NewsDay / This Week Health – June 12, 2023: Bob Klein, CEO at Digital Scientists joins Bill Russell, Host of NewsDay.
What role can generative AI play in addressing healthcare challenges and driving innovation within budget constraints? How can health systems leverage technology and digital solutions to improve efficiency, patient care, and overall performance?
Do smaller health systems face unique challenges in implementing digital innovations compared to larger health systems? What are the key considerations for healthcare organizations when deciding to prioritize and invest in AI models and generative AI technologies?
Key Points:
- Economic challenges
- Financial losses
- Efficiency and innovation
- Rural healthcare projects
- Constraints and innovation
- Role of generative AI
Watch the interview
Running time: 28 minutes
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
Today on This Week Health.
Understanding the potential of AI in healthcare
Bill Russell: Welcome to Newsday, this week’s health newsroom show. My name is Bill Russell. I’m a former CIO for a 16-hospital system and creator of this week’s health, a set of channels dedicated to keeping health IT staff current and engaged. For five years we’ve been making podcasts that amplify Great thinking to propel healthcare forward. Special thanks to our new stay show partners and we have a lot of them this year, which I’m really excited about.
Cedars Sinai accelerator, clear sense CrowdStrike digital scientists optimum health care IT Pure Storage, Shore test how site LUMION at VMware. We appreciate them investing in our mission to develop the next generation of health leaders. Now onto the show. All right, it’s Newsday and today we’re joined by Bob Klein, Chief Executive Officer, digital scientist. Bob, welcome back to the show. This is your second show. Looking forward to it. Hey, Bill, great.
Bob Klein: Yeah, nice to be back again.
Bill Russell: I was doing a little research on you. I was doing that stalking thing on the internet. I just went to LinkedIn. I didn’t really stalk you. But on LinkedIn, I noticed that you University of Florida ba political science with honors, and then Master’s in Russian and Eastern European Studies. Wow. Well, I happen to so we could really talk about the Ukraine and all the things that are going on there you you’re probably fairly well versed in that.
Bob Klein: Yes, sir, is that it’s a an earlier chapter where I worked in logistics in the former Soviet Union. So yes, I set up an office and give us to manage freight that came through Mary Opal, the port there, and we did a lot of business with the oil field. So Chevron and Halliburton and Schlumberger folks like that and it definitely taught me how to be patient and how to work with in a large bureaucracy and how to be persistent and to get things done and the hands on approach, but that’s logistics in general.
Bill Russell: I mean, doing that kind of work in that area of the world. The geopolitical ramifications of everything that’s going on around has the potential to slow down a project or completely change a project or shut it down, for that matter. There have a long time horizon, especially for a lot of those were big capital investments and that’s the kind of extractive industry that’s paying for everything over there. So it’s oil and gas rhenium gold mines, diamonds things like that. I did some work with Caterpillar overseas there. So yeah, definitely, if that’s in there somewhere, although it’s just I just pull those stories out at cocktail parties, Bill.
Bill Russell: All right. Well, we’ll get into health IT and talking about that will hopefully make people feel better about the challenges that healthcare is facing, although I will preface this we’re going to do a story from Becker’s CIOs or healthcare leaders first how 10 it execs are confronting the economic challenges. And I want to preface this with I’ve seen some promising signs. I saw I think it was Cleveland Clinic posted a positive number. I saw inner mountain posted a positive number. There was somebody else and I can’t remember which health system it is posted the positive number so the operationally well run health systems are coming out of this.
They’re starting to post profits we’re seeing the next year. They’re starting to come out. They were underwater, now. They’re above water. But I also did see a couple of health systems post hundreds of millions of losses and it’s those really big health systems. Scale is scales good when it’s going good and scales bad. When it’s going bad. And it’s really hard to turn those chips around. Assume you’re seeing the same thing. Are you feeling the same thing in some of the conversations? Are we starting to feel like we’re coming out of this?
Bob Klein: Well, I mean, I mean, I have to as a service company, or whatever I do feel it’s the kind of economics of it and some of it I see more in this requirement for efficiency is focus on really short term ROI. And I think last time we talked about rationalizing, spend ongoing spending and licenses and investments in new projects, new capabilities, and so they’ve got to get their house in order to be able to hopefully make larger investments in the future. But I think that’s a challenge of it. I worry. For some the larger Yes, there are some challenges with scale.
