Interview in Action @ HIMSS '23 - Margaret Lozovatsky, MD, SVP, CHIO, Novant Health
Episode 68 β€’ 18th May 2023 β€’ This Week Health: Conference β€’ This Week Health
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interview in action from the:

Special thanks to our cDW, Rubrik, Sectra and Trellix for choosing to invest in our mission to develop the next generation of health leaders.

You can check them out on our website this week,, now onto this interview.

l right. Here we are at HIMSS:

It's been fantastic. I particularly enjoy seeing all of my colleagues and all of the things that I learned from them.

So that's the highlight for me.

Yeah. This is for people who don't know, we went to the vibe conference, very technical in nature. CIOs there and whatnot. Not that there haven't been CIOs here. There have been, but a lot of clinical people here. I mean, sharing stories, the education sessions. Did you get a chance to go to any of the education?

I did, and I also sat in a couple panels, so the Kim's Amnesty Physician Symposium is really interesting and educational. That information tends to be very relevant for myself and my team.

So you were on some panels? I was. What, so what, what are the titles of your panels?

So the first panel was focused on workflow and how to integrate that into your daily work.

And the second one was focused on digital engagement.

Wow. All right. So what's the takeaway from your first panel?

That everything we do needs to be integrated into clinical workflow. If it does not seamlessly flow for the clinicians, we will not get adoption and we will kill our efficiency.

So that is primarily about adoption.

If clinicians don't adopt technology, that's like, well, that's death. I mean, there's just nothing. It's like, why did you spend the money if they're not going to adopt it? And so, essentially what you're telling me is, into their existing workflow, can you modify their workflow at all?

You can absolutely modify their workflow.

So if you do it right, and that's the key clinicians like everyone else, but especially folks that have such busy schedules, they have a hard time with change. So the change management process has to be done very thoughtfully. And we talked actually in that panel a lot about the fact that it's really important to have the champions in those clinical spaces and it's important to have them in those particular specialties.

So I'm a pediatrician and when I go to talk to cardiologists, I bring a cardiologist with me.

It's interesting. We one of the EHR providers, we just interviewed them and we were talking about the voice of the. Nurse and the voice of the clinician really being there and the customization that's going on within the EHR to the specific roles.

And we're just seeing that more and more and it's, it's really around the cognitive load and quite frankly, the burden of if you have to look for the same information 40 times a day, it's better if that information just gets surfaced when you log in. I mean, if that's your practice,

is customization getting better as we move along?

That's a great question. I've been doing this a long time. And I don't know if it's gotten better. I think that we've tried to make it better. We've certainly attempted to improve this exact issue, right? The challenge is, is that there's more and more data that is now part of the EHR.

So now we have wearables. Now we have real time information that clinicians are responsible for. And so as much as we have fixed some of the issues, it's sort of like playing whack-a-mole because the big picture, because there's more data, there's more data, and to me the big picture is that we're never going to be able to address this issue unless we have a process.

And maybe some of this new AI technology will get us to serving up the right information at the right time to the right person.

Yeah, it's turning data into information, into insights. and delivering those insights. And it's a lot. When I describe that to people, a lot of times what I'll talk about is a I in imaging.

They're like, Well, is this gonna replace the clinician? It was never meant to replace the clinician. But what it was meant to do is it can process all those images and identify. Hey, you might want to look at this, this and this. And somebody said to me you're my last interview out of 35. So you're getting like, I feel like I'm giving you a report on what I've heard.

But they said, A. I. Plus humans is a winning combination.

100% because there's obviously things that each of us can't do well. When I think about getting the right information to the clinicians, it needs to be coupled together. So, for example, if you're looking at trending and infection, there are pieces of information that are important, like the white blood cell count, the fever curve, the medicines that they're taking specifically to address that issue.

And we've built those reports. manually putting all those pieces into those reports. Now imagine a world where we have a process that does it for every problem. So they know we have a patient with cellulitis and boom, you get the information that you need and you're able to trend it over time.

What's keeping us from doing that?

I don't know if we have technology that's smart enough yet. to couple those pieces together. So how do you build something that says if a patient has substance, you need the white blood cell count, the fever curve and these particular medications. Eventually, the technology will catch up with understanding the clinical pieces because that's what it really takes.

is the clinical knowledge. πŸ“

β€Šβ€Šβ€Š πŸ“ We'll get back to our show in just a minute. I am excited about our webinars this year. They have been going very well. What I've done is I've gone out and talked to people in the community and said, what works in webinars?

And they came back and said, look, this is what we want. We want a webinar that is not product centric. It's really focused in on the problems of health care. And we want people on there that are actually solving those problems. And so we have done that. And the response has been fantastic this year. We have another webinar coming up.

It is the future of care spaces. Where care is being delivered is changing rapidly. Even the care spaces within the hospital themselves are changing. Technology is being added in different types of technology. A. I obviously computer vision and whatnot is changing that modality as well as what's going on in the home and whatnot.

So we're gonna have that webinar June 8th at one p. m. Easter time. We usually have it on the first Thursday. Happens to be a little too close to my anniversary. So we're going to do June 8th at 1 p. m. Eastern time future of care spaces. We would love to have you be a part of it. If you are interested in being there, go ahead and hit our website.

Top right hand corner. We have a card. You can click on that card and go ahead and fill out the form and get registered today. We would love to have you join us we look forward to seeing you there. Now back to our show.

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Yeah. And generally what I'm hearing from people is we're closer. Everyone feels optimistic that we're closer now than we were even last year. It's like there's just an optimism that we're getting.

definitely feel optimistic. I also have to say that I still practice. I'm a pediatric hospitalist and the feeling in the clinical spaces is right now so heavy with burnout.

