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July 27: Today on TownHall Jeffrey Cleveland, Chief Medical Information Officer at Atrium Health speaks with Eric Kirkendall, Chief Information Officer & Chief Medical Information Officer - Academic Health at Atrium Health. How did Eric's interest in informatics and technology evolve from his initial role as a pediatric hospitalist? What is a learning health system and what benefits does it bring to the healthcare delivery system? What is the role of innovation in a learning health system? What are some of the unique challenges for designing and implementing health information technology within a learning health system?

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Transcript

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Today on This Week Health.

To me, innovation really means doing that with that innovative mindset. And a lot of things that you typically would associate with startup culture.

So being very creative using emerging technologies, being very quick. So one of the things that. Health care systems are usually not thought of as being very agile and quick. And so how do you build up innovation programs within our health systems that are quick that get to answers very quickly?

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.

would like to welcome Dr Eric who is currently the CIO and CMI at atrium health Wake Forest to the show today. Welcome Eric today. We'll be discussing some of the unique opportunities and challenges of an academic health center of which. Atrium Health Wake Forest is a superb example. By the way, I was a student at Wake Forest Medical School many years ago, and it's been a lot of fun for me as over the past few years, my alma mater has now become part of Atrium Health.

So Eric, let's just start off and have you tell us a bit about your professional training and then your journey as your career morphed into informatics and technology.

Yeah, absolutely. And thanks for having me, Jeff. Super excited to be here and and kind of tell you my story. I finished my residency and training in pediatrics and entered into attending as a a hospitalist.

So pediatric hospital medicine started getting interested in looking outside of clinical practice and what other things I could do for a career and informatics was something that was a relatively new concept to me, but I kind of started from the place of, Always been interested in computers, kind of a hobbyist programmer kind of thing had the experience as a user of different electronic health records and technologies and thought that there was a lot of room for improvement there.

So just started looking for some training opportunities research projects or anything in that space. And I discovered informatics had some great mentors who made some awesome introductions and suggestions on professional growth. I went to American Medical Informatics Association meeting, got to know what the informatics community was about, got formally trained up, and then some of my first early tasks were in the operational realm.

So we were designing and implementing an electronic health record at the time. So I sort of got boots on the ground experience working with those teams and serving as a subject matter expert. And then after go live, we really started switching into this. Place where the system was stable, but we were analyzing a lot of data, and I kind of, discovered that I was inadvertently doing a little bit of light research because we were making observations from the data, trying to improve the systems and then watching to see what our interventions did.

And so eventually I, you know, being in an academic medical center, I was encouraged to start applying for research grants and funding to really put more rigor around those investigations. So, I kind of evolved from a clinical... Informatics operations kind of main role into more of a research role and then as the interventions that I was putting in place became sort of more cutting edge, more emerging technology, more custom software development kind of things.

We started doing more and more research in the emerging technology space realized that I had a big interest in sort of what people would think of as typically as innovations type activities. So working with more startups working on more creative brainstorming and those kind of things for the solutions that we were working with.

So I kind of evolved from operations to research to an innovation space. And then recently in the last six months, I've taken on new roles that have swung the pendulum back more into operations. So, always had feet in all of those camps spending more time in operations these days.

Yeah, now you're the chief information officer.

So you're leading the whole thing. Awesome. Well, we talked a little bit today about learning health system. We use the term academic health system. Tell me what those are and what they're about and why they're important. What's the value there or the value proposition for a learning health system?

Yeah, so the basic concept of learning health system, or as we like to call it, our academic learning health system is that you're really sort of creating this virtuous cycle between your clinical side of the house, your research and academic side of the house and the benefit of all. And what I mean by that is.

You're taking a lot of the data and input you're getting from your clinical operations. You're studying it. You're putting a little rigor behind it. And then you're through QI or quality improvement or other methods, you're really taking those learnings and putting them back into your healthcare delivery system and making it better.

And so that becomes the cycle. Clinical ops creates data, you transform that data into information. And interventions and you put those back into play. So, for us, informaticists, that's a pretty easy concept to grasp. It's a lot of what we do because we work with data so much. For others, it's a little bit of a more of a learning curve.

And then the sort of next level of detail around that is, is that you really start designing your infrastructure, your strategy or operations to support that because you. Sometimes each of those areas works in silos. And so what you want to do is get each of the components to work together. So that's the core concept of a learning health system.

The academic side is just that you're really flexing those academic muscles. So the research and science and discovery side of the house and using that to inform whereas Other organizations may look externally for a lot of ideas, academic learning health system. You're leveraging your academic strengths.

 we'll get back to our show in just a minute. Our rural healthcare systems face unique challenges in America. Join us for our upcoming free webinar, Rural Healthcare Challenges and Opportunities, on August 3rd at 1 o'clock Eastern Time. We'll unpack these challenges and look for opportunities for smaller health systems to take the lead in the delivery of care to this underserved population.

