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it was like, wow, are you sure you want to do this? Turned out to be a pretty good decision because 50 days into that job, I tore up my 100 day plan because COVID hit. And the rest is history, but that's a long road from pharmacy to something else. And I think it's a bit of a cliche, but it sort of reinforces for me the notion that you may train for 1 thing, but the jobs you may end up in don't even exist.

Maybe at the time.  

Welcome to 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 dedicated to keeping health IT staff and engaged. For five years we've been making podcasts that amplify great thinking to propel healthcare forward. We want to thank our show partners, MEDITECH and Transcarent, for investing in our mission to develop the next generation of health leaders now onto our show.

Welcome to the this week health community town hall conversation. I'm Reed Stephan, VP and CIO of St. Luke's Health System in Boise, Idaho.

And I'm joined today by my friend, Scott Jocelyn, who is the chief information and innovation officer at UC Irvine Health. Scott, welcome and thank you for

taking a few minutes. Thank you. I'm happy to be here and thank you for having me.

Yeah. Take a minute and just introduce UC Irvine Health to listeners who may not be familiar with you.

Sure. UC Irvine Health is the only academic medical center in Orange County where I live here in Southern California. It is part of the University of California. There are 13 campuses, there are 5 sort of 5 and a half. If you could include, you see Riverside medical centers, you'd be familiar with them.

UCLA, San Diego, San Francisco, Davis, and you see, provide health. We have to be the smallest, but I'd like to think 1 of the best. And as I said, the only 1 here in Orange County, we're academic, of course. A 460 bed hospital in the city of orange that 30 some years ago was the county hospital. We are building a new facility, a new hospital 142 beds on our university campus, which is 10 miles to the South in the city of Irvine.

We're building an ambulatory care center and a center for advanced care. We have a new school of medicine at a school of medicine, but new buildings there. The Sam well, a integrative health Institute, a credible organization. we have the schools of medicine, pharmacy, nursing, public health, along with the other schools and engineering and things you would expect and a mirage business school.

So, that's a, you see, Irvine is growing is thriving. We're not a highly competitive market, but I think we offer the kinds of care that really compliments. Care offered by some of the other hospitals in our market as well.

Okay. That's an impressive organization. Thanks for that background. 1 of the purposes of these town hall community shows is to create a sense of community and a network and I think a great way to do that is to.

learn about people's career paths and make connections with where they've been and what they've done. So just take a few minutes and walk us through your education background and your career journey that's led to the role you have today at UC Irvine Health.

Sure. Well, when I went to school, which was quite some time ago and came out of that school as a doctor of pharmacy there was no such thing as a CIO and I practiced pharmacy for 2 and a half years the last year, which was.

A clinical residency at place, it still exists long beach memorial medical center, which is part of something called memorial care, which I became a part and it was wonderful. Great experience right at the bedside with clinicians. And so on rounding with physicians providing really to residents and insurance in particular, but residents pharmacy advice as we're talking about patients often critical care, med surg, Wherever you may be, I actually had the most fun and spent most of my time programming. A PC, an early version of a PC. I won't even go into the details there. But what I did is program it to do what is known as pharmacokinetic dosing. Basically, there are any number of drugs for which the amount that will help you and amount that will hurt you are not far apart.

And it's called an aero therapeutic index. And so pharmacists were involved with dosing of those drugs. Genome isoline would be an antibiotic. And many people may know, for example, that too much damage your kidneys and lead to deafness, so you can damage the ear. so that it's rather straightforward 1st order calculus in which.

Those drugs typically behave in the body and you can calculate the elimination and so on. And basically, you want to get peaks and troughs in a range that does the job you want and doesn't do what you don't want. the math is not that difficult. It was not hard at all for me to program it on which later became an Apple computer, and I had reverse engineered at the time what was known as Apple Plot, and so all the data that I produced could be graphed, and we would produce a report that would go on the chart.

And those good old days pharmacy was actually reimbursed for that. So it became really sort of a revenue thing. At the end of that, my residency, I had 2 offers to stay with pharmacy, but um, was actually offered a position in. Dare I say what was known then as dead processing, which I ran toward ready to take a salary cut because I had so much fun doing it didn't have to and I grew up with it.

