Latest / Becker’s Healthcare Podcast / The Role of AI in Transforming Medication Management and Pharmacy Leadership in Healthcare Systems
Transcript
- 0:00- Hi, everyone. This is Lucas Voss with Becker's
- 0:02- Healthcare. Thanks so much for tuning in to
- 0:03- the Becker's Healthcare podcast series. So excited to
- 0:06- have you. Today, we're talking about the role
- 0:08- of AI in transforming medication management and pharmacy
- 0:11- leadership in health care systems.
- 0:13- And joining me for today's discussion, so excited
- 0:16- to have them both, is doctor Janjari Desai,
- 0:19- interim vice president pharmacy services at Stanford Health
- 0:22- Care, and doctor Seth Hartman, also vice president
- 0:25- clinical applications and chief pharmacy information officer at
- 0:29- UChicago
- 0:30- Medicine. Doctor Desai, doctor Hartman, so great to
- 0:32- have you on. Thanks for being here today.
- 0:34- Thank you so much for having us. Seth,
- 0:36- great to have you. We have a lot
- 0:37- to talk about. There is certainly a lot
- 0:39- of buzz still around the two lettered words
- 0:42- that we're going to discuss.
- 0:44- I wanna start us off with introduction. So,
- 0:46- doctor Desai, I'll start off with you. If
- 0:48- you could just introduce yourself and share a
- 0:50- little bit about your work in health care.
- 0:51- Sure. Thank again, thank you for having us
- 0:53- today. My name is Jandri Desai, and I'm
- 0:55- currently the interim VP of pharmacy services at
- 0:58- Stanford Health Care. I've been at Stanford for
- 1:00- a bit over a decade now in various
- 1:02- roles,
- 1:03- and I've had the pleasure of, you know,
- 1:06- working cross functionally across the organization with
- 1:10- various teams in that capacity.
- 1:12- And so I'm really excited to talk about
- 1:14- with Seth today,
- 1:16- the work that we're doing with AI in
- 1:18- the pharmacy space. Seth and I are both
- 1:21- also members of the Autonomous Pharmacy Advisory Board
- 1:25- and, have recently published a white paper,
- 1:28- that outlines a framework for the use of
- 1:30- AI for medication management. So hoping we can
- 1:33- dive into that a little bit as well.
- 1:34- Absolutely. Let's discuss. Doctor Hartman, over to you.
- 1:36- Yeah. Excellent. So as you said, my name
- 1:38- is Seth Hartman. I serve as the vice
- 1:39- president of, clinical applications
- 1:41- to set over the full, application portfolio for
- 1:44- all of our clinical workspaces at UChicago Medicine.
- 1:47- Then I also wear the head of chief
- 1:48- pharmacy information officer, pharmacist by training,
- 1:51- spent, you know, decades now working in pharmacy
- 1:53- informatics and many different types of health systems
- 1:56- and,
- 1:57- different types of applications within those,
- 2:00- spheres. And so a lot of my work
- 2:02- today is focused on, like, how do we
- 2:03- modernize our health systems, how do we make
- 2:05- sure
- 2:07- that we're really patient focused, and how do
- 2:08- we use the tools like AI and figure
- 2:09- out how to both evaluate and harness the
- 2:11- power of those and then guide ourselves forward
- 2:13- and the use of those to better patient
- 2:14- care. Yeah. And I mentioned,
- 2:17- up top of our episode here, everybody's talking
- 2:19- about it. Artificial intelligence is everywhere. AI is
- 2:22- everywhere, so to speak.
- 2:24- And it's part of a lot of workflows
- 2:28- right now, but it's also becoming, again, part
- 2:31- of pharmacy more than ever, across the board.
- 2:34- From your perspective,
- 2:36- where are you currently seeing the most opportunities
- 2:39- for AI to improve specifically medication management
- 2:43- across health systems? Doctor. Desai, I'll start off
- 2:45- with you.
- 2:46- Sure. I think there's two components to consider.
- 2:49- There's the administrative
- 2:51- workflows, and then there are the clinical workflows.
- 2:53- And I think a lot of the current
- 2:55- innovation or the current,
- 2:57- AI vendors and platforms that are coming forward
- 2:59- are really focused on the former.
