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Today on Town Hall

ethical use of ai, ensuring that we're not just putting in algorithms to put in algorithms and letting them do their things in their black box, but understanding what's happening. Understanding, areas of opportunity and areas of weakness, many vendors are releasing AI models, and it's good to understand the efficacy and where they stand up and where they fall down.

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health.

Where we are dedicated to transforming healthcare, one connection at a time. Our town hall show is designed to bring insights from practitioners and leaders. on the front lines of healthcare. 📍 Today's episode is sponsored by ARMIS, First Health Advisory, Meditech, Optimum Health IT, and uPerform. Alright, let's jump right into today's episode.

Hello, I'm Sue Shade, Principal at Starbridge Advisors and one of the hosts for the Town Hall Show at This Week Health. Today, my guest is Josh Glandorf. He's the Chief Information Officer at UC San Diego Health. He's been at UCSD since 2016 and in the CIO role for the past two plus years. I'm really looking forward to talking with Josh today and hearing what he and his team at UCSD are currently focusing on.

Welcome, Josh. Thanks, Sue. Thanks for having me. Yeah, great to have you here. Let's start by having you briefly introduce yourself and tell us about UC San Diego Health. Yeah, thanks. So I've been in healthcare IT for over 20 years now, actually started my career with Cerner Corporation as an analyst and progressed throughout the ranks.

I've been with UC San Diego Health now for over seven years going on eight, and started out as Director of Affiliations and helped to manage our implementation of. University of California, Irvine, EPIC which went live in 2017 and have since taken over different pieces and portions of the IT infrastructure and as you mentioned about two years ago, took over at CIO and running the IT department UC San Diego Health, just so, folks can acclimate themselves.

It's the only academic medical center in the San Diego area. We're a three hospital system, just recently acquired a new hospital our east campus, and so, we are over 800 beds we were just ranked in U. S. News World Report it's one of the nation's top hospitals many specialties ranked as well, so high performing academic.

Excellent. Congratulations on that recognition. So, let's start by hearing about some of your current priorities for the new year. We're in

2024. Yeah, so I mentioned briefly acquisitions. We have a recent acquisition we're going to be bringing live on our Epic instance. In the summer. So that's gonna, that's gonna be a considerable effort.

We have another joint partnership that we're exploring with Tri City Medical Center that you know, we anticipate will keep us very busy as well. In addition to that you know, all things AI so we've got a, you know, a big focus on integration of artificial intelligence into our existing systems like Epic, which we've done some pilot projects.

On with them as well as net new vendors and acquiring some net new functionality in the AI space. Additionally, as part of our Center for Health Innovation we are ramping up our development of our command center, which will be positioned in the hospital co location of various functions in the hospital transfer center nursing administration, et cetera to help to make our operations more efficient and increase our throughput, reduce barriers, integration of, you know, various technology systems, AI helping us operate you know, at a higher level to more patients considering we are A full hospital on a daily basis now with numerous patients boarded in the ED waiting for beds.

There's a tremendous burning platform for us to do more and be more efficient. So those are the big focus areas. We've also got some core, I'd say foundational areas we're focusing on, like, CRM. So we're looking at the implementation of a CRM system for enhancement of our relationships with our patients and our customers.

Those are the big focus areas for this year. Okay, big agendas. So some follow up questions just on that. You said you started as a Director of at UCSD, and then you mentioned in terms of some of your priorities this year partnerships. Do you still have that role? And someone else, or is that part of your role as the

CIO?

I would say it's, you know, semi part of my role from a hospital standpoint. We do have from a practice standpoint so ambulatory practices, we have a director of. Affiliations or practice affiliations that does manage our community connect practice and our relationships with those practices that are part of our clinically integrated network.

Some of those are on our Epic instance, and we host them some are not. And, you know, there's other integrations like MSSP ACOs and things like that. But that's certainly something that I think is core to my role, but we've got somebody from a practice standpoint that's directly over that.

Got it. Yeah, core to your role because it's a lot of strategic aspects of those, those affiliations. Great. And then you mentioned that as part of the innovation center, you're developing a command center. So I immediately thought command center in an IT. You know, terms for an implementation, but then you went on to describe it more like your central traffic control for access and transfers.

Is that what

it is? That's exactly what it is. Yeah, so don't think incident command center think you know, daily, IoT. engagement, a central place in the hospital for co location of core features and functions operational folks, you know, in there having discussions talking about transfers and discharges and potentially bottlenecks in different services to get patients.

In and out of the hospital, their care, the most efficiently possible and as safe as we can. That's the focus there. And so you can imagine there's a people process and a technology, component to all of that. And all will be instrumental to being successful.

Good,

good. Well, you mentioned AI already, but I want to get into that in a little bit here. Because I know you're doing a lot in that area at UCSD. But just, you know, back to you and your role and organization. I know that Chris Longhurst was the previous CIO prior to you. You took that role over when he was promoted, interestingly enough, to the joint roles of chief medical officer, he's a physician, and chief digital officer.

