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(Intro) many times in health care. I think we look at the particular encounter, but If I go see my primary care physician, and he indicates that, hey, I would really like for you to go see a cardiologist even though those may be a separate encounters. I'm looking at that as a continuum.

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 keynote show is designed to share conference level value with you every week.

Now, let's jump right into the episode.

(Main) welcome to Keynote from This Week Health. Today, I am joined by Eric Smith, Senior Vice President and Chief Digital Officer at Memorial Hermann Health System. A recognized leader in digital transformation and AI governance, Eric has played a key role in Memorial Hermann's epic EHR transition.

Thanks, Sarah. Looking forward to it and appreciate the opportunity to be on with it.

Likewise, your background is so fascinating and I want to jump right into the space of digital transformation and leadership. And let's start with the evolution of the EHR system. So Memorial Hermann recently transitioned to the EPIC record health system. And I'd love for you to share some insights into the transition and its impact on both patient care and your operational efficiencies.

Yeah. So it's obviously been a very busy couple of years for us. This is one of those transitions. It's not quick by any stretch considering it touches all aspects of. patient care, all of our employees, our physicians, our affiliated providers, et cetera. We really did this over two phases as I've shared in some other interviews.

But overall, I would tell you that the feedback has been very positive from our providers, our clinical staff. Despite, some speed bumps and things like that, getting getting used to new systems and, the way we've actually standardized our processes across the system. It's been really positive.

Feedback from patients has been positive. They feel like they have a lot more information about their care. And I would tell you the insights that we're able to glean right now have really lifted our ability to really have a more holistic picture of the patient, in large part because we have a lot more, a lot better interoperability with other care providers in the city of Houston and even outside.

With some of the sharing platforms that Epic provides. Overall really positive. And I would tell you that despite the fact that it's been a busy couple of years, I'm really proud of the team and our collective system and how we've come together to to bring this to life.

What were some of the elements of that aspect of the transition that worked well for your organization and how did your role help to make that happen?

Yeah, so I think probably the biggest thing that we did is our training program. We were really prescriptive in the way we outlined our training.

So we essentially took a stance of no training, no access. Which sounds a little bit harsh, but we also wanted to make sure that everybody had a baseline to work on. And so we started off with that and we were able to track based off specialty and role to make sure we had the right training programs in place, and we could track the progress of our clinicians and our physicians and other users throughout that entire training journey.

So My role was really more around helping to orchestrate that and make sure we had the right people in the right place, as well as to watch some of our metrics to identify where we had some hot spots and we needed to make sure that we pointed some additional resources. One other thing I would share, Sarah, that we did, I think, was really beneficial as part of this change is obviously we had a whole set of patients that needed a transition into a brand new platform, and so this is where my team probably had a larger role in that we actually stationed ambassadors, digital ambassadors that are different practices and within our hospitals to help patients understand the download process for our mobile application, what the sign up process was, et cetera.

So that really helped us One take the load off the front desk staff so they didn't have to worry about answering those questions since they were also getting used to a new system, but also to be there for our patients and help guide them along the way,

How has that evolved your patient engagement overall satisfaction? What kind of feedback have you also received from your patient populations?

So I'll give you some updated numbers. I knew we were going to talk today, so I thought I would just go check. We're actually approaching about a half a million activations.

So it's gone up pretty significantly. And this week, we just passed 200, 000 downloads of our application. So a couple of things. One is that tells me that patients are, engaging, they're continuing to download. But I think a couple of points of feedback that we look for.

One is obviously we're getting anecdotal feedback from them giving us comments feedback that we, they give us directly within the app but also feedback we're getting from staff. I think the other thing that I look at, too, is the actual number. So it's one thing to download the application.

We also look at the way that they're using some of the self service features, like self service check in, forms fill out self scheduling, all those features. And so we're seeing really a significant lift over what we've had in the past. And really overall, I think we've just made it easier for patients to engage with Memorial Hermann as a system, but also their providers.

And we see that through. significant lift in messaging that happens with the care teams that our patients are associated with. So overall feeling very good right now and we continue to see a positive momentum.

