This Week Health

Keynote: How do we Restore Joy back into the Healthcare Workforce?

January 13, 2023: How do we restore joy back into the healthcare workforce? We assume that everybody is acting in the best interest of the patient but that is not always the case, unfortunately. And it creates inefficiencies across the system. How did Baptist Health, Jacksonville consolidate the EHR to maximize clinical efficiency? Aaron Miri, SVP, Chief Digital & Information Officer joins us to discuss application rationalization, workflow rationalization, process rationalization and the magic of automation. The name of the game? To free up our hardworking clinical staff so that they can practice at the top of their license. 

Key Points:

  • Do not overlook staff burnout
  • One of the things that drives clinicians crazy is prior authorization
  • In consolidating the EHR you’re literally reinventing your clinical practices and your financial rev cycle practices simultaneously
  • Baptist Health, Jacksonville

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Today on This Week Health.

Do not overlook staff burnout. Our team was burning the candle at both ends. They're incredibly proud to work at Baptist. It was also a major worry point for me cause I only have so many people to go around and here we are going through the trials and tribulations of normal Florida life with hurricanes and others. It's one of those that you're gonna have to balance and don't overlook the importance of staff burnout.

Thanks for joining us. This is Keynote a This Week Health Conference show. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a set of channels dedicated to keeping health IT staff current and engaged. For five years now, we have been making podcasts to amplify great thinking to propel healthcare forward. Special thanks to our keynote show partners for choosing to invest in our mission to develop the next generation of health leaders. Now onto πŸ“ our show.

All right. Today we are joined by Aaron Miri, chief Digital and Information Officer for Baptist Health Jacksonville. Aaron, welcome back to the show. Thanks for

having me, my friend. Good

seeing you. Yeah, it's good seeing you as well. We've got a fair amount to talk about.

The last time we talked, we focused in on. You were new to the role, and this is actually, we're kicking off our fifth year of doing this week health. And what we did is we went back over the first five years we said, which were the most downloaded episodes of the people we interviewed. And you, my friend, were one of the one of the champions.

So we. Thought we would have all the, the people that helped to establish us as a, a brand in the industry back on the show to have discussions. So, hey, we really appreciate you taking the time. I know there's a lot of things going on at Baptist, so let's start there. What's going on at Baptist?

Yeah. First

off, congratulations. That's an amazing milestone and achievement, and I can remember when you first started this podcast and this recording series, and so it's been some amazing guests I've learned from over the years, so thank you for that. So kudos to you. Kudos to your. Appreciate it. So Baptists doing great.

We are in the middle of a growth mode here. We opened up our new children's Barri Tower earlier this year. There's a state of the art, 10 story plus nicu, city of the art technology, leveraging artificial intelligence and others. We went live with electronic medical record conversion this past summer going from multiple EMRs, not just one multiple EMRs to a singular em.

And then we most recently are about to open up our newest hospital in the fleet here in just a couple of weeks on Fleming Island in Clay County. So we're in growth. Right. But that's Florida, as right? It's new rooftops every single day. And so we are also working to expand and continue to grow to meet the overwhelming demand for our services in our region.

And then Jacksonville itself is also growing. We also announced a new partnership with LECOM for a do program and an MD program at Baptist Health. And we're doing other things to make sure we also position ourself for the future. So it's incredibly exciting times. I'm enjoying it. I'm having a lot of fun.

Now, we're year into the, into the role and we really are pushing the envelope with things that, quite frankly, Northeast Florida has never seen.

The first couple of months you're at a new location, you're sort of stepping on rock saying, is that, is that really a rock? Or am I gonna sink into something?

But after a year, you feel like you have your footing, you know when somebody says something you go, yeah, I know the three or five people we should talk to. I know who to bring into the broom and you start to really get things going. But I'm looking at this building over your shoulder. Is that a new building for you?

It's actually a

few years old. That is our Baptist MD Anderson building. I don't remember exact year. It was like twenties, 15, 20 16, somewhere in there. Opened up gorgeous talking about some of the most beautiful artwork I've ever seen. When you walk in, very serene as you can imagine. You have very sick patients there seeking some really necessary treatments.

But it's a gorgeous, gorgeous site right there on the St. John's River bank. It's beautiful. So

what, what is, what does the partnership look like with MD Anderson? Yeah,

so it's really interesting. So MD Anderson has a network where they do have partnership with Scripps Health and other health systems across the country where you build a, basically a full service oncology practice leveraging a lot of the MD Anderson protocols.

So research protocols or clinical therapies that they're just world class in, you adopt those for your health system. So it's a Baptist hospital, oncology hospital our hospitals, our physicians, our surgeons, our staff, our. But we, we trade a lot of research data and pathway, clinical pathway data with MD Anderson to say, how do we make sure that Aaron gets the best possible treatment?

