Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Gregg Nicandri, Chief Medical Information Officer at University of Rochester Medical Center

Transcript

Dr. Gregg Nicandri, Chief Medical Information Officer at University of Rochester Medical Center · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  Would you like to exchange best practices and ideas to improve care,
• 0:03
  enhance operational efficiency,
• 0:05
  and address financial challenges with your peers?
• 0:08
  Becker's Healthcare is facilitating these conversations at their eighth annual
• 0:12
  health, IT Digital health and RCM meeting.
• 0:15
  You can check your eligibility for complimentary attendance at the Lincoln,
• 0:19
  the description. We are excited to welcome you in October.
• 0:23
  This is Laura Dedo with the Becker's Healthcare Podcast.
• 0:26
  I'm thrilled today to be joined by Dr. Greg Ry,
• 0:28
  chief Medical Information Officer at the University of Rochester Medical Center.
• 0:33
  Drand is a pleasure to have you on the podcast today.
• 0:36
  Thanks, Laura. Yeah, it's great to be here.
• 0:39
  Now, I know we've got a lot to talk about. This is, you know,
• 0:42
  such an important year in space,
• 0:45
  the intersection between clinical care and medicine and it informatics.
• 0:49
  But before we dive into my questions,
• 0:51
  can you tell me a little bit more about yourself and your background?
• 0:55
  Yeah, um, so I'm an orthopedic surgeon. Uh,
• 0:59
  I practice and do, uh,
• 1:00
  sports medicine and shoulder surgery at the University of Rochester Medical
• 1:04
  Center. Uh, I'm also our Chief Medical Information Officer. Um,
• 1:09
  we are a nine hospital, uh, mid-sized, uh,
• 1:14
  system in, uh, kind of the Finger Lakes region of New York. So we,
• 1:19
  we cover basically from, uh, Buffalo to Syracuse down south to the,
• 1:23
  to the Pennsylvania border. Um, I've been in my role for about,
• 1:29
  uh, three years, and I still practice clinically, uh,
• 1:31
  doing orthopedic scene patients one day a week and doing surgery about three
• 1:35
  times a month. And then the rest of my time is, uh, spent, um,
• 1:39
  translating between technology and workflow.
• 1:43
  Got it. Wow. That's, you know, such a, uh, huge undertaking.
• 1:46
  I can imagine to really be the person that is the liaison between the, um,
• 1:51
  medical teams and then the IT teams too. And from that vantage point,
• 1:56
  where do you see some of the big opportunities in the future as well as the
• 1:59
  headwinds that you have your eye on today?
• 2:02
  Yeah, I think, you know, I'll,
• 2:04
  I'll start with headwinds because I think we're all kind of feeling it right
• 2:08
  now. You know, obviously, um, there's tremendous, uh,
• 2:12
  financial pressures in, in healthcare, uh,
• 2:15
  and there's a significant amount of clinician burnout both on
• 2:20
  the nursing side and the provider side.
• 2:23
  And so we really need to be leveraging technologies
• 2:28
  that help us automate processes and be more efficient. Um,
• 2:33
  but a lot of those require changes in workflow.
• 2:37
  And our frontline clinicians, nurses, providers, uh, doctors,
• 2:42
  residents, uh, all, you know,
• 2:44
  are at a point where it's just very difficult for them to engage in all
• 2:49
  of these changes. Uh, and so there's definitely a, a balance. Uh,
• 2:54
  and so my team is, uh, really working hard, uh, focusing on, you know,
• 2:58
  some very key strategic initiatives, um, to, to help us, uh,
• 3:03
  through, but we're really, um, trying to focus on a few as opposed to,
• 3:09
  you know, I think with the pandemic,
• 3:10
  there was a lot of stuff that got put on the back burner, um, and, you know,
• 3:15
  there was a long backlog, uh, and it's easy to just say, all right,
• 3:18
  we're gonna do it all at once. Um, but understanding, you know,
• 3:22
  what the organization is capable of doing, we really are, are, um,
• 3:27
  kind of laser focused on trying to figure out, okay,
• 3:29
  what can we do well and effectively that actually leads to less, uh,
• 3:33
  burnout increased, uh, provider, uh, and uh, nursing satisfaction.
