Latest / Becker’s Healthcare Digital Health + Health IT / Robert Isaiah Nielsen, Epic Site Director for Jacobi Medical Center and North Central Bronx at NYC Health and Hospitals

Transcript

Robert Isaiah Nielsen, Epic Site Director for Jacobi Medical Center and North Central Bronx at NYC Health and Hospitals · Becker’s Healthcare Digital Health + Health IT

• 0:02
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• 1:00
  - This is Laura Dierdahl with the Becker's Healthcare
• 1:02
  - podcast. I'm thrilled today to be joined by
• 1:04
  - Robert Isaiah Nielsen,
• 1:06
  - the Jacobi NCB EPIC site director at NYC
• 1:09
  - Health and Hospitals North Central Bronx.
• 1:12
  - Robert, it's a pleasure to have you on
• 1:13
  - the podcast today. Thank you. I'm so happy
• 1:15
  - to be here.
• 1:16
  - Absolutely. And, you know, I'm excited for our
• 1:18
  - conversation. I know there is a lot going
• 1:21
  - on in health care right now, and it
• 1:22
  - would truly be interesting to get your perspective
• 1:24
  - on the future too. But before we dive
• 1:26
  - in, can you tell us a little bit
• 1:27
  - more about yourself and your background?
• 1:29
  - Yeah. Absolutely. So I've been working in health
• 1:31
  - care since 2017,
• 1:33
  - and in healthcare technology specifically since 2018,
• 1:37
  - I actually started my career at New York
• 1:39
  - City Health and Hospitals as a project manager
• 1:41
  - on their EPIC implementation,
• 1:43
  - and then,
• 1:45
  - after about a year,
• 1:47
  - they actually moved me to one of the
• 1:49
  - application teams. So I worked in the revenue
• 1:52
  - cycle side and hospital billing for about four
• 1:54
  - and a half
• 1:55
  - years, before leaving to go into consulting.
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  - I worked in advisory consulting for about a
• 2:01
  - year and a half with a firm called
• 2:02
  - Guide House,
• 2:04
  - also advising on the revenue cycle side.
• 2:07
  - And then now I have been in my
• 2:09
  - current role back in health and hospitals in
• 2:12
  - one of the facilities
• 2:15
  - since, the middle of April.
• 2:18
  - And
• 2:19
  - we, as you mentioned, it's Jacoby NCB, two
• 2:22
  - of the hospitals merged together. So,
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  - we say one hospital, two campuses,
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  - and I'm one of two epic site directors.
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  - My counterpart sits at Jacobi and I sit
• 2:33
  - at North Central Bronx,
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  - but we we both work across both facilities.
• 2:38
  - And this role has been
• 2:40
  - a real expansion for me and my skills,
• 2:43
  - because it's much more clinical oriented.
• 2:46
  - And so after coming from the revenue cycle
• 2:48
  - side,
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  - there's been a lot of opportunity for me
• 2:51
  - to grow and learn, learning about what doctors
• 2:54
  - and nurses,
• 2:55
  - deal with on a daily basis within Epic,
• 2:59
  - and ways that we can improve their
• 3:02
  - workflows just to make their jobs a little
• 3:04
  - bit easier. So,
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  - I'm pretty passionate about healthcare technology.
• 3:09
  - I recently finished a master's of health care
• 3:11
  - administration at Columbia University.
• 3:13
  - I also have an MBA from Seattle Pacific
• 3:15
  - University,
• 3:17
  - and I've just submitted applications
• 3:19
  - for a doctorate of public health,
• 3:22
  - degree at a few,
• 3:24
  - universities on the East Coast.
• 3:27
  - That's amazing to hear. And, you know, what
• 3:29
  - a a great career journey and trajectory from
• 3:31
  - working on the revenue cycle side now to,
• 3:34
  - connecting with the clinicians and and doing, you
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  - know, hugely important work, but something a little
• 3:39
  - bit different. So what's been the biggest thing
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  - you've learned or or thing that,
• 3:43
  - has surprised you since coming into this role
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  - and working more with the clinicians?