Congratulations on just the amount of activations and downloads and to your point seeing where people are engaging the most.

\ we actually watch that closely and we actually capture data points associated with that type of engagement. So when they engage through text messaging, whether they're engaged through MyChart or through voice, we track that and we start to identify where we have opportunities.

And in some cases, it may be it's a matter of us spending a little bit of time with the local staff. To help them understand and educate them and maybe place one of our ambassadors out there to really help guide patients to come through. But we're also looking at different populations to understand how we might need to adjust the way we interact with our patients around their care.

So it's something that's a continual evolution for us as we identify different trends based on age, population, and even, socioeconomic status.

What [00:08:00] strategies or projects do you believe contributed the most to the recognition?

So I would be remiss. First of all, I was very honored for that recognition, but I'd be remiss if it was just me. So I would say first and foremost, I've got a fantastic team. It's a team that we brought together that's composed of comprised of folks that from within health care and those outside of health care that kind of bring a different lens for retail.

And other industries. So it's been a good collaboration, and it's set of folks who are really working to press the envelope. I think if I think about strategy overall, I think the approach I've taken is to look at the patient's holistic journey many times in health care. I think we look at the particular episode or encounter, which we absolutely want to make sure we nail.

But if you think about it from a patient standpoint, I think If I go see my primary care physician, and he indicates that, hey, I would really like for you to go see a cardiologist is to do some preventative testing in this area, even though those may be a separate encounters. I'm looking at that as a continuum.

So I think those are probably the big things. And last but not least, I would say working for Memorial Hermann is a very progressive organization. As part of our overarching system strategy, there's a very defined digital transformation edict in there. So we are working to press the envelope.

And what I love is when I bring an idea forward, a lot of times it's not me trying to sell it. It's more, that's great. Can we also do X, Y, and Z? So that really help us be successful overall. And I think it's been really what's helped me be successful in this role.

It makes such a tremendous difference in the overall outcomes. Both for the providers and for the patients, which leads us a bit to what you're doing in the AI and innovation space. So you have established a governance council for AI and overseeing those use cases. Tell us how the council's role and the importance of transparency and safety is being utilized in these applications.

I'd also love for you to share some early understanding or perspectives about this because so many organizations that we talk to, whether it's in our summits or our city tour dinners, struggle with, should AI be a separate governance council or should it layer into existing governance conversations?

And either way, how those are thoughtfully coming together to make the best decisions for the health system and for the patients.

And what we did was initially it was we set up a governance council and our first, the core of the governance council is really set to establish processes and procedures as well as how we would want to communicate, educate around AI. And so the team really got together. It was a very cross functional team.

We included folks, obviously, as you would expect from legal, from privacy, from our contracting areas, because there were contracting elements that were very important as we work with different vendors. Our providers, clinicians, our diversity team also played a part to make sure that we were making sure that we were equal in the way I was interacting treating our patients and the interactions we have with them, and obviously the technologist.

And what we did was we established our initial three set of specialty work groups, one around clinical, one around consumer and patient experience, and then one around operations. And so we staffed those with subject matter experts in those respective areas. For example, in the clinician side, we would, we have a core group of physicians, but then they also bring in specialists whenever we want to take a look at various specialty capabilities, say, in behavior health or cardiology or oncology.

And so what they do is this group coupled with legal privacy and a couple of the core team members around the technology space, actually then review different capabilities we may want to bring into the organization or pilot. And then they essentially own the responsibility and the way that will, that technology or that AI will be used across the system, but they also act as the advocates because what we don't want to do is have these small pockets.

How we would use that within the system and just our daily interactions. So

they're definitely not something that was just drummed up overnight, like the level of intentionality. That goes into constantly refining these structures. How often do you find yourself bringing just new findings? I is changing so quickly every single day.

How are you keeping up with everything that is happening in the advancement of a I tools and opportunities and also getting a sense for what's going to work most effectively within your health system?

Yeah, that's is. It's just like literally every day, many times during the day. Actually, you'll see advancements or note around.

