This Week Health

Keynote: Virtual ICUs, Wellness Sprints, and The AI Revolution in Medicine with Bridget Barnes

August 25, 2023: Alongside Bridget Barnes, SVP and CIO for Oregon Health & Science University, we delve deep into the transformative role of technology in the healthcare sector. How is the digital age reshaping the responsibilities of clinicians and providing support in an era marked by staff constraints and burnout? With innovations like virtual ICUs and wellness sprints, where does the future of healthcare lie, especially when AI and ML seem poised to revolutionize our systems? But as technology advances, does the old adage "Nothing can screw things up quite like a computer can over time" still hold weight? And as AI becomes more integrated, how do we discern the genuine potential from the overstated promises?

Key Points:

  • AI's Role Healthcare
  • Clinician Burnout Causes
  • Technological Support Initiatives

As healthcare technology professionals, we're in a seismic shift. Artificial Intelligence is not just a buzzword—it's transforming our field and altering how we deliver healthcare. But with these technological advancements come complex challenges and unique opportunities. Are you ready to navigate this new landscape? Join us, September 7th, 1pm ET for an unmissable journey into the future of healthcare. Register Here

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Transcript

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.

my opinion is there needs to be some common definitions about what AI is because everybody says AI, but it means so many different things. And I really think it's important to understand exactly what you're talking about when you say AI.  

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. Here we are for another keynote episode and I'm excited today be joined by Bridget Barnes, s v p and c i o for Oregon Health Science University, O H S U. Thank you for coming on the show. Look forward to the conversation. Thanks for having me, Bill. so people might not be familiar, especially, on the East coast Oregon health and science university.

Give us a little background on your institution in the area that you serve. Sure.

So, OHSU is Oregon's only academic medical center. We have a budget of about 5 billion. We have 20, 000 employees. We have about 5, 000 students and other learners. And we get about 600 million in annual research revenue.

From an IT perspective and in my role, we're a highly centralized organization. So many different academic medical centers you might visit across the country would have a number of CIOs. There's only one CIO at OHSU and I serve, we serve all missions of the organization, including our OHSU foundation about 800 employees report up to me in our IT organization.

And it's a little. There are some areas of of the organization that I support that might be a little bit outside of traditional I. T. For example, I'm responsible for health information management. I'm responsible for our enterprise program management office, managing strategic planning for the organization as a whole.

It's, I've talked to other academic medical center C. I. O. S. Some. Are considered the CIO of the medical school as well as the health system. And some are not. Is there a benefit or a downside to that? Do you think?

I think both are true actually. So it's, when you have a number of different CIOs responsible for different parts of the organization, I think it's inherent to have some conflicts and maybe some squabbling that might happen and maybe lack of consistency in approach across the organization, depending on what hat people are wearing. I mean, our faculty, have a foot in research, have a foot in teaching and have a foot in clinical care.

Oftentimes And if you had different I. T. support structures for that, they're going to have different experiences across the organization. So it's good that we have that ability to provide a consistent platform and approach to I. T. across the organization. I think that there are also, we're more efficient from from how much does it cost to run I.

T. because we're structured in that way. The other side is, from I. T. management perspective. It can be extremely difficult. I mean, trying to blend think about it from an information security perspective. You're trying to lock down, you know what you can in the health care row.

Realm to make sure that we protect our patients and providers, but on the academic and research side, everybody sort of wants open exchange of ideas and information with, all comers and their colleagues across the organization. So it can cause some challenges in terms of how you support the organization.

I actually think that with the recent Increase in cyber security awareness and threats across the country that that's actually helped in some ways in terms of giving us a platform to say it's really important that we have some of these standard security protocols in place because they're coming after everybody.

And I, while you want to freely exchange information, also coming to, to threaten your ability to do that.

It's interesting when I talk to research institutions, especially like, OHSU, one of the areas that has a lot of distinction is the area around data very different academic medical center will handle data and have data needs that a, Just an integrated delivery network or a standard hospital.

