HealthIMPACT Live Presents: Protect Your Providers from Critical Burnout and Information Overload
Original Publishing Date: Nov 15, 2021
YouTube Video: https://youtu.be/LQ8cICoEk9Y
Exhausted and overwhelmed clinicians are reaching a breaking point as the COVID-19 pandemic enters another phase. Technology developed to improve treatments and clinical data collection has become an additional burden to bear. Technology must align with clinical workflow – not the other way around. Information overload is contributing to the burnout of exhausted clinicians already overtaxed by the ongoing COVID-19 epidemic.
Finally, automation, voice recognition, and smart processes are cutting down on the demands of physicians so that we can finally experience the full benefit of new technologies. Natural language APIs are extracting pertinent information from EMRs to save on scrolling while speech recognition software is taking on the laborious task of updating medical records.
Deb Muro, CIO, El Camino Health
Christopher Kunney, Chief of Strategy and Business Development, DSS Inc
Ashish Atreja, MD, MPH Chief Information and Digital Health Officer, UC Davis Health
Shahid Shah, Publisher and Chief Editor Medigy.com, Moderator
Shahid N. Shah: All right, great alright so we're going to get started in 321 welcome health impact audience.There wouldn't be a health impact or modern one without a discussion about physician burnout clinician burnout in general. And we've got a great lineup here to talk from a nurses angle, a doctors angle and a technology specialist angle about what each of us think about.
The general topic of burnout but in special health impact format we're going to clear away all the bs and get to the realities of what could we actually do with burnout and so i'm really excited and ready to talk to deb ashish and Chris we're going to have each one of them, introduce each other and then we'll jump into a quick conversation so deb tell us a little bit about yourself and what you do.
Deb Muro: Hi good afternoon I'm Deb Moreau I'm the chief information officer at El Camino Health for located in the Silicon Valley, and so we have a bit of pressure here to provide high technology, but also have happy physicians. I am a nurse is my background and I moved into it years ago and I love that intersection between the clinician and technology that's my real passion.
Shahid N. Shah: Perfect welcome welcome.
Ashish Atreja: Hi everyone, this is our she should treasure i'm CIO and chief digital health officer at UC Davis Health UC Davis so central valley area 33 counties in California and i'm a physician by training and the goal is to unify this new emerging field of digital health and innovation with it and prior to that I was not mount Sinai and i'm known as an APP doctor we built an APP formulary so we can automate many of the processes for patient care.
Shahid N. Shah: that's fantastic Christopher.
Christopher Kunney: yeah Hello everyone i'm Christopher Kenny, I served as Chief of strategy and business development for a company called DSS incorporated and specifically our commercial line business under general health. We are actually in the process of launching a next generation cloud based acute care ehr to go after the market. My background is 30 plus years and the it feel about 20 or so or that and healthcare i'm actually a former CIO as well. For a large healthcare system and i've served as an advisor and strategist for both fortune 500 as far as and as well as mid sized startups in the space of healthcare technology i'm also I also serve as an adjunct professor in Healthcare Informatics at Morehouse school of medicine.
Shahid N. Shah: Excellent guy so man 30 years that's a long time you started when you were 15 I guess. In your career right. So that's fantastic So you see we've got a great lineup here let's start with the first question, though in we're all from, especially the clinicians angle tired of hearing about burnout. But nobody actually doing something about it, and so we could almost play this role here, where Devon ashish can talk about the realities and the complaint and then Christopher can say well we've got this solution we've got that other solution etc, and have a good discussion around that so given that we have to clinicians on the panel here. Let's start with Deb with you, and let us know you know from a nurse's angle and from what you're seeing from the physician angle.
What's actually the realities of burnout and what can we actually do about it right, so instead of just talking about the fact that burnout is there describe what it means to you from a clinician perspective and then say what can we actually do like to have things changed post pandemic for the worst or the better and that could be technology solutions, it could be changing process.
It could be moving people around to do things that they weren't doing before pretty much any idea, just to kick us off.
Deb Muro: Sure absolutely and I have to start with what's the real problem here, and if you look at the way medicine is performed across the world. You know the fact that we require our physicians to documents so much just so that they can get paid is really the problem. And the problem is that they're required to follow all these documentation brown rules and regulations in it creates a real hardship for them, so I think all of us can work with our legislators.
And those that are you know, can make those may maybe reverse some of the cms regulation and work with them to make that an easier process but what we're doing it don't camino right now is we are using the data that we have regarding physician usage.
And we are able to see how physicians are using the emr and so we're able to see how much time at physician us at uses in the emr after hours we call it the Java time.
So, in other words after a physician spends their busy day in the clinic they go home they're trying to take care of their family they're actually having to log in at night, and sometimes finish their documentation, so that they can get paid. And so we are what we are looking at that, and we can actually see how much time each physician spins and each activity.
And we are then working with our emr vendor to put a strategy together to go work with physicians to help them.
Really overcome some of the challenges that they have and we just met yesterday we're calling these friends and we're going to take a team into the into each clinic and work with the physicians to say how can we help you do, or the order entry process easier, how can we help you enter notes and.
