Q: Hi Priti, this is Rohit Mahajan. Thank you for joining us on The Big Unlock podcast. We are in season 6. The audience is diverse and broad. So, we are looking forward to an exciting interaction today with you, and with that, would you like to introduce yourself?

Priti: Sure. Well, that is amazing, the number of podcasts you have done. I enjoyed listening to some of your former guests. Son and I appreciate the opportunity to be here. So, my name is Priti Patel. I am a family physician and clinical informaticist.

I am serving as the Chief Medical Information Officer at John Muir Health, where I have been for 23 years now. John Muir Health is a community-based health system located in The San Francisco Bay area. We serve Contra Costa County and some of the surrounding areas. We have a two-hospital system, one behavioral health center, and over a thousand providers.

When I started 23 years ago, I started off as a primary care physician and quickly got into the administrative side of medicine and medical directorships somewhere along the journey. The electronic health record came to be, and so I started off as a super user, and then one thing led to the other. I was very involved with our enterprise-wide implementation of Epic, so that was in 2012. From there, I just continued to keep doing the same and took the position of associate CMIO, and then for the past three years, I’ve been in the CMIO role, so I am very fortunate that I get to spend most of my days at the intersection of clinical care and technology.

Q: That’s amazing, Priti. You spend so much time in this field. Tell us a little bit about how you work with your colleagues. If you are the CMIO, then you might have other colleagues in your organization who are also involved with technology. So, how do you work together as a team, and what do you think is the evolving role of the CMIO in health IT and its adoption?

Priti: I am fortunate that I have had two other CMIOs before me, and so they were critical in laying the foundation for our informatics structure. Our first CMIO was responsible for our EHR implementation. The second came in and really established a lot of committees, the governance, structures really helped optimize those, and through that entire journey we continue to grow year by year. Just the number of clinicians and physicians that have been involved in informatics is really astounding. When I started, no one even knew what the term informatics was, and we were just a part of IT now. When we add people to our team, many of them have master’s degrees in informatics. Many have done board certifications in informatics, and some have even gone through fellowships. So, we continue to grow, and IT is now part of every part of the health system. I think there’s informatics that is part of our team. Formally, our physician staff includes many informatics representatives. And then our nursing staff now has really kind of come to the table and joined us in this journey. More recently, we brought on a nursing director of informatics, and I continue to see these types of roles growing as time goes on.

Q: So, could you talk to us a little bit about how you, at your community-based health system, how do you think about aligning the digital strategies with your priorities, especially keeping your patients and employees in mind?

Priti: As a community-based health system, our focus is really on our patients, our workforce, and the quality of care that we deliver.

So those are our founding principles, and so when we think about what type of digital tools we would want to implement, we look to see, you know, how does that make them better at what they do? How does it support them? How do we elevate the care with these various tools? We are an epic organization, and so we do have an epic strategy, and that’s true of most of our core applications.

We focus on leveraging what is available to us through our major applications. And then the other key component is really driving the adoption. So, it’s not enough. To really have the application but really trying to leverage it fully is one of the things that my team does is that we identify where perhaps people aren’t really leveraging it in their workflows.

Maybe the patients could really come to know a little bit more about this. So, we have a whole team that goes out to the clinics, to the hospital, and rounds through the floors to really share a lot of that knowledge of what is available through all of our core applications. When we get to a place where our core applications cannot serve the need. Let’s say we have some special strategic initiatives, and you know, ambient AI is a perfect example of this. This is not something that was part of our Epic application. So we looked at other vendors and found one that we thought would be the best fit. This is something that we have integrated with Epic.

However, it is a freestanding application, and we do that with a number of different solutions where we are looking to align it with what we’re the outcome that we have in mind. So, we do add innovation on top of our basic core application structure.

Q: I heard you say before, when we were talking earlier, that you have a Gartner report, which got published around the Ambient Listening initiatives. And that, of course, is a business application, which a lot of health systems are embracing, and they are finding a lot of value in that. But I think you have a lot more to share with the audience on this specific implementation. So, could you talk to us about some of the three aspects I would like to bring out with you, if we can? What were some of the challenges that you faced? What do you think were some of the key success factors, and what were, I think, you measured? Results in this particular case. So, do you have any quantitative results that you could share with the audience? 

Priti: We started our journey very early. This is the technology I was waiting for, as a primary care physician. I really wanted to spend more time with patients instead of interacting with the EHR and spending time on documentation. And so, for a number of years, we were looking at the early ambient solutions that were out there. And then a couple of years ago when large language models came to be. We really focused on that, and so it was early 2003 when we started to look at a variety of different vendors, and we ultimately settled on ambiance, and really, our providers had the opportunity to test it.

We did a lot of role-playing with physicians and complicated patients’ situations, and so we landed on a tool called ambiance. We implemented that very early, in July 2023. I would say that it was a very exciting time, and I think everyone was very interested in utilizing this technology. So, the adoption was easier than most technologies that we’ve tried to implement before because we had that enthusiasm and eagerness from our physician population.

The challenges were that no one had done this before and this was new territory. We were co-developing. A lot of the technology that we have today is things that have evolved over the last year and a half. And so, I think really the exciting part of this was giving people this technology and within four hours, most physicians adopted and start seeing really the benefit of it, really enhancing that human connection.

Finishing their notes on time, being able to go home on time, and not having to spend time, documenting the electronic health record. Patients have also shared with us that they enjoy the interaction that they have with their physicians because now they are face-to-face, and they’re not distracted by any technology.

So, it’s been a really positive experience for us. When we first started, we were in a non-integrated state, so the applications were side by side, and we were copy-pasting notes from the ambiance application into the electronic health record. So, the adoption had slowed because of that lack of integration.

And then once we integrated, all of a sudden, a hundred providers just came out and signed up, and we are ready to go. And you know, at this point, we have 60% of our users utilizing it. And every week our adoption continues to grow, not just with the number of people using it, but just how often they are.

When you look at certain users, some physicians use it a hundred percent of the time. We had one provider that hit the all-time record of 10,000 encounters. So, this is how we deliver care at, John Muir Health. It’s been a really exciting journey. We’ve got lots of qualitative feedback from our physicians, saying that this is something that would allow them to practice for a lot longer.

How it’s given them a light work-life balance backport of the quantitative side. So, we’ve been tracking a number of different outcomes. There are efficiency gains for sure. We’ve seen about 30 minutes of time savings in documentation. And then, when you ask our providers – how much time do you think you’re saving? They will say, we are saving two hours. And so, what that tells you is that they’re feeling less fatigued. There is a tremendous reduction in cognitive load. And so, I think there’s just so many benefits with this technology, and we’re just starting to really realize what it can do. And I foresee this continuing to improve and expand as time goes on.

Q: Yeah, it’s very interesting Priti that you said that the inflection point came when it got integrated with your, in this particular case, Epic system. So that was kind of like a good learning point. So, how did you go about building a data-driven culture? Also, talk to us a little bit about your enterprise data strategy.

Priti: In addition to AI, we have also been focusing a lot on our data strategy. About a year and a half ago, we really focused on a number of different strategic initiatives, and we wanted to really measure outcomes at all levels to be able to drive continuous improvement.

So, we have also implemented lean methodology and a daily continuous performance improvement program that everyone is doing at all levels of the organization, from leadership to the frontline. So, there was this incredible need for data to see how we are driving our operational success. And so that really laid that sort of foundational need for data.

One of the things that my team did was really try to figure out how we can support each of the users in their need for data. So, about a year ago, we launched a data literacy program. We have lots of dashboards, lots of reports, and self-serving tools but unfortunately, people don’t know how to use these tools; they’re not able to access the data that they need.

So we, starting with our C-Suite, did one-to-one training with on a variety of different reporting and analytics tools. From there, we moved to the directors and the managers. We have webinars, recorded self-service, and self-paced learning. We have open office hours now so that people can drop in.

What’s astounding is that you see the increase in the reporting tool usage, and then when we are doing our weekly report outs on all of the variety of the various strategic initiatives, everyone is now speaking with data and really sharing their outcomes and tracking that. So, it has been a really exciting journey where, a number of different initiatives came together.

