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The 229 Podcast: 20 Years, Zero Paper, One Vision: Pioneering on a Budget with Tanya Townsend

Tanya Townsend': How do we as CIOs get our arms around the conundrum of we wanna enable, we wanna enhance, we wanna continue to invest in things like AI and technologies, et cetera. But we also have these budget constraints because of all of those headwinds 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.

Tanya Townsend': Pleasure to be here. Thank you.

Bill Russell: The, c-I-O-C-D-O role in academic pediatrics. You know, it's it's interesting. Talk a little bit about that role. I mean, what's, what makes it distinct? Talk about the digital initiatives that maybe are on that plate versus just the traditional CIO role.

Tanya Townsend': this has been my first role where I have worn both hats, which I have appreciated.

So, have had experiences in the past where the digital officer is different from the information officer and. What I appreciate about this role in combining it is just be because there, there is so much integration. And so now that I have the opportunity to mold those together.

But it also is really understanding the business and how can we leverage those digital tools to advance the future of healthcare through digital technology. So it's been really fun to blend those roles together.

Bill Russell: We're gonna go in a lot of different directions today.

I, I was looking at your bio and your background. My, my staff sent it over to me and it's impressive. And you just received a lifetime achievement award from CHIME. That's hot off the presses. That was last week. And congratulations on that. I didn't, I just didn't know you were that old.

Does it feel like a world away? Does it feel like it's been that long that you can receive a lifetime achievement award at this point?

Almost a. 20 years ago. And so it seems like yesterday, but I also have enjoyed really reflecting on every step along the way. And I've been just so fortunate to have stepped into this specific role in this industry. And because healthcare, it, even when I think about the last 20 years,

Bill Russell: gonna say, what were we doing in 2005? That was, yeah. Like what was the role in 2005? What were you doing?

Tanya Townsend': So I had this amazing opportunity to, and I was. Asked to lead the opening of what we, as far as we know, was the first all digital hospital of its kind.

So we were truly pioneers and had that vision. And if you can think about 20 years ago, like wifi wasn't as stable as it is now. The whole concept of computer on Wheels. Wasn't, it was new at the time. Voice recognition was just in its infancy. And even things like CPOE and electronic health records were not really embraced yet.

So it. [00:05:00] It's been quite the journey over those 20 years and a lot of different experiences from putting in new electronic health records to mergers and acquisitions and consolidations, to building teams and developing strategies to now really being focused on pediatrics and what do we mean when we say digital transformation?

And building upon that whole experience has been so fun and so rewarding.

Bill Russell: You've done a lot of stuff from scratch and, and innovative and, and you know, leading things really from nothing to something, but you step into Stanford. Stanford was already very well established and had a probably a fair number of initiatives already going and those kinds of things.

How did you change your sort of, I mean, did it require you to change your leadership style or to approach things a little differently?

So you're right, Stanford already. Very mature, well, very well organized. My predecessor, Ed Kapetski did a fabulous job, having a wonderful team that now I get to just build upon, but great team doing great things. And we had a vision, or the organization had a vision of just bringing it to the next level.

So how do we take the tools and technologies that we've already invested in and just take it to that next level? How do we embrace. The new technologies that are coming out, ai, digital, front door analytics, all of those sorts of things like how do we build upon this already very stable, mature organization that's doing great things and has wonderful culture.

So that's been really exciting to just focus particularly around patients and families and pediatrics is really rewarding as well.

A, a bunch of it was on. The challenges facing pediatric uh, health systems across the country. Let's start with the fun one first. Let's start with the digital transformation initiatives. You just mentioned some of them. How much is the digital front door changing? how families and children interact with Stanford medicine.

Tanya Townsend': So I think we talked about this maybe about a year ago. We were just starting our journey Leveraging the capabilities that we already sort of had. So we are live on Epic. We have several other tools that intersect or integrate in with what we call our digital front door. But what we found is the utilization and adoption was maybe not where we wanted it to be.