So we have our specialty work groups and actually go out and find those and they will, in many cases, bring those things forward. And so they're doing some of that sifting through what really looks good. It looks valuable. What may just be a lot of presentation. And so they really dig into those things, but we've really tried to step back and instead of just looking at all the shiny capabilities the different AI solutions have, let's look at the core set of problems we're looking to solve, and let's see where there's opportunities where we can apply AI.

And so that's really been our North star. And then along with that, making sure that we can demonstrate and ask, where's the ROI for this? Because there is a cost associated with these capabilities. And so are we really seeing lift in efficiency? Are we really seeing lift? In capabilities and scalability with these tools.

I'm curious to Eric, when you basically try out some of these new capabilities, How the culture of the organization and you mentioned very forward thinking how open are different areas of the clinician experience, even financial, operational, et cetera, to try out certain things, knowing that we're going to try it.

We may not like it. We'll pull it out because so often we'll put something into place in a hospital or health system, and then it just has to keep on going. People aren't willing to say, Okay. We're going to try this for 30 days and decide if we're going to keep it. How successful has that? Try it. And if it doesn't work out the way we want it to, we pull it out without being disruptive to workflows.

How have you managed to tackle that element in your organization?

So the great thing is we had about, I guess it's been about two years ago. We stood up what we call the innovation hub. And the Innovation Hub is chaired by myself, our Chief Operating Officer, and our Chief Strategy Officer. And the purpose of that is exactly what you mentioned.

And if so, then we'll move into more of a scale mode But it gives us the opportunity to do that testing early. And the expectation is set that, look, we may have to pull this out and everybody needs to be okay with that. So that's really been a real good chassis for us to really take and leverage to pilot some of these capabilities.

So are you the one that gets to tell Dr. Smith that the tool that only he loves is not going to make the cut and now is going to get pulled out of his workflow?

The good thing is I have a good set of friends that together. We lock arms in some cases, but I will give you a perfect example of a piece of technology that we deployed through a pilot mode.

So not only did it provide some great physician satisfaction, patient satisfaction is very high. And there were other metrics that met the need as well. But yes, there are times when we've had to tell folks that, this looks really good, but it's just not hitting the mark for us. So

thank you for sharing the story.

I've done a pilot before where it was anything but a pilot. And we got stuck with a really hefty bill because five doctors refused to your point to give up something that was meant just to be a test run, and we ended up keeping it and made those doctors happy and productive. But I'll tell you, it took a long time to get the actual ROI back on that.

And so you've also used AI in value based care. In your recent article, you emphasize the potential. Of AI to advanced value based care. How do you see a transforming health care delivery models in the near future? Because getting to a true value based care space is long. It's intensive. It's hard to do well.

As I think about, there's probably three key areas where I think that can really affect the value based journey, right? I think one area is definitely patient experience and patient engagement at scale. A. I.

s get the capability through the different delivery mechanisms, whether it's through messaging, a chat bot, whether it's through a voice bot To really be able to keep a level of engagement, a higher level of touch and engagement with patients that we just wouldn't be able to do with people and be able to do it in a way that's very natural, and it feels very companion like, and I think we're getting to a point where folks are very much used to that, think about a chat GPT, a partner along with my care journey along the way, and along with that, I think it's also the ability to use AI in a way that allows us to support care delivery.

And to be able to comb through that using AI to summarize that to where before my provider comes in that maybe I haven't seen in six months, he or she can get a quick summary on, hey, here's where Eric's been. He's been checking in regularly with our MA and nursing staff with his hypertension or whatever his chronic condition is.

And so the provider gets a quick summary on the fly right there. So it feels like a much more informed but also personal experience. And I think last but not least, if you take a look at the overall cost of health care, there's a lot of back office costs, right? Whether it's around billing or coding or supply chain, and there's all kinds of AI capabilities that serve those areas similar to what they do in other industries.

So I think all that comes together to really support, some of the work that needs to happen to really bring value based care to life.