And if it's something really unique, a really rare cancer, you can quickly admit them to Houston if you need to, and get 'em on a plane out there to see what's going on. So, It's brought a level of service to the Jacksonville region, which was desperately needed. And if you think about how sad that is, there wasn't anything out here before Baptist Anderson.

Yeah, you had some small clinics doing some, some good stuff, but nothing as comprehensive as what we've been able to bring to the region and service. Tremendously

that's exceptional. And I think we're gonna see a lot more of that going forward. I tell the story at, at St. Joe's in Orange County, orange County, California.

One of the things we were unable to do was stem the tide of people leaving the county to go get cancer care. because if you get, if you get diagnosed with cancer, you, you just want the best period, right? That's right. And they would drive up to ucla, they'd drive up to usc, they'd drive up to Cedars and others that just had a better city of hope.

They, they had a lot of, yeah. Better options in LA County. And this kind of partnership opportunity made a lot of sense and we just never pulled the trigger on it. And, It is the right thing to do for the community. So I, I love the fact that you guys are doing

that. Yeah, and I mean, you've got two exceptional CEOs, right? With Dr. Piers at MD Anderson, Dr. Mayo here at Baptist Jacksonville, the two of them collaborate. There's so much opportunity, and again, to meet the demand growing in Florida. This is the best way to it because it's. Baptist product, which is already top of class here in the area with MD Anderson, which is world renowned, I can't think of a better healthcare system for cancer in the world.

You put the two together, it's a recipe for success with two established leaders like that. So being in the middle of the technology part, me and my counterpart Craig Owen, CIO over MD Anderson, we talk often and are often sharing best practice research data. How do we make sure our two EMRs talk together seamlessly? And our teams are working together constantly. And so that makes it also fun to collaborate with

friends. So I'm gonna talk to you about priorities, but I wanna go to last year's priority first. So you finished consolidating the ehr. There's something magical about getting an integrated EHR across ambulatory and whatnot, but I did talk to some people who were a part of, I talked to Brett Oliver.

Him and his team came down. Mm-hmm. you guys, Baptist isn't exactly an early adopter in terms. of Going to Epic and you really benefited from not being an early adopter. There's a lot of people to help and a lot of best practices already established.

That's exactly right. So with Brett Oliver, Dr. Oliver and his team came down from Baptist, Kentucky. We're not affiliated. We both say Baptist, which is just something for the 1950s when they were all established. But because we're all friends, We're able to collaborate and cooperate and the, and the epic community tends to come together and rally around each other going, Hey, let's help you.

So St. Luke's Main Health Cleveland Clinic, they've all been phone a friends for us to say, Hey, how'd you solve this weird issue? Or, how'd you do this? Because it's a lot of moving parts. You're literally reinventing your clinical practices. And your financial rev cycle practices simultaneously, and you gotta think about how much time you're gonna go back and go, gosh, we've been doing it this way for 20 years.

That doesn't make much sense. Let's fix it. Right? So getting ideas from help from other friends and getting their ideas of what could happen is invaluable. So yeah, we went live. With a lot of friends to call up and say, Hey, how'd you do this? I would say that we are safely in the still. We're optimizing phase, but we're really more of looking towards automation and trying to do things like eligibility, checking automation and prior auth automation, all these things that aren't EHR dependent.

Just now we're at that phase where it's like, all right, it's on. It's working. Let's go faster, let's go smarter, let's go cheaper. So to the degree of it, you're exactly right. It opens a lot of eyes. And it also, and I'm gonna borrow a phrase from our cfo, it's also like the daylight, right? The cloud's part, the daylight comes on and you realize, man, I have a lot of clutter in my backyard, I gotta clean up, right?

So it's also a lot of that which is realizing, hey, we don't need to do it this way anymore. We can do it a better way. So it's been a lot of good conversations and process improvement, which has been fun. for me Any,

any learnings? I mean, you've been around, you've been around the industry for a while, but any learnings in going through this one?


so three things. First thing, never count out your friends. You need a good network of people you can pull on, establish that early and upfront, which we did here. So we partnered again, md Anderson Baptist, Kentucky, all these other folks to make sure that we had that network effect for all of your.

Not you as a bottleneck to give to the teams RevCycle team, clinical team, et cetera, et cetera, to call their peers and say, how'd you deal with it? So that's number one. Don't discount your friends. Number two. Be very, very, very tight with your EHR vendor. Make sure they understand the ebbs and flows of what's going on with your health system.

It takes a lot of time in the CIO role to do that, but it's important they know what you're planning for when you're planning it, so that as you go live, those variables have been encountered for If a lot of people miss that step and go, oh, I don't even need to talk to them. I don't need to talk to Epic.

You do. Or Cerner, whoever you're going live with. You do. You gotta make sure you take the time and the last thing. Do not overlook staff burnout. Our team was burning the candle at both ends. They're incredibly proud to work at Baptist. It was also a major worry point for me cause I only have so many people to go around and here we are going through the trials and tribulations of normal Florida life with hurricanes and others.