It's so difficult for clinicians who have just lived through three years. Of a pandemic and masking and all of the challenges that we've experienced that I feel like we need to get there as fast as possible because I worry with all of the nurses leaving healthcare, I definitely feel like physicians are next.

The writing has been in the wall for a long time and we need to get ahead of that. And you, we mentioned cognitive burden that is so prominent. in everything that I see in our clinical areas.

Yeah, I, you know, burnout to me is a trigger word because burnout is very close to depression and a lot of a lot of mental health related issues.

That, you know, that doesn't stay at work. That goes home with you. I mean, who you are is who you are 7 24 365. And I'm not sure people recognize how critical this issue is.

Oh, absolutely. You know, We in medicine go through training where we're working 100 hours a week. And we are told to put all of our personal needs aside for the patient.

And you sort of get this. ingrained in who you are and you put all of that aside, day after day after day, eventually it catches up with people. And I feel like we're at that pivotal place in healthcare where we need to address this in an environment where we are not doing well financially. And I don't mean we as my health organization, I mean we as health organizations.

across the country

as an industry. And we have a lot of work to do. Your second panel was

it was on digital engagement. We talked about managing data. Actually, a lot of these same topics.

Digital engagement. Are we seeing more engagement from our patients in terms of the programs we have? Because it used to be they'd come in and we'd say, Oh, there's this program and they'd have to go down and, like, fill out some papers and all that.

And I would imagine the engagement on that kind of stuff because of the friction involved. There is probably pretty low. Are the digital tools making progress in this area?

That's a fantastic question. And you know, we talked a lot about the fact that the pendulum in the last five years has swung in both directions.

No one health was always very forward thinking, and we had all of our digital platforms in place well before the pandemic, but nobody wanted to use them. Of course, with the pandemic, we're 100% utilization for some time, right? Forced by the environment. And now we've definitely seen the pendulum come back.

And I think the truth is really somewhere in the middle. What I feel like we as an industry haven't figured out is where are the right places to use these digital tools? What makes sense clinically, financially? And how do we give our patients choices? The patients aren't always engaging because I don't think we've given them choices.

for when to engage in the right way and provided some of that guidance.

Interesting. I want to talk to you about governance. So you mentioned as an industry, this is a very difficult time and there's, been budget cuts. Well, there's been budget cuts at your health system, but it's across the board.

I mean, I can't think of any health system that hasn't had to make some challenging cuts. Governance becomes really critical here there's almost an assumption. I'll say it so you don't have to. You can't keep doing all the things that you were doing. If you're going to cut the staff and do all these things, how does governance adjust to that or adjust to the, realities that exist within the organization?

Yeah, we certainly as an industry have had to adjust drastically very quickly in our institution. Like many others, we've had a process in place and often we said yes. to a lot of things. And so the answer was always yes. I think the adjustment is the answer is not always going to be yes in the future, but it can't be no either because we need to continue to move the clinical enterprise forward.

One of the things that we have been very intentional about is trying to get to the root of the problem. So often people You know, sign contracts with vendors. They come to us with a solution. And part of the challenge is we were using tons of resources to put these solutions in place that didn't work.

And so we've embedded a lot of our informatics team. And I think that's been a critical aspect of success embedded in the process of demand management. Oh, okay. Upfront. I've done this in my previous institution and brought a lot of my learnings with me to know about how And one of the things we found when we were able to embed clinical informatics into that request process is we decreased our number of tickets by 200% in the first year.

And the reason, in my opinion, and I think what was shown in reality, is that when we embed clinical informatics into the conversation, we're able to actually address the problem. the problems, we're able to help with design, but more importantly, so much of the requests are education. And so about 50% of them were just knocked out in the beginning.

They never went into the hopper and that made a really big difference.

In our governance process, our project governance process, it was really interesting because people would come with, their initial requests for things. The first thing would be from a prioritization standpoint is, does this align with our five year strategy?

And now most of them realized that that had to be in there so they'd bring it in. And our initial response was, once it came to the governance group, is they would end up getting like 10 questions back. And the 10 questions would be simple things like, Do you realize that we're doing this solution in two other hospitals that looks like this?

Have you talked to them about their solution? Will that work for you? That happens so often. Oh,

absolutely. And so that's why the clinical informatics is connecting the dots for people. It makes such a big difference. You're absolutely right. Sometimes they come to you with something and they're like, we're already building this in a totally different way.

It will be ready for you tomorrow. Or this other hospital is doing this better. Go connect and speak with them. And connecting all the different specialties. The key of course is every group has their number one. And then you have to figure out what's the

number one. So how do you prioritize? I mean, a matrix that the governance group sort of looks at and says, Is it the strategic plan?

or is there some other aspect? It, unfortunately a lot of stuff is driven by... just flat out regulatory. I used to bemoan that a little bit. It's like, 25% of this is regulatory and you just have to understand that we have to do this and then that takes the amount of time you have for your projects down.

So how do you guys prioritize?

So you're absolutely right. We do the things that are must do. There's safety, quality things that need to be done. There's regulatory that has to be done for everything else. We really tie it to our system priorities. Which right now are probably very similar to everyone else's system priorities.

It needs to be revenue generating or savings. We need to think about our workforce and retention. So those are things that are prioritized. Safety and quality at the top of our list. And if it doesn't fit into those buckets, then those are things that we need to hold on so that we can move some of these other priorities forward.

Fantastic. Marguerite, thank you for spending a little extra time with me. I appreciate it. Of course.

Another great interview. I wanna thank everybody who spent time with us at the conference. I love hearing from people on the front lines and it's phenomenal that they've taken the time to share their wisdom and experience with the community. It is greatly appreciated.

We wanna thank our partners, CDW, Rubrik, Sectra and Trellix, who invest inour mission to develop the next generation of health leaders. Thanks for listening. That's all for now.



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