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Deb Muro: And do those you know those activities easier so that's our short term strategy or long term strategy as we're moving towards ambien listening.
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Deb Muro: Where physicians can simply talk and the emr will collect that data populated and then make that a much more, I would say integral process between the patient and the physician having that dialogue emr is not in the middle, creating the distraction.
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Shahid N. Shah: You know that's a great intro and shisha if you think about what deb said two main things come to mind one is.
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Shahid N. Shah: physicians need to get paid.
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Shahid N. Shah: And to they have to document in order to get paid, but so do many, many play I mean lawyers have to document in order to get paid lots of people have to document in order to get paid.
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Shahid N. Shah: So, do you agree in general with the framing that deb has laid out so well, or would you want to add to that or change something.
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Ashish Atreja: yeah I mean the difference between the lawyers and the doctors in terms of payment structure is the lawyers get paid for the time for every time they spend they get a payment back right.
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Ashish Atreja: The clock is taking for them for physicians they don't get paid by the time right so there's a fixed amount of payment that's there.
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Ashish Atreja: And if you have to document so much you still get the same fixed amount of money and, and so I think there's a there's a different alignment there.
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Ashish Atreja: But also, I feel a lot of the documentation is, I would say a little mundane, so to speak, which is more for compliance it's not clinically relevant.
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Ashish Atreja: So so anything that you anyone is asked to do, which is not part of the job profile it's just that becomes an added burden and if that happens every single day.
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Ashish Atreja: and multiple times in a day for multiple years ultimately that catches up, and so I think that's what's happening in the bowl now I think what pandemic has done.
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Ashish Atreja: is actually increased awareness around us for sure, and it is also allowed that many of the things we felt have to be done, face to face can be done virtually, so it is opened up a solution box.
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Ashish Atreja: That we can choose now one thing which I wanted to kind of, say, our approach has been to look at very holistically from a physician burnout thing, which means we do not believe that is limited, first to physicians only.
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Deb Muro: I think know says.
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Ashish Atreja: Have a same burnout aspect, they document a lot as well, in fact, many cases more than the physicians.
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Ashish Atreja: We have started seeing burnout among it colleagues, and that is more about remote work for us because they have not been able to kind of.
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Ashish Atreja: come together and have that you know I would say the support mechanism or the social kind of aspect, which was there as part of the work, culture, so I think it's it's there and and and the work that's imbalance in a virtual environment.
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Ashish Atreja: So I, and we are looking at, there was a study that came documentation alone is very important to address I like i'm going listening is dimension and others, but it still explains on the 20% of the burnout.
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Ashish Atreja: There is much more aspect in the bar not that we have to learn today, so we had coming with this thinking or this concept of well being index.
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Ashish Atreja: If you feel your valued in the workplace, you may not feel that much burnout even if you may be doing some documentation, so I think the the the science is still early on this for us to learn more about it.
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Shahid N. Shah: Now I love that Dan and before I bring in Christopher for some solutions here deb can you talk a little bit about that last piece that ashish mentioned, which is.
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Shahid N. Shah: documentation as part of it, and then there's more what would you say is from a Community perspective, what are you, seeing as the more than documentation, causing burnout.
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Deb Muro: that's a great that really spurred my thought i'm glad you're allowing me to speak on this because I thought man I wish I had brought this up, you know we're really.
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Deb Muro: Thinking about how do you move the work away from the physician to others, and so you know one concept is you move part of the work away to the patient.
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Deb Muro: You allow the patient to schedule their appointment you allow them to enter the information into the emr.
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Deb Muro: into their portal, so that the the position of the nurses and documenting the medical history or trying to you know that they enter that information you're allowing them to see their medical record interact with their medical records.
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Deb Muro: And so it takes some of the work away from the physician to the patient, the other piece is to take the work away to their assistant or their nurse and so having that person.
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Deb Muro: You know not getting their inbox cluttered with patient messages, but you have this team we call it team based care built around the position.
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Deb Muro: That is taking care of all these messages that are occurring everyday triage.
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Deb Muro: So that the physician can focus on those things that they really do need to focus on freeing them up to be a physician and not you know, a recorder or a message provider, but really being able to use them, you know have them use their skills are needed.
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Shahid N. Shah: You know I love it down, in fact, a you know we've heard about this idea of operating at the top of your license.
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Shahid N. Shah: And it turns out that there is a bottom of the license that maybe we should get rid of as well right so just because they can do something.
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Shahid N. Shah: doesn't mean that they should do that something and we've seen this in other areas where.
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Shahid N. Shah: In other sectors it's very clear lines of delineation you know the pilot isn't out there, serving drinks on an aircraft, but here in the world of physicians the pilot and the.
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Shahid N. Shah: drink servers the same person right and so that's a that is a major major problem let's bring in Chris here specifically to talk about two specific things one is.
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Shahid N. Shah: The idea of the moving into an acute care environment, the cloud based the HR sound fast fascinating and scary at the same time, because it's not easy so we'll talk about that, and what is a cloud based ehr in the way that Juno sees it, and then.
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Shahid N. Shah: Talk about the specific things that ashish and deb just mentioned around documentation who's doing that documentation the ambient listening.