- 3:01- So when we think about, Ambient Scribes
- 3:05- or agentic
- 3:06- platforms that allow you to query the electronic
- 3:09- health record,
- 3:10- platforms that automate the prior authorization
- 3:13- process or the prescription benefits check process,
- 3:16- those are really addressing administrative burdens and workflows
- 3:20- that exist today.
- 3:21- You know, improving time to patient access, but
- 3:24- also
- 3:25- improving,
- 3:25- I think, staff satisfaction. Right? Nobody wants to
- 3:28- go through these tedious, laborious
- 3:30- workflows.
- 3:31- And having an agent that you can work
- 3:33- with that helps you through that,
- 3:34- makes the work just a little bit easier,
- 3:36- I would say. And I think the opportunity
- 3:39- really lies in that second bucket of, more
- 3:42- clinical support.
- 3:43- And, rightfully so, I think,
- 3:46- you know, everyone is approaching that with a
- 3:48- little bit of caution,
- 3:49- because of the direct potential impact on patient
- 3:53- care. But I still think that there are
- 3:55- a lot of things that can be protocolized
- 3:58- or that AI can pick up on maybe
- 4:00- more quickly
- 4:01- than we can pick up on. And so
- 4:03- it's important that we figure out, you know,
- 4:05- just as a health care community, what are
- 4:07- those use cases and then continue to iterate
- 4:09- on that.
- 4:11- Seth is doing a lot of work in
- 4:12- the AI space as well. He's,
- 4:14- doing some fantastic things at University of Chicago,
- 4:16- so I'd love to hear his thoughts too.
- 4:18- Yeah. Doctor Hartman, I I know governance is
- 4:20- big pieces you've just mentioned, but I'd love
- 4:21- to get your perspective on the opportunities
- 4:23- that this presents as well. Absolutely. I think
- 4:25- exactly as Chondry was kind of painting the
- 4:27- picture of there, it's like, I I imagine
- 4:30- we have this workforce, and we can do
- 4:31- x number of things in a given day
- 4:33- without AI. And then if we can start
- 4:35- embedding AI into the processes to smooth out
- 4:37- these workflows. Right? Automating PA so we spend
- 4:39- less time spending on the paper pushing and
- 4:41- more time figuring out how does this medication
- 4:43- impact that patient, and then we start figuring
- 4:45- out how do how do we benefit ourselves
- 4:47- in terms of, like, more advanced dosing algorithms
- 4:49- and understanding the the population's needs around our
- 4:52- health system, and should we be investing in
- 4:54- them in different ways and looking at things
- 4:55- and spending more time in the social determinants
- 4:57- of health and how that really impacts health
- 4:59- care. Like, we can't do so many of
- 5:01- those things today because of the administrative burden
- 5:03- that kinda sits behind a lot of the
- 5:04- tasks that we have to do in health
- 5:05- care. And so as we use AI to
- 5:07- further our ability to automate those things that
- 5:10- can be automated and then support the end
- 5:12- clinician in terms of the decision making, the
- 5:14- research of the chart, and the other things
- 5:16- that need to be done to help them
- 5:17- really figure out how to make the right
- 5:19- decisions for patient care. We allow ourselves to
- 5:21- move more quickly with the workforce that we
- 5:23- have. We're already looking at, you know, challenges
- 5:25- with getting, you know, physicians into our health
- 5:27- systems and getting pharmacists out through. We the
- 5:30- enrollment is low in pharmacy schools and nursing
- 5:31- schools are the same, and so we're there's
- 5:33- gonna be this really big problem in the
- 5:34- next ten, fifteen years where as the baby
- 5:37- boomers are aging, more of them are needing
- 5:38- more health care and we are seeing lower
- 5:40- enrollments, we're gonna hit this nexus where if
- 5:42- we do not figure out how AI benefits
- 5:44- health care to make ourselves more efficient, we're
- 5:46- gonna struggle to provide even basic care for
- 5:48- that population and their need. And so we
- 5:50- really have to lean into these technologies, but
- 5:52- lean into them safely
- 5:53- to make sure that we understand what they're
- 5:55- doing, why they're doing, how to train our
- 5:57- staff to use them, and how to make
- 5:58- sure that when we do use them, we're
- 5:59- doing them with the utmost benefit so that
- 6:01- our humans can interact with the human patients
- 6:03- on the other side and let a lot
- 6:04- of these documentation tasks and these other types
- 6:07- of things fall back to the AI to
- 6:09- automate those pieces so we can help these
- 6:12- patients with what they actually need. Just to
- 6:14- illustrate this for our listeners, is there an
- 6:16- initiative that you can point to specifically at
- 6:18- your organization that illustrates this very well that
- 6:20- shows that opportunity, that impact that you've just
- 6:23- described?
