Q. Thank you for joining the podcast, Sophy. It’s great to have you here.​ Likewise. I’m Rohit Mahajan, managing partner and CEO of BigRio and Damo Consulting, and the host of the Big Unlock podcast. As you know, it was started by Paddy a long time ago. We’re honored to continue this podcast. We’re now in the 150s episodes, so it has come a long way. Sophie, could you please introduce yourself?

Sophy:  Thank you. My name is Sophy Lu. I am currently the Senior Vice President of Digital Integration and Business Relations at Northwell Health. Previously, I’ve held multiple executive roles at Northwell, including System CIO, and I’ve been with Northwell for approximately 15 years. I grew up in the application space. Prior to that, I was trained as a chemical engineer. I enjoy continuous learning, integration, connecting people, and solving problems by bringing common to chaos. I live in Brooklyn, happily married with two grown kids. I have four Labradors and two Norwegian cats.

Q. That’s awesome. So, how does a chemical engineer like you, Sophy, wind up in one of the largest healthcare systems in the country? Please tell us a bit about your journey and about Northwell as well.

Sophy: Absolutely. I often say it’s a mix of luck, timing, and a lot of hard work, along with the networks you’re exposed to. Initially, I wanted to be a kindergarten teacher, but my love for science and math led me to chemical engineering. I worked in that field for about seven years after graduation, focusing on process and industrial design for chemical plants. This role took me across Europe and Indonesia.​

During that time, I was drawn to sustainability, working on clean energy projects. About 20 years ago, I was involved in expanding liquefied natural gas and combined natural gas. While these concepts are well-established today, back then, scaling them in the transportation and energy industries was quite ambitious.​

As the engineering sector shifted more towards the central United States, I wanted to stay close to my family here. I explored other opportunities, sending out numerous resumes at job fairs. A consulting company noticed my background and brought me on board to work on technology integration and implementation, leveraging my industrial gas experience.​

This consulting role involved extensive project management, business integration, and participation in mergers and acquisitions. Notably, I worked with St. Vincent’s Hospital, which expanded from a single institution to about seven or eight. Unfortunately, it eventually faced bankruptcy. This experience provided deep insights into management during financial crises and organizational turnarounds.​

This was my first exposure to healthcare—a sector dedicated to care and wellness but often challenged by reimbursement issues and technological limitations. After St. Vincent’s closure, I was recruited by Northwell Health to work in their application space. I joined during the inception of their revenue cycle implementation, marking the beginning of their patient journey and EHR initiatives. Since then, I’ve been with Northwell and have never looked back.​

Q. Oh yeah, yeah. So you spent many years at Northwell and that’s a fabulous, you know, segue from your industrial engineering and engineering background into healthcare. You know, and you got a glimpse up close of a, of an institution that, that went through that phase as well of M& A and, you know, turn around.

So Sophy, tell us about your new role. I understand that you have a new role here at Northwell and that you are looking at, uh, some very different initiatives. So how’s that coming along and, and. What can you share with the audience? 

Sophy: Yes. So as we started the digital transformation journey at Northwell, laying out the foundation of simplifying the ecosystem and selecting strategic functions that we wanted to implement relative to sort of the cloud foundation, the data platform and evolving our EHR for the entire organization, there was a need that we looked into that we wanted to focus on for digital transformation integration and business relations. And what does that mean? If you look at the heart of where technology and a seat at the table, along with operations and clinical care and patient experience has married, the new discipline of digital relationship management really is trying to make sure that we are bridging operations to technology to patient at the center.

Right. And some of those objectives, no matter whether you’re looking at an adoption of technology that you just are implementing, like an EHR or your new emerges and acquisitions of how are you going to integrate the business  looking at building out a new facility? And what are you thinking about relative to innovative workflows and engagement and experience for, for the patient and the families, right?

And so you look to bridge in that relationship, strategic alignment, you want to make sure that the stakeholders are engaged in the decision making and the journey. And you want to facilitate effective communications because everybody doesn’t always speak the same language at the same time. It is what’s important to me and what’s relative to my role at that time, right?

You want to get synergy across that and you promote the continuous improvement and selection of what works best to meet the mission and the vision of whatever that initiative that you’re working on. Always focusing on process improvement.  Efficiencies and helping out the users, whether the users persona is the clinician or the operations or, of course, the patient and the family as they’re going through the continuum and last, at least you want to ensure you’re translating all that into something that is executable, um, have a translation, understanding that the implementation is not technology only right that are addressing the problem you’re trying to solve, you’re addressing the vision that you have sort of enabled across the institution, and then you want to measure and look at how you’re doing in that implementation real  often and repeat. Basically, uh, there is constant tweaking and recalibrating because that changes life changes and roles change.

Q. Yeah, of course. And you mentioned Sophy previously, before we started the podcast, about change management and cultural alignment, right? Would you illustrate that with an example from your new role? What works, how does it work, and what works best? You also mentioned something interesting about measuring it—any such measures you actually use in the business enterprise?

Sophy: Yeah, I’ll use a couple of examples. Right now, our main focus is preparing for our EHR implementation. As part of this readiness, while we ensure best practices and enterprise standards in our processes, we also prioritize operational engagement. We work closely with operations to understand their needs, ensuring workflows complement and meet their requirements.

We focus on operational input regarding readiness and translating that understanding across departments. Another key aspect of cultural success is our partnership with perioperative teams. Since our organization has grown through mergers and acquisitions, we don’t have a standardized system across our 21 institutions. This presents challenges, especially in OR throughput.

Think about OR throughput—not just scheduling surgeries, but also coordinating surgeons, care teams, room logistics, pre-op, and post-op processes. We collaborated with operations to understand these challenges and explored technology solutions to optimize data and improve real-time decision-making. This turned out to be a great success. We now have significant measurable outcomes in optimizing OR scheduling and real-time adjustments.

Planning on paper is easy, but managing the complexity of multiple ORs, surgeons, and a triple-digit workforce in real-time is challenging. We successfully balanced workloads, improving clinician and patient experiences while optimizing throughput. While efficiency was a key outcome, we also increased volume and revenue. Most importantly, we brought joy back to clinicians and improved patient scheduling.

Q. That’s a great example, Sophy. Thank you for sharing that. You mentioned that Northwell has grown significantly through mergers and acquisitions, now comprising 21 organizations. Given your involvement in this process, could you tell us more about Northwell’s approach to M&As?

Sophy: Absolutely. Northwell Health is the largest healthcare provider in New York State and one of the largest employers, with nearly 90,000 employees. We have 21 hospitals—11 of which are Magnet-designated—and almost 1,000 outpatient facilities. Our workforce includes about 12,000 physicians and over 19,000 nurses. We continue to grow while investing in community education, research, and outreach.

One of our CEO’s key visions is intentional growth. We don’t expand randomly; we grow in a way that ensures integrated, continuous care for the communities we serve. This approach also applies to our M&A strategy. We prioritize synergies, ensuring that mergers align with our mission and values. We focus on contiguous growth, enhancing referral networks, and leveraging our size and capabilities to improve healthcare access and quality.

Most recently, we’ve been working on a major merger with a health system about a third of our size. While it’s not yet approved, it would be one of our largest acquisitions.

Q. That’s awesome. So, Sophy, you mentioned earlier in our conversation that there is no standard playbook for M&As and that success comes from finding complementary technology strategies. Could you share your thoughts on how mergers and acquisitions are approached at Northwell and what makes for some success stories? 

Sophy:  Yeah. I hear this a lot from our partners and customers—Northwell’s approach to mergers and acquisitions isn’t a forced takeover. It’s a very collaborative, synergetic process.