Talk a little bit about what some of those demands are. What are some of the requests that come to a CIO that are, I don't know just challenging or just different than what is the norm?

So, I mean, I think in standard health care, you've got to manage your data and think about how you do things like social determinants of care, how you partner with other health systems, but there's a lot of standardization to that work.

And so when you're exchanging information there, there's standard protocol for doing that in the research world. That's entirely different. I mean, you're collecting data from. Non standard devices. You're collecting large volumes of data, and there aren't those standard protocols that help you understand how to organize that data in meaningful ways so that it can be reused for research purposes.

There's also a lot of interest in just basic high performance computing against some of those data sets.

Being the sole academic medical center in Oregon, does that come with any specific requirements or demands that are distinct as well?

Well, one example would be, we were really a very trusted resource uh, When we went through the pandemic with the state, we were not only an advisor, but we helped in terms of data collection. We did a lot of predictive analytics that were run out of our shop specifically that helped informed how the state was going to respond to the pandemic, what it was looking, whether or not we were going to have mask mandates, whether we were going to, ease off on those sorts of things.

So that is one thing that's very different.

Well, let's take a look at What's going on today? And what's going on in the future? There's a lot going on in health care. What are some of the priorities for your organization and for your I. T. organization at O. H. S. U.

So I'll begin by talking about the organizational priorities.

First and foremost, we are very much focused on continuing improvement on our financial performance. And I don't think that's A surprise to anybody in the health care space. It is really challenging right now. We have, extreme inflation as it relates to wages as it relates to, suppliers, the stuff we buy day in and day out.

But we are constrained in terms of reimbursement rates and it is a difficult time for hospitals right now. So that's number one. The second would be we are building a new hospital on OHSU property. We are located at the top of a hill. And it is very space is exceedingly hard to come by. So the construction projects that we have on the hill are very complicated, but we really need to increase our capacity.

Oregon actually has the lowest per bed capacity of Of any other state in the nation. So, we are really under capacity across the entire state. We are also really working on continuing to optimize and align the relationships we have with partner organizations.

So we OHSU has a specific health enterprise that we call it, which is you health. It's a defined partnership with Adventist Health Portland and our Hills and Hillsborough Medical Center. And we share a common bottom line. So there are separate legal entities, but we have strong alignment and need to focus on how we can optimize the.

Provision of services across all of those sites. And then finally, organization is highly focused on diversity, equity, inclusion and belonging. Everything from some very significant transformational work in HR, new supplier, diversity programs and health care equity.

steer away from the financial performance, even though I was just reading the coffin hall report this morning.

And I think it's the first time in like almost a year that the financials are looking up for the months of May and June. And that just is indicative of all of healthcare and what they're going through. Right now. I think that's a relevant topic, but I want to talk about the new the new construction in the new building.

As you do that. I found that to be one of the biggest challenges I ever had as a cio. It's you're trying to create a building. You're creating these new care spaces. You're thinking about not only how care is delivered today, but you're also trying to try to factor in what care is going to look like in five years or 10 years.

Talk a little bit about that approach and how you're looking at care spaces as you're building out those new facilities.

So, much of it is actually very traditional. I would say that we're looking at that space to really optimize some of our service lines cancer in particular, we have the Knight Cancer Institute.

And so we're looking at ways to make sure that we have enough capacity in those areas. In some of our other spaces, we have been transitioning what used to be sort of outpatient surgery space, surprisingly to more Infusion based services. So some of those services that we know are there's a dearth of in our community.

And so trying to provide an opportunity for patients to receive those services when there aren't other service providers that are able to do that from a technology perspective. We're also looking at things like virtual care areas. So we have a significant Service in terms of virtual ICU that we have implemented over the last couple of years at OHSU and at the right now we are providing that service both to OHSU.

So we sort of have a command center of sorts. And we don't have necessarily. ICU physicians actually sitting in the ICU. Instead, we have this virtual command center and they're managing the ICU both for OHSU at various locations, different ICUs, as well as Hillsborough Medical Center, our partner.

