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October 6: Today on TownHall, Brett Oliver, Family Physician and Chief Medical Information Officer at Baptist Health interviews Will O’Connor, Chief Medical Information Officer at TigerConnect about clinical communication technology. Where did his passion for the subject come from? How does he see clinical communication technology evolving in the near future? What role does he see communication tools playing versus operational leadership?

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Today on This Week Health.

Everyone is using either SMS or iMessage or WhatsApp to communicate it has become part of human behavior

I see a lot of people using the EMR on one screen and having Tiger Connect on another screen and communicating in a way that they're used to communicating. And what that ultimately gets you. What you're doing for that caregiver is reducing toil

Welcome to This Week Health Community. This is TownHall a show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels designed to amplify great thinking to propel healthcare forward. We want to thank our show sponsors Olive, Rubrik, Trellix, Medigate and F5 in partnership with Sirius Healthcare for investing in our mission to develop the next generation of health leaders. Now onto our show.

All right. Hello and welcome back to Town Hall. I'm Brett Oliver, the CMIO for Baptist South in Kentucky and Indiana. And with me today is Will O'Connor orthopedic surgeon and a uh, CMIO for Tiger Connect. Welcome Will.

Thanks, Brett. How are you today?

I'm doing pretty well. I'm glad to have you.

Thanks for having me.

Yeah, let's just jump right in. So you've got a background and interest, a passion about clinical communication and throughput, particularly in the hospital. I'm just curious, like from the average clinician, where does that come from? Were there specific examples in your career where you thought, my goodness, there needs to be a better way?

Or was it a progression of things, or, I'm just curious.

Yeah, I think it was a little bit of both. I mean, I started really early, so I got. Even in as an elementary school student, I knew I wanted to be a doctor. And so my natural first jobs were to try to get a job hospital. And my mom had sisters that were nurses and had a connection at a hospital that was local to me where I was growing up.

So when I was 16 and old enough to work there, I got a job as an orderly, started working, on the floor and it was hard, hard work. But I, it was sort of very valuable to me because I really got to see, I worked very closely with the nurses obviously, so I really had to see what it was like to be a nurse, which became very helpful later in my career in working with nurses as a physician.

But I saw right away. Delays in care and it wasn't like TV or like the movies where the patient would be crashing and the doctor would be there instantly. It would be hard for them to find the physician sometimes, and there was a delay in the physician showing up sometimes. And even just routine care of patients.

I saw what a struggle it was. Especially for the nurses to find the right person who's covering, like, who is covering for this patient for this specific thing. It's a question that still get asked today, , all the time. So that was very early frustration and toil that I witnessed, that I thought was, kind of a necessary, I was like, this gotta be a, a better way.

And then when I, became a, medical student as a MS three. We were working and at, at the time we were rotating a medicine rotation through a public hospital. And, it was a while ago now, so the students at the time we. Pretty large level of responsibility. So the primary call from the nurse about the patient the first call was to the MS three.

And it gave us this pager. And I still remember it was this big blue thing and it had one light on it. And the light could only display one number at a time. So the pager would go off, beep, beep, beep, and the light would blink and you'd have to look at it and it. Beep, the five digit extension, you know, 5, 2, 3, 1 4, 1 number at a time.

And you'd have to remember it. It didn't store it in any way. Oh. And I remember having my brick Nokia phone in my other pocket thinking like, Wait a minute, there's gotta be a better, Why can't they just call me on this? What is wrong here? So that was my first experience with really that.

What amounts to that toil? Little bit more of a cognitive burden of having to then remember that number, not knowing what they wanted when they were calling me, and then being in the middle of something that I didn't really know if it was more important or less important than what they were calling me for.

So that really got me going and started thinking about that really at a very early age. And then as I advanced as a resident and saw delays in care, result in pretty significant morbidity and mortality over time, with things. Related to, incorrect call schedules and. Nurses and other caregivers trying to page or contact the wrong physician and result in delays in care, that caused some real problems.