I was an analyst. I knew the background. I knew. fair amount about computers, although not a whole lot didn't have that much formal training, but I had taken programming as an elective and we were in the midst of developing a hospital information system with computer sciences corporation.

It turns out that didn't work out. people have learned ever since that, our core competency is really taking care of patients and not building health information systems, if you will. But anyway, I, as an analyst programmer, I did that for a couple of years, and I managed programming for a couple of years.

Then I became an associate director of the department and picked up responsibilities at that point for the data center. Evolving PC infrastructure training, et cetera, and then became a director of clinical systems. And later on during that period, I worked for the organization's 1st CIO.

And I, 1 of my early assignments was in the big assignment was to roll out an, we were going to that massive development of our own system. Clearly failed the self development that followed clearly failed. And so we ended up acquiring a system called TDS or technical data systems that many people will know later became eclipses.

And so my, I was the project director and we roll it out and we had 100% order entry and our children's hospital high degrees of entry elsewhere. And that places, not so much. So my predecessor. Sure. Outsource the entire it department move that position forward or move that concept forward.

And it was. Enormous outsourcing endeavor 1 of the 1st and largest of its kind in healthcare, and I was asked to stay behind and manage that contract. And I elected not to do that and go with my boss, if you will, in the end, that didn't work out. And 2 and a half years later, I was asked. And allowed by the outsourcing company to come back as the, and from there the 1st, big gig was 1 learning how to be a and frankly, I wasn't qualified, but I was there.

They liked me. They trusted me. I managed the contract. 1st, big gig with court Y2K and then after that, we had acquired some hospitals and integrating all of them. So, and none of them operated similarly. come the early 2000s, it was time to replace the HR and that led to selection of epic that went exceedingly.

Well, even those quite early and high risk ended up managing research along the way. Got involved with our venture capital fund and was planning to leave. Memorial care where I was and just sort of ease back and maybe do venture capital. So, 2 or 3 months before that, I was going to retire if you will really just kind of do something else.

I was helping you see Irvine health, try to find. A CIO and I met with the CEO. I knew the prior person. I've been in the industry for a while. I knew some people and I really like the fellow and end up throwing my hat in the ring with no expectation of landing on that job. And then I end up with a job offer.

And then it was like, wow, are you sure you want to do this? I decided to do it. Turned out to be a pretty good decision because 50 days into that job, I tore up my 100 day plan because COVID hit. And the rest is history, but that's a long road from pharmacy to something else. And I think it's a bit of a cliche, but it sort of reinforces for me the notion that you may train for 1 thing, but the jobs you may end up in don't even exist.

Maybe at the time. And that was certainly true for me. It's clearly true for young people today.

Well, I love that story. I love the. ongoing journey of education that you obviously have pursued over your career, the agility and willingness to be curious, to change your mind, to be open to something unexpected.

And I think you're better for it, but also the benefit that you provided where you've worked, but also to the broader community at large. I'm curious, so you have two I's in your title. Information, which is, very boilerplate for CIO. When did the word innovation get added to your title? And maybe kind of talk about the why behind that and what it's meant.

So, as I said just a short period into my job at UCI health COVID hit, and we were like everybody else scrambling. We put up a 50 bed tent et cetera. And I was walking around with. The CEO actually, he was the CEO who I'd originally met and he was the CEO. When I started my position, the CEO and departed and they were recruiting are going to replace that person.

The CEO got the job and 3 months or 4 months in. And so we're walking around looking at the tent and just talking generally. And we were talking how remarkably telemedicine e visits and the like had advanced out of necessity, really. And the idea that it was probably going to stick. And I said, yeah, I think it's that's good.

It's good for everybody. And we've established the fact that a lot of care can be done sort of remotely, if you will. And I said to him, I said, but that's just the beginning. I think we need to think about this beyond that. We need to think about what let's just call it virtual care. He said, I absolutely agree and he said, I just need somebody to lead it.