And then the State of Literacy program was there to support everyone’s need for data to support, the work that they have been doing.

Q: I am sure in this journey, when you try to do cultural changes there is always change management, which comes into play, and then I’m sure you are adept at balancing your innovation efforts with the clinician or the patient design. So, talk to us a little bit about how do you drive innovation, change management, and what are some of the things that you are seeing are working or not working in that space?

Priti: Yeah, change management is by far the most important component. When I think about what I do every day, even as a position, I was a change management agent.

And then on the IT and informatics side that skill comes in very handy. Even if you have the best technology, the technology that you think is really going to support the clinician or the business owner, I think what happens is not everyone approaches that technology the same way, and they need support in different ways.

They need to understand why they should use it and how it will help them. That is one of the things that we do as informaticists is we really try to bridge the workflow with technology. If technology is designed well, it is very easy to do. If it is not really designed with the end user in mind, then that’s where, the change management becomes even more challenging.

So, I think that change management is really key to adoption. Adoption is really key to seeing the benefits of technology so that connection is really key.

Q: As we move on to more discussions around AI and GenAI, what are you thinking could be the next initiatives? You have a very successful one already underway, and things are changing fast around us. As you know, everyone is talking about Gen AI. In fact, we have a webinar coming up in the next two weeks on Agentic AI, and I was surprised by the number of registrations for that. It seems to be very topical and of great interest. So, how are you thinking about new AI initiatives and Gen AI in your organization?

And I know you might be early on how you are thinking about the policies and the governance aspects as well.

Priti: Yeah, this is a very exciting time, and we, too, are excited about the AI agents where we have started with GenAI. I mean, our first application was the ambient scribe. But we have also been utilizing Gen AI to help draft responses back to messages that come from patients.

So, it really helps reduce the documentation burden. We are thinking about leveraging it on the inpatient side for nurses to help create care plans. In about a month, we are going to start a pilot to really look at how GenAI can and natural language processing can really summarize the medical record.

So, our inpatient physicians have to spend a lot of time looking through the chart to really understand why the patient might be in the hospital. And so, there are some great tools that might help summarize and really raise up some very pertinent points to care that’s a pilot that we’re really excited about.

There are a number of different applications on the business side, so when you think about doing prior authorization and letters for responses to denials. Those are really appealing use cases where I think a lot of people spend time in this paperwork, administrative back and forth.

And this is where gen AI really has a great application.  As I mentioned, we’re on this data-driven journey and teaching people how to leverage these self-service tools. There is quite the learning curve, you know, on how to sort of set up your query, right? And that’s where natural language processing and gen AI may be very helpful.

So, there are some tools that we’ve been looking at to say, can the user just speak out their query. So that then the data analysis is done for them and then they can more easily utilize it. So that is really exciting. We have been doing a lot in predictive analytics, so that’s kind of the next level. I mean, having the data and the EHR is one thing, but now, doing things with it, that is where the magic really happens. So, we have a number of different predictive analytics tools live today. One that helps predict readmissions. We have another one that has been in play for a very long time, really predicting the high-risk patients, those who are at risk for clinical deterioration in the hospital.

So, that’s been great at identifying those who may be developing sepsis or may need a higher level of care. We have a great tool that helps us detect steps stroke early and really mobilize the team. And that has really improved our stroke care. So, I think there’s so many applications and tools.

It is almost like we have so many solutions that how do we implement these fast enough in order to, You know, really take advantage of everything that is out there. And then, of course agentic AI is coming, and that is something that we’re very excited about, too. So, I’ve had a chance to see a few demos, and it was very compelling. So yeah, we’ll have to see what happens over the next six months.

Q: That’s amazing. So, I think as we are heading to the close of the podcast, Priti, are there any other thoughts or information you would like to share with the audience before we close?

Priti: Yeah, this is a very exciting time to be part of this. I think we’ve all kind of noticed that there’s something different in the last year. And I would say that I am really interested in everything that’s out there and trying to find a solution that will fit our problems. That is always a challenge and when I think about what would really make a big difference for us is finding solutions that really solve problems that we have. I am someone who really enjoys technology, and so everything’s exciting, but how do you figure out what’s the one that’s really going to make a big difference and really improve patient care and experience for our clinicians? 

Subscribe to our podcast series at www.thebigunlock.com and write us at info@thebigunlock.com 

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

Rohit: Hi Crystal, great to see you. Thank you for joining us. As you might be aware, Crystal, the show—is called The Big Unlock. It was started by Paddy Padmanabhan of Damo Consulting, and we are building on the foundation that he had laid. And it is great to have you here. I’m Rohit Mahajan, I’m the Managing Partner and CEO at Damo Consulting and BigRio. Would you like to please introduce yourself to the audience?

Crystal: Hi Rohit. Thanks for having me on the show. Hi everybody. I am Crystal Broj. I’m the Chief Digital Transformation Officer at the Medical University of South Carolina. I am based in Charleston, South Carolina, but our system spread the entire state—all 46 counties of South Carolina. We are one of the oldest medical universities in the country, and we’re celebrating our 200th year this year. So, we’ve been around a long time. We have 2.4 million patient encounters annually, 16 hospitals, and about 2,700 licensed beds. But besides being a health system, we’re also one of two national telehealth centres in the country, recognized as Centres of Excellence.

We have a university with six colleges, about 884 residents and fellows, and 42-degree programs. We’re the number one rated hospital in South Carolina according to U.S. News & World Report. We’re also a research organization with about $300 million in research funding annually, 1,200 clinical trials, and about 55 active startups. There are a lot of exciting things happening here, and I’m just so blessed to be here, bringing digital transformation to the organization in a variety of ways. 

Q: Can you please tell us what inspired you and attracted you to this space? How did you get started in healthcare? Tell us a little bit about your journey, where you’re at, and what you might be thinking about for the future.

Crystal: I started out as a COBOL programmer when I came out of school. I was in IT, doing COBOL and programming. Then I jumped around to a few different jobs—back in the day, if you didn’t move, you’d get stuck in the system. So, I moved around, went into consulting, then back to big business, then back into consulting. I did that for a while, but with two young children at home, working 60 hours a week in consulting wasn’t sustainable. So, I took some time off and had the opportunity to be a Director of Christian Education at a church for a couple of years. It was totally different—a passion project.

I don’t have the typical IT trajectory. I bounced around quite a bit. Eventually, I went back to management roles, working across various industries—manufacturing, health clubs, insurance, human resources companies. So, I gained a broad range of experience. I didn’t grow up in healthcare. My first step into the healthcare space was as Chief Technology Officer for the American Association of Diabetes Educators. It was healthcare-adjacent—we trained diabetes educators to help patients. That was my first real jump into healthcare.

Then COVID happened, and like many, I found myself out of work for a while. During that time, I actually wrote children’s books.

Yeah, that’s the fun fact—I saved it for now. I put them on Amazon. I probably made a hundred dollars, but it was fun. I wrote and illustrated them, and it gave me something creative to focus on. Afterward, I ran a business analyst office, and we started teaching Agile. Then I went to NorthShore University HealthSystem in Chicago, where I was Vice President for Digital. I built a digital team from scratch—there wasn’t one before—and we grew it to eight people, supported by some consulting services.

Then my dream job came up in Charleston. I wasn’t actively looking, but my daughter was attending school here—she’s earning her doctorate in Nurse Anaesthesiology and graduates next month. We started spending more time here and fell in love with Charleston. When this job opportunity appeared, I knew it was exactly what I wanted.

I started as a team of one. This organization is very innovative—they truly believe in innovation. What we’ve done in just two and a half years is incredible. My team has grown from one to eight, and I’m lucky to work with amazing people—not just my staff, but also the senior leadership who constantly ask, “What can we do next?”

The team that works for me puts their whole heart into everything they do, and it shows. When we roll out projects, they’re rolled out carefully and thoughtfully. One of the things I always say is: We won’t roll it out until it’s right, because we only get one chance to make a good first impression. We don’t just throw something out there and hope it works. We started with a small project. We were, we were using Notable is the, is the key name, right? You, you’ve heard of them, obviously. They’re well known in the marketplace.  We started with a pre-engagement process. So, if you have an appointment, we send you a note three days before— “Hey, here’s a reminder. Do you want to confirm or cancel your appointment?”