The key to our approach is thoughtfulness—whether it’s a partnership or an M&A, we prioritize cultural and value alignment. If those two things are in place, everything else becomes much easier. When you have similar mindsets and ethics, you’re already aligned on what you’re trying to achieve.

From there, we move into the business aspects. Every M&A is different because it depends on the type of deal, the initial objectives, and the long-term goals. Ultimately, the goal is to optimize and integrate the best of both worlds while learning from each other.

Our playbook starts with integrating people first—creating a sense of unity, where we operate as one team with one purpose. Next, we align on strategic initiatives, assess key risks, and map out long-term goals. We ask: What are your priorities? What challenges need to be addressed? How can we help each other move forward? These discussions help us build a roadmap for business integration.

From there, technology plays a critical role in accelerating and supporting these objectives. If there’s a low-complexity, high-impact opportunity that addresses a pressing challenge, we double down on it. That way, we can create immediate value while laying the foundation for future innovation and growth.

At the same time, risk mitigation is a top priority. We need to ensure that our infrastructure is solid—cybersecurity, resiliency, regulatory compliance—these are non-negotiables. They form the foundation that allows us to focus on investments that drive meaningful impact for both organizations.

Q: That’s great to know. And that leads us to the innovation and AI aspect of things. Sophy, no podcast would be complete without touching on artificial intelligence, augmented intelligence—any type of intelligence in today’s conversations! Looking into the future, especially regarding EHR adoption and the broader integration of AI in business, what are some things you see coming our way, and what might you be working on?

Sophy: Yeah, I want to emphasize again—and maybe it’s my bias now—that any successful AI initiative should always start with defining the problem you’re trying to solve and involving the operators in that process. We can easily get caught up in the tech itself, especially with the fast pace of innovation, and try to find sponsors and problems to fit the tools.

For AI to be successful and scalable, you really need to start with the operators in mind. And by operators, I mean the people who will be using it day to day. AI isn’t just about generative or machine learning; there’s a broad spectrum of AI that includes RPA and other technologies that we can leverage. But to truly scale it in clinical, administrative, or experience spaces, you have to go to the source.

When I talk about AI, I always remind people that AI has been around for decades. In the last five years, generative AI has taken center stage and is often viewed as the “magic” solution for everything. But we should remember that AI is much broader than just generative AI.

At Northwell, we’ve been exploring AI across multiple areas, including imaging and precision medicine, for years, and we’re now diving into generative AI. We’ve had an internal AI hub in place for about five years, focused on security and data protection, which are our most important assets. This hub allows our workforce to securely access generative AI and leverage it for a variety of use cases, all while protecting sensitive information.

We’ve also put in place a governance structure to better understand the needs of our team, identify high-value use cases, and drive innovation. One of the areas we’ve already made an impact is in administrative tasks, like using generative AI to search for information, saving time when employees need to sift through policies and documents. These small efficiencies can add up significantly across a large organization.

Q: That’s amazing! Giving time back to 90,000 people adds up to a huge impact. There are so many use cases that people don’t even realize. They might not be flashy, but they solve real problems that make a big difference in people’s daily work. As we come toward the end of the podcast, Sophy, I’d like to touch on something you mentioned before we started—the celebration of International Women’s Month.

Sophy: Oh, yes! Thank you, Rohan, for reminding me. I’d love to wrap up today by recognizing and celebrating International Women’s Month. Some people focus on just a day, but I say we should make it a whole month! It’s important to recognize the incredible women and all the support behind the agendas advocating for women. Let’s make sure we support each other, raise the bar together, and make a real impact in the world.

Lastly, thank you all for the work you do, and remember: self-care is just as important. It’s okay to take a compliment and take care of yourself, so you can give your best every day.

We hope you enjoyed this podcast. Subscribe to our podcast series at www.thebigunlock.com and write to 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 Soumya, welcome to the Big Unlock Podcast. It is a pleasure to have you here. Thank you very much, Rohit. Appreciate it that you are able to spare time for this. So Soumya, we would like to start with some quick introductions. So I’m Rohit Mahajan, I’m the CEO and Managing Partner at BigView and Demo Consulting.

We’ve been doing this podcast for a while, so it’s pretty popular with our listeners. So I’m sure they’re looking forward to understanding your thought process and, and what advice you have for them. So could you please start with your introduction as well?

Soumya: Thanks Rohit. Very nice to meet you again. I am Dr. Soumya Viswanathan. And I’m the Chief Physician Executive at BayCare Health System in Tampa, Florida.

That’s amazing. So what motivated you, Soumya, into this direction? That is my, one of my questions. And second is, what are the differences that you find between the two, let’s say, geographies or the roles that you had here previously in Massachusetts and now what you’re doing over there?

Soumya: Absolutely. So I heavy hitter on the clinical side. You know, I love clinical. My patients love me the typical clinician, but I started getting roles and opportunities to take on projects on the management side or so called the leadership side. When I took the projects on, I felt very comfortable. Then I was doing them and I started getting more projects because as you deliver on the outcomes and the results for each of the projects, people say, Oh, she’s done this.

So let’s give her more. So it ended up being that I was, uh, first I raised my hand for projects and then I just started getting them and I had some really good mentors. And the mentors trusted me, which is also important. So I circled back to them and said, you know, I like doing this, but I’m not sure do I want to give up clinical or not.

So that was the time when I decided to do MBA and MHCM just to make sure that I do want to go down this path of leadership. And it turned out that I started liking it a lot. I liked it as much as I liked clinical. So it came to a point where I couldn’t do both equally well if I spent 100 percent of my time on both of them.

So it’s 200 percent of my time. So I had to carve out and figure out which direction I wanted to go in. And finally, once I did my MHCM, I realized I really like leadership and I want to give it my best. Put my best foot forward and give it my best shot and see how well I do. And that’s what led me to taking on leadership role.

And Baycare has been pivotal because the health system is on a tremendous growth mode. We are expanding like crazy. So what also helped us in that journey is a lot of the health systems in Northeast North. I should say all the northern states through COVID  they allow their people to work remotely. And as you may have seen in the news, a lot of people gravitated or they move migrated down to southern states for warm weather.

And they could work remotely. So the fastest growing cities ended up being, at that time it was Austin, Texas and Tampa, Florida. So, the population here has grown so much that the system, and BayCare is the largest health system in the West Central Florida. So, and it is rated as one of the best in quality outcomes, patient safety, people provide clinically excellent care.

So, it became imperative that, you know, we are on a growth mode, we need to support the population that has migrated here. And I jokingly say, when people move down and move, migrate to other areas, they don’t bring their doctors with them. So we had to support, you know, we need more doctors here. That’s what helped me make the decision to make this my, my stop where I can contribute to leadership team and administration.

Big differences that I see is at least in Bay Care, I should say that, you know, Bay Care has traditionally come together as a health system with the acquisition of community hospitals. And then we set up a medical group. to move forward in expansion of the medical group. So there hasn’t been a lot of focus on academics, which is heavy in Massachusetts, as you know.

So for me, that was a big difference is okay. We need to support, we need to support our physician pipeline for the next generation with a pipeline for recruitment. So what we have done now is moving forward. I’m doing a huge. focus on building the academic mission for Bay Care Health System. We have not delved into academics, and right now we are on the run for being one of the fastest growing GME programs in the country, almost, with 650 residents who will be graduating by 2029, which means in three years we went from 24 residents to, we’ll be looking at 500 plus residents who are approved by ACGME next year, in the next year.

So it’s a very exciting time for us. I want to say academics is one big piece culturally or from a practice pattern perspective. Massachusetts and Northeast is heavily steeped in value based care and, um, the fee for service mentality is still a little bit present in some of the southern states. So we’re moving towards value and taking on more risk.

