Welcome to the big unlock podcast where we discuss digital transformation and emerging technologies in healthcare. Here are some of the most innovative thinkers and leaders in healthcare and technology talking about how they are driving change in their organizations.

Paddy: Hello again, everyone, and welcome back to my podcast. This is Paddy and it is my great privilege and honor to introduce my special guest today, David Quirke, newly appointed CIO for Inova Health System in Northern Virginia. David, thank you so much for joining us and welcome to the show.

David: Paddy, thank you for having me. It’s a great pleasure and honor to be talking with you today.

Paddy: Thank you. So, you’ve recently come on board as CIO for Inova Health System. Can you share a little bit about your technology environment and your high-level priorities in the near-term?

David: Sure, I will be happy to do so. I am very newly minted in the role, this is week number four for me, but I’m happy to share what I’ve uncovered in the last three and a half weeks. In terms of technology like many organizations, we’re a core EMR platform, the Epic platform. We’re in the middle of a large ERP, enterprise resource planning, deployment across the organization. In terms of our PACS systems, we have our core PACS on the cardiology system focused around Fuji. But really in terms of our priorities in technology, they’re exactly the same as the priorities of the rest of the organization. Our mission to provide world-class healthcare every time, every touch, in every community, we have the privilege to serve our very thoughtful words in terms of how we’ve created our mission. And really, when we look within the technology infrastructure on platform, we leverage the exact same goals and mission in terms of how we operate and organize our information technology journey. Like many organizations is towards a service line model and a clinical enterprise. So, within IT, we’re on that journey too, in terms of how we evolve from the facility-based system model to really as we look at the various different service lines. How do we need to evolve as a service component to that to support a new service line model, which is essentially a triad model, where we have a clinical leadership, a nursing leadership, and an administrative leadership really driving systemness commonality throughout the organization. The themes that we talk about as a system within IT really revolve around evolving to a systemness model. So, when we talk about every touch, every time, wherever one of our community members interact with an Inova caregiver, there’s that system. There’s some commonality of service everywhere we go. Within IT that customer focuses our customers being the full community of patients, we have the privilege to serve and the customers, which are all the caregivers that go into supporting that care model. High reliability within information technology and the health system is a theme. It’s challenging to drive a high-reliability organization without a high-reliability infrastructure beneath it. Fiscal acumen is something we all in health care have to be conscious of. And that model of fiscal document relating to value is something that we’re very consciously aware of. Then research and innovation are at the core of all we do. We are absolutely focused on looking at research and innovation that will have direct, tangible impacts on the care models that we’ve built.

Paddy: Thank you for that background. And we will unpack a little bit more of that as we go through the conversation. So, let me jump right away into a couple of points that you made. One was around the consumer focus and the other one was around reliability in terms of all the infrastructure, because you can’t really drive better experiences and so unless you have a reliable infrastructure that enables you to deliver that experience, so many people refer to what is known as digital transformation today. Many of the things that you referred to are actually components of what I hear as digital transformation when I talk to other health systems. The focus area, at least as far as all the research that we’ve done in my firm, is clearly on the patient engagement and following that closely behind is also the caregiver experience and the caregiver enabled so that they can be productive and effective. So, can you talk to us a little bit about what you’re doing specifically in terms of the patient experience and the patient engagement aspects? We see a lot of health systems launching patient apps, digital front doors, as they’ve been called, in a very generic way. Can you talk to us a little bit about what you’re doing in that regard?

David: Absolutely. In general terms, our approach to the patient experience of digital transformation is really not focused around a particular technology, but really a suite of technologies. And rather than looking at how we deploy telehealth, how we do our digital front door, we really want to think in terms of the patient experience and their caregiver experience. To that end, when we think about terms like reimagining primary care, breaking down in a kind of lean like model, understanding the touchpoints on how we deliver primary care from that front door app through to allowing, through to arrival, through to rooming, through to ordering results that the visit, the post-visit. And rather than look at a specific technology and how we’re gonna deploy it, we really want to leverage how we want that experience to be for our patients and for our caregivers and really look at technology as just the enabler, not for its own sake. So the example being, you know, as we look at our front door, as we look at rivals looking at geolocation, looking at how we welcome, how we greet the patient with equipping the caregivers with the right technology, how we room the patient, how we engage the patient during that visit, how we make the EMR more passive in that way rather than at the forefront. You know, the analogy of the caregiver trying to keep up on the keyboard as the patient is working through the components of the visit. We want to look at technologies where the EMR becomes a vital but more passive element of that and really is an enabler in terms of the care model. So, we’re excited looking at technologies where those passive listening. There have been some recent announcements that we’re excited about exploring in that model. And the concept of the provider being bent over a keyboard and not a perceived to be attentive to the patient’s needs is something we really want to explore and how we add value to that visit and make the process of gathering data, presenting data in a much more passive way rather than look at a particular technology. How well do we really want to break down the experience from a patient first perspective and make sure that the technologies that we’re deploying and looking to deploy really facilitate a much smoother experience for both the patient and the caregiver.

