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Today on Keynote

(Intro) we gotta deal with it, because, the country's not getting younger. And, managing people proactively, primary care that's what other countries do. And we can either do that, or we can take care of sicker people in the hospital.

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 and I am honored to be joined by Dr. Joel Klein today from University of Maryland Medical System. amazing career trajectory and as noted for his transition from an emergency room physician to a leadership role within healthcare IT, where he now sees system wide initiatives such as EPIC implementations, cyber and IT.

infrastructure. And Joel, you've got over 29, 000 employees across 14 hospitals, which in and of itself is amazing and working to make sure those IT solutions meet the needs of providers, patients, and reducing administrative burden. So thank you for being here and welcome to our keynote show.

Thanks a bunch.

course. I'm going to start with a pretty broad question for you. And that's how your experience as a physician has shaped your approach to leading healthcare IT.

Sure being a doctor and then, moving into something like IT means I started out as a customer of IT working in the emergency department for all those years meant that I had to use the computers and the phones and the faxes.

Back when we used faxes and all of the applications on the computers. And so I know what it feels like when the computer or the programs or the EMR or whatever it is, it doesn't work well or at all. And so I think that has a little bit of a fire for me about making sure that the IT team understands this is really, how important this stuff is for everyday folks.

And there's, the whole story of how I went from one career to the other and, how the skill sets translate, but I think from a pure, passion point of view and wanting to get it right. On behalf of, all my fellow clinicians out there who depend on this stuff.

When you shared in some of the conversation we had prior that in that shift to making a career change, that everybody is scared of something professionally. When you think about that from the perspective of a physician and now a CIO, what comes to mind?

Yeah all the time I would show up for a shift in the ER and I would be doing what is called sign out.

So that is where the doctor who's going home tells the doctor who just showed up, in this case me, here are the patients that I need you to take over for me because I'm leaving and you're not taking, my place. And in some cases the patients had already been all figured out and worked up and there was a good plan for them.

But in some cases, My partner might not have figured out what was going on. And now I need to pick up the ball. And in some cases, I have to start all over again because what they were doing, either didn't make sense or they weren't looking at it correctly. Or, you always help each other out and there's always because what goes around comes around and I'm certainly going to be the one giving someday.

Either we just don't know the medicine well enough, or we had a bad experience with a patient like that, a long time ago. Or we forgot what to do, whatever it is. Or we're just generally super conservative and you are scared of everything. And so what happens is you see people start to act super defensively.

And order lots of tests, and I ordered all these tests, and now you figure it out. This is something, that starts to become a pattern for some people. And even for, the rest of us, there's always a disease, or ten diseases, or, certain kinds of patients that you just You know, you're afraid of.

Everyone's got to, tap into that and be honest with themselves and reflective about it. and go figure out how you're going to deal with it because it's going to come through the door again. So for me, I would say a big one, strangely enough, was nosebleeds. That was always something that I just didn't like to deal with.

I'd had a few. Terrible cases early on in my career and, just the prospect of how am I, what am I going to do if I can't get this bleeding, under control? Whenever I saw one of, when that's when I picked up a chart and that's what it said, I would always think, Oh, God, here we go.

Same reaction, like you're gonna get that feeling of oh no, the day has finally come, and that's where you fall back on your training, you fall back on we had a plan somewhere, where's my plan we practiced this, we talked about it everybody's got a job, everybody's got a role.

And let's just launch into that. Whatever it is, we will get through it just a bad nosebleed. And being honest about the fact that I don't feel ready for this, or I, we need to talk about this some more because I don't feel like we have it together on this that could be a super motivating, super galvanizing.

Way to get organized around, stuff that we're responsible for.

There's a way to think about it. There's got to be a level of appreciation for your background now dealing with the executive and technology side of the equation. How well has that worked for you and what are some big takeaways being on the other side of it now?

Yeah, so it's the same job. I'm telling you, there's almost no difference. So when I started after residency I got hired at a community hospital where I was the night guy. So there's not a lot of help around. And I will never forget, they brought me Like an 80 something year old woman and she was having some trouble breathing. And when you're 80 and you're having trouble breathing, there's half a dozen common things and they're all managed a little differently.

