November 6, 2023: Laura O’Toole, CEO of SureTest, explores the transformative power of diversity in healthcare expertise. In this Newsday they consider the impacts of introducing non-traditional backgrounds into the healthcare realm, questioning the balance between overwhelming new entrants and harnessing their unique skill sets. The conversation naturally extends to the potential of AI in healthcare, challenging current structures like large Epic shops and urging a shift towards meaningful engagement and efficient workflows. The episode concludes with a call for financial courage and stewardship, urging leaders to discerningly invest in solutions with substantial returns by giving staff time to critically and creatively think. Laura and Bill’s exchange encourages a reevaluation of healthcare’s status quo, pushing for innovation, efficiency, and a bold embrace of change.
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Today on This Week Health.
god forbid you don't have a patient advocate or you don't have somebody that's willing to pick up the phone and fight back and be an advocate for somebody and that's what keeps me up at night.
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 we're joined by Laura O'Toole. CEO of SureTest, and it's been a long time, Laura. been going on in the world of SureTest these days?
It only seems like a long time, Bill, because we, used to talk a lot more, but really, it could be probably last month, but...
I miss you. Let's just say it that way.
Ditto that, and I miss your bride even more, I gotta say. What's been going on in the world of SureTest? It's been a fun year for us. We've signed some really large strategic accounts, so that's been incredibly exciting for us.
I guess more importantly, we're focused on the whole AI play and how we can integrate that into our solution. I think you know that we really wanted our solution to be one that optimizes and helps transform workflow for our clients and not just focus on the testing. So now we've gotten really creative with leveraging some AI to actually help maximize our library so that when we sign a new client and we see that they're doing ABC workflow in, , 40 steps, and we have another client that's doing it in 20, , everybody's workflow is theirs, and we respect that, but where we can help really transform and help optimize, that was always my vision and our goal of our library, so we're starting to see that.
Okay. the benefits of that and reap some of that reward. So I'm excited about
that. that is exciting. And two things on that. One is we're seeing some of the initial applications of AI and those are really driving efficiency, but we're also seeing some clinical things.
We'll talk about some of that today, but we just had a 229 event and and you guys were their sponsor. Of the 2 29 event. And invariably we end up having a conversation around budgets and cost reductions and ways to find those things. I think there is a strong search towards efficiency at this point in all areas, in, in it, in administrative, in the clinical burden that we've created.
for the clinicians at the bedside and in documentation, those kind of things. There's a strong push towards, hey, we know that there's inefficiencies in the workflows and other things we can drive some of that out. And so there's just this renewed emphasis on the basics on let's the things we have to do that we're doing all the time.
Let's make sure we're doing them in the most efficient fashion.
Yeah, absolutely. , our clients have to improve, their operating costs. They have to, they don't have a choice. And I think that there's been a lot of investment in tools and a lot of solutions that are out there.
But then taking those tools and those solutions and getting them to work for you and your environment, I think Finding the time to do that our clients are struggling with, just putting the emphasis on it. It's, it's like anything, I had a realtor come look at my house last night because I'm trying to decide what I want to do, if I want to sell it, what not, because I'm spending most of my time down in Florida and she's spend a little bit of money and you're going to make a lot more money on the sale of this house.
Paint your inside of your house. Make everything the same color, etc. So, where you can get synergies and get optimization, it's going to pay off in the long run. And I think our clients still are just trying to catch their breath. And they've got more work than they can shake a stick at.
I still maintain that the CIO's job is one of the hardest, for sure. And it's hard to get going, and they buy the tools, and then they're sitting there, and that's what I'm excited about, because we're able to come in with a real roadmap and help them move to automization, and, I think we're starting to see it not just in the testing area, but in, Bountiful and in RPA.
And we're starting to see that loosen up by some of our vendors as well. I think it's a great convergence that's happening.
I'm going to have to look up the word automation. automation. Automation. know if that's a Jersey thing coming out. I can make fun of your Jersey because I'm from Pennsylvania.
That's called Laura just mispronouncing the
word. No, we're good. All right, Kaufman Hall, first story, Kaufman Hall, 2023 State of Health Care Performance Improvement, signs of stabilization emerge. Interesting report.