It's, it's one of those that you're gonna have to balance and don't overlook the importance of staff burnout. You get those three dimensions right, for the most part. You're gonna be successful with your emr.

Yeah, we, we sent a hurricane straight up the co or straight across the state to you from Naples.

That was an interesting one. Hope you were okay.

Hopefully you were okay. Is

that right? Yeah, that was an interesting one because it really was about storm surge and then it was about river surge. So anyone near a river or near, near the ocean really got hammered pretty hard. We were, we were far enough.

We didn't have enough money to live in those locations, so we did, we didn't get hammered quite as bad. You, you alluded to some of these things, but I wanna talk about 23. We're recording this in early December, so people give, give Aaron A. Little bit of grace here if he I remember some of the interviews we did early and then the pandemic hit people would be.

Don't they know pandemic hit is like, no, they didn't because we're so anyway, we're early in December. Priorities for 23. What, what are you looking at saying, all right, we've, we've gotta get really good at this and, and we've gotta get ahead of some of these things.

So number one issue affecting the entire industry right now is obviously the, the prevailing wins of inflation.

Cost containment, cost control. It reminds me of 2008 or earlier bumps in the road for the economy where hospitals had to really maneuver and make sure that they could deal with those headwinds and work through that effectively without losing your. Two, it's about staff retention and ensuring that we make sure there's not burnout with our clinicians.

We're spending a consider amount of time with our nurses, our docs, our allied health techs, to make sure they have the tools to do their job. And they feel like it's a, it's a, it is a great place to work, but we are identifying any bugaboos that they have and really partnering with them. I give a lot of credit.

Our chief nursing officer, our chief medical Officer, now there. Third from a technology sense, automation, automation, automation, we've established a center of excellence for automation. We're starting with IT workflows cuz those are easier along with rev cycle workflows cuz there's direct ROI working our way down towards clinical workflows to automate and really leveraging an ensemble of tools to make sure that we can do that.

So we work smarter and not harder. Next is robotics. We were the first health system in all of Florida to go live with am Moxi robots here at Baptist Jacksonville, and that's already showing tremendous roi, helping to keep our nurses at the bedside so they don't have to run and go retrieve linens or go get the food from dietary for the patient.

The robot goes and gets it. So these are the things we're looking at is try to alleviate the manual processes across the health system and really digitize the experie. I would be remiss if I don't say what I've told you before, which is consumerization. We are leaning all in to making sure we have digital approaches for any which way that our patients wanna transact care with us.

And that's really nice to say, but it's really hard to do when you've been a really good health system for a long time in a traditional sense, to suddenly say, Hmm, how do I give the Baptist experience when you come in person and just. On a device and have the same type of feedback and feedback loop where the person is just as wild and just as amazed that that digital componentry and that human component is what we're working on with chatbots and more automation there and digital tooling to make sure that the consumer, the patient feels at home.

πŸ“ πŸ“ All right. We're doing webinars a little different this year. As we have told. You got a lot of feedback from the community about what works, what doesn't work. We talked to our advisors, our cio, CMO advisors, and they said, Hey, Community generated topics, great contributors, not product focused. They want the questions ahead of time so that they can incorporate them into their answers. And they want a forum that is honest and open. And what we decided was once and done. If you're at the webinar, you get to hear the content. If not, it's not on demand. You don't get to download it later. We're gonna do it on a consistent date and time, and our next one coming. Is February 2nd. It is priorities for 2023, and this one is around academic medical center. So we have some great leaders who are gonna come in and discuss the priorities for 2023. We already have Donna Roach lined up. We have Dr. Michael Pfeffer with Stanford lined up. we're gonna continue to just bring great content, community generated topics and keep the the discussion going. If you have feedback, love to hear. And if there is any questions you have, go ahead and fill out the registration form and you have a space there to give us your questions ahead of time. We wanna make sure that we cover the topics that are of interest to you. website, top right hand corner. Sign up today. Love to see you there. πŸ“ πŸ“

All right, automation I'll, I'll start with automation. I do wanna talk about the clinician burden and the staffing shortage. That we have people keep correcting me. It's like, it's not a staffing shortage, it's a, it's a permanent whatever. But regardless, we'll, we'll use that terminology to start automation.

is interesting to me. The, the IT automation that's, that's been available for quite some time. What has kept us from really pushing the envelope here? I mean, we've known about DevOps, we've known about dev SecOps, we've known about these things. What has kept us from really embracing those things? Within the healthcare.


A couple things. So first off, the tooling, as and we talked about many times in the show, a lot of the health IT tools out there were built in 1980s and are still being sold as of the 1980s. Well, it's very hard to automate an on premise, only very landlocked system that doesn't have API access or whatever else you're doing.