- 6:24- Yeah. Actually, so we're we have a very
- 6:26- great opportunity at UChicago. We are building a
- 6:28- brand new cancer center. It goes live roughly
- 6:29- a year from today.
- 6:31- And this, cancer center, we're really focusing in
- 6:33- on the smart hospital room, and that's gonna
- 6:35- be laden with different technologies to make sure
- 6:37- that we are delivering care to our patients
- 6:39- in the best way. We have a vision
- 6:41- that eventually, probably not an opening, but over
- 6:43- years, we might be able to have these
- 6:45- rooms be keyboard less. So we're in the
- 6:46- room interacting with patients, having a human to
- 6:49- human connection about their care, and the rest
- 6:51- of that documentation that needs to happen in
- 6:53- that space is happening automatically.
- 6:55- Now this takes a lot of work and
- 6:56- effort and planning and figuring out how we
- 6:58- engage our community in this and how we
- 7:00- take all these next steps together. And so
- 7:02- there's a lot of effort in figuring out
- 7:03- AI today, a lot of governance work, a
- 7:05- lot of time spent with our patient and
- 7:06- family groups to figure out what their reactions
- 7:08- to these types of technologies are and how
- 7:10- we bring them to them in a way
- 7:12- that feels respectful to them and helps them
- 7:14- understand that we're doing this for the betterment
- 7:15- of their care. And that's the effort that's
- 7:17- being done across health systems today is figuring
- 7:19- out how do we do this, how do
- 7:21- we do it responsibly, ethically, and in the
- 7:23- right ways to make sure that we can
- 7:25- do these types of things in the future
- 7:27- to make care that much better. Doctor Josiah,
- 7:29- is there an initiative that sticks out for
- 7:30- you?
- 7:32- I would say that, you know, we're sort
- 7:34- of dabbling in a couple different initiatives.
- 7:36- Both Seth and I have talked about the
- 7:38- opportunities with prior authorization, and I think that's
- 7:40- a space that most pharmacy organizations
- 7:43- are already
- 7:44- either have adopted or on the path to
- 7:47- adopting. So I think that's an easy one
- 7:49- just because, again, it is such a manual
- 7:51- process. So anything is better than what the
- 7:53- current state is.
- 7:56- But the other things that we're dabbling in,
- 7:58- at Stanford are using real world evidence also
- 8:02- at the point of care.
- 8:04- We have the benefit of having some homegrown
- 8:06- real world evidence platforms that essentially will run
- 8:09- analysis on our own data.
- 8:11- And so we are able to
- 8:13- essentially leverage that
- 8:15- to either make interventions from a formulary perspective.
- 8:18- Right? What what are we gonna add to
- 8:19- formulary versus what may not actually be beneficial
- 8:22- from both the efficacy safety, but also a
- 8:25- cost perspective and really using that from a
- 8:27- cost containment standpoint,
- 8:29- but also using that to delineate
- 8:31- the clinical impact of our programs.
- 8:34- I think, you know, the whole role of
- 8:36- a pharmacist is to make sure things don't
- 8:39- happen.
- 8:40- So if you're doing that successfully, it's really
- 8:42- actually difficult
- 8:44- to quantify the impact of your role.
- 8:47- And, historically, it's been challenging to show the
- 8:50- impact of pharmacist intervention on either readmission rates
- 8:54- or, you know, specific clinical endpoints such as
- 8:58- a one c for diabetes.
- 9:00- But now with the power of AI and,
- 9:02- you know, having tools that essentially will comb
- 9:05- the chart in seconds and run these complex
- 9:07- analyses,
- 9:08- what we can actually show and demonstrate and
- 9:10- we have at Stanford
- 9:12- is that when a pharmacist is involved in
- 9:14- the patient's care, we're able to help them
- 9:16- achieve their, a one c goal for their
- 9:19- diabetes more quickly.
