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Episode 3: David Bensema on Role of EHR and Government in Innovation and Google Glass in Healthcare

[00:00:28] Today. [00:00:30] I'm joined by David, Dr. David Bensema, former CIO for Baptist health in Kentucky. Welcome David.

[00:00:42] Bill Russell: [00:00:42] Yeah, I'm looking at looking forward to the discussion. So, but before we get started, why don't you give us a little idea of what you're working on these days and what you're excited about?

[00:01:17] The other thing that I'm excited about is. The fact that we are now in regards to EHR is at that point where almost every system has a most physicians, offices have them, [00:01:30] even with the pain points, it's a period of enhancement of utilization. It's the time when we're now finally approaching some of the hard questions like interoperability.

[00:01:56] Bill Russell: [00:01:56] Wow. So, so retirement, so grandchildren [00:02:00] catching up on your reading. Yeah. You know, and I've heard from a lot of CEOs that they wish they had more time to read and to catch up on the news, which is one of the reasons for this podcast.

[00:02:35] David Bensema: [00:02:35] That's an absolute joy and you know, one of the things that I reflect on with. The greatest joy and pride in regards to my time as DMIO CIO at Baptist health is that we had a strong succession plan in place. And when I stepped away, Trisha, Julian and Dr. Brett Oliver stepped in and the system never missed a beat. In fact, it accelerated and that's what I did best was get [00:03:00] out of the way and let some really good people do their job, but having prepared them in advance so they could do the job.

[00:03:12] Getting preparing to step out of the way. It's a good, good thing for a CIO to to take away from this. So let's let's get started. We'll go into our first segment. Let's take a look at what's in the news. So, you know, we each pick a story. I picked this story. It's a. [00:03:30] It's interesting to me. I think it speaks to maybe some feelings that are maybe under the surface out there in the industry.

[00:04:06] He essentially said that the electronic health record well here, let me just read it. It'll make it a lot easier. He said, I will submit that one of the biggest impediments to innovation in healthcare is Epic because of the way that Epic thinks about their intellectual property. Of others that develop on that platform.

[00:04:53] However you, you know, you fast forward two days and this is, this is the [00:05:00] press following up with their health system, with Fairview health system on this, it says despite adding to the sea of complaints about the HR companies, Fairview health system services leaders are optimistic about working with their vendor Epic systems.

[00:05:36] We we've all made these kinds of mistakes in our careers where we. Got out over our skis maybe said something that that we shouldn't have, you know, if your hospital runs on Epic, there's no need to have an adversarial relationship with that vendor. You just, you don't want to have to overcome the complexities of innovating in healthcare while trying to handle a strain relationship with the vendor.

[00:06:25] You don't have to mention them by name, but what was your experience working with your EHR vendor? I mean, [00:06:30] did you feel it was a little of both that they hindered in some areas and moved to Ford, or I'm just curious what, what your experience was.

[00:06:48] You're trying to minimize some of the unnecessary variability out in the markets and in our system, we were really more of a constellation of hospitals when we started [00:07:00] our journey to an integrated EHR back in 2014. And it was a big part of us becoming a system. So we wanted to eliminate some of the variability product, helped that in that it was going to be integrated across our entire system.

[00:07:48] They know what their guardrails are. And they're moving fairly quickly through their enhancements. Other people call it optimization. I don't believe you optimize because that's the first, there's an [00:08:00] end point of perfection that you reach you don't, you, you continue to enhance. And that enhancement is actually facilitated by the structure of the EHR.

[00:08:36] And to your point, get out over your speed, you know, get, get ahead of ourselves and overrun the change capacity of our clinicians and end users. You have to balance it. So at this point in time, I don't see Baptist health being impaired in its innovative capabilities, but I can see where somebody would feel [00:09:00] that constraining yourself to the foundation system is a block to innovation because you say, if my product can do it, we're going to use it.

[00:09:22] Bill Russell: [00:09:22] Yeah, it's a, it's interesting because you know, one of our future guests, ed marks, and I had a conversation, I think about two [00:09:30] years ago and we were just just getting ready to go into our EHR consolidation.