So tell us a bit about your respective roles and how you work together

with Chris. Yeah, so Chris and I are I think joined at the hip from an IT standpoint Chris is our Executive Director for our Center for Health Innovation. I sit on the Steering Committee for our Center for Health Innovation.

And as you can imagine, there's a lot of overlap and diagram between innovation and IT. And so, there's constant communication and back and forth in terms of what is the Center for Health Innovation's goal and aim? How does IT support that? What are the needs of IT in the organization?

That can be assisted by, the center. Chris is instrumental in cyber security as well, and that's an area that we co lead something that, you know, I think is a concern and near and dear to every CIO's heart as we're in the world we're in right now. But yeah, Chris and I work together well and often, it's important for us to stay close in terms of, the portfolio as a whole.

Yeah it's an interesting pairing and roles and titles that is probably unique to your organization and unique to the two of you, because I would imagine just being chief medical officer in an academic medical center, Chris would have his hands full, just in that role, right?

Right. Yeah, absolutely.

Okay. Definitely unique. And I think UC San Diego Health is unique and we're evolving to, solve the issues at hand to be as best as we can.

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 Okay, great. Well, one of the things that I wanted to talk with you about too, is physician burnout. What are you doing at UCSD to address physician burnout?

And I imagine you're going to talk a little bit too about your partnership with Chris in this respect as the chief medical officer.

Yeah. Yeah. So physician burnout is certainly a huge focus for us. There are, numerous work groups. We've got, some executive governance groups that are addressing physician burnout from, people, process and technology because tech is certainly part of it, but not all of it.

We can help, but we can't solve all the issues. But from an IT standpoint, one of the interesting things that we're doing or have done is piloted with Epic. We were one of the early adopters of the in basket suggested response where providers can use AI to then help craft a message in response to patient inquiries in MyChart and through in basket.

And so the idea there was Can we enhance the quality of the communication? Can we reduce the time spent in the chart? Et cetera. So that's one example where we're using AI and partnering with our existing vendor, Epic, to do that. Additionally, we're constantly looking for opportunities such as, clearing out noise in the system, whether that be clinical decision support tools and notices that are low value add or non value added, so continuing to look at that to optimize it to make this system as user and efficient as possible.

To, , clearing out unnecessary messages in InBasket for providers that, aren't adding value as well. We also have what we call our sprint team which goes out and is, , it's kind of a tiger team of about five people. They'll go out to practices, meet with providers in the practice, and help them understand what are the tools that exist inside of Epic and or other, ancillary tools.

To make them as efficient as possible looking at adoption reports and other tools we use to assess the competency, the technical competency of the positions to then tailor that support. So that's a constant, Stream of knowledge that we're continuing to impart, on each position.

That's great. Sounds

like you have several initiatives in that area. That's great to hear. Let's get into AI, okay? I saw that Chris participated in the White House discussions on AI in recent months. Testified before a congressional hearing on AI and health care. I also saw that UCSD has recently announced your inaugural Chief Health AI Officer Karandeep Singh.

I don't think there's a lot of them in the country yet in terms of healthcare systems roles. So clearly you're playing a leadership role in our industry when it comes to AI. So, tell us more about what you're doing there. You've already mentioned something I think with Epic and the Inbox pilot.

But what else are you doing? How are you addressing governance? How are you integrating it with other IT work? Yeah, so great question. We are certainly, positioning ourselves to be successful and to be a leader. We feel it's prudent of us to, think of AI holistically. And, to be a leader, we've got the tools and the technologies and we've got the resources here locally.

Academic center to be a leader and to help pave the way. Dr. Singh is a fantastic addition, to UC San Diego health, and he's going to do tremendous things and help lead us in that vision. We've had AI governance in place now for a couple of years that's been chaired by Dr.

Amy Sitti. And so looking at, I'd say proper use of ai responsible use of ai, ethical use of ai, ensuring that we're not just putting in algorithms to put in algorithms and letting them do their things in their black box, but understanding what's happening. Understanding, areas of opportunity and areas of weakness, many vendors are releasing AI models, and it's good to understand the efficacy and where they stand up and where they fall down.

One area that we felt was there was an opportunity was in. Steps is prediction, so we worked with Dr. Meem Namadi to create a bimodal AI model that basically takes Philips patient monitoring data as well as Epic data, combines the two. And does a real time assessment of each patient in our ICU to understand their risk of sepsis.

We've had tremendous success with that. We're talking to the other UC campuses to, to understand the potential to scale that as well. So that's an area where we've. We've said, hey there's models that exist here today that we can, kind of take off the shelf from some of our vendors, but we don't feel that they're adequate, and so we're going to develop something ourselves.

So we're certainly in the build, buy, borrow space, depending on what it is. And, we're not afraid to partner with a vendor as well and co develop where maybe they have the skill set we don't. So, we're leaving no stone unturned and nothing off the table.

