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Bill Russell: Today on Keynote

Tanya Townsend: Patients do have a choice.

And with technology advancing as quickly as it is, they have an expectation. They want to have convenience, they want to have quality, they want to have better access and they want to have it at [00:01:00] their fingertips, My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a time. Our keynote show is designed to share conference level value with you every week.

Bill Russell: Now, let's jump right into the episode.

(Main) All right. It's Keynote and today we're joined by Tanya Townsend, Chief Information and Digital Officer at Stanford Children's Health. Tanya, welcome to the show.

Tanya Townsend: Thanks for having me.

Bill Russell: Is this the first time you're on this show? I think it is. It

Tanya Townsend: is. Yes, it is.

Bill Russell: I've seen some of your other interviews. You did a interview with Kate Gamble over at Health Systems CIO and and others. I'm excited to have this opportunity to talk to you. You've been at Stanford Children's now, for we were just talking about this coming up on one full year.

Tanya Townsend: Yes, just a couple of weeks shy of my one year anniversary. Yes.

Bill Russell: Congratulations on that. That's a great location. Great place to be. I'm [00:02:00] curious, when do you start to feel like

That you have to lay the land and you feel like you're comfortable in it. Does that take a month, two months, three months, or is there still aspects that you're like, I'm still getting my arms around some things?

Tanya Townsend: Yeah, it's definitely a journey. So there's definitely aspects that I'm still getting acclimated to.

There's, lots of acronyms and new things like that to, to learn in any new organization. But but yeah, I would say it probably took, probably around the six months mark for things to start really clicking and to feel like I know where the bathroom is and things like that now.

Bill Russell: Absolutely. Give us a little bit about your journey because you've been in CIO roles for quite some time now. What was the first CIO role you got into? And give us the path that you've taken to get to here.

Tanya Townsend: Oh, wow. We're going way back.

So I've been in healthcare IT for around 25 years or so. I started the journey by accident, almost. I like to say it's a little bit of accident, a little bit of luck. But as I was finishing up my [00:03:00] undergrad degree, was right around the time that we were starting to talk about electronic health records.

So I thought and of course at that time we said, oh, they're coming, they're going to be here in just, a couple years. And that was in the nineties. And of course we're still working on electronic health records. But that was just timing that I was like, yeah, I really want to learn more about that.

I'm intrigued. HIPAA had just come out at that point in time and there was a big concern around patient privacy and, of course, electronic medical records made that even more important. So anyway, I got my master's degree in a field called medical informatics and I was one of the first classes that we know about that offered that as a master's degree.

And I was a class of five and I spent many years talking about what informatics is because a lot of people didn't, hadn't heard of it yet. And now, of course it's a pretty well known term, but anyway, so I've been doing it ever since I started out. I've been at a number of organizations. I'm from Wisconsin originally, so spend a lot of time in the Wisconsin markets Aurora Healthcare, Ministry Healthcare HSHS I [00:04:00] started out rolling out electronic health records, and then I and then I got a call for this exciting opportunity, again, a little bit of luck, a little bit of timing, but I got a call to see if I was interested in building the nation's first all digital hospital.

Yeah, and I thought, wow, that sounds cool. And so that's what I did. It was a hospital in Weston, Wisconsin called St. Clair's, and this was early 2000s. So of course, the epics and the Cerners and the integrated records weren't what they are now. So it was very best of breed. So really proud of that experience because we were bleeding edge, I would almost call it.

So we were introducing concepts like Wi Fi and computers on wheels and a lot of niche products that we bolted together from an integration standpoint. Voice recognition wasn't really what it is yet. So we were doing a lot of digital forms. So anyway, it was a great experience and that was my first CIO role

Bill Russell: long ago.

When you get that phone call and they say, hey, greenfield [00:05:00] opportunity, we're going to do something for, sometimes that scares people, but it sounds like you gravitate towards that kind of Wow, that sounds like a really fun challenge.