And they, where's the doctor? What's going on here? What is wrong with her? Like right now. And the staff came and got me and I went in there and I said something like we, we're not sure yet, we're working on it. We're doing all these, and he just cut me off. and said, you need to tell me right now.

where something goes completely sideways that you didn't think was going to be a problem, and you suddenly realize that, the board chair is making a valid point, and you hadn't thought about this, and your CEO is looking at you like this is a problem. And so the only way out of that, again, just a super sick person, is you got to collect yourself.

You got to pick up the pieces and say, all right, here's what we're going to do. 5, let me come back to you, and we'll fix it There's, three options, and one of these is probably going to end up, making sense. And as long as you come back and do that, and actually follow through on what you say you're going to do, and it does make sense, Then, all will be well, just like it was with that patient.

But, it takes time. It takes experience. But it's the same job. I'm telling you there's tons of careers where, you have to do things like that, but certainly for me I have found them to be remarkably similar jobs.

That's an incredible perspective.

Those are those Oh my gosh, on the job moments that can sometimes make or break your success within an organization. And so having the experiences that you do, how do you teach that type of resilience and that thought process to your non physician executives?

Yeah, so I think if there's one thing I've tried to, tell people is just say yes and just help out.

It can numb up people's eyeball, and then when dust or something gets in their eye, they won't blink it out. And it can cause you to really damage your eye. And I guess one of my partners, somebody had a corneal abrasion or something, and they thought it would help them feel better, which might be true, but it's still not a very good idea.

So he wanted to complain about this. So I wrote it all down, and I went into my boss and said, I just took this phone message. And my boss just looked at me and said, okay, we'll go deal with it. And I had no idea what that meant. And he's go find the guy who, gave it out and, talk to him about it.

So that was my first patient complaint. And hundreds of those later I didn't ask to do that. He just, you just follow through and do it. And whether it's, fundraising for your hospital or serving on some committee or, giving out ice cream cones or whatever it is, if you just do it, people start to think of you as someone who is willing to help.

And that's the reputation you want, and that's what great leaders do. And if you just say yes, if you just lean in, even if it's got nothing to do with you, nothing to do with IT or, whatever it is you do, That's how you get noticed. Just say yes to stuff.

I love that perspective because you now have this dual responsibility of ensuring that the IT solutions that are being implemented to a degree remain user friendly for clinicians while still managing the cyber security elements like you mentioned the Phone call in the middle of the night. How do you ensure that balance remains in the organization?

And I think, whether it's cyber risk or just decision making in general, I think people who have taken the time to spend a shift or a week or, a chunk of their time in the clinical space. Even if that's just consistent rounding you're gonna make decisions that are more aligned with what the business is trying to do.

And yeah, that might mean taking on more risk, or it might mean, not just cybersecurity risk, but, other kinds of risk as well. But you at least are doing it knowing, what the troops need and what the patients need and what their families need. And if you say you know what, I know they need this, but we can't do this.

And they're not always binary choices, right? One of the things we're struggling with, right now is how many minutes should it be before a workstation, hibernates or locks or whatever before you have, should have to log back in again? We have it set to some number of minutes, and there's a debate going on about right now about whether we should, cinch that down.

Or actually, there's other people who say why can't we relax it a little bit, under other circumstances? And that's literally a thermostat. That's a volume knob of, are we going to turn it up or down? And it's not like there's any, Bible about how to do that. But if you'd spent time running between a patient room and a desk and running back and back and back, you're going to think about that differently.

You still have to be thoughtful about the technology you're bringing into the facility. What does that look like from your perspective when you think about being able to meet people where they are, being able to introduce new innovation, and still scale that potentially across multiple facilities? What are some of the challenges, but also some of the wins that you've experienced?

Yeah, so I have fairly strong opinions about that but they're not maybe what you would think. They're in both directions. There's a lot of people in IT who refer to pilots as the good idea fairy. And the way I've had to explain it to a lot of my, operational colleagues is we've got 14 hospitals and if all of them want to do three pilots, I just bought myself 50 new projects.

And I don't just mean, as one healthcare organization within the industry. As an opportunity to help take care of our patients more, constructively. We've got to try stuff. And there's a bunch of things you can do. Stopping a pilot early if it's clearly not, going where you want it to go.

I think having super clear endpoints. Which, you can change them later, you can move the goalposts, but you gotta have something. It shouldn't just be Mikey likes it versus, Mikey doesn't like it. And I think having governance around it, right? It can't just be Bob saw something at a meeting, and now Bob gets what Bob wants, because that's how, it works in a lot of places.

