Latest / Becker’s Healthcare - Clinical Leadership Podcast / AI Tools, Physician Alignment and the Future of Clinical Care at UNC Health

Transcript

AI Tools, Physician Alignment and the Future of Clinical Care at UNC Health · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  - At Vituity,
• 0:02
  - we're transforming
• 0:03
  - health care to improve lives. As a physician
• 0:06
  - owned multi specialty partnership,
• 0:08
  - we put patients first in every decision.
• 0:12
  - With 6,000
• 0:13
  - clinicians
• 0:14
  - caring for over 10,000,000
• 0:15
  - people each year, we lead with innovation
• 0:19
  - to make care more connected,
• 0:21
  - more responsive,
• 0:22
  - and more human.
• 0:25
  - Learn more at vituity.com.
• 0:30
  - Welcome to the Becker's Healthcare podcast. My name
• 0:32
  - is Paige Twenter, and I'm an editor here
• 0:34
  - at Becker's Healthcare.
• 0:36
  - I'm thrilled to be interviewing doctor Matt Ewend,
• 0:39
  - president of UNC
• 0:41
  - Physicians
• 0:42
  - and,
• 0:43
  - chief clinical officer of UNC Health on the
• 0:45
  - podcast today. Thank you so much for joining
• 0:47
  - me, doctor Ewen.
• 0:49
  - Before we dive in, I'd love for you
• 0:50
  - to just briefly introduce yourself to the audience
• 0:52
  - and tell us a bit about your background.
• 0:55
  - Great. Thank you, Paige. Really appreciate the opportunity
• 0:57
  - to be with you. My name is Matt
• 0:59
  - Ewan. I'm a I'm a Michigan native. I,
• 1:02
  - graduated medical school many years ago, trained in
• 1:04
  - neurosurgery.
• 1:05
  - My interest was in caring for brain tumor
• 1:07
  - patients, and I came to the University of
• 1:09
  - North Carolina to be an academic neurosurgeon and
• 1:12
  - and work on treating and research around brain
• 1:15
  - tumors. And I've been here twenty nine years.
• 1:17
  - About eight years ago,
• 1:19
  - I became the chief clinical officer for the
• 1:21
  - health care system. And and in that role,
• 1:23
  - my team and I oversee and facilitate our
• 1:26
  - physician practices,
• 1:28
  - hospital quality, our population health and value programs.
• 1:31
  - So it's a wonderful system that serves the
• 1:34
  - state of North Carolina and is very committed
• 1:36
  - to both community care and the academic mission.
• 1:40
  - So you've been at UNC for about three
• 1:43
  - decades, and in the last few years, I've
• 1:45
  - seen a lot of changes in
• 1:47
  - AI scribes and new documentation
• 1:49
  - tools. You mentioned before,
• 1:52
  - there's two main tools, the ambient scribing and
• 1:54
  - then
• 1:55
  - AI chart summarization.
• 1:56
  - Can you
• 1:58
  - share a little bit about
• 1:59
  - how
• 2:00
  - those two tools have Yep. Changed the way
• 2:03
  - clinicians are going about their workday?
• 2:06
  - Yeah. So we... We've been troubled as many
• 2:09
  - of my colleagues have about the
• 2:11
  - the increasing burden on providing clinical care and
• 2:14
  - how the joy of caring for patients and
• 2:17
  - the contact with patients was being lost as
• 2:19
  - we added layers and layers of
• 2:21
  - electronic medical record duties and charting and other
• 2:24
  - requirements.
• 2:26
  - With the advent of
• 2:27
  - AI scribing and now with AI summarization tools,
• 2:31
  - this is the first time in my career.
• 2:32
  - I really feel like this technology is making
• 2:34
  - things better for our clinicians. So we started
• 2:38
  - with implementing AI scribing, and many of my
• 2:41
  - colleagues around the country have done the same
• 2:42
  - thing. We're just this month approaching the three
• 2:45
  - millionth note transcribed by our caregivers. So
• 2:49
  - really wonderful uptake among,
• 2:52
  - physicians and clinicians and medical students and and
• 2:55
  - and folks. And what we see with that
• 2:58
  - is just the ability to refocus
• 3:00
  - on the patient. And so
• 3:03
  - wonderful testimonies from patients that say my doctor
• 3:06
  - sat and talked with me and looked me
• 3:07
  - in the eye instead of looking at the
• 3:08
  - computer screen,
• 3:10
  - and the same from the physician side where
• 3:12
  - they're really able to reengage.
