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Khalid Turk: (INTRO) We have provided the technology to record the whole episodes in a better way, and perhaps help with the bottom line in some cases too. But we have not really implemented the patient care.

Bill Russell: My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health.

Where we are dedicated to transforming healthcare, one connection at a time. Our town hall show is designed to bring insights from practitioners and leaders. on the front lines of healthcare.

Bill Russell (2): Today's episode is sponsored by Meditech and Doctor First .

Bill Russell: Alright, let's jump right into today's episode.

Sarah Richardson: Welcome to this week's Health Town Hall. We are honored to have Khalid Turk with us today. He is currently the Chief Health Info Tech Officer at County of Santa Clara.

Khalid is also known for his Being innovative, driving digital transformation, AI initiatives. He's an author, a speaker, a mentor, and continues to do amazing work in his career. I find most fascinating is that when you think of County of Santa Clara, Khalid, you've got three hospitals, 20 clinics, 14, 000 customers, but you're also managing behavioral health and public health departments.

We'll jump into all of that. Welcome to the show today.

Khalid Turk: Thank you. Thank you, Sarah. What an honor to be here. This is something that I've been looking forward to for many months, because I know the great work you do during these interviews. So thank you, and I'm glad to be here.

Sarah Richardson: Of course, and I love the footprint that you serve and just your history and your background.

So can you share a bit about your journey in healthcare leadership? What inspired you to pursue a career in this field?

Khalid Turk: Yeah, I think it started with happenstance, and then I fell in love with that. I started my career in technology as a software engineer many years ago. And it wasn't even in healthcare industry.

I was actually working in telecom with AT& T, which used to be called SBC. At the time, so yeah, I did back then. And I built some software for them on the mainframe. And we presented at a conference people who are old like me, they know a tandem computer, what it is. And eventually it became Compaq, eventually it became HP.

So in 2000 I joined the healthcare and I have never regretted since then, almost 24 years. It's been a fantastic journey, starting humbly as a software engineer, as an interface analyst. As a project manager, then for almost 10 years, I wandered around working as a consultant implementing Epic EMR, and in 2020, in the midst of pandemic, County of Santa Clara offered me to lead their health system, and I humbly accepted, and I've never regretted that.

I'm glad to be here, and I love what I do, and I love my customers. I love the services we provide. I love the mission that we serve and everybody here at the county and especially in the health system, they are all mission driven. So it's great to be part of that team

Sarah Richardson: . And you've got a big team.

You've got 260 people. Your budget's over 150 million. You've done a ton with Epic and Epic Cloud. Your disaster recovery is noted. You've done the NetSmart, MyAvatar, EHR for Behavioral Health Services Department, and you're in the heart of Silicon Valley. We love doing a little bit of a geography lesson.

You've got a unique perspective in that you're seeing the newest advancements in innovation all of the time. With that being said, what are some of the most significant challenges and opportunities your healthcare system faces, and how do you address them?

Khalid Turk: That's a great question. So you are right that we are in the midst of Silicon Valley.

So one challenge that we face, obviously, we are a public sector organization with limited resources. So how to attract the best and brightest talent and then keep them on our pedal. That definitely is the biggest challenge. But we have been lucky to recruit some of the best minds. I'm really honored and privileged to have a team of 260 individuals, as you mentioned.

And they make a fantastic team. And that's the reason that we have been able to deliver before pandemic, during the pandemic, and even after the pandemic. So that's the main challenge that how we can get those employees. engaged an ongoing basis. The point here is that we are a mission driven organization.

Our job is to provide health care to all under the umbrella of Santa Clara Health System and Everybody that works here that believes in that mission. So all the perks that happen like free lunches and whatnot in the private sector, they really don't matter much to us because we come and drive to work every day this thought in mind that what we are going to do, what we're going to contribute that actually matters and matters.

to the lives of people who are not that fortunate enough. And in Silicon Valley, we may have tens of billionaires, but if you walk around in the Valley, you will see many people who don't have a shelter on their head. They don't have access to the clean water. They don't have access to So what we do as a county of Santa Clara Health System, we actually provide services to those underserved, or totally not served population and part of our community.

