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Today on This Week Health.

Overtime is a hard cost where the nurses stay, where the nurses do their job. Can you actually keep a richer caregiver nurse to patient mixture? Can you actually keep that if we're using the right tools so that they can actually get their job done and all those patients are well taken care of. 

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.

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Welcome, everybody who's joining look forward to getting started.

This is part of our leadership series, future of Care Spaces. This is the conversation today. We're gonna start in acute care. We're gonna move out from there. Go end up all the way out at the home. I wanna thank our listeners for coming in.

I wanna thank you for giving us some questions to think about as we go into this, and we will discuss as many of them as we can. Feel free to go ahead and put those in the chat. And let me thank our panelists again and give you some introductions.

Fred Holston, c d w Healthcare, and he is really focused in on the next evolution of technology in care spaces for CDW. Healthcare does a lot of work in the industry with various partners, and we have Todd Larson with Honor Health. Todd, I didn't, I went out to LinkedIn. I didn't catch your title.

What is your role at Honor Health?

So my role, I focus completely on projects. So I just, I am an employee of Honor Health, but I'm a consultant on the projects they want to assign me to. So I would consider me of a project manager and currently working on the network operations center, clinical command center, and the innovation lab.

So those are the three projects I'm working on.

Awesome. And I think today we'll probably end up talking about the clinical command center. Probably the most, cuz let me set up the conversation. So we're, we are gonna move from the campus acute care spaces, and then we're gonna work our way out partially because Todd, I think you need to take off in about 25 minutes, right?

Yeah, about 1230. 1235, somewhere

around there. Right. So I wanted to focus in on the acute care spaces to start and then eventually we'll start to move out. Let me start with this. Th this sort of setup question, and it is what's changing about the care spaces? What's the problem set?

What is the problem we're trying to solve with these evolutions? A lot of times we start with, Hey, let's talk about computer vision and the really cool technologies, but I know it as leaders within healthcare systems, we like to start with the problems. So, Todd, I'll start with you. What's the problems that we're looking to solve by evolving these care spaces?

Yeah, I think much like many industries, healthcare is greatly challenged right now with resourcing staffing all of the above when it comes to that patient care. So we have struggled they've known specifically in the nursing world that there was gonna be a nursing shortage coming that was coming before the pandemic.

Then the pandemic sort of, I think exacerbated that. So the real key is to focus on providing the best care. In the most efficient way. So to do that, we need to enhance caregivers with technology but not technology. We think back to the initial implementations of an E M R or a medical record where it was very labor intensive and typing, and often turn your back to the patient and you're on the computer.

This is more moving to the next phase, I would say of transformation in workforce efficiency. So how can we improve nursing staffing? We may not be able to create more nurses right away and get all them on the floor, but. Could we have that remote nurse? That's one example. The remote nursing example of that nurse who's in a cl clinical command center going in and out of rooms and assisting when you think about actual care utilizing technology and devices that can help do monitoring and patient care.

Bed turns and roles and automated charting and taking away a lot of those tasks. If the nurse doesn't have to go in the room and manly do a bed roll because the patient already did the bed roll, the technology sensed it and it auto-filled that right into the chart, then the nurse doesn't have to go in and do that task.

She can continue to focus on other tasks. So I think really the general answer to your question, I think the big push that I am seeing nationally in healthcare is how can we be more efficient with the staff that we have and yet continue to provide the highest level of care.

it's interesting you gave , that example of the bedroll automated entry into the E H R.

Is that something we're doing today, or is that a future that we're talking about?

Well, the technology's there, but like any other, obviously AI is this massive, media covered topic right now in every industry. But the actual technology's there, but organizations make sure they need to have the infrastructure.

Then you need to have the training, then you need to have sort of the machine learning to go through this. But it's there, it's available bill, but you have to get there through a few step process so it can be done now. It's just gonna take some work by your organization to start implementing these

things.

So Fred, I wanna, I want to come to you. I mean, this it's interesting. We are gonna talk about the technology and we're gonna get there, but these are just like every other healthcare project that we're doing. It starts with that problem set. How can we be much more efficient with the resources we have, deliver the quality of care that we that we want to deliver and even better care than we're delivering today.

So that's the problem set that we're starting with. But these implementations a lot like the e h R start off as, alright, that's the problem set. There's an awful lot of the old adage, which I hate using, but I'm going to anyway. People process technology. I mean, there's, we have to redo workflows, we have to redo all that stuff.

Fred, how, what do these projects look like as you put them together?

Yeah I just expand a little bit on what was said. I, so staffing efficiencies, the cost side of that world is one thing, but the other side of that world is joy and satisfaction. Our staffs are also, and frankly, patients right, don't necessarily get the satisfaction, and certainly nursing and other caregivers aren't seeing the joy.

So that's where the people side of this kind of comes in. We have you, you know this, right? We have historically put a whole lot of technology into healthcare and said, this is gonna make your life better. We solved a problem, or we think we're solving a problem, but all we've done is created one more thing for them to carry one more thing for them to do one more thing that might solve that problem, but it's creating five more.