So making sure that we are set up to have the appropriate equipment and and connectivity in those rooms to support sort of a more I don't know how to describe that kind of model of care where you'd have more nurses in the environment as opposed to nurses and physicians, where you have sort of more of a hub and spoke type of operation.

Yeah putting those buildings in place is not only just about the buildings in the care spaces, but it is those command centers. It's virtual. It's the move to home. I mean, as the academic medical center for Oregon, there's partnerships across the entire state.

I would imagine that our opportunities to support the care of. The entire states as a community of health that's precisely right. Talk to me about the partnerships. I found this to be 1 of the most challenging things was partnerships and coordinating care and doing those kinds of things.

Is it a case where you're on a, common instance of the E. H. R. Or are you trying to share data and scorecards and try to orchestrate outcomes across various types of systems? With those partnerships, so

I'll begin by saying you're exactly right. I think it's one of the hardest things we do.

And it's the hardest thing for me to actually explain even to my employee or others what those relationships are, because we just do is taken a different approach to the partnership. As I told you, we share a financial bottom line. Each of them remain their independent legal status as organizations.

And in one case, the Adventist Hospital also has a relationship with Adventist Corporate, which is out of Roseville, California. So it's very complicated and they aren't acquisitions. So that's actually what makes it even more challenges. They have independent boards. They have independent leadership team.

So there's a lot of socialization and coordination that is required. We just as of March of this year, we just brought Adventist Portland onto our epic instance. We brought Hillsborough onto our epic instance and we provide actually all it services for Hillsborough Medical Center. About, I don't know, seven years ago or so when we originally engaged in the partnerships.

So, the tricky thing is that every partnership is different. They don't have sort of a standard model. And so it's difficult to say, we have different service levels because there's different. So we have a lot of different organizations from an I T perspective. We do have a common governance strategy across the health system.

So we have you know what we call our health system management team that is executive leadership across all those organizations. We have subcommittees, one for I T governance, specifically another for clinical decision making. So standardization of clinical work across the system. Just different sort of governance bodies in different areas of discipline.

it's just, I mean, that's so fascinating to me. I mean, what about data governance? Do you have data governance across there as well? Is that part of that?

We do manage we do manage data across across all the organizations, and I will say that the ties are more close with the Hillsborough Medical Center because we've been working with them, and I think they rely on us much more heavily than Adventist.

So, for example, we basically set up a shadow. A shadow instance for that that we're Adventist headquarters sort of pulls in the information that they need so that they can look not only at that specific hospital that combine it with their information about their other hospitals. So again, it's sort of custom for every entity that we're working with, which, which can be challenging.

We are, we have common dashboards across the enterprise. We actually have a mission control operation as well. That helps us understand in real time what our census looks like at our current organization. What that census looks like at those partner hospitals so that we can transition patients based on acuity from one location to another.

And that's managed in real time every single day.

We'll get back to our show in just a minute. To celebrate our fifth year as a podcast, we set out to raise 50, 000. for childhood cancer in a partnership with Alex's Lemonade Stand. Thanks to the generosity of the Health IT community, we hit that goal already. It's August 2nd or 3rd, and we've already hit that goal.

It's pretty amazing. In July, two of our 229 Project events brought together Health IT leaders with the help of the chairs. want to recognize the chairs, Sarah Richardson, Tressa Springman, Michael Pfeffer, and Donna Roach. The group of leaders they brought together. And the sponsors that were a part of that helped to donate over 10, 000 to Childhood Cancer and Research and Alex's Lemonade Stand.

And we want to thank them and we want to thank you for participating all year long. It's still going. we're still raising money and we hope to really break through this goal. Alex's lemonade stand is doing wonderful things in cancer research and family support. join us by going to this week, health.

com, clicking on the Alex's lemonade stand logo. It's right there on that front page in the top right hand column. we would love to have you do that and give today and be a part of helping us to fight childhood cancer. Now back to our show.

So you mentioned diversity, equity, inclusion, and in belonging. I'm wondering from an IT leadership perspective how do you participate in that? What does that look like for IT to be an active participant in those initiatives?