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Shahid N. Shah: what's new in your world and we'd love to hear it back you know when you are a CIO if you're looking at what you're saying, would you buy what you're selling so talk about that that'd be great.
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Christopher Kunney: No absolutely when you think about the generation of ehr that we've gone through, I mean the reality of what the angels have actually been around since the late 60s in some form or fashion.
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Christopher Kunney: They originally were documentation management tools you scan information and you converted it from paper to electronic system, and that was kind of the case.
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Christopher Kunney: Up until probably, then the MID 80s and early 90s, and then we started leveraging other technologies that were collecting and providing data.
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Christopher Kunney: And then we wanted to start to try to centralize the information we're getting from labs and from pharmacy and and from other parts of the care process.
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Christopher Kunney: into some sort of centralized repository and that's when this emergence of you know the true clinical base ehr started to occur, but it was still very much driven to everyone's point around you know.
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Christopher Kunney: Pushing out a bill, you know pushing out a claim and it wasn't really driven initially around the clinicians use of the technology.
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Christopher Kunney: And then, with the high tech, and some of the others are regulations that and outsourcing clinicians to leverage these platforms and I call them the political determinants of health, we talk about social determinants there the political determine.
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Christopher Kunney: that have an impact on the delivery of care it started to.
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Christopher Kunney: Put more burden on the clinician to be to your point that the documentation person on within the electronic technology.
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Christopher Kunney: And so it started to contribute to this, you know enhance burnout the fact that these technologies work design intuitively which means you have to go back and do additional training and additional optimization within the systems.
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Christopher Kunney: They were not designed, based on their clinical workflow as well, and so the clinicians is having to go and click and a number of different places, to try to consolidate information in their head understand what the total.
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Christopher Kunney: Care of that patient should look like, or what they should do, and so what we've started to do is start to reimagine what that next generation ehr really looks like.
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Christopher Kunney: How do we reduce the cognitive workflow on the clinician.
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Christopher Kunney: How do we now design a system that really works, the way the clinician works, but still provides the administrative functions of collecting the necessary information to submit a claim.
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Christopher Kunney: And so, our organization embarked upon that task and I don't want to sound like a sales guy here but i'll just kind of highlight in general.
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Christopher Kunney: least our philosophy, and that is first and foremost.
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Christopher Kunney: We want to design a system or have designed a system that works, the way the clinician works, we designed in a way, it is intuitive so that it doesn't require you to keep going back and.
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Christopher Kunney: Doing optimization training for the clinician we're starting we're creating an open architecture platform.
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Christopher Kunney: Now, there was a time where you know organizations wanted to buy one solution, and then you had all parts of it, the pharmacy the lab the documentation.
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Christopher Kunney: The registration, the financial pieces, but what we found that these ehr companies don't do all of those things well.
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Christopher Kunney: They may do parts of it well and others that they may fail miserably and and with the cloud we've now moved to most of much more of an open architecture.
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Christopher Kunney: philosophy you take a salesforce, for example, which is a CRM well salesforce has a function of a CRM, but there are all sorts of applications that sit on top of salesforce.
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Christopher Kunney: That extends the capabilities of the core platform from beyond what it currently was designed to do.
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Christopher Kunney: And that's what we're doing with Juno ehr we're creating a clinical repository that provides the basic functionality.
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Christopher Kunney: of an electronic health record system but we're also you know, creating the connectors into it through fire api's.
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Christopher Kunney: That extends its capabilities beyond the core system so remote patient monitoring you talk about how to reduce cognitive workload well, how can we push data into the system without a clinician having to do it.
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Christopher Kunney: Through things like virtual scribe, for example, for example, ambient voice technologies are remote and tell a virtual care platforms and building Ai behind it, so that the system not only be as a tool for documentation, but it actually becomes an advisor.
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Christopher Kunney: A colleague of the clinician as well as taking all the data that is collecting not only just the vitals with the determinants of health.
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Christopher Kunney: On this remote patient monitoring information that it has consolidating that and then using Ai and machine learning to help the clinician make a better decision about the.
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Christopher Kunney: The treatment of that patient, so that they can do what they do best which is focused on delivering care.
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Christopher Kunney: and making smarter decisions through that care continuum so our philosophy is to leverage these next generation technologies do now make that.
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Christopher Kunney: ehr and advisor a colleague and a useful resource to optimize and provide a smarter way to deliver tier.
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Christopher Kunney: And then, finally, because we're moving to the cloud, how do we can monetize the cost of the systems, I mean one of the big frustrations for the administrative leadership in these organizations is.
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Christopher Kunney: The unbearable cost to acquire them and maintain them over their life cycle and moving to the cloud allows you to now leverage them as a service.
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Christopher Kunney: Where you don't have to expand all that capital expenditure on servers and staff and infrastructure to support them, but you have a much more manageable and predictable operational costs.
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Christopher Kunney: That you can you can manage and scale up to as your organization scales or God forbid the organization needs to downsize they can scale down without having to have all that some capital costs in your infrastructure as well.
