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June 16, 2023: Shane Thielman shares his journey and experiences as the CIO of Scripps Health as well as all the initiatives Scripps is taking in this upcoming fiscal year.. What is the process of determining technology priorities and investments at Scripps Health for the upcoming fiscal year? How has the organization's approach to technology investments changed in recent years, and what is the focus for fiscal year 24? How does Scripps Health measure and demonstrate the value of its technology projects? What strategies does Scripps Health employ in managing change and driving adoption of new technology solutions? How does Scripps Health envision the future integration of technology into its care delivery model?

Key Points:

  • Scripps Health overview
  • Technology background and deficiency
  • Fiscal year planning and priorities
  • Measuring and demonstrating project value

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This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Today on This Week Health.

what are we doing in order to manage the narrative moving forward?

Right? We want to tell the stories about how we're using AI today at Scripps. How are we evaluating aI and incorporating that into our environment moving forward. For instance, G P T as an example,β€Š

Thanks for joining us on this keynote episode, 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, we've been making podcasts that amplify great thinking to propel healthcare forward. Special thanks to our keynote show. CDW, Rubrik, Sectra and Trellix for choosing to invest in our mission to develop the next generation of health leaders. Now onto our show.

all right. Today we are joined by Shane Thielman CIO for Scripps Health out San Diego. Shane, welcome to the show. Thanks, Bill. Glad to be here.

You and I have interacted a bunch of times, so if this is the first time you're on the show, so I'm looking forward to this this conversation. I start all of these interviews the same way, and that is tell me about your health system. Tell us about scripts.

Sure. Yeah. I think just a quick rundown on the vital statistics.

Not-for-profit, integrated delivery network located in San Diego, California. We have five acute care hospitals about 35 outpatient locations, a few thousand affiliated physicians, about 17,000 employees, and just around 4 billion in annual revenue. We have value-based care contracts, so a few hundred thousand lives under management and GME program with about 200 trainees in a clinical research arm.

So, large, complex idn. In the greater San Diego County region mostly servicing the coastal region between the border and Camp Pendleton and then all points inland as well. So,

so your role your path to the cio. Were you there when Andy Crowder

was there?

I was. So I've been at Scripps, I'm coming up on my 17th year, but I had sort of a circuitous. Even into healthcare.

You don't go all the way back to Drex DeFord days,

do you? I worked at Scripps when Directs was here probably my first few years here. Wow.

All right. Well, give us that path.

That's pretty interesting that you've been there and you came up through the ranks to the CIO

role. Yeah. I'm a big fan of context. In fact, I was telling this story earlier today to a Frontline Leadership Academy group, but I finished undergraduate with two degrees, one in political science in Spanish.

Thought I was going to transition to law school. Took a gap year, followed a passion of mine, which was working in the outdoors, and found a role working with adjudicated adolescents. Fell in love with the work. Ultimately ended up as a director for a 77 bed virtual program in the wilderness.

And at the same time was committed to pursuing law school. So I ended up taking the lsat. At the time all your applications were were, written applications that had to be mailed into to the school admission offices. I filled out three applications, had everything in envelopes, and had a moment of truth and decided that I enjoyed what I was doing so much that to make such a stark pivot into law school was not the right path for me.

And so I went back to school, got an MHA degree, and that brought me to California and ultimately to Scripps. And I came to Scripps as an administrative fellow in the office of the president, our current c e o, who is been with Scripps for over 20 years. I was mentored in our corporate project management office and took a job after about six months as a manager of strategic planning.

Did that for a few years. Learned a lot about the organization and There was really an interesting moment where I was sort of offered to an opportunity to work on one of two projects. And the one that I selected was a project that we were struggling with. It was behind on a from a schedule standpoint, it was behind on budget or over budget, and it was upgrading our inpatient electronic health record back in 2009 as we were preparing for.

Meaningful use and all of the ara hit regulation and obligations that healthcare systems had. And so it was a great opportunity for me to get exposed to acute care operations, work closely with nursing. And I fell in love with the, not only the project, but the work itself. It brought me very close to it, but it also brought me really close to operations.

And I I really discovered that I had a passion. For working with clinical operations and finding ways to successfully integrate technology into workflow and the project turned out to be successful. And that really was the catalyst for, my dedication really to working in it.