But there are those regional health systems that have investment funds that can continue to innovate. I worry about smaller hospitals, smaller systems falling behind, right as technologies that leverage to achieve some of the efficiencies and some improved performance, nevermind, expanded share. And so I think we’ve mentioned this where it’s a lot of pressure to improve performance and make improvements and not just hold steady. But that’s the the challenge of the economic cycle.
Bill Russell: It’s interesting as we just coming back to this article, I think it really illuminates some of the things you’re talking about. We have Eric Lee from permanente group, and he talks a lot about alignment. It’s like we need to be aligned with the specific objectives of our organization aligned with strategic priorities, and to focus our investments on the things that are actually going to deliver as you would imagine a permanent take Group CIO would do but then you have Eric Jimenez, CIO for Artesia, New Mexico talking about as rural healthcare. We’re no stranger to economic uncertainty.
It’s like we live in a perpetual state of economic uncertainty. And so we have to focus on very tactical type projects. And he goes on to talk about RPA and how they’re looking at RPA. Others talk about digital transformation and the things that are going on, but a lot of them really, in this article, seem to be talking about, not the big projects that we think are going to have a significant impact long term. It’s the I guess, when economic times are tough. The lens and the focus gets a lot more close. We’re not looking to in three years out for return, we’re looking like 12 months, which is what you were just saying, what’s the danger in doing that? What are they going to miss if they’re focused only on the next 12 months?
Bob Klein: I don’t know if they have a choice. I mean, the danger is they was back thinking about RPA right? So is RPA innovation, or is RPA paving the cow path I’ve got a lot of kind of paper bound processes, a lot of forums, a lot of things that are they’re not necessarily a big lift. I mean, they’re important to do and they’re important things to streamline and save time and create efficiencies but it’s not. I’m not sure if it would pass for innovation, innovation.
We’ll talk more about these other articles that are more out there. But I know I think that’s the CIOs job to balance things where I’ve got to find efficiency, but I also inefficiency in running the way things are internally just in a way it’s improved throughput or kind of speed of the way things move through the system. But also, I’ve got to kind of do more than that. I have to improve share, I have to be able to touch more people at the lower overall costs, not just speed up the throughput, and it’s a different kind of mindset, and I look at what he decided to do internally and we work with vendors or partners to do and I feel like for where things are going that health IT plays an important role and will play a larger role as technology starts is just as is so important for for this system to survive and thrive. Right. It’s not just the care maintenance and feeding of Epic and Cerner and whatever the laundry list of EHRs it’s more of how do you drive? How do you drive the organization and help apply the technology for leverage? So I know that probably didn’t answer your question, but that’s usually and we’re going to talk generative AI we haven’t done an episode of any show. For the last like, since January that we haven’t talked about generative AI. We haven’t talked about these things. And a lot of times people think oh, that’s innovation. Innovation is the new technologies that are on the horizon. I don’t think that’s true. So I want to bend the paper a little bit in two directions.
One is, I think now is the best time to be innovating. And I think innovation within constraints is always better than innovation outside of constraints. And the example it’s a silly example, but I’ve used it for years and people understand it. The most creative people in the world I think are people that take a license plate with like seven characters or six characters. And they like say a whole paragraph in that in those six letters and you’re like, oh my gosh, how did they communicate like, who they are, what they’re interested in? What excites them. I mean, it’s in sixth character. I mean, it really is amazing at times what people can do. And that’s innovation within constraints. We say, Hey, you have seven letters. Now communicate who you are, what you’re excited about in those seven letters, and they do well when you have financial problems. Now it’s like, alright, what are the problems we really need to solve what’s really going to move it forward? And there is I guess, incremental innovation, if you will. We’re doing the same things. And we’re just going to do them better.
