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Today on This Week Health.

whether or not I'm going to a retail organization in c v s and they recognize that I need to go see a specialist, who are they recommending me to and why? And how does AI come to determine that?  (Intro) 📍

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. Clear sense crowd strike. Digital scientists, optimum Healthcare it, pure Storage Shore Test, Tao Site, Lumion and VMware. We appreciate them investing in our mission to develop the next generation of health leaders.

Now onto the show.

all right. It's Newsday and today we're joined by Cameron Lewellen, director of Healthcare, ISVs and Alliance Partners at VMware.

Cameron, welcome back to the show.

Hey, bill. Great to be back.

Have we ever done a news day show together? I know we've done some other stuff.

Nope. This is the first time when we've kind of done current events. I'm looking forward to it.

Yeah, this should be interesting. There's a bunch of current events.

Let me get over here to my browser. There's just a lot of stuff going on. Clearly we're gonna talk generative AI cuz it's top of mind of what's going on. Sure. I wanna talk to you about Epic. So, epic announced some things at the HIMSS conference, integrating with nuance.

And integrating with G P T four. And now they're announcing integration with Suki Voice assistant into the ehr. Let me give you a little idea. Two paragraphs here. Suki recently announced one of its biggest partnerships to date. It is integrating its voice assistant into Epic's ehr, the startups assistant can be thought of as Apple, Siri, or Amazon Alexa for doctors.

By calling out Suki assistant, the physician can quickly assess information about their patient, ranging from medications to vital signs, to allergies, to surgical histories. They can also ask Suki to do things like, Dictate clinical notes, pull up their weekly schedule and help with ICD 10 coding.

Suki also recently announced that its assistant can generate clinical notes from Ambiently listening to a conversation between a physician and their patient. These notes are automatically sent back to the patient's EHR so that relevant sections can be updated. I guess it doesn't surprise me that these tools are coming out and that we're integrating these tools in.

What surprises me is that it's epic. I mean, epic gets a knock and I know you have to be careful here cause VMware's a partner with Epic as well, but they generally get a knock for not partnering. Like they don't do these kinds of, this is like more announcements than I remember in a long time of them saying, Hey, we're going to partner in these areas.

Do you think this represents a shift for them?

I do. Right. But I think it's two things. On the one hand most people that are familiar with Epic know that. If you're an Epic employee, you live in Verona. Right? Right. There, there's a bit of a culture there that historically did not need partnerships, but as the landscape has changed, this is an example of where Epic is realizing that they can actually improve the outcomes of clinicians and providers.

And I think that they've been more sensitive post pandemic or mid pandemic or whatever you feel like we are at about making sure that they listen to what providers are asking for. The other part is that I. I've been also reading about how aggressively they're looking at the global market, and I think they're starting to think about how they would be able to do that, considering how centralized they are.

And I just don't see how it happens without really opening up the partnership ecosystem.

Yeah I, I agree with you. I think to a certain extent they've done well by developing everything themselves. The world is moving really fast right now, and I didn't see Epic coming out with their own large language model.

I didn't see them coming out with their own. Right. Their own voice assistant, and I mean, they do have a voice assistant, but really taking it to the next level. I mean, you're almost talking about developing 5, 10, 15, 20 different kinds of software. Now it gets very in Judy's words, it is rocket science.

I mean, you really gets complicated to develop all these things. And they're focusing on the things that they do Well, I like the model. I'm surprised it took so long for them to adopt this kind of model.

Well, let's be honest they're a victim of their own success in some ways too.

Right? So one of the things that I have found to be very interesting is what they learned in trying to consider the move from hyperspace to hyperdrive, right? It was a situation where I'm old enough to remember Coke and New Coke. Right, right. Yes. But when they decided to come out with Hyperdrive, they realized they couldn't change that much in terms of the the interface, the ways that things were working.

And so as a result, I now see some of these partnerships as a way of being able to enable a functionality that they weren't gonna be able to do when they initially started thinking about

Hyperdrive.

Yeah. And I like the partnership model too, because you can partner really closely with an organization and.

You can co-develop. You can essentially say, look, this is what our customers are asking for. Is this something that you can do? You can find the right partner. That is going to be responsive to your customer's needs as well. And, it's complimentary technology. VMware being an example of that with with them.

I'm gonna keep talking about chat, G p T and generative ai. And I know I run the risk of every episode having some aspect of this in it. But I also had four CIO conversations this week, and the word generative AI came up in all four of them. So it is top of mind as long as it remains top of mind.

I think it's safe to talk about it. So, Bertalan Mesko, md, PhD director of the Medical Futurist Institute. He has a newsletter. He posts every day on LinkedIn and worth following, by the way. I follow him because he tends to do, he's more research-esk, so he will bring things together.

