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Justin Brueck: (Intro) it's like dichotomy in terms of we wanna change what we're doing. We're constantly putting out fires. When are we gonna actually have time to build a fireproof house?

Bill Russell: My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a time. Our keynote show is designed to share conference level value with you every week.

Now, let's jump right into the episode.

(Main) All right. It's keynote, and today we're joined by Justin Brick, the system VP, innovation and research at Endeavor Health.

Justin Brueck: Justin, welcome to the show. Thanks, bill. Great to be here. Yeah looking forward to the conversation. What exactly does the role of system VP of innovation and research do at Endeavor Health?

It's actually probably one of the best roles that I've ever had because it sits in this unique spot between innovation and research.

And in our health system, we're community based focused on solving for the last mile, and I even say not last mile. It's like the last lap and even the last three feet. And that's where healthcare innovation tends to fall down. Part of what I really like about this role is when you're going to clinicians, I'm not just going with the latest pitch deck, I'm actually going with evidence and I have my team that's also looking at it from a research perspective and they're publishing on it, so it adds a little bit more validity to it.

But in terms of my role overall I'm constantly sourcing what's the latest and greatest out there. And I've really been tasked with thinking about what is a dual transformation mandate for our health system.

Bill Russell: So a dual transformation mandate. Elaborate on that a little bit more.

again, similarly with Costco, Costco makes some money off of their supplies and goods there, but they also make a lot of money off of membership fees. Yeah. And so the question is, as healthcare organizations, we're getting to an age where we're basically sitting at a net loss almost, or a break even in terms of a budget.

What is gonna be that dual transformation that's gonna allow us to have the consistent revenue that's going to allow us to make those investments. And so as I take a look at a lot of what we do in innovation. I'm trying to figure out are there multipliers that can be added onto what we're doing, whether it's research, whether it's venture, whether it's just visibility of our organization that can help us as we bolster our reputation, US News World Report.

Bill Russell: Yeah we probably should have started with Endeavor 'cause Endeavor's a new name for some people.

So give us an idea of the community that you serve and the breadth

of

endeavor.

Justin Brueck: Yeah. So, we are a newly formed system. It's made up of actually four legacy organizations in the North Shore Chicagoland. And it's Edward Elmhurst Northwest community, which is in Arlington Heights.

And then Swedish Hospital, which is a safety net hospital that's based in the north part of the city. Fascinating hospital, to be honest with you. It's one of the original hospitals for migrants, and so they speak over a hundred languages at the hospitals. It's quite fascinating. We've come together as a system, we're now nine hospitals.

We're over 300 sites of care. We're the second or third largest system now in Illinois. And we have close to 28,000 employees. Our service area right now is approximately 1.4 million patients and growing.

Bill Russell: That's pretty amazing. So, let's talk about let's talk about the current innovation climate.

Justin Brueck: Yeah. I mean, It goes back to the whole reality. Like there's a hype curve that exists, and I truly believe that is a way that we have to look at technology. There is a lot of excitement about what's going on.

I'm not gonna be one of the people that lodge it or like adds on to the whole AI situation. But it's true. It's, it took

Bill Russell: you nine minutes to say the word ai. I was just wondering how long it was gonna take.

Justin Brueck: Yeah, no, it's good. I but I don't think that AI is gonna be the panacea that everyone is making it out to be.

It will be transformational, no doubt. Like I'm seeing it in terms of our ambient dictation solutions that we're launching and everything like that. But for me, innovation is solving for the obvious at times. And as we've talked with our team, we recognize that innovation has different flavors, but it is, it's solving for the expected that just people didn't have the time bandwidth to be able to focus on because they're putting out fire.

But I think the ones that are gonna emerge are really going to be probably the winning course now, because there isn't the cash that's gonna sustain all these new ideas. So yeah, no I think it's bright. I also think that it's challenging because people are I was, interestingly enough, one of our hospitals, Skokie Hospital we were working on all these cool ideas and then all of a sudden there was a storm sewer froze and broken.

Pretty soon they had to literally close down the hospital for three days. And it's like you're thinking about how do you innovate when you legitimately had to just cancel all of your surgeries, you had to move all your patients out of the building and you're asking operations to find the space to innovate.

So, those are the things where I think it's like dichotomy in terms of we wanna change what we're doing. We're constantly putting out fires. When are we gonna actually have time to build a fireproof house?