[00:10:02] And he goes, and when you baseline on the day of going live, it's going to be that the lowest point within the organizations. Satisfaction with it, but if you stick with it and you continue to iterate on top of it that you know, you're going to be able to build a pretty good system around the workflows that you know, the clinicians really need.

[00:10:41] There, there's not an employed physician model, so there's a foundation model, but it means that there's a lot of independent physicians in the state of California. So for our clinically integrated network, we literally, there's not an exaggeration. Literally had a spreadsheet with a hundred different AMRs on it.

[00:11:24] And really what I was looking for from the EHR provider for innovation was two things [00:11:30]access to the data by directional where possible and access to present the data back into the workflow. So if I could embed something into the, you know, a tab into Epic or a tab into Cerner where I could present some data back that has gone through maybe machine learning or AI.

[00:12:10] All right. So why don't you, why don't you set up your your story and, and and we'll go from there.

[00:12:29] [00:12:30] This committee was of course set up by last year's legislation and the cures act. And as with so many things set up by legislation, it's taken nearly a year to have the. The group sit down for their first meeting, which they actually did a weekend a half ago. But my reason for wanting to put this article in was a couple of the quotes which feel a little bit like [00:13:00] me standing on it.

[00:13:29] This was Dr. [00:13:30] Steven Lane, a member of the committee. And he's a terrific guy from Sutter health and. Then it goes on, but he's optimistic that the group will successfully and positively guide federal health, it policy and regulations. So I take some hope there. And then the other quote was, as it's currently written, I worry the trusted exchange framework and common agreement is overly prescriptive.

[00:14:24] They're going to take input from folks who are boots on the ground. And then the first thing [00:14:30] that comes out is really a little hedging of the bet.

[00:14:47] To that will facilitate the exchange of patient records in a secure way between between all entities setting up a network of networks, if you will, that has at [00:15:00] its core. I mean, that's not all, all of what the 21st century cures act, but this is how it's really impacting health it systems. Right now this is sort of you know, they have some voluntary stuff out there, but if this proves it's, it'd be the same as other things, you'll start to see it move into an incentive-based and probably a carrot stick kind of thing.

[00:15:47] I have yet to talk to somebody who said, you know, interoperability is an important. And it's not something we were all striving for. So we all agree that it is, is the government going to be able to move this as fast [00:16:00] as the industries currently, do you think the industry is going to move faster? Or, or the innovators are going to move faster than, than maybe the government can get this thing in place.

[00:16:33] I do take heart that there are some very good people when you read the entire list. You look at some of the Lake appointees to some of the folks who were announced in November, like Robert, Bob farmer president of the American medical association but global chief medical officer for DXC technology who has been a voice for a very long time in it from medicine.

[00:17:26] Go through the storming and norming process of any group, but [00:17:30] hopefully have their meeting cadence be fast enough. Be frequent enough. That they can catch up with no, where we thought they should be, but they are not because of the delay in putting the group together. Now that the groups together, I hope they themselves start to call for more frequent interaction so they can get to the next stage quickly.

[00:18:18] Bill Russell: [00:18:18] Yeah. I as well, I know some people on that, on that, in that group and that I would love to be at that table. That's an exciting group of people and I think they're, they're really [00:18:30] You know, well positioned to do something. And then I'll close this out with you know, Genevieve Morris is the principal, deputy national coordinator for health information technology at the ONC.

[00:19:10] And his whole mantra was that whole idea of stop competing on the data and, and make it available. All right, so let's move to our second segment. We talked about either a leadership topic or emerging technology, you know, if you agree to come back on here, you know, we'll, we'll talk about mentoring, I think in one of our next [00:19:30] get togethers.

[00:19:54] David Bensema: [00:19:54] Yeah. So several years ago, a lot of us were excited about Google glass. We had a couple of our [00:20:00] physicians who were wanting to use it, and we tried to do some internal piloting and use voice command to move the cursor around and allow them to use it. There were some glitches and some difficulties, and I think other industries found similar issues and we thought it was folding, but there's folks like Augmedix who have partnered with in this case Sutter health is one of the groups that's [00:20:30] kind of leading the charge in looking at how could this be used in healthcare? How could this help to enhance the physicians utilization of the EHR? Get the EHR somewhat more out of their way by using Google glass with Offsite real-time scribing and reduce the paperwork or the input time at the end of the day for the physicians.