So that's what we've really been focused on over this past year or so, was standardizing the experience on both sides. So setting expectations with our operational side of we are going to turn this on, we're going to allow patients to schedule where appropriately. And that's a little bit of change management that comes with that.

But and I could go into to more details there as to how we did that what that looks like. But we did find when, as soon as we went live, this was probably in the spring timeframe but we've now improved our online scheduling capabilities. We jumped up by 36% in some areas of being, just having appointments allowed to be scheduled.

And we've seen just a huge increase in self-scheduling for our patients as well as people are willing to pay their bill online as well. So there's been a huge increase in just revenue collections as well.

Bill Russell: I'm not sure people appreciate how much of a heavy lift that is to just say, all right, hey, we need to increase adoption of the tool.

And you think, well, let's just put up more signs in the hospital and people will log in, that kinda stuff. But the experience matters and the experience a lot of times is dictated based on. The how, the, how the organization has decided to operationalize scheduling being one of those things and time slots and making those available and whatnot.

How much of a lift is that and what does that look like to orchestrate that throughout organization as complex as pediatric healthcare is.

Tanya Townsend': Yeah, well we definitely wanted to start with areas that are maybe don't wanna say easy, but maybe less complex. So, because we are a pediatric.

what the patient experience, as well as those time slots should look like. So that's where we started. But again, it really came back to a lot of change management. A lot of, we've always done it this way, you know, from an operational standpoint. So we did have to do a lot of negotiating, meeting, building, and a lot of partnerships with our operational partnership partners as well as it to help get that experience ready.

And now we're going specialty by specialty and rolling out that same approach.

Bill Russell: Where are you guys at on your ambient listening journey? Everybody seems to be on that continuum somewhere.

Tanya Townsend': that has been a really fun story to watch.

And now what we're calling Dax or the ambient experience has just brought that to a whole new level, and I didn't necessarily expect it to explode as quickly as it did to find the clinician happiness and efficiencies that we found almost overnight. But we were careful. We piloted that in a couple areas.

First just to make sure before we completely bought on to, to the whole plan. But we very quickly were able to prove the results and the value. We've got so many testimonials from clinicians that love it, couldn't imagine life without it now. And so we are completely across the board on the ambulatory side, completely rolled out.

And now we're improving our. Ability to close our charts much faster so that leads to faster revenue in the door hopefully. So there's just been so many pieces and parts of fun to tell that story, but it was really, it was rapid. We did that all in the last year. Started out piloting maybe about a year ago, and now it's completely implemented across the board in our ambulatory setting.

Bill Russell: Are there specific. How do I, how would I ask this? Digital challenges with regard to the pediatric community, maybe privacy or family centered care, those kinds of things.

Tanya Townsend': Yeah, we did have to think about that with the ambient experience specifically there because the patient, AKA, the baby might not be the person actually speaking in the room.

There are additional regulations or privacy things to consider when that baby grows into an adolescent, grows into an adult. There are additional things that we just have to think about when we're releasing notes or releasing information through the portal as example. And so. Thankfully we have a lot of people that are very focused and sensitive to those types of topics, so, but yes, it's a great question around additional considerations with ai.

Bill Russell: what are the maybe top two or three challenges facing the children's hospitals, across the country that that you heard?

I don't think any of these will surprise people.

Structure. But I do think these types of headwinds are not unique to children's hospitals. And so I think we're all faced with a lot of different challenges around our budgets and how we're going to continue to, stabilize our revenue models. So, we are embarking on, which we talked about at the 2 29 event not too long ago.

We're embarking on a project called Operational Transformation. And we're trying to get in front of that as best we can. Of course, some of this is reactionary as. Rules change, things change, tariffs are happening, et cetera. So we're trying to get in front of it as best we can, as well as react to what we know is happening in the moment.

Budget constraints because of all of those headwinds happening. So how do we balance between cost savings battling normal things like inflation and growth, and how do we continue to be able to invest in our future? So operational transformation for us. Is at least for this, for my role as the CIO is trying to get my arms around all of that.

