HealthIMPACT Live Presents: AI and Machine Learning to Improve Clinical Workforce Satisfaction
Originally Published: Oct 26, 2022
YouTube Video: https://youtu.be/YDMHdRdDG7c
Victoria Tiase, PhD, RN-BC, Assistant Professor University of Utah
Yauheni Solad, MD, MBA, Vice President of Innovation UC Davis Health
Jitendra Barmecha, MD SVP, Chief Information & Digital Strategy Officer SBH Health System
Janae Sharp, Founder, The Sharp Index
Megan Antonelli, Chief Executive Officer, HealthIMPACT Live
Megan Antonelli: Hi, and welcome back to Health Impact Live. Today we are joined by Yauheni Solad, Jitendra Barmecha and Vickie Tiase, and it's very exciting also to have Janae back here with me.
I have known G and Yohei and Vicky. For almost seven years, I think and maybe some a little longer since we started Node Health and we started running , the digital Medicine Conference. We are in our sixth year, so it's exciting to have them here because they are all chairing the AI workforce theme for this year's conference.
And Jeep, let's start with you. Introduce yourself and tell us a little bit about.
Jitendra Barmecha: Sure. Hi. Good morning everyone. Thank you Megan and Janae for bringing us over here. I think Megan, I know you more than seven or eight years, but I don't wanna you know, give up my looks and age on this program, but It's always excited exciting times to have you and regarding known health.
Yeah, I've been with Node from the very, very beginning actually. It's, it's still a journey. And what intrigued node was the evidence piece. Cause during those times There were about close to 200 to quarter million digital apps. And we as a physicians were very challenged with how do we know, which had good evidence.
And there was no platform in us or any regulatory bodies. Looking at the approach to the evidence for these digital apps or startups. And I think that was the idea which turned into a not-for-profit foundational organization with some key leaders from health systems. Both of them are here, Wiki and Hanni.
And it's still a journey with a very simple mission of having any digital or any innovation or care innovation with evidence. And so we started with the collating some of the evidence behind these digital apps to now. Actually being a catalyst on the validation work which Node helps through our champion Dr.
Ben Rosner and his team. And yeah, this year is our sixth year. For our annual digital medicine conference in New York City we are very thankful to, once again, Microsoft for hosting us. And we do have several tracks, which I think Hanni is going into, go into more details. And as far as I'm concerned I am the Chief Information and Digital Strategy Officer, ATBs Health System.
Always learning through these networking events and digital medicine conference, how our patients and the physician. Clinical community can benefit whether these are processes, people, or technology. Thank you, Megan.
Megan Antonelli: Yeah, it's been really great to work with Node and to sort of, I mean, to really see what's evolved.
I mean, yeah, we do know each other longer than the last six years. It's been longer, you know, more like 10, maybe even more than that. Since we started Health Impact and. You know, those first four years, there wasn't much change. But in the last six there has been so much, you know, and particularly in the world of evidence and where, where people are looking and evaluating what's working and what's not.
And when we named Health Impact, it was in fact because it was trying to find the places where technology was making a measurable impact, right? That was our, our goal. And so, How we all joined really was because Node was focused on evidence and it was aligned with what we were doing. So and so as such evidence continues to be a big theme at DMC Ya Honey, we got to work on it virtually for the last couple of years, but it's exciting to see it coming back to in person.
So tell us a little bit about the themes for this year and how it's gonna be.
Yauheni Solad: Thank you Megan. And we are extremely excited that Now finally, note is going back to the in-person event, and as a chair of last year conference where we had a full virtual event, I'm actually excited to see some of the people who were.
Had a chance to connect virtually now face to face. And frankly, so much changed not only from the last year, but specifically from the time we started the organization. Because back then a lot of the notion and the topics we are. Talking about today, we're still fresh in you. Telemedicine was not a given and some leaders even questioned the value of a telemedicine.
We, we didn't really have a concept of digital therapeutics and a lot of the focus on evidence that as a community were able. To bring across the industry is absolutely amazing to see how it's reshaping the whole way we do practice digital health. So for this particular event we'll be focusing on discussion between healthcare leaders, people who are doers, people who can go and share the best practices and lesson learn through.