So

it's a huge reward in itself. So the challenge that we have from retaining the talent that we addressed with the mission, other than that, at a higher level or at a macro level, Obviously, we operate in the environment where we have giants around us like Stanford Healthcare, Kaiser Permanente, Sutter.

And they probably have deeper resources than we do. We have a limited amount of resources as again, talking about being a public sector organization. So how we compete in that area, like if Stanford and Kaiser are providing the cutting edge patient portal, we have to get there. And that's the reason that organization 10 year ago decided to go on this journey of implementing EPIC EMR.

And since then, we have been pretty competitive in some areas, actually, we have center of excellences available in our healthcare system. So to compete with other organizations, established large organizations like Kaiser Permanente and Kaiser Permanente. And Stanford. And luckily we have really good partnerships with them, so we can bank upon each other's learning, as well as at the operational level, which is not my department, but operational level, we also have a cooperation that we can also either transfer or divert our patients, as well as tap into the talent that Stanford has. Is working in any of those organizations. So Silicon Valley provides a huge opportunity from that end and also a challenge, but I believe that we, as one of the largest public sector organization, healthcare organization, are doing our best to provide the best healthcare services to our individuals.

Sarah Richardson: It's impressive when you think about the breadth and depth of who you serve and where you are serving them. So when you think about how you have leveraged technology, the decision to go to Epic, the decision to keep up with the competition as much as possible, how are you improving patient outcomes and enhancing operational efficiencies in a way that makes you most proud of your organization?

Khalid Turk: Yeah, it's interesting that you ask this question. I just had a conversation with my colleagues that how we can make sense of the technology from the business perspective. So at a high level, at the county, we have a three year IT strategy. An IT strategy has been developed in conjunction by working with different business units.

In the counties, health system is not just one unit. We have public safety and justice. We have social services. We have parks and recreation and many other departments that we serve our community through. But I'll focus on the healthcare system. So we work very closely with our business partners and our strategy, which has seven different goals.

At the core IT level, it'll focus on things like modernization of the infrastructure, like new age infrastructure should be there, but what does it mean to the business, or we should modernize our business systems, or we should improve the official efficiency. What we have done underneath that is We have looked at the core business objectives that the business wants to achieve, like they want to see more patients in some facilities.

They want to save time and reduce the provider burnout, which has been our focus for a long while now that when we first with the ARCH Collaborative and did the survey that survey results were eye opening, and since then we have been working on different measures that from your questions perspective, how we contribute to operational efficiency.

Recently, we introduced AI functionality, which is pretty common for the clients that use the EPIC EMR, because it comes from the EPIC, but the organization has to tailor it and implement it, which is how we improve the communication between the patient and the provider and save providers some time. Implementing this particular workflow, which automates.

Some of the response generation, not sending to the patient, but actually taking it to the point, it saves doctors to give them a draft that they can review, finalize, and send. And that saves about, 15 minutes per doctor per day, which is significant when you look at the population of the patients that , they have to see every day.

Similarly, we have implemented other technologies that save time in different specialties of the hospital, including remedy cycle, like some of the areas where. The way these EMRs work, that if you don't close the encounter, then the charge will not drop, and when charge does not drop, claim doesn't go out, and claim doesn't go out, obviously, you don't get paid.

So in that workflow, we have to see that what tools we can implement that can help providers to close their encounters on time, and the technology actually takes care of the rest of the thing. Same thing we are doing on the coding side, which is on the medical records side. HIM, as typically they call them.

In that area, we are also working on introducing some AI based workflows. Currently, our coders look at the documentation and manually generate the codes that correspond to the diagnosis code, what I mean by that. And we are trying to enhance that by some AI functionality that they look at the huge database of the codes and bring in the optimal code to that.

Number one, it saves. time for the coders. They will rather than going through this repository, they already have few codes to work with. And again, it's not fully automated to be safe and compliant that a human still looks at that. But we save time, to the human that's working on that. And we also improve the bottom line with that effort.

Sarah Richardson: Absolutely. So philosophically, Introducing AI into these workflows to streamline some of the functionality or to take away some of the more mundane tasks and allow people to focus on the harder work that needs to be done. You'll hear me often say in interviews, where to insert the human. Do you believe, Khalid, that we're better off being able to give more time back to practitioners and to those that are needing to get the harder work done?