I was involved in our EPIC implementation and. Ultimately was overseeing all of our clinical and revenue cycle applications. And my predecessor left the organization for a c i O role on the East coast, and that was in 2019. I was tapped to step into the interim role and been in the position ever since.

So it's been it's been An unexpected but incredible career journey and an organization that I value deeply and experiences that I wouldn't trade for anything. So, really really just an unexpected career pathway, but one that has brought a lot of gratification and, and certainly a level of service that I'm very passionate about.

Your career path is really interesting to me because it's not the traditional technology laden, technology driven career path. It's more the business side, understanding the operations, understanding the clinical operations which as and I know having done this, the E H R implementation is 98%.

That it's 98% really understanding the business of clinical workflows and how things function. And it's 2% technology. But have you found that to be a deficiency at times not having as much of a tech background? I get the question in the other. Direction, by the way. People always ask me, you, you don't have a big healthcare background.

Is that a deficiency? And my answer is, absolutely. It's not. Having to learn the business very quickly was very difficult for me. What about you on the technology side? What did it look like for you to come up to speed on the tech side?

Yeah. I think I would answer the question the same way that you did Bill.

It was absolutely a deficiency. However, it was one that, could be mitigated. One I just have a natural curiosity and desire to learn. It brought me closer to members of the team that I hadn't, necessarily been as accustomed to working with. So it allowed me to forge some new relationships.

And, it also allowed me to build a team around me, right? Because we all have strengths, but we also have our our deficits and And so it allowed me to, really build a cadre of of advisors and experts that are very complimentary. and so, I do spend time particularly in, the enterprise architecture, the infrastructure space, trying to keep up to speed.

It's ever changing kind of area of information technology in general, not specific to healthcare. It's also one that can become a lever, right? For both cost savings, I believe, but also allowing us to enable the organization in new and different ways that ultimately I think, can yield some competitive advantage if done effectively.

So, it's an area that I spend more time in but I approach it more from a learning perspective versus a subject matter expert standpoint. Yeah.

That's a very similar conversation then that I've had with other, especially when physicians become CIOs. It's the same kind of thing.

It's bringing in the right people. I hired a lot of nurses and physicians and others into our IT organization and had to build partnership with them. And you built those partnerships with the technology leaders as well. All right let's go in the direction of priorities. So we're, I mean, we're around the July timeframe.

What's your fiscal year? Is it July or is it January?

Yeah, our fiscal year is October one, so we're in the we're approaching the fourth quarter of the fiscal year and ramping up, finalizing our FY 24 capital plan and just pivoting into starting our operational budget planning for next year.

Yeah, it's it is amazing to me the amount of work that goes into figuring that out prior to the start of the fiscal year. Give me an idea of what that process looks like. How do you determine as an organization the priorities that Scripps is going to have that are going to involve technology moving into the next year?

Yeah. I think it starts with governance. There are things that we need to do from an IT perspective. Asset lifecycle management, whether it's on the application side or the infrastructure side. And really the IT department is responsible for making those recommendations back to the organization as the subject matter experts.

But there are additional investments. We really focus first on strategy, so we use the organization's. Three year strategy and as a roadmap for identifying, enabling technology capabilities that would be necessary to help achieve those specific objectives. And then we really have sort of a ground up process as well.

And that, is funneled through acute care and ambulatory operations through our business office, through our health plan. And we evaluate opportunities. I would say that the environment has changed a little bit over the last couple of years and probably for obvious reasons and not dissimilar from other organizations.

We are being much more particular about the investments that we're making in technology to ensure that we're achieving specific outcomes. And that usually comes in the form of either reducing expense or. Increasing revenue and so. Being very practical and thoughtful about where those investments are occurring so that they're actually enabling the organization from a competitive standpoint and not just adding cost.

And that's been a bit of a new discipline all around, not just for the IS department, but quite frankly for the entire organization. And so what I see is a little bit of a rationalization going into fiscal year 24 as compared to prior years. And in some ways I think that's a good thing, bill, because it also allows for a more discreet focus and really a clear understanding of how we're translating the value proposition of the investments that we're making into real benefits that we can measure.