Implementation or development of a digital health solution, but also multi society task force. That's include some of the biggest organization across. So we can talk with leaders that do make the change all across the organizations. And we have several team, as Megan mentioned, the team. One is future proving digital health with evidence.
And the key part here is to learn what's regulatory. Updates. What's changing, how our landscapes is different? How do we properly measure success and our implementation of the evidence? Why does a new normal? What, where are we going from the innovation perspective, from the team? Number two, which is focused on a digital health role in improving diversity.
Equity and inclusion. We will be diving deeper into the role of digital medicine in addressing disparities and inequity, and I'm pretty sure all of you can agree about the timeliness. Of of those discussion. We'll try to see how we can harness the power of public health and digital health to build a better, more equitable healthcare system, and what can be done to better promote woman health.
And life cycle of innovation around the human health for team number three as a digital front door. And now all of our assets are digital oil hybrid. And now we're knowing and seeing that's virtual hair here to stay. How can you learn what's working? How do we know what additional tool can help us to scale and what can we do with remote patient monitoring in telemedicine now?
And how to properly transition your workforce from the previous place to this new normal? And that's where. We go into theme number four, where all three of us will be leading and that's focused on how do you build the new best practices to actually leverage the power of technology to address the burnout.
We have such an amazing changes in the landscape. We have additional workload that's coming into all the clinical aspects of our healthcare system. So how can we ensure that we are not adding additional work that cannot be sustainably handled by our. Oh, that's a great, Please join us for this year event.
And you know, the last but not least, little bit about myself I'm a clinician by training. And I'm currently serve as vice president of innovation for uc, Davis Health N C M I O for digital health.
Megan Antonelli: Awesome. Also those are a lot of themes that I care about, so we'll have to come back to some of those.
Janae Sharp: Before that, I wanna, I wanna hear from Vicky, like you've been a long term champion of Node
Megan Antonelli: health.
Janae Sharp: For those on the recording, we just heard that Vicky moved to Utah and I've lived there and I love Utah. And you're working with AI machine learning. and clinical workforce satisfaction, which is such an interesting and fascinating area.
I'd love to hear kind of about why you're, why you believe in this, but also more about more about that
Megan Antonelli: work.
Victoria Tiase: Yeah, sure. Thank you. It's, it's great to be here with g and Yohei and special thanks to Health Impact for continuing to celebrate and elevate Node and the digital Medicine conference. Agree with the sentiment.
Super excited about this year's conference and our themes. So I am a nurse informaticist and specifically do applied informatics research in digital health. And as, as you noted, just recently moved to University of Utah Health. To lead the strategy around their new digital health initiative.
And I think the exciting piece about digital health today compared to where we started years ago is that initially we were. Just broadly thinking about how we could share lessons learned and, you know, really collaborate as health leaders around digital health. And, and now we've really advanced and we're to a point where we now have specific solutions namely our Clinical workflows and supporting our clinical workforce using digital health.
So this is absolutely an area that I'm quite passionate about. I think now more than ever, we need to think about how we are leveraging technologies to create the most efficiencies. So thinking about the evidence related to those clinical efficiencies. And I think the other interesting piece as while, you know, digital health was, was quite large when we first started Node.
Now if we look at some of the project projections, digital health is expected to be at over 500 billion by 2025. So we have a huge market of, of digital health products. However, However, we still hear that the clinicians do not feel the impact at the bedside. So I think thinking about how we close that gap, and to your point, how we use technologies like artificial intelligence natural language processing and other digital means to ensure our clinicians can feel that a digital impact at the bed.
Yes,
Janae Sharp: I just read that report where it talked about the gap, Like patients are more excited about it and like physicians, it's not that they're not excited, but the adoption is really different. Like it's spotty essentially across the board. And then also there's that gap where they feel like they can get better interaction for like new patients or for new diagnoses in in person.
Yauheni Solad: Vicky, I think that was a great point. And I think the important distinguishing here is physician need to feel a positive impact, right? Or clinical outcomes improvement around the technology. Because, you know, as, as a focus of our session, unfortunately, a lot of clinician do feel the impact of a digitalization of some of that with a.
Sentiment. Yeah. Because of additional workload that not necessarily properly integrated or reimbursed. So I think the, the, the key part of here is how do you ensure that this is really a multiplier on the quality and efficiency of you as a clinician? Yeah, that's a
Megan Antonelli: great point. Like
Janae Sharp: if you feel like no, you get, you get.