Paddy: Just on that point of making the EHR systems more usable, more passive, obviously everybody talks about the huge burden that’s come down on caregivers because of the digitization of medical records, which was necessary. But at the same time, it’s had some unintended consequences. So, can you just talk a little bit about one or two specific things you’ve done to make the EMR systems more usable and give some time back to caregivers because that seems to be one of the big issues?

David [00:08:21] Right. One of the things that we’re exploring right now is in the acute care setting we have, I’ll use the term system to talk about all the components of a system, not a specific system. All our caregivers have a badge with an identity component that has the ability for us to identify that caregiver. We have systems that identify the patients that we have in every room. We have computers in rooms that know where the patients are. And we have wireless technology that can inform of movement and location. Yet when a caregiver viewed a nurse, med administration, or a hospital is surrounding. Today still have to go from device to device to device, almost in a muscle memory model bouncing from screen to screen. So, we’re right now interested in exploring technologies that combine a variety of systems to facilitate care. So, for example, if I’m a nurse and it’s 3 o’clock in the afternoon and it’s med admin time, why can’t the systems know that I’m Nurse Quirke? Know the room that I’m walking into, know the patient that I am there to attend to, know that it’s probably med admin time. So why can’t these systems, as soon as I identify, walk into the room, bring me the credential of the system through touch or through a more passive model, bring me right and present me the exact information on the patients I need, probably in the EMR that medication administration record, rather than have me move from room to room and go through the exact same exercise. And you can use that analogy, whether I’m a hospitalist, whether I’m a NA taking vitals, whether I am a consultant that’s there to do a specific consult on the patient. So, we really want to look at technologies that certainly facilitate access, facilitate the display of information and really look at how we bend the curve on clinician burnout and how we can support technologies and invest in research and technologies that really take that out. Those technologies are not mutually exclusive of security. They’re not mutually exclusive of other components that we have. They really are complementary. So, those are things in terms of direct research that we want that we’re looking to do and we want to do that will really kind of bend the curve in the right direction in terms of presentation, access and facility of use of these tools.

Paddy: Those are great examples. Let’s switch to the patient engagement on the patient experience aspects of what you just talked about. So there’s a huge innovation ecosystem out there that are really focusing on that one area. How to engage patients better, how to create better experiences. Big tech firms are involved in this, many health systems are developing their own applications. And of course, there’s a whole ecosystem of startups. There are getting billions and billions in VC money to develop these innovative new solutions. How are you going about transforming or reimagining, as you said, the patient experience are you doing it all internally? Are you using a partner ecosystem, a combination of the above? Can you talk a little bit about that?

David: Yeah, I think, you know, just as we see large organizations come together and I think, you know, whether its CVS-Aetna whether any large payers and different kinds of the retail model, I think we see an environment where we can comfortably exist as partners and competitors. So, the model of where we look at partnering into the delivery of some care, we compete in other areas. So, as we look at some of our own development on our patient’s experience and patient engagement tools, we are also looking at partnership with academic organizations, with regional incubators and hubs. We’ve recently acquired the Exxon campus across from one of our core hospitals, Fairfax Hospital, which is a 117-acre campus that we will be further developing and that will be one of our core innovation hubs. Within there we see academic partnerships. We see commercial partnerships. And we really want that innovation to be a regional hub where we develop these patient engagements, patient experience tools in partnership with the patient because patient first and really understanding and as we move ourselves through the care continuum, either as an in the arbitrary setting, as we hope not that much in the acute care setting, but we’ve got to connect to how the patient and family members feel and engage them in this development process. I see a lot of organizations doing wonderful work. Well, I question whether we really understand the consumer and we really understand the needs of that consumer and the fears and expectations of the different kinds of consumers we have. My dear mother in Ireland has a different expectation of care and different needs than my younger brother who’s more mobile-enabled that say than my dear old mother. So, I think we got to understand and engage the consumer as we develop these tools. So, I would hope that certainly, our journey will have a large patient, first patient informed component of how we developed these tools.