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Shahid N. Shah: yeah that's so that's so cool you had me at at open architecture, but then, when you said, reduce costs that sealed the deal so.
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Shahid N. Shah: And and deb mentioned a little while ago, the self service aspects helping reduce reducing burden you've mentioned that.
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Shahid N. Shah: Putting it a little bit Ai and other things are helpful as well Devon love to bring you in to talk about this specific.
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Shahid N. Shah: There was a paper out that came earlier this year in JAMA the April, the kid was published in May, but it was of the April issue.
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Shahid N. Shah: Where they were citing that increased patient engagement and the you know, using their own data getting into their ehr getting to portals.
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Shahid N. Shah: actually contributed to more physician burnout, at least in this particular study.
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Shahid N. Shah: Does that sound right to you or does that sound like it's an intuitive and and maybe different than what you've seen.
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Shahid N. Shah: With the self service and the fact that patients have data and decide the paper was basically citing the examples of.
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Shahid N. Shah: The physician still having 15 to 18 minutes, with the patient, but now having to be prepared to read data that might have come in that morning or earlier that time or at predominate time.
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Shahid N. Shah: Reading it afterwards, so do you when you think about that what, how do you feel about this patient self service adding on to that burden.
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Deb Muro: Well, you know we there was a lot of anger recently about the new regulation that we needed to open that notes to patients or allow patients to see their notes there's a lot of concern.
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Deb Muro: Regarding from our physicians regarding that was going to create more work and really more time in their day.
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Deb Muro: What we found is it hasn't that at providing patients access to their notes has not created this delusion of activity for for the physician.
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Deb Muro: I do think that it does, though, provide a patient that wants to know more about their care wants to know more about their diagnosis and i'm not sure that's a negative thing, even though it might at the light at the end of the day.
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Deb Muro: There may be more questions there may be something that you have to answer.
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Deb Muro: I think that that's a positive at the end of the day, to have a patient that's engaged in their care.
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Deb Muro: And as we start educating them and we use our portal where we can put training on the portal for the patient to see.
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Deb Muro: And as the patient becomes more engaged than I think more of their questions are answered if we're if we do a good job of it.
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Deb Muro: it's where we don't do a great job of it and we give them a little bit of information, and then the patients, you know, asking what that means.
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Deb Muro: I mean we had dialogue about how quickly we should release lab results to the portal, you know it is the patient's information and so we've now decided to release them immediately.
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Deb Muro: Unless there is a you know the physician needs to spend some time talking to the patient about about a lab value or about a result, but we found that that at the end of the day, that's positive for the patient.
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Shahid N. Shah: yeah great dear.
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Deb Muro: Is their health right and that we shouldn't be the keepers of information, we should be the providers of it.
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Christopher Kunney: Real time just wanted to comment and there's where the possibility of machine learning and Ai comes into play.
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Christopher Kunney: As well you know again to reduce that cognitive workload if we can take that information that a patient and all these systems are providing and allow technology to aggregate that information in a way.
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Christopher Kunney: and serve up meaningful data back to the clinician so that they're not the ones, having to digest all the information.
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Christopher Kunney: But they're taking the summary of all that data that's being collected to make a clinical decision then it starts to becomes a real value to.
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Christopher Kunney: To the to the clinician and I also will comment that you know when you think about the next generation ehr it's really becoming more of a clinical repository I mean healthcare organizations have invested millions of dollars in the systems and now they're trying to get their.
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Christopher Kunney: reap the benefits of them and so they're starting to layer on top of them analytics platforms and Ai platforms to start to mind that data in a way.
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Christopher Kunney: To make better and smarter decisions, both on the operation side and on the clinical side and that data is now being leveraged by a broader.
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Christopher Kunney: audience it's not just a patient you've got farmer you've got government agencies you've got research facilities academic academia.
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Christopher Kunney: That wants to have that want to have access to this information, and so it truly has become the two currency within the delivery of care model now.
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Christopher Kunney: And you got to have a broader level constituents that are going to want to have access to it and so.
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Christopher Kunney: The technology has to be designed in a way that supports that both from the from the delivery of care, but from all these other you know constituents who want to leverage the patient data as well.
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Shahid N. Shah: yeah you're so right Christopher so when you think about this problem of.
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Shahid N. Shah: Potentially increasing the workload of physicians with new patient engagement data pete patient generate healthcare data and this new interaction that they're doing a she should do you generally agree with what debbie saying.
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Shahid N. Shah: Or does anything in that paper kind of resonate with you to say yeah you're taking on more burden because of that interaction that the patient is doing, because we don't have enough self service like Christopher saying.
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Ashish Atreja: yeah I think it's a it's an old right.
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Ashish Atreja: The technology comes but it's not fully mature in the first instance, and sometimes the burden gets created and or multiple iterations.
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Ashish Atreja: We find workflows we find more Ai embedded so it becomes more automated right, but if we just look at the trend automation is the key that's gonna really help us Ai is definitely the trend, we also need with a workforce, the alignment, we are actually working a lot on creating new.
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Ashish Atreja: workforce dollar digital monitoring or digital navigation exports right so when we turn on digital monitoring.