[00:21:30] But I think Google glass is a technology that it staff ought to be aware of. And, you know, the first thing they ought to know about is what it's going to be needed for support. And you're more on the tech end than I ever was as a physician who came into the CIO role. But you can probably speak to some of the things that it teams ought to know.

[00:22:15] And I think the guys at automatics are doing a phenomenal job, really getting the word out there. I mean, you mentioned Sutter, obviously dignity and just a ton of others. I mean, th they're, they're really getting the word out there and using it, but at the end of the day, [00:22:30] it maybe it's changed since I've looked at it a year and a half, two years ago.

[00:22:58] So you, you don't have to [00:23:00] hire scribes. You you know, you typically, you have a recording of the session and you have the ability to to go back. And I think there's also some creative things where you can actually take that recording between the doctor and the patient, and actually give that to the patient.

[00:23:36] I think those are probably the most exciting things. And because it's so simple, it's not overly difficult. To to implement or maintain it's, but it is there are a bunch of little compliance things, but the best thing about that are other health systems we've gotten through it. And you just have to, you know, you have to ask the right questions to make sure your compliance people are at the table and, [00:24:00] and work it through.

[00:24:27] I mean, would there be a [00:24:30] w what process would you follow to bring it in.

[00:24:51] I used to joke that I liked to function on the green principle. I wanted somebody to get jealous of what I was doing or what I had because [00:25:00] nothing causes people to be more avid for adoption than jealousness and. You know, so it it's worked in a lot of areas. And so I would pilot it with a couple of early adopters and get the buzz.

[00:25:45] But convincing the C-suite would be, I think the hardest part, I think getting a couple of position pilots, easy getting through the security and permissions aspects, some of the compliance, you talked [00:26:00] about complicated, but not complex. It's just followed the dots, you know, just do things in the proper step sequence.

[00:26:30] I think patients will actually have. More comfort with it, maybe because they don't fully understand it all, but mostly because they get their doctor back, I think patients would be more favorably inclined towards it. Then the general physician population initially. I think the other area that you have to think about is.

[00:27:16] That's the thing I think is going to create some bumps in the road. They're not insurmountable. You just have to be aware of them.

[00:27:36] We had a great relationship but she she was a stickler for hard dollar numbers. And the challenge with some of those projects that she noted is if they're calling for hard dollar numbers, it means you have to force adoption. And when you have to force adoption, It creates a a different dynamic than if it just gets pulled through naturally the organization.

[00:28:16] So. Exciting stuff. So let's let's go to our final segment. Favorite social media posts for the week. I'll let you as our guests give you a nomination for for your favorite social media posts for this week.

[00:28:42] But his comment was a lot of social media is platform for discussions, bereft of the kind of empathy and nuance that an in-person conversation has. So he first get trolled for something you didn't mean, then have no way of explaining yourself without finding yourself, shouting into ether. And finally, you wonder why you spoke in the [00:29:00] first place.

[00:29:20] So as I read that, I thought, you know, I've done some of those posts, but I've also done some where I'm stronger worded. And I think people have to have the [00:29:30] courage of their convictions. But I think it's also a little bit of a reminder of the rule that we had in our, I sent two emails. You've sent two emails.

[00:30:00] [00:29:59] Bill Russell: [00:29:59] Yeah. And I think we use that. Thanks for sharing that. That's a, that's a great post then. And I think we've all been there. I have a couple people at troll. My posts and constantly are commenting how it has ruined has ruined healthcare. And you know, I, I understand where they're coming from, but you know, social media platforms, probably not the best place to definitely not the best place to pick a fight and definitely not a good place to Try to have that discussion in an open dialogue.

[00:30:55] You know, I'm not even going to comment on that. It's it stands on its own. [00:31:00] It's amazing to me, that managers make that much. And you know, and when I was going to school, it was a big thing. I don't know. Maybe, maybe now that college degrees are starting to focus on, on running franchises or being managers and franchises.