Latest / Becker’s Healthcare Digital Health + Health IT / Dr. Thomas Maddox, Vice President of Digital Products and Innovation at BJC HealthCare and Professor of Medicine at Washington University School of Medicine

Transcript

Dr. Thomas Maddox, Vice President of Digital Products and Innovation at BJC HealthCare and Professor of Medicine at Washington University School of Medicine · Becker’s Healthcare Digital Health + Health IT

• 0:00
  - Prepare to dive into the forefront
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  of healthcare innovation at our 14th annual meeting coming
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  up on April 8th
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  through 11th at the Hyatt Regency in Chicago, with thousands
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  of industry leaders converging over four dynamic days
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  of discussions on crucial topics from health IT
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  to executive leadership.
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  It's where the future of healthcare takes shape.
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  We can't wait to connect with you in person
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  and engage in these important conversations.
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  - Welcome back to the Becker's Healthcare Podcast, devote
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  to the people who power us healthcare.
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  I'm Molly Gamble with Becker's,
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  and delighted to have you join us for another episode filled
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  with insights from healthcare leaders.
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  Today we're spending some time with Dr. Thomas Maddox.
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  Dr. Maddox is the Vice President of Digital Products
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  and Innovation with BJC Healthcare
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  and Washington University School of Medicine,
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  and also Professor of Medicine
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  with Washington University School of Medicine.
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  Dr. Maddox, welcome to the podcast.
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  Thanks so much for being my guest today. How are you?
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  And where does the podcast find you?
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  - Well, thank you so much for the invitation.
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  I'm doing well. It's a Monday,
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  which is always a little treacherous,
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  but, uh, so far so good.
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  And I'm in St. Louis, Missouri, which is where, uh,
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  BJC Healthcare and the Washington University
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  School of Medicine are based.
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  - Great. Yeah.
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  I should mention I'm extra grateful to start the week off
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  with some afternoon catching up with you.
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  Um, Dr. Maddox, you know,
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  as I highlighted in my introduction,
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  you wear a couple different hats
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  in your work and your roles.
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  Can you start us off by sharing a bit more
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  with our listeners about your responsibilities
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  and the scope of your work, both with the BJC health system
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  and then Wash U School of Medicine?
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  - Sure, sure. So you're right.
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  I wear several hats, um, all of which I enjoy.
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  First and foremost, I'm a cardiologist.
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  Um, I've, I've been practicing for a couple decades now
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  and, and just love it.
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  You know, medicine is a, is a wonderful profession,
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  and it's really cool to be able
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  to pull on the white coat periodically
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  and, um, do what I've trained to do for years.
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  And that is, is try to take really good care of patients,
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  particularly those with cardiac issues.
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  So that's part of my job. And then, um, I arrived in St.
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  Louis about seven years ago
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  to help found their healthcare innovation laboratory.
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  And so at that time, 2017, uh,
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  digital health was really starting to take off.
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  Uh, and the presence
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  of digital data in our healthcare system through EHRs
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  and other methodologies really was starting to take hold.
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  So the school felt like, um, it was a good time
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  to have a group focused exclusively on
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  how might these digital health tools
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  and this digital information
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  and the, uh, the communications technologies, uh, be
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  engineered in a way that could be maximally useful
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  for our patients, for their families,
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  and for the care teams to take care of them.
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  So they brought me on to kind of help think
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  through how that might work.
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  And for the last seven years, we've really been trying
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  to tackle some of these, uh, new approaches to healthcare,
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  be it, um, predictive analytics, uh,
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  remote patient monitoring, digital tools
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  that can be used at the point of care by our care teams,
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  all the myriad ways that, um,
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  digital health can provide some innovative
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  approaches to better healthcare.
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  Mm-hmm, . So that's, uh, a role that I've had
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  for seven years, continue to have, enjoy that immensely.
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  It's, uh, it's, it's fun to be charged
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  with thinking down the road of what could be coming
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  and to have that creative component to my job.
