Latest / Becker’s Healthcare Digital Health + Health IT / Tomas Gregorio, Senior Vice President and Chief Digital Information Officer at Care New England Health System

Transcript

Tomas Gregorio, Senior Vice President and Chief Digital Information Officer at Care New England Health System · Becker’s Healthcare Digital Health + Health IT

• 0:02
  - There's a version of AI in health care
• 0:04
  - that lives mostly in press releases,
• 0:06
  - pilot programs, partnership announcements,
• 0:09
  - theoretical
• 0:10
  - use cases.
• 0:11
  - And then there's the version that lives in
• 0:13
  - the work, the CIO trying to get a
• 0:15
  - model into production without breaking a dozen workflows,
• 0:19
  - the revenue cycle leader weighing automation against accuracy,
• 0:22
  - the CISO who knows that every new integration
• 0:25
  - is a new attack surface.
• 0:28
  - Becker's eleventh annual IT and revenue cycle conference
• 0:31
  - is built for the people doing that work.
• 0:33
  - More than 2,500
• 0:35
  - executive level attendees,
• 0:37
  - 600 plus speakers,
• 0:39
  - and four days of sessions designed around the
• 0:41
  - real operational questions behind
• 0:44
  - AI, cybersecurity,
• 0:45
  - revenue cycle performance, and digital health.
• 0:48
  - Join us September 14 through the seventeenth.
• 0:51
  - For the agenda and event details, visit beckershospitalreview.com
• 0:55
  - and click on the events tab in the
• 0:57
  - upper right.
• 1:00
  - This is Laura Dierda with the Becker's Healthcare
• 1:03
  - podcast. I'm thrilled today to be joined by
• 1:05
  - Tomas Gregorio,
• 1:06
  - senior vice president and chief digital information officer
• 1:09
  - at Care New England Health System. Tomas, it's
• 1:11
  - a pleasure to have you on the podcast
• 1:13
  - today. Thank you, Laura. It's great to be
• 1:15
  - here.
• 1:16
  - Absolutely. Now I'm excited for our conversation because
• 1:18
  - I know there's so much happening in health
• 1:20
  - care and particularly in technology and innovation.
• 1:23
  - It's a transformative time, and so I'm looking
• 1:25
  - forward to learning more about what you're doing
• 1:26
  - at Care New England. But before we dive
• 1:28
  - in, can you just tell me a little
• 1:30
  - bit more about yourself and the organization?
• 1:32
  - Sure.
• 1:34
  - I'm the senior VP and chief digital information
• 1:37
  - officer, as you said, and I'm based in
• 1:40
  - Providence, Rhode Island.
• 1:42
  - CNE is, an academic health system,
• 1:46
  - and, we're anchored by women and infants,
• 1:50
  - hospital, Kent Hospital, Butler Hospital,
• 1:53
  - and,
• 1:54
  - behavioral health and academic medicine, which
• 1:57
  - makes the digital transformation work generally complex
• 2:02
  - and genuinely meaningful. Right? So my portfolio spans
• 2:06
  - the epic strategy,
• 2:08
  - AI adoption,
• 2:09
  - cybersecurity,
• 2:10
  - and a
• 2:11
  - set of academic and rural health partnerships that,
• 2:15
  - I think are some of the most interesting
• 2:17
  - work happening in New England right now.
• 2:21
  - Absolutely. I love that. I know we're gonna
• 2:22
  - dig into all of that, within our conversation
• 2:25
  - here. So let's let's dive into it. What
• 2:27
  - are some of the most powerful forces in
• 2:30
  - digital health and IT that you see shaping
• 2:32
  - your organization today as well as in the
• 2:34
  - next couple of years or so?
• 2:37
  - I three I see three forces. Right? And
• 2:39
  - they all compound on each other.
• 2:42
  - First,
• 2:44
  - the EHR is an AI platform.
• 2:46
  - We completed our epic implementation last October,
• 2:50
  - which I what that unlocked wasn't just workflow
• 2:54
  - modernization.
• 2:54
  - Right? It was
• 2:56
  - data foundation to actually deploy
• 2:59
  - generative AI at the point of care.
• 3:02
  - We live with ambient voice
• 3:05
  - documentation
• 3:06
  - and actively
• 3:07
  - tracking, coding
• 3:09
  - for the physicians,
• 3:10
  - and denial appeals,
• 3:13
  - automation are all
• 3:14
  - AI,
• 3:17
  - after effects as a result of going live
• 3:19
  - with epic that are already improving so many
• 3:22
  - things.