We launched this with just five offices to see how it would go. We wanted people to try it, to prepare the offices, and to understand how patients would react. It began as a pilot, and then we started to grow from there. One of the biggest lessons learned was: start small, then scale. From five offices, we moved to 100, then 500, and now it’s implemented across all offices in the organization. We send out pre-reminders, and we receive confirmations and cancellations in advance. Then we added another layer: validating demographic information. We pulled data from Epic, so patients could quickly review— “Yes, I still live at the same address,” “Yes, I’m still married,”—all the things providers need to know before you walk in the door.

After that, we integrated bill pay. Patients could pay their copay or any outstanding balance in advance. So, you can see, we added small features step-by-step. We didn’t try to perfect everything at once, but each step was rolled out thoughtfully and intentionally.

We also listened to patient feedback. At the end of each interaction, patients could give a thumbs up or thumbs down. And so patients would say, thumbs up, and then they’d say, this was great, or this is this. We get some thumbs down and we read every single one from our customers. We make sure that we’re touching the patients and find out what they want. And so we got things like, Hey, I come to the doctor three times a week. Why are you sending me the same information all at once?

So, we worked with the vendor and adjusted it. Now, at the beginning of the week, patients receive a single message listing all appointments: “You have three appointments this week. Do you want to check in for all of them now?” They can fill out all their information at once and then simply walk in and say, “Hi, I’m Crystal. I’m here.” We also added Spanish support. Spanish-speaking patients now receive the messages in Spanish, and the feedback has been fantastic—things like, “This is easy,” “Thank you,” “I can do this from home.” It’s been a huge success.

But one key thing we learned was the importance of change management. Our front desk staff were used to handing out clipboards. So when we rolled out digital check-in, some staff were unsure—“How do I know it really worked?” Some still wanted to give patients the clipboard. That, in turn, frustrated patients who had already checked in online. They’d say, “Wait a minute—I already did this!” So we had to step back and think through how the technology impacts everyone, not just the patients. We retrained front desk staff to trust the system and support the new process.

Of course, there were a few glitches—nothing is ever perfect. Sometimes the system didn’t work, and staff would say, “Just come to the front desk,” which undermines the experience. But we’ve been learning and improving every step of the way. It’s okay. Sometimes we’d get someone new at the front desk who had no idea what this was. They hadn’t been part of the rollout, so they didn’t know, they didn’t understand it, and it just wasn’t on their radar. So, we created training materials for new hires. Now, whenever someone joins, they receive the necessary training. We also make sure to communicate updates—like, “By the way, patients can now get this in Spanish,” or “Here’s a new feature we’ve added”—so that everyone is on the same page. Those were some really valuable lessons for us: start small, communicate—and over-communicate—and grow alongside the vendor to create something truly impactful.

Q: That’s great to know Crystal. Lot of great experience there. In terms of scaling the solution, I did read somewhere that you mentioned that innovation is in in our DNA. Could you talk any other of you Digital transformation projects or innovation projects where you’ve had success and you, I think you are very good at tracking metrics as well, is what I understood. So how, how do you track those metrics and kind of look at the return on investment?

Crystal: Sure. I’m happy to go into a bunch of those things. Once we started with Notable doing that, then we started looking at how we could do other outreaches to patients. In Covid, people didn’t go to the doctor, right? So, women especially don’t take care of themselves. We went back to close the care gap for mammograms because most women didn’t go during Covid, and then they got busy and forgot about it. So, we did outreach. If you haven’t had a mammogram in a year, we send you a reminder saying, “Hey, we care about your health. You’re overdue for a mammogram. Would you like to schedule it now?” Automatically schedule it. You didn’t have to call in. You didn’t have to do anything. We turned it on at five o’clock at night on a Thursday, and by the next morning, we had 129 women that had scheduled their mammograms. That’s a KPI. And then we started tracking those women to see. It’s still in progress today. We do it monthly and go, “Who hasn’t gotten it in a year?” Every month. We send out these notifications. Up to date, I think we’ve had 18,000 mammograms that have been scheduled. What we found is that about 180 of those women needed to come back because they had abnormal results. So, we got them the care that they needed before it became too late. That’s where you’re like, okay, this is digital. And there might be KPIs, but these are KPIs where we could potentially be saving people’s lives. And there’s no dollar amount that you can put on that, right?

And so, with that being very successful, we started hitting up well-child to make sure people came in for their visits, for their kids getting the shots they need before school. We send notifications about flu shots to remind people to come in and schedule. We’re going to start doing uncontrolled hypertension and getting readings on that so people can do it—diabetes as well—start checking on that. We’re just continuing to build on that platform and get those kinds of things.We know that we have sent out, since June last year, 1.7 million reminders to our patients. We’ve had about 50,000 cancellations. That seems like a lot of canceled appointments. But at the same time, if you cancel, it’s not a no show. The doctor can refill it. We have an automated way to do that through Epic. It’s called Fast Pass. You can get somebody else in. That helps with access because then people can get in sooner. Helps doctors’ schedules. Makes everything flow better for both patients and providers, which is really what transformation should do, right? We don’t ever want to burden providers. We want to make things easier every month. Easier for patients as well. With Notable, I can’t say enough about it. We have a 98% satisfaction rate from our patients, and that’s another KPI that we track. We just started with a new product with Notable where we’re actually working with revenue cycle—we’re doing prior authorizations.

We all know that you might get a referral for an MRI, but you have to wait for your insurance company to say it’s okay before you get it and make sure they’ll pay for it, all that kind of stuff. Well, to do that, somebody has to take your referral, type it in Epic, and then go to the payer site and type in all the information again. And play back and forth with the payer, then put it back into Epic. That can take anywhere from 15 to 30 minutes. But we have an automated AI agent that does that now, and they can do it in about 30 seconds.

If you think about how much faster that is for the back of the house—not just that number alone—but how much quicker patients can get in. And tracking how many are automatically approved right away—we have about a 37% accuracy on this agent, and it keeps learning all the time. That means almost 40% of the ones we send through are done and the human doesn’t have to touch it.

Coming up next, we’ll go, “Okay, Rohit, you’ve been approved. Here’s a link. Schedule.” We’re going next with that. So those are some things that we’re doing. Great success with that really helped our senior staff know that this is a team that can take big things on and do it well. We brought a voice bot into our patient access center. We have 42 phone lines, about 150 people that answer phones every day. If you ever call the access center and you press one for this, press two for that, and wait on hold for who knows how long—we’ve got an automated natural language processing agent.

We call her Emily. She answers the phone: “Hi, I’m Emily, your digital assistant. How can I help you?” You say, “I’m checking on my appointment.” She says, “Okay, give me some information to validate who you are.” It goes into Epic. “Yes, Crystal, I see that you have an appointment next Tuesday and next Friday. Which one do you want to know about?” “The one with Dr. E.” “Okay, sure. That’s two o’clock next Tuesday. Do you want to confirm, cancel it, or do you need to reschedule?” “Actually, I just needed to know where to park.” She can do all of that, and it doesn’t take up an agent’s time.

We deflect—and that’s another thing we track—we deflect about 17% of the calls that come into the patient access center. We’re not getting rid of jobs, not by any means, but it means that our patient access reps can handle more complex questions. Something that’s harder to do. Our hold times have gone down. The number of people that get frustrated and just hang up has gone down. So those are the types of things that we track to prove that the software—these digital tools—are doing what we really want them to do.

Q. That’s interesting implementation. So, the handoff between Emily and the real live agent is seamless?

Crystal: Yep. The thing about Emily is she can answer the phones 24/7. So if the center was only open, I don’t know, eight to five or whatever. So, she can answer after hours and answer questions and maybe sometimes it’s a more complex thing.