That really reinforced what I had now been thinking about for 10 years or so. So that's really how I got my, start in that. And then, as I advanced looking at the technology that was then available to alleviate the problem that's when I really started getting passionate about.

I would, imagine any position that's gone through a residency has multiple stories of that whether it's the wrong position gets paged. I can remember going to a code, the ICU team was the code team. We get to a code, but we were the second to have been notified. It was the neurosurgical intern.

No offense to the neurosurgery interns, but they didn't have a clue what they were doing and, the resulting effects of what happens with that. So it's interesting how it sort of builds up over time. Yeah. And results in a career.

Yeah. Yeah. It's, it's, it's been, you know, and the nice thing is about it is it's still, there's plenty of opportunity to help things have changed so slowly.

I was just talking to a medical school friend the other day. He's a ur. And he was telling me last time he was on call three times, he was called for looking for the neurologist on call. So this is still happening. Yeah. And there's, there's just, there's a better way.

I think you also brought a really good point too, that I hadn't thought about throughout my training and early in my career, how when you would get paged, you had no idea.

The level of concern, what it was about. Is it, I need you right now, or I just wanna let you know something. It was, There was just one shot. One shot at it. Yeah, exactly. Yeah. Well, as you and I both know, and I'm sure the audience does, there's tons of work being had in the interoperability space, whether we're talking about TEFCA at a national level or HIEs or all that, with that focus, forcing all the information to the patient, which I agree with, but it can be overwhelming, does that effort and maybe take the patient out of it as just the physician to physician communication, but does that effort facilitate or does that potentially complicate this communication piece that we're talking


Involving the patient? It certainly complicates it just from a process point of view. Right. How, how do you engage them in a way. that Fits the financial model of medicine that we're in. But then, also does so in a way that helps, but is not overwhelming to either the patient or the clinician.

So there's a lot that, goes into that. But I think it's, all available to, be addressed. And I think we can do a much better job focusing. on the patient and using some of the things that are coming that are being driven by more interoperability to enhance the experience of care, and then do things like, avoid, readmissions and do remote patient monitoring and things like that.

I find it, as you mentioned, even more exciting on the caregiver side and on the physician and the provider side. I think that. Like 21st Century Cures, act, think final coming into effect, I think October 6th, and thinking of how it's going to make the data and the clinical data in these systems a bit more liquid so that applications like a communication platform can grab pieces of that data and serve it up.

To the right person at the right time in the right workflow. So in the context of what they're doing and being able to enrich communication that way, any given workflow as a physician or a nurse, right? There's a few pieces of data that you really care a lot about, and you don't care, Mostly don't care about almost everything else in the medical record in that given moment, right?

So why make people go through the toil of looking in something that is an inherently sort of bad experience for a lot of people and difficult and time consuming if you can take that data from these other systems and serve it up in a way, leveraging this new interoperability that we have that enhances that workflow, therefore enhancing care. 📍

📍 We'll get back to our show in just a moment. I wanted to take this opportunity to share with you our next webinars. On October 13th, we have delivering better patient experiences with modern digital infrastructure. During this conversation, we're gonna discuss multi-cloud, how to modernize health it, and a blueprint for creating an agile digital infrastructure without impacting the quality of care. If all those things sound really complicated, we're gonna make them less complicated for you on this webinar. This webinar has five campaign episodes. You can view them before the webinar to learn more. You can find these episodes as they release and register for the webinar at this week, Click on the upcoming webinar section and top right hand corner, and I look forward to seeing you there.

📍 📍 I think it's, I really like that.

Very exciting.

I agree with you a hundred percent. I mean, sometimes what a vendor won't understand is all you gotta do here is just click right here and it'll take you to our dashboard, and then the clinician can see , what they're looking for in that moment.

