This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

The 229 Podcast: Journey From First Ever EMR and Enabling Proactive Care with Deborah Muro

Deb Muro: healthcare, we're very reactive, we don't know what's going to happen tomorrow generally. And so my goal is for us to move into a predictive model of care where we know exactly what's happening

Bill Russell: My name is Bill Russell. I'm a former health system, CIO, and creator of this Week Health, where our mission is to transform healthcare one connection at a time. Welcome to the 2 29 Podcast where we continue the conversations happening at our events with the leaders who are shaping healthcare.

Let's jump into today's conversation.

All right it's the 2 29 podcast, and today we're joined by Deb Muro, El Camino Health. Deb, how's it going?

Deb Muro: It's going great. Great to talk with you today, bill.

Bill Russell: I'm looking forward to it. I assume you have the D in your title. You're the CIDO?

Deb Muro: I am the CIO, but I'm also leading innovation and digital strategy, so it's like have to have, whether you have

Deb Muro: You do.

Bill Russell: you know, you have an interesting background and I'd like to start here. You started as as a nurse at the bedside before moving into healthcare IT leadership. I'm curious how that shapes your role as CIO, like when you walk into a room with clinicians now as the CIO, how does that nursing foundation either assist or change the conversation that you have?

Deb Muro: it was interesting when I moved into my role the organization had been interacting on a more technical level with the, you know, previous leadership. And so as I moved into my role, I found that I was able to approach conversations with empathy, understanding that the workflow that nurses and physicians are trying to accomplish the challenge that they have,

And I, and the background helps me really understand. Next step solutions. Nurses are trained to see data very quickly and come up with a solution. And so that's served me well in my current role.

Bill Russell: So, to give people a little bit of background, so El Camino is literally in the shadow of Cupertino and the big spaceship that happens to have landed out there.

And Google's down the street as well and whatnot. So it's not a slam dunk that they hire a nurse for their CIO mean. It's a very technology focused area that you live in.

Deb Muro: It is however, you know, you build a great team, obviously, and so we have technicians and leaders that are experts in all aspects of the technology that we provide.

And so as we're thinking about technology it's great to have those types of patients that can help us. Stretch us and make us do things that you might not be thinking about otherwise.

Bill Russell: Do they stretch you in the area of the patient experience or user experience? Do they expect more digital tools?

Obviously everybody wants high quality. When you go into a health system, I mean, where do they push you the most?

Deb Muro: the expectation because they are providing technology to consumers. I think they really want us to be retail oriented in the way that we do our work. And we're not in healthcare.

If you think about airline industry, if you would think of 18% of all consumers, you know, booking their airline through online, and then the rest of the time they call center, that's what we're dealing with here is how do we move the dial and really catch healthcare up to where retail is? And our patients are expecting that in this area because of their background in high tech.

Bill Russell: Yeah. And you know, the pushback I would give people on that is essentially that healthcare is not one business. It's a hundred businesses within a campus. And yeah, the part that's retail, we can do online scheduling without breaking a sweat. The stuff that's not retail, it's a little bit more complicated.

So today, at this moment, your issue is back pain. Here are some options for you. We have an urgent care visit this afternoon that you could schedule. We have a virtual visit you could schedule right now over lunch. Nice. Or you could see a primary care physician next week. So it gives the consumer some choices that they can choose based on their preferences.

We then do some questioning of insurance, but we do a lot of that on the backend. We let them get the appointment scheduled. We'll work through any of the challenges with the, you know, insurance and other questions that we have, and then we'll call them and do some concierge help if we need to help direct them to a new place.

Deb Muro: Currently we are all in with MyChart. We do have a digital front door app that we've toyed with over the last several years, and we're just embarking on selecting a patient experience platform that will bring in MyChart, we'll bring in other applications and really create journeys for the patient and be very robust.

So we are excited about that. That's one of our big projects for this next year is to really deliver on patient experience and retail is constantly bringing you into their products, their ecosystem. We wanna do that in healthcare as well, is engage the consumer often to meet their needs of what they have.

You know, is it wellness that they wanna learn more on? Is it a condition that they are trying to deal with? We're gonna meet them, we're gonna personalize the experience, and we're going to guide them. Through their care journey.