So, what are the problems, what are the significant challenges facing healthcare today that you say, yeah, I believe there's a potential for innovation in this space to either incrementally change it for the better or dramatically transform it.

Justin Brueck: What's in front of us right now, like the silver tsunami we will not have enough workers to be able to take care of our patients.

And I just saw a statistic the other day that was talking about 42% of physicians are between the age of 55 and 65. And simply looking at those numbers, it's not a sustainable model for us to care for patients in the way that we are now without dramatically changing how we approach either. Education for physicians, or we start thinking about different care levels and different care providers caring for patients.

And this is where you can get into the whole question of like, AI triage and all these different things that are out there but we really need to begin personalizing that. And fortunately actually at Endeavor, we've been a leader in the use of genomics, which is just one component. but It's 20% of your health risk is in your genomics.

And so how many patients currently know their genomic profile? Not enough. And so those are the things that I think ultimately are gonna be transformational, but we're not gonna achieve transformation if we can't afford to keep the lights on.

Bill Russell: I'm gonna work through those one at a time. That's a great framework.

So workforce, there's just no possible way. The silver tsunami it's an interesting problem set. And we hear this over and over again. We're not gonna be able to print more doctors. I more people aren't gonna go to school all of a sudden and say, I wanna be a physician or I wanna be whatever.

This is what happened when they reached this age. Well, now they're reaching this age and we're not gonna have enough people to care for 'em. This is a serious problem. We've known it's been coming. What potential solutions are we looking at? I mean, you, you You talked about education.

But there also has to be, I assume, a significant improvement in productivity in terms of how we move people through that process in a much better way.

Justin Brueck: So I think there's a lot of different ways that you can appeal this, but I think it does come down to making sure that you're matching care appropriately.

Again, I'm not a doctor, so I'm not suggesting that's right or wrong, but I think that mentality that it's not one size fits all, and we really do need to think about getting patients to the level of care that they need to be seen at. So think that's gonna be one of them, because that's just helping us address a the demand issue.

I think on the supply side, when we think about our staff and our workforce, we have to lean into technology. no way around this. We have to become smarter with the resources that we have. I'm very bullish on all the things that are happening with our ambient solutions, like ambient dictation services, but also things like virtual nursing.

We're gonna have to upskill. We have to get people that are currently doing things that are very manual tedious, and we have to get them working at a higher level.

Bill Russell: and we're not gonna give any one of these topics enough justice, I don't think. But I wanna talk about access a little bit.

Access is interesting also to me in that especially in metropolitan areas, like, like you're serving. There's a default to go to the ER. We've gotta break that habit. And now we have retail clinics and those kind of things. But it's even more than that.

as you talk about, the people who really don't need to go see a doctor, There's other solutions that are coming forth. We've seen some technologies where you can actually have a conversation. I've seen them demonstrated where you have a conversation, a clinical conversation, as a persona of the health system's knowledge is sort of communicating back to that patient saying, Hey, you know what what you're describing is just go down to Walgreens and pick up some over the counter meds kind of thing.

So if you log into the app today it's giving people that medical advice, and again, it's not medical advice, let's be clear. It's more of like, Hey, here's some things, and then it has even I haven't had a chance to look at it because it was just shared this morning with me, but it gives kinda like a doctor approved, like these are recommended in terms of things that you may want to consider.

So again it's coming. I think about this. So I, I, I'm a father of six. So, one thing that's really important to us is our grocery bill. Go figure. Um, Thankfully that's not they're not teenagers yet. But I think about healthcare in the future as almost akin to as we think about like anything in the consumer world.

I go to this grocery store for this. I may go to this grocery store for that. I might get this from Amazon. And I think one of the questions that we have to really challenge ourself with is, can we be everything to everyone? And will patients be comfortable coming to only one system to get their services met?

And I wanna be clear, like that is something that we can't just cast aside saying it's okay to have patient records sitting in 15 different facilities that don't talk to each other, but it also allows us to think about what's the most cost effective way to deliver this. And maybe health systems are not always best positioned to use a certain digital access point because our tech stack doesn't mirror what Silicon Valley has.

I do think, though, going back to your point that you said, why do people show up in the ed? I heard somebody speak about this not too long ago, but it actually comes back to the idea of why do hospitals exist? It's because outpatient care failed. Why does outpatient care exist? It's because primary care failed.