Let me give you a couple of things, because we didn't have a chance to really prep on this. So, hospitals and health systems are seeing some signs of stabilization in 2023, following an extremely difficult year in 2022. Workforce related challenges persist. However, keeping costs high and keeping costs high and contributing to issues with patient access to care the percentage of respondents who reported that they have run less than full capacity at some time over the past year because of staffing shortages, for example, remains at 66 percent unchanged from last year's report a solid majority of respondents, 63 percent are struggling to meet demands within their physician enterprise.
with patient concerns or complaints about access to physician clinics, increasing approximately one third, 32%. Let me give you a couple of the stats before we dive into this. So survey highlights, 98 percent of respondents are pursuing one or more recruitment and retention strategies. That's really,, it's almost a hundred percent, 90 percent have raised starting salaries.
of or their minimum wage. 73 percent report an increased rate of claims denials. 71 percent are encouraging distribution delays in their supply chain. 70 percent are boarding patients in emergency departments. So when you walk into that emergency department, you see beds all over. That's what's going on there.
66 percent report that staffing shortages have required their organization to run at less than full capacity. That's what we just heard. 63 percent are struggling to meet demand. for patient access. This is where we call in and it's, oh yeah, what, we could see you in three months. It's I have debilitating back pain.
You mean three months is my wait to see somebody? And 60 60 percent see decreasing utilization of contract labor, which is a good thing. There was a huge spike, 44 percent report that inpatient volumes remain below pre pandemic levels. And there's a couple more, but I'll stop there.
This is good information, but
I think it paints the picture we were two big takeaways from that article for me. First, I think it said half of the respondents have volumes that are higher than pre pandemic. And obviously they need these patients to be seen. And access continues to be a problem. I was really pleased to see that all the spend and bringing things back in house, because that was driving their operating costs up so much.
so significantly for all the contract labor, so I think we're coming to a normalization on that. I completely agree, but when you think about access and the importance of patients being able to be seen three months for you, my dad's got a spot on his lung, can't get him to go get a biopsy for six weeks, , it's really concerning.
And I think that there is a real opportunity for automation to help with what, Some of our clients are terming 365 access. So where you can use automation to be smarter about a physician's schedule. And I think we saw Scripps doing that at one of the 229 events that I was at. I thought it was really cool what Shane was doing.
But to really be able to use let me say it right this time. Bill, to to maximize not only the physician's schedule, right, and maximize revenue, but also more transparency for the patient and using automation to really target when the availability is. So anything that we can do to be creative, to get access for our patient population, then we're all doing our jobs,
yep. And by the way, that story was my father's. My father has debilitating back pain, and He could get the MRI, but there was a couple weeks to get the MRI, but he couldn't get the MRI read for four weeks after that. I'm like, oh my gosh that's like really unacceptable at this point. If that's the condition you're in and they gave him some drugs and that kind of stuff, but essentially we're masking the pain with drugs.
to mask a problem with access. Let me ask you this specific question, which is, the hospitals are full. I, at the children's, at least children's hospitals, I was asking them, , a couple of them were building buildings. I'm like, I'm surprised you're building buildings. They're like, look we're at capacity.
We're consistently at capacity in our rooms. And I'm wondering if that... is short sighted to be building buildings. Is that going to be the model five and ten years from now? And I'm a little concerned because, I mean, if, look, if you build a building, especially a building of this Specialization and whatnot.
There's a huge amount of cost and carry for that building over the next, what, 20, 30 years. Yeah, I
completely agree. And I think that if you really begin to focus more on technology and automation and the virtual care visit. In the right way and can connect everything so that we make sure that we're holistically dealing with these patients.
We're going to need less buildings, in my opinion, and you're going to see , more things coming to the home. I think the key right now is that there's still such a lack of coordination of care so that the patient can actually get those services that they need at the right time, at the right place, at the right cost.
, I really think we all as an industry have to. Push our creative juices to figure out how we, , it's the age old adage. How do you combine technology and process? to create real transformation for how we care for patients. Because a lot of this can be done virtually.