Or is it a headcount play?

Is it a bringing joy back to practicing medicine play? Where are you finding that the introduction of AI is? Bringing joy to the human factor of what we do every day.

Khalid Turk: I would say the short answer will be all of the above. But as you said, this is a philosophical question.

It requires some philosophical considerations in every area. If you see the tool of AI in the business sector, in the private sector, the core driver is that for any business to operate is to maximize the value to the stakeholders. When you are coming from that lens, Your perspective changes.

So every tool that you look into, whether AI or any other digital transformation, is that how we can improve our bottom line. That system, now I'm not saying it's bad or good, basically looks at that how you can maximize your value, which in turns, actually turns into dollars and cents. So they don't necessarily say that if tool came up that can save you 15 minutes, it doesn't say you that enjoy those 15 minutes.

That system will say, Can I fit in one more patient? Because you've got 15 minutes now, right? But when you are in the public sector, the perspective totally changes. We are mostly providing the value to our constituents. Our stakeholders, which is the county of Santa Clara here in this county, and we serve about 2 million residents in this area.

So for us, the focus is going to be that how we can optimize the value that we provide to our customers. If some services being provided after a week, can we reduce the time for that? The time that provider spends to see a patient, if we can save that provider time, Where that remaining time or saved time could be used.

Perhaps we can improve the quality. Perhaps we can improve the documentation. Perhaps even we can improve the well being of the doctors because our organization is really strong about the personal well being of the individuals that work here, no matter what department. And in that case, we'll say that maybe 15 minutes.

you can dedicate that you saved you to doing yoga or meditation or whatever your thing is. So the reason I wanted to highlight that the perspective of tools and technology automation and efficiency is very different between the private sector and the public sector. Me right now working in the public sector, my perspective is that how we can utilize those tools to increase the value for the personal life and also the value of the services to the, we provide to our constituents.

Sarah Richardson: That's an important lens to be looking through, Colleen. I'm glad I hear you say it, because too often when we make decisions about what technologies we're going to put into place, the person that's most affected or will be using them isn't always brought into the conversation. early enough to inform if it's even a good idea.

So with that guiding principle in your organization and no shortage of access to innovation, how do you prioritize which systems to adopt within your organization and which ones to perhaps table or say now is not the right time?

Khalid Turk: Another great question, Sarah. in any organization, whether public or private.

The drivers are of two types. One of them are external, one of them are internal. And we talk about the external, basically they could be regulatory and compliance related, or they could be basically business related. Even if you're a public sector organization, you need to get paid for the services you provide to continue to remain operational.

So from that end, when market is going in a certain direction and providing certain goods and services to the constituents or consumers. You as a public sector organization has to do the same thing. So sometimes when competing service somewhere else as a function, I always use this very simple example, for example, patient portal that they can use to set up an appointment.

If you're a competitor, even being in a public and private, they are not necessarily your competitors, but if they are the competitors providing a service, you have to provide a service. And that becomes a driver. So when you are undertaking any project that's going to transform the way you do the business, you will undertake that, you will make it a priority because you're saying that this patient, when it goes to Organization X, gets these services, ABC, but when they come to you, They have to wait on the phone for 20 minutes to get to the talk to the person to set up an appointment and then have to wait another week to see the doctor.

So obviously you have to address that and that's where the technology comes in. So that's one driver. Other driver is internal. Internal means that we know our capacity, we know patient volume that we have to see. Right now in this particular region, maybe you are aware too, what has happened that one particular hospital, they have stopped.

Providing certain critical services to the community here in the county. And because of that, we, our organization, Santa Clara Valley Healthcare, is getting additional patients. We don't have a choice but to take care of them. And in order to take care of them, what we have to do, add more people.

enhance

our technological capabilities in a way that we can handle that additional

Load of patients that is coming here or do something radically different.

So in this case, what we're going to do is that we see, find the efficiencies in some of our systems. So we say that this particular service, because we are, for example, based on an antiquated system, it is not going to be able to see more than 20 patients in a day. So we look at the possibilities and see that, yeah, if you can move them on the Epic EMR that we have done in some cases, or you can go to a different workflow that will require change of technology, then you can not only increase your capacity, but also provide additional services, which also So there are a couple of drivers that are, that's what I meant by the internal driver that you're looking at your own context, what is happening within the organization, and how you can meet your additional demands.