So the agent can go like – sorry, I can’t, you know, have you call back to talk to an agent tomorrow to say you call kind of thing. And we’re just now changing it so that she can reschedule because      rescheduling is much harder than just scheduling. And, within the next month she’ll speak Spanish too.  But that comes with another thing where we really had to train the bot. Right. So, it’s, it had to learn. It must learn. Accents. We’re in the south. I come from Chicago, so I don’t sound like I’m Southern except when I say y’all. But we had to train it so it understands the accents. It would understand certain words, understand that appointment may mean visit may mean something else. And do that training of the model. And take the time to do that. So, testing is important. Yes. Really going through and testing and validating that to make sure that it works. Getting the people that are going to use the software to use it, so they understand what patients are hearing so that when it comes to me, I’ll know that, oh, Emily already asked this and this, and I’ll have some of that information for me.

Things like that. But it’s wildly successful. All 42 lines on it. Now we’re going to roll it out to the rest of the state because Right. Oh great. Just in Charleston, we’re going to roll it out for our revenue cycle. We’re going to roll it out for our pharmacy.  So that we can take some work off the back of the house. So again, they can work at a higher level of license, whatever that license is. So that growth stuff that that things that we just want to get out stupid stuff and then start to do, you know, those higher level things that provide more value to both our system as well as our patients. 

Q. So, I heard you say, I think early on in our conversation, maybe even before the podcast started, that you, you did look at a lot of KPIs and you, you have a certain way of looking at return on investment and there’s certain benchmarks that you kind of track. So, could you tell us a little bit more about that piece?

Crystal: Some of it is based on how many patients encounters we’re facilitating or the financial impact we’re seeing. For example, with pre-experience copays, we’ve collected about $1.4 million through the technology—completely automated, no human involvement.

Front desk staff often don’t like asking patients for money, but if you collect ahead of time or send a reminder afterward, patients can just use their credit card—done. For open balances, we’ve collected about $1.9 million. For voice, we track how many calls are deflected, how many are completed, and how much labor time we’re saving. A phone call can take three to five minutes. If an employee doesn’t have to handle that, they can be more productive elsewhere.

We also track bot performance—how many calls it picks up, how many referrals and authorizations it handles. We compile all of this into a monthly report for our stakeholders, including business leaders and senior staff, showing how many appointments were scheduled, how many tasks were completed, and the overall impact of the technology. It clearly shows the value and why we continue investing in it.

We just launched new scheduling software last week. If you visit our website, uchealth.org, and click on “Find a Doctor,” you’ll see the new interface powered by a product called DAX Care. You can search by specialty—primary care, ortho, etc.—or use natural language, like “I have an elbow strain,” and it’ll pull up orthopaedics with first available appointments, both for new and returning patients. It pulls directly from Epic and displays real-time availability, making appointment access completely transparent.

In just one week, with no advertising, we’ve had over 200 appointments scheduled through the new system. People are finding it on their own, and satisfaction is high. We started with primary care and are rolling out specialties next—orthopaedics tomorrow, then new specialties every couple of weeks.

We expect strong results from this rollout because patients everywhere are asking for easier access. Now, they can see exactly when a doctor is available. And if someone searches something like “I have a cold,” we surface not just primary care, but also options for virtual care. So if they want to be seen now, they can click and do a virtual visit—something many forgot about after COVID.

Virtual care helps alleviate scheduling pressure since we don’t have enough doctors to meet demand in-person. If your child gets sick at 7 p.m., this gives you quick access and guidance on what to do next. Speaking from experience as a busy mom, having that option is incredibly valuable.

Q: That’s awesome. So, what are some of the challenges, crystal, like you go about implementing all these solutions? What are some of the big challenges that are being faced by, you know, people who are implementing these solutions?

Crystal: I think, across the country, you know, we’re short staffed. Our IT departments are short-staffed, so you know, they’re busy keeping the lights on and they do an amazing job making sure epic, workday and all those things are working and going plus. All the technology from the laptop I have to the network and all that kind of stuff they must handle as well.

So, you know, they’re doing that. And then they’re busy full-time. It’s not like they’re sitting around. Right. And then here comes digital transformation and they have a new toy that they want to have. Right. And they want to put it in. And it’s like, it’s not like I can go do that on my own. Like I do all the work around it but eventually tie into a main system. So, it’s, you know, sharing with. It why this is important, what we’re trying to do, and getting on their schedule so that they can connect me to a Cadence analyst or an API analyst who you know, get cooked up together. But it’s not like the projects they’ve done in the past. You know, if you do an upgrade for a major system, you know, on June 30th, I’m going to, you know, implement the system.

So, 30 days before, I should be done with testing and 30 days before I should do something else. When you start using these new technologies, like I said, you start small. Five offices. So okay, I need a connection for the five offices, then I’m going to go in in two months to a hundred offices. Well then I need a new report that gives me a hundred offices, and then six weeks later I need another report added on for these many things. So, I’m like the gift that keeps on giving to IT. Which does not always make me popular. Exactly. And yet, you know, you know, we found a way to kind of work together and we’re still working out some of the fine tuning on that to make it really sing because it’s hard for them to figure out what does digital transformation means now, right? An API person, you know, the vendors will tell me, oh, this is easy. It’s four hours, you’ll be done. Yeah. Four hours to get the connection going. And then, you know what? When it doesn’t work, I’ve got to give you a call so you can talk to my analyst to go, why does troubleshoot. That’s it. They can’t plan for that.

Right. And so, we don’t know. Well, we might have problems, but you know, they say they won’t, but we probably will. So, let’s see if we can figure out, let you know that this might happen. But there’s no way I can predict what the problem’s going to be or how many hours I’m going to need. And that’s, that makes it, I think a lot of people are struggling with that across the country. And that whole agile concept of, we’re going to add more. It’s sort of, it’s never done. It makes it hard to budget resources. You know, my team’s just constantly churning through it, but it’s got like a whole other job to keep the lights on. That’s a whole different. So that’s a little bit of a challenge.

And then working with our user side, our business side. You know, we’re changing the way they do things. And change is hard. And so, there’s a lot of change management. Why are we doing it? What’s in it for me? Why should I do this? And some people resist that. We’re using ambient technology as well here. Not with a pilot of 125 doctors that are using, nuanced stacks and they’re talking in their phones and saying, okay, Rohit, I’m the doctor. You’re my patient. So this is going to record my notes. So, if you’re okay with that, and we always ask. And so, press play and then you and I talk and like we did before, we were talking about my daughter’s graduation, we’re talking about other stuff.

And then I’m going to ask you about, I don’t know, maybe you have asthma or something else. I’m going to talk to you about that. I’m going to talk about the medications, how it’s working, how it’s not, and then tell your dog I said hi, tell whatever. And all that gets translated into the note. Except the stuff about my kid, about your vacation, about your dog isn’t there? It just takes the medical stuff. Which is still amazing to me that AI can do that. And then, you know, you can say yes no, or adjust stuff. There’s always human that are just checking the ai cause it’s a consistent, it’s not, you know, an independent body. Right. And then you pick that and it’s that; well it saved 37% of pajama time for doctors.     

Yeah. Which is crazy good. Right? And it also closes charts faster. So, revenue cycle’s really happy about that. When we did our pilot, not every doctor loved it. Yeah. You’re like, uh, and of course they don’t want to look dumb in front of their patients. Yeah. So, if they aren’t comfortable with it, they’re not going to use it. And so, there are a lot of things that we learned from that, that you know, okay, we have to find out what the sweet spot is. How do we communicate? We wrote great emails, the most beautiful emails in the world, Dr. Crystal here, this is what you need to know, and here’s some information. And we’d send them out.

The doctors don’t read it. They don’t. So you, they weren’t responding, they weren’t asking questions, they just stopped using the software. So, we had to figure out ways to either text or have somebody in their office ask them how it’s going. And some doctors just didn’t take it right away, so then we gave it to somebody who wanted it. Overall, the amount of time savings and closing charts faster and doing those kinds of things to give doctor satisfaction. At the end of the year was great. It was so great that we’re giving an enterprise license. We have 600 doctors waiting to get the technology. Which we’re going to start rolling out this spring. So, the KPIs were important to show that this really was valid in the pilot to, there was a no go, and if it wasn’t working, we weren’t going to use it. We showed that it did work and so then we can add on to something else.