And that's something that we've been really passionate about over the last several years, is really feeding back results to the organization. When we're implementing a new a new technology solution. And so that exists already. Now, it's just building on that in terms of the upfront planning to make sure that we're solving problems of consequence with the technology investments that we're making.

Yeah, and I'm gonna ask you to share an example of, if you can, the. I was in San Diego earlier this year and you and I got a conversation had, were able to discuss this a little bit and I was really impressed. I was impressed with how your organization looks at projects. I was making the case that most organizations will start a project and we'll never go back and look at.

A lot of the things, we'll never go back and look at the roi. We'll never go back to see if it actually delivered on the promise. And then you started giving me examples of how Scripps approaches that and the methodology. If you could, give us a little bit of an example of how you measure and demonstrate back to the organization the value of the


Yeah, happy to. There's several that come to mind. I'll focus on one that is I think very exciting and one that I know many healthcare organizations are pursuing. And that is the implementation of ambient experience. And so, really the exam room of the future concept where there's a listening device that's capturing.

The interaction that's occurring between the patient and the provider and then translating that into the note for the physician to review and sign off. And so we were I guess relatively speaking, an early adopter of ambient experience. But we approached it on a limited basis with about 50 providers and.

The underlying assumption that we had is that the the investment in the technology was a fraction of the cost of a scribe. So we would mitigate any cost associated to having human scribes. And that too, we would reduce the time in documentation for the providers such that we could actually help improve throughput and enable them to see additional patients.

We didn't have an assumption about the number of patients that the providers would be able to see because we really hadn't chance to road test the technology. But we started with a small group of physicians that really spanned both medical and surgical specialties. We committed ourselves to really a change management model to help bring them up to speed, which it takes about 90 days, 60 to 90 days before a physician really gets to a point of, I think, productivity improvements that are meaningful.

But what we saw with our first cadre of providers was about a 30% reduction in in time and notes per appointment and overall That translated into about 30 to 35 minutes on average per provider per day of time back. And that, that was impressive. What we ultimately determined without asking physicians to see additional patients was that Most physicians were seeing about one to two more patients per day as a result of having access to ambient experience.

And we actually were able to demonstrate ROI within 12 months. And of course, the cost avoidance associated with scribes because the cost differential was quite significant on an annualized basis. And then of course from a patient standpoint, we wanted to get feedback as well. And so we looked at our patient experience data and what we saw was that patients were equal to, if not more satisfied, and it really took the keyboard out of the competing for the physician's time with the patient.

And that really played out in terms of some of the patient experience data. So we we were able to translate that into a more formal business case and continue to grow the number of physicians that are using ambient experience and really have created a playbook for how we roll that out. And then of course, I think as you're aware, bill, just looking forward, what's really exciting is that currently with Ambient experience, we're still dependent on a human reviewer.

And where this technology is going is that human reviewer will eventually be removed from the equation. The documentation will be available in near real time and arguably the cost will be lower as a result, which will give us an opportunity to expand this further. But we didn't achieve that by chance.

There was a lot of investment in the change management piece and also, Some deselection of physicians that thought this would be right for them, and they determined that they weren't up for making some of the changes in their templates and were not ready for some of the process changes that would be required for them to achieve some of the outcomes.

So it's been a great learning experience for us, but we really spend a lot of time feeding back this information to our. Physicians that are involved, but also our physician leadership and our administrative leadership because I think it tells the story that we all want to tell, which is, technology is enabling.

Changes in our care delivery model, and it can be a transformative agent in terms of how we think differently about the healthcare system of the future. So that's just one example of several, but one that has been a real area of passion for my team and and it's a great story and it's one that we are always excited to share.

It is a great story and it's one that since you and I have had the conversation, I've shared with a couple people of how important it is to demonstrate that, because otherwise I think what happens as a former CIO and I think what happens over time is people are like, Hey, are we getting anything from these investments in it?

And if you're constantly. Telling the story all along the way. And also by the way, I, from our conversation, identifying things that aren't delivering on their roi. Yeah. We anticipated that's an important metric to understand as well. Absolutely. You talked about governance. And I'm curious cuz I've read Eric Topples book a most recent book and I've heard him speak and and now we have generative AI coming.