Bill Russell: That's awesome. You know, we are gonna talk about AI and automation somewhat, but I wanna talk about your journey.

Talk about that transition into. Focusing on other areas you do that big project and then, how did you sort of define where the organization was gonna go from there? Who did you pull in and what were the conversations like?

We started with Lockheed Martin [00:08:00] and we developed this platform. We kept it in our ecosystem for many years. It evolved and it actually became Allscripts at the end of the day. And so I came and I replaced Allscripts and we're doing a video right now about that history because the engineer that worked on that project is still alive and he's one of our patients.

And so we're really recreating that history. But when I arrived, that was our first focus. We had just you know, we were developing and building a new data center. We were implementing a new EMR, so we kind of set the table for two big areas, but when I moved into the CIO role, I found that we had a lot of opportunities with the 300 plus other applications that were in the environment, really making sure that we were following lifecycle management, that they were where they needed to be.

Cybersecurity obviously came into that era where we had to do some things immediately, and now we're at a place where we're innovating and transforming while we're growing as an organization.

Deb Muro: Yeah.

Bill Russell: I'm trying to think what that was running on. I mean, that predates me in the industry, so I'm not

Deb Muro: Right.

And so the technology was a medical information system using the light pen for doctors to select orders off of the screen. I wasn't here then, obviously, but what I was told was when we did transfer over to using a mouse from the light pen, doctors were trying to put the mouse on the screen [00:10:00] to select.

So, you know, really just a, an unusual, wonderful project. And as I mentioned we're just finishing a video right now telling that story. It's quite a story to tell. It could be made into a movie, I think. Very interesting.

Bill Russell: you're in the right place for that. Somebody will probably buy the rights and we'll be watching on the big screen

Deb Muro: and we could have used AI for that, right?

So, yeah.

Bill Russell: let's talk about ai. The thing I love about the things I've heard you talk about is it's very practical and you guys at El Camino have a very pragmatic approach. To AI and we were talking earlier just about just all the different things that you are u utilizing it on.

And I think people are, every time we talk about AI in these 2 29 meetings we, people talk about governance and we're gonna put this together and all this other stuff. And it's so refreshing when someone like you goes, oh yeah, we're using it here, we're using it here, we're using it here, we're using it here.

I'd love for you to talk about some of those things that you guys are doing some of the practical applications you currently have stood up?

Ecosystem in our current system. So Epic, we are now implementing probably 30 use cases of AI right at the moment. We've started using Deterioration Index several years ago to reduce patient untoward events such as code blues. It has, we've seen a decrease in that. We use it for fall risks. So the.

It alerts the nurse when a patient is you know, getting off of the bed so that we can prevent falls, which is one of our safety and quality goals. When we think about, you know, other platforms in our ecosystem, we implemented AI in a system that provides employee sentiment to the manager. So it alerts the manager of which employees they should be focusing on.

which are the priorities that they should read, which X-ray or image should they read first? Because it has a higher severity. It also creates the impression for them in a matter of seconds, and then it provides incidental findings. Things that, that would not have been seen by the human eye.

So really we are using all of the technology that's embedded in our current applications. The next layer is then, you know, using generative AI or chat GPT to answer questions on our own internal area of ai. So we are using it, you know, as you typically do to prompt and to get answers from information.

Out in, the world, but it's our area our area of the data. We don't let that data go back into the cloud. Our next level that we're embarking on now is to create a data fabric and then be able to, put AI on top of the EMR, put AI on top of all of our data so that we can answer our very unique, specific questions that are within El Camino.

Bill Russell: Man, I don't even know where to go. You gave me so many things. I the incidental finding things to me is fascinating. One of the things about imaging is it's probably the purest data that we have. I mean, an image is an image. And 10 years from now, AI will be able to look at it's good quality data, which is what we want.

How far back will you go? So obviously you'll do it moving forward. Every image that's taken, you'll have the incidental findings. Will you actually go back like a year or so and start looking at older images?

Deb Muro: Yeah, it does. It brings in priors as appropriate. So for the radiologist that's their workflow is to look at the current image and then they bring in priors to do some comparative there.

Bill Russell: Well be between this and ambient listening.