And so I'm a fan of putting the right technologies in place to assist the caregiver or the clinician physician environment. So long as the expectation, I'm curious about your thoughts on that. is if we put new tools in place that allow you to reduce the amount of people on the back end taking care of this or allow you to see more patients is the expectation that the physician is going to see more patients because it's one thing to have a panel of 1500 to 2000 people.

It's another thing to say. I'm going to put all this technology in place so you can increase your panel to 5, 000. What is that magic balance, Eric, for a physician and in your role, the tools you're bringing forward for them to create panels that allow them to still have a personal connection, but tools that allow them not to have to spend so much personal time getting there?

So yeah. And I do think there's probably an opportunity over time to increase the number that are on the panel, especially if you have the ability, if they're all in bad chronic condition, that probably not, but you have the ability to have different levels of acuity. If you have the right level of touch points that can happen, it may be we can leverage these tools make that happen.

The tools are to customize the schedule based on how much time each patient needs to your point, which is going to be a win across the board because any physician that I speak with today, what they really want is just that time with the patient. They don't want to be typing when their patient is there and then the ability to follow up and be really thoughtful about their care plans.

we have this conversation internally about making sure that our providers and our nurses can actually operate at the top of license. Because they have a desire to care for the patient. They don't have a desire to document in the EMR and to do all these other administrative things.

So we can take those things off of them and really manage follow up and things like that, that are more administrative in nature. And even just regular check ins using some of these tools, then it really becomes a satisfier for them. And they don't necessarily see it as a threat. And if you talk to our nursing staff and our physician staff, they're pushing us and they're actually welcoming these capabilities because.

They, they're frustrated about the administrative time they have to spend with basic follow ups that could be done with digital tools.

And they want to be able to get back home and not be charting as an example. So I love the, to your point, clinicians asking us as, practitioners for tools that allow them to be more effective while they're at work and actually go home at the end of the day.

What services will this facility offer? How does that align with the broader strategic goals and how you can put the digital offerings in there with a de novo location?

to answer one of your later questions around what our strategy is.

We tend to continually look across the Houston area to determine, hey, where are we? Where do we have patients that have a need in an area we need to service that maybe is just not part of what is in our current area? And so I think the Alvin expansion's a perfect example. And so our intent there is we're making an investment to put a freestanding 24 7 emergency center.

And so it's going to give us an opportunity with the location. It's there to actually let the students come in and see what the experience is like and actually learn along the way. Not only is it an investment to serve the community, but it's also an investment to, to serve students in that area and hopefully grow some careers along the way.

That was going to be where I headed with that, is that career growth. So exposing Kids at a younger age to a career in health care. They may not be wired to go into a four year degree program. And so by learning about the system offerings that you have, they can see a career path for themselves that may start in phlebotomy or P.

A. Work, but they can work themselves up into higher positions. Should they choose to do that?

And so they may start out as a PCT, but then there's a path for them and Memorial Hermann will also invest with them. To over time, obtain a nursing degree, right? And even further up into master's and other programs. To your point, it's like there's roles for everybody. And in some cases, they're happy in that role.

And to your point, maybe a four year degree just isn't for them, but maybe initially, but down the road, we give them the opportunity, should that be something they actually want to pursue.

So you're addressing some of the staffing shortages within your own hometown by getting people involved early, which is going to be a win, especially if they want to stay in the community and you have such a tremendous community impact when you think about addressing some of the health care costs, facility fees are often a topic of discussion.

Yeah, so I think a couple of things. So first of all, we fully agree that the cost of health care has just got to be better managed, right? It's obviously just given that the numbers are staggering. If you take a look at a percentage of our GDP. And so there are a number of things that we've done that we're currently doing, but also we've done over the years to try to really get a handle on that and try to manage our costs and overall reduce the cost of health care for Houstonians.

One of the big ones is we've talked about value based care. We have a program that we've a longer term strategy. We call our road to value, which is really focused on delivering high value care, reducing hospital admissions, improving the management to your point of chronic conditions, being able to proactively get in front of those really focusing on overall wellness as opposed to just treating specific conditions or specific illnesses.

