March 9: Today on TownHall Jake Lancaster, Chief Medical Information Officer at Baptist Memorial Health Care talks with Anwar Jebran, MD, Clinical Informatics Fellow at UI Health about hospital at home and informatics on the international scale. How is Anwar and UI Health setting up hospital at home for their organization? How is he planning to go about patient selection for it? What does the informatics landscape look like outside of the United States? What are the needs for informatics training or informatics trained physicians to get involved internationally?
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you feel there that their whole approach of a medical record is different. You go to a clinic, your doctor, they have your medical record papers, but the main up-to-date record is always with the patient.
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Hey everybody. I'm Jake Lancaster, an internal medicine physician, and the Chief Medical Information Officer for Baptist Memorial Healthcare based outta Memphis. And today I'm very excited to be with Dr. Anwar Jabon. Dr. Jabon, welcome to the podcast.
Thank you. Thank you for having
me. So tell the honest just a little bit about yourself and what
Sure. Anja Brown, originally from Damascus, Syria, finished my med school there, did my internal medicine residency in Chicago. Worked for a year in Michigan as an internist, and then now I'm a second year clinical informatics fellow at the University of Illinois in Chicago. At the same time I'm part of AIF with the AMIA Clinical Informatics Fellows executive board, and I'm part of the, American College of Physicians.
That's wonderful. And we have a couple of really interesting topics we wanna go through today. One, we want to talk about hospital at home, and then I wanna talk about your experience with international informatics and what you do. Yes. So let's start off with hospital at home. I know my group, my hospital, we developed our program a couple years back in the midst of the pandemic.
But we never really got it off the ground. I think we enrolled one patient , and the limiting factor for us was finding nurses that could actually staff the program. Tell me about your experience and what you've been doing.
As we all know, it's the trendy topic of the day.
Started with the Medicare waiver in November, 2020. And lot of hospital signed up. A lot of them rolled some patients for us at U I C. We're still in the works. We're planning to go live hopefully end of this year, early next year. We, you know, putting the pieces together has been challenging because you need to get the buy-in for, multiple service lines.
You need, as you mentioned, get the nurses. and with all the shortage that we have, it's a tough task to have and then get whether doing this in-house of the technology that you need to incorporate the telemedicine that you need to add or get a vendor and incorporate that. So we're in the midst of all these decisions.
The most likely decision we're looking to doing most of the stuff in-house. To be able to have control on it and hopefully be able roll the program soon.
Yeah, no let's, talk through a few of those decisions that you need to make. Yes. So, we had a similar thought process.
We evaluated some external vendors , and we did end up using a third party vendor for our remote patient monitoring piece. Yes. We're on Epic, so we used Epic for like our patient list and how to keep track of it. And that was actually. , same workflow that our hospitalists that would, round on these patients would use for their inpatients.
But we did end up going with a third party vendor for kind of that telehealth piece and for their remote patient monitoring. And that was largely based on, because the staff that we were using to actually assess the patients in the home were part of our Home health team and they were on a different platform already for that.
So that's why we went that direction. Talk to us about your thought process and how y'all are going about making those decisions.
Regarding the remote patient monitoring, to us it's, we wanna do it like a step-by-step in terms of. Let's first perfect the workflow. Let's first make sure we have a, a robust system and then the remote continuous monitoring probably it's gonna come down the line.
For now we're, using the technology that already exists in Epic, which is like the MyChart bedside solution in Epic, which, They really created well in terms of the use case for hospital at home the rover epic Rover in terms of nursing documentation. So we're trying to stay with one try to use the possible solutions and one vendor, which is epic in our case.
Because as you know, having third party there, there will be some bottlenecks , in workflows and data integration and interoperability and the fact that you need to scan stuff or move stuff with some validation errors in the horizon, that's a challenging process for us.
But for now, We're planning to use all the tools available in the Epic shop and then down the line, if we need to build on that with a third party or something in-house, we gonna take it from there.