• 3:23
  - The the vendors are moving fast,
• 3:25
  - and the the health system that didn't prioritize
• 3:28
  - go live quality are going to be left
• 3:30
  - behind.
• 3:31
  - So whoever doesn't
• 3:33
  - prioritize that as part of their,
• 3:36
  - process moving towards AI is gonna be left
• 3:38
  - behind. Second is
• 3:40
  - cybersecurity
• 3:41
  - risk in health care
• 3:43
  - has crossed the new threshold.
• 3:45
  - This isn't IT IT risk anymore. It's it's
• 3:48
  - a patient safety risk.
• 3:50
  - It's board level fiduciary risk.
• 3:53
  - The threat, actors
• 3:56
  - targeting health systems are increasingly
• 3:58
  - AI enabled,
• 3:59
  - and most systems are not.
• 4:01
  - We're in the middle of a c CISO
• 4:03
  - build out so that we can
• 4:05
  - figure out
• 4:06
  - how we can protect ourselves
• 4:09
  - with AI itself.
• 4:11
  - And Kyndryl, our partner, is helping us go
• 4:13
  - through that process.
• 4:14
  - We have a big meeting this month with
• 4:16
  - Anthropic
• 4:17
  - and a lot of the CISOs in the
• 4:19
  - region.
• 4:21
  - So as an industry, we aren't
• 4:23
  - represented
• 4:24
  - well,
• 4:26
  - as part of
• 4:27
  - Glasswing and all of those initiatives that that
• 4:30
  - Anthropic has put together,
• 4:32
  - which worries me
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  - because
• 4:35
  - we don't have the capacity to patch on
• 4:38
  - demand our our systems.
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  - We have life's at stake
• 4:43
  - and, it's a fiduciary
• 4:45
  - quality issue for our board,
• 4:47
  - and they are very well aware and they
• 4:49
  - back us up with everything that we do
• 4:51
  - to make sure that we're successful.
• 4:53
  - And the third thing is,
• 4:56
  - workforce and access, right?
• 4:58
  - Rural and underserved communities in Rhode Island are
• 5:00
  - watching the same technology revolution
• 5:03
  - happen around them
• 5:05
  - without benefit benefit benefiting from it. That's where
• 5:08
  - our community connect expansion and our epic academic
• 5:12
  - certification pipeline
• 5:14
  - with, Rhode Island College comes in. Right? We're
• 5:16
  - gonna try to
• 5:18
  - stimulate,
• 5:20
  - you know, the use of epic at
• 5:23
  - the Rhode Island universities in order to find
• 5:26
  - the next generation of IT leader, whether it
• 5:29
  - be in the nursing school, whether it be
• 5:31
  - in the cyber school,
• 5:32
  - whether it be in the business school. That's
• 5:34
  - what we're trying to put together.
• 5:37
  - And I think that in the next year,
• 5:39
  - I expect that AI to shift from pilot
• 5:42
  - to operating assumption.
• 5:44
  - The organizations that's
• 5:46
  - that's still doing proof of concepts
• 5:49
  - will be
• 5:50
  - lapped
• 5:51
  - by one's
• 5:52
  - treating AI as infrastructure. So
• 5:55
  - it's a
• 5:56
  - you need to get past that pilot stage
• 5:58
  - at this point, and and that's why we're
• 6:00
  - bullish about finding that right company to work
• 6:03
  - with to make sure that we can be
• 6:04
  - successful
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  - and move the needle slowly as we move
• 6:07
  - forward.
• 6:10
  - That makes a lot of sense. You know?
• 6:11
  - And I I really appreciate your thoughts on
• 6:13
  - all of this because, to your point,
• 6:16
  - technology is moving so quickly and AI is
• 6:18
  - becoming integrated into so many aspects of health
• 6:21
  - care delivery, whether it's on the clinical side
• 6:23
  - or the administrative side, but understanding and balancing
• 6:26
  - both the opportunities as well as the risks.
• 6:29
  - They're really a huge huge job right now
• 6:31
  - with how quickly things are changing. So, you
• 6:33
  - know, when you look at that from your
• 6:35
  - position,
• 6:37
  - where do you see some of the the
• 6:39
  - conversations going, I guess, or or the practical
• 6:41
  - things that you're gonna have to do and
• 6:44
  - shift your teams towards to,
• 6:46
  - make the the shift and take advantage of
• 6:48
  - the innovation
• 6:49
  - without having too much exposure for the patient,
• 6:53
  - data and information and safety.