Paddy: Yeah. Now, talking about innovation, I wrote recently about the two-canoe problem for healthcare, which is you have it here and now that you have to take care of, keep the lights on. You also have to invest for the future. And as a system, as a sector, healthcare is still pretty much relying on fee-for-service reimbursement. Its only about a third of the payments are going through some kind of an alternate payment model or value-based care model. In this context now you know that reimbursement is declining. You have not as much discretionary funds as you need. At the same time, you know that to be ready for the future you make all these big investments. It was really encouraging to hear that you made this big investment in acquiring this large piece of land and you are going to build out innovation. How do you actually do the tradeoffs and how do you sort of build a business case for these investments at a system level? What kind of ROI expectations or non-ROI expectations? Do you have from these innovation programs? Can you talk a little bit about the thinking process on this?

David: Sure. And I think there are certainly a variety of different payment models out there in the different markets that I’ve been exposed to be New York, be it Merola Market, Pennsylvania or the Virginia market. I think successful organizations will always put patients first and quality first and outcomes, and I think everything else follows. So, I absolutely understand the two-canoe model, but I think organizations that focus certainly have to attend to that. But really, when our core focus is the delivery of high quality, high-value care, that I think the focus of the health system as we put our patients first, engage our team members and how we give the best value and the best quality outcomes possible. All the rest follows, I believe Paddy. I think driving one payment and you are chasing one payment model versus another I think is something we have to be aware of. But at the core of what we do have to be the delivery of world-class care.

Paddy: OK, let’s talk about the technology environment. Technology is obviously playing a very big part in the transformation that health systems are going through much more so than in years gone by. We are seeing a shift in the landscape. We’re seeing the big tech firms moving into healthcare. They’re offering their cloud platforms or other technology platforms, and they want to get into healthcare in a big way. But my firm’s research suggests that most health systems are really looking by default at the EHR system to drive innovation, to drive some of these patient experiences and optimize the investments. The big investments that have been made in the EHR systems before you go out and start looking at alternative or additional platforms. How do you see this balance between some of the capabilities of these big tech firms bring to the table Cloud, Advanced Analytics AI, machine learning, and so on with what EHR systems are really good at but may not be so good? How do you do the trade-offs?

David: I think I would challenge you something that there needs to be a tradeoff. I would go back to the comment I made about partner and competitor. Organizations like Amazon do a really good job of delivering hundreds of millions of parcels throughout the country and the world. We have much to learn from models like that in the health care delivery business. We are challenged as an industry with elements of patient care like Med reconciliation. We as the care community view acute care provider, be primary care, be you a pharmacy benefit management, be you a retail pharmacy. We as a system can do a better job of ensuring that we get the right medications at the right dose to the right person at the right time. And we minimize the harm that we, the health delivery system, the avoidable harm that’s out there. So I, for one, would be really keen to understand how we partner with organizations to learn from machine learning or learn from AI, or learn from analytics that we as an industry, we, the whole healthcare industry have not really looked at deeply to see how we can deliver better care to our patients and avoid some of the components that have risk and harm that exist in our system today.

Paddy: You make an interesting point about these partnerships and I just wanted to refer to some recent partnerships that have been announced, specifically the ones involves the health system, The Cleveland Clinic, and the American Well. You know that came out recently. We are seeing others too, Centene with Walgreens on the whole PBM space, Microsoft and Humana, Google and Mail. So, can you talk to what these partnerships really signify in terms of a market trend? And can you maybe talk about any partnerships that you’ve built similar to any of these?

David: Yeah, we certainly are, as we develop our Inova Center for Personalized Health, which is our new campus, we are creating partnerships with both academic and commercial organizations. I can’t speak to those at this point that will be coming soon, but I think it’s an inevitability. When we look at the opportunities that exist for us to drive more and more quality into care, I think it’s reasonable that we see large partnerships when we look at the national spend both here within our own country and globally, the cost of healthcare and the percent GDP that is invested in healthcare is not surprising that more and more large institutions and global organizations are looking at how they can participate and facilitate the delivery of better care. So frankly, I’m not surprised by this. I think I’m surprised that it took this long before us to start seeing these kind of relationships begin to evolve. I think it’s still in the nascent stage in terms of how we work together and how we align. But I think it’s there’s a level of inevitability to this and frankly a level of excitement. I think there are skill sets that these organizations bring to our industry that we have not explored fully. And they are far more mature in some of these other industries. So from my perspective, I see it as a catalyst to accelerate our ability to deliver quality care.

Paddy: That’s very well said. So let’s talk quickly about the non-traditional players that are getting into healthcare. You mentioned CVS, we are also seeing Walgreens get into the primary care, urgent care space, Walmart. Even Amazon, you we saw recently that Amazon made an acquisition of a company that does symptom triaging. They’re also forming partnerships to deliver telehealth. How do you see the landscape shifting in terms of the non-traditional players and where they fit into the future state of healthcare delivery relative to where traditional health systems are?

