June 12, 2023: Bob Klein, CEO at Digital Scientists joins Bill for the news. How are health systems coping with economic challenges, and what are the recent trends in their financial performance? What are the potential risks and consequences of focusing only on short-term financial gains and operational efficiency in healthcare organizations? How do you balance the need for immediate cost-saving measures with the importance of investing in long-term innovation and transformative technologies in healthcare? What role can generative AI play in addressing healthcare challenges and driving innovation within budget constraints? How can health systems leverage technology and digital solutions to improve efficiency, patient care, and overall performance? Do smaller health systems face unique challenges in implementing digital innovations compared to larger health systems? What are the key considerations for healthcare organizations when deciding to prioritize and invest in AI models and generative AI technologies?
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Today on This Week Health.
AI is just another thing that's in this list of things that they can be working on that touch digital and technology and software that's It's almost, it's hard to prioritize, what are the things that we can do that can have an impact?
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.
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(Main) 📍 all right. It's Newsday, and today we're joined by Bob Klein, chief Executive Officer, digital Scientist. Bob, welcome back to the show. This is your second show. Looking forward to it.
Hey, bill. Great. Yeah, nice to be back again.
I was doing a little research on you.
I was doing that stalking thing on the internet. I just went to LinkedIn. I didn't really stalk you, but on LinkedIn I noticed that you university of Florida BA Political Science with honors. And then masters in Russian and Eastern European studies. Wow.
So we could really talk about the Ukraine and all the things that are going on there.
You, you're probably fairly well versed in that.
Yes. There is a, it's a, an earlier chapter where worked in logistics in the former Soviet Union. So yes, I set up an office in Kiev. Used to manage freight that came through Mary Opal, the port there. And we did a lot of business with the oil field, so Chevron and Halliburton Schlumberger folks like that.
And it definitely taught me how to be patient and how to work within a large bureaucracy and how to be persistent, to get things done on and a hands-on approach. But that's logistics in general.
I mean, doing that kind of work in that area of the world the geopolitical ramifications of everything that's going on around has the potential to slow down a project or completely change a project or shut it down for that matter.
There you have a long time horizon, especially for a lot of those were big capital investments and that's the kind of extractive industry. That's paying for everything over there. So it's oil and gas, uranium gold mines diamonds, things like that. I did some work with Caterpillar overseas there, so, yeah, definitely.
That's in there somewhere, although it's just I just pull those stories out at cocktail parties, bill and review.
Alright, well, we'll get into health it and, we'll talking about that. We'll hopefully make people feel better. About the challenges that healthcare is facing, although I will preface this.
We're gonna do a story from Becker's CIOs or healthcare leaders first, how 10 IT execs are confronting the economic challenges. And I wanna preface this with, I've seen some promising signs. I saw, I think it was Cleveland Clinic, posted a positive number. I saw Intermountain posted a positive number.
There was somebody else, and I can't remember which health system it is posted a positive number. So the operationally well run health systems are coming out of this. They're starting to post profits. We're seeing the next tier they're starting to come out.
They were underwater. Now they're above water. But I also did see a couple of health systems post. Hundreds of millions of losses, and it's those really big health systems. Scale is scale's good when it's going good and scale's bad when it's going bad, and it's really hard to turn those ships around.
I assume you're seeing the same thing. Are you feeling the same thing in some of the conversations? Are we starting to feel like we're coming out of this.
Well, I mean, I mean, I have to, as a service company or whatever, I do feel it. The kind of economics of it, and some of it I see more in this requirement for efficiency, this focus on really short-term roi.
And I think last time we talked about rationalizing spend. Ongoing spend in, in licenses and investments in new projects, new capabilities. And so they've gotta get their house in order to be able to hopefully make larger investments in the future.
But I think that's the challenge of it. I worry for some the larger, yes there are some challenges with scale. But there are those regional health systems that have investment funds that can continue to innovate. And I worry about smaller hospitals, smaller systems, falling behind, right, as technologies that leverage to achieve some efficiencies.
And some improved performance, nevermind, expanded share. And so, I think we've mentioned this where it's, a lot of pressure to improve performance and make improvements and not just hold steady, but that's the challenge of the economic cycle.
It's interesting as we just going back to this article, I think it really illuminates some of the things you're talking about. We have Eric Lee from Permanente Group, and he talks a lot about alignment. It's like we need to be aligned with. The specific objectives of our organization aligned with the strategic priorities and to focus our investments on the things that are actually going to deliver, as you would imagine a Permanente group CIO would do.
But then you have Eric Jimenez CIO for Artesia and New Mexico talking about as rural healthcare, we're no stranger. To economic uncertainty. It's like we live in a perpetual state of economic uncertainty. And so we have to focus on very tactical type projects. And he goes on to talk about RPA and how they're looking at rpa.