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  - Just how complicated their workflows are compared to
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  - the revenue cycle side. They, the I
• 3:53
  - I I understood the concept of administrative burden
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  - before stepping into this role, but I've really
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  - gotten to see it firsthand by being in
• 4:00
  - this role just how
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  - deeply
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  - complex
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  - their their charts are, their workflows within the
• 4:08
  - system, the amount of documentation and noting that
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  - they have to do,
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  - and and how even just missing, like, a
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  - signature in one spot prevents the chart from
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  - closing out and then prevents the hospital from
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  - actually billing for the visit. And so there's
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  - just
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  - so much intricacy to what they have to
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  - do.
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  - And I and I I have a much
• 4:31
  - better appreciation now for just how
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  - severe the administrative burden is for providers and
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  - why we need to really find ways
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  - to improve that,
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  - because
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  - even though we give them administrative time to
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  - close out their charts, it's still not enough,
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  - and we're having to constantly work with them,
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  - to
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  - to be able to get these charts closed
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  - out in a timely
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  - manner so we can, bill and get reimbursed
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  - for the visits. You know? It's it's it's
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  - a simple
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  - business model,
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  - but the the moving pieces within that business
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  - model are much more,
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  - complicated than it seems at first.
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  - That makes a lot of sense, you know,
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  - and it's just fascinating to hear about. I
• 5:14
  - can imagine it's a whole new world opening
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  - up. So,
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  - just
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  - really, really excited to dig deeper and more
• 5:21
  - in into that point.
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  - What are some of the opportunities and headwinds
• 5:25
  - that you have your eye on right now?
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  - What are some of the things that you're
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  - discovering and excited to dig deeper into?
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  - Well, I'm really hoping that AI is gonna
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  - actually play a positive role in some of
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  - this, and we have yet to see just
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  - to what extent we'll be able to integrate
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  - artificial intelligence. I know that Epic is starting
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  - to release a lot of,
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  - different functionality
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  - within their EHR,
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  - to help with,
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  - coding and documentation
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  - and,
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  - claim denials
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  - and just a lot of different opportunities to
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  - sort of clean things up where there's where
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  - there are holes in the bucket, so to
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  - speak.
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  - But I really wanna see,
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  - the AI help clinicians
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  - sort of navigate their charts more efficiently
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  - and help them find where they're missing the
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  - different pieces that need to be put together
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  - in order to get them closed out. So
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  - they're not spending so much of their time
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  - when they're not with patients dealing with documentation
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  - and charting,
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  - because it really just adds
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  - so many hours to their week, which is
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  - already, you know, packed full by providing
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  - patient care and and the follow ups that
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  - are inherent in that. And so I really
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  - wanna see
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  - what we can do to make things much
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  - more efficient and streamlined with AI. I think
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  - the headwind to that is what is the
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  - cost involved?
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  - And,
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  - you know, there's been a lot of talk
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  - about AI potentially replacing people and I don't,
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  - you know, I I I'm not sure if
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  - that is gonna happen, but I am concerned
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  - about
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  - the cost of health care already
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  - sort of skyrocketing
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  - and then
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  - just getting an idea of, like, what the
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  - cost of implementing these different AI technologies is
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  - going to be and to maintain them on
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  - an ongoing basis.
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  - I wonder if we will see the return
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  - on investment,
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  - by putting so much money into that. And
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  - so,
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  - you know, from my perspective, there's a lot
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  - of benefit to it because
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  - the more you can help providers provide better
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  - care, the better it is for your patients,
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  - the more they wanna come back, that improves
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  - your business,
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  - The more they can get through their difficult
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  - charts and and closing them out, the more
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  - you can bill and get reimbursed. So it
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  - seems like the ROI is there, but I
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  - don't think we're gonna know until we actually
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  - get some of this new technology integrated and
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  - see
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  - how much it actually helps.
