"Think big. Start small. Scale fast."

Welcome to the big unlock where we discuss data analytics and emerging technologies in healthcare. Here’s some of the most innovative thinkers in healthcare information technology talking about the digital transformation of health care and how they are driving change in their organizations.

Paddy: Hello and welcome back to my podcast. This is Paddy and it’s my great privilege and honor to have as my special guest today, Neil Gomes, Executive Vice President and Chief Digital Officer of Jefferson Health. Neil welcome to the show.

Neil: Thanks Paddy. Great to be here and thank you for having me.

Paddy: You’re most welcome. So, Neil let’s get started. For the benefit of our listeners maybe you can tell us a little bit about Jefferson Health; about the digital group within Jefferson health.

Neil: Yes about four and a half years to almost five years ago, Jefferson invested in this idea that there’s tremendous value to be gained at the confluence of digital innovation and consumer experience, and so my group was founded. And what we do is, we focus very strongly on the consumer. Sometimes these can be internal, and sometimes these can be external consumers. Hence the term consumer. And then we know that if we do that and we anticipate needs in advance of these consumers even experiencing them, and if we provide for them, using many times digital innovations, many times design, and if we provide for them in advance, then there’s tremendous value to be generated both with the institution, as well as our own consumer. So that’s the ethos of this group. And that’s what we’ve been doing over the last five years.

Paddy: And I’d love to dig into some examples, of the successes that you’ve had. But before that, let me ask you a question. Jefferson Health is unique in making a commitment to the kind of group that you lead. You know a standalone specialist group. Tell us how that came about, and also in the last four and a half years maybe if you could touch on one or two examples of how you deliver the kind of superior experiences that you just described in your earlier comments.

Neil: Well this group came about through a joint vision across Jefferson as well as with our President and CEO, Stephen Klasko, who always felt that there’s tremendous value to be generated at these, at the confluence of digital innovation and digital experience, and he has invested in other organizations he’s been lead at too. And we’ve done a lot of work in this space now, in the last five years, that proves that this is true. We’ve created applications like myJeffHealth that are focused on the front-end patient experience, that have been well received by our patients. We’ve created back end solutions for our processes, to enhance our processes so that we can meet these great fun and consumer experiences and deliver them. We’ve done things for example in our ERs that use data in real time to deliver good decision-making insights to physicians and clinicians in the ER. So that they can deliver care really quickly, they can get patients to a physician really quickly, they can reduce the total amount of time spent in the ER, reduce the left without being seen rates, that sometimes hospitals and ER see a lot of. And that way, overall create a great experience not just for the patients, who are really important to us of course, but also for our staff so that they may be able to feel fulfilled in the work that they do too. And similarly we’ve done other work, which is in both the academic space as well as the clinical space and in the last five years we’ve created several such solutions that have changed our institution, as well as now also starting to change other institutions, as people outside of Jefferson also come to us and want us to build solutions for them.

Paddy: So, let’s talk a little bit about the academics and the health system side of the enterprise. Can you touch on maybe what are some overarching common themes? Can you try to build experiences for the academic side of the enterprises, enterprise vs. healthcare side? What are may be one or two fundamental differences that you have to take into account?