And so we just have this history of throwing tech at stuff that, again, might solve the problem. It might check the box, but it isn't necessarily a well-rounded thought process. Implementations like this are gonna have to step back and say, Maybe what are the collection of problems I want to do?

And maybe a couple of them can't be done today because I don't know, the tech hasn't quite caught up with this. But let me put all the foundations in place. Let me put the platforms in place. Let me put one thing and then solve real problems along that. Whatever you're going to do, solve something new and take it off their plate and not create three more.

As we go into it. And those are the things that we have to step back and look. And we've got a number of organizations in the country that are saying, oh, I wanna solve, I just use bad turns on him because we used it. I wanna solve that. Well, they put in a solution for that. Maybe it works, maybe it doesn't.

Maybe it satisfies that problem, but then something else rolls out, then something else rolls out and then something else rolls out. And it's time that we stepped back and said, what are the collections of things that create caregiver efficiency? Create joy in that, that make the people actually want to do, come to work and do that job and take care of the patients the way I believe the vast majority of them want to they're just not inci to because of all the tasks that have to get done.

So they need to step back and we need to rethink that. Then to your point, and it is overused, but it is very accurate. There is a technology issue. I do not believe this is a technology problem. There are people issues and then there are organizational workflows that have to change and how we look at doing the work.

That may be not standard from the way we have traditionally

done it. Yeah. So Todd I'll come back to you and since there's only three of us, I might chime in a little bit more here. I I mean, one of the things that's struck me, I had, I interviewed Shane Thalman yesterday for a future podcast.

It'll be released in the next couple of weeks. And and he is a CIO at Scripps, and one of the things we were talking about is Scripps does a good job of measuring the effectiveness of their projects post-project, like we've identified physician satisfaction and efficiency as two key metrics.

They define those metrics, they actually do the projects, and then they go back and measure. I find that's a discipline that's getting better in healthcare. But if I go back to when I was in healthcare, it was not a discipline that was practiced all that often of really measuring roi, measuring the return on these projects.

But let's go back to that problem set. Todd, I wanna come to you. We talked about bed turns. What are some of the other things we're looking at, hand washing, nurse sitter? What are some of the other things we're looking at?

Yeah, so I think the common themes are sort of three areas.

So the first area would be how do we help those acute care centers, those those staff. So whether it's you brought up hand washing, those are really easy processes to automate. But I think we're looking deeper than that. We're looking at coordination of all services across a network. So how can we coordinate patient transfer, patient transport, things such as float pool, staffing, bed control all of these entities in one place using the same technology platform, job sharing through those ideas creating synergy in those roles.

So that, that's one aspect. The second aspect then is then tying in the rest of the efficiency with the patient. So hospital operations, for instance I often, I say it in a way jokingly, but it's true. How can I get on Amazon and order a package to my house and within two seconds the order's made, I know where it's coming from, I know the tracking number.

I can ship that package every step of the way. I know everything about it, and I just ordered it 30 seconds ago. Yet, try to call your local hospital and say, you'd like to talk to your grandmother, but you don't know what room she's in and see how long you're on hold or on pause until you actually talk with your family members.

So we need to look at operations as well from a network standard, all of those various things that are creating inefficiencies. Then thirdly, is moving forward outside of that realm. It, intertwining that with post-surgical, intertwining that with chronic disease management in the home care, all of these things.

That's what we're really focused on doing. Is taking all of these sets in these areas. So if we can make our clinical medicine an acute area and our operations and flow, and then we can take that and look at it with our support services within the facility and have that all flow together and have synergy.

And then in the end you can have it as they are either coming or going from your facility. And then finally, how are we gonna take this out into population health? Right? Our trauma surgeon uses an example at Honor Health all the time of. Why is it I cannot be in the ambulance? The technology's there.

The military is using field medicine with, ultrasound and surgical devices and coop and communicating overseas on these things. Why can't I be right in the ambulance? Why can't I be right there working with the paramedics as someone's in transport to my facility? Why can't we get remote diagnostics coming right in so that we already have all their information, it's all dumping into the system as they're pulling into the trauma bay.

So I probably gave you too many buckets there, bill, but it's just an example of how overwhelming in many ways the problem really is.

All right, let's go one level below that. How did these projects start? Do they start with a massive process mapping exercise? Is that And I like the fact that, I think you started with the first one of saying, look, we're not looking at this at a single hospital level.

We're looking at it across the entire system. And you use transport as the example. Which is something that happens between multiple entities. And then you finish with pop health, which says to me, outside of honor health, right? So, but where does it start? Does it start with a huge process mapping exercise and then assigning efficiency inef, or identifying inefficiencies across that?

Yes, that's

correct. So we have a governance committee. People will either submit ideas to the governance committee, or it might even be another committee, right? That, that has come up with something that comes over to the governance committee for innovation. Those are reviewed. There's a scoring standardized scoring with percentages of what areas it affects, because what we wanna be leery of, right, is, are we solving one physician or one clinician's problem in their one minute area that, that bothers them because they're in a heavy specialty.

And it's, we're really just solving one daily workflow for one person. That's not really our goal. Our goal is really things that are going to help the greater network, the greater process. And so the ideas come in. Things come in, they will go to the governance committee. The governance committee reviews it.

