Latest / Becker’s Healthcare Podcast / Laren Tan, MD, MBA, Chair of the Department of Medicine at Loma Linda University School of Medicine and COO of the Loma Linda University Faculty Medical Group

Transcript

Laren Tan, MD, MBA, Chair of the Department of Medicine at Loma Linda University School of Medicine and COO of the Loma Linda University Faculty Medical Group · Becker’s Healthcare Podcast

• 0:02
  This is where health care leadership comes together.
• 0:04
  Becker's sixteenth annual meeting brings more than 3,500
• 0:07
  hospital and health system executives and nearly 800
• 0:11
  speakers to Chicago April.
• 0:14
  This year's event includes keynote conversations with Dallas
• 0:17
  Cowboys legend Troy Aikman and former president George
• 0:20
  w Bush. For the agenda and event details,
• 0:23
  visit beckershospitalreview.com
• 0:25
  and click on the events tab in the
• 0:27
  upper right. We're looking forward to hosting you
• 0:29
  in Chicago.
• 0:32
  Hi, everyone, and welcome to Becker's Healthcare podcast.
• 0:35
  My name is Giles Bruce. I'm an assistant
• 0:38
  editor with Becker's Healthcare.
• 0:39
  I'm pleased to be joined today by doctor
• 0:41
  Laren Tan. We are gonna be talking about
• 0:44
  some AI and digital health related projects at
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  his organization,
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  following up on our our discussion at the
• 0:51
  Becker's
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  AI Summit at our CEO
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  CFO roundtable recently.
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  Laren, we're really pleased to have you join
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  us today.
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  Thank you, Giles. It is
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  a great honor. I'm humbled to be able
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  to to be here on this podcast,
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  and thank you for the introduction.
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  Of course. And and can you tell me
• 1:12
  a little bit more about your your role
• 1:14
  in your organization
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  and and what you're doing these days?
• 1:17
  Absolutely.
• 1:18
  Currently,
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  at this time, I I am still a
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  practicing pulmonary and critical care physician. I do
• 1:24
  inpatient in the medical ICU,
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  do pulmonary consults, and also have a very
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  small footprint on the outpatient side.
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  I've been blessed to serve as the chair
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  of the department of medicine here at Loma
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  University,
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  in school of medicine.
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  In addition to that, I also serve as
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  the chief operating officer, officer,
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  for our faculty medical group, which is the
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  physician side of Loma Linda University Health.
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  Excellent. Well, again, we're pleased to have you
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  join us. And,
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  yeah, I just wanna keep the conversation going
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  from the the last time we talked. So,
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  yeah, I meant to keep talking about that.
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  We were at the the Becker's AI summit
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  at our our conference in the, fall. And
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  and there, you drew a a parallel between
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  Star Wars and New Hope and how clinicians
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  view AI. It was
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  a, yeah, cool metaphor and one that stuck
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  with me. So what does New Hope, you
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  know, what does that New Hope look like
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  to you today? Is it more about relief
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  from burnout or renewal of purpose in medicine?
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  And how do you balance that optimism with
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  the practical fears that clinicians still have around
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  AI?
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  That's
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  and and that's I think that that is
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  that is probably one of the biggest issues
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  that we're facing right now, especially in in
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  health care,
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  where everywhere you turn, there seems to be
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  more work to be done. Access continues to
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  be piling up or be extremely hard to
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  to provide adequate access.
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  And and as a clinician, I'm looking and
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  and we're looking for hope. Right? And and
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  that's where that that
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  example of looking at Star Wars in in
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  the title of a new hope.
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  And I know that during Becker's, it it
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  was it was cool. It was a lot
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  of laughter, but, you know, I wasn't trying
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  to just be cute. I was really being
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  honest.
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  There's so much pressure that we're feeling as
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  if we're fighting an empire.
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  Right? Much like within Star Wars. Only this
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  empire that we're that we're battling has to
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  deal with the clicks, the inboxes,
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  the documentation,
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  access throughput,
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  trying to review medical histories and clicking all
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  these various different things. These are all important
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  components, but it is just so much duties.
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  And that's where a new hope came in.