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  Mm-Hmm. , about three years ago, um,
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  I was asked by our CIO to then, uh, take on, uh,
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  a digital products effort.
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  So I think most of your listeners
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  who are involved in it will recognize that, you know,
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  digital products and a,
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  and a product, uh, philosophy is really sort of, um,
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  uh, the standard now in technology.
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  And really it was pioneered by a lot
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  of the big tech companies, the, the Googles and Metas
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  and others, uh, in the, in the big tech sector.
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  And it's basically the idea of
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  how can you really get deep into your user's problems
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  and then build a product, build a solution, um,
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  in a rapid way that is continually checking in
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  with those users to make sure
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  that it truly is solving the problem
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  that it's ostensibly designed to solve.
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  And you use various techniques to develop
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  that human-centered design, uh,
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  agile delivery methods, rapid sprints.
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  And it really is sort of bringing, in my opinion,
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  the scientific method of inquiry into the development
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  of technology products
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  and solutions into, in how we,
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  in our case and how we deliver care.
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  So, uh, those teams have product managers, uh,
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  scrum masters, product designers,
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  and our first sort of set
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  of products have focused on our digital front door.
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  So how do we have digital tools like find a doctor
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  and online scheduling
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  and other things to make it easier for patients
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  to get in to see us.
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  And then we've also been working a lot on our nursing, um,
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  front and building some digital tools to help our nurses
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  who are, who are really at capacity, if you will, um, to,
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  to enable their work
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  in a little bit more of an effective way.
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  As we built a virtual nursing product,
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  we built our scheduling has to make it easier for them
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  to pick up shifts and sort of, um, uh, be able
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  to provide maximum care to our patients.
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  And we've really had some good success with that.
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  And, and now, um, I think we're on the cusp
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  of introducing this product methodology more broadly across
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  our IT portfolio.
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  And then finally, most recently, um, with the rise of ai,
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  both analytic and generative ai,
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  and seeing some of the possibilities it can provide
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  for healthcare, um, I've been asked to help lead some
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  of those AI development efforts in conjunction
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  with washus chief data scientist, Philip Hane.
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  And together with our teams, we're really trying to think
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  through how can we bring the best of what AI's developing
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  to our patients into our care teams.
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  And right now we're exploring a couple
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  of different predictive models that use AI
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  to help us understand how patients are progressing
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  through their inpatient stay, trying to make that
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  as most efficient as possible.
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  And then we're also experimenting with some
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  of the new generative AI technologies,
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  and particularly how they might help our clinicians be more
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  efficient in their documentation,
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  which is often a real time suck
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  and a, a real dissatisfier
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  to our care teams drives a lot of burnout.
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  So we're trying to see if generative AI can help, um,
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  with them generating notes in clinic visits
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  and really knock down some of the time needed to, uh,
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  to record, uh, those clinical encounters.
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  We're also using it to help the clinicians respond
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  to the sometimes hundreds of secure message
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  and end baskets, um, email responses they receive daily
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  from, uh, from, uh, patients and care teams.
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  So it's a lot of different hats.
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  They're all connected in my mind. Mm-Hmm.
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  , um, and, and sort of speak to one another.
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  So it's not like they're totally disparate jobs,
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  but it does make for full days and weeks.
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  But I, I really enjoy it.
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  - I imagine, you know, as, as you're walking us
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  through this, I mean, not to go too deep on the,
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  the hat metaphor, but some of these hats that you described,
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  I mean, these are new hats.
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  These are roles that you were asked to take on.
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  It was a first of its kind opportunity or position. And Dr.
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  Max, can I ask you a question for other leaders
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  who might one day be invited to head up such opportunities,
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  which I think at academic medical centers
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  and large integrative health systems,
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  it's really interesting.
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  It's like, directionally, we know where we're headed,
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  it's time to formalize a lot of the idea generation we have
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  around this, a lot of the potential.
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  We want someone to head it up and take it on
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  and lead formally and properly.