So there are, different ways.

I would answer that question. I have the privilege of participating at a very high level because of my role in managing the enterprise program management office. It is a dedicated program of work. So we are providing the project management support for that. And, Thank you. And everything associated with that.

I'm a member of the both our implementation committee, our oversight committee to do all the work that we have planned from a D. E. I. B. perspective that includes H. R. transformation work supplier diversity work and healthcare equity work is sort of new for us. I'm most involved in the sort of administrative transformation that's happening at this point in time on the health care side.

Specifically, we have a new leader for health care equity, really helping us to understand what, how we're serving our patients. We were running all the vaccine clinics across the state during the time of covid. And during that time we really had to do things differently to be able to get those vaccines to some of our underserved populations.

And we had a lot of lessons learned that came out of that. I mean, you can't just What we did, we set up shop at the airport. We set up a mass clinic at the airport, got a lot of people through that, but we found to get some of those underserved populations, we had to go to churches. We had to, go to different places and engage the leadership of those churches to be accepting of us to come.

And so we're really sort of taking those lessons learned and helping. And seeing how they apply to the larger scope of health care delivery services across the state right now,

talk to me about the vendor diversity program. What does that look like to roll that out?

So, I mean, 1st of all, it requires sort of a dedicated efforts.

So, oregon is a very Caucasian state. And we could and we will do better in terms of increasing the diversity of our supply chain. And we had a really unique opportunity as we were building this new hospital at the same time, it's probably nearly a billion dollars by now

to bring the hospital up. And so there are lots of vendors and we, you have a tendency to work with the people that you've worked with in the past. We really had to be purposeful in terms of taking a step back, making sure again, in the same way that, that I'm talking about reaching patients in a different way, we had to reach suppliers in a different way.

We had a standardized approach. We said, okay, we're going to post all of our We're going to post all of our contract opportunities out on this common website. We expect everybody to come and need to look at those or not. And if they don't look and they don't apply, then, that's the way it is.

When you look at a diversity first perspective, you have to reach out to those those small businesses. You have to reach out to the communities of interest to make sure they're aware of those opportunities to make sure that you're also not bias in the way that you present those opportunities.

So if you submit an RFP and you have requirements that some of those, Smaller vendors may not be able to explicitly respond to. You need to have a way of of thinking about those responses differently. Maybe not be so heavy handed in terms of the requirements for even getting your foot in the door.

Yeah, it's interesting from a diversity standpoint. I appreciate the things that you guys are doing. But it's, for me it's the big players, small players is one of the biggest things I mean, because the big players come in there and have all these resources and capabilities and whatnot, and you're trying to really lift up a whole new next generation of potential vendors who can have those capabilities.

And you're trying to give them a leg up, but where they're starting from a lot of times, given the needs of an OHSU, they're going to, they're going to fall short because they just don't have the skill and the resources to make some of those things happen. How do you help them up in those cases?

So I mean, I guess an example would be insurance coverage or something like that, that we might require in a contract, right? So we are able to talk with them about, as they're applying for some of this work, and maybe partner with them to help gain that additional coverage that they might need to support OHSU, be an advocate for them in that process.

So, I mean, I don't know that we have it all figured out yet but we're trying,

when I started my consulting business, I had to sign some contracts. I was a single person consulting organization. I had to sign some contracts with some health systems and they would send it over and say, have your lawyers review it.

And I'd send it over to my lawyer. My lawyer would look at me like. Oh, my God. All right. This is huge. Like I need a team of lawyers to go through this thing. And the insurance requirements are always one of those things that, that we sort of got stuck on. I want to take you in the direction of technology for a little bit.

In what ways would you say that OHSU Is leading or pushing the envelope with regard to the use of technology or data?

So I guess the two areas I would talk about, I've talked about one already with the virtual ICU and I'll just talk a little bit more about that area. And then secondly like everybody else, we're trying to understand what AI means to us as an organization.