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Sarah Richardson: Wouldn't it be great if it was that simple? When someone asks you the question like, hey Khalid, how do you make true governing decisions in your organization?

We have internal and external factors. Done. But of course we know the politics that go along with that. Serving the community. Having the appropriate governance perspective. Having the stakeholder management. So much more nuanced than that. And what's really special, and what you have shared, is that you've got this culture of continuous improvement.

Of serving everybody where they are. All healthcare systems do, and yet you're in a bit of a unique space. Tell me about how collaboration within your healthcare system, and really creating those relationships with your peer group, have allowed that perspective that you just shared to be so successful.

Khalid Turk: Every change is easier said than done. So I understand all the challenges we would face. Sometimes even within the same organizations, the perspective are differing and even the priorities are differing. Your pharmacy head may have a certain goals in mind to maximize the output and services of the department the radiology or imaging may have totally different perspective and having the limited resources, they will compete with each other and will Clash.

So I understand that's where you're coming from or your comment that, yeah, it's never that easy. And we understand. So a couple of things. One of them is that how we have built the collaboration. I was telling you, and honestly, it's not just the words.

I mean it that most of our leaders are mission driven, so they know why they are there. So when we implemented Epic, we had a governance then almost 10 years ago. And through that process, a lot of learnings were had, a lot of relationships were built. I personally believe the relationship makes things 50 percent there.

The rest of the 50 percent is actually work. So once we agreed on a shared vision, our goals, And once the EMR was rolled out 10 years ago, there was a lot of learning happening behind that. And based on those learnings, we have a very comprehensive governance model. My mantra of leadership is to be transparent, whether you like it or not.

If you don't tell the facts, Always the outcome is going to be different than you want to drive yourself, your team, and your organization to. So in that process, different leaders give us their priorities. Year round, we keep taking these tickets or requests to make enhancements or do certain projects. We put them together.

We have some scoring mechanism that we assign, and we bring that entire list three to four times a year actually more than that, in front of our decision makers. All the executive director levels in this whole operation, and there are quite a few of them. We tell them This is our capacity from the IT perspective. These are resources we have. Obviously, they can bring the finance side of that. They can bring the dollars, but it's still limited by the number of human resources. No matter how many contractors you can bring in, there is still a limit on that. Then we work with them and prioritize.

And sometimes it takes time to understand the goal, or objective,

or even a project is more important,

that, we can do it. When the decision is made, there's at least a consensus and there's a clarity that, yeah, I'm not getting what I want today or tomorrow or three months from now, but it's coming down the pike in six to 12 months.

So something like that. So I think my organization has been pretty successful in that. Sometimes we do get external pressures, like some regulation change that would make you to do things differently. And in that case, then we have to see that how we can expand either bring the, in the external resources, are we.

tweak our teams in a certain way, or we put something on the back burner and continue to work on that. It is never a percent successful model, but I would say that 90 percent plus times we are able to serve our customers to their full satisfaction.

Sarah Richardson: Which is a huge win ratio. If 90 percent of the time governance is holding strong for you and your organization, that's a hallmark right there.

And something to be proud of because too often there's all these conflicting priorities that are coming in from across the org. And I have found, at least in my experience, that the longer that a team has been together, building on that trust and the relationships and the outcomes and expectations, the adoption, the ROI, it's fascinating how well that flywheel can work.

We've also seen it break over and over again. Name an organization that you've gone into and have not had to establish and maintain governance. It's one of the things that should just be like every CIO job description is organizational change management, governance, adoption, all these different aspects of what we do, because working with that human factor can be tough sometimes people want to do the right thing for the right reasons, and that's where priorities can sometimes conflict.

And I love hearing how well your organization is doing it, but think about this one. If you were to look ahead, I'm going to say a year, 18, 24 months, going further than that. Especially post pandemic feels a little bit fruitless in its effort. What do you see as the most important trends for developments in healthcare that are going to shape the future of your organization, as well as our industry?