Now, he and I are alone out by this tent and I'm looking around and what am I going to say? I said, well, I actually was anxious to do that. Are happy to do that. I said, well, sure. So I ended up with responsibility for what was fairly new at the time and whatever you want to call it today. The phrase virtual care for not just the telemedicine what we're going to do next and it started with how do we get our patients out of the hospital into the home remote monitoring and so on.

So that went on. And then I helped to get working with the chief investment officer, another CIO of the University of California, who manages, 250Billion dollars worth of funds 4 months after meeting him, we had a 50Million dollar venture capital fund and the only 1 amongst the UC medical centers.

So, as that happened Chad effectively promoted me unexpectedly and made me the. Chief information officer and innovation officer at the same time. So I acquired that title. Yeah, and I want to get rid of 1 of the eyes and I plan to do. So, in the next 4 to 6 weeks, 3 months behind schedule what I mean by that.

I just want to stay with you. See, I help manage the fund and let someone else be the chief information officer. I will just be the chief innovation officer.

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That's a great blueprint of how to do that. lot of questions,

you talked about care at home. Maybe describe a bit about like hospital at home and what you've done at UC Irvine Health, what you're doing, lessons that you would share with others, and maybe you're just starting their hospital at home journey.

We are, and I have to say it's still evolving. Others have gone not sooner, but maybe a little faster with it.

California is unique in some of its requirements, but as we were thinking about it in the earliest days, I took eight physicians up to a hospital in central California that was using a product called medically home and as a model of. Or a way by which you get and it was strictly to deal with coven in the foothills of California where there was really no health care.

We came back with the idea. We should do something like this. We looked at medically home. The bottom line is we began to look at it as and I see care at home to care at home today as sort of a 3rd. Service line, if you will, there's ambulatory, there's inpatient, and then there's care outside of those 4 walls in ideally a patient's home, but sometimes it can be a sniff or whatever, but it's not inside the acute or ambulatory space that is evolving today.

There's reimbursement, lots of considerations, but there's a whole spectrum of things from just sending patients home when expected, or maybe slightly earlier than expected, depending on how they're doing with remote monitoring. The idea is to avoid remissions. Put it into an environment that frankly is safer, less likely to acquire sepsis or other kinds of problems and manage them safely.

All the way up to a license hospital bed in the home, which to me is sort of Nirvana, but we were the only the organization in California to get a California Department of Public Health. Waiver, if you will, to do a license bed in the home. So, and Venice, the hospital we had visited had the 1st using medically home.

We have the 2nd and now I wouldn't say it's common, but we're developing a very target care home capability. We, also partnered with a company called dispatch health so that we could dispatch. Or the people could call patients that at home to avoid emergency trips, or if we had patients that are gone home and began to somehow decompensate, we could dispatch help there to avoid an unnecessary readmission.

So that's all in play now along with, various care at home infusions, you name it. That really makes us more vertically integrated, more complete. and more complete with respect to our patients and what we can do for them across the spectrum. Now that's also alongside integrative health, maintaining wellness, keeping people well monitoring people with chronic diseases.

So that's an evolution and maybe the next CIO's job to figure out how to really make that work along with the medical director.

Well, I know it's still early days, but what outcomes have you seen in terms of patient satisfaction? Improved health care outcomes with hospital at home experiences.

I can't say we have lots of measurements. We have observations. Yeah, and we're challenged and I don't think we're alone with just basic throughput. How do we get patients out of the organization to the point where more often than not, it sometimes we're stuck simply because we can't find a sniff.

So, we're trying to forecast, for example, upon admission, the likelihood that a patient will, end up needing a sniff. So we begin looking for it ahead of time. We're trying to forecast the likelihood of readmission of a patient chronic heart disease, congestive heart failure is one of those in which patients can decompensate.

They go home and it's starting to feel better from whatever inpatient experience they had. They may not follow their diet. They may somehow gain weight pretty soon. They end up back in the D. so we have seen early reductions in readmission rate by being very. Much aware of that, but also sending patients home with whether it's scales, blood pressure monitors and the ability to measure things at home up.

We've seen non invasive strips. That will monitor electrolytes, so we can begin to see what's going on with the patient there potassium in the case of chronic kidney disease, for example. So we're starting to see 1 care being in a more appropriate venue. There's typically a fixed cost reimbursement.