The governance committee is a make of clinicians, both at the physician level, the nursing level, various different specialties support services, personnel, operations personnel, the research institute, right? Because somebody might come in, bill, and it might say, well, that's really a clinical trial and a research institute issue.

That's not really a process or a clinical command center issue, but it comes through the governance committee, and then it's assigned out, it's gonna be assigned out through various specialty, right? How, the committee says, yeah, we, look, we've done the scoring. We feel this is a proper project.

Let's go ahead and then create, if we need to create, maybe a subcommittee or a specialized group or just assign the team that's gonna work on this process. But that, yes, you're correct. If you don't have that governance committee if you don't have a process intake and then review to make sure that it's going to benefit the network.

It's crucial.

Yeah. Benefit the network. It's, so let's start to, let's start to tap into maybe give us a handful of one or two of the projects that you've identified at Honor Health that you're looking at that'll get us into the pragmatic and practical aspect of this. Yeah. So I'll

give two real quick.

The first is already been implemented, and that was patient transport. We found patient transports to have a waiting line, a queue area, whatever term you want to use. At one facility alone, we were seeing a patient wait or a patient queue of 10 to 12 patients constantly needing internal facility patient transport.

And just by moving that, And that's a delay. It's a delay in care. Then it delays CT or it delays, various other procedures or the lab or scans or whatever, X-ray, wherever they need radiology, wherever they need to be moved. It's delaying everything down the line. By moving that function into the clinical command center at the knock by having, we didn't have to bring all the team there.

We brought the key leader there, and that key leader from the air traffic control model then can see everything going on. Utilize the cameras in the facility, utilize the information coming in, and start doing those assignments based more on flow and need and patient care versus just, people being able to handpick who they're gonna go transport where and when, and how We've reduced the queue rate or the wait time.

Having on average zero patients in queue zero. So that's one example where we used that flo, that process, and it's been successful. A current one, it's coming up frequently. Network issue is voice commands, voice recognition, utilizing voice software with the medical record and really trying to even look at, can we go away from, A lot of the keystrokes, a lot of the typing, a lot of the eye focus away from the patient and onto computers and keystrokes, same thing.

Do we necessarily need scribes if we have a much be, in the ED setting if we have a much better robust voice software. So I th that's a key project we're looking at right now is how are we gonna use and integrate voice? And that's been studied for a while and it's far from perfection.

But that's one. And then another, obviously, and I know I said it earlier, but I'll go back to it cuz it's so key. And that is how are we gonna utilize remote nursing And instead of looking at to Fred's point remote nursing of which product or which software we're backing up and looking at it, what is the right way to do this and how do we do it the right way with the right tools and the right resources?

So tho those are two or three examples right there.

Are you focused mainly on the acute care setting? Are you also thinking of going all the way into the home and how that for lack command center, I was gonna call it air traffic control, but that's essentially what it is. You're bringing the expert in.

They're able to see a, b, a broader picture. Are you thinking care to the entire community from that command center?

I think that's the long-term goal. We have had that conversation. That's gonna take us some steps to get there. I think we want to solve some internal, make sure our process people flow, the management of those things are good, and that the model is solid, and then move to that to really two quick examples.

One I already gave was the utilization of maybe integrating our community partners because you could integrate fire, e m s ambulance those types of things I think could be easily and quickly integrated into the clinical command center. Our local ambulance company is already requested a seat inside of there and to into be participative and that can bring your inpatient transfers.

Whether it's from the field or from facility. But the other setting, you think something like post-surgical, right? We have a large neuroscience servo line. If someone is post-surgical, maybe they need to stand on a balance pad, maybe, right? There's some post-surgical testing or things that they're doing in the home.

Could they do that in the home? Could that data be transferred right in through a remote nurse or staff in the clinical command center? Goes right into the chart right there. So the answer is yes. I think that's a little further out, but I think it'll probably start more with community partners, fire, e m s, places like that, that have, good resources and already are used to collaborating with us.

And then I think we move into the home health center, post-surgical, maybe acute or, I'm sorry, maybe chronic disease management, things like that.

So, and Fred, you'll have to excuse me. I feel like I have another couple of minutes with with Todd. So that's, I'm trying to get as much of this in.

No problem. So let me ask you, who in the organization leads this initiative and who is I, you talked about IT governance group, but like who leads the governance group? How does this initiative really take off? And I think specifically I'm talking about the standing up, the governance, putting some of the foundational technologies in place, the command center, and then obviously if you're able to see how things are moving, there's other technology that's reporting back to the command center, who, who is, who's leading this effort within the healthcare organization.

Yes. So the clinical command center, the network operations center is led by the vice president of hospital operations. So that's Ashley Gerhardt. She's a nurse by trade and she has a team. Then within that facility, there are two directors. There's one director on the clinical side. There's one director on the support services side, so that you have a director on each side of the team.

You have anything, clinical transfer, patient transport, all of those things we talked about earlier. Nursing float, all of that. And then on the other side, whether it's, your dispatch, your call taking, your security, your emergency management all of those support services, that's, that has a director as well.

