Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Dr. Natalie Pageler, Chief Medical Information Officer at Stanford Medicine Children's Health

Transcript

Dr. Natalie Pageler, Chief Medical Information Officer at Stanford Medicine Children's Health · Becker’s Healthcare -- Pediatric Leadership Podcast

• 0:03
  It is so important for leaders at the top of organizations to keep learning,
• 0:07
  stay sharp,
• 0:07
  grow their networks to help our audience better do this in a more simplified,
• 0:11
  personalized, and meaningful way. Becker's Healthcare has launched my BHC,
• 0:16
  it's your trusted Becker's healthcare experience and more with content,
• 0:19
  connections, events, and learning opportunities.
• 0:22
  Join the community free of charge@www.my dot becker's hospital
• 0:27
  review.com, and we'll see you there.
• 0:33
  This is Chris Soer with the Becker's Healthcare Podcast.
• 0:36
  I'm thrilled today to be joined by Natalie Pager,
• 0:38
  chief Information Officer for Stanford Medicine Children's Health, Dr. Pager,
• 0:42
  thank you so much for joining us today.
• 0:45
  My pleasure. Thanks for having me.
• 0:48
  Dr. Pager,
• 0:49
  could you please introduce yourself and tell us a bit about your background?
• 0:52
  Yeah, sure. So I'm Natalie Pager. I am a pediatric intensivist, intensivist,
• 0:57
  uh, and the Chief Medical Information Officer at Stanford Children's Health.
• 1:01
  I also serve as the program director for the Clinical Informatics Fellowship
• 1:05
  across Stanford Medicine.
• 1:09
  Excellent. Dr. Pager, what do you say are top priorities today?
• 1:14
  Gosh, there are so many, but, um,
• 1:16
  a couple that come to mind immediately are continuing to try to,
• 1:20
  uh, optimize the experience and efficiency for providers and staff, um,
• 1:25
  especially using, um, our electronic health record. I think, you know,
• 1:29
  during the pandemic, uh, especially, we saw such a rise in,
• 1:34
  uh, digital health and in basket messages,
• 1:37
  so really struggling to help with some of those provider efficiency issues. Uh,
• 1:42
  and then a second major issue as we've gone forward with, uh,
• 1:46
  health information sharing across, across the nation, um, uh,
• 1:50
  I think there's a lot of really exciting, uh, potential opportunity there.
• 1:54
  But here at a, at a pediatric organization, pediatric and episte organization,
• 1:59
  we are really working hard to figure out how to do that in the most
• 2:04
  effective way for children and adolescents and their families,
• 2:07
  which has a few extra complications.
• 2:10
  I'm glad you mentioned that actually.
• 2:12
  Given your background as a pediatric intensivist,
• 2:15
  how has that affected the job you're doing right now?
• 2:18
  Yeah, so I, I think, I think there's lots of different,
• 2:20
  different ways to go there from a health information sharing. I, I, I do think,
• 2:25
  uh, there's a lot. I think we are moving in the right direction as an, as a,
• 2:30
  as a nation and really trying to empower our patients and families, um,
• 2:34
  and ensure, you know,
• 2:35
  especially with complex children that we see in at Stanford Children's, um,
• 2:40
  ensure that their families,
• 2:42
  that the families have all the information they need to,
• 2:44
  to navigate the health system. Uh, and so, you know, as I mentioned,
• 2:49
  I really think it's the right thing to do. Um,
• 2:52
  and we've had really grateful comments from some of our patients and families
• 2:57
  saying how much easier it is now that they can see their notes and, um, and,
• 3:01
  and take notes from one provider to another or,
• 3:04
  or check back in on what the plan had been when they get a little bit confused.
• 3:08
  Um, so again, totally the absolutely right thing to do,
• 3:11
  but it is a huge shift in how we approach patient care, um, as a nation.
• 3:17
  So the, the, the few things that we are working on, I think, you know,
• 3:21
  one in the, especially in the ICU setting, um, it is,
• 3:25
  it has been a change to have our patients and families, um, be able to see,
• 3:29
  you know, lab results or see, uh,
• 3:31
  data maybe sometimes even before we've seen it. Uh, and I think a lot of that,
• 3:36
  um, we've handled just through expectation setting and talk and telling them,
• 3:40
  you know, when we will talk about this information and, and,
• 3:43
  and being aware that they're seeing it and, and addressing, you know,
• 3:46
  kind of how, how the information, uh, gets released and, and,
• 3:50
  and how we will process it, you know,
• 3:52
  during rounds or when they have questions afterwards. I think the,
• 3:56
  the other issue that we really see, again at a,
• 3:58
  especially at a pediatric organization, are the challenges around adolescents.
• 4:02
  Um, we really, we know, uh, again,
• 4:05
  for some of our adolescents with complex medical conditions,
• 4:08
  having their family fully engaged in their care can be the best way to
• 4:14
  ensure that they are getting the right care and moving their health plans
• 4:17
  forward. However,
• 4:19
  for certain challenging or sensitive topics like reproductive health,
• 4:24
  like mental health, like drug and alcohol abuse,
• 4:27
  we know that some adolescents won't seek care or won't share information
• 4:32
  with their healthcare providers if they are concerned about their guardians
• 4:36
  inappropriately getting access to that information.