So that’s a difference I do see that the risk taking capability of physicians is definitely ramped up significantly over the past few years and at least in the region where I am.

That’s pretty cool. And, and I was noticing, uh, Soumya that, uh, you recently celebrated your 10th anniversary and, uh,

Sowmya: One of our hospitals, one, one of our 16 hospitals. So it’s St. Joseph South celebrated our 10th anniversary. And, uh, that’s one of the newer facilities we had built, which has been really, growth has been tremendous in that region, but Baycare by itself is 25 years old. As a health system.

That’s cool. And also curious, Soumya, that you are the chief physician.

Executive. Executive. What does that mean as in relation to, let’s say, a chief information officer, chief medical information officer, or a CTO? So what kind of roles do you play and where is the overlap or where is the synergy with your other?  Colleagues.

Sowmya: Yeah. So from the chief physician executive role has been evolving through many health systems where traditionally the chief medical officers would lead certain aspects of the health system such as quality, patient safety, you know, dealing with physician enterprise only in the form of peer review and clinical care.

The chief physician executive officer pretty much bridges a little bit more than that So what it does is it it requires us to have a little bit more input into operations A little bit more input into looking at financials and cost accounting and gap, you know So it’s kind of a well rounded Cmo role where you pull into tap into all the other aspects that are required for a health system To be very successful, I want to say.

So we form a very close relationship with every other aspect of our health system. Whether it’s the technology officer, informatics officer, CMIO, or the chief financial officer, the COO, we form a very close dyadic partnership with almost everybody in the organization. The CMIO and the CIO, so we do have an informatics officer and we do have chief medical informatics officer.

Work very closely with them because now that there is so much of enhancement and technology input into almost everything we do, especially for doctors to  raising the electronic health record and everything, you know, we cannot do without that kind of partnership. 

That’s awesome. That was my segway. I was going to ask you that you mentioned new care delivery models and also, you know, about patient engagement and technology now.

So how does it all come together for you? Some of your what are some of your digital, you know, initiatives? that you are, you are, you know, thinking about or you’re happy about that you have implemented? What are some of the things in the future that you’re looking for?

Sowmya: We have quite a few things, you know, electronic health record optimization obviously is one of the key areas we want to continue to focus on.

We have Cerner as our EMR, so we definitely want to make sure there is always room for improvement and how the clinicians are taking on the EMR. positives and the pros and cons within an electronic health record. So optimizing that flow. The second piece that we are working actively on is tele visits and tele health in general.

Tele health and remote patient monitoring is a big focus for us just because I already mentioned the population has grown and the access to care has been amplified several folds. So we need more visits. to be delivered to this community. The third one is AI innovation in all forms. So artificial intelligence, which is the buzzword these days and data driven, you know, a lot of data driven platforms that we strive to make sure that when we make changes that impact any workflow, that it’s backed up and validated by data.

So data driven platforms are very near and dear to us. The other most important one, I think, is the patient engagement. Bayfield is very focused on providing the right care at the right time in the right place. So we follow that mission to the T, where we want to make sure that patients Providers. So physicians allied health professionals as well as nurses are all taken care off in a similar manner.

So patients should have ease of access to care. So all that becomes very critical for us. And so patient engagement tools is another big portion that we’re looking at. And of course, you know, interoperability and cyber security come hand in hand with everything that we just discussed.

Yeah, yeah. So, Swami, you touched on a lot of things. Could you help us understand more in detail or with any examples that you might have of any digital health initiatives that you found, you know, success in the past with, you know, or that you’re moving in the direction of?

Sowmya: So, in terms of just the tools of engagement, we have engaged. So, we do a lot of  We have done a lot of pilots.

We have done a lot of phased approaches to engaging in digital health platforms.  So let me just share a few of them without mentioning specific names. So for example, we have engaged in a telehealth platform that improves the care coordination of patients. So we are working with a platform right now that actually engages patients.

And then they also have the care management or the care coordination support on the back end. So with the tools first, we risk stratify the patients on who is high risk for certain diseases and disease conditions. And then we have the care coordination team actually work with us on identifying the disease conditions.

So there is a patient engagement. There is a chronic disease management component to it. And then there is the engaging the patient through the care coordination team that we have. And then looking at, you know, how the outcomes measure out. So that is one we are actively working on. Then we also have like rehab potential, right?

So when a patient has acute hospitalization and they are discharged to home, for example, let’s say they have a heart attack, post heart attack. Oftentimes, the past would be that cardiac rehab has to, the patient has to come in. To the hospital to have the rehab done. Now we are looking at platforms that actually will engage with the patient at home so they are able to do rehab at home without having to drive around and having to take that long distance trial time for commute to come in and have the rehab option available to them.

The other piece that we are working on is early detection. So, early detection is critical. The speed to detecting certain conditions can actually change the outcome of that patient’s condition. So, how quickly do we identify a stroke in a patient? And is it a stroke mimic or is it a real stroke? We are working with a company that allows us for Accurate and early stroke detection.

That’s one of them We also have a couple of others where we have an eicu  platform Where it’s an electronic icu because we need to monitor the icu in patients, but we cannot have that many intensivists rounding 24 seven. So we have an electronic methodology to identify that. We’re looking at platforms that look at sepsis bundles, you know, so there is a whole host of conditions that they’re looking at, which are digitally oriented, that allows us to look at them.

You said what has gone well and what hasn’t, I will share with you that some of the exciting ones are. The radiology ones, the radiology digital analytics, because the radiology ones help to identify the accuracy is outstanding. It’s like they have done studies on how many AI driven platforms can actually identify incidental findings  versus a radiologist reading it or, you know, how many radiologists do you need to read X number of films? And so we are looking at platforms that look at incidental findings in the lungs, as well as lesions on the heart through echocardiogram.  So there’s a whole host of digital platforms that allow us to do this. One thing that we have to watch out for is the fatigue that can set alarm fatigue. So sometimes you have these platforms and it’s pinging away nonstop because it depends on how you set the platform. If you say that you need to alarm me when this happens and you have the metrics not correct, it will be blowing out of control and the alarm fatigue sets in amongst the end user.

So I want to say that we have had our mixed bag where we tested a few and we had to give up on a few and some of them we are many of them we are moving forward with.

That’s great to know Soumya. So is there a way that you think about innovation in certain areas and how about working with startups? Any thoughts or suggestions around those?

Sowmya: We are very open to the areas of focus are definitely driven by, like I said, the three pronged approach. You know, is this going to help our patients? Is this going to help our physicians in any way? Is this going to help our nursing team in any way? We are working with technology tool that’s actually looking at You probably have heard of this, the doctor’s dictations.

Yeah, it used to be transcription in the past. And now we are looking at a dictation modality that allows them to just have a conversation with a patient  and not have to worry about the dictation. And there is AI methodology that works on it. We have looked at a similar, we are working with another company that’s doing a similar modality for nurse driven, nurse voice is being recognized, that a nurse can walk into a patient’s room and have a conversation and not have to worry about, have I captured everything that the patient told me? So, you know, every aspect of clinical care is being looked at very closely to see, does it make sense for us to invest in this or not?

In terms of, you know, so we definitely look at the feasibility of. The patient, the physicians, the nursing, and if it helps improve the way we deliver care, we look at it more closely. The second thing that we do look at, you know, obviously there is going to be all kinds of macroeconomics that jumps into all this with, you know, funding and what is the cost and all that, but we, we weigh it very carefully.

As far as startups go, the one thing that Baycare is very open to is if there are programs that are going to deliver on improving care and help our trio team, as I mentioned, and they are willing to co develop a product with us. We are willing to look at it. So Baycare is not just going to say, well, I’m going to open up my purse strings and just, you know, invest in all this technology because there is so much out there.