• 3:40
  That makes a lot of sense. You know, and it's really,
• 3:42
  it seems like the word of the year is just that simplification and really
• 3:45
  focusing in on where the most value is gonna be. So from your vantage point,
• 3:49
  what does that look like? Where,
• 3:51
  where are you able to add value and really see the organization and potentially
• 3:56
  get back to more of a growth trajectory in the future?
• 3:59
  So I think right now we're still kind of pushing through with our,
• 4:03
  our digital transformation strategy. So we had kind of a three-pronged, uh,
• 4:08
  five year approach, uh, focused on access first and then engagement and then,
• 4:13
  uh, driving value, uh, at the end. And so access was all about, uh,
• 4:18
  the digital front door and, you know, how do you find a provider?
• 4:21
  How do you schedule an appointment online?
• 4:23
  How do you do on-demand telemedicine and, and, and all the other, uh,
• 4:28
  things, e-visit you, check in, um, and that sort of thing.
• 4:30
  And we're largely kind of through that.
• 4:33
  And we were going to be heading towards engagement,
• 4:36
  which was how do you engage with the patients outside of the,
• 4:40
  the four walls of the medical center, um, you know, through, uh,
• 4:44
  clinical care pathways, uh, digital therapeutics, um, uh,
• 4:48
  apps and, and things like that. Um, but we've really pivoted more towards,
• 4:53
  um, value sooner. Uh,
• 4:55
  and where we're looking at value is really around automating things. Uh,
• 5:00
  a lot of the, uh, I'll say adminis trivia, uh,
• 5:03
  stuff that our nurses and our providers, uh, need to do on our,
• 5:06
  on a regular basis. And so that's, you know,
• 5:08
  leveraging things like ambient voice technology, um, looking at, uh,
• 5:13
  ways that you can do, you know, more, um,
• 5:16
  remote nursing activities or automate different, uh, nursing tasks,
• 5:21
  um, things like that.
• 5:24
  Got it. That's fascinating and,
• 5:25
  and really seems like there's a lot of opportunity there when you look at
• 5:29
  bringing in automation and, um, making I,
• 5:33
  I guess streamlining with some of the,
• 5:34
  whether it's artificial intelligence or other technology, bringing it in. Um,
• 5:39
  what does it look like to incorporate it and really integrate that into the
• 5:42
  larger workflows? How do you do that with the, um,
• 5:45
  the teams that you have with the nurses, doctors and, and clinical teams,
• 5:49
  just to make sure that, you know,
• 5:51
  everybody understands why that change is happening and feels like it's, uh,
• 5:54
  a helpful change versus a scary change?
• 5:58
  Yeah, I think that that's really been the biggest focus,
• 6:02
  I would say on our organization as a whole,
• 6:04
  is just kind of looking at our organizational change management process. So,
• 6:09
  um, you know,
• 6:10
  we historically would talk about a change coming and we'd send out a,
• 6:15
  a mass email that was designed for everybody. It was designed for nurses,
• 6:20
  doctors, administrators,
• 6:22
  and they were supposed to understand the whole program and the why.
• 6:26
  But when you do that,
• 6:27
  you kind of lose the what's in it for me for each of those specific groups
• 6:31
  because the what's in it for me is very different when you look at a nurse or a
• 6:36
  doctor and an administrator. And so, um,
• 6:39
  we're taking a more strategic approach about just that kind of awareness stage
• 6:44
  and trying to focus on, uh, verbal in-person delivery or,
• 6:49
  uh, via, uh, you know, by Zoom or you know, um,
• 6:52
  something like that as opposed to email and then actually having some ability to
• 6:57
  assess, you know, does the organization actually want this change?
• 7:00
  So you delivered the message. Did people actually hear it and say, okay,
• 7:05
  we want to participate in this, um, or not.
• 7:08
  And that's historically something that we haven't done. We've just kind of said,
• 7:11
  we're gonna do this, and then we roll out some training that says, alright,
• 7:17
  um, you know, here, here's what you're gonna need to know to be able to do it.
