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Today on This Week Health.

the eventuality is we're going to have interoperability between language models. So although I'm dealing with one that's very healthcare specific, if I need something from another, I can pull that from, but it's really important that we understand that this is adjunctive to our practice. This is helping us. This is not replacing us. This is making us better, putting more information at our hands

Welcome to Newsday A this week Health Newsroom Show. My name is Bill Russell. I'm a former C I O 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 Newsday show partners and we have a lot of 'em this year, which I am really excited about. Cedar Sinai Accelerator. Clearsense, CrowdStrike,. Digital scientists, Optimum Healthcare IT, Pure Storage, SureTest, Tausight,, Lumeon and VMware. We appreciate them investing in our mission to develop the next generation of health leaders.

Now onto the show.

   (Main) All right. It's Newsday, and today we are joined by Charles Boicey. The Charles I always get your title wrong, but innovation,

yeah, just call me the Chief Innovation Officer,

innovation Guy over at Clearsense. And, people may not know this, but you and I go back a long way.

You were at UCI the first time I met you, and you were essentially doing all this incredible stuff with data. That then became, you fine tuned that, went over to Stony Brook, did some stuff over there. And then eventually, somebody grabbed you and ClearSense was birthed out of all of that that history of working with data in very distinct ways, and you guys now do some really cool stuff.

And with that, you travel the world. And I catch you you're in Southern California now. You've been in the UK, you've been in Ireland, you've been in India. That's where you've been. What's going on around the world with regard to health IT and health technology? I mean, why are you visiting those spaces?

Sure. So one we shouldn't feel bad. Everybody's in the same spot. They're not advancing anywhere any quicker than we are, so that's that's either a good thing or a bad thing depending on your perspective and whatnot, but especially those environments where there's only one health care plan, it's a government based basically socialized medicine and whatnot.

Again, just like us, all the best intentions in the world, but the the implementations and the follow through is slow, just like us. I will say, though, that in India, because of the the nature of less regulation, we're able to move quite a bit faster. So, new innovations are able to, come into practice.

And the really great thing that I like about, working in India is that the major technical universities are, All behind healthcare. So, a lot of innovation is happening and then it's being pushed out. But they're doing things a little bit differently, Bill. They're looking at it from a personal health record perspective as opposed to a full blown EMR implementation.

So, the patient is going to be in charge of their medical record. You may go to an organization, there is no Electronic records, so you'll scan the record, it'll go into a repository, and then by permission, it will allow others to view it and whatnot. So, that's a little bit different approach, but but yeah, no difference in us.

Trying to innovate.

That could be, we've been talking about, and I think you and I have been talking about this model, the personal health record being the locus of data interoperability, because it just, all the data just keeps coming back to me. I carry it. Because I'm at the point of care everywhere I go.

So India could become the test bed at scale for this model.

Well, you think about it, there's no way in hell that they're going to you can have a wide rollout of an EMR, right? It's just not going to happen from an economic perspective, but they have the best, 5G network in the planet.

Everyone has a smartphone. Regardless of where you are on the economic scale. So, why not? If you get a paper record, why not just scan it and, send it up? From a clinical perspective, yeah, maybe you have to scroll through some PDFs and whatnot, but at least the information is there to treat, and you're not starting from scratch, each time.

So, I think it's going to be interesting to see how well they do.

Why the UK? What are you looking at in the UK and Ireland?

Well, Northern Ireland from a perspective of innovation and technology they have an excellent program for, us technologists to utilize both their resources as well as office space and whatnot.

So, and again, Bill, they're five hours ahead of us. They're five and a half hours behind India, so it's a good place for healthcare technology to have, like product development and so forth. So it works both ways. Yeah. It makes perfect.

Yeah. And on the n h A side, the the various trust and whatnot are they are innovating and they are putting things into practice. So, pretty much everyone's, on par and whatnot.

the first story I wanted to cover with you, I saved stories for you and because you were practicing clinician, practicing nurse in L. A. And the first article is violence against health care workers is rising. How can we protect them? And I would imagine in your environment, that was a pretty high risk environment that you worked in. I was curious your thoughts on that. Thank you. First of all, the fact that violence against healthcare workers is rising, and, what do you see us doing, and what do you think we could be doing better?