What's coming next? that you are aware of, excited about, and starting to also inform your organization so that it's not the buzz of the season as it comes forward in our industry?

Khalid Turk: Yeah, it's a wonderful question and one of my favorite actually. I'll go in history for that to answer the future. And I've been doing this EPIC EMR implementation for almost 20 years now.

We are not treating the patient. That has continued on in those 20 years. A lot has changed like Epic's first few customers still like they have more than 200 customers, I believe, largest hospitals, but there has been no transformation in that effort. Most of the time I had an opportunity to visit a doctor, they look at you less and look at the computer more, because that's what their workflow demands that.

And they will be going hurriedly, like looking through the chart. patient care has not become personable. We have provided the technology to record the whole episodes in a better way, and perhaps help with the bottom line in some cases too. But we have not really implemented the patient care.

So fast forward, where we can make a dent in that? I believe that recently, there are a couple of players in the technology world that are making a change, a major change on that. Some people call it ambient technology, some people call it ambient clinical wise. I really am excited about that. Once implemented, and it has to go through the maturity level, the way the EMRs have become mature in the past 20 years, I believe that is going to be a game changer.

So when you go to the doctor doesn't have to treat the chart, the doctor doesn't have to treat the computer, but actually they treat the patient. So most of the interactions are going to happen in some organizations, there may be pilots running, there may be And we are on that path to some point in time, we're going to implement the ambient clinical voice in a way that Technology takes the notes, records the interaction, whereas the doctor provides the personal care that the patient deserves.

So they focus on the human side of the treatment rather than the technology side of the treatment. That is one area at a micro level that I think that is going to transform us hugely. But then everybody's talking about AI, to some extent is a buzzword, but it's also beyond buzzword. I see that in future, when this technology gets mature than it is right now, when we talk about AI, we are only talking about generative AI, but generative AI has its utilities and functions.

But the actual AI, as we, where we bring the machine learning to the point that we can reduce the time that individual face to make decisions. I was at a conference and talking with one of the AI and data scientists in one of the hospitals in Texas. And he shared a fact, actually, I was.

Totally blown out when learning that. He was saying that they have built an AI based machine learning system, whereas their system, and it's a computer vision, so it's a vision based system, when they look at the patient, almost like 99 percent accuracy, the system can predict that the patient is having a stroke, whereas with the humans, that accuracy is 87 percent or so.

I may be off by one or two numbers, but 80s versus 90s. So just see that where the opportunities are. And it doesn't have to be like a wholesale AI. Many organizations where they have resources, they will invest in their own infrastructure and try to create those opportunities. So the sky's the limit with AI.

So what is going to happen is the technology will bring efficiencies and accuracy and quality in some areas, which reduce the time that the care providers.

can spend on coming to that diagnosis or result. So

So they will be assisting them. I don't see a world

any time

soon where the technology is totally replacing the doctors and nurses.

We will continue to need them, but we will be able to save them time so they can spend their time to improve the quality of the patient care as well as improve the quality of their life.

Sarah Richardson: Yes. I love that you shared that because you start thinking about the prediction and the prevention, which lends itself more and more towards well care versus sick care, which is what we continuously talk about.

And wouldn't you want to know if markers that you are exhibiting put you at a propensity for certain types of ailments, and being able to get ahead of that is such a huge win. And to your point, a conversation that you would prefer to have with your doctor versus what to do after something happens. So thank you for sharing that perspective.

We're going to move to speed round. I've got three questions for you. This is always my favorite part. You know what's coming, but you still got to think on your feet as far as what your answers will be. So speed round number one, if you could have any superpower to solve one healthcare IT challenge instantly, what would it be?

And why?

Khalid Turk: I think this will be interoperability. I started my career in healthcare IT with interoperability. It's been 20 plus years. The challenges are still the same. Making systems talk with each other. In my organization, I have 300 plus systems, even though I have a major multi million dollar EPIC EMR.

But obviously EPIC can do so much and EMR can do so much. So when it comes to talking with your radiology, your pharmacy, your lab your, Urology, there are many systems. And then you have to talk with our regional level organizations. You have to talk worldwide organizations. I believe we have come a long way in that, but we are still not there.