A lot of fancy scripting and honestly, the true cost of ownership of that system. To be able to enable that to be automated the juice isn't worth the squeeze. So you had ancient systems that are just now getting modernized in health it. So that's first. off right. A true physical limitation two. The people who were doing DevOps before were gravitating to the Facebooks, the Amazons, or whatever.

Well, guess what? They're all doing massive layoffs. And I realize that in healthcare we pay a fair wage. We don't pay a Facebook wage, but we do pay a fair and we give you the intangible of actually being able to deliver care to somebody that's attracting a new generation of talent that. Usually didn't want to come into healthcare it.

So now I'm able to recruit and fight with some of the best because this new generation of workforce wants that intrinsic return on investment of their time, which is I want to help somebody. It's not about a paycheck anymore as it was in the old days. Third thing. Is that the tooling actually has become a lot simpler to work in.

Now it's all drag and drop low code, and it's very easy for me to enable my staff to quickly go faster without having to be trained for years and years and years to be able to write a script to do automation. Back in the day, we would say, oh, write a PowerShell script. Well, that would take weeks to spin out.

Now I could spin up a system like Ansible or out systems or whatever, and drag and drop and boom, you're off to the. races That's powerful. I will also say this. Here's an interesting phenomena about automation. I'm actually getting the request from our nurses and docs coming outta school that join us, say, Hey, I want a code.

I wanna make a solution here. So we actually rolled out a low code platform for our enterprise where our nurses can create their own apps, push to Baptist. devices And fix their own problems so that my DevOps team doesn't get in their way. My DevOps team becomes the phone a friend, let them code, let them solve their problems.

The first app was released just a few weeks ago, which was a crash card app. The second app was released earlier last week, which was a eye washing station tracking app. They were doing all this manually and in spreadsheets taking hours and days. Now down to minutes, they solved that problem. Why am I in your way?

That culture shift takes time in healthcare to make happen. But if you look at all the tech giants like the Dell Technologies and Salesforces of the world, they've been doing this with their internal teams for forever with hackathons. So we're just now starting to get with the Jones's per se, and follow that same methodology, which will permeate through the industry like wildfire.

It's, it's interesting cuz you beat me to it. I was gonna say, that's great. The two areas you identified it and the administrative really rev cycle and administrative side they pose a lot less risk, but there's a lot of opportunity. Mm-hmm. and we have to, it would feel to me that given the challenges around burnout and lack of availability of.

Clinicians and technicians and other things across the board that we have to start applying some of these things to clinicians. And I was gonna ask you to share some examples. Well, you just, you you beat me to it. And and the thing I love about that is you have. The people who understand building the, the code.

Actually that's right. Building the apps. Is there any concern that we're gonna end up with like the Microsoft Access, you know what I'm talking about? The Microsoft access of, of just a whole bunch of apps that are sort of silos. You,

you, yes, I do worry about that, but to me, if you're gonna shift a culture, you, you've gotta break, you gotta break a few eggs and make an omelet, right?

So I know that in the future we're gonna have app sprawl and we're gonna have to consolidate and really look at this. But if I really wanna get the culture of, of innovation going, and for folks to be able to feel free and liberated to do that, I can't start. Stop immediately and say, ah, I'm too scared. I don't want it to happen.

I've gotta start embracing eyes wide open, measure the roi, make sure that we fail fast. If an app isn't cut in the mustard right, we take it out of there. And my hope is we're we end up with a plate of 2030 apps that are Baptist, homegrown, curated, that we would help the end users manage and make sure it's patched and all those sorts of things.

But to me, if you do this right, it's no different than how the app store works today for Apple, right? You could eventually start putting things in folders, start grouping them together. You end up with a plethora of Baptist homegrown apps that is not so much like access, where it's on your one single computer and your one database for Aaron only.

It's for an entire nursing division. It's for an entire allied health division or whatever that may be. So the impact is greater. Are we always gonna have sprawl? Yes, there's brilliant people who wanna do brilliant things, but if I don't give them something, they're gonna do it anyways using Excel access and others.

So you might as well help them, give them a weighted path, and then deal with the cleanup down the road.

πŸ“ πŸ“ In 2023 we are celebrating five years at This Week Health, and we are working to give back and we will be partnering this year with Alex's Lemonade stand all year long. As you know, having a child with cancer is one of the most painful and difficult situations a family can face. At Alex's Lemonade Stand Foundation, they understand the personal side of the diagnosis, the resources needed and the impact that funded research can have for better treatments and more cures. Today, Alex's Lemonade Stand is one of the leading funders of pediatric cancer research in the US and Canada, funding more than a thousand research projects and providing programs to families affected by childhood cancer. You can get more information about them at So how are we going to partner? The leadership team and myself personally, we have put some money aside to really fund the start of this. But what we're looking for is partners, right? So we're gonna ask our partner our partners, our sponsors to be a part of this. We're gonna ask you to be a part of this. And some of the ways that you can help contribute is we're gonna have drives throughout the year. We're gonna have follower drives, followers of the show, followers of our LinkedIn channel, Twitter channel, YouTube channel, you name it. We're gonna have these drives. And as part of those drives, we're gonna ask people to be a part of putting donations towards Alex's Lemonade Stand. There should be many opportunities this year, so keep an eye out all year long to see how you can support Alex's lemonade stand. You can find more information out on our website You can also check out Alex's Lemonade Stand again at A L E X S And if you go to our website their logos gonna be on our homepage on the top right hand corner. We're celebrating our five year anniversary, and we want to continue to give back to the community. So we welcome you to be a part of it and looking forward to seeing what we can do this year.