Yeah, Bill, you just gave me goosebumps with that, and I didn't know that you were going to bring that one up. February 10th, 1993 I was at L. A. County. I actually left The trauma environment to go into the cafeteria and a gentleman came in and shot three of our physicians. I ended up in that cafeteria environment for several hours, as you might guess.

That wasn't the first time that I ever experienced, violence and this was a. A patient that was upset that they had to wait three hours for pain medication. Prior to that, a year prior to that, we had a nurse stabbed in the neck with, a pair of scissors by a patient.

I know nurses that have been, had their arms broken by patients and so forth. What did we do after that? We did a complete lockdown that, is still there, with full on metal detectors, the appropriate, Guards, if you will. Not really the fight you really want, but again, this was LA County, the county trauma, unit and whatnot.

But this is something that's been ongoing. You had a physician Texas shot, just this year. I'm not exactly sure what the answer is, but if you talk to the nursing unions, And others, again very strict measures, no different than getting on an airplane, we need to, check people in, check people out.

So We have technology. I mean, the minute that there's an issue, we have some sort of communicator device that's communicating back, identify and we have some protective measures to make sure that this stuff's not getting in. I assume we're going to. cut down significantly on gun violence and stabbings and that kind of stuff in the ED.

And it's not only here. I mean, you're seeing it on planes. You see those stories on social media that, you know, person subdued by five passengers. And you're like, what's going on? Like, what is leading people to the point where they're just, they're snapping. On the people who are trying to get them from one location to another or help them or physically help them to get better.

And actually I may not want to go down that path because this is more about the intersection of technology and healthcare. And I guess the question is what, we have metal detectors, we have those kinds of things. We have like vocera badges and that kind of stuff where we can call a situation in and go to lockdown.

We practice those lockdowns and those kinds of things. I am worried about though, that physician that's seeing a patient and the patient goes. Because you need close physical contact to people to care for them.

Yeah, I think Bill, you have to bring in a behavioral cognitive psychologist to properly answer that one, but it is escalating, I travel, I see it all the time and I don't have a good answer for that.

But that's going to be something that's going to take a long time to correct. But in the meantime, we just, like you said, have to put as many protective measures as we can in place.

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I want to talk to you about generative AI because I love talking you and you've been traveling around the country, around the world.

And we see a lot of promise for generative AI. I read an article this morning put out by Stanford, a bunch of people at Stanford including Mike Pfeffer. That said these models, even though they can pass medical exams. aren't trained with medical data. And we may want to switch our thinking a little bit to say because we've allowed technology to sort of come into healthcare and we then try to figure out how to adapt healthcare to the technology.

And we may want to start training models, these large language models, specifically on clinical data, on health record data, and that kind of stuff because generally a large language model is just guessing the next word. And it depends on what you've trained it on, what it's going to guess or what it's going to put in that space.

And the theory is, if you train it more on the medical record data and the specific medical data, it is going to be more accurate. as it pulls that medication out of the record or it pulls some diagnosis out of the record, those kinds of things. are you hearing as you travel the world and what are your thoughts

on making these models, they're already relevant for healthcare, but more relevant for healthcare.

Sure, so, a couple of things. When you said generative AI, I was going to do this, okay? Here's my concern. One, generative AI is not all encompassing of machine learning and AI. In healthcare, we've latched on to this and it's, I think it's really important and it's really a point that I want to get across that generative AI is not the end all be all for machine learning and AI.

There's a bunch of other technologies around this. There's, predictive type, models. There's a whole bunch of different ways that we're, using AI machine learning. And I just want to make sure that folks don't lose the focus that generative AI is the end all be all.

I think that's fair to say, wouldn't you say, Bill? Oh, no,

absolutely. I mean, you... It's got the

focus. It's got the focus. Yeah.

Yeah. I mean, you and I, back in 2015, 2016, we were working on AI models that weren't generative AI models, but they were AI models that Learning predictive models based on the data that we had.

Now, that being said we've all been interacting with CHAT GTP which is an all encompassing large language model, right? It's everything. And really, it was put out in the public not to train the model. But to train us and to learn more about us. And I kid you not, Bill it's interesting that we've got people in organizations, you know, even in healthcare technology organizations that are putting all their trade secrets into chat GTP to summarize their offerings to, for marketing and so forth.

Yet they've just contributed. That which they probably shouldn't have to that language model. We also got, folks that are doing development and whatnot, putting IP code into a large language model, looking for efficiencies and whatnot. That's probably not the best use of it. So I just want to put that caution because I'm seeing a lot of that, what we put in.

to these large language models, then becomes part of that large language model. So it's really important that we do understand that we're not putting, proprietary information, PHI, and all that good stuff.