• 7:22
  And then it would just kind of go live on the go live date and,
• 7:26
  and kind of we would move on. And so we're really focusing on, okay,
• 7:30
  are people ready to actually engage? Did we really get the word out? Uh,
• 7:34
  and then we're still delivering the training.
• 7:37
  And then after training we're trying to determine, okay, you know,
• 7:40
  do they really have the skills that they need to be effective at this?
• 7:44
  And then after we're training,
• 7:45
  we're building in more of a stabilization process with these technology, uh,
• 7:49
  implementation so that, you know,
• 7:51
  it's not just turning the technology on and walking away,
• 7:54
  but how are we going to evaluate whether it was actually effective and what
• 7:58
  process do we have built in for making sure that we're getting the most out of
• 8:03
  it? That obviously slows down how quickly you can move to the next thing.
• 8:08
  And so, again, for us, it's kind of a little bit of a less is more approach.
• 8:11
  We're we're doing less projects,
• 8:14
  but we are aiming to execute much more effectively, uh,
• 8:18
  and drive a better ROI out of those few projects as opposed to kind of just
• 8:23
  dumping many projects on everybody.
• 8:26
  That really makes a lot of sense and sounds like a great approach to get
• 8:29
  everybody on board and kind of the one-on-one connections as well as, you know,
• 8:33
  making sure people really understand, uh,
• 8:36
  what benefit they're driving from the change. Uh, now from your perspective,
• 8:41
  I,
• 8:41
  I know that we've talked through this being somewhat of a challenging time right
• 8:44
  now in healthcare across the board and for many industries as well. Um,
• 8:49
  but still needing to keep an eye on the future and, you know,
• 8:52
  what is still a risk or investment that's worth, worth making this year,
• 8:56
  even if, you know, is a little bit of a, um,
• 8:58
  more pinched financially than before. It didn't have, you know,
• 9:01
  staffing shortages and other things that could be, uh, prohibitive and limiting.
• 9:05
  Uh, where do we still need to spend some of our precious health healthcare
• 9:09
  resources?
• 9:11
  So I think, you know, if you asked me two months ago,
• 9:16
  you know, I I definitely would've said, uh, in, in the area of the,
• 9:21
  you know, ambient ai, um, stuff to help with documentation burden,
• 9:26
  particularly with my lens as a, as a physician. Um, you know,
• 9:30
  cuz that's a large portion of, of what we do. Um, I, you know,
• 9:35
  I would say focus on documentation or, or in-basket. Um,
• 9:39
  but I would say with the advent of, uh,
• 9:42
  G P T four and these large language models and
• 9:47
  understanding how quick those are probably going to evolve over the next several
• 9:51
  years, we've actually kind of paused a little bit, uh, in,
• 9:56
  in thinking about when we want to invest to make sure that, you know,
• 10:00
  we're taking a platform approach and that we're being cost effective with these
• 10:05
  things. Because I think the cost of those types of solutions,
• 10:08
  obviously is significantly decreased, literally in the last couple of months.
• 10:13
  So I think, you know,
• 10:14
  one thing that we're really focused on right now is our clinical
• 10:19
  predictive, uh, uh, analytics. Um, you know, we,
• 10:24
  uh, had our sepsis, um, predictive model that we rolled out,
• 10:29
  I think, um, mid covid and, you know, we were having quite a few issues with it,
• 10:34
  you know, just firing, you know,
• 10:35
  we used to have the Covid bpa and it was the most ignored BPA in the,
• 10:39
  in the history, uh, of BPAs, um,
• 10:42
  BPAs for those who don't know our best practice advisories,
• 10:44
  there's a little pop-ups that basically, you know, fire in the chart and say,
• 10:48
  Hey, this patient might have sepsis, but they almost never did.
• 10:51
  And so providers kept clicking out of it, uh, and it became more of a, uh,
• 10:55
  a nuance in the, in, uh, a nuisance in the background. And so we went with,
• 11:00
  you know, something we thought would be more intelligent, um,
• 11:02
  or EMRs predictive model. Um,
• 11:05
  but even with that in instituting workflows, it was still firing, you know,
• 11:10
  73 times, uh, for every positive, uh,
• 11:14
  patient with sepsis. And, you know, for our, our doctors and nurses,
• 11:19
  you know, that's like, if your GPS takes you to the wrong place,
• 11:22
  74 out of 75 times, um, you're just not gonna use it. And so they,
• 11:26
  so they weren't using it. Um, and you know, there's potential and, you know,
• 11:31
  tons of opportunity to save patient lives, um, if this is employed correctly.