So they both report up. Through that traditional chain to a hospital operations vice president who reports directly to the chief operating officer. So that's the flow on that side, on the innovation side that we're talking about with creating and bringing in projects to the clinical command center, working on how we're gonna utilize the clinical command center to integrate projects, inefficient in, in, into efficiency, workflow, all of that.

On the innovation side, I am the the business leader on that project, but I work very closely with a co-business leader who is the chief Technology Officer. So it's the chief technology Officer who's handling all, I would say the IT and the infrastructure and engineering side of the technology.

And I'm handling the business operations and flow. And then we both report directly to the chief transformation officer. So the chief transformation officer is ultimately has the oversight over all of the various projects we would be doing. And then he is the ultimate chair. Of the governance committee that, that would chair that committee.

But that committee is it's, we do not want it to be too large bill. Right. You get too large and, you're just never gonna get a decision made. Right Now it sits around 13 people. That's where it sits. A number large enough to get a diverse ideas, to get different input to to get some people giving feedback that we may not think about.

But on the other hand, if it's bigger than the old two pizza rule, it's really hard to get things through. But ultimately, innovation and the process side of this flows through the chief transformation officer and the operations side of the clinical command center. Reports through traditional operations, through a vice president up to the chief operating officer.

Let's say I just picked you up, I moved you to a different health system. Same demographics. Honor, health is, Roughly a handful of hospitals and a bunch of ancillary services around that. Let's say I, I put you in a 10 hospital system and you're standing this up. What areas have you found to offer the most benefit, the most efficiency to be gained as well as the clinician experience to be radically improved?

Yeah, so number one obviously the float pool, the staffing is such an issue in so many places. So we found immediate success there by having all of them together in the clinical command. So moving all of that through the pandemic and everything moving forward, I think the emergency management side, to really integrate them as part of the care team to really understand that you can't just put out directives and emergency management operations plans, and then the care team or the clinical side, it's, it is not part of that.

So the integration of all that initially is number one, but number two taking a lot of those daily roles, nursing bed bed control, float pool, transfer, transport, we have just had outstanding success moving all of that right into one place. And I think if you're gonna stand it up, I would heavily look to involve your day-to-day operations, especially in nursing as you get going.

Yeah. So, you're gonna be leaving soon, so this question seems relevant for you. And then Fred, we're gonna, we're gonna dive into how you make all this possible, right? How you, well, the technologies that we bring into these different areas standing at the command center. And we're gonna go all the way out to the home.

Kevin had this question, why have an innovation governance subcommittee and not charge overarching governance with the with innovation? Does having a subcommittee cause prioritization challenges that need to be reconciled with other governance priorities?

It's a good question. And this came up, we actually talked about this, is that with our innovation lab and the projects we're doing with C D W and we're gonna be moving through and then using the network operations center what we did is we took the key players.

So, our chief transformation officer sits over all of innovation for honor health. So he's the chair of this committee. And then in addition, we have our research institute personnel on there so that if we were to have a conflict we wanna make sure that we're not doing things that would really be part of a clinical trial or a clinical study or something that would involve research institute.

And then the overarching committee, if there's any subcommittees done they're gonna give a report back to that overall committee. So we found it to be effective because it allows us to be nimble and you can sort of give that committee that subcommittee, the room to run. You let 'em go run with that authorized project and it allows us to be nimble.

Fantastic. Todd, feel free to drop when you need to. Fred, I wanna come over to you. We've talked a lot about the people and process. We're gonna talk about the technology, but you've just heard an awful lot of things. Is there anything you want to add to what Todd has talked about so far?

No, we're obviously very supportive of what Todd's doing and doing our best to be as much a part of that as we can be cuz we think it's all going in the right direction.

I, what I would say is that a lot of these things, organizations have looked at and poked at and done some things at and so forth. And I think what you see Todd, and you'll hear me advocate for again, is to step back and try to be more holistic about this. It's always been, somebody's yelling over here, this is happening over there and we've tried to pick at problems and you can do technology that way.

You can do process change that way, but it's time to step back and think about where are you today, where you want to go, why the air traffic control for patients becomes important. It's. Important today because Todd has noted how they've begun to make changes, patient satisfaction, changing workflows, re resources are getting better.

But if you look at where medicine probably is going and where we're going with home and hospital at home and all the things that we could be doing around that, you can't do it if you don't have some, an air traffic control that's worried about Bill Russell and, bill Russell moving in and out of the traditional system and what's happening to Bill when they're, he's not in the system the traditional system I should say.

Right. And that's not a 1984 kind of conversation. That's just, if something bad's going to happen or trending the wrong way, we need to take advantage of that, when we can. And how do we do that appropriately? And you have to have something somewhere at some point that's really watching that greater.

Peace and less concern. Well, I only own this department inside the organization, therefore I can only do this much. I only own this part of, within the organization, I can only do this much. And that's where Todd's going, starting with the core and saying, look, we have to prove value. You have to start somewhere, prove value, get it done.

And everybody goes, this is great. And then you take the next appropriate steps to expand that over some reasonable amount of time.

Yeah and what you're describing as a former CIO happens all the time. Some a single hospital will come to you and say, it's, we would like to solve hand washing. I just keep using that.