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  And that in several instances was you, what,
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  what's really critical as a leader in those times?
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  What leadership traits
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  or qualities really emerged as you were working
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  through these new enterprises with BJC
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  and Washington University that you relied on most?
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  - That's a great question. Um,
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  and I'm not sure there's, you know, a, a
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  pat answer at least I don't have one.
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  But, um, things that have really helped me
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  in starting to understand a new area on behalf
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  of our organization is, you know,
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  one, don't go it alone.
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  Um, I think both internally
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  and externally, I've relied a lot on folks
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  who maybe have deeper knowledge in certain areas like
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  technology than I've had, and just the, the type of training
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  and experiences I've had to date.
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  So, for example, I have a lot
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  of peers in our technology group who've just taught me a ton
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  about the, the technical mechanics of digital tools
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  and infrastructure and information security
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  and all the other things you need to have
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  to have an effective technology solution.
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  I've also learned a ton from our care
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  teams and our patients.
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  Like what are they experiencing?
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  What are they running into issues with
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  that innovations may help them with?
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  And I think that's where some of the methodologies
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  as human-centered design, which I've, you know,
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  recently learned, have been really powerful, particularly,
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  um, the, so-called ethnographic interviewing,
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  where you really kind of walk along with somebody,
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  literally walk along with them as they're trying
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  to get care if they're a patient
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  or trying to deliver care if they're a doctor or nurse,
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  and really sort of see
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  and ask like, why are you doing it that way?
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  What are you trying to solve?
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  And really sort of getting deep into the user journeys
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  and experiences that ultimately fuel the
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  solutions you need to develop.
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  Mm-hmm, . And then externally, you know,
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  there's a lot of people trying to tackle all
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  of this other people at other am, uh,
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  academic medical centers, um,
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  other people even in industries outside of healthcare who,
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  um, who are also trying to harness technology
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  to do a better job for them.
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  And I have found that just being open
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  and connecting to those folks
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  and making time to just sort of run ideas by them
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  or talk through problems really has sort
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  of expanded my ability to be more effective in my job.
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  And then the final thing I'll say,
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  and this has been true my entire life, read voraciously.
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  Um, I have a couple of ways that I maintain reading lists
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  and receive input about interesting things to stay on top
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  of, either on the web or books or just other materials.
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  And even though you can quickly run out of time to read,
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  if you aren't conscious
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  and like block out time, which I do into your calendar,
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  I find that your ability to get smart about things
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  and make connections about things
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  that ultimately fuel innovations is greatly accelerated.
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  Um, the more that you can read
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  and the more broadly that you read.
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  So those are just some of the things that I have found,
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  you know, both internal and external community, um,
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  taking advantage of some
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  of the human-centered design insights,
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  and then just being a voracious reader.
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  I find all of those to be really helpful in some of these,
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  these roles I've had to date. Can
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  - You talk about reading broadly?
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  Is there something you've read recently
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  that might surprise me?
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  - Hmm. That, oh, that's a got got you.
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  Question, isn't it? , you told me you were gonna ask
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  me one of those . Well, if you
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  - Need a minute, I don't, I'm a reader myself always
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  looking for suggestions.
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  - Yeah. You know, I, um, I'm a little bit of a history buff,
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  and I just find it fascinating to read
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  about different parts, different times in history.
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  I, I just recently finished the Truman biography,
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  which I felt like I needed to do now
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  that I'm here in Missouri and he's, uh,
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  obviously a Missouri Missouri son.
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  And as, as the listeners in, uh, no Doubt know, he was,
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  he was president at, uh, a specific time in our history
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  where a ton was being developed not only in the,
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  in the aftermath of World War ii,
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  but then, you know, America was starting to reemerge out of
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  that war and develop in some ways the foundations
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  of the modern economy and sort of the various things that he
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  and his administration had to tackle
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  and deal with, not only sort of the rise of the Soviet block
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  and some of the, the foreign matters that were going on,
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  then the rise of nuclear weapons, um,
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  but also some of the other sort of societal things.