So let me start with the virtual. So in addition to the virtual ICU, I talked about how that serves not only OHSU specifically in our partner organizations, but we're looking to provide that service at the community level. So community hospitals, I think there are at least three or four that we're currently Well down the path and discussion to provide that service to hospitals that, they really can't afford to have a physician there all the time.

And so, really Transitioning from what was sometimes sort of tele support for ICU to active virtual ICU activity where we actually have physicians that are available sort of all time and real time monitoring their patients. So that's one way that I think we're ahead of where other entities are and really trying to serve the state of Oregon.

The other would be, hospital at home. And, I will tell you, I had sort of mixed feelings about this. It is, thank you. It is one of those technologies that is very difficult to Do in a financially responsible way. It's difficult to get the reimbursement that's required to pay for the services, and it's sort of outside of the way we had thought of ourselves as an academic medical center, right?

I think it's going into somebody's home. Academic medical centers are You know, oftentimes, quaternary care and, very specialized services and when you're going to somebody's home for that kind of service, that's just a very different experience. And so I think that's been a challenge for us, but we have, we began that work in that pandemic.

That was the right time to do that work. We are jam packed full every single day at capacity having. I think we have a 35 bed emergency department and we've got 35 borders all the time. On top of that. So we just we don't have room for all the folks that we need to serve in the community. So the hospital home really gives us that opportunity.

If those patients have the right support structure in place that we don't have to put them in the hospital that we can provide the care that they need in their home, which actually I think leads to better outcomes and better, greater satisfaction for the families as well.

So before we get to AI, let me ask you about. So the virtual ICU and hospital at home, but specifically virtual ICU. What's the special equipment that you need in the remote location in order to make this work? Is it a common EHR? Is it a special camera. Is it audio? What do you need in order to make this work?

So a couple of things. So it isn't a common EHR. And that has been a challenge, especially as we look at some of the small community hospitals that may be running EHRs that are let's say close to end of life and maybe aren't able to do standard HL7 interfaces So, so, that is one, one challenge that we've run into with the community hospitals.

We are partnering with GE Health to, there's a mural platform that we use. It's their brand, a virtual a virtual ICU, and that's the platform that we're using. So it takes data from our EHR. It takes data from those other EHRs so that we are able to, and the devices that are remote placed remotely, not just EHR.

And bring them into a common platform that provides the view for our clinical providers to provide guidance there. It was your other

question. Yeah. So so you are, you're collecting all the telemetry data. Are there other devices you would need?

Cameras definitely, there's additional cameras that we've got located at the bedside there that are that help.

We've also have in some locations. So again, you can have some equipment in the room that is sort of always in the room. And you can do that. We do that at the facility, but we also have mobile cart technology. So we will things into the room when we're doing exams and they have cameras on them.

That's amazing. And so the, I'm not sure I have any conversations with CIOs.

It seems to be a very common topic, generative AI being one, but also clinically we've been implementing AI for quite some time. Talk about the journey at OHSU.

So clearly, I mean, we're using it now. You're right. And a limited basis. So everything from, your mammogram results, their AI is used to do a sort of first pass analysis at that.

For example and my opinion is there needs to be some common definitions about what AI is because everybody says AI, but it means so many different things. And I really think it's important to understand exactly what you're talking about when you say AI. So some people could say predictive models are AI and some people may not agree that they are AI.

We have done a lot of work with predictive models at OHSU. We've set up a digital twin for helping us analyze our hospital, our clinical environment. We have, Been doing things like sepsis. There are sometimes when we have used the models that are available to us from vendors, but then we actually have an advanced analytics team that builds our own predictive models as well so that we can be more reactive because you can't always sort of wait for what's Coming from your vendor.

So I'm proud of the advanced analytics team that we built and that really the foundation for that was actually the mission control activity that I already talked about, transferring patients from one location to another and the needs of the state as they were responding to the pandemic.

So Dr. Peter Graven, has built that team within I. T. And actually, he says he likes being in I. T. He wasn't too sure about it when he first started. But he says that's where all the data is. That's where you know you have access to all the information you need from all the different sources.