Tanya Townsend: Yeah they're unique, right? So the unique opportunity is that you're not trying to run a hospital at the same time as you're building one, because that's oftentimes what happens with renovation projects or replacement projects, is you're doing day to day operations while you're trying to build this new thing at the same time, which is really tricky.

I've done those before, too. But the unique opportunity of being at Greenfield is you're not, that is your day job. Your day job is building and designing this product to be the best and the first of its kind that we knew about at the time.

Bill Russell: I think for some people this is going to be an obvious question, but what's the draw to Stanford Children's?

Tanya Townsend: really wanted to get back to my last organization started out as a children's hospital and grew from there, which is a unique story too, but Children's Hospital wound up acquiring adult hospitals and became an IDN, which is also a very unique story. But my draw to that organization in the first [00:06:00] place was the children's aspects, opportunity to work with pediatrics and focus on children.

It's just a really nice mission, of course. And then I'll say it, the Stanford brand has certainly got a wonderful reputation. And the location's not bad either.

Bill Russell: No, is not bad. You're stepping into this role. Look, you have the chief digital officer title as well as chief information officer.

I'd love to talk to you about. picking some topics this year that I'm delving into. And one of them is organizational change management and this whole bringing technology into an organization. Discuss some of the challenging aspects of integrating new technologies into healthcare systems and how you go about addressing some of those challenges.

Tanya Townsend: Yeah that's exactly what I would say. The biggest challenge is change. It's the change management because we're introducing technologies into, like I was saying, it's difficult to be running the shop and learning new things or building new things at the same time. So we're tapping on our end users.

To manage a lot of [00:07:00] change and keep the wheels running. So that has to be a key focus is making sure that the organization's culture appreciates the level of change. And I'm going to go back to the cliche thing of the go live is only the beginning. It really does take continuous process improvement, continuous partnerships.

To understand that change and to continuously optimize and ensure that the implementation is being used or it's bringing the value that we thought it would, and that does take a lot of partnership and collaboration. And again, I really do believe it has to be a culture within the organization.

The concepts of the old days of identifying super users and really having those go to people in the units or in the operations areas to partner with, to help with that ongoing education and communication. So I like to say the ongoing support model. Around how you're gonna manage that change and needs to be a focus before the go live, before the implementation.

Understanding what that lift and effort's [00:08:00] gonna look like.

Bill Russell: I'm thinking about there's all this push to move and to move rapidly. And move quickly. Have you ever had the opportunity to slow a project down or to stop it so that the organization could catch up or catch its breath?

before they took on new new projects or new technology.

Tanya Townsend: Yeah, not very often. Usually we're trying to do more and with the time constraints, etc. We're usually trying to push to do more. But yeah, I can think of a, an opportunity where we knew if we kept pushing on that timeline

it was going to be bumpy and risky, so I won't talk about the specifics of that project, but yeah, we did have to have kind of a timeout and educate the organization on, yes, we're probably going to spend more money by extending that timeline, but the risks are far greater to keep down this path that we don't think we're going to be ready for just to hit a date.

That's not very often, but it has happened.

Bill Russell: Yeah, it is interesting because, [00:09:00] a lot of these timelines are tied to, a lot of resources are tied up into it, a lot of training, and everything's pointing to a specific day. When you move that day, The costs tend to escalate pretty rapidly just to push those things back.

But I'm just, I'm wondering if, we go back earlier in your career and you looked at projects, do you look at projects differently based on just knowing how important the adoption is and how important it is? For the for the community to be ready and able to take on the new technology that's coming into the organization.

Tanya Townsend: like to think that's a big focus that I'm actually working on right now, heading into our next fiscal year starts in September. And yeah, really partnering with the organization to develop what that project portfolio is going to look like, which is pretty robust, but we don't want to just check the box and hit the timeline.

We want to go into those projects with a goal in mind. What's our goal? What's our return on investment? What's the value proposition? And let's [00:10:00] establish that on the front end. And then measure it along the way. A little bit of a learning curve to, to take that approach.