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  How do you, how do you handle the influx
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  of all the GIS coming home
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  and stand up the economic supports
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  to make sure they can get off to a good start?
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  The baby boom was starting to happen.
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  How do you think about supporting all the, the children
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  that were coming, just starting to sort of think about
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  how do you take these massive problems
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  that in many cases people had never seen before.
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  IE needed an innovative approach.
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  And just see how smart people at
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  that time would sort of tackle the issues.
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  Um, I, I think everybody's always had this challenge.
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  They've got, they've got new challenges in front of them,
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  and just sort of seeing in history
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  how different figures have tackled that
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  to me, it's both interesting.
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  But then, um, you certainly get, get lessons about
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  how you might not apply that to your own set of problems
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  and challenges you might have professionally.
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  Mm-Hmm. . So history's, history's a big thing.
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  Um, you know, all sorts of industry reads that I do.
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  I stay on top of the medical literature for my clinical job,
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  but also to see kind of what's coming.
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  And then every now and then I'll sprinkle it in with,
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  um, with fiction.
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  And my current, my current plug is for, um,
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  a more tolls book, A Gentleman in Moscow,
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  which I just finished and absolutely loved.
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  So that's a good, that's a good escape from it all.
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  So maybe more than you wanted.
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  I don't know if I surprised you,
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  but that's kind of what I'm reading.
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  - Very well rounded. You know,
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  the last thing you touched on when walking us
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  through your roles was the, the rise of ai.
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  And I'm curious if there's one aspect
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  or one dimension of AI that has been demanding most
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  of your time and energy as of late, is,
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  is there one singular thing you could highlight
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  for myself and listeners?
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  - Yeah, I think, um, obviously AI
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  moved into a whole nother realm of public consciousness
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  when open AI put chat GPT in the public domain.
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  And I think it's, it's an interesting phenomenon
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  to just think about almost sociologically,
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  because why a has been around for decades,
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  why is this an inflection point?
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  And I, my theory, I don't know if it's right,
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  but my theory is that for the first time,
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  this technology is speaking
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  to us quite literally in a language that we understand.
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  Hmm. You know, previously we, we, the lab
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  and our organization been working with predictive ai,
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  analytic AI for a couple years now,
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  but when you build a predictive model, often the output of
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  that is, is like a numerical score
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  or maybe a risk level like this, oh, this patient
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  is at a high risk for readmission, for example.
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  And even though that's an important thing to know
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  and, you know, certain teams would act on that information,
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  it doesn't really capture the imagination, particularly
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  of the lay public as much as generative ai.
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  When you ask it a question, it gives you a response
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  that like, feels like a human is answering you.
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  Mm-Hmm. . And I think it's that sort of factor,
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  that sort of interaction with language, that use of language
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  that this particular approach of AI uses
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  that has really captured the imagination, both in terms of,
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  oh, how exciting it can help us in all these myriad ways,
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  and frankly, probably causes some
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  of the anxiety we've heard too about, oh my God, here it is,
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  how he's gonna lock us out of the bay doors
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  and we're all gonna die.
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  Um, so I, I think
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  that's probably the biggest driver of why it's
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  so front of mind for everybody now.
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  And now my job is to then take that somewhat hypey situation
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  and say, okay, that's cool, but in reality, how can it help?
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  How can it really solve problems that matter to us?
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  And so I think, um, I'm, I'm excited about
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  what we're focusing on because clinical documentation,
• 16:43
  the amount of information that we generate as we visit
• 16:46
  with patients that need to record those encounters
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  has never been more, um, voluminous than it is right now.
• 16:54
  And it's really just a huge challenge for our clinicians.
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  You know, a huge number of them are spending hours a day
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  documenting sometimes obviously, to just make sure
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  that we're staying on top of the care
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  we're providing for our patients.
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  But sometimes it's just a lot of regulatory requirements.