For me on a specific topic, he is very focused on generative AI right now. The medical futurist created an infographic and they have 15, 16, 16 companies. That have integrated chat G P T, and he does make a note. He goes, probably by the time you're reading this, another three or four companies have integrated it.

But he has nuanced communications and medical note taking. Nala transcribes video conversations, em prepares referrals and authorization be my eyes connects. Blind people incited volunteers chat beacon support through emotional assistance, bionic health, preventative health management. Firma AI provides answers to life science questions.

Medi match, med Match Network connects physicians and patients live wello genetic data analysis. Epic Electronic medical record lightly. Fasting app for weight loss dot compliance, quality management solution. Cahoon a clinical reasoning tool. Wonder Precise Fitness Content Services aim a amazed fit. Health management, wearables and.

Am Moya Med Private Hospital is a private hospital, and so what's interesting to me about this is you have some billion dollar big companies that are saying, Hey, you know what? Let's get ahead of this. Let's integrate this in. And then you have gosh, you have just flat out startups that are coming into the space and integrating chat G P T into their in, in, into their model.

I guess, my question for this is as I think about chat G P t I'm convinced it's going to continue to make inroads. What are the biggest challenges or barriers to implementing. Generative AI in a healthcare application, do you think, I mean, you work with a lot of ISVs. Sure.

We're probably looking at it right now and saying, is this something that could add value to us? Are there barriers or challenges in, in integrating

it?

I think one obviously is understanding the difference between AI and generative ai. Right? My aunt is blind and as a result of growing up with her, there are a lot of these technologies that represent really meaningful ways to make her.

A right. Able to do some of the things that, that she's never been done able to do before. And when I think about implementing generative ai, one of the questions that I always wanna know is budget. You're right. Have you really considered what it's going to take? What are we trying to solve? Is it a really big problem?

I think with a lot of the larger organizations that you named, They are looking at this in a much wider way. It's a much bigger aperture. I thought you were going to actually mention that Chat GPT just announced I think 16 plug-ins that they've got. Right? So one of the things that went viral on Twitter was a guy that used ChatGPT to create essentially what was going to be his meal list for the week, and it ordered it.

And it got everything right. It stayed in budget. And so, some of these other meal kit organizations, are they now at risk? Well put that within a he a healthcare context, right? If now I can have that sort of conversation with the healthcare organization, then we can get versions of personalized medicine that I think are real.

But going back to your original question the adoption, the integration, we are still at a very nuanced point. Where it feels like unless you are being prescriptive thinking about this with a scalpel as opposed to a sledgehammer, that you're gonna have a lot of organizations that are gonna say, yeah, we want to do something.

We're just not really sure what

We'll get back to our show in just a minute. I am excited about our webinars this year. They have been going very well. What I've done is I've gone out and talked to people in the community and said, what works in webinars?

And they came back and said, look, this is what we want. We want a webinar that is not product centric. It's really focused in on the problems of health care. And we want people on there that are actually solving those problems. And so we have done that. And the response has been fantastic this year. We have another webinar coming up.

It is the future of care spaces. Where care is being delivered is changing rapidly. Even the care spaces within the hospital themselves are changing. Technology is being added in different types of technology. A. I obviously computer vision and whatnot is changing that modality as well as what's going on in the home and whatnot.

So we're gonna have that webinar June 8th at one p. m. Easter time. We usually have it on the first Thursday. Happens to be a little too close to my anniversary. So we're going to do June 8th at 1 p. m. Eastern time future of care spaces. We would love to have you be a part of it. If you are interested in being there, go ahead and hit our website.

Top right hand corner. We have a card. You can click on that card and go ahead and fill out the form and get registered today. We would love to have you join us we look forward to seeing you there. Now back to our show.

Yeah.

It's interesting. So I have the $20 a month paid G p t four access, and it now has a new control panel and it has plugins. It also has a settings. Down here and the settings has beta features. Well, the two beta features that showed up today, one was plugin and the other was web browsing.

Right, right. Version of chat PT that knows when and how to browse the internet and answer questions about recent topics in events.

That's right. There's a

Chrome extension. It should be a chrome extension there. Yep.

Yeah, so that's interesting in and of itself. So now you have, plugins.

So I'm gonna go to the plugin store. I'll give you some of the ideas of what's out there. E dx find courses and content leading universities.

Notable, which is a great notebooks in Python, SQL, and markdown to explore data and visualize. Likewise Vox script, shimmer nutrition, world news trip.com, Redfin. And by the way, there's a million of these. Let me tell you the most popular ones and people could think about how this will integrate. Number one is Zapier.