You've gotta have the right eyes. on these things so that you're not, putting a whole bunch of effort behind something that's never going to work. And then I think talking to your peers. If you hear that five other places near you or like you, they're all piloting this and they're all yeah, this kind of feels right, then go for it.

When you think about, to your point, hey, let's do three pilots times, 15 or 16, and that would be the entire capacity of your team, minus keeping lights on and other aspects, but you are breaking ground on a new facility.

You're doing a replacement for rural care, 540 million dollars in Easton. And what I love about that is it becomes a playground to a degree for you to put the existing things that are proven, but try out some of the newer technologies. What kind of a foundation does a brand new facility give you in that ability to try something that maybe hasn't been launched anywhere else in your system?

It's ridiculous. The community really needs a new really needs a new hospital, and we're really excited to have broken ground on that. You're absolutely right. There is a ton of excitement for us around all the things that we're gonna, be able to bring to bear. And a lot of it has to do with the refinement of what telemedicine looks like in what will be 2027, I think is when it will open.

So we know what that looks like today, and it's wired telemedicine setups not just for, remote consultation from our tertiary care center into, any room in the building, but remote nursing as well, family visits, pastoral visits. We'll end up doing I'm going to guess, remote social work, remote patient placement for, post acute services.

And that's the team for us that I think will have a ton more to show by the time we get the building open. And I guess I'd add one other thing, and that is, for those of us who have done new hospitals, we did another new one about three years ago. It's such a fun, amazing, exciting when you open a new place, and you've got to transport 300 patients in one morning and, put all new hardware in there and test it all and make sure it all works.

And. We're really looking forward to it from an IT point of view, but also because of what it will mean for that community.

When you think about The high point, the energy that comes with that type of endeavor, the excitement and the fact that maybe those first few weeks or months that the conversation isn't about burnout or capacity or other issues, how can you take Something like the opening of a new building that's serving a community, a whole new hospital.

To addressing clinician burnout with the help of technology, where do those two come together with something like what you're building in Easton?

Yeah, so I think when you empower people to make decisions, getting control over your environment, we know is a critical piece of how to manage burnout in a constructive way.

So we are one of the health systems that did. A ginormous field hospital. Ours ended up having, a pretty decent census for most of the time that it was open. It was in the Baltimore Convention Center, which we did with the Army Corps of Engineers. It was one of these vast places that has, just endless rows of beds and our epic stuff and our, WoWs and our telephones and our printers and all that stuff in there.

But then, okay, now can you stand up, a monster vaccination thing in an NFL stadium? Or we found another big parking lot over here. Can you have that, done tomorrow? The kinds of things that under, peacetime conditions people would say no, we can't do that tomorrow.

And burnout continues to be such a huge challenge in our industry. And and especially, in a community like this Eastern Shore where the burnout isn't necessarily different, but recruiting for staff like nurses is a huge challenge just because of the inherent geography.

Offering more structures for things like telemedicine, more opportunities to care for patients remotely, whether you're a doctor or a nurse, those are all things that we want to try to empower. Again, to keep people going in the profession so that we can keep them again as part of the team and take advantage of all of their experience.

I literally would not wear the clothes into my house that I wore to work because you just didn't really know what you've been exposed to or experienced in those given days. It is a more rural area and so if you have to think about interoperability and data sharing and getting the confidence of those clinicians and that community, what are some of the things that you have to face and be thoughtful of as you open a new facility with the newer technologies?

And they don't have our EPIC instance. They don't necessarily want that kind of, infrastructure. They're very happy with what they have, thank you. But we want to make sure that we can, let them know what happened to their patient when they were in the hospital.

How do I get a discharge summary? And we're really fortunate that in Maryland, there is a robust health information exchange that makes all that kind of thing possible, and we are one of the part owners and of that exchange. And, sit on its board of directors and certainly, provide a substantial amount of funding for it.

But it doesn't change the fact that we still have to have dialogue with these practices. We still want to be available, for instance, to do lab work for their patients radiology studies for their patients. And so building plumbing, essentially, between our infrastructure and whatever it is that they're using in their office is still something that, that we have to do.