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  Right? And and where
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  it is not necessarily just
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  a a a new hope in how we
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  do things, but really
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  a new hope in both relief and renewal.
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  Yeah. That really paints a great picture,
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  particularly some for someone like myself who grew
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  up watching those old Star Wars movies.
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  But, yeah, great examples there. So in the
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  panel, you also said that AI could help
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  clinicians,
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  get back to doing what they love to
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  do. What what specific technologies or workflows have
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  actually freed your physicians to spend more face
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  to face time with patients?
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  And how are you measuring whether AI is
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  truly improving the human connection in care?
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  I think this is this is where part
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  of that new hope and where we're looking
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  at
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  is
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  is is being able to get us back
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  to what we love. And and I wanna
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  be at least very clear with all the
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  listeners, and I think many on that are
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  listening in will actually agree that not all
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  AI
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  are gonna deliver on on that promise. Right?
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  Some are actually just moving the burden around,
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  in and that's not what what I am
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  actually
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  talking about. It it's where where that real
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  impact
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  that we're seeing within health care, especially is
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  through ambient AI documentation,
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  intelligent chart, like, summarizations,
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  whether that be on,
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  seeing a new patient for the first time
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  and more on discharge summaries, utilizing
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  the, like, inbox triages.
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  All these various things may I know we've
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  probably heard this time and time again are
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  flashy.
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  They they draw our attention, but they truly
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  are liberating when used in the right fashion.
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  See, many times when as physicians we walk
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  into a room,
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  we do see that there is this barrier,
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  this barrier between the patient and what I
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  need to type and document.
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  But through utilizing, let's say, Ambient AI documentation,
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  now our eyes are actually
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  replacing actually the typing. Right? The eye contact
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  with our patients.
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  And I feel, at least when I'm in
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  clinic or seeing these patients, they're they do
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  see this immediately. It's like, oh, you used
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  to spend more time typing and not even
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  looking at me, and now you're actually are
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  looking at me.
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  Let alone also, I think that there are
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  some clinicians who who are
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  utilizing
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  AI Ambient,
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  but are still looking at the computer screen
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  and not at the patient. So so this
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  is where, again,
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  just because you have some new AI technology,
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  it doesn't necessarily mean it actually
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  relieves everything. It's just how we're gonna end
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  up needing to use it and using it
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  appropriately.
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  To answer your other question on how we're
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  actually measuring things, we've seen a reduction in
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  after hours documentation
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  very similar to what others have already reported,
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  somewhere between ten to thirty five percent.
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  Time to note
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  closures is another one that we've looked at.
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  You know, what used to for some people
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  could be hours, even days, have now been
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  minutes right after the encounter is done.
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  Physician reported presence during visits have actually improved.
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  And, yes, patient experience scores have actually improved
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  too. But you see, again, it it really
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  depends on how that clinician is actually utilizing
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  the AI tool. Right? Just because you have
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  it, we still have to be able to
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  use it in the right way.
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  So, you know, when we look at things,
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  AI is saving time,
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  but it isn't, oh, how we feel is
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  actually eroding trust.
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  I think the human connection
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  still can be preserved at this scale as
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  we continue to use more and more
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  AI solutions.
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  Yeah. Yeah. Really interesting points there, especially
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  the one you made about
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  you know, it doesn't mean that clinicians are
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  automatically going to be not looking at the
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  computer screen either, you know, out of habits
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  or or because there are still things they
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  need to to look in on there that
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  that AI isn't isn't accomplishing for them.
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  At the conference, you also shared a great
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  story about, rolling out Ambien AI to surgeons
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  and how culture
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  and not the technology itself determines success. What
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  what did that experience teach you about managing
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  cultural resistance among highly specialized teams, and and
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  how should leaders approach AI adoption differently across,
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  different service lines?
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  Yeah. I I I gave that example
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  as and I and I did use surgeons,
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  but I'll but I'll see I'll broaden it
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  out to surgeons and even non surgeons.