The work of plugging in every day you get the work of taking more notes, which I know every clinician loves notes all the time. But yeah, you want, you need to be able to actually feel the positive difference and the people who are making, doing the work don't always get the reward, you know, It's just more work for you.
Especially in, now we've talked to a lot of nurses and a lot of clinicians who are just understaff. You know, do you think, and this is for anyone, like do you think digital health can bridge that gap? Like, is that going to be a positive change? Is that the future?
Yauheni Solad: So it's, it's an interesting question, right?
And I think to a certain degree, this is a very reactive approach to this, right? I'm, I'm short staffed. I cannot properly attract the workforce to my location. What can I do? Right? Can I bring more people? Pro? No, because it's becoming financially you know, unstable, right? So what else can I do, right?
How can I replace and automate? I think to a certain degree it will get little bit worse before it get better. Here is why, because you will have to redesign a lot of your inefficient workflows that will properly leverage the technology, right? That will then return the joy of practicing to a lot of clinical specialty that will then attract a.
Workforce back. Right? And I think that the talk around, oh, can I replace my workforce without automated chat bots and everything else as of 2022 in nonsense, right? Like we, we will have some additional tool to augment this, but we cannot and actually should not talk about the full replacement because that's just portraying unrealistic and potentially clinically harmful.
Janae Sharp: That's a strong opinion. See, we're gonna put that in quotes. You know, it, it is unrealistic. I'd love to hear what
Megan Antonelli: you're gonna say. Yeah.
Jitendra Barmecha: Sorry Megan,
Megan Antonelli: I was just gonna ask what you think in terms of the, you know, different you, cause you all from different hospitals and health systems and organizations, so also representing where certain organizations are in this.
So
Jitendra Barmecha: I will take a little bit, slightly different approach because I serve on the digital Health Advisory board for American College of Physicians. Actually, there is a actual shortage of healthcare workforce and there are numerous data which is evident whether it is nurses or respiratory therapist or physicians.
So we have to make sure. That our aging populations are given appropriate care, not increasing the scope of practice. The Americans too deserve to be seen by physicians or allied professionals. So I, I think with the regulatory changes and the transformation of the cu. We will be seeing hopefully next 10 or 15 years, the increased workforce.
As far as digital health or technologies concerned, there are, there are a lot of unintended consequences for examination, for example. The administrative workload for physicians have increased and recent study showed that the prior authorization is number one burdensome for the physicians.
While, while they are Doing the right thing for the right patient, for right reasons. Still prior authorizations and also the infrastructure for the care where they're being provided. So if you look at the primary care physicians or the primary care practitioners Because of the unintended consequences.
They're bringing so much work at home, what they call it is increased by pajama time. You know, so they are continued to get cluttered with their inboxes, getting requests from pharmacist or the patients or so, unless you change those infrastructure. I, I think that, Also going to add some burden or I would say burnout for the clinicians.
And again, these were all unintended unintended consequences. The other classic example is the information sharing for the labs. Because of the CURES Act now the patients are receiving some of the lab results without being reviewed by clinicians. So that has increased more anxiety. To the caregivers and the patients.
And as a result, the inboxes are increasing significantly. So again, the, the intentions were very good, but the unintended consequences on the physicians are the sort of recipe for the clinician burnout. But as you mentioned it'll take some time. We are in the transformational phase. We have to take each individual unintended consequences and turn into a positive.
Feedback both to the patients, caregivers, and the patients. I mean, and the physicians. Hopefully that will mitigate some of the issues. But again, it'll take some time.
Megan Antonelli: Yeah, I think that's, It
Janae Sharp: sounds like long-term planning and time
Megan Antonelli: as part of it. Correct. And there's a lot of that for some people,
Janae Sharp: but , That's true.
It takes long conscious
Megan Antonelli: work making the organization. And I think what I'm hearing, you know, I mean there's a lot of metrics at play, right? I mean, there's not only the, you know, it's how, how do you measure even burnout, Right? Or, or what is making it easier, right? So when it comes down to the evidence, you know, I think we're just.
Getting to the point where we're even understanding what the impacts, what the unintended consequences are, that might be, you know, some that might even be positive, that we've gotta measure to show that the, you know, what's happening. So is that something you're seeing, like Vicky in particular, like with clinical informatics, Are there different data points being collected with these new technologies that then evaluated?