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That makes sense. Talk to me about how y'all are gonna go about patient selection. Is this gonna be patients that are coming in through the ER that you decide to admit through there?
Or are these gonna be patients that were already inpatient that maybe you can send 'em home early with hospital to home? How are you? Walking through that.
Yeah. That's also a really interesting point. So, a lot of them, they call it like the completion at home where you start your admission in the hospital and then you complete it at home.
We gonna start slow, As all program and we wanna start it as safe as we can in our pilots. So we wanna do completion at home as a start. So, okay. We wanna pick the patients that, we did most of the major workup for them, like, the imaging the main samples collection. They're mostly stable.
They just need few more days of antibiotics iv, for example, or they need few more days of IV Lasix for C H F exacerbation. They need few more days. IV steroids for asthma exacerbation and so on and so forth. We, We picked five to six diagnoses that are relatively common, like c H f, asthma, C O P D, cellulitis U T i, these sort of things that.
They're bad enough to be in the hospital, but not bad enough to require full hospital staff. So, , that selection we gonna start with that and then hopefully we can expand on it after the pilot. One of the opportunities that we dabbled in, but we were like, you know, there's a lot of regulations about it, is the sickle cell population.
. I'm curious to hear your thoughts about that. Because there are regulations to kinda deliver and ship opioids. So it's a state by state thing I'm not sure if you had similar interactions at your system.
No, I mean, that is a really good point. And we were not planning on doing narcotics at home, at least in the beginning for our pilot.
Yeah. We had a similar approach though, we're gonna try both the ed and hospitalist units trying to get patients home sooner. I like that y'all are just gonna start with the completion at home piece because our emergency departments are really, bogged down right now.
It would be tough to add another piece to them right now, even though it could help with some of those bottlenecks. I think fixing the bottleneck on the inpatient side would probably be a better start, especially as you're starting out your program. But yeah, I mean the narcotics at home, I think that was just one that there was, it was just so thorny that we wanted to get the program up and running first before we addressed that.
Let's switch gears a little bit. Yes. You were telling me before we started recording about your work that you're doing in Morocco within Yes, , you know, A lot of us probably don't have international experience within informatics, and it's intriguing. What is the landscape like outside of the us?
Yeah. So, , I got exposed to the whole international col collaboration and especially Morocco. My my beautiful wife is from Morocco. And we went there last summer. We loved it. So, she had connections with few academic institutions back there.
She's originally from Casablanca and she was talking with those institutions about. The informatics I, I kept telling her about the informatics, the role of it, the future of informatics, artificial intelligence, all these exciting topics. And they were interested. So, just to give you like paint a picture about North Africa in general, middle East and especially Morocco they're in the phase.
Pre and during high tech as of the us so, basically they're now in the midst of transformation to electronic medical records from paper. Big institutions they're already taking that step. Smaller community hospital and clinic, they still do paper charts. In terms of policies.
Overall, the government is trying to do some programs to incentivize similar to high-tech and the Aura Act. They wanted to incentivize healthcare institution to move towards that. , especially after Covid, it was a big catalyst in the Middle East region. So we went there.
I, I presented the idea to my leadership at U I C. They were super excited for the collaboration. We created an o u with the University of Mohamed Premier in Wda, which is a city on the eastern region of Morocco. We created a partnership and collabo. And we actually with them, we hosted the first clinical informatics conference for medical students in whole North Africa.
And the conference was two or three days conference. We brought f. Faculty in person and virtual from U I C. We presented a slew of concepts. You can look at it as like a clinical informatics 1.0 in terms of introduction to these concepts. A lot of which they're not too familiar with.
So, it was really successful. We had a big turnout and now we're taking it to the next step in terms of collaboration with them. We're creating an exchange program with students and faculty. They just opened their innovation center , so we're doing collaboration as well.
And they have an AI center that we're trying to leverage for public health informatics.
Wow. So you know a lot going on there and I would like to, you know, like to hear a little bit more. So are they currently all on paper and are y'all planning on helping them with that transformation as well?