Q: That’s great initiatives, Crystal. So, as we are coming now to kind of close off the podcast, I would like to ask you for, you know, what do you see when you look into the future? What is your peek into the future? And any other closing remarks or thoughts that you would like to share with the audience? Crystal?

Crystal: I think we’re going to see more and more AI, but I don’t think we’ll ever see AI taking over our jobs. I think we’re going to have to find some sort of a sweet spot where integration becomes easier between our main systems and these add-on systems. I think go away from like, if you go to any show, you see, oh, there’s this for, I don’t know, brain cancer. Let’s say there’s this for heart, there’s this for whatever. And you know what? I can’t afford to buy this. Nor can I integrate those. Do that kind of stuff. So we have to have something that can kind of do everything at least somewhat well, but we can customize and make it so that it’s better for the whole system. I think we’ll see more of that coming along. The spot solutions, not that they’re not great ideas, but I can’t afford to do it. I don’t know many hospital systems that can take on that many things.

I think we’ll see more in patient navigation, and I don’t mean wayfinding per se, but I mean like I know I’m going to have to go in for an ortho appointment, so you’re in education before that, I’ll be able to maybe answer my questions through two-way text or something beforehand. I’ll get stuff a day before or three days before. Maybe my husband who’s going to support me will get something as well, and then I’ll come in, maybe there’s something in the hospital that does some education or whatever, and then when I’m discharged, I’ll get follow-up both from a nurse. Maybe it’s text first, and then I have a question. A nurse will call me back. Maybe I’ll get some more education. Then all of that will be seamless to me as the patient. It may be pointing solutions along the way, but for me it’s just seamless. It’s my hospital system caring about me. It’s my hospital system showing me the way to go. Those kinds of things we’ll see a lot more of that coming out as we get better at using the tools that are at our disposal.

Subscribe to our podcast series at www.thebigunlock.com and write us at info@thebigunlock.com   

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

Q. Hi Rita. Welcome to the Big Unlock podcast. We are really happy to have you on our show. This is the sixth season, and we look forward to a very engaging conversation with you. So welcome once again. Just to get started, I’ll give you a very brief introduction about BigRio and Damo Consulting.

I’m a managing partner here at BigRio and Damo, and I’m based out of Gurugram, India. BigRio and Damo are both heavily into technology consulting, and BigRio is mainly into strategic and advisory consulting. We have a proprietary DigiM maturity model that we had several very good clients — Geisinger, Intermountain, Montefiore — and we’ve had two versions of our DigiM awards for the last two years. We had very good participation and we also added an AI maturity model to that as well. BigRio is the technology implementation partner. So we have the entire offering because we do the strategy consulting and the advisory, and then we can also help with the technology implementations. So that’s a little bit about Big and Damo. Would love to hear about your background and about Pager Health and your journey into healthcare.

Rita: Yes, absolutely. So I am the Chief Product Officer for Pager Health. Previously I was at Salesforce, having led the development of Health Cloud, which is focused on patient relationship management. For my entire career, I’ve been dedicated to healthcare technology, really bringing solutions to the market to improve.

The experiences for patients and for providers. I had an opportunity to join this Pager team. Super exciting. Some of the work that was happening at Pager Health and continues to. We provide nurse triage, wellness care management for nearly 30 million lives for payers and for providers, and our NPS score is over 90. That’s exciting to me because I know that we’re making impact in the market for members and for patients.

We’re fortunate to work with leading health plans in the US and in Latin America, self-funded employers, and large health systems. I think we have the whole breadth of the offerings that are available. We’re white labelled, so a lot of people don’t necessarily know Pager Health, but they know our technologies and our services because they’re encountering them under the brand name of a health plan or a provider.

That’s really great to know and I was really interested to read the report, which Samantha shared with me. That had some brilliant insights about numbers in terms of metrics and how 67% of your audience feels that they trust the copilot. It was really amazing to see the level of Gen AI adoption from that survey.

Q. So how do you feel about the Gen AI implementation at Pager Health? What are some of the challenges that you’ve encountered? What are some of the big wins you’ve seen, and what is your overall view towards the next trends for Gen AI and for Pager Health?

Rita: Yeah, so I think that we’re right at the beginning of this revolution, right? So, I think we’re going to see some amazing transformation. It’s an exciting, exciting time to be here. I think we’re going to have meaningful impact on patients and providers. I think we can help providers with administrative functions, medical documentation. We, we just rolled out something that allows us to summarize a chat and actually submit it into an EHR. It takes five to 10 minutes out the process. We use it for triaging patients, doing intake with them, providing conversational chat bots and AI assistance. We do provider facing chats. We do patient facing chats and agents.

There’s a lot of ways we’re gonna be able to impact. I love to talk about this one example. In Columbia, we have a connected health platform for an integrated health system, which supports 14 million lives today. And so they use our platform to do 3000 per week consultations remotely. And because the technology is AI powered, there’s a lot of concurrencies, right? They can have six concurrent conversations at the same time, using the chat technology, using the AI technology, and then they can ramp that up extremely quickly. They can also get the healthcare providers onto the platform extremely quickly. So, whether that’s a nurse or that’s a physician, they go onto our Enterprise 360 platform. But all of that is enabled with ai. Other thing that’s super exciting to me when I look at our ai. Possibilities. We can use AI agents to navigate benefits or schedule appointments. We can use it to create really personalized health journeys based on people’s preferences, their lifestyle, their care needs.

We can help them find doctors, and these are all the things that consumers told us. That’s what’s gonna build trust for me in the health system.  And you talked about. Consumer survey and they said, they said, I trust AI to help my healthcare professional. I trust AI to help me navigate the system. I help a, I trust AI to be able to give me a personalized journey for my healthcare. So, what I think is so exciting is that the consumer has said, I trust ai. It’s partly because it’s all around them. So, it’s not so novel anymore, but they’re starting to build more and more trust. And the consumer survey showed us. I do think another component of it that’s very important to Pager Health and I think is important to the healthcare industry to be frank, is we have to keep the humans in the loop. So I think AI is going to create efficiency. I think it’s going to help us. I think it’s going to help our healthcare professionals with clinical decision support reviewing vast amounts of data. We know 20% of the world’s data is in gen ai, right? So that’s a lot of data to be able to consume and to be able to use for healthcare decision making. But I think we’ve, we’re going to have to keep humans in the loop for the time being. I think with consumers, we’re going to be able to do a lot for them, to help them better navigate providers and the system in general, and their benefits, and figuring out what access they have to healthcare professionals and to services.

Q. That’s a really good answer. Thank you. I was at a couple of healthcare conferences, and the number one issue or challenge or barrier was when they talked about trustworthy AI and responsible AI. They felt that, because of all the hallucinations, deep fakes, and the problems encountered with Gen AI, the trust of the consumers in Gen AI is not as high as what your survey indicates. This was really heartening to see and also hear about your Columbia implementation—that it’s going well and that people have a high level of trust in Gen AI.

Rita: Yeah, and it’s creating efficiency in the system, right? So that’s really important for the time being. If we keep humans in the loop when it comes to healthcare decision-making, it’s going to be super helpful because we can start to build more and more trust with the end consumer. It’s not a new technology, but it’s relatively new in the way we’re using it. So, if we keep humans in the loop and focus on efficiency, we’re going to see amazing inroads with Gen AI and AI in general.

Q. Yeah, that might be an interesting one because with GenTech, we are sort of moving away from human-in-the-loop and going into autonomous systems, letting them do things on their own. It’ll be interesting to see how this plays out and at what level we still need to have humans in the loop versus autonomous systems.

Rita: That’s right. Agentic is very important. When I talked about benefit navigation, finding a provider, or scheduling within a provider, we have AI agents today that can deliver that. We help with intake, with clinical intake, but delivering the care—humans do that. We continue to make the humans more efficient with their consumption of data and how they provide the best care to a particular patient.

So, it’s this hybrid mix. We’ve rolled out several agents into the market, but they’re focusing on data consumption—benefits, providers, and helping consumers get to the right resources. Consumers told us they trust that. When it comes to the clinical piece, we have this hybrid approach.