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  - And, you know, it is fascinating to hear.
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  - And I think definitely,
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  - understanding
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  - how that integration goes and then adoption too,
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  - I know, is a huge part of that
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  - and something that,
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  - oftentimes it feels like it should be easier
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  - than it is. But it takes a lot
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  - of effort to your point of, you know,
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  - looking at the complex workflows and all the
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  - different areas that have to be correct in
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  - order for the physicians and nurses and other
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  - clinicians to realize the true potential of technology
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  - and what AI is capable of.
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  - So, as you're thinking into the future, how
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  - are you looking at growth and adding value
• 8:29
  - and continuing to expand what you're doing?
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  - Well, I just wanna help providers get back
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  - to the place of enjoying
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  - doing what they do, what they trained to
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  - do. You know, I,
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  - mentioned on another podcast a couple of months
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  - ago that I feel like in some ways,
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  - we've
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  - turned providers into technicians because there's so much
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  - technology they have to learn just to do
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  - their job now. And even beyond the EHR,
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  - you know, we're we're integrating different interfaces and
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  - different
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  - technologies that they have to figure out how
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  - to use them in order just to provide
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  - patient care, and it's not fair. They didn't
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  - go to school to be technologists. They went
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  - to school to be clinicians,
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  - and yet we've sort of just
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  - handed them this burden that we expect them
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  - to figure out in order to
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  - do their jobs. And then when they don't,
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  - you know, it's like we we we penalize
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  - them for not doing it correctly. So
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  - I really want
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  - to find ways that we can make their
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  - jobs easier. And, you know, I work with
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  - a whole spectrum of ages in my hospital.
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  - And so some of the younger
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  - doctors are fine with the technology. They've grown
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  - up with technology. It's just a part of
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  - who they are. It's very second nature. But
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  - some of the older doctors, there's a real
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  - steep learning curve here. And every time we
• 9:48
  - make changes to the system or integrate a
• 9:50
  - new device
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  - into the system,
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  - you know, we recreate
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  - that that learning curve for them and it
• 9:57
  - and it just creates a lot of frustration.
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  - And I'm concerned about
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  - some of the burnout numbers that we're seeing
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  - with doctors and nurses who are who have
• 10:05
  - just had enough and they're walking away from
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  - the profession
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  - because of what the expectations
• 10:10
  - are. So
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  - I I really want us to find ways
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  - to
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  - leverage the technology
• 10:17
  - to provide better care, but to also make
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  - sure that we're reducing the burden on the
• 10:21
  - provider so that they can show up to
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  - work and do what they were trained to
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  - do and provide good care without
• 10:28
  - feeling like they're lost or confused or frustrated
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  - with whatever the newest technology
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  - I I really appreciate that goal and mission.
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  - I know it's so important for the clinicians
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  - to have that connection, that one on one
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  - time with patients. I think so often I
• 10:46
  - still am hearing,
• 10:47
  - that, you know, fears of the humanity
• 10:50
  - leaving health care, which just seems such an
• 10:52
  - integral part of what the whole health care
• 10:54
  - system is doing. And so to have that
• 10:56
  - really as a top goal, to have the
• 10:58
  - technology supportive of the physicians and
• 11:01
  - clinicians and how they are,
• 11:03
  - able to provide better patient care makes a
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  - lot of sense and is an exciting potential
• 11:07
  - reality.
• 11:09
  - But I'm curious as well. When you look
• 11:11
  - into the future, is there
• 11:13
  - a lot of challenges too? So is there
• 11:15
  - a risk or investment that you see as
• 11:17
  - really being worth making towards these goals and
• 11:20
  - very lofty goals of trying to,
• 11:22
  - make sure clinicians avoid burnout and can incorporate
• 11:25
  - the technology smartly into what they're doing?