Yes, so, in the case of university of Mohamed Premier, they're they have some aspect of their workflow in the hospital. Already digitized. So they're doing some C P O E, they're doing pharmacy and pathology digitized. But in terms of medical documentations, in terms of nursing communications, so, like I would rate them at.
Pre stage one or stage one hems in terms of inpatient in the outpatient, to my knowledge, they're still paper based, so, they're trying to go through the hems stages and take it from there. But overall, most universities they're still on that phase and trying to move more towards connected system in the ehr.
Yeah, no, that's great. It sounds similar to my experience when I was in Peru for residency. I did a month there. Oh, wow. Um, Just a clinical rotation. And they had a couple of aspects that were on the computer, but most of it was still on paper. Still plain film X-rays, at least in the hospital. But then if you go to some of the private clinics, they were already computerized, but the public hospitals were not.
I was wondering if you had any insight into, other countries and where they are and what needs do they have from informatics training or, \ even, opportunities for informatics-trained physicians or clinicians here to get involved internationally.
That's a very good point in terms of training, we're actually presenting at the Med Info this year in Australia about workforce development.
So the base of any initiative you need, A workforce to take that initiative. And as we know in any especially digital initiative, you need like a homegrown champion to take the initiative. So we're planning to do a lot of workshops with them. You can come as an outside firm or university and give them some advice, give them some recommendations.
But if they don't have the workforce to follow through the home expertise and the local expertise that's an issue. So, in the Middle East overall from what I've noticed the uae, especially Dubai and Abu Dhabi and Saudi Arabia they're pretty advanced in terms of digital health.
They have a lot of conferences going on, a lot of. Investments, money and activity there. And even Epic and Cerner they're really active in that region. One of the big companies in the world, Saudi Aramco with which for oil, they have a really robust partnership with John Hopkins.
And they have multiple hospitals and Interconnected system in Saudi Arabia for John Hopkins UAE and some Gulf State. They have Cleveland Clinic there, Cornell, nyu. , that part of the Middle East is really robust and some of them they reached HIMSS stage seven, believe it or not, which is.
7% in the US and some hospitals there. They reached it. So, you see multiple it's not like a homogenous region. You see some countries they're really advanced. Some countries they're moving towards there but as an overall trend, they're all moving towards that, and their main need.
Workforce development some awareness at the beginning and then helping out in creating a roadmap to improve their implementation.
No, that's great. The last thing I want to ask about, yes. The topic is, you know, some would say our implementation or digitization and transformation in the US did not go as smoothly as it could have.
And there's still a lot of fallout from it. There's burnout has Possibly increased due to this transformation. And a lot of the workflows are clunkier than they need be. And meaningful use is still a four letter word for a lot of physicians and hospital systems. How are other countries internationally learning lessons from the US and not repeating our mistakes?
Yeah, , that's,
maybe you won't be able to answer that, but somebody's thinking about it, .
But yeah. To me, I feel I've always, I've had this discussion with them, you feel there that their whole approach of a medical record is different. So, Meaning. You go to a clinic, your doctor, they have your medical record papers, but the main up-to-date record is always with the patient.
so, you know, the, whole dynamic is different. The patient, they have their papers medical record because there if you are a patient and you're not following your case, nobody would. Right? So, they have all their papers with. them In a paper folder under their arm, and they're going from doctor to doctor to follow their stuff.
, so to them, I feel if we reorganize the medical record with patient-centric medical record versus institution-centric I think that's the approach for a lot of countries, like developing countries like this here in the us. Institutions are they have the power here that all your records are there and.
You need a lot of acts, like 21st Century Cures Act to at least get access to your information. The ownership of information is really hazy in the us. Like you don't know who owns what. So there they have an opportunity to rearrange their stuff from scratch and put everything patient-centric versus institution-centric In terms of medical record, that's what I noticed.
Yeah. No, that, that's really good insight. , well thank you again for jumping on and talking to us about these. Absolutely.
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