Cause oftentimes my history has been hit the timeline and moved to the next project.

Bill Russell: is a skill in and of itself.

Tanya Townsend: how do we do that look back and again, ensure the value is there, or just maybe the lessons learned too. So maybe we aren't achieving the, the goal that we thought we would, but do we pivot or do we focus on that?

Bill Russell: So talk to me a little bit about the patient and centric approach. It's interesting in the case of children's. patient is the child, but in a lot of cases, it's the family from a technology standpoint. Tell me a little bit about, balancing technology approach And patient centric, I guess that's the catch word there.

Patient centric approach to to technologies in healthcare. specifically around children.

Tanya Townsend: Yeah you, you said that great. It's not just the patient, it's the family in the pediatric space. Because babies aren't born with cell phones and they're not interacting with our Not [00:11:00] yet. So there is a unique nuance there and oftentimes our electronic health records or our technologies are mostly built on in the adult space. So it is a lot of education and partnerships with our vendors as well to understand the uniqueness of PEDS and ensuring that the systems are safe and supported for patients and their family.

Just around the whole patient experience, I would emphasize the, I'm really excited to see how we've, I would say almost pivoted in the last five to ten years or so to understanding and appreciating the patient's experience. I think when electronic health records first were coming out, the focus was on the clinician experience, which is also still very important, but I think now we've learned that patients do have a choice.

And with technology advancing as quickly as it is, they have an expectation. So they want to have convenience, they want to have quality, they want to have better access and they want to have it at their fingertips, the same way they do some of other things that they do in their daily lives.

So that would [00:12:00] just be something I think that we've learned over the last. Again, five to 10 years is really focusing on both the clinician and the patient and understanding

Bill Russell: how do you capture the voice of the patient? Like, how do you get feedback from them on how this stuff is working?

Tanya Townsend: We do have some focus groups.

have family focus groups and pilots. We do a lot of pilots. We don't just do mass implementations. We pilot in certain areas and. Ask for the feedback throughout the way.

Bill Russell: Those focus groups are always interesting to me. Just I've sat in a couple of them and just, you're behind the glass and in some cases just watching them interact.

And it's interesting because in some cases they, depending on what kind of focus group you do, they may not even know what they're there to talk about. And then they're just, they're looking at this stuff going. Oh my gosh, this is the worst technology I've ever seen. I'm like, oh my gosh, we just spent months on that.

And they're like, oh, and what they're comparing you to now, they're not comparing you to other health systems. They're comparing you to other stuff that they just readily do. And they just go, I can do this way on this [00:13:00] other app and it takes me, two clicks and away you go, but that feedback is so valuable for us as health system leaders, because we realize.

We don't live in that world anymore where it's just other health systems. In you, specifically Stanford, that whole community is really digitally enabled.

Tanya Townsend: Yeah. Yeah, and embarrassingly, I do have to ask my kids how to do certain things still.

My iPhone, every now and then, they know how to do things better than I do.

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Bill Russell: And, you've been at Stanford now for a year. How is technology helping to change the way that that patients are cared for your system and in your community?

Tanya Townsend: Yeah. So I can give a couple of recent examples, but that question does bring me back all the way back to that experience that I mentioned when we were bleeding edge and pushing the envelope on putting out electronic health records.

And again, this was early 2000 ish where it wasn't like a wide adoption yet, meaningful use, and ARA hadn't come out yet. And things like CPOE and evidence based medicine were very, almost controversial at that time. And so in that instance, we really pushed the envelope to prove that it was the right trend, the right [00:15:00] way of the future, and now, of course, those things are widely accepted and adopted, and there is no challenging that as It's expected now.

So I think that was really just an example of how technology changed the way we practice and had some dramatic outcomes and efficiencies and best practices and things like that. But some recent examples, Back to the patient experience, we've got a really big focus on what we're calling the digital front door.