What's your adoption rate on ambient listening? Is it I would assume it's pretty good.

Deb Muro: It is. We're over the 60% rate for a good number of our physicians. And we are just, we're implementing, we implemented, you know, under just under a hundred physicians and we have some that are highly engaged in adopting, and we have others that we're working with, but, you know, we're in the middle of implementation, so it takes some time.

I, I would say the hardest part of. Of the job of a CIO and I would, a technology leader is not only to turn on the technology, but you have to making sure that there's adoption of it and that you're removing the roadblocks, you're removing, you're understanding what the pain points are. That's real, the real work that we do.

Bill Russell: It is the hardest thing that we do. It's the it's the change management, it's the it's the application of the technology. I'm curious, as you roll out AI. And you know, we talked about, everybody likes to talk about governance, but one of the things they like to talk about is oversight of these AI models.

Deb Muro: We do, we have a full AI governance process, and then we have an AI steering committee that is made up of you know, many different C-suite players and other individuals. And so we look at first of all the risk and the value of the ai. That group approves that, and then we are monitoring the use of it.

And then there are some new tools out to help you discover where AI is being used in your environment and also the risk. Profile of the ai. So we're interested in a product like that, that will help us even learn and, you know, develop more of our capabilities within that area.

Bill Russell: I want to take advantage of the fact that you have the nurse background.

Deb Muro: First of all, we're a magnet designated hospital. We've been probably one of the first hospitals in the country that became Magnet received that designation. And so there's a whole shared governance model within Magnet where nurses. Are engaged in the decision making related to technology. And we've got some great leaders here at El Camino in nursing that are helping make that happen.

And they really push us to, you know, they're looking at the reports of our EMR vendor and saying, how is nursing utilizing the EMR and how can we improve it? And so we partner together really well. They're also excited now about our project to give nurses smartphones and to have nurses start using ambient listening as well.

You are talking and the documentation is occurring as you're talking. So really some exciting things that we're really helping nursing with right now to improve their workflow.

Bill Russell: I've had people push back on me on the ambient and nursing. They said, you know, it's so different from a physician workflow that it would be really hard.

They think it's gonna be really hard to get high adoption rates on nursing ambient listening technology. I'm curious 'cause everybody's pushing in this direction. I assume there's some breakthroughs.

Deb Muro: It is hard work and you know, you think about documentation going from spoken word into a flow sheet.

But it is a challenge and out of the gate you have to do it well. You can't have a product that's going to make nursing have more time, you know, dedicated to that has to improve their time and their efficiency. But it is gonna be hard work. I will claim that quite upfront. So,

Bill Russell: Yeah, I was, so looking at your calendar for the next let's call it 12 to 18 months what's the technology, or probably a better word, is capability that you're most excited about implementing?

so we're looking at. A couple of things. First of all, having sensor technology throughout our organization that's with the vital signs coming in. We talked about deterioration index, that's predictive of the patient experience. I'd like, you know, with our analytics and informing data fabric and being able to put chat on top of it.

, We should be able to predict tomorrow what type of patients will be coming to our, ed, ed based on seasonality, what supplies they need. Things. So looking for a world where it's predictive where it, the patient experience is forefront. We're implementing a patient experience platform, as I mentioned, so, and using AI to its fullest and then inserting agents.

Bill Russell: Do you find that the conversations around technology and AI and ambient listening and computer vision and all the things that are coming to, is it easier 'cause you're in Silicon Valley?

Are the nurses and doctors more receptive or do you feel like it's the same across the board.

Deb Muro: I think there is this openness to the newest technology. So I'm excited about that. And as I implemented Epic here, the doctors were so used to order entry. It was very, it wasn't the challenge that I had experienced in other areas or other parts of the country.

But I think our challenge is that we have so much technology that people bring in such great ideas. We have to really think through priorities. We have to think through what's the right thing for our organization. I mean, we have startups. We have a Fogarty Institute here that's always involved with research.

Bill Russell: So if you were talking to a smaller health system potentially without the innovation focus and the Silicon Valley focus. You talked about a two. A two layer implementation. It sounds like, I mean, you are focused first and foremost on your partners are bringing AI to you.

Like you don't have to wake up in the morning and go out shopping for it. It's showing up at your doorstep. That's probably where most CIOs should starch, isn't it?