Cause a simple example we wanna solve. Hand washing happens all the time. Then you go, well, do we wanna solve it across two hospitals? We wanna solve it across three. And Todd made a great point, which is essentially, Why not solve it across all of 'em? Like it's a, if it's a problem at one, it's probably a problem at all of them.

And it's probably something we can do with a single technology solution or even a platform that could potentially do multiple things. And then you're not investing in little point solutions all along the way, which at some point when you do try to step up and look at the overall the workflow and the process and the patient flow and you say, oh my gosh, we gotta go across these 16 systems.

Or actually it's worse than that, it's a hundred systems. Now you're saying, no, we've thought about this before. And we have the technologies, we have the process, we have the framework of a air traffic control, so we can actually see, and we do have the data flow, and we do have the ability, the communication framework in place to receive signals and to send out signals to get people into the right place.

Todd, I'll give you your last statement before you take off. I

appreciate that. Yeah. Real quick, I, you hit the nail on the head with those resources and how you handle it. When we stood this up, when I wrote the business plan Four years ago, and we got to work on it. We stood it up. I think you brought up one question earlier, bill.

How do you take another network and how do you get this going? One of the things that I'm really thankful we did, and the decision we pushed forward, is we didn't immediately buy any platforms. We didn't buy any software. We didn't buy any technology. We said, we are currently operating all of our hospitals the way we're operating.

Let's do step one, which is create the aircraft control, build out the facility in the building, put everybody in together, start working with what we have now, create those efficiencies, and then we'll determine what we need to buy, not buy, add, cut out, do, stop doing. So I just wanna make it known that we did not spend money on platform software solutions prior to moving in.

We moved in with everything we had, and then we were gonna look to optimize once we were there, because we were already operating. We didn't wanna buy something until we're already there and we started playing around with this model.

Yeah. And Todd, I wanna thank you for your time. If people want to get, take a look at what Todd's doing or even hang out with Todd you can contact one of your C D W reps.

There is now a lab 📍 at Honor Health to take a look at that command center and some of the things that they've done, and you can go through the c d W team to, to talk to them. Todd, thank you. Thank you.

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 Fred I have to talk about the technology. I know we don't start by buying a whole bunch of solutions, but I have to talk about the technology.

When he was talking about transport and whatnot, he was saying, oh, we can see where everything is. Is that R F I D? Is it cameras? Where have we evolved to in that space?

Yeah. I mean, I think it's evolving. Each one of those services has their own, a lot of 'em aren't tracking and so forth, and it's just sometimes getting access to it.

Because a lot of 'em have it, they're not. It is unclear how, in my mind, how that should fall together. I'm just speaking of the technologists. I fear, and this is what's happened in the past, that people buy products in order to enforce either the way they want to do things in an organization or in order to drive them to do something different in an organization.

Instead of stepping back and deciding what they wanna do, which is what Todd's doing, where that technology comes in. What Todd did, he said there's already, and he also started on physical security and said, that's the easiest one for me to move cuz I have pretty much direct control over it.

We already have these systems that do these X, Y, and Z things. Let's just get 'em all leveraged into one place and use them in one big, as one big organization instead of, in number of hospitals doing it separately. And then, well, we already have this piece over here. So when we talk about transfer and so forth, they already have a system with transfer.

They just weren't using it and looking at it. Right? So let's pull it in and start using it the way it should be across all the resources that we had. When we started looking at bed management and those kinds of things, they didn't replace Epic with a bed management system. They just said, let's start putting the things together and the people together who have to coordinate those things.

And all of a sudden they started seeing all the opportunities and started managing it that way and yet didn't put any other great software. So a lot of it's just leveraging what's already out there. Is the technology for real time location services and traditional facilities, and other GPS based kinds of things coming yeah, I think so.

But how it's going to be useful doesn't really matter if you can track an ambulance, if you don't figure out that you're doing something in the ambulance and deciding either to transport or not to transport, how long you have and based on how long you have, you need to do this versus that.

Those things, people aren't processed for that yet. It is funny, just as a side note, as you go back with your first computer I remember the old show, er not er emergency, oh yeah. Way back when. Rep,

Rampart something I forget the number. Rampart.

That's it. But they had a communication device and they put a little antenna on that thing and they started transmitting an EKG or equivalent of, that back then.

And then the hospital would look and say, okay, based on that, we'll start, it was always, lactated, ringers and all this other stuff. But that's the kinda thing that we still don't have. Well, even though it's not a technical problem. That we're collecting all of that and shipping that as well as we could and then putting the right processes in place.

And by the way, I think a lot of people won't ship. I certainly think, and we had this conversation with someone in Hawaii, maybe damage can deal with it all. If we just empower, and I realize there are a lot of state regulations to this problem. But if we've got the right communications, if we're sending the right data back and forth and we have the right command center style on the other end that can say this person is capable of directing them to do that kind of, whatever's going on, A lot of this may be solved back there and you quit shipping 'em to a traditional ER and they're done, they're happy.

They're back in the, the home or wherever you picked them up from very quickly. And problem may be solved. And on the flip side of that, if they happen to be stroke, you'll know fairly quick and to administer whatever. And you can do it much faster in, in just because you have a different way of looking at that

problem.