Neil: Well so both these academic and the clinical side, many times in academic medical centers they come together to form this union of sorts that generates tremendous value just on its own. And that’s why we have a lot of academic medical centers and we should promote academic medical centers and the research that happens at them, because it’s all ultimately benefiting all of us as either students or as patients. So, many times as we approach problems that come to us, from either the academic side or the clinical side, we see it as a common thing. Firstly, as a problem that we need to solve and then we try to delve in deeper and find out what exactly is the cause of this problem, what is the outcome that is desired, and ultimately how do we design a solution that meets this? And there are common themes sometimes across both these pillars as we call them. But, there’s also quite a lot of differences between the way we solve problems sometimes. On the academic side we have a lot of research related problems that come to us, and sometimes, and many times, a lot of efficiency related problems that come to us that people would like to solve. And there’s also an interest, many times from the people coming to us with the problems because they are themselves researchers too to be very involved in the solution. Whereas sometimes, on the clinical side we are seen more as an agency coming in and trying to solve a problem without interfering too much with the day to day workings of the clinical organization, because that needs to keep on moving. So, we know how to operate in both spaces, and we try to be as flexible as possible. With the academic side we’ve created several research applications like the physician counseling program, for example, for whom we created the DCP tool in close collaboration with their research team, and now it’s being used by multiple organizations, not just Jefferson. We also took a long-standing study that was done by Dr. Hojat on the scale of empathy, and we digitized that so that he could then use it at other institutions too. He was extremely involved in that, and that was literally his baby, kind of in way that he created it, and so that was a different level of engagement. And then sometimes we create on the academic side, we create tools like the clinical rotation tool that we created in close collaboration with our COO of the academic pillar, Kathy Gallagher. And when we did this work with her, she was very involved with what we did. But this was a brand-new application that we were creating, so we could really think outside the box and build something from scratch that we got very involved in from a design standpoint, all the way to developing the solution. Working with administrators to find the right way to express the solution and then ultimately bringing it out to everybody and getting involved in training and all of that to make sure that had a life of its own. So very different situation from developing, say the research tools. And then finally in the clinical space, it can be either of the two, sometimes we are called in for discovery to find out what problems might exist in a particular unit of space and help a lot of the operational teams with discovering that. And then sometimes we may be asked to go on to build digital solutions wherever we see potential for delivering digital solutions. We don’t always assume that a digital solution is going to solve the problem, sometimes it’s a very human thing, and because we operate in very human environment and sometimes it’s just a matter of moving a few things from the human perspective, you don’t need to build any new digital solution and we are completely open to that. And then sometimes we have to and when we try to get as much as we can in terms of detail around the problem, the outcome, and then build a solution. And then prove the long way to go ourselves as well as to our organization that we are solving the problem with the solution that we have created, and if you’re not, then we pivot just like any other agile, being startup kind of group. We pivot and develop something different or stop doing what we were trying to do.

Paddy: Right. Right. So is it fair to say that on the academic side more often than not there is some clarity about what is the problem that we are collectively trying to solve, whereas on the clinical side more often than not it’s a matter of even going through a discovery to find out what the real problem is before you even try to build a solution.

Neil: You could say that. It really depends on the problem that comes to us, because sometimes on the clinical side too, there’s a very discrete problem. Many of us know those problems and for many years no solution has been developed, because it’s a very complex problem. And so, we know what the problem is. But you know on the clinical side many times we think the distinction really is in we are many times focusing on operational tasks and trying to resolve those and create a better experience at the end for the consumer, or during the course of to all of the consumers in between that are involved in the value chain. And in the case of academic projects, many times it’s a completely brand-new idea. It’s creating a new scale, let’s say, or creating you know some kind of new instrument for clinical research. And there may not be an operational problem we’re trying to solve there. It’s just a brand-new way of doing things. So, it really differs that way I think so, a better way to put it probably.

Paddy: Right. That makes a lot of sense. You know obviously when you work across multiple stakeholder groups there is a big element of gaining alignment right and it’s not just among the stakeholders who are consumers of the solutions but also stakeholders who are important for the enablement of the solution at an enterprise level, whether it is IT or whether it is operations or whatever group it is. What have been some of your learnings or what would you suggest as best practices to other organizations that are undertaking their digital journeys and want to make sure that there is a proper alignment across stakeholder groups in order to improve success rates.

Neil: Yeah. See I think it’s very important of course to work with the entire organization. You cannot leave certain people out if they are part of the solution or sometimes even part of the problem. So, you have to have them engaged because either you are developing something that may be replacing a piece of work that they have been doing. Hence, you need to build a vision for what’s going to happen after that. Otherwise people might feel threatened and then also sometimes it’s going to just create this great new thing that will solve problems for a lot of people, reduce the total amount of time they spend in doing things that they don’t want to do. But even in that scenario where it’s so positive that everyone’s just gonna be so happy is what you might think. Many times, that may not be the case. You know it may be that this problem that someone may have a better insight about that they may feel like oh this is not really going be as the single pill that fixes everything that you might think. But there is a different perspective to it. There may be a different problem that’s causing what you think is a problem. So, it’s always good to get diverse opinions on a lot of these things before we make them and also definitely involve a lot of the stakeholders that would be affected by that decision or by that solution. So, we try and do that as much as possible. Also, because we need help, we can’t do these things on our own. We don’t assume that we’re going to do them on our own. We need the help of all of the stakeholders that are involved in the process for building a solution and for whom, sometimes we’re building a solution. And so, we do get everyone together as much as we can – IT, marketing – very important functions for any digital enterprise to succeed. And so, we do need support from all of these areas as much as possible. And that’s what we try and do and engage and involve people from, not just IT and marketing but also from research, from the pillars themselves depending on where we’re working and what problem we’re trying to solve from operational group. Sometimes when you’re doing work in the IOT space we always connect with our facilities teams. If you’re building something for supply chain, then we involve the supply chain teams of course to inform us firstly of what problems they would like to solve and then beyond that, as many people from supply chain to figure out how we do the solution and so also for clinical teams and academic teams. So I mean you don’t want to belabor the process of building the solution by continuously inviting as many opinions as you can, but you have to build the vision of what’s going to happen if you solve that problem, try and get as many people involved as that could help solve the problem and then move on very quickly to build as with a lean startup mindset. You know, think big, start small, scale fast, and if you have to fail in between them then fail early and figure out things as we go along basically.