So we want to make it appropriate, available for our team. But at the same time, if people are willing to co develop, we are willing to look into it. That’s fantastic approach.

Yeah, so as we’re getting close to the end of the podcast and this session here, Soumya, I would like to touch upon the subject of chat GPT, Gen AI, and all the new things which are coming our way in terms of agentic AI.

So any thoughts there or anything that you are, you know, kind of. Heading in the direction of.

Sowmya: I think it’s very fascinating. I’m waiting to see what the next generation of even chat GPT and Jenny do  because it’s mind blowing how data can be aggregated. Data can be utilized and how it can effectively help us.

But we also have to be cognizant that, you know, there is always, there could be a downside that we have to watch out for. And unless. It is fine tuned to the point where we feel comfortable, you know, all of us in the digital world feel comfortable that there is no harm, no threat that’s coming out of this.

I think we should forge ahead and move forward because that is the next generation that’s going to come our way, whether we like it or not. And, uh, it’s going to be in every industry, you know, healthcare has traditionally been. I want to say probably at the bottom of the totem pole trying to adapt and adopt technology because we always felt as a doctor, we always felt, well, technology can never overtake doctors and take care of patients, but.

When we started understanding how technology can help us drive better patient care, the adoption became easier. So we have to get to that stage where the chat GPTs of the world have to help us drive better patient care and better outcomes for our patients. Then I think the comfort level will set in.

Rohit: Absolutely. So on that beautiful note, Soumya, thank you so much for this interaction. Really enjoyed it. And, uh, if you would like to add anything, I really appreciate this opportunity. And, uh, so, so much appreciate your time too today.

We hope you enjoyed this podcast. Subscribe to our podcast series at www.thebigunlock.com and write to 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. Welcome to the Big Unlock podcast, Mark. As you might be aware, Paddy used to do these, and I’m continuing after that. We’re up to the 150 to 160 range in terms of the number of episodes now. So it’s going pretty well. I’ll do a quick intro for myself, then I’ll ask you to introduce yourself as well. I’m Rohit Mahajan, the Managing Partner and CEO at Damo Consulting and BigRio. Mark, please go ahead and introduce yourself to the audience. 

Mark: Yeah, thank you. I’ve been on once before, probably about three years ago with Paddy. It was a great time, so I appreciate you guys having me back. I’m Mark Weisman. I am the Chief Information Officer and Chief Medical Information Officer at Tidal Health. We’re on the eastern shore of Maryland. We are a two, soon-to-be-three-hospital system, and we take care of a large chunk of the eastern shore. It’s a great place to be. Ocean City, Maryland, is probably the most familiar area in this region. Thanks for having me on. I look forward to talking, particularly about digital engagement, which is one of the areas I’d love to bring forth to our organization and help our patients and clinicians interact.

Q. That’s awesome, Mark. So could you please share with us how you got started? What attracted you to the healthcare industry segment and your role? How has it changed over the years? Please share the story. 

Mark: Yeah, sure. So I started as a doctor. Uh, if you go back to, to, to that beginning, and actually I started as a paramedic and a firefighter.

That was how, okay. When I was much younger and much stronger, I was involved with volunteer fire and rescue, and really loved it. I really loved the medical side of it and then went on to medical school and at some point got involved in in primary care and getting into data and analytics and quality measures.

It’s really where I got my start. I started moving over once I saw how dirty the data was and how much. I got more into the informatics side and eventually led to my role as a CMIO and then the CIO. I love being the CIO and the CMIO. I get to use my medical knowledge and bring the technology knowledge and say, All right, how do we make the technology better?

blend into the background for the clinicians and for the patients as much as possible so that let the people interact. That’s what we want. We want those interactions. We want people who are spending time on the harder level things, let machines do easy, repetitive, boring things so that, that the clinicians can really focus on the, on the important stuff and the patients as well. That’s how I got my start. It was really around data analytics and then more used the technology. 

Q. That is so interesting that you have both perspectives and you’re able to wear both hats in the same organization and add so much value to patient care. So, Mark, what do you think about—like you said—dirty data? That is something that caught my attention. How do you get from dirty data to clean data?

Mark: Yeah, good luck. But mostly, I think the most effective way has been getting operational leaders to look at the data. Until they can touch and feel, see it, and go, “Oh, that particular data point is wrong because we don’t do it that way. We do this other thing on the floor,” and then they realize the measurement is just totally wrong.

Without that operational engagement, I can’t know everything about how every different unit does it differently. And neither can Epic, Cerner, Meditech, or whichever. The data will always be dirty in healthcare until the operational leaders sit down, look at their data, engage with it, use it to make operational decisions, and then challenge it. They need to say, “This just doesn’t feel right. There’s no way our time to seeing the patients is that wrong.”

Well, because of the workflow, it’s not capturing something. And until you do the workflow the way the designers made the program to capture it, the data will be dirty. So healthcare is loaded with dirty data—it’s just the nature of the beast.

Q. Yeah, and I quite agree with you. This is a very interesting perspective. You said that operational people need to look at it. How do you do that at an enterprise scale, Mark, both from the people perspective and the technology perspective? If you can give us some insights into that. 

Mark: Yeah, our HR department authorized me to use tasers because it’s really effective on operational leaders. It’s the only thing that gets them to look at their data.

It is a challenge. One of the things we use is Epic, and the Epic Slicer Dicer is their self-service analytics tool. It’s really easy to use. Now, people are terrified of it at first. They’re intimidated. But once you get them to sit down and play with it a little bit, a portion—maybe 5, 10 percent—of the operational leaders will say, “Okay, I can use this tool and I can explore the data, start to ask questions, and then sit with an analyst and say, ‘Show me where this came from.'”

Then we start to realize, “Oh, how we’re capturing it—that little flow sheet row isn’t doing what we thought it should do.” The only way it works is if the senior leaders ask for data. If they ask data-driven questions, their directors and managers will go out and try to look at the data.

Otherwise, they do what they do today and don’t make data-driven decisions. It has to come from the top, with interested people who are willing to explore and experiment with data, and then you’ll start to see the ball move slowly. It’s a journey. There’s nothing quick about this.

Q: Absolutely. And what are your thoughts, Mark, on data governance? How did you put a structure to it, even though you mentioned Epic? How do you put a structure on the data governance piece?

Mark: I don’t want to mislead anyone into thinking that I’ve mastered this by any means. Let’s be realistic here. Yes, we’ve been trying for years to put in place the basics of data governance, particularly operational data governance.

I happen to have an excellent partner in finance. Her name’s Kathy, and she’s wonderful because she’s very data-driven and knows the value of data governance and how the “wild west” happens with people showing data that’s not finance-approved—particularly in finance. It’s all about the data, the numbers, and they’re data-driven. They deal with numbers all day. She’s really been a strong proponent for pushing it forward, and I partner with her.

We’re trying to get definitions for the major projects going on in the organization today. What are you measuring? How do you know if the project is successful? That’s where we start. We ask, “Okay, you’ve got this in your head about what makes it successful, but what’s the definition of that?” And we’re starting to collect these definitions. It’s just one of those things where you just get started—that’s the key piece. Start somewhere.

We then started to figure out how we’re collecting that information. It’s taking too long, so we need data stewards who are closer to the data. The world will start to develop, and it will begin to snowball. We’re still pretty raw at this, but I can see it starting. At least we’re making baby steps.

For so long, we’ve just said anyone who wants data gets data and can present it however they want. We’ve occasionally been bitten by that, and we’re finding that putting some structure in place and finding the champions—those who are passionate about it—is where it starts.

Our population health team is also very good, so we’ve started with some initiatives with them. There are other areas in the organization that aren’t as good, so I’m not starting there. I’ll go back and prove how this works in certain silos, and then we’ll work back.