Others talk about digital transformation and the things that are going on. But a lot of 'em are really, I in this article. Seem to be talking about not the big projects that we think are gonna have a significant impact long term. It's the I guess when economic times are tough.
The lens and the focus gets a lot more close. We're not looking two and three years out for return. We're looking like 12 months, which is what you were just saying. What's the danger in doing that? What are they gonna miss if they're focused only on the next 12 months?
Don't know if they have a choice.
I mean, the danger is they well, I was back thinking about rpa, right? So is RPA innovation, or is RPA paving the count path? I've got a lot of kind of paper bound processes a lot of forms, a lot of things that are, they're not necessarily a big lift, I mean, they're important to do and they're important things to streamline and save time and create efficiencies, but it's not, I'm not sure it would pass for innovation.
Innovation. We'll talk more about these other articles that are more out there. But I know, I think that's the CIO's job to balance things where I've gotta find efficiency. But I also an efficiency in running the way things are internally, just in a way it is improved throughput or kind of speed of the way things move through the system.
But also I've gotta I've gotta do more than that. Like, I have to improve share. I have to be able to touch more people. I have to lower overall costs, not just speed up the throughput. And it's a different kind of mindset and I look at, what do you decide to do internally and what do you work with vendors or partners to do?
And I feel like for where things are going the health, it plays an important role and will play a larger role as technology starts, is just as is so important for for the system to survive and thrive. Right. It's not just the care maintenance and feeding of Epic and Cerner and whatever the laundry list of EHRs, it's more of how do you drive, how do you drive the organization?
And help apply the technology for leverage. So I don't know that probably don't answer your question, but that's
no. Well, here's the and we're gonna talk generative ai. We haven't done an episode of any show for the last, like, since January that we haven't talked about generative ai. We haven't talked about these things.
And a lot of times people think, oh that's innovation. Innovation is, the new technologies that are on the horizon. I don't think that's true. So I want to bend the paper a little bit in two directions. One is, I think now is the best time to be innovating and I think innovation within constraints is always better than innovation outside of constraints.
And the example, like, it's a silly example, but I've used it for years and people understand it. The most creative people in the world, I think are people that take a license plate. With like seven characters or six characters and they like say a whole paragraph in that, in those six letters and you're like, oh my gosh.
How did they communicate? Like who they are, what they're interested in, what excites them? I mean, it's in six character. I mean, it really is amazing at times what people can do. And that's innovation within constraints. We say, Hey, you got seven letters. Now. Communicate who you are or what you're excited about in those seven letters.
And they do. Well, when you have financial problems, now it's like, all right, what are the problems we really need to solve? What's really gonna move it forward? And there is, I guess, incremental innovation, if you will. We're doing the same things and we're just gonna do 'em better.
RPA falls into that category. We're gonna do it better than we did it before. But then I in that constraint of, hey, we're financially challenged, you start to look at it and say, can we do this thing with less nurses? Can we do it with less doc? And I know that's controversial to say, but at the end of the day, we don't have enough of them.
And we won't have enough of them in our lifetime or ever again. I've heard a physician tell me, we will never have enough physicians ever again, period. Like we don't train enough of 'em. There aren't enough people going into the business. Therefore, that's the constraint. That's the license plate. Okay?
If that's the license plate, we can't keep doing things the same way we've been doing it. That requires, more labor than we have, therefore, How do we do it differently? It's that line of questioning inside of constraints that leads us to, all right, I think. We can have generative AI respond to our inbox, I think we can have chatbots that interact with more people in the community than we did before.
As long as we have some sort of parameters around that chatbot that we know it's going to be delivering high quality answers and those kind of things. I'm curious what your thoughts are as I'm throwing that stuff out.
Yeah. No, I mean, I think back to your earlier question, I mean, the risk is, when you cut budgets or is people stop willing to experiment and try, right?
And innovation is sometimes just we need folks to be working to try and make things better and looking at some of the same measures and have enough time in the day. To run experiments and attempt, so your point about nurses, I think about the remote nurses that are on the iPad next to the patient bed.
Of folks that are trying to do that and just to create leverage for the nurses who are on the floor, who don't necessarily have to come into every room when someone presses the button, or the nutty robot that runs, that does deliveries across the hospital to save somebody time so a nurse doesn't have to do it.
Right. So it seems it's a little kind of, yes, it gets attention. There's lots of VR and those aren't the only things that are out there. Just funny things that come to mind. But I think that that's where they have to keep going because everyone wants to make improvements.
And like we said last time, there still is this impetus from Covid to reflect lessons learned, and to make the changes that are needed. And yeah, AI is just another thing that's in this list of things that they can be working on that touch digital and technology and software that's It's almost, it's hard to prioritize, what are the things that we can do that can have an impact?