• 4:38
  So we've done a lot of work here at Stanford Children's to really thoughtfully
• 4:43
  approach how we share information with adolescents and their families and,
• 4:46
  and try to ensure the right information goes to the right person.
• 4:52
  Dr. Page,
• 4:53
  I understand it can be important to deploy not only technological experts in
• 4:58
  implementing technology, but also clinicians.
• 5:01
  Could you please expound upon that?
• 5:04
  Yes, absolutely. So I, I 100% agree that it's,
• 5:07
  it's critical to have clinicians involved in, uh,
• 5:12
  in all of our, uh, information systems and informatics, uh, implementations.
• 5:17
  And so we have a really advanced clinical informatics program here where we
• 5:22
  have, uh, physician informaticists, nurse informaticists, um, uh,
• 5:27
  informaticists from, from multiple other specialties,
• 5:30
  really working tightly with our information services department to ensure that
• 5:35
  we are, uh, that we are thinking through any,
• 5:37
  any implementation appropriately. Uh, so, so for example,
• 5:42
  we have a, a large range of physician and provider informaticists,
• 5:48
  uh, who are trained both in clinical informatics, um,
• 5:52
  and their own clinical specialty.
• 5:54
  And they can oftentimes really be both a partner to our analyst,
• 5:58
  but also sometimes that liaison between our analyst, uh,
• 6:01
  technical teams and the operational or clinical teams in the hospitals,
• 6:06
  um,
• 6:07
  and can really kind of help us that translator to make sure that we are clearly
• 6:10
  defining the problem and designing, you know, the best,
• 6:13
  the best solutions and thinking about how to optimize the workflows and get
• 6:18
  technology to support. Um, you know, similarly, uh, um,
• 6:22
  amongst our physician informaticists, we have a large group of, of, um,
• 6:27
  of ad adolescent medicine, uh, informaticists.
• 6:30
  So these are folks who are really on the front edge, uh,
• 6:34
  of thinking through some of these adolescent privacy issues that I was
• 6:38
  mentioning early, earlier. So, um, Ash and Shivani,
• 6:43
  Jen Carlson, Rachel Goldsteins,
• 6:44
  are all experts in both informatics and adolescent medicine at our organization.
• 6:48
  And having that perspective from, from both viewpoints,
• 6:53
  understanding the clinical needs of our adolescent population and understanding
• 6:57
  the technical options and the informatics challenges or, uh,
• 7:01
  privacy and information sharing issues has really helped them to partner
• 7:06
  with our analytics specialists, with our,
• 7:10
  our information service analysts and create novel solutions
• 7:15
  that, that truly help us optimally serve that population. Uh,
• 7:20
  similarly, I'll say, um, we have a,
• 7:22
  we have a clinical informatics fellowship program across Stanford venison. So,
• 7:27
  um, for those of you who don't know, uh,
• 7:30
  clinical informatics is now a board certified specialty.
• 7:32
  And so any clinician who has completed their clinical residency, uh,
• 7:37
  training can do a two year fellowship after, um,
• 7:40
  after their clinical training is complete, and, uh, get,
• 7:44
  get specific, develop specific expertise in clinical informatics.
• 7:49
  Uh, and again,
• 7:50
  these folks are really serving as the liaisons between our
• 7:55
  analytics teams and our, and our clinical and operational specialists, um,
• 7:59
  and or bringing their clinical viewpoint and divi and designing, uh,
• 8:03
  novel informatics implementations to improve the quality of care patient safety
• 8:08
  and patient family and provider experience. So having these, uh,
• 8:11
  these energized trainees in our program has been remarkable for moving forward
• 8:16
  some really cool innovation.
• 8:19
  I can certainly appreciate that you used the word translator.
• 8:22
  I think that is something that a lot of people can relate to when it comes to
• 8:26
  wrapping their brains around informatics. Uh, Dr Pager,
• 8:29
  how do you anticipate your role is gonna change over the next 18 months or so?
• 8:35
  Again, another great question. Uh, you know, I don't think it would be, uh, uh,
• 8:40
  uh, fair to to say anything right now,
• 8:42
  but the next 18 months without at least mentioning large language models like
• 8:46
  chat, GPT, definitely, uh, those have come on, on the scene,
• 8:51
  um, in a dramatic way. And I,
• 8:55
  I think we are at the top of the height, the height cycle right now,
• 8:57
  and really trying to understand, um,
• 9:00
  what these large language models or generative ai, um,
• 9:04
  have the power to do, um, and, and what are the potential, um,
• 9:08
  unintended consequences. So, you know, I think, um,
• 9:11
  we are lucky here at Stanford Medicine, uh, you know,
• 9:15
  on the Stanford campus and,
• 9:17
  and part of Silicon Valley to have incredible experts in advanced
• 9:22
  data science in AI machine learning. Uh,
• 9:25
  and thankfully have really been able to be thoughtful over the last couple years
• 9:29
  about how we meaningfully safely translate AI and machine learning, uh,
• 9:34
  into the clinical setting. Uh, and I think we are, you know,
• 9:37
  doing the same thing with these large language models, uh,
• 9:41
  and partnering with our vendor partners as well as our data scientists to think
• 9:45
  through, um, what the potential implications may be. Both, you know,
• 9:49
  like I said, both positive and, and both, uh,
• 9:52
  and potential unintended consequences that we need to make sure we, we prevent.
