Latest / Becker’s Healthcare Digital Health + Health IT / Dr. Benjamin Hohmuth, Chief Medical Informatics Officer at Geisinger Health System

Transcript

Dr. Benjamin Hohmuth, Chief Medical Informatics Officer at Geisinger Health System · Becker’s Healthcare Digital Health + Health IT

0:02
- Nuance is a pioneer
0:03
and a leading provider of conversational AI
0:06
and cloud-based, ambient clinical intelligence
0:09
for healthcare providers used by 77% of hospitals
0:12
and 10,000 healthcare organizations worldwide.
0:16
Our AI powered solutions capture 300 million patient
0:19
stories each year.
0:21
We help unburdened clinicians, radiologists,
0:24
and care teams with efficient new ways
0:26
to capture clinical information,
0:28
applying real time intelligence
0:30
for better decision making across the continuum of care.
0:33
Now, a Microsoft company Nuance brings industry leading
0:36
generative AI and deep vertical expertise.
0:39
To address your biggest challenges
0:41
and accelerate healthcare outcomes, visit
0:45
www.nuance.com/healthcare for more information.
0:50
- This is Laura Dedo with the Becker's Healthcare Podcast.
0:53
I'm thrilled today to be joined by Dr.
0:55
Ben Holman, the Chief Medical
0:57
Informatics Officer at Geisinger.
0:59
Dr. Homuth, it's a pleasure
1:00
to have you on the podcast today.
1:03
- Thanks for having me. Dere, a pleasure to be here.
1:06
- Now. I'm really looking forward to our conversation.
1:08
I, I think, you know, there's
1:10
so much happening in the healthcare space
1:11
and certainly, um, a lot to be excited about.
1:14
But before we dive into the broader questions,
1:16
you tell me a little bit more
1:17
about yourself and your background.
1:20
- Sure, yeah. I guess my background's a little bit eclectic.
1:23
I, my background is, I don't come from a it
1:26
or technology space.
1:27
Um, you know, I was,
1:30
'cause I've always been focused on breadth over
1:33
depth and, and variety.
1:35
I was an anthropology major who wound up going
1:37
to medical school who couldn't make a decision
1:40
and wound up in internal medicine.
1:41
And my clinical practice, uh,
1:44
for my first five years was a mix of emergency medicine,
1:47
urgent care, hospital medicine.
1:50
Um, my administrative roles, you know,
1:53
were also fairly varied,
1:56
included roles in medical education, hospital quality,
1:58
patient blood management,
2:00
and then a significant amount of time leading departments
2:03
of hospital medicine.
2:05
Um, and I found that informatics
2:08
and the intersection between technology and people
2:11
and process we're often the means
2:15
to the desired ends in both my very personal
2:19
and professional roles in the past
2:22
and sort of wound up in this role almost
2:25
by accident in 2018.
2:27
And, um, six years later,
2:30
this is the longest I've been doing a single
2:32
thing in a single place.
2:33
And I, I think I found my home in informatics.
2:37
And, and what I've really loved about it is, um,
2:41
that it really touches every part
2:42
of the organization from the health plan, uh,
2:45
to the hospitals, to the physicians and nurses
2:47
and the clinics, uh, to the medical school
2:50
and every layer of the organization from the CEO down
2:53
to the folks at the bedside.
2:55
And so, you know, my passion really is
2:58
clinical operations quality, trying to make it easier
3:01
for our folks at the frontline to take better care
3:04
of our patients and members.
3:07
- Well, that's great to hear. And certainly such an
3:09
important aspect of healthcare today is being able
3:11
to have the understanding of both the clinical world as well
3:14
as the informatics and technology.
3:16
Because like you said, you know, it touches so many aspects
3:19
of healthcare delivery as well as system operations and,
3:23
and certainly, um, you know, it continues
3:25
to evolve and, and grow.
3:27
Could you tell me about your most successful project
3:30
from the last year or two?
3:31
What did you do and how did you measure results? Yeah,
3:36
- So it is hard to pick out one project.
3:38
I mean, I have two biases that I'll be upfront about.
3:41
One is I'm always biased towards projects that simplify life
3:45
for our clinicians at the front line
3:47
and make it easier for them to do their job.
3:49
You know, we, we spend a lot of time standardizing
3:52
and creating high reliable systems as we should.
3:55
But, but the reality is, at the end of the day, um,
3:59
you know, a major, if not probably the most important
4:02
variable contributor to the quality
4:03
of the care we provide is still
4:04
that clinician at the bedside.