- 9:21- And and those patients are actually more likely
- 9:23- to achieve their goal than if, compared to
- 9:26- standard of care. And so I think that's
- 9:28- really exciting,
- 9:30- you know, not just from a clerical standpoint
- 9:32- or administrative standpoint to use AI in those
- 9:35- ways, but really to use
- 9:37- AI to identify where are the opportunities for
- 9:40- us
- 9:41- to augment or maybe even change our workflow
- 9:44- so that we're delivering
- 9:45- true value focused, value based care to our
- 9:49- patients.
- 9:50- Speaking of of providing that value,
- 9:52- to be able to do that,
- 9:54- you have to be aligned around these initiatives.
- 9:56- People have to be working together. Otherwise,
- 9:58- there's very isolated impact. Right? What does it
- 10:01- take to create that alignment across organizations
- 10:03- for you? And
- 10:05- are there any examples where you think we
- 10:07- aligned
- 10:08- and have really worked? Are there certain outcomes
- 10:11- that stick out to you because of that
- 10:13- alignment?
- 10:14- Yes. Maybe just using that same example. It's
- 10:17- a little bit of chicken and the egg.
- 10:19- You gotta start somewhere. Right? And so, initially,
- 10:21- maybe there wasn't that shared understanding or that
- 10:24- shared alignment on the value that the pharmacist
- 10:27- brings in primary care.
- 10:29- But once we had the data to show
- 10:32- and to demonstrate that as we continue to
- 10:35- socialize that, now, you know, the conversation is
- 10:38- more around, okay.
- 10:40- Where else can we leverage pharmacists in the
- 10:42- care? Right? Thinking about the care model at
- 10:45- large, when does it make sense for a
- 10:47- pharmacist to be involved? And so those conversations
- 10:49- aren't just happening, you know, with myself or
- 10:52- other pharmacy leaders. They're happening with our service
- 10:54- line leaders to say, you know, hey. That
- 10:57- team benefited from pharmacist involvement. How can we
- 11:01- have some of that too? And rather than
- 11:03- having siloed conversations with each service line, it's
- 11:06- more globally. Okay. Let's define the role of
- 11:08- the pharmacist in the organization or in ambulatory
- 11:11- care specifically.
- 11:13- Doctor Hartman, just to come back to your
- 11:14- example that you mentioned in terms of building
- 11:15- a a new building. Right? That certainly needs
- 11:18- alignment.
- 11:19- People have differing opinions about what works. But
- 11:21- what does this look like for you? Are
- 11:22- there specific examples that you can point to
- 11:24- where you think, okay. We aligned. We talked
- 11:27- about it. What does it take? Right? But
- 11:29- it actually worked because we were aligned, and
- 11:31- we had conversations about this. Yeah. Absolutely. And
- 11:34- I think
- 11:35- the the cancer center example that we had
- 11:37- is a great platform for looking at this
- 11:39- because we're trying to do truly innovative things
- 11:42- in the space, but it also means that
- 11:44- the folks that are providing care in the
- 11:45- space, the patients that will be in the
- 11:47- space, the providers that will, like, exist in
- 11:49- that space as well, have to be on
- 11:50- board with what it is you wanna do.
- 11:52- There are myriad different takes on different AI
- 11:54- technologies, whether that's computer vision and having cameras
- 11:54- at the bedside or whether that's, technologies, whether
- 11:55- that's computer vision and having cameras at the
- 11:57- bedside or whether that's,
- 11:59- ambient recording for audio devices. And you're gonna
- 12:01- have people who are very pro and want
- 12:03- to do this today, and you're gonna have
- 12:04- people who are very resistant and don't ever
- 12:07- want to have this in the space. And
- 12:08- so you have to bring all those groups
- 12:10- together. You have to discuss the true risks,
- 12:11- the true benefits, really look at the ROI
- 12:13- on these different things. So that ROI is
- 12:15- greater than what are the revenues associated with
- 12:17- it, but what is the betterment to the
- 12:18- patient? What is the betterment to the providers
- 12:21- who are providing this care? And how can
- 12:22- we make this easier for everyone? And then
- 12:25- make difficult decisions
- 12:26- on should we or shouldn't we. And walking
- 12:27- down those paths is difficult, and it takes,
- 12:29- you know, many different perspectives in a room
- 12:31- and a lot of conversations. And we're truly
- 12:33- in the middle of this process right now.