• 3:13
  - And then at the end of the documentation,
• 3:15
  - if it's reviewed and and done well, I
• 3:18
  - think it's more robust because it captures everything
• 3:21
  - that was said where
• 3:22
  - sometimes I'll look at that note and be
• 3:24
  - like, oh, I forgot we talked about that.
• 3:25
  - That's really good. Let's leave that point in
• 3:27
  - there. So that was a wonderful addition, step
• 3:29
  - one. The second tool that we have implemented
• 3:32
  - across the whole triangle area for for all
• 3:36
  - of our health care team members, not just
• 3:38
  - the physicians and the APPs, is a is
• 3:41
  - a AI chart summarization tool.
• 3:43
  - So that tool, at the start of an
• 3:45
  - encounter,
• 3:46
  - reads the medical record. Sometimes it'll come back
• 3:48
  - and say we looked at a 100,000 data
• 3:50
  - points,
• 3:51
  - and it can summarize for me the story
• 3:53
  - of a patient. And I can tell it
• 3:56
  - what to go look for. So my practice
• 3:58
  - is still in treating, you know, cranial neurosurgery
• 4:00
  - patients. I focus the questions I ask it
• 4:03
  - on
• 4:04
  - things that impact my practice. Have there been
• 4:06
  - MRIs? Are there prior instances of neurosurgery?
• 4:09
  - Are there medical conditions that would impact surgery?
• 4:11
  - My wife is a medical oncologist. She might
• 4:14
  - ask it very different questions.
• 4:15
  - You know, what... Tell me about the cancer.
• 4:17
  - What chemotherapy has been given? You know, what
• 4:19
  - what are the recent changes in the labs?
• 4:21
  - And then you can just query it and
• 4:23
  - ask a question like we all do with
• 4:25
  - with, you know, CHAT, GPD, or CLOG. You
• 4:27
  - know? What... What's the most recent weight for
• 4:30
  - this patient or whatever point we want? So
• 4:32
  - the combination of those two, an ambient scribing
• 4:35
  - and an AI chart summarization tool deployed well,
• 4:38
  - I think, is really making a difference for
• 4:40
  - our workforce. And particularly with the AI summarization
• 4:44
  - tool, it's not just our doctors, but our
• 4:46
  - nurses, our care managers,
• 4:49
  - transfer center, our access referral management people are
• 4:53
  - all using that to more quickly get the
• 4:55
  - information they need. Right? They say the average
• 4:57
  - medical record is, you know, half the length
• 4:59
  - of Hamlet. It's very hard in a fifteen
• 5:02
  - minute visit to get through half of Hamlet.
• 5:04
  - I didn't get through it in all of
• 5:05
  - high school. I'm certainly not gonna get through
• 5:07
  - it in the morning in clinic.
• 5:09
  - I love that. I've never read Hamlet, but
• 5:12
  - Yeah. I don't know if I'd wanna tackle
• 5:14
  - it. It's long and and some find it
• 5:16
  - beautiful and wonderful to read, but others find
• 5:18
  - it very difficult to get through. And I
• 5:20
  - think the medical record is kind of the
• 5:22
  - same.
• 5:23
  - Yeah. Yeah.
• 5:24
  - Yeah. You mentioned that,
• 5:27
  - the AI
• 5:28
  - scribe and possibly even the AI chart summarization
• 5:31
  - is used by medical students.
• 5:34
  - I'm curious what your policy is on, like,
• 5:38
  - at what point is a medical student allowed
• 5:40
  - to use that AI technology? Because I know
• 5:42
  - there's been concerns about ensuring they have enough
• 5:44
  - clinical
• 5:45
  - judgment
• 5:46
  - before kinda using the... That tech.
• 5:49
  - Right. So the first thing is as an
• 5:52
  - institution,
• 5:53
  - UNC Health has very firm AI governance and
• 5:56
  - policies. So all of our
• 5:59
  - applications of
• 6:00
  - AI require that it end with a human
• 6:02
  - being. And all of our education is that
• 6:04
  - this is a tool that you can use,
• 6:07
  - but that you are responsible
• 6:09
  - for what you generate with it. And so
• 6:12
  - there is a cert... Certain set of skills
• 6:14
  - that we need our medical students, our residents
• 6:17
  - to learn, and we don't wanna replace that
• 6:20
  - opportunity with these sorts of tools.
• 6:22
  - On the other hand, I'm firmly convinced that
• 6:25
  - by the time any of those folks get
• 6:27
  - out into their own practice, these tools and
• 6:30
  - and additional ones will be embedded in the
• 6:32
  - normal workflow.
• 6:33
  - So we wanna teach them the basic history
• 6:36
  - taking skills. We wanna teach them where they
• 6:39
  - find information that they need in a hurry.