I would say the other piece that is actually, it may sound odd, but our EHR transition, our move to EPIC, has also been one of those factors that we think over time would definitely help us with managing our costs. So while there was definitely a capital cost in actually making that transition, When you consider all the systems that we've been able to retire because we've been able to class and use the the integrated applications with an epic.

If you were just at another hospital system and you just had a imaging scan for whatever that might be, if you come to our system, we shouldn't replicate that same test if you just had that done two weeks ago. So if we have the ability to see that in totality, then again, that's just one less cost that's involved.

The, app rationalization that has followed organically to a degree from being able to collapse, to your point, some of these systems into Epic. How are you working with your teams to decide what you keep outside of Epic, whether it's available or not, because some things may be on the roadmap two, three years down the road, you may find there's something that's just too good to integrate because you love some of the features that it has.

It's probably one of those we look at, I won't say every day, but very frequently. So we look at the problem we're trying to solve is really our starting point. And if we feel that there's a capability within Epic, that they have the ability to solve that problem.

And in a way that provides the experience that we want to provide. Then we'll definitely use what's native to the platform where we see differentiation for certain capabilities. We will. First of all, we're very transparent in our conversations with epic, but we start off with not because we absolutely love vendor X, but because this is the overall problem in the experience.

We're trying to solve for the patient. And so what we have found over time is it's a collaborative discussion. In some cases, it is on the road map, but other cases like the listening capability I talked about a little bit ago. That's not something that they shared openly. That's just not something that they see them with a strength in.

So that way we can continue to have that holistic view of the patient.

It's definitely a conversation that every team that we talk to is going through about. What to integrate, what to keep, what to transition in these different environments, and then again, how long before some of the functionality that we need or want is going to be available natively within the EHR.

Eric, I want to jump to what I would call speed round questions. These are always a fun way to learn a little bit more about you and the conversation and the first one is what inspired you to pursue a career in healthcare technology?

It definitely wasn't, I came from financial services. I spent 15 years in financial services before coming to healthcare.

Invariably, you'll probably have to go to a hospital. And there's elements of care. And as I think about that, and the experiences I have in my traveling, in my purchasing in e commerce, in financial services, why can't I bring that same experience into healthcare, right? Because I should expect that.

Just like I should expect a level of capability and experience in my other walks of life as a consumer. And so I think that was the thing that was intriguing is, okay, so instead of complaining about it, let's do something about it. So it was a great opportunity to really from the ground up, build some capability and really tackle this problem.

And to your point, everyone's a patient, and when you're a patient inside your own health care system, you get to give that real time feedback and solve for the problem. And my husband used to have a hard time getting an appointment in a previous lifetime. And I would be like, we'll just, call so and so in the office.

I called your call center and I waited for an hour. And I'm like, that's not okay. And getting those perspectives. And so I love that you view it as we are all patients and here's how we can make a difference. And my wife is

the secret shopper for our system, right? And I typically get play by play on what's happening and what's working well.

What's not, but it's actually good because to your point, you get to see. What our typical patient, our typical consumer experiences, and I think that's critically important because you're right. We can be very trained, if you will, to just pick up the phone and call somebody because, we've got the inside knowledge, but the vast majority of people don't,

that's why there's the confusion, right? And just health care in general. I see that as opportunities to how we can deconstruct that in order to provide that a better experience for our patients.

And we've talked quite a bit about A. I. But truly, which emerging technology do you believe is gonna have the most significant impact on health care in the next few years?

B. R. S. And things like that. But I think what we're seeing now, and I think what's going to be more apt, especially with some of these AI based capabilities is. a much more natural conversation that you have. And you can have it through text and other means, but what we're finding is people actually like the interactive voice because there's so much that can come across on text to where it's okay, I'm, if I'm not careful, I'm going to have carpal tunnel.

In addition to the other three conditions I'm trying to manage, right? So I think there's some great advancements and we're seeing a lot more start to evolve in this space. I think there's a lot more to that's going to come if you think about the ability for me to manage my health. And even if I have major and serious chronic conditions, the ability to manage more of that outside of the hospital setting.