Q. I think that’s a fair resolution for now because that’s where we’re seeing a lot of success, even in other healthcare implementations. With ambient and scribing, taking away the burden of documentation and letting clinicians focus on patient care, with Gen AI taking care of administrative tasks. Also, I wanted to ask you about your “Really  Well” product, because that also uses agentic tech and seemed like an interesting implementation. Can you tell us a little more about that?

Rita: Yes. “Really Well” is our wellness program, our product, I should say our platform. It has the ability to take a health assessment, gather data from the patient or member, and then give them specific journeys around self-guided programs or other programs they have access to—challenges, things like that. It gets very personalized. We’ve introduced a Wellness Companion that now lives within that platform. For a particular consumer, it guides them through their experience. It’s not just 100% self-serve—they’ve got the companionship of their AI agent, their Wellness Companion, to help guide them to specific solutions. For instance, if someone takes their health assessment and says they have high levels of stress or that their job is stressful, the Wellness Companion can guide them to a stress management or mindfulness program. In order to deliver the N-of-one experience for every person, Gen AI is incredibly powerful. It gives that personalized experience within the wellness platform. That’s how we’re leveraging AI and the Wellness Companion within “Really Well.”

Q. So in terms of adoption of “Really Well,” have you seen any challenges? Or as your survey mentioned, did people trust it and engage with it? What were the success metrics for that program?

Rita: So, our success metrics are how many people engage in the wellness program. We built this platform for health plans to use with employers. They use the wellness program and sell it into employers. What we’ve seen is adoption is over 50% in terms of filling out health assessments and engaging with the program and getting wellness.

We’ve seen results in terms of reduction of stress, reduction of weight within the program, smoking cessation increases. We’ve seen impact, which we know has clinical implications downstream and helps reduce costs with a wellness program. In some cases, we can integrate care navigation so people can access a nurse if they need specific help—say, mental health support. A nurse can be accessed within the same platform, and we’re starting to see more uptake because it’s an integrated platform. For a long time in the industry, wellness sat in one compartment and health in another. Our opportunity with Pager Health has been to bring those experiences together. people do not compartmentalize themselves, right? They don’t have a sense of like, this is my wellness compartment, this is my health compartment, it’s me, it’s my body, it’s my health. So, when you’re in a wellness experience and need access to a nurse, you can get that within the same platform. That integrated experience and whole-person approach has been very successful. We’re seeing great results and also ROI. For employers to keep investing, we have to deliver ROI, and we’ve seen it—sometimes as high as 7x within populations using Really Well and our care navigation solutions.

Q. Have you been using voice assistance or is it all just text-based?

Rita: They’re not using voice assistance today. There are the ones integrated into phones, and we have an omnichannel experience. So people can go on the web, they can go on their mobile phones, so they can leverage the voice technologies that are available to them in either one of those platforms.

Q. Okay, because that was one of another trends that we were seeing at, you know, the HIMSS conference and other conference. The voice has just exploded suddenly. And we were talking to a partner, Vivid Health, which does longitudinal care management plans, and they said that they were seeing like a flat demand, but then as soon as they added voice, it was like a hockey stick and just, you know, they haven’t been able to keep up with it.So, in your opinion, what do you think caregivers or clinicians are looking for in terms of digital enablement? What we’ve seen so far is mainly like their number one ask seems to be ambient, but in your opinion, what do you think? Like what have you come across and what do you feel?

Rita: I’m gonna reference that consumer experience survey where we actually heard from 2000 consumers about what their experience with health plans and the health system is today. We know that trust is broken, that what they said to us. Three out of four people said, Hey, customer service. That reduces my trust quite a bit. Lack of access that reduces my trust. So what they’re actually looking for, and this is the great news I thought from the consumer survey for me personally as a, a leader in healthcare, is that they are willing to put that trust back into the healthcare system. It’s, there’s an opening. So they haven’t shut themselves off, they haven’t given up. Maybe they have on communications, they have not done so on healthcare, which is great news. And so they’re frustrated by things like not being able to find information or get access. And what they said they would want is 24/7 access to a nurse.

Having one agent, one coordinator, answer all their questions. Think about your experience in healthcare being sent from one place to another place to another place. They don’t want that.  They want one experience and they would like to be able to be supported through navigating the system. The system is complicated. So whether it’s a health plan system or a provider system, or all the great digital programs that are available to people, just navigation, they want to be able to have some help with that and they would like the information and support to be timely. So they told us what they want and from a technology perspective, we can address all of this. And so if there’s the right technology partners, the right infrastructure in place. This is all very possible for us to deliver. And so we just have to prioritize it. Healthcare systems have to prioritize it. Health plans have to prioritize it, and if they do, and I’m seeing lots of health plans and, providers starting to do this, they’re able to get that better experience to the consumer.  That’s what they want and they want the, not only the convenience of it, but they want the ability to feel like they’re being cared for in the system because. They told us they’re telling you what they want and you’re delivering that. So that I think is what people are seeking.

Q. What were the kind of timelines that you were seeing on this implementation that you built for really well and you know, for these other products? Because what we were seeing with a lot of clients and companies that we were talking to, they all have FOMO. They know that they all have to do GenAI, but then they’re also like, we saw 70% of the POCs are not moving forward or not being able to translate or scale into production. So did you, you know, have a similar experience at Pager Health or was it a smooth implementation? What were your thoughts or feelings about that?

Rita:  In terms of implementation, it was very straightforward, right? Because we’ve trained the models, we’ve trained the agents, we’ve got it specific to a health plan or provider’s needs, right? So that part from a technology perspective. That did not have friction. Okay. I think all of that is well honed. I think the biggest issue we actually had, believe it or not, has been data use rights. So plans, providers, very sensitive to the use of data, sensitive to data breaches. They’re sensitive to that. So what we’ve done is created a data use rights memo. Our legal team has done that. And again. Just to ensure that the legal teams feel comfortable in terms of what’s going to happen with the data. Our goal is not to leverage the data to be able to do, to utilize it. It’s not to you put it into the LLM, we rely on the Google Vertex model and their LLMs to be able to build our agents. And so it’s not our LLM, it’s their LLM and the Google relationship says you don’t have to give me that data back into the LLM. Right. So some of those things, again, I could. It comes back to trust. That’s what’s created more barriers right now. Again, this is all new. The technology part of it has been very straightforward. For the most part, it’s been about building trust with the organizations themselves around data use.

Q. Yeah, I would agree with you there. I mean, people have had like a different you know, experience sometimes with the models also, but maybe because you locked in with a technology provider and you felt that the implementation went smoothly. In that case. That’s right. So we also heard at the same conference that company culture was another thing that frequently came up because they said that culture can be an enabler or it can be a barrier sometimes.  Because when people are not, you know, bought in to the entire concept of Gen AI or the education doesn’t happen across the company, then people are more reluctant to participate and then culture becomes a barrier. So what were your feelings about that at Pager? And did you like have a formal education program? How did you create that buy-in from all the stakeholders and ensure the smooth implementation, like you said.

Rita:  I think it’s a technology forward company. In terms of pager health, we were started by the founder, one of the founding members of Uber, so Oscar Alazar. And so it’s already always been this disruptive, innovative technologies. It’s, you know, it’s a relatively, it’s a young company, so it terms of new technologies, it. It’s very receptive to that. Like that is our, the crux of our organizing principles. So Gen AI was very welcome. We have a significant data science team, data engineering team, so it wasn’t a big change within Pager Health for sure. Okay. A big change has been at the health plan and provider level to help them feel comfortable. Like I was just talking to you about data use rights. People saying, okay, so what are you going to do with my data? How are you going to ensure that it’s safe? How are you going to ensure that it’s not going to end up in some LLM that I don’t have control with? These are the kinds of questions people are asking. That’s where there’s been more of a change of mindset.

But this is the great news. Many of them, many of our customers. Are building their own AI gen AI technologies. So they’re using them for their internal purposes to reduce some administrative costs to reduce just the navigation within their own system. It’s the piece of it when you have to introduce it back out to consumers where they have to be extra careful and they’re being extra careful. But I think the change has happened. I don’t know that people are resisting it anymore as much. Yeah. Because it’s here. It’s not like we can’t afford to sit on those sidelines, and the leaders of healthcare plans and professionals, they know that that’s the case. So they’re embracing it, they’re leaning it.