We suffer penalties upon readmission. That's not good for the patient. So starting to see improvement there and we're starting to see, I guess, and maybe enjoy the satisfaction of being more complete in our market, but it's really early. And we're not alone, but we can see better care and. Key to that is also as we look to our new hospital, it's going to be completely different.

It's going to be largely a huge intensive care unit, emergency department and surgery. Everything else is going to be somewhere else.

Yeah, no, I think that's exactly right. And I think you're right. It's still early. But it's also so clearly the future state that we need to be planning for and driving towards as you think about hospital at home care outside the inpatient traditional facilities, what are some of the most innovative or exciting technologies that you're aware of, or kind of tracking that are gonna really help to kind of close that gap of what's possible today.

For our inpatient facilities for sure, our current one and the new one we that we're building, there is, and it's been pretty clear a need for sort of a central command center. To really monitor if you will, a factory through which patients move to track their progress intervene as necessary when there are bottlenecks, frankly, if you can automatically and certainly interventions that may become necessary because the patient's not doing what we expect them to do at that point in time, it became obvious that same infrastructure Can both be used and is actually needed in an environment all the way into the home.

And so the evolution of patches and other ways to monitor patient status outside of the facility, as if they were an inpatient, the ability to dispatch nursing or other kinds of care to the home, including infusions in the case of oncology patients and the ability to integrate that with the epic is now I'm going to say table stakes, but.

It can be done so that the clinician, the physician, nurses and others can see into a single record and in our case, epic and across the spectrum, this patient's care as well as history and so on. So that technology is really evolved. And I would say that what's evolving now is the idea of passive audio and video, particularly inside the new medical center where.

Though it's going to cause some anxiety, I think reality is that our inpatient environments and other environments are going to have a passive audio and video just there. The ability to listen as much as, I have 2 phones in front of me here and they both have Siri running. And if I'm not careful, either my watch or my phone is going to start saying, what do you want?

Yeah, well, imagine in a patient's room, a nurse changing a central line dress and the nurse remarking hey, call it a system. Siri. Hey, Siri, I'm changing the patient's central line dressing. Now, Epic knows there's an order for that. And. Our protocol knows that at least daily you do those kinds of things that statement by the nurse or the observation by the camera can be documented without the nurse having to do anything.

So we've saved her him a few minutes. And all I need to do is go in and validate that. So that's just the start. There's fall risk instead of observations. You got cameras that could do all these things and the camera and the system we're looking at blanks out the people. You can't, it's all black, you can't see it.

So you see there are humans there, you see movement, you see everything else with all the HIPAA protections. So I think that's going to become fundamental along with real time location systems and so on to track things that move through the hospital. more practical application of things like lean processing techniques.

I don't want to say single piece flow because patients are not at all uniform, but their themes of patients, and they can go along a process that can generally be somewhat predicted and guided because they're similar. And we can begin to track all of that, and we can begin to measure it, and we can begin to optimize it.

And in the end, it's better for the patients, better for us, increases throughput, lowers costs, patients going home to a safer environment, generally will lead to a better outcome. So, I it's the audio, the video. The sensing the 5G always aware. It's the awareness, right? Situational awareness, the ability to monitor that the ability to apply AI to that the ability to do what a nurse that I saw as a pharmacy resident say my patient doesn't look good.

I think they're going to crash, which is what they would do. Couldn't tell you exactly why they could just say they don't look good. We can now measure things like that. That today we know was best. The early onset of sepsis. That's all in the realm of AI today and table stakes, frankly.

Yeah, it's such an exciting time to do what we do and to really be able to make a meaningful difference in the care experience for the provider, for the patient, for their family, for everyone involved.

Scott, thank you. Always a delight to visit with you. I appreciate your experience, your wisdom, your insights. Thanks for making a few minutes to spend time with me today and for the conversation.

Well, you're quite welcome, Reed. It's good to see you and I've always enjoyed these podcasts, and I think um, you, Bill, and his team just do an extraordinary job.

You're really helping all of us share with each other and learn. So I think it's terrific. Glad I had an opportunity to do it.

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