So making that patient portal as easy and user friendly as possible, but also driving access. So we are a bit of a destination organization, so we have a lot of referrals and patients that want or need to see us, and we do have capacity limits. So we're doing a lot around how we manage our schedules, make sure we've got good schedule utilization, standardizing the interaction with our providers and how access is obtained.

A lot of new technologies around appointment reminders and reductions [00:16:00] and no shows, which also then frees up for new patients to come in the door. So I would say that's just huge strides in terms of the patient experience as well as the value for the organization and the patient. On that family centered approach that we mentioned, I mentioned, babies aren't born with cell phones.

And so we had a lot of one of the real challenges with just capturing the correct information for our pediatrics and teens, and there's a whole confidentiality piece around even teens and interaction with us and their what we call proxies. So we did a big project recently, what we're calling true patient demographics to try to correct some of that and make sure we're capturing the right information and communicating with the appropriate person when we are.

Using that contact information. So again, I think that just was a huge opportunity to address concerns from teens specifically, but also to get the right caregivers communications.

Bill Russell: I'm going [00:17:00] to change directions a little bit here. We're going to talk more about emerging technologies and it would be a miracle if we got through this interview without saying the words artificial intelligence at some point.

But I want to go back to, you're going into a new organization. You've been there for about a year. would you describe your approach, your leadership? philosophy or your leadership approach as you go into the organization, what are some of the foundational ways that you will engage the organization, engage the staff and engage the the community in order to lead them effectively as a chief digital and information officer.

Tanya Townsend: So I would answer that question differently depending on the culture of the organization you might be stepping into. So I've been into certain organizations where it's really, like I said, a building greenfield. So that's a little bit different experience than walking into a very stable, mature operation.

So I would approach them a little bit differently. My approach here at Stanford Children's is it's a very, again, [00:18:00] stable, mature, established organization. My predecessor had been here for about 14 years before he retired and ran off into the sunset, but certainly not anything messy to clean up or anything like that.

I spend a lot of time observing, just observing. And then making small adjustments, I would call them. So don't need to come in guns blazing and, blow it all up and change it or everything. It was really more how do we maintain this well established operation and just pivot or adjust for the future?

So that's what I spent most of the last year doing is just getting to know the leaders, getting to know my teams and then focusing on what we mean when we say digital transformation. So that is the new piece in my title is that I'm the Chief Information and Digital Officer, so I spent a lot of time working with my executive team, with my counterparts and across Stanford Medicine, because we are part of all Stanford University, and so there's a lot of partnerships with the adult side of Stanford as [00:19:00] well.

And so that's what I spend a lot of time doing is just establishing those relationships, defining the journey for digital and where we go from here, and not have too much disruption along the way.

Bill Russell: How would you describe the culture within the IT organization? What, what makes it tick?

What makes it function really well? How can a CIO have that longevity before you, it's like there's a certain amount of continuity to have a leader in that position for that long. What does the culture look like and what makes it thrive?

Tanya Townsend: Great question. I'll have to go back and ask Ed what the secret sauce was, but it is a wonderful culture. So in my first 30 days or so, I was asked to answer that question and I did a whole kind of presentation around it, but just very family driven, oriented. They're all supportive of one another.

They're all Very proud of the organization and our mission and the results that we're achieving. And yeah, how I would describe it. I would just say it's a big family and they're [00:20:00] doing wonderful things. They've got great recognitions in terms of awards and we don't have to rattle all those off, but they are high achieved in all of those different areas.

And everyone, like I said, is super supportive, super collaborative, very welcoming. And I would say that's not just within IS, it's really across the whole organization. So I'm really excited to be a part of it because that's not the case everywhere. But that's definitely what I've seen here so far.

Bill Russell: Yeah, that's fantastic. All right, we'll get back to technology questions. What emerging technologies are you keeping an eye on right now that you see having an impact on healthcare in the, I don't know, near term or even long term.

Tanya Townsend: Yeah of course, artificial intelligence is probably the key buzzword that we're working on and looking at.