Yeah. And it's gotten to the point now where the inefficiencies that we used to have are really dragging us down.
There are a weight on us right now, and it's going to require us to step back. Look at the workflows and, the time we look at the workflows the most is when we do an EHR implementation or a new system implementation, but mostly the EHR, we look at all the workflows, we rebuild them and that the challenge is we need to keep going back to that almost like It would be, this would be crazy, but it's almost like every eight years you want to redo the EHR so that you rethink through the workflows and the processes and all those things, or better yet, because that's not tenable doing something like just a continuous improvement process and target specific areas to see if you can drive out those inefficiencies.
Absolutely, and then go up the value chain. I don't think any of us would survive. Either from a cost perspective or a sleep perspective doing net new EHR implementations every few years, but certainly I agree with you taking the pause to be more efficient and to optimize where you can and around those things that I think that can drive efficiency automation and give care back even if it's in a more virtual way.
I mean, I just think that's where we have to go.
Yeah, it's interesting. I'll hit one more diagram on this and then we'll go. To we'll go to an AI story. The to address staffing shortages, and I've seen this more and more, they have a handful of strategies that people are doing. One is internal float pools or enterprise float pools.
And I was talking to Honor Health out of Arizona. And they have close to 500 nurses in their float pool that their job from day to day may shift and change. And I was like, does this create training issues and that kind of stuff? And they were talking about their program. It sounds very efficient because it's almost hey, we can.
We can morph to this kind of organization tomorrow and then morph back to this the next day. 'cause , our caseloads are not consistent, if you will. That's right. It might ramp up in one area in another. Anyway the flow pool was really interesting to me.
More per diems, they're flexible shift lengths are coming into Vogue. Weekend only positions, flexible start times, job share positions. A lot of creative strategy, a lot of creative strength has been put towards this challenge of staffing shortages. Still hasn't addressed all the access issues, but it, we're at least addressing the significant cost of those
Yeah, and that they had no choice, right? That board that I sit on, Rochelle Health, they're doing a lot of this, creating these pools of these on demand resources that, have some specialty amongst them, but that can also, do other things and creating this Talent attractor for people that want to work in different ways.
And I actually envision, wouldn't it be great if we could get to the place where if you have hospitals that even are our competitors, but that could share a pool of resources and to serve the collective communities that they serve. Because there's all kinds of ways to engage with an associate.
They don't have to all be, regular W 2 full time employees. And I think we all have to put our creative hats. That's on with the end goal in mind, which is how do we get the best care. to our patients in a timely way and not have them have to wait like your dad three months or my dad six weeks and god forbid you don't have a patient advocate or you don't have somebody that's willing to pick up the phone and fight back and be an advocate for somebody and that's what keeps me up at night.
All these people that don't have somebody, they don't know how to navigate the system because believe me you can imagine I got on the phone and guess what my dad's getting his biopsy on Tuesday. But I can be persuasive, but not everybody is going to do that or be able to do that or have the wherewithal to do that or the time to do it.
So, I think we just have to keep the end game in sight, what our patients
need. Right, absolutely. So, this came across my feed. Breast cancer breakthrough, AI predicts a third of cases prior to diagnosis in a mammography study. And this was I think a Scandinavian country. They essentially... Put all this historical data through this AI model and it's, historical data because now we know who did present with, a cancer diagnosis years later.
And they were able to say, all right, AI model, here's the image. What do you think? Essentially, I mean, it came back, a third of the cases prior, it was able to give it a risk score of a 10, which is yes, they're going to, and it's based on factors that are known, and this is.
I think the reason this story jumped out to me is it's a story of promise. This is still fairly early on in our advancement on this technology. Although I will say imaging is farther along than most in the AI machine learning area. But we will get to some more of this predictive medicine based on historical data that it may present some false positives, but rather have, a certain percentage of false positives and get that early detection of breast cancer.
Yeah, absolutely. This one was near and dear to my heart because I've. been a breast cancer survivor. It was really cool to see. And I think that not only was it one third of the cases, but they were able to isolate it two years prior to the diagnosis, which, talk about having early intervention.