I would say that wasn’t true two years ago, but now I would say it’s, definitely true. Not so much change management.

Q. I think we can conclude with maybe some of the risk factors or security related questions or, you know, security considerations, cybersecurity or what in your mind would be the top risks and how at Pager do you address those? And on that note, I have another related question. In some of the companies we are seeing that this primarily falls under the role for a Chief AI officer. So does Pager have a Chief AI officer and you know, do you have a governance or ethics committee?  What are your thoughts about all of that?

Rita:  Yes, so we don’t have a chief AI officer.  I do have, very senior data scientists that work within our team, and they’ve issued memos and findings and policies about responsible use of ai and, and we’ve issued these, they’re available for consumption by any of our customers. So again, that’s the governance. Body essentially was our C-suite and the data scientist team that continues to reinforce for us. The partnership with Google also helps to reinforce the responsible use of AI because they’ve done made so many incredible investments in that area. So as a partner, we can leverage that. I think the security in governments, it’s, again, I come back to the data use rights. We just have to help people feel comfortable with the fact that we’re going to be very responsible with the use of the data and we’re going to be very responsible to the consumer with the use of their data. So we cannot breach privacy. HIPAA compliance continues to be a complete commitment from us as a technology company, and so we sign BAAs. We make sure that the data is not transferred between customers. It’s all for the customers, for the needs of the customer. All those kinds of things are very important, again, to building that trust with the organization. Security, privacy, all the things that we have been doing for a long time in healthcare. We just have to keep doing. Them and just keep doing them more and reinforcing the responsible use of ai powerful technology. But we have to be responsible with it. And that’s how I think we’re approaching it.

Q. I think it’s been a wonderful conversation and we look forward to going live with this. Rita, any other closing remarks that you would like to share or, you know, tell our viewers about?

Rita: I know I want to thank you for a great discussion. It’s, uh, fascinating to talk about this and hear about your perspectives as well. I think people are going to want access to that consumer experience survey. They can go to https://www.pagerhealth.com/cxsurvey and get access to the report, or they can reach out to me directly at our rsharma@pager.com and I’m happy to get. That report sent to them, so they should get access to it. We want as many people as they want to use that. I think it’s a seminal piece of work, and it’s going to help with a lot of decision making as we think about future initiatives. And there’s a lot of misbeliefs, if you will, within. With about AI You know, people are scared of it, but actually they’re not that scared of it. There’s also misinformation around elderly people not wanting to use technology or using text or it’s not true. It’s just not true. They’re using it, they’re embracing it, they’re not afraid of it. So we just need to dispel some of these, these issues, and so this report I think will be very help in doing helpful in doing that. I thank you for your time and this discussion. It’s been fantastic.

Subscribe to our podcast series at www.thebigunlock.com and write us at info@thebigunlock.com   

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

Q. Hi Yaa, welcome to the Big Unlock podcast. So, I’m Rohit Mahajan. I’m the CEO and managing partner at Big and Demo Consulting. And we’ve had the good fortune of having you on our podcast once before when Paddy was running it. So welcome back. And with that, would you like to introduce yourself to the audience?

Yaa: Absolutely. My name is Yaa Kumah-Crystal. I’m a paediatric endocrinologist and biomedical informaticist, and I serve as a clinical director of health IT at Vanderbilt University Medical Center here in Nashville, Tennessee.

Q. That’s awesome. Tell us a little bit more—how did you start in this field of being a physician, and what attracted you? How did you move from being a practicing physician into health IT, which is a dry field for many people?

Yaa: I think the luck of it all is that one of my features and bugs is that I’m a complainer. I’m always trying to improve systems around me, always finding opportunities. When I came to med school, we were transitioning from paper to the EHR, and as we started using some of the electronic health record systems, I had a bit of a computer science background. I saw that there were lots of ways we could be improving things—the way data flowed, to not have to repeat entry. I think I just complained, complained, complained to enough people that they said, “You should talk to Kevin Johnson.” He was the chair of our biomedical informatics department. He said, “You think you have some good ideas that can improve things?” And I said, “I think I do.” He was like, “You should consider informatics.” And through luck and happenstance, I got involved in a lot of really interesting projects in improving the EHR. Got my master’s in biomedical informatics and was able to get a position serving in health IT to improve the EHR.

Q. That’s awesome. So talk with us about some of these early experiments in improving EHR, because they’ve come a long way now—including, we were just talking about how Epic is integrating generative AI into the product itself and the platform itself. Share with us what you’ve seen so far, and where you think it’s going in terms of all these new developments.

Yaa: Sure thing. It’s funny—I almost want to break up the EHR into three eras: the paper era, the classic data entry era, and now the generative era In the classic era, there are a lot of great concepts and thinking to improve the way we’re. Capturing information because a lot of the problem was we had these paper records and people would just clone a paper form into a digital form and say, have at it. Go ahead and enter all this data in doctors, and please do a good job on the way and don’t miss anything and make sure you can get everything for our quality improvement and billing.” Doctors were getting so frustrated, and we tried different modalities to improve things. We had dictation, voice technology—we even worked on a project that was a voice assistant for the EHR, kind of like Alexa, early on. You could ask it things and get information back. We collaborated with Epic on a tool called “Hey Epic” to talk with the EHR, but architecturally, it was so complicated to plan for every single way someone might ask a question.

Then generative AI—large language models—entered the scene, and suddenly the concept of naturalistic interaction became feasible. You can now ask for things and get responses in the way we think about them as humans. Is just part of what we do now. So a huge aspect that has been an improvement that doctors have seen right away is ambiance workflows. So being able to just have a regular conversation with your patient, have the AI do all the work of the documenting for you. Yeah. And generally, note at the end so you can pay attention. So the person in front of you has been such a game changer. We literally get emails from providers saying, “This is such a game changer. I get my notes done on time. I can pay attention to my patients.” And it’s getting better every day.
So I think this new era, following the standard digital EHR era, is going to bring some of the most exciting advancements in patient care.

Q. Yeah, that’s good to know. One of the things you hit upon—ambient listening and integrating it into workflows—is resonating across the board. It’s quickly becoming a key technology that everyone is going to use. What others do you see on the horizon as you look around and evaluate developments in the generative AI space?

Yaa: What I see—and I’ve always been interested in—is voice technology and being able to converse with technology the way we’re conversing right now. I think everyone listening to this podcast has probably played with ChatGPT, Claude, and other similar tools. One interesting feature I find is voice mode, where you can ask questions and get responses back. Any of us who’ve played with, you know, the older Siri and all that stuff, know that. Sometimes you ask the question, it’s like, um, I’ll search the internet for you. And you’re like, ah, yeah. But with these tools now you ask it and you get something back, and the thing you get back is related in context to the thing you’re asking for, and you can ask follow up questions. My biggest question is when will we be able to integrate a workflow like That into the EHR, because many times when you are trying to put together the story of a patient to figure out what to do next or what’s been going on with them, you have the questions in your mind. You’re like, when did they last get this test? Or how many times have they, um, been to the hospital for this particular issue? These are questions you have in your mind. To find them, you have to navigate the EHR. You have to say, well, if I wanna figure out how many times they have an encounter, I need to go to the encounters tab and I need to filter for ED visits.

And there are these steps that you’re taking to answer this question, but what if you could just like ask the question and then have the EHR understand you because it’s , it has this transformer architecture in the background that. Understands that can inter interpolate what is you’re saying and feed you back the information, and that takes off so much of the cognitive burden of the work to find the things you need to care for your patient.

Q. That’s so interesting you say that because recently, I’ve been talking with several people—including at VIVE —and one of the leaders I speak with often, Dr. Ashish Atreja, described it as a “headless EMR EHR.” The voice interface comes to the front, allowing you to ask questions in natural language, while the EMR EHR itself fades into the background for the purpose of just gives you the answers. It’s fascinating that you’ve been following this for so long.  Let’s flip perspectives now—how does this look from the patient or caregiver perspective?  And we were chatting about patient portals a few minutes ago before we got on the podcast. How are your paediatric patients and their caregivers embracing this technology, and what are they asking for?