Deb Muro: Yeah. Again, yeah, looking at the landscape, I love to see what's out there and I'm constantly the great part of Silicon Valley is that there's so many opportunities for CIOs to get together and it's cross industries.

But then, you know, the area itself, we have so many joint venture opportunities. We have so many opportunities with investment capital groups. It's exciting time, but it was really important that you focus on what's the pain point that we have and what's the technology that's gonna help us with that pain point.

And I always like to link that back to our strategic vision and plan so that the work we're doing is enabling the organization to be successful.

Bill Russell: Everything is resource constrained at some point. I mean, the opportunities are limitless. I joke with the only person probably who has more people knocking on their door than you is effer over at Stanford?

For Epic and I think they introduced like 150 every year because like you're, they do.

Deb Muro: It's just, it's mind boggling. It's hard for us to stay on top of it all. And we have to, you know, obviously make sure that we're doing everything else that we need to do with growing our organization, but it's so important.

I find that if I don't optimize the core platforms that we have, I will have someone asking for new technology that duplicates what's already in our core platforms. And so I really do spend time making sure that we've enabled that so that we're not duplicating technology because you know that increases your exposure risks for cyber and other things when you're duplicating, especially if PHI is involved.

Bill Russell: Were you at UGM this year?

Deb Muro: I was.

Bill Russell: Cosmos and the, what they showed in that I mean, what were your thoughts on that? I'll just open-ended. What were your thoughts?

You know, like I, I have a cadre of report writers and they write reports. And when we went live with Epic 10 years ago, or you know, a little bit longer than that, we wrote. A thousand reports that were never used. I

Bill Russell: know.

Deb Muro: Like such a waste of time, and so I'm excited about people being able to ask a question and get the answer.

That they need and not having to go find a report, not having to ask someone to write a report for them. I think that's gonna be transformational. Of course, we're gonna have to make sure the data's accurate. We're gonna have to go through a lot of you know, making sure the data definitions, data governance, all that's going to be really important and role based.

You know, you don't want someone going in and asking a question. They didn't have the right to that data, like a salary. Can you imagine someone going in and saying. Gimme the salary information for a certain role. So we're gonna have to be very oriented to security and then, and really making sure that the data is valid.

Bill Russell: That, that, that was one of my learning experiences. When I came in as A-C-I-O-I was pretty green and the report writing team came to me and said, Hey, we need four more people.

And the first year I was like, okay, here's your four people. Then the second year they came and said, Hey, we need four more people. I was like, what? What? What's going on? And they're like, oh, well, the number of report requests I've gone up and said, as you dig into that, you're like. Hey, are we using all these reports?

And the answer is no. Not even close.

Deb Muro: You know, it's funny when you implement new technology, people try to think about the old technology and they try to build all of that into the new technology. And so. You do a lot of wasted work there. And so my mantra is go live with the new system as designed, and then over time, learn where the gaps are and what you need to do versus building all of these reports up front that you'll never use because the system can take care of that in a different way than you before.

Deb Muro: Oh, I hope not. I hope that, you know, I have loved 2 29. It has been one of those opportunities to. I always love to go to events, and I give information. I'm able to, you know, be part of the conversation and participate, but also get so much back. And your organization has, first of all. This job is a hard job and it's a lonely job.

And so, you know, you were in the job, you know that. And so creating that networking where we feel like we're with peers, we're, we can share our thoughts, we can really get a reaffirmation of what we're doing and we're on the right path. 'cause this is a hard job. Often you're moving cheese daily for folks and you know, it is really great to be together.

And so thank you for your leadership of. Helping us do that.

Deb Muro: Well, we would love to have you and it would be, you know, it's fun.

There's a lot going on in our area here and so love to have you come, be great.

Bill Russell: Thanks for listening to the 2 29 podcast. The best conversations don't end when the event does. They continue here with our community of healthcare leaders. Join us by subscribing at this week health.com/subscribe.

If you have a conversation, that's too good not to share. Reach out. Also, check out our events on the 2 29 project.com website. Share this episode with a peer. It's how we grow our network, increase our collective knowledge and transform healthcare together. Thanks for listening. That's all for now.