RPA falls into that category. We’re going to do it better than we did it before. But then in that constraint of, hey, we’re financially challenged, you start to look at it and say can we do this thing with less? Nurses? Can we do it with less doc? I know that’s controversial to say, but at the end of the day, we don’t have enough of them, and we won’t have enough of them in our lifetime or ever again. I’ve heard a physician telling me we will never have enough physicians ever again. Period. Like we don’t train enough of them. There aren’t enough people going into the business. Therefore that’s the constraint. That’s the license plate. Okay, if that’s the license plate, we can’t keep doing things the same way we’ve been doing it that requires more labor than we have. Therefore, how do we do it differently? It’s that line of questioning inside of constraints that leads us to Alright, I think we can have generative AI respond to our inbox. I think we can have chat bots that interact with more people in the community than we did before. As long as we have some sort of parameters around that chatbot that we know it’s going to be delivering high quality answers and those kinds of things. I’m curious what your thoughts are as I throw that stuff out. Bob Klein Yeah. No, I mean, I think back to your earlier question, I mean, the risk is when you cut budgets, or is people stop willing to experiment and try, right? And innovation is sometimes just we need folks to be working to try and make things better and looking at some of the same measures and have enough time in the day to run experiments and attempt.
So your point about nurses I think about the remote nurses that are on the iPad next to the patient bed of folks that are trying to do that and just to create leverage for the nurses who are on the floor. You don’t necessarily have to come into every room when someone presses the button, or the neti robot that runs that does deliveries across the hospital to save somebody’s time. So a nurse doesn’t have to do it, right. So it seems it’s a little kind of, yes, it gets attention slots, er.
The practicality of AI in healthcare
Those aren’t the only things that are out there just finding things that come to mind, but I think that that’s where they have to keep going because everyone wants to make improvements and like we said last time, there still is this impetus from COVID to reflect lessons learned and to make the changes that I needed.
And I Yeah, AI is just another thing that’s in this list of things that they can be working on and touch digital and technology and software, but it’s almost it’s hard. To prioritize. What are the things that we can do that can have an impact, and we can test out so it doesn’t have to be this big bang effect on anything because that’s really disruptive. Right? So how do I test things out? And I’ve got go no go decisions. It’s not everything is going to be a good idea. And that’s okay. Right. So that’s, that’s why I hope the smaller health systems have the opportunity because in a way, they’re closer to their population. And don’t you don’t know what they could come up with. And I think the there’s this efficiency call but I think there’s also this clinical insights and clinical relevance, like how it is like your we all go to the nurses and we talked about that and we talk about other things, but a lot of opportunity out there that’s digital is tied to things that are clinically significant.
And it’s, I think about all the hardware and all in the alert fatigue as a kind of service provider in this space. We’re not trying to tell the providers what to do. We’re trying to give them insights and create some efficiencies for them.
It’s like, how does the (artificial intelligence and machine learning) technology work for you?
So he reduced cognitive load in a way that’s like how technology work for you. It’s not all about you know, we’re replacing people or they’re making them more effective.
Bill Russell: Alex’s Lemonade Stand was started by my daughter Alex in our front yard, and by the time she was four, she knew there was more that could be done and she told us she was gonna have a lemonade stand and she wanted to give the money to her doctor so they can help kids like her. It was cute, right? She’s gonna cure cancer with a lemonade stand like only a four year old would think that but from day one, it just exceeded anything we could have imagined because people responded so generously to her.
Bill Russell: We are working to give back and are excited to partner with Alex’s Lemonade Stand this year. Having a child with cancer is one of the most painful and difficult situations a family can face. At Alex’s Lemonade Stand Foundation. They understand the personal side of the diagnosis, the resources needed and the impact that funded research can have for better treatments and more cures. You can get more information about them at Alex’s lemonade.org. We are asking you to join us. You can visit our website. There’s a banner at the top and it says Alex’s Lemonade Stand there. You can click on that and give money directly to the lemonade stand itself. Now back to the show. We have three three stories here. Hippocratic is building a large language model for healthcare. Second one is how will gender have aI impact healthcare and the third one is just calm down about GPT four already. It’s interesting.