Paddy: Right. That’s very helpful. So, switching gears here a little bit. You know healthcare is in early stages of digital transformation relative to other sectors like consumer banking, e-commerce, or any of those other sectors. Jefferson health and your group in particularly is probably a little bit ahead because you’re a separate group, you had an early vision, and there’s significant progress as an independent group. What is your assessment of the current state of digital transformation especially among health systems and what do you think are the biggest use cases that people are looking at to launch their digital transformation journeys?

Neil: Well so I think that it’s never too late to start. And if you’ve ever gone to HIMSS which is the largest health IT conference, you’ll see there’s so many people trying to solve complex problems in this industry. And if anyone thinks that we one day just going to rest and say ok. Problem solved. That’s never going to happen because we as humans we will always figure out another way to fix an existing solution, sometimes to make it better to make it more efficient. And we should be continuously engaged in that kind of work because optimization is extremely important, and we owe it to patients and students in our industry. Now yes, healthcare is I think a little behind compared to other industries in terms of digital but that doesn’t mean that we are in a bad place. When you are sometimes behind you can learn from the mistakes of others. You can take these quantum leaps as we like to call them, to solve problems because you realize what another industry has learned, and you try not to repeat that. You also get new insights from these industries and from what they’ve done, not just what they’ve done and hasn’t worked, but also when they’ve done things that have worked; not just doing the same things but trying to fit it into your industry, you realize new things and new ways of doing things that sometimes can even inform other industries. I’ll give you an example. We started working on this smart rooms concept about three years ago, employing AI and machine learning to create a voice assistant for our hospital rooms that could do the things that we expect from most other voices assistants, like Amazon Alexa and Google Home, and all of that. But to go a little bit beyond and start working on the environment or enabling people to interact with the environment of care that they are in. So, we built connections into building automation systems that we use into the TVs that are in the room. Some of the things that you can do with some of your voice assistance for the home, but in a clinical environment these things are a lot more complex. You know being HIPAA compliant is ensuring that PHI is protected, personal health information is protected for the patient, while interacting with these devices that we create for them, is quite a complex task, it’s not easy. So, we started building those things, slowly we realized you know we are really leading in this space as compared to most other industries, because in the hotel industry for example you would thought that by now you would have seen these types of devices in every hotel that you went into. Because when you think about the friction when you enter a hotel room that is caused by not knowing what channel corresponds to what number on your TV, where the remote is, where the light switches are because the fixtures are all different many times in every hotel that you go into so you’re trying to fiddle around and find those instead as you walked into a hotel room. If you could just say to the room turn the lights on you know you could tell them to turn off so you can conserve energy. And that’s just leaving the room and leaving them on if you could tell the TV what channel to go through like you want to watch HBO you know just they go to HBO and it would go then you’re not left clicking channel after channel to find the right one. And so other industries are ahead of us in some areas, but in some areas what we are doing work in, we’re far ahead. In supply chain we have a lot of innovations that sometimes other industries I think could learn from, especially in the perishable and non-perishable kind of areas. With IOT they’re starting to do a lot of things that other industries have not even started thinking about many times. So, there’s lots to be learned I think from healthcare, but the vice versa is also very true.

Paddy: Yeah. So, obviously a lot of emerging tech is involved when you think about building the kind of experiences that you’re describing and taking examples from other sectors whether its hospitality or retail or anything else. So, one of the things I like to do in my podcast is what I call a lightning round and I’m going to mention a few of the emerging tech terms and we would like to invite your top of the mind sort of comment or response on that. Are we ready to do this?