There's an article in here, the data driven hospital and the inevitability of AI.

So meaningful use, we all digitize the medical record to some degree. We end up with a mess of data. I mean, you know better than I do. I mean, just a mess of data and the core of this article, again, the data driven hospital and the inevitability of AI. In fact the strategy that we put together at St.

Joe's back in the day that I brought you in to help to educate our executive team on what's called the data driven healthcare, data driven hospital. And the theory was, we've digitized all this data, we have this ton of data, and it's going to revolutionize healthcare.

But it's still pretty messy, and there's a belief that AI is somehow going to be able to alleviate that mess. Is that an accurate assessment?

Yeah, that's, yeah, that's still accurate, Bill, and going back to your previous question Democratic, have put together LLM for for healthcare specifically, and that's the direction that we need to go. We don't need to necessarily participate in OpenAI's, large encompassing model, but from a Language model perspective one specific to healthcare, and then what you're going to see at some time, it's going to eventuality, the eventuality is we're going to have interoperability between language models.

So although I'm dealing with one that's very healthcare specific, if I need something from another, I can pull that from, determinants of health, language model that we could bring in that information that's specific to you and then, for further treatment and whatnot. So, This is absolutely, but it's really important that we understand that this is adjunctive to our practice.

This is helping us. This is not replacing us. This is making us better, putting more information at our hands. And then the eventuality bill, we talk about this all the time. We don't provide sick care. At some point in time, we'll provide healthcare. These these generative AI applications and so forth done properly with the proper requisite information behind them will help guide ourselves and our patients from a health perspective, through their day to day, week by week, month by month.

And that's where I really see this working out really well. And then just from an information perspective Hey, I need to see a certain physician, a certain specialty. I need to where's the closest, all that kind of, chatbot type stuff that we're doing now, where we actually curate the responses.

These large language models actually will generate those responses and whatnot. Are we there 100%? No, but we will be at some point in time.

It's interesting to me. that we have so much data to work with at this point. I think what I would like to have more than anything in healthcare is, we have these command centers that are going up. And why do we have command centers? Well, the command centers are to try to alleviate the flow of the patient throughout the system from intake all the way through, rehab and health.

As you say, we're sick care more than healthcare. But I think about the inefficiencies that exist in that model. People are all worried about the clinical data going in and all this other stuff. I think there's a whole bunch of operational data that can go in. And I'd like to be able to ask the model, where are the bottlenecks in from our ED to here?

Where are the bottlenecks in our imaging? I would like it to identify, hey, you know what, we have our imaging centers in the wrong place. We should put a new one here. We should do these kinds of things. I think there's a whole operational model. that can be built around AI that would make us so much more efficient.

And to be honest with you, when we talk about patient experience, a lot of times we go down to, Oh, what are we going to do on the phone? And the reality is the back end operation is so broken that it doesn't matter what you do on the phone. If we could really fine tune that, that command center, that flow of patient throughout the thing, I, and I think that information, first of all, I don't think there's as much risk to building out those kinds of AI models.

and looking at the flow of patients. And I think there would be incredible value if you can have a model that drops in, collects information, and then you could start asking it about the different aspects of the operation. And if you could do that at scale, across all of healthcare, I think you could really make a dent in not only the cost, but also the experience.

So, the back end technology is around graph technology and whatnot. And we actually did this, CI and, Stony Brook as well, where I call them colleague aware applications. So at any particular time, let's say a nurse has given a medication they haven't given before, yes, they're given some information about it, but they're also made aware of colleagues, other nurses in the facility , that have given that medication many times so they can reach out.

Same thing when a PGY1 is working up a patient that is not, basically in their history, in their experience level, they can reach out to somebody that has had the requisite experience. So, yes, that data can be used for that operationally. Hey, Let's start diverting people from the labs, lab over to radiology because things are getting hung up from a blood draw perspective.

And then from a, just from a pure operational, we realized that the pediatric population in Long Island was such that the clinic that we were going to put We shouldn't put it where we should, where we're going to put it. We put it in this other area where there's more pediatric, patients and whatnot.

So, so yes, those are extremely good use cases for for this type of technology in healthcare. M& A activity. Phenomenal technology for M& A activity. If the acquiring organization is willing to relinquish that data, you can really make some excellent decisions on whether you really should pick them up or not, what you should take, what you shouldn't.