Is there ever a case where, how do you keep all the technology The ai, the just all the new technology projects from overwhelming, because I'm sure physicians get excited. They look at it and they go, Hey, look what look what this health system's doing. Look what this is doing. I mean, you work with a lot of great professionals that are keeping their their ear to the ground in terms of what else is going on in other systems.

How do you, how does the governance keep that from just overwhelming the system?

Yeah. I wouldn't say we've perfected it by any means. There's always more demand and there's capacity and there are so many good ideas out there. I think it's how those ideas get parsed and matched up with what is realistic.

And we know that there are technologies out there that have a lot of promise but maybe haven't realized their full potential in terms of really demonstrating outcomes. I would say first and foremost, it starts with When I ask of my team and how I hold myself accountable or attempt to, which is, really we have to be connected partners and we have to be information and insight resources for, our clinical operations leaders and our physicians.

And what that means is that, our job is to be expert in understanding technology and understanding solutions. We have to commit ourselves to doing research, doing our homework. And being honest, there are great ideas out there and there are so many of them that we can get overwhelmed, right?

Chasing ideas and concepts and so, Part of what we try to do is use the those meeting opportunities to build in some time for education. What do we know about what's happening and what's on the horizon? What's real versus what is maybe at this point it's exciting, but it's still more or less vapor.

And really position is. As being that information and insight resource so that there is truly a partnership that we're in this together. We're not just implementers of technology, but as you and I were talking earlier, I mean, achieving results is really predicated on people in process.

That technology is the enabling capability that's part of a solution, but it's just that it's part of the solution. And so I, I would say that's one aspect. The other is that we spend time actually developing roadmaps. Technology roadmaps, but those technology roadmaps are intended to connect back to our multi-year strategic plan as well as our annual operations plan.

And so what we try to do is then build a funnel, right? So that we are staying focused on the levers that are gonna help scripts achieve the results that it needs to achieve, both on an annual basis, but over a time horizon as well. So those are just, I think, two, two examples of how we do that. I would say that it's not entirely perfected and we do get things that sort of get lobbed over the fence, but we have good processes to really make sure that we're evaluating those in the context of what I just shared.

When you do perfect it, make sure I get a phone call. Cause this governance is one of those things that comes up over and over again. Especially now with AI as well. People keep asking me questions around, what are organizations putting in place around AI governance? And I'm like, governanceis governance.

AI is just a, another set of tools that we have to look at and understand. And. It also has an ethical aspect to it as well. I mean, there's, but governance is governance. It's it's a muscle that we're constantly exercising. It's interesting to look at.

β€Š πŸ“ πŸ“ β€ŠWe'll get back to our show in just a minute. Ever wonder how technology can reshape the patient experience? Join us for our next live webinar, the Patient Experience, a Technology Perspective on July 6th. At 1:00 PM Eastern Time, we're bringing together expert speakers to dive into the intersection of technology and healthcare.

We're gonna explore topics on digital health tools and the impact of ai, blockchain, and other things around this. Whether you're a CIO or part of a healthcare IT team, we think you will gain practical insights from this discussion. Uh, don't miss out on this conversation. Register today at this week,

We hope to see you there. Now, back to our show.

I want to talk to you about different areas.

As we talk about priorities and things you're looking at I'm gonna give you some different categories and just gimme an idea of how how the team and how you at Scripps are thinking about this. Let's start with the clinician experience. What are some of the things you guys are thinking about and how are you approaching.

Technology in the clinical experience. Now, obviously you just talked significantly about the ambient technology. Are there other more contextual things around how you're approaching the clinician experience?

Yeah absolutely. I mean, I think ambient experience is probably, kind of one of the bright shiny stars.

There's day-to-day work that that we do in the clinical environment both around our physicians But also around extended members of the care team as well, and that's really focused on optimization. One of the things that I think we learned truly on the shoulders of others with the implementation of comprehensive electronic health records several years ago was that, the upfront investment is just that.

It's what you do thereafter, and that's how you unlock innovation. It's also where you win and lose with the clinical community and you can build on the success of a good install by really investing in. Following up with the physician community in nursing. Identifying quick wins both at the individual provider level or employee level, so nurse as an example, or a physician or at the department level.

And so we've really committed ourselves to, how can we help improve efficiency? How can we make sure that our clinicians understand how to use the tools that are available within the electronic health record to help improve their documentation processes. And then feeding back results. I think, the impact, what, what did this activity ultimately result in.