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  Mm-Hmm. , which, you know,
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  each has their own rationale,
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  but when you add it all up, it's an enormous burden,
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  particularly on, you know, a doc who kind of has to pull
• 17:21
  that all on their own shoulders.
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  So even though it's early innings, if this tool,
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  which does seem to be well-suited
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  for summarizing information
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  and putting it in the formats that we typically use
• 17:35
  for clinical notes, if this is an opportunity to really kind
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  of offload some of that clerical burden, which
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  to be honest is like a necessary evil,
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  but not really the reason that any of us get into medicine,
• 17:49
  I think that could be a huge satisfier
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  and a huge help to some of the burnout
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  and dissatisfaction that I
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  and my colleagues are seeing in some
• 17:59
  of the day-to-day practice of modern medicine.
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  Mm-Hmm. . So I'm hopeful that as we continue
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  to build this technology out
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  and it matures in our ability to work with I tours
• 18:09
  that we can really see some productive inroads made
• 18:12
  into that particular problem.
• 18:15
  - I think that's a really interesting theory
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  that you put forward on why cha EPT this public
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  fascination took hold, especially early 2023.
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  I just remember so many of the headlines
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  and you know, what could be,
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  and a lot of hypotheticals around it.
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  And it seems like,
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  and I'd be curious what your reaction is to this,
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  but it seems like in this time we've learned
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  it's really skillful and good
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  and helpful in doing a lot of aspects of my job
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  that I can't even bear to talk about
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  because it's like the most boring aspects
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  of my job can now be done by chat EPT.
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  It doesn't really make for interesting conversation
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  though, if that makes sense.
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  Um, compared to the headlines early on that were like,
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  you know, a a lot of provocative questions being asked
• 18:58
  around chat EPT, who it will displace and so forth.
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  And right now at least it seems like it's really good at
• 19:03
  some basic routine admin things.
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  Um, I don't know if that's similar for, for
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  what you're seeing in medicine.
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  - Yeah, I think that's right.
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  And you know, now the hard work begins, right?
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  Like, we've gotta figure out how to take this sort of
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  cool technology and apply it to real world problems.
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  And I think, um, sure what,
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  especially when you don't know much about something,
• 19:27
  you tend to extrapolate either for, you know,
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  exorbitant ends, you know, really optimistic ends
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  or really pessimistic ends.
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  And there was a lot written about that.
• 19:36
  And, and you're right, it was very hypey
• 19:38
  right when it first hit the market.
• 19:41
  But I think now, um, you know, reality's starting
• 19:45
  to set in, it's not perfect.
• 19:47
  Um, it takes some doing this, this idea of the right prompts
• 19:52
  to direct the models
• 19:53
  to generate relevant output is becoming more
• 19:56
  and more important is just tricky.
• 19:58
  Uh, I think we're getting a little bit better at it,
• 20:01
  but I, I, I think this idea that it will
• 20:06
  displace jobs we've heard
• 20:09
  before, you know, this gets back to history.
• 20:12
  Um, there are technological innovations that have happened
• 20:16
  for centuries, and at each point society has almost the,
• 20:20
  a same question and the same word.
• 20:23
  They're like, oh my God, now all this is gonna go away.
• 20:26
  Now the Gutenberg designs the printing press, oh my God,
• 20:29
  what about all the scribes?
• 20:30
  They're gonna lose all their jobs
• 20:33
  and you know, so on and so forth.
• 20:34
  And I think what we have seen time
• 20:37
  and time again is sure, some jobs
• 20:41
  can now be replaced, if you will, by the technology,
• 20:46
  but the people doing those jobs
• 20:49
  almost inevitably have other things to do.
• 20:52
  Mm-Hmm. . And one of the examples
• 20:54
  that made the most sense to me recently was the idea that,
• 20:59
  uh, electronic calculators,
• 21:01
  whenever they came out, everybody thought
• 21:03
  that is now the end of being an accountant.
• 21:07
  There will no longer be a need to be an accountant,
• 21:10
  and that's just not true.