• 6:56
  - You know, I think that,
• 7:00
  - in order to
• 7:02
  - successfully
• 7:04
  - use the technology, everybody has to be trained
• 7:07
  - and forewarned of its capabilities.
• 7:10
  - Right? So my team
• 7:12
  - needs to understand,
• 7:14
  - a, the whole
• 7:16
  - billing aspect of how this thing works and
• 7:19
  - tokens and and all of that is still
• 7:23
  - crazy to, to figure out. Right? And it
• 7:25
  - can be an exorbitant cost to your organization.
• 7:27
  - So you we really need to get under
• 7:30
  - the covers and understand what we're really doing.
• 7:32
  - You know, we're just not releasing a search
• 7:34
  - engine.
• 7:35
  - We're releasing an intelligence
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  - to be able to collect information
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  - to give you an answer. It's an answer
• 7:41
  - engine. It's no longer a search engine. Right?
• 7:44
  - So those
• 7:46
  - educational
• 7:47
  - points need to be part of your deployment,
• 7:50
  - or else you could see a bill that
• 7:52
  - that, you know, is consumption based that that'll
• 7:54
  - that'll
• 7:55
  - cripple your organization and not give you the
• 7:58
  - the ROI you want.
• 8:01
  - That's such a good point. And, you know,
• 8:03
  - a very, very important thing to be thinking
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  - about because it is completely different than the
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  - way traditionally
• 8:09
  - health systems have interacted with vendors and partners
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  - and and thinking about billing for those services.
• 8:14
  - So,
• 8:15
  - that that's definitely critical and and will be
• 8:17
  - fascinating to see how organizations,
• 8:20
  - navigate around it in the future.
• 8:22
  - Yeah.
• 8:24
  - So could you tell us a little bit
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  - about a big swing or a project you
• 8:28
  - worked on the last year that has really
• 8:29
  - paid off? What did you do, and what
• 8:31
  - were the results?
• 8:32
  - Well, obviously, you know, the big swing for
• 8:34
  - us was, the epic implementation,
• 8:36
  - you know, a $100,000,000
• 8:38
  - project.
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  - But
• 8:42
  - what I'm most proud of is that we
• 8:44
  - built on top of an built on top
• 8:47
  - of it immediately after. Right?
• 8:49
  - Rather than letting the post go live
• 8:52
  - become a stabilization
• 8:54
  - plateau, we we used it as a launchpad.
• 8:57
  - And,
• 8:58
  - we stood up, you know, the structured support
• 9:00
  - that we needed.
• 9:02
  - We met mapped the full optimization
• 9:04
  - backlog.
• 9:05
  - Over a thousand take requests have been logged.
• 9:07
  - So imagine,
• 9:08
  - we go live
• 9:10
  - because it's part of the process. You're looking
• 9:11
  - at screens. You're not really using it. And
• 9:14
  - then you make a decision to go live
• 9:15
  - and you say, wow. That does really, really
• 9:17
  - work for me.
• 9:18
  - So we that has resulted in a a
• 9:21
  - list of a thousand items that need to
• 9:23
  - be
• 9:24
  - requested changes, modifications,
• 9:26
  - and we've we've now put a timeline on
• 9:29
  - all that work
• 9:30
  - to make sure that we can get, through
• 9:32
  - the process
• 9:34
  - of,
• 9:36
  - optimizing
• 9:38
  - right after the conference in in August. Right?
• 9:40
  - We're gonna use the conference at at UGM
• 9:43
  - with EPIC as our baseline.
• 9:45
  - Okay. What do we accomplish up until August?
• 9:48
  - Our fiscal year is on October.
• 9:50
  - So in September, we sit down and we
• 9:52
  - plan for the year to the next conference.
• 9:54
  - So we're getting into that groove, and and
• 9:56
  - I think it's gonna be very exciting for
• 9:57
  - us,
• 9:59
  - as an organization. And the other big one
• 10:01
  - is the relationship with the Rhode Island College
• 10:04
  - for for
• 10:07
  - talent.
• 10:08
  - Right?