4:06
And when we can unburden them, take away unnecessary tasks,
4:10
make it easier for them to use their judgment
4:13
and easier for them to do the right thing, it winds up in,
4:17
um, you know, a better experience, better retention,
4:19
less burnout, and better care.
4:21
So on the physician side, I think everyone knows
4:24
that documentation and in basket are two hot,
4:27
hot button topics right now in terms of burnout
4:29
and, uh, decreased the GA engagement and attrition.
4:33
So, um, we're working on both, um, uh,
4:36
along with a lot of other things.
4:37
And we've spent a lot of time over the end basket over the
4:40
past year focusing on things like better triage at the front
4:44
door, um, you know, optimizing our choice architecture
4:47
for our patients to promote self-service
4:49
so the patient gets what they need.
4:51
If they need a me med refill, an appointment,
4:54
a virtual urgent care, uh, visit that day, let's get them
4:57
that without burdening the care team downstream,
5:00
it's a better experience for the patient.
5:02
And it's one less message for our physicians
5:04
and their care team, um,
5:05
eliminating low value messages with another focus.
5:08
We realized over the years, we developed this culture
5:11
of CCing the primary care doctor on just about everything.
5:15
And that a lot of that was unnecessary.
5:17
Some of that was automated, some of that was behavioral.
5:20
The automated things are easy to turn off,
5:22
the behaviors were harder to change, uh,
5:25
but we've made progress on, on both fronts.
5:28
And so, you know,
5:29
we discovered things like when you start digging.
5:31
We've been live with EPIC since 1996,
5:34
so there's a lot there.
5:35
We found things like, you know,
5:37
every ED visit not only was the ED note routed to the PCP,
5:41
but they also got an a DT notification
5:43
and there was no value in having both.
5:46
So consolidating that,
5:47
and there were a lot of similar examples.
5:49
And then getting our specialists to break the habit
5:52
of just constantly ceasing the PCP
5:55
and really ceasing the PCP when there was an action item
5:58
for them, not just as an FYI.
6:01
And so that was helpful in terms
6:02
of decreasing the low value messages.
6:04
We decreased a lot of clutter.
6:06
Again, having been live on Epic since 1996,
6:09
and with no sort of expiration dates for incoming messages,
6:12
we found we had close to 10 million age messages
6:15
that we were able to purge from the system.
6:17
And then going forward, we have expiration dates
6:20
because we know that a lot of messages, if not acted on
6:23
with a certain date, are never gonna be seen again.
6:26
So just in terms of a, a simple cleanup
6:28
and then auto closing, certain types of encounters
6:31
that are non-billable telephone encounters were a big one
6:34
that wind up generating messages, uh, later on, um,
6:38
that are low value.
6:40
And then for those messages that really do need to be, um,
6:44
handled by the care team, we wanted to provide the
6:48
support staff for the physicians with best practices on how
6:51
to handle those messages so
6:53
that the messages are ideally dealt
6:55
with without needing the physician's input
6:57
or if the physician's input
6:59
or the advanced practitioner's input is needed,
7:01
that the message is mature
7:03
to provide the incremental information that
7:05
that results in less back and forth
7:07
and allows the provider to more efficiently, uh, respond.
7:13
Um, and then also giving providers, you know, we found
7:15
that perhaps not surprisingly, that the extent
7:18
to which our providers are
7:21
using the most efficient tool sets within our, um,
7:24
electronic health record to manage those ME messages
7:27
as efficiently as possible using quick actions
7:30
and shortcuts was highly variable.
7:32
So we had some
7:33
of our physicians create short little two minute videos
7:36
and best practices documents that we really tried
7:39
to socialize peer to peer to make sure
7:42
that when those physicians
7:43
and advanced practitioners were getting messages
7:46
that they had the tools, um, to deal with them
7:49
as efficiently as possible.
7:52
You know, in terms of measuring the impact, um,
7:55
we looked at a couple of things.
7:56
We looked at the volume of messages.
7:58
Uh, number one, we looked at the time spent in,
8:01
in basket per appointment, number two.
8:03
And then number three, we did a, um, survey
8:07
because we found frequently there,
8:09
there's two things that matter.
8:11
One is objective reality, are, you know, in this case,
8:14
are there fewer messages?
8:15
And, and did the, uh, physicians
8:17
and advanced practitioners spend less
8:19
time managing messages?