Neil: Ya, sure.

Paddy: Right. Let’s start with this one. Artificial intelligence.

Neil: I think that’s one of the most promising thing for any industry. As long as we focus not just on artificial intelligence, but machine learning and as long as we keep machine learning as open as possible, algorithms that we create because people really need to know, especially in healthcare and education, need to know when the machine is making a decision. What is the source of that logic and how it has built that logic? I think that’s important. But otherwise you know a phenomenal greenfield kind of area for health care.

Paddy: All right. Voice enablement.

Neil: Voice enablement and AI are kind of really tied at the HIPAA field because voice would not work without all of these deep learning models, be it AI and others but other types of models. But I think voice is the best operating system that we have. We all know it, the learning curve is pretty low and now you can speak, of course these voice assistants can speak in multiple languages; so, it’s not like you have to learn a new language either in order to interact. So, I think voice is great. There are limitations of course. You know there’s not as much privacy as many times you might want. You also sometimes want to do things without creating any noise of any kind in many scenarios. So, voice might not work in those, otherwise I think we’ve not really leveraged voice at all. You know physicians just talking to a voice assistant getting information about a patient before they go to see a patient. Physicians have told us they would love something like that. It reduces friction and so many spaces, I gave you the example of other smartroom project and example in a different industry, like in hospitality. I think voice is a phenomenal platform for growth and creating a great consumer experience for any industry.

Paddy: Awesome. How about 5G networks.

Neil: 5G networks, I mean that’s a very technical kind of thing at this point. I mean we haven’t really been able to see the real effect of it because it isn’t here yet except for maybe a few select cities and a few devices if I’m not mistaken. But any kind of additional bandwidth, any kinds of processing power at local end points is phenomenal to be able to do it right and we’ll continuously be seeing these types of new technologies, come up 6G maybe sometime soon. About what 5G will really enable us to do in healthcare is leverage things like AI, leverage things like augmented reality and virtual reality in ways that make them more portable, that make it more possible to do these things sometimes even without a lot of processing power at the device level which is sometimes hit some roadblocks. So, I think that’s what 5G would be great for.

Paddy: All right I have one last one on this lightning round. This one is a term that made a lot of waves a year or two ago and it seems to have quieted down a little bit, blockchain.

Neil: Yes. I always think of technology as a tool not as a way to start a conversation. And so, when people come to us with sometimes even with a solution, a discrete technology solution, I always ask the question what’s the problem. What problem are we trying to solve? What is the actual problem you are experiencing and for which you are looking for this particular solution and I think that many of us in our own and we are to blame to some extent for this. Technologists you know really sometimes just pick something and run with it, without thinking okay well, one of the ways that we could use blockchain is one of those things. Now there’s lots of potential for blockchain in healthcare especially at the confluence of many people working together, like payers and providers and pharma companies and the patient of course. All coming together and then being able to track data and who gets to use and access to certain types of data, it would be phenomenal for clinical research, but a lot more work needs to get done. I think more in bringing people together, to do work together rather than just trying to throw the technology at the problem and say OK well this technology could solve it all and I think a lot of people have realized that, have invested in this technology at the outset have realized that, first we have to solve the human problem and get people to start working together and then you should apply the technology to it and say OK well this is a technology that could help you do that. It can help you track processing of data [00:25:42 unclear] all those things. And I think a lot of good companies are now starting to do that, create these networks so that we can actually use blockchain and use its benefits in a way that real problems get solved.

Paddy: Right. And you mentioned you know that it’s all about people and you know the humans you know coming to your own digital innovation group. Tell us about your talent pool. I know you have a specialized unit. What does it take to attract and retain the kind of talent you need to really keep a group like this going?