We are in Palo Alto, like you mentioned, so we do have access to some of those emerging technologies. And like I mentioned, we also want to be safe and careful though, too, because pediatrics is a little bit unique, so we can't just adopt what works in the adult world. So we're spending a lot of time looking at new [00:21:00] technologies that are coming out, such as we're piloting right now ambient voice recognition and voice listening.

We've got some good wins there, and we've got some things that we've learned, maybe that's not ready for yet but I do think that has a ton of potential. Particularly around, I think, clinician burnout is real. So in basket, I believe, the messaging now that patients can message to the portal, it's a wonderful advancement, but it now becomes a burden sometimes for our physicians to try to manage that in basket.

So we're using some AI on that to try to help automate some of that messaging and clean that up a little bit. I don't think we're seeing huge time savings, but I do think we're seeing some user satisfaction improvements there. But I do think opportunities in that space to help our clinicians either better manage their days, manage their throughput and workflows even better predict sometimes or anticipate some of our patient outcomes so that we can get in front of potentially declining patients.

I think those are huge [00:22:00] opportunities in the AI space. Data and analytics, I think is going to be key. So we're doing some things right now in the research space. And just now that we have, Access to this wide pools of data. Like how do we use it and get even smarter based on that information.

And again, even almost predictable and make that easy to, I'm really excited for some of the voice recognition and the data analytics to come together, because otherwise you need to be like a programmer to figure out how to even query what you're looking for, and now the voice recognition can help do that for you.

That's really exciting. We're exploring all those things.

Bill Russell: Yeah, our interaction with technology is changing by the day. I'm curious, being in Palo Alto, being at Stanford, and you've been in other places, there more of a push towards building things or adopting things? Because there's probably a million startups down the hall, if I would think.

Tanya Townsend: we are trying to define that right now. I don't know that we have a clear. best practice in that [00:23:00] space. I think we're establishing our governance framework to help us with that, build versus buy. Right now, a lot of the tools that I just mentioned are partnerships.

If Epic has it, we're going to leverage that. Microsoft, if they have it, we're going to leverage that versus having to build them ourselves. But we are exploring where that opportunity exists as well, because we do have, Stanford University and Stanford Research right at our fingertips.

Bill Russell: All right. I'll go in the cliched direction here, which is I'm going to ask you a little bit more deeper about artificial intelligence, machine learning. We've interviewed Mike Pfeffer who's on the adult side before, and we talked about ambient, but we also talked about generative AI and the inbox management and those kinds of things.

A lot of great learning there. And you guys are. Out ahead in terms of doing that and being transparent with the community that you're doing that. mentioned, we're learning some things, we're finding some things, or is there anything specific that you're learning?

Let's start with the inbox management. What are some of the learnings in the inbox management that maybe [00:24:00] others who are getting ready to head down this path might benefit from?

Tanya Townsend: Accuracy, I guess is one of the things that we're looking into just, with the automated messages, how accurate, how often are you having to edit it anyway?

So those sorts of things. And again, because of the pediatrics uniqueness. The the niche is that you're actually communicating with the caregiver, not necessarily the patient. Again, making sure that those drafted messages are worded correctly with that in mind. Those are some of the things we're finding.

Bill Russell: Does it struggle with the vocabulary of children's of pediatrics?

Tanya Townsend: Yeah, it can on the in basket side. I would say that comes into play more on the ambient voice listening side. Interpreter services, for example, we have found that it didn't work out so well because of the different dialects and different languages.

Bill Russell: Yeah, and that's the thing about California, I know I was in Southern California, the number of languages that are spoken is pretty significant. And it would be great if we're looking at generative AI and we're hearing, oh, you can do hundreds of languages and whatnot, but there are still challenges, especially in this [00:25:00] highly technical area.

Tanya Townsend: Yeah, I'm very optimistic though that we'll get over that hurdle very soon. I remember looking at Dragon which is now the standard, one of the standards and that again, back to that all digital hospital that I mentioned in 2005, it wasn't ready. We did it, but it was not the best in terms of even know, understanding English, let alone other languages, but it's come a long way.