So I'm grateful that he's has the opportunity that work and that he works within our organization for us. The large language models have really shifted the focus across the entire organization. Everything from administrative, craft, I'm sure you've heard that, I can't remember what hospital was, but, or university, somebody sort of crafted a, an AI message in response that was created by the communication team in response to an active shooter event or something.

And so they got, themselves in trouble there. Our research community is, very interested in this and our clinical teams are as well, but we want to make sure that whatever we do in the AI space is, trusted before we would apply that to any of those activities.

And so one of the things we've done is we began probably a year ago with the, a statement on AI that sort of talked about our principles, the principle of transparency, the principle of attribution those sorts of things as we are evaluating AI technology. So we started with that sort of said, okay, these are our principles.

And now we have representatives working with others across the nation to codify those so that they can be applied across, all academic medical centers. In addition to that, I am actually going with my chief research information officer to our executive leadership team next week to establish an overall governance process so that we can understand who's using it across the organization and make sure that they are thinking about these things like attribution and transparency.

Do we know what it's doing? Do we? How are you going to use the information, making sure there's sort of a human check? Thank you. Point in there before we would say, for example, use it to create my chart messages, making sure that there's a validation process in there before it would go directly to our patients for anything that might impact clinical care.

So we are talking with Epic about how we can partner with them and their assessment and continued adoption of AI, but we can't be just looking at that. I mean, it's coming from all directions across the organization.

Yeah, there's so much to consider here. And you hit on a lot of the topics AI governance, transparency quality and making sure that it's, I mean, I love the approach.

One of the things I'm trying to socialize is when I like simple definitions and when somebody AI? I say it's, it's an algorithm that gets smarter with more data and more transactions. And so as transactions, as data washes over it, it gets better and better as it goes.

If it's just an algorithm, it's just going to keep running that same algorithm over and over again. But if it's AI. It actually adapts and learns and says, Oh, the last three times I told you that this was a, a cancerous spot on the lung and you overrode me as a human, you overrode me and told me it was, Hey, the fourth time it looks at it and it goes.

This looks like an awful lot like the last three, and I'm now going to, I now recognize that is this and so those I think AI is a learning mechanism, it's a learning set of code as opposed to just algorithms. I

think that's right. I will tell you, I was a skeptic. For a very long time, and it's just in the last few months that it feels like, okay, there's something here.

We need to pay attention to.

Yeah I mean, a lot of my members of my team have come to me and said, Hey, it is in every area, by the way. I mean, AI is being applied to graphic design. My graphic designer came to me and showed me all these really cool things you can do with AI In the new Adobe suite and whatnot.

I'm like, wow that's a, they could take a picture and there's no data on what's on the right or left. And they can expand the picture to the right or left and it's like 99% accurate. And you're like, that's amazing anyway, it is eerie. And it is, it does it. And I understand your skepticism as well.

Cause what's the old adage? Nothing can screw things up quite like a computer can over time. I mean, it's just it's doing a lot of transactions in a very short period of time. I do want to talk to you about some of the clinician staff constraints.

Some of the. Some of the challenges we had coming through the pandemic. What are some of the ways that technology or the I. T. team is supporting our clinicians moving forward to maybe decrease the burden of the cognitive load that the administrative burden and those kinds of things.

So there's, I guess, a couple examples I would share with you.

The 1st is something. To support the nurses. So as as there are fewer nurses in supply, and we're going to have younger nurses coming in, less experienced nurses, we want to be able to provide a support network for those folks. And one of our ideas that we're exploring right now is something similar to the virtual ICU, but for nursing and sort of a nursing support center where what we're expecting to happen because of the way that nursing, because of where nurses come into the organization when they're sort of fresh out of college, many of them are working the night shift. There aren't a lot of other people around they need to be able to have that support. So, our idea is that we'll have this nursing resource center where they can ask virtual questions, or we can have an answer to combine that with.