Q: And Mark, we were talking before about some new Epic tools that are very easy to use and simple in terms of standing them up for patient engagement. Would you like to share some of those experiences?

Mark: There’s a new tool that’s out. Again, we’re an Epic shop, and so anytime I start to play with a new tool, I like to talk about it—especially if my colleagues get interested in these things. This new tool is called MyChartBuilder.

What it enables us to do is build a very simple one-page microsite. It’s a very static page—it might have a link or a phone number in it for people to take action. For instance, we have a new rheumatologist who just joined our organization. Well, maybe people who have rheumatologic diseases would want to know about that. Rheumatology is severely underserved in our area, as in most areas. So we’re lucky to have a new one.

I can now put in MyChart a link that says we have a new rheumatologist, but only present it to those where it makes sense using the medical knowledge we have in Epic. I can say, “Look, knowing that this doctor only sees people over 18, don’t show it to a 17-year-old. Show it to those who are eligible to see this kind of doctor.”

It’s that kind of tool where we can start to use this vast repository of data we have and actually use it to bring good education to patients. I should be showing diabetic education to diabetics, not those with some other disease. And so now we can do that.

What’s nice is that we can do this in IT. We took some of the templates to marketing and branding and said, “Look, I know your logo, we need to use it. This is what it’s going to look like,” and we take that. So when we’re building our microsite, it’s just these templates that the branding center gives us—colors we use. But once that’s set up, now IT can spin up a page in a matter of 20 minutes.

It’s a drag-and-drop website designer. I don’t know if anyone’s ever built a Wix website or one of those, but it’s that simple. These are drag-and-drop and repetitive templates you can reuse. And all of a sudden, you’ve got quick and easy tools to deploy that patients are now engaging with. You get analytics on that using Slicer Dicer—you can see patients are clicking on it when you set it up this way, they’re not clicking on it when you did it another way.

It’s wonderful to see patients engage with some of the tools that were early. This has been out for probably six months now, and we just picked it up in the last month or so. We’re starting to put these in place, and we’re just experimenting with a handful of them. But I can see this being really valuable in terms of things like lung cancer screening. We’ll just put that in front of those who qualify for the screening and not put the information in front of those who don’t. Stuff like that is going to be really powerful.

Q: That’s good to know. So, which are some of the other areas of either patient care or technology at the intersection, Mark, that you’re super excited about? Are there any new digital initiatives that you’re thinking about or seeing coming down the pipeline?

Mark: I think most CIOs are now focusing on virtual nursing and how to scale that. Most of us have done the pilots now. It’s a good thing. The nurses do seem to be responding well to it.

The technology’s in the room. They’re not bothered by it—the “big brother’s watching me” thing. No, it’s here. These are tools that are here to help you. And then the AI we can start to bring in.

Now that we have cameras and microphones going into the rooms, we can bring AI to detect when a patient’s moving out of bed. Right now, we have humans staring at screens, like little Hollywood Square screens—18 screens that they’re just staring at, saying, “Okay, is this patient moving?” It’s a very repetitive, boring job. Computers do that well.

Let’s let the computer do that work and then set off an alert. Let someone know this patient has moved out of a threshold of what we said was safe, and bring the human into the loop to correct the situation or go to the bedside.

This kind of technology is possible now because we’re really investing in virtual nursing. And, oh, by the way, there’s this AI that’s going to come with it, which I’m looking forward to working with these AI models and starting to deploy. So, I think virtual nursing, and all the benefits that come from that, is a great area that most CIOs are now starting to play in.

Q: So, any other aspects of Epic or any other tools that you’re using, Mark, in your health system that are driven by new technologies, like generative AI? Any thoughts on that?

Mark: We all talk about generative AI and some of the use cases—some are panning out, some maybe not so much. But what we’ve been discussing in our organization is the education needed about large language models—how they work, where they can be good, and where they may not be great. We also need to be careful because they could lead a doctor astray.

We have some doctors who are very seasoned and experienced, and I think they’re wonderful candidates to use a large language model because they’ll know when it’s wrong. Then, we have some new trainees who are willing and eager to use AI, but I’m not sure we trust them yet to know enough about medicine to spot potential issues. It takes intuition and experience to know when something doesn’t feel right.

So, the sweet spot for using AI seems to be with doctors who are willing, eager, and engaged to use it—but usually not the most seasoned physicians. My junior physicians are ready to try it, but they might not be quite ready yet. We’re watching and learning as we go, but we’re definitely exposing them to it and teaching them about it.

I think that’s essential for where we are now. As we start putting microphones in the exam rooms and recording conversations with patients, we can input that data into large language models to help with things like differential diagnosis or determining the next best cost-effective test to order. That’s coming—but not quite yet. I could take a transcript today, copy and paste it into a Microsoft Copilot (that’s what we have available), and ask questions about the data. That’s interesting, and in the future, it’ll happen automatically.

I could ask the large language model to develop a Python program for me, but I’m not that good at it myself. I don’t have the subject matter expertise to know if what it’s producing will launch a rocket or serve me breakfast. So, you should have some domain expertise when you’re working with a large language model. It doesn’t replace that, not yet.

Q: That’s true. Which other areas of interest, Mark, on the innovation side? How do you innovate in a health system like yours? How do you encourage innovation with physicians, nurses, or other staff? How do you bring in third-party startups into your ecosystem? Any thoughts on that or advice for fostering innovation?

Mark: It’s challenging. I’d consider us an academic community hospital system. We have residents, medical students, and fellows, but we’re not typically working with biotech startups. If we’re bringing in new tech, it’s because we think it solves a problem, and we see value in it. Sometimes, it’s from a startup, and there’s definitely room for that.

I surveyed my IT team—CIOs, I encourage you to do this. Ask your teams, “How many failures are you allowed to have this year?” Some will say zero (and those are my network guys!). I love them, but yes, correct. There should be zero failures on the network. But there should also be areas where we’re okay with experimenting—even in a network. What if we try something new, like a software-defined wide-area network instead of traditional MPLS? What if we try it in a small clinic? There won’t be any major fallout if it fails, but we get some experience.

Risk tolerance varies across teams. Most IT people are on the conservative side, favoring no failures, because they see a failure as a waste of time and money. But I try to push the team to say, “Let’s try this. It might not work, and I’ve had failures working with startups, but that’s okay.” One tool we tried didn’t work for us, but it will be successful someday. We had invested time and energy into it, but finance wasn’t comfortable with it. We moved on, and that’s the job of a CIO—taking losses and moving forward.

Advice: For other CIOs, assess your team’s risk tolerance. If your team says, “We can’t fail,” you’ll have trouble being innovative. On the other hand, if you have people willing to try, innovating while handling daily operations is hard. You must carve out time, protect it, and give it a safe space. In a community health setting, even with an academic background, it’s still tough to get daily operations to accept new pilots.

Q: I understand. So, Mark, as we’re coming towards the end of this podcast, what do you see in the next 1-3 years for your healthcare setting?

Mark: I see movement toward the cloud, and it should accelerate. Our data center has some weaknesses that would be expensive to fix. If I were to build another data center, AWS or Azure might do it better than we could, actually. So, we’re exploring that. I think we’re middle of the pack in this regard, but there are cutting-edge examples like Dr. Shafiq Robinson, who has gone all-in on AWS and done great things with Epic, or Sentara with all-Azure. Our teams are starting to get on board mentally—they see the benefits of cloud adoption, though it’s a new skill set for us.

That’s exciting. The computing power we gain will let us use data in new ways. And if we wanted to use our own large language model, I don’t know if we will in three years, but we should at least be positioning ourselves to participate in the game. Otherwise, we’ll be left behind.