πŸ“ πŸ“ I do wanna talk to you about the the clinicians. Let me ask you this. Where have you found now you just consolidated, you just went through this EHR implementation, and generally there's a lot of gains through that. You have application rationalization that happens. You have workflow rationalization and process rationalization that happens through that, that process. Where do you see the next gains? For them where you can free them up, practice the top of their license and as Stephanie, Laura likes to say, restore the joy of medicine back to the clinician.

I love the question. So you've interviewed Dr. Stacy Johnson before and you showed my applications officer. My chief Medical Information Officer is a pedia family medicine pediatric. Hospitalist. My head of data data analytics is a pulmonologist, PhD, md physician researcher. So we have three physicians leading key components of the IT enterprise here at Baptist that are always asking that question, how do I bring joy back?

What we have found is a couple of interesting things. One, the actual data on usage patterns in the EMR to figure out when pajama time is and what those bugaboo workflows. Has been invaluable to be able to sit down with a primary care physician or sub-specialist and go, you're spending a ton of time placing orders.

What's going on? Like, why, what has happened here? Right? So it's that customization, personalization, taking the junk out of documentation, entry and whatever else that EMRs are so notorious for being. So that's number one. Physician experience, clinician experience, right? Nursing experience second.

Is looking at the overall practice data and going, what are our patients coming to us for and how do we maneuver some of these clinics? As these regions grow to do more services, what are people looking for? What do they want? And being able to proactively forecast as before, we couldn't see the data because we really couldn't see two EHRs, predominantly an ambulatory and inpatient setting.

And then there's more miniature EHRs everywhere here that really didn't. Now it's all one big database. So looking at that and projecting forward, what services can we offer? A zip code that didn't have it before is critical, so that's two is being predictive. And then third is really alleviating all the manual phone calls and scheduling and all the things that that are cumbersome in healthcare that everybody universally.

And despises. If we can really automate those and manage that so that it's as easy, easy as ordering a pizza on Twitter from Domino's, but I can schedule myself an appointment at a Baptist primary care clinic as just as an example. Why not? Why not engage over social media? Why not engage over chat bots?

Why do I have to make a phone call and do these things? So we were laser focused on that, sort of that omnichannel contact center and really alleviating the doors. We didn't have the ability to do that before. We couldn't do that because you couldn't see into schedules, you couldn't see practice variation, and you couldn't see what was really happening.

Data and visualization of data is everything for the future and those lenses. At Baptist, what we did was we reorganized our analytics team into a central function. It is underneath it, but accountable to the enterprise. We have both a data intelligence. These are the folks who are like data managers, data architects, and decision science who help write the basically lenses as to what does this data actually mean for us.

Those two teams then work with finance, hr. And really curate out those questions from the data sets that we did not have the ability to see before. On top of you getting more efficient from an EMR in general, which alleviates other burdens that cascade down through the health system. It gives you a pen of view you just never had before.

So for us right now, it's like, Walking into a, a giant restaurant with a huge buffet of options, I'm spending a lot of time making sure that the teams are staying right lock step with operations exactly what's going on, because it's very easy to go wide and get distracted unless you stay focused.

One of the things that drives clinicians crazy is prior authorization. So I guess my question on that is, you mentioned it earlier in terms of in the automation Yes. Discussion. Anything you can share in terms of how you're approaching.

Yeah, so we actually partnered with a company and installed them quickly, although we wanted to optimize native, native epic for a while before doing Boltons.

This was a good Bolton to do, which we started with prior authorization for imaging. These are for all the radiology images and, and those sorts of things, and automates prior auth. And what's important here isn't so much the technology to do that. It functions like any broker would, connecting to multiple data sources.

It's the payers, right? It is amazing how much of an uphill battle. To work with some of the government payers like a TRICARE and others because they're just on the same urgency level that you are. Right? So to get prior off to work, it's not so much the hospitals being willing to do it. It's not so much, there's a lot of technology that can help automate that function, including the new Epic payer platform, which is brand new.

It's still learning its way, it's working with the payers to push them to do those things. Now, some payers, their two thumbs up, they see the ROI on their side of like, yeah, streamlines our headaches. So we're good with. Some payers, even the big ones, and I'll just leave the names off this conversation, push back hard because they realize at that point that's faster revenue out the door for them, and they make money on the interest they hold back from sending out from authorizing the claim.