And so every year, we provide a report to our physician leadership cabinet, which is all of our chiefs of staff, across our acute care locations and vice chiefs. And we provide a report out on what's been accomplished as it relates to optimization activities. What are we doing about clinical decision support so that it's it's supportive, it's not overbearing.

We do a similar report to nursing and we talk about the number of clicks that we've been able to reduce. We talk about the number of physicians that we were able to do, shoulder to shoulder sessions with. In fact we just got endorsement a couple of months ago. We're gonna start really a silent strugglers program.

Doing outreach to our chiefs of staff and physician leadership at our hospitals and inviting physicians into basically customized training sessions to help them become, or, to achieve a level of comfort that that they don't have today. And it plays out in the data and the information that we have.

So we, we focus on that because we know that it's important and that's where I think we win and lose. And if we get a few of the folks that are silent, strugglers. Feeling more comfortable that has an exponential effect. It starts to attract others in and then, I think you know this well, bill, you've said it already, but we have to tell the stories.

What have we achieved? Who have we touched? What is the impact? And that goes a long way, I think, in really kind of creating a virtuous cycle where there's more demand for that type of activity because it's actually contributing to improved experience for our clinical community.

You know that, that is one of the stories I tell when people ask me.

They're like, Hey, how has the e h R benefited the clinical community? And I will essentially, I'll go to that and say, we now can identify those silent strugglers. Like we knew there was people that struggled with documentation and those kind of things. We now can see it, we now can come alongside them and assist them.

Not to mention a handful of other things, but that's one of the areas. That. I think there's a way to if we take the information, we can actually assist. I'm sorry, I'm doing an interview here. I need to stop chiming in.

No, it's great. The other thing I'd say is that we have two chief medical information officers, one that focuses on the acute care space and one that focuses on the ambulatory environment.

And they really partner shoulder to span the continuum of care. I will tell you though having two resources, one that gets up every day focused on the acute care space and one focused on the ambulatory space and the way that they compliment one another, we are able to achieve so much more, so much faster.

And that has been, and they play obviously the lead role in that optimization work because they have the credibility and the ability to have the types of conversations that only physicians can have with one another. And so, That has also been, really paramount to our success.

All right, so we clinician experience, let's talk about the patient experience. I'm sure you guys spend a lot of time talking about the patient experience and connecting with the patient. And technology is creating some of those some of those pathways to communicate and help people to be live healthier lives.

Talk to me a little bit about the priorities around the patient experience.

Yeah. It is it is probably one of the most gratifying aspects, at least of my role because, we now understand collectively as an industry that technology touches every patient. Not just every physician and every employee.

In fact, they are our largest volume of users on a daily basis at Scripps. And so, I'll just take a half step back. Prior to the pandemic, we had invested a lot of time and effort in really building a digital health roadmap that was focused on how can we improve patient experience through digital and virtual access.

How can we improve convenience? How can we deliver more self-service? So how can we transition some of the things that were dependent on our internal workforce to our patients if they elect to to participate with us in that way? And. How can we lower cost structure how can we potentially capture incremental volume and revenue?

And then lastly, right, how can we address what we knew prior to the pandemic as this emergence of consumerism, which became very front and center once we were in the midst of the pandemic. And so we we longitudinally have thought about all of the various digital touchpoints that that our patients can have with Scripps And we've driven our focus and our resources from a technology standpoint along with our operations partners, but also on the revenue cycle side to really create those touchpoints. So, we have about 15% of all of our ambulatory appointments are now scheduled by our patients online.

We have a great success story with open scheduling, so patients that don't have an existing relationship with Scripps are able to go on to our website. And schedule an appointment with a provider. As we've done the look back on that bill we've had over 40,000 appointments scheduled in about the last, I dunno, two years or so with patients that did not historically have a relationship with Scripps.

But what's most interesting about that is, is that, 75% of those patients have choice in where they receive their care, so their commercially insured patients. That are finding scripts and coming to scripts for their first appointment. And so we see that as a real win, right? Because we've now established a relationship with a patient that started with a digital interaction.