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Ashish Atreja: The goal should not be physician scattered the data back it's actually now we it's actually look by our digital monitoring expert who can be a master's in public health student right.
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Ashish Atreja: It doesn't have to be even a licensed practitioner, and we train them the trends and those trends ultimately get trained from them to the Ai as well, so even their board and gets less.
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Ashish Atreja: And that we physicians do not get the burden, except when there's an alert that they have to really act on in that regard, so I think we need to do a better job with his new workforce.
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Ashish Atreja: And I think we have the opportunity with Kobe provides that we can hide that from anywhere right they don't have to be within that same State so some of those barriers of supply chain are also going away.
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Ashish Atreja: And that's will allow remote monitoring, we did an initial study on remote monitoring around five years ago, showed 50% readmission risk reduction.
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Ashish Atreja: In heart failure population, but now is the time embedding this digital monitoring exports embedding that technology, you can actually make mainstream, not just as a pilot.
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Shahid N. Shah: right and as she's what advice would you give to even though Chris comes from the hospital world and the CIO.
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Shahid N. Shah: role if you are giving advice from an Ai automation etc perspective to.
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Shahid N. Shah: innovators out in the field about where they should concentrate their automation efforts because we're seeing a lot of Ai discussion lots of people want to do, Ai but are they focusing on the right things from your perspective, as both the buyer as well as they implemented at hospitals.
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Ashish Atreja: very tough to say they're focusing on the right things I think it's a the trend is definitely the right trend.
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Ashish Atreja: And within the trend the evolution happens when you see various use cases right you don't know when you start a use case that's right use this necessarily or not.
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Ashish Atreja: But you try it validated and then becomes the relevant one knew the right path.
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Ashish Atreja: And if it's not the right use case you leave that use case go to the next one, so I think there's a little bit of iteration and learning if you, especially if you are the cutting edge at the bleeding edge.
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Ashish Atreja: It is impossible for you to do right every single time because you're learning new things which may or may not work right.
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Ashish Atreja: But I would say there for five applications that are coming, which are becoming much more validated trend.
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Ashish Atreja: In the Ai space, and I would say, maybe I will go on a limb and say next four to five years you'll see these technologies mainstream across different hospitals.
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Ashish Atreja: So one of the technologies that's coming is the computer vision which allows it the images to be read the patterns, to be recognized and provides.
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Ashish Atreja: Extra guidance to the radiologist or other image readers and if you really look at radiology it's a very high cognitive view.
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Ashish Atreja: Because you're looking at so much data points visually right and it is sometimes inhumane to actually find all those patterns when you're finding something right in the front of you right.
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Ashish Atreja: A big lesion there'll be something hidden underneath it so computer can actually have a very good peripheral vision, it can help perfect peripheral vision right.
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Ashish Atreja: And that has been shown not only radiology but it's also in my field in it in gastroenterology.
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Ashish Atreja: Right, we may not be able to find sometimes that policy which is just hidden are not shining up but computer vision can actually bring that up, so I think.
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Ashish Atreja: That is one aspect of Ai that's really I think is going to be a game changer and already started changing the game in that regard, I think the other aspect we're seeing.
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Ashish Atreja: I would say automation and Ai and combining them both is what was touched by that before self service for the patients.
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Ashish Atreja: You have bots which can actually real time triage the questions, based on what is the patient is asking.
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Ashish Atreja: Right, so the patients have to answer less questions what we don't want is the same linear burden, you have one physician.
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Ashish Atreja: You pass on the patient and expectations to do it was they are not at all trained to do it right and that's like anything they can't handle the entire process face.
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Ashish Atreja: We have to use Ai To be sure, though, the one of the least minimum questions, we can ask to get from point A to Point B guide the patients to that, but it's a referral making appointment or intake cautionary in that regard.
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Shahid N. Shah: And before you get to number three Christopher said a few minutes ago.
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Shahid N. Shah: That they were reimagining the ehr you know from an open architecture more modern cloud based so when you look at your numbers one and two, and as you talk about three, four and five.
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Shahid N. Shah: What reimagining would you suggest to innovators like say.
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Shahid N. Shah: Like what we do i'm a software engineer, all I do is I come, you ask you hey smart doctor, what do you do during the day, and then I turned that into software that's not helpful today right because.
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Shahid N. Shah: You doing the same thing faster is just dumber right it just doesn't doesn't help you any, the question is, what does what would reimagining look like in this world where.
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Shahid N. Shah: The the Ai eyes and the bots etc are doing more.
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Shahid N. Shah: than what you'd be doing as a doctor anything you've seen and one reason i'm asking you this as she says, as I know, really well and maybe not everybody in the audience does.
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Shahid N. Shah: But the the project do started at mount Sinai that helps look at all these Apps and find the right ones get them installed and deployed into your hr.
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Shahid N. Shah: is something you've seen you're seeing a lot of the so that's why I kind of like wanting to talk about the innovators to say.
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Shahid N. Shah: When you are building something reimagine it in this way, so talk about one and two, like that, and then, when you talk about three, four and five, maybe you can add to that too.
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Ashish Atreja: So absolutely I think that's a great way to position in fact we just established at uc Davis or digital Cola.