Right. If you're not familiar with Zapier and you're familiar with Zapier, but if you're not familiar with it, it's a way that we integrate all these various internet applications. So if they have an api, Zapier typically taps into that and it's sort of like an if then it is I F T T. Or was before Zapier is now you have a trigger and then you have events and actions you can actually do from that trigger kayak.

So search flights, rental cars, hotels. I saw that. Yep. Open table. That's what we're ordering.

Yep. Yeah,

so you integrate it and then you just go into chat g p T and say, is there a table available in, wherever you happen to be speak, learn how to say anything in another language with speak your AI powered language tutor.

And that's interesting. Expedia, obviously, world of information, Wolfram access to computation and math, curated knowledge. And then fiscal note. Yeah, I mean, these are major upgrades you used to have to go to auto G P T, which is separate. It's essentially open source code that you can get and you can load up auto G P T in order for it to read websites and then spawn other things.

But it's a different application altogether. In order to have it read the web, it looks like now we're gonna be able to do that. I have not tested this yet. I do have it enabled, but I haven't tested this. That really does change things a little bit, what do you think you might do?

Have you even played with G P T four yet?

So I've been on G P T three, since November, haven't got on the newest version yet. But honestly, everything that I'm, I've been doing with Cha G P T three has been enough. Right? Like, I haven't needed to go to four yet.

Yeah, three, 3.5 is pretty well, I mean, when it came out it was incredibly revolutionary.

The crazy thing to. Believe is we went from 3.5, which everyone was going, oh my gosh, this thing's amazing to four like overnight and you're talking three. Yeah, 3.5 had billions in, in, it was trained on essentially I think it was one 175 billion parameters. There it is.

And g PT four was trained on trillions of parameters. So G p t four has the ability to string some things together that three could not. Now you have plugins, now you can read the internet, you can do prompts like I, I would assume you could do prompts like, Hey go out to these four or five websites and give me the most relevant healthcare IT news articles.

Right? For sure. Yeah. So as we're preparing for this conversation, I could have done that, pulled those in and away we go. It's really interesting. If you were a cio, I'm gonna now mint you, you're now a CIO for a health system. How do you. I don't know. How do you introduce your organization to this?

I mean, I'm sure there's a whole bunch already using it. A hundred million people have adopted it already, but how do you prepare your IT organization? How do you. Lead them into this? What are your thoughts on that?

Well, first, the standards in control, right? I wanna make sure that if we're using a version that's got things on the internet, we just need to be aware of what kind of security protocols might need to be in place.

Then next, right? When we start talking to individual users, understanding that they are not necessarily based in it, the question becomes, what kinds of things would make your job better? And I don't even know that it's a chat G b T question sometimes, because again, we now see an entire burgeoning field of people that are prompt engineers who know how to form a question in order to get the answers.

And so if I were a cio I would obviously be thinking about going to my heads of department, thinking about my chief nursing officer for sure. But then there's other questions as well that come out in annual reports that we're not thinking of. We're places where fraud, waste and abuse could be reduced if we were looking at using AI and not necessarily chat g p t, but the questions that I would ask would be initially related there, and then after that we actually need to go and we need to train people how to use the system.

Right. In the same way that when we started to see the burgeoning group of people that understood search engine optimization, right? There is a way to optimize your prompts and to ask questions in a way that give you the most relevant information so you don't have to go through iterations. Where I see Chad g, pt, and this is just Cameron speaking personally it's going to possibly have the same effect on productivity.

That the internet had for information access, whereas now you can go to this one source that everyone is used to doing and trying to find information, but not just information on a particular subject, but to your previous point, you could actually correlate information and if it was just you or I doing it would've to go through those five websites.

But now the acceleration on productivity is going to receive that same kind of magnitude jump only because now you're going to be able to do it. Without looking at all the other sources without necessarily thinking about the same sort of workflows. I think that's huge.

Yeah. It's interesting.

There's so much hype about the large language models. We forget that we've been using AI in healthcare for quite a number of years, especially in the imaging space. We've been utilizing it and we continue to make advances there, and there's whole hosts of areas. Where you can apply AI within healthcare, not just on the diagnostic side.

Cause we're a little slow to adopt it on the diagnostic side for obvious reasons. Sure. We don't want to cause any harm. But on the on the administrative side you have areas such as such as revenue cycle. You have areas such as it, I mean, let's just take it for example, one of the things we hear all the time is we can't process all the alerts that we get from cybersecurity and I can envision AI rapidly going through all of those.