And a lot of it is education with the organization. And some of it is changing the way we've always done it. So, I don't think I speak for myself, but oftentimes it departments are cost centers. We're a cost center at the end of the day. And if you don't really get your arms around what's involved in those costs, you kind of forget and then it just.

How do we really show the story on how we're generating revenue? So, we are a cost center, so I'm not necessarily bringing money into my cost center, but I am generating revenue for the organization. So again, how do we tell that ROI story? This also was an opportunity to reassess the structure of our staff, our labor.

So we talked about non-labor, but also need to assess our labor. Do we have the right people? Do we have the right skill sets? Do we have them operating in the right place? So we are doing a little bit of restructuring around that. New lens. And then lastly, as we are balancing all of this out, we've gotta get really good at prioritization or that awful word, governance.

Bill Russell: You know what Sarah directs and I have, we're preparing for some of our end of year stuff and we went through this year and the conversations we've been having, and it was interesting.

I mean, this year has been one of the most. Dynamic years. I can remember, I mean, it started in the beginning of the year with people going, we don't even know what to set our budgets at. Like, there's so much uncertainty that it's like, are we planning for this? Are we planning for this? And the ranges were pretty dramatic of, you know, business as usual to significant cuts.

And so there was a lot of uncertainty then when things sort of came into picture. It, you know, as you said, you know, Medicare there's a different things were on the table. And if all those things came through, it was pretty significant. And then then we had a government shutdown, which, you know, no, no small deal as well.

We did significant EHR projects. A lot of us have redone our ERP solutions. We have obviously ambient listening and other things. How does. You know, how are we looking at ROI today? How is the organization looking at ROI today? Is it you know, is it a shorter window for the return? Is it or is it more about the impact on some of the quadruple aim initiatives?

Mm-hmm. I think people get the picture that it's all financial and it's not always all financial. So how are, how are we looking at ROI these days?

Tanya Townsend': . I could go on and on about this particular topic because I couldn't agree more that like I mentioned, we have to get really good at telling our story.

And sometimes we hit it out the park, like in the case of ambient. And sometimes we maybe didn't hit. What we thought we would, and it's not necessarily to be a punitive look back, but it's lessons learned. How do we you know, reflect on that or pivot faster sometimes or just learn for that for the future.

But you're right everything that we're working on has some sort of goal and sometimes it is financial in terms of we're actually going to be reducing costs by. Putting in X, sometimes it's revenue generating, like, Hey, we're gonna automate this process and we believe we're gonna be able to improve our visit volumes, or improve our charge capture or reduce our denials.

And I could go into projects that we're doing in that space too, where we're reducing surgical site infections, for example, or capturing better root cause analysis, which then is then reinvested into how we analyze how we care for our patients. So, ROI can be in any one of those categories, not necessarily just cutting costs.

Bill Russell: It's interesting in the 2 29 meetings we'll talk about ROI and I'll ask, um. You know, how many of you actually do the post-project analysis and the number's rising, but it's, it was fairly low to begin with, and it's and the response was we don't have the resources to go.

It's like you have to. That's how you learn. That's how you actually accelerate. But it's, it is still it's hard to culturally do that. And it's not necessarily just it, right? It's the entire organization.

Tanya Townsend': Yeah. That's exactly what I was gonna say is oftentimes is just supporting a business plan that came from somewhere else.

It's not to be punitive or finger pointing, but it's learning like, okay, the next time we do a business case, are there things that we could look at differently if we didn't actually hit what we thought we were going to hit? And so there's some accountability around that and we're actually building in this conversation into our entire project lifecycle process.

But you're right, it is something we need to mature at, just as an industry, as a, as the IT community.

It's just it's, it's just another tool that we look at and say, all right, do we use AI over here? Or AI over there? How are you approaching this AI conversation and how are you seeing it sort of play out in healthcare?

Tanya Townsend': Yeah, completely agreed. I do think, this I don't wanna get myself in trouble, but I do think AI is a big buzzword right now.