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  - Well, I wanna make sure that we're investing
• 11:30
  - as much in humans as we are as
• 11:32
  - in technology. And so what I mean by
• 11:34
  - that is making sure that we're providing the
• 11:35
  - training that's necessary to adopt this technology,
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  - to make sure that we're
• 11:41
  - doing ongoing follow-up to check-in with providers to
• 11:44
  - make sure that they're doing okay as they're
• 11:46
  - having to navigate these changes.
• 11:48
  - You know, one of the things that I've
• 11:50
  - been really focused on since I started
• 11:53
  - in my new role is to make sure
• 11:55
  - that I'm working with the training team to
• 11:56
  - provide regular office hours as a space for
• 11:59
  - providers to show up and say, I don't
• 12:01
  - know how to do this. Please help me
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  - because
• 12:04
  - I spend so much time getting stuck on
• 12:06
  - this one thing and I just need someone
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  - to show me what
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  - to do. And so I really want the
• 12:11
  - conversation to be around that and less about,
• 12:14
  - you know, how much do we invest in
• 12:16
  - technology in order to automate everything and more
• 12:19
  - about
• 12:20
  - how do we create a balance between the
• 12:22
  - investment in technology and the investment in people.
• 12:25
  - So that way we actually optimize
• 12:29
  - both areas of the environment and allow the
• 12:31
  - technology to play its role, but allow people
• 12:34
  - to play their role too and to be
• 12:36
  - able to do so in an efficient
• 12:39
  - and safe manner. You know, we work in
• 12:40
  - health care,
• 12:42
  - and there's the opportunity for mistakes.
• 12:45
  - And we wanna make sure that everyone is
• 12:47
  - trained as much as possible to use this
• 12:49
  - technology to reduce the number of mistakes that
• 12:52
  - happen.
• 12:54
  - And so I,
• 12:55
  - you know, as I read more and more
• 12:57
  - about how much organizations are putting
• 13:00
  - into AI and into the, you know,
• 13:04
  - developing their EHRs more and into integrating these
• 13:07
  - other devices,
• 13:08
  - I I I feel like we're leaving people
• 13:10
  - out
• 13:12
  - of the loop. And I want to bring
• 13:14
  - the people back into the loop because in
• 13:17
  - my opinion,
• 13:18
  - health care is still very much a human
• 13:20
  - centric industry.
• 13:22
  - And even if technology
• 13:24
  - does optimize and make things more efficient, I
• 13:26
  - still think we need
• 13:27
  - people to provide the care.
• 13:30
  - That's an excellent point, and it certainly is
• 13:33
  - such a a cool thing to have, within
• 13:36
  - your
• 13:37
  - realm responsibilities and be able to, you know,
• 13:39
  - continue to develop the EHRs. I can imagine
• 13:41
  - they'll evolve, and there's always new technology coming
• 13:44
  - down the pipe.
• 13:45
  - Is there anything recently that you found,
• 13:48
  - has been, you know, beneficial, has either been
• 13:50
  - rolled out or initiative that you've been working
• 13:53
  - on on the change management side that's been
• 13:55
  - really effective to share with others?
• 13:57
  - Yeah. So we,
• 13:59
  - have adopted
• 14:01
  - a bridge,
• 14:02
  - as a pilot,
• 14:04
  - at our facility specifically.
• 14:07
  - And the feedback that we're getting so far
• 14:10
  - is pretty positive.
• 14:12
  - Clinicians are feeling like
• 14:15
  - once they're able to turn on the Abridge,
• 14:17
  - which is Ambient AI technology,
• 14:20
  - and basically does the note taking and chart
• 14:23
  - doc a lot of the chart documentation
• 14:26
  - for them so they can just focus on
• 14:28
  - engaging with the patient and not have to
• 14:30
  - be staring at the computer screen, you know,
• 14:33
  - during the actual visit,
• 14:36
  - we're finding
• 14:37
  - that there's been a a strong positive response
• 14:40
  - with that. And so
• 14:42
  - I think that's a great opportunity to basically
• 14:45
  - say that
• 14:46
  - this is a good leverage of technology.