Yeah. I mean, the thing you're describing, it's interesting cuz all these projects at some point come back to I love the fact that it reports into the chief operating officer because, if you want to make it, it's not that we couldn't create a communication line from the ambulance to the specialist.

It's that the specialist isn't available. It's like you, you actually have to look at scheduling. You have to look at resourcing and and pulling and all that other stuff and say, okay, they need to talk to somebody. They're potentially having a stroke. They need to talk to a specialist on this end.

How do we have a specialist available? I mean, it's almost that basic. It's like, yeah, because obviously the communication between the ambulance and the hospital, we can do that today. And we don't even have to talk about 5G yet. I mean, it's like we can do, we couldn't do that today, period. Yeah. Yeah.

But there are so many operational aspects that we have to step back and I mean, I think this is what you're trying to drive home.

I'm gonna force you into talking about the technology, by the way, but it's okay. But I mean, that is where this project has to start. So now that we've level set, I mean, it has to start there. It probably has to start at the COO level. It has to start with a a burning platform. Going back to Cotter's stuff, you gotta start with the burning platform and the burning platform, I think today is financial, but it could be other things as, it could be nurse satisfaction could beli clinical satisfaction.

Returning the joy to medicine as Stephanie Lahr has driven into our heads. And we do wanna see that. And so, I mean, that could be the burning platform that's driving all this, but it start, it really does start as an operational project. Let's talk about the technology, and I'm gonna take you up one level before we talk about this, the distinct technologies.

And cuz you and I have had this conversation before when I was designing for a new room back in the day, I got, every CIO should get this opportunity to design a new building or a new room. And you're really stuck in this, okay, am I designing for today or am I designing for five years from now?

And back then I'm sitting there going, okay, how many wireless devices are going to be in this room? So let's start at the basic level, which is the network. Can our existing network handle can our existing design and architecture for our network handle the communication that's going to be coming over the next three to five years?

I can and handle it. Yes, but, and here's the caveat, right? Depending on how you're going to, these devices are going to work on that network, whether they're wired or wireless and so forth. It's whether or not hospitals today have big enough closets to put enough switches. It's not that the switches aren't good enough to do it, but can you physically get enough wires in there?

Can you put enough switches in there? Do you have enough power and backup power in those closets to get the job done? If you're retrofitting and you're not designing a true new one, can you really get all those cables over there? If you're designing a new one, do you really wanna pay the cost? Look, when we were building a hospital at Intermountain, we'd look and say, well, we think we need six cables in that room.

Well, six cables now of, what is it, getting close to seven now, cat seven, they're not cheap. And when you look at that across an entire hospital, entire new facility tower, multiple floors, that's a significant cost. I mean, so much so that even hospitals where we think, oh, the new thing of a new hospital is the patient needs to be able to control the blinds and the lights and all that stuff.

And every one of those requires a wire. And we've got hospitals coming back and saying, ah, they're gonna cut this out because that wiring and few other things, it is just too expensive in the cost of our hospital. I've had a

conversation with the CIO who was building a building and he goes, I don't, I, I think we're gonna have to just put CAT six or Cat five back in this thing cuz it's just too expensive.

I'm like, I what's your response? I think that's shortsighted. Or maybe Edge Computing offers an opportunity to change how we, maybe we're bringing one cable in. I don't. Is that the future?

I, you do know how I feel about this and I do believe that there's more of a concentrator mentality. And I'm.

Being a little coy on it, I've been asked not to share as much as you and I have talked about it to some extent. But I do believe there's a concentrator mentality where a room exists as a thing. And in that thing it can operate almost on its own. And that doesn't mean separate with its own ehr. I don't mean things like that, but a lot of what we would say, we need to be doing a lot of polls and we need to expand our networks.

And to your point, edge computing can really be brought down to that basic module, that basic nugget of this is the patient's space. And then you can multiply that over other spaces. And in my mind, that space that can then go to the parking lot in the next pandemic, it can go into a storefront or a warehouse that you buy and decide to start, building care that's cheaper to deliver than what our traditional hospitals are, and then eventually can go home and be that thing that you can get almost the same technology of care.

That you get inpatient, you can almost get that as a hospital home and potentially as an outpatient, in that same mentality. And those don't have to be such distinctly different things as we look at 'em today. Cuz today we run wires from, point A to point B and all that's within the hospital system where you said go put in a parking lot when you know Covid came along and went, well how do I put my network out there and then how do I wire something like that out there?

Right? Yeah, we had to. What does that do?

Right. It's, it is crazy. I'll tell you when you're describing that it reminds me of Edward Jones and everybody yeah. Edward Jones and everybody knows there's like an Edward Jones office and every little strip mall around the country.

But when Edward Jones was really going strong I worked for a company that was doing work with Edward Jones and we essentially had a, a two whatever office, a five person office, a six person office, all created up, ready to go, and the technology was like plug and play. And you just went, I want to push you in this direction.

Which is to say how important is that standardization when we're thinking, alright, we're doing a new hospital, we're building a new hospital. We want this room to be able to handle these things. Couldn't we be thinking also in the future that the home is that same kind of thing?