Bill Russell: And we know from, social determinants of health and all that research that's been done, only 20% of your health is actually related to the healthcare facility and the services that they provide. And so it does come down to, education opportunities, access to food, just a whole host of things.

And it's interesting you threw out genomics

Justin Brueck: So 20% of your inherited risk actually, or your risk factors from not inherited risk, just overall risk factors come from genetics. This is fascinating.

So my mother's adopted. And her being adopted. I don't know my family history on that side. And so as I think about what is my inherited risk, the doctor says, do you have a family history of cancer? Well, my mom doesn't have cancer, thank God, but I have no idea what happened outside of that.

And in doing this, we've established a program now that we've tested almost 50,000 patients as part of clinical care in primary care. And so when you think about the ability to use genomics for things like drug selection, does this work pharmacogenomics? Those become important. I don't metabolize Plavix, do you know what drugs, Bill that you metabolize or don't metabolize?

How could that impact our spend on drugs? How could that impact my amount of time that I need to take PTO because I'm not, adjusting to medications appropriately. All those things I think have become very fascinating and help us as we think about personalizing care. As I kinda started the conversation off.

Bill Russell: What's it gonna take for genomics to take a more central role? I understand that the cost of getting the genomic test has come way down, so I assume that portion's not really the driver, like it's affordable now to do that genomic testing, but it is just not part of the daily regimen.

I think that's a significant issue and, and part of this is changing and I'm really excited to see a lot of health systems are beginning to look at genetics and how that can be incorporated. But until you change the foundation around that and the expectation around clinicians to be aware of all these things, I think that's gonna be a challenge.

Second thing is genetics has always been viewed as something that only the geneticist does, and that came from our payers. Our payers knew that genetic testing was super expensive, so they put all these gates in the path to make sure that you weren't ordering a hundred thousand, 10,000, 5,000 dollar test on every single patient that came through the door.

Oh. And so for us, given they only have 30 seconds to talk to their patient, it's, what am I doing? Am I addressing this as part of an annual physical? Am I addressing this as part of a, immediate care visit? No, you can't do it as immediate care. You have somebody that's, lacerated, they, they need to be fixed.

For me, I think this is where, again, that shift to a health system and not a sick care system and all those things, genetics is not beneficial to know after you have a disease. It can be modifiable risk and things that you could do. You need to have the genetics upfront. And I think that's where, you know, we're at 50,000 right now.

And even at a hundred thousand patients a year, that's 14 years. And so you see just the numbers here that you really need to get going and have done proactively to really make an impact. But I think we're on the precipice of it happening and, we're really excited actually, as a system to begin thinking about some of the things that we've developed and how we could potentially teach other systems how to do it, because it's not rocket science.

It really isn't it's about making sure that you have processes that are automated that make sure it's an easy button for clinicians and patients alike.

Bill Russell: I wanna come back to AI specifically. I wanna talk about generative ai. One of the things that's happening is the processing capability associated with this is pretty amazing.

A model trained specifically for doing this kind of thing

Justin Brueck: in genetics and in specific, and with ai they, this has been used for a long time and so this is not new to laboratories and really give a lot of credit to places like the Broad MIT Harvard for what they did to really get this going.

'cause they're the ones that are delivering to that price point and it's only because they've been able to maximize the bioinformatics pipelines and everything that you're talking about. Because again, doing the genetic test. Is not the expensive part now, it's the bioinformatics that sits behind it. And so AI is playing a huge role in that.

Because it's actually helping us identify disease pathways, you're able to do these very large association studies and even start looking at kinda reverse engineering drug targets based off of certain populations that are on certain medications. And what was it that specific gene mutation that made this patient population respond differently versus that?

How is that now changing heart health? How is that changing kidney health? How is that changing liver health? And so you're starting to see AI is able to help draw those correlations and associations.

Bill Russell: The other problem or challenge that I see in health systems is these complex charge summaries.

We're talking, I remember talking to a woman and she had a child with significant challenges and she had three binders that she carried with her everywhere she went. 'cause she went to different health systems and that kinda stuff and her challenge to the panel was, you have to solve this. I have to carry these binders. I know they can't read this entire binder every time I show up. She's worried that they're gonna miss something and her child is going to be adversely impacted.