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Ashish Atreja: To actually work at the intersection of our health system and outside entities to cooperate co design using design thinking what is possible.
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Ashish Atreja: Where it's a smart hospital or experience right and, and the reason is, we not only it's my perspective, it's a patient perspective we bring in.
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Ashish Atreja: it's the nurses perspective we're bringing it's a technology perspective biomedical engineering perspective right to reimagine that but, if I have to give kind of some trends that if I have to kind of restart the emr part.
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Ashish Atreja: Maybe we need to use the digital and data for strategy, it should not be you have an emr with a repository, then I add on tool of digital engagement or a.
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Ashish Atreja: I think it should be data and Ai first digital first right, and I think if we start with that approach, we may end up creating which may not look like an emr.
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Ashish Atreja: Right.
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Ashish Atreja: Right, I think, Chris Chris has some points I want to pass it on to him, but he's.
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Christopher Kunney: No absolutely I think you're you're.
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Christopher Kunney: tracking everything you said i'm shaking my head because, first and foremost, you started out a conversation earlier about you know software engineers building.
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Christopher Kunney: In HR and passing it on to the clinicians I absolutely am a firm believer that the provider community has to be at the very beginning of the design process, they should be partnering.
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Christopher Kunney: With these technology companies to build those solutions to design those solutions.
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Christopher Kunney: Based on their understanding of the current workflow but also reimagining how work that workflow should look going forward.
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Christopher Kunney: And so what we did was we actually went out not only in higher doctors and nurses and pharmacists and other clinicians to be a part of the design the ui ux design and what they're looking for.
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Christopher Kunney: We also went out to other markets know the gaming industry, the banking industry, the logistics industry.
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Christopher Kunney: To bring in people who bring those perspectives to the table as well too because there may be things and other verticals that we could take full advantage of.
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Christopher Kunney: And the healthcare sector that we haven't even imagined or thought about and bringing that lens to the table, I think, is equally as important as well, so now that design process has to.
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Christopher Kunney: Not only contain the people who are currently using a technology, but people who can reimagine what technology should be within that within that field of endeavor as well.
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Shahid N. Shah: And everything for before we give it back to.
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Shahid N. Shah: Do you want to comment on his first and second what.
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Shahid N. Shah: You know, look at this.
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Christopher Kunney: i'm a firm believer that the next generation ehr won't be called an ehr it's the clinical data repository and around that clinical data repository are the technology tools.
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Christopher Kunney: That mine that data or provide input in that data to provide whatever that function is in the in the clinical ecosystem, whether it's you know.
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Christopher Kunney: Patient engagement functions, what is the delivery of care function, whether it's surveillance monitoring our research.
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Christopher Kunney: components, the technologies will wrap around the data lake of the clinical data that's being collected.
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Christopher Kunney: and extend the capabilities of that platform beyond the four walls of the hospital, so I am absolutely a firm believer that you know the next generation ehr it's not going to be one that's just based on the delivery of care, but it's about.
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Christopher Kunney: The amalgamation of all that information that creates this this precision care that needs to be delivered from the time that person is born and you map their DNA to the time they pass away you do an autopsy and understand why they die.
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Christopher Kunney: And then collecting all that information and leveraging in a way to provide it using Ai and machine learning to make that clinician.
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Christopher Kunney: be an advisor to that clinician for the next person that comes to the care process as well, we should always be getting smarter every time we treat a patient that next patient that retreat, we should learn from the last picture that retreat.
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Shahid N. Shah: yeah so it's a more of a life record here, instead of health records that sounds great so a kiss your your your first one was machine visioning and the second one was automation for better self service what was three, four and five.
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Ashish Atreja: yeah so the third one has been mostly around analytics you need to do a population health not individual level.
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Ashish Atreja: But population level analytics right, so you can actually then say oh this person is that this risk or this population and then you have a much more intensive.
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Ashish Atreja: kind of a program for that person, I think that is something that we all have started doing in population health analytics for needs to become mainstream terms of predictive analytics.
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Ashish Atreja: The the other kind of technology, which we are looking at the same time, which is a variation of computer vision is the same part, but this is always on looking at the patients.
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Ashish Atreja: And anonymizing them and seeing what they activities are and then saying oh this person now has fall or is about to fall.
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Ashish Atreja: or this person like, for example, now we have a vision technology, which is actually watching like suicide vouchers patients who have risk or suicide.
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Ashish Atreja: Normally, you know sitter for that person for 24 seven to keep an eye they don't commit suicide, but you can now take that through a camera Ai camera.
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Ashish Atreja: And you can always say hey this person is doing fine or the person is about to fall, or this person has now come into the or let me just think the physician the surgeon to come into the or.
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Ashish Atreja: Right so ambient intelligence has gone beyond just the sound in that regard.
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Ashish Atreja: The the the fifth one I say is actually coming to ambient intelligence is basically alexa and the sound right, so we are able to actually have a different medium of communication.
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Ashish Atreja: and capturing that and automatically getting into emr right and then takes all the niceties away hello, how are you.
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Ashish Atreja: i'm through the core documents it and it's done and it can be much more richer right because it's not boring one liners from the physicians.
