Beyond the EHR: Advancing Patient Care with AI and Data Strategies

Q. Yeah. Hi Priti . This is Rohit Mahanjan. Thank you for joining us on this Big Unlock Podcast. the audience. Is pretty diverse and, uh, broad. So we are looking for an exciting interaction today with you.

And, uh, with that, would you like to introduce yourself,

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

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

And when I started 23 years ago, I started off as a primary care physician and quickly got into administrative side of medicine, um, 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 much involved with our enterprise wide implementation of Epic, so that was in 2012.

From there, I. 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, and 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 that I. You spend so much time in this field. So tell us a little bit about how do you work with your colleagues? You are the CMIO, then you might have other colleagues in 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: So I’m very fortunate in that I’ve had two other CMIOs before me, and so they were really critical in laying the foundation for our informatics structure. So our first CMIO was really responsible for our EHR implementation. The second sort of came in and really established a lot of the.

Committees, the governance structures really helped optimizing and that those, and through that entire journey, I’ve been part of that we continue to grow year by year. Just the number of clinicians and physicians that have been involved in informatics is really astounding. You know, I think 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, some have even gone through fellowships. So we continue to grow and IT now is part of every part of the health system. And so I think there’s informatics that are part of our team.

Formally, our physicians staff, you know, many of them are informatics representatives. And then our nursing staff now has really kind of. Come to the table and, 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, as time goes on.

Q. That’s great to know. So could you talk to us a little bit about how do you, at your, you know, community-based health system treaty, 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 for strategy, and that’s true of most of our core applications.

So we focus on really leveraging what is available to us through our, 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, 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, the rounds through the, the floors, to really share a lot of that knowledge of, 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. You know, this is not something that was part of our, our Epic application. And so we looked at other vendors. And found one that we thought would be the best fit. And that is something that we’ve really integrated with Epic.

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

Q. That’s amazing to know. Priti. So I heard you say before when we were talking separately earlier, that you have a Gartner report, which got published around the Ambient Listening, you know, initiatives, which you just mentioned about.

And that of course is a business application, which a lot of health systems are embracing and they’re 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, in three aspects I would like to bring out with you if we can, that 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? Of course.

Priti: So we started our journey very early. This is the technology I was waiting for, you know, as a, uh, primary care physician.

Really wanted to spend more time with patients instead of interacting with the EHR and spending time and documentation. And so for a number of years we were looking at the early ambient solutions that were out there. And then a couple years ago when large language models came to be. We really focused on that, and so it was early 2003 is when we started to look at a variety of different vendors and we ultimately settled on ambience 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 ambience, and so we implemented that very early, so July, 2023. And 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, our physician population.

The challenges were that. No one had done this before. You know, this was something, yeah, 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, uh, year and a half. And so I think really the exciting part of this was giving people this technology that within four hours most physicians adopted and start really seeing the benefit of it, really enhancing that human connection.

Finishing their notes on time, being able to go home on time and not have to spend time, you know, 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’re face to face and they’re not distracted by any technology.

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

And then once we integrated, you know, all of a sudden a hundred providers just came out and signed up and we’re ready to go. And you know, at this point we have 60% of our users utilizing it. And you know, every week our adoption continues to grow and adoption, 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 now how we deliver care at, uh, John Muir Health. So it’s been a really exciting journey. We’ve got lots of qualitative feedback from our physicians, you know, saying that this is something that would allow them to practice for a lot longer.

How it’s given them light work-life balance back, um, sort of the quantitative side. So, you know, we’ve been tracking a number of different outcomes. There’s efficiency gains for sure. We’ve seen about 30 minutes of time savings in documentation. And then, you know, when you ask our providers. How much time do you think you’re saving?

They’ll say, we’re saving two hours. And so what that tells you is that they’re feeling less fatigued. There’s this tremendous reduction in cognitive load. And so I think there’s just so many benefits with this technology and, and we’re just starting to really realizing what it can do. And I foresee this continuing to improve and expand as, as time goes on.