So it's a huge challenge but again it's gratifying when you realize, you've made it work and you get the positive feedback that yes, this is exactly what

we need. So when you have that increased. You have increased equity. You may even have increased availability of information.

How do you also balance availability of getting an appointment, as an example? Because you can open up more beds, you can open up more locations, and yet being able to actually get an appointment in a timely manner in a timely manner. How does opening new facilities and working with these other entities open up that capability for a patient as well?

And we acquired or I would, I think it's fair to say they joined our organization. And part of the plan at the time that they joined was that we would build a new hospital. And so we did that, and it's an absolutely gorgeous facility. And utilization has gone way, way up and we can't meet the demand.

And there's a whole nother side to that in Maryland because of the way hospitals are reimbursed in Maryland. If our volume goes up, we don't actually get. Any more reimbursement at all, no, our net income from patient care operations stays exactly the same. So it's actually a disincentive for us to build a gleaming new facility to take care of people who really need the care, because then when they come we get, it's not 10 cents on the dollar, but it's some version of that.

And that's before we start talking about, cardiology and, all the specialists. We've got a problem. And I think this is a national issue. It's not something that any one health system, I think, is responsible for solving in isolation. This is something that we as a country have to figure out.

And, some of that comes back to reimbursement. Some of it comes back to, what it's like to practice in those specialties. And the choices that people coming out of medical school with half a million dollars in debt. The choices that they have to make economically.

And to me that's the way to go. A no brainer but it's obviously super complicated.

You bring up the aging population aspect, especially the geriatric care, and what you may have heard coined as the silver tsunami coming our way with the next 20 plus years being the largest influx of senior care that we'll ever see in this country for multiple generations to come.

Yeah I think it's a little tough at this stage to say that, automation is going to solve that problem. We need a workforce. We need a competent, experienced workforce that has pipelines that can take somebody, at the start of their career and [00:29:00] accommodate, the mentorship and continuous learning they're going to need to be a senior nurse.

Or, an experienced surgeon, or what have you. We have to do that, and we're not going to do it if we keep going the way we're going. Because, you're right, we're going to have more folks to take care of than we'll be able to. And, there are some people who say that the emergency departments are, the canary in the coal mine of what that's going to look like in a given community.

And that can be really scary, we've got to figure this out. I know in our organization, our Chief Nursing Executive, the amazing woman named Lisa Rowan and our new C& E Peggy Norton Roscoe, they are working incredibly hard to forge partnerships with community colleges all around the state.

And, it's not just finding people who have decided to go to nursing school. And getting them, into our organization come, do your rotations with us. What we've got to do now is start thinking about, okay how do we actually show people who didn't even consider nursing?

It is, and you wrote an article or a perspective a few months ago about aviation, and I'm curious, from your perspective, as you bring up junior ranks, how can healthcare teams implement strategies from aviation to ensure that the newer entries or the junior staff, they feel empowered to not only speak up during critical situations, but also help plan for the future in the scenario that you just described?

Aviation for me is a little boy thing. always loved airplanes, and I probably would have become a pilot if I wasn't afraid of heights. such an amazing industry. So I guess there's a few things I'd specifically point to. One is this whole idea of what the high reliability community calls standard work.

They talk about that on the first flight of the day. These two people are going to go through this. And I can tell you that when you go to intubate somebody in the operating room or the emergency department, you don't say, here's what we're going to do. You're going to hold the stylet. You're going to, I'm going to hold the suction.

When I go like this, you're going to hand me, the T tube from the vent. There's none of that. That's not part of the culture. It's not part of the expectation. When somebody gets their appendix out, there's a timeout in the operating room where, we talk about the right patient, the right site, the right, allergies, all that stuff.

That's one big thing. The other big thing is training. And I find that so fascinating because, training for clinicians of all stripes, that's a sacred thing, right? Going to medical school, the whole ceremony of all of that everything that we go through. But then, I think it really diverges from there.

I think there are parts of our industry where continuous training and a commitment to know we're going to bring people in and pay them in hours to do in service on all this new equipment that we have, not what it should be. And, when you compare that to you have to do all this simulator, training where we're going to do, upset training where we're going to take the plane and flip it over and, have it heading straight at the ground and you have to recover from that.

All of those kinds. Lots of opportunity, but I think we as an industry just have to commit to that.