But if you were a few folks that could rotate around the organization and maybe even look at what's going on in a particular unit. So, for example, we did an analysis and we learned that, this particular unit was struggling with updating vitals, getting the updated vitals in, in, and the time cadence that they should be.

So we're able to look at those dashboards right now and sort of say, okay, we know we need to go help nurse Jones or we need to go help. Nurse Jeffrey's that they're having they're having a difficult time. So, so having those dashboards helps us identify where those where folks need help so that we can apply sort of a limited resource pool to helping those folks do the things that they need to.

And then that sort of after hours support for the new nurses, I think is a benefit as well. The other thing we're doing is we have Okay. More broadly across the organization, and this is largely focused on physicians right now, but we're also exploring how we can do this for other care providers.

We have what we call wellness sprints. We just initiated a program. We did a pilot the last 18 months, and we got funding to roll this out across the organization so that we'll go to all the units across the organization where we have our clinical informatics team goes shoulder to shoulder and shadows shadows, physicians and clinics and says, okay, show me how you're doing.

Show me how you're doing the work. And we help them with an optimization going clinic by clinic. We have Jeff Gold is one of our researchers in this space who we've employed on this project. And he's using software that also helps we can send them to I would say sort of study portal so we can see where they're looking, it evaluates their eye movements so we can see where they're going in the chart to get information and then help them say okay you know there's a more streamlined approach to do this, how, and then give them that personalized training that they need.

In order to streamline their workforce. And sometimes it could result in, personalization that would be appropriate for that particular position. So there's a large effort a couple of million dollars a year that we're spending to help improve our hope is that helps lessen the burden for providers.

So they aren't, doing pajama notes so that they can get all that work done while they're on site, as opposed to so much work that they're now doing after hours.

Yeah, I think the more and more I talk to people outside of healthcare. And they're trying to understand, what is this clinician burnout about?

Why can't I get an appointment for, six weeks and that kind of stuff? It's like, look there's burnout. There's not enough of these people. And and they say, well, explain it to me. I'm like, well. Imagine if you had to go throughout your day and everyone you came in contact with, and by the way, you have 25 appointments today or 15 appointments today and everybody you came in contact with, you had to document everything you said to them, everything you recommended to them, everything you, whatever, every single one of those appointments.

They just looked at me like doctors have to do that. I'm like. Absolutely. And you know what? The next person you see might not be them. They have to be able to read that note. It has to make sense. And it has to continue care in a high quality way. Yep. And they have

to look at the record before you walk in the door.

So they know, what the situation is.

Yeah it's I, I think people are starting to gather the challenge that we have in front of us. We're getting close to the end of our time. So how about this as a closing question? We talked about AI. I'm gonna ask you, is there a technology you're keeping an eye on that you believe will have an impact on health care over the next five years that that you're sort of looking at today?

I mean, clearly AI falls into that category. It's, it seems like it's emerging. I still caution people still feels like it's on the front end of what AI is going to do. And there's still. We don't have enough studies and those kinds of things out there. Is there another technology you're keeping an eye on?

I actually think that's where my interest is right now. I, in my career, I feel like I've gone through these waves where, different things are of interest to me. The last big spike was, cyber security. I'm still very interested in that and try to learn about that and optimize our cyber environment.

But this feels like the next thing that's really very interesting to me. And I don't know how it's going to evolve. And I'm actually looking forward to the governance program that we're putting in place so I can, again, use it as a learning tool. To figure out how we can apply that and where we might partner with others.

I think is the other question, because everybody that comes in the door, wants to talk about ML or AI or whatever they can offer us and some of it's real and figuring out what's real and what kind of investment we need to make to partner with others is going to be the challenge.

Yeah, I would love to see the AI model in at Stanford inform the AI model at O H S U, inform the AI right model at unc, inform, yeah. And healthcare get better as a community across the, well, across the world, quite frankly. I think it would be really interesting. Bridget, I wanna thank you.

I wanna thank you for your time. I wanna thank you for sharing your experience with the community. It's greatly appreciated.

It was lovely to talk to you as always. Thank you for the opportunity.

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