David: I think, again, there’s a level of inevitability when you look at these large players, these are some of the largest employers in the country and they are like all of our employers are seeing the cost of healthcare and the delivery of healthcare for their team members, for their employees continue to go up with the skill set that they bring. And I think there’s, you know, the capabilities that they could bring to such a large owned employee base and how they can have an impact on value and outcomes. Again, I think it’s exciting and I think it’s something that we should embrace. And like any significant shift in an industry, be it the steam engine, the motor car. I think those that embrace it and those that really want to understand how they can participate in the bending of the curve in the other direction, I think will be the ones that will benefit the most. I think organizations that don’t see the change and see where the puck is going may find themselves on the not realizing as much benefit as those that, you know, understand where the change is, embrace this change. And it is going to be a I think, a quantum change in how healthcare is delivered. But I think if we embrace it, we understand that we get comfortable with being a partner and a competitor. You know, this is one of the most exciting times to be in healthcare technology because of the new organizations that want to participate in the delivery of care.

Paddy: Alright let’s get to your final thoughts on a couple of things. I do something called a lightning round where I get to a top of my thoughts on a few emerging technologies and how you’re using them or deploying them in your own environment. So let’s start with one that you already alluded to a little earlier on artificial intelligence.

David: Yeah, I think again, when we look at how we still require our providers to manually enter data. When there are systems and tools out there in our homes that have facility to understand questions, to interpret questions, to predict questions for us not to be looking at technologies where we can leverage machine learning, leverage this kind of passive component of consuming and presenting clinical data, be it in a office visit, be it in a ICU, be it in a ward for that matter, the ability for us to leverage AI and machine learning to facilitate the delivery of care and move away from the keyboard. I envision a day in the future where 20 years from now a CIO will be talking to you and talking about, you know, the days when keyboards disappeared and you know, we chuckle. But it was not 15, 20 years ago where people assume surgical site infections were a inevitability of running in a ward. People thought that CLABSI an inevitability. And, you know, having an IV in somebody. Today, we’ve moved the needle in terms of quality and outcomes where they become more and more and never event. I’m looking forward to the days where we talk about Med reconciliation and harm that occurs around that process being a never event. I’m excited about the days where people chuckle and laugh about the times when we were acquiring clinicians to pack away at keyboards to enter data that system should and could be able to do for them.

Paddy: Yeah. So that UI-less interfaces or whatever they’re beginning to call them now. And that’s probably a perfect segue into the next thing I wanted to get your thoughts on. Voice recognition.

David: You know, I think the ability for us to understand voice in terms of the collection and assimilation of data and the ability for us to understand voice in terms of the IoT setting. When we look at attending and caring for people more and more in a home setting, tools and technology around understanding voice and understanding triggers of voice. I think it’s something that voice technology beyond just the ability to consume and present data. I think voice as a diagnostic, as an analytic tool in terms of care models would be interesting and exciting. When we look at safety, when we look at agitation, when we look at these triggers in there that help us identify scenarios or events where we could avoid conflict or avoid challenging de-escalate scenarios and predict scenarios. So I think voice has got a lot of potential beyond where we’re looking just now in terms of consumption and presentation. I think as I dare use the term diagnostic tool in our care delivery model. I think there are some companies out there doing exciting studies on voice levels and mood. So I think as we move forward, voice will become not just the recording, recording. I think it will become part of our diagnostic process.

Paddy: Yeah, that’s great. One more before we round this out. And healthcare, as I asked this, because healthcare is typically predominantly an on-prem environment. So cloud. Where do you see healthcare in terms of cloud enablement and cloud adoption in the coming years?

David: I’m a massive proponent of cloud technologies. One of the things that as we design and engineer and architect cloud solutions, it’s really critical that we understand the patient care and operations model of those clouds that we design. I mentioned earlier high reliability in our delivery of care requires high reliability and the availability of systems. So, when we in the IT world think about high reliability, we really need to shift and think about the delivery of care in our ambulatory acute care settings and how we design and architect cloud solutions that will support events that occur. I was privileged or lucky enough to be in Manhattan and supporting organizations during the 9/11 outrage. And these things, you know, unfortunately are something we have to think about a plan for as we design architect cloud solution and the ability across to ensure that the privilege we have of creating these tools and systems to support patient care and the architecture that we design around that support organizations at every potential scenario, what could occur. So I’m a massive advocate. I think there is a tremendous potential for value in cloud solutions. But we’ve got to be cognizant of how we develop highly reliable cloud solutions that will support highly reliable healthcare delivery.

Paddy: David, its been such a pleasure speaking with you and thank you so much for sharing your thoughts. And we wish you the very best in your new role and all success to you and look forward to staying in touch.

David: Paddy, thank you very much. Been a pleasure to talk to you today.

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