I mean, clearly we’re at the peak of the hype cycle. I saw a post just this past week where somebody said for the last any number of years we’ve really elevated the Chief Digital Officer title and we said there’s gonna be digital transformation. And because so much emphasis has been put on AI recently their supposition was that we will have chief AI officers. Well, I’m not sure that we will. But the Chief Digital Officer or someone within the organization is going to start to have a very keen focus on AI models bringing AI into healthcare, but they’re essentially saying look, this is where the change is going to happen. And so when we focus on just the next year, one of the things that happens is we take our eye off the ball on something that’s a big change that’s happening, and it’s going to hit us in in two years or three years. And if we’re not working on that big change today, it becomes an emergency in two or three years like oh, how do we catch up? And so we’re always playing catch up, because we’re not looking at the big macro changes in these things. Generative AI is a big macro change to healthcare.
Bob Klein: Yes, I think it is there. But I guess my question back to you around it is the role that each health system is going to play right. So I have some real bounce about from a macro change being is everyone we’re waiting around for open AI and Microsoft nuance or whoever to show up with some care model and some insights that are going to be built into a bunch of different software products or epic or Cerner.
Whoever, but essentially, the wild gardens that today have all the data and have all the insights like how much can the health systems create their own capability in this area, and they leverage these models like or even open source versions of these models to create their own capabilities because they have unique populations. And some of these articles talk about things that are more patient facing but I think the challenge is creating a personalized care model for each and every individual because health is tied to and I got comorbidities and it just put your arms around this other data for one patient. And can we make any sense for just that one patient and for the provider or the care team that’s trying to support that one person and then or even just somebody’s population, a particular health system so because they can be so different, we do a bunch of we do a bunch of work and post acute care and are building things for them.
But that means I don’t we don’t have much overlap with pediatric. Right. So it feels like there’s an opportunity there. If there’s funding and interest, and honestly I think that’s ultimately differentiated. But I guess my question Bill is, are the health system’s gonna sit back and wait and expect kind of vendors to fill the void and provide all these insights or could be amazon it could be others, or are they going to take the initiative and build some things on their own and get closer to the problem?
Bill Russell: Yeah, I will about a limb here. 60% are going to wait for epic to do whatever epic does for them. If you’re an epic client, you’ve almost been trained to wait for Verona to figure things out integrated put it in there and because it and I don’t say that disparagingly, I mean, you don’t want to get ahead of Verona because if they come out with something after you’ve gone and done something innovative, eventually you’ve invested in areas that you really don’t need to, but we’ve been trained in 60% We’ll wait for the end.
And it could be Meditec. It could be Cerner. It could be whoever I mean, well, if they’re going to do whatever they’re going to do, we’ll wait for them to do it and I think 60% will wait for that to happen or work with them as a partner. To do that. I saw UNC just announced they’re doing something with epic around generative AI, Stanford is UC Davis is and others. So partners are stepping up and saying, Look, we’re not going to do this ourselves. We want to partner with you. You have these capabilities. You’re also our source of truth, our system of record.
So we’re going to do that. This is the vision I think people should be working towards and I don’t know how many will be working towards this. I do know that Amazon will be working towards the CVS we’ll be working towards this. Wal Mart we’ll be working towards this and Walgreens will be working towards this and optim will be moving towards this and UnitedHealthcare and that is Bill Gates was talking about this and I know we’re not supposed to talk to us people’s names who are currently being spirited in the runner media but the Bill Gates is still a great mind from a technology standpoint, and he looked at GPT for a long time ago. And when he was interviewed, he said we are as close as we’ve ever been to everyone having an AI assistant, a physician having an AI system a nurse having an AI system, who understands their job, knows their data can find data for them, and just helps them to be more effective all the time every day.
So we’re gonna have that aspect of it, including your pharmacist, you name it across the board, everybody’s gonna have an AI assistant, then I would go one step. further and say I think every individual in the community is gonna have an AI assistant that is going to help them with their health, either navigating health care, or understanding the questions we have about health should I eat this should I not eat this? Is gut health really important? How important is exercise how important I know some of these questions to doctors are going to be silly, but these are the kind of Google search questions that get asked. And if we have a an assistant, we all have an assistant that is geared towards making us healthier. The question becomes who is providing that? Right so Hippocratic is one of the stories and they are essentially taking generative AI to med school. And they’re gonna have very specific training around that model so that it can be trusted and it’s going to be used to help people to remain healthy.