We spend a lot of time Focusing on virtual care. Still today we have about 17% of our ambulatory eligible visits are being delivered with video, and so it tells us that our patients appreciate the ability to access care from wherever they are. It tells us that They appreciate not having to commute and that ultimately it's playing out for them in terms of their patient experience.

We're seeing equal to, if not better than patient experience ratings from patients that have a video visit as compared to an in-person visit. And so we've taken that another step forward and focused on, okay, well if they're efficient for patients and they're efficient for our clinicians, what if we looked at block scheduling video visits for physicians?

That frees up physical space for more in-person care. It allows the physician to deliver care from wherever they are, not necessarily at their clinic site when they have those block schedules. So that's a nice balance point for them. And more recently we've started doing on-demand primary care visits and it has been wildly successful.

So we're sort of taking technology that we put in place and we're iterating on it. To address some of the current bottlenecks that our patients are bumping up against in terms of accessing care at Scripps. And we are unable to even measure the total demand because we are chock full from eight o'clock in the morning until four in the afternoon with those on-demand primary care visits.

We're doing a lot to really make sure that we're maximizing. The utilization of our existing appointment slot. So we use the automated wait list feature. We're seeing about 10,000 patients a month, get access to care 18 days earlier. So we're, we're just really continuing to invest. We've deployed a chat bot on our website to help patients navigate to resources.

We're we're really excited about some of the the future with the large language models and how that can really Get responses back to patients faster, for instance, with in-basket messages. So sort of a win-win both on the provider side, potentially in terms of queuing up draft responses that reduces some of the time that the physician would spend in the, in-basket, but also potentially get that response back to the patient even faster because we know immediacy is really important.

And then on the inpatient side, we're we've spent quite a bit of time rolling out the inpatient patient portal and. It's something that our inpatient our acute care chief medical officer really sponsored and saw as a differentiator in terms of patient experience. And so we had four areas of focus there.

One, transparency for the patient and their family as to who are the members of the care team and what's the daily schedule for the patient. Let's create more predictability. For everybody involved in caring for the patient, but most importantly, the patient. Two is around a video-based or video enabled education platform.

So on demand access to educational content versus, here's your pre-printed patient education information. And that can follow the patient home, right? So they can access those videos at home. It can be delegated to their family members entertainment, right? So distraction in the hospital.

Food service ordering, those sorts of things. And then I think lastly, this concept of autonomy, right? We're at our most vulnerable when we're in a hospital As a patient, how can we give back some autonomy through, through the bedside interactive patient care tool that we've deployed and give them the ability to interact using using their phone or using a tablet with members of the care team?

We're we have we track this on a weekly basis again, kind of focusing on measurement and. We are now seeing that 50% of our patients that are admitted to the hospital are using bedside interactive patient care. We're starting to correlate that to patient experience scores. How is it improving clinical communication?

How is it improving overall experience? So we're really excited about that, but we're really proud that we've created a capability that our patients and their families are really responding to. So trying to think holistically, right? And then patient financial experience. Undoubtedly is really important as well.

I'm we're doing work in that space. We're getting more adoption in terms of, each check-in and online bill pay. I think with some of the. Solutions that are going to be available in the future with with G P T. I think that's gonna be another, kind of inflection point for getting even more patient engagement in sort of the digital financial experience that they have with with our organization as well.

Just in terms of creating another opportunity for simplifying. And creating more context and understanding about obligations financially and so forth. So, we're doing a lot of work. It's where we spend a lot of our time and but we're doing it in a practical, and I'd say very pragmatic way, really focusing on, where the bottlenecks, where the pain points, and then how can we, how can we transition a patient from a digital interaction into an in-person interaction and do that seamlessly as well.

And do that across the continuum of care. So, it is as you can probably tell a real area of passion, but I think it's an area where we can all positively affect. Right. And it's so important cuz we're all patients at some point.

Yep. You've given me so much to jump off on I, I wanna talk about the on demand visits.

Because to someone who's not familiar with this is a gnarly problem to do. How, what were some of the obstacles and challenges that you had to overcome in order to do those on-demand visits?

Well, I think it starts first with with clinical engagement, right?

We we have some great Physician leaders in our organization, both within is, but outside of is. And we've been talking about the possibility of doing these on-demand visits for some time for primary care. What has become apparent is that, we have some access challenges. We have patients that are waiting for extended periods of time to get access or a routine appointment.