And we can test out, so it doesn't have to be this big bang effect on anything, cuz that's really disruptive, right? So how do I test things out? And and I've got go to no-go decisions. This, not everything is gonna be a good idea, and that's okay. Right. So that's that's where I hope the smaller health systems have the opportunity because in a way they're closer to their population and you don't know what they could come up with, and I think the There's a efficiency call, but I think there's also this clinical insights and clinical relevance. Like how do you know? It's like you're, we all go to the nurses and we talk about that and we talk about other things, but a lot of opportunity out there that's digital is tied to things that are clinically significant and it's.
I know, I think about all the hardware and all, and the alert fatigue. As a kind of service provider in this space, we're not trying to tell the providers what to do. We're trying to give them insights and create some efficiencies for them so you reduce cognitive load in a way.
It's like how does the technology work for you? And it's not all about. Replacing people are there. It's making them more effective.
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now, back to the show. 📍 📍
We have three, there are three stories here. Hippocratic is building a large language model for healthcare. Second one is, how will generative AI impact healthcare?
And the third one is just calmed down about G P T four already. It's interesting, I mean, clearly we're at the peak of the hype cycle. I saw a post just this past week. Where somebody said for the last any number of years, we've really elevated the chief digital officer title.
And we said there's gonna be digital transformation. And because so much emphasis has been put on AI recently their supposition was that we will now have Chief AI officers. Well, I'm not sure that we will. But the chief digital officer or someone within the organization is gonna start to have a very keen focus.
On AI models bringing AI into healthcare. But they're essentially saying, look, this is where the change is gonna happen. And so when we focus on just the next year, one of the things that happens is we take our eye off the ball on something that's a big change that's happening. That's going to hit us in a, in two years or three years.
And if we're not working on that big change today, it becomes an emergency in two or three years. Like, oh, how do we catch up? And so we're. Always playing catch up because we're not looking at the big macro changes. Do you think generative AI is a big macro change to healthcare?
Yes I think it is there. But I guess my question back to you a around it is the role that each health system is going to play, right? So I have some real doubts about, from a macro change being. Is everyone waiting around for open ai, Microsoft Nuance, or whoever to show up with some care model and some insights that are gonna be built into a bunch of different software products or Epic or Cerner, whoever, essentially the walled gardens that today have all the data and have all the insights, like how much can the health systems create their own capability in this area, and can they.
Leverage these models, right? Or even open source versions of these models to create their own capabilities because they have unique populations and some of these articles talk about things that are more patient facing. But I think the challenge is creating a personalized care model for each and every individual.
Cuz health is tied to, I got comorbidities and. It just put your arms around just the data for one patient, and can we make any sense for just that one patient and for the provider or the care team that's trying to support that one person, and then, or even just somebody's, the population of a particular health system.
So cuz they can be so different and we, I do a bunch, we do a bunch of work in post-acute care and are building things for them. But that means I don't, we don't have much overlap with pediatric, right? So, it feels like there's an opportunity there if there's funding and interest. And I honestly, I think that's ultimately differentiating.
But I, I guess my question Bill is are the health systems gonna sit back and wait and expect kind of vendors to fill the. Void and provide all these insights? Or could be Amazon, it could be others or are they going to take the initiative and build some things on their own and get closer to the problem?
Yeah. I will I'll go on a limb here. 60% are gonna wait for Epic to do whatever Epic does for them. If you're an Epic client, you've almost been trained to wait for. Verona to figure things out, integrate it, put it in there and, because if you and I don't say that disparagingly, I mean, you don't want to get ahead of Verona because if they come out with something after you've gone and done something innovative, eventually you've invested in areas that you really don't need to, but we've been trained and 60%, we'll wait for the E the, and it could be Meditech. It could be Cerner, it could be. Whoever. I mean, if they're going to do whatever they're going to do, we'll wait for them to do it. And I think 60% will wait for that to happen or work with them as a partner to do that.
I saw UNC just announced they're doing something with Epic around generative ai. Stanford is uc, Davis's and others. So partners are stepping up and saying, look we're not gonna do this ourselves. We wanna partner with you. You have these capabilities, you're also our source of truth, our system of records.
So we're gonna do that. This is the vision I think people should be working towards, and I don't know how many will be working towards this. I do know that Amazon will be working towards this. CVS will be working towards this. WalMart will be working towards this, and Walgreens will be working towards us, and Optum will be moving towards us in UnitedHealthcare.
And that is, Bill Gates was talking about this, and I know we're not supposed to talk, use people's names who are currently being smeared in the broader media, but but Bill Gates is still, a great mind from a technology standpoint. And he looked at G P T four a long time ago, and when he was interviewed he, he said, we are as close as we've ever been to everyone having an AI assistant.