Like, you lost me with, you gotta click here. And to your point, I'm looking for two or three things right now, and this remainder of this massive set of data is not important to me. To your point in that moment and to get to that point where we can have those specific data points, I mean, I got ways to go with getting it all structured, I guess.

And we've had multiple meetings in my organization about how do we get this flow sheet data to our portal or maybe we don't put in the portal, but how do we get it to the patient, down when they request. lots of work still to be done. But yeah, I think it's exciting. It's creating a, certainly a different ecosystem for data to be used.

So kind of along those lines this is kind of what you're doing now, where do you see this clinical communication, whether it's the technology or just in general evolving to in, I don't know, we can talk about near future or. semi-near future.

, I think, I'll talk about near future and things that are possible today to just taking advantage of the technology that exists today.

And I, I think to me where it's going and where I've seen the most success is adapting it to workflow. So don't, think about. Communication in terms of like, Oh, I gotta have a secure messaging system and now I need

a,, scheduling system and I need middleware for this. Right? And taking that technology approach, rather what I see people doing and where I think the change is coming very soon is working backwards and saying, at the executive level, Hey, we've gotta length of stay problem we've got a capacity problem.

We need to take a look at the very specific workflows that exist inside our health system and apply communication to them. To make them faster. And I'll give you an example , of something that we're doing. We're doing a lot of work now in stroke care where we're working with health system and hospital clients to improve their door to needle time among other types of critical path scenarios where time is tissue and.

One of the hospitals we were working with that's shown tremendous improvement. Their door to needle time was around, I think they started about 64 minutes. So right around the average for stroke treatment and simply by applying communication to the workflow. And taking people, connecting them in terms of not just their names, but the actual persona, the job they're doing at the time, and the schedule that they're doing it on.

So that stroke team consists of roles and people on a schedule, right? So you have the person that's gonna read the CT scan on there. You have the nurse on there, you have the stroke coordinator on there, you have the pharmacist on there so they can mix up the TPA and get it ready, right? You have someone from transport on there.

We're able to take that 64 minutes, and I think we were they're down to about 27 now. Wow. So, right. Amazing results just from using communication, just applying it to the workflow and. The impact of that has been incredible. One, their mortality has been greatly reduced. I think they estimated it's saving about 75 lives a year.

Their length of stay is down, right, because the people aren't getting as sick. I think it's around 4 million neurons a minute. You lose when you're having a stroke, so, Time is brain in that scenario. Obviously the quality of life for those patients is, better, and the experience of delivering care as a clinician is obviously much better as well, right?

You're getting a great result. And if you're purely financially motivated, right? The length of stay is lower. So for that DRG that I'm being reimbursed on, if the patient's there two days instead of. five That's better for me as a, health system. And the margin is gonna be better on that patient.

I'm gonna have healthier, finances based on using these. So that's really where I see things going is taking these technologies and applying them to the workflows directly.

I mean, 75 lives, it's almost like you don't have to do the math on that one, right? I mean, that's 75 families and you take care of that.

And I. Guarantee the money follows the length of stay and all that stuff. That's amazing. Yeah. I'm curious, One of the communication challenges that I've seen over and over again is someone's got a great new tool. The technology here, this is how we're gonna communicate, does this, this, this, and this.

But what role do you think the technology plays versus, and you kind of touched on it a little bit, sort of starting with executive leadership and saying, what's the problem we're trying to solve? But that operational leadership in determining how we're gonna communicate. Sometimes I see we're very, operationally they're very happy to bring a new tool forward.

But from my perspective, from the IT perspective, like until you say, this is how we're doing it, we're not gonna allow you to do this, this, and this. It, it. You're gonna end up in the same position. I'm just curious, like have you, with your experience in all this, the tool versus the operation leadership, and it's, I know it's not either one, but is it 50 50 or what's been your experience


Yeah, it's, it's a great question. I think it used to be more, 50 50. I think that, this technology used to be pretty hard. Okay. Hard to build something that's super reliable, that's super secure, that's super scalable, right, Where you can have, I think last year we sent over 4 billion messages across our platform, so the incredible amount of traffic, and that was hard to get there.