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Ashish Atreja: And if you really take it further, you can have this conversation, even outside the clinic.
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Ashish Atreja: And then have a clinic and so you can create multiple efficiencies we use the ambient kind of our intelligence in the right manner, so I think it's just just amazing to see all this coming together, but you can imagine, from a cios perspective.
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Ashish Atreja: it's not easy, just to bring it and dump it right, this validation, we have to do the security, we have to do there is a plugin, we have to do in the workflow.
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Ashish Atreja: And we can unleash among all the physician there's a training that has to be done once we know it is working right with them, we had to train more people.
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Ashish Atreja: Then it expands and this combined with the security efforts, we have to do within our organization, the new implementations our existing emr, we have to do.
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Ashish Atreja: The research, we have to support so basically it's the same human bodies we have in it right, the budget increases minimal.
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Ashish Atreja: But we just can't take all of these technologies in at the same time, our capacity is limited and that's why many technologies are here, which should have been within our system but it's our capacity to ingest them validate them train them and then transform them that is more linear.
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Shahid N. Shah: yeah that's right and in the April Gemma article that we were just talking about there was a term that they introduced called techno stress.
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Shahid N. Shah: which was capturing in one word what you were just saying, which is there's a bunch of stuff around the technology, the technology itself and how do you.
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Shahid N. Shah: Get trained on it, how do you get untrained from your prior technology to the new technology, so all of that techno stress, I think, is is very real that causes.
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Shahid N. Shah: The level of burden that we see now Christopher you're welcome to comment on the three that she mentioned but i'd love for you to add on to that this problem of.
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Shahid N. Shah: So she she is a buyer at a hospital as an example, there are incumbents that are there, you know them.
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Christopher Kunney: As well as ideas or.
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Shahid N. Shah: What do you feel you can offer to the hospital cios and others that could go over what the incumbents are doing and say yes it's worth going after what Christopher and Juno is doing.
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Christopher Kunney: Absolutely, well, I do want to first of all, comment on a couple of things that were said earlier, the hospital at home is definitely emerging market.
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Christopher Kunney: Going forward, you know, the majority of healthcare is going to be treated less urgent healthcare is going to be treated outside of the four walls of the House.
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Christopher Kunney: And more more importantly closer into your own home environment so those ambient voice technologies like Alexis of the world are going to play a critical role in that my lecture just went off.
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Christopher Kunney: they're going to play a critical role in you know capturing patient information and then allowing clinicians.
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Christopher Kunney: who are going to be all over work the world you're going to have people who work for a Cleveland clinic or you know UFC or whoever that may not always be in the four walls of that hospital, they may be in Israel, they may be in Japan.
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Christopher Kunney: You talk about you talk about radiology studies, I mean those things are being read all over the world now you don't necessarily have to have those individuals sitting in the four walls of the hospital.
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Christopher Kunney: And so technology has given us the capability of becoming virtual clinicians today and that will continue to grow, especially as we see the shortage of clinicians now.
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Christopher Kunney: In the marketplace consolidating them into virtual clinics and virtual care settings is going to be the way to hopefully combat that.
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Christopher Kunney: Your point in terms of how do we, how does a Juno now start to penetrate the income at market well that's that's an interesting question so one that we're living right now, I think, for some, first and foremost we have to.
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Christopher Kunney: help our industries, on our industry, understand that technology is always evolving you always should have a lifecycle management strategy for any technology.
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Christopher Kunney: And if you have technology that's built into your environment, you find a challenge to rip and replace or you know or upgrade from then that's a problem that's a that's a.
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Christopher Kunney: that's a challenge, you need to start looking towards technologies that aren't composite composite innate nature are disposable in nature.
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Christopher Kunney: Because, why should I have to be burdened with a platform that is 1015 years old, when the technology of today has surpassed it.
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Christopher Kunney: And now i'm having to wrap around these these solutions to keep it viable even more because I see you more costly to do that.
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Christopher Kunney: And so I think what you'll start to see over the next you know, three to five years, once we get past, you know this initial investment in these monolithic ehr.
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Christopher Kunney: you're going to see hospital system started to want to come monetize the cost of this technology, because it should I wrote an article on.
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Christopher Kunney: The concept of it is the next utility when you think about you know the water and the lights in a building, you know, in a hospital.
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Christopher Kunney: You know those things are pretty commodity, today you buy those as a service you buy those as your utility well.
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Christopher Kunney: Ideally, it is not become your next utility you can't run a hospital without electricity you can't run it without water, and now you can't run it without it.
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Christopher Kunney: And now moving technology to the cloud and selling it as a service, it should be commodities as well also, and so I think you're going to start to see.
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Christopher Kunney: hospital leaders like a she starts I started having these crucial conversations with their leadership and asking themselves Why are we having to spend millions of dollars in replacement of hardware.
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Christopher Kunney: Of licenses and staff when there are platforms out there that allow us to be able to scale and commodities that and move that to an op X expense going for it and allow us to shift.
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Christopher Kunney: When the market shift or when the industry shifts and when new technologies emerge and in the market that we're not burdened by that legacy platform so that's one way that we're trying to approach it.