So that's

great. That's really good to hear. And I've not heard the build by borrow. I haven't heard the borrow before. That's interesting. And obviously within healthcare, we learned so much from each other and it's such an open community for sharing. You also mentioned the University of California system.

So I imagine. I don't know that much about it, but I imagine there's a lot of sharing between those organizations. Is that right?

Yeah, absolutely. So, yeah, so, six health organizations. We have a number of work groups. Across IT and other, areas that are looking for our ability to leverage our scale and to, not reinvent the wheel six different times.

As you may know, or others may know, UC San Diego, we host UC Irvine and we host UC Riverside on our same epicate instance. So there's inherent integration and collaboration opportunities between the three campuses. Since we share that infrastructure but there's certainly an appetite at the UC level to do more together.

We understand that, our power together is much, much more than individually and I would say over the past. Probably, seven years or so when I started at UC is when I think the Leveraging Scale for Value initiative was kicking off and getting its footing.

Now it's a fairly well oiled machine, we've got a cadence for a tremendous amount of collaboration, on site meetings across the UCs, we'll travel to each. Campus quarterly and meet in person really to share and understand and create those relationships. That's

great. That's great.

I wanted to go back on a question to when you mentioned AI and that you've had governance for in place for 2 years and you mentioned an individual who's been sharing it. What is that person's title and role? I'm just curious who?

Yeah. So, Jared. Yeah, Dr. Amy Siddhapati she is one of our CMIOs for PopHealth and she is also more recently the interim chair for Department of Biomedical Informatics and so just a wonderful partner in IT and, bringing that to to research in various ways.

Okay, but but Amy's been instrumental. Got it. Good, good.

So, is there more that you wanted to cover about the Innovation Center? I know I had teed that up as something to talk about in terms of how you organize and staffed and some of the projects going on beyond what you've already said.

Not a lot.

I mean, I think I covered most of it. The Innovation Center, I think that I think the secret sauce in the way we've structured this is. It's highly 📍 integrated with IT. As I mentioned, I'm part of the steering committee. We have, a number of there's a couple other IT folks. That are part of the steering committee we have a number of executive advisors, and so we're trying to really thread the needle in terms of how the center is situated, aligned, integrated so it's not, creating kind of this silo of work it's integrated and it's meaningful to the health system.

We want to solve real issues and scale. So it's not focused on theory, it's focused on reality and. What are the real problems that we have in our health system today that we can solve? And, the command center is certainly one of those. I'd also be remiss if I didn't mention that we have also a Center for Healthcare Cybersecurity that was recently granted 10 million through an ARPA H grant.

That center is co led by Dr. DeMeth and Dr. Tully who are. Basically looking at, big bodacious ideas about what we can do to solve the the cyber security risks and problems, right? So, from the ability to stand up a hospital that's been ransomed. With a complete copy and infrastructure in a semi truck, , under two hours till preventing these cyber attacks from happening and in understanding the landscape of you know, San Diego County,

are there data elements and metrics that can help us understand if somebody's currently under attack from a cybersecurity standpoint to help inform others in the community that, there may be opportunities that we're going to have to pick up some of that volume and things. Because these cyber attacks are, a couple of hours or typically days or weeks,

Great. Oh, thanks for sharing that too. I do want to ask you 1 more question on a totally different topic. And that's workforce. Every organization is facing workforce challenges. We've got this new age of hybrid and remote work. So I'm curious if you have any particular innovative approaches to , recruiting, retaining, developing your workforce for the challenges of

the future.

Yeah, great question. I think I get an article a day on, bring everybody back, leave everybody remote, , and it depends on, I think, where you stand in terms of mentality. Right now we have a couple, like a, an approach where we split it up into three different buckets. We have our fully remote folks, which we have, , around 10 percent of the IT staff is , working remotely or out of state.

We have those folks that need to be on site, so think, , desktop techs, field techs biomedical technicians, those kind of folks that are in the hospital, they're in the clinics and they're working. On site on a daily basis. And then we have the people though, which are hybrid. what we've created as opposed to, you know, just come into the office and sit on Zoom, , for a, certain number of days per week, which you could do at home come in for meaningful encounters with your team, right?

So that's more directed to our leadership in the IT department where, , they're bringing their teams in for , maybe it's weekly team meetings, it's one on ones. It's, , happy hours, it's get togethers, brainstorming sessions, , project planning, those kind of things which takes everybody out of an office or out of a cube and gets them collaborating in some bigger rooms.

So we're actually looking at, we've done some revamping of our space. We've relinquished some of our space because it was underutilized and we're looking at revamping our core space right now for facilitating that level of collaboration and making it just more desirable for folks to come in, work with other team members and have meaningful encounters.

Love it. Meaningful

encounters. Great phrase. So thanks for covering that. Okay. This has been great. Thank you so much. Pleasure talking with you. Have a great day.

Thanks, too.

Appreciate it.

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