Neil: Well I think the most important thing is the why. Why we do what we do? I think that matters. And being able to get that story out to the right kinds of people. It’s very important that you get the right kinds of people on a team like this. You know you have very little margin for error. You have to create a fantastic culture around this team based on principles. We have 12 principles that guide our team, I’m coming out with a book on that, because we feel like we’ve been able to leverage these principles really well and build a good team that can solve, not the perfect team but a good team that can really address these problems in very creative ways. Get people together, to solve them together not just try and build a solution that is devoid of that insight. And then once we build a solution it has to thrive on its own without us having to be there. So, having a team that can also say OK, well we built something of tremendous value, we have given it a life of its own and that itself is a hard task to achieve. And then being able to focus on another problem to solve is hard, many times because people want to own that solution for its life and that can get difficult to pull yourself away from. But we’ve built a team that can do that and that can solve many many problems. We address about a hundred and twenty different initiatives a year. And with this team and we’ve created a lot of positive energy across the organization. We’ve attracted other organizations to us, that this message of innovation as well as actual solutions that we’ve created. And I think we’ve created it not just within our team but across the organization, a cohesive mindset that says OK, we can solve these problems if we work together in healthcare. We can build incentives of people within these value chains that we have. So that the consumer at the end, be it in healthcare or education can see this benefit. And is it transforming healthcare or not, in certain ways yes, but it takes time to build these types of solutions and create momentum and get them out to everyone and others even to learn from them. We’ve been successful in those areas too. So, I think the team’s doing well. I think we picked the right kinds of people. The message I mentioned earlier, I said the story and the why is really important. That’s how we also draw people to us and fortunately in healthcare and learning we do some really good work. We help people either build lives of their own with education and good learning or we help many times save people’s lives. They come to us at the worst times of their lives. So if you want to do something really meaningful with your life, if you’re a programmer or if you’re a designer or if you’re a learning specialist, because those are the primary roles that we recruit into our team then this is a great place to be. You know and it’s a great mission to serve, knowing that you will be helping other people, either get better through learning or improve their lives to save their lives through the work of our clinicians and helping them do their work better.

Paddy: Right and the mission driven aspect of it is so important. I was talking to a student just over this weekend. He is graduating with a degree in computer science and he wonders if healthcare and healthcare informatics was a good place to be. And you know when I talked to him, I realized that the mission driven aspect of working is something that resonated strongly. So, I think we tend to underestimate it or maybe take it for granted, but everyone that I meet in healthcare has some relationship with the missionary aspect of working in healthcare, which I think is fantastic. All right awesome. Last question for you Neil. Your digital innovation group is obviously doing very exciting things you are kind of out there at the front end of the curve. What is your advice for technology providers, big and small, who want to be a part of this journey with you?

Neil: So yeah I would say, one invest in people, people are what’s going to make or break your team and what you do. Pick the right people right at the outset, so form a culture within your group that you know is able to promote innovation, entrepreneurship. Also joint decision making around things, but rapid decision making also and also I think being able to just bring people together around a vision that you can bring, that you can express to others is important. And then once you do that once you get the right people together you have these kinds of principles to guide you. This culture that you create of innovation, then it’s a matter of finding the right things to do. And so, I think that’s very important, you can have a great team. But if you don’t select the right things to focus on you could end up not solving the problems and therefore not having much momentum. The other thing I would say is that there’s a kind of equation that we like to think about when we build this group. One you need good people; two you need good partners. So, it’s not possible to do this on your own. Both you need internal partners as I mentioned earlier. But you also need external partners. You need good firms and start ups and and other such companies working with you that are focused on many times on healthcare. Sometimes you can learn a lot even from folks that are not in healthcare and sometimes that should be a goal. But work with other people is the message. You can’t do this on your own and then finally invest in the right types of platforms. I will just spend a few seconds on this. Platforms are very powerful. You know they enable you to create new solutions at much faster pace, because you’re not reinventing the wheel each time. You don’t need multiple skill sets to solve multiple problems. You can use a single really powerful platform if you invest in one, that enables you to solve maybe 50 problems and ultimately you’re licensing one platform, so you’re paying for all of those solutions, except for the costs of building them of course and maintaining them. But otherwise you might have licensed 50 end point solutions to solve 50 of those problems. You know which can get really costly. Because we are in an industry that cannot invest as many other industries do sometimes, innovation at the same scale. So, we’ve got to build things very frugally, we’ve got to find ways to solve problems very creatively and very quickly, but also many times at a lower cost to organizations. So I think it’s very important to invest in platforms in order to be able to do that.

Paddy: Thank you. Thanks very much Neil. That was really interesting. Thank you so much for sharing your thoughts and sharing some of your experiences and all the best of the digital innovation group at Jefferson Health. Thank you once again for joining.

Neil: Thanks Paddy. I really appreciate.

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