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Christopher Kunney: Is because it's a platform because it's open architecture and because its cloud based the total cost of ownership for the organization becomes much more tenable.
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Christopher Kunney: And what's a longer runway for them as well, too, because now as technology changes and experience, I can integrate to that and then much more cost effective way.
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Shahid N. Shah: Now, and that makes a ton of sense to me, I mean ashish when you think about this year, the Nash nations APP doctor.
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Shahid N. Shah: You know that without proper open architecture you can't get Apps done fire has been something you've been looking at, for many, many years and have been pushing on it.
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Shahid N. Shah: So just in the last two minutes that we have left before we close out his talk about how difficult it is for what Christopher saying at.
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Shahid N. Shah: Just at uc Davis or mount Sinai where you've been you've been at Cleveland clinic as well.
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Shahid N. Shah: What did those incumbents mean in terms of burden reduction and that unless those incumbent gets shaken somehow you can't really do bird introduction, because you can't get the technology introduced fast enough, am I, being pessimistic, or is there some truth to that.
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Ashish Atreja: No, I think there's a definitely a truth to that and I think we try to address that by building this digital health formulary.
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Ashish Atreja: which can connect to any HR right and the goal was to create build all this initially we started with Apps.
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Ashish Atreja: Right, but then very soon realized that's more than APP so we added chat bots and now we're adding lot of other digital assets right there.
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Ashish Atreja: So it's creating a window of digital health automation and Ai that is fire API connected with the ehr plug and play.
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Ashish Atreja: Right, so I think I would say that that allowed us to actually go beyond each individual service line because, once you have this formulary within your emr.
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Ashish Atreja: Which is cloud based formulary you can embed anything within just three API clicks right right you pass on a single sign on you get the engagement data back and you get the outcomes data back.
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Ashish Atreja: Read right both of them, but I would say that has been just amazing success story for us and now 22 hospitals have it, I don't 3 million people have got it, but I would still say it's early on the transformation.
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Ashish Atreja: Right, this should be 300 million should be getting multiple times you know, in a month right, so I think we're still very early maybe we do know that vision may get more consolidated right, we need more players like that to take us from innovation and validation to actually transformation.
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Ashish Atreja: And we have seen that takes time.
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Ashish Atreja: You know, because of all the traditional regions we see, but sometimes i'm hoping with Kobe is a bull approach, not just push approach where cios are getting dragged hey, we have to, we want to use it and it's still being said Oh, we have to use it right that's a big conversation change.
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Shahid N. Shah: yeah so Chris Christopher we got about 30 seconds, if you ever just kind of summarize and say what can we What can it do you know do to coexist as well, so you don't have to look at a rip and replace.
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Christopher Kunney: or i'm going to ask the beauty of an open architecture right if you can integrate to legacy platforms, as well as next generation platforms as well, so why those platforms to go through their life cycle and die out you still leverage them as much as you can.
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Christopher Kunney: But you do have to have a lifecycle strategy for an organization in order to survive, because the reality of it is those those systems are not going to be able to.
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Christopher Kunney: be sustainable, as our technology continues to emerge and change your over time you're going to have to sunset them.
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Christopher Kunney: But having and having an open architecture fire, you know enabled platform gives you the flexibility to do that without having to.
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Christopher Kunney: Completely disrupt your entire environment by rip and replace everything, at the same time.
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Christopher Kunney: And so i'm optimistic about that the other thing i'd comment just from a humanistic standpoint digital natives are going to demand it anyway.
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Christopher Kunney: And so yeah me as a baby blake blake baby Boomer you know I.
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Christopher Kunney: didn't grow up with a computer they want these people are born with them in their hands are using them at one and two years old there, they are used to technology changing.
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Christopher Kunney: You know, those of us may be on this call, are not quite as used to the technology changes I still like my old iPhone and I still want to change to the next, these guys are looking for change.
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Christopher Kunney: they're always looking for the latest and greatest technology and they're going to demand it as the customer, the consumer the patient care provider when they become a part of that ecosystem.
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Shahid N. Shah: And right now, as usual, the panel time flew by but we've got a close up now, and just to add on to what crystal for was saying is that.
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Shahid N. Shah: The patients are certainly demanding it and the digital natives and natives will do so, but from a hospital health system perspective, you have to be even more worried.
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Shahid N. Shah: That your nursing staff and your physicians staff who are now a digital native.
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Shahid N. Shah: are leaving your hospital, because your technology sucks that's right, and if you don't get if you don't understand that.
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Shahid N. Shah: You can have already a heart you're already having a hard time keeping staff.
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Shahid N. Shah: Going burden reduction often occurs through process change, but sometimes just just bad technology that you just need to get rid of, in order to bring in something new, so.
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Shahid N. Shah: worth thinking about with that enough to thank deb she had to jump off the last couple of minutes, but then she she did a great job, as usual, Christopher thanks for the insights and we look forward to seeing how well you know does over the next few years.
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Shahid N. Shah: Thanks everybody see you later.
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Ashish Atreja: The best Chris Thank you Shahid, thanks.