- 12:35- You know, my my team on the IT
- 12:37- side is building the system while we're working
- 12:38- with a group who's stitching together new operational
- 12:41- workflows. And every week, we're having cross pollinating
- 12:43- meetings where those ideas are being shared. We're
- 12:45- finding new issues, having new discussions, making new
- 12:47- decisions around things, and we're coming back all
- 12:49- trained to land this at the beginning of
- 12:51- the summer so that we can then start
- 12:52- testing and vetting and training until we can
- 12:54- open this thing in a year from now.
- 12:56- And so these these conversations are happening dynamically,
- 12:59- and a lot of those decisions are made
- 13:00- as a result of getting all of the
- 13:02- right voices in the room and making sure
- 13:03- you're not missing an important component of that.
- 13:05- Can I actually add Yeah? Go ahead. Comment
- 13:07- to that. As Seth was talking, I also
- 13:09- was thinking about this from just a economics
- 13:11- perspective. Yeah. I think that,
- 13:14- that cross pollination or that collaboration is actually
- 13:17- necessary if you're gonna adapt adopt these technologies.
- 13:20- Otherwise, I'm not sure that the ROI would
- 13:23- pan out. Mhmm. So something else that we're
- 13:25- exploring today
- 13:27- is the use of, you know, robotic delivery
- 13:30- systems.
- 13:31- And if I look at that and just
- 13:32- take pharmacy or medications as the use case,
- 13:36- the cost of these technologies
- 13:37- is usually, you know, pretty significant.
- 13:40- And so I don't know, you know, it's
- 13:42- really a comparison of the robot versus labor,
- 13:45- which one would win out.
- 13:47- And I don't know, especially in the Bay
- 13:49- Area, which one would actually what I was
- 13:51- gonna say.
- 13:53- So but then I have to think more
- 13:55- broadly. It's not just you know, pharmacy is
- 13:58- not the only group that needs these these
- 14:00- types of technologies. Who are my other key
- 14:02- stakeholders? So partnering with our lab colleagues, our
- 14:05- nursing colleagues,
- 14:06- food services, etcetera, who all are delivering things
- 14:09- across the organization.
- 14:11- So how do we all come together and
- 14:13- identify
- 14:14- one vendor who can actually
- 14:17- support all of those needs? And then with
- 14:19- that scale,
- 14:21- not only does it make the economics panel,
- 14:23- but it also gives us greater bargaining power.
- 14:25- Yeah. Absolutely. You mentioned something really important here,
- 14:29- sort of the the overarching trend. This is
- 14:31- developing so fast. There's new things every single
- 14:34- time.
- 14:36- As we close our conversation,
- 14:38- how is this going to reshape
- 14:40- pharmacists,
- 14:41- pharmacy leaders, etcetera? How is it going to
- 14:43- impact them? How is AI going to impact
- 14:45- them?
- 14:46- And, again,
- 14:47- what capabilities will pharmacy teams need to develop
- 14:51- to be able to keep up and operationalize
- 14:53- this at scale?
- 14:54- I'll start off with you.
- 14:56- Yeah. There there's a whole host of changes
- 14:59- that I think will come come from this.
- 15:00- Some of them in the short term, some
- 15:01- in the long term. Mhmm. I think in
- 15:03- the short term, upskilling staff to understand how
- 15:05- to react to, use, respond to these models,
- 15:09- understand what it means to have drift, how
- 15:11- to assess for drift.
- 15:13- I think it creates some new roles in
- 15:14- the workforce in terms of you you you
- 15:16- know, today, we have, like, a data science
- 15:18- team who does a their work is really
- 15:20- focused on these models. If you have, you
- 15:22- know, hundreds of these models deployed across every
- 15:24- department in your health system, pharmacy is gonna
- 15:26- need their own data scientists who are skilled
- 15:28- in understanding pharmacist workflows,
- 15:30- clinical decision that's made in that space, and
- 15:32- how to assess for drift in a population
- 15:34- that, you know, one or two percent of
- 15:35- drift might have a meaningful impact across those.