Absolutely. They essentially take a device in, put it in, and then you just, be a Geek Squad or whoever comes in. I don't know if they're still called Geek Squad. I don't, I have no idea what Best Buy calls their team, but whatever that team is that goes out there, and we, as we start to get higher and higher levels of acuity, which I believe is what's already happening, but I believe it's gonna continue until essentially we have hospice out of the home and it's a pretty high acuity kind of care coming outta the home.

But from a network standpoint, from an IT standpoint, from where we live, it should look pretty standard of, what we do in that room on the campus looks very similar to what we're doing at that home for that high acuity care.

That's my argument. That's and that's why, I struggle with, the way we talk about remote care and we do all these separate things and we send 'em home with all these little devices that they have to use and everything.

We really ought to step back and think about what you just said. And there's always to, to the Edward Jones thing, there's always the small, medium and large. Right. And, if they're, you have a hospital bed in the home and they're really that thick versus, the, I just need to watch 'em and make sure they're just fundamentally okay.

But it still, from a technology perspective comes back to some basics. And let me just back up on the entire continuum of that and just say some basics. It's really getting into a set of sensors that do a certain set of jobs. I think the nose is in there. I think sight is in there. I think both voice and listening, is in there.

I think how do we replicate, touch in a non-touch touchless version of touch to be able to get that information that we would normally have to reach out and touch people, in some way, whether that's a blood pressure cuff or some other vitals or whatever we're watching. And there's a set of those things.

And then, there's specialty sensors. I'm not gonna argue that, but if you just looked at the fundamentals and whether that's building a new hospital or what you're sending home, how do I put those basic sensoring sensors in and get that data and use it in such a way then that I inform air traffic control or document?

I am a huge believer and you wanna say this during Todd's piece, but I'm a huge believer in automated documentation. The providing care, doing care should just document I'm not arguing the effectiveness of the use of the ahr. It's valid, it's there for a variety of reasons, but there gotta be a better way to get information to it.

So let's figure out that automation, well, these senses, right, that are becoming sensor or using sensors for are those fundamentals. And if you get those in there, then there's a huge amount of stuff that you can start doing as a platform approach. And it really doesn't matter whether you're at home.

Doesn't matter if you're in that parking lot or ambulance. It doesn't matter whether you're in the facility, and that should be something that we can replicate. Now, there will always be, a blood pressure a an IV pump and those kinds of things, right? Which we need to connect in that process.

But there's really a set of fundamentals. And the question is certainly if I'm building a new hospital, well, how do I get those fundamentals in there? Well, nobody's gonna go build a hospital and say, well, let me put in a nose and a this and a this without some usefulness for it. So each one, we have to find reasons to go put those in.

They solve a fundamental problem, okay, we solve the falls problem, or the hand washing problem, or the bed turn problem, or the virtual nursing kind of problem. So that gets the sensor in there. But if you really are looking at this long term, we're stepping back and saying it's a Trojan horse.

I'm really trying to get those things in there, solve those problems so people are happy and we have the money to do it. While I'm digging, building this bigger vision, which is to say, let's get these sensors in here, likely on an edge computing kind of mentality that we can easily just replicate very standardly from one thing to the other.

And from there, I should be able to do traumatic improvements in how care is delivered both in how caregivers do it, as well as the outcomes to patients and potentially change the way maybe medicine is delivered in, fundamental fashion.

I've been reviewing these questions and peppering them in as we've gone along, but let me, I'm gonna hit a couple of these in rapid fire as we close here.

The it's a longer question, but here's fundamentally what it breaks down into the important que important question is, how will these solutions help reduce the tr, reduce the true cost of care? How will these solutions support the transition from revenue new constructs to those constructs focused on cost reduction?

Clearly cost reduction is one of the drivers. How do these. Solutions that we're talking about compu, computer vision, ambient listening and touchless devices and whatnot. How do they reduce the total cost of care? Well,

if you just look at traditional inpatient, right? Nurses spend a third of their time documenting that's the national average, right?

Roughly a third of their time doing documentation. So if we can reduce any amount of that automatically, nurses have more time. We're seeing where we're putting in ambient or machine vision to look at everything from falls to bed turns using virtual nursing to help with the documentation and not dragging a bunch of things around and typing in that nurses are using less.

We have some studies where they're doing near zero over time and their satisfaction's going up, turnover's going down, and they're saying they're actually able to get more of their tasks done, if not all their tasks done during their actual shift. Versus either having to stay later or somebody else have to do it on another shift, which just, those are hard costs.

At the end of the day. Overtime is a hard cost where the nurses stay, where the nurses do their job. Can you actually keep a richer caregiver nurse to patient mixture? Can you actually keep that if we're using the right tools so that they can actually get their job done and all those patients are well taken care of.

Cause at the end of the day, you can keep increasing the ratio and people can keep trying to do it, but patients are taken care of. And so there's a balance in there. And all of that is a cost kinda thing. Right.

Fred, I love this question here. I love, and I just wanna get your perspective on it.

It's a really good question which is, what is the future for printing in healthcare spaces?

It's in, I mean,

it's interesting. I mean, we have printers all over the place still. I'm, so, I'm curious, is this like answering the fax question?

It may be printing in the sense of needing a physical eight and a half by piece of love. I think we still have to find a way out of that.