• 21:12
  The fact of the matter is, being an accountant changed
• 21:15
  and you no longer needed to go through the drudgery
• 21:17
  of summing up massive rows of numbers
• 21:20
  and doing everything
• 21:21
  that an electronic calculator can now do in seconds.
• 21:25
  But now the job in an accountant became much more strategic
• 21:29
  and taking advantage of that technology
• 21:31
  to further their thinking
• 21:32
  and productivity in the overall world of accounting.
• 21:36
  Mm-Hmm. . And I think that'll be true in the
• 21:38
  various ways that AI gets applied for healthcare too.
• 21:41
  It'll change the nature of my job.
• 21:44
  And, and somebody once said, you know,
• 21:46
  AI is not gonna replace to the doctors,
• 21:49
  but doctors using AI will replace doctors
• 21:53
  not using ai.
• 21:55
  And I think that's true. Mm-Hmm. .
• 21:57
  So we'll see how it plays out.
• 21:59
  But if history's a guide
• 22:00
  and it very often is, I suspect that's
• 22:03
  where we'll land. Yeah.
• 22:04
  - We're coming full circle now.
• 22:06
  Dr. Maddox, uh, this has been such an interesting
• 22:08
  dynamic conversation.
• 22:09
  Is, is there anything we didn't mention that you'd like
• 22:12
  to leave our listeners with as we wind down here?
• 22:16
  - No, I think, um, you know, most of what I,
• 22:18
  what I've been saying around the use of AI as an assistant,
• 22:21
  as a co-pilot, as an augmentation in medicine, I,
• 22:24
  I do feel strongly about, um, I haven't, well,
• 22:27
  I should say I haven't seen any signals
• 22:28
  to dissuade me from that point of view.
• 22:31
  And so I'm, I'm a bit of a techno optimist,
• 22:33
  but I also think I'm realistic and, uh,
• 22:36
  and I'm just excited to do the hard work.
• 22:38
  But I think ultimately the productive work to, um,
• 22:41
  to really mature the technology into something
• 22:45
  that can be useful for our organization and,
• 22:48
  and for the patients that we serve.
• 22:51
  I think the other thing that, um, is exciting
• 22:54
  to me about the technology is I've mentioned that so much
• 22:58
  of a clinician's day,
• 22:59
  day-to-day experience right now is filled
• 23:01
  with clerical drudgery and administrative tasks
• 23:04
  and note generation, et cetera.
• 23:06
  And I think it's really exciting to think about
• 23:08
  how technology can kind of remove that, at least
• 23:11
  to a degree from the day-to-day experience of healthcare.
• 23:15
  And, and in some ways re-enable the humanity of healthcare,
• 23:19
  that I can finally take my eyes off the computer screen
• 23:23
  instead, look at my patient, talk to them,
• 23:26
  and really, you know, continue to build the relationship
• 23:29
  that frankly underpins all effective, uh,
• 23:33
  clinician patient relationships.
• 23:36
  And so if this, if this technology can help to that end,
• 23:40
  then um, you know, the work
• 23:42
  and sometimes the aggravation of all the work is,
• 23:45
  is certainly gonna be well worth it.
• 23:48
  - Well, Dr. Max, I wanna wish you continued luck in,
• 23:50
  in success in your role as a techno optimist,
• 23:54
  but a realistic one at that .
• 23:56
  I think always a, a real pleasure to catch up
• 23:58
  with people like you and, and get your read on things,
• 24:00
  um, to set us straight.
• 24:01
  So listeners, this has been Dr. Thomas Maddox,
• 24:04
  vice President of Digital Products
• 24:05
  and Innovation with BJC, healthcare
• 24:07
  and Washington University School of Medicine.
• 24:09
  Also Professor of Medicine
• 24:10
  and Cardiology at Washington University School
• 24:13
  of Medicine, Dr. Maddox.
• 24:14
  Hope we can catch up again sometime soon.
• 24:17
  - Love it.