8:21
But equally important is what were their perceptions,
8:23
because we've seen times where objectively work decreased,
8:27
but perception didn't change.
8:29
And we've seen, uh, situations where objectively work, um,
8:33
stayed the same, but people perceived that it was easier,
8:37
that there was less work.
8:38
Ideally, we wanted to, uh, make progress in both areas.
8:41
So we also had a survey, uh, asking people both
8:44
before the initiative and six to 12 months
8:47
after the initiative, things like, you know,
8:50
I received too many in basket messages
8:52
and, you know, a Likert scale from disagree to agree.
8:56
Um, I receive messages that add no value.
8:59
I spend too much time in, in baskett.
9:01
So in, in those three domains, you know,
9:04
we decreased the total number
9:05
of messages per provider per day in primary care by about,
9:09
uh, 15 to 20%.
9:10
We reduced time in, in per, per, per primary care provider,
9:15
also by about 15 to 20%.
9:18
And we had statistically significant improvement in all
9:20
domains, uh, related to perception
9:23
as measured by our survey.
9:25
So that was exciting
9:26
because I think it's something that matters
9:29
and it's a burden to our providers,
9:31
but it's really only just the beginning
9:33
because there's a huge amount of in basket work still to do.
9:36
And one of the big burdens is just the, the rise in
9:41
advice messages, which manifest either via the,
9:44
the patient portal or via telephone calls that are routed
9:47
to our providers and are really asynchronous, um,
9:51
telemedicine that's, that's handled via the in baskets
9:54
and figuring out how best to measure an account
9:57
for this work is an ongoing challenge.
10:00
So, um, we have a team
10:02
that's continuing to work on the in basket.
10:03
There's, this is gonna be a big focus as, uh, part
10:06
of our work with Ryzen.
10:07
A lot of the things that have mattered to Geisinger, one
10:10
of them being, you know, creating simpler,
10:13
more effective workflows for our clinicians, uh,
10:16
are gonna be priorities for Ryzen as well.
10:18
So this work will continue
10:19
and we'll figure out, uh, ways, um, to scale that, uh,
10:23
in the new parent organization.
10:26
- Well, that's fantastic to hear,
10:27
and it sounds like an extremely valuable initiatives you've
10:30
been able to put in place, especially looking at how,
10:33
you know, you're decreasing some
10:34
of those low valuable messages and,
10:36
and really giving the frontline clinicians time back in
10:39
their day, um, in a significant way.
10:41
And, you know, um, speaking of that, um,
10:46
rise in, in that partnership
10:47
and now, you know, becoming part of
10:49
that larger organization, I can imagine, um, there are a lot
10:52
of big opportunities for, for you and Geisinger.
10:55
What are some of your top priorities over the next 12 months
10:58
or so as you, um, continue on the work
11:00
that you've been doing historically as well
11:01
as move into this, uh, new situation?
11:07
- Yeah, well, really the priority for the next 12 months,
11:10
uh, you know, as you mentioned earlier,
11:11
the announcement came out this week sort of formalizing
11:15
the relationship between K and Geisinger.
11:18
And, you know, Kaiser Permanente has created this new
11:20
organization called ryzen.
11:23
Uh, the vision of Verizon is
11:25
to spread value-based care in
11:27
multi-payer provider environments.
11:29
You know, Kaiser Permanente is typically a patient
11:33
as a member, and a member is a patient at Geisinger.
11:36
Uh, you know, half of our patients are members
11:39
and about half of our members are patients.
11:41
So we deal with other health insurance companies on the,
11:44
on the clinical enterprise side.
11:45
And our health plan deals
11:46
with network physicians on the health plan side.
11:49
So, you know, a lot of the things
11:51
that we've been working on, we're going, going to continue
11:54
to work on, but figure out how we can do it at broader scale
11:58
and how we can take advantages, advantage of resources that,
12:01
uh, the KP Foundation brings to the table.
12:04
But the high level goals are gonna be to ensure
12:06
that all patients receive, uh, evidence-based care, um,
12:11
when the evidence is there,
12:13
and also that they receive the right level
12:15
of care at the right time.
12:17
And generally that means moving the care upstream.
12:19
So most patients would rather be cared
12:21
for at home than in the hospital.
12:23
So if we can turn an emergency de, uh,
12:26
department visit into a
12:28
increased services at home rather than a hospital
12:31
stay, that's good for us.
12:32
That's good for the patients.
12:33
If we can avoid an emergency department stay
12:36
by having a timely urgent care stay, that's generally good
12:40
for patients, and that's good for us.