• 10:09
  - Being able to get them certified, give them
• 10:12
  - internships with our organization
• 10:14
  - and the others that we work with
• 10:16
  - all benefits the ecosystem
• 10:19
  - of the folks here in Rhode Island, as
• 10:20
  - well as, you know, anywhere else that wants
• 10:22
  - to be trained here. It's actually a national
• 10:24
  - program.
• 10:27
  - That's really cool to hear about. And so,
• 10:30
  - especially when you're thinking through, you know, that
• 10:33
  - relationship,
• 10:34
  - for talent,
• 10:35
  - is that all across the board? Is it
• 10:37
  - more clinical or technology?
• 10:38
  - And, you know, how do you see,
• 10:41
  - those individuals really being able to make a
• 10:44
  - difference,
• 10:45
  - for for the broader pipeline coming into Care
• 10:47
  - New England?
• 10:48
  - You know, it's interesting because what we're gonna
• 10:50
  - do is
• 10:51
  - we're we're gonna give them
• 10:53
  - a a test.
• 10:55
  - It's a test that Epic uses called the
• 10:57
  - Sphinx,
• 10:58
  - and that will drive
• 11:00
  - their capability to be an analyst,
• 11:03
  - to be
• 11:05
  - a a credentialed
• 11:06
  - trainer,
• 11:08
  - right,
• 11:08
  - or another role
• 11:10
  - tied to technology that may not have anything
• 11:13
  - to do with those specific roles that are
• 11:16
  - having to do with IT. Right? It could
• 11:18
  - be a a nursing informaticist
• 11:20
  - as a result of that information. So
• 11:23
  - building that relationship with that school, I mean,
• 11:25
  - I've done it where I came from.
• 11:27
  - So I kinda have a history of being
• 11:29
  - able to set it off, and and it's
• 11:31
  - been very successful
• 11:32
  - in the past when I did it. So
• 11:34
  - I'm I'm very excited about doing here here
• 11:36
  - in Rhode Island where,
• 11:38
  - you know, the the the scope is much
• 11:39
  - smaller in terms of a small state,
• 11:42
  - and the impact could be much greater as
• 11:44
  - a result.
• 11:46
  - That's great to hear and, you know, exciting,
• 11:48
  - exciting times ahead. And, you know, to that
• 11:50
  - point, I suppose now you've finished the EHR
• 11:53
  - implementation,
• 11:55
  - and getting ready, as you said, to, figure
• 11:57
  - out the next steps for optimizing Epic.
• 12:00
  - What do you see as being the next
• 12:01
  - most important problem you're trying to solve with
• 12:03
  - AI and technology?
• 12:05
  - Right now,
• 12:07
  - honestly,
• 12:08
  - time.
• 12:09
  - Clinician
• 12:10
  - time.
• 12:12
  - The administrative burden on physicians and nurses
• 12:17
  - in a system like ours is enormous.
• 12:20
  - Documentation,
• 12:21
  - coding, prior or authorizations,
• 12:23
  - denials.
• 12:24
  - These are all
• 12:26
  - things that cost you a lot of time,
• 12:28
  - and and we've really
• 12:30
  - invested a lot of time in ambient
• 12:32
  - money in ambient listening.
• 12:35
  - Every minute of the physician spends
• 12:38
  - in administrative work
• 12:41
  - is a minute not spent by
• 12:44
  - them with the patient. Right? So
• 12:47
  - what what ambient voice allows you to do
• 12:48
  - is to remove that triangle. Right? The twenty
• 12:51
  - years ago when I first installed this stuff,
• 12:54
  - you know, you had a computer between you
• 12:55
  - and the patient,
• 12:57
  - and then you had the, you know, the
• 12:58
  - doctor across the hall. Well, now what ambient
• 13:01
  - listening does is allows you to put the
• 13:03
  - phone in front of you and the patient
• 13:05
  - and have a conversation about everything, about how
• 13:08
  - his golf day was intertwined
• 13:11
  - to the the record that you're trying to
• 13:13
  - get information on, and it automatically goes into
• 13:16
  - the epic. And you go there and you,
• 13:19
  - make those modifications and you save your note.
• 13:22
  - It has been transformative
• 13:24
  - to the organization.
• 13:25
  - On June 1, we went live.
• 13:27
  - All physicians now have access
• 13:29
  - to use,
• 13:31
  - ambient listening, which is transformative. I can't tell
• 13:34
  - you how many docs have told me if
• 13:36
  - it would have been around
• 13:38
  - earlier, they wouldn't have retired. It's it's truly
• 13:40
  - transformative.