Q: That makes sense. Thank you, Mark. This was wonderful. I really appreciate your thoughts, advice, and suggestions. We’ll have another session.

Mark: It’s always great to be on the show. I enjoyed the conversation—it was easy-flowing, and time flew by. If you ever need me back, just let me know. People can reach me on LinkedIn, that’s the best way.

We hope you enjoyed this podcast. Subscribe to our podcast series at www.thebigunlock.com and write to 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: Welcome to The Big Unlock podcast. It is great to have you as our guest. We are looking forward to an exciting discussion to share with our audience.

I’m Rohit Mahajan, CEO and Managing Partner for Damo Consulting and BigRio. As you may know, we’ve done over 150 of these episodes, and I believe this is our 152nd episode of The Big Unlock podcast. With that said, would you like to introduce yourself?

Jeremy: Absolutely. First of all, Rohit, thank you very much for the opportunity to speak on The Big Unlock podcast and to all the listeners out there—I appreciate it.

My name is Jeremy Cauwels, and I serve as the Chief Medical Officer for Sanford Health, based in the Upper Midwest. I have been in this role for roughly the last five or six years. Before that, I worked in direct patient care as a hospitalist at the Sanford USD Medical Center in Sioux Falls, South Dakota, where I still currently live.

At Sanford, we provide care for roughly 425,000 lives from a health plan standpoint and 2.4 million lives from a broader patient population perspective. We cover a large geographical area, stretching from Wyoming in the west to Wisconsin and even the Upper Peninsula of Michigan in the east. Our largest medical centers are primarily located in South Dakota and North Dakota, both affiliated with the universities in those states.

Recently, we also expanded through the acquisition of the Marshfield Clinic, adding additional clinic sites in and around Marshfield, Wisconsin. This has been an excellent addition to our system.

Sanford Health operates 56 hospitals, over 270 clinics, and 144 senior care communities. Currently, we have 4,500 physicians and advanced practice providers.

For perspective, I used to say that we covered a landmass the size of Texas. Now, we are even larger than Texas.

Q: Wow, that’s amazing. And in the rural setting too, Jeremy, so that makes it even more challenging in terms of being able to reach the patients and serve them in such a setting, right? Where you’re covering such rural areas.

Jeremy: Absolutely. If you think about the Dakotas, western Minnesota, and northern Wisconsin, all of those areas are known for relatively small towns and communities—lots of open space between people, generally farming or ranching communities.

So, it is not unusual for us to deal every day with patients who may have to drive an hour or two hours to see their doctor, and potentially even farther to see a specialist.

Q: That’s amazing. So, Jeremy, please tell us more about how you ended up on the technology side of things. You started, as you said, as a physician and were practicing. What attracted or motivated you to this side of the house?

Jeremy: For me, it was really about how we reach patients. When I stepped into this role, I wanted to quickly understand what technology could do to help us overcome the longstanding challenges of healthcare access in the Midwest.

What we know is that many of the counties we live and work in are considered healthcare deserts. Even more of them are mental healthcare deserts. It’s impossible for many families to take a full day off work to drive to the doctor’s office, have a 15-minute appointment, and then drive back home—especially for single-parent families or those where making ends meet every day is the primary concern.

What got me into this was the idea that we could provide virtual care to patients and meet them where they live. Rather than the old phrase, “Your doctor will see you now,” we like to think of it as, “The patient will see us now.”

Q: That’s beautiful. That’s a great flip. So, talking about all things digital—you mentioned telehealth and telemedicine as well. What are some of the digital initiatives you’ve worked on in the past, and what are you looking at for the future? Jeremy, can you share how this digital front door or digital approach is likely to increase access for patients?

Jeremy: Absolutely. Thankfully, Sanford has been blessed with philanthropic support dollars that have been earmarked for improving our digital health footprint. With that, we’ve been able to expand. We actually just opened our virtual care center, a standalone building outside of our hospitals focused on using technology to better reach our patients.

Inside, you’ll find everything from 3D-printed models that physicians can use to understand anatomy before they have to work with it firsthand, to virtual connections that allow physicians to see patients remotely. More importantly, as an educational organization, we have nearly 350 residents and fellows at any given time. So, having the ability to teach them “webside manner” instead of bedside manner—getting them comfortable interacting through a screen, just like you and I are talking today—is critically important.

We also have an innovation hub, a safe space where we can test digital tools in ways we wouldn’t be able to during an actual patient encounter. Alongside that, we house a significant portion of our clinical operations for virtual care in the same building. That way, if something isn’t working as it should, IT resources are right there to ensure smoother operations. They’ve done a wonderful job of putting all of these resources at our fingertips in one location.

Q: That’s awesome. And, Jeremy, in any podcast these days, it’s impossible to avoid the topic of AI and GenAI. So, of course, I have to bring it up—what are your thoughts on AI? Have you been using any traditional AI, and now more generative AI, in your innovation initiatives?

Jeremy: Absolutely. One of the things we’ve focused on with AI is making physicians more efficient in finding the information they already have access to—if only they had unlimited time to pore over the electronic medical record.

For example, we’ve published research with the American College of Gastroenterology showing that our AI can identify 85 different factors that affect an individual’s risk for colon cancer. It can literally score you and explain why my risk for colon cancer might be different from yours.

The upper Midwest has a higher risk for colon cancer, and it’s also an area where screening rates are lower than they should be. So, we’ve been pushing forward, gathering the evidence base we need to roll out a prospective study that proves this AI model works. The goal is to help physicians by giving them real-time insights—when they look at a patient, the screen next to them might say, “Jeremy is at higher risk, and we may need to be more aggressive with screening.”

Another challenge we’ve tackled is the shift in screening guidelines. A couple of years ago, the U.S. Preventive Services Task Force lowered the recommended screening age for colon cancer from 50 to 45. In the Dakotas and the upper Midwest, that change meant that overnight, 100,000 people who didn’t need screening yesterday suddenly did today.

So, we had to think beyond just colonoscopies. How do we reach people who may not be able to come in? One way is through stool-based testing that can be done at home. And as you can imagine, whether someone lives in Howard, South Dakota—a town of 848 people—or anywhere else, they’re used to getting Amazon deliveries. They know how that works. So, if we can put a box at their door that helps them stay on top of their healthcare, we’re moving them forward.

We’ve worked hard to bring all these programs together—not just for patients at normal risk but also to identify who’s at slightly higher risk versus significantly higher risk. Because of who we are and the extensive data we have on our patients, we can personalize care in a way that wasn’t possible before.

Q: I see. Just a curious question coming to mind, Jeremy—do you see a very diverse patient population speaking many different languages, or is it pretty homogenous? How does it look when you do population health analytics?

Jeremy:  Interestingly enough, we have more diversity than people expect in the Upper Midwest.

The largest ethnically diverse group is Native Americans. In some of our regions, the three counties surrounding some of our hospitals are entirely Native American land. In South Dakota alone, three of the poorest counties in the United States are on Native American land. So, those areas present unique challenges that we have to work through.

I’ll also say that one of the communities we regularly serve speaks 57 different languages because a large portion of that town and county is supported by the meatpacking industry. We have several areas like that, where different ethnic pockets of people absolutely need to be served and cared for—regardless of their ethnic background or the language they speak.

The key question is: What is the best way to reach them? How do we find the approach that works for them?

Q: And again, a curious question—one of our clients is one of the largest telemedicine companies. We saw a huge spike during COVID in telemedicine visits, up to 8,000%. But now, people seem to be going back to normal, and COVID is starting to be forgotten.

How has your experience been with telemedicine visits, given the geography and rural nature of your area?

Jeremy: So far, we’ve saved our patients roughly 33 million miles of driving. To put that in perspective, that’s about the closest distance Mars gets to Earth during its rotation.