Then it's only when I get and I can proactively monitoring track that to know before I get to a point where I'm in an emergency situation, I can interact with my physician and he or she can monitor that along the way. I think it's going to be huge,

especially if you're able to use the voice technology to ask the question.

All those devices are almost embedded in our homes anyway. And to say, Hey, this is what's happening. Should I call this person and be able to connect that way? And the level of yeah. I'm hesitant to use the word empathy, but the way the voice inflection has already matured in some of these voice conversations with these agents is pretty darn impressive.

So if you're maybe speaking with a patient that is a little slower to respond, we're seeing the voice spots and some of the capabilities to where they will slow their pace down to match that of the patient, right? Whereas my kids are like, chop, chop, speak faster. The voice plot has the ability to pace accordingly.

So again, it makes it much more personal, and it's actually tailored, and, ideally, if they're engaging, then it's going to be a benefit for all of us because they will be much more engaged in that health care and health process.

And in theory, there's also going to be either a text chain or a transcript of the conversation, and so What may get lost in translation between two humans is recorded somewhere to follow up for the physician.

100 percent agree.

All right. I want to ask you about a book recommendation.

What book has profoundly influenced your professional approach?

Oh, profound. I, one of the books that I guess was probably just and I think it's I think the subtitle is how to make everybody else smarter, and it really talks about how as a leader really empowering your team, your leaders to make decisions and to own it gives you the scale and really allows you to multiply at the end of the day.

And it's a fantastic book has written several years ago, but I don't know. It just really from a leadership standpoint. Just really helped me examine my own leadership style and determine, Hey, am I really helping to Multiply my capabilities through my team and my staff and really give them those opportunities or am I holding them back?

Thank you for that one. And then how do you unwind after a busy week? I mean you are digitally connected. This is your job 24 7 365 and yet We all need to walk away sometimes. What do you do in those moments?

So oddly enough, i'm probably very analog when i'm not working, right? So a couple of things I enjoy doing I haven't done as much as I would like lately, but I enjoy woodworking.

So there's just an element of tactileness In you know shaping wood cutting wood and building things at the end of the day. So it's something I enjoy I like to tinker with old air cooled cars There is nothing computerized about them. It's all about again. It's a very tactile experience and a very manual experience and just a lot of troubleshooting that has to happen to where you don't plug in something and it gives you a diagnosis code, right?

So I don't know if that makes me a novel or not but I my wife will laugh all the time because the amazon truck shows up all the time and there's usually three or four books inside at least a couple of times a week, so

I'm 100 percent on board with you with a tactile sensation of reading a book, having a book, smelling a book, turning the pages.

We have too many books in this house. We always say that, that and coffee mugs, strangely.

Oh yes, coffee mugs, absolutely.

But I love to read a book and I do it on a plane. That's like the best reading time for me with all the travel we do. I don't read any digital content. I, it's a book and all of those moments and I find on airplanes, they love to watch human behavior.

Eric, how many people are reading physical books again? It's interesting. There's probably half the plane that is just reading a book and I'll ask people about being super awkward. Hey, like you're reading a book and they're like, I just got tired of always being online.

And so I said something about it because I had a physical book and I'm like, are you typically a kindle person? And they're like, no, I've been traveling internationally for three weeks and I love physical books. But I just have a hard time hauling a stack of books around internationally like this, but I can't wait to get back.

He was looking at me with some envy I can't wait to get back because I could smell the book at the day, right? So it's funny.

He's are you going to finish that so I can just borrow it or take it from you? I will do that on big trips. I've got a lot of books. I'll leave them behind.

I'll pass them out to Flight attendants and other people, unless it's something that's very treasured and I keep it with me, but I'll take those travel books and leave them behind for people for that very reason. So thank you again for being on the show. So many amazing insights and ideas. We're going to track the continued progress of what you're doing in your organization, mostly because we obviously love what Memorial Hermann is doing.

Sarah, thanks a lot. I enjoyed the time and great conversation.

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