• 6:41
  - But I also want them to be prepared
• 6:43
  - for practice
• 6:44
  - and what it will look like when they
• 6:46
  - finish their career. And that practice will include
• 6:49
  - ambient scribing, AI summarization,
• 6:52
  - rapid access to medical information using some sort
• 6:55
  - of query function, and they need to learn
• 6:57
  - to be
• 6:58
  - successful practicing physicians using those tools. So, certainly,
• 7:03
  - we don't wanna cheapen
• 7:05
  - the medical education or the basic skills, but
• 7:07
  - I think more and more this is part
• 7:09
  - of the basic skills. When I was a
• 7:11
  - medical student,
• 7:12
  - we could memorize
• 7:13
  - or keep on a note card everything we
• 7:15
  - needed to know.
• 7:17
  - Nowadays,
• 7:18
  - it's more about
• 7:20
  - knowing where all the information is and being
• 7:22
  - able to access it, but the
• 7:24
  - expansion of medical information makes it impossible for
• 7:27
  - almost anyone to hold it all in their
• 7:29
  - mind. They have to be really good at
• 7:31
  - finding it quickly, and these are just tools
• 7:33
  - to find the right information.
• 7:35
  - Before, everything could be fit on a note
• 7:38
  - card.
• 7:39
  - Now
• 7:40
  - definitely not able to fit on a note
• 7:43
  - card unless you have very, very, very small
• 7:45
  - handwriting,
• 7:46
  - and it's more important, what I'm hearing is
• 7:49
  - more important to be able to identify and
• 7:51
  - access that information rather than just like automatically
• 7:54
  - have it, which is just near
• 7:56
  - impossible.
• 7:57
  - Right. And and we need to help
• 8:00
  - our learners to know. There's certain things you
• 8:02
  - just have to know. Like, if a patient
• 8:03
  - has a sudden emergency
• 8:05
  - in neurosurgery, you need to know how to
• 8:07
  - treat a patient who's having herniation.
• 8:09
  - You can't
• 8:10
  - go look that up.
• 8:11
  - So... But if there's so much information, you
• 8:14
  - can no longer prioritize. These are the things
• 8:16
  - that I must know immediately.
• 8:18
  - These are things that I need to know
• 8:20
  - where to find. And and then I need
• 8:22
  - to be inquisitive when I face something I've
• 8:24
  - never seen before. How do I
• 8:26
  - harness the whole world of information to find
• 8:28
  - new information that's never been presented to me
• 8:31
  - before? Kind of three different skills,
• 8:33
  - and we wanna we wanna help develop all
• 8:36
  - three of those. And not just in the
• 8:38
  - medical student, even in the people who are
• 8:39
  - currently practicing, the practice of medicine is changing.
• 8:42
  - So the skill set I brought from Johns
• 8:45
  - Hopkins in 1999 or 1997 when I finished
• 8:48
  - residency isn't the one that helps me be
• 8:50
  - successful today. I built on that, but we
• 8:52
  - have to all be constantly evolving in the
• 8:54
  - way we deliver our care and seek information.
• 8:58
  - On a slightly different topic than,
• 9:00
  - kind of new technology tools, but kind of
• 9:03
  - in the same vein as, like, dealing with
• 9:06
  - today's status.
• 9:07
  - For UNC,
• 9:09
  - with the difference between employed and independent practices,
• 9:12
  - physicians, clinicians,
• 9:14
  - can you kinda spell out
• 9:16
  - that dynamic
• 9:18
  - in
• 9:18
  - the, triangular area?
• 9:21
  - Yeah. Let me let me frame UNC Health
• 9:24
  - as it is today. We started as a
• 9:27
  - single academic
• 9:29
  - hospital
• 9:30
  - and a faculty practice in Chapel Hill. You
• 9:33
  - know, the health care system came into existence
• 9:35
  - in the late nineties. We've now grown to
• 9:37
  - be a statewide system with 20 hospitals.
• 9:41
  - We have two large physician
• 9:43
  - arms. Our
• 9:44
  - academic arm, we call the faculty practice, and
• 9:47
  - then a large
• 9:48
  - community arm that we call the medical group.
• 9:51
  - And these two groups
• 9:53
  - all practice as part of UNC physicians.
• 9:56
  - The the practices,
• 9:58
  - are different somewhat in terms of the scope
• 10:01
  - of practice. Our community physicians are often, you
• 10:03
  - know, spread across our state. They're very close
• 10:05
  - to the people they care for. They they
• 10:08
  - provide
• 10:09
  - rapid access,
• 10:11
  - a great patient experience, really good care, often
• 10:14
  - treating frontline problems. Then we have our specialists
• 10:17
  - who
• 10:18
  - work in the community, and then we have
• 10:19
  - our academic physicians who are often quite subspecialized.