I thought that was so cool and amazing. I know Penn Medicine been a client on and off of mine for, 20 plus years. They're doing a lot of this work, and it's really cool, and it's encouraging to think that you could look at the calcification of a breast or, the way that a breast appears and looks on imaging and make some predictions and really categorize it, like you said, 10 being the most likely, but even that middle category, you would watch those patients very differently than you would someone that didn't come up as a risk.
So, I get really excited when I see that we're using this for predictive diagnoses because talk about getting ahead of the game.
Yeah, it's pretty amazing. I wanted to hit this. with you. It's not a story per se. It's a post on Twitter, X. I still have trouble calling it X, but anyway I'll get used to it.
We're at the one year anniversary of Elon Musk coming in. And one of the things that Elon tends to do is from an engineering perspective, cause people to rethink how they do things, like with the, with obviously building Tesla he wasn't technically the founder of Tesla.
He came in mid stream, but when he got there, they had a card that they could not manufacture at scale, they could not make money and all this other stuff around it. And he came in with, again, these first principles thinking and said, what's the problem we're trying to solve? He came up with the battery technology and it just drove the engineers.
This is a, this post is really interesting to me because it has all the things That I imagine he went in and pushed the team to do. And I want to talk about this with a lens towards what, we talked about inefficiencies in healthcare and health IT. I'm going to share some of these things now.
I want to, I want us to talk about it from a lens of. What opportunities exist in health IT because I think there's a similar like if Elon took over a hospital tomorrow Yeah, I think it there would be a strong drive. So let me give you a couple of these Consolidated the tech stacks for a bunch of their features around a single product framework completely rebuilt the couple of other features from the ground up, resulting in a decrease of 90 percent reduction in lines of code from 700, 000 lines of code to 70, 000 lines of code, complexity gone, speed increases, you name it, unified against more features, you name which significantly improved the video recommendation quality, refactored the API middleware of our tech stack, and in so doing, simplified the architecture by removing more than 100, 000 lines of code, reduced post metadata sourcing latency by 50%.
and Global API Timeout IRIS by 90%. He talked about blocking bots and some other things. Shut down the 5, 200 racks, 148,
000 servers, which generated more than 100 billion in annual savings in total. Freed up 48 megawatts of capacity and tore down 60, 000 pounds of network ladder racks before reprovisioning it to other data centers. And then he optimized cloud storage for, let's see, and monthly cloud costs were reduced by 60%.
Overall cloud data storage size by 60%. And separately, he succeeded in reducing the cloud data processing costs by 75%. And that's probably enough to sort of get started. You think? You think that's enough? Yeah, and that's one year. Pretty tumultuous. A lot of people left. A lot of people were let go.
So, this is the kind of environment where people would normally be sitting around the water cooler saying, Are you next? Am I next? What's going on? And if this is to be believed, because it can be marketing and we're, it's hard to fact check it, but I doubt it's a lie because He's done it in rockets.
He's done it in cars. He's done it in other areas. So it rings true to me. If we were to take, let's just stay with model. If Elon Musk were to walk into a hospital today, what kind of things do you think he would look at and go, Eh, let's take a look at that problem. I think we could fix that problem.
Yeah, I mean, I think obviously he'd look at all the applications and there'd be some immediate rationalization, much more so than we're seeing it happening.
Isn't it incredible? I mean, 800, I ask the question all the time and I get we have 800 we have 600, we have, and I'm like, wow. And no other industry do I know is that spread out.
I'm not, yeah, it's just amazing.
Yeah, it's, and I think we in healthcare think we're special, and I, of course, think we're special, but I think there's this great convergence that can happen and I applaud Reid at St. Luke's for doing this. He just brought on somebody completely outside of healthcare the guy came from NASA or something, looking at all his development that he's doing in house, what he wants to keep, what he doesn't.
And. The guy has no healthcare experience, so the poor guy's, I'm sure, drinking from a fire hose and is overwhelmed by the amount of consensus, right, that we have to drive in order to get anything done. But I think when you can take someone like that's so super smart and pair them together and make a partnership and a team with the healthcare domain expertise, I think that becomes really powerful.