- 15:38- You're also gonna need to make sure that
- 15:40- you are looking long term at what these
- 15:42- mean. You know? So AI is really good
- 15:44- at understanding what's happening, creating information flow, and
- 15:47- trying to do things in terms of, like,
- 15:48- summarization and bringing things together. This probably means
- 15:52- a a broadening of what needs to be
- 15:53- done of, like, putting supervisors closer to the
- 15:55- front lines and putting senior leaders a little
- 15:57- bit higher because that middle gap that's happening
- 15:59- there, that information flow that a lot of
- 16:01- that management layer is doing today can be
- 16:04- tackled by these individuals, which means you need
- 16:07- more people looking at these agents, which is
- 16:09- probably an elevation of some roles, and then
- 16:11- you need some more people closer to the
- 16:13- front lines serving as those experts for how
- 16:15- to use these tools effectively and to how
- 16:17- to manage that work. And so I think
- 16:18- we're really gonna see the workplace shift dynamically,
- 16:22- and we're gonna see that there is a
- 16:24- lot more capability
- 16:25- that's handed to the humans that are interacting
- 16:27- with patients. The agents that are interacting with
- 16:30- patients will be taking on a lot more
- 16:31- tasks. So, hopefully, it feels like the human
- 16:33- touch of care is a lot more realized
- 16:35- in that future state so that as a
- 16:38- pharmacist, as a pharmacy technician, even you have
- 16:40- more time at that patient's bedside than you
- 16:43- do behind the computer dealing with all the
- 16:45- documentation and approvals and all the things that
- 16:47- we do today. It comes back to patient
- 16:49- outcomes and and better care for the patient,
- 16:50- which is so crucial. Yeah. Doctor Desai, same
- 16:52- question for you. How is this going to
- 16:54- reshape pharmacy?
- 16:55- Yeah. I'm smiling because this is something Seth
- 16:57- and I have actually discussed at length. So
- 16:59- I'm just gonna ditto and think Absolutely. Discuss
- 17:02- that.
- 17:03- But I think there's also an opportunity for
- 17:05- us to really think proactively about
- 17:08- what does the pharmacy technician of the future
- 17:11- look like and what does the pharmacist of
- 17:13- the future look like. There's, you know, these,
- 17:16- core competencies
- 17:17- or core tasks that we all,
- 17:20- perform today. Those aren't going away,
- 17:23- but the question is who is performing those
- 17:25- in the future and how are they performing
- 17:28- it. And so I think, you know, historically,
- 17:30- our pharmacy technicians have been very tied to
- 17:32- the drug and have been the ones preparing
- 17:35- the doses,
- 17:36- compounding the doses, etcetera.
- 17:38- Now with increasing automation,
- 17:40- maybe they're not maybe the pharmacy technician of
- 17:42- the future is more trained
- 17:44- from a technical standpoint or a data science
- 17:48- standpoint to really understand
- 17:50- and optimize the technologies that we're using. And
- 17:53- then to Seth's point, the pharmacist of the
- 17:55- future,
- 17:56- this is something, you know, I think we
- 17:58- as a profession have been waiting for for
- 18:00- so long, just being recognized as clinicians, as
- 18:03- providers, and actually focusing on providing that direct
- 18:07- patient care rather than being more behind the
- 18:10- scenes all of the time,
- 18:11- verifying orders and and doing other things more
- 18:14- tied to the dispensation of a medication.
- 18:17- And all of this is I I think
- 18:18- it's wonderful because to set point earlier about,
- 18:21- workforce shortages, it's coming.
- 18:24- And so how can we really spread our
- 18:26- precious resources to ensure
- 18:28- fantastic, safe, and effective care for our patients?
- 18:31- It's so great to have you both on.
- 18:33- Thanks so much for being here. Thank you.
- 18:35- So much. It's great to have you. And
- 18:36- we also want to thank our podcast sponsor,
- 18:38- Omnicell. You can tune into more podcasts from
- 18:40- Becker's Healthcare by visiting our podcast page at
- 18:42- beckershospitalreview.com.