Yaa: This has been a very interesting time as a paediatric provider because our patients are young, and their parents are from an early tech-savvy generation. They’re more in tune with technology than, I think, some of the older patient populations in internal medicine, for example. I’ve actually had a patient say to me, Hey, I ran this through chat GPT, and this is what it told me. Do you agree? And what my relief was that they asked. Me for my opinion, yes, to see if I concurred with what chat GPT was giving them course, but I don’t think it’s gonna be a long time until we’re going to start seeing patients discover more and more that these tools are able to give responses. The only concern that I have is how reliable and accurate these responses are, and what responsibility do we have as a medical organization to work, to develop tools where that they can safely ask for questions and can give back more certified, approved answers  to answer some of their questions.

Concern that I have is how reliable and accurate these responses are, and what responsibility do we have as a medical organization to work, to develop tools where that they can safely ask for questions and can give back more certified, approved answers, uh, to answer some of their questions

Also, circling back to voice user interfaces on patient portals—patients are navigating these platforms trying to find information, but sometimes they just have a question. What would it look like if they could ask the portal: “When’s my next appointment with Dr. McChrystal?” or “Are my labs back yet?” or “Hey, I need a refill on my albuterol—can you send that in?” And then those things just happen as part of the process. Right now, the buzzword is “agents.” So we’re talking about smart agents that can make our patients’ lives easier.

Q. That’s awesome that to think that we are, because I would love to do that. Ask my a question and get an answer back instead of us trying to validate my, my user ID and password. 

Yaa:  And that’s the thing because um, there’s so many, there are really interesting ways to authenticate people like it would know your voice. There are other factors, like it knows that, oh, you’re nearby because it detects like your phone’s nearby. There are just. Many ways. It’s such a fun time to be a nerd right now because there’s so many things that are converging with a lot of technologies we’ve been thinking about for a long time. 

Q. That’s great. So that leads me to my next curious question: in a large system like yours, how do you approach innovation and new technologies? Do you measure return on investment? How do you decide your next projects for, say, this year or the next?

Yaa: Great question. Vanderbilt is a large academic organization. We have trainees and a lot of researchers. I think we’re all aware of the changes happening in the broader landscape around funding and priorities, so we have to be thoughtful about how we implement technology—making sure it serves our mission and benefits our providers. At the same time, we want to try new things and partner with vendors to say, “Hey, we’re experimenting with this, and we have opinions and suggestions for improvement. So I think part of our strategy is to do early pilots. So we can help to steer the direction that these tools are going to be materializing when they go to full production. At the same time, we aim to deeply understand what ROI even means in this context. Are we trying to improve turnaround time for notes? Reduce pyjama time for providers Do we want to decrease the number of messages that patients want to send back and forth? Once you can really define what is you’re trying to improve, then you can figure out how to measure it. And once you can measure it. Then you can really know if you’re making an impact. I think a common concern that people raise with looking at ROI is, well, sometimes the ROI is just that your providers are less miserable, that they’re less out, and how do you measure something like that?

There are interesting metrics that can help us assess whether the cognitive and emotional load on providers is being offset by the tools we provide. Some of these tools aren’t inexpensive, but I think we’ll start seeing providers expect a certain level of expectations that their EHR systems are working at a certain state of the art. EHR systems are working at a certain state of the art. I work with trainees and one of my trainees, she’s finishing up her training and she was looking for a new organization and she joked to me, she was like, well, I sure hope they have ambient there because I’m so spoil right now. I don’t know what I’d do without it.

Yeah, that was a joke that she made because it’s so early days, but I think it’s actually gonna become a truth where if your organization is not on the leading edge and not providing these tools to improve the way your providers work. People might decide that they want to go to a different organization. So, I think the people in the C-suite needs to be giving that consideration. 

Q. That’s great to know. So, you touched upon this, topic of one of your trainees. So, talk with us about education, training and learning initiatives in the community or at the. At the health system, how do you go about that? How do you level up and what are some of the things that you can do about it? 

Yaa:  Yeah, this is a really, really fascinating part. A lot of the new tools that we have help people become more proficient and help people be more efficient. You help you see patients faster, help you write notes faster, and that’s great. But on the other side of the coin. Trainees are not just supposed to learn how to be efficient. They’re supposed to learn how to practice medicine and how to balance logistics. So, we need to find a good balance of teaching them how to use the tools they’re gonna be using in the future, but not to the extent that we’re impeding on. Their actual learning process. In medical school, I took a course on how to write a good medical note because you had to think through the diagnosis. You had to figure out of all the things the patient told you, what things do you wanna keep in the note? What things do you leave out of it because it’d just be too much and that’s distracting. You have to do that synthesis and assimilation yourself. Well, we have tools to do that. Now, does that mean that we don’t teach students what a good note is anymore? Do they just solely rely on something that’s generated? These are decisions that we are going to be making and making in real time because no one knows the answer. cause we’re on the pioneering edge of it all.  But I think we need to not forget that trainees being a medical student, a resident, a fellow. It’s not just about learning how to be efficient. You need to reach a level of proficiency before you need to worry about efficiency. So, we need to make sure that we’re teaching them things they need to be good doctors so they can be efficient, good doctors eventually.

Q. Do you give that into your program over there? How does that? 

Yaa:  Absolutely. Yes. We have medical students and we all sorts of trainees that rotate through and I, I love, love working with trainees because they will ask me questions about things I have never thought about. I’m like. Let me go look that up. Yeah, just think of things in very, very new and interesting ways. 

Q. That’s very cool. So just curious that, you know, many times the focus is on the main system, which is the EMR EHR system. Let’s say a pick  Epic in this case, and then there’s patient portals. It could be MyChart or anything else from the same vendor or, or different providers as well. What other systems is a physician touching upon during their work? Which could be transformed digitally. Any thoughts on any other systems which come into play? 

Yaa:  So many, so many. So communication systems in general, a lot of what we do is communicating. Yeah. In the medical system, we’re still using like fax machines and pages. Yeah. Like we’re singly keeping those industries alive. There’s. So many ways, things could be improved about the way we communicate with other medical centers. Interoperability is a huge, huge challenge that we’ve been trying to tackle for years. Where I see a patient, they’ve been referred to me, their paediatrician has all their records and all their growth charts, and I’m like. Boy, I wish I had those. Yes, and they’ll fax me something and I can like pull up a very fuzzy PDF. I’m like, oh, there’s got to be a better way. And we know there is, we have standards like Smart on Fire where yeah, we were integrated appropriately. Everything that they had could magically show up on my growth chart, that so many opportunities there.

Q. I would like to ask you if there’s any other thoughts you have in closing, and if you were to look in the crystal wall, what you’d see, see coming our way in the next, let’s say, one to two years, and any other thoughts that you would like to share with the audience?

Yaa: I think my crystal ball is going to be really interested in how care can be delivered more at home and how we can get more insights from patients based on what they’re doing outside of the medical centre. So I’m a paediatrician, so I care a lot about kids and the fact that they spend most of their time just in school and the school nurse. That’s our main touch point to anything that’s going on with like our patient’s diabetes and what tools do we have that can help us. Better understand what’s going on with our patients when they’re outside of our medical center walls. So with diabetes, they have these things called continuous glucose monitors. That can help. Blood sugars are periodically. What are interesting ways for me to get the information in real time, to get alerts, to get, stratified risks of the patients that have the different technologies so I can know how to act. How useful would it be to have information like that available for. All sorts of patients for anyone on their watch, just so we can get a sense of which patients we need to make sure that we’re really engaging with so we can help improve their health and on the patient’s side, so they can have a sense of autonomy also, to say like, Hey, I really understand these details about my health. I’m getting these insights from my environment, and I can be proactive about how to stay well. 

Q: Great. So with that, yeah, I think thank you for the podcast being a guest on the podcast second time around like we, we talked about, and thank you for your time. 

Yaa: Thank you so much. I look forward to a third, fourth, and fifth time we’ll talk about Yeah, of course. What we got. Implement our, our new robot army to take care. We hope you enjoyed this podcast. 

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Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.