But now that we're there, it's about 90 10. The other. It is all operational, like these are interfaces and technologies and things that we've done now, thousands of times, literally in thousands of different locations. So the technology part has gotten pretty easy. It's the operational part.

It's getting someone at the top. CEO is the best that says, you know what? Communication is important. It is the source of toil for our clinicians. It is the source of medical errors and the source of problems with safety and quality. We need to all communicate on the same channel.

Whatever that is, we're all gonna communicate on one. And we have 25,000 employees. All 25,000 employees are gonna use this channel. And when you do that and you have that network, That's when you really start to drive the value and see the value of this, and for every additional person you add to that network, it's exponentially more valuable to the people that are already part of it.

Right? If you can find everyone, it just makes it so much easier. And to your point, you know, if these fragmented solutions that exist, right? If I'm using a communication application, but I can only get in touch with like 30% of the people. It's no good to me,

sort of a self-fulfilling prophecy there, right?

So I told you this is gonna be terrible. Yeah.

Yeah. So you've really gotta have leadership from the top that says this is the right thing to do and this is the way we're gonna do it.

Awesome. Awesome. Well, one final question. If you had one thing to speak to other CMIOs or other IT executives, what would be that take home?

From your perspective, it's communication and the like.

I think it would be, to prioritize communication and prioritize it as I suggested before in terms of workflow and give something to your clinicians that's gonna enhance their workflow. And I think the biggest piece of granular advice, I would give very specific advice that I would give would be, don't do this in your emr.

For a few really good reasons. I think number one, you need to give people a backup to a way to communicate in the case of downtime of an emr. And we've seen it happen all over the country this year, either from some sort of outage an error schedule or unscheduled downtime or ransomware. have seen it all this year, and if you're having all your communication run through your emr and EMR is down, you've paralyzed your caregivers, right?

How is that nurse in the middle of the night gonna get in touch with the physician to get orders or otherwise talk about that patient? Right? You have to give something for a backup in case of disaster. I think the other thing is, and the reason you don't want to use the EMR, is you need to replicate the human.

Messaging experience. Everyone is on their phone, right? Everyone is using either SMS or iMessage or WhatsApp to communicate with everyone in their lives. It has become part of human behavior and you have to recognize. That, and you have to try to replicate that. Even Facebook back when they were maybe even a little more wise, right?

Early, I think it was probably 20 13, 20 14, they realized they had to split out Facebook Messenger from Facebook. That fundamentally messaging and communication is a primary use case and it has to be separate. And the places that I've seen most successful in communication, where they're getting the most value out of.

I see a lot of people using the EMR on one screen and having Tiger Connect or something similar on another screen where they're using both at the same time and communicating in a way that they're used to communicating. And what that ultimately gets you. In addition to the benefits we talked about before in terms of cost, quality, experience of care, most of all, what you're doing for that caregiver is reducing toil and.

That's something that today with all the rates of people leaving the profession and not practicing medicine anymore, I don't like that word burnout. I like the term, Hey, these people are realizing this is not so good. I wanna leave and go do something else. And it's happening with physicians, it's happening with nurses.

This is a way to make their jobs a little bit better and a little bit easier. And it's something that is easy for IT departments to do. And it's something I think I would advise folks to very much consider.


I appreciate, That's good Sage advice. I think that cognitive burden, while it's difficult to objectively measure, is a big deal and we can do whatever we can to lower that.

So not only do we not make enough of. Of us from a provider perspective, nurse perspective, we have to utilize the ones we have and become more efficient with, with the ones that we are training up. So well, will I? Super. This was great. I think we could probably talk for another 20 or 30 minutes. Easy. I appreciate you coming on today and thanks for being here.

Yeah, thanks for having me, Brett. Enjoyed it.

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