So I think Elon would come in and completely start looking at how can we look at not only application rationalization, but how do we leverage AI to do more modeling of the workflows that we see our patients typically do? And do we really need to have 200, 300 person Epic shops with this huge cost? How do we get these people to be out engaging more with their business?
Partners, as opposed to constantly keeping up with the build and the optimization of a system. So, I think we all have to be creative. And I think sometimes it's like anything. It's like the boiling frog story. Remember you read to your kid. You sit there and you only slowly increase.
the water and lukewarm water until it's boiling and then the frog has boiled itself to death and didn't even know that it was happening to him. And so we have a great opportunity in healthcare to get out of our own way.
Yeah, it's really interesting because I always talked about creating margin.
I wanted to create margin for my team, which was hours. Hours that they could actually work on problems. And what I find in a lot of IT organizations when I walk in is their IT staff has no margin. And so it's like when they come in today, all eight hours are spoken for. Eight hours, ten hours, whatever they happen to be working.
And it's I've got this project, I got this, I got these deliverables, I got to do this. And oh, by the way, we're going to. We're going to take a new release of these software packages over the next month. Therefore, I'm going to be doing this, and this. Without margin, people never have time to go, Hey, there might be a better way of approaching this.
I remember sitting down, early on in my IT career, I was sitting down with our VP. he was onboarding new physician practices into our into our clinically integrated network. And we had a backlog that was I don't know, like 120, 130 practices. And we were able to take on I don't know, three a month or two a month or something like that.
And I just looked at him like. We're going to take three years to get through this list. I'm like, no, there's got to be another way. And this isn't a story about, Oh, isn't Bill smart? This is a story about. That happens a lot where if I wasn't there to say, really are you kidding me? Like they, they might still be doing it.
that project might still be going on.
And probably would be, and probably would be. And that's just it. It's, and that's why we were so passionate about the solution that we created. It's really important to bring something to a market that's actually going to free people up. And when you can use automation to let people do more meaningful work.
And. give them the opportunity to be creative and use their brains rather than a lot of the rote stuff that they have to do. That's important. You've got to get it done. You've got to, you've got to test, you've got to regression test your system. You have to be more efficient. It's the only way you're going to save money and you have to protect and make sure that you're testing, that you're not going to hurt a patient.
But my gosh, nobody likes to do it. And let these people free up and go work more creatively. But I think it's, I think it's just broader than that. Bill, I feel like we just need to give permission to people to say, go solve this problem, be resourceful. How do you solution this? We don't have to do things the same way that we've always done them.
Sometimes I want to say, help me help you, so, I just think we have to continue to help and push and you got to meet, we have to meet our clients where they're at and help as best we can get them to that place.
Yeah, and I'll close on this because we're a little bit over time, but it's interesting to me the number of times people say I have no money to spend.
And you look at the problem and you go. you do realize if you spend 400, 000 here, you're going to free up this and you're going to save that over two years. It's yeah, but I don't have that 400, 000. I'm like, I think you should talk to somebody because I know your organization has an investment fund that has.
Half, a billion dollars in it. , I'm sure if you could make the case that $400,000 is gonna lead to 1.2 million in return over two years, that they would, they, somebody might go, they figure it out. Yeah, that sounds good. Because you know what if I told you today, Hey, gimme $400,000 and in two years I'm gonna give you 1.2 million.
You would look at me and go, that's the best investment in history. Let me write
check, Bill. Yeah, exactly. And so think to a certain extent, we need to have courage. I think to a certain extent, we need to use logic and understand that the leadership, even though they, sometimes they will say, Hey, cut back, no budgets.
We can't do this. Sometimes you don't take those statements at face value. What they're actually saying is don't spend money, is not what they're saying. What they're saying is, be discerning. Be a good steward of the money that we're giving you. And if you identify those areas, I think it will be well received if you take it forward.
Laura, always great to catch up. It's been too long. Let's make sure we see each other a little bit more next year.
Sounds great. I look forward to it, Bill. Thanks so much. Awesome to see and talk
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