Justin Brueck: So we have a, a committee that looks at all sorts of things relative to ai.

It's actually a great committee. It's advanced technology oversight and monitoring. Because to your point, how do these models perform over time? When I think about the example that you brought, and I'll give like a parallel way of thinking about it. When we think about risk factors and we think about overall understanding what is risk around Bill?

It depends on what you're looking at. And are you looking at it in terms of an instant in time or are you looking at it longitudinally? And I think that's getting to what you're talking about is. There may be signal in the noise that in isolation doesn't make sense when you're looking at it over a period of three years.

But I, again, going back to this committee that we have I often ask them like, what is good enough? Because when we talk about, for example, AI bias, there is absolute truth to AI bias, but there's also human bias. So are we over expecting these engines to perform? And I think when we're talking about matters of life and death, they gotta get it right.

Bill Russell: it's also not addressing the reality that we know to be true. I remember walking into a physician's office and he had like, , don't bring your Google search stuff in here. I'm a trained doctor.

Essentially what it said. And I remember sitting down and having a conversation with 'em and I said, yeah, the reality is they needed answers and Google was there. And Google's there all the time, and now it's AI. AI has taken the place of Google because Google, you just have to find this specific article that you were gonna read.

Now you just go in and you ask ai, it's like, look, doctor said I have this, I have these symptoms. I have this stuff going on. It's happening. It is absolutely happening. We know that Google searches around health are in the,

Justin Brueck: Million mil

Bill Russell: millions every year. So we know it's happening.

Justin Brueck: It is interesting and I think it's evolving and take it for what it is. I think healthcare is always going to be delayed to Silicon Valley and probably for good reasons so that we're not taking too many risks. But an interesting thing that I've actually done myself I had an annual physical and I had an elevated, I forget what it was, but it was not a big deal.

But I remember somebody saying oh, it was like high cholesterol triglycerides or something. And I remember going and into one of these, that I propel perplexity, I think I used, and I typed it in and it gave me all this stuff. And of course, if you Google hard enough, you're gonna have cancer, right?

Everything leads to cancer, right? But what was interesting, and I think this is where it's gonna become very important for people to understand how you use AI. If you log into an AI tool today, honestly, , it's a blank sheet of paper. It doesn't know anything about you.

And it's fascinating to see how it responds. So again it's just another way that you think about like, well, you're

Bill Russell: saying the persona actually changes the response.

Justin Brueck: Oh, absolutely. Yeah. Yeah. Wow. Because, 'cause if you put in a more of an academic flavor they'll give you things that are more associated with like clinical trials and different ways that you could potentially approach it versus if you say like, I am somebody who lives in rural America.

Like, what are my options? And again, I haven't gone detailed into it, but I've begun starting to play with the idea of this context and baseline setting so the AI actually has an understanding of what you're asking for. I think that's gonna be a fascinating space as you start looking at how do you create these different personas for your ai.

And I could take my entire record and say, Hey, here's the context. And you go, oh, there's your medical history, there's your context that's great. I'm not giving you a persona because you've given it the persona of primary care physician. So you know the safeguards. not gonna go outside of these bounds.

What keeps a health system from taking on an effort like that?

Justin Brueck: I think there are health systems that are beginning to do that. I think it, again, it comes back down to the bandwidth issues that we have. Yeah. I think so often we're focused on just meeting today's needs, that you don't have the ability to anticipate tomorrow's.

And that's where I think as we're looking at, the fire drills and the fireproof house analogy, it's like we have to get out of this constant and the question is what's gonna do it for us? You raise a question about patients and owning their data. What's really interesting, and I think this is a way that we need to begin looking at this, is I'll give my data to people who are able to help me do something better.

And so I think when we come to healthcare data and being willing to share it with the health system, the question is, what can they do with your data that's gonna make your life better, and how are they teeing that information up to be able to do it? There are all sorts of, regulatory hurdles to get through relative to data ownerships.

We can't wade into that territory, but you're right, I think creating these types of large language models that sit out in front, it will help us better triage patients and get them where they need to be seen and hopefully provide them with the confidence in the accuracy. But we still have to realize these are not medical devices.

Bill Russell: Yeah, absolutely I'm gonna go in a different direction here, so you have a lot of experience here with innovation. So talk to me about leading organizational or transformational change. What are the principles that guide, that approach for you?