12:42
If we can avoid a urgent care visit by better, uh,
12:46
preventative care upstream, again, that's
12:49
good for our patients.
12:50
Uh, and that's good for us.
12:52
So, um, and then of course, we just talked about the example
12:56
of the in baskets, but continuing to ensure
12:59
that we provide our clinicians with simplified
13:02
and efficient workflows that make it easier
13:04
to get their work done and to provide great care
13:06
for our patients and members.
13:08
Those are gonna be our, our priorities, evidence-based care,
13:11
the right level of care at the right time, ensuring that,
13:14
uh, we provide a simplified environment for our clinicians
13:18
to do the right thing with less effort at a high level.
13:22
I mean, figuring out what that means
13:24
and how to do it at scale is gonna be, uh, consuming a lot
13:28
of, um, our informatics time, uh, over the next 12 months.
13:33
- That's a huge task and especially important, but,
13:36
but I know a lot of moving parts
13:38
that when you think about the whole system transforming in
13:40
certain ways and really getting used to, um, you know,
13:43
how you can, uh, problem solve and be creative
13:46
and innovative, um, within that value-based care space.
13:50
And, you know, along those lines,
13:52
as you're looking at those top priorities
13:54
as you're looking at being able to, um,
13:56
really scale your resources and,
13:58
and make sure that every patient receives, um,
14:01
evidence-based care, how do you anticipate your
14:03
role in teams will change?
14:04
What will you need more of?
14:06
Um, is there anything, you know, that you're looking to, um,
14:09
pivot away from or just love to hear your insights on,
14:13
you know, what that looks like for you
14:14
and your teams moving forward?
14:18
- Yeah, I don't know.
14:19
You know, in the short term, a lot of this is work
14:23
that we've been doing.
14:25
So it's how can we do it better?
14:26
How can we do it differently?
14:28
I tend to focus on what won't change.
14:31
And I think what won't change is the need for informatics
14:35
and it to support the strategic needs of the organization.
14:38
And so, uh, Geisinger's vision is
14:41
to make better health easier,
14:43
and that's gonna continue with ryzen.
14:45
And so things like making sure that we're working, um,
14:49
hand in glove with clinical operations to improve access
14:53
and ease of use for our patients
14:54
and members to improve our ability
14:57
to manage total health from both the cost
14:59
and quality perspective
15:00
and creating efficiencies when it comes to operating.
15:03
So promoting operational excellence so that we can be, uh,
15:07
as effective as possible, as efficiently as possible.
15:10
So I think, you know,
15:13
those are the things I focus on making sure
15:15
that we're really aligned with both the vision and the,
15:19
and the strategic priorities down to the tactical level
15:22
of the organization.
15:23
And so I don't think those are gonna change significantly
15:26
because what's important
15:28
to Geisinger historically is gonna be what's important
15:31
to Verizon, but, um, sometimes hard to predict the future.
15:35
So we'll see. But, um, I think as long as we sort of, uh,
15:40
keep our eyes on those, you know, that vision
15:43
and those priorities, I think, uh,
15:45
I think that'll be the most important thing
15:47
for our group going forward.
15:50
- That makes a lot of sense.
15:51
And certainly it is a great way to ground yourself and,
15:54
and make sure your continued success, um,
15:56
amid all the change and transformation.
15:59
And Dr. Homa, thank you so much
16:00
for joining us on the podcast today.
16:02
This has been a fascinating discussion.
16:03
I really appreciate your time,
16:04
and I look forward to connecting with you again soon.
16:08
- Yeah, sounds great.
16:09
Thank you for your time and thanks for the opportunity.
16:11
I appreciate it.
16:15
- Nuance is a pioneer
16:17
and a leading provider of conversational AI in cloud-based,
16:20
ambient clinical intelligence for healthcare providers used
16:24
by 77% of hospitals
16:25
and 10,000 healthcare organizations worldwide.
16:29
Our AI powered solutions capture 300 million patient
16:33
stories each year.
16:35
We help unburden clinicians, radiologists,
16:37
and care teams with efficient new ways
16:39
to capture clinical information,
16:41
applying real time intelligence
16:43
for better decision making across the continuum of care.
16:46
Now a Microsoft company Nuance brings industry leading
16:50
generative AI and deep vertical expertise.
16:52
To address your biggest challenges
16:55
and accelerate healthcare outcomes, visit
16:58
www.nuance.com/healthcare for more information.