A physician, having an AI assistant, a nurse, having an AI assistant who understands their job, knows their data, can find data for them, and just helps them to be more effective all the time, every day. So we're gonna have that aspect of it, including, your pharmacist, you name it across the board, everybody's gonna have an AI assistant.
Then I would go one step farther and say, I think every individual in the community is gonna have an AI assistant that is going to help them with their health. Either navigating healthcare or understanding the questions we have about health. Should I eat this? Should I not eat this? Is gut health really important?
How important is exercise? How important. I know some of these questions to doctors are gonna be silly, but these are the kind of Google search questions that get asked. Oh yeah. And if we have a an assistant, if we all have an assistant that is geared towards making us healthier the question becomes who is providing that?
So Hippocratic is one of the stories and they are essentially taking generative AI to med school and they're gonna have very specific, training around that model so that it can be trusted and it's gonna be used to help people to remain healthy. My question, and I think it's question you're asking, is as a health system, if I were a CIO for a health system, if I were still at St.
Joe's, we had 16 hospitals. Multiple communities in multiple states. Would I want that provider of that information to come from Hippocratic or CVS or somebody else? Or would I want it to come from St. Joe's? And the answer is, it has to come from St. Joe's because if it doesn't, you become irrelevant in health.
All you become is whatever they leave you. If it's the high acuity, high risk care, whatever they leave you, that's what you're gonna end up with. If you are not gonna be relevant in the day-to-day conversation of the patient or even the consumer and their health, then whoever is there, they're the ones who are gonna direct the economic flow of, where that person goes for care.
I don't, I mean, that's why I feel like the health system has the opportunity, but has to put the entire, all the pieces together for the patient, and to be trusted because you have all the data and that includes, that doesn't include everything that's in, it's not necessarily everything that's in the EHR today.
Right, right. So genomic data other data. So I work a lot with telehealth data, other information. And, there's I don't know, there's all this. Focus on efficiency and I've, we've, I've built something with that uses chat G P T four and it's use it as a language model and it helps us create something that's really just the clinical note from a telehealth encounter.
So now, and that's just efficiency. But over time there are other kind of services being created that will plug in that look at voice biomarkers, for example. So based on our conversation, they might just say, Hey Bob, you sound like there's something off. Right? And it could be, some marker based on word choice speech pace, things like that.
And could say, okay, let's flag this person for follow up. Right? Something seems off. But you have to be capturing that data. You have to be capturing all of my previous telehealth sessions. So right now a lot of that's not even recorded. So it's not recorded, it's not transcribed, it's not retained, and so I just look at telehealth as just as another, it's another sensor for data, just like the in-person interactions, all the labs genomic data.
So complete data model for that patient, and that's how the health system has knows the most. And knows all the details where this kind of, one size fits all on the front end based on some enormous model isn't gonna be great. Because like I said, I've got post-acute, 85 year olds and five year olds and the same model.
And it's started. It's like, okay, this just seem to make sense. So it's gonna be super broad or narrow based on the population. I think that's where the opportunity is. I just don't know if anyone's gonna take it.
Yep. Yeah, the narrow models is the direction more personalized, highly personalized models.
I, I love this discussion. We're gonna continue this discussion probably in four or five weeks. You're gonna come back on the show. There'll be a whole new set of articles, and we'll see how much we were right about and how much You know how much has changed? It's, to be honest with you, this space is moving really fast.
It feels to me like every day I open an article and I read a bunch yesterday about Google's response to G p t four. But they have a little different bent. Their model's a little different, and it's better at some things than. G PT four, but it's not as good with text and all that stuff.
And so it's really highly geared towards search. Go figure.
The logical inferences aren't there in these models, and so it doesn't know, what it's doing in terms of the language model for chatGPT four. So just to be cautious about that and say, oh yeah, my recommendation is use it for what it's really designed to do.
If you go in there and. Bill, if you've got a long email that you wanna reduce to a paragraph, you can do that, right? Yeah. And it's always that does create some efficiency or automate some of the things where some of the correspondence or or stuff like that. I think that the providers are
already using it.
Well, and I love the model you said, I mean, you take a transcript and you turn it into a soap note. Yeah.
Yeah. So they're, and it's, I think it's, that's disruptive because Microsoft spent 20 billion to buy nuance three years ago. And was that really worth it? And I think each of the health systems need access to this kind of technology for that efficiency we're talking about.
But over time, it's and efficiency. It's mostly speech to text, which has gotten to be really good. Right. And that's the aha for me with Whisper which is part of open ai. And and then it's like start creating your own models, build your own model, get smart about your own population.
And I hope that the health systems are willing to give that a trying and kind of start to experiment. But go easy with everything that we were reading from the hype cycle. Yep,
absolutely. Bob, thanks for your time. Really appreciate it. Great conversation. Sure
thing. Thanks so much, 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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