a very exciting time because it is moving so fast. The job you don't wanna have to worry about is putting that budget together for the hospital in five years, because it will significantly change year over year. And we have colleagues who are going through that right now. It's like you can put a placeholder out there.

What is your most used app on your phone right now?

Michael Han: I actually had to look. And so, luckily the iOS tells me what I'm using the most. It may have been because I traveled a lot last week. But it's Spotify. I love listening to podcasts, what are my favorite podcasts out there right now? I'm a big Kai Ryssdal, so, Marketplace. I don't know if people are out there aware of it and then Acquired and I'm gonna put a shout out there. There was just podcast that was released by the folks that acquired on Epic Systems.

It's four hours. It goes by really quickly and it's extremely well done. So, but yeah, Spotify is the most used app on my phone.

Sarah Richardson: I'm glad you said the thing about Acquired and Epic that literally got sent around multiple times in the last week or so. So if you've got a trip, car ride, plane ride, whatever you're doing, working outta the gym, that's an excellent thing to listen to.

And you're right, it goes by more quickly than you would imagine.

Michael Han: Yep.

Sarah Richardson: One technology you think is overhyped.

And so I think that wearables right now, or over overhyped, we'll see what happens in the next five years. Right.

Sarah Richardson: What's under hyped from an perspective in that space.

Michael Han: So, and people might argue that this is a wearable as well, but. God, I really love my wireless earbuds. When Steve Jobs took away my headphone jack, right?

I don't know, five or six years ago, I was like, what do you mean you're taking away my headphone jack? And now like, just thinking about my day to day. Not having those wireless earbuds or when they're not working or when they're not charged, it is terrible.

It's, it is terrible. And so think that's something that's, that's underappreciated.

And you're the person on the plane who's like. Of wires. And if I always take the aisle seat and the person in the middle needs to use the restroom, I'm like, let me unplug myself from all of the devices that are basically look like I'm on telemetry while I'm in my plane seat. So,

Michael Han: So that's wireless, right?

So that's the thing. The advent of wireless technology is pretty amazing if you really think about it, right? Like even enabling something like hospital at home. I think that like, if there was another answer to looking ahead, what innovations excite me the most?

I think it's enabling aging in place, hospital at home. Right, because the silver tsunami that is facing us it's gonna get real and it's gonna be fast. We were talking about this last week at a conference in Santa Clara and the median age in Japan is now 48.

Sarah Richardson: Depending on your views of Mother Nature that actually might be good for the planet.

That's a totally separate conversation. I'm sure that you and I will tackle next time We are. Oh yeah, we have fun convos. Thank you for bringing all of your perspectives, ideas, and again, your sense of humor to our conversation today.

Can't wait for the next time we get a chance to catch up and chat, but I'm grateful for all that you're bringing to our industry, to MultiCare and beyond.

Michael Han: Thanks, Sarah. I really appreciate the opportunity to talk.

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