Interesting. Well, you brought it up and I'm going to close with it again because I like to stick with the technology with you as much as possible. Cleveland Clinic went with a private 5G over Wi Fi for its newest hospital. Okay. You talked about 5G in India, fantastic 5G network. We have, I don't know, half built 5G network throughout the United States and it's the same way every other.

Wireless technology has grown over the years, it grows in the major metros, then it grows out from there until it covers the entire country. What's the future of 5G as you look at this, by the way, if people want to see this, there's a Becker's article on a Cleveland Clinic goes to 5G over, over wifi, and they're looking for partners who are going to utilize that the 5G network and, innovate, it's a smaller hospital.

So their thought is, let's see what happens here. And we'll take it elsewhere. What are your thoughts on five G?

Yeah, bill. So I was involved with I, at U C I with the folks at U C S D, which did a lot of pioneering work in putting together the requisite organizations to, promote five G and this goes back quite some time.

So what's important for everyone to understand about five G is the bandwidth is quite wide, and that's really important for us. As well as the prioritization you can prioritize, traffic. Medical traffic over other traffic. So, what I think about is as we're going more and more into the home environment, 5G is the ideal, mechanism for that.

So at some point in time, we'll have diagnostic, ultrasound equipment and whatnot that, you basically can carry from a suitcase. Utilize, not from a diagnostic perspective, that can be done, at the edge, but from a actual doing the diagnostic work in the home and whatnot, absolutely 5G as well as the telemonitoring and so forth, but inside the hospital security.

And again, a bandwidth and prioritization and from a hacking and everything else, you've got a much, much more controlled environment, but that environment, they didn't, create that environment, the vendor brought that environment in for that. But yeah, 5G is, really will help us bring the, healthcare to the home and

everywhere else.

Yeah, because if people don't know this Wi Fi across the internet, there's no deterministic aspect of that. You cannot prioritize certain, I mean, you, no, you, you can't, quite frankly. I mean, because we've tried, I mean, we've tried everything we could to prioritize it. And so, therefore, the...

The kid playing a game and the the monitor, they're getting the same priority of getting across that network.

That's

correct. Absolutely correct.

Yeah, so 5G, so you're saying 5G I mean, you talked about more deterministic, we can prioritize, but you also talked about security. You said more secure.

Now, why would you say more secure?

Well, think about how from a Wi Fi perspective, the different technologies and the folks out there that know each technology it's a little bit the narrow, it's a narrow band for five G, and if you dig really deep into five G, there's a lot less opportunity to really get into it.

Yeah,

no, it's interesting. Do you envision more hospitals partnering with one of the major players bring in five G to, I mean, this is five G over wifi. It's interesting that they're doing that, so they must be encapsulating or something across that wifi network.

Yeah,

I see that, Bill, but I really see the opportunity to use, utilize 5G to to get, sophisticated equipment monitoring equipment, as well as diagnostic equipment into the home.

Well, Charles, thank you for, taking time in between your world travels. In fact, you haven't been home, I mean, you haven't been home in so long, it's it's been wild, but this is the time of year that you usually travel. And then will we see you at some of the conferences in the fall?

Oh,

absolutely. I'll be there. Yeah, I'll be at himss whatever incarnation. It takes this next year.

Yeah, well, you saw they sold it off. Yeah,

it'll be interesting to see. That's going to be a fun one to watch, Bill, because we all my first SIEMS was 1994, and I think there was like 350 people, something like that.

So, it'll be interesting to see what transpires.

350 people at HIMSS?

Something like that. 350 to 500, somewhere in there. And it was all financial people. The clinical people were really the odd people out. And HIMSS was well represented.

I don't know. I mean, do you anticipate much change? I mean, they sold it off. Do you anticipate much change in in the overall structure of the conference?

Not the first year, but we'll see. The group that picked them up that's what they do. So I think you'll see more of some Vive esque

features, maybe.

Yeah, if they had contacted you and I, we could have put a bid together, but they did not contact us, so. No, they did not. We'll have to see what happens. Charles, thanks again for your time. Really appreciate it. Alright. Thanks,

Bill.

And that is the news. If I were a CIO today, I think what I would do is I'd have every team member listening to a show just like this one, and trying to have conversations with them after the show about what they've learned.

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