• 13:43
  - That's really cool to hear, and especially thinking
• 13:45
  - about the long term
• 13:46
  - impact
• 13:47
  - of that for the clinical workforce. I mean,
• 13:49
  - you know, shortages across the board, and so
• 13:51
  - being able to have technology that really brings
• 13:53
  - the joy back into what they're doing,
• 13:56
  - it seems like the point of everything. Right?
• 13:59
  - Exactly. Exactly.
• 14:00
  - So I we we and we're we're gonna
• 14:02
  - move on to nursing.
• 14:04
  - Right? So nursing will be able to do
• 14:06
  - the same thing. So all of those things
• 14:08
  - reduce time and burden.
• 14:10
  - Right? I was around when when during the
• 14:13
  - the craze of installing this stuff early early
• 14:16
  - on,
• 14:17
  - and,
• 14:20
  - it wasn't easily adopted. A lot of physicians
• 14:22
  - retired,
• 14:23
  - right,
• 14:25
  - back then twenty five years ago when this
• 14:27
  - stuff started. But,
• 14:29
  - you know, now we flip the the the
• 14:31
  - table and things are much better for them,
• 14:33
  - but it it was they deserve the change.
• 14:36
  - They absolutely do for what they do for
• 14:38
  - us.
• 14:40
  - Absolutely.
• 14:40
  - Couldn't agree more. Now before I wrap up
• 14:43
  - here, I wanted to take another look into
• 14:45
  - the future. What are you most curious about?
• 14:47
  - What is that top of mind for you
• 14:49
  - when you think about all the potential and
• 14:51
  - possibilities coming ahead?
• 14:53
  - Well, obviously, it's it's AI related. Right? But,
• 14:57
  - what's the boundary between human judgment
• 15:02
  - and I AI recommendation actually settles in clinical
• 15:06
  - care. Right?
• 15:07
  - Now we're careful
• 15:08
  - appropriately careful to keep AI in a support
• 15:11
  - role. I won't use it for anything diagnostic,
• 15:14
  - not through my shopper,
• 15:16
  - or it has to go through all we
• 15:18
  - don't use it that way. We wanna
• 15:21
  - first, we wanna be at the crest of
• 15:22
  - the wave,
• 15:24
  - not at the bleeding edge of AI.
• 15:26
  - So we we've taken the approach that administratively,
• 15:29
  - we wanna reduce that burden as an organization.
• 15:36
  - But the models are improving faster than our
• 15:39
  - governance frameworks.
• 15:40
  - Right?
• 15:41
  - And I think that within three to five
• 15:43
  - years,
• 15:45
  - we're going to face real hard questions
• 15:48
  - about AI's role in diagnosis and treatment planning
• 15:51
  - that we're not fully
• 15:53
  - prepared for as an industry. We're not ready
• 15:55
  - for that. One technology set on the on
• 15:58
  - the technology side, I'm watching the frontier of
• 16:01
  - AI models very closely,
• 16:03
  - kind of reasoning capable
• 16:05
  - systems that can handle
• 16:07
  - genuinely complex,
• 16:10
  - multivariable
• 16:11
  - problems. Health care is full of those, right,
• 16:14
  - types of problems. And the organization that figures
• 16:16
  - out how to safely deploy
• 16:20
  - that capability will will,
• 16:22
  - have a durable advantage
• 16:24
  - that's not hype,
• 16:26
  - that's just the trajectory of the curve.
• 16:29
  - That's fascinating to think about. And, you know,
• 16:31
  - truly, truly helps you why it's so important
• 16:34
  - to set the foundation today with the technology
• 16:36
  - and AI. So as it evolves, you aren't
• 16:39
  - left behind.
• 16:40
  - Absolutely.
• 16:42
  - Absolutely. Well, Thomas, thank you so much for
• 16:44
  - joining us on the podcast today. This has
• 16:46
  - been such a a fun and invigorating conversation.
• 16:49
  - I think,
• 16:50
  - truly a lot of fascinating questions and use
• 16:52
  - cases and things to think about as we
• 16:54
  - move ahead. And I'm looking forward to continuing
• 16:56
  - this conversation as well at the health IT
• 16:58
  - and, Revenue Cycle Conference coming up in September.
• 17:01
  - I know you'll be a panelist and and
• 17:03
  - speaking up on stage with us, and so
• 17:05
  - it'll be nice to see you in person
• 17:06
  - there. Likewise.