And that was really a catalyst to say, Hey, Listen, we've demonstrated that virtual care is a viable alternative is now a standard of care in our organization. We can create pools of providers that can pick up a patient between between their other, scheduled appointments.

We can create dedicated resources to manage a queue. And so we started small. We started with a group of about 30 physicians that agreed to volunteer. To pick up on demand video visits between specified hours. We did a soft communication via our patient portal, and we specified that patients needed to have a preexisting relationship with the primary care physician in one of our medical groups in order to access this.

I'll tell you the day we turned it on, the queue was full within the first 30 minutes, but the doctors love it because it keeps them productive between visits. It addresses when a provider has a no-show, they can jump in and pick up a patient in the queue. And so now we're iterating off of it. Bill.

It's really exciting. We have kind of continued to expand this. We have a lot of physician interest and I'm hopeful that it creates an opportunity for us to even think about doing this beyond the traditional clinic hours. So that we create an opportunity for patients, say after hours or on weekends as well.

That's all predicated on making sure that the financial model works. But I think it's really exciting, but it all started with the clinical engagement and the identification of a real challenge that our patients were experiencing. And the feedback from patients has been tremendous as well as you would probably expect.

So you mentioned it, so I'll go there. The promise of generative AI chat, G P t is something that I'm talking about with a lot of organizations right now. A lot of CIOs and they're responding to notes. Seems to be, we're trying to find places where it can be constructive but still have oversight so that we can we can measure and make sure that we do know harm.

Right. So we're gonna read those notes before we send them out. Are there other areas that you're looking at saying, we see real promise here. I think you also mentioned the interaction with patients in, in the form of chatbots and other things. But how is that conversation evolving at this point?

Yeah, I would say it's just starting, it was really interesting. Our CEO asked the question recently based on some articles that have been published about kind of the potential for Armageddon associated to open ai. Right? And so his question was, what are we doing in order to manage the narrative moving forward?

Right? We want to tell the stories about how we're using AI today at Scripps, and then how are we evaluating. AI and incorporating that into our environment moving forward. For instance, based on G P T as an example, and there's a lot of questions there to answer, right? How do you do it responsibly, safely, ethically?

How? How do you evaluate some of these large language model capabilities against the current legal and regulatory framework? There's really no precedent, right? And we know those regulatory and legal frameworks tend to be dated against what is a very modern, technology. So the first thing that we're doing, in fact, we're gonna start communicating to the organization.

Here are examples today of how we're using ai. It's transparent to those that use it, but it's not transparent to all 17,000 employees because they don't necessarily interact with AI in the context of their day-to-day work. The second piece is building the roadmap. Bill, and, we want to actively participate in what our EHR vendor is offering and are committed to that.

But I think there's just sort of infinite potential as long as it's managed and organized and there is good governance in place, and we're asking those questions about, how are we doing this in a safe, responsible, and frankly ethical way. Questions like, is it ever appropriate for the AI to not be transparent to an end user or to a patient?

I don't know the answer to the question, I guess I could guess at it, but those are important, dialogues for us to have before we really jump in with both feet, but. We're dipping our toes and we have some connections with Azure, G P t and Codex and are doing some work in the background.

In the meantime, as we get, more organized around how we will adopt and ultimately implement this in our organization

I end up, when I'm talking to clinicians, end up having a lot of conversations around the word transparency. Like, they wanna know how that.

That answer was generated, and I think that's gonna be one of those, one of those points that we're gonna have fierce debate around, the use of these models and how they are actually coming up with the answers that they're coming up with. And, as long as a, at this point, as long as the clinician is looking at them and those kind of things, but, As I'm talking about that I realize I'm talking about chat, g p t, there's a whole bunch of other AI models we've implemented that we do have transparency into.

We know how they're coming up with the information they're coming up with. So it will be really interesting over the next couple of I would say years, but it feels like this thing is moving so fast it might, conversations over the next couple of months.

I agree. Kinda amazing. Well, I, I mean, I have a ton of other questions, but at this point you've I really appreciate all the things that you have shared. I love the things you're doing. Down there in San Diego, and really appreciate your time and sharing with us today.

So, Shane, thank you again for coming on the show.

Thanks, bill. My pleasure. (Main)

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