Or is it more complicated than that? ?
Victoria Tiase: It is a little more complicated. I just wanted to clarify a couple of terms. So I think broadly we talk about burnout of clinicians. And there are ways to measure burnout. There are some tools that are out there, actually some that AMA has developed and others, Yeah.
But also recognizing that a segment of burnout is documentation burden. So I just don't wanna confuse those two topics because although they're related, they're measured very differently and I think we're still trying to figure out how to measure documentation burden To G'S point, pajama time has been a somewhat you know, Past method that hasn't really worked well.
So we're now seeing some new methods to examine time in documentation such as looking at logs looking at time to complete certain activities. So looking at more of a task analysis. So I definitely think we have some work to do in the measurement area. But if you don't mind, I just wanted to go back to Jana's point cuz I just had a couple of additional pieces on.
Do we think that digital health can help with some of these issues? And I would argue absolutely. I think we're seeing great. Solutions in the education space. So I think we sometimes miss that piece. We need to educate our clinicians, especially if we wanna bring new people into the workforce. And I think there are some great digital health solutions to do that.
So I just wanna make sure that, that, that is highlighted. And then I think the other tricky piece related to this, you know, we've got a, a lot of work to do before we'll see these efficiencies manifest. I think the trick is thinking about return on investment and kind of flipping that on its head because I think our healthcare leaders are still in that mindset of, Oh, if I'm gonna invest in this solution, I need to see a return on investment.
Well, it might not be hard dollars. Right. And if you're investing in your workforce and thinking about the wellness of your workforce, maybe that's a better metric than simply looking at the roi. Yes. And, and then the, the last piece around. The, the workforce is the resources to implement. So what I'm seeing is that because of workforce reductions, we have less resources to implement some of these technologies, and they're just being thrown at the clinicians, right?
It's like, here we go. It's technology. Just use it. And, and we have to remember that hasn't worked in the. And it's not gonna work moving forward. So really thinking about how we invest in those resources to implement properly.
Megan Antonelli: Yeah. I
Janae Sharp: love what you said because when I talk to people who are like wellbeing officers, they, they ask, they're like, Here's the gap.
The gap for me is being able to show the value to people who are decision makers like CFOs. When you can't always see it, you know, on your balance sheet right away. Like where, where should we be investing? And what does that look like? So what have you found anything, like, what would you tell those people?
Like, cause everyone asks that everyone says like, Well how do I show if the program that we're using is, is great or,
Victoria Tiase: So yeah, I think that swings back to the measurement piece. We really have to work on getting those measurements and think about evidence a little differently. So I'm hoping we'll be able to dig into that at the conference and really showcase some of the areas now I'm like,
Janae Sharp: Wait, that's a real question.
What is it?
Megan Antonelli: See that teaser I saw you did there .
Yauheni Solad: So Jen, if I also jump I think Vicky, you know, covered the extremely important part of the, of the value creation, right? And, and the interesting that when you start speaking about decision maker, your first thought was cfo, right? But I think that's actually an example of an inverted value chain in our current.
Right, Because technically it's not, You're not, didn't mention Chief Nursing Officer. Or Chief Medical Officer. Right. But he automatically went to the funds flow as a main decision making. Right. And I think going back to some of the discussion around the measurement, That's why, because money is relatively easy to measure, right?
We, we've been living in a fee for service world, right? And to a certain degree, we used it as a proxy of a success of our practices. But I think the transition to value based, right? Not necessary care, but value based delivery of care is important because we actually didn't even talk about the clinician's experience with the technology.
Before we started adopting the ehr, that's why a lot of the first lines of the EHR came up with some challenges, right, to the burnout. So now we, we finally look on the metrics that's not necessary exclusively driven by finance and performance, but actually incorporate the user experience on both patient and clinician side.
We actually getting closer. To the ecosystem where digital health actually can try thrive.
Megan Antonelli: Yeah,
Janae Sharp: I like what you said though. We need to, you know, it's an in system and I wonder if we'll put more of the power for decision making, even in the hands of the people who are responsible for care. I'd love to hear what you're most excited about.