• 10:22
  - We also, at a number of our hospitals,
• 10:25
  - have independent physicians in the community who are
• 10:27
  - crucial parts of practicing at that hospital. And
• 10:30
  - so for us as a health care system,
• 10:33
  - we wanna have a way for all of
• 10:35
  - those folks to contribute to the care of
• 10:37
  - patients and for us to be able to
• 10:39
  - integrate that care so that the patient feels
• 10:41
  - like they're seamlessly being cared for, not being
• 10:44
  - moved from silo to silo to silo.
• 10:47
  - We have a large clinically integrated network that
• 10:50
  - spans much of North Carolina,
• 10:52
  - and it's about 8,000
• 10:54
  - providers of various sorts. About two thirds of
• 10:57
  - those folks are employed by UNC Health or
• 10:59
  - the School of Medicine, but a full one
• 11:01
  - third of them are independent doctors or
• 11:04
  - pharmacists or APPs who've chosen to partner with
• 11:07
  - UNC Health to work on quality and value.
• 11:10
  - So the first way that we have brought
• 11:12
  - a partnership between independent physicians and physicians who
• 11:15
  - work for the health care system is through
• 11:16
  - our clinically integrated network, which aligns us around
• 11:20
  - those really important values. Let's let's take better
• 11:22
  - care of folks. Let's make it more cost
• 11:24
  - efficient.
• 11:25
  - And we wanna be the choice partner for
• 11:27
  - independent physicians
• 11:29
  - in North Carolina
• 11:30
  - to to work with. And that,
• 11:33
  - expands the impact of our health care system
• 11:35
  - in in our mission to meet the state
• 11:37
  - without requiring that if you wanna work with
• 11:39
  - us, you have to come be employed by
• 11:40
  - us because not everybody wants to be employed
• 11:43
  - by a big system. And I don't think
• 11:45
  - all doctors should be employed by a large
• 11:47
  - system. I think there there is a place
• 11:49
  - in good health care for independent groups and
• 11:52
  - for community arms of big systems and for
• 11:54
  - academic arms of big systems.
• 11:57
  - And
• 11:58
  - we have other independent folks who work at
• 12:00
  - our hospitals,
• 12:01
  - even if they aren't part of our clinically
• 12:03
  - integrated network, and we want them to feel
• 12:05
  - like they are aligned with our mission of
• 12:08
  - striving for quality and and great patient experience
• 12:11
  - and great provider experience
• 12:13
  - even if they're not,
• 12:15
  - either employed by us or part of our
• 12:16
  - clinically integrated network. So we just view it
• 12:19
  - as a whole spectrum, and we wanna meet
• 12:21
  - each group where it is and have a
• 12:23
  - way that our system interacts with them in
• 12:25
  - a way that brings value both for their
• 12:27
  - patients and for them.
• 12:29
  - Has there been a recent, like, tension between
• 12:31
  - wanting to standardize
• 12:33
  - as a system
• 12:34
  - versus kind of meet the individual
• 12:36
  - needs of each group, each cohort?
• 12:39
  - Yes. Of course. And and there is... Even
• 12:43
  - within our system, within the folks who who
• 12:45
  - are, you know, part of our team and
• 12:47
  - are are employed for the system, we're always
• 12:50
  - seeking a balance between trying to get care...
• 12:53
  - Onto care pathways,
• 12:55
  - but also allow
• 12:57
  - some variability for people in terms of their
• 12:59
  - own practice.
• 13:00
  - Always believe that leading with data,
• 13:03
  - leading with inclusiveness
• 13:05
  - in the decision making,
• 13:07
  - and in the process...
• 13:09
  - I mean, not everybody can be in charge
• 13:11
  - or decide, but if you bring all the
• 13:12
  - neurosurgeons together to decide on how to solve
• 13:15
  - a particular problem and give everybody a voice
• 13:17
  - in that area of process, then when you
• 13:19
  - make a decision, you're more likely to get
• 13:21
  - uptake. And then we like to come back
• 13:23
  - to everybody and share the data to show
• 13:25
  - the success that we've had.