Join us as we look to unlock the potential of technology to make a difference in the lives of thousands. In rural communities. Remember August 3rd, 1:00 PM Eastern Time and 10:00 AM Pacific time. You can register over on this week health.com. Now back to our show.

Yeah, 1 of the real drivers behind the merger between Wake Forest and atrium health was bringing that academic learning depth and expertise into our large clinical system to take advantage of that virtuous cycle that you described. I'm curious, where does innovation fit into that cycle?

And well, what, how do you define innovation? And then where do you see it growing within an academic learning health system?

Yeah, so, I always start from a place of saying that innovation means a lot of different things to a lot of different people. One of the early exercises I did was just to go out and see what those formalized definitions were.

And they're kind of all over the place, but most of them center around the proposition of, you know, problem solving novel solutions that generate value for multiple stakeholders. So I always look at things through a problem solution, value framework. There's a lot of the quote, shiny objects out there in the innovation space.

A lot of really great ideas for solutions and things, but sometimes those are solutions that are in search of problems. So innovation really is bringing something new to bear that's going to generate value. And in healthcare and healthcare innovation, I always think of it as sort of, I try to root it or ground it in the quadruple aim.

So are we making patient care better, cheaper, faster? Are we improving the lives of all of our staff, teammates, providers, et cetera. To me, innovation really means doing that in sort of with that innovative mindset. And a lot of things that you typically would associate with startup culture.

So being very creative using emerging technologies, being very quick. So one of the things that. Health care systems are usually not thought of as being very agile and quick. And so how do you build up innovation programs within our health systems that are quick that get to answers very quickly?

And then the last thing I'll say is just in the research environment, anybody who's ever applied for a federal grant, one of the 5 main criteria that you're judged on from your ideas and your proposals is innovation. So there's a natural sort of marriage there between innovation and in the research and academic environment.

Very interesting. Thank you. So this podcast, as you know, is about the intersection of health care and technology. I guess I'm curious, what are some of the unique challenges to designing and using health information technology within. A learning health system innovative research educational system.

Yeah. So I think one of the key things I just alluded to in my previous answers around just being, agile, right. And getting to things quickly, getting things implemented quickly and learning. Another is around resource management and stewardship. Right? So, these activities take time and money and effort.

So we try to de risk a lot of our activities. We work on the things that we think will work and are the most important, but by its nature you're trying out new things. So a lot of our environments are sometimes not set up to be really conducive those kinds of things. So resourcing is always a challenge.

in health care if you're trying to do a lot of what we try to do from an innovation standpoint, and our learning health systems interacts with the clinical system, it's already busy and stressed. And so, if you're gonna be changing workflows, or there's a requirement there, you have to be very cognizant of that and plan for that.

And, lastly, because a lot of the technology that , using. It has access to data and patient data. We have to be very careful, be good stewards of that data, keep it secure, private, confidential and all of those things because the , you know, all the cyber security risks are only growing these days.

So lots of challenges, which is why you're seeing more and more. Academic medical centers putting together innovation groups that focus specifically on this because it's not something you know, there's no recipe for anyone. One place to do it easily.

Tell us some things that you're proud about or unique strengths of atrium health Wake Forest.

Yeah, I think we talked about earlier Jeff a little bit that it's an exciting time for us because we were a large research enterprise, large health care system by all rights before we sort of joined up. With atrium and now advocate. I think bringing all of our strengths to bear is the thing that is very exciting to me.

So you already hit the nail on the head. So we have a lot of great research going on. But now we've got an even larger clinical footprint to try things out to personalize care for patients and improve patients at a much larger scale. So there's everybody in the kind of innovation and technology space is always talking about scale.

I think about scale from a technical perspective, but also now are Ability to do so across a larger patient population and make a difference for even more patients. So, as I mentioned, a lot of these efforts are, resource intense and so forth, but now we can scale it out to even more people.

Some of our solutions and innovations, we can make an even bigger difference. So, super excited about that. I am a clinician and operations guy, a researcher and an educator. And all of my worlds are kind of coming together now and in my new role and in our organization as it has evolved.

It doesn't sound like it's ever boring in your office and many of our viewers may not know that we are launching a new medical school under the leadership of Wake Forest School of Medicine in the Charlotte market. And you obviously. As our will be a key to setting up all of the technology to support that important endeavor that we're busy about right now.

Yeah. And as these things are, these very large projects very important for the organization, but it's, there's a huge team there. Right? So, we're also working on transitioning into one e h r. So, you know, I'm, I'm one person on that whole team. I'm working closely with you on a day-to-day basis down in the trenches trying to get these huge things done.

But I think in the end, things like a new campus for the School of Medicine, getting on one EHR to serve all of our patient population in the southeast and so forth are huge projects that sometimes we lose sight, the magnitude of 'em, cuz we're in the day to day, but extremely happy to be part of the.

A larger team working on such important work.

Well, thanks for taking some time today, Eric. This has been a good conversation, and I've enjoyed hearing more about your journey. So I appreciate you making the investment, and thanks very much.

Yeah, thanks for having me, Jeff. Appreciate it.

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