It's come a long way very quickly. And now it's like the standard. So I'm very optimistic that we'll get over that hurdle very soon.

Bill Russell: Are you surprised how, ambient listening it feels to me like went from zero to a hundred over the last two years, like it just, amazing.

And most health systems I'm talking to, it's gone from a subset of the physicians using it to we're giving at least the option of a lot of physicians the ability to use it now.

Tanya Townsend: Yeah we're in the process of pilot mode, but all of the feedback so far. So we have a couple practices that are volunteering to participate and all of the feedback is great.

They're ready to make sure that we don't take it [00:26:00] away. And of course there's a growing list of expansion opportunities next.

Bill Russell: When you look back over your career, what are some of the markers? have things that you were given the opportunity to either a mentor or training or whatever that you feel gave you this opportunity get this far in your career.

Tanya Townsend: Oh, so great questions. I would say when I got that call for the Nation's First All Digital Hospital, I was in my 20s. So I was very green and remember feeling a little bit overwhelmed and actually this mentor of mine, the guy who took the chance on me and gave me that job, I would say thank you, and I'm so fortunate and lucky, and he used the Vince Lombardi quote on me, and luck is nothing more than preparation meets opportunity rose to the occasion, but really great mentors along the way that I've had.

Continuing education, also super important. Networking, such as the 229 event that we just had about a month ago, huh? Keeping that network close and just [00:27:00] having access to all of these experts to lean on when you have a question or just need some support. Those are some of the keys. And I've been very fortunate in my career.

Like I've mentioned, I've had all various different experiences from building a new hospital to, I did a lot of mergers and acquisitions when a lot, that's still happening, but that definitely was happening a lot in the last decade or so. So everything ranging from building new hospitals to merging people together that don't necessarily want to play nice together.

So building teams around things like that. I'm really proud of the outcomes on those opportunities. And now this is just the most, really exciting latest one is really having this focus on pediatrics. And being in a great location where we can access these different technologies and be a little more cutting edge as well.

Bill Russell: interesting, when you describe your career and just listening to you there, you have a lot of confidence in yourself, and so your ability to network and figure things out. And so it's jump out of the plane and then figure it out on the way down. Because you know [00:28:00] who knew how to build a all digital hospital back then?

It might as well be you. Nobody else knew how to do it. So But yeah really fascinating. So was going to ask you the cliched question about advice you would give somebody, but let me give you a little different bend on that. There's so many healthcare practitioners who are just below that leadership level.

that feel like they have great ideas, feel like they, have things. What advice do you give them in order for them to be heard or to move their good ideas forward while still respecting the culture and respecting the leadership as they do that? How do they get heard?

How do they get their voice heard on some of the ideas that they have?

Tanya Townsend: like to call, I'm going to, this is a quote from somebody else, but I like to call that get out of IT. So get, oftentimes people get into IT because they are a computer science major, for example, and they could work in any industry.

But I, I'm a little bit biased and I would [00:29:00] say healthcare is unique. Healthcare is a special space. But yes, if you are a technologist, you in theory could work in different industries. But I like to say really get out of IT and understand the business. Understand what healthcare is all about, whether that's improvements in revenue cycle or helping our clinicians.

So just really being able to articulate and understand the value that we bring because it just makes. All of your relationships and stories and that lens is always in mind then when you're building systems or implementing systems. So that would be my best advice. It's just really understand the business and the value that you're bringing.

Bill Russell: Absolutely. Tanya, I want to thank you for your time. I really appreciate it.

Tanya Townsend: Okay. Thank you so much, Bill.

Bill Russell: Thanks for listening to this week's keynote. If you found value, share it with a peer. It's a great chance to discuss and in some cases start a mentoring relationship. One way you can support the show is to subscribe and leave us a rating. it if you could do that. Thanks for listening. That's all for now.. [00:30:00]