• 11:36
  And so we've kind of revisited with that and, and have, um, you know,
• 11:41
  engaged with some, some newer technology that allows that to fire, you know,
• 11:45
  three times for every patient.
• 11:47
  And it kind of fits within the clinician workflow and allows you
• 11:52
  to engage with the model almost like a clinical consult, which, you know, is,
• 11:57
  is, uh, much easier, um, on, on our clinicians and,
• 12:01
  and nurses and yields better adoption and obviously, um,
• 12:04
  because people are using it better, better outcome in, in life saved.
• 12:09
  That's great to hear. It really seems like it's something that, uh,
• 12:13
  makes a big difference for the organization. So, uh, certainly, um,
• 12:17
  very inspiring to hear about now. I wanted to,
• 12:20
  before we wrap up our conversation,
• 12:21
  look into the future just a little bit further.
• 12:24
  Where do you see some of the best growth opportunities for you as well as the
• 12:27
  teams that you work with?
• 12:29
  So I, I think it's definitely gonna be within, you know, uh, the,
• 12:34
  the large language models. Um, you know,
• 12:36
  the ability of those things to help with those administrative,
• 12:42
  uh, tasks that are all, um, put on us and, and are really, um,
• 12:47
  creating the largest amount of clinician burden. So the documentation,
• 12:50
  the in basket tasks.
• 12:52
  I think what'll be interesting is whether this is something that
• 12:57
  is solved by industry or the EHR vendors
• 13:02
  or whether that's something that, you know,
• 13:06
  we actually task our own innovation labs and innovation teams, uh,
• 13:10
  on solving, um,
• 13:12
  because the ability to create those things has just gotten, um,
• 13:17
  so much easier. And obviously we have to work through all of the, um, you know,
• 13:21
  the privacy, uh, considerations, uh, with them and,
• 13:24
  and really understanding what the, what the risks are. Um,
• 13:28
  so I think there's a lot of work that needs to go into evaluating our approach
• 13:32
  around those models. And, you know,
• 13:35
  that's something hopefully we'll be doing this year and then obviously, um,
• 13:38
  starting to really engage with that next year.
• 13:42
  Fantastic. I, I love it. It's just so, such a, a great way to think through,
• 13:46
  you know,
• 13:46
  how you're leveraging the technology and those large language models to, um,
• 13:50
  really make an impact on patient care as well as the administrative tasks,
• 13:54
  operational efficiency and those kinds of things. Um, Dr. McCanty,
• 13:59
  thank you so much for joining us on the podcast today.
• 14:01
  This has been such a fun discussion. And,
• 14:03
  and I'm also looking forward to seeing you in person at our Health IT Digital
• 14:06
  Health and Revenue Cycle event.
• 14:07
  It'll be great to have you speaking on a panel and really just adding a lot of
• 14:11
  color to the different themes we talked about here,
• 14:14
  as well as the overall discussion at the event. So we're looking forward to it.
• 14:18
  Yeah, I'm really excited. You know, I, it's funny, you know,
• 14:22
  that's gonna be in the, in the fall and it's just gonna be, I,
• 14:26
  I bet a lot is gonna have changed between now and the fall,
• 14:28
  so I'm really looking forward to getting together with everybody and, and, uh,
• 14:32
  talking.
• 14:33
  Absolutely. It'll be a lot to catch up with.
• 14:40
  It's so important for leaders at the top of organizations to keep learning,
• 14:44
  stay sharp, grow their networks,
• 14:46
  help our audience better do this in a more simplified, personalized,
• 14:49
  and meaningful way. Becker's Healthcare has launched my bhc,
• 14:53
  it's your trusted Becker's healthcare experience and more with content,
• 14:57
  connections, events and learning opportunities.
• 14:59
  Join the community free of charge@www.my dot becker's hospital
• 15:04
  review.com and we'll see you there.