• 14:48
  - It's not, you know, we're not thinking about
• 14:51
  - using it to replace anyone. We're just basically
• 14:54
  - saying that
• 14:56
  - by implementing this,
• 14:58
  - then the provider can actually focus on the
• 15:00
  - patient, really get to the heart of things,
• 15:02
  - not be stuck in the EHR dealing with
• 15:05
  - hard stops and, you know, difficult
• 15:08
  - note taking,
• 15:09
  - situations, and then they can follow-up later, review
• 15:12
  - the notes, have it recorded, have it, you
• 15:15
  - know, a lot of it automated, and not
• 15:17
  - spend so much time sort of having to,
• 15:21
  - go through the whole,
• 15:23
  - workflow again after the fact. So
• 15:26
  - that is one,
• 15:29
  - one technology that I am really happy about,
• 15:32
  - and I am really looking forward to some
• 15:34
  - of the things that EPIC is going to
• 15:35
  - roll out,
• 15:37
  - you know, also around like coding and claims
• 15:40
  - denial because the, you know, these are huge
• 15:42
  - pain points that the organization has from a
• 15:44
  - much higher level
• 15:46
  - beyond just what the clinicians do
• 15:48
  - of, you know, what it takes to get
• 15:50
  - reimbursed and the amount of money that it
• 15:53
  - costs to collect and, you know, to keep
• 15:55
  - your doors open. And,
• 15:57
  - I think that there's just a there's just
• 15:59
  - a a real opportunity
• 16:02
  - to sort of clean up some of the
• 16:03
  - messiness in these workflows
• 16:06
  - that then makes everybody's job a little bit
• 16:08
  - easier and less stressful and ultimately
• 16:11
  - allows the hospital to keep providing better care
• 16:14
  - because they're they're getting the reimbursement dollars they
• 16:16
  - need to provide that care.
• 16:20
  - I love it. And, you know, I I
• 16:22
  - think that's really such a critical part to
• 16:24
  - your point, being able to have the technology
• 16:26
  - and making things easier and then,
• 16:28
  - getting to the point where, you know, the
• 16:30
  - reimbursement matches is there's so much value there
• 16:33
  - and it's exciting to get to that point.
• 16:36
  - Where do you see some of the best
• 16:38
  - opportunities for that additional growth in the future?
• 16:41
  - I would love to see personally
• 16:43
  - more investment in, like, remote patient monitoring.
• 16:47
  - I think there's a huge opportunity, especially in,
• 16:49
  - like, rural communities
• 16:51
  - and in sort of medical deserts,
• 16:54
  - to be able to improve access to care
• 16:57
  - for patients,
• 16:59
  - that currently just don't have that access. You
• 17:01
  - know, I
• 17:02
  - am fortunate that I live in New York
• 17:04
  - City, and we have many options here from
• 17:06
  - a health care perspective in hospitals and clinics
• 17:09
  - and and whatnot and really top tier medical
• 17:12
  - centers,
• 17:13
  - but that's not true everywhere else. And we're
• 17:16
  - starting to see that there's a real issue,
• 17:19
  - in rural health care, you know, and even
• 17:22
  - if there is a hospital, some of them
• 17:24
  - are shutting down or they're reducing
• 17:27
  - the amount of,
• 17:29
  - operations that they're able to provide
• 17:31
  - or services that they're able to provide and
• 17:33
  - sometimes they'll end up having to send a
• 17:35
  - patient
• 17:36
  - much further away to a larger medical center
• 17:39
  - to get certain things done. And so I
• 17:42
  - see personally
• 17:44
  - advancing technology in a way to where remote
• 17:46
  - patient monitoring becomes a real key component
• 17:50
  - to the
• 17:52
  - the life cycle of the visit, you know,
• 17:55
  - working with the patient on an ongoing basis,
• 17:58
  - being able to to