We're kind of on the hype cycle, kind of like cloud was a few years ago. I do think it's just another tool in the toolbox that's not necessarily intended or we shouldn't be thinking about it differently than how we looked at other tools and technologies that we needed to assess and govern and prioritize.

So Epic has a whole gen AI suite. That's. That's making a lot of things available and things on their roadmap. Things like, Microsoft Co-pilot or even you know, Microsoft Nuance with the ambient solutions. Workday has a whole AI suite now. There's so many of the, our current core tools that have a lot of AI opportunities embedded within the core platforms that we're going to start.

Assessing. And then there's additional products that you can purchase. So there's new third parties that are being developed that we could assess and we're going to be assessing some of those, particularly around agentic ai we're looking at. And some of that'll be embedded in our tools, and some of it's a third party new tool.

But I do think we need to look at it just like that because it's not just, one tool fits all. It's going to be what's the best. Fit for the right solution with using

Bill Russell: You go to UGM and they go, Hey, we've got 150 new AI tools.

And then you go back the following year and they go, Hey, we've got a hundred, you know, plus AI tools. And you're like, wow, that's, you know, we've gotta vet that. And then Workday comes out with theirs and ServiceNow comes out with theirs and Microsoft comes out with theirs. You're like just the trusted partners that you're already working with.

So you have to vet them not only as a solution, but you have to vet them as a partner as well. I mean, I'm wondering how we're going to get in front of the, the appetite for all these solutions and be able to vet even just the ones that we know are gonna be wins for the health system.

Tanya Townsend': Yeah if somebody has the answers to that, let me know. But yes, it can be overwhelming. But we are taking a little bit of an approach of platform First. So if we already have the tools, like in Epic or Workday, we already have our core partners, we should probably evaluate that.

And then like I said lastly there is some opportunity for core custom development, but that's probably. Not the first thing that we're gonna start down the path with, but yes, it's, it takes a lot of energy and talented people and a lot of focus on how do we start this assessment. And we're actually taking an inventory of all the AI types of tools that we've already introduced.

And, I mean, this is still pretty new. It's been the. You know, maybe a year a little bit more, and we've already got almost a hundred tools or technologies that we would consider ai types of arrangements that are up and running or underway in development.

Bill Russell: I'm curious if, you know, if we fast forward three years staying on the AI theme, where do you think AI is gonna have the most impact on healthcare over the next three years? We're recording this for posterity, so in three years people are gonna dig it up and they're gonna go, Ugh.

And it's being used extensively in, in certain areas. So, you know, I'm curious, three years from now, what's your prediction on this?

Tanya Townsend': I think the clinical side, like you just hit on the clinical side is go, it's going to be better and become more trustworthy. And it's almost just like I mentioned like 20 years ago, voice recognition was just not quite where it needed to be.

And so we're gonna have to embrace it. It's here to stay. So clinically I think it's going to just help with advancements and how we use analytics and how we can do precision or even predictive medicine. And how we just use it as an enabler or an augmentation is never going to replace.

Our own experience and the human logic, it will never replace altogether, but it will be a tool to assist. I think that's what we're afraid of a little bit on the administrative side is of course we're fearful that it's going to replace our jobs. Same thing there, I think. I mean, we do know our workforce does need to do things differently on the adminis administrative side. So it's a tool to help us augment and potentially prevent us from inflation and things like that going forward. So it's just gonna be an expectation of how we do business going forward. And so I think it, again, it's here to stay.

I don't think we should be afraid of it. We're gonna have to learn how to use it in the best, most effective, safe way.

Tanya Townsend': No. Nope. I'm uh, I'm really actually mostly energized. Like, like I said, it's been like such a journey and it's never been boring. And it's even more exciting than ever. So I'm looking forward to where we're going from here for the next decade or so.

Bill Russell: Well, I appreciate you spending some time with us, and I look forward to seeing you at the next event.

Tanya Townsend': All right. Thanks, bill.

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.