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

Priti: Yeah, so we’ve had a, in addition to ai, we’ve also been focusing a lot on our data strategy. So about a year and a half ago, we really sort of focused on, you know, we’ve got a number of different strategic initiatives and we wanted to really. Measure outcomes. Outcomes at all levels to be able to drive continuous improvement.

So we also have 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.

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

So we set up, you know, we actually started with our C-Suite and did one-to-one trainings with ’em on a variety of different reporting and analytics tools. From there, we moved to the directors, the managers. We have webinars, recorded self-service, sort of self-paced learning. We have open office hours now 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. And so it’s been a really exciting journey where, you know, a number of different initiatives came together.

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

Q. Yeah. And I’m sure in, in this journey, priti, like when you try to do cultural changes, right? There’s always like change management, which comes into play and then I’m sure you are, you’re adept at balancing your innovation efforts with, with the clinician or the patient centric.

Design. So talk to us a little bit about that. How do you drive innovation and how do you do 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. And you know, when I think about what I do every day, you know, even as a position, I was a change management agent.

And then, you know, on the IT and informatics side, you know, that skill comes in very handy. You know, I think that. Even if you have the best technology, the technology that you think is really going to support the clinician or the business owner, you know, 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, how it will help. Them. That’s one of the things that we do as informaticists, is we really try to bridge the workflow with the technology. If the technology is designed well, it’s very easy to do. If it’s not really designed with the end user in mind, then that’s where, you know, the change management becomes even, 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, that connection is, is really key.

Q. That’s great to know. And as we move on to more discussions around AI and Gen ai, what are you thinking could be next initiatives? You have a very successful one already underway and things are changing fast around us.

As you know, everyone’s talking about as Gentech ai. In fact, we have a. Webinar coming up in the next two weeks on Agen tki and I was surprised that the number of registrations for that, you know, so it seems to be very topical of very 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’re thinking about the policies and the governance aspects as well.

Priti: Yeah, no, this is a very exciting time and we too are excited about the AI agents where we’ve started with Gen ai. I mean, our first application was the ambient scribe. Yeah. But we’ve also been utilizing Gen AI to help draft responses back to messages that come from patients.

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

So our inpatient physicians, you know, 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’s some great tools that might help summarize and really raise up some very pertinent points to care. Mm-hmm. So that’s, that’s a pilot that we’re really excited about.

There are a number of different applications on the business side, so, you know, when you think about, you know, 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. You know, as I was mentioning, we’re on this data-driven journey. And teaching people how to leverage these self-service tools. There’s 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’s some tools that we’ve been looking at to say, can the user just. Speak out their query. Yeah. So that then the data is kind of, the analysis is done for them, and then they can more easily utilize it. So that’s really exciting. We’ve 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’s. Where the magic really happens. Mm-hmm. So we have a number of different predictive analytics tools live today. One that helps predict readmissions. We have another one that’s been in play for a very long time, really predicting the high risk patients, those who are at risk for clinical deterioration on the in the hospital.

And so, you know, that’s been really 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, uh, a stroke early and really mobilize the team. And that’s really improved our stroke care. And so I think there’s so many applications and tools.

It’s almost like we, we have so many solutions that how do we implement these fast enough in order to, yeah. You know, really. Take advantage of everything that’s out there. And then of course, you know, age agentic AI is coming and that’s something that we’re very excited about too. So I’ve had a chance to see a few demos and very compelling.

So yeah, we’ll have to see what, what happens over the next six months.

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

Priti: Yeah, no, I think this is a very exciting time to, you know, be part of this.

And you know, I think we’ve all kind of noticed that there’s something different in the last year. And I would say that I’m 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 so, you know, when I think about what would really, uh, make a big difference for us is finding solutions that really solve the.

Problems that we have. Technology, I’m someone who really enjoys technology and so everything’s exciting, but how do you figure out what’s the one that’s really gonna make a big difference and really improve patient care and uh, experience for our clinicians?