• 13:27
  - And, you know, we have hundreds of care
• 13:29
  - pathways deployed across our system, and we believe
• 13:32
  - we can show folks where there's been real
• 13:34
  - improvement in
• 13:36
  - outcomes. And then
• 13:38
  - once it... Because steam rolls, once people see
• 13:40
  - like, oh, that's that's better. And it will
• 13:43
  - be better for my patients and
• 13:45
  - and better for me, and it removes some
• 13:47
  - of the decision fatigue of making a million
• 13:49
  - decisions. But it's
• 13:51
  - certainly a step more challenging to take independent
• 13:54
  - physicians who work with us as part of
• 13:56
  - our CIN or at our hospitals and be
• 13:59
  - inclusive
• 14:00
  - in the process,
• 14:01
  - but also realize that if you're... You know,
• 14:04
  - the care at our hospitals, we are accountable
• 14:06
  - for. And so we are gonna have some
• 14:08
  - standards and and some care pathways that we
• 14:10
  - expect everybody to follow.
• 14:13
  - I have one more question. I know we're
• 14:14
  - kinda coming up on time, but I really
• 14:15
  - wanna ask this. It's related to workforce.
• 14:18
  - So you've recently changed
• 14:20
  - your compensation
• 14:22
  - model. Can you kinda delve into that a
• 14:24
  - bit? Sure. So we we start out out
• 14:26
  - of the gate with a large academic arm
• 14:28
  - and a large community arm, and the world
• 14:32
  - looks at those two groups differently. If you
• 14:34
  - pull the benchmarks,
• 14:35
  - they're different for academic and community physicians. So
• 14:39
  - we have a single philosophy
• 14:41
  - about physician compensation. It should be transparent.
• 14:44
  - It should be,
• 14:46
  - tied directly to
• 14:48
  - individual
• 14:49
  - performance and the overall performance of the care
• 14:52
  - that's delivered within, you know, the hospital or
• 14:55
  - the practice. It should be easy to understand,
• 14:59
  - it should be explainable,
• 15:00
  - and it should be tied to to work
• 15:03
  - standards.
• 15:04
  - Our academic physicians have a slightly different job
• 15:07
  - and scope, and they take on research and
• 15:09
  - education to a deeper degree than most of
• 15:11
  - our community physicians.
• 15:13
  - A compensation plan needs to account for that.
• 15:15
  - Our community physicians are often
• 15:18
  - spend more time clinically engaged, and we wanna
• 15:20
  - make sure the plan accounts for that. And
• 15:22
  - so we've just tried to build on these
• 15:24
  - same principles
• 15:25
  - in both groups, and that would be perfect
• 15:28
  - if they never interacted with each other. But,
• 15:30
  - of course,
• 15:31
  - academic and community are... Is a Venn diagram,
• 15:34
  - and they overlap. And so the challenge has
• 15:37
  - been when we have academic and community physicians
• 15:40
  - sitting side by side in the workplace
• 15:43
  - but on different compensation plans. So we have
• 15:45
  - worked to build hybrid plans that account for
• 15:48
  - when people are working in a... So if
• 15:50
  - you're an academic position, but you're spending most
• 15:53
  - of your time out in what really looks
• 15:55
  - like community practice, we built a separate employment
• 15:58
  - model. We have different compensation plans that acknowledge
• 16:00
  - this is the reality of the practice you
• 16:02
  - have, the work standards, the call expectations, the
• 16:05
  - involvement of residents or others, and tried to
• 16:08
  - to have it sort of be a sliding
• 16:10
  - scale. I'll be honest. It's a work in
• 16:12
  - progress. But by starting with a single philosophy
• 16:15
  - across the group
• 16:16
  - and building off of that, we think we're
• 16:18
  - making progress
• 16:20
  - towards getting a better overall compensation strategy that
• 16:24
  - encourages people to provide high quality care, facilitate
• 16:28
  - access for patients,
• 16:30
  - push for great patient satisfaction scores, and and
• 16:33
  - take care of the team that's that's delivering
• 16:35
  - that care.
• 16:37
  - Well, thank you so much, doctor Yuen, for
• 16:39
  - joining me on the podcast today. I just
• 16:41
  - really appreciate
• 16:42
  - your time. So just thank you again. Yeah.
• 16:45
  - No, Paige. Thank you for the chance to
• 16:46
  - be here.
• 16:48
  - At Vitality,
• 16:49
  - we're transforming health care to improve lives.
• 16:52
  - As a physician owned multi specialty partnership,
• 16:56
  - we put patients first in every decision.
• 16:59
  - With 6,000 clinicians caring for over 10,000,000 people
• 17:03
  - each year,
• 17:04
  - we lead with innovation
• 17:06
  - to make care more connected,
• 17:09
  - more responsive,
• 17:10
  - and
• 17:11
  - more human.
• 17:12
  - Learn more at vituity.com.