In addition to that, we’ve now done over 800,000 virtual visits. Twenty percent of our mental health visits every month are still virtual—one in five patients still choose to see their mental health provider virtually.

Some of that may be because they simply can’t find a mental health provider in their area. But for others, it’s about privacy. I drive a blue Ford pickup, and in some small towns, there are folks who wouldn’t want their blue Ford pickup seen parked outside a psychologist or psychiatrist’s office. Stigma still exists, and giving people the option to see their doctor in a way that makes the most sense for them is extraordinarily helpful.

Q: That’s great to know. One other thought I wanted to discuss with you, Jeremy—there are three aspects I’m trying to think about together: What are patients looking for? What are caregivers looking for? And what are clinicians looking for in some of these digital approaches you’re taking?

Jeremy: Absolutely. So, from the patient’s perspective—you can see over my right shoulder, I have three children. They’re much younger, and I’ll tell you, my kids haven’t gone to an in-person medical visit in the last year, except when they needed a sports physical.

If they feel ill, they set up a virtual visit. If they have a follow-up with a specialist, they do it virtually. What’s great is that it allows flexibility for both the specialist and the patient. My kids have even had medical visits while eating breakfast at the kitchen table. That concept would be unheard of to my parents, who would much rather drive to the doctor’s office than try to interact over the phone.

So, from a patient’s standpoint, there’s definitely a shift happening.

From a clinician’s perspective, we’ve been lucky enough to implement AI-driven automated dictation technology with ambient listening. One of our busiest family practice doctors recently switched to it—he simply sets his phone between himself and the patient, and he no longer has to look away at the computer screen.

Not only are his notes completed by the time he finishes his scheduled day at 5 PM, but he told me just the other day: “I finished my day at five, my notes were done by 5:15, I made it home for dinner with my family—which almost never happens—and I even had enough extra time to take my daughter to buy her first used car.”

That’s amazing. Ambient listening is definitely proving to be one of the top use cases for generative AI. I completely agree—it’s only going to grow from here.

People always talk about the “good old days,” whenever that was for them. But many doctors remember a time when they didn’t have to be attached to a keyboard, constantly documenting. This brings us back to that—where the most important thing is the interaction with the patient.

Whether it’s through a screen like this or one-on-one in a room, it’s a much more satisfying discussion for both the doctor and the patient.

Q: Yeah, that’s amazing, Jeremy. What are some of the digital tools or new approaches you’re using for taking care of patients at home, including remote patient monitoring and home-based care?

Jeremy: Yeah, so one of the things we rolled out in 2023 was a text-based patient monitoring tool.

We can use it for common diagnoses like diabetes, heart failure, and depression. We also use it for patients who have been discharged from the hospital to ensure they receive rapid follow-up and scheduled interventions. The technology allows patients to provide feedback without having to call, wait in line, or book an appointment.

I’ll share one example. We had a patient who came into one of our emergency rooms for depression. It’s always heartbreaking when someone is in such distress that the ER becomes their only option, but unfortunately, it happens every day across the country.

After discharge, we sent her home with this monitoring tool, and about a week or two later, she responded to a mood scale with a score of one out of ten. That immediately set off an alarm for us. We called her back and found out she was a single mother, overwhelmed by life’s challenges. She had already written a suicide note and was planning to end her life.

Because of this tool, we were able to intervene, get her the help she needed, and months later, she and her young family are continuing to grow and thrive.

Q: That’s an amazing story. As we come to the end of our conversation, Jeremy, any other thoughts you’d like to share with the audience? Any news or new initiatives you’re focusing on this year?

Jeremy: Sure. I’d like to expand on what I just mentioned about mental health. Many places across the country are what I’d call “mental health deserts.”

In our region, about 95% of the Dakotas—95% of our footprint—is in a mental health desert. That means there are limited providers and significant challenges in getting timely psychiatric care.

To address this, in addition to the virtual visits I mentioned earlier, we’ve implemented virtual psychiatry consults in our emergency rooms. If someone needs to see a psychiatrist and they’re already in an ER—which is never an ideal situation—they often have to wait until morning, or worse, wait for an open psychiatric bed, which could take days.

Now, instead of waiting, we can connect them with a licensed psychiatrist virtually, right there in the ER, even if the psychiatrist isn’t in the same city or state. That immediate access makes a huge difference in getting people the right care when they need it most.

Q: That’s amazing, Jeremy. It’s incredible that technology enables us to do this now. Any closing remarks?

Jeremy: I just want to say thank you. Thank you for allowing me to share a little bit about Sanford and how we continue to reach out to our patients. Despite the distances, we’re doing everything we can to bring them closer to the care they need.

We hope you enjoyed this podcast. Subscribe to our podcast series at www.thebigunlock.com and write to 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: David, welcome to the 150th episode of The Big Unlock Podcast. Padmanabhan had done a lot of the previous episodes of this podcast and I’m carrying on his legacy.

So, David, would you take a few minutes and like to introduce yourself to the audience and talk about yourself and the health system as well where you have been working? 

David: Yeah, sure. Thanks a lot for hosting me. It’s an honor to be here with you this afternoon.

I’m David Berger. I started out as an academic surgeon and surgical oncologist. I did my general surgery training at SUNY Downstate and a fellowship in surgical oncology at MD Anderson Cancer Center in Houston, Texas. I initially thought I would become an academic surgeon—maybe a surgical oncology division chief, chair of surgery, or even a dean someday—but my career trajectory shifted due to unique opportunities.

Early in my career, I undertook a management role as the Chief of the Operative Care Line at the Houston VA, the Michael E. DeBakey Medical Center. It’s the largest, most complex, and busiest VA medical system in the country. Around that time, as part of the sandwich generation, I was also taking care of both my children and my parents. I realized how difficult it was to navigate the healthcare system. If it was challenging for me—someone who knows the system and has contacts—I couldn’t imagine how hard it must be for those without the same resources.

This experience shaped my career goal: to make healthcare simpler. The healthcare system is extremely complex, and I saw the potential of digital tools to transform care delivery, making it more accessible and effective. While at the VA, I implemented sophisticated digital health tools. One notable project involved real-time location systems (RTLS) for managing our operating rooms. We reduced turnover time between cases by nearly 50% and achieved a 95% on-time first case start rate—remarkable for any healthcare system, not just the VA.

Building on this success, I moved to the private sector as Chief Operating Officer at Baylor St. Luke’s Medical Center. There, we implemented machine learning tools to predict which patients were at risk of sepsis-related decompensation. By intervening early, we reduced sepsis mortality by almost 50%. This was back in 2014, well before the recent wave of AI publicity, but it reinforced my belief that digital health, AI, and machine learning are poised to revolutionize healthcare.

After Baylor St. Luke’s, I returned to SUNY Downstate, where I had completed my training, to serve as the Chief Executive Officer of University Hospital at Downstate. I started in September 2020 and recently left to focus on my passion: digital health and artificial intelligence in healthcare.

Now, I advise early-stage startups, participate in advisory boards and venture studios, and am about to become an LP in early-stage venture funds supporting digital health companies. That’s a little about me and my journey.

Q: That’s really great to know, David. It’s fantastic that physicians like yourself are taking on this journey because your deep domain knowledge can drive meaningful change in digital health.

I also learned that you’ve been an entrepreneur. Could you share a bit about your entrepreneurial journey and the kinds of software or digital solutions you worked with?

David:  So, about 10–12 years ago, I was approached by an early-stage startup company based in Canada. They had come across an article we published on early warning signs for readmission after colon cancer surgery.

We had identified at least 10 early warning signs and developed a machine learning algorithm to predict who was at risk of being readmitted. This software company wanted to integrate our findings into their tool. We conducted a couple of successful pilots and started discussing a long-term relationship. The idea was that we, as clinicians and researchers, would provide the intellectual property to power their software. 