• 9:58
  What do you consider the most exciting part of language models and AI in
• 10:02
  general?
• 10:04
  You know, I think we've, we've,
• 10:05
  we've heard so much and seen so much over the last, you know,
• 10:08
  decade or so about provider burden, about clinician burden. Uh,
• 10:13
  we know that, you know, as the EHRs, uh,
• 10:16
  came onto the scene that it significantly disrupted the way, uh,
• 10:20
  clinicians do their work and have, uh, and, and,
• 10:24
  and that our providers end and other clinicians spend a, a large amount of time,
• 10:28
  uh, interacting with their computers, um, with the, with the EHR and,
• 10:32
  and having to do documentation. And so I really think, uh,
• 10:37
  we are at a point now where we have so much data that has been translated or
• 10:42
  then has been entered into the EHR. It gives us huge, you know,
• 10:45
  vast amounts of data to, to capture and to innovate upon. So I think these,
• 10:49
  you know, I think, I think data science in,
• 10:52
  in general and large language models in particular really, um,
• 10:57
  give us both the opportunity to create learning health systems,
• 11:01
  learn from our, um,
• 11:04
  from the data that is being generated every day in the clinical and operational
• 11:07
  setting, and also to hopefully mitigate some of the, the,
• 11:11
  the challenges that have been introduced by our electronic health systems and,
• 11:15
  uh, and help help capture documentation more quickly,
• 11:19
  help providers and other clinicians do their work more efficiently. So, um,
• 11:23
  both an opportunity to transcend what was ever,
• 11:27
  ever possible before through advancing learning health systems and, and,
• 11:32
  you know, hopefully to make our, our, our work more efficient, um,
• 11:37
  as we continue to adapt to these system systems.
• 11:41
  Lastly, Dr. Pager, I will ask you this question,
• 11:45
  understanding that it could be a very, very long list. Uh,
• 11:48
  but I do want to know from your perspective,
• 11:50
  what in pediatrics deserves a brighter spotlight than it's getting right now?
• 11:56
  Oh, great question. Uh, so, you know, I think we are,
• 12:00
  we are incredibly lucky that we have an,
• 12:02
  we have an amazingly vibrant pediatric community across the nation and across
• 12:06
  the world. Um, and, you know,
• 12:08
  organizations like the AAP and the Children's Hospital Association are helping,
• 12:13
  uh, helping to bring us together to highlight and and advocate for some of the,
• 12:18
  um, necessary work that needs to be,
• 12:20
  that needs to happen across pediatric execution general,
• 12:22
  and especially with pediatric informatics. So, um, you know,
• 12:26
  one example of that is how do we meaningfully, uh,
• 12:29
  enable information sharing for children, um,
• 12:33
  and their guardians and adolescents? And there's,
• 12:35
  there's multiple complexities there, uh,
• 12:38
  that we really need to continue to work through. And, and again, um,
• 12:41
  both our vendor partners and our,
• 12:43
  our professional organizations are helping us to, um,
• 12:47
  to work through those challenges. And so grateful for that work. I also think,
• 12:51
  you know, there's, there, um, there are ongoing, uh,
• 12:55
  opportunities for optimizing our health information system to specifically take
• 12:59
  care of children. Um, and, uh, you know, for example,
• 13:04
  uh, pediatric medication safety, uh, is,
• 13:08
  is a really challenging area. Uh,
• 13:11
  and pediatric dosing is much more complicated than adult medication dosing
• 13:15
  because it changes as the child ages. Um, and because, uh, it,
• 13:20
  you know, it can be weight-based or it can be age-based, or it can be, uh,
• 13:24
  based on, you know, on body surface area. Uh, and so,
• 13:29
  uh, and then,
• 13:30
  and then you add to it the complexity of making sure that both the patient and
• 13:34
  or the appropriate parent or guardian has, has access to that information, um,
• 13:39
  and that it's clear, it just gets really complex really quickly.
• 13:43
  And so we've been so grateful to our, our vendor partners, you know, like Epic,
• 13:47
  um, in really helping us to,
• 13:49
  to focus on how do we optimize some of our base,
• 13:54
  baseline, uh,
• 13:55
  functionality to really ensure the highest quality and,
• 14:00
  and highest level of patient safety in some of these,
• 14:03
  these pediatric specific areas.
• 14:08
  No doubt there are many people who share that Worthy Go. Doctor Pager,
• 14:11
  thank you so much for your time and energy and insights today. No doubt,
• 14:15
  our audience will find this very useful and hopefully we can connect again soon.
• 14:20
  Sounds great. Thanks so much for having me.