So they'll drag it through the mud. It's just the business model. So I expect in future prior auth legislation, which there was an NPRM just released by CMS yesterday on this, which is going to streamline this and force the hand of the entire ecosystem to play ball and stop doing this at the expense of the payers and their, of the patients and the headaches of patients encumber.

Yeah. I, I, I like when I see policies and things coming down the pike that put the consumers in in. Consumers and the patients in the, at the center of the equation. And we assume that everybody's gonna be acting in the best interest of the patient. And that is not always the case, unfortunately. And it creates these inefficiencies across the system. And, and that burden quite, I think part of that is the burden that the clinicians are feeling. They're like, we, they know they can do better. And they're like, I can't, why can't I make this better? And their, their patients are coming in and complaining and they're like, I can't do anything like this.

There's, there's something broken into the system and that's where outside forces have to come in and Absolutely

right. I, I, I really do feel, I feel bad for the physician of the 21st century and how much documentation is required of them because of the legality purposes, because of whatever.

It's the reality of the medicine, the world of medicine that we live in today. Right. Versus the world of medicine 50 years ago with advancements come, advanced headaches. I always say it. So you know, they're having to work through a true Storm of stuff they have to do. You have to do billing to get the bills out.

You have to do orders the right way. Guess what? You have to be careful what you say because all your information now is being given to the patient out of information blocking the right thing to do. But if I say Aaron is clinically obese, that could be misinterpreted by a normal understanding going, why are you plumbing me obese?

Well, that's a clinical term, right? So having to work through all these things adds to that cacophony of frustration. But it's up to us to listen. Partner and engage on that and make sure that we're putting things back respectfully for the clinician. We, in healthcare, it really deviated off of that as we digitized records and we lost sight of making sure the patient was at the center and everybody around them has a frictionless experience.

Yeah, I, I, somebody was relaying a story to me and they said She got pregnant late in life and she was labeled at geriatric pres pregnancy. She's like, geriatric, I can't believe you're calling me geriatric at this point. It's like, but that's a clinical term for some. I mean, it just is. Yeah, exactly.

And it's,

it's tough. Right? That's a tough thing to be in. So,

You had an interesting decision to make. So you're making all this progress with regard to the consumer and access and digital tools and whatnot. And now you've taken on a new ehr, which has a digital front door and whatnot. How did you, I mean, to a certain extent, you are encouraging adoption of tools across the board for the last, I don't know, maybe five, 10 years, whatever it is. How did you maintain that momentum in the transit? Yeah. So

first of all, one of the reasons I came to Baptist was it was apparent from the very, very top, from our board of directors all the way to our frontline staff. As I interviewed folks and I talked to a ton of people before, I said, yes, the hunger was there.

So I can't teach hunger, right? You gotta be hungry to want to learn tools. So the culture. Was just craving technology, new ways of doing business and getting outta the frustrating world of the old. So first of all was, is the environment ripe for it so that Aaron doesn't come in like a, like a wrecking ball, right?

And just crush a culture that hell has nothing to do with it, which some organizations just wanna do well, what they're doing and not move the cheese. Okay, good for them. We wanted to adopt those things. That's first. Was the culture ready? Second thing, the first four months I was here at Baptist, I toured every single hospital, rounded every clinic.

Met with many of the almost 20,000 teammates that we have face to face. Not everybody, but as many people as I could over shifts talking to folks, what are your bugaboos? What's going on? How are things working for you? How are things not working for you? Really understanding what was going on there and really beginning to formulate the right approach.

So I knew that the culture wanted technology. What's the rate of change? So through those interviews, I was able to figure out what rate of change could we go so I didn't overwhelm folks or bore them to death cause we're going too slow. And then third was making sure that we inov these technology pieces in between these major rocks that had to get done right, the Children's Hospital Epic, and now our new Clay Fleming Hospital.

Right? To make sure that we're not running into those hard goal posts. If you get the balance right and the culture wants it. And you're able to explain it and plain English to people. 99% of folks will adopt what you're selling. They just will. Right, right. But a lot of folks make the mistake of trying to shove technology down someone's throat or not listen and say, I know better than you talk to the hand.

That's not gonna cut it, right? That's, that's the old way of doing things. So this is a much more together type of approach, which allowed us to overcome hesitancy. I will say, even with things like Moxi robots, which are cool and they're really cute too, with little heart for eyes. I still get interesting.

Feedback from staff going, oh, robots are coming to take my job. I'm not gonna talk to this robot. Or, oh, this thing may be stealing my information. This is from the staff who say these snarky things from time to time, so it's not perfect, right? There's still some resistance to change, but it's in pockets which can then be listened to, to figure out what factually.