And that's really hard in healthcare. And I think for me, what I have realized is change management is what allows innovation to be successful. Being able to explain to a nurse that we are going to be introducing a new technology that's going to help us prevent patient falls. And it's okay to trust it because, again, it's their patient.

It's that nurse's patient. They do not wanna see anything bad happen. And you have to say, trust me, the AI algorithm running on our camera is going to prevent that patient from falling. That's really challenging. And so, as I think about it, it is trust, it's change management. I also think we're going to have to get to a point where we accept the fact that short-term thinking is gonna get short term results.

And I think the question is, are we comfortable with radically disrupting ourselves? And that gets back to incentive. And so for me, as I think about what's really important, trust. It's about managing change and it's making sure that we have the right incentives because if we don't have the right incentives to make us think about the future of healthcare, and we're looking at can we meet margin this year, we're not gonna be making those investments that are gonna futureproof us for five years from now.

I'm like, well, it's sales. Like, you're trying to sell them something and there's a whole host of things that they're like, well, that's not who we are. It's not how we operate. And I'm like, yeah, well that's not gonna, you're not gonna bring any employers in.

You're not gonna have any partnerships.

Justin Brueck: If you have the same people sitting around the table, you're gonna end up having the same discussions unless you have people who are willing to bring in ideas from the outside. And I actually think, that's what I've really appreciate about Endeavor is that we are making those hires that I think do look outside and

And so that's really where I hope. As a community hospital, honestly where we are positioned to do things that are differently

Bill Russell: the thing that made me laugh is I read an article yesterday about somebody saying, Hey, this is the New Frontier.

It potentially it's gonna take three or five years.

Justin Brueck: So number one, it takes being willing to accept that sometimes proformas have more gaps than they have answers. And that comes to an organizational risk tolerance. I think the other thing is, and one of our physicians has actually talked about this whole concept of pilot-itisis and how do we stay out of that?

And what we're trying to do is really be intentional to say on the other side of our, ambient technology or digital pathology. Digital pathology is actually somewhere we're leaning very heavily into, and it's probably a $20 million investment over a decade. And the question is like, how do you ultimately generate the support to do that?

You have to have a vision and you have to have an idea of where it's going, but then you have to bring partners to the table that are gonna be there for the long term as well. And so one of the things that's challenging for health systems, given there are all these startups that are out there, it's hard for health systems to be willing to bet the bank or whatever the expression is on a startup that's been around for six months.

And it's not gonna be just more ideas.

Bill Russell: Let's close with this. I like talking about culture how does a culture of innovation how do you, I wanna say create it, but it's not create it because there's already a culture there. How do you foster it?

How do you get it to grow so that people do have sense in which I. Adopting new things isn't horrible. Change isn't bad. There's paths that only go through innovation that have to go through innovation to get to the other side.

That is going to solve those problems of workforce access and other things.

Because if it's not, it's gonna be grassroots efforts that are ultimately gonna be blown away by all the other priorities that are coming through. I also think it's the idea of, how do you eat an elephant one bite at a time? Like you have to recognize that it's not going to happen overnight, and you have to celebrate the small wins.

And honestly, like even being on this podcast with you is a great opportunity for me. But ideally what I would love to see is one of my clinicians having this conversation with you because that's where you start to recognize that it's not about the innovation team having these wildly successful things.

It's about the people who are actually being impacted and them being able to tell their story. And the, we had an event recently where we had physicians that were talking about, our new ambient solution that we're using. And it ultimately, we were thinking about how do we present this?

Even they might even be informal influencers in your organization. You get them excited, you get their support behind it. Once they get that win, they're willing to have that next conversation. And so for me, it's really about creating that culture where you're promoting those who are leaning in heavily.

And it doesn't have to be on, NBC news or anything like that. It can sometimes just be in a newsletter. It can be sometimes just a thank you note for, Hey, I appreciate the fact that you did this really impressive work and you get your, CIO writing a message or something like that.

It just starts to build that, feeling of I'm getting recognized and appreciated for the fact that I'm willing to take that additional risk.

Bill Russell: Yeah. That's fantastic. Justin, I wanna thank you. I wanna thank you for your time and thanks for sharing your history and your wisdom with us.

Justin Brueck: Thanks, bill. I appreciate it.