My question and I think his question you’re asking is, as a health system if our CIO for a health system, if I were still at St. Joe’s we had 16 hospitals, multiple communities in multiple states. Would I want that provider of that information to come from Hippocratic or CVS or somebody else or what I want it to come from St. Joe’s? And the answer is, it has to come from St. Joe’s because if it doesn’t, you become irrelevant. In health. All you become is whatever they leave you. If it’s the high acuity, high risk care, whatever they leave you that’s what you’re gonna end up with, if you’re not going to be relevant in the day to day conversation of the patient, or even the consumer and their health. Then whoever is there, they’re the ones who are going to direct the economic flow of where that person goes for care.
Bob Klein: I don’t I mean that’s why I feel like the health system has the opportunity but has to put the entire all the pieces together for the patient and to be trusted because you have all the data, and that includes that doesn’t include everything that’s in it’s not necessarily everything. It’s in the HR today. Right? So genomic data, other data so I work a lot with telehealth data, other information and there’s I don’t know there’s all this focus on efficiency. And I’ve we’ve I’ve built something with that uses Changi VT four, and it’s use it as a language model and helps us create something that’s really just the clinical note from a telehealth encounter, and that’s just efficiency, but over time there are other kinds of services being created that will plug in that look at voice biomarkers, for example. So based on our conversation, they might just say, Hey, Bob, you sound like there’s something off, right and it could be some marker based on word choice. Speech, pace, things like that.
And it could say, Okay, let’s find this person for follow up. Right, something seems off, but you have to be capturing that data. You have to be capturing all of my previous telehealth sessions. So right now, not a lot has been recorded. So it’s not recorded. It’s not transcribed. It’s not routine. And so I just look at telehealth is just as another as another sensor for data, just like the in person interactions, all the labs, genomic data so complete data model for that patient. And that’s how the health system has knows the most and knows all the details where this kind of one size fits all on the front end, based on some enormous model isn’t going to be great because like I said, I’ve got published acute 85 year olds and five year olds in the same model. And it started it’s like okay, this just seems to make sense. So it’s going to be super broad or narrow based on the population. I think that’s where the opportunity is. I just don’t know if anyone’s gonna take it.
Bill Russell: Yep. Yeah, the narrow models is the direction more personalized, highly personalized models. I love this discussion. We’re gonna continue this discussion probably in four or five weeks, you’re going to come back on the show, there’ll be a whole new set of articles and we’ll see how much we were right about and how much you know how much has changed. It’s to be honest with you. This space is moving really fast.
Assessing the current market and benefits of AI in healthcare
Bill Russell: It feels to me like every day I opened an article and I read a bunch yesterday about Google’s response to GPT four, but they have a little different bent their models a little different, and it’s better at some things than GPT four, but it’s not as good with text and all that stuff. And so it’s really highly geared towards surgeon.
Bob Klein: The logical inferences aren’t there and these models and so it doesn’t know what it’s doing in terms of the language model for tension PT for us. So just to be cautious about that. My recommendation is use it for what it’s really designed to do. If you go in there, and Bill if you’ve got a long email that you want to reduce the paragraph, you can do that right and it’s okay is that does create some efficiency or automate some of the things where some of the correspondence or stuff like that, I think that that the providers are already using it.
Bill Russell: Well, and I love that model. You said I mean, you take a transcript and you turn it into a soap note. Bob Klein Yeah, yeah. So there can it’s I think it’s that’s disruptive because Microsoft spent $20 billion to buy nuance three years ago, and was that really worth it? And I think each of the health systems need access to this kind of technology for that efficiency we’re talking about, but over time, it’s an efficiency. It’s mostly speech to text which has gotten to be really good, right? And that’s the for me with whisper, which is part of open AI and then it’s like, start creating your own models, build your own model, get smart about your own population. And I hope that their health systems are willing to give that a try and kind of start to experiment, but to go easy with everything that we were reading from hype cycle. Yep, absolutely.
Bill Russell: Bob, thanks for your time. Really appreciate it. Great conversation. Thanks. Thanks so much, Bill. And that is the news. If I were CIO today, I think what I would do is I’d have every team member listening to a show just like this one, and trying to have conversations with them after the show about what they’ve learned, and what we can apply to our health system. If you want to support this week health one of the ways you can do that is you can recommend our channels to a peer or to one of your staff members. We have two channels this week health newsroom and this week health conference.
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