Is making you buzz negatively about a robot, which is here to literally just take your linen from point A to point B or whatever else. Those are things you've gotta unpack and takes time. So that's what we spend a

lot of time doing. So let, let me take you outside the four walls. Yeah. Because you have, you have a larger community of consumers and patients who interact more and more with your health system, with technology in a digital.

You now have Epic MyChart. You had something prior to that. How are you going to maintain that consistency and, and actually drive deeper adoption of the technology as you move forward?

I mean there's healthcare is on the four walls bill. Really, really . Absolutely. So couple things. First of all, this is established well before I got here.

We have a number of patient advocacy councils that are on the wide area that go into the communities like p Vitra and others and talk to folks in those communities to say, what do you want from Baptist? Our chief marketing officer leads this along with our head of service line development or business development officer.

And really gathers a lot of those feedbacks native from the community as to what do you like, what are you doing, what can we do better for you? So listening active, active listening in those community centers. Second thing, making sure that when we do major changes like rollout epic or whatever, we're communicating with the public in a very effective and easy to understand manner so they can understand why the why and every language you can possibly imagine.

And so again, our communications team here does a great job of really working with our community to. Here's why we're doing this and what it means for you. What's the with. Third thing we do as it looks at technology, we'll use hospital at home as an example, right? We have an excellent hospital at home program led by our, our leaders there that really takes care of multiple comorbidities, like long covid or C O P D or, or other renal kidney failure.

These other conditions that are going on. If you say, Hey Aaron, we wanna expand that program, which we're looking at and saying, what other services can we help people with at their house? That takes technology, that takes conversations, that takes partnership with the service lines. So then it's partnering with the right service lines to enable technology that at their fingertips will actually work on somebody else's wifi or somebody else's cellular capabilities so that they have an experience as if you were in the back to school walls.

So it's really listening, working with each of the dynamics of the. And then going to the communities and saying, will this work? I will also say, and, and this is sort of like Texas, but not Florida, works really well together. So we'll have folks even in Southeast Georgia that we'll talk to and collaborate with.

Cause there's only 40 miles away from us. And, and so talking to them, talking to folks in Orlando, talking to Baptist, Pensacola, and other health systems in Pensacola, to kind of get a feel for what are your patients seeing and saying they. So if you do that, now you're looking at a geography of the, of the country.

That is pretty much our entire psa, and you're able to figure out, okay, real time telemetry, early warning radar, what do people want? And more importantly, what do they don't want?

You made that transition from Texas to Florida. That's I would assume Jacksonville's pretty nice compared to where you came from.

I know you don't wanna say anything disparaging about beautiful. I assume you lived in the Austin area with Yeah, yeah, yeah, yeah. And that's spoken highly of, but the Jacksonville area is really nice and we talked about recruiting to that area before. I have two, two exit questions for you.

Yeah, go for it. The first one is is there a technology you're keeping an eye on that you believe will have an impact on he. And that maybe not today, but in the next three to five years. So

I'm a big believer in voice recognition systems. I think natural language processing is absolutely taking off as those algorithms get better.

We are also laser focused, both at a federal level with the high tech, all the way down to my day job as a cio, c d, on ensuring there's no bias in those algorithms. But I think natural language processing is the future of healthcare. It is voice driven, voice activated, along with other sensors in the room to really automate a lot of task.

That you would normally be typing into a computer or telling somebody you're going to do. So that's first nlp. Second thing, I'm still big on blockchain and in fact we're partnering with a company, I'll leave their name out of it that is really developing a blockchain based identity management for our master patient index.

Right. We do MPI like everybody else does, but there's a better way to crack the walnut and for, and, and actually give You bill, a digital token that represents your mpi, your unique patient identifier. So as you present to Baptist, we know who you are immediately, and more importantly, you know who interacted with you.

My ideal state is we authenticate to the patient, the patient doesn't authenticate to us, but to get there, that takes a long road and a lot of, a lot of levers, but it is part of the zero trust framework, so we're driven towards that. So I really believe in those two texts that I'm watching closely along with a lot of other things, but most importantly above all of this, I love the next generation of talent coming into the health systems.

They are hungry, they are eager, they wanna do big. This is why I, I volunteer to serve as a trustee for the Florida State college Jacksonville to be able to help really teach next generation of students coming out of these vocab schools and teaching them the right hard earned lessons to be able to come into healthcare it and immediately get the ground running.

So I'm, I'm bullish on the future and I'm incredibly excited about what's coming outta the.

I agree with you on all three. It's interesting, the the blockchain one, you're probably the only cio, I'm trying to think. You're the only CIO that's mentioned blockchain probably in the last 12 months to me.

Yeah. And I'm, I'm wondering why that is cuz I love the framework you're shooting for. Makes perfect sense to me. I mean, authenticate to the, to the patient instead of the other way around. It's almost a patient-centric interoperability model. I've been talking about it on the show for a long time. That I think is, is how we solve a lot of the interoperability.