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  It's just that our surgeons really are are,
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  what I would say,
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  just really
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  set in a lot in in a lot
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  of cultures. And and I think that's that's
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  the thing. It's and and rightfully so, our
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  surgeons have a way of doing things. And
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  just like Mandalorians,
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  this is the way Well, this is the
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  way we do things. And you could say
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  that that for even non surgeons too. But
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  surgeons are precision driven. Right? They don't tolerate
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  inefficiency
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  or loss of control.
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  And so that's why it's very important, at
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  least, when we look at
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  at the surgical way or or or how
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  surgeons actually
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  go about with new change,
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  it's very important to understand at least the
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  culture.
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  Because culture beats technology every single time.
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  And while I was trying to roll it
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  out to some of our surgical groups,
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  I it it it made me realize very
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  quick
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  that the tech wasn't the problem.
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  What we were facing is the culture, the
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  egos that were there, the identity, the workflow
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  pride that has taken years within a surgical
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  practice
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  that we're trying to actually truly disrupt in
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  a lot of ways. So, you know, it
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  it it really was a time to to
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  just understand
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  and and and
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  see how is it that I that we
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  could try to
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  to reframe it so this way we would
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  have better adoption.
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  Right?
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  Culture eats strategy for breakfast. That that is
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  what Peter Drucker has always stated. Right? Especially
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  in health care. So subculture eats culture even
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  at that.
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  So we have to tailor our adoptions.
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  A lot of times what I found within
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  our surgical groups is they want proof. They
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  want pure validation.
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  For our primary care, the culture is they
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  want relief and speed. For our trainees that
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  are coming up to be the future of
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  health care, they want fluency and safety.
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  So all these various different things need to
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  come into play.
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  And and really the context is gonna end
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  up being leadership. How do we actually go
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  about to make it sort of this way?
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  Everything is reframed
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  where it is now this ambient technology,
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  especially with with,
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  ambient AI scribes. It is your silent assistant.
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  You know, and and that this is gonna
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  be something that's gonna help you out. And
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  from a surgical perspective, imagine a silent assistant
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  that never scrubs out.
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  Right? That itself is is mind is is
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  is almost like just a different mindset frame.
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  It's a different change, and that's helped out
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  some of our surgical groups to be completely
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  off,
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  utilizing live scribes to now changing now to
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  only just using ambient AI
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  scribes. Yeah. We had really great success there.
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  You you gave another Star Wars example, of
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  course, with Mandalorians,
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  you know, people who might be set in
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  their way, quote unquote, armored by habit.
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  So how do you persuade these another, quote,
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  unquote, warriors to, you know, take off the
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  helmet and trust these AI powered tools? And
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  have you found any early adopters who later
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  became champions and helped change the narrative of
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  your organization?
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  I I love, you know,
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  just the Mandalorians itself because there's there's so
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  many parallels to, I think, what we face
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  in life and and and in any sector
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  of of health care or business.
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  And and we talked about, you know, what
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  you mentioned is is is an armor. I
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  think all of us to some degree, shape,
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  and form actually have some armor, whether that
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  you're a surgeon or nonsurgeon.
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  And and that, at least in health care,
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  that armor has kept patients alive for decades.
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  Right? It's such in a way that that
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  is this is what we do. This is
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  how we do it. And you don't wanna
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  rip it off. Right?
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  And in order to even have that change
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  or we would say vulnerable state, you have
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  to earn that right. We have to earn
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  that right in order for them to to
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  loosen it. And
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  and that's why,
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  you know, trying to immediately say that that
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  we're gonna lead with
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  this is the way to do it because
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  this is AI and this is how everybody
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  else is doing it. Doesn't doesn't resonate.
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  Right? As well as
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  this is the way we're gonna lead because
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  it gives you five minutes back of your
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  with your patient. Right? There is it is
• 12:29
  gonna improve
• 12:30
  the the various different cares. Almost like we
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  could say starting back with the why to
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  be able to gain back that trust.
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  I remember very early on
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  when we were first trying to be able
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  to get this in a room full of
• 12:43
  surgeons,
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  it was there was a lot of discussions.
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  Right? This is not the way we've done
• 12:48
  things. This is the way I do things.
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  My way is a little more efficient, and
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  then just things just spiral out of control.
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  But all it took was just one or
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  two early adopters. Right? One or two different
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  surgeons.