• 18:01
  - monitor their vitals and get ahead of any
• 18:04
  - major issues or
• 18:06
  - if they think they're having an emergency, being
• 18:08
  - able to be with them in real time
• 18:10
  - and realize that they're not having an emergency
• 18:12
  - and that they don't have to go to
• 18:13
  - the emergency room, which then saves time and
• 18:16
  - money for everybody involved. And so,
• 18:19
  - I, you know, I I don't know how
• 18:21
  - this is all gonna play out and how
• 18:23
  - it will all be integrated into the way
• 18:25
  - hospitals currently function, but I think we're seeing
• 18:29
  - that, like, with the cost of health care
• 18:31
  - rising and
• 18:33
  - these
• 18:34
  - these really thin margins in some hospitals, especially
• 18:37
  - in rural areas that we need to really
• 18:40
  - start leveraging technology and have the conversation
• 18:44
  - about not using, again, not using technology to
• 18:46
  - replace people, but to enhance care and to
• 18:49
  - provide more access to care to people that
• 18:51
  - have limited access right now. So,
• 18:55
  - I'm really excited about that and then I
• 18:57
  - think also
• 18:59
  - just the idea of a much more intelligent
• 19:02
  - health care system in general. Like, instead of
• 19:05
  - just having disparate,
• 19:07
  - you know, technology
• 19:09
  - implemented
• 19:10
  - in different hospitals, trying to figure out how
• 19:12
  - to coordinate them,
• 19:14
  - start like connecting the dots with the technology
• 19:16
  - and have it flow much more
• 19:18
  - effectively and efficiently and create almost like a
• 19:21
  - smart hospital to where,
• 19:24
  - you know, things are running much more smoothly.
• 19:27
  - You still have people that are providing the
• 19:29
  - care, but a lot of
• 19:31
  - the excess stuff is sort of being taken
• 19:33
  - care of by the technology and patients are
• 19:35
  - able to show up, get the care they
• 19:37
  - need, not have to wait long periods of
• 19:40
  - time to get to care, be able to
• 19:42
  - get discharged and go home and and feel
• 19:44
  - better about whatever it is that's going on
• 19:46
  - with them. So there's a lot of opportunity
• 19:49
  - here, and I and I I really hope
• 19:51
  - that we
• 19:52
  - focus on using technology to enhancing health care
• 19:55
  - and taking care of people,
• 19:59
  - because I think there are just a lot
• 20:00
  - of long term benefits to that.
• 20:05
  - Absolutely. That's, you know, such an inspiring thing
• 20:07
  - to think about. And looking at the whole
• 20:09
  - person care, really impacts entire communities in in
• 20:12
  - ways that, you know, society functions in general.
• 20:16
  - So it's a huge responsibility, but exciting to
• 20:18
  - see how the technology can support bringing that
• 20:21
  - all together and then, of course, you know,
• 20:24
  - help boost the clinicians so that they're able
• 20:26
  - to focus their time and attentions and energies
• 20:28
  - on really providing that type of care that's
• 20:30
  - needed. So thank you so much for joining
• 20:32
  - the podcast today. This has been such a
• 20:34
  - fascinating conversation. Truly exciting to see where health
• 20:37
  - care is headed and what's possible in the
• 20:39
  - future, and then be, you know, looking forward
• 20:42
  - to connecting with you again soon.
• 20:44
  - Alright. Thank you so much. I appreciate it.
• 20:48
  - Alright. Perfect. I think it sounded great on
• 20:50
  - my end. How did it feel for you?
• 20:52
  - It felt great. I thought it went really
• 20:53
  - well.
• 20:54
  - Awesome. That's great to hear. Well, I think
• 20:56
  - my team will be producing the episode over
• 20:58
  - the next, couple of days.