It's use case, right? It's use case, and blockchain is not for everything. I think folks, at one point were using the word blockchain, like we used to use the word Microsoft access, right? Oh, put it in a blockchain. That doesn't mean anything, right?

That's just, that's just nonsense. But the right use case, which in this case I want a. Federated decentralized identity store. It's the perfect use case in exactly what blockchain was created for. Right now, you can use Ethereum, you can use all these different types of blockchains, but the reality is that decentralized concept is what does.

Unless you wanna become a certificate of authority yourself, and I don't wanna be in that business, then that's the best way to do it in a decentralized manner. That's why it's use case.

Yeah, I, and I like that use case. I'm gonna keep exploring that one. The NLP people will say, oh, it's, it's been around for so long. And I, I think what they're missing is we are now getting to the point of AI being trained with self, self supervised learning. Mm-hmm. , right? So you have AI training, AI and the models are getting smarter faster, right? And so there's an acceleration that's happening, right? That's why I think more and more people are talking about the promise it's being used more and more in healthcare.

And I, I agree with you. I think the, the promise of, of all that the listening technology, ambient or other is I mean probably right on our doorstep.

Absolutely. And patients, right? I mean, you're seeing all the white papers come out right now about listening to the patients calling in and detecting depression before the patient realizes they're depressed.

If you think about all the things we can clinically do now with your voice patterns that we could never see into before and predict with a simple PHQ two nine survey now can be done leveraging, looking at your voice pattern to say, Aaron has a depression problem, or he's suicidal, or, or even other catastrophic, If you're thinking about the live save simply by listening to the way someone talks now, it could go really far and go creepy.

Like we've seen that happen with Facebook and others recently taking it way too far. But I feel that as long as you're transparent with the patient, you're telling them in plain English what you're doing and I'm doing it to really help you. Right? I'm really analyzing your voice patterns for depression.

That is an example or whatever other. That is nothing but beneficial and, and takes that stress off your shoulders. You wanna know these things you do, and that's what people want. They just don't want you to be creepy with the data.

Final exit question. we pulled our, our listeners and one of the things they want to hear from CIOs this year is what works from a vendor standpoint, from a new technology or founder, somebody who's trying to work with health systems. What do you find has worked over the years and what are some things that haven't really worked? Let's just start with what's worked. What vendors have you partnered with that you were like, yeah, this is, this has been a phenomenal experience.

This really has helped the health system. I like this partnership. What were the aspects of that? What, what were the characteristics of that relat?

First, I would say to any founder or ceo, cto, solve a problem through a straw, meaning solve a problem and solve it really well. Do not boil the ocean in what you're doing.

So I'm gonna fix prior authorization since we talked about that. I'm gonna do this really, really, really well. Yes, I could do eligibility checking. Yes, I could do a zillion other things. I'm gonna solve prior auth, and so bring me a solution that solves that pain point of mine exceedingly well. So deliver results two.

Do not sell me hopes and dreams. You don't clap for hope. So have a track record of showing that you can actually solve the problem. It's not a slide deck, it's not your pitch deck to get your seed round of funding. It's an actual, here's the product and how it works, right? Or how it's worked in other industries you wanna bring into healthcare.

That's totally fine. Show me the money, per se, right? Show me the meat of it. Third thing. Don't come at me with, oh, we have this integrator that can integrate it for you into your workflow, because it's gotta be shoehorned in, oh, I can't sell to you direct. We have to go through a var. Oh, I don't know what my pricing strategy is.

I don't wanna go at risk on any contracts. You gotta have your ducks in row, man. And I get it. A startup, e i I went to the for-profit side, the vendor side for a st. I understand sales cycles, I understand pricing strategy and go to market, but you gotta come to me with a sense of, here's what it's gonna take to make it happen for you on a fixed cost.

Or an at risk basis. I'm fine with splitting the money too, but to the degree of it coming with a sense of what you wanna do. I have a lot of startup vendors that approach me that don't have those ironed out, and it's very difficult for me to sell the idea internally and then two, to adopt it in good conscience if I know you don't have all your ducks in a row. So I'd say those three things. Yeah,

absolutely. Aaron, it is always fantastic to catch up with you. I appreciate you taking the time. I know you're very busy. Thanks again for being a part of the show and, and sharing your wisdom and experience with the with the community. Appreciate it. Always happy to help.

Thank you for having me on my friend. Congrats again. Thank πŸ“ you.

I love the chance to have these conversations. If I were a CIO today, I would have every team member listen to a show like this one. It's conference level value every week. If you wanna support This Week Health, tell someone about our channels. We have three This Week Health conference, This Week Health Newsroom and This Week Health Community. Check them out today. You can find them wherever you listen to podcasts. Apple, Google, Overcast, Spotify, Stitcher, you get the picture. We are everywhere. We wanna thank our keynote partners πŸ“ who are investing in our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.


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