There should be a seamless. If I'm a patient, I'm a record in XYZ organization with XYZ system. Wherever I go, I should be able to take my information with me, even if I don't take electronically with my permission, it should be available there. We are not there yet. So if a superpower makes systems talk with each other.

Sarah Richardson: We're getting traction every day. As you and I noted, we've been in this business 20, actually like 30 years for me now, but don't tell anybody it's totally 30. It gets a little bit better every year. And to your point, it's nice when you see that, Hey, I remember when I was the one having to enter all that information and now we're able to streamline some of those efficiencies, I'm confident.

We'll get there because we're having these continuous conversations, and we're having them at the policy level and beyond, and we're seeing that traction across all of our systems, which is important. When you think about the most unexpected lesson that you've learned from working in healthcare IT, what is it?

Khalid Turk: That's a tough one. Unexpected lesson, that is that be ready for a change anytime. Change is inevitable, as they say. I've been lucky and challenged in many ways that I got projects that actually put me on the map where I am right now, but at the same time they were impossible. Like you will be getting a direction certain part of the year that in next six months we have to acquire these two hospitals and bring them on your systems, go make it happen.

And we did it in five months. So what I learned from there, that. You have to be flexible to get things done. Easiest answer that many people actually did and would have given, and I wouldn't blame them, or this is not possible. No, there is in the realm of rationalization, there are certain things that are always possible.

So you have to, as they say, how are you going to eat an elephant in small bites? So you have to, no matter how the big challenge is, cut them in small bites. and then deal with them. So for me it is in healthcare definitely the things may be thrown at you without any planning, without any forewarning, but you have to be ready to take them head on and get them done.

And I've been lucky in that I had not only opportunities but great teams to work with. Where we were able to meet those. And I'm ready now. Tomorrow makes some challenge that was not in my three year plan. It was not anything even from a year plan or something. And it'll come my way and we'll be ready to tackle it.

Sarah Richardson: And last question for you. How do you stay positive? How do you stay motivated? How do you keep moving forward in an organization and in an industry that is constantly changing? And maybe you can have a long term plan or strategy and there's always going to be things that are hitting up against you that could either derail or make you rethink some of these strategies.

How do you stay focused and positive?

Khalid Turk: Yeah, there, there's a short answer and long answer. I think the short answer is that it's intrinsic, whether you are optimist or pessimist, that's how you are. And obviously you as an individual, and even of us, is a sum of our past experiences. Some people have difficult experiences and they become, their outlook becomes gloomy on the life and things, and others, it could be positive.

For me, I'm naturally an optimist person, so for me it comes easily to stay positive. But if I really have to coach myself or other teams that I do mentor and coach, is that all the difficulties are time based and temporary. They are not permanent. I'm talking about the context of work, not necessarily the general, generalizing to the life.

In life, stories are different and different lessons. But in the work it's, you could be dealing with a difficult colleague, a difficult boss, difficult environment. All these things will change with time. Difficult projects, Other challenges. So if you know that, whatever challenge I have today, it wasn't there yesterday or a week ago, and it won't be here three months from now.

So from that end, I always know that these things are temporary. with time, things will improve. So that's how I actually stay positive. And that's the Sermon I give to the team that I lead.

Sarah Richardson: And I bet it's the quote unquote sermon you give to your mentees as well. And that's why you came on my radar.

It's why we've connected in the past. And it's why I always enjoy having conversations with you. Thank you for hanging out on town hall today and for sharing your wisdom, your ideas, your perspectives, the mission of your organization, the communities you serve, your background. It is truly pioneers like you Khalid that make what we do today possible.

So thank you for being a guest on this week Health Town Hall. Look forward to seeing you in person soon.

Khalid Turk: Thank you. It's a pleasure and honor is all mine. Thank you so much for having me on your show.

Bill Russell: Thanks for listening to this week's Town Hall. A big thanks to our hosts and content creators. We really couldn't do it without them. We hope that you're going to share this podcast with a peer or a friend. It's a great chance to discuss and even establish a mentoring relationship along the way.

One way you can support the show is to subscribe and leave us a rating. That would be really appreciated.

Bill Russell (2): Special Thanks to today's episode sponsors Meditech and Doctor First

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