Like what's the. What are you excited about at the conference? I'm excited to hear from Vicky more about measurement and like how that
Megan Antonelli: change looks.
Jitendra Barmecha: I would like to hear or understand I mean, we don't have a single EMR in this country. Even if those who are epic install base the way it has been installed between various Epic or Cerner or Allscripts, they are not the same.
Or they may look similar, but they're not the same. That is number one. Number two As Johanni mentioned, we did not or the industry did not give enough thought on the clinician or human design. I would like to hear from the user experience or the human design how we can change and be a little bit more innovative on the screen sites, whether it is data innovation on bringing in.
Meaningful information at the point of care or even the way the EMR is on the screen how it can be a little bit more human friendly just to get to one result. Sometimes we have to have about 10 or 15 clicks, you know, so everything. So I, I'm more interested in given on the human design factor and some data innovation at the point of care which can help physicians to be more, or clinicians to be more productive.
I mean, I have. I've heard of ambient or speech to text technologies and all. Some of them are on research side. Some of them are still in the early stages of adoption. So combination of those technologies and the human design interfaces. I'm really looking forward and I'm, I hope we will have some good learning lessons over there.
Great.
Victoria Tiase: I'll, And those are great g when it comes to the theme of supporting our clinicians with technology, there are two items that I'm excited about. One is, you know, understanding some of the systems approaches that are working and hopefully hearing from individuals that are included. In some of these innovations.
So again, really thinking about how we, we flip the tables and it's not technology being done to the clinicians, but the clinicians actually participating in, in creating innovation and presenting the problems that need to be solved. I think a lot of times we see digital solutions that are not even solving a problem.
Clinicians have. So how do we flip that? So I'm excited about that. And then the other piece is from the, the patient side. I think there has been a, a nice proliferation of shared decision making tools. And I'm really interested in seeing how those tools can support our clinical workflows, right? So how can we partner with patients so that we are receiving data from patients, you know, taking away some of.
Intake burden from our clinicians and then, you know, vice versa. Having that, you know, feedback and patients being able to see their own data. So I think there are some interesting developments there, especially related to the information blocking regs that just went into effect. So I think it's a nice time to think about that patient side
Megan Antonelli: as well.
Yauheni Solad: Perfect. So I am extremely excited and I think that the future look right and here is why the whole fact we are talking about a lot of those problems mean that we are focusing our efforts and our resources on, on a lot of those problems. And that's. In most of the cases, a good start, right? It's not necessarily guarantee your success, but a lot of people starting to look at that from a lens and to certain degree, technological, you know, slowness of a healthcare industry for the first time potentially playing into advantage.
Here's what I need is by the time we actually all came to agreement that it's a good idea to help with additional automation. A lot of other industry already try it out. The cost of our cloud services went down significantly. We will learn how to properly use some of the predictive models. We're still struggling in a best way to do it an ethical way or evaluated for the long term, but at least we're not making a billion dollar mistakes while learning the lesson.
So the cost of trying and innovating. You know, became lower. So we can actually put it in places where before because of a lack of potential ROI from financial staff, that will be totally neglected. So now that's allow us to actually look onto newer way to manage, newer way to deliver and, and, and bring solutions.
And Vicky's point, the whole fact that we now have. Information blocking law, right? Then you actually expect to go to any healthcare system around the nation and connect your smart application to pull your data is amazing to me. Because that was not the case even five years ago. And liberating a lot of the data access now combined with the technology around the machine learning.
Create an unprecedented opportunities for the future grow. So I think all the tailwinds right now is in favor of a big grow and a bright future for the digital health.
Megan Antonelli: Well that's great. And it is, The future is bright and it's exciting. You know, and we're coming out of a couple not so bright years, so it's really great that we have some stuff to look forward to.
And it's just, you know, there's been incredible innovation and I. As with that, I think Vicky was probably in 2019 that we were talking about the people, the processes and the technology and getting those all together. And now, you know, the tech, I think the technology is there and it is good that there's been some testing of it by other industries, healthcare as it should be.
Is a bit more risk adverse. So good times and good things and I'm so excited. We'll be DMC is December 7th and eighth in New York and we'll all be there. And we'll continue this conversation later during the round. And thank you all for joining us and I can't wait to see you in person in December ever.
Jitendra Barmecha: Likewise. Thank you. Thank you Megan.