Yeah, we've seen the ability for now, augmented reality, to start to train both clinicians in these scenarios, patients for something like infusions when they're going through cancer treatment. And really giving people almost like an alternate sense of ability to absorb and retain the information in a way that could be safer than the actual real time experience.

Yeah I used to have an acoustic kit back here, and then COVID happened, which meant everyone was in the house.

So this was my way of trying to be quieter for my family which they appreciate, although I do sometimes turn that amp up all the way. And then I've got a keyboard over here that I also play. I don't think of it so much as stress relief. I just like playing and I'm right at that point where I need to find other people to play with or I'm not going to get any better.

I think I sound great down here, but I'm right at that stage of development where if I don't like gig with other people, it's this is going to be as good as it ever gets. So yeah, I will turn up, some Van Halen or some whatever it is The cure or whatever that I happened to be listening to that day.

And pretend that, I had yet another alternative career.

I'm sure that people listening to this episode may reach out to you and say Hey, I'm a bass player and I need some help or some friends as well. And then you're going to have the other guitars that shows up and pretty soon.

be pretty sweet.

It would

be

pretty sweet. I have a

basement.

We actually have one of our partners plays in a metal cover band. And one of the things he said recently was, man, if you get Van Halen wrong, The crowd goes nuts.

They'll start yelling at you you missed that riff! And he was like, I never knew people could be so passionate about a certain way music is played.

So I am a pretty big Van Halen fan, and I actually agree with that. I don't think you should try to cover Van Halen songs unless you're going to do it in a unique and interesting way.

Actually, There's an amazing bluegrass album that is a bunch of bluegrass covers of Van Halen. If you want to do it, that's how you do it. Don't try to copy Eddie Lee's. won't work.

I think I'm going to go find the bluegrass covers because yes. So

good.

It'd be good. It's a new perspective as well.

It's called strumming with the devil.

And you think there's always just so many corollaries that, I tend to go through and actually read a full contract now before I just assume that I know what made it.

Okay, so the Alex Van Halen YouTube clip where he explains that is hysterical. He, because he tells stories very well. And, he talks about how the stage sunk into the, it's, look it up, it's fantastic.

I will, and our production team will put into the show notes, Please. Bluegrass reference and that clip to that YouTube video. I'm going to throw a couple of fun speed round questions in for you because I appreciate the depth by which you share your expertise. And then I think it's always fun to get a little bit inside people's heads outside of a boardroom perspective.

House of God.

Okay.

Samuel Shimm.

If you weren't in healthcare, what would you be doing? If you weren't a pilot, and you're not a musician, and you're not a doctor, gosh, what else would you be doing, Joel?

Yeah, I'd be working in a restaurant.

Any particular favorite food that would aim you for

better? Yeah, you have to either be a pastry chef or a line cook, and I'm probably more of a line cook.

Yeah, I probably would be too. Actually, I'd be the dishwasher. That's my role in my house now, and I'm actually pretty good at it, so be my entry point.

Describe your job in three words. How

about just whiplash?

Compound word. Good one. Last question for you in the speed round. What's one technology you can't live without?

The phone.

And his quote was something like, is this the best we can do? And everyone was like, no, it shouldn't be. We, of course we could do better than, a phone. What does that look like? And so it got everybody thinking about what the next form factor, might be. And I don't mean a folding phone or, a folding screen.

Minority report, stuff in the air or something, truly crazy. Whatever that is, I think, having it at my fingertips is I will have a seizure if it goes away.

For sure. You saw Google Glass had its moment and some trying out, but now during the World Series, pictures of Ray Ban with Meta, and it's all presented right there in your glasses.

So I'm already wearing contacts. So I imagine if the phone gets any smaller, I have to rely just on that. But if it's displaying for me somehow in a heads up view from your contacts. They're doing all these experiments with the astronauts and measuring the impact of being, weightless for a period of time.

It'd be awesome.

Yep. Thanks as always for your time, your perspectives, what you give back to the community, the support of 229 and This Week Health. We appreciate you and we look forward to continue conversations and summits with you.

Thanks a ton. Great talking to you.

You too. Take care.

Thanks for listening to this week's keynote. If you found value, share it with a peer. It's a great chance to discuss and in some cases start a mentoring relationship. One way you can support the show is to subscribe and leave us a rating. it if you could do that. Thanks for listening. That's all for now..