And essentially kicking off some automated process. I mean, the easiest one of which is, kick into ServiceNow, create a service ticket, assign that ticket, and where you go that automation shouldn't be all that hard to put together. And then you can even, depending on your testing and your approach and whatever, you can even kick off some remediation based on the type of ticket and what's going on.

And I think we are gonna see a significant. Productivity gain within healthcare. And it'll be interesting to see how we approach that productivity gain. And this is one of those areas where I think as leaders it's really important to get in front of this. It's really important to think through.

What are the training implications? What are the HR implications? What are the staffing implications around certain things? When it all of a sudden your staff gets 20 or 30% more productive, where does that lead you? Where do you go with that? And I think that'll be interesting. Hey, let me give you the out question.

The out question is by the time this airs, so people give us a little grace here. We don't know what's gonna happen yet. But the Apple Worldwide Developer Conference will be going on. I don't know how closely you follow that. Are you an Apple person or are you an Android person?

I'm actually a Android guy. I, the only Apple I've used is in a prior life as a dj.

A dj. Well, there's man, I thought this was gonna be an ex exit question on what do you expected that. Worldwide developer conference, but you know, how have things changed in terms of being a dj? Just outta curiosity.

Well, if you recall older music that we all know and love being six and seven minutes long, your average song now that really is getting popular when, say like TikTok is like two minutes. Two minutes. So when I started DJing I probably, let's say say 50 songs a night, something like that.

And then when I finished DJing 200, In a night because of how quickly you're coming in and out of things. But I want, I will circle back really quick if you don't mind, to something that you said cuz I didn't get a chance to just say on the diagnostic support side. Yeah. One of the places that I think AI has got this huge opportunity is to obviously make Care Pathways.

Streamlined, right? When we see retail organizations entering in to, to the care provider network how does a doctor decide really where the next sort of reference point should be? If I start thinking about social determinants of health, I start thinking about access. I know some initiatives that are going on in Memphis Memphis and Michigan, and about giving cell phones to underserved populations.

All of a sudden now I get this web. Of Care Pathways that they're kind of new, whether or not I'm going to a retail organization in c v s and they recognize that I need to go see a specialist, who are they recommending me to and why? And how does AI come to determine that?

Wow. And then past that, how do we track that in a meaningful way so that I can go back to you as the payer, the insurer and say, Hey, you've got the best value out of that integration. Right. That's a big point. Yeah. But I, we didn't really go down,

Well, I think the other interesting thing to consider is you have things like Hippocratic, which is funded by General Catalysts and Andreessen Horowitz, and they're going directly to consumer with a essentially a large language model that has been taken to med school that people can ask and interact with.

Questions. When you think about that has the ability to really disrupt the referral cycle, correct. Correct. So now you could have hippocratic actually making referrals to, different programs, different doctors and that kind of stuff. And they're not the only ones going down this path.

I've consulted with a company that has a large language model that's doing the same thing going directly to consumers. And now you have, all right. As a health system, should I be thinking about. Having a model, having a large language model that represents me to the community. So you're going to, you're gonna, I used to work for St.

Joe's, so you're gonna interact with the St. Joe's large language model. We maintain our referral patterns and we're still offering that level of high quality advice and potentially. Better advice because we're connect. We live in your world. We're connected to your world. We can That's right.

Do those kinds of things. I don't know, man. This is a bold new world. There's a lot of, but

let me, lemme put it to you like this. You Bill are a source of big data. And when I start thinking about what you just said, if I had a model that could take into consideration, obviously where you lived, but then all of the other information that you may or may not be sending to your provider, what you're coming out of your Apple watch what does medical adherence become as we really shift from fee-based, value-based care?

Well, if I can get all of that data, if I can extract that in St. Joe's, Example that you just gave, it's going to give me information that's going to be relevant to me as a person. So it's gonna say, Hey Cameron you wanna be considerate of the fact that we have seen a spike in your area of strep throat.

So as a result, maybe I'm, changing my buying preferences, but past that, if for some reason my child starts to show symptoms to your example, right? There is a way that you could anonymize some of that same data on the back end. Ask it a question, and then now I'm getting a quicker. Time to my child being seen versus the other night when I literally went and bill like I was at the emergency room for three hours, right?

And it's a major metropolitan area. If it could have routed me or it could have told me that there, yes, we're seeing a spike in strep throat. Unless you are, seeing these kinds of things, you're probably okay and we'll help you to schedule with your pediatrician at the earliest time tomorrow morning.

That would've given me a lot of comfort, and I think that's where we're going.

Yeah, absolutely. Cameron, always great to catch up with you and thank you for doing the news with me. Appreciate it.

Appreciate it. 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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