But we thought they were undervaluing what we were bringing to the table. So we actually went to Baylor College of Medicine, and they spun us off as a company, as our own company, from Baylor Technologies.

I learned a lot from trying to start my first company. Not all the learnings were good, but they were important.

What I learned is, one, if you’re going to start a startup, you have to devote all your time to it. You can’t do it on the side. I was heavily involved as a clinician and an administrator, and I was trying to do this on the side.

Second, you must have alignment of your board. We had five board members—me, two from Baylor, and two from the company that was helping us on the IT side. Well, the people on the IT side and the people at Baylor College of Medicine were diametrically opposed on the direction, and we got stuck and couldn’t move forward.

So after about running through a million bucks, the company died. But what’s interesting is that there are a couple of startups just getting going with the same idea we proposed and were trying to move forward 10 years ago.

So, the idea was the right one, but the alignment was poor, and I wasn’t committing full-time to it. Those are really important lessons for anyone trying to start. 

Q: Great lessons learned there. Yeah. And then, David, you were talking about how AI is, you know, going to be changing the landscape, and you have a certain way of looking at it, especially for healthcare systems. So we’d love to learn your thoughts about that—about AI, GenAI, and where you think it is going, and how one should, you know, kind of embrace it and adopt it to get more value. 

David:  So I am extremely excited about the potential for artificial intelligence to help us provide healthcare because there are so many repetitive processes in healthcare that are being done by people that probably can be done by technology.

When I think about a health system—and, you know, I was running a hospital—about the different places where artificial intelligence could have a major impact, I break it down really into four different areas. This is general; there’s overlap.

So the first one is obviously back-office functions—things like revenue cycle, coding, billing, documentation, pre-authorization. All those things that have to do with revenue cycle.

Then I look at the front end or access—giving patients the opportunity to interact with a provider, giving them the opportunity to schedule, how they’re going to pay for their healthcare, et cetera.

And then on the care delivery side, there are things that help make care easier to deliver, and then there are things that actually help provide care.

So let’s break down those two things. When I say make it easier to deliver care, I’m talking about things like artificial intelligence scribes or ambient listening, ambient dictation.

When I talk about things that help actually deliver care, I’m looking at adjuncts to help read X-rays. So one use case that’s fairly well-developed is the issue around mammography. An important fact and something that radiologists look at in mammograms is breast density.

Breast density sometimes predicts further cancer down the road. Radiologists are really bad at quantitating breast density, and there’s a total lack of correlation from one radiologist to another. But using artificial intelligence, you can improve the ability to determine breast density to almost 95 percent accuracy.

So that is a place where artificial intelligence could augment care and improve how care is delivered and the diagnostic accuracy. That’s what I mean when I say help facilitate care versus actually help deliver care.

Q: Understood. And David, in particular, just for a moment to segue into all the new generative AI technologies that are coming our way. It’s not just about text; it’s also about so many different forms of care and media that it can transform. So any thoughts on where you think generative AI might play a larger role or be more conducive in the healthcare setting?

David: Yeah, so in terms of generative AI, one of the solutions we implemented is something called AVO. And what AVO does is ambient listening—it helps physicians to write the note. But that’s just part of it; that’s not really the full generative AI component.

What it then does is pull relevant information from the electronic medical record to create a real functioning note. It puts in front of the clinician a differential diagnosis, as well as the clinical pathways related to that diagnosis. So yes, it’s ambient listening, which is important, but it’s also natural language processing. It helps to generate feedback, a differential diagnosis, and then the proper treatment pathway for that patient.

It also presents the note in a way that facilitates coding, billing, etc., for the hospital or system to get reimbursed. That has been a game changer for our patients.

Thinking about implementation, though, the implementation of any new tool is really, really challenging. What we found with the ambient listening and ambient dictation is that there was a different level of adoption between specialists like surgeons and primary care doctors. Why do you think that is? I’ll throw it back at you.

Q: I couldn’t even guess that. First of all, I’m thinking to myself, is it the primary care physicians who adopt it more, or is it the—yeah?

David: It’s the specialists and the surgeons who adopt it more readily. For them, a note is something they have to do; it’s not really what they want to do. They want to focus on their operation, their procedure, etc. So, for them, the note is more of a barrier to doing what they really want to do.

For a primary care doctor, one of their primary goals is to create a detailed note. So, for them, the nuances around creating the note are really important. Whereas for a surgeon, they don’t care as much if it’s perfect—they just want to get it done. So, the adoption was much quicker with surgeons than with primary care physicians.

We also implemented it in the emergency room, which is a tight space with a lot going on. Some of the ambient listening got distracted because of other noises in the environment. We had to figure out ways to ensure that, during the interaction between the clinician and the patient, there was as little ambient noise as possible. But we worked through that, and the adoption was incredible.

People have talked about AI replacing physicians. Five years ago, someone came out and said that within five years, there wouldn’t be any need for radiologists. Well, clearly, that hasn’t happened. But I see AI being used as an adjunct to clinicians—helping them to be better at what they do, not just in terms of efficiency, but also in improving accuracy in care and diagnoses.

I think clinicians are going to become partners with artificial intelligence. Another area where I think AI, generative AI, augmented reality, and virtual reality are going to have a huge role is in education.

Even in teaching within the operating room. Right now, the way you teach in the operating room is by working with a resident across from you. Over time, you give them more and more experience and freedom to conduct the procedure. But think about this: if you have really good augmented reality, you could have them work with a headset in an environment outside of the operating room to hone their skills in a space where there’s no risk to patients.

So, there are amazing opportunities for augmented reality and virtual reality, not just in education, but also in surgery. For instance, I used to do a lot of liver surgery. The liver is a three-dimensional structure, but the inputs—like where the vessels are or where the tumor is—come from 2D images. These are from CT scans, MRIs, or ultrasounds.

Then, once you’re in the operating room, you’re trying to reconstruct that 2D image in your mind into a 3D picture, relating it to the organ in front of you. It’s challenging, but you get better at it with experience. Now, with augmented reality, you can actually see, right in front of you, where the tumor is in relation to other structures within the organ.

This has been really well-developed in neurosurgery, but it’s an exciting opportunity for AI, virtual reality, and augmented reality in other types of surgery as well.

Q: Yeah, great example, David. So, my last question is about your new venture or the new role you’re going to be taking on soon, as you described earlier in the podcast. Which aspect are you more excited about? Because you’ve seen the startup side of things, and now you’ve been in a large health system. Where do you think you’ll be spending more of your time and adding value?

David: So, I think healthcare is slow to change from the inside. A number of the bigger systems have developed innovation labs and are trying to move the field forward, but I think a lot of the change is going to come from outside—from companies outside of healthcare.

What I’ve decided to do is move away from running a healthcare system or hospital to being more involved in the digital health and AI ecosystems. I think the way I can best contribute is as an advisor to early-stage companies within this space, but also as an advisor to investors and venture companies looking at which technologies are actually going to make a difference.

Since I have the perspective of both a clinician and an operator within the health system, I think I bring a unique lens to identifying which digital health solutions are really going to make an impact.

Q: Awesome opportunity, David. I’m wishing you all the best in this role? And then would you have any other closing thoughts for our audience? 

David: I think we are at an inflection point, between technology and the desperate needs within the health system. The costs have risen dramatically, people do not have adequate access and there are huge problems within our health system. I think we have opportunity right now to make a difference. 

To move healthcare forward and to improve the healthcare system within this country, I encourage people who are thinking about careers within healthcare to think about the innovation side and the digital health side, because that is really going to have a huge effect and move the needle. 

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