It's funny, I'm playing with a couple pieces of technology that feel more like paper than easy to carry and you can write on it like paper and so forth. I think there's some interesting things there. But the other side of printing, which is a huge part of it, is just basic labels, right? The fact that you have to label just about everything to know that this was Fred's test, blood draw, whatever sample that happens to be, I dunno how that disappears.

Can we imagine this technologist, boy, you barcode everything and you could do all these fancy things and do it. Yeah. But what really works and what's really safe and what's really non fallible for the most part, is you pick up an empty one. You stick a label on there and you put that sample in there, and it's Fred's.

And as long as somebody scans or does Fred's thing and ties that to the right person, it's not fallible. I think that's gonna hang around for a while. I just don't know how, I know how it could happen. I don't see that anybody's gonna

walk away from, I'm hearing a lot more the discharge instructions and patient care stuff.

I think that's going away. We usually go away. Yeah. Yeah. I think we're seeing videos, we're seeing things go home with people that are much more much higher utility. I don't want to tell people, I, I always use this. It's a tough example, but I don't wanna tell people about my cancer 50 times.

I want a video that I can say, Hey, here, watch this video. This essentially, this is what the doctor had to say about my kind of cancer or that kinda stuff. It's there, there are so many better ways to do that now that I think we're seeing What about supply chain computer vision?

Did somebody put in, supply chain, computer vision cameras and that kinda stuff? Are we still struggling with supply chain on some of this stuff?

I think we're certainly struggling with like supply chain on making sure, let's just take traditional inpatient, right? That floors are well stocked and when somebody opens the supply closet or cabinet or whatever, right?

That things are getting replaced at a rapid enough. Right. And I think computer vision at this point, obviously there are other ways to do it. Rtls can do it. There are a number of ways to do it and, instrumented bins, I mean all kinds of things. But machine vision can pretty much look at a bin and say, when this gets down to about that level on that bin, we should probably put out a call to, the logistics and the facility to come up and fill that bin.

And I think those kinds of things are still problematic because there's just not a great cost effective. I'm not saying the tech isn't there, but there's not cost effective that people wanna put in that handle that last mile, right? Where nurses just keeping going and grabbing or, needing this or that and making sure that those supplies are refilled.

And I think machine vision and some other tech, but certainly machine vision can make that a much more cost effective

opportunity. Well, and we'll close with this. Because I think this is pretty well understood at this point. We've talked this to death for the last three to five years, and that has been the power of platforms, the importance of platforms of buying technology that can be used for multiple use cases as opposed to those single use case type systems.

This is one of the ways we end up with so many data silos, so many process silos, so many so many things that were essentially one way streets into an alley that you're like, okay, we've gotta back completely, we've gotta back this truck completely up and start over. Talk about platforms in this area specifically.

What kind of platforms are we looking at? A, across the care spaces, obviously the ehr.

Yeah, and I

think what's interesting is that all these platforms tend to start with fairly similar in devices, right? Cameras and speakers and mics and TVs and those kinds of things, but. People think they're buying platforms because they bought a camera.

Well, everybody should be able to use that camera. But then they buy a solution that will only, I'm the only one that can use that camera. And if you wanna use something else, another piece of tech, another solution, you have to put in another camera. And so you have to not only just look at the fundamental end points, you also have to look at the platforms you're buying from the software perspective and say, are you gonna let me use that same video stream for something else?

I wanna use it for security. For example, security versus machine vision and clinical and so forth. Can we all share the same, resources to be platformed? We think they bo it boils down into that machine vision platform, right? So how do you see, how do you hear and how do you detect things that are going on that are not just purely so vitals and all those kinds of things.

And we think those are fundamental platforms and you can put those in once, and then today you may get, x amount of usage, but as the models change, you just it's. As we learn more, we just keep adding models to that. We add models, and it continues to grow. And in many cases with no greater cost on your perspective other than the workflow changes that they might incur.

And so you really need to look at platforms as I would, I'll call it, who will let the endpoints be shareable by others who need to use it and who have a corporate drive to not just be what they are today. And not just expand that in a little bit, but actually go and say Machine vision, yes, I can watch follows today, that's great.

Tomorrow though, can I actually detect a stroke, as it's almost onset, and go deal and notify somebody and go deal with that, that I might otherwise, miss and code blues and go down the list of all the things that you could be adding to. And you need to be looking for companies who want to go that direction and not just sell you.

Hey, I do falls great. Today I do telemedicine great. Today, I do this great today. What you gonna do tomorrow?

Yeah, absolutely. Fred, I wanna thank you for your time. Also, Todd Larson for being a part of this with Honor Health

If people want more information about this, they can obviously contact Fred, contact the C D W people around some of this stuff. To be honest with you, this may sound like a C D W commercial, but it wasn't meant to be. It really was. The reason that we're talking to these two is cuz I really feel like Fred has spent so much.

Time in this space. And it's been very valuable and I believe that the stuff that they're doing at Honor Health is what I wish we had been doing at my health system. And that is looking at it holistically and really starting at a out of platform. So as we looked at this topic, I really wanted to accentuate some success stories and that's how we ended up here.

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