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  And it started the skepticism
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  started to to really change. Now so much
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  so where it's I can't go without my
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  clinic visit without Ambient AI or utilizing AI
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  in some shape or form to be able
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  to help me be more efficient.
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  So, you know, at least for me in
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  looking at this, and we talked about the
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  Mandalorians, the narrative has truly changed. You know,
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  the pure credibility,
• 13:22
  the getting the culture clan altogether to be
• 13:24
  aligned has really proven to be probably one
• 13:27
  of the best things rather than an executive
• 13:30
  decree saying that this is the way it's
• 13:31
  gonna be and this is how you need
• 13:33
  to do it.
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  Yeah. And at the the conference, you also
• 13:38
  mentioned that Loma Linda has about 1,100 residents,
• 13:41
  a k a, the the future of medicine.
• 13:43
  So how are you integrating AI literacy,
• 13:46
  into your medical education so residents graduate
• 13:49
  comfortable using these tools?
• 13:51
  And, also, what skills do you think tomorrow's
• 13:53
  physicians will need that today is often don't
• 13:55
  have?
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  That that is
• 13:58
  you're spot on, Giles. And and I'm I'm
• 14:00
  glad you mentioned about at least residents because,
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  you know, our residents, our fellows,
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  this is the future of health care. I
• 14:07
  I remember my mentor at some point saying,
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  hey. You know, I'm putting all this time
• 14:11
  into you because at some point, I'm gonna
• 14:13
  need medical care, and you may end up
• 14:15
  being the one that's gonna take care of
• 14:17
  me.
• 14:18
  And and I just see that, you know,
• 14:20
  if my residents and my fellows and our
• 14:22
  learners are able to actually learn something that
• 14:25
  makes it so they can refocus back, be
• 14:28
  happier of what they do, provide even better
• 14:30
  medical care, then I'm gonna be a recipient
• 14:32
  of that. That's a selfish,
• 14:33
  like, look into it. But externally looking at
• 14:37
  at health care as a whole,
• 14:39
  it is our responsibility
• 14:41
  to to be able to make sure that
• 14:43
  that our learners, our residents, and fellows are
• 14:46
  able to safely and use this technology in
• 14:49
  a transparent way.
• 14:51
  And so
• 14:53
  being able to train them on how to
• 14:55
  use it as clinical documentation,
• 14:57
  use it to synthesize evidence, you know, the
• 15:01
  the the health care literature continues to grow
• 15:03
  exponentially.
• 15:04
  And being able to pull in multiple papers,
• 15:07
  synthesize it in a way that they can
• 15:09
  responsibly use it for their patient care is
• 15:11
  huge.
• 15:12
  Understanding that there are biases and there there
• 15:15
  are some ethics that's gonna be involved, These
• 15:18
  are all key components beyond just the,
• 15:22
  the the documentation,
• 15:24
  the various different utilizations
• 15:26
  of of coding and whatnot.
• 15:28
  So the this is this is the future,
• 15:31
  and this is what's needed. And and how
• 15:33
  we actually integrate it within here at Loma
• 15:35
  Linda is being able to let our learners
• 15:38
  experience it, letting them be able to experience
• 15:41
  ambient AI tool for them to start learning
• 15:44
  so that once they're done and they're graduating
• 15:47
  into wherever they go, they'll seamlessly build it
• 15:50
  integrated into their workflow.
• 15:52
  So tomorrow's physicians, at least, you know, they
• 15:55
  need to be able to to answer these
• 15:57
  questions on how to explain
• 16:00
  AI and decisions to their patients, how they're
• 16:02
  gonna be accountable.
• 16:04
  And I'm hoping that all these things that
• 16:05
  they're learning now here at Loma Linda will
• 16:07
  help them
• 16:08
  to be able to be,
• 16:11
  that much more efficient and also responsible in
• 16:14
  applying AI.
• 16:17
  Yeah. Great stuff there and and so important
• 16:19
  for the future of health care.
• 16:21
  So, yeah, also on the panel at our
• 16:23
  our conference, you predicted that AI will let
• 16:25
  health care do more with less, but also
• 16:28
  give clinicians the chance to refocus.
• 16:30
  So when you look five years ahead, what
• 16:32
  what does success look like to you, and
• 16:34
  how will you know if AI has truly
• 16:35
  transformed the workforce for the better?
• 16:38
  I I see success in the next five
• 16:41
  years
• 16:42
  as
• 16:43
  is it
• 16:44
  with fewer physicians doing more work? I don't
• 16:46
  see it that way.
• 16:49
  I I feel that's a failure with the
• 16:50
  better tools.
• 16:52
  Because what we know more and time and
• 16:53
  time again is we have to be able
• 16:55
  to focus back to build that relationship with
• 16:57
  our patients, and we actually need more physicians,
• 17:00
  more clinicians to actually do work.
• 17:03
  And and really, what do I mean by
• 17:06
  that? More specifically,
• 17:07
  our physicians and clinicians need to be practicing
• 17:09
  at the top of their license, not not
• 17:12
  be suppressed because of all the various different
• 17:15
  administrative things that we need to do.
• 17:17
  Teams need to be augmented.
• 17:19
  Right? Not necessarily replaced.
• 17:22
  I think there are some positions that are
• 17:24
  going to be replaced,
• 17:25
  but we can be able to augment either
• 17:27
  those those different
• 17:29
  positions to somewhere else or strengthen the current
• 17:32
  positions that we actually have.
• 17:34
  One of the biggest things that I see
• 17:36
  time and time again, at least within health
• 17:38
  care, we've talked about this for years, is
• 17:40
  burnout. Right? The burnout curves
• 17:43
  really should be bending downward, especially if we're
• 17:46
  utilizing AI in the right manner.
• 17:48
  And then actually being able to hack medicine
• 17:52
  feel meaningful again. Right? Building that relationship, turning
• 17:55
  it back to the patient, being able to
• 17:57
  connect and touch physically touch that patient again
• 18:01
  is gonna be amazing. So I'll know we
• 18:04
  succeeded
• 18:05
  when
• 18:06
  I'm seeing our clinicians leave work with energy
• 18:09
  left, being able to go because I utilize
• 18:12
  AI, I'm able to go exercise. I'm able
• 18:14
  to spend more meaningful time with my my
• 18:17
  my family, my friends.
• 18:20
  And then also seeing that
• 18:22
  the new wave, the new future,
• 18:25
  those that may not have already entered medicine
• 18:27
  or looking to enter into medicine will want
• 18:30
  to do it because they go, hey, they
• 18:31
  found a way to be more efficient.
• 18:34
  And I'm seeing that there are healthier
• 18:36
  clinicians or physicians, and look at how happy
• 18:39
  they are. Well, I want some of that
• 18:40
  too.
• 18:42
  I think those two things are gonna be
• 18:44
  really important
• 18:45
  as as I see for success. And then
• 18:47
  lastly, it comes down to what the patient
• 18:50
  truly feels. Right? If we're able to establish
• 18:54
  great relationship with our patients and they go,
• 18:57
  man, my doctor really listened to me because
• 19:00
  of x, y, and z technology.
• 19:03
  Fantastic.
• 19:04
  I don't think AI isn't the hero of
• 19:06
  the story. I think our clinicians are gonna
• 19:08
  continue to be the heroes of these stories,
• 19:10
  but we need to we need to position
• 19:12
  ourselves
• 19:13
  through governance structure, through the narratives, to be
• 19:15
  able to make sure we're using it responsibly
• 19:18
  for the future
• 19:20
  of of medicine, and that's what that success
• 19:22
  is gonna look like for me.
• 19:26
  That's great. And, yeah, hopefully, we can keep
• 19:28
  the the conversation going and and, you know,
• 19:30
  check back in five years and hopefully all
• 19:32
  those things will come true. But, I I
• 19:34
  know we will keep the conversation going at
• 19:37
  our our health IT conference,
• 19:39
  next September in Chicago where you'll be a
• 19:41
  a speaker on a a panel about ambient
• 19:44
  AI. So appreciate you joining us for that.
• 19:46
  And,
• 19:47
  Laren, again, thank you so much for doing
• 